Gs Selection Medline Embase DP

No.
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1 4-Liter Split-Dose Polyethylene Glycol Is Superior to
Other Bowel Preparations, Based on Systematic Review
and Meta-analysis
2 53 years of reporting colorectal cancer in Nigerians-a
systematic review of the published literature
3 A 54 year analysis of articles from Mpilo Central
Hospital,Bulawayo, Zimbabwe - 168 articles cited 999
times
4 The 2009 influenza pandemic: a review of the strengths
and weaknesses of the health sector response in New
Zealand
5 2010-2011 Queensland floods: Using Haddon's Matrix to
define and categorise public safety strategies
6 2010-2011 Queensland floods: Using Haddon's Matrix to
define and categorise public safety strategies
7 ABCB1/MDR1 gene polymorphism and colorectal cancer
risk: A meta-analysis of case-control studies
8 Abuse in health care: A concept analysis
9 The academic value of rehabilitation medicine meetings
10 Accuracy of 18F-FDG PET/CT for diagnosing inguinal
lymph node involvement in penile squamous cell
carcinoma: systematic review and meta-analysis of the
literature
11 Accuracy of 18F-FDG PET/CT for diagnosing inguinal
lymph node involvement in penile squamous cell
carcinoma: Systematic review and meta-analysis of the
literature
12 Accuracy of endoscopic elastography for detection of
malignant pancreatic mass lesions. Systematic review
and meta-analysis
13 Accuracy of external cause-of-injury coding in hospital
records
14 Accuracy of hepatobiliary scintigraphy for differentiation
of neonatal hepatitis from biliary atresia: Systematic
review and meta-analysis of the literature
15 Accuracy of sentinel lymph node biopsy for inguinal
lymph node staging of penile squamous cell carcinoma:
Systematic review and meta-analysis of the literature
16 Accuracy of sentinel lymph node biopsy for inguinal
lymph nodes staging of penile squamous cell carcinoma:
Systematic review and meta-analysis of the literature
17 The accuracy of sentinel node biopsy in breast cancer
patients with the history of previous surgical biopsy of
the primary lesion: Systematic review and meta-analysis
of the literature
18 Achieving interprofessional practice in cardiac
rehabilitation
19 The ACTTION repository of analgesic clinical trials
(REACT) database: Results for post-herpetic neuralgia
20 Acupuncture for Anxiety
21 Acupuncture in clinical and experimental reproductive
medicine: A review
22 Acute and chronic pathological effects of sulfur mustard
on genitourinary system and male fertility
23 Acute and transient psychotic disorders (ICD-10 F23): A
review from a European perspective
24 Acute distal tibiofibular syndesmosis injury: A systematic
review of suture-button versus syndesmotic screw repair
25 Acute transient psychoses and their differentiation from
schizophrenia
26 Adalimumab for Crohn's disease after infliximab
treatment failure: A systematic review
27 Additional ablation of complex fractionated atrial
electrograms (CFAES) after pulmonary vein isolation
(PVAI) in patients with atrial fibrillation: A meta-analysis
electrograms after pulmonary vein isolation in patients
with atrial fibrillation: a meta-analysis
electrograms after pulmonary vein isolation in patients
with atrial fibrillation: a meta-analysis
30 Adenosine does not improve clinical outcome in ST-
segment elevation mycocardial infarction patients: A
meta-analysis of randomised trials
31 Adenosine improves post-procedural coronary flow but
not clinical outcomes in patients with acute coronary
syndrome: A meta-analysis of randomized trials
32 Adherence to antiretroviral therapy during and after
pregnancy in low-income, middle-income, and high-
income countries: A systematic review and meta-
analysis
33 Adherence to antiretroviral therapy during and after
pregnancy in low-income, middle-income, and high-
income countries: a systematic review and meta-analysis
34 Adherence to treatment among children with cardiac
disease
35 Adipofascial anterolateral thigh flap safety: Applications
and complications
36 Adipofascial anterolateral thigh flap safety: applications
and complications
37 Adjustable gastric band prolapse leading to near fatal
hemmorhage: A case report and review of the literature
38 Advances in chemotherapy of differentiated epithelial
and medullary thyroid cancers
39 Advances in the design and discovery of drugs for the
treatment of prostatic hyperplasia
40 Advantages of Moxifloxacin and Levofloxacin-based
triple therapy for second-line treatments of persistent
Helicobacter pylori infection: A meta analysis
41 Aerobic exercise to improve cognitive function in adults
with neurological disorders: A systematic review
42 Aerobic physical exercise as a possible treatment for
neurocognitive dysfunction in bipolar disorder
43 The aetiology and associations of conjunctival
intraepithelial neoplasia
44 The Affordable care act and pharmacists: A qualitative
survey on the perceptions of health care reform
45 Aftercare following syndesmotic screw placement: A
systematic review
46 Ageing in the European Union
47 The ageing ovary and uterus: New biological insights
48 Aging baby boomers - A blessing or challenge for driver
licensing authorities
49 Aging baby boomers--a blessing or challenge for driver
licensing authorities
50 Alcohol advertising and alcohol consumption among
youngsters: Review of the international literature
51 Alcohol as a risk factor for liver cirrhosis: A systematic
review and meta-analysis
52 Alkaloids from piper: A review of its phytochemistry and
pharmacology
53 Allergen-specific oral immunotherapy for peanut allergy
54 Allergen-specific oral immunotherapy for peanut allergy
55 Allergic reactions associated with metal alloys in
porcelain-fused-to-metal fixed prosthodontic devices-A
systematic review
56 Allograft involvement by lymphoproliferative disorders
after lung transplantation: report from the PTLD. Int
survey
57 Alloplastic bladder substitution: Are we making
progress?
58 Alternate-day statin therapy for the treatment of
hyperlipidemia
59 Alternating antipyretics in the treatment of fever in
children: A systematic review of randomized clinical
trials
60 Alternating antipyretics in the treatment of fever in
children: a systematic review of randomized clinical trials
61 Alternative medicines for stroke treatment in India:
Need for more evidence
62 Analysis of publication status of abstracts presented at
the annual meeting of the korean academy of
rehabilitation medicine
63 Analysis of ventilator associated pneumonia (VAP)
studies in Egyptian University Hospitals
64 Analytical methods for heavy metals in herbal medicines
65 Anastrozole in combination with fulvestrant in the first
line treatment of hormone receptor positive advanced
breast cancer: A meta-analysis
66 And the pain goes away-80 years fighting tic douloureux
by Martin Kirschner's thermocoagulation of the
gasserian ganglion
67 Androgen abuse in athletes: detection and
consequences
68 Anesthetic aspect of malaria disease: A brief review
69 Anesthetic aspect of malaria disease: a brief review
70 Angiotensinogen gene polymorphism and ischemic
stroke in East Asians: A meta-analysis
71 Antecolic versus retrocolic bypass surgery in Obesity. A
systematic review and meta-analysis of the literature
72 Antecolic versus retrocolic gastric bypass surgery for
obesity: A meta-analysis and systematic review of the
literature
73 Anthropology and addiction: an historical review
74 Antibiotic prophylaxis is not protective in severe acute
pancreatitis: a systematic review and meta-analysis
75 Antibiotic Use and Resistance in Long Term Care
Facilities
76 Antibiotics for acute laryngitis in adults
77 Antibiotics for the treatment of abscesses: A meta-
analysis
78 Antibodies to Toxoplasma gondii in patients with
schizophrenia: A meta-analysis
79 Antibodies to Toxoplasma gondii in patients with
schizophrenia: a meta-analysis
80 Antinociceptive, anti-inflammatory, and antipyretic
activity of mangrove plants: A mini review
81 Antioxidant properties of some cardiovascular medicines
82 Antiplatelet medications in hemodialysis patients: a
systematic review of bleeding rates
83 Antiplatelet therapy in patients with ST-elevation
myocardial infarction undergoing myocardial
revascularisation: Beyond clopidogrel
84 Antiplatelet therapy in patients with ST-elevation
myocardial infarction undergoing myocardial
revascularisation: beyond clopidogrel
85 Antipyretic therapy in febrile critically ill adults: A
systematic review and meta-analysis
86 Antiseptic mouth rinses: an update on comparative
effectiveness, risks and recommendations
87 Antispasmodics for labour
88 Antispasmodics for labour
89 Anti-tumour necrosis factor alpha therapy and increased
risk of de novo psoriasis: Is it really a paradoxical side
effect?
90 Application of medicinal plants in maternal healthcare
and infertility: A South African perspective
91 Applications of nanotechnology in orthopaedics
92 Applications of nanotechnology in orthopaedics
93 Approach to diagnosis of Parkinson disease
94 An approach to finding indications and contraindications
for nephrectomy in post-transplant renal graft
lymphomas: PTLD.Int Survey
95 Approved uses of dabigatran etexilate as an
anticoagulant
96 Archetype-based electronic health records: a literature
review and evaluation of their applicability to health
data interoperability and access
97 Are current treatment guidelines in celiac disease
adequate?
98 Are there health benefits associated with
comprehensive smoke-free laws
99 Are there new therapeutic options for treating lung
cancer based on herbal medicines and their
metabolites?
100 Are there new therapeutic options for treating lung
cancer based on herbal medicines and their
metabolites?
101 Are treatments for cervical precancerous lesions in less-
developed countries safe enough to promote scaling-up
of cervical screening programs? A systematic review
102 Are treatments for cervical precancerous lesions in less-
developed countries safe enough to promote scaling-up
of cervical screening programs? A systematic review
103 Arterial closure devices versus manual compression for
femoral haemostasis in interventional radiological
procedures: A systematic review and meta-analysis
104 Arterial closure devices versus manual compression for
femoral haemostasis in interventional radiological
procedures-a systematic review and meta-analysis
105 Arteriovenous fistulae for home total parenteral
nutrition a review of the literature
106 AskHERMES: An online question answering system for
complex clinical questions
107 Assessing citations with Google Scholar: A new feature
108 Assessing citations with Google Scholar: A new feature
109 Assessing outcomes in pharmaceutical care research:
The case of health-related quality of life
110 Assessing research impact with Google Scholar: the most
cited articles in the journal 2008-2010
111 Assessing the applicability of the nintendo wii as a
device for advancing clinical practice and functional
independence
112 Assessing the evidence supporting the claims of select
dental implant surfaces: A systematic review
113 Assessing the impact of paediatric oncology publications
using three citation databases
114 Assessing the incidence of gastroenteritis among elderly
people living in long term care facilities
115 Assessing the quality of pharmacoeconomic studies in
India: A systematic review
116 Assessing the qualityofpharmacoeconomic studies in
India: A systematic review
117 Assessment of mortality morbidity conference in
obstetrics: Literature review
118 Assessment of PD speech anomalies @ home
119 Assessment of topical steroid treatment for childhood
phimosis: Review of the literature
120 Assessment tools and classification systems used for the
upper extremity in children with cerebral palsy
121 Association between clomiphene citrate and visual
disturbances with special emphasis on central retinal
vein occlusion: A review
122 Association between HLA-DRB1 polymorphisms and
pemphigus vulgaris: A meta-analysis
123 Association between interleukin-8 gene -251 T/A
polymorphism and the risk of peptic ulcer disease: A
meta-analysis
124 Association between interleukin-8 gene -251 T/A
polymorphism and the risk of peptic ulcer disease: a
meta-analysis
125 Association between interleukin 10 gene -1082 A/G
polymorphism and the risk of type 2 diabetes mellitus: A
meta-analysis of 4250 subjects
126 Association between interleukin 10 gene -1082 A/G
polymorphism and the risk of type 2 diabetes mellitus: a
meta-analysis of 4250 subjects
127 Association between MMP1 -1607 1G>2G Polymorphism
and Head and Neck Cancer Risk: A Meta-Analysis
128 Association between MMP-1 g.-1607dupG
Polymorphism and Periodontitis Susceptibility: A Meta-
Analysis
129 The association between oral microorgansims and
aspiration pneumonia in the institutionalized elderly:
Review and recommendations
130 Association between polymorphism of MTHFR c.677C>T
and risk of cardiovascular disease in Turkish population:
A meta-analysis for 2.780 cases and 3.022 controls
131 Association between postoperative acute kidney injury
and duration of cardiopulmonary bypass: A meta-
analysis
132 Association between smoke-free legislation and
hospitalizations for cardiac, cerebrovascular, and
respiratory diseases: A meta-analysis
133 Association between T174M polymorphism in the
angiotensinogen gene and risk of coronary artery
disease: a meta-analysis
134 Association between T174M polymorphism in the
angiotensinogen gene and risk of coronary artery
disease: A meta-analysis
135 Association between the +104T/C polymorphism in the
5'UTR of GDF5 and susceptibility to knee osteoarthritis:
A meta-analysis
136 Association between the +104T/C polymorphism in the
5'UTR of GDF5 and susceptibility to knee osteoarthritis:
a meta-analysis
137 Association between the TNF-alpha-238G>A and TGF-
beta1 L 10P polymorphisms and breast cancer risk: A
meta-analysis
138 The association of depression with adherence to
antihypertensive medications: A systematic review
139 Association of hepatitis C virus with insulin resistance:
Evidences from animal studies and clinical studies
140 Association of hepatitis C virus with insulin resistance:
evidences from animal studies and clinical studies
141 Association of HLA and post-schistosomal hepatic
disorder: A systematic review and meta-analysis
142 Association of hyperhomocysteinemia with
osteoporosis: A systematic review
143 Association study of IL28B: Rs12979860 and rs8099917
polymorphisms with SVR in patients infected with
chronic HCV genotype 1 to PEG-INF/RBV therapy using
systematic meta-analysis
144 Associations between environmental factors and
incidence of cutaneous melanoma. Review
145 Associations between environmental factors and
incidence of cutaneous melanoma. Review
146 Asynchronous and synchronous teleconsultation for
diabetes care: a systematic literature review
147 Atomic force microscopy application in biological
research: A review study
148 Atrial septal defect closure is associated with a reduced
prevalence of atrial tachyarrhythmia in the short to
medium term: A systematic review and meta-analysis
149 Attention deficit hyperactivity symptoms and disorder
(ADHD) among African children: a review of
epidemiology and co-morbidities
150 Attitudes towards carrier testing in minors: A systematic
review
151 Attitudes towards predictive genetic testing in minors
for familial breast cancer: A systematic review
152 Attitudes, implementation and practice of family
presence during resuscitation (FPDR): a quantitative
literature review
153 Attracting and maintaining the Y Generation in nursing:
A literature review
154 Attracting and retaining doctors in rural Nepal
155 Atypical scanpaths in schizophrenia: evidence of a trait-
or state-dependent phenomenon?
156 Atypical scanpaths in schizophrenia: Evidence of a trait-
or state-dependent phenomenon?
157 Augmentation of antipsychotic drug action by azapirone
5-HT1A receptor partial agonists: A meta-analysis
158 Augmentation or reconstruction of PCL? A quantitative
review
159 Autism screening and diagnosis tests: A review article
160 Autologous Atem Cell Transplantation (ASCT) FOR HIV-
related lymphomas in the haart era: A meta-analysis of
response and survival post transplant
161 Autologous conditioned serum for the treatment of
osteoarthritis and other possible applications in
musculoskeletal disorders
162 Autopsy discoveries of death from malaria
163 Availability of renal literature in six bibliographic
databases
164 The babkin reflex in infants: clinical significance and
neural mechanism
165 Barriers and facilitators to self-care in chronic heart
failure: a meta-synthesis of qualitative studies
166 Barriers and facilitators to self-care management: A
systematic review of qualitative studies
167 Barriers for adopting electronic health records (EHRs) by
physicians
168 Barriers of enrollment in HIV vaccine trials: A review of
HIV vaccine preparedness studies
169 Barriers to kidney transplants in Indonesia: A literature
review
170 The barriers to the early diagnosis of dementia and
diagnostic disclosure in primary care
171 Barriers to the management of diabetes mellitus - Is
there a future role for laser doppler flowmetry?
172 Barriers to the use of reminder/recall interventions for
immunizations: a systematic review
173 Barriers to the use of reminder/recall interventions for
immunizations: a systematic review
174 Barriers to the utilization of thrombolysis for acute
ischaemic stroke
175 Barriers, facilitators, recommendations, and priorities for
EMS research: A scoping review of research agendas
176 Basics of fluid and blood transfusion therapy in
paediatric surgical patients
177 Bazedoxifene: A third-generation selective estrogen
receptor modulator for treatment of postmenopausal
osteoporosis
178 Benefits and harms of pharmacologic treatment for
urinary incontinence in women: A Systematic Review
179 Benefits and risks of clopidogrel use in patients with
coronary artery disease: Evidence from randomized
studies and registries
180 The benefits and risks of structuring and coding of
patient histories in the electronic clinical record:
protocol for a systematic review
181 Benign thyroid disease is associated with breast cancer:
A meta-analysis
182 Berberine: A potential phytochemical with
multispectrum therapeutic activities
183 Best strategies for patient education about
anticoagulation with warfarin: a systematic review
184 The best surgical treatment for type II fractures of the
dens is still controversial
185 Beyond the beers criteria: A comparative overview of
explicit criteria
186 Beyond the beers criteria: A comparative overview of
explicit criteria
187 The bibliographic impact of epidemiological studies:
What can be learnt from citations?
188 The bibliographic impact of epidemiological studies:
what can be learnt from citations?
189 A bibliometric study of publication patterns in rational
use of medicines in Iran
190 Bibliometrics of anaesthesia researchers in the UK
191 Bibliometrics of global malaria vaccine research
192 Bibliometry of Costa Rica biodiversity studies published
in the revista de biologia tropical/international journal of
tropical biology and conservation (2000-2010): The
content and importance of a leading tropical biology
journal in its 60th anniversary
193 Bifrontal ECT: A systematic review and meta-analysis of
efficacy and cognitive impact
194 Biliary complications secondary to post-cholecystectomy
clip migration: A review of 69 cases
195 Biochemical monitoring of patients treated with
antihypertensive therapy for adverse drug reactions: A
systematic review
196 Biofeedback therapy compared to standard treatment
for patients with dyssnergic defecation: Results from a
meta-analysis
197 Biofilm-associated eye infections: An evaluation of the
published evidence
198 The bioidentical hormone debate: are bioidentical
hormones (estradiol, estriol, and progesterone) safer or
more efficacious than commonly used synthetic versions
in hormone replacement therapy?
199 Biologic width and its importance in periodontal and
restorative dentistry
200 Biological effects of a maternal ED on pregnancy and
foetal development: A review
201 Biomechanical Considerations in the Competitive
Swimmer's Shoulder
202 Biopsy of soft tissue masses: Evidence-based medicine
for the musculoskeletal tumor society
203 Birth as transcultural phenomenon
204 Birth environment: How it affects birth and following life
205 The bittersweet success of orphan drugs
206 Black women and breast health: A review of the
literature
207 Bladder cancer, a review of the environmental risk
factors
208 Bladder cancer, a review of the environmental risk
factors
209 Bladder involvement in Behcet's disease
210 Bladder involvement in Behcet's disease
211 Bleeding risk under Serotonin Specific Reuptake Inhibitor
(SSRI) antidepressant: A meta-analysis of observational
studies
212 Bloating in Iran: Sepahan systematic review no. 4
213 Block first, opiates later? The use of the fascia ilica block
for patients with hip fractures in the emergency
department: A systematic review
214 Blonanserin for schizophrenia: Systematic review and
meta-analysis of double-blind, randomized, controlled
trials
215 Boceprevir: A Protease Inhibitor for the Treatment of
Hepatitis C
216 Bochdalek hernia in the adult: Demographics,
presentation, and surgical management
217 Body mass index and hot flashes in postmenopausal
women: A meta-analysis
218 Bone marrow involvement by lymphoproliferative
disorders after renal transplantation: PTLD. Int. Survey
219 Botany, traditional uses, phytochemistry and
pharmacology of Apocynum venetum L. (Luobuma): A
review
220 Botany, traditional uses, phytochemistry and
pharmacology of Waltheria indica L. (syn. Waltheria
americana): A review
221 Brazilian health technology assessment bulletin: Editorial
process, dissemination strategies, critical appraisal, and
initial impact
222 Breaking worse: The emergence of krokodil and
excessive injuries among people who inject drugs in
Eurasia
223 Breaking worse: The emergence of krokodil and
excessive injuries among people who inject drugs in
Eurasia
224 [Breast cancer during pregnancy and chemotherapy: a
systematic review]
225 Breast reconstruction in elderly women breast cancer: A
review
226 'BRICS without straw'? A systematic literature review of
newly emerging economies' influence in global health
227 Bull Bars and Vulnerable Road Users
228 Burden and cost of snakebite envenoming: Antivenom
out of reach?
229 Burden of dyslipidemia in hospitalized patients with
cardiovascular disease in Sub-Saharan Africa: A
systematic review
230 Calorie menu labeling on quick-service restaurant
menus: an updated systematic review of the literature
231 Can functional magnetic resonance imaging improve
success rates in central nervous system drug discovery?
232 Can the London 2012 Olympics 'inspire a generation' To
do more physical or sporting activities? An Overview of
systematic reviews
233 Can the ottawa knee rule be applied to children? a
systematic review and meta-analysis of observational
studies
234 Can the pivot-shift be eliminated by anatomic double-
bundle anterior cruciate ligament reconstruction?
235 Can the pivot-shift be eliminated by anatomic double-
bundle anterior cruciate ligament reconstruction?
236 Can tweets predict citations? Metrics of social impact
based on Twitter and correlation with traditional metrics
of scientific impact
237 Can we talk about addiction for excessive indoor
tanning?
238 Cancer education for medical students in developing
countries: Where do we stand and how to improve?
239 Cancer, Warburg effect and laser photobiomodulation-
progress beyond skepticism review
240 Candiru - A little fish with bad habits: Need travel health
professionals worry? a review
241 Candiru--a little fish with bad habits: need travel health
professionals worry? A review
242 Cannabis and psychosis: have we found the missing
links?
243 Cardiopulmonary resuscitation with rescue breathing is
superior to hands-only cardiopulmonary resuscitation
for children and infants: Results of a systematic review
244 Cardiovascular Effect of Bans on Smoking in Public
Places. A Systematic Review and Meta-Analysis
245 Caregivers of Alzheimer's patients and factors
influencing institutionalization of loved ones: some
considerations on existing literature
246 Carrier testing in minors: A systematic review of
guidelines and position papers
247 Carrier testing in minors: a systematic review of
guidelines and position papers
248 Carvedilol vs propranolol in portal hypertension: A meta-
analysis
249 Carvedilol vs propranolol in portal hypertension: A meta-
analysis
250 Case conferences as interventions dealing with the
challenging behavior of people with dementia in nursing
homes: A systematic review
251 The case for home based telehealth in pediatric
palliative care: A systematic review
252 A case of psychosis after use of a detoxification kit and a
review of techniques, risks, and regulations associated
with the subversion of urine drug tests
253 A case of toxic epidermal necrolysis-like skin lesions with
systemic lupus erythematosus and review of the
literature
254 A case report of unusual vasculitic reaction after
methocarbamol injection
255 Catecholamine-induced cardiomyopathy
256 Catecholamine-induced cardiomyopathy
257 Causes of child deaths in India, 1985-2008: A systematic
review of literature
258 Ceftaroline Fosamil: A Cephalosporin With Activity
Against Methicillin-Resistant Staphylococcus Aureus
259 Cell salvage in obstetrics
260 Centella asiatica (L.) Urban: From traditional medicine to
modern medicine with neuroprotective potential
261 Central hyperexcitability as measured with nociceptive
flexor reflex threshold in chronic musculoskeletal pain: A
systematic review
262 Central venous access sites for the prevention of venous
thrombosis, stenosis and infection
263 Central venous access sites for the prevention of venous
thrombosis, stenosis and infection
264 Cerebral thromboembolic events in patients with beta-
thalassemia: A systematic-review
265 Cerebral thrombosis in patients with beta-thalassemia: A
systematic review
266 Cerebral thrombosis in patients with -thalassemia: a
systematic review
267 Cervical disc arthroplasty versus fusion: A systematic
literature review
268 Cervical necrotizing fasciitis with descending
mediastinitis: Literature review and case report
269 Cervical spine surgery: an historical perspective
270 Challenges for authors and publishers in scientific
journal
271 Challenges of linking chronic dehydration and fluid
consumption to health outcomes
272 Challenges of older patients' knowledge about warfarin
therapy
273 Challenges of therapeutic substitution of drugs for
economic reasons: Focus on CVD prevention
274 Challenges to the measurement of estradiol: An
endocrine society position statement
275 [The chameleon of psychiatry - psychiatric
manifestations of neurosyphilis]
276 The chameleon of psychiatry psychiatric manifestations
of neurosyphilis
277 Changes in gastroesophageal reflux disease
epidemiology: A systematic review
278 The changing roles of pharmacists in community
pharmacies: Perception of reality in India
279 Characteristics and prognosis of post-transplant
lymphoproliferative disorders within renal allograft:
Report from the PTLD.Int. Survey
280 Characteristics and publication patterns of theses from a
Peruvian medical school
281 Characteristics of medical research news reported on
front pages of newspapers
282 Characteristics of medical research news reported on
front pages of newspapers
283 Characterization of neuroendocrine stress response to
minimally invasive surgery-systematic review of animal
data
284 Childhood disability and socio-economic circumstances
in low and middle income countries: systematic review
285 Childhood food allergies: current diagnosis, treatment,
and management strategies
286 Choline PET or PET/CT and biochemical relapse of
prostate cancer: A systematic review and meta-analysis
287 Choline PET or PET/CT and biochemical relapse of
prostate cancer: a systematic review and meta-analysis
288 Chronic toxicology of cannabis
289 Cigarette smoking and H. pylori infection: A meta-
analysis of literature
290 Circumcision status and risk of HIV and sexually
transmitted infections among men who have sex with
men: A meta-analysis
291 Cisplatin ototoxicity in children: implications for primary
care providers
292 Citation analysis of Australia-trained optometrists
293 Citation Analysis of Hepatitis Monthly by Journal Citation
Report (ISI), Google Scholar, and Scopus
294 Citation analysis of Iranian journal of nuclear medicine:
Comparison of SCOPUS and google scholar
295 Citation analysis of the Korean Journal of Urology from
web of science, scopus, Korean medical citation index,
KoreaMed Synapse, and Google scholar
296 The citation and articles published in the TURKDERM
between 1999-2007: A retrospective assesment
297 Citation classics from Indian Pediatrics
298 Citations to trials of nicotine replacement therapy were
biased toward positive results and high-impact-factor
journals
299 Citations to trials of nicotine replacement therapy were
biased toward positive results and high-impact-factor
journals
300 [Classification of complications of entero- and
colostomy]
301 Classifications and definitions of adverse events in
primary care: A systematic review
302 Climate change and infectious diseases in New Zealand:
a brief review and tentative research agenda
303 Climate change and infectious diseases in New Zealand:
A brief review and tentative research agenda
304 Clinical anatomy aspects of functional 3D training - case
study
305 Clinical anatomy aspects of functional 3D training -- case
study
306 The clinical effectiveness of length of bed rest for
patients recovering from trans-femoral diagnostic
cardiac catheterisation
307 Clinical efficacy of antibiotics in the treatment of peri-
implantitis
308 Clinical evaluation of serum cystatin C and creatinine in
patients with chronic kidney disease: A meta-analysis
309 Clinical features and Seroepidemiology of anti-HDV
antibody in patients with chronic hepatitis B virus
infection in Iran: A meta-analysis
310 Clinical Features and Seroepidemiology of Anti-HDV
Antibody in patients With Chronic Hepatitis B Virus
Infection in Iran: A Meta-Analysis
311 The clinical features of ankle syndesmosis injuries: A
general review
312 Clinical operational tolerance in liver transplantation:
State-of-the-art perspective and future prospects
313 Clinical operational tolerance in liver transplantation:
state-of-the-art perspective and future prospects
314 Clinical outcome following Doppler-guided
haemorrhoidal artery ligation: A systematic review
315 Clinical pharmacogenomics for CYP2C8 and CYP2C9:
General concepts and application to the use of NSAIDs
316 [Clinical pharmacogenomics for CYP2C8 and CYP2C9:
general concepts and application to the use of NSAIDs]
317 Clinical pharmacology of nonsteroidal anti-inflammatory
drugs in dogs
318 Clinical prognostic messages about cerebral palsy: A
systematic review
319 Clinical relevance of linezolid-associated serotonin
toxicity
320 Clinical review: Spinal imaging for the adult obtunded
blunt trauma patient: Update from 2004
321 Clinical risk factors for late intestinal toxicity after
radiotherapy: a systematic review protocol
322 Clinical significance of elevated intraabdominal pressure
during common conditions and procedures
323 Clinical spectrum of microsporidial keratoconjunctivitis
324 Clinical update: suspension trauma
325 Clinical update: suspension trauma
326 Clinical updates on carvedilol: A first choice beta-blocker
in the treatment of cardiovascular diseases
327 Clinical uses of the medicinal leech: a practical review
328 Clinical uses of the medicinal leech: A practical review
329 Clopidogrel hydrogen sulphate for atrial fibrillation
330 Cocaine cardiotoxicity: A review of the pathophysiology,
pathology, and treatment options
331 Cocaine induced psychotic disorders: A review
332 Cocaine use in elder adults: A focus on recognition and
risk factors
333 A Cochrane systematic review finds tongue scrapers
have short-term efficacy in controlling halitosis
334 Coexistence of breast cancer and tuberculosis in axillary
lymph nodes: A case report and literature review
335 Cognitive behavioral therapy and graded exercise for
chronic fatigue syndrome: A comparative meta-analysis
including moderators of effects
336 Cognitive modifications associated with tobacco
smoking
337 [Cognitive modifications associated with tobacco
smoking]
338 Cold challenge to provoke a vasospastic reaction in
fingers determined by temperature measurements: A
systematic review
339 Collagenous repeat-containing sequence of 26 kDa
protein - a newly discovered adipokine - sensu lato - a
minireview
340 Collagenous repeat-containing sequence of 26 kDa
protein - a newly discovered adipokine - sensu lato - A
minireview
341 Collective findings neither support nor refute the use of
oral motor exercises as a treatment for speech sound
disorders1
342 Collective wisdom and decision making in surgical
oncology
343 Colorectal carcinoma in West Africans: Some
considerations on its relatively lower incidence
compared to Caucasians
344 Colorectal carcinoma: Why is there a lower incidence in
Nigerians when compared to caucasians?
345 A commercial line probe assay for the rapid detection of
rifampicin resistance in Mycobacterium tuberculosis: a
346 A commercial line probe assay for the rapid detection of
rifampicin resistance in Mycobacterium tuberculosis: A
systemic review and meta-analysis
347 Common post-operative complications in children
348 Communicating genetic information in families - A
review of guidelines and position papers
349 Communicating genetic information in families--a review
of guidelines and position papers
350 Communication: An improvement tool of midwifery
practice
351 Community-acquired pneumonia in the elderly
352 Community-based intervention packages for reducing
maternal and neonatal morbidity and mortality and
improving neonatal outcomes
353 Community-based participatory research in cancer
control studies among indigenous people of Australia,
New Zealand, Canada and the US
354 Comorbidity in lung cancer: Important but neglected. A
review of the current literature
355 Comparative effectiveness of novel oral anticoagulants
for atrial fibrillation: Evidence from pair-wise and
warfarincontrolled network meta analyses
356 Comparative incidence of cancer in HIV-AIDS patients
and transplant recipients
357 Comparative incidence of cancer in HIV-AIDS patients
and transplant recipients
358 Comparing semi-automatic systems for recruitment of
patients to clinical trials
359 Comparing test searches in PubMed and Google Scholar
360 Comparison of docetaxel- and vinca alkaloid-based
chemotherapy in the first-line treatment of advanced
non-small cell lung cancer: A meta-analysis of seven
randomized clinical trials
361 Comparison of docetaxel- and vinca alkaloid-based
chemotherapy in the first-line treatment of advanced
non-small cell lung cancer: a meta-analysis of seven
randomized clinical trials
362 Comparison of fibrin glue versus suture for conjunctival
autografting in pterygium surgery: A meta-analysis
363 Comparison of fibrin glue versus suture for conjunctival
autografting in pterygium surgery: a meta-analysis
364 A comparison of four methods to quantify the
cumulative effect of taking multiple drugs with sedative
properties
365 Comparison of ISI web of knowledge, SCOPUS, and
Google scholar h-indices of Iranian nuclear medicine
scientists
366 Comparison of medical literature searches using either
pubmed central or google scholar
367 Comparison of PubMed and Google Scholar literature
searches
368 Comparison of PubMed, Scopus, Web of Science, and
Google Scholar: Strengths and weaknesses
369 Comparison of the efficacy of ondansetron and
granisetron to prevent postoperative nausea and
vomiting after laparoscopic cholecystectomy: A
370 Comparison of the efficacy of ondansetron and
granisetron to prevent postoperative nausea and
vomiting after laparoscopic cholecystectomy: a
371 A Comparison of the Performance of the I-gelTM vs. the
LMA-STMduring Anesthesia: A Meta-Analysis of
Randomized Controlled Trials
372 Comparisons of citations in Web of Science, Scopus, and
Google Scholar for articles published in general medical
journals
373 Comparisons of disparities and risks of HIV infection in
black and other men who have sex with men in Canada,
UK, and USA: A meta-analysis
374 Comparisons of disparities and risks of HIV infection in
black and other men who have sex with men in Canada,
UK, and USA: a meta-analysis
375 Complex networks of multiple factors in the
pathogenesis of uterine leiomyoma
376 Complications of Laparoscopic Surgery for Renal Masses:
Prevention, Management, and Comparison with the
Open Experience
377 Complications of Wrist Arthroscopy
378 Compounds derived from endophytes: A review of
phytochemistry and pharmacology
379 A comprehensive appraisal of meta-analyses focusing on
nonsurgical treatments aimed at decreasing
perioperative mortality or major cardiac complications
380 A comprehensive review of antibiotics in clinical trials for
inflammatory bowel disease
381 A comprehensive review of health benefits of qigong
and tai chi
382 A comprehensive systematic review and meta-analysis
of treatments for lichen planus
383 A comprehensive systematic review of the psychometric
properties of VFQ-25 in glaucoma
384 A comprehensive systematic review of visitation models
in adult critical care units within the context of patient-
and family-centred care
385 Computer Navigation vs Conventional Mechanical Jig
Technique in Hip Resurfacing Arthroplasty: A Meta-
Analysis Based on 7 Studies
386 A computer-based readability analysis of patient-
reported outcome questionnaires related to oral health
quality of life
387 Concept analysis of professional commitment in Iranian
nurses
388 Conceptual framework of acute care nurse practitioner
role enactment, boundary work, and perceptions of
team effectiveness
389 Conductive energy devices: A review of use and deaths
in the united states
390 The confusion assessment method: A systematic review
of current usage
391 Congenital heart disease : Its prevalence and importance
in indian population
392 Consensus methods: Review of original methods and
their main alternatives used in public health
393 Conservative management of Achilles tendinopathy: A
mixed methods study, integrating a systematic review
and clinical reasoning
394 Conservative management of midportion Achilles
tendinopathy: a mixed methods study, integrating
systematic review and clinical reasoning
395 Considerations and methodology for trialing ziconotide
396 Considerations and methodology for trialing ziconotide
397 Consistent evidence to support the use of xylitol- and
sorbitol-containing chewing gum to prevent dental
caries
398 Constipation in Iran: Sepahan systematic review no. 5
399 Constructing confidence: Rational skepticism and
systematic enquiry in local ecological knowledge
research
400 Consumers' views on generic medicines: A reiew of the
literature
401 Consumers' views on generic medicines: a review of the
literature
402 Contemporary adjuvant polymethyl methacrylate
cementation optimally limits recurrence in primary giant
cell tumor of bone patients compared to bone grafting:
A systematic review and meta-analysis
403 Contextual factors influencing success or failure of
emergency department interventions for cognitively
impaired older people: A scoping and integrative review
404 The contribution of teleconsultation and
videoconferencing to diabetes care: a systematic
literature review
405 Control measures for invasive group A streptococci
(iGAS) outbreaks in care homes
406 Controversial effects of non-steroidal anti-inflammatory
drugs on bone: a review
407 Controversies related to living kidney donors
408 A conventional microwave oven for denture cleaning: a
critical review
409 Corneal endothelium: Developmental strategies for
regeneration
410 Coronary artery fistula
411 Corticosteroids in the treatment of community-acquired
pneumonia in adults: A meta-Analysis
412 Corticosteroids in the Treatment of Community-
Acquired Pneumonia in Adults: A Meta-Analysis
413 Cost effectiveness analysis of minimally invasive internal
thoracic artery bypass versus percutaneous
revascularisation for isolated lesions of the left anterior
descending artery
414 Cost effectiveness of breast cancer screening using
mammography; a systematic review
415 The cost of schizophrenia: A literature review
416 Cost-effectiveness analysis of pregabalin in the
treatment of diabetic peripheral neuropathy
417 Cost-effectiveness analysis of pregabalin in the
treatment of fibromyalgia
418 Coverage of Google Scholar, Scopus, and Web of
Science: A case study of the h-index in nursing
419 Craniofacial and upper airway morphology in pediatric
sleep-disordered breathing: Systematic review and meta-
analysis
420 Crestal bone preservation: A review of different
approaches for successful implant therapy
421 Criterion-based clinical audit to assess quality of
obstetrical care in low- and middle-income countries: a
systematic review
422 Criterion-based clinical audit to assess quality of
obstetrical care in low- and middle-income countries: A
systematic review
423 Critical success factors for the uptake of novel vaccines
ontonational immunusation programmes
424 A critique of the National League for Nursing/Jeffries
simulation framework
425 Croatian medical journal citation score in web of science,
scopus, and google scholar
426 Crofelemer, a novel agent for treatment of secretory
diarrhea
427 The crucial role of recess in schools
428 Cruveilhier's legacy to skull base surgery: Premise of an
evidence-based neuropathology in the 19th century
429 Crying and health: An introduction
430 Culturally tailored postsecondary nutrition and health
education curricula for indigenous populations
431 Culture and mental health in Haiti: A literature review
432 Current advances in intraosseous infusion - A systematic
review
433 Current and potential uses of clinical registries for
comparative effectiveness research
434 Current concepts for clean air and total joint
arthroplasty: laminar airflow and ultraviolet radiation: a
systematic review
435 Current opinion in the pharmaceutical management of
irritable and inflammatory bowel diseases: Role of ATP
436 Current status of the neutral zone: a literature review
437 Current status of the treatment of acute colonic
diverticulitis: A systematic review
438 Current trends in the pharmacotherapy of diabetic
retinopathy
439 Current, new and future treatments of osteoporosis
440 Cushing's syndrome: Diagnosis and surveillance using
salivary cortisol
441 Cutaneous melanoma in Latin America: The need for
more data
442 Cutting edge assessment of the impact of autoimmunity
on female reproductive success
443 Cytochrome P450 2C19 2 polymorphism and
cardiovascular recurrences in patients taking
clopidogrel: A meta-analysis
444 Cytochrome P450 2C19*2 polymorphism and
cardiovascular recurrences in patients taking
clopidogrel: a meta-analysis
445 Cytokines in HIV-infection - Inflammatory damage or
therapeutic potential?
446 Cytological diagnosis of atypical squamous cells - A
critical evaluation of diagnostic guidelines
447 [Cytological diagnosis of atypical squamous cells: a
critical evaluation of diagnostic guidelines]
448 Cytotoxicity of denture base and hard chairside reline
materials: a systematic review
449 Cytotoxicity of denture base and hard chairside reline
materials: A systematic review
450 Dabigatran: Is there a role for coagulation assays in
guiding therapy?
451 Data linkage for hpv vaccination, screening, and cervical
cancer outcomes: Is there an evidence base for public
health decisionmaking on cervical cancer prevention
strategies?
452 De novo erectile dysfunction after anterior
urethroplasty: a systematic review and meta-analysis
453 Decompressive craniectomy for the treatment of
refractory high intracranial pressure in traumatic brain
injury
454 Deer antler base as a traditional Chinese medicine: A
review of its traditional uses, chemistry and
pharmacology
455 Defining a lowest observable adverse effect hair
concentrations of mercury for neurodevelopmental
effects of prenatal methylmercury exposure through
maternal fish consumption: A systematic review
456 Defining and measuring health literacy: how can we
profit from other literacy domains?
457 Defining and measuring health literacy: how can we
profit from other literacy domains?
458 Defining informal payments in healthcare: A systematic
review
459 Defining racial and ethnic disparities in THA and TKA
460 Defining the relative utility of lumbar spine surgery: A
systematic literature review of common surgical
procedures and their impact on health states
461 Defrosting the digital library: bibliographic tools for the
next generation web
462 Delayed contrast enhancement on cardiac mri and risk
of clinically significant ventricular arrhythmias in
hypertrophic cardiomyopathy: A meta-analysis of
observational studies
463 Dengue transmission in the Asia-Pacific region: Impact of
climate change and socio-environmental factors
464 Deoxypodophyllotoxin: A promising therapeutic agent
from herbal medicine
465 Dermatologic symptoms of dermatoyositis do not lead
to early detection of ovarian cancer
466 Dermatologist and the Internet
467 A description of barriers and facilitators to childhood
vaccinations in the military health system
468 Designing for sustainability: ergonomics--carpe diem
469 Developing a checklist to assess clinical severity indices
in inflammatory bowel disease
470 Developing a Photonovela for Latino adolescent and
young adult cancer survivors
471 Developing search strategies for clinical practice
guidelines in SUMSearch and Google Scholar and
assessing their retrieval performance
472 Developing Swansea inflammatory bowel disease clinical
severity index (SICSI)
473 The development, retention and decay rates of strength
and power in elite rugby union, rugby league and
American football: a systematic review
474 Dexamethasone prolongs the duration of brachial plexus
block: A meta-analysis
475 Diabetes and stress: an anthropological review for study
of modernizing populations in the US-Mexico border
region
476 Diabetes increases the risk of breast cancer
477 Diabetes increases the risk of breast cancer: a meta-
analysis
478 Diabetes mellitus in pregnancy: an update on the
current classification and management
479 Diabetes mellitus increases the risk of bladder cancer: an
updated meta-analysis
480 Diagnosis and consequences of cocaine addiction
481 The diagnosis of tuberculous meningitis: A current
review of the clinical and laboratory methods
482 The diagnostic accuracy of bedside ocular ultrasound in
the diagnosis of retinal detachment: A systematic review
and meta-analysis
483 Diagnostic accuracy of nitroglycerine as a 'test of
treatment' for cardiac chest pain: A systematic review
484 Diagnostic precision of CT in local staging of colon
cancers: A meta-analysis
485 Diagnostic precision of CT scanning in local staging of
colon cancers: A meta-analysis
486 Diagnostic test of rifampicin resistance in
mycobacterium tuberculosis: A meta-analysis
487 Diagnostic test of rifampicin resistance in
Mycobacterium tuberculosis: a meta-analysis
488 The diagnostic value of urine-based survivin mRNA test
using reverse transcription-polymerase chain reaction
for bladder cancer: A systematic review
489 The diagnostic value of urine-based survivin mRNA test
using reverse transcription-polymerase chain reaction
for bladder cancer: a systematic review
490 Did general douglas MacArthur have Parkinson disease?
A video and archival analysis
491 Diet and risk of development of inflammatory bowel
disease: A systematic review
492 Dietary intake and risk of developing inflammatory
bowel disease: A systematic review of the literature
493 Dietary tyramine restriction for hospitalized patients on
linezolid: An update
494 Differential effects of exercise on cancer-related fatigue
during and following treatment: A meta-analysis
495 Differential expression and methylation of maspin gene
in various cancers suggest its potential role in
carcinogenesis
496 Diffusion MRI at 25: Exploring brain tissue structure and
function
497 Disposal practices for unused medications around the
world
498 Dissemination of research into clinical nursing literature
499 Distributed storage healthcare - the basis of a planet-
wide public health care network
500 Distribution of pathogens associated with acute otitis
media: A systematic review of the literature
501 Distribution of road traffic deaths by road user group: A
global comparison
502 Do antiviral agents effectively treat Ramsay Hunt
syndrome?
503 Do corticosteroids have a role in preventing or reducing
acute toxic lung injury caused by inhalation of chemical
agents?
504 Do cystic vestibular schwannomas have worse surgical
outcomes? Systematic analysis of the literature
505 Do energy drinks contain active components other than
caffeine?
506 Do leucopenia rates change after widespread folic acid
fortification in randomized controlled trials of breast
cancer chemotherapy?
507 Do longer consultations improve the management of
psychological problems in general practice? A systematic
literature review
508 Do patient access schemes result in an acceptable
administrative burden?
509 Do prescription stimulants increase the risk of adverse
cardiovascular events?: A systematic review
510 DoD2006: molecular biology database update
511 Does chewing gum shorten the duration of
postoperative ileus in patients undergoing abdominal
surgery and creation of a stoma?
512 Does evidence based medicine support the effectiveness
of surgical facemasks in preventing postoperative wound
infections in elective surgery?
513 Does in utero exposure to synthetic glucocorticoids
influence birthweight, head circumference and birth
length? A systematic review of current evidence in
humans
514 Does in utero exposure to synthetic glucocorticoids
influence birthweight, head circumference and birth
length? A systematic review of current evidence in
humans
515 Does living in a family slow cognitive decline in
dementia?
516 Does patent foramen ovale closure have an anti-
arrhythmic effect? A meta-analysis
517 Does prolonging the time to bladder cancer surgery
affect long-term cancer control: a systematic review of
the literature
518 Does prolonging the time to bladder cancer surgery
affect long-term cancer control: a systematic review of
the literature
519 Does prolonging the time to prostate cancer surgery
impact long-term cancer control: a systematic review of
the literature
520 Does prolonging the time to prostate cancer surgery
the literature
521 Does prolonging the time to renal cancer surgery affect
long-term cancer control: a systematic review of the
literature
522 Does prolonging the time to renal cancer surgery affect
long-term cancer control: a systematic review of the
literature
523 Does prolonging the time to testicular cancer surgery
the literature
524 Does prolonging the time to testicular cancer surgery
the literature
525 Does random participant assignment cause fewer
benefits in research participants? Systematic review of
partially randomized acupuncture trials
526 Does random participant assignment cause fewer
benefits in research participants? Systematic review of
partially randomized acupuncture trials
527 Does risk for ovarian malignancy algorithm excel human
epididymis protein 4 and CA125 in predicting epithelial
ovarian cancer: a meta-analysis
528 Does robotic rectal cancer surgery offer improved early
postoperative outcomes?
529 Does spinal fusion influence quality of life in
neuromuscular scoliosis?
530 Does this patient have ventilator-associated pneumonia?
531 Does warfarin safely prevent clotting of hemodialysis
catheters?: A review of efficacy and safety
532 Domestic violence in pregnancy, outcomes and
strategies: A review article
533 Dopamine versus norepinephrine in the treatment of
septic shock: a meta-analysis*
534 Dopamine versus norepinephrine in the treatment of
septic shock: A meta-analysis*
535 Double Meckel's diverticulum presenting as acute
appendicitis: A case report and literature review
536 Doxofylline: A promising methylxanthine derivative for
the treatment of asthma and chronic obstructive
pulmonary disease
537 Driving simulator sickness: An evidence-based review of
the literature
538 Driving under the influence of amphetamine and
metamphetamine
539 Drug interactions between common illicit drugs and
prescription therapies
540 Drug interactions with tobacco smoke in community
pharmacy practice
541 Drug-induced crystal nephropathy: An update
542 Drug-induced rheumatic diseases: A review of published
case reports from the last two years
543 Drugs as anti-nutrients
544 Drugs impairment on driving performance: An overview
545 Duplex ultrasound for surveillance after endovascular
repair of abdominal aortic aneurysm
546 Duplicate Publications in Korean medical journals
indexed in KoreaMed
547 Duplicate publications in Korean Medical Journals
indexed in KoreaMed
548 Dyspepsia in Iran: SEPAHAN systematic review no. 3
549 Earlier recognition of nephrotoxicity using novel
biomarkers of acute kidney injury
550 Early biomarker activity in severe sepsis and septic shock
and a contemporary review of immunotherapy trials:
Not a time to give up, but to give it earlier
551 Early diagnosis of abnormal development of preterm
newborns: Assessment instruments
552 Early diagnosis of abnormal development of preterm
newborns: assessment instruments
553 Early onset post transplantation lymphoproliferative
disorders: Analysis of international data from 5 studies
554 Early versus delayed percutaneous coronary
intervention for patients with non-ST segment elevation
acute coronary syndrome: A meta-analysis of
randomized controlled clinical trials
555 Early versus late outset of lymphoproliferative disorders
post-heart and lung transplantation: The PTLD. Int
Survey
556 Economic and quality of life outcomes of antiretroviral
therapy for HIV/AIDS in developing countries: a
systematic literature review
557 Economic evaluation of nurse staffing and nurse
substitution in health care: A scoping review
558 Ectopic bone formation and extramedullary
hematopoiesis in the thyroid gland: report of a case and
literature review
559 Educational and behavioral interventions for asthma:
who achieves which outcomes? A systematic review
560 Educational governance in the NHS: A literature review
561 Effect of anti-rheumatic agents on periodontal
parameters and biomarkers of inflammation: a
562 Effect of automatic versus fixed continuous positive
airway pressure for the treatment of obstructive sleep
apnea: an up-to-date meta-analysis
563 The effect of CHEK2 variant I157T on cancer
susceptibility: Evidence from a meta-analysis
564 The effect of CHEK2 variant I157T on cancer
susceptibility: evidence from a meta-analysis
565 Effect of chromium on glucose and lipid profiles in
patients with type 2 diabetes; a meta-analysis review of
randomized trials
566 [The effect of circumcision on the mental health of
children: a review]
567 The effect of computers for weight loss: A systematic
review and meta-analysis of randomized trials
568 Effect of dopexamine infusion on mortality following
major surgery: Individual patient data meta-regression
analysis of published clinical trials
569 Effect of drug law enforcement on drug market violence:
A systematic review
570 Effect of embolic protection devices on major adverse
cardiac events and mortality after saphenous vein graft
intervention: A systematic review and meta-analysis
571 Effect of ephedrine on intubating conditions created by
propofol and rocuronium: A meta-analysis
572 The effect of exercise on haemodynamics in intermittent
claudication: a systematic review of randomized
controlled trials
573 The effect of exercise training on anxiety symptoms
among patients: a systematic review
574 Effect of exercise training on depressive symptoms
among patients with a chronic illness: A systematic
review and meta-analysis of randomized controlled trials
575 Effect of final kissing balloon inflation on outcomes of
PCI of bifurcation lesions using a two-stent strategy: A
576 Effect of glycemic index and glycemic load on energy
intake in children
577 The effect of health facility delivery on neonatal
mortality: Systematic review and meta-analysis
578 The effect of interventions to reduce potentially
inappropriate antibiotic prescribing in long term care
facilities: A systematic review of randomised controlled
trials
579 The effect of interventions to reduce potentially
inappropriate antibiotic prescribing in long-term care
facilities: A systematic review of randomised controlled
trials
580 Effect of low-protein diet on kidney function in diabetic
nephropathy: Meta-analysis of randomised controlled
trials
581 The effect of neostigmine on in-hospital mortality of
adult patients with severe puffer fish poisoning: A
pooled analysis of case reports and case series
582 The effect of occupational whole-body vibration on
standing balance: A systematic review
583 Effect of point-of-purchase calorie labeling on restaurant
and cafeteria food choices: A review of the literature
584 Effect of preoperative weight loss in bariatric surgical
patients: A systematic review
585 The effect of prosthetic margin location on caries
susceptibility. A systematic review and meta-analysis
586 Effect of proton pump inhibitors on the risk of hip
fracture: Systematic review and synthesis
587 The effect of psychosocial interventions for patients with
cancer on psychoneuroimmunologic outcomes: A
systematic review
588 The effect of rising food prices on food consumption:
systematic review with meta-regression
589 The effect of rising food prices on food
consumption:systematic review with meta-regression
590 The effect of simulation in improving students'
performance in laparoscopic surgery: a meta-analysis
591 The effect of simulation in improving students'
performance in laparoscopic surgery: A meta-analysis
592 Effect of statins use on the prevention of venous
thromboembolism: A meta-analysis
593 Effect of systemic steroids on post-tonsillectomy
bleeding and reinterventions: Systematic review and
meta-analysis of randomised controlled trials
594 Effect of systemic steroids on post-tonsillectomy
bleeding: A meta-analysis
595 Effect of the UGT1A1*28 Allele on unconjugated
hyperbilirubinemia in HIV-positive patients receiving
atazanavir: A systematic review
596 Effect of transcranial magnetic stimulation on parkinson
motor function - Systematic review of controlled clinical
trials
597 Effect of transcranial magnetic stimulation on Parkinson
motor function--systematic review of controlled clinical
trials
598 Effect of transcranial magnetic stimulation on Parkinson
motor function--systematic review of controlled clinical
trials
599 The effect of weak hip abductors or external rotators on
knee valgus kinematics in healthy subjects: A systematic
review
600 Effective and ineffective aspects of harm reduction
school-based substance misuse programmes for children
and young people
601 Effective home programme intervention for adults: a
systematic review
602 Effective interventions in the management of
osteoarthritis
603 The effectiveness and cost-effectiveness of pregabalin in
the treatment of diabetic peripheral neuropathy: A
systematic review and economic model
604 Effectiveness and feasibility of telepsychiatry in resource
constrained environments? A systematic review of the
evidence
605 Effectiveness and safety of Etanercept in treatment of
arthritis
606 Effectiveness and safety of Saccharomyces boulardii for
acute infectious diarrhea
607 The effectiveness of arts-based interventions in medical
education: a literature review
608 The effectiveness of cultural competence programs in
ethnic minority patientcentered health care-a systematic
review of the literature
609 The effectiveness of cultural competence programs in
ethnic minority patient-centered health care--a
systematic review of the literature
610 The effectiveness of low-dye taping, in patients with
plantar fasciitis for the short term treatment of pain in
the heel
611 Effectiveness of manual physical therapy in the
treatment of cervical radiculopathy: a systematic review
612 Effectiveness of manual physical therapy in the
treatment of cervical radiculopathy: A systematic review
613 Effectiveness of midurethral slings in mixed urinary
incontinence: A systematic review and meta-analysis
614 Effectiveness of mid-urethral slings in mixed urinary
incontinence: A systematic review and meta-analysis
615 Effectiveness of midurethral slings in recurrent stress
urinary incontinence: A systematic review and meta-
analysis
616 Effectiveness of multifaceted fall-prevention programs
for the elderly in residential care
617 Effectiveness of Neurogenesis in treating children with
cerebral palsy
618 Effectiveness of orthodontic treatment with functional
appliances on mandibular growth in the short term
619 Effectiveness of percutaneous posterior tibial nerve
stimulation for overactive bladder: A systematic review
and meta-analysis
620 The effectiveness of PET-scan in diagnosis and treatment
of non-small cell lung carcinoma (NSCLC) and lymphoma:
A comprehensive review of literature
621 Effectiveness of prevention programmes for obesity and
chronic diseases among immigrants to developed
countries - a systematic review
622 Effectiveness of prevention programmes for obesity and
chronic diseases among immigrants to developed
countries - a systematic review
623 Effectiveness of probiotics in health and diseases of
children
624 Effectiveness of robot-assisted therapy on ankle
rehabilitation--a systematic review
625 Effectiveness of TAD-anchored maxillary protraction in
late mixed dentition
626 Effectiveness of TAD-anchored maxillary protraction in
late mixed dentition: A systematic review
627 Effectiveness of testing for genetic susceptibility to
smoking-related diseases on smoking cessation
outcomes: A systematic review and meta-analysis
628 Effectiveness of thermal and athermal short-wave
diathermy for the management of knee osteoarthritis: A
629 Effectiveness of yoga therapy as a complementary
treatment for major psychiatric disorders: A meta-
analysis
630 Effectiveness, tolerability and safety of azithromycin 1%
in DuraSite for acute bacterial conjunctivitis
631 Effects of bicycle saddle height on knee injury risk and
cycling performance
632 Effects of changes in the pre-licensure education of
health workers on health-worker supply
633 Effects of creative arts therapies on psychological
symptoms and quality of life in patients with cancer
634 Effects of Dietary Approaches to Stop Hypertension
(DASH) diet on some risk for developing type 2 diabetes:
A systematic review and meta-analysis on controlled
clinical trials
635 Effects of exercise training on fatigue in multiple
sclerosis: A meta-analysis
636 The effects of flavonoids on the ABC transporters:
Consequences for the pharmacokinetics of substrate
drugs
637 The effects of health literacy on Asthma self-
management
638 The effects of manual therapy on balance and falls: A
systematic review
639 Effects of maternal cigarette smoking during pregnancy
on cognitive parameters of children and young adults: A
literature review
640 The effects of physical exercise on reducing body weight
and body composition of obese middle aged people. A
systematic review
641 Effects of probiotics for the prevention and treatment of
radiation-induced diarrhea
642 Effects of retrograde autologous priming on blood
transfusion and clinical outcomes in adults: A meta-
analysis
643 The effects of smoke-free legislation on acute
myocardial infarction: a systematic review and meta-
analysis
644 The effects of zero-balance ultrafiltration on
postoperative recovery after cardiopulmonary bypass: A
meta-analysis of randomized controlled trials
645 Efficacy and adverse effects of venlafaxine in children
and adolescents with ADHD: A systematic review of non-
controlled and controlled trials
646 Efficacy and Feasibility of Nonpharmacological
Interventions for Neuropsychiatric Symptoms of
Dementia in Long Term Care: A Systematic Review
647 Efficacy and incontinence rate of biomaterials (fibrin
glue and fibrin plug) in comparison to surgical
interventions in the treatment of perianal fistula: A
systematic review and meta-analysis of randomized,
controlled trials
648 Efficacy and Safety of Bevacizumab for the Treatment of
Advanced Hepatocellular Carcinoma: A Systematic
Review of Phase II Trials
649 Efficacy and safety of bevacizumab for the treatment of
advanced hepatocellular carcinoma: a systematic review
of phase II trials
650 Efficacy and safety of certolizumab pegol for Crohn's
disease: A systematic review and meta-analysis
651 Efficacy and safety of DBS in tremor of multiple sclerosis
652 The efficacy and safety of herbal medicines used in the
treatment of hyperlipidemia; a systematic review
653 Efficacy and safety of modafinil in the treatment of
cancer-related fatigue
654 Efficacy and safety of second-generation antipsychotics
in children and adolescents with psychotic and bipolar
spectrum disorders: Comprehensive review of
prospective head-to-head and placebo-controlled
comparisons
655 Efficacy and tolerability of enteral formulations of
ibuprofen in the treatment of patent ductus arteriosus in
preterm infants
656 Efficacy and tolerability of enteral formulations of
ibuprofen in the treatment of patent ductus arteriosus in
preterm infants
657 Efficacy and tolerability of immunoregulators and
antibiotics in fistulizing crohn's disease: A systematic
review and meta-analysis of placebo-controlled trials
658 Efficacy of antibiotics and probiotics in management of
pouchitis; a meta-analysis
659 Efficacy of antidepressants as analgesics: A review
660 Efficacy of baclofen on abstinence and craving in alcohol-
dependent patients: A meta-analysis of randomized
controlled trials
661 Efficacy of botulinum toxin type A for the prophylaxis of
episodic migraine headaches: A meta-analysis of
randomized, double-blind, placebo-controlled trials
662 Efficacy of deep venous thrombosis prophylaxis in the
medical intensive care unit: A systemic review
663 Efficacy of gemcitabine plus platinum agents for biliary
tract cancers: A meta-analysis
664 Efficacy of gemcitabine plus platinum agents for biliary
tract cancers: a meta-analysis
665 Efficacy of high-fiber diets in the management of type 2
diabetes mellitus
666 Efficacy of information interventions in reducing transfer
anxiety from a critical care setting to a general ward: A
667 Efficacy of Iranian traditional medicine in the treatment
of epilepsy
668 Efficacy of midodrine plus octreotide in hepatorenal
syndrome: A meta-analysis
669 Efficacy of pregabalin in acute postoperative pain: A
meta-analysis
670 Efficacy of Traditional Chinese Herbal Medicine in the
management of female infertility: A systematic review
671 Efficacy of tramadol with local anaesthetic for caudal
analgesia in paediatric surgery: A meta-analysis
672 Efficacy of treatment for pterygium by autologous
conjunctival transplantation and mitomycin C
673 Efficacy of treatment for pterygium by autologous
conjunctival transplantation and mitomycin C
674 The efficacy of virtual reality simulation training in
laparoscopy: A systematic review of randomized trials
675 The Efficiency of Virtual Reality Simulation Training in
Laparoscopy: A Systematic Review of Randomized Trials
676 Efficient source data verification in non-interventional
studies: Literature review of current methods
677 Electric and magnetic fields applied to peripheral nerve
regeneration
678 The electronic patient record in the Brazilian health
system: Is it a reality for the physicians?
679 Email for clinical communication between healthcare
professionals
680 Email for clinical communication between
patients/caregivers and healthcare professionals
681 Email for communicating results of diagnostic medical
investigations to patients
682 Email for the coordination of healthcare appointments
and attendance reminders
683 Email for the provision of information on disease
prevention and health promotion
684 Embryotoxic, teratogenic and abortive effects of
medicinal plants
685 The emergent threat of community college hookah
waterpipe use
686 Emerging therapies for Clostridium difficile infections
687 Emotional adjustment in infertile couples
688 Emotional, physical, and sexual abuse in fibromyalgia
syndrome: A systematic review with Meta-Analysis
689 Empiric quadruple vs. triple therapy for primary
treatment of helicobacter pylori infection: Systematic
review and meta-analysis of efficacy and tolerability
690 Employment conditions and health inequities: A case
study of Brazil
691 Employment conditions and health inequities: a case
study of Brazil
692 Endocrine sequelae of cancer and cancer treatments
693 End-of-life issues for aboriginal patients: a literature
review
694 Endothelial Nitric Oxide Synthase Gene Polymorphisms
(G894T, 4b/a and T-786C) and Preeclampsia: Meta-
Analysis of 18 Case-Control Studies
695 Endothelial progenitor cells (EPCs) and mesenchymal
stem cells (MSCs) in bone healing
696 Endothelin receptor antagonists for subarachnoid
hemorrhage
697 Energy drinks: An unknown risk
698 Enteral nutrition therapy for critically ill adult patients;
critical review and algorithm creation
699 Eosinophilic colitis: An update on pathophysiology and
treatment
700 Epidemic of hypertension in Ghana: a systematic review
701 An epidemiological overview of malaria in Bangladesh
702 Epidemiological patterns and risk factors associated with
hepatitis B virus in Pakistani population
703 Epidemiology of hepatitis E in Iran and Pakistan
704 Epidemiology of HIV infection in the middle east and
North Africa
705 Epidemiology of injuries and prevention strategies in
competitive swimmers
706 The epidemiology of injury among surfers, kite surfers
and personal watercraft riders: Wind and waves
707 The epidemiology of injury in adventure and extreme
sports
708 The epidemiology of injury in skateboarding
709 Epidemiology of mecA-Methicillin Resistant
Staphylococcus aureus (MRSA) in Iran: A Systematic
Review and Meta-analysis
710 Epidemiology of meca-methicillin resistant
staphylococcus aureus in Iran: A systematic review and
meta-analysis
711 Epidemiology of thyroid diseases in Africa
712 Epidermal growth factor gene polymorphism and risk of
hepatocellular carcinoma: a meta-analysis
713 Epidermal growth factor gene polymorphism and risk of
hepatocellular carcinoma: a meta-analysis
714 Episodic vertigo resulting from head rotation, in the
presence of vascular risk factors and cervical
spondylosis: An intriguing tetrad?
715 Epithelial mesenchymal transition in colorectal cancer:
Seminal role in promoting disease progression and
resistance to neoadjuvant therapy
716 Eribulin: A novel cytotoxic chemotherapy agent
717 Erythema multiforme in the setting of lupus
erythematosus (so-called "rowell syndrome"): A
reappraisal based on a systematic review of the
worldwide literature
718 [Erythrocyte alloimmunization in pregnant women,
clinical importance and laboratory diagnostics]
719 Estimate of infectious disease burden attributable to
climate change
720 An estimate of syphilis incidence in Eastern Europe
721 Estimating the avoidable burden of certain modifiable
risk factors in osteoporotic hip fracture using
Generalized Impact Fraction (GIF) model in Iran
722 Ethical considerations in the study of online illness
narratives: A qualitative review
723 Ethnicity and academic performance in UK trained
doctors and medical students: systematic review and
meta-analysis
724 Ethnicity and academic performance in UK trained
doctors and medical students: Systematic review and
meta-analysis
725 An ethnomedicinal, phytochemical and pharmacological
profile of Desmodium gangeticum (L.) DC. and
Desmodium adscendens (Sw.) DC
726 Etiology and pathogenesis of anterior open bite: a
review
727 Etiology and pathogenesis of anterior open bite: a
review
728 Evaluation of 44 Kikuchi-Fujimoto disease cases reported
from Turkey between 2000-2010 with pooled analysis
method
729 Evaluation of impact on health-related quality of life and
cost effectiveness of traditional chinese medicine: A
systematic review of randomized clinical trials
730 Evaluation of impact on health-related quality of life and
cost effectiveness of Traditional Chinese Medicine: a
systematic review of randomized clinical trials
731 Evaluation of Intervention Research in Weight Reduction
in Post Menopausal Women
732 Evaluation of intervention research in weight reduction
in post menopausal women
733 Evaluation of the efficacy and incontinence rate of
biomaterials in comparison to conservative and other
interventional therapies in treatment of perianal fistula.
a meta-analysis
734 Evaluation of the medication process in pediatric
patients: A meta-analysis of medication errors rate
735 An evaluation of web-based clinical practice guidelines
for managing problems associated with cannabis use
736 Evans' syndrome in pregnancy: A systematic literature
review and two new cases
737 Evidence of improved access to dental care with direct
access arrangements
738 [Evidence of social support as therapy for weight loss: a
systematic review]
739 An evidence-based assessment and treatment plan for
arachnoiditis
740 Evidence-based choice of esophageal stent for the
palliative management of malignant dysphagia
741 Evidence-based management of central cord syndrome
742 Evidence-based practice: Quality indicator analysis of
antecedent exercise in autism spectrum disorders
743 An evidence-based review of fat modifying
supplemental weight loss products
744 An evidence-based review on medicinal plants used for
the treatment of peptic ulcer in traditional Iranian
medicine
745 Evolution and effectiveness of palliative care
746 The evolution in our understanding of prostatic anatomy
and its surgical management
747 The evolution of advocacy and orthopaedic surgery
748 The evolution of advocacy and orthopaedic surgery
749 The evolution of proton pump inhibitors for the
treatment of gastroesophageal reflux disease
750 Evolution of the definition of "autism" in the twentieth
century
751 Examining characteristics, knowledge and regulatory
practices of specialized drug shops in Sub-Saharan
Africa: a systematic review of the literature
752 Excess of non-verbal cases of autism spectrum disorders
presenting to orthodox clinical practice in Africa - a trend
possibly resulting from late diagnosis and intervention
753 Exercise programs for patients with cancer improve
physical functioning and quality of life
754 Exercise therapy in juvenile idiopathic arthritis
755 Exercise therapy in juvenile idiopathic arthritis
756 Exertional compartment syndrome: review of the
literature and proposed rehabilitation guidelines
following surgical release
757 Existential suffering in the palliative care setting: An
integrated literature review
758 Existing research is inadequate for the development of
guidelines for the basic life support management of
airway obstruction in adults: Results of a systematic
review
759 The experience of lung cancer in Aboriginal and Torres
Strait Islander peoples and what it means for policy,
service planning and delivery
760 Expert searching in health librarianship: a literature
review to identify international issues and Australian
concerns
761 Exposure to general anesthesia and risk of Alzheimer's
disease: a systematic review and meta-analysis
762 Extended lymphadenectomy versus conventional
surgery for rectal cancer: a meta-analysis
763 Extended lymphadenectomy versus conventional
surgery for rectal cancer: a meta-analysis
764 Extended scope physiotherapy roles for orthopedic
outpatients: An update systematic review of the
literature
765 The extensor pollicis brevis: a review of its anatomy and
variations
766 Extracorporeal cardiac mechanical stimulation:
Precordial thump and precordial percussion
767 Extracorporeal membrane oxygenation (ECMO) in
patients with H1N1 influenza infection: A systematic
review and meta-analysis including 8 studies and 266
patients receiving ECMO
768 Extracorporeal shock wave lithotripsy (ESWL) versus
ureteroscopic management for ureteric calculi
769 Extracorporeal shock wave lithotripsy (ESWL) versus
770 Extra-corporeal shock wave lithotripsy (ESWL) versus
771 Extranodal Rosai-Dorfman disease: A rare soft tissue
neoplasm masquerading as a sarcoma
772 Eyecare in the critically ill: Clinical practice guideline
773 Face to face interventions for informing or educating
parents about early childhood vaccination
774 Factors associated with intended and effective
settlement of nursing students and newly graduated
nurses in a rural setting after graduation: A mixed-
methods review
775 Factors associated with intended and effective
settlement of nursing students and newly graduated
nurses in a rural setting after graduation: a mixed-
methods review
776 Factors associated with patient and health care system
delay in diagnosis and treatment for TB in sub-Saharan
African countries with high burdens of TB and HIV
777 Factors associated with the willingness of health care
personnel to work during an influenza public health
emergency: An integrative review
778 Factors influencing consent to having videotaped mental
health sessions
779 Factors influencing self-management in chronic
obstructive pulmonary disease: An integrative review
780 Factors that influence the efficacy of stretching
programs for patients with hypomobility
781 Family history questionnaires designed for clinical use: a
systematic review
782 Family needs and involvement in the intensive care unit:
a literature review
783 Far lateral approaches (XLIF) in adult scoliosis
784 Fascia: a morphological description and classification
system based on a literature review
785 Fatal interstitial lung disease associated with high
erlotinib and metabolite levels. A case report and a
786 Fatigue in multiple sclerosis: A short clinical update
787 Feasibility and safety of robot assistedadrenalectomy-
systematic review
788 Feasibility and safety of robot assistedendoscopic
thyroidectomy-systematic review
789 The feasibility, safety and outcomes of laparoscopic re-
operation for achalasia
790 Features, predictors and prognosis of
lymphoproliferative disorders post-liver transplantation
regarding disease presentation time: Report from the
PTLD.Int.survey
791 The Female Sexual Function Index (FSFI): A potential
"gold standard" measure for assessing therapeutically-
induced change in Female Sexual Function
792 Femoral neuropathy following total hip arthroplasty
review and management guidelines
793 Femoroacetabular impingement syndrome
management: Arthroscopy or open surgery?
794 Fenoldopam and acute renal failure in cardiac surgery: A
meta-analysis of randomized placebo-controlled trials
795 Fenoldopam Reduces the Need for Renal Replacement
Therapy and In-Hospital Death in Cardiovascular Surgery:
A Meta-Analysis
796 Fesoterodine for overactive bladder: A review of the
literature
797 The fiery landscape of depression:A review of the
inflammatory hypothesis
798 Fifty years of soft contact lenses: Life and impact of Prof.
Otto Wichterle
799 Finasteride for benign prostatic hyperplasia
800 Finding the ideal place for a psychotherapeutic
intervention in a stepped care approach - A brief
overview of the literature and preliminary results from
the Project PREDICT
801 Finding the ideal place for a psychotherapeutic
intervention in a stepped care approach--a brief
overview of the literature and preliminary results from
the Project PREDICT
802 Findings of the literature review on larviciding in
elimination environments in Asia Pacific
803 Findings of the literature review on mobility, infectious
diseases and malaria
804 Fistula-in-ano: advances in treatment
805 Five common cancers in Iran
806 Five years after implementation: A review of the Irish
Mental Health Act 2001
807 Five-year outcomes following PCI with DES versus CABG
for unprotected LM coronary lesions: meta-analysis and
meta-regression of 2914 patients
808 Fluid and volume monitoring
809 Forensic investigation of submersion deaths
810 Forensic telepsychiatry: A possible solution for South
Africa?
811 Four decades of health economics through a
bibliometric lens
812 Fractals in dentistry
813 Fracture healing and drug therapies in osteoporosis
814 Fracture of ceramic bearing surfaces following total hip
replacement: A systematic review
815 A framework and methodology for navigating disaster
and global health in crisis literature
816 A Framework and Methodology for Navigating Disaster
and Global Health in Crisis Literature
817 A framework to prevent and control tobacco among
adolescents and children: introducing the IMPACT model
818 Free radical scavengers in anaesthesiology and critical
care
819 The frequency and nature of incidental findings in cone-
beam computed tomographic scans of the head and
neck region: a systematic review
820 From abstract to publication: Characteristics and natural
history of abstracts from phase III randomized clinical
trials in IBD therapeutics presented at digestive disease
week
821 From ambient assisted living to global information
management: IMIA-referencing publications in 2008
822 From the Editors
823 Full scientific paper publications of research papers
presented as abstracts at IRA: Analysis of 3 years
824 Functional assessment and performance evaluation for
assistive robotic manipulators: Literature review
825 Functional assessment and performance evaluation for
assistive robotic manipulators: Literature review
826 Functional interactions among morphologic and tissue
quality traits define bone quality
827 Functional relationship between obesity and male
reproduction: From humans to animal models
828 Further validation of swansea inflammatory bowel
disease clinical severity index (sicsi)
829 Fusion versus Nonfusion for Surgically Treated
Thoracolumbar Burst Fractures: A Meta-Analysis
830 Fusion versus nonfusion for surgically treated
thoracolumbar burst fractures: a meta-analysis
831 The future of primary care in Thailand in the context of a
global financial crisis
832 Gabapentin and postoperative pain: A qualitative and
quantitative systematic review, with focus on procedure
833 Gallium-68: a systematic review of its nononcological
applications
834 Gambling and suicidal behaviour
835 Gaps and unmet needs in antiplatelet therapies for
acute coronarysyndrome (ACS)and chronic
coronaryheart disease (CHD)
836 Gaps in the current knowledge of acute respiratory
infections affecting children under 5 years in Morocco
837 Gastroesophageal reflux disease in Iran: SEPAHAN
systematic review no. 2
838 Gender-specific care of the patient with diabetes:
Review and recommendations
839 Gender-specific care of the patient with diabetes: review
and recommendations
840 Gene knockouts that affect female fertility: novel targets
for contraception
841 Gene therapy in the treatment of peripheral arterial
disease
842 Genetic and neurocognitive foundations of emotion
abnormalities in bipolar disorder
843 Genetic Polymorphisms of GSTM1, GSTT1, and GSTP1
with Prostate Cancer Risk: A Meta-Analysis of 57 Studies
844 Genetic susceptibility to acute rheumatic fever: a
systematic review and meta-analysis of twin studies
845 Genetics education in the nursing profession: Literature
review
846 Genetics of age at menarche: A systematic review
847 The Genetics of sporadic ruptured and unruptured
intracranial aneurysms: A genetic meta-analysis of 8
genes and 13 polymorphisms in - 20, 000 subjects
848 The genus Commiphora: A review of its traditional uses,
849 The genus Commiphora: a review of its traditional uses,
850 The genus Cordyceps: A chemical and pharmacological
review
851 The genus Cynomorium in China: An
ethnopharmacological and phytochemical review
852 The genus Rhododendron: An ethnopharmacological
and toxicological review
853 Geriatric professional's guide to the internet: Searching
the evidence-based literature in geriatric psychiatry
854 Getting "un" constipated in the 21st century
(constipation... the "low-serotonin syndrome")
855 Gingival retraction techniques for implants versus teeth:
current status
856 Glenohumeral arthropathy following stabilization for
recurrent instability
857 Global ultrasound utilization for point of care
management: Assessment in countries with high
maternal mortality ratios
858 Global use of obstetric ultrasound: Applying the
technology in regions with high maternal mortality
859 Global use of ultrasound for maternal mortality
reduction in countries with high maternal mortality
ratios
860 Glucocorticoids can increase the survival rate of patients
with severe viral hepatitis B: A meta-analysis
861 Glucocorticoids can increase the survival rate of patients
with severe viral hepatitis B: a meta-analysis
862 Gluteal muscle activity and patellofemoral pain
syndrome: a systematic review
863 Glycaemic control in type 1 diabetes during real time
continuous glucose monitoring compared with self
monitoring of blood glucose: meta-analysis of
randomised controlled trials using individual patient
data
864 Glycogen phosphorylase isoenzyme BB in the diagnosis
of acute myocardial infarction: A meta-analysis
865 Goal-oriented therapy with miglustat in Gaucher disease
866 Google and PubMed for physicians: How to find
information without getting lost
867 Google scholar and e-journals
868 Google Scholar and the h-index in biomedicine: The
popularization of bibliometric assessment
869 Google Scholar is not enough to be used alone for
systematic reviews
870 Google scholar versus pubMed in locating primary
literature to answer drug-related questions
871 Google Scholar: A source for clinicians?
872 Gossypibomas Mimicking a Splenic Hydatid Cyst and Ileal
Tumor
873 Gossypibomas mimicking a splenic hydatid cyst and ileal
tumor : a case report and literature review
874 Graft-versus-host disease after liver transplantation: A
comprehensive literature review
875 Graft-versus-host disease after liver transplantation:
Comprehensive literature review
876 Green tea and the risk of gastric cancer: Epidemiological
evidence
877 The "Gretchen question" for psychiatry - The importance
of religion and spirituality in psychiatric treatment
878 [The "Gretchen question" for psychiatry--the importance
of religion and spirituality in psychiatric treatment]
879 Growth factors and myometrium: Biological effects in
uterine fibroid and possible clinical implications
880 Growth hormone axis treatments for HIV-associated
lipodystrophy: a systematic review of placebo-controlled
trials
881 Growth hormone axis treatments for HIV-associated
lipodystrophy: A systematic review of placebo-controlled
trials
882 The growth of fellowship programs in medical simulation
883 Guideline of the German Society for Nutritional
Medicine (DGEM): DGEM terminology for clinical
nutrition
884 A guideline to medical photography: A perspective on
digital photography in an orthopaedic setting
885 Guidelines for the selection of tooth whitening products
amongst those available on the market
886 Haematogenous acute and subacute paediatric
osteomyelitis
887 Haematogenous acute and subacute paediatric
osteomyelitis: a systematic review of the literature
888 Haemobilia following percutaneous radiofrequency
ablation of hepatocellular carcinoma: A case report and
literature review
889 Haemophagocytic lymphohistiocytic (HLH) syndrome in
IBD patients treated with Immunosuppressors increasing
awareness makes diagnosis
890 Hand hygiene prior to contact lens handling is
problematical
891 Hand-suture versus stapling anastomosis in the
incidence of anastomotic leakage following
esophagogastrostomy: A systematic review
892 The Hantavirus - A zoonosis with varying incidence
893 Has laparoscopic colorectal surgery become more cost-
effective over time?
894 Has laparoscopy increased surgical indications for benign
tumors of the liver?
895 Have we learned from lessons of the past? A systematic
review of training for single incision laparoscopic surgery
896 Hazards of unintentional injection of epinephrine from
autoinjectors: a systematic review
897 Hazards of unintentional injection of epinephrine from
autoinjectors: A systematic review
898 Health and medication information resources on the
World Wide Web
899 Health care professionals' attitudes and opinions
regarding the vaccination of measles-A systematic
review
900 Health education interventions to raise awareness of
rheumatic fever: a systematic review protocol
901 Health information in the arab world
902 Health information technology approaches for
continuous quality improvement of antiretroviral
programs in developing countries
903 Health Literacy and Women's Health: Challenges and
Opportunities
904 Health literacy screening instruments for eHealth
applications: A systematic review
905 Health risks, correlates, and interventions to reduce
sedentary behavior in young people
906 Health system drivers of hospital medicine in Canada:
Systematic review
907 Health workforce skill mix and task shifting in low
income countries: a review of recent evidence
908 Healthcare professionals' organisational barriers to
health information technologies-a literature review
909 Heart failure among Indigenous Australians: a systematic
review
910 Heart failure and skilled nursing facilities: Review of the
literature
911 Heart failure and skilled nursing facilities: review of the
literature
912 Helicobacter pylori infection and hyperemesis
gravidarum: A systematic review and meta-analysis of
case-control
913 Helicobacter pylori infection and hyperemesis
gravidarum: a systematic review and meta-analysis of
case-control studies
914 Helicobacter species are associated with possible
increase in risk of hepatobiliary tract cancers
915 Hemoglobin levels and transfusions in neurocritically ill
patients: A systematic review of comparative studies
916 Hemoglobin levels and transfusions in neurocritically ill
patients: a systematic review of comparative studies
917 Hemorrhagic Hepatic Cyst: Report of a Case and Review
of the Literature with Emphasis on Clinical Approach and
Management
918 Heparin prophylaxis does not prevent post-ERCP
pancreatitis: A systematic review and meta-analysis
919 Hepatic involvement by lymphoproliferative disorders
post liver transplantation: PTLD.Int. Survey
920 Hepatic lymphomas post renal transplantation may
signify worse disease behavior: analysis of data from 26
international studies
921 Hepatitis B infection is associated with an increased risk
of non-hodgkin lymphoma: A meta-analysis
922 Hepatitis B virus in Pakistan: a systematic review of
prevalence, risk factors, awareness status and genotypes
923 Hepatitis B virus infection has no significant role on
lymphoproliferative disorders post liver transplantation:
PTLD. Int survey
924 Hepatitis C virus in Pakistan: A systematic review of
prevalence, genotypes and risk factors
925 Hepatitis C virus infection can affect lymphoproliferative
disorders only as a cofactor for epstein-barr virus in liver
transplant recipients: PTLD. Int survey
926 Hepatitis e virus infection: A general review with a focus
on hemodialysis and kidney transplant patients
927 Hepatotoxic botanicals - An evidence-based systematic
review
928 Herbal medicinal oils in traditional Persian medicine
929 Herbal remedies affecting coagulation: A review
930 Heterogeneity of reporting standards in randomised
clinical trials of endovenous interventions for varicose
veins
931 Heterogeneity of reporting standards in randomised
clinical trials of endovenous interventions for varicose
veins
932 The 'hidden' burden of malaria: cognitive impairment
following infection
933 High burden of protein-energy malnutrition in Nigeria:
beyond the health care setting
934 High-dose insulin therapy in beta-blocker and calcium
channel-blocker poisoning
935 High-energy extracorporeal shock wave therapy is
effective for treating chronic calcific tendonitis of the
shoulder: A meta-analysis
936 High-resolution computed tomography for clinical
imaging of bone microarchitecture
937 History and development of trauma registry: lessons
from developed to developing countries
938 The history of cerebral PET scanning: From physiology to
cutting-edge technology
939 A history of intraspinal analgesia, a small and personal
journey
940 HIV related Hodgkin's lymphoma in the HAART era: A
comprehensive review and meta-analysis of response
and survival rates
941 HIV, poverty and women
942 The hMLH1 promoter polymorphisms and cancer
susceptibility in Asian populations: a meta-analysis
943 A holistic framework to improve the uptake and impact
of eHealth technologies
944 A holistic framework to improve the uptake and impact
of eHealth technologies
945 Homeopathic treatments in psychiatry: A systematic
review of randomized placebo-controlled studies
946 Host biomarkers of clinical relevance in tuberculosis:
Review of gene and protein expression studies
947 How clean is your toothbrush?
948 How common is tooth pain after root canal treatment?
949 How do chemotherapeutic agents damage the ovary?
950 How many low birthweight babies in low- and
middleincome countries are preterm?
951 How many low birthweight babies in low- and middle-
income countries are preterm?
952 How many presentations are published as full papers?
953 How much vitamin D Do we need for skeletal health?
954 How patient cost-sharing trends affect adherence and
outcomes: A literature review
955 How strong is the evidence for the need to restore
posterior bounded edentulous spaces in adults? Grading
the quality of evidence and the strength of
recommendations
956 How strong is the evidence for the need to restore
posterior bounded edentulous spaces in adults? Grading
the quality of evidence and the strength of
recommendations
957 How to check the validity of clinical severity indices in
inflammatory bowel disease
958 How to construct and implement script concordance
tests: insights from a systematic review
959 Hyperbaric oxygen therapy for treatment of children
with autism: A systematic review of randomized trials
960 Hypertension in an adolescent secondary to
performance enhancement supplement use
961 Hypoxic hepatitis: A challenging diagnosis
962 Iatrogenic femoral nerve injury: A systematic review
963 Iatrogenic upper limb nerve injuries: A systematic review
964 ICF: Clinical relevance for physiotherapy? A critical
review
965 Identification of high risk patients with pulsatile tinnitus
966 Identify the Endodontic Treatment Modalities
967 Identifying the educationally influential physician: A
systematic review of approaches
968 Iloprost as a preventative strategy of contrast induced
nephropathy in patients undergoing coronary
angiography
969 Immune reconstitution inflammatory syndrome (IRIS)
incidence in patients starting antiretroviral therapy (ART)
eartlier versus later during tuberculosis (TB) therapy: A
systemic review and meta-analysis of cohort sutdies
970 Immunomodulatory dietary polysaccharides: a
971 Immunotherapy strategies in the treatment of breast
cancer
972 Impact factor and other indices to assess science,
scientists and scientific journals
973 Impact of advanced versus basic electronic-medical-
record systems on the quality of patient care: A meta-
analysis of 10 randomized controlled trials
974 Impact of alcohol advertising and media exposure on
adolescent alcohol use: a systematic review of
longitudinal studies
975 The impact of asthma and COPD in sub-Saharan Africa
976 The impact of chronic constipation on quality of life in
adults and children: A systematic review
977 The impact of community health workers (CHWs) on
Buruli ulcer in Sub-Saharan Africa: A systematic review
978 [The impact of dental trauma on quality of life of
children and adolescents: a critical review and
measurement instruments]
979 The impact of deployment to Iraq or Afghanistan on
military children: A review of the literature
980 Impact of European pharmaceutical price regulation on
generic price competition: A review
981 Impact of fear of insulin or fear of injection on treatment
outcomes of patients with diabetes
982 Impact of fetal and neonatal malnutrition on the onset
of puberty and associated noncommunicable disease
risks
983 Impact of HIV type 1 DNA levels on spontaneous disease
progression: A meta-analysis
984 The impact of nutrition education interventions on the
dietary habits of college students in developed nations:
A brief review
985 The impact of nutrition education interventions on the
dietary habits of college students in developed nations:
a brief review
986 Impact of pharmaceutical prior authorisation policies: A
987 The impact of polyol-containing chewing gums on dental
caries a systematic review of original randomized
controlled trials and observational studies
988 Impact of reduction in working hours for doctors in
training on postgraduate medical education and
patients' outcomes: systematic review
989 The impact of sexually transmissible infection programs
in remote Aboriginal communities in Australia: A
systematic review
990 The impact of sexually transmissible infection programs
in remote Aboriginal communities in Australia: a
systematic review
991 The impact of the Stroke Rehabilitation Evidence Based
Review
992 The impact of warm weather on mass event medical
need: a review of the literature
993 Improvements and difficulties in postoperative pain
management
994 Improving ethics analysis in health technology
assessment
995 The in vitro and in vivo effects of nicotine on bone, bone
cells and fracture repair
996 In vivo implantation of tissue-engineered tendon for
repairing tendon defect
997 Inadequacies in computer access using assistive
technology devices in profoundly disabled individuals: an
overview of the current literature
998 Incentives and barriers to lifestyle interventions for
people with severe mental illness: A narrative synthesis
of quantitative, qualitative and mixed methods studies
999 The incidence of pulmonary embolism and deep vein
thrombosis after knee arthroplasty in Asians remains
low: a meta-analysis
1000 The incidence of pulmonary embolism and deep vein
thrombosis after knee arthroplasty in Asians remains
low: A meta-analysis knee
1001 Incontinence rates after cutting seton treatment for anal
fistula
1002 Increased use of percutaneous technique for totally
implantable venous access devices. Is it real progress? A
27-year comprehensive review on early complications
1003 Indexed publications generated from abstracts of
angiology and vascular surgery congresses in Brazil
1004 Indoor air pollution from biomass fuels: A major health
hazard in developing countries
1005 Indoor solid fuel combustion and tuberculosis: Is there
an association?
1006 Induction immunosuppression for orthotopic heart
transplantation: a review
1007 Induction immunosuppression for orthotopic heart
transplantation: a review
1008 Induction of oxidative stress in kidney
1009 Inefficacy of self-regulation of alcohol advertisements: A
1010 Infants' and toddlers' coping with immunization stress: A
literature review
1011 Inflammatory diseases of the parathyroid gland
1012 Inflammatory diseases of the parathyroid gland
1013 The influence of combined oral contraceptives on
female sexual desire: A systematic review
1014 Influence of compensation status on time off work after
carpal tunnel release and rotator cuff surgery: A meta-
analysis
1015 The influence of low-intensity laser therapy on bone
healing
1016 Information basis for rating Global Assessment of
Functioning (GAF)
1017 Information resources in medicine: Present and future
trends
1018 Information systems for patient follow-up and chronic
management of HIV and tuberculosis: a life-saving
technology in resource-poor areas
1019 Information systems for patient follow-up and chronic
management of HIV and tuberculosis: A life-saving
technology in resource-poor areas
1020 Infragenicular stent implantation for below-the-knee
atherosclerotic disease: Clinical evidence from an
international collaborative meta-analysis on 640 patients
1021 Infusion of calcium and magnesium for oxaliplatin-
induced sensory neurotoxicity in colorectal cancer: A
1022 Inherited invasive lobular breast carcinomas without
diffuse gastric cancer as a special phenotype of CDH-1
germ-line mutation
1023 Injection of Botulinum Toxin for Treatment of Chronic
Lateral Epicondylitis: Systematic Review and Meta-
Analysis
1024 Insertion/deletion (I/D) in the angiotensin-converting
enzyme gene and breast cancer risk: lack of association
in a meta- analysis
1025 Insertion/deletion (I/D) in the angiotensin-converting
enzyme gene and breast cancer risk: Lack of association
in a metaanalysis
1026 Insomnia and risk of cardiovascular disease: A meta-
analysis
1027 An institutional analysis and systematic review with
meta-analysis of pneumatic versus hydrostatic reduction
for pediatric intussusception
1028 Insulin analogues: How observational studies provide
key insights into management of patients with type 2
diabetes mellitus
1029 Insulin degludec as an ultralong-acting basal insulin once
a day: A systematic review
1030 The insulin-like growth factor system, metabolic
syndrome, and cardiovascular disease risk
1031 Integrating informatics into the BSN curriculum: A
1032 Integrating lactation consultants into primary health
care services: are lactation consultants affecting
breastfeeding success?
1033 Integrating prevention of mother-to-child HIV
transmission (PMTCT) programmes with other health
services for preventing HIV infection and improving HIV
outcomes in developing countries
1034 Integration of short bouts of physical activity into
organizational routine: A systematic review of the
literature
1035 An integrative review of literature examining
psychometric properties of instruments measuring
anxiety or fear in hospitalized children
1036 An Integrative Review of Literature Examining
Psychometric Properties of Instruments Measuring
Anxiety or Fear in Hospitalized Children
1037 Interaction of Hepatitis C virus proteins with pattern
recognition receptors
1038 Intercultural communication in health care: challenges
and solutions in work rehabilitation practices and
training: a comprehensive review
1039 Interdental spacing and orthodontic treatment in
competitive athletes: clues to doping with growth
hormones?
1040 An interesting case of HSV pneumonia and PCP co-
infection in a patient with aids: A diagnostic and
management challenge
1041 Internet and computer game addiction - A review of
current neuroscientific research
1042 Internet pathways in suicidality: A review of the
evidence
1043 Internet-based interventions for smoking cessation
1044 Interventions for Hispanic caregivers of patients with
dementia: A review of the literature
1045 Interventions for mycosis fungoides - Protocol for a
systematic review
1046 Interventions for promoting reintegration and reducing
harmful behaviour and lifestyles in street-connected
children and young people
1049 Interventions to improve continuity of care in the follow-
up of patients with cancer
1050 Interventions to improve continuity of care in the follow-
up of patients with cancer
1051 Interventions to reduce college drinking: Observations
from the substance use risk educationmeta-analytic
team
1052 Interventions to support a palliative care approach in
patients with chronic obstructive pulmonary disease: An
integrative review
1053 Intracoronary versus intravenous abciximab
administration in STEMI patients: Overview of current
status and open questions
1054 Intranasal fentanyl in the treatment of acute paina
systematic review
1055 Intranasal fentanyl in the treatment of acute pain--a
systematic review
1056 Intra-operative conversion is a cause of masked
mortality in off-pump coronary artery bypass: A meta-
analysis
1057 Intraoral treatment of veneering porcelain chipping of
fixed dental restorations: a review and clinical
application
1058 Intrathecal magnesium as analgesic adjuvant for spinal
anesthesia: A meta-analysis of randomized trials
1059 Intrathecal magnesium as analgesic adjuvant for spinal
anesthesia: A meta-analysis of randomized trials
1060 Intrathecal ropivacaine+/-opioid vs.Bupivacaine +/-
opioid for caesarean section: A meta-analysis
1061 Intrathecal ropivacaine+opioid vs bupivacaine+opioid
perioperatively: A meta-analysis
1062 Intratracheal Clara cell secretory protein (CCSP)
administration in preterm infants with or at risk of
respiratory distress syndrome
1063 Intratympanic steroids for sudden sensorineural hearing
loss: a systematic review
1064 Intrauterine anesthesia for gynecologic procedures: A
systematic review
1065 Intravenous opioids for severe acute pain in the
emergency department
1066 Intussusception due to inflammatory fibroid polyp: A
case report and comprehensive literature review
1067 Investigation on the indication of ipsilateral
adrenalectomy in radical nephrectomy: A meta-analysis
1068 Investigation on the indication of ipsilateral
adrenalectomy in radical nephrectomy: a meta-analysis
1069 Irritable bowel syndrome in Iran: SEPAHAN Systematic
Review No. 1
1070 Is additional complex fractionated atrial electrograms
ablation added to pulmonary vein antrum Fisolation
effective? A metaanalysis of six controlled trials
1071 Is cartilage tympanoplasty more effective than fascia
tympanoplasty? A systematic review
1072 Is cartilage tympanoplasty more effective than fascia
tympanoplasty? A systematic review
1073 Is citrulline a marker of small intestinal absorption? A
systematic review and metaanalysis
1074 Is complete lymph node dissection after a positive
sentinel lymph node biopsy for cutaneous melanoma
always necessary? A meta-analysis
1075 Is completion lymph node dissection after a positive
sentinel lymph node biopsy for cutaneous melanoma
always necessary? A meta-analysis and systematic
review
1076 Is Ginkgo biloba a cognitive enhancer in healthy
individuals? A meta-analysis
1077 Is minimally invasive surgery beneficial in the
management of esophageal cancer? A meta-analysis
1078 Is nasal packing necessary after septoplasty? A meta-
analysis
1079 Is power training or conventional resistance training
better for function in elderly persons? A meta-analysis
1080 Is reflexivity the key to minimising problems of
interpretation in phenomenological research?
1081 Is routine thromboprophylaxis justified among Indian
patients sustaining major orthopedic trauma? A
systematic review
1082 Is serious aggressive behaviour in school preventable? A
literature review concerning school shootings and
discussion of two case reports
1083 Is the coverage of Google Scholar enough to be used
alone for systematic reviews
1084 Is the coverage of Google Scholar enough to be used
alone for systematic reviews
1085 Is the non-verbal behavioural emotion-processing profile
of bipolar disorder impaired? A critical review
1086 Is the pelviureteric junction an anatomical entity?
1087 Is the prevalence of asthma declining? Systematic
review of epidemiological studies
1088 Is there a consensus on patient selection criteria for
accelerated partial breast irradiation in early breast
cancer treatment? A critical review of the literature
1089 Is there a projected difference in cost effectiveness
between developed and developing countries in
laparoscopic colorectal surgery?
1090 Is there a relationship between depression and crying? A
review
1091 Is there any difference between blood and crystalloid
cardioplegia for myocardial protection during cardiac
surgery? A meta-analysis of 5576 patients from 36
randomized trials
1092 Is there pathology associated with asymptomatic third
molars?
1093 Is there pathology associated with asymptomatic third
molars?
1094 Is this case of a very rare disease work-related? A review
of reported cases of Pacinian neuroma
1095 Is this case of a very rare disease work-related? a review
of reported cases of pacinian neuroma
1096 Is truth survival in hepatology associated with hirsch
index (H)?
1097 Is whole-body thermoregulatory function impaired in
type 1 diabetes mellitus?
1098 Isolation: a concept analysis
1099 Issues for the Selection of Wheelchair-Specific Activity
and Participation Outcome Measures: A Review
1100 Japanese encephalitis in Asia: Clinical burden and
costeffectiveness of vaccination program
1101 Juvenile mental health courts for adjudicated youth: role
implications for child and adolescent psychiatric mental
health nurses
1102 Kangaroo mother care to reduce morbidity and mortality
in low birthweight infants
1103 Keeping patients safe in healthcare organizations: A
structuration theory of safety culture
1104 Ketamine in Adult Emergency Medicine: Controversies
and Recent Advances
1105 Ketamine-induced vesicopathy: A literature review
1106 Ketamlne abuse: New causative factor of LUTS
1107 Key components to consider when developing an
anticoagulation clinic - A pharmacy teaching and training
approach: Literature review
1108 Knowledge mining from microbiological data -
Application of network science in food microbiology
1109 Knowledge transfer (part 1) - Asking the question for a
lung cancer MDT
1110 Laparoscopic approach to incarcerated and strangulated
inguinal hernias
1111 Laparoscopic liver resection-an extended literature
review
1112 Laparoscopic management of spigelian hernias
1113 Laparoscopic partial nephrectomy in obese patients: A
1114 Laparoscopic partial nephrectomy in obese patients: a
1115 Laparoscopic peritoneal lavage for perforated colonic
diverticulitis: A systematic review
1116 Laparoscopic peritoneal lavage for perforated sigmoid
diverticulitis
1117 Laparoscopic revision of failed antireflux surgery: A
systematic review
1118 Laryngeal mask airway surfactant administration for
prevention of morbidity and mortality in preterm infants
with or at risk of respiratory distress syndrome
1119 Laryngomalacia and acid reflux: A systematic review
1120 Laser photobiomodulation as a potential multi-target
anticancer therapy-Review
1121 The last image: On the history of optography
1122 Late evening snack: Exploiting a period of anabolic
opportunity in cirrhosis
1123 Late onset post transplantation lymphoproliferative
disorders: Analysis of international data from 5 studies
1124 Latex immunotherapy: State of the art
1125 Lazarus phenomenon: Spontaneous return of circulation
after cardiac arrest and cessation of resuscitation
attempts
1126 L-carnitine for acute valproic acid overdose: A systematic
review of published cases
1127 Learning centred approach for developing the electronic
information search processes of students
1128 Learning for holistic care: Addressing practical wisdom
(phronesis) and the spiritual sphere
1129 Learning from failure - Implications for respiratory and
intensive care medicine: A conceptual review
1130 Left ventricular systolic function in sickle cell anemia: A
meta-analysis
1131 Left-sided Acute Appendicitis with Situs Inversus Totalis:
Review of 63 Published Cases and Report of Two Cases
1132 Left-sided appendicitis: Review of 95 published cases
and a case report
1133 Lesbian, gay, bisexual, and transgender parents seeking
health care for their children: a systematic review of the
literature
1134 Lessons learned and questions unanswered from use of
multitargeted kinase inhibitors in medullary thyroid
cancer
1135 Level of daily physical activity in individuals with COPD
compared with healthy controls
1136 Level of daily physical activity in individuals with COPD
compared with healthy controls
1137 Levels of adherence required for virologic suppression
among newer antiretroviral medications
1138 Levels of salivary IgA antibodies to Candida spp. in HIV-
infected adult patients: A systematic review
1139 Lifestyle modification, nutritional and vitamins
supplements for age-related macular degeneration
1140 Lifestyles and new non-drug addictions
1141 Limited economic evidence of carotid artery stenosis
diagnosis and treatment: A systematic review
1142 Limited evidence for intranasal fentanyl in the
emergency department and the prehospital setting - A
systematic review
1143 Limited evidence for intranasal fentanyl in the
emergency department and the prehospital setting--a
systematic review
1144 Linking health information technology to patient safety
and quality outcomes: a bibliometric analysis and review
1145 Lipoprotein (a) and stroke: A meta-analysis of
observational studies
1146 Lipoprotein-associated phospholipase A2 (Lp-PLA2): A
review of its role and significance as a cardiovascular
biomarker
1147 Lipoprotein-associated phospholipase A2 as a novel risk
marker for cardiovascular disease: A systematic review
of the literature
1148 A literature review of professionalism in surgical
education: Suggested components for development of a
curriculum
1149 Literature review: Considerations in undertaking focus
group research with culturally and linguistically diverse
groups
1150 Literature search on risk factors for sarcoma: PubMed
and Google Scholar may be complementary sources
1151 Literature search: PubMed versus Google Scholar
1152 Liver abscess in children: An overview
1153 Liver hydatid cyst rupture into the peritoneal cavity after
abdominal trauma: case report and literature review
1154 The Long and Tortuous History of the Discovery of
Testosterone and Its Clinical Application
1155 Long-acting beta(2) agonists in asthma and allergic
rhinitis
1156 Long-term continence disturbance after lateral internal
sphincterotomy for chronic anal fissure: A systematic
1157 Long-term developmental outcome of Children of
Women with epilepsy, unexposed or exposed prenatally
to antiepileptic drugs: A meta-analysis of cohort sstudies
1158 Long-term developmental outcome of children of
women with epilepsy, unexposed or exposed prenatally
to antiepileptic drugs: a meta-analysis of cohort studies
1159 Long-term neuropsychological effects of opioid use in
children: A literature review
1160 Lonicera japonica Thunb.: Ethnopharmacology,
phytochemistry and pharmacology of an important
traditional Chinese medicine
1161 Lost in translation: the impact of publication language on
citation frequency in the scientific dental literature
1162 Low blood pressure and preserved systolic function in
elders with heart failure
1163 [Low publication of the papers presented at the
Congresses of Gastroenterology Society of Peru 1998-
2008]
1164 Low-dose ketamine in addition to propofol for
procedural sedation and analgesia in the emergency
department
1165 Lymphoproliferative disorders in pediatric liver allograft
recipients: A review of 212 cases
1166 Madarosis: a marker of many maladies
1167 Magnesium sulfate for acute asthma in adults: A
1168 Magnesium sulfate for acute asthma in adults: a
1169 Mammary ductoscopy in the current management of
breast disease
1170 Management of ankylosed primary molars with
premolar successors: a systematic review
1171 Management of calcaneal fractures: Systematic review
of randomized trials
1172 Management of chronic cough in patients receiving
palliative care: Review of evidence and
recommendations by a task group of the Association for
Palliative Medicine of Great Britain and Ireland
1173 Management of combined ACL-MCL tears: A systematic
review
1174 Management of envenomations during pregnancy
1175 Management of extravasation in cancer patients: What
is the evidence?
1176 Management of high grade squamous intraepithelial
lesion of the cervix of adult women
1177 [Management of high grade squamous intraepithelial
lesion of the cervix of adult women]
1178 Management of non Alcoholic fatty liver diseases and
their complications
1179 Management of prolonged post-operative ileus:
evidence-based recommendations
1180 The management of rectal cancer with synchronous liver
metastases: a modern surgical dilemma
1181 The management of rectal cancer with synchronous liver
metastases: A modern surgical dilemma. A review
1182 Management of the greater trochanteric pain syndrome:
A systematic review
1183 Mandating nutrient menu labeling in restaurants:
potential public health benefits
1184 Mandibular incisor extraction: A systematic review of an
uncommon extraction choice in orthodontic treatment
1185 Manipulative and multimodal therapy for upper
extremity and temporomandibular disorders: A
systematic review
1186 Manipulative therapy for pregnancy and related
conditions
1187 Manipulative therapy for pregnancy and related
conditions: a systematic review
1188 Manneristic behaviors of visually impaired children
1189 Maori with aphasia: a people without a voice?
1190 The Map of Medicine: a review of evidence for its impact
on healthcare
1191 Mapping the maze of terms and definitions in dementia-
related wandering
1192 Mapping the unimmunized: Understanding vulnerability
to vaccine preventable diseases in conscientious
objectors
1193 Massage therapy for fibromyalgia symptoms
1194 Masturbation and mass delusion - The story of
spermatorrhoea
1195 Maternal metabolism and obesity: modifiable
determinants of pregnancy outcome
1196 Maternal vitamin d status and risk of pre-eclampsia: a
1197 Measures assessing spirituality as more than religiosity:
A methodological review of nursing and health-related
literature
1198 Measures assessing spirituality as more than religiosity:
a methodological review of nursing and health-related
literature
1199 Measuring academic performance for healthcare
researchers with the H index: Which search tool should
be used?
1200 Measuring depression in persons with spinal cord injury:
a systematic review
1201 Measuring physical activity and sedentary behaviors in
women with young children: A systematic review
1202 Measuring physical activity and sedentary behaviour at
work: a review
1203 Measuring self-harm in adults: A systematic review
1204 Mechanical CPR devices compared to manual CPR during
out-of-hospital cardiac arrest and ambulance transport:
a systematic review
1205 Mechanical CPR devices compared to manual CPR during
out-of-hospital cardiac arrest and ambulance transport:
a systematic review
1206 Mechanisms of obesity induced higher intestinal
permeability
1207 The mechanisms of positive effects of melatonin in
dyslipidemia: A systematic review of animal and human
studies
1208 Medical ethics history in Iran
1209 Medical literature search dot com
1210 Medical literature searches: a comparison of PubMed
and Google Scholar
1211 Medical malpractice reform: the role of alternative
dispute resolution
1212 Medical malpractice reform: The role of alternative
dispute resolution
1213 Medical multimedia retrieval 2.0
1214 Medical treatment of overactive bladder: An overview
1215 Medical treatments for idiopathic thrombocytopenic
purpura during pregnancy
1216 Medical-scientific research: Google Scholar is possibly
superior to PubMed
1217 Medication adherence self-report instruments:
implications for practice and research
1218 Medicinal plants of genus Curculigo: Traditional uses and
a phytochemical and ethnopharmacological review
1219 Medicinal plants with teratogenic potential: Current
considerations
1220 The medicinal uses of Callicarpa L. in traditional Chinese
medicine: An ethnopharmacological, phytochemical and
pharmacological review
1221 MEH Tyr113His polymorphism and the risk of ovarian
cancer development
1222 mEH Tyr113His polymorphism and the risk of ovarian
cancer development
1223 Melatonin in autism spectrum disorders: A systematic
1224 Melatonin: An overlooked factor in schizophrenia and in
the inhibition of anti-psychotic side effects
1225 Meningitis: is a major cause of disability amongst Papua
New Guinea children?
1226 Meniscal root tears: From basic science to ultimate
surgery
1227 Meniscectomy as a risk factor for knee osteoarthritis: A
systematic review
1228 Mental health issues in fetal alcohol spectrum disorder
1229 Mental health response to community disasters: a
systematic review
1230 Mental health services for black and minority ethnic
elders in the United Kingdom: A systematic review of
innovative practice with service provision and policy
implications
1231 Mentoring programs for underrepresented minority
faculty in academic medical centers: A systematic review
of the literature
1232 Mesiodistal tooth size in non-syndromic unilateral cleft
lip and palate patients: a meta-analysis
1233 Meta analysis of 99technetium-methylene
bisphosphonate for treatment of thyroid-associated
ophthalmopathy
1234 Meta analysis of comparison of central corneal thickness
measurement between Pentacam and A-scan in normal
people
1235 Meta analysis of grade 3 and/or 4 toxicities in follicular
(FL) and mantle cell (MCL) non-hodgkin lymphoma (NHL)
patients receiving maintenance rituximab (MR): Impact
of schedule, histology, and induction regimen
1236 A meta analysis on artemether in the prevention of
Schistosomiasis
1237 Meta-analysis appraising high clopidogrel loading in
patients undergoing percutaneous coronary intervention
1238 Meta-Analysis Appraising High Clopidogrel Loading in
Patients Undergoing Percutaneous Coronary
Intervention++Conflicts of interest: Dr. Angiolillo is a
consultant and on the speaker's bureau for Bristol Myers
Squibb, New York, New York, and Sanofi-Aventis, Paris,
France. Dr. Biondi-Zoccai has consulted for Boston
Scientific, Natick, Massachusetts, and Cordis, Miami
1239 Meta-analysis for efficacy of etanercept for treatment of
psoriatic arthritis
1240 Meta-analysis for efficacy of romiplostim for treatment
of immune idiopathic thrombocytopenia
1241 Meta-analysis for safety of dabigatran and warfarin for
treatment of atrial fibrillation
1242 Meta-analysis of 5,674 patients treated with
percutaneous coronary intervention and drug-eluting
stents or coronary artery bypass graft surgery for
unprotected left main coronary artery stenosis
1243 A meta-analysis of anastrozole in combination with
fulvestrant in the first line treatment of hormone
receptor positive advanced breast cancer
1244 Meta-analysis of association between cytokine gene
polymorphisms and lung cancer risk
1245 Meta-analysis of association between cytokine gene
polymorphisms and lung cancer risk
1246 Meta-analysis of CAG (cytarabine, aclarubicin, G-CSF)
regimen for the treatment of 580 patients with acute
leukemia in China and Japan
1247 Meta-analysis of case-referent studies of specific
environmental or occupational pollutants on lung cancer
1248 A meta-analysis of computerized assessment batteries in
schizophrenia medication trials
1249 Meta-analysis of diffusion tensor imaging studies shows
altered fractional anisotropy occurring in distinct brain
areas in association with depression
1250 Meta-analysis of functional magnetic resonance imaging
studies of inhibition and attention in attention-
deficit/hyperactivity disorder: Exploring task-specific,
stimulant medication, and age effects
1251 A Meta-analysis of hypnosis in the treatment of
depressive symptoms: A brief communication
1252 A meta-analysis of hypnosis in the treatment of
depressive symptoms: a brief communication
1253 Meta-analysis of impact of different types and doses of
statins on new-onset diabetes mellitus
1254 A meta-analysis of injection laryngoplasty vs thyroplasty
1255 Meta-Analysis of Microsomal Epoxide Hydrolase Gene
Polymorphism and Risk of Hepatocellular Carcinoma
1256 Meta-analysis of microsomal epoxide hydrolase gene
polymorphism and risk of hepatocellular carcinoma
1257 Meta-analysis of minimally invasive internal thoracic
artery bypass versus percutaneous revascularisation for
isolated lesions of the left anterior descending artery
1258 Meta-Analysis of MMP2, MMP3, and MMP9 Promoter
Polymorphisms and Head and Neck Cancer Risk
1259 Meta-Analysis of Mortality in Dialysis Patients With an
Implantable Cardioverter Defibrillator
1260 Meta-analysis of mortality in dialysis patients with an
implantable cardioverter defibrillator
1261 A meta-analysis of potential risks of low levels of protein
Z for diseases related to vascular thrombosis
1262 A meta-analysis of potential risks of low levels of protein
Z for diseases related to vascular thrombosis
1263 Meta-analysis of prevention and treatment of
toxoplasmic encephalitis in HIV-infected patients
1264 Meta-analysis of prevention and treatment of
toxoplasmic encephalitis in HIV-infected patients
1265 Meta-analysis of probiotics for the prevention of
antibiotic associated diarrhea and the treatment of
Clostridium difficile disease
1266 Meta-analysis of probiotics for the prevention of
traveler's diarrhea
1267 Meta-analysis of probiotics for the treatment of irritable
bowel syndrome
1268 A meta-analysis of the association between Caesarean
section and childhood asthma
1269 Meta-analysis of the association between hOGG1
Ser326Cys polymorphism and risk of colorectal cancer
based on case-control studies
1270 Meta-analysis of the association between hOGG1
Ser326Cys polymorphism and risk of colorectal cancer
based on case--control studies
1271 A meta-analysis of the clinical effectiveness of school
scoliosis screening
1272 [A meta-analysis of the safety of simultaneous versus
staged resection for synchronous liver metastasis from
colorectal cancer]
1273 [A meta-analysis of the safety of simultaneous versus
staged resection for synchronous liver metastasis from
colorectal cancer]
1274 Meta-analysis of the tolerability of tapentadol
1275 A meta-Analysis of voice outcome comparing calcium
hydroxylapatite injection laryngoplasty to silicone
thyroplasty
1276 Meta-analysis on effectiveness and side-effects of
fluoroquinolones (FQS) versus non-fqs for treating acute
exacerbation of chronic obstructive pulmonary disease
(AECOPD)/ Acute exacerbation of chronic bronchitis
(AECB)
1277 A meta-analysis on the effectiveness of propranolol for
the treatment of infantile airway haemangiomas
1278 Meta-analysis: Can Helicobacter pylori eradication
treatment reduce the risk for gastric cancer?
1279 Meta-analysis: sequential therapy appears superior to
standard therapy for Helicobacter pylori infection in
patients naive to treatment
1280 Meta-analysis-maintenance of remission following
discontinuation of infliximab in patients with crohn's
disease
1281 Metabolic and endocrine adverse effects of second-
generation antipsychotics in children and adolescents: A
systematic review of randomized, placebo controlled
trials and guidelines for clinical practice
1282 Metabolic syndrome in bipolar disorders
1283 Metastatic colorectal cancer: From improved survival to
potential cure
1284 Metformin & glitazones: Do they really help PCOS
patients?
1285 Metformin and glitazones: do they really help PCOS
patients?
1286 Methanol poisoning among travellers to Indonesia
1287 A method for the automated, reliable retrieval of
publication-citation records
1288 A method for the automated, reliable retrieval of
publication-citation records
1289 Methodological quality and scientific impact of
quantitative nursing education research over 18 months
1290 Methotrexate in the management of idiopathic
granulomatous mastitis: Review of 108 published cases
and report of four cases
1291 Methylenetetrahydrofolate reductase gene C677T
polymorphism and lung cancer: an updated meta-
analysis
1292 Methylenetetrahydrofolate reductase gene C677T
polymorphism and lung cancer: an updated meta-
analysis
1293 The metoclopramide black box warning for tardive
dyskinesia: Effect on clinical practice, adverse event
reporting, and prescription drug lawsuits
1294 Metoclopramide for nausea and vomiting prophylaxis
during and after Caesarean delivery: A systematic review
and meta-analysis
1295 Metronidazole encephalopathy: A case report and
systematic review of literature
1296 Micronutrients and pregnancy; Effect of
supplementation on pregnancy and pregnancy
outcomes: A systematic review
1297 Midazolam versus diazepam for the treatment of status
epilepticus in pediatric emergency
1298 Might infection explain the higher risk of coronary heart
disease in South Asians? Systematic review comparing
prevalence rates with white populations in developed
countries
1299 Migraine-associated vertigo: A review of the
pathophysiology and differential diagnosis
1300 Milnacipran for treatment of fibromyalgia
1301 Mindfulness based cognitive therapy for major
depression: A systematic review and meta-analysis
1302 Minimally invasive hip arthroplasty: A quantitative
1303 Minimally invasive surgery: Lateral approach interbody
fusion: Results and review
1304 Mini-Sentinel's systematic reviews of validated methods
for identifying health outcomes using administrative and
claims data: Methods and lessons learned
1305 Mini-sling procedures in stress urinary incontinence: A
systematic review of efficacy and complications
1306 Misoprostol for prevention and treatment of postpartum
haemorrhage: A systematic review
1307 Misrepresentation of scholarly works by integrated
plastic surgery applicants
1308 Missing X and Y: A review of participant ages in
population-based eye studies
1309 Mitigate, adapt, or suffer: Peak oil's new disaster
paradigm
1310 Mobilisation versus Bed Rest after Skin Grafting Pretibial
Lacerations: A Meta-Analysis
1311 Models of care for socially isolated older rural carers:
barriers and implications
1312 Molecularly targeted therapies for thyroid cancers
1313 Mood disorders and complementary and alternative
medicine: a literature review
1314 Mood disorders and complementary and alternative
medicine: A literature review
1315 Moral distress in neuroscience nursing: An evolutionary
concept analysis
1316 The morbidity surrounding reversal of defunctioning
ileostomies: A systematic review of 48 studies including
6,107 cases
1317 More benign lymphoproliferative disease after liver
transplant in infants
1318 Mortality in dialysis patients with a defibrillator: A
quantitative meta-analysis
1319 Mortality rate after posterior circulation infarction
treated conventionally a systematic review and
metaanalysis of observational studies
1320 Mosquirix (RTS,S): A novel vaccine for the prevention of
Plasmodium falciparum malaria
1321 Motivation and retention of health workers in
developing countries: a systematic review
1322 Motivations, Experiences, and Perspectives of Bone
Marrow and Peripheral Blood Stem Cell Donors:
Thematic Synthesis of Qualitative Studies
1323 Motivators of enrollment in HIV vaccine trials: A review
of HIV vaccine preparedness studies
1324 Motivators of enrolment in HIV vaccine trials: A review
of HIV vaccine preparedness studies
1325 Mouth: A portal to the body
1326 Moving towards pharmacy 2.0: Practising pharmacy in
the era of social media
1327 MTHFR gene polymorphisms are not involved in
pancreatic cancer risk: A meta-analysis
1328 MTHFR gene polymorphisms are not involved in
pancreatic cancer risk: a meta-analysis
1329 MTHFR polymorphisms and pancreatic cancer risk: lack
of evidence from a meta-analysis
1330 MTHFR polymorphisms and pancreatic cancer risk: lack
of evidence from a meta-analysis
1331 Multi-detector computerized tomography angiography
for evaluation of acute chest pain - A meta analysis and
1332 Multi-detector computerized tomography angiography
for evaluation of acute chest pain--a meta analysis and
1333 A multidisciplinary esophageal atresia continuity clinic at
BC children's hospital: A systematic evaluation in design
and feasibility
1334 Multidrug resistant acinetobacter
1335 Multiple sclerosis and pregnancy, a meta-analysis of the
literature
1336 Multipotent Stromal Cell Therapy for Cavernous Nerve
Injury-Induced Erectile Dysfunction
1337 Multiprofessional interventions to improve patient
adherence to cardiovascular medications
1338 Music exposure and hearing health education: A review
of knowledge, attitude, and behaviour in adolescents
and young adults
1339 Music therapy in the treatment of multiple sclerosis: A
comprehensive literature review
1340 N-Acetylcysteine in Cardiovascular-Surgery-Associated
Renal Failure: A Meta-Analysis
1341 Nanomedicine in otorhinolaryngology: What does the
future hold?
1342 A narrative review of South Asian patients' experiences
of cardiac rehabilitation
1343 Natriuretic peptides in the management of solid organ
transplantation associated acute kidney injury: a
1344 Naturally derived anti-inflammatory compounds from
Chinese medicinal plants
1345 Nebulised surfactant in preterm infants with or at risk of
respiratory distress syndrome
1346 The necessity of HIV testing in Iranian pregnant women
and its ethical considerations
1347 The neglected
1348 Neonatal animal testing paradigms and their suitability
for testing infant formula
1349 Neonatal hypothermia in sub-Saharan Africa: a review
1350 Nepafenac: An ophthalmic nonsteroidal
antiinflammatory drug for pain after cataract surgery
1351 Netting the Evidence: How family and carers of patients
with cancer use the internet and what they find useful
1352 Neural network modelling and dynamical system theory:
are they relevant to study the governing dynamics of
association football players?
1353 Neural stem cells as tools for drug discovery: novel
platforms and approaches
1354 Neurocritical care morbidity and mortality (M&M): A
multidisciplinary systems-based approach for improving
patient care
1355 Neurodevelopmental outcomes in children with
congenital heart disease: Evaluation and management a
scientific statement from the american heart association
1356 Neurodevelopmental outcomes in children with
congenital heart disease: evaluation and management: a
scientific statement from the American Heart
Association
1357 Neuroendocrine stress response and minimally invasive
surgery
1358 Neurogenic bladder and disc disease: A brief review
1359 Neurologic effects of exogenous saccharides: A review of
controlled human, animal, and in vitro studies
1360 Neurological complications following sclerotherapy:
What are the risks?
1361 Neurological complications of sclerotherapy for varicose
veins
1362 Neuromodulation therapies and treatment-resistant
depression
1363 Neuroprotection in glaucoma: Present and future
1364 Neuroprotection in glaucoma: present and future
1365 Neuropsychological & behavioral effects of antiepileptic
drugs
1366 Neurotrophins and cochlear implants: A solution to
sensorineural deafness
1367 New and emerging roles in out of hospital emergency
care: a review of the international literature
1368 New and emerging roles in out of hospital emergency
care: A review of the international literature
1369 New mechanisms and the anti-inflammatory role of
curcumin in obesity and obesity-related metabolic
diseases
1370 New media and tobacco control
1371 A new proposal for a clinical-oriented subclassification of
baboon syndrome and a review of baboon syndrome
1372 New specialized search tools from Copernic and Google
1373 Nicorandil treatment in patients with acute myocardial
infarction - A meta-analysis
1374 Nicorandil treatment in patients with acute myocardial
infarction: a meta-analysis
1375 Nicotine vaccines for smoking cessation
1376 Nitrous oxide for colonoscopy
1377 Nitrous oxide for colonoscopy
1378 NMDA receptor antagonists interventions in
schizophrenia: Meta-analysis of randomized, placebo-
controlled trials
1379 No good evidence to link toothbrushing trauma to
gingival recession
1380 No reliable evidence for the association between dental
crowding and caries
1381 Non-haematological effects of unfractionated heparin in
neonates
1382 Non-pharmacological interventions on cognitive
functions in older people with mild cognitive impairment
(MCI)
1383 Non-skeletal manifestations of vitamin D deficiency- A
review
1384 Noradrenergic reuptake inhibition in the treatment of
pain
1385 Nosocomial HIV infection: Epidemiology and prevention -
A global perspective
1386 Nosocomial HIV infection: epidemiology and prevention--
a global perspective
1387 Not so benign: The clinical manifestations, diagnosis and
treatment of trichomoniasis in men
1388 The NTI-tss device may be used successfully in the
management of bruxism and TMD
1389 Nurse anesthetist follow-up of an adolescent female
with gunshot trauma: a case study
1390 Nurse competence: a concept analysis
1391 Nurse-family interaction in Malaysian palliative care
settings: a focused literature review
1392 Nurse-family interaction in Malaysian palliative care
settings: A focused literature review
1393 Nurses' perceptions of sexuality in institutionalized
elderly: A literature review
1394 Nursing care of patients with the risk of pulmonary
embolism and deep venous thrombosis following
bariatric surgery
1395 Nursing home residents in emergency departments: A
Foucauldian analysis
1396 Nursing interventions to reduce the risk of catheter-
associated urinary tract infection: part 2: staff education,
monitoring, and care techniques
1397 Nursing interventions to reduce the risk of catheter-
associated urinary tract infection: part 2: staff education,
monitoring, and care techniques
1398 The nursing profession in Saudi Arabia: An overview
1399 Nutrient intake of pregnant women in indonesia: A
review
1400 Nutrition transition in India: Secular trends in dietary
intake and their relationship to diet-related non-
communicable diseases
1401 Nutrition, health, and aging in sub-Saharan Africa
1402 Nutritional and dietary influences on attention deficit
hyperactivity disorder
1403 Obesity and weight management in the elderly
1404 Observer bias in randomised clinical trials with binary
outcomes: systematic review of trials with both blinded
and non-blinded outcome assessors
1405 Observer bias in randomised clinical trials with binary
outcomes: Systematic review of trials with both blinded
and non-blinded outcome assessors
1406 Observer bias in randomized clinical trials with
measurement scale outcomes: A systematic review of
trials with both blinded and nonblinded assessors
1407 Observer bias in randomized clinical trials with
measurement scale outcomes: a systematic review of
trials with both blinded and nonblinded assessors
1408 Obstacles and solutions in spotaneous reporting of
adverse drug reactions
1409 Obstacles and solutions to maintenance of advanced
procedural skills for rural and remote medical
practitioners in Australia
1410 Obturator hernias: A review of the laparoscopic
approach
1411 Occipital nerve blocks: When and what to inject?
1412 Occupationally-acquired noise-induced hearing loss: A
senseless workplace hazard
1413 OCD in the perinatal period: is postpartum OCD (ppOCD)
a distinct subtype? A review of the literature
1414 Ocular psoriasis
1415 Off-Pump Coronary Artery Bypass Surgery and Acute
Kidney Injury: A Meta-analysis of Randomized and
Observational Studies
1416 Off-pump coronary artery bypass surgery may reduce
the incidence of stroke in patients with significant left
main stem disease
1417 Off-pump versus on-pump coronary artery bypass
surgery: meta-analysis and meta-regression of 13,524
patients from randomized trials
1418 The oil-dispersion bath in anthroposophic medicine - An
integrative review
1419 The oil-dispersion bath in anthroposophic medicine--an
integrative review
1420 An old drug for a new application: Potential benefits of
sildenafil in wound healing
1421 An old drug for a new application: potential benefits of
sildenafil in wound healing
1422 Older parents' experiences following a serious illness
trajectory of an adult child: A review of the literature
and recommendations for future research
1423 Omega 3 and 6 oils for primary prevention of allergic
disease: Systematic review and meta-analysis
1424 On the benefit of probiotics in the management of
pouchitis in patients underwent ileal pouch anal
anastomosis: A meta-analysis of controlled clinical trials
1425 One size fits all? Slow cortical potentials neurofeedback:
a review
1426 Open tibial fractures in the paediatric population: A
1427 Opioid maintenance treatment with buprenorphine: The
French experience, 1996-2010
1428 Optimal case definitions of upper extremity disorder for
use in the clinical treatment and referral of patients
1429 Optimal timing of coronary invasive strategy in non-ST-
segment elevation acute coronary syndromes: A
1430 Optimal timing of coronary invasive strategy in non-ST-
segment elevation acute coronary syndromes: a
1431 Optimizing outcomes in laparoscopic urologic training:
Toward a standardized global consensus
1432 Optimizing the management of acute ischaemic stroke:
A review of the utilization of intravenous recombinant
tissue plasminogen activator (tPA)
1433 Oral and inactivated poliovirus vaccines in the newborn:
A review
1434 Oral contraceptive use and uterine leiomyoma risk: A
meta-analysis based on cohort and case-control studies
1435 Oral health promotion programmes during orthodontic
treatment beneficial
1436 Oral health surveillance in Africa: Current review of
policies and strategies
1437 [Oral health surveillance in Africa: current review of
policies and strategies]
1438 OReFiL: An online resource finder for life sciences
1439 Organizational facilitators and barriers to implementing
effective clinical audit: Systematic review
1440 Oro-facial manifestations in patients with eating
disorders
1441 Osteomyelitis: An overview of antimicrobial therapy
1442 Outcome of arthroscopic debridement and
microfracture as the primary treatment for
osteochondral lesions of the talar dome
1443 Outcomes following hip arthroscopy: Asystematic review
of the literature
1444 Outcomes in facial aesthetics in cleft lip and palate
surgery: A systematic review
1445 Outcomes sensitive to nursing service quality in
ambulatory cancer chemotherapy: Systematic scoping
review
1446 An outline of the history of head and neck oncology
1447 An outlook to journal publications from theses of MSc
and PhD students at Dokuz Eylul University Graduate
School of Health Sciences
1448 An overview and commentary on retrospective,
continuous glucose monitoring for the optimisation of
care for people with diabetes
1449 Overview of methods used in cross-cultural comparisons
of menopausal symptoms and their determinants:
Guidelines for Strengthening the Reporting of
Menopause and Aging (STROMA) studies
1450 An overview of triple infection with hepatitis B, C and D
viruses
1451 Overweight and obesity in Italian children aged 6-11
years
1452 Overweight, obesity and related non-communicable
diseases in Asian Indian girls and women
1453 Overweight, obesity, and metabolic syndrome in adults
and children in South Korea: A review of the literature
1454 Pain treatment after craniotomy: Where is the
(procedure-specific) evidence? A qualitative systematic
review
1455 Palliative radiotherapy for cervical carcinoma, a
systematic review
1456 Palliative surgery for malignant bowel obstruction: A
systematic review
1457 Pancreatic extragastrointestinal stromal tumors,
interstitial Cajal like cells, and telocytes
1458 Papuloerythroderma 2009: Two new cases and
systematic review of the worldwide literature 25 years
after its identification by Ofuji et al
1459 Papyrus to prostheses - The evolution in managing
priapism
1460 The paradox of nutrition-related diseases in the Arab
countries: The need for action
1461 Paralympic sports medicine-current evidence in winter
sport: Considerations in the development of equipment
standards for paralympic athletes
1462 Paralympic sports medicine--current evidence in winter
sport: considerations in the development of equipment
standards for paralympic athletes
1463 Paramedics' ability to perform drug calculations
1464 Parental beliefs about cause and course of their child's
autism and outcomes of their beliefs: A review of the
literature
1465 Parenteral treatment of tension-type headache: A
systematic review
1466 Partner notification for sexually transmitted infections in
developing countries: a systematic review
1467 Passive smoking and the development of cardiovascular
disease in children: a systematic review
1468 Passive smoking and the development of cardiovascular
disease in children: A systematic review
1469 The pathogenesis of adolescent idiopathic scoliosis:
1470 The pathogenesis of adolescent idiopathic scoliosis:
1471 Pathopharmacology of excessive hemorrhage in
mifepristone abortions
1472 Pathophysiology of mifepristone-induced septic shock
due to Clostridium sordellii
1473 The pathway from diabetes and obesity to cancer, on
the route to targeted therapy
1474 Patient reported outcomes in chronic myeloid leukemia:
A systematic review
1475 Patient reported outcomes in glaucoma a systematic
review
1476 Patient reported outcomes in metastatic castration-
resistant prostate cancer: A systematic review
1477 Patient rights in Iran: A review article
1478 Patient safety in dermatology: a review of the literature
1479 Patient safety information system: Purpose, structure
and functions
1480 Patient-centered medical homes: primer for pharmacists
1481 Patient-controlled transdermal iontophoretic fentanyl
system as an alternative to intravenous morphine PCA
1482 Patient-reported quality of life outcomes in celiac
disease (CeD):a systematic literature review
1483 Patients' and clinicians' attitude towards long-acting
depot antipsychotics in subjects with a first episode of
psychosis
1484 Patients' preferences within randomised trials:
systematic review and patient level meta-analysis
Systematic review and patient level meta-analysis
systematic review and patient level meta-analysis
1487 Pectoralis major muscle rupture: More than 440 cases
already reported. A review of the recent literature
1488 Pedestrian and motorized mobility scooter safety of
older people
1489 Pediatric bilateral spontaneous pneumothoraces in
monozygotic twins - A case report and review of the
literature
1490 Pediatric Health Mobility: Is it Only an Italian Problem?
1491 Pediatric obsessive-compulsive disorder: A review for
nursing professionals
1492 Pediatric Post-Discharge Mortality in Resource Poor
Countries: A Systematic Review
1493 Pediatric residency training on tobacco: Review and
critique of the literature
1494 Peer-reviewed journals in urology: Assessing quality and
impact through alternative bibliometric indices
1495 Pegloticase: A novel agent for treatment-refractory gout
1496 People with disabilities and social determinants of health
discourses
1497 Perceptions about female urinary incontinence in
different racial and ethnic groups: A systematic review
1498 Percutaneous vertebral compression fracture
management with polyethylene mesh-contained
morcelized allograft bone
1499 Performance of urinary liver-type fatty acid-binding
protein in acute kidney injury: A meta-analysis
1500 Periodontal disease and its association with chronic
disease: A literature review
1501 Perioperative dexamethasone on postoperative
analgesia and recovery - A systematic review
1502 Perioperative IV lidocaine infusion and postoperative
outcomes: A meta-analysis
1503 Peripartum cardiomyopathy: Incidence, pathogenesis,
diagnosis, treatment and prognosis
1504 Peripheral arterial disease: A literature review
1505 Peripheral facial nerve palsy in severe systemic
hypertension: A systematic review
1506 Persistent and recurrent ischemic mitral regurgitation
1507 Personalised support delivered by support workers for
people with severe and persistent mental illness: A
systematic review of patient outcomes
1508 Personalized medicine: Has it started yet? A
reconstruction of the early history
1509 Perspectives on quality of life in glaucoma
1510 Phantom organ pain: A myth or a clinical entity
1511 Pharmaceutical applications and phytochemical profile
of Cinnamomum burmannii
1512 Pharmacoeconomic studies of the highly active
antiretrovirus therapy of HIV/AIDS
1513 Pharmacogenetics of risperidone: A systematic review of
the clinical effects of CYP2D6 polymorphisms
1514 Pharmacogenomics of pediatric asthma
1515 Pharmacokinetic evaluation and clinical utility of
azilsartan medoxomil for the treatment of hypertension
1516 Pharmacokinetic profile of artemisinin derivatives and
companion drugs used in artemisinin-based combination
therapies for the treatment of plasmodium falciparum
malaria in children
1517 Pharmacokinetics of antimalarials in pregnancy: A
systematic review
1518 Pharmacological effects of Rosa damascena
1519 Pharmacological management of pain during
orthodontic treatment: A meta-analysis
1520 Pharmacological scientific evidence for the promise of
Tribulus terrestris
1521 Pharmacological treatment in patients with C4, C5 and
C6 venous disease
1522 Pharyngeal instillation of surfactant before the first
breath for prevention of morbidity and mortality in
preterm infants at risk of respiratory distress syndrome
1523 Phenazepam abuse in the UK: An emerging problem
causing serious adverse health problems, including
death
1524 Physical activity and menopause: A systematic review
1525 Physical activity and risk of cognitive decline: A meta-
analysis of prospective studies
1526 Physical activity and risk of cognitive decline: A meta-
analysis of prospective studies
1527 Physical activity for cancer survivors: meta-analysis of
randomised controlled trials
1528 Physical activity for cancer survivors: meta-analysis of
1529 Physical activity for cancer survivors: Meta-analysis of
1530 Physical activity in Brazil: A systematic review
1531 Physical activity reduces the risk of breast cancer
1532 Physical exercise dependence
1533 Physical rehabilitation interventions in nonambulatory
people with multiple sclerosis: a systematic review
1534 Physician assistants in Canada: Update on health policy
initiatives
1535 Physiological functions of L-ornithine and L-aspartate in
the body and the efficacy of administration of L-
ornithine-L-aspartate in conditions of relative deficiency
1536 Picking the best novel oral anticoagulant for atrial
fibrillation: Evidence from a warfarin-controlled network
meta-analysis
1537 Pilots of oncology health care: a concept analysis of the
patient navigator role
1538 Piper umbellatum L.: A comparative cross-cultural
analysis of its medicinal uses and an
ethnopharmacological evaluation
1539 Pistoning assessment in lower limb prosthetic sockets
1540 Pistoning assessment in lower limb prosthetic sockets
1541 The place of antibiotics in management of irritable
bowel syndrome: A systematic review and meta-analysis
1542 Place of cabergoline in acromegaly: A meta-analysis
1543 Place of Preoperative Treatment of Acromegaly with
Somatostatin Analog on Surgical Outcome: A Systematic
Review and Meta-Analysis
1544 Placenta accreta and the risk of adverse maternal and
neonatal outcomes
1545 Plant extracts with appetite suppressing properties for
body weight control: A systematic review of double blind
randomized controlled clinical trials
1546 Plants and plant products with potential antipsoriatic
activity - A review
1547 Plants and plant products with potential antipsoriatic
activity--a review
1548 Plants traditionally used in age-related brain disorders
(dementia): An ethanopharmacological survey
1549 Plate versus intramedullary nail fixation in the treatment
of humeral shaft fractures: An updated meta-analysis
1550 Platelet-mediated vascular dysfunction during acute
lung injury
1551 Platelet-rich plasma application in the management of
chronic tendinopathies
1552 Platelet-rich plasma application in the management of
chronic tendinopathies
1553 Point of use ultrasound by general surgeons: Review of
the literature and suggestions for future practice
1554 Point-of-sale: A review of home blood glucose meters
1555 Poisonous plants in New Zealand: A review of those that
are most commonly enquired about to the national
poisons centre
1556 Polymorphisms and pancreatic cancer risk: A meta-
analysis
1557 The polynesian perinatal paradox
1558 Pomegranate peel and fruit extracts: A review of
potential anti-inflammatory and anti-infective effects
1559 A pooled analysis of diagnostic value of 99mTC-
ubiquicidin (UBI) scintigraphy in detection of an
infectious process
1560 A pooled analysis of diagnostic value of (99m)Tc-
ubiquicidin (UBI) scintigraphy in detection of an
infectious process
1561 Poor quality evidence suggests that failure rates for
atraumatic restorative treatment and conventional
amalgam are similar
1562 Position statement on visiting in adult critical care units
in the UK
1563 Position statement: Utility, limitations, and pitfalls in
measuring testosterone: An endocrine society position
statement
1564 Positive and negative trial data: Are there publication
differences?
1565 Positive pre-resection pleural lavage cytology is
associated with increased risk of lung cancer recurrence
in patients undergoing surgical resection: A meta-
analysis of 4450 patients
1566 Posterior reversible encephalopathy syndrome following
chemotherapy with oxaliplatin and a fluoropyrimidine: A
case report and literature review
1567 Postpartum haemorrhage in the developing world a
review of clinical management strategies
1568 Posttransplant lymphoproliferative disorders in
paediatric recipients of kidney allograft
1569 Post-transplantation lymphoproliferative disorders
(PTLD) localized in the central nervous system: report
from an international survey on PTLD
1570 Post-transplantation lymphoproliferative disorders in
renal vs. simultaneous renal-pancreas allograft
recipients: a survey and analysis of data from the
literature
1571 Post-Transplantation Lymphoproliferative disorders
localizing in the adenotonsillar region: Report from the
PTLD.Int survey
1572 The potential of support vector machine as the
diagnostic tool for schizophrenia: A systematic literature
review of neuroimaging studies
1573 The potential role of heparin in assisted conception
1574 Potential role of salicylates in type 2 diabetes
1575 Potential roles of stem cells in the management of
sensorineural hearing loss
1576 Pott's spine: Diagnostic imaging modalities and
technology advancements
1577 The power of googling
1578 Pragmatic indicators for remote Aboriginal maternal and
infant health care: why it matters and where to start
1579 Predicting acute uncomplicated urinary tract infection in
women: a systematic review of the diagnostic accuracy
of symptoms and signs
1580 Predicting acute uncomplicated urinary tract infection in
women: a systematic review of the diagnostic accuracy
of symptoms and signs
1581 Predicting the response of localised oesophageal cancer
to neo-adjuvant chemoradiation
1582 Predicting treatment response in major depressive
disorder: the impact of early symptomatic improvement
1583 Prediction, prevention and management of
postresection liver failure
1584 Pregabalin for chronic prostatitis
1585 Pregnancies that just won't go away
1586 [Pregnant women alloimmunisation of non-RhD
erythrocyte antigens: review article]
1587 Prenatal and postpartum depression in fathers and its
association with maternal depression: A meta-analysis
1588 Prenatal factors affecting the age at menarche
1589 Presentation and management of Morgagni hernias in
adults: A review of 298 cases
1590 Presentation of research in anesthesia: Culmination into
publication?
1591 Preservation versus non-preservation of mitral valve
apparatus during mitral valve replacement: A meta-
1592 Preservation versus non-preservation of mitral valve
apparatus during mitral valve replacement: a meta-
1593 Presymptomatic and predictive genetic testing in
minors: A systematic review of guidelines and position
papers
1594 Preterm delivery and psycho-social determinants of
health based on World Health Organization model in
Iran: a narrative review
1595 Prevalence and correlates of antipsychotic
polypharmacy: A systematic review and meta-regression
of global and regional trends from the 1970s to 2009
1596 Prevalence and correlates of antipsychotic
polypharmacy: a systematic review and meta-regression
of global and regional trends from the 1970s to 2009
1597 Prevalence and risk factors associated with nutrition-
related noncommunicable diseases in the Eastern
Mediterranean region
1598 Prevalence of alcohol and tobacco use among Brazilian
adolescents: a systematic review
1599 Prevalence of alcohol and tobacco use among Brazilian
adolescents: A systematic review
1600 Prevalence of bisexual behaviour among bridge
population of men who have sex with men in China: A
meta-analysis of observational studies
1601 Prevalence of diabetes among female breast cancer
1602 Prevalence of diabetic retinopathy in mainland China: a
meta-analysis
1603 Prevalence of Diabetic Retinopathy in Mainland China: A
Meta-Analysis
1604 Prevalence of hepatitis B and C in HIV-infected patients:
A meta-analysis
1605 Prevalence of hepatitis B and C in HIV-infected patients:
a meta-analysis
1606 Prevalence of hepatitis D in the eastern mediterranean
region: Systematic review and meta analysis
1607 Prevalence of hepatitis d in the eastern mediterranean
region: systematic review and meta analysis
1608 Prevalence of HIV and Syphilis Infection among High
School and College Student MSM in China: A Systematic
Review and Meta-Analysis
1609 Prevalence of influenza vaccination among nurses and
ancillary workers in Italy: Systematic review and meta
analysis
1610 Prevalence of obstructive sleep apnea in Asian adults: A
1611 The prevalence of tourette syndrome in school age
children
1612 Preventing congenital neonatal heart block in offspring
of mothers with anti-SSA/Ro and SSB/La antibodies: A
review of published literature and registered clinical
trials
1613 Prevention and treatment of acute kidney injury in
patients undergoing cardiac surgery: A systematic
review
1614 Prevention of congenital transmission of malaria in sub-
Saharan African Countries: Challenges and implications
for health system strengthening
1615 Prevention of dementia with sex hormones: A focus on
testosterone and cognition in women
1616 Prevention of mother to child transmission of human
immunodeficiency virus: the nigerian perspective
1617 Prevention of respiratory distress syndrome in preterm
infants by antenatal ambroxol: A meta-analysis of
randomized controlled trials
1618 Prevention of respiratory distress syndrome in preterm
infants by antenatal ambroxol: a meta-analysis of
1619 Prevention of thromboembolic events in traumatologic
surgery: A meta-analysis of randomized trials
1620 Preventive treatments of iron deficiency anaemia in
pregnancy: a review of their effectiveness and
implications for health system strengthening
1621 Primary anastomosis vs Hartmann procedure in acute
complicated diverticulitis. Evolution over the last twenty
years
1622 Primary antifungal prophylaxis for cryptococcal
meningitis and impact on all-cause mortality in
hivinfected patients:a systematic review and
metaanalysis
1623 Primary retroperitoneal hydatid cyst: report of 2 cases
and review of 41 published cases
1624 A primer for biomedical scientists on how to execute
Model II linear regression analysis
1625 Prions in dentistry - What are they, should we be
concerned, and what can we do?
1626 Prions in dentistry--what are they, should we be
concerned, and what can we do?
1627 Private duty nurses in Greek hospitals: A literature
review
1628 Probiotics and remission of ulcerative colitis: A
systematic review
1629 Processing of food, body and emotional stimuli in
anorexia nervosa: A systematic review and meta-analysis
of functional magnetic resonance imaging studies
1630 Proctalgia fugax, an evidence-based management
pathway
1631 Prognostic indices for older adults: A systematic review
1632 Prognostic significance of lymphovascular invasion in
radical prostatectomy specimens
1633 Prognostic significance of lymphovascular invasion in
radical prostatectomy specimens
1634 Prophylactic corticosteroids do not prevent post-ercp
pancreatitis: A meta-analysis of randomized controlled
trials
1635 Prophylactic intra-aortic balloon pump in high-risk
patients undergoing coronary artery bypass surgery: A
meta-analysis of randomized controlled trials
1636 Prophylactic vaccination against human papillomavirus
infection and disease in women: A systematic review of
1637 Prophylactic vaccines for prevention of prostate cancer
1638 A proposed framework for understanding the forces
behind legislation of universal health insurance: lessons
from ten countries
1639 A proposed framework for understanding the forces
behind legislation of universal health insurance-Lessons
from ten countries
1640 A proposed model for an optimal mentoring
environment for medical residents: A literature review
1641 Propranolol versus corticosteroids in the treatment of
infantile hemangioma: a systematic review and meta-
analysis
1642 Propranolol versus corticosteroids in the treatment of
infantile hemangioma: a systematic review and meta-
analysis
1643 Propranolol's effects on the consolidation and
reconsolidation of long-term emotional memory in
healthy participants: A meta-analysis
1644 The prospects of antagonizing the growth hormone
secretagogue receptor to treat obesity
1645 Prosthodontic maintenance of maxillary implant
overdentures: a systematic literature review
1646 Prosthodontic maintenance of maxillary implant
overdentures: a systematic literature review
1647 Protein Z levels and vascular thrombotic diseases: A
meta-analysis
1648 Proteomic signature of periodontal disease in
pregnancy: Predictive validity for adverse outcomes
1649 Prothrombin complex concentrates for oral
anticoagulant therapy-related intracranial hemorrhage:
A review of the literature
1650 Proton pump inhibitors versus histamine-2-receptor
antagonists for the management of iatrogenic gastric
ulcer after endoscopic mucosal resection or endoscopic
submucosal dissection: A meta-analysis of randomized
trials
1651 Proximal junctional kyphosis as a distinct form of
adjacent segment pathology after spinal deformity
surgery: A systematic review
1652 Pseudoaneurysm after carotid revascularization: A case
report and systematic review of literature
1653 Pseudomonas aeruginosa infections of cartilaginous
structures
1654 Pseudopapillary tumor of the pancreas. An algorithmic
approach
1655 Psychiatric symptoms in caregivers of patients with
bipolar disorder: A review
1656 Psychological treatments for the management of
irritable bowel syndrome
1657 Psychosocial Factors That Shape Patient and Carer
Experiences of Dementia Diagnosis and Treatment: A
Systematic Review of Qualitative Studies
1658 Psychotherapy for adjustment disorder in oncological
1659 Psychotic Disorders with HIV Infection: A Review
1660 Public attitudes to laws for smoke-free private vehicles:
A brief review
1661 Public health ethics related training for public health
workforce: an emerging need in the United States
1662 Public health perspectives of preeclampsia in developing
countries: implication for health system strengthening
1663 Public health preparedness for maritime terrorist attacks
on ports and coastal waters
1664 Public health preparedness for the impact of global
warming on human health
1665 The public image of psychologists, psychotherapists, and
psychiatrists: A systematic review
1666 Public reporting of cost and quality information in
orthopaedics
1667 Publication bias in randomized controlled trials (RCTs) of
colorectal cancer presented at ASCO Annual Meetings
1668 Publication misrepresentation among otolaryngology
residency applicants
1669 Publication misrepresentation among otolaryngology
residency applicants
1670 Publication of summaries presented at the scientific
congresses of medical students, Peru 2002-2009:
Characteristics and related factors
1671 [Publication of summaries presented at the scientific
congresses of medical students, Peru 2002-2009:
characteristics and related factors]
1672 Publication productivity and citation analysis of the
Medical Journal of Malaysia: 2004 - 2008
1673 Publication rate of presentations at an annual military
orthopaedic meeting
1674 Publication rates for hip surgery-related abstracts
presented at national and international meetings
1675 Publication rates of abstracts presented at pediatric
orthopaedic society of north America meetings between
2002 and 2006
1676 Publish or Perish as citation metrics used to analyze
scientific output in the humanities: International case
studies in economics, geography, social sciences,
philosophy, and history
1677 Published Endodontic Articles in PubMed-Indexed
Journals from Iran
1678 Published research is inadequate for the development of
guidelines for the basic life support management of
airway obstruction in adults: Results of a systematic
review
1679 PubMed assistant: A biologist-friendly interface for
enhanced PubMed search
1680 PubMed, ScienceDirect, Scopus or Google Scholar -
Which is the best search engine for an effective
literature research in laser medicine?
1681 [Pulsed electromagnetic field therapy for the treatment
of knee osteoarthritis: a systematic review]
1682 [Pulsed electromagnetic field therapy for the treatment
of knee osteoarthritis: a systematic review]
1683 Purse-string approximation is superior to primary closure
following ileostomy reversal: A meta-analysis and
systematic review
1684 Qualitative studies using in-depth interviews with older
people from multiple language groups: Methodological
systematic review
1685 Quality and Certification of Electronic Health Records:
An overview of current approaches from the US and
Europe
1686 Quality and consistency of phase III clinical trials in
inflammatory bowel disease presented at the digestive
diseases week between 1998-2003 compared with their
subsequent full-text publications
1687 Quality and publication success of abstracts of
randomized clinical trials in inflammatory bowel disease
presented at digestive disease week
1688 Quality function deployment in healthcare: A literature
review and case study
1689 Quality of colorectal cancer screening by nurse
endoscopists: A systematic review
1690 Quality of life after intensive care: A systematic review
of the literature
1691 Quality of online pharmacies and websites selling
prescription drugs: a systematic review
1692 Quality of reporting of randomized controlled trials
published in Intensive Care Medicine from 2001 to 2010
1693 Quantifying federal funding and scholarly output
resulting from the academic emergency medicine
consensus conferences
1694 Quantifying publication bias in cystic fibrosis clinical
trials
1695 A quick review of carbamazepine pharmacokinetics in
epilepsy from 1953 to 2012
1696 Quit and Win contests for smoking cessation
1697 Race, ethnicity and urolithiasis: A critical review
1698 Radial artery versus saphenous vein conduits for
coronary artery bypass surgery: Forty years of
competition - which conduit offers better patency? A
1699 Radial artery versus saphenous vein conduits for
coronary artery bypass surgery: forty years of
competition--which conduit offers better patency? A
1700 Radiology practice in Latin America: a literature review
1701 Ramadan fasting and digestive disorders: SEPAHAN
systematic review no. 7
1702 Ranirestat: A selective aldose reductase inhibitor for
diabetic sensorimotor polyneuropathy
1703 RANTES gene polymorphisms and risk of pediatric
asthma: A meta-analysis
1704 Rapid fire: Fifty years of soft contact lenses: Life and
impact of prof otto wichterle
1705 Rapid health technology assessment in rehabilitation
hospital: Review article
1706 Rapid sequence induction lege artis-A myth?
1707 Rates of emergence of HIV drug resistance in resource-
limited settings: A systematic review
1708 Re: South African plants and male reproductive
healthcare: Conception and contraception
1709 Readability of Health Related Quality of Life Instruments
in Urology
1710 Real-world data-improving approaches for
demonstrating benefits and risks of new drugs
1711 Reamer-irrigator-aspirator indications and clinical
results: A systematic review
1712 Reassessing the role of acetaminophen in osteoarthritis:
Systematic review and meta-analysis
1713 Rebamipide helps defend against nonsteroidal anti-
inflammatory drugs induced gastroenteropathy: A
1714 Recent developments in anxiety disorders
1715 Recent developments in Anxiety disorders
1716 Recent patents on oral insulin
1717 Recombinant FSH vs urinary FSH in intrauterine
insemination: Meta-analysis of prospective randomized
trials
1718 Reconstructing nursing altruism using a biological
evolutionary framework
1719 Recruitment of nursing students into gerontological
mental health nursing: Facilitating and constraining
factors
1720 Reduced esophageal cancer incidence in statin users,
particularly with cyclo-oxygenase inhibition
1721 Reducing hospital noise: A review of medical device
alarm management
1722 Reduction of diabetes risk in routine clinical practice: are
physical activity and nutrition interventions feasible and
are the outcomes from reference trials replicable? A
1723 Regional specific strengthening of infraspinatus: A
1724 Registration of clinical trials in cystic fibrosis
1725 Rehabilitation of syndesmotic (high) ankle sprains
1726 Rehabilitation systems for physically disabled patients: A
brief review of sensor-based computerised signal-
monitoring systems
1727 Relapse following bilateral sagittal split osteotomy with
rigid internal fixation
1728 The relationship between anti-merozoite antibodies and
protection from Plasmodium Falciparum malaria: A
1729 The relationship between distal and proximal colonic
neoplasia: A meta-analysis
1730 The relationship between executive function and obesity
in children and adolescents: a systematic literature
review
1731 The relationship between executive function and obesity
in children and adolescents: a systematic literature
review
1732 Relationship of citations received for published articles
to a journal's impact factor at time of submission
1733 The Relative Renal Safety of Iodixanol Compared With
Low-Osmolar Contrast Media. A Meta-Analysis of
Randomized Controlled Trials
1734 The relevance of fatalism in the study of Latinas' cancer
screening behavior: a systematic review of the literature
1735 Reliability and validity of child/adolescent food
frequency questionnaires that assess foods and/or food
groups
1736 The reliability of assessing methods that monitor pain in
children and adolescents with a cognitive disorder
1737 Remarkable differences between three evidence-based
guidelines on management of obstructive sleep apnea-
hypopnea syndrome
1738 Remission induction in decitabine resistant multiply
relapsed granulocyte sarcoma using gcsf priming
1739 A report on disability and rehabilitation medicine in
Pakistan: Past, present, and future directions
1740 Requirements for the design and implementation of
checklists for surgical processes
1741 Research and application progress of visual fixation
component separation
1742 Research risk for persons with psychiatric disorders: A
decisional framework to meet the ethical challenge
1743 Resource allocation strategies in Southeastern European
health policy
1744 Results of surgical management of symptomatic
shoulders with partial thickness tears of the rotator cuff
1745 Results of umbilical cord care in the last 10 years:
Systematic review
1746 Resume Fraud: Unverifiable Publications of Urology
Training Program Applicants
1747 Resuscitation training in developing countries: A
systematic review
1748 Retained surgical sponges, needles and instruments
1749 Retrieving Clinical Evidence: A Comparison of PubMed
and Google Scholar for Quick Clinical Searches
1750 Retroperitoneal haematomas in obstetrics: Literature
review
1751 Return to Play Guidelines Cannot Solve the Football-
Related Concussion Problem
1752 Return to sports after ankle fractures: A systematic
review
1753 A review and classification of contingent valuation
methodstudies in sub-Sahara Africa
1754 A review and meta-analysis of the efficacy of antibiotics
and probiotics in management of pouchitis
1755 Review article: Magnetic resonance imaging and
computed tomography in the diagnosis of occult
proximal femur fractures
1756 Review article: The emerging interplay among the
gastrointestinal tract, bile acids and incretins in the
pathogenesis of diabetes and non-alcoholic fatty liver
disease
1757 Review of automatic segmentation methods of multiple
sclerosis white matter lesions on conventional magnetic
resonance imaging
1758 Review of boceprevir and telaprevir for the treatment of
chronic hepatitis C
1759 Review of boceprevir and telaprevir for the treatment of
chronic hepatitis C
1760 A review of community engagement in cancer control
studies among Indigenous people of Australia, New
Zealand, Canada and the USA
1761 Review of community-based interventions for
prevention of cardiovascular diseases in low- and middle-
income countries
1762 Review of continuous-infusion vancomycin
1763 Review of continuous-infusion vancomycin
1764 A review of current management of brain metastases
1765 A review of current management of brain metastases
1766 A review of demineralized bone matrices for spinal
fusion: the evidence for efficacy
1767 A review of dental caries in Australian Aboriginal
children: the health inequalities perspective
1768 A review of drug interactions with boceprevir and
telaprevir: Implications for HIV and transplant patients
1769 A review of drug interactions with boceprevir and
telaprevir: implications for HIV and transplant patients
1770 A review of empathy education in nursing
1771 Review of floor of mouth dysontogenic cysts
1772 A review of human papillomavirus (HPV) infection and
HPV vaccine-related attitudes and sexual behaviors
among college-aged women in the United States
1773 Review of ICT-based services for identified unmet needs
in people with dementia
1774 A review of interventions aimed at reducing pre-hospital
delay time in acute coronary syndrome: what has
worked and why?
1775 Review of methods for objective surgical skill evaluation
1776 A review of methods of analysis in contouring studies for
radiation oncology
1777 A review of psychosocial issues in patients with chronic
hepatitis B
1778 A review of psychosocial issues in patients with chronic
hepatitis B
1779 A review of retrospective, continuous glucose
monitoring: An example of a medical device where the
typical primary outcome measure may be inappropriate?
1780 Review of rural and regional alcohol research in Australia
1781 A review of smoke-free health care in mainland China
1782 A review of some antiretroviral therapies used in
management of HIV/AIDS in Ghana
1783 Review of the complications associated with treatment
of oropharyngeal cancer: a guide for the dental
practitioner
1784 A review of the ecological effects of radiofrequency
electromagnetic fields (RF-EMF)
1785 Review of the economic evidence on the use of deep
brain stimulation in late stage Parkinson's disease
1786 A review of the effect of immunization programs on
antimicrobial utilization
1787 A review of the evidence supporting the aesthetic
orthodontic treatment need indices
1788 A review of the literature and latest advances in
research of Piper sarmentosum
1789 A review of the medicinal potentials of plants of the
genus Vernonia (Asteraceae)
1790 Review of the occurrence of anti-infectives in
contaminated wastewaters and natural and drinking
waters
1791 A review of the oncologic and surgical management of
breast cancer in the augmented breast: Diagnostic,
surgical and surveillance challenges
1792 A review of the oral health-related evidence that
supports the orthodontic treatment need indices
1793 A review of the psychometric properties of the crafft
instrument: 1999-2010
1794 A review of the safety implications of magnetic
resonance imaging at field strengths of 3 Tesla and
above
1795 Review of the status of physical activity research for
individuals with traumatic brain injury
1796 Review of transmitted drug-resistant HIV in resource-
limited countries
1797 A review of, and commentary on, the ongoing second
clinical introduction of preimplantation genetic
screening (PGS) to routine IVF practice
1798 A review on biological, nutraceutical and clinical aspects
of French maritime pine bark extract
1799 Review on epidemiology, diagnosis, occupational
hazards and management of pulmonary tuberculosis in
elderly: A guide for general physicians working in the
health network setting, Khuzestan, Iran
1800 A review on the vascular features of the
hyperimmunoglobulin e syndrome
1801 Review: Keratoconus in Asia
1802 Review: keratoconus in Asia
1803 Rheum australe D. Don: A review of its botany,
ethnobotany, phytochemistry and pharmacology
1804 Rheumatoid arthritis, cardiovascular disease and
physical exercise: A systematic review
1805 Rheumatoid arthritis, cardiovascular disease and
physical exercise: a systematic review
1806 Rhinophototherapy: Gimmick or an emerging treatment
option for allergic rhinitis?
1807 Rifamycin antibiotics for treatment of Clostridium
difficile-associated diarrhea
1808 Right versus left radial artery access for coronary
procedures: an international collaborative systematic
review and meta-analysis including 5 randomized trials
and 3210 patients
1809 Risk assessment with intellectual disabled forensic
psychiatric patients: How useful are risk assessment
instruments?
1810 Risk factors for dengue shock syndrome: A systematic
1811 Risk factors for developing gadolinium-induced
nephrogenic systemic fibrosis
1812 Risk factors for intimate partner violence (IPV) in low-
and middle-income countries (LMIC): A systematic
review
1813 Risk factors for uterine rupture after laparoscopic
myomectomy
1814 Risk Factors for Uterine Rupture after Laparoscopic
Myomectomy
1815 Risk factors for uterine rupture following laparoscopic
myomectomy
1816 Risk Factors for Violence in Psychosis: Systematic Review
and Meta-Regression Analysis of 110 Studies
1817 Risk factors, barriers and facilitators for linkage to
antiretroviral therapy care: A systematic review
1818 Risk management considerations for ultra-endurance
events and solo attempts
1819 Risk models and scores for type 2 diabetes: systematic
review
1820 Risk of cervical mylopathy developing secondary to
spinal cord compression in adults with cerebral palsy: A
1821 Risk of colorectal cancer in relation to frequency and
total amount of red meat consumption. Systematic
1822 Risk of completed suicide after bariatric surgery: A
systematic review
1823 Risk of infection with intravenous iron therapy
1824 Risk of neurological decompression sickness in the diver
with a right-to-left shunt: Literature review and meta-
analysis
1825 Risk of obsessive-compulsive disorder in pregnant and
postpartum women: A meta-analysis
1826 Risk of venous thromboembolic events on antipsychotic
drugs: A metaanalysis of observational studies
1827 Risk prioritization of the potential threat of emerging
infections to blood safety
1828 Risk stratification and short-term prognosis in acute
heart failure syndromes: A review of novel biomarkers
1829 Rituximab therapy for membranous nephropathy: a
systematic review
1830 Robotic technology in ophthalmic surgery
1833 Role for a sense of self-worth in weight-loss treatments:
Helping patients develop self-efficacy
1834 The role of antibiotics in acute sinusitis: A systematic
review and metaanalysis
1835 [The role of antibiotics in acute sinusitis: a systematic
review and meta-analysis]
1836 The role of artesunate for the treatment of urinary
schistosomiasis in schoolchildren: A systematic review
and meta-analysis
1837 The role of carbohydrate drinks in pre-operative
nutrition for elective colorectal surgery
1838 The role of continuity of care (COC) in the treatment of
comorbid mental health and substance use disorders
(SUDs): A systematic review of the literature
1839 The role of electronic assessment of adherence in the
education and counseling of children taking growth
hormone: progress and challenges
1840 Role of gabapentin in the treatment of uremic pruritus
1841 Role of huperzine A in the treatment of alzheimer's
disease
1842 The role of intraperitoneal anaesthetic in laparoscopic
cholecystectomy
1843 The role of mast cells and their mediators in
reproduction, pregnancy and labour
1844 The role of melatonin in anaesthesia and critical care
1845 Role of menstrual blood cells in treatment of stroke
1846 The role of metabolic acidosis in chronic kidney diseases
1847 The role of microwave ablation in the management of
hepatic colorectal metastases
1848 The Role of Natriuretic Peptide Administration in
Cardiovascular Surgery-Associated Renal Dysfunction: A
Systematic Review and Meta-Analysis of Randomized
Controlled Trials
1849 The role of ondansetron in the treatment of
schizophrenia
1850 Role of postoperative vitamindand/or calcium routine
supplementation in preventing hypocalcemia after
thyroidectomy:Asystematic review and meta-analysis
1851 The role of pringle's manoeuvre in liver resection
1852 The role of propellants in inhalation products-
hydrofluoroalkane versus chlorofluorocarbon
1853 The role of radioactive iodine usage in the management
of thyroid disorders with emphasis on sub-Saharan
Africa
1854 The Role of Superficial Venous Surgery in the
Management of Venous Ulcers: A Systematic Review
1855 The role of the Internet in supporting and informing
carers of people with cancer: A literature review
1856 Romiplostim in chronic immune thrombocytopenic
purpura
1857 Rosiglitazone in treating type 2 diabetes mellitus with
essential hypertension patients: A meta-analysis
1858 Rufinamide for the treatment of Lennox-Gastaut
syndrome
1859 Safety and efficacy of biodegradable vs. durable polymer
drug-eluting stents: Evidence from a meta-analysis of
randomised trials
1860 Safety and efficacy of corticosteroids for the treatment
of septic shock: A systematic review and meta-analysis
1861 Safety and efficacy of corticosteroids for the treatment
of septic shock:A systematic review and meta-analysis
1862 Safety and efficacy of intrathecal ziconotide: A literature
review
1863 The safety of anti-TNF biologic agents in rheumatoid
arthritis-a meta-analysis of 35 rcts
1864 The safety of aprotinin and lysine-derived antifibrinolytic
drugs in cardiac surgery: A meta-analysis
1865 The safety of direct trocar versus veress needle for
laparoscopic entry: A meta-analysis of randomized
clinical trials
1866 Safety of excluding suspected deep vein thrombosis with
a single whole-leg compression ultrasound: Systematic
1867 Salvage banding for failed Roux-en-Y gastric bypass
1868 Satisfaction of patients: A right to health indicator?
1869 Saxagliptin: A clinical review in the treatment of type 2
diabetes mellitus
1870 Scaling up maternal nutrition programs to improve birth
outcomes: a review of implementation issues
1871 'Scared Straight' and other juvenile awareness programs
for preventing juvenile delinquency
1872 Schizophrenia: Medical illness, mortality, and aging
1873 School-based Approaches to the Correction of Refractive
Error in Children
1874 Science searches shift up a gear as Google starts Scholar
engine
1875 Scoping review report: Obesity in older adults
1876 Screening for scoliosis: different countries' perspectives
and evidence-based health care
1877 Screening for viral hepatitis among migrants in the EU -
The quest for 'good screening practice'
1878 Screening instruments for detecting illicit drug
use/abuse that could be useful in general hospital
wards: A systematic review
1879 Screening women for oral contraception: Can family
history identify inherited thrombophilias?
1880 Seasonal influenza vaccination of healthy, working-age
adults: A systematic review of economic investigations
1881 Second-generation antipsychotic use in schizophrenia
and associated weight gain: A critical review and meta-
analysis of behavioral and pharmacologic treatments
1882 Secondhand tobacco smoke exposure in open and semi-
open settings: A systematic review
1883 Secular trends in size at birth of Iranian neonates: Meta-
analyses of published and unpublished studies
1884 Sedation for critically ill adults with severe traumatic
brain injury: A systematic review of randomized
controlled trials
1885 Sedation scales and measures--a literature review
1886 Selective serotonin reuptake inhibitor-induced akathisia
1887 Self reported functional outcome measure in the field of
prosthesis: A systematic review
1888 Self-esteem of children and adolescents with chronic
illness: a meta-analysis
1889 Self-medication practice with nonprescription
medication among university students: A review of the
literature
1890 Semantic tagging of and semantic enhancements to
systematics papers: ZooKeys working examples
1891 Senecio scandens Buch.-Ham.: A review on its
ethnopharmacology, phytochemistry, pharmacology,
and toxicity
1892 Sensory processing problems in children with ADHD, a
systematic review
1893 Sentinel node biopsy in endometrial cancer: Systematic
review and meta-analysis of the literature
1894 Sentinel node mapping in the prostate cancer: Meta-
analysis
1895 Sequential therapy versus standard triple-drug therapy
for Helicobacter pylori eradication: A systematic review
of recent evidence
1896 Serenoa repens for benign prostatic hyperplasia
1897 Serum 25-hydroxy vitamin D levels in relation to body
mass index: A systematic review and meta-analysis
1898 Service delivery in Kenyan district hospitals - what can
we learn from literature on mid-level managers?
1899 The severe sepsis bundles as processes of care: A meta-
analysis
1900 Sex and life expectancy
1901 Sexual, Psychological, and Relational Functioning in
Women after Surgical Treatment for Vulvar Malignancy:
A Literature Review
1902 Short term and intermediate term comparison of
endarterectomy versus stenting for carotid artery
stenosis: Systematic review and meta-analysis of
randomised controlled clinical trials
1903 The shortened dental arch revisited: From evidence to
recommendations by the use of the GRADE approach
1904 Should biatrial heart transplantation still be performed?
A meta-analysis
1905 Should torsemide be the loop diuretic of choice in
systolic heart failure?
1906 Should we google it? Resource use by internal medicine
residents for point-of-care clinical decision making
1907 Should we use one-sided or two-sided P values in tests
of significance?
1908 Shoulder pain in water polo: A systematic review of the
literature
1909 Significance of HSPB1 expression in Head and Neck
Squamous Cell Carcinoma: A meta-analysis of published
literatures
1910 Significance of in situ hybridization results for EBV-
encoded RNA in post-transplantation
lymphoproliferative disorder setting: Report from the
PTLD.Int survey
1911 Significant association between CYP1A1 T3801C
polymorphism and cervical neoplasia risk: A systematic
1912 Simulation based learning in midwifery education: A
systematic review
1913 Simulation in neurosurgery: A review of computer-based
simulation environments and their surgical applications
1914 Simulation in neurosurgery: a review of computer-based
simulation environments and their surgical applications
1915 Single-Incision Laparoscopic Cholecystectomy vs.
Conventional Laparoscopic Cholecystectomy: A Meta-
analysis of Randomized Controlled Trials
1916 Sitting-meditation interventions among youth: A review
of treatment efficacy
1917 Skeletal sequelae of cancer and cancer treatment
1918 Skeletonized versus pedicled internal thoracic artery and
risk of sternal wound infection after coronary bypass
surgery: Meta-analysis and meta-regression of 4817
patients
1919 Skeletonized versus pedicled internal thoracic artery and
risk of sternal wound infection after coronary bypass
surgery: meta-analysis and meta-regression of 4817
patients
1920 Sleep disorders in Internet addiction
1921 Small intestinal involvement by lymphoproliferative
disorders post-renal transplantation: a report from the
post-transplant lymphoproliferative disorder
international survey
1922 Smartphone as a personal, pervasive health informatics
services platform: literature review
1923 Smokeless tobacco use in the United States military: A
systematic review
1924 Smoking cessation interventions and cessation rates in
the oncology population: an updated systematic review
and meta-analysis
1925 Social and behavioural HIV/AIDS research in Jordan: A
systematic review
1926 Societal costs of hearing disorders: a systematic and
critical review of literature
1927 Societal costs of hearing disorders: A systematic and
critical review of literature
1928 Sociocultural and epidemiological aspects of HIV/AIDS in
Mozambique
1929 Soft Tissue Profile Changes After Bilateral Sagittal Split
Osteotomy for Mandibular Advancement: A Systematic
Review
1930 Soft tissue profile changes after bilateral sagittal split
osteotomy for mandibular setback: A systematic review
1931 Soft tissue profile changes after bilateral sagittal split
osteotomy for mandibular setback: a systematic review
1932 Software technology applications for repertorisation in
homeopathy-a systematic review
1933 Soil-transmitted helminth reinfection after drug
treatment: a systematic review and meta-analysis
1934 Soil-transmitted helminth reinfection after drug
treatment: a systematic review and meta-analysis
1935 Solar cheilosis: An ominous precursor: Part I. Diagnostic
insights
1936 Soldiers can take it - a conceptual analysis of trauma
1937 Somatosensory stimulation of the upper limb after
stroke: A systematic review
1938 Soothing suffering swimmers: A systematic review of the
epidemiology, diagnosis, treatment and rehabilitation of
musculoskeletal injuries in competitive swimmers
1939 Source data verification in observational studies: Review
of current practice
1940 Sources of bibliographical information (VI). Obtaining of
scientific literature with the Scopus database and the
specialized search engines Scirus and Google Scholar
1941 Special issue: The message and the media: Impact of
alcohol advertising and media exposure on adolescent
alcohol use: A systematic review of longitudinal studies
1942 Spectrum and Risk of Neoplasia in Werner Syndrome: A
Systematic Review
1943 Spectrum and risk of neoplasia in Werner syndrome: a
systematic review
1944 Spectrum of lithium induced thyroid abnormalities: a
current perspective
1945 The spectrum of pyruvate dehydrogenase complex
deficiency: Clinical, biochemical and genetic features in
371 patients
1946 Speech impairment in Down syndrome: a review
1947 Speech perception outcomes following auditory
brainstem implantation in both tumour and non-tumour
patients: A review
1948 Spinal cord injury: From inflammation to glial scar
1949 Spinosad for treatment of head lice infestation
1950 Spirometry: tool for pharmacy practitioners to expand
direct patient care services
1951 Spondylodiscitis: Standards of current treatment
1952 Spontaneous perforation of the colon and rectum
complicating anorectal malformations in neonates
1953 Sports activities after lower limb osteotomy
1954 Sports related concussion and spinal injuries: the need
for changing spearing rules at the National Capital
Amateur Football Association (NCAFA)
1955 Squamous cell carcinoma in association with dental
implants: an assessment of previously hypothesized
carcinogenic mechanisms and a case report
1956 Stability After Bilateral Sagittal Split Osteotomy
Advancement Surgery With Rigid Internal Fixation: A
Systematic Review
1957 Stability After Bilateral Sagittal Split Osteotomy Setback
Surgery With Rigid Internal Fixation: A Systematic
Review
1958 Standard of care for the edentulous mandible: A
systematic review
1959 Statin use in sepsis (STATUS): A meta-analysis
1960 Statins in the prevention of venous thromboembolism: A
meta-analysis of observational studies
1961 Statins: A new way to treat breast cancer?
1962 Status of open access in the biomedical field in 2005
1963 Stay healthy through game-care therapeutics: It's time
to play the game!
1964 Stem cell therapy for human cartilage defects: A
systematic review
1965 Stoma complications: a literature overview
1966 Strategies for prevention of postoperative delirium: A
systematic review and meta-analysis of randomized
trials
1967 Stress incontinence in the era of regenerative medicine:
Reviewing the importance of the pudendal nerve
1968 The stress response and critical illness: A review
1969 Strong association of 677 C>T substitution in the MTHFR
gene with male infertility - a study on an Indian
population and a Meta-Analysis
1970 Strong association of 677 C>T substitution in the MTHFR
gene with male infertility--a study on an indian
population and a meta-analysis
1971 The structure and organization of local and state public
health agencies in the U.S.: A systematic review
1972 A study of injuries and violence related articles in Nepal
1973 Submental intubation: A literature review
1974 Substance abuse among individuals with intellectual
disabilities
1975 Substance abuse among individuals with intellectual
disabilities
1976 Successfully integrating aged care services: a review of
the evidence and tools emerging from a long-term care
program
1977 Sudarshan kriya yoga: Breathing for health
1978 Sugar-sweetened soft drinks and obesity: a systematic
review of the evidence from observational studies and
interventions
1979 Suicidal mothers
1980 Suicide in deaf populations: A literature review
1981 Sulbactam-based therapy for Acinetobacter baumannii
infection: A systematic review and meta-analysis
1982 Supervised exercise in intermittent claudication: a
sedentary notion?
1983 Supplementation with long chain polyunsaturated fatty
acids (LCPUFA) to breastfeeding mothers for improving
child growth and development
1984 Suprapubic compared with transurethral bladder
catheterization for gynecologic surgery: A systematic
1985 Surgical and prosthetic rehabilitation of patients with
hemimandibular defect
1986 Surgical and prosthetic rehabilitation of patients with
hemimandibular defect
1987 Surgical correction for unilateral lambdoid synostosis: A
systematic review
1988 Surgical technique and recurrence in cholesteatoma: a
meta-analysis
1989 Surgical versus nonsurgical treatment of displaced intra-
articular calcaneal fracture: A meta-analysis of current
evidence base
1990 Surgical versus nonsurgical treatment of displaced intra-
articular calcaneal fracture: a meta-analysis of current
evidence base
1991 A survey of scholarly literature databases for clinical
laboratory science
1992 Survey of the h index for all of academic neurosurgery:
Another power-law phenomenon?
1993 A survey on virtual environment applications to fear of
public speaking
1994 A survey to identify neurology education in africa
1995 Sustaining a hemodialysis exercise program: A review
1996 Symptom outcomes in endoscopic sinus surgery: A
systematic review of measurement methods
1997 A systematic literature review of celiac disease: Cost of
care and global reimbursement variations for gluten-free
diet
1998 A systematic literature review of parenting behaviours
exhibited by anxious people
1999 A systematic literature review of the Profix in primary
total knee arthroplasty
2000 A systematic literature review on first aid provided by
laypeople to trauma victims
2001 A systematic review about effects of aerial portions of
Urtica dioica (nettle) on some cardiovascular risk factors
in diabetes mellitus
2002 Systematic review and meta analysis: Polyethylene
glycol in adults with non-organic constipation
2003 A systematic review and meta-analysis of cognitive bias
to food stimuli in people with disordered eating
behaviour
2004 Systematic review and meta-analysis of currently
available clinical evidence on migraine and patent
foramen ovale percutaneous closure
2005 Systematic review and meta-analysis of currently
available clinical evidence on migraine and patent
foramen ovale percutaneous closure: Much ado about
nothing?
2006 A systematic review and meta-analysis of different
dietary approaches to the management of Type 2
diabetes
2007 Systematic review and meta-analysis of different dietary
approaches to the management of type 2 diabetes1-3
2008 A systematic review and meta-analysis of pancreatic
autoantibody's (PAB) diagnostic accuracy vs standard
diagnosis in patients with inflammatory bowel disease
2009 A systematic review and metaanalysis of recurrence and
survival following the use of sirolimus in liver
transplantation for hepatocellular carcinoma
2010 Systematic review and meta-analysis of the effect of pre-
transplant diabetes mellitus on 5-year mortality after
liver transplantation
2011 Systematic review and meta-analysis of the literature
regarding accuracy of sentinel lymph node biopsy for
axillary staging of breast cancer patients undergone
prior surgical biopsy
2012 Systematic review and meta-analysis of the relationship
between hospital volume and outcome for lower limb
arterial surgery
2013 A systematic review and meta-analysis of Toxoplasma
gondii infection among the Mexican population
2014 Systematic review and recommendations for
intracompartmental pressure monitoring in diagnosing
chronic exertional compartment syndrome of the leg
2015 Systematic review and synthesis: Proton pump inhibitor
exposure duration and association with Hip fracture
2016 A systematic review of adherence to diabetes and
cardiovascular medications in Iran; a call for patient
education and reinforcement
2017 A systematic review of anti-obesity medicinal plants - an
update
2018 A systematic review of asthma and health literacy: a
cultural-ethnic perspective in Canada
2019 A systematic review of bilateral upper limb training
devices for poststroke rehabilitation
2020 A systematic review of bilateral upper limb training
devices for poststroke rehabilitation
2021 A systematic review of catheterisation following pelvic
organ prolapse repair surgery
2022 Systematic review of clinical cases as an adapted
methodology for rare retinopathies
2023 Systematic Review of Controlled Clinical Trials on the
Use of Ursodeoxycholic Acid for the Prevention of
Hepatic Veno-occlusive Disease in Hematopoietic Stem
Cell Transplantation
2024 A systematic review of disability awareness
interventions for children and youth
2025 A systematic review of economic studies on biologic
agents used to treat Crohn's disease
2026 A systematic review of efficacy and safety of urtica
dioica in the treatment of diabetes
2027 Systematic Review of Efficacy of Nutraceuticals to
Alleviate Clinical Signs of Osteoarthritis
2028 A systematic review of grand multiparity
2029 Systematic review of head cooling in adults after
traumatic brain injury and stroke
2032 A systematic review of HIV interventions for black men
who have sex with men (MSM)
2033 Systematic Review of Interventions for Post-traumatic
Headache
2034 A systematic review of interventions in primary care to
improve health literacy for chronic disease behavioral
risk factors
2035 A systematic review of iranian medicinal plants useful in
diabetes mellitus
2036 A systematic review of laryngomalacia and acid reflux
2037 A systematic review of magnesium therapy for treating
ADHD
2038 A systematic review of magnesium therapy for treating
attention deficit hyperactivity disorder
2039 A systematic review of mental disorder, suicide, and
deliberate self harm in lesbian, gay and bisexual people
2040 A systematic review of mortality in schizophrenia: Is the
differential mortality gap worsening over time?
2041 Systematic review of non-disease specific prognostic
indices for older adults
2042 A systematic review of non-pharmacological treatments
for depression after TBI
2043 Systematic review of outcome of cochlear implantation
in superficial siderosis
2044 Systematic review of outcome of cochlear implantation
in superficial siderosis
2045 A systematic review of personality disorder amongst
people with intellectual disability with implications for
the mental health nurse practitioner
2046 Systematic review of Purtscher's and Purtscher-like
retinopathies
2047 Systematic Review of Randomized Controlled Trials of
Different Types of Patch Materials during Carotid
Endarterectomy
2048 A systematic review of remuneration systems for clinical
pharmacy care services
2049 A systematic review of telephone-based interventions
for mental disorders
2050 Systematic review of text-messaging interventions to
promote healthy behaviors in pediatric and adolescent
populations: implications for clinical practice and
research
2051 Systematic review of the association between
respiratory diseases and oral health
2052 A systematic review of the effectiveness of
videoconference-based tele-education for medical and
nursing education
2053 A systematic review of the efficacy and safety of
desipramine for treating ADHD
2054 A systematic review of the efficacy and safety of herbal
medicines used in the treatment of obesity
2055 A systematic review of the efficacy and safety of
Teucrium species; from anti-oxidant to anti-diabetic
effects
2056 A systematic review of the evidence for percutaneous
gastrostomy tube feeding or nasogastric tube feeding in
patients with dysphagia due to idiopathic Parkinson's
disease
2057 A systematic review of the impact of alcohol use
disorders on HIV treatment outcomes, adherence to
antiretroviral therapy and health care utilization
2058 A systematic review of the impact of brief interventions
on substance use and co-morbid physical and mental
health conditions
2059 Systematic review of the literature on simulation in
nursing education
2060 A systematic review of the literature on the
effectiveness of exercise therapy for groin pain in
athletes
2061 A systematic review of the potential herbal sources of
future drugs effective in oxidant-related diseases
2062 Systematic review of the psychometric properties of the
questionnaire to evaluate the adherence to HIV therapy
(CEAT-VIH)
2063 A systematic review of the therapeutic effects of Reiki
2064 A systematic review of the unit costs of allied health and
community services used by older people in Australia
2065 A systematic review of upper extremity casting for
children and adults with central nervous system motor
disorders
2066 Systematic review of upper limb casting
2067 A systematic review of validated methods for identifying
transfusion-related ABO incompatibility reactions using
administrative and claims data
2068 A systematic review of validated methods for identifying
transfusion-related sepsis using administrative and
claims data
2069 A systematic review of visual and instrumental
measurements for tooth shade matching
2070 A systematic review on oxidant/antioxidant imbalance in
aluminium Toxicity
2071 A systematic review on the antifungal properties of
Iranian herbal medicine
2072 Systematic review on the efficacy of anti-inflammatory
agents, immunomodulators and biological agents as post-
operative prophylaxis to prevent recurrence of Crohn's
disease
2073 A systematic review on the quality of
pharmacoeconomics studies in china
2074 Systematic review: change in the quality of life of
children and adolescents younger than 14 years old after
oral health interventions: a systematic review
2075 Systematic review: The prognostic role of alpha-
fetoprotein following liver transplantation for
hepatocellular carcinoma
2076 Systematic reviews have twice the impact of narrative
reviews: A bibliometric analysis
2077 A systematic scoping literature review of incorporating a
total quality culture within radiotherapy staffing models:
A management strategy to improve patient safety and
quality of care in radiation therapy departments
2078 Systemic review of aripiprazole for the treatment of
children and adolescents with tic disorders
2079 Tachyphylaxis to topical glucocorticoids; what is the
evidence?
2080 Tafluprost: The first preservative-free prostaglandin to
treat open-angle glaucoma and ocular hypertension
2081 Takotsubo-like cardiomyopathy in pheochromocytoma
2082 A tale of two systems: Poisoning management in Iran
and the United States
2083 Taming the burgeoning stroke epidemic in Africa: Stroke
quadrangle to the rescue
2084 Taming the burgeoning stroke epidemic in Africa: stroke
quadrangle to the rescue
2085 Tapentadol extended release for chronic pain patients
2086 Tapentadol: A novel centrally acting analgesic for
moderate-to-severe acute pain
2087 Targeting cyclooxygenase-2 in depression is not a viable
therapeutic approach and may even aggravate the
pathophysiology underpinning depression
2088 Targeting IL-1 in depression
2089 Targeting the small airways asthma phenotype: If we can
reach it, should we treat it?
2090 Teaching cause-of-death certification: Lessons from
international experience
2091 Teaching evidence based medicine to surgery residents-
is journal club the best format? A systematic review of
the literature
2092 Teaching evidence based medicine to surgery residents-
is journal club the best format? A systematic review of
the literature
2093 Technologies for coordination support in hospitals - A
review
2094 Telavancin: A lipoglycopeptide antimicrobial for the
treatment of complicated skin and skin structure
infections caused by gram-positive bacteria in adults
2095 Telemedicine in veterinary practice
2096 Telemedicine interventions for substance-use disorder:
A literature review
2097 Telephone communication of HIV testing results for
improving knowledge of HIV infection status
2098 Telephone communication of HIV testing results for
improving knowledge of HIV infection status
2099 Telephone delivered interventions for preventing HIV
infection in HIV-negative persons
2100 Telephone delivered interventions for reducing
morbidity and mortality in people with HIV infection
2101 Telomerase reverse transcriptase locus polymorphisms
and cancer risk: A field synopsis and meta-analysis
2102 Tensile strength after closure of mesenteric gaps in
laparoscopic gastric bypass: Three techniques tested in a
porcine model
2103 Teplizumab for treatment of type 1 diabetes mellitus
2104 Terlipressin versus octreotide as an adjunct to
endoscopic variceal ligation in acute esophageal variceal
bleeding: A meta-analysis
2105 Terpene compound drug as medical expulsive therapy
for ureterolithiasis: A metaanalysis
for ureterolithiasis: A meta-analysis
for ureterolithiasis: a meta-analysis
2108 Therapeutic trajectory following intra-articular
hyaluronic acid injection in knee osteoarthritis - meta-
analysis
hyaluronic acid injection in knee osteoarthritis: Meta-
analysis
hyaluronic acid injection in knee osteoarthritis--meta-
analysis
2111 [Thoracolaparoscopic esophagectomy versus open
esophagectomy: a meta-analysis of outcomes]
2112 Thoracoscopic esophagectomy in the prone position
2113 Threats to Validity in the Design and Conduct of
Preclinical Efficacy Studies: A Systematic Review of
Guidelines for In Vivo Animal Experiments
2114 Three options for citation tracking: Google Scholar,
Scopus and Web of Science
2115 Thrombocytopenia following percutaneous coronary
intervention
2116 Thrombolytics for cardiac arrest: Case report and
systematic review of controlled trials
2117 Thromboprophylaxis in cancer patients with central
venous catheters. A systematic review and meta-analysis
2118 Thyroid cancer in functioning thyroid nodules
2119 Thyroid disease is associated with breast cancer: A meta-
analysis
2120 Tibial inlay for posterior cruciate ligament
reconstruction. A systematic review
2121 Time-lapse microscopy and image analysis in basic and
clinical embryo development research
2122 Timing of dornase alfa (DNase) inhalation for cystic
fibrosis (CF)
2123 Timing of surgery and radiotherapy in the management
of metastatic spine disease: A systematic review
2124 Tobacco and poverty: Evidence from Vietnam
2125 Tobacco and poverty: evidence from Vietnam
2126 Tobacco and tuberculosis: A qualitative systematic
2127 Tobacco use and illicit substance use disorders: What
should we have to do?
2128 Top-cited articles on hyperbaric oxygen therapy
published from 2000 to 2010
2129 Top-cited articles on hyperbaric oxygen therapy
published from 2000 to 2010
2130 Towards improving cervical cancer screening in Nigeria:
A review of the basics of cervical neoplasm and cytology
2131 Towards public health decision support: a systematic
review of bidirectional communication approaches
2132 Toxoplasmosis as a cause for behaviour disorders -
Overview of evidence and mechanisms
2133 Toxoplasmosis as a cause for behaviour disorders--
overview of evidence and mechanisms
2134 TP53 codon 72 polymorphism and colorectal cancer
susceptibility: A meta-analysis
2135 TP53 codon 72 polymorphism and colorectal cancer
susceptibility: a meta-analysis
2136 Tracking of obesity-related behaviours from childhood to
adulthood: A systematic review
2137 Traditional uses, phytochemistry and pharmacology of
Ficus religiosa: A review
2138 Traditional uses, phytochemistry, pharmacology,
pharmacokinetics and quality control of Polyporus
umbellatus (Pers.) Fries: A review
2139 Training program for hypertension training in Uganda
2140 Transmission of Nonviral Sexually Transmitted Infections
and Oral Sex
2141 Transobturator and retropubic tape procedures in stress
urinary incontinence: A systematic review and meta-
analysis of effectiveness and complications
2142 Treatment and prophylaxis of catheter-related
thromboembolic events in children
2143 Treatment and prophylaxis of catheter-related
thromboembolic events in children
2144 Treatment for depression after traumatic brain injury: a
systematic review
2145 Treatment for hemothorax caused by spontaneous
rupture of hepatocellular carcinoma
2146 Treatment modalities in children with teeth affected by
molar-incisor enamel hypomineralisation (MIH): A
systematic review
2147 Treatment of acute ankle ligament injuries: A systematic
review
2148 Treatment of adolescent overweight and obesity
2149 Treatment of brucellosis: A systematic review of studies
in recent twenty years
2150 Treatment of cervical adjacent segment pathology: A
systematic review
2151 Treatment of nightmares with prazosin: A systematic
review
2152 Treatment of refractory obstetric antiphospholipid
syndrome: The state of the art and new trends in the
therapeutic management
2153 Treatment of skin and soft tissue infections in the
Elderly: A review
2154 Treatment of streptococcal tonsillitis with once-a-day
amoxicillin: A meta-analysis
2155 [Treatment of streptococcal tonsillitis with once-a-day
amoxicillin: a meta-analysis]
2156 Treatment satisfaction with medication: A review of
conceptual frameworks and applications
2157 Treatment-resistant depression: therapeutic trends,
challenges, and future directions
2158 A tree must be bent while it is young: Teaching
urological surgical techniques to schoolchildren
2159 Trema orientalis Linn. Blume: A potential for prospecting
for drugs for various uses
2160 Trema orientalis Linn. Blume: A potential for prospecting
for drugs for various uses
2161 Trend analysis of disaster health articles in peer-
reviewed publications pre- and post-9/11
2162 Trends and determining factors associated with
adherence to antiretroviral therapy (ART) in Cameroon:
A systematic review and analysis of the CAMPS trial
2163 Trends in tertiary breast reconstruction: Literature
review and single centre experience
2164 Trends in use of health economic evidence for
developing clinical guidelines
2165 Triaging women with acute coronary syndrome: a review
of the literature
2166 Trimethoprim/sulfametrole: Evaluation of the available
clinical and pharmacokinetic/pharmacodynamic
evidence
2167 Trk kinase inhibitors as new treatments for cancer and
pain
2168 Tuberculosis: a review of current concepts and control
programme in Nigeria
2169 Tuberculosis: Current situation, challenges and overview
of its control programs in India
2170 Tuberculosis: current situation, challenges and overview
of its control programs in India
2171 Tumor marker-guided PET in breast cancer patients - A
recipe for a perfect wedding: A systematic literature
2172 Tumorigenesis: Cell defense against hypoxia?
2173 Twenty years of research on mineral trioxide aggregate:
a scientometric report
2174 Two routes of transobturator tape procedures in stress
urinary incontinence: A meta-analysis with direct and
indirect comparison of randomized trials
2175 Type 2 diabetes as a risk factor for Alzheimer's disease:
The confounders, interactions, and neuropathology
associated with this relationship
2176 Ultrasonographic contrast media: Has the time come in
obstetrics and gynecology?
2177 Ultrasound guidance compared with electrical
neurostimulation for peripheral nerve block: A
systematic review and meta-analysis of randomized
controlled trials
2178 Understanding constructive feedback: A commitment
between teachers and students for academic and
professional development
2179 Understanding postdivorce coparenting families:
Integrative literature review
2180 Understanding suicide and disability through three
major disabling conditions: Intellectual disability, spinal
cord injury, and multiple sclerosis
2181 Understanding the role of general dentists in the process
of screening and early diagnosis of oral premalignant
and malignant lesions - brief literature review
2182 Understanding weight loss in patients with colorectal
cancer: a human response to illness
2183 Understanding weight loss in patients with colorectal
cancer: a human response to illness
2184 Unintentional injuries in the home environment: home
safety
2185 Unintentional injuries in the home environment: Home
safety
2186 Untangling toxicity: Reduction in rectal morbidity from
radiotherapy requires uniform collection of dose-volume
data
2187 Unusual cause of adult intussusception: Diffuse large B-
cell non-Hodgkin's lymphoma: A case report and review
2188 Unusual cause of defecation disturbance: a presacral
tailgut cyst
2189 Unusual histopathological findings in appendectomy
specimens: A retrospective analysis and literature review
2190 Unusual locations of the hydatid cyst: A review from Iran
2191 Unusual side effects of interferon Beta-1a in patient with
multiple sclerosis
2192 Unverifiable publications in otolaryngology residency
applications
2193 Unverifiable publications in otolaryngology residency
applications
2194 Update on food allergy in adults
2195 Update on HIV-1 diversity in Africa: A decade in review
2196 Update on HIV-1 diversity in Africa: a decade in review
2197 An update on pharmacology of Satureja species; from
antioxidant, antimicrobial, antidiabetes and anti-
hyperlipidemic to reproductive stimulation
2198 An update on the ability of St. John's wort to affect the
metabolism of other drugs
2199 Update on the long-term complications of renal
transplantation
2200 Update on the management of spondyloarthritis in Asian
countries
2201 Updated meta-analysis on adherence to Mediterranean
diet and health status
2202 An updated meta-analysis to assess the effectiveness of
psychological interventions delivered by psychological
specialists and generalist clinicians on glycaemic control
and on psychological status
2203 Upper extremity orthoses in ALS/MND
2204 The Urban enviroment as a cardiovascular disease risk
factor
2205 Ureteroscopic treatment of larger renal calculi (>2 cm)
2206 Urodynamics before stress incontinence surgery-a
2207 US pharmacists' effect as team members on patient
care: Systematic review and meta-analyses
2208 The use of "cognitive" in health terminology. A latent
controversy
2209 The Use of a PleurX Catheter in the Management of
Recurrent Benign Pleural Effusion: A Concise Review
2210 The use of antiarrhythmic drugs for adult cardiac arrest:
A systematic review
2211 Use of arteriovenous fistulae for home parenteral
nutrition - A review of the literature
2212 Use of bipolar radiofrequency in parenchymal
transection of the liver, pancreas and kidney
2213 Use of conjugated estrogens in life-threatening
gastrointestinal bleeding in hemodialysis patients - A
review
2214 Use of conjugated estrogens in life-threatening
gastrointestinal bleeding in hemodialysis patients--a
review
2215 The use of hyperbaric oxygen for treating delayed
radiation injuries in gynecologic malignancies: A review
of literature and report of radiation injury incidence
2216 The use of multimedia consent programs for surgical
procedures: A systematic review
2217 The use of narrative text for injury surveillance research:
a systematic review
2218 The use of nipple-sparing mastectomy in patients with
breast cancer
2219 Use of nitrates before ERCP helps decrease pancreatitis,
a meta-analysis and systematic review
2220 [Use of Spanish proposals for measuring social class in
health sciences]
2221 Use of the ETV Success Score to explain the variation in
reported endoscopic third ventriculostomy success rates
among published case series of childhood hydrocephalus
2222 Use of the h index in neurosurgery: Clinical article
2223 Using crisis theory to explain the quality of life of organ
transplant patients
2224 Using data to drive emergency department design: A
metasynthesis
2225 Using evidence-based management in a medical practice
2226 Using google scholar to conduct a literature search
2227 Using the internet to research hidden populations of
illicit drug users: a review
2228 Uterine leiomyoma: Available medical treatments and
new possible therapeutic options
2229 Utilising the characteristics of small enterprises to assist
in managing hazardous substances in the workplace
2230 The utility and challenges of using ICD codes in child
maltreatment research: A review of existing literature
2231 The utility of a weblog to stay current with the new
developments in allergy and immunology
2232 Utility of choline positron emission
tomography/computed tomography for lymph node
involvement identification in intermediate- to high-risk
prostate cancer: A systematic literature review and meta-
analysis
2233 Utility of choline positron emission
tomography/computed tomography for lymph node
involvement identification in intermediate- to high-risk
prostate cancer: a systematic literature review and meta-
analysis
2234 The utility of procalcitonin as a biomarker to predict the
duration of antibiotic therapy in adult sepsis patients
2235 Utilizing E-coded data for nonfatal injury surveillance in
the pediatric emergency department setting: A literature
review and recommendations
2236 Validated surrogate endpoints needed for peri-
implantitis
2237 Validity of intraoperative gross examination of
myometrial invasion in patients with endometrial
cancer: A meta-analysis
2238 The value and impact of information provided through
library services for patient care: Developing guidance for
best practice
2239 The value and impact of information provided through
library services for patient care: developing guidance for
best practice
2240 The value of a statistical life in Sweden: A review of the
empirical literature
2241 The value of autofluorescence bronchoscopy combined
with white light bronchoscopy compared with white
light alone in the diagnosis of intraepithelial neoplasia
and invasive lung cancer: A meta-analysis
2242 The value of prostate-specific antigen in Asia
2243 The value of prostate-specific antigen in Asia
2244 VanA-positive vancomycin-resistant staphylococcus
aureus: Systematic search and review of reported cases
2245 Varenicline and neuronal nicotinic acetylcholine
receptors: A new approach to the treatment of co-
occurring alcohol and nicotine addiction?
2246 Varenicline for smoking cessation: A review of the
literature
2247 Variability in the international patterns of CKD
epidemiology: Real or bias?
2248 Variants of Arachidonate 5-Lipoxygenase-activating
Protein (ALOX5AP) Gene and Risk of Coronary Heart
Disease: A Meta-analysis
2249 Variants of arachidonate 5-lipoxygenase-activating
protein (ALOX5AP) gene and the risk of coronary heart
disease: A meta-analysis study
2250 Variations in self-reported practice of physicians
providing clinical care to individuals with dementia: a
systematic review
2251 Vascular comorbidities in familial Mediterranean fever
2252 Vascular endothelial growth factor polymorphisms and
risk of Alzheimer's disease: A meta-analysis
2253 Venous thromboembolism in Pakistan:a neglected
research agenda
2254 Very late onset lymphoproliferative disorders occurring
over 10 years post-renal transplantation: PTLD.Int.
Survey
2255 Vesicovaginal fistula: a review of nigerian experience
2256 Vesicovaginal fistula: A review of nigerian experience
2257 Video recruitment of non-English-speaking participants
2258 Vilazodone for the treatment of depression
2259 Vinpocetine for acute ischaemic stroke
2260 Viral infections in workers in hospital and research
laboratory settings: A comparative review of infection
modes and respective biosafety aspects
2261 Visual disturbance following sclerotherapy for varicose
veins, reticular veins and telangiectasias: A systematic
literature review
2262 Vitamins and cutaneous wound healing
2263 Vitreous cryopreservation of engineered tissue
bioproducts
2264 Volvulus of the sigmoid colon
2265 Vulvodynia interventions-systematic review and
evidence grading
2266 Vulvodynia interventions--systematic review and
evidence grading
2267 Web-based neuroblastoma research information for
parents: A model for international collaboration of
pediatric cancer non-profits
2268 Weight management in African-Americans using church-
based community interventions to prevent type 2
diabetes and cardiovascular disease
2269 Welcome to cultural competency: Surgery's efforts to
acknowledge diversity in residency training
2270 Wernicke encephalopathy after obesity surgery: a
systematic review
2271 What are the facilitators, inhibitors, and implications of
birth positioning? A review of the literature
2272 What is <> - A review of the literature, phenotype
diversity, and portal hypothesis
2273 What is the best treatment option for infertile women
aged 40 and over?
2274 What is the clinicopathological characteristic of
cloacogenic carcinoma outside the anorectal zone?
2275 What is the evidence that 1Hz rTMS positively affects
chronic tinnitus?
2276 What Is the Evidence That Environmental Remediation
Programs Are Effective in Urban Children With Allergic
Asthma? An Integrated Review
2277 What is the impact of comparative effectiveness and
value based pricing on a product's value and market
access?
2278 What Is the Role of Informal Healthcare Providers in
Developing Countries? A Systematic Review
2279 What is the state of the stone analysis techniques in
urolithiasis?
2280 What potential research participants want to know
about research: A systematic review
2281 What should be the approach in the long-term
management of patients with gastroesophageal reflux
disease?
2282 What we do not know about olfaction. Part 1: from
nostril to receptor
2283 When honeybees attack: Adrenal insufficiency as a late
consequence of massive exposure
2284 Where do we submit our papers on neurointervention?
2285 Which providers can bridge the health literacy gap in
lifestyle risk factor modification education: a systematic
review and narrative synthesis
2286 Which quality of life score is best for glaucoma patients
and why?
2287 Will visceral leishmaniasis be eliminated from Nepal? A
review of recent (1994-2006) control efforts
2288 'Wind turbine syndrome': fact or fiction?
2289 Women with atrial fibrillation: Greater risk, less
attention
2290 Work: A potential addiction
2291 Workers' Compensation Status: Does It Affect
Orthopaedic Surgery Outcomes? A Meta-Analysis
2292 Working with men before and after birth
2293 Wound drainages in total hip arthroplasty: to use or not
to use? Review of the literature on current practice
2294 Wound infiltration with local anesthetics for post-
operative pain relief in lumbar spine surgery: A
systematic review
2295 XRCC1 Arg399Gln gene polymorphism and
hepatocellular carcinoma risk in the Chinese Han
population: A meta-analysis
2296 XRCC1 Arg399Gln gene polymorphism and
hepatocellular carcinoma risk in the Chinese Han
population: a meta-analysis
2297 Yoga therapy for Schizophrenia
2298 Zinc for treating of children and adolescents with
attention-deficit hyperactivity disorder: A systematic
review of randomized controlled clinical trials
AB
Background & Aims: Adequate bowel cleansing is an important determinant of the efficacy of screening colonoscopy.
Polyethylene glycol (PEG)-based solutions are used commonly in bowel preparation, but their poor palatability and
large volumes (4 L) influence compliance. Adjunct therapies, such as bisacodyl, split-dose regimens, and lower-
volume regimens have been tested. We performed a meta-analysis to determine whether a 4-L split dose of PEG is
better than others for bowel cleansing before colonoscopy. Methods: We searched MEDLINE, the Cochrane Central
Register of Controlled Trials and Database, recent abstracts from major conference proceedings, references from
selected reviews and randomized trials (http://clinicaltrials.gov), and Google Scholar, through September 2011, for
high-quality, randomized trials that compared 4-L split-dose PEG without adjunct therapy with other bowel
preparation methods. Nine of 2477 trials considered were used in the analysis. We calculated pooled estimates of
bowel preparation quality (primary outcome: excellent or good), preparation compliance, favorable overall
experiences, willingness to repeat same preparation, and side effects. We calculated pooled estimates of odds ratios
by fixed- and random-effects models. We also assessed heterogeneity among studies and publication bias. Results:
The overall pooled odds ratio for excellent or good bowel preparation quality for 4-L split-dose PEG was 3.46, Background: Colorectal cancer (CRC) is a worldwide disease, more common in the western world. Its seeming rarity
in Africans has been contested in recent studies in which increasing incidence has been indicated. This study
performed a systematic review of all the available published data on CRC in Nigerians over a period of 53 years (as a
proximate indication of the burden of the disease. Materials and Methods: The data were sourced from PubMed,
MEDLINE, EMBASE and Google Scholar search engines as well as direct contact to some authors. All published
studies on histologically confirmed CRC from the various geo-political zones of Nigeria during a 53-year period from
1954 to 2007 were identified. Results: Of 35 papers found, 19 met the criteria and a total of 2497 cases reported in
these 19 publications constituted the materials utilized for the review. The average age incidence was 46 years (peak
= 41-50 age group); 32% of all the cases were below 40 years. The male : female ratio was 1.3 : 1. The commonest PubMed and Google Scholar were searched to obtain articles originating from Mpilo Central Hospital, Bulawayo,
Zimbabwe - 1958 to August 2011 (54 years). 168 articles cited 999 times were retrieved giving about 6 citations per
article. Analysis of publication trends over time as well as publication avenues is made. The full research dataset for
this study is shared. This study adds to the body of knowledge on teaching hospital research performance To inform future pandemic planning and disaster response, we aimed to review the literature on the health sector
response to the influenza A (H1N1) 2009 pandemic in New Zealand in 2009. We searched PubMed and Google
Scholar along with the websites of government agencies for the period 1 April 2009 to 20 May 2012. In 2009, 18% of
the New Zealand population had evidence of infection from the pandemic strain, 1122 people were hospitalised
(with pandemic influenza as the primary diagnosis), 102 of those hospitalised were treated in intensive care units
(ICU), and there were an estimated 49 pandemic-attributed deaths. At the severe end of the disease spectrum (ICU
admissions and mortality), the health burden was significantly worse for Maori and Pacific peoples. The available
evidence (including various estimates of low case-fatality risk relative to other high income countries), is consistent
with the overall response in the public health, primary care and hospital sectors being fairly successful. Nevertheless,
a number of likely weaknesses were identified, including a relative lack of: (i) a detailed review of the epidemiology The 2010-2011 Queensland floods resulted in the most deaths from a single flood event in Australia since 1916. This
article analyses the information on these deaths for comparison with those from previous floods in modern Australia
in an attempt to identify factors that have contributed to those deaths. Haddon's Matrix, originally designed for
prevention of road trauma, offers a framework for understanding the interplay between contributing factors and
helps facilitate a clearer understanding of the varied strategies required to ensure people's safety for particular flood
types. Methods: Public reports and flood relevant literature were searched using key words 'flood', 'fatality',
'mortality', 'death', 'injury' and 'victim' through Google Scholar, PubMed, ProQuest and EBSCO. Data relating to
reported deaths during the 2010-2011 Queensland floods, and relevant data of previous Australian flood fatality
(1997-2009) were collected from these available sources. These sources were also used to identify contributing
factors. Results: There were 33 deaths directly attributed to the event, of which 54.5% were swept away in a flash
OBJECTIVE: The 2010-2011 Queensland floods resulted in the most deaths from a single flood event in Australia
since 1916. This article analyses the information on these deaths for comparison with those from previous floods in
modern Australia in an attempt to identify factors that have contributed to those deaths. Haddon's Matrix, originally
designed for prevention of road trauma, offers a framework for understanding the interplay between contributing
factors and helps facilitate a clearer understanding of the varied strategies required to ensure people's safety for
particular flood types., METHODS: Public reports and flood relevant literature were searched using key words 'flood',
'fatality', 'mortality', 'death', 'injury' and 'victim' through Google Scholar, PubMed, ProQuest and EBSCO. Data
relating to reported deaths during the 2010-2011 Queensland floods, and relevant data of previous Australian flood
fatality (1997-2009) were collected from these available sources. These sources were also used to identify
contributing factors., RESULTS: There were 33 deaths directly attributed to the event, of which 54.5% were swept Aim: ABCB1/MDR1 protein is found in high concentrations on the apical surfaces of colonic epithelial cells. It acts as
an efflux pump by transporting toxic endogenous substances, drugs and xenobiotics out of cells. Polymorphisms in
the ABCB1/MDR1 gene may either change expression of the ABCB1/MDR1 protein or alter its function, suggesting its
possible association with colorectal cancer. Several studies have reported a relationship between ABCB1 gene
polymorphisms and colorectal cancer risk, but no consistent conclusion has been reached. We therefore conducted a
meta-analysis to identify any association between the ABCB1 gene and CRC risk. Method: PubMed, Embase, Google
Scholar, Cbmdisc and CNKI were searched for studies on the relationship of ABCB1/MDR1 gene SNPs and the
incidence of colorectal cancer. Eligible articles were included for data extraction. The main outcome was the
frequency of ABCB1/MDR1 gene SNPs among cases and controls. Comparison of the distribution of SNPs was
performed mainly using Review Manager 5.0. Results: Ten, four and two trials were identified that focussed on the
ABCB1 gene SNPs rs1045642, rs2032582 and rs3789243, respectively. A total of 3175 cases and 3715 controls were
included. The meta-analysis, stratified by ethnicity or population source, indicated no association between the
ABCB1 gene rs1045642 polymorphism and colorectal cancer risk. However, when the study by Bae et al. was objectives: To analyse the concept of abuse in health care. This analysis also covers how abuse in health care is
different from the related concepts of medical error, patient satisfaction and personal identity threat. Background:
Abuse in health care is an emerging concept in need of a clear analysis and definition. At the same time, boundaries
to the related concepts are not demarcated. Design: Concept analysis as developed by Walker and Avant. Method:
The databases Cumulative Index to Nursing and Allied Health Literature, Medline, and Google Scholar were used to
obtain articles published between 1997 and 2009. A total of eleven articles are referred to on abuse in health care,
four on medical error, six on patient satisfaction and three on personal identity threat. Results: Abuse in health care
is defined by patients' subjective experiences of encounters with the health care system, characterized by devoid of
care, where patients suffer and feel they lose their value as human beings. The events are most often unintended. Twice-yearly meetings of The British Society of Rehabilitation Medicine (BSRM) take place at which posters and free
papers are generated, as abstracts, to present novel research findings, audits and case reports. The aim of this study
was to evaluate the academic value of these meetings, by determining the subsequent rate of publication in peer-
reviewed journals of abstracts presented. This was compared to the publication rate of other European medical
specialist society meetings. The authors used MEDLINE, PubMed and Google Scholar search engines to look for
publication of abstracts presented at BSRM meetings within peer-reviewed journals over a 7-year period (2000-
2006). The abstracts were categorised into sub-groups (original study, audit, review, case report and service
description) to determine which type was more likely to be published. The above databases were used also to extract
studies on publication rate of other medical specialties in Europe. In 7 years, a total of 251 abstracts (of which 152 Metastatic involvement of the inguinal lymph nodes is associated with decreased survival and is a strong prognostic
factor in penile squamous cell carcinoma. The aim of the current systematic review was to evaluate the accuracy of
(18)F-FDG PET/CT for inguinal lymph node staging in penile squamous cell carcinoma and possible influential factors.
Medline, SCOPUS, Springer, Science Direct, and Google Scholar were searched using the key words "(penile or penis)
and PET," with no date or language limitation. The meeting abstracts were not excluded either. Statistical pooling
was performed using the random-effects model. Seven studies were included in the meta-analysis. One article had 2
different subgroups of patients, and each subgroup was considered as a separate study. Pooled sensitivity and
specificity were 80.9% (95% confidence interval [CI]: 69.5%-89.4%) and 92.4% (95% CI: 86.8%-96.2%), respectively.
PURPOSE: Metastatic involvement of the inguinal lymph nodes is associated with decreased survival and is a strong
prognostic factor in penile squamous cell carcinoma. The aim of the current systematic review was to evaluate the
accuracy of F-FDG PET/CT for inguinal lymph node staging in penile squamous cell carcinoma and possible influential
factors. MATERIALS AND METHODS: Medline, SCOPUS, Springer, Science Direct, and Google Scholar were searched
using the key words "(penile or penis) and PET," with no date or language limitation. The meeting abstracts were not
excluded either. Statistical pooling was performed using the random-effects model. RESULTS: Seven studies were
included in the meta-analysis. One article had 2 different subgroups of patients, and each subgroup was considered
as a separate study. Pooled sensitivity and specificity were 80.9% (95% confidence interval [CI]: 69.5%-89.4%) and Background: The diagnosis of benign versus malignant pancreatic lesions has always been a clinical challenge
especially in the setting of chronic pancreatitis. Endoscopic ultrasound (EUS) with fine-needle aspiration (EUS-FNA) is
currently considered the procedure of choice to evaluate and sample pancreatic lesions; however, it has some
limitations. EUS elastography of the pancreas is an emerging and developing imaging modality that can differentiate
between diseased and healthy tissues based on studying tissue hardness. The aim of our study was to perform a
systemic review and meta-analysis to assess the ability of EUS elastography to differentiate between benign and
malignant masses of the pancreas. Methods: Search of the English literature for studies reporting experience with
EUS-elastography of the pancreas was prepared using Medline, Pubmed, Google Scholar and Embase database from
January 2000 to October 2011. Relevant and comparable studies were extracted. Only prospective series and
randomized controlled data were used when available. Case reports and non-English published studies were
excluded. Estimates for sensitivity and specificity were obtained from each study, and random effects meta-analysis
was performed to provide overall estimates. Corresponding Forest plots were constructed. Since studies utilized
different approaches in terms of population of interest and study design, we examined individual studies and their
reported results for patient's classification and methods. In two studies, we re-calculated sensitivity and specificity
for a subgroup of observations, in order to look only at pancreatic malignancies from an overall reported pancreatic Objectiva: To appraise the published evidence regarding the accuracy of external cause-of-injury codes in hospital
records. Design: Systematic review. Data sources: Electronic databases searched included PubMed, PubMed Central,
Medline, CINAHL, Academic Search Elite, Proquest Health and Medical Complete, and Google Scholar. Snowballing
strategies were used by searching the bibliographies of retrieved references to identify relevant associated articles.
Selection criteria: Studies were included in the review if they assessed the accuracy of external cause-of-injury
coding in hospital records via a recoding methodology. Methods: The papers identified through the search were
independently screened by two authors for inclusion. Because of heterogeneity between studies, meta-analysis was
not performed. Results: Very limited research on the accuracy of external cause coding for injury-related
hospitalisation using medical record review and recoding methodologies has been conducted, with only five studies
matching the selection criteria. The accuracy of external cause coding using ICD-9-CM ranged from ~ 64% when exact
code agreement was examined to ~ 85% when agreement for broader groups of codes was examined. Conclusions:
Although broad external cause groupings coded in ICD-9-CM can be used with some confidence, researchers should
exercise caution for very specific codes until further research is conducted to validate these data. As all previous
studies have been conducted using ICD-9-CM, research is needed to quantify the accuracy of coding using ICD-10-
AM, and validate the use of these data for injury surveillance purposes.
Hepatobiliary scintigraphy is an important diagnostic modality for work-up of neonatal cholestasis. Therefore, our
objective was to evaluate the literature regarding the accuracy of hepatobiliary scintigraphy in differentiating biliary
atresia from non-biliary atresia causes of cholestasis (collectively called neonatal hepatitis). Our search included
Medline, SCOPUS and Google Scholar. Only studies using Tc-99 m-labeled immunodiacetic acid (IDA) derivatives
were included. Overall, 81 studies were included in the meta-analysis. Pooled sensitivity and specificity were 98.7%
(range 98.1-99.2%) and 70.4% (range 68.5-72.2%), respectively. Factors that increased specificity included the use of
radiotracers with high hepatic extraction, administration of hepatic-inducing drugs (such as phenobarbital), use of a
calculated dose/kg and administration of a booster dose in cases of non-excretion of the tracer in the bowel. SPECT
imaging and duodenal fluid sampling also had high specificity; however, they need further validation because of the
low number of studies. Semiquantitative imaging methods do not seem to have any incremental value. We conclude
that hepatobiliary scintigraphy using IDA derivatives can be very useful for diagnostic work-up of neonatal
cholestasis. To improve the specificity, several measures can be followed regarding type and dose of the radiotracer
and imaging protocols. Non-imaging methods seem to be promising and warrant further validation. 2013 Springer-
Verlag Berlin Heidelberg.
Purpose: Sentinel lymph node biopsy is emerging as a promising method for inguinal lymph node staging of penile
squamous cell carcinoma. In the current systematic review we evaluated the accuracy of sentinel lymph node biopsy
for inguinal lymph node staging of penile squamous cell carcinoma and studied possible influential factors. Materials
and Methods: MEDLINE, Scopus, ISI, Ovid SP, Springer, ScienceDirect and Google Scholar were searched by the key
words "(penile OR penis) AND sentinel". No date or language limitation was imposed on the search and meeting
abstracts were not excluded from analysis. A random effects model was used for statistical pooling. Results: A total
of 17 studies suitable for meta-analysis were detected. Three articles had 2 different subgroups of patients and each
subgroup was considered as a separate study. Overall 18 studies (including the subgroups) were used for detection
rate meta-analysis and 19 for sensitivity meta-analysis. The pooled detection rate was 88.3% (95% CI 81.992.6). Background: Sentinel lymph node (SLN) biopsy is emerging as a promising method for inguinal lymph node staging of
penile squamous cell carcinoma (SCC). Objective: The aim of the current systematic review was to meta-analyse the
accuracy of SLN biopsy for inguinal lymph node staging in penile SCC and possible influential factors. Evidence
Acquisition: Medline, SCOPUS, ISI, OVID SP, Springer, Science direct, and Google scholar were searched by the
following key word: "(penile OR penis) AND sentinel". No date or language limitation was imposed on the search. The
meeting abstracts were not excluded either. Last search was done on December 2010. Evidence Synthesis: Random
effects model was used for statistical pooling. 17 studies were detected suitable for meta-analysis. Three articles had
two different sub-groups of patients and each sub-group was considered as a separate study. Overall, 18 studies
(including the sub-groups) were used for detection rate meta-analysis and 19 studies for sensitivity meta-analysis.
Background: One of the subjects under debate in sentinel node mapping is the eligibility of patients with the history
of previous surgical biopsy of the primary lesion for sentinel node biopsy. In the current systematic review, we
evaluated the false negative and detection rates of sentinel node biopsy in breast cancer patients with and without
previous surgical manipulation of the primary breast lesions. Methods: Pubmed, SCOPUS, and Google scholar were
searched for any relevant study with head to head comparison of patients with and without history of previous
surgical manipulation of the primary breast lesions. The outcomes of interest were detection and false negative rates
in each group, and odds ratio as well as risk difference of having sentinel node detection failure or getting false
negative results in the surgical biopsy compared to the non-surgical biopsy group. Results: 18 studies for false
negative rate and 68 studies for detection rate evaluation were included in this review. Pooled detection rates for
patients with and without previous surgical biopsy were 91.3% and 92.8%. Odds ratio and risk difference of having PURPOSE: Cardiac rehabilitation staff members consider interprofessional practice to be the standard for delivering
effective care. However, it is not known how interprofessional teams collaborate or what they consider to be
important elements of collaboration. Thus, it is important to investigate how healthcare professionals plan and
communicate care, work together, and define their roles as members of the cardiac rehabilitation teams. The
purpose of this report was to provide an analysis of current literature related to interprofessional practice in cardiac
rehabilitation, with a particular focus on examining the terms interprofessional practice and collaboration.
METHODS: For this review, published articles in peer-reviewed journals for the preceding 20-year period were
included from online databases (CINAHL, MEDLINE, EBM Reviews, PubMed, and Google Scholar). Key words used in
the search included 'cardiac rehabilitation,' 'cardiac recovery,' and 'interprofessional and interdisciplinary practice
and collaboration.' Of the 67 articles reviewed, 7 met inclusion criteria specifically addressing interprofessional
practice in cardiac rehabilitation. RESULTS: Analysis revealed that (1) the terms interprofessional and In 2007, the U.S. Food and Drug Administration Amendments Act mandated that all clinical trials must be registered
and results reported on a public website ('clinicaltrials.gov'). Although accessibility of clinical trials information to the
public has greatly improved, few registered studies provide results through links on clinicaltrials.gov. Completed
studies are not published in a timely manner due to publication bias and a variety of other reasons.1 The purpose of
this project, a component of the ACTTION public private partnership sponsored by the FDA and NIH, is to create a
searchable database of analgesic clinical trials that can be sorted by a variety of study characteristics and provides
results for listed trials where available. The primary data source, clinicaltrials.gov, is searched for analgesic clinical
trials for particular categories of disease. For each disease of interest, the REACT database is organized by categories
including drug or device, number of subjects, study status, and study design. For each completed study, results are
located using a basic search strategy of: 1) ClinicalTrials.gov; 2) PubMed; 3) ClinicalStudyResults.org; 4) Sponsor-
This review aims to examine the volume and quality of the evidence base which supports the use of acupuncture in
the treatment of anxiety disorders. A literature review was conducted using Pubmed, Google scholar, AMED, BMJ,
Embase, Psychinfo, Cochrane library, Ingenta connect, and Cinahl databases. Keywords were
"anxiety,""anxious,""panic,""stress,""phobia," and "acupuncture" limited to year 2000 onwards and English language
where available. The quality of research examining the use of acupuncture in the treatment of anxiety disorders is
extremely variable. There is enormous variety regarding points used, number of points used in a session, duration of
sessions, frequency of treatment and duration of treatment programme. While the generally poor methodological
quality, combined with the wide range of outcome measures used, number and variety of points, frequency of
sessions, and duration of treatment makes firm conclusions difficult. Against this, the volume of literature,
consistency of statistically significant results, wide range of conditions treated and use of animal test subjects
suggests very real, positive outcomes using a treatment method preferred by a population of individuals who tend to
be resistant to conventional medicine. 2011 Blackwell Publishing Ltd.
Background: Acupuncture has been used as treatment for infertility for hundreds of years, and recently it has been
studied in male and female infertility and in assisted reproductive technologies, although its role in reproductive
medicine is still debated. Aim: To review studies on acupuncture in reproductive medicine, in experimental and
clinical settings. Methods: Papers were retrieved on PubMed and Google Scholar and were included in the review if
at least the abstract was in English. Results: There is evidence of benefit mainly when acupuncture is performed on
the day of embryo transfer (ET) in the live birth rate. Benefit is also evident when acupuncture is performed for
female infertility due to polycystic ovary syndrome (PCOS). There is some evidence of sperm quality improvement
when acupuncture is performed on males affected by idiopathic infertility. Experimental studies suggest that
acupuncture effects are mediated by changes in activity of the autonomic nervous system and stimulation of
neuropeptides/neurotransmitters which may be involved in the pathogenesis of infertility. Conclusions: Acupuncture
seems to have beneficial effects on live birth rate when performed on the day of ET, and to be useful also in PCOS as
well as in male idiopathic infertility, with very low incidence of side effects. However, further studies are necessary to
confirm the clinical results and to expand our knowledge of the mechanisms involved. 2011, Editrice Kurtis.
PURPOSE: To review the acute and chronic pathological effects of sulfur mustard on the genitourinary system and
male fertility., MATERIALS AND METHODS: We searched PubMed and Google Scholar to find studies related to the
sulfur mustard-induced genitourinary effects and male infertility. Information in the abstracts of non-English related
papers as well as those in the proceedings of congresses on sulfur mustard were reviewed as well., RESULTS: In acute
phase after sulfur mustard exposure, evidences are in favor of microscopic and macroscopic renal lesions, very low
androgen levels, and impaired spermatogenesis. Several years following sulfur mustard exposure, the long-term
pathological effects vary from the renal function impairment to the gonadal damage, in particular the
spermatogenesis. Nevertheless, carcinogenic effect of sulfur mustard on the genitourinary system as well as the
prevalence of male infertility among sulfur mustard-exposed veterans in the chronic post-exposure phase is still
unclear., CONCLUSION: Sulfur mustard causes both acute and chronic injuries to different parts of the genitourinary
system.
The tenth revision of the International Classification of Mental and Behavioural Disorders (ICD-10) introduced the
category F23 'Acute and transient psychotic disorders' (ATPD) to incorporate clinical concepts such as the French
bouffee delirante, cycloid psychosis (Germany), and the Scandinavian reactive and schizophreniform psychoses. The
aim of this paper is to review the literature on ATPD and to examine how it has been differentiated from the other
categories of F2 group 'schizophrenia and related disorders'. Papers published between 1993 and 2007 were found
through searches in Medline, PsychInfo and Google Scholar. Further references were identified from book chapters
and comprehensive reviews of the topic. ATPD is reported as being prevalent in females and as having onset in early-
middle adulthood. Although follow-up studies suggest that its outcome is more favourable than other disorders in
the F2 group, ATPD tends to recur and half of cases convert mainly into either schizophrenia or affective disorders.
No evidence supports the view that the traditional conditions subsumed under ATPD all refer to this diagnostic
category. The lack of defining features and poor prognostic validity argue against the separation of ATPD from
borderland categories. 2009 Springer-Verlag.
Purpose: Recently, a new suture-button fixation device has emerged for the treatment of acute distal tibiofibular
syndesmotic injuries and its use is rapidly increasing. The current systematic review was undertaken to compare the
biomechanical properties, functional outcome, need for implant removal, and the complication rate of syndesmotic
disruptions treated with a suture-button device with the current 'gold standard', i.e. the syndesmotic screw. Method:
A literature search in the electronic databases of the Cochrane Library, EMbase, Pubmed Medline, and Google
Scholar, between January 1st 2000 to December 1st 2011, was conducted to identify studies in which unstable ankle
fractures with concomitant distal tibiofibular syndesmotic injury were treated with either a syndesmotic screw or a
suture-button device. Results: A total of six biomechanical studies, seven clinical full-text studies and four abstracts
on the TightRope system, and 27 studies on syndesmotic screw or bolt fixation were identified. TheAOFAS of 133
patients treated with TightRope was 89.1 points, with an average study follow-up of 19 months. The AOFAS score in
studies with 253 patients treated with syndesmotic screws (metallic and absorbable) or bolts was 86.3 points, with
an average study follow-up of 42 months. Two studies reported an earlier return to work in the TightRope group.
Implant removal was reported in 22 (10%) of 220 patients treated with a TightRope (range, 0-25%), in the screw or
bolt group the average was 51.9% of 866 patients (range, 5.8-100%). Conclusion: The TightRope system has a similar
outcome compared with the syndesmotic screw or bolt fixation, but might lead to a quicker return to work. The rate
of implant removal is lower than in the syndesmotic screw group. There is currently insufficient evidence on the long-
term effects of the TightRope and more uniform outcome reporting is desirable. In addition, there is a need for
studies on cost-effectiveness of the treatment of acute distal tibiofibular syndesmotic disruption treated with a
suture-button device. The Author(s) 2012.
Current psychiatric classifications include provisional categories for acute transient psychoses such as ICD-10 'Acute
and transient psychotic disorders' (ATPD) and DSM-IV-TR 'Brief psychotic disorder'. Following on from an account of
earlier concepts such as bouffee delirante, cycloid psychosis and the reactive and schizophreniform psychoses, this
paper describes the process whereby they were subsumed under the heading of ATPD, then sets out research
comparing ATPD and schizophrenia in terms of epidemiology, clinical features, course and outcome. Papers
published between 1 January 1993 and 30 June 2011 were found through searches in Medline, PsychInfo and Google
Scholar. Further references were identified from book chapters and reviews of the topic. Acute onset, polymorphic
symptoms, early remission, absence of premorbid dysfunctions and association with female gender are features
reported to distinguish ATPD from schizophrenia. However, case identification may be difficult owing to the fleeting
nature of the clinical phenomena ATPD encompasses, and high rates of change of diagnosis in subsequent episodes.
It is concluded that the lack of clearly defining symptoms and poor predictive validity of ATPD argue against a sharp
demarcation from schizophrenia. 2011 Bentham Science Publishers.
The tumor necrosis factor inhibitors infliximab and adalimumab are effective treatments for Crohn's disease (CD);
however, some patients treated with infliximab experience a loss of efficacy. There is a lack of high-quality evidence
available on whether adalimumab is an effective treatment for patients who have failed infliximab treatment. A
systematic review was carried out to examine the efficacy and safety of adalimumab for the treatment of CD in
patients who have failed infliximab treatment. PubMed, Google Scholar, and the Cochrane Library were searched
using the terms 'adalimumab AND infliximab AND Crohn's'. Randomized-controlled trials and cohort studies were
included if they involved patients treated with adalimumab after failing infliximab. Outcomes were response and
remission rates, adverse event (AE) rate, and the rate of discontinuations because of AEs. Ten studies (one
randomized-controlled trial and nine cohort studies) involving 1009 patients were included. Luminal disease
remission rates ranged from 12 to 67% during induction and 29 to 72% during maintenance therapy. Fistulizing
disease remission rates ranged from 5 to 50% during induction and 27 to 68% during maintenance therapy. Luminal
disease response rates ranged from 29 to 83% during induction and 31 to 59% during maintenance therapy.
Fistulizing disease response rates ranged from 15 to 44% during induction and 41 to 56% during maintenance
therapy. The overall AE rate ranged from 13 to 69%. Most AEs were mild to moderate in severity. The rate of
discontinuation because of AEs ranged from 0 to 14%. The findings reported in the current literature support
adalimumab as an efficacious and safe treatment for CD in patients who have failed infliximab treatment. 2013
Wolters Kluwer Health | Lippincott Williams & Wilkins.
Background: The efficacy of additional complex fractionated atrial electrograms (CFAEs) ablation after pulmonary
vein antrum isolation (PVAI) in patients with atrial fibrillation (AF) remains controversial. This meta-analysis was
performed to assess the additional efficacy of CFAEs ablation after a single procedure without antiarrhythmic drugs.
Methods: Four electronic databases were searched: MEDLINE, Cochrane Library, Embase, Google Scholar; articles
regarding long-term outcomes of CFAEs ablation in patients with AF were reviewed; references in relevant studies
were manually retrieved. Controlled cohort studies comparing the long-term efficacy of additional CFAEs ablation
after PVAI with PVI alone were included. Primary endpoint was maintained of sinus rhythm (SR) without
antiarrhythmic drugs. Results: Six controlled trials (total 526 patients with AF, 263 patients underwent PVAI plus
CFAEs ablation, and 263 patients underwent PVAI alone) were included in the meta-analysis. In an overall pooled
estimate, compared with PVAI alone, long-term rates of SR maintenance (relative risk [RR] 1.13, 95% confidence
interval [CI] 0.97-1.31, P=0.107) were not increased by additional CFAEs ablation. Subgroup analysis demonstrated
that additional CFAEs ablation increased rates of SR maintenance in non-paroxysmal AF (RR 1.28, 95% CI 1.00-1.64,
P=0.048), whereas it had no effect on patients with paroxysmal AF (RR 1.02, 95% CI 0.90-1.16, P=0.741). Conclusions:
Adjuvant CFAEs ablation in addition to standard PVAI increase the rate of long-term SR maintenance in non-
paroxysmal AF patients after a single procedure without antiarrhythmic drugs, whereas it does provide additional
benefit to SR maintenance in paroxysmal AF patients.
The efficacy of additional complex fractionated atrial electrogram (CFAE) ablation after pulmonary vein antrum
isolation (PVAI) in patients with atrial fibrillation (AF) remains controversial. This meta-analysis was performed to
assess the additional efficacy of CFAEs ablation after a single procedure without antiarrhythmic drugs. Trials were
identified in MEDLINE, Cochrane Library, Embase, Google Scholar, reviews, and reference lists of relevant papers.
Controlled cohort studies comparing the long-term efficacy of combined CFAEs plus PVAI ablation with PVAI alone
were included. The primary end point was the maintenance of sinus rhythm without antiarrhythmic drugs. Seven
controlled trials (9 comparisons) with a total of 622 participants (332 patients underwent PVAI plus CFAE ablation
and 330 patients underwent PVAI alone) were included in the meta-analysis. In an overall pooled estimate,
compared with PVI alone, long-term rates of sinus rhythm maintenance (relative risk, 1.17, 95% confidence interval,
1.03 to 1.33, P=0.019) were increased by additional CFAE ablation. Subgroup analysis demonstrated that additional
CFAEs ablation increased rates of sinus rhythm maintenance in nonparoxysmal AF (relative risk, 1.35; 95%
confidence interval, 1.04 to 1.75; P=0.022), whereas had no effect on patients with paroxysmal AF (relative risk, 1.04;
95% confidence interval, 0.92 to 1.18; P=0.528). Adjuvant CFAE ablation in addition to standard PVAI increases the
rate of long-term sinus rhythm maintenance in nonparoxysmal AF patients after a single procedure without
antiarrhythmic drugs but does not provide additional benefit to sinus rhythm maintenance in paroxysmal AF
patients.
BACKGROUND: The efficacy of additional complex fractionated atrial electrogram (CFAE) ablation after pulmonary
vein antrum isolation (PVAI) in patients with atrial fibrillation (AF) remains controversial. This meta-analysis was
performed to assess the additional efficacy of CFAEs ablation after a single procedure without antiarrhythmic drugs.,
METHODS AND RESULTS: Trials were identified in MEDLINE, Cochrane Library, Embase, Google Scholar, reviews, and
reference lists of relevant papers. Controlled cohort studies comparing the long-term efficacy of combined CFAEs
plus PVAI ablation with PVAI alone were included. The primary end point was the maintenance of sinus rhythm
without antiarrhythmic drugs. Seven controlled trials (9 comparisons) with a total of 622 participants (332 patients
underwent PVAI plus CFAE ablation and 330 patients underwent PVAI alone) were included in the meta-analysis. In
an overall pooled estimate, compared with PVI alone, long-term rates of sinus rhythm maintenance (relative risk,
1.17, 95% confidence interval, 1.03 to 1.33, P=0.019) were increased by additional CFAE ablation. Subgroup analysis
demonstrated that additional CFAEs ablation increased rates of sinus rhythm maintenance in nonparoxysmal AF
(relative risk, 1.35; 95% confidence interval, 1.04 to 1.75; P=0.022), whereas had no effect on patients with
paroxysmal AF (relative risk, 1.04; 95% confidence interval, 0.92 to 1.18; P=0.528)., CONCLUSIONS: Adjuvant CFAE
ablation in addition to standard PVAI increases the rate of long-term sinus rhythm maintenance in nonparoxysmal AF
patients after a single procedure without antiarrhythmic drugs but does not provide additional benefit to sinus
rhythm maintenance in paroxysmal AF patients.
Aims: Adjunctive therapy with adenosine improves coronary flow in patients with acute myocardial infarction
(STEMI) undergoing successful reperfusion. However it is still unclear whether adenosine effectively reduces adverse
cardiac events in STEMI patients. The aim of our study was to perform a meta-analysis of all randomised studies
investigating clinical outcomes in STEMI patients treated with adjunctive adenosine therapyMethods and results: We
performed a meta-analysis, systematically searching data from Medline, Google Scholar and HighWire. Only
randomised, placebo-controlled trials were included; studies enrolling less than 100 patients were excluded. In order
to evaluate mortality and congestive heart failure (CHF), three (2961 patients ) and two (2353 patients) studies have
been respectively included in the analysis. Pooled estimates were Relative Risks (RR) with their confidence intervals.
Maximum follow up period was one year. The estimates were computed using fixed effect model. Random effect
was used in case of statistical heterogeneity. There was no difference in death at one year between adenosine (R.R.
0.89, 0.72-1.11, p= 0,30) and placebo patients. CHF was more frequently observed in adenosine than in placebo
patients (RR 1.64, 1.05-2.55, p= 0.03). Our analysis did not show a difference of adverse clinical events in both
patients receiving low (<70 mcg/Kg/min) (RR 0.87, 0.68-1.11, p=0.25) and high (>70 mcg/Kg/min) doses of adenosine
(1.0, 0.59-167, p=0.99) as compared to placebo.Conclusions: Our results demonstrate that adenosine does not
reduce adverse clinical events in STEMI patients. These data suggest that adenosine improvement of coronary flow
velocities may be only a transient vascular effect, without any clinically relevant salvage of reperfused myocardium.
Aims: Adjunctive therapy with adenosine has been shown to improve coronary flow in patients with acute coronary
syndromes (ACS); it is unclear, however, whether adenosine can effectively reduce adverse clinical events. The aim
of our study was to perform a meta-analysis of all randomized controlled trials (RCTs) investigating angiographic and
clinical outcomes in ACS patients undergoing PCI or thrombolysis and receiving adjunctive adenosine therapy vs.
placebo. Methods: Medline/CENTRAL/EMBASE and Google Scholar database were scanned. The meta-analysis
included ten RCTs (N= 3821). All-cause mortality was chosen as primary endpoint. Secondary endpoints were re-
infarction (MI), heart failure (HF) symptoms (NYHA class III/IV), no-reflow (defined as TIMI 0 flow) and >50% ST-
resolution. Results: Adenosine compared to placebo was associated with a significant reduction of post-procedural
no-reflow (OR [95% CI]=0.25 [0.08-0.73], p=0.01); however, at a median follow-up of 6 months, prior treatment with
adenosine did not confer significant benefits in terms of reduction of mortality (ORFixed [95% CI]=0.87 [0.69-1.09],
p=0.23), as well as re-MI (p=0.80), HF symptoms (p=0.44) and ST-resolution (p=0.09). Separate analyses conducted in
the subgroups of ST-elevation MI patients treated with either PCI or thrombolysis confirmed the findings found in
the overall population. Conclusions: This meta-analysis shows that adenosine adjunctive therapy does not improve
survival nor reduce the rates of re-MI and HF symptoms in patients with ACS treated with PCI or thrombolysis. The
beneficial effect on post-procedural coronary flow was not associated with consistent advantages on clinical
outcomes. 2011 Elsevier Ireland Ltd.
OBJECTIVE: To estimate antiretroviral therapy (ART) adherence rates during pregnancy and postpartum in high-
income, middle-income, and low-income countries. DESIGN: Systematic review and meta-analysis. METHODS:
MEDLINE, EMBASE, SCI Web of Science, NLM Gateway, and Google scholar databases were searched. We included all
studies reporting adherence rates as a primary or secondary outcome among HIV-infected pregnant women. Two
independent reviewers extracted data on adherence and study characteristics. A random-effects model was used to
pool adherence rates; sensitivity, heterogeneity, and publication bias were assessed. RESULTS: Of 72 eligible articles,
51 studies involving 20153 HIV-infected pregnant women were included. Most studies were from United States
(n=14, 27%) followed by Kenya (n=6, 12%), South Africa (n=5, 10%), and Zambia (n=5, 10%). The threshold defining
good adherence to ART varied across studies (>80, >90, >95, 100%). A pooled analysis of all studies indicated a
pooled estimate of 73.5% [95% confidence interval (CI) 69.3-77.5%] of pregnant women who had adequate (>80%)
ART adherence. The pooled proportion of women with adequate adherence levels was higher during the antepartum
(75.7%, 95% CI 71.5-79.7%) than during postpartum (53.0%, 95% CI 32.8-72.7%; P=0.005). Selected reported barriers
for nonadherence included physical, economic and emotional stresses, depression (especially postdelivery), alcohol
or drug use, and ART dosing frequency or pill burden. CONCLUSION: Our findings indicate that only 73.5% of
pregnant women achieved optimal ART adherence. Reaching adequate ART adherence levels was a challenge in
pregnancy, but especially during the postpartum period. Further research to investigate specific barriers and
interventions to address them is urgently needed globally. Copyright 2012 Lippincott Williams &Wilkins.
OBJECTIVE: To estimate antiretroviral therapy (ART) adherence rates during pregnancy and postpartum in high-
income, middle-income, and low-income countries., DESIGN: Systematic review and meta-analysis., METHODS:
MEDLINE, EMBASE, SCI Web of Science, NLM Gateway, and Google scholar databases were searched. We included all
studies reporting adherence rates as a primary or secondary outcome among HIV-infected pregnant women. Two
independent reviewers extracted data on adherence and study characteristics. A random-effects model was used to
pool adherence rates; sensitivity, heterogeneity, and publication bias were assessed., RESULTS: Of 72 eligible articles,
51 studies involving 20 153 HIV-infected pregnant women were included. Most studies were from United States (n =
14, 27%) followed by Kenya (n = 6, 12%), South Africa (n = 5, 10%), and Zambia (n = 5, 10%). The threshold defining
good adherence to ART varied across studies (>80, >90, >95, 100%). A pooled analysis of all studies indicated a
pooled estimate of 73.5% [95% confidence interval (CI) 69.3-77.5%] of pregnant women who had adequate (>80%)
ART adherence. The pooled proportion of women with adequate adherence levels was higher during the antepartum
(75.7%, 95% CI 71.5-79.7%) than during postpartum (53.0%, 95% CI 32.8-72.7%; P = 0.005). Selected reported
barriers for nonadherence included physical, economic and emotional stresses, depression (especially postdelivery),
alcohol or drug use, and ART dosing frequency or pill burden., CONCLUSION: Our findings indicate that only 73.5% of
pregnant women achieved optimal ART adherence. Reaching adequate ART adherence levels was a challenge in
pregnancy, but especially during the postpartum period. Further research to investigate specific barriers and
interventions to address them is urgently needed globally.
Objective: Our purpose was to review the literature with respect to issues of adherence to treatment among children
with congenital and acquired cardiac disease. Materials and Methods: Databases used for this review included
MEDLINE, Pub Meds Single Citation Manager, Cochrane Library, Cochrane Central Register of Controlled Trials,
Scopus, and Google Scholar. We did not use any restrictions on date when locating peer-reviewed articles published
worldwide through December of 2008. Results: There exists a lack of published research regarding adherence to
medical treatment for children with cardiac conditions. Of the few published studies, rates of adherence for children
with congenital and acquired cardiac disease ranged from a high of 96% for an in-patient exercise programme, to a
low of 33% among those who made all of their medical appointments. Risk factors for nonadherence included older
age, one as opposed to two parents in the home, lack of emotional availability of parents, smoking, sedentary
lifestyle, use of illicit drugs, presence of tattoos, and multiple body piercings. Clinical outcomes associated with non
adherence in the population of children undergoing transplantation included mortality, acute episodes of rejection,
lower levels of Cyclosporine A, and lower values for the International Normalised Ratio of prothrombin. Conclusions:
For children with congenital and acquired heart disease, the challenges of adherence to treatment can often be
overwhelming. Recommendations designed to maximize the impact and scientific rigour of future studies include
obtaining quantitative and qualitative measures of adherence, identifying primary and secondary endpoints,
emphasizing factors of interest, planning studies with sufficient power to impact on the adherence to treatment, and
developing epidemiologic foundations. 2009 Cambridge University Press.
Background A thinned anterolateral thigh (ALT) flap is often harvested to achieve optimal skin resurfacing. Several
techniques have been described to thin an ALT flap including an adipocutaneous flap, an adipofascial flap and
delayed debulking. Methods By systematically reviewing all of the available literature in English and French, the
present manuscript attempts to identify the common surgical indications, complications and donor site morbidity of
the adipofascial variant of the ALT flap. The studies were identified by performing a systematic search on Medline,
Ovid, EMBASE, the Cochrane Database of Systematic Reviews, Current Contents, PubMed, Google, and Google
Scholar. Results The study selection process was adapted from the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses statement, and 15 articles were identified using the study inclusion criteria. These articles were
then reviewed for author name(s), year of publication, flap dimensions and thickness following defatting, perforator
type, type of transfer, complications, thinning technique, number of cases with a particular area of application and
donor site morbidity. Conclusions The adipofascial variant of the ALT flap provides tissue to fill large defects and
improve pliability. Its strong and safe blood supply permits adequate immediate or delayed debulking without
vascular complications. The presence of the deep fascia makes it possible to prevent sagging by suspending and
fixing the flap for functional reconstructive purposes (e.g., the intraoral cavity). Donor site morbidity is minimal, and
thigh deformities can be reduced through immediate direct closure or liposuction and direct closure. A safe blood
supply was confirmed by the rate of secondary flap debulking. 2013 The Korean Society of Plastic and Reconstructive
Surgeons.
BACKGROUND: A thinned anterolateral thigh (ALT) flap is often harvested to achieve optimal skin resurfacing. Several
techniques have been described to thin an ALT flap including an adipocutaneous flap, an adipofascial flap and
delayed debulking., METHODS: By systematically reviewing all of the available literature in English and French, the
present manuscript attempts to identify the common surgical indications, complications and donor site morbidity of
the adipofascial variant of the ALT flap. The studies were identified by performing a systematic search on Medline,
Ovid, EMBASE, the Cochrane Database of Systematic Reviews, Current Contents, PubMed, Google, and Google
Scholar., RESULTS: The study selection process was adapted from the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses statement, and 15 articles were identified using the study inclusion criteria. These
articles were then reviewed for author name(s), year of publication, flap dimensions and thickness following
defatting, perforator type, type of transfer, complications, thinning technique, number of cases with a particular area
of application and donor site morbidity., CONCLUSIONS: The adipofascial variant of the ALT flap provides tissue to fill
large defects and improve pliability. Its strong and safe blood supply permits adequate immediate or delayed
debulking without vascular complications. The presence of the deep fascia makes it possible to prevent sagging by
suspending and fixing the flap for functional reconstructive purposes (e.g., the intraoral cavity). Donor site morbidity
is minimal, and thigh deformities can be reduced through immediate direct closure or liposuction and direct closure.
A safe blood supply was confirmed by the rate of secondary flap debulking.
The incidence of obesity continues to increase in the US population. Diet-based and pharmacological interventions
have yet to show significant, sustainable weight-loss in clinical trials. Obesity surgeries are becoming more common
and it is important for all surgeons to be aware of their complications. It is estimated that over 100,000 adjustable
gastric bands (AGB) are placed annually. The complication rate of the AGB has been reported to be as high as 19.2%,
with 1.2% being life threatening events. Gastric prolapse of the AGB is a well-known, albeit rare complication of this
procedure. It typically presents with gastric outlet obstruction and is managed with surgical repositioning of the band
or removal. It is believed to be extremely rare for the slippage to result in violation of major arteries. Here we
present an instance where the AGB prolapsed and eroded into the lesser curve vessels of the stomach, subsequently
resulting in intra-abdominal hemorrhage. Using both PubMed and Google Scholar searches, we were able to locate
three Englishlanguage articles which described the same complication as the one seen at our institution. In each of
these cases, there was a near-death experience following significant blood loss into the abdominal cavity. These
three cases all presented with nonspecific signs and symptoms and the etiology of the bleed was not discovered until
the time of exploratory surgery. Our patient was a 52-year-old female who was 16 months status post a laparoscopic
AGB placement. Her surgery had gone well initially and there were no complications. In the days leading up to the
acute event, the patient had an acute episode of ureterolithiasis which required narcotic analgesics for management.
She reacted to the medication with a protracted course of emesis. The patient was on vacation and presented to an
outside hospital in hypovolemic shock. She was stabilized in the emergency room and transferred to the ICU. A
computed tomography (CT) of the abdomen demonstrated what appeared to be blood in the lesser sac and
mesocolon. A CT angiogram did not identify any active source of bleeding but she continued to show signs of blood
loss. Upon laparoscopic exploration, the AGB was explanted and bleeding from the lesser curve of the stomach was
controlled. She recovered fully. As the number of patients who are treated with an AGB increases, we can expect to
see more of the complications that accompany this procedure. It is important that surgeons in general are
competent in managing these complications, as a bariatric surgeon will not always be available. All patients who have
a history of an AGB and present with any signs of intraabdominal hemorrhage should be evaluated and treated
expediently to avoid life threatening complications.
CONTEXT: Systemic chemotherapies for advanced or metastatic thyroid carcinomas have been of only limited
effectiveness. For patients with differentiated or medullary carcinomas unresponsive to conventional treatments,
novel therapies are needed to improve disease outcomes. EVIDENCE ACQUISITION: The PubMed and Google Scholar
search engines were used to identify publications and peer-reviewed meeting presentations addressing
chemotherapy and targeted therapy for differentiated or medullary carcinoma. EVIDENCE SYNTHESIS: Multiple novel
therapies primarily targeting angiogenesis have entered clinical trials for metastatic thyroid carcinoma. Partial
response rates up to 30% have been reported in single agent studies, but prolonged disease stabilization is more
commonly seen. The most successful agents target the vascular endothelial growth factor receptors, with potential
targets including the mutant kinases associated with papillary and medullary oncogenesis. Two drugs approved for
other malignancies, sorafenib and sunitinib, have had promising preliminary results reported, and are being used
selectively for patients who do not qualify for clinical trials. Randomized trials for several agents are underway that
may lead to eventual drug approval for thyroid cancer. CONCLUSION: Treatment for patients with metastatic or
advanced thyroid carcinoma now emphasizes clinical trial opportunities for novel agents with considerable promise.
Alternative options now exist for use of tyrosine kinase inhibitors that are well tolerated and may prove worthy of
regulatory approval for this disease.
Introduction: Benign prostatic hyperplasia (BPH) is a common medical problem in nearly 80% of geriatric male
population severely affecting the quality of life. Several strategies has been suggested in the past for the
management of BPH, but only alpha-blockers and 5alpha-reductase inhibitors are in clinical use. This review aims to
give deep insight into advances in the design and discovery of newer chemical entities as 'druggable' molecule for
the management of BPH. Areas covered: In this review, the authors cover various classes of drugs that have shown
their potential for management of BPH. These drugs include alpha-adrenergic antagonists, 5alpha-reductase
inhibitors, phytochemical agents, phosphodiesterase inhibitor, luteinizing hormone releasing hormone antagonists
and muscarinic receptor antagonists. Literature searches were carried out using Google Scholar, SciFinder and
PubMed. Expert opinion: The exact etiology of BPH is unknown; however, several mechanisms may be involved in
the progression of the disease. Beside surgery and watchful waiting, medical therapies to treat BPH include alpha-
adrenergic antagonist and 5alpha-reductase inhibitors. Phytotherapeutic agents are also used in some countries.
Various other chemical classes of drugs are proposed for the treatment of the disease, but none of them have
reached the clinic. Many classes of drugs are currently undergoing clinical trials such as phosphodiesterase inhibitors,
luteinizing hormone releasing hormone antagonists and muscarinic receptor antagonists. The current need is to
develop a potent, efficacious and highly selective drug for the treatment of BPH. 2013 Informa UK, Ltd.
Summary: Objective: The main aim of this meta-analysis was to compare the efficacy and safety of clarithromycin
and second-generation fluoroquinolone- based triple therapy vs. bismuth-based quadruple therapy for the treatment
of persistent Helicobacter pylori infection. Methods: A systematic literature search was conducted for articles and
abstracts from 1981 to March 2009 using Medline, PubMed, EMBase, Google Scholar and CNKI (Chinese), Wanfang
(Chinese) digital database and recent Digestive Disease Week, United European Gastroenterology Week, and
European Helicobacter Study Group conferences were also performed. Boolean operators (NOT, AND, OR) were used
in succession to narrow and widen the search. Sixteen articles and four abstracts met the inclusion criteria, and were
included in the meta-analysis by using Review Manager 4.2.8. Results: The eradication rates demonstrated that
clarithromycin-based triple therapy is inferior to bismuth-based quadruple therapy (OR = 0.53, 95% CI: 0.35-0.80, P =
0.002). Thirteen RCTs compared levofloxacin-based triple therapy vs. bismuth-based quadruple therapy, the
eradication rates of the two regimens were shown to have no significant difference (OR = 1.43, 95% CI: 0.82-2.51, P =
0.21). But the eradication rates demonstrated superiority of the 10-day levofloxacin-based triple therapy over 7-day
bismuth-based quadruple therapy (OR = 4.79, 95% CI: 2.95-7.79, P < 0.00001). Levofloxacin-based triple therapy was
better tolerated than bismuth-based quadruple therapy with lower rates of side effects (OR = 0.41, 95% CI: 0.27-
0.61, P < 0.0001), and lower rates of discontinuation of therapy due to adverse events (OR = 0.13, 95% CI: 0.06-0.33,
P < 0.0001). Furthermore, our meta-analysis suggested that the eradication rates of the moxifloxacin-based triple
therapy has a slight superiority to bismuth-based quadruple therapy, but there was no significant difference between
them. Conclusion: Second-generation fluoroquinolone-based triple therapy can be suggested as the regimen of
choice for rescue therapy in the eradication of persistent H. pylori infection especially 10-day levofloxacin-based
triple therapy. 2010 Springer-Verlag.
McDonnell MN, Smith AE, Mackintosh SF. Aerobic exercise to improve cognitive function in adults with neurological
disorders: a systematic review. Objective: To evaluate whether aerobic exercise improves cognition in adults
diagnosed with neurologic disorders. Data Sources: The Cochrane Central Register of Controlled Clinical Trials,
MEDLINE, CINAHL, PubMed, EMBASE, PEDro, AMED, SPORTDiscus, PsycINFO, ERIC, and Google Scholar, with the last
search performed in December 2010. Study Selection: We included controlled clinical trials and randomized
controlled trials with adults diagnosed with a neurologic disorder. Studies were included if they compared a control
group with a group involved in an aerobic exercise program to improve cardiorespiratory fitness and if they
measured cognition as an outcome. Data Extraction: Two reviewers independently extracted data and methodologic
quality of the included trials. Data Synthesis: From the 67 trials reviewed, a total of 7 trials, involving 249
participants, were included. Two trials compared the effectiveness of yoga and aerobic exercise in adults with
multiple sclerosis. Two trials evaluated the effect of exercise on patients with dementia, and 2 trials evaluated the
effectiveness of exercise to improve cognition after traumatic brain injury. One trial studied the effect of a cycling
program in people with chronic stroke. Lack of commonality between measures of cognition limited meta-analyses.
Results from individual studies show that aerobic exercise improved cognition in people with dementia, improved
attention and cognitive flexibility in patients with traumatic brain injury, improved choice reaction time in people
with multiple sclerosis, and enhanced motor learning in people with chronic stroke. Conclusions: There is limited
evidence to support the use of aerobic exercise to improve cognition in adults with neurologic disorders. Of the 67
studies retrieved, less than half included cognition as an outcome, and few studies continued the aerobic exercise
program long enough to be considered effective. Further studies investigating the effect of aerobic exercise
interventions on cognition in people with neurologic conditions are required. 2011 American Congress of
Rehabilitation Medicine.
Neurocognitive dysfunction associated with bipolar disorder (BD) is pervasive, persistent across illness phases, and is
demonstrated to predispose and portend psychosocial impairment. Moreover, no approved therapies for various
phases of BD have been shown to reliably improve any dimension of neurocognitive performance. In this article, we
emphasize that aerobic physical exercise is a viable neurocognitive-enhancing adjunctive treatment for patients with
BD. The overarching aim of this review is to emphasize that aerobic physical exercise is a viable neurocognitive-
enhancing adjunctive treatment for patients with BD. We conducted PubMed and Google Scholar searches of all
English-language articles published between January 1966 and February 2010 using the search terms bipolar
disorder, major depressive disorder, depression, exercise, and physical activity cross-referenced with each other and
the following terms: cognition, executive function, learning, memory, attention, emotion, and behavior. Articles
selected for review were based on adequacy of sample size, use of standardized experimental procedures, validated
assessment measures, and overall quality. Available studies have documented an array of persisting neurocognitive
deficits across disparate bipolar populations. Abnormalities in verbal working memory are highly replicated; deficits
in executive function, learning, attention, and processing speed are also a consistent abnormality. The effect sizes of
neurocognitive deficits in BD are intermediate between those reported in schizophrenia and major depressive
disorder. Several original reports and reviews have documented the neurocognitive-enhancing effects of aerobic
exercise in the general population as well as across diverse medical populations and ages. Proposed mechanisms
involve nonexclusive effects on neurogenesis, neurotrophism, immunoinflammatory systems, insulin sensitivity, and
neurotransmitter systems. Each of these effector systems are implicated in both normal and abnormal
neurocognitive processes in BD. Available evidence provides a rationale for empirically evaluating the neurocognitive
benefits of aerobic exercise in BD.
Aim: To summarise the main causes and associations of conjunctival intraepithelial neoplasia (CIN) found in the
literature to date. Method: Literature search using Ovid databases on the NHS Scotland E-library, Medline, and the
Cochrane Library. The internet search engine Google Scholar was also used to identify relevant articles. Results: The
main causes and associations of CIN in the literature are sun exposure and distance from the equator; human
papillomavirus infection, increased p53 expression, and HIV seropositivity. It has been found that in HIV positive
individuals CIN is on the increase with people being affected with more aggressive tumours at younger ages.
Conclusion: Given that CIN is becoming more common in HIV infected populations and that it has the potential to
cause severe disability, it is important to improve our understanding of the condition. Early identification of CIN by an
understanding of its aetiology and associations may enable the implementation of preventative measures to reduce
its incidence and potentially lead to the diagnosis and further management of conditions such as HIV. Young people
presenting with CIN in particular may benefit from HIV testing.
Objective: This research aims to assess the level of understanding pharmacists in various practice settings have of
health care reform provisions in order to identify gaps in knowledge. Methods: The Affordable Care Act (ACA) and
accompanying Health Care and Education Reconciliation Act were passed in March 2010. There have been
publications describing pharmacists' role in shaping the implementation of the ACA, but this can only occur after
frontline pharmacists-those practicing in hospital, community, long-term care, pharmaceutical industry, and
managed care-understand the various provisions and see their distinct role. There is a need to qualitatively capture
this level of understanding. A literature search of existing publications was conducted via Medline and Google
Scholar using key words relating to both the profession of pharmacy and health care reform. Surveys were then
designed based on the literature search to capture demographic information as well as to assess knowledge
regarding specific sections of the ACA relating to pharmacists. Surveys were distributed electronically to pharmacists
currently practicing within hospital, community, industry, managed care, and long-term care. Individuals were
excluded if they were not licensed pharmacists. The ACA and Health Care and Education Reconciliation Act were
accessed using the Library of Congress website. Pharmacists' names and respective organizations were not included
in the aggregation and analysis of collected data. The total duration of data collection was approximately 4 months.
Results: NA (research in progress).
For ankle fractures, in general, several studies have been published on immobilization (e.g., cast or boot) versus early
motion after surgical treatment. However, no studies have been performed to determine the best aftercare strategy
for surgically treated patients with ankle fractures with concomitant acute distal tibiofibular syndesmotic injuries.
The aim of the present review was to compare the functional outcomes of ankle fractures with syndesmotic injury
treated with a cast or boot versus early motion. We performed a systematic review using the electronic databases
from January 1, 2000 to September 1, 2012 of the Cochrane Library, PubMed MEDLINE, EMbase, and Google Scholar.
The included studies were those in which ankle fractures with acute distal tibiofibular syndesmotic injuries had been
treated with 1 or more syndesmotic screws, with a mean follow-up period of at least 12 months and at least 25
patients included. The functional outcomes, measured using the American Orthopaedic Foot Ankle Society Hindfoot
scale, Olerud-Molander Ankle Scale, and Short Musculoskeletal Function Assessment, were compared. A total of 9
studies were identified with a total of 531 patients. The number of included patients ranged from 28 to 93. The mean
follow-up period was 12 to 101 months. Of the 9 studies, 3 used an early motion protocol (195 patients) and 6 (336
patients) a protocol of immobilization for at least 6 weeks. For the American Orthopaedic Foot Ankle Society
Hindfoot scale, the mean scores for immobilization were 86 to 91 points and for early motion, 84 to 89. For the
Olerud-Molander Ankle Scale, the scores for immobilization were 47 to 90 and for early motion, 46 to 82 points. The
Short Musculoskeletal Function Assessment score for immobilization was 11 and for early motion ranged from 12 to
27 points. No apparent differences could be detected in the published data considering the functional outcomes
between immobilization versus an early motion protocol in ankle fractures with acute distal tibiofibular syndesmotic
injuries treated with a syndesmotic screw. However, level 1 and 2 studies on this subject are lacking. 2013 American
College of Foot and Ankle Surgeons.
The ageing of European populations presents health, long-term care, and welfare systems with new challenges.
Although reports of ageing as a fundamental threat to the welfare state seem exaggerated, societies have to
embrace various policy options to improve the robustness of health, long-term care, and welfare systems in Europe
and to help people to stay healthy and active in old age. These policy options include prevention and health
promotion, better selfcare, increased coordination of care, improved management of hospital admissions and
discharges, improved systems of long-term care, and new work and pension arrangements. Ageing of the health
workforce is another challenge, and policies will need to be pursued that meet the particular needs of older workers
(ie, those aged 50 years or older) while recruiting young practitioners.
BACKGROUND: Advanced maternal age is associated with reduced fertility and adverse pregnancy outcomes. This
review details recent developments in our understanding of the biology and mechanisms underlying reproductive
ageing in women and the implications for fertility and pregnancy. METHODS: Sociological online libraries (IBSS,
SocINDEX), PubMed and Google Scholar were searched for relevant demographic, epidemiological, clinical and
biological studies, using key words and hierarchical MeSH terms. From this, we identified and focused on key topics
where it was judged that there had been clinically relevant advances in the understanding of ovarian and uterine
ageing with implications for improved diagnostics and novel interventions. RESULTS: Mapping of the ovarian reserve,
follicular dynamics and associated biomarkers, across the reproductive lifespan has recently been performed. This
now allows an assessment of the effects of environmental, lifestyle and prenatal exposures on follicular dynamics
and the identification of their impact during periods of germ cell vulnerability and may also facilitate early
identification of individuals with shorter reproductive lifespans. If women choose to time their family based on their
ovarian reserve this would redefine the meaning of family planning. Despite recent reports of the potential existence
of stem cells which may be used to restore the primordial follicle and thereby the oocyte pool, therapeutic
interventions in female reproductive ageing at present remain limited. Maternal ageing has detrimental effects on
decidual and placental development, which may be related to repeated exposure to sex steroids and underlie the
association of ageing with adverse perinatal outcomes. CONCLUSIONS: Ageing has incontrovertible detrimental
effects on the ovary and the uterus. Our enhanced understanding of ovarian ageing will facilitate early identification
of individuals at greatest risk, and novel therapeutic interventions. Changes in both ovary and uterus are in addition
to age-related co-morbidities, which together have synergistic effects on reducing the probability of a successful
pregnancy outcome. The Author 2012. Published by Oxford University Press on behalf of the European Society of
Human Reproduction and Embryology. All rights reserved.
Introduction. In less than 5 years, the first wave of baby boomers will begin turning 65, with the last wave of
boomers entering their senior years in January 2029. Currently, boomers make up a significant percentage of the
population in Canada, the United States, and other developed countries. The baby boom generation has had a
profound impact on our society over the last six decades, and this large cohort will continue to exert its influence for
several decades to come. Central to this article is the rapid growth in the number of persons 65 years of age and
older, beginning in 2011, with a corresponding increase in the number of older drivers. The demographic shift has
important implications for licensing authorities, the regulatory bodies charged with licensing and 'fitness to drive'
decisions. Objectives. The objectives of this paper are to summarize the published scientific literature on licensing
policies and procedures currently in use for older drivers, discuss their limitations, and provide recommendations for
meeting the upcoming challenges of an aging baby boomer population of drivers. Method. Online searches were
conducted using the following databases: PsycINFO, MEDLINE, Scopus, and TRIS. Google and Google Scholar also
were searched for scientific articles. References identified from database and online searches were examined for
relevant articles. Results. A number of studies have investigated the utility of different licensing policies and
procedures for identifying older drivers who may be at risk for impaired driving performance. Overall, results suggest
that current policies and procedures are ineffective in identifying high-risk older drivers. The results also emphasize
the need for a different approach for the identification of high risk older drivers by licensing agencies.
Recommendations to assist with that goal are provided. Conclusions. The aging of the baby boomer population,
combined with the projected high crash rates for this cohort of drivers as it moves through the senior years,
underscores the need for cost-effective, accurate, and efficient methods for identifying and assessing the subgroup
of older drivers whose driving has declined to an unsafe level. That subgroup consists of individuals with medical
conditions (and treatments) affecting driving performance. The demographic shift has been a blessing for licensing
authorities in that it has created awareness of the need for a reexamination of licensing policies and procedures
designed to identify those older drivers who may no longer be safe to drive. If that awareness becomes translated
into effective policies and procedures that appropriately target the medically at-risk/impaired older driver rather
than the older driver per se, the result will be an increase in the safety and mobility of the older driving population
and increased public safety overall. However, a continued focus on older drivers rather than medically at-risk drivers
will result in a costly, ineffective, and overburdened system. Copyright 2008 Taylor & Francis Group, LLC.
INTRODUCTION: In less than 5 years, the first wave of baby boomers will begin turning 65, with the last wave of
boomers entering their senior years in January 2029. Currently, boomers make up a significant percentage of the
population in Canada, the United States, and other developed countries. The baby boom generation has had a
profound impact on our society over the last six decades, and this large cohort will continue to exert its influence for
several decades to come. Central to this article is the rapid growth in the number of persons 65 years of age and
older, beginning in 2011, with a corresponding increase in the number of older drivers. The demographic shift has
important implications for licensing authorities, the regulatory bodies charged with licensing and 'fitness to drive'
decisions., OBJECTIVES: The objectives of this paper are to summarize the published scientific literature on licensing
policies and procedures currently in use for older drivers, discuss their limitations, and provide recommendations for
meeting the upcoming challenges of an aging baby boomer population of drivers., METHOD: Online searches were
conducted using the following databases: PsycINFO, MEDLINE, Scopus, and TRIS. Google and Google Scholar also
were searched for scientific articles. References identified from database and online searches were examined for
relevant articles., RESULTS: A number of studies have investigated the utility of different licensing policies and
procedures for identifying older drivers who may be at risk for impaired driving performance. Overall, results suggest
that current policies and procedures are ineffective in identifying high-risk older drivers. The results also emphasize
the need for a different approach for the identification of high risk older drivers by licensing agencies.
Recommendations to assist with that goal are provided., CONCLUSIONS: The aging of the baby boomer population,
combined with the projected high crash rates for this cohort of drivers as it moves through the senior years,
underscores the need for cost-effective, accurate, and efficient methods for identifying and assessing the subgroup
of older drivers whose driving has declined to an unsafe level. That subgroup consists of individuals with medical
conditions (and treatments) affecting driving performance. The demographic shift has been a blessing for licensing
authorities in that it has created awareness of the need for a reexamination of licensing policies and procedures
designed to identify those older drivers who may no longer be safe to drive. If that awareness becomes translated
into effective policies and procedures that appropriately target the medically at-risk/impaired older driver rather
than the older driver per se, the result will be an increase in the safety and mobility of the older driving population
and increased public safety overall. However, a continued focus on older drivers rather than medically at-risk drivers
will result in a costly, ineffective, and overburdened system.
Objective: Problems related to alcohol consumption are frequent, especially among the youth population. We
analyzed advertisement as one of several modifiable factors with impact over alcohol consumption. Method: The
authors carried out a literature review within Medline, SciELO, PsychoInfo and Google Scholar databases between
1990 and 2008, retrieving studies with different approaches of the alcohol advertisement impact on consumption.
Besides, a "snowball" technique was applied to identify the most proficuous authors on the matter. Over a hundred
papers were initially selected. Results: The overall set of papers indicate that factors such as exposition to the
advertising and attractiveness of the alcoholic beverage advertising are related with greater expectation of future
consumption and with a higher and precocious consumption of alcohol, specially among adolescents and young
adults. Despite methodological difficulties, recent econometrical studies indicate that reduction and/or banishment
of advertising would decrease alcohol consumption. We also consider issues about the neurophysiology of decision
making process and the freedom of choice in the context of exposition to advertisements. Conclusions: The current
knowledge on the matter strongly suggests that a reduction of the exposition to alcohol advertisements impacts on
its consumption, mainly among young populations.
Introduction and Aims. Alcohol is an established risk factor for liver cirrhosis. It remains unclear, however, whether
this relationship follows a continuous dose-response pattern or has a threshold.Also, the influences of sex and end-
point (i.e.mortality vs. morbidity) on the association are not known. To address these questions and to provide a
quantitative assessment of the association between alcohol intake and risk of liver cirrhosis, we conducted a
systematic review and meta-analysis of cohort and case-control studies. Design and Methods. Studies were
identified by a literature search of Ovid MEDLINE, EMBASE, Web of Science, CINAHL, PsychINFO, ETOH and Google
Scholar from January 1980 to January 2008 and by searching the references of retrieved articles. Studies were
included if quantifiable information on risk and related confidence intervals with respect to at least three different
levels of average alcohol intake were reported. Both categorical and continuous meta-analytic techniques were used
to model the dose-response relationship. Results. Seventeen studies met the inclusion criteria.We found some
indications for threshold effects. Alcohol consumption had a significantly larger impact on mortality of liver cirrhosis
compared with morbidity. Also, the same amount of average consumption was related to a higher risk of liver
cirrhosis in women than in men. Discussion and Conclusions. Overall, end-point was an important source of
heterogeneity among study results. This result has important implications not only for studies in which the burden of
disease attributable to alcohol consumption is estimated, but also for prevention. 2010 Australasian Professional
Society on Alcohol and other Drugs.
Objective: Piper has been used for long timelike condiment and food, but also in traditional medicine around of the
world. This work resumes the available and up to date work done on members of the Piperaceae family and their
uses for therapeutic purposes. Methods: Information on Piper genus was gathered via internet using scientific
databases such as Scirus, Google Scholar, CAB-abstracts, MedlinePlus, Pubmed, SciFinder, Scopus and Web of
Science. Results: The large-leafed perennial plant Piper is used for its spicy aromatic scent and flavor. It has an
important presence in the cuisine of different cultures. Another quality of these plants is their known medicinal
properties. It has been used as emollient, anti-rheumatic, diuretic, stimulant, abortifacient, anti-inflammatory,
antibacterial, antifungal and antidermatophytic. A survey of the literature shows that the genus Piper is mainly
known for its alkaloids with cytotoxic, chemopreventive, anti-metastatic and antitumor properties in several types of
cancer. Studies of its alkaloids highlight the existence of various potential leads to develop new anti-cancer agents.
Modern pharmacology studies have demonstrated that its crude extracts and active compounds possess wide
pharmacological activities, especially asantioxidant, anti-depressive, hepatoprotective, antimicrobial, anti-obesity,
neuropharmacological, to treat cognitive disorders, anti-hyperlipidemic, anti-feedant, cardioactive, immuno-
enhancing, and anti-inflammatory. All this evidence supporting its traditional uses. Aim of the review: This review
summarizes the up-to-date and comprehensive information concerning the botany, traditional use, phytochemistry
and pharmacology of Piper together with its toxicology, and discusses the possible trend and scope for further
research on Piper in the future. 2013 Bentham Science Publishers.
Peanut allergy is one of the most common forms of food allergy encountered in clinical practice. In most cases, it
does not spontaneously resolve; furthermore, it is frequently implicated in acute life-threatening reactions. The
current management of peanut allergy centres on meticulous avoidance of peanuts and peanut-containing foods.
Allergen-specific oral immunotherapy (OIT) for peanut allergy aims to induce desensitisation and then tolerance to
peanut, and has the potential to revolutionise the management of peanut allergy. However, at present there is still
considerable uncertainty about the effectiveness and safety of this approach. To establish the effectiveness and
safety of OIT in people with IgE-mediated peanut allergy who develop symptoms after peanut ingestion. We
searched in the following databases: AMED, BIOSIS, CAB, CINAHL, The Cochrane Library, EMBASE, Global Health,
Google Scholar, IndMed, ISI Web of Science, LILACS, MEDLINE, PakMediNet and TRIP. We also searched registers of
on-going and unpublished trials. The date of the most recent search was January 2012. Randomised controlled trials
(RCTs), quasi-RCTs or controlled clinical trials involving children or adults with clinical features indicative of IgE-
mediated peanut allergy treated with allergen-specific OIT, compared with control group receiving either placebo or
no treatment, were eligible for inclusion. Two review authors independently checked and reviewed titles and
abstracts of identified studies and assessed risk of bias. The full text of potentially relevant trials was assessed. Data
extraction was independently performed by two reviewers with disagreements resolved through discussion. We
found one small RCT, judged to be at low risk of bias, that enrolled 28 children aged 1 to 16 years with evidence of
sensitisation to peanut and a clinical history of reaction to peanut within 60 minutes of exposure. The study did not
include children who had moderate to severe asthma or who had a history of severe peanut anaphylaxis.
Randomisation was in a 2:1 ratio resulting in 19 children being randomised to the intervention arm and nine to the
placebo arm. Intervention arm children received OIT with peanut flour and control arm participants received placebo
comprising of oat flour. The primary outcome was assessed using a double-blind, placebo controlled oral food
challenge (OFC) at approximately one year. No data were available on longer term outcomes beyond the OFC
conducted at the end of the study.Because of adverse events, three patients withdrew from the intervention arm
before the completion of the study. Therefore, only 16 participants received the full course of peanut OIT, whereas
all nine patients receiving placebo completed the trial. The per-protocol analysis found a significant increase in the
threshold dose of peanut allergen required to trigger a reaction in those in the intervention arm with all 16
participants able to ingest the maximum cumulative dose of 5000 mg of peanut protein (which the authors equate as
being equivalent to approximately 20 peanuts) without developing symptoms, whereas in the placebo group they
BACKGROUND: Peanut allergy is one of the most common forms of food allergy encountered in clinical practice. In
most cases, it does not spontaneously resolve; furthermore, it is frequently implicated in acute life-threatening
reactions. The current management of peanut allergy centres on meticulous avoidance of peanuts and peanut-
containing foods. Allergen-specific oral immunotherapy (OIT) for peanut allergy aims to induce desensitisation and
then tolerance to peanut, and has the potential to revolutionise the management of peanut allergy. However, at
present there is still considerable uncertainty about the effectiveness and safety of this approach., OBJECTIVES: To
establish the effectiveness and safety of OIT in people with IgE-mediated peanut allergy who develop symptoms
after peanut ingestion., SEARCH METHODS: We searched in the following databases: AMED, BIOSIS, CAB, CINAHL,
The Cochrane Library, EMBASE, Global Health, Google Scholar, IndMed, ISI Web of Science, LILACS, MEDLINE,
PakMediNet and TRIP. We also searched registers of on-going and unpublished trials. The date of the most recent
search was January 2012., SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-RCTs or controlled clinical
trials involving children or adults with clinical features indicative of IgE-mediated peanut allergy treated with allergen-
specific OIT, compared with control group receiving either placebo or no treatment, were eligible for inclusion.,
DATA COLLECTION AND ANALYSIS: Two review authors independently checked and reviewed titles and abstracts of
identified studies and assessed risk of bias. The full text of potentially relevant trials was assessed. Data extraction
was independently performed by two reviewers with disagreements resolved through discussion., MAIN RESULTS:
We found one small RCT, judged to be at low risk of bias, that enrolled 28 children aged 1 to 16 years with evidence
of sensitisation to peanut and a clinical history of reaction to peanut within 60 minutes of exposure. The study did
not include children who had moderate to severe asthma or who had a history of severe peanut anaphylaxis.
Randomisation was in a 2:1 ratio resulting in 19 children being randomised to the intervention arm and nine to the
placebo arm. Intervention arm children received OIT with peanut flour and control arm participants received placebo
comprising of oat flour. The primary outcome was assessed using a double-blind, placebo controlled oral food
challenge (OFC) at approximately one year. No data were available on longer term outcomes beyond the OFC
conducted at the end of the study.Because of adverse events, three patients withdrew from the intervention arm
before the completion of the study. Therefore, only 16 participants received the full course of peanut OIT, whereas
all nine patients receiving placebo completed the trial. The per-protocol analysis found a significant increase in the
threshold dose of peanut allergen required to trigger a reaction in those in the intervention arm with all 16
participants able to ingest the maximum cumulative dose of 5000 mg of peanut protein (which the authors equate as
OBJECTIVE: To systematically review the allergic reactions associated with metal alloys in porcelain-fused-to-metal
(PFM) fixed prosthetic devices., METHOD AND MATERIALS: After reviewing the titles and abstracts of the articles as
well as removing duplicates, 22 articles were considered relevant. PubMed, Web of Science, ScienceDirect, and
Google Scholar from 1970 to 2012 were evaluated, and randomized studies, review articles, case reports, cross-
sectional surveys, and abstracts were included. Conference papers and posters were excluded., RESULTS: Although
reported, allergic reactions to metallic alloys in the context of PFM devices are not well documented. Allergic
reactions to high noble and noble metal alloy cores of palladium and gold and to base metal alloys nickel and cobalt
in the context of PFM fixed partial dentures (FPDs) are reported. Each type of metal is associated with a different
rate of allergic reactions, which may be attributed to the extent of corrosion of the alloy, population exposure, and
the biologic environment. Because few studies document allergic reactions to metals that comprise PFM crowns and
partial dentures, further research in this field is necessary to determine the frequency and type of reactions elicited.,
CONCLUSION: Though allergic reactions to metal alloys used in dentistry are well documented, only few articles
focus on the correlation between FPDs and metal allergies. Thus, this paper surveys case reports of hypersensitivity
reactions linked to FPDs and reviews the current literature on allergic reactions to the metallic elements comprising
those devices.
Few cases of graft posttransplant lymphoproliferative disease (PTLD) in pulmonary transplant recipients have been
reported. Published data on PTLD are pooled to analyze and compare characteristics, predictors, and prognosis of
pulmonary PTLDs arising in lung allograft recipients. PubMed and Google Scholar were searched for reports of
lymphoproliferative disorders occurring within the graft in lung transplant recipients. Data from 23 studies were
pooled and analyzed. Data from 137 patients (61 graft locations) with PTLD after lung transplantation were analyzed.
Lung recipients with pulmonary graft PTLD were significantly more likely to have early-onset PTLD (70% vs 31%,
respectively; P<.001). Lung graft PTLD also was associated with having tested negative for infection with Epstein-Barr
virus before transplantation (P=.05). Log-rank test showed significantly higher survival rates for pulmonary transplant
recipients with allograft complication than for recipients with PTLD elsewhere (P=.02). Pulmonary transplant
recipients who show early symptoms of impaired graft function should be evaluated for a potential lung graft PTLD in
addition to being assessed for risk of rejection. Further prospective studies with large populations of patients are
needed to confirm these results.
Radical cystectomy with lymphadenectomy and urinary diversion is the gold standard treatment for bladder cancer
in organ-confined muscle-invasive disease and selected patients who have high-grade non-muscle-invasive disease
or are non-responders to BCG. The main and most morbid complications of this challenging surgery are related to the
use of bowel for urinary tract reconstruction. For this reason, many past projects were devoted to finding an
alternative to the use of bowel. The aim of this review is to provide a summary of the evolution of alloplastic bladder
substitution. A comprehensive review of the literature was performed using the Medline National Library of
Medicine database and Google Scholar. Keyword used were cystectomy and intestine/bowel, replacement, bladder
substitution, organ replacement, artificial bladder, alloplastic material, biomaterial, and tissue engineering. Various
prostheses have been proposed for replacement of the urinary bladder, silicone being the most frequently used
material. The first published model of an alloplastic bladder was described by Bogash et al. in late 1959, while the
last, in 1996, was suggested by Rohrmann. Interprofessional collaboration, recent advances in technology, and tissue
engineering may help in developing suitable bladder prostheses. Urologists as well as engineers and the industry
need to give this matter serious attention. Springer Science+Business Media, B.V. 2012.
OBJECTIVE: To evaluate the safety, efficacy, and cost of alternate-day statin therapy in the treatment of
hyperlipidemia. DATA SOURCES: Systematic searches were conducted for primary literature sources involving
alternative statin regimens using PubMed, EMBASE, Google Scholar, and International Pharmaceutical Abstracts
(January 1966-March 2010). Articles selected were limited to those published in the English language. Reference
citations from relevant publications identified were also reviewed. STUDY SELECTION AND DATA EXTRACTION: All
English-language articles identified were reviewed and 17 trials (14 prospective and 3 retrospective) involving
alternate-day statin dosing were included. Studies involving alternative statin dosing regimens other than alternating
days were excluded from this review. DATA SYNTHESIS: Daily administration of statins is the standard of therapy
used to reduce low-density lipoprotein cholesterol (LDL-C) levels as well as atherosclerosis that may lead to coronary
events. Through LDL-C lowering and pleiotropic effects, statins decrease cardiovascular morbidity and mortality.
Unfortunately, due to cost and adverse effects of statins, some patients are nonadherent to statin therapy. Several
small studies have found alternate-day statin therapy to be as effective at reducing LDL-C as daily administration,
while also lowering the incidence of adverse reactions and potentially lowering cost. CONCLUSIONS: Alternate-day
statin therapy may decrease cost and therapy-limiting adverse reactions while potentially increasing regimen
adherence and positively affecting the lipid panel. Further research is needed to determine whether this alternative
regimen produces similar cardiovascular outcomes as those with daily statin therapy.
Objective: To summarize the existing evidence on the efficacy of therapy with alternating antipyretics compared to
monotherapy in the management of fever in children. Sources: MEDLINE, EMBASE, Cochrane Library, LILACS, SciELO,
IBECS, Web of Science, Clinical Trials, Google Scholar and references of the articles found. The review included
randomized clinical trials published until December 2011, in which one of the arms was the alternating antipyretics
therapy to treat fever in children younger than 12 years, treated on an outpatient basis. Data selection and
extraction were performed independently by two reviewers. The quality of the studies was assessed according to
CONSORT items. Summary of the findings: The selected studies showed great heterogeneity of participants,
temperature for fever diagnosis, interventions (dose and dosing intervals) and assessed outcomes. The treatment
groups ranged from 38 to 464 children. The studies compared paracetamol and ibuprofen alternated with
paracetamol and/or ibuprofen. Only one study used different doses from the 15 mg/kg for paracetamol and 10
mg/kg for ibuprofen, but the dosing intervals varied considerably. The alternate use with dipyrone or acetylsalicylic
acid was not assessed by any of the studies. Overall, the articles pointed to a tendency of lower mean temperatures
in groups with alternating therapy. Few adverse effects were reported. Conclusion: Although there was a tendency
towards the reduction of mean temperatures with alternating antipyretics compared to the use of one antipyretic
alone, there is not enough evidence to say that alternating antipyretic therapy is more effective than monotherapy.
Copyright by Sociedade Brasileira de Pediatria.
OBJECTIVE: To summarize the existing evidence on the efficacy of therapy with alternating antipyretics compared to
monotherapy in the management of fever in children., SOURCES: MEDLINE, EMBASE, Cochrane Library, LILACS,
SciELO, IBECS, Web of Science, Clinical Trials, Google Scholar and references of the articles found. The review
included randomized clinical trials published until December 2011, in which one of the arms was the alternating
antipyretics therapy to treat fever in children younger than 12 years, treated on an outpatient basis. Data selection
and extraction were performed independently by two reviewers. The quality of the studies was assessed according
to CONSORT items., SUMMARY OF THE FINDINGS: The selected studies showed great heterogeneity of participants,
temperature for fever diagnosis, interventions (dose and dosing intervals) and assessed outcomes. The treatment
groups ranged from 38 to 464 children. The studies compared paracetamol and ibuprofen alternated with
paracetamol and/or ibuprofen. Only one study used different doses from the 15 mg/kg for paracetamol and 10
mg/kg for ibuprofen, but the dosing intervals varied considerably. The alternate use with dipyrone or acetylsalicylic
acid was not assessed by any of the studies. Overall, the articles pointed to a tendency of lower mean temperatures
in groups with alternating therapy. Few adverse effects were reported., CONCLUSION: Although there was a
tendency towards the reduction of mean temperatures with alternating antipyretics compared to the use of one
antipyretic alone, there is not enough evidence to say that alternating antipyretic therapy is more effective than
monotherapy.
Background: Alternative medicines (AM) are commonly used by stroke patients in developing countries. AM's often
practiced in India are acupuncture, chiropractic, ayurvedic massage, homeopathy, diet and lifestyle changes, herbal
medicine, magnetic therapy, marma therapy, reiki therapy etc. Aim: To review the literature on the effectiveness of
AM to treat stroke patients in India. Methodology: We searched 'MEDLINE, PubMed, Google and Google scholar'
with various search terms related to AM and stroke in India. There were four randomized controlled trials, seven
research articles and four systemic reviews. Result: The effectiveness of acupuncture in stroke is controversial.
Massage has shown to be effective in stroke patients in reducing pain, anxiety, blood pressure and heart rate.
Massage of masseter muscle showed improvement in biting force in stroke patients. Some homeopathically
prepared remedies show promise for reducing infarct size and associated impairments. Certain vitamins have
recently been proposed to reduce the risk of stroke by lowering homocysteine levels. There is little evidence to
support the use of magnets in the treatment of stroke patients. Marma therapy may be beneficial to the patients.
There is no clear evidence for the effectiveness of reiki therapy in stroke treatment. Conclusion: Evidence for the
beneficial effect of AM's in the treatment of stroke from India is lacking. More randomized controlled trials with
adequate sample size are required to assess the effectiveness of AM in stroke treatment and recovery.
OBJECTIVE: To analyze publication rate, time to publication and the characteristics of the abstracts presented at the
annual Korean Academy of Rehabilitation Medicine (KARM) meetings., METHODS: A total of 1,027 abstracts
presented at the 2008 and 2009 annual KARM meetings were enrolled in the database and searched for their
subsequent citation in PubMed, KoreaMed, and Google Scholar., RESULTS: The data analysis revealed that 317
(30.87%) abstracts, were published as full-length journal articles and publication rates by subject were not
significantly different. The mean time to publication was 17.17+/-10.48 months, and the journals written in English
(20.39+/-10.20) required a longer duration than those written in Korean (11.94+/-8.44) with statistical significance
(p<0.001). There was no statistical difference (p=0.284) in the duration between domestic (17.61+/-10.37) and
foreign (16.48+/-10.51) of the 220 domestic journal articles, 190 (86.76%) were published in the Annals of
Rehabilitation Medicine and the 97 articles published in foreign journals were scattered over 60 different journals.,
CONCLUSION: The publication rate of abstracts presented at the 2008 and 2009 annual KARM meetings was 30.87%
and the mean time to publication was 17.17+/-10.48 months.
Background: Ventilator associated pneumonia (VAP) is a dynamic disease caused by a wide spectrum of pathogens
and associated with morbidity and mortality. Purpose: The study concerned with an analysis of VAP studies done in
Egyptian University Hospitals in the last 10. years to describe the magnitude of the problem of VAP as a complication
of mechanical ventilation, and to explore its predictors and most common causative organisms. Methods: To identify
relevant published studies we searched the medical literature for articles done in Egypt published during the past 10.
years, using midline PubMed and Google scholar, where the full text articles were downloaded. We also searched
the thesis discussed and passed (Registered) at the website of the Egyptian Universities libraries consortium visiting
the website of the supreme council of Egyptian Universities. Results: Most of the 37 studies on which analysis were
done were concerned with the risk factors, causative organisms, and incidence. The most common risk factors were
leukopenia, thrombocytopenia, high CRP, metabolic acidosis, nasal endotracheal intubation, re-intubation, prior
antibiotic use, and contaminated ICU environment with lack of infection control measures, use of antacids and H2
blocker, corticosteroids use, and coma. The most common causative organisms were Pseudomonas aerogenosa,
Klebsiella, Escherichia coli, Staphylococcus aureus, Acinetobacter, Candida and Proteus. Conclusion: It is important to
establish large-scale multi center national studies to explore incidence of VAP, all possible risk factors (whether
preventable or non preventable), causative organisms, and mortality due to VAP and its economic aspect. 2013 The
Egyptian Society of Chest Diseases and Tuberculosis.
Introduction - It is estimated that about 70-80% of the world's population relies on non-conventional medicine,
mainly of herbal origin. However, owing to the nature and sources of herbal medicines, they are sometimes
contaminated with toxic heavy metals such as lead, arsenic, mercury and cadmium, which impose serious health
risks to consumers. It is critical to analyse source materials for heavy metals in order to ensure that their
concentrations meet the related standards or regulations limiting their concentrations in herbal medicines. In this
review, different analytical methods for analysis of heavy metals in herbal medicines are discussed. Objective - To
provide a comprehensive review of the current state of the art in analytical methods used to detect heavy metals in
herbal medicines. Methodology - We systematically searched and reviewed the research articles regarding analytical
methods for heavy metals in herbal medicine from various databases, such as Medline/PubMed, ScienceDirect,
SciFinder, Google Scholar, EBSCO, Gale InfoTrac, Ingenta, Ovid, ProQuest and ISI Web of Knowledge. Results - In this
review, we discuss in detail several commonly used and sensitive analytical techniques, including atomic absorption
spectrometry, inductively coupled plasma optical emission spectrometry or mass spectrometry, X-ray fluorescence
spectrometry, high-performance liquid chromatography, differential pulse polarography, neutron activation analysis
and anodic stripping voltammetry. We also provide some application examples of these analytical techniques for
heavy metals in herbal medicines. Copyright 2011 John Wiley & Sons, Ltd.
Background: Emerging resistance to single agent aromatase inhibitors (AI) or fulvestrant as first line treatment for
postmenopausal women with advanced hormonal receptor positive breast cancer calls for alternative therapeutic
options. This meta-analysis studies the effectiveness of combination therapy with fulvestrant and an AI, as compared
to an AI alone in first line treatment of postmenopausal patients with hormonal receptor positive relapsed or
metastatic breast cancer. Methods: Literature search was performed using PubMed, Google Scholar, Embase, ASCO
and ESMO to search for studies published during the last 10 years using relevant keywords. Two prospective
randomized clinical trials were found to fulfill the search criteria for combination of fulvestrant + AI vs. AI alone (both
studied anastrozole in combination with fulvestrant). Meta-estimates were calculated by combining study estimates
using the DerSimonian and Laird random effects model. The linear mixed-effects model was used to generate 95%
prediction intervals for study-specific hazard and odds ratios. Results: Pooled hazard ratio for progression free
survival was 0.88 (95% CI 0.72-1.09, 95% prediction interval [PI] 0.65-1.21). Pooled HR for overall survival was 0.88
(95% CI 0.72-1.08, 95% PI 0.68-1.14). Pooled odds ratio for response rate was 1.13 (95% CI 0.79-1.63, 95% PI 0.78-
1.65). Conclusions: Pooled results showed a small, non-statistically significant, improvement in progression-free and
overall survival. These results do not support the use of combination therapy with fulvestrant and anastrozole in the
first line treatment of postmenopausal patients with hormonal receptor positive relapsed or metastatic breast
cancer.
Objective. Trigeminal Neuralgia, also called "Tic Doulourex", is recognized as the most severe facial pain known.
Martin Kirschner, multitalented German surgeon modified Hartel's puncture technique and developed a safe and
effective surgical procedure to treat Trigeminal Neuralgia (TN). This poster is to honour Kirschner's life and
contribution to neurosurgery due to the 80th anniversary of the first electro coagulation of the Gasserian Ganglion
by Kirschner in 1931. Methods. Selective literature research of books and journal articles via PubMed, Google Scholar
and Google. Results. Among the most remarkable achievements of Martin Kirschner was the first electro thermo
coagulation of the Gasserian Ganglion in 1931 in patients suffering from TN by using a stereotactical aiming device
especially invented for this surgery. He was successfully tapping the Foramen Ovale in over 90% by using this skull
fixed "frame". For electro coagulation he used a steel needle with an uninsulated tip. Five years later Kirschner
published 250 cases of TN he had successfully treated by this technique. Thermocoagulation in TN is worldwide used
and in selected cases the initial success rate is very high (85-95%) although long term follow-up evaluates a pain
recurrence in up to 50% after several years. Conclusion. Kirschner was one of the most important surgeons of the
first half of 20th century. In times of diversifying surgical specialties he was one of the rare who not only overlooked
but performed successfully also the newly emerging techniques. By applying electric coagulation Kirschner enabled
many patients a life without the severe stabbing "Tic douloureux".
CONTEXT: Doping with anabolic androgenic steroids (AAS) both in sports (especially power sports) and among
specific subsets of the population is rampant. With increasing availability of designer androgens, significant efforts
are needed by antidoping authorities to develop sensitive methods to detect their use. EVIDENCE ACQUISITION: The
PubMed and Google Scholar search engines were used to identify publications addressing various forms of doping,
methods employed in their detection, and adverse effects associated with their use. EVIDENCE SYNTHESIS: The list of
drugs prohibited by the World Anti-Doping Agency (WADA) has grown in the last decade. The newer entries into this
list include gonadotropins, estrogen antagonists, aromatase inhibitors, androgen precursors, and selective androgen
receptor modulators. The use of mass spectrometry has revolutionized the detection of various compounds;
however, challenges remain in identifying newer designer androgens because their chemical signature is unknown.
Development of high throughput bioassays may be an answer to this problem. It appears that the use of AAS
continues to be associated with premature mortality (especially cardiovascular) in addition to suppressed
spermatogenesis, gynecomastia, and virilization. CONCLUSION: The attention that androgen abuse has received
lately should be used as an opportunity to educate both athletes and the general population regarding their adverse
effects. The development of sensitive detection techniques may help discourage (at least to some extent) the abuse
of these compounds. Investigations are needed to identify ways to hasten the recovery of the gonadal axis in AAS
users and to determine the mechanism of cardiac damage by these compounds.
Background: Malaria has caused an estimated 190-311 million cases in year 2008 alone and around 1500 patients are
diagnosed with the disease annually in the United States. Out of these numbers, few of them have presented for
surgery. Malaria disease is a multi-organ systemic disease that may affect significantly patient's outcome after
surgery. It is therefore prudent for the anesthesiologists, from both the endemic and non-endemic area, to
understand the implication of the disease during the preoperative, intraoperative and postoperative course.
Methods: Google scholar, Medline and Cochrane data base search are performed using keywords malaria,
anesthesia, quinine, dapsone, clindamycin, mefloquine, surgery, wound healing, cardiopulmonary bypass and
obstetric. Bibliographies are systemically analyzed and grouped base on clinical presentation and potential anesthetic
implication.
BACKGROUND: Malaria has caused an estimated 190-311 million cases in year 2008 alone and around 1500 patients
are diagnosed with the disease annually in the United States. Out of these numbers, few of them have presented for
surgery. Malaria disease is a multi-organ systemic disease that may affect significantly patient's outcome after
surgery. It is therefore prudent for the anesthesiologists, from both the endemic and non-endemic area, to
understand the implication of the disease during the preoperative, intraoperative and postoperative course.
METHODS: Google scholar, Medline and Cochrane data base search are performed using
OBJECTIVE: To investigate the association between angiotensinogen gene M235T polymorphism and ischemic stroke
in East Asians. DATA RETRIEVAL: A computer-based online search was conducted in PubMed, Google scholar, China
National Knowledge lnfrastructure database between January 1990 and April 2012 for relevant studies. The key
words were angiotensinogen or AGT, polymorphism or genetic and ischemic stroke or cerebral infarction. SELECTION
CRITERIA: Case-controlled studies addressing the correlation between angiotensinogen gene M235T polymorphism
and ischemic stroke in East Asians were included. The distribution of genotypes in the included studies was tested for
Hardy-Weinberg equilibrium. Quality evaluation of the included studies was conducted by two physicians. Statistical
analyses were carried out using Stata 12.0 software for meta-analysis. Heterogeneity tests, sensitivity analysis and
publication bias were also conducted. MAIN OUTCOME MEASURES: The association between angiotensinogen gene
M235T polymorphism and ischemic stroke risk in East Asians was assessed. RESULTS: Six relevant studies involving
891 patients with ischemic stroke and 727 controls were included in this meta-analysis. Results showed that there
was a significant association between angiotensinogen gene M235T polymorphism and the risk of ischemic stroke in
East Asians (T vs. M: odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.10-2.16; TT vs. MM: OR = 2.24, 95%CI =
1.37-3.66; TT vs. MT: OR = 1.76, 95%CI = 1.41-2.20; MM + MT vs. TT: OR = 0.57, 95%CI = 0.46-0.70). Sensitivity
analysis confirmed that the study results were stable and reliable, with no publication bias. CONCLUSION: The
angiotensinogen gene M235T polymorphism is associated with ischemic stroke in East Asians, and the TT genotype
and T allele are risk factors for ischemic stroke.
Aim The most commonly preformed operation for obesity is the Roux-en Y gastric bypass. There are two principle
variations of this procedure, antecolic and retrocolic, depending on the Roux Limb orientation.The aim of this study is
to compare clinical and technical outcomes between retrocolic and antecolic gastric bypass procedures. Methods An
electronic search of PubMed, MEDLINE, Ovid, Embase and Google Scholar was performed utilizing keywords agreed
in consensus by all Co-Authors. Relevant articles were assessed by two independent reviewers. Comparative studies
(randomised and non-randomised control trials) of antecolic and retrocolic gastric bypass surgery for obesity were
included. Individual case series of antecolic and retrocolic techniques were also identified and assessed. Data
Extraction Data was extracted by two independent investigators. Disagreements were resolved by a third Co-Author.
Inclusion and exclusion criteria were clearly outlined in advance. Outcomes of interest included technical operative
endpoints and post-operative complications. Results A total of 12 studies including one RCT were identified.
Metaanalysis demonstrated a significant reduction in post-operative small bowel obstruction associated with the
antecolic technique (RR 0.33, 95 % CI 0.23 - 0.47, fixed effects analysis). Incidence of internal herniation was also
significantly reduced in the antecolic patient groups (RR 0.55, 95%CI 0.37 - 0.81, fixed effects analysis), as was overall
operative time (WMD -16.39 minutes, 95%CI -22.25 to -10.53, fixed effects analysis). Conclusion This study suggests
that antecolic bypass surgery is associated with a reduction in postoperative small bowel obstruction and faster
operative times. Large randomized controlled trials are required to investigate this relationship further.
Introduction: The most commonly preformed operation for obesity is the laparoscopic Roux-en Y gastric bypass
(LRYGB). There are two principle variations of LRYGB, antecolic and retrocolic, depending on the orientation of the
Roux limb. The aim of this study is to compare clinical and technical outcomes between retrocolic and antecolic
LRYGB procedures. Methods: An electronic search of PubMed, MEDLINE, Ovid, Embase and Google Scholar was
performed utilizing keywords/ phrases agreed in consensus by all authors. Relevant articles were assessed by two
independent reviewers. Comparative studies (randomised and non-randomised control trials) of antecolic and
retrocolic gastric bypass surgery for obesity were included. Individual case series of antecolic and retrocolic
techniques were also identified and assessed. Inclusion and exclusion criteria were clearly outlined in advance. Data
on technical and clinical outcomes was extracted and tabulated by both investigators. Outcomes of interest included
technical operative endpoints and post-operative complications. Results: A total of 12 studies including one RCT
were identified. Meta-analysis demonstrated a significant reduction in post-operative small bowel obstruction
associated with the antecolic technique (RR 0.33, 95% CI 0.23 - 0.47, fixed effects analysis). Incidence of internal
herniation was also significantly reduced in the antecolic patient groups (RR 0.55, 95%CI 0.37 - 0.81, fixed effects
analysis), as was overall operative time (WMD 16.39 minutes, 95%CI 22.25 to 10.53, fixed effects analysis).
Conclusions: This study suggests that antecolic LRYGB surgery is associated with a reduction in postoperative small
bowel obstruction and faster operative times. Large randomized controlled trials are required to investigate this
relationship further.
This paper reviews the world anthropology of drugs and alcohol use literature, identifying key issues addressed by
anthropologists, methods and theoretical models in use, trends in focus over time and future directions. Papers and
books that comprise the literature were identified through computer search using the keywords: ethnography of
drug use (and variants, e.g. drug ethnography, qualitative approaches in drug research), ethnography of drinking,
anthropology and drug use, and anthropology and drinking. Search engines included Google Scholar, EBSCOHost,
AnthroSource and PubMed. Identified sources were read and integrated into the review. The literature search
identified a rich and growing literature on the anthropology of drinking and drug use. The research and published
literature on the anthropology of drug use has grown and diversified since the 1970s, found acceptance in the wider
multi-disciplinary domain of alcohol and drug studies and developed beyond the socio-cultural model to include life-
style, critical medical anthropology and experiential explanatory models. Anthropological research has helped to
shape the field of addiction science, e.g. ethnographic studies show that the lived worlds and self-identities of drug
users have cultural order and socially constructed purpose and meaning, and experiential research shows that some
addictions or aspects of addictions can be affirmative, creative and sustainable, at least at the individual level. The
human immunodeficiency virus/acquired immune deficiency syndrome pandemic has significantly increased
anthropological research on drug-related issues world-wide. 2012 The Author, Addiction 2012 Society for the Study
of Addiction.
Background: The use of prophylactic systemic antibiotics to prevent infection and reduce mortality in severe acute
pancreatitis (SAP) remains a contentious issue. We assessed the clinical outcome of patients with SAP treated with
prophylactic antibiotics compared with that of patients not treated with antibiotics. Methods: We performed a
systematic search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, using PubMed,
Google Scholar, and Ovid as search engines without language restriction until the end of May 2008. We also
manually searched the references of original/review articles and evaluated symposia proceedings, poster
presentations, and abstracts from major gastrointestinal and surgical meetings. Relative risks were calculated for
individual trials and data were pooled using a fixed-effects model. Relative risk (RR) reduction, absolute risk
reduction, and number needed to treat were calculated and are reported with 95% confidence intervals. Results:
Results were subjected to sensitivity analysis to determine heterogeneity among studies. We pooled 502 patients
from 8 studies. Patient age ranged from 43 to 59 years, and length of stay ranged from 18 to 95 days. There were
253 patients with SAP who received prophylactic antibiotics, and 249 patients were randomized to the placebo arm.
Overall, there was no protective effect of antibiotic treatment with respect to mortality (RR, .76; 95% confidence
interval [CI], .49-1.16). With respect to morbidity, antibiotic prophylaxis did not protect against infected necrosis (RR,
.79; 95% CI, .56-1.11) or surgical intervention (RR, .88; 95% CI, .65-1.20). There was, however, an apparent benefit in
regards to nonpancreatic infections (RR, .60; 95% CI, .44-.82), with a RR reduction of 40% (95% CI, 18%-56%),
absolute risk reduction of 15% (95% CI, 6%-23%), and number needed to treat of 7 (95% CI, 4-17). Conclusions:
Antibiotic prophylaxis of SAP does not reduce mortality or protect against infected necrosis, or frequency of surgical
intervention. 2009 Elsevier Inc. All rights reserved.
Introduction: The common occurrence of infectious diseases in nursing homes and residential care facilities may
result in substantial antibiotic use, and consequently antibiotic resistance. Focusing on these settings, this article
aims to provide a comprehensive overview of the literature available on antibiotic use, antibiotic resistance, and
strategies to reduce antibiotic resistance. Methods: Relevant literature was identified by conducting a systematic
search in the MEDLINE and EMBASE databases. Additional articles were identified by reviewing the reference lists of
included articles, by searching Google Scholar, and by searching Web sites of relevant organizations. Results: A total
of 156 articles were included in the review. Antibiotic use in long term care facilities is common; reported annual
prevalence rates range from 47% to 79%. Part of the prescribed antibiotics is potentially inappropriate.The
occurrence of antibiotic resistance is substantial in the long term care setting. Risk factors for the acquisition of
resistant pathogens include prior antibiotic use, the presence of invasive devices, such as urinary catheters and
feeding tubes, lower functional status, and a variety of other resident- and facility-related factors. Infection with
antibiotic-resistant pathogens is associated with increased morbidity, mortality, and health care costs.Two general
strategies to reduce antibiotic resistance in long term care facilities are the implementation of infection control
measures and antibiotic stewardship. Conclusion: The findings of this review call for the conduction of research and
the development of policies directed at reducing antibiotic resistance and its subsequent burden for long term care
facilities and their residents. 2012 American Medical Directors Association.
BACKGROUND: Acute laryngitis is a common illness worldwide. Diagnosis is often made by case history alone and
treatment is often directed towards controlling symptoms. OBJECTIVES: The aim of this review was to assess the
effectiveness of different antibiotic therapies in adults suffering acute laryngitis. A secondary objective was to report
the rates of adverse events associated with these treatments. SEARCH STRATEGY: We systematically screened the
following electronic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4,
2006); MEDLINE (January 1966 to December Week 2 2006); and EMBASE (1974 to June 2006), LILACS (from 1982 to
December 2006 ) and BIOSIS (1980 to June 2002). Other strategies included hand searching relevant journals,
searching ongoing trial databases and general databases such as Google scholar. SELECTION CRITERIA: Randomized
controlled trials comparing any antibiotic therapy with placebo in acute laryngitis. The main outcome measurement
was objective voice scores. DATA COLLECTION AND ANALYSIS: Data were independently extracted by two review
authors and then descriptively synthesized. MAIN RESULTS: Only two trials met study inclusion criteria after
extensive literature searches. One hundred participants were randomly selected to receive either penicillin V (800
mg twice a day for five days), or an identical placebo, in a study of penicillin V in acute laryngitis in adults. A tape
recording of each patient reading a standardized text was obtained during the first visit, subsequently during re-
examination after one and two weeks, and at follow up after two to six months. No significant differences were
found between the groups. The trial also measured symptoms reported by participants and found no significant
differences.The second trial investigated erythromycin for treating acute laryngitis in 106 adults. The mean objective
voice scores measured at the first visit, at re-examination after one and two weeks, and at follow up after two to six
months did not significantly differ between control and intervention groups. At one week there were significant
beneficial differences in the severity of reported vocal symptoms as judged by the participants (P = 0.042).
Comparing the erythromycin and placebo groups on subjective voice scores the a priori relative risk (RR) was 0.7
(95% confidence interval (CI) 0.51 to 0.96, P = 0.034) and the number needed to treat (NNT) was 4.5. AUTHORS'
CONCLUSIONS: Antibiotics appear to have no benefit in treating acute laryngitis. Erythromycin could reduce voice
disturbance at one week and cough at two weeks when measured subjectively. We consider that these outcomes are
not relevant in clinical practice. The implications for practice are that prescribing antibiotics should not be done in
the first instance as they will not objectively improve symptoms.
Background: While incision and drainage (I&D) alone has been the mainstay of management of uncomplicated
abscesses for decades, some advocate for adjunct antibiotic use, arguing that available trials are underpowered and
that antibiotics reduce treatment failures and recurrence. Objectives: To investigate the role of antibiotics in addition
to I&D in reducing treatment failure as compared to management with I&D alone. Methods: We performed a search
using MEDLINE, EMBASE, Web of Knowledge, and Google Scholar databases (with a medical librarian) to include
trials and observational studies analyzing the effect of antibiotics in human subjects with skin and soft-tissue
abscesses. Two investigators independently reviewed all the records. We performed three overlapping meta-analy-
ses: 1. Only randomized trials comparing antibiotics to placebo on improvement of the abscess during standard
follow-up. 2. Trials and observational studies comparing appropriate antibiotics to placebo, no antibiotics, or
inappropriate antibiotics (as gauged by wound culture) on improvement during standard follow- up. 3. Only trials,
but broadened outcome to include recurrence or new lesions during a longer follow- up period as treatment failure.
We report pooled risk ratios (RR) using a fixed-effects model for our point estimates with Shore-adjusted 95%
confidence intervals (CI). Results: We screened 1,937 records, of which 12 studies fit inclusion criteria, 9 of which
were meta-analyzed (5 trials, 4 observational studies) because they reported results that could be pooled. Of the 9
studies, 5 enrolled subjects from the ED, 2 from a soft-tissue infection clinic, and 2 from a general hospital without
definition of enrollment site. Five studies enrolled primarily adults, 3 pediatrics, and 1 without specification of ages.
After pooling results for all randomized trials only, the RR = 1.03 (95% CI: 0.97-1.08). Exposure being "appropriate"
antibiotics (using trials and observational studies) resulted in a pooled RR = 1.01 (95% CI: 0.98-1.03). When we
broadened our treatment failure criteria to include recurrence or new lesions at longer lengths of follow-up (trials
only), we noted a RR = 1.05 (95% CI: 0.97-1.15). Conclusion: Based on available literature pooled for this analysis,
there is no evidence to suggest any benefit from antibiotics in addition to I&D in the treatment of skin and soft tissue
abscesses.
Recent studies have linked infectious agents to schizophrenia. The largest number of studies has involved the
analysis of Toxoplasma gondii; these studies were subjected to a meta-analysis. Published articles and abstracts were
identified by searches of MEDLINE, Ovid, and Google Scholar; by a search of Chinese publications; through letters to
researchers; and by visiting China. Published and unpublished controlled studies that used serological methods for
measuring T. gondii antibodies to assess inpatients and/or outpatients diagnosed with schizophrenia were selected
for analysis, and source documents were translated as needed. Forty-two studies carried out in 17 countries over 5
decades were identified; 23 of these (6 unpublished) met selection criteria. The combined odds ratio (OR) was 2.73
(95% confidence interval, 2.10 to 3.60; chi-square with 1 df 263; P <. 000001). Seven studies that included only
patients with first-episode schizophrenia (OR 2.54) did not differ significantly from 16 studies that included patients
in all clinical phases (OR 2.79). The results suggest that individuals with schizophrenia have an increased prevalence
of antibodies to T. gondii. This association is consistent with other epidemiological studies as well as with animal
studies. Although the OR of 2.73 is modest, it exceeds that for genetic or other environmental factors identified to
date and suggests that Toxoplasma is in some way associated with a large number of cases of schizophrenia. If an
etiological association can be proven, it would have implications for the design of measures for the prevention and
treatment of this disease. The Author 2006. Published by Oxford University Press on behalf of the Maryland
Psychiatric Research Center. All rights reserved.
Recent studies have linked infectious agents to schizophrenia. The largest number of studies has involved the
analysis of Toxoplasma gondii; these studies were subjected to a meta-analysis. Published articles and abstracts were
identified by searches of MEDLINE, Ovid, and Google Scholar; by a search of Chinese publications; through letters to
researchers; and by visiting China. Published and unpublished controlled studies that used serological methods for
measuring T. gondii antibodies to assess inpatients and/or outpatients diagnosed with schizophrenia were selected
for analysis, and source documents were translated as needed. Forty-two studies carried out in 17 countries over 5
decades were identified; 23 of these (6 unpublished) met selection criteria. The combined odds ratio (OR) was 2.73
(95% confidence interval, 2.10 to 3.60; chi-square with 1 df 263; P < .000001). Seven studies that included only
patients with first-episode schizophrenia (OR 2.54) did not differ significantly from 16 studies that included patients
in all clinical phases (OR 2.79). The results suggest that individuals with schizophrenia have an increased prevalence
of antibodies to T. gondii. This association is consistent with other epidemiological studies as well as with animal
studies. Although the OR of 2.73 is modest, it exceeds that for genetic or other environmental factors identified to
date and suggests that Toxoplasma is in some way associated with a large number of cases of schizophrenia. If an
etiological association can be proven, it would have implications for the design of measures for the prevention and
treatment of this disease.
Mangrove plants are specialised plants that grow in the tidal coasts of tropic and subtropic regions of the world.
Their unique ecology and traditional medicinal uses of mangrove plants have attracted the attention of researchers
over the years, and as a result, reports on biological activity of mangrove plants have increased significantly in recent
years. This review has been set out to compile and appraise the results on antinociceptive, anti-inflammatory, and
antipyretic activity of mangrove plants. While the Web of Knowledge, Google Scholar, and PubMed were the starting
points to gather information, other pieces of relevant published literature were also adequately explored for this
purpose. A total of 29 reports on 17 plant species have been found to report such activities. While 19 reports were
on the biological activity of the crude extracts, 10 reports identified the active compound(s) of various chemical
classes of natural products including terpenes, steroids, and flavonoids. This review finds that antinociceptive, anti-
inflammatory, and antipyretic activity appears to be widespread in mangrove plants. Copyright 2012 J. A. Shilpi et al.
Introduction: Free radical reactions have been implicated in the pathology of more than 50 human diseases including
cardiovascular diseases. Experimental and clinical studies suggest that oxidative stress contributes to the
development and progression of cardiac and vascular abnormalities in different types of cardiovascular diseases. The
dietary and supplemental intake of antioxidant vitamins (E, C, niacin) reduces the manifestations of atherosclerosis
and inflammatory response in patients with heart failure; improves endothelial functionality. Angiotensin -
converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, alpha receptor
blockers have antioxidant properties which play an important role in treatment of cardiovascular diseases. The aim
of this paper is to systematize research (1991 - 2011) on antioxidant properties of cardiovascular drugs and the
relation with their effects. Materials and methods: Subject of review were publications from in vitro, animal and
clinical studies that examine antioxidant properties of cardiovascular medicines. Publications from Scopus,
ScienceDirect and Google Scholar (1991 - 2011) were systemized according to the type of study, investigated drug
and relation to antioxidant properties. Results: A total of 75 publications were reviewed. 25 drugs were studied for
antioxidant properties in hypertension, heart failure, coronary disease treatment. The potential role of the
antioxidant actions of carvedilol in prevention of apoptotic cell death in heart failure was discussed. Amlodipine,
diltiazem, metoprolol, nebivolol, verapamil, trimetazidine antioxidant effects' studies were examined. Special
attention is given to antithrombotic drug dipyridamole; the role of probucol and multivitamins in the prevention of
restenosis after coronary angioplasty; pleiotropic effects of statins. Conclusions: Understanding the antioxidant
effects of particular cardiovascular medicines is important to optimize their use in treatment and prevention of
cardiovascular diseases. Although experimental evidence is promising, more clinical trials are needed to clarify the
exact role of oxidative stress in cardiovascular diseases and the potential benefits of antioxidant intervention.
BACKGROUND AND OBJECTIVES: Patients with end stage renal disease (ESRD) are often prescribed antiplatelet
medications. However, these patients are also at increased risk of bleeding compared with the general population,
and an aim was made to quantify this risk with antiplatelet agents. DESIGN, SETTING, PARTICIPANTS, &
MEASUREMENTS: A systematic review of the literature (Medline, EMBASE, Cochrane CENTRAL and Google Scholar
databases) was done to determine the bleeding risk in ESRD patients prescribed antiplatelet therapy. The secondary
outcome was the effect on access thrombosis. All case series, cohort studies and clinical trials were considered if
they included ten or more ESRD patients, assessed bleeding risk with antiplatelet agents, and lasted for more than 3
mo. RESULTS: Sixteen studies, including 40,676 patients, were identified that met predefined inclusion criteria. Due
to study heterogeneity and weaknesses in methodology, bleeding rates were not pooled across studies. However,
the bleeding risk appears to be increased for hemodialysis patients treated with combination antiplatelet therapy.
The results are mixed for studies using a single antiplatelet agent. Antiplatelet agents appear to be effective in
preventing shunt and central venous catheter thrombosis, but not for preventing thrombosis of arteriovenous grafts.
CONCLUSION: The risks and benefits of antiplatelet agents in ESRD patients remain poorly defined. Until a clinical
trial addresses this in the dialysis population, individual risk stratification taking into account the increased risk of
bleeding should be considered before initiating antiplatelet agents, especially in combination therapy.
Background: Despite revascularisation, outcomes among patients presenting with ST-elevation myocardial infarction
(STEMI) remain suboptimal. Scope: This review compares clopidogrel, ticagrelor and prasugrel as antiplatelet
strategies with a particular focus on STEMI. Medline and Google Scholar were searched for relevant terms and
citations from these articles were also assessed. Findings: While clopidogrel represented an important therapeutic
advance, variations in platelet response and a relatively slow onset of action compromise outcomes in some
patients. Ticagrelor and prasugrel are more effective than clopidogrel, although essentially only one large study
supports each drug. Nevertheless, a detailed examination of the evidence reveals several issues that may influence
the decision to prescribe ticagrelor instead of prasugrel and vice versa. Arguably, prasugrel could be the preferred
strategy in STEMI, reflecting the drugs' efficacy in clopidogrel-nave patients, the most common group in clinical
practice. Conversely, ticagrelor may be a better option than clopidogrel in clopidogrel-pretreated patients showing a
mortality benefit irrespective of clopidogrel pre-treatment. The clinical benefits offered by prasugrel and ticagrelor
need to be offset against the increased cost and we suggest an algorithm for using these new compounds in the
primary percutaneous coronary intervention (PCI) setting. The risk of bleeding associated with prasugrel is similar to
that of clopidogrel and ticagrelor following exclusion of at-risk patients. Nevertheless, prasugrel may be especially
appropriate for STEMI patients undergoing PCI who are considered to be at high risk of ischaemia. Conversely,
ticagrelor's short half-life, while potentially a limitation during maintenance therapy, may reduce bleeding risk if the
patient undergoes CABG during the same hospital admission, although confirmatory studies are needed. Conclusion:
Future studies also need to address several other outstanding issues, such as the subsequent approach if patients do
not undergo PCI, and to overcome limitations in and differences between the primary studies. In particular, head-to-
head comparisons need to compare directly the risks and benefits of ticagrelor and prasugrel in STEMI patients.
These caveats notwithstanding, ticagrelor and prasugrel markedly improve the prognosis for patients with STEMI.
2012 Informa UK Ltd.
BACKGROUND: Despite revascularisation, outcomes among patients presenting with ST-elevation myocardial
infarction (STEMI) remain suboptimal., SCOPE: This review compares clopidogrel, ticagrelor and prasugrel as
antiplatelet strategies with a particular focus on STEMI. Medline and Google Scholar were searched for relevant
terms and citations from these articles were also assessed., FINDINGS: While clopidogrel represented an important
therapeutic advance, variations in platelet response and a relatively slow onset of action compromise outcomes in
some patients. Ticagrelor and prasugrel are more effective than clopidogrel, although essentially only one large study
supports each drug. Nevertheless, a detailed examination of the evidence reveals several issues that may influence
the decision to prescribe ticagrelor instead of prasugrel and vice versa. Arguably, prasugrel could be the preferred
strategy in STEMI, reflecting the drugs' efficacy in clopidogrel-naive patients, the most common group in clinical
practice. Conversely, ticagrelor may be a better option than clopidogrel in clopidogrel-pretreated patients showing a
mortality benefit irrespective of clopidogrel pre-treatment. The clinical benefits offered by prasugrel and ticagrelor
need to be offset against the increased cost and we suggest an algorithm for using these new compounds in the
primary percutaneous coronary intervention (PCI) setting. The risk of bleeding associated with prasugrel is similar to
that of clopidogrel and ticagrelor following exclusion of at-risk patients. Nevertheless, prasugrel may be especially
appropriate for STEMI patients undergoing PCI who are considered to be at high risk of ischaemia. Conversely,
ticagrelor's short half-life, while potentially a limitation during maintenance therapy, may reduce bleeding risk if the
patient undergoes CABG during the same hospital admission, although confirmatory studies are needed.,
CONCLUSION: Future studies also need to address several other outstanding issues, such as the subsequent
approach if patients do not undergo PCI, and to overcome limitations in and differences between the primary
studies. In particular, head-to-head comparisons need to compare directly the risks and benefits of ticagrelor and
prasugrel in STEMI patients. These caveats notwithstanding, ticagrelor and prasugrel markedly improve the
prognosis for patients with STEMI.
Purpose: To determine whether fever control with antipyretic therapy effects the mortality of febrile critically ill
adults. Methods: Systematic review using MEDLINE, EMBASE, Cochrane Central Register for Controlled Trials,
CINAHL, Google Scholar, and 2 clinical trial registries from inception to April 2012. Randomized clinical trials
comparing treatment of fever with no treatment or comparing different thresholds for fever control in adults
without acute neurological injury admitted to intensive care units (ICUs) were selected for review. The effect of fever
control on all-cause ICU-mortality was determined using a random effects meta-analysis. Results: Five randomized
clinical trials in 399 patients were included. The temperature threshold for treatment in the intervention group was
commonly 38.3degreeC to 38.5degreeC, whereas it was typically 40.0degreeC for controls. Four studies used
physical measures and 3 used pharmacologic measures for temperature control. There was no significant
heterogeneity among the included studies (I2 = 12.5%, P = .3). Fever control did not significantly effect ICU mortality
with a pooled risk ratio of 0.98 (95% confidence interval 0.58-1.63, P = .9). Conclusions: This meta-analysis found no
evidence that fever treatment influences mortality in critically ill adults without acute neurological injury. However,
studies were underpowered to detect clinically important differences. 2013 Elsevier Inc.
PURPOSE: Antiseptic mouth rinses are widely recommended and marketed to improve oral health. This article
summarizes current studies on the comparative effectiveness of selected antiseptic mouth rinses in controlling
plaque and gingivitis, as well as risks associated with daily exposure, including salivary flow rate, oral cancer and wear
of composite restorations., METHODS: Electronic database searches were conducted using Google Scholar and
PubMed to identify articles comparing the effectiveness of 4 commercially marketed antiseptic mouth rinses
differing in active ingredients (0.12% chlorhexidine gluconate, essential oils (menthol, thymol and eucalyptol) and
methyl salicylate, 0.7% cetylpyridinium chloride and 20% aloe vera gel) for controlling plaque and gingivitis. Criteria
for inclusion included controlled clinical trials and systematic reviews appearing in English language publications
evaluating the comparative effectiveness of the mouth rinses in controlling plaque and gingivitis, as well as risks
associated with daily usage., RESULTS: The majority of studies have shown mouth rinses containing chlorhexidine
gluconate or essential oils and methyl salicylate provide clinically significant anti-gingivitis and anti-plaque benefits.
Cetylpyridinium chloride has been found to provide only limited clinical benefits compared to inactive control mouth
rinse. Inadequate evidence is available to evaluate the clinical effectiveness of aloe vera gel. Chlorhexidine, essential
oils and cetylpyridinium have been found to be safe. However, limited data are available on the effects of the mouth
rinse on wear patterns of dental restorations. Studies reviewed reported no significant difference in salivary flow rate
related to alcohol based mouth rinse., CONCLUSION: Research supports the effectiveness of antiseptic mouth rinses
in reducing plaque and gingivitis as an adjunct to home care. Insufficient evidence is available to support the claim
that oral antiseptics can reduce the risk of developing periodontitis or the rate of progression of periodontitis.
Prolonged labour can lead to increased maternal and neonatal mortality and morbidity due to increased risks of
maternal exhaustion, postpartum haemorrhage and sepsis, fetal distress and asphyxia and requires early detection
and appropriate clinical response. The risks for complications of prolonged labour are much greater in poor resource
settings. Active management of labour versus physiological, expectant management, has shown to decrease the
occurrence of prolonged labour. Administering antispasmodics during labour could also lead to faster and more
effective dilatation of the cervix. Interventions to shorten labour, such as antispasmodics, can be used as a
preventative or a treatment strategy in order to decrease the incidence of prolonged labour. As the evidence to
support this is still largely anecdotal around the world, there is a need to systematically review the available evidence
to obtain a valid answer. To assess the effects of antispasmodics on labour in term pregnancies. We searched the
Cochrane Pregnancy and Childbirth Group's Trials Register (2 September 2011), the ProQuest dissertation and thesis
database, the dissertation database of the University of Stellenbosch (2 September 2011), Google Scholar (2
September 2011) and reference lists of articles. We also contacted pharmaceutical companies and experts in the
field. We did not apply language restrictions. Randomised controlled trials comparing antispasmodics with placebo or
no medication in women with term pregnancies. Two review authors independently screened abstracts and selected
studies for inclusion, assessed risk of bias and extracted data. Data were checked for accuracy. We contacted trial
authors when data were missing. Nineteen trials (n = 2798) were included in the review. Fifteen trials (n = 2129)
were included in the meta-analysis. Antispasmodics used included valethamate bromide, hyoscine butyl-bromide,
drotaverine hydrochloride, rociverine and camylofin dihydrochloride. Most studies included antispasmodics as part
of their package of active management of labour. Overall, the quality of studies was poor, as only four trials were
assessed as low risk of bias. Eleven trials (n = 1507) reported on the duration of first stage of labour, which was
significantly reduced by an average of 65.80 minutes when antispasmodics were administered (mean difference
(MD) -65.80 minutes; 95% confidence Interval (CI) -92.32 to -39.28). Seven studies (n = 797) reported on the total
duration of labour, which was significantly reduced by an average of 85.51 minutes (MD -85.51 minutes; 95% CI -
121.81 to -49.20). Five studies (n = 632) had data for the outcome: rate of cervical dilatation. Administration of
antispasmodics significantly increased the rate of cervical dilatation by an average of 0.55 cm/h (MD 0.55 cm/h; 95%
CI 0.22 to 0.87). Antispasmodics did not affect the duration of second and third stage of labour. The rate of normal
vertex deliveries was not affected either. Only one study explored pain relief following administration of
antispasmodics and no conclusions can be drawn on this outcome. There was significant heterogeneity for most
BACKGROUND: Prolonged labour can lead to increased maternal and neonatal mortality and morbidity due to
increased risks of maternal exhaustion, postpartum haemorrhage and sepsis, fetal distress and asphyxia and requires
early detection and appropriate clinical response. The risks for complications of prolonged labour are much greater
in poor resource settings. Active management of labour versus physiological, expectant management, has shown to
decrease the occurrence of prolonged labour. Administering antispasmodics during labour could also lead to faster
and more effective dilatation of the cervix. Interventions to shorten labour, such as antispasmodics, can be used as a
preventative or a treatment strategy in order to decrease the incidence of prolonged labour. As the evidence to
support this is still largely anecdotal around the world, there is a need to systematically review the available evidence
to obtain a valid answer., OBJECTIVES: To assess the effects of antispasmodics on labour in term pregnancies.,
SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2013),
the ProQuest dissertation and thesis database, the dissertation database of the University of Stellenbosch and
Google Scholar (28 February 2013) and reference lists of articles. We also contacted pharmaceutical companies and
experts in the field. We did not apply language restrictions., SELECTION CRITERIA: Randomised controlled trials
comparing antispasmodics with placebo or no medication in women with term pregnancies., DATA COLLECTION AND
ANALYSIS: Two review authors independently screened abstracts and selected studies for inclusion, assessed risk of
bias and extracted data. Data were checked for accuracy. We contacted trial authors when data were missing., MAIN
RESULTS: Twenty-one trials (n = 3286) were included in the review. Seventeen trials (n = 2617) were included in the
meta-analysis. Antispasmodics used included valethamate bromide, hyoscine butyl-bromide, drotaverine
hydrochloride, rociverine and camylofin dihydrochloride. Most studies included antispasmodics as part of their
package of active management of labour. Overall, the quality of studies was poor, as only four trials were assessed as
low risk of bias. Thirteen trials (n = 1995) reported on the duration of first stage of labour, which was significantly
reduced by an average of 74.34 minutes when antispasmodics were administered (mean difference (MD) -74.34
minutes; 95% confidence Interval (CI) -98.76 to -49.93). Seven studies (n = 797) reported on the total duration of
labour, which was significantly reduced by an average of 85.51 minutes (MD -85.51 minutes; 95% CI -121.81 to -
49.20). Six studies (n = 820) had data for the outcome: rate of cervical dilatation. Administration of antispasmodics
significantly increased the rate of cervical dilatation by an average of 0.61 cm/hour (MD 0.61 cm/hour; 95% CI 0.34
to 0.88). Antispasmodics did not affect the duration of second and third stage of labour. The rate of normal vertex
deliveries was not affected either. Only one study explored pain relief following administration of antispasmodics
Objective: Tumour necrosis factor (TNF) alpha inhibitors (infliximab, etanercept, adalimumab) revolutionised the
treatment of autoimmune diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), Crohn's disease
(CD) and plaque psoriasis. During these treatments, cutaneous adverse effects may occur like eczema, lupus,
alopecia areata or psoriasis, which represents a paradoxical adverse effect. The aim of this study was to collect and
to analyse characteristics and outcomes of psoriasis induced by anti-TNF alpha treatments. Methods: A search in the
French Pharmacovigilance Database was performed between January 2002 and September 2009 using the following
terms " infliximab", "etanercept", "adalimumab" combined with the term "psoriasis". A literature review was
performed utilising PubMed Database and Google scholar using permutations of the following terms "infliximab",
"etanercept", "adalimumab", "tumour necrosis factor-alpha inhibitor" combined with "psoriasis", "palmoplantar
pustular psoriasis ", palmoplantar pustulosis ". Certolizumab pegol and golimumab were approved only recently and
so were not included in the search. Results: We found 57 cases in the French Pharmacovigilance Database and 184
cases in the literature. It appeared that the eruptions are most often pustular lesions and occur mainly on palms
and/or soles (33.3% in the French Pharmacovigilance Database and 42.9% in the literature), while palmoplantar
pustular psoriasis represents only 1.7% of the psoriatic patients. The three anti-TNF-alpha are involved in the
psoriasis induction. Half the cases appeared with infliximab. The patients affected by this adverse effect are mostly
women aged between 40-50 years old. The time of onset of psoriasis is highly variable. Those patients treated for
their psoriasis with TNF-alpha inhibitor developed a psoriasis induced by the treatment with a different localisation
and a different morphology from the initial psoriasis while other patients had a recurrence of this side effect with
two different TNF-alpha antagonists, then the psoriasis developed with the 2nd anti-TNF alpha is of the same type as
the psoriasis developed with the first molecule. Conclusion: This suggests that psoriasis occurring during anti-TNF
alpha therapy are de novo psoriasis and not an aggravation of a pre-existing psoriasis. To this day several hypotheses
have been proposed to explain the mechanism of action. The occurrence of this adverse effect may call into question
the continuation of the treatment which is nevertheless effective. Copyright CLINICAL AND EXPERIMENTAL
RHEUMATOLOGY 2012.
Plants have played significant roles as medicine during pregnancy, birth, and postpartum care in many rural areas of
the world. In addition to this, plants have been used for centuries to treat infertility and related reproduction
problems. The aim of this paper was to review the current status of plant species used in maternal healthcare,
including infertility, in South Africa, in terms of scientific evaluation for efficacy and safety. In addition to this, the
role of medicinal plants as a tool in achieving the MDG5 of reducing maternal mortality by 2015 was evaluated. A
search was done with the aid of Google Scholar, PubMed, Science Direct, peer-reviewed papers, and books, using
keywords such as child birth, labour pain, maternal health, maternal mortality, menstrual pains, and postpartum. The
plants listed in the different research articles were classified according to their use and the target effect of a plant
extract or compound on reproductive function. Eighty-four plant species were found to be used to treat infertility
and related problems. Twenty plant species are used during pregnancy, while 26 plant species are used to ease
childbirth. For postpartum healing and any problems after childbirth, nine plant species were recorded. Unhealthy
pregnancy and birth complications are among the factors that contribute to the loss of cognitive potential in the
developing worlds children, condemning them to impoverished lives. The best way to keep a country poor is to rob
its children of their full developmental potential. In this respect, medicinal plants play a significant role in reducing
maternal mortality and ensuring the birth of healthy children. Georg Thieme Verlag KG Stuttgart New York.
Nanotechnology is the application of science and engineering at the nanoscale. A diverse range of applications are
beginning to emerge in all areas of medicine. We performed a survey from November 2005 to March 2006 using the
Internet search engines PubMed, ScienceDirect, ISI Web of Knowledge, and Google Scholar. We report on the role of
nanotechnology in orthopaedics, exploring current and potential applications. Nanostructured materials have been
proposed as the next generation of orthopaedic implant properties by creating a surface environment more
conducive for osteoblast function. Bone substitute materials, whose nanoscale composition emulates the hierarchic
organization of natural bone, shows initiation of the desirable formation of an apatite layer. Nanotechnology also has
been harnessed to improve the cutting performance and quality of surgical blades. Postoperative infection rates may
be reduced by using nanofibrous membrane wound dressings containing antibacterial properties. The most notable
application of nanotechnology in orthopaedics may be drug delivery, including nanotherapeutics for treating bone
cancer and arthritis. Nanotechnology is being used in orthopaedics, and likely will play a valuable role in future
developments.
Nanotechnology is the application of science and engineering at the nanoscale. A diverse range of applications are
beginning to emerge in all areas of medicine. We performed a survey from November 2005 to March 2006 using the
Internet search engines PubMed, ScienceDirect, ISI Web of Knowledge, and Google Scholar. We report on the role of
nanotechnology in orthopaedics, exploring current and potential applications. Nanostructured materials have been
proposed as the next generation of orthopaedic implant properties by creating a surface environment more
conducive for osteoblast function. Bone substitute materials, whose nanoscale composition emulates the hierarchic
organization of natural bone, shows initiation of the desirable formation of an apatite layer. Nanotechnology also has
been harnessed to improve the cutting performance and quality of surgical blades. Postoperative infection rates may
be reduced by using nanofibrous membrane wound dressings containing antibacterial properties. The most notable
application of nanotechnology in orthopaedics may be drug delivery, including nanotherapeutics for treating bone
cancer and arthritis. Nanotechnology is being used in orthopaedics, and likely will play a valuable role in future
developments. 2007 Lippincott Williams & Wilkins, Inc.
OBJECTIVE: To review the clinical features of Parkinson disease (PD) and other causes of motor parkinsonism with an
emphasis on diagnosis in elderly patients. SOURCES OF INFORMATION: MEDLINE and Google Scholar were searched
for original research articles describing clinical diagnosis of parkinsonism. Consensus statements and articles
summarizing diagnostic criteria for parkinsonian syndromes were also reviewed. Most evidence was levels II or III.
MAIN MESSAGE: Diagnosis of PD is made clinically and can be challenging. In older patients, PD can present with
general functional decline and nonspecific symptoms. Clinical criteria for diagnosing PD and the TRAP mnemonic can
be helpful. A 2-week trial of levodopa-carbidopa treatment can be considered. Specific signs and a minimal response
to levodopa treatment suggest other causes of parkinsonism. Clinical features of other causes of parkinsonism are
reviewed in the article. CONCLUSION: Parkinsonism and PD are common in older patients. Family physicians should
consider parkinsonism in the differential diagnosis of patients who have falls and exhibit general functional decline.
BACKGROUND AND OBJECTIVES: Allograft involvement can occur in some renal transplant recipients who develop
post-transplant lymphoproliferative disorders (PTLD). We aimed to find indications and/or contraindications for
nephrectomy in renal allograft PTLD based on an outcome analysis of previous reports. DESIGN AND SETTING: A
comprehensive search of Pubmed and Google scholar was performed to find reports of different treatment
strategies addressing PTLD occurring within the allograft after renal transplantation. PATIENTS AND METHODS:
Patients who underwent nephrectomy due to kidney allograft localization by PTLD were categorized as the case
group, and renal recipients with kidney PTLD for whom nonsurgical treatment modalities were used served as
controls. RESULTS: Survival analysis demonstrated that patients with renal allograft involvement who underwent
allograft nephrectomy had a significantly better outcome compared to patients for whom a non-surgical approach
was used (P=.03). In patients with disseminated PTLD, nephrectomy was not useful (P>.1). Patients with
simultaneous kidney and lung complications by PTLD benefitted from nephrectomy. CONCLUSIONS: We found that
patients with renal graft complication with disseminated PTLD do not benefit from nephrectomy, which can be
considered the only contraindication. However, some particular PTLD co-localizations were not as likely to adversely
affect the benefit of nephrectomy in these patients, and these can be considered indications for the procedure.
Future multicenter studies are needed to confirm our results.
Objective: To review, analyze, and critique dabigatran etexilate's approved uses as an anticoagulant. Data Sources:
Literature searches were performed via MEDLINE, International Pharmaceutical Abstracts, and Google Scholar
through February 2011, using the term dabigatran. Additional data were obtained from tertiary sources and
prescribing information. Study Selection and Data Extraction: AU published Phase 3 anticoagulation trials
investigating dabigatran for currently approved indications were selected. Information from other anticoagulation
trials investigating dabigatran was used for critiquing Phase 3 studies. Data Synthesis: Dabigatran etexilate has been
evaluated in multiple clinical trials as an alternative to enoxaparin for prevention of venous thromboembolism in
total hip and knee replacement surgeries. It has also been evaluated as an alternative to warfarin in stroke and
systemic embolism prevention in patients with atrial fibrillation. Results have generally been positive, with few
exceptions. The standard adult dose of dabigatran 150 mg twice daily, approved for use in the US for stroke
prevention in nonvalvular atrial fibrillation, was found to be superior to warfarin in regard to occurrence rates of
stroke or systemic embolism and hemorrhagic stroke. The occurrence rates of intracranial bleeding, life-threatening
bleeding, and major or minor bleeding were lower with dabigatran 150 mg twice daily than with warfarin; however,
the occurrence of gastrointestinal bleeding was significantly higher. Conclusions: With its numerous benefits, and
despite its drawbacks, dabigatran remains a promising option for oral anticoagulation therapy.
Health Information Managers (HIMs) are responsible for overseeing health information. The change management
necessary during the transition to electronic health records (EHR) is substantial, and ongoing. Archetype-based EHRs
are a core health information system component which solve many of the problems that arise during this period of
change. Archetypes are models of clinical content, and they have many beneficial properties. They are interoperable,
both between settings and through time. They are more amenable to change than conventional paradigms, and their
design is congruent with clinical practice. This paper is an overview of the current archetype literature relevant to
Health Information Managers. The literature was sourced in the English language sections of ScienceDirect, IEEE
Explore, Pubmed, Google Scholar, ACM Digital library and other databases on the usage of archetypes for electronic
health record storage, looking at the current areas of archetype research, appropriate usage, and future research.
We also used reference lists from the cited papers, papers referenced by the openEHR website, and the
recommendations from experts in the area. Criteria for inclusion were (a) if studies covered archetype research and
(b) were either studies of archetype use, archetype system design, or archetype effectiveness. The 47 papers
included show a wide and increasing worldwide archetype usage, in a variety of medical domains. Most of the papers
noted that archetypes are an appropriate solution for future-proof and interoperable medical data storage. We
conclude that archetypes are a suitable solution for the complex problem of electronic health record storage and
interoperability.
Aim Celiac disease (CeD) is an inherited autoimmune disease triggered by ingesting gluten, with a worldwide
prevalence of 0.71% to 1.25%. In the absence of a pharmacotherapy, most healthcare systems lack an evidence-
based approach to long-term treatment of CeD. We reviewed similarities and differences among key US, UK, and
global treatment guidelines for diagnosis and management of CeD. Methods PubMed, Advanced Google Scholar, and
the AHRQ National Guideline Clearinghouse (http://www.guideline.gov) were searched to identify English language
papers detailing classification and treatment guidelines for CeD over the last 3 years. Bibliographies of identified
articles were also examined. Results Key practice guidelines for CeD were identified from the World
Gastroenterology Organization, American Gastroenterological Association, North American Society for Pediatric
Gastroenter-ology, British Society of Gastroenterology and Clinical Resource Efficiency Support Team, and Primary
Care Society for Gastroenterology. The National Institute for Health and Clinical Excellence (UK) is developing
guidelines for the recognition and diagnosis of CeD in England and Wales. There was a strong consensus on the need
for an initial serology assessment. Endoscopic biopsy is agreed to be the gold standard for confirming the diagnosis
of CeD. Most treatment guidelines supported the need to adhere to a strict gluten-free diet (GFD) with regular
(annual) assessments with a specialist and/or dietician. The importance of adequate patient education, motivation,
and support to adhere to GFD, was also noted. While careful long-term follow-up is desired 4-6 months after
initiating GFD, practice guidelines for CeD management vary in their recommendations and are based on expert
opinion. Most guidelines recommended a scheduled annual review to include assessments of body mass index, serial
tissue transglutaminase antibody, hemoglobin, ferritin, and folate, and dietary review by a nutritionist. Other
guidelines recommended additional laboratory and bone density measurements. None of the guidelines specifically
addressed management of refractory CeD. Conclusion Diagnosis and initiation of GFD management are consistent
among the several CeD treatment guidelines. However, recommendations for long-term management of CeD
patients vary. The lack of pharmacotherapeutic options may foster inconsistent and more passive approaches to long-
term management of CeD. Prospective studies are needed to develop data that can be used to create evidence-
based guidelines to optimize long-term management of CeD patients.
Introduction: In the past few years, comprehensive smoke-free laws that prohibit smoking in all workplaces have
been introduced in many jurisdictions in the US, Canada, and Europe. In this paper, we review published studies to
ascertain if there is any evidence of health benefits resulting from the implementation of these laws. Methods: All
papers relating to smoke-free legislation published in or after 2004 were considered for inclusion in this review. We
used Pubmed, Google scholar, and Web of Science as the main search tools. The primary focus of the paper is on
health outcomes, and thus many papers that only report exposure data are not included. Results: Studies using
subjective measures of respiratory health based on questionnaire data alone consistently reported that workers
experience fewer respiratory and irritant symptoms following the introduction of smoke-free laws. Some studies also
found measured improvements in the lung function of workers. However, the most dramatic health outcome
associated with smoke-free laws has been the reduction in myocardial infarction in the general population. This
outcome has been observed in the US, Canada, and Europe, with studies reporting reductions of between 6 and 40%,
post-legislation, the larger reductions being mostly from studies with smaller population groups. The evidence as to
whether these smoke-free laws have helped smokers to stop smoking or to reduce tobacco consumption is less
clear. Conclusions: There is now significant body of published literature that demonstrates that smoke-free laws can
lead to improvements in the health of both workers who are occupationally exposed and of the general population.
There is no longer any reason why non-smokers should be exposed to SHS in any workplace. We recommend that all
countries adopt national smoke-free laws that are in line with article 8 of the WHO Framework Convention on
Tobacco Control that sets out recommendations for the development, implementation, and enforcement of national,
comprehensive smoke-free laws. 2009 Birkhauser Verlag, Basel/Switzerland.
Ethonopharmacological relevance: Lung cancer is one of the most lethal cancers in terms of mortality and incidence
worldwide. Despite intensive research and investigation, treatment of lung cancer is still unsatisfactory due to
adverse effects and multidrug resistance. Recently, herbal drugs have been recognized as one of attractive
approaches for lung cancer therapy with little side effects. Furthermore, there are evidences that various herbal
medicines have proven to be useful and effective in sensitizing conventional agents, prolonging survival time,
preventing side effects of chemotherapy, and improving quality of life (QoL) in lung cancer patients. Aim and
methods of the study: Nevertheless, the underlying molecular targets and efficacy of herbal medicines in lung cancer
treatment still remain unclear. Thus, we reviewed traditionally used herbal medicines and their phytochemicals with
antitumor activity against lung cancer from peer-reviewed papers through Scientific Database Medline, Scopus and
Google scholar. Conclusions: We suggest that herbal medicines and phytochemicals can be useful anti-cancer agents
for lung cancer treatment by targeting molecular signaling involved in the regulation of angiogenesis, metastasis and
severe side effects, only provided quality control and reproducibility issues were solved. 2011 Elsevier Ireland Ltd. All
rights reserved.
ETHONOPHARMACOLOGICAL RELEVANCE: Lung cancer is one of the most lethal cancers in terms of mortality and
incidence worldwide. Despite intensive research and investigation, treatment of lung cancer is still unsatisfactory due
to adverse effects and multidrug resistance. Recently, herbal drugs have been recognized as one of attractive
approaches for lung cancer therapy with little side effects. Furthermore, there are evidences that various herbal
medicines have proven to be useful and effective in sensitizing conventional agents, prolonging survival time,
preventing side effects of chemotherapy, and improving quality of life (QoL) in lung cancer patients. AIM AND
METHODS OF THE STUDY: Nevertheless, the underlying molecular targets and efficacy of herbal medicines in lung
cancer treatment still remain unclear. Thus, we reviewed traditionally used herbal medicines and their
phytochemicals with antitumor activity against lung cancer from peer-reviewed papers through Scientific Database
Medline, Scopus and Google scholar. CONCLUSIONS: We suggest that herbal medicines and phytochemicals can be
useful anti-cancer agents for lung cancer treatment by targeting molecular signaling involved in the regulation of
angiogenesis, metastasis and severe side effects, only provided quality control and reproducibility issues were
solved. Copyright 2011 Elsevier Ireland Ltd. All rights reserved.
BACKGROUND: Since the mid-1990 s, there have been growing efforts to prevent cervical cancer in less-developed
countries through the development of innovative screening approaches such as visual inspection of the cervix
associated with same day management of cervical lesions with cryotherapy or loop electrosurgical excision
procedure (LEEP). In the past, promising cancer screening interventions have been widely promoted despite
incomplete evidence, only to become the subject of intense controversies about ensuing net health benefit. Because
the efficacy and effectiveness of the new protocols for global cervical cancer screening have not been well
characterized yet, and as a contribution to the evaluation of the balance between the benefits and risks of these
protocols, we reviewed the literature on the safety of cryotherapy and LEEP for cervical intraepithelial neoplasia
(CIN) in low- and middle-income countries. METHODS: We searched 12 databases (Medline, Google Scholar, Scopus,
Cochrane Library, Web of Science, OCLC, PAIS International Database, WHO Global Health Library, CINAHL,
Science.gov, NYAM Grey Literature Report, and POPLINE) for original research published between January 1995 and
April 2009. Both peer-reviewed publications and items of "grey" literature were retrieved; no language restriction
was applied. We calculated the median (minimum, maximum) reported rate for each harm considered. Because of
limitations and heterogeneity in the data, no formal meta-analysis was performed. RESULTS: The search identified 32
articles that reported safety data from 24 cryotherapy and LEEP studies. The combined sample consisted of 6,902
women treated by cryotherapy and 4,524 women treated by LEEP. Most studies were conducted in reference or
research settings in Asia and Africa. Short-term harms of cryotherapy and LEEP appeared to be similar to those
described in the literature from high-income countries. Information was sparse on HIV-related harms and long-term
reproductive outcomes of treatment. CONCLUSIONS: When performed in resource-limited settings by qualified
providers, cryotherapy and LEEP are not associated with excess harm. However, available data are insufficient to
propose fully evidence-based protocols for routine screening of HIV-infected women and women of reproductive
age.
Background: Since the mid-1990s, there have been growing efforts to prevent cervical cancer in less-developed
countries through the development of innovative screening approaches such as visual inspection of the cervix
associated with same day management of cervical lesions with cryotherapy or loop electrosurgical excision
procedure (LEEP). In the past, promising cancer screening interventions have been widely promoted despite
incomplete evidence, only to become the subject of intense controversies about ensuing net health benefit. Because
the efficacy and effectiveness of the new protocols for global cervical cancer screening have not been well
characterized yet, and as a contribution to the evaluation of the balance between the benefits and risks of these
protocols, we reviewed the literature on the safety of cryotherapy and LEEP for cervical intraepithelial neoplasia
(CIN) in low- and middle-income countries.Methods: We searched 12 databases (Medline, Google Scholar, Scopus,
Cochrane Library, Web of Science, OCLC, PAIS International Database, WHO Global Health Library, CINAHL,
Science.gov, NYAM Grey Literature Report, and POPLINE) for original research published between January 1995 and
April 2009. Both peer-reviewed publications and items of "grey" literature were retrieved; no language restriction
was applied. We calculated the median (minimum, maximum) reported rate for each harm considered. Because of
limitations and heterogeneity in the data, no formal meta-analysis was performed.Results: The search identified 32
articles that reported safety data from 24 cryotherapy and LEEP studies. The combined sample consisted of 6,902
women treated by cryotherapy and 4,524 women treated by LEEP. Most studies were conducted in reference or
research settings in Asia and Africa. Short-term harms of cryotherapy and LEEP appeared to be similar to those
described in the literature from high-income countries. Information was sparse on HIV-related harms and long-term
reproductive outcomes of treatment.Conclusions: When performed in resource-limited settings by qualified
providers, cryotherapy and LEEP are not associated with excess harm. However, available data are insufficient to
propose fully evidence-based protocols for routine screening of HIV-infected women and women of reproductive
age. 2010 Chamot et al; licensee BioMed Central Ltd.
Purpose: The use of arterial closure devices (ACDs) in interventional radiological (IR) procedures has not yet been
validated by largescale randomised trial or meta-analysis. Improved haemostasis and early mobilisation are
publicised advantages; however, anecdotal evidence of haemorrhagic and ischaemic complications is also apparent.
Meta-analysis from interventional cardiology cannot be directly extrapolated for IR patients. Materials and Methods:
Literature search was performed using MEDLINE, Cochrane and Google Scholar databases to assess 4 ACDs:
Angioseal; Starclose; Perclose; and Duett versus manual compression. Included interventions were: peripheral
vascular interventions; uterine artery embolisation; transhepatic chemoembolisation and neurointerventional
procedures. Cardiac and non-femoral procedures were excluded. Outcomes assessed were: device failure;
haematoma; bleeding; groin pain; retroperitoneal haematoma; arteriovenous fistula; infection; distal ischaemia;
need for vascular surgery and for manual compression. Random-effects models were used for meta-analysis with
tests of heterogeneity performed. Results: A total of 32 studies were analysed. 19 non-comparative (3304 patients)
and 13 comparative studies were analysed separately with meta-analysis performed on 10 studies (2373 patients).
Metaanalysis demonstrated total complication rates of all 4 ACDs versus manual compression of (odds ratio (OR)
0.87: 95%CI 0.52-1.48, p=0.13). Total complication rates of Angioseal versus manual compression were (OR 0.84:
95%CI 0.53-1.34, p=0.49) and Perclose versus manual compression were (OR 1.29: 95%CI 0.19-8.96, p=0.01).
Conclusion: Meta-analyses demonstrate no statistically significant difference between ACDs and manual
compression. A marginal trend favouring Angioseal over manual compression, and favouring manual compression
over Perclose was seen, but heterogeneity factors make conclusion difficult. Adequately powered randomised
controlled trials are required to further elucidate the efficacy of ACDs.
Aims: To examine via systematic review and meta-analysis whether arterial closure devices reduce or increase the
rate of haemorrhagic, infective and ischaemic complications, and the need for vascular surgical intervention when
compared with manual compression in femoral haemostasis in interventional radiological procedures. Materials and
Methods: MEDLINE, Cochrane and Google Scholar databases were examined to assess 4 ACDs: Angioseal; Starclose;
Perclose; and Duett; versus manual compression. Included interventions were: peripheral vascular interventions;
uterine artery embolisation; transhepatic chemoembolisation and neurointerven-tional procedures. Cardiac and non-
femoral procedures were excluded. Outcomes assessed were: device failure; haematoma; bleeding; groin pain;
retroperitoneal haematoma; arteriovenous fistula; infection; distal ischaemia; need for vascular surgery and for
manual compression. Random-effects models were used with tests of heterogeneity performed. Results: A total of
32 studies were analysed. 19 non-comparative (3304 patients) and 13 comparative studies were analysed with meta-
analysis performed on 10 studies (2373 patients). Meta-analysis demonstrated total complication rates of all 4 ACDs
versus manual compression of (odds ratio (OR) 0.87: 95%CI 0.52-1.48, P = 0.13). Total complication rates of Angioseal
versus manual compression were (OR 0.84: 95%CI 0.53-1.34, P = 0.49) and Perclose versus manual compression
were (OR 1.29: 95%CI 0.19-8.96, P = 0.01). Conclusion: Meta-analyses demonstrate no statistically significant
difference between ACDs and manual compression. A marginal trend favouring Angioseal over manual compression,
and favouring manual compression over Perclose was seen, but heterogeneity factors make conclusion difficult.
Adequately powered randomised controlled trials are required to further elucidate the efficacy of ACDs.
Rationale: Delivery of home parenteral nutrition (HPN), traditionally via tunnelled central venous catheters (CVCs) is
associated with several complications, the commonest being catheter related bloodstream infections. We have
reviewed the literature to investigate the use of arteriovenous fistulae (AVF) as a viable alternative to traditional
routes for long-term PN. Methods: A literature search was performed using the Medline database, PubMed and a
Google Scholar search. Search terms (keywords) used were: parenteral AND nutrition AND arteriovenous AND fistula
for Title and Abstract. The articles were limited to Humans. Our search yielded 12 articles (1972 2012). Two were
excluded due to foreign language and difficult retrieval. The final yield was 10 papers. Results: See the table. (Table
Presented) A recent large retrospective study1 of 62 AVFs for HPN patients (32 native fistulae, 20 autologous grafts,
8 synthetic grafts, 2 bovine grafts) showed an infection rate far lower than all types of CVC, a slightly higher occlusion
rate than long-term CVCs but lower occlusion rate than short-term CVCs. Conclusion: AVFs may be a viable
alternative to traditional routes for HPN. AVFs can possibly be recommended in patients with poor vasculature, on
haemodialysis or recurrent line sepsis. Further higher evidence level research is required.
Objective: Clinical questions are often long and complex and take many forms. We have built a clinical question
answering system named AskHERMES to perform robust semantic analysis on complex clinical questions and output
question-focused extractive summaries as answers. Design: This paper describes the system architecture and a
preliminary evaluation of AskHERMES, which implements innovative approaches in question analysis, summarization,
and answer presentation. Five types of resources were indexed in this system: MEDLINE abstracts, PubMed Central
full-text articles, eMedicine documents, clinical guidelines and Wikipedia articles. Measurement: We compared the
AskHERMES system with Google (Google and Google Scholar) and UpToDate and asked physicians to score the three
systems by ease of use, quality of answer, time spent, and overall performance. Results: AskHERMES allows
physicians to enter a question in a natural way with minimal query formulation and allows physicians to efficiently
navigate among all the answer sentences to quickly meet their information needs. In contrast, physicians need to
formulate queries to search for information in Google and UpToDate. The development of the AskHERMES system is
still at an early stage, and the knowledge resource is limited compared with Google or UpToDate. Nevertheless, the
evaluation results show that AskHERMES' performance is comparable to the other systems. In particular, when
answering complex clinical questions, it demonstrates the potential to outperform both Google and UpToDate
systems. Conclusions: AskHERMES, available at http://www.AskHERMES.org, has the potential to help physicians
practice evidence-based medicine and improve the quality of patient care. 2011 Elsevier Inc.
Hintergrund: According to Hepler and Strand, pharmaceutical care should lead to .outcomes that improve a patient's
quality of life. What is the state of the art concerning the assessment of quality of life in the field of pharmaceutical
care research? Methode: We conducted a literature review on the assessment of health-related quality of life
(HRQpL) and the specific methods within pharmaceutical care research using the databases Medline and Google
Scholar. An overview of major definitions and types of assessment instruments was established. Furthermore, we
reviewed publications which specifically researched the impact of pharmaceutical care on HRQpL. Ergebnisse: Our
review revealed rather a spectrum than a single definition of terms associated with quality of life, which is a complex
and highly individual measure showing numerous dependencies. Assessment tools are divided into four major
groups: generic - specific and index -profile. Several quality attributes should be considered when choosing an
instrument. Whether a specific or generic instrument proves an asset, turns out to be a question of which patient
cohort is examined. Most experiences in relation to HRQpL within pharmaceutical care research obviously exist with
the SF-36 questionnaire. Schlussfolgerung: The SF-36 seems to be the gold standard for the assessment of the HRQpL
in pharmaceutical care research. Nevertheless, the choice of a suitable instrument remains a highly specific question
and has to be answered individually.
The purpose of this review was to assess the potential of the Nintendo Wii to collect clinical data such as center of
pressure and weight. The use of this system as an assistive device for individuals with disability was also reviewed.
Keywords including "Wii," "Nintendo Wii," "rehabilitation," and "instrumentation" were entered into the search
engines Pubmed, CINAHL, and Google Scholar. Articles in English, and focusing on the use of the Nintendo Wii were
reviewed. Articles focusing on the use of this system in a rehabilitation setting were excluded. In total, 260 articles
were identified. After reviewing the abstracts, 13 were considered suitable for the current review (12 from Pubmed
and CINAHL, 1 from Google Scholar). The Nintendo Wii, when paired with customized software, is able to collect data
regarding center of pressure, weight-bearing asymmetry, and posture similar in quality to data collected by
laboratory equipment. The literature is equivocal regarding the validity and reliability of data that the device can
collect its own, suggesting the need for further research. When paired with custom software, the Nintendo Wii may
act as an assistive device allowing individuals with disability to interact with, and respond to, environmental stimuli.
2011 by Begell House, Inc.
Objective: The claims in some dental implant marketing brochures may lack strong supporting evidence. The
objective of this review was to examine peer-reviewed literature to assess the strength of evidence to support
selected claims, to help clinicians in making evidence-based decisions. Methods: The claims proposed by Astra Tech,
Straumann, 3i and Nobel Biocare, all companies with a significant market presence, were examined. A PubMed
database search was conducted using the following limits- English language, RCT, Meta- analysis, 1970-2006.
Selective searching using the Cochrane database and Google Scholar was performed up to 2008 for searches that
had exhibited no outcomes with the PubMed search. We performed quantitative and qualitative analysis of these
RCTs and assessed if the claims could be supported by these RCTs. Results: The data were extremely heterogeneous,
making comparisons difficult. The majority of the included RCTs were rated as having low risk of bias. Some of the
claims proposed by the companies could not be completely substantiated on the basis of the relevant literature.
Conclusions: Future studies should follow the guidelines as stated in the CONSORT statement to enable
standardisation and comparison across different implant systems. 2008 FDI/World Dental Press.
Despite some reported limitations, Web of Science has been the standard source to assess the impact of individual
articles, and consequently journals. By analysing the citations to articles published in the field of paediatric oncology,
we demonstrate that Scopus and Google Scholar, the two new citation databases, retrieve more citations than Web
of Science. The strength of Scopus lies in identifying non-English literature from Western and Eastern Europe, while
Google Scholar is proficient at identifying English and non-English literature from Africa, Asia and Central and South
America. These findings have implications for researchers, journals and health libraries. 2010 Wiley-Liss, Inc.
We conducted a systematic review and meta-analysis of the literature in order to estimate the incidence of
gastroenteritis in long term care facility (LTCF) residents from published accounts of infection surveillance. PubMed,
Web of Science and Google Scholar were searched using keywords 'long-term care facility', 'nursing home',
'gastroenteritis', 'surveillance', and 'incidence'. We manually searched reference lists of all articles included. The
number of cases of gastroenteritis and bed-days under surveillance was recorded so as to calculate incidence and
assess the influence of the study country and case definition using random effects meta-analysis and regression. We
included one trial and 14 surveillance studies in the analysis, with 47% (7/15) conducted after 1995. One study
focused only on gastroenteritis in residents; the remainder considered a range of infections. There were 2 071 330
combined bed-days under surveillance and 717 cases of gastroenteritis. In all, 194 cases were associated with 10
outbreaks during these studies. We observed heterogeneity between studies, which may have been due to
unreported clustering of gastroenteritis cases. The mean incidence of gastroenteritis in LTCF residents was 0.40 (95%
confidence interval: 0.27-0.56) episodes per 1000 bed-days. Investigators conducting studies in the USA reported
incidence three times lower than investigators in other countries. Use of a case definition developed specifically for
LTCFs was not associated with a higher incidence of gastroenteritis. From our analysis, residents could expect to
experience gastroenteritis once every 5-10 years, which is a lower rate than that estimated from point prevalence
surveys. New studies are needed to better assess the incidence and causes of gastroenteritis in LTCF residents. 2010.
Objective: The aim of the study was to evaluate the quality of pharmacoeconomic studies based in India. Methods: A
literature search was conducted using PubMed, MEDLINE, EconLit, PsycInfo and Google Scholar to identify published
work on pharmacoeconomics studies based in India. Articles were included if they were original studies that
evaluated pharmaceuticals, were based in India and were conducted between 1990 and 2010. Two reviewers
independently reviewed the articles using a subjective 10-point quality scale in addition to the 100-point Quality of
Health Economic Studies (QHES) questionnaire. Results: Twenty-nine articles published between 1998 and May 2010
were included in the review. The included articles were published in 23 different journals. Each article was written by
an average of five authors. The mean subjective quality score of the 29 articles was 7.8 (standard deviation [SD] =
1.3) and the mean QHES scores for the complete pharmacoeconomic studies (n = 24) was 86 (SD = 6). The majority of
authors resided in India (62%) at the time of publication and had a medical background (90%). The quality score was
significantly (p <= 0.05) related to the country of residence of the primary author (non-India = higher) and the study
design (randomized controlled trials = higher). Conclusion: Although the overall quality scores were comparable to
(e.g. Nigeria) or higher than (e.g. Zimbabwe) similar studies in other developing countries, key features such as an
explicit study perspective and the use of sensitivity analyses were missing in about 40% of the articles. The need for
economic evaluation of pharmaceuticals is imperative, especially in developing countries such as India as this helps
decision makers allocate scarce resources in a justifiable manner. 2012 Springer International Publishing AG. All
rights reserved.
OBJECTIVES: The aim of the study was to evaluate the quality of pharmacoeconomic studies based in India.
METHODS: A literature search was conducted using PubMed, Medline, EconLit, PsycInfo and Google Scholar to
identify published work on pharmacoeconomics studies based in India. 0riginal research studies that evaluated
pharmaceuticals, and were conducted between 1990 and 2010 in India were included. Two reviewers independently
reviewed the articles using a subjective 10-point scale (10 being the highest) and the 100-point 'Quality of Health
Economic Studies' (QHES) questionnaire (100 being the highest). RESULTS: The included articles
(n=29)werepublishedin23 differentjournals. 0nly9articleswerepublished in journals based in India. The first article
was published in 1998. Each article was written by an average of five authors. The majority of authors resided in
India (62%) at the time ofpublication and had a medical background (90%). Cost-effectiveness analysis was the most
frequently used method of analysis (79%). The source of funding and study perspective was not listed in 45% and
41% of the studies respectively. The study design was a randomized controlled trial for 41% of the studies. The mean
subjective quality score ofall the articles (n = 29) was 7.8 (SD=1.3) and the mean QHES scores for the studies
evaluating costs and outcomes (n = 24) was 86 (SD=6). The quality score was significantly (p<0.05) related to country
of residence of primary author (non-India= higher) and the study design (randomized controlled trials= higher).
CONCLUSIONS: The need for economic evaluation of pharmaceuticals is imperative, especially in developing
countries like India; because it can help decision makers allocate scarce resources in a justifiable manner.
Standardizationofguidelines, and improvedpharmacoeconomiceducation-starting from the undergraduate level to
specialization - are two suggestions to help to improve the quality of the pharmacoeconomic research in India.
Objectives: To assess this effectiveness of morbi-mortality conference (MMC) in improving quality of care. Materials
and methods: A review was carried out by searching Medline, Pascal and Cochrane databases, Google scholar and
websites of French obstetrics professional societies, until July 2011. Search terms included morbidity, mortality,
conference, and obstetrics. The eligible reports of assessment of MMC in obstetrics have been analysed by four
reviewers with a standardized form. Results: Among 319 records identified, four observational studies published
between 2009 and 2011 were included. The objective of these MMC was students' training (n = 2), quality of care
improvement (n = 1), or both (n = 1). The MMC organization was heterogeneous. The impact of MMC was assessed
using qualitative (n = 2), semi-quantitative (n = 1) or quantitative (n = 1) method. None of these studies showed a
significant impact of MMC on students' training or quality of care. Conclusion: Available evidence is insufficient to
evaluate the effectiveness of MMC in improving quality of obstetrics care. 2011 Elsevier Masson SAS. All rights
reserved.
Objective: To compose an algorithm for assessment of PD speech severity in the home-environment based on a
review synthesis. Background: Voice processing in real-time is challenging. A drawback of previous work for
Hypokinetic Dysarthria (HKD) recognition is the requirement of controlled settings in a laboratory environment. A
personal digital assistant (PDA) has been developed for home assessment of PD patients. The PDA offers sound
processing capabilities, which allow for developing a module for recognition and quantification HKD. Methods: A two-
tier review methodology is utilized. The first tier focuses on real-time problems in speech detection. In the second
tier, acoustics features that are robust to medication changes in Levodopa- responsive patients are investigated for
HKD recognition. Keywords such as "Hypokinetic Dysarthria", and "Speech recognition in real time" were used in the
search engines. IEEE explorer produced the most useful search hits as compared to Google Scholar, ELIN, EBRARY,
PubMed and LIBRIS. Results: Vowel and consonant formants are the most relevant acoustic parameters to reflect PD
medication changes. Since relevant speech segments (consonants and vowels) contains minority of speech energy,
intelligibility can be improved by amplifying the voice signal using amplitude compression. Pause detection and peak
to average power rate calculations for voice segmentation produce rich voice features in real time. Enhancements in
voice segmentation can be done by inducing Zero-Crossing rate (ZCR). Consonants have high ZCR whereas vowels
have low ZCR. Wavelet transform is found promising for voice analysis since it quantizes non-stationary voice signals
over time-series using scale and translation parameters. In this way voice intelligibility in the waveforms can be
analyzed in each time frame. Conclusions: This review evaluated HKD recognition algorithms to develop a tool for PD
speech home-assessment using modern mobile technology. An algorithm that tackles real-time constraints in HKD
recognition based on the review synthesis is proposed. We suggest that speech features may be further processed
using wavelet transforms and used with a neural network for detection and quantification of speech anomalies
related to PD. Based on this model, patients' speech can be automatically categorized according to UPDRS speech
ratings.
Objectives: Questions concerning nonretractile foreskin are frequently asked by parents in infant consultations.
Topical steroid treatment could be a less expensive and less traumatizing alternative to surgery. Aim: To assess the
effectiveness of topical steroid therapy in boys with phimosis. Methods: Literature review. All randomized controlled
trials were selected, using the following research sources: Medline, Cochrane Library, Pascal, Embase, Blackwell
Science, Google, Google scholar, SUDOC, international register of trials, and congress abstracts. Unpublished trials
were also searched. The trials were analyzed using the ANAES guide from a therapeutic article. Results: Seven
randomized controlled trials (n = 714 patients) were in accordance with the inclusion criteria. The patients were
between 1 and 12. years old. The treatment lasted for 4-8. weeks. The success rate at the end of the study was
higher with the steroid (53.8-95%) than with the placebo (6.25-52%), P< 0.05 for 6 randomized control trials.
Discussion: According to the ANAES criteria, the level of scientific evidence is low (grade. C) because of the lack of
power in clinical trials and numerous methodological shortcomings and biases, even when examining both
randomized control trials and nonrandomized trials. Only a few local side effects were noted. Conclusion: The use of
topical steroids can be recommended in first-intention treatment before surgery for the management of phimosis.
2011.
Background: Clinicians interested in assessment and outcome measurement of upper extremity (UE) function and
performance in children with cerebral palsy (CP) must choose from a wide range of tools. Questions/purposes: We
systematically reviewed the literature for UE assessment and classification tools for children with CP to compare
instrument content, methodology, and clinical use. Methods: We searched Health and Psychosocial Instruments
(HaPI), US National Library of Medicine (PubMed), and Cumulative Index to Nursing and Allied Health Literature
(CINAHL Plus) databases (1937 to the present) to identify UE assessment and outcomes tools. We identified 21 tools
for further analysis and searched HaPI, PubMed, CINAHL Plus, and Google Scholar (
http://scholar.google.com/schhp?tab=ws ) databases to identify all validity and reliability studies, systematic
reviews, and original references for each of the 21 tools. Results: The tools identified covered ages birth to
adulthood. International Classification of Functioning, Disability and Health domains addressed by these tools
included body function, body structure, activities and participation, and environmental factors. Eleven of the tools
were patient or family report, seven were clinician-based observations, and three tools could be used in either
fashion. All of the tools had published evidence of validity. Nine of the tools were specifically designed for use in
subjects with CP. Two of the tools required formal certification before use. Ten of the tools were provided free of
charge by the investigators or institution who developed them. Conclusions: Familiarity with the psychometric and
clinometric properties of assessment and classification tools for the UE in children with CP greatly enhances a
clinician's ability to select and use these tools in daily clinical practice for both clinical decision-making and
assessment of outcome. 2011 The Association of Bone and Joint Surgeons.
Objectives: To determine whether clomiphene citrate (CC) can be implicated as a cause for central retinal vein
occlusion (CRVO) and other visual disturbances. Methods: For this systematic review, we performed a search of the
following databases: PubMed (1976 to November 2009), Medline Plus 2009, Cochrane Library (1996 to November
2009), Google and Google Scholar (1996 to November 2009). Thirty-five relevant titles (25 full papers and 10
abstracts) were identified and read by authors. No review has been published in the literature. The publications
included describe adverse effects with clomid and selective estrogen receptor modulators and in particular visual
disturbances. The population consisted of infertility patients under ovulation induction with CC. The main outcome
measures were loss of vision due to CRVO and other visual changes. Results: CC may predispose to CRVO, but further
trials are clearly needed in this area. Conclusion: Physicians should be aware of the potential risk of CC, especially in
patients with associated risk factors for CRVO. If visual disturbances occur, therapy should be terminated and the
patient referred for specialist ophthalmic care. Copyright 2010 S. Karger AG, Basel.
Background Several studies have reported that HLA-DRB1 may be correlated with pemphigus vulgaris (PV), but most
have been based on small samples and the results remain inconsistent and unclear. Objectives To investigate the
correlation between DRB1 and PV by a meta-analysis of case-control/nonfamily studies. Methods PubMed, Wiley
Online Library, ScienceDirect, Google Scholar, Cochrane Library, Chinese National Knowledge Infrastructure and
Wanfang databases were searched for studies including: (i) 'pemphigus'; and (ii) 'human leukocyte antigen', 'HLA',
'major histocompatibility complex', 'MHC' or 'DRB1'. Eighteen selected studies were used in meta-analyses to
evaluate DRB1 alleles and phenotypes by calculating the respective odds ratios (ORs) and 95% confidence intervals
(CIs). Stratified meta-analyses and meta-regression analysis were also conducted. Results The frequencies of three
genotypes (allele and phenotype, respectively) were significantly increased in PV: DRB1*04 [P-value for
comparability (Pc) < 000001, OR 361, 95% CI 228-571; Pc = 00002, OR 414, 95% CI 198-865], DRB1*08 (Pc = 003, OR
225, 95% CI 107-470; Pc = 00003, OR 246, 95% CI 151-401) and DRB1*14 (Pc < 000001, OR 647, 95% CI 452-926; Pc <
000001, OR 968, 95% CI 447-2098). Three others (allele and phenotype, respectively) were significantly decreased in
PV: DRB1*03 (Pc < 000001, OR 028, 95% CI 019-041; Pc = 00001, OR 025, 95% CI 012-051), DRB1*07 (Pc = 0004, OR
045, 95% CI 026-078; Pc = 00002, OR 027, 95% CI 014-054) and DRB1*15 (Pc = 0001, OR 035, 95% CI 018-066; Pc =
0002, OR 032, 95% CI 016-065). Ethnicity partially explained the heterogeneity of DRB1*07, DRB1*08 and DRB1*14
phenotypes. Conclusions Our findings suggest that DRB1*04, DRB1*08 and DRB1*14 are statistically significant
susceptibility factors for PV. Conversely, DRB1*03, DRB1*07 and DRB1*15 may be negatively associated with PV.
Specific HLA-DRB1 types may influence the susceptibility or resistance to PV, which needs further investigations.
2012 British Association of Dermatologists.
It remains controversial regarding the association between interleukin-8 (IL-8) gene -251 T/A polymorphism and
peptic ulcer disease (PUD) riskThus, a large-scale meta-analysis evaluating the precise association between this gene
variant and PUD risk is requiredWe searched the PubMed, Embase, Web of Science, and Google Scholar until April
25, 2012Additionally, hand searching of the references of identified articles were performedAll the statistical tests
were performed using Stata 11.0A total of eight studies (3105 subjects) were included in this meta-analysisOverall,
no significant association was found between IL-8 gene -251 T/A polymorphism and PUD risk (for A allele vsT allele:
OR=1.17, 95% CI=0.97-1.41, p=0.094; for A/A vsT/T: OR=1.33, 95% CI=0.94-1.90, p=0.108; for A/A vsA/T+T/T:
OR=1.22, 95% CI=0.97-1.52, p=0.083; for A/A+A/T vsT/T: OR=1.26, 95% CI=0.95-1.67, p=0.113)However, in the
subgroup analyses by ethnicity, Hpylori infection and the subtype of PUD, significant associations were found
between IL-8 gene -251 T/A polymorphism and PUD risk in Asians, Hpylori+, duodenal ulcer disease (DUD) and gastric
ulcer disease (GUD), respectivelyIn summary, the present meta-analysis suggests that IL-8 gene -251 T/A
polymorphism is associated with increased PUD risk among Asians, and especially for the subgroups of Hpylori+, DUD
and GUD. 2012 American Society for Histocompatibility and Immunogenetics.
It remains controversial regarding the association between interleukin-8 (IL-8) gene -251 T/A polymorphism and
peptic ulcer disease (PUD) risk. Thus, a large-scale meta-analysis evaluating the precise association between this
gene variant and PUD risk is required. We searched the PubMed, Embase, Web of Science, and Google Scholar until
April 25, 2012. Additionally, hand searching of the references of identified articles were performed. All the statistical
tests were performed using Stata 11.0. A total of eight studies (3105 subjects) were included in this meta-analysis.
Overall, no significant association was found between IL-8 gene -251 T/A polymorphism and PUD risk (for A allele vs.
T allele: OR = 1.17, 95% CI = 0.97-1.41, p = 0.094; for A/A vs. T/T: OR = 1.33, 95% CI = 0.94-1.90, p = 0.108; for A/A vs.
A/T+T/T: OR = 1.22, 95% CI =0.97-1.52, p = 0.083; for A/A+A/T vs. T/T: OR = 1.26, 95% CI = 0.95-1.67, p = 0.113).
However, in the subgroup analyses by ethnicity, H. pylori infection and the subtype of PUD, significant associations
were found between IL-8 gene -251 T/A polymorphism and PUD risk in Asians, H. pylori+, duodenal ulcer disease
(DUD) and gastric ulcer disease (GUD), respectively. In summary, the present meta-analysis suggests that IL-8 gene -
251 T/A polymorphism is associated with increased PUD risk among Asians, and especially for the subgroups of H.
pylori+, DUD and GUD. Copyright 2012 American Society for Histocompatibility and Immunogenetics. Published by
Elsevier Inc. All rights reserved.
Increasing evidence suggests that interleukin 10 (IL 10) gene -1082 A/G (rsl800896) polymorphism may be associated
with an increased risk of type 2 diabetes mellitus (T2DM). However, the results are inconsistent. The aim of this
study is to analyze the association between this variant and the T2DM risk by meta-analysis. PubMed, Embase, Web
of Science, and Google Scholar were searched from January 1, 1989 to February 17, 2012, as well as hand searching
of the references of identified articles were performed. All the statistical tests were performed using Stata 11.0.
Seven case-control studies were identified, covering a total of 1879 T2DM cases and 2371 controls. The results
showed evidence of significant association between IL 10 gene -1082 A/G polymorphism and T2DM risk (for
G/G+G/A vs. A/A: OR=1.21, 95% CI=1.05-1.40, p=0.010, p=0.040 after Bonferroni testing). In the subgroup analysis by
ethnicity, no significant association was found between IL 10 gene -1082 A/G polymorphism and T2DM risk in
Europeans. In summary, results from this meta-analysis provide evidence that IL 10 gene -1082 G allele is associated
with increased risk of T2DM. 2013 Elsevier Ltd.
Increasing evidence suggests that interleukin 10 (IL 10) gene -1082 A/G (rsl800896) polymorphism may be associated
with an increased risk of type 2 diabetes mellitus (T2DM). However, the results are inconsistent. The aim of this
study is to analyze the association between this variant and the T2DM risk by meta-analysis. PubMed, Embase, Web
of Science, and Google Scholar were searched from January 1, 1989 to February 17, 2012, as well as hand searching
of the references of identified articles were performed. All the statistical tests were performed using Stata 11.0.
Seven case-control studies were identified, covering a total of 1879 T2DM cases and 2371 controls. The results
showed evidence of significant association between IL 10 gene -1082 A/G polymorphism and T2DM risk (for
G/G+G/A vs. A/A: OR=1.21, 95% CI=1.05-1.40, p=0.010, p=0.040 after Bonferroni testing). In the subgroup analysis by
ethnicity, no significant association was found between IL 10 gene -1082 A/G polymorphism and T2DM risk in
Europeans. In summary, results from this meta-analysis provide evidence that IL 10 gene -1082 G allele is associated
with increased risk of T2DM. Copyright 2013 Elsevier Ltd. All rights reserved.
Background: MMP1 is an important member of the MMP endopeptidase family that plays a critical role in the
development of head and neck cancer (HNC). Several studies have investigated the association between the MMP1 -
1607 1G>2G polymorphism and risk of HNC, but their results have been inconsistent. Here, we conducted a meta-
analysis to further explore the role of the MMP1 -1607 1G>2G polymorphism in HNC development. Methods: We
identified all eligible studies in the electronic databases of PubMed, ISI Web of Knowledge, MEDLINE, Embase, and
Google Scholar (from January 2000 to June 2012). A meta-analysis was performed to evaluate the association
between the MMP1 -1607 1G>2G polymorphism and risk of HNC by calculating odds ratios (OR) and 95% confidence
interval (CIs). Results: Twelve studies were included in this meta-analysis. In overall comparison, significant
associations were found using the recessive and allelic contrast models (OR, 1.38; 95% CI, 1.07-1.79 and OR, 1.27;
95% CI, 1.05-1.53, respectively), but no association was detected using the dominant model. In the stratified
analyses by several variables, significant associations were observed using the recessive, dominant, and allelic
contrast models in the Asian population (OR, 1.64; 95% CI, 1.29-2.08; OR, 1.39; 95% CI, 1.06-1.82; and OR, 1.41; 95%
CI, 1.21-1.65, respectively), European population (OR, 0.58; 95% CI, 0.40-0.84; OR, 0.64; 95% CI, 0.44-0.92; and OR,
0.68; 95% CI, 0.54-0.85, respectively), and population-based subgroup (OR, 1.24; 95% CI,1.05-1.47; OR,1.48; 95%
CI,1.04-2.12; and OR, 1.22; 95% CI, 1.07-1.38, respectively). Furthermore, significant associations were detected in
oral cavity cancer and nasopharyngeal cancer under the recessive model. Conclusion: Our results suggest that the
MMP1 -1607 1G>2G polymorphism is associated with risk of HNC and that it plays different roles in Asian and
European populations. Further studies with large sample size are needed to validate our findings. 2013 Zhang et al.
Background: Matrix metalloproteinase-1 (MMP-1) plays an important role during the destruction of periodontal
tissue. Although multiple studies had focused on the association between MMP-1 g.-1607dupG and periodontitis
susceptibility, the results remained inconclusive. The purpose of this meta-analysis was to explore its role in the
development of periodontitis. Methods: Retrieved studies from Pubmed, Web of Science, Medline and Google
Scholar Search regarding MMP-1 g.-1607dupG and periodontitis susceptibility were included into the final analysis
with definite selection and exclusion criteria. Overall and stratified analyses based on disease type, severity, ethnicity
and smoking status were performed. Odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the
association between MMP-1 g.-1607dupG and periodontitis susceptibility, while Q test and Egger's test were
adopted respectively to assess heterogeneity among studies and publication bias. Results: A total of 1580
periodontitis cases and 1386 controls in 11 case-control studies were included in the meta-analysis. The pooled
results showed significant association between periodontitis susceptibility and MMP-1 g.-1607dupG polymorphism
in homozygote (2G/2G versus 1G/1G, OR = 1.50, 95% CI = 1.02-2.20) and dominant model analysis (2G/2G+2G/1G
versus 1G/1G, OR = 1.28, 95% CI = 1.04-1.57). For subgroups by type of periodontitis, increased risk of chronic
periodontitis was observed on heterozygote (2G/1G versus 1G/1G, OR = 2.01, 95% CI = 1.58-2.56) and dominant
model (OR = 1.27, 95% CI = 1.03-1.57). Furthermore, similar association was also detected in severe chronic
periodontitis (2G/2G versus 1G/1G, OR = 2.15, 95% CI = 1.35-3.43; 2G/2G+2G/1G versus 1G/1G, OR = 1.64, 95% CI =
1.12-2.39; 2G/2G versus 2G/1G+1G/1G, OR = 1.86, 95% CI = 1.31-2.64). Conclusions: Our meta-analysis
demonstrated that MMP-1 g.-1607dupG polymorphism was associated with chronic periodontitis, especially the
severity of the disease condition. 2013 Li et al.
Aspiration pneumonia is a leading cause of illness and death in persons who reside in long-term-care facilities and,
combined with the lack of proper oral health care and services, the risk of aspiration pneumonia rises. The purpose
of this article is to review recent literature on oral hygiene and oral care in long-term-care facilities and report new
findings regarding associated risks for aspiration pneumonia, as well as research on oral care and health outcomes.
The PubMed MeSH database was utilized to direct a specific search by entering terms "aspiration pneumonia" and
"oral hygiene" from 1970 to 2009, which yielded 34 articles. The Ovid and Google Scholar databases were utilized as
well and provided no additional references for the two terms. A manual search of references from other articles,
including three systematic reviews published over the past decade, provided additional information regarding oral
microorganisms and respiratory pathogens, as well as investigations of oral care. Finally, a brief but comprehensive
introductory review was organized regarding oral microorganisms, biofilm, periodontal disease, and pneumonia to
establish a framework for discussion. Overall, studies suggest (1) an association between poor oral hygiene and
respiratory pathogens, (2) a decrease in the incidence of respiratory complications when patients are provided
chemical or mechanical interventions for improved oral care, (3) the complex nature of periodontal disease and
aspiration pneumonia make direct connections between the two challenging, and (4) additional studies are
warranted to determine adequate oral hygiene protocols for nursing home patients to further reduce the incidence
of aspiration pneumonia. Springer Science+Business Media, LLC 2010.
Objective: Cardiovascular disease (CVD) remains the main cause of morbidity and mortality around the world. A
common polymorphism c.677C>T has been identified in the gene coding for methylenetetrahydrofolate reductase
(MTHFR), which is involved in the remethylation of homocysteine, and may predispose to CVD. A meta-analysis was
performed to estimate the risk of CVD associated with MTHFR c.677C>T in Turkish population. Method: Published
studies were retrieved from PubMed, Science Citation Index/Expanded, Google Scholar, Turkish Medline, and the
Turkish Council of Higher Education Theses Database. For each study, we calculated odds ratios and 95% confidence
intervals, assuming frequency of allele and homozygote comparison, dominant and recessive genetic models.
Results: Thirty-one separate studies were included and 2.780 cases/3.022 controls were involved in the current meta-
analysis. Significant association was found between c.677C>T polymorphism and risk of CVD when all studies pooled
with randomeffects model for T vs. C (OR = 1.33; 95%CI = 1.11-1.59; p = 0.002), TT vs. CC (OR = 1.87; 95%CI = 1.35-
2.60; p < 0.001), TT+CT vs. CC (OR = 1.32; 95%CI = 1.06-1.64; p = 0.014) and TT vs. CT + CC (OR = 1.75; 95%CI = 1.29-
2.37; p < 0.001). Further analysis indicated the significant association between MTHFR TT genotype and groups with
venous thrombosis, peripheral arterial thrombosis, acute MI /MI. No publication bias was observed in any
comparison model. Conclusion: In conclusion, meta-analysis has an important role in medical research, public policy,
and clinical practice. Our results support an association between the MTHFR c.677C>T polymorphism and the risk of
CVD in Turkish population. This finding may potentially be important when considering pharmacogenetic
cardiovascular therapies.
Objective: This meta-analysis examined the association between cardiopulmonary bypass (CPB) time and acute
kidney injury (AKI). Design: Meta-analysis of previously published studies. Setting: Each single-center study was
conducted in a surgical intensive care unit and/or academic or university hospital. Participants: Adult patients
undergoing heart surgery with CPB. Interventions: A systematic literature review was conducted using PubMed,
EMBASE, and Cochrane Library databases and Google Scholar from January 1980 through September 2009. Initial
search results were refined to include human subjects, age >18 years, randomized controlled trials, and prospective
and retrospective cohort studies, meet the Acute Kidney Injury Network definition of renal failure, and report times
on CPB. Measurements and main results: The length of time on CPB has been implicated as an independent risk
factor for development of AKI after CPB (AKI-CPB). The 9 independent studies included in the final meta-analysis had
12,466 patients who underwent CPB. Out of these, 756 patients (6.06%) developed AKI-CPB. In 7 of the 9 studies, the
mean CPB times were statistically longer in the AKI-CPB cohort compared with the control group (cohort without
AKI). The absolute mean differences in CPB time between the 2 groups were 25.65 minutes with the fixed-effects
model and 23.18 minutes with the random-effects model. Conclusions: Longer CPB times are associated with a
higher risk of developing AKI-CPB, which, in turn, has a significant effect on overall mortality as reported by the
individual studies. 2012 Elsevier Inc. All rights reserved.
Background-Secondhand smoke causes cardiovascular and respiratory disease. Smoke-free legislation is associated
with a lower risk of hospitalization and death from these diseases. Methods and Results-Random-effects meta-
analysis was conducted by law comprehensiveness to determine the relationship between smoke-free legislation and
hospital admission or death from cardiac, cerebrovascular, and respiratory diseases. Studies were identified by using
a systematic search for studies published before November 30, 2011 with the use of the Science Citation Index,
Google Scholar, PubMed, and Embase and references in identified articles. Change in hospital admissions (or deaths)
in the presence of a smoke-free law, duration of follow-up, and law comprehensiveness (workplaces only;
workplaces and restaurants; or workplaces, restaurants, and bars) were recorded. Forty-five studies of 33 smoke-
free laws with median follow-up of 24 months (range, 2-57 months) were included. Comprehensive smoke-free
legislation was associated with significantly lower rates of hospital admissions (or deaths) for all 4 diagnostic groups:
coronary events (relative risk, 0.848; 95% confidence interval 0.816-0.881), other heart disease (relative risk, 0.610;
95% confidence interval, 0.440-0.847), cerebrovascular accidents (relative risk, 0.840; 95% confidence interval, 0.753-
0.936), and respiratory disease (relative risk, 0.760; 95% confidence interval, 0.682-0.846). The difference in risk
following comprehensive smoke-free laws does not change with longer follow-up. More comprehensive laws were
associated with larger changes in risk. Conclusions-Smoke-free legislation was associated with a lower risk of
smoking-related cardiac, cerebrovascular, and respiratory diseases, with more comprehensive laws associated with
greater changes in risk. 2012 American Heart Association, Inc.
BACKGROUND: Angiotensinogen (AGT) T174M gene polymorphism has been suggested to be linked to risk of
coronary artery disease, however, results from studies of this association have been inconsistent. In this study, we
assess the relationship between AGT T174M gene polymorphism and coronary artery disease., METHODS: We
conducted a meta-analysis of 18 case-control studies with 8,147 coronary artery disease cases and 5,344 controls in
Google scholar, PubMed, Cochrane Library and China National Knowledge Infrastructure (CNKI) databases to identify
eligible studies published by July, 2012. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated from
these studies., RESULTS: Overall, a significant association was found between angiotensinogen T174M polymorphism
and coronary artery disease risk when all studies were pooled into the meta-analysis (TT vs. MM: OR = 0.53, 95% CI =
0.40-0.71; dominant model: OR = 1.16, 95% CI = 1.01-1.35; recessive model: OR = 0.54, 95% CI = 0.40-0.72). In a
stratified analysis, the results indicate a significant association in Caucasians suffering from coronary stenosis (TT vs.
MM: OR = 0.38, 95% CI = 0.23-0.63; recessive model: OR = 0.39, 95% CI = 0.23-0.64). No significant increased risk for
coronary artery disease was found in Asians., CONCLUSIONS: The meta-analysis indicate a significant association of
T174M polymorphism with coronary stenosis risk in Caucasians.
Background: Angiotensinogen (AGT) T174M gene polymorphism has been suggested to be linked to risk of coronary
artery disease, however, results from studies of this association have been inconsistent. In this study, we assess the
relationship between AGT T174M gene polymorphism and coronary artery disease. Methods: We conducted a meta-
analysis of 18 case-control studies with 8,147 coronary artery disease cases and 5,344 controls in Google scholar,
PubMed, Cochrane Library and China National Knowledge Infrastructure (CNKI) databases to identify eligible studies
published by July, 2012. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated from these studies.
Results: Overall, a significant association was found between angiotensinogen T174M polymorphism and coronary
artery disease risk when all studies were pooled into the meta-analysis (TT vs. MM: OR = 0.53, 95% CI = 0.40-0.71;
dominant model: OR = 1.16, 95% CI = 1.01-1.35; recessive model: OR = 0.54, 95% CI = 0.40-0.72). In a stratified
analysis, the results indicate a significant association in Caucasians suffering from coronary stenosis (TT vs. MM: OR =
0.38, 95% CI = 0.23-0.63; recessive model: OR = 0.39, 95% CI = 0.23-0.64). No significant increased risk for coronary
artery disease was found in Asians. Conclusions: The meta-analysis indicate a significant association of T174M
polymorphism with coronary stenosis risk in Caucasians. 2013 JGC All rights reserved.
Although the +104T/C polymorphism in the 5' untranslated region (UTR) of growth differentiation factor 5 (GDF5)
plays a role in the pathogenesis of knee osteoarthritis, the results have been inconsistent. In this study, we
performed a meta-analysis to assess the association of +104T/C polymorphism with knee osteoarthritis. Published
literature from PubMed, Google Scholar and China National Knowledge Infrastructure data was retrieved. Pooled
odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. A total
of 6 case-control studies containing 2,744 patients and 4,518 controls were enrolled in this meta-analysis. Overall, a
statistically significant association was found between the +104T/C polymorphism and risk of knee osteoarthritis (TT
vs. CC: OR 1.68, 95% CI=1.41-2.01; TT vs. TC: OR 1.18, 95% CI=1.01-1.38; dominant model: OR 0.72, 95% CI=0.61-
0.86). Taking into account the effect of ethnicity, further stratified analyses were performed. In the subgroup
analysis, the same association was identified in Caucasian (TT vs. CC: OR 1.45, 95% CI=1.13-1.85) and Asian (TT vs.
CC: OR 1.99, 95% CI=1.53-2.60; TT vs. TC: OR 1.33, 95% CI=1.16-1.52; dominant model: OR 0.64, 95% CI=0.56-0.72;
recessive model: OR 1.77, 95% CI=1.37-2.29) populations. The meta-analysis results demonstrated that the +104T/C
polymorphism in the 5'-UTR of GDF5 is associated with risk of knee osteoarthritis. Copyright 2013 Spandidos
Publications Ltd.
Although the +104T/C polymorphism in the 5' untranslated region (UTR) of growth differentiation factor 5 (GDF5)
plays a role in the pathogenesis of knee osteoarthritis, the results have been inconsistent. In this study, we
performed a meta-analysis to assess the association of +104T/C polymorphism with knee osteoarthritis. Published
literature from PubMed, Google Scholar and China National Knowledge Infrastructure data was retrieved. Pooled
odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. A total
of 6 case-control studies containing 2,744 patients and 4,518 controls were enrolled in this meta-analysis. Overall, a
statistically significant association was found between the +104T/C polymorphism and risk of knee osteoarthritis (TT
vs. CC: OR 1.68, 95% CI=1.41-2.01; TT vs. TC: OR 1.18, 95% CI=1.011.38; dominant model: OR 0.72, 95% CI=0.61-
0.86). Taking into account the effect of ethnicity, further stratified analyses were performed. In the subgroup
analysis, the same association was identified in Caucasian (TT vs. CC: OR 1.45, 95% CI=1.13-1.85) and Asian (TT vs.
CC: OR 1.99, 95% CI=1.532.60; TT vs. TC: OR 1.33, 95% CI=1.16-1.52; dominant model: OR 0.64, 95% CI=0.56-0.72;
recessive model: OR 1.77, 95% CI=1.37-2.29) populations. The meta-analysis results demonstrated that the +104T/C
polymorphism in the 5'-UTR of GDF5 is associated with risk of knee osteoarthritis.
Background: The tumor necrosis factors alpha and beta (TNF-alpha, TNF-beta) can regulate a wide range of cellular
responses and facilitate tumor growth and progression. However, the effects of the polymorphisms TNF-
alpha238G>A and transforming growth factor (TGF)-beta1 L10P on breast cancer risk are still unclear or inconclusive.
Materials and Methods: In order to provide a full estimation of the association with breast cancer, a metaanalysis of
the most valid literature was performed by searching the databases PubMed, Web of Science, ScienceDirect, EBSCO,
CNKI, and Google Scholar. Results: For TNF-alpha-238G>A, 3 studies including 35,578 cases and 38,095 controls were
selected. For TGF-beta1 L10P, 11 studies including 7,903 cases and 8,797 controls were selected. For TNF-alpha-
238G>A, a significant association with breast cancer risk was found in the recessive model (odds ratio = 0.954, 95%
confidence interval 0.912-0.998), but other models did not reach significance. For TGF-beta1 L10P, no significant
correlations were found. Conclusions: Our study indicates that TNF-alpha238G>A may be associated with breast
cancer incidence, although significance is weak. Its role as an indicator for cancer diagnosis should be studied more.
Moreover, for TGF-beta1 L10P, further comprehensive meta-analyses are necessary. Copyright 2011 S. Karger AG,
Basel.
Objective: To examine the strength and consistency of the evidence on the relationship between depression and
adherence to antihypertensive medications. Methods: The Medline, Cinahl, Psycinfo, Embase, SCOPUS, and ISI
databases were searched from inception until 11 December 2009 for published studies of original research that
assessed adherence to antihypertensive medications and used a standardized interview, validated questionnaire, or
International Classification of Diseases Ninth Revision code to assess depression or symptoms of depression in
patients with hypertension. Manual searching was conducted on 22 selected journals. Citations of included articles
were tracked using Web of Science and Google Scholar. Two investigators independently extracted data from the
selected articles and discrepancies were resolved by consensus. Results: Eight studies were identified that included a
total of 42 790 patients. Ninety-five percent of these patients were from one study. Only four of the studies had the
assessment of this relationship as a primary objective. Adherence rates varied from 29 to 91%. There were widely
varying results within and across studies. All eight studies reported at least one significant bivariate or multivariate
negative relationship between depression and adherence to antihypertensive medications. Insignificant findings in
bivariate or multivariate analyses were reported in six of eight studies. Conclusion: All studies reported statistically
significant relationships between depression and poor adherence to antihypertensive medications, but definitive
conclusions cannot be drawn because of substantial heterogeneity between studies with respect to the assessment
of depression and adherence, as well as inconsistencies in results both within and between studies. Additional
studies would help clarify this relationship. 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Context: HCV infection is strongly associated with development of insulin resistance and type-2 diabetes, however
molecular mechanism of these associations is not known. The aim of this review was to conduct a comprehensive
literature search to understand the nature of the association between hepatitis C virus (HCV) infection and insulin
resistance (IR). We also explored the role of HCV core protein and NS5a in modulating the course of the insulin-
signaling pathway. Evidence Acquisitions: We searched Directory of Open Access Journals (DOAJ) Google Scholar,
Pubmed (NLM), LISTA (EBSCO), Web of Science (TS and PakMediNet). Results: Emerging evidence suggests an
association between HCV infection and carotid/ coronary vascular disease. IR appears to be a dominant underlying
cause of accelerated atherosclerosis in patients with chronic hepatitis C (CHC). HCV can induce IR directly through
the stimulation of SOCS3 and PPA2, and both of these molecules have been shown to inhibit interferon-alpha
signaling. Improvement of insulin sensitivity may increase the response rate to antiviral treatment and prevent IR
complications, including vascular diseases. The results of several clinical trials that have used insulin sensitizers
(metformin and PPAR- agonists) have been inconclusive. Conclusions: Beside the association between HCV and IR,
the published data also have showed the possible association of HCV core and NS5A protein with IR. 2012 Kowsar M.
P. Co. All rights reserved.
CONTEXT: HCV infection is strongly associated with development of insulin resistance and type-2 diabetes, however
molecular mechanism of these associations is not known. The aim of this review was to conduct a comprehensive
literature search to understand the nature of the association between hepatitis C virus (HCV) infection and insulin
resistance (IR). We also explored the role of HCV core protein and NS5a in modulating the course of the insulin-
signaling pathway. EVIDENCE ACQUISITIONS: We searched Directory of Open Access Journals (DOAJ) Google Scholar,
Pubmed (NLM), LISTA (EBSCO), Web of Science (TS and PakMediNet)., RESULTS: Emerging evidence suggests an
association between HCV infection and carotid/coronary vascular disease. IR appears to be a dominant underlying
cause of accelerated atherosclerosis in patients with chronic hepatitis C (CHC). HCV can induce IR directly through
the stimulation of SOCS3 and PPA2, and both of these molecules have been shown to inhibit interferon- signaling.
Improvement of insulin sensitivity may increase the response rate to antiviral treatment and prevent IR
complications, including vascular diseases. The results of several clinical trials that have used insulin sensitizers
(metformin and PPAR- agonists) have been inconclusive., CONCLUSIONS: Beside the association between HCV and IR,
the published data also have showed the possible association of HCV core and NS5A protein with IR.
Several human genetic variants, HLA antigens and alleles are reportedly linked to post-schistosomal hepatic disorder
(PSHD), but the results from these reports are highly inconclusive. In order to estimate overall associations between
human genetic variants, HLA antigens, HLA alleles and PSHD, we systematically reviewed and performed a meta-
analysis of relevant studies in both post-schistosomal hepatic disorder and post-schistosomal non-hepatic disorder
patients. PubMed, Scopus, Google Scholar, The HuGE Published Literature database, Cochrane Library, and manual
search of reference lists of articles published before July 2009 were used to retrieve relevant studies. Two reviewers
independently selected articles and extracted data on study characteristics and data regarding the association
between genetic variants, HLA antigens, HLA alleles and PSHD in the form of 2 x 2 tables. A meta-analysis using fixed-
effects or random-effects models to pooled odds ratios (OR) with corresponding 95% confidence intervals were
calculated only if more than one study had investigated particular variation. We found 17 articles that met our
eligibility criteria. Schistosoma mansoni and Schistosoma japonicum were reported as the species causing PSHD.
Since human genetic variants were only investigated in one study, these markers were not assessed by meta-
analysis. Thus, only HLA-genes (a total of 66 HLA markers) were conducted in the meta-analysis. Our meta-analysis
showed that human leucocyte antigens HLA-DQB1*0201 (OR = 2.64, P= 0.018), DQB1*0303 (OR = 1.93, P= 0.008),
and DRB1*0901 (OR = 2.14, P= 0.002) alleles and HLA-A1 (OR = 5.10, P= 0.001), A2 (OR = 2.17, P= 0.005), B5 (OR =
4.63, P= 0.001), B8 (OR = 2.99, P= 0.02), and B12 (OR = 5.49, P= 0.005) serotypes enhanced susceptibility to PSHD,
whereas HLA-DQA1*0501 (OR = 0.29, P<= 0.001) and DQB1*0301 (OR = 0.58, P= 0.007) were protective factors
against the disease. We further suggested that the DRB1*0901-DQB1*0201, DRB1*0901-DQB1*0303 and A1-B8
haplotypes enhanced susceptibility to PSHD, whereas DQA1*0501-DQB1*0301 linkage decreased the risk of PSHD.
The result improved our understanding of the association between the HLA loci and PSHD with regard to pathogenic
or protective T-cells and provided novel evidence that HLA alleles may influence disease severity. 2011 Elsevier
Ireland Ltd.
Osteoporosis, especially in postmenopausal women, is a major health and economic concern in the world.
Environmental, metabolic and genetic factors play roles in determination of bone mass and health, Over the past
several years, evidence has been growing regarding the negative effects of homocysteine on bone health. The
objective of this paper was to provide a review of the state of the science of homocysteine and osteoporosis.
Medline, Index Medicus, Scopus, Google Scholar and Web of Sciences were searched for any paper regarding the
effects of homocysteine on osteoporosis using key words of osteoporosis, bone health, homocysteine,
hyperhomocysteinemia, and methylentetrahydrofolate reductase polymorphism. Most of the relevant citations from
human literature were studied and summarized. Regarding bone mineral density, risk of fracture and bone markers
that have been studied, the negative effects of homocysteine on bone health seems considerable. Vitamin B
deficiency may play an important role in bone metabolism, which has to be further investigated, According to the
differences in genetic predisposition, environmental, sex differences and nutritional factors, further studies are
needed to explore the effective mechanisms of association between homocysteine and osteoporosis. 2008 Future
Medicine Ltd.
Recently, genome-wide associated studies (GWAS) have identified that host genetics IL28B SNPs rs12979860 and
rs8099917 were significantly associated with SVR in patients infected with chronic HCV genotype 1 to PEG-INF/RBV
therapy. Results from these studies remain conflicting. We conducted this meta-analysis to estimate the overall
association of SVR with rs12979860 and rs8099917. We searched the PubMed, Embase, Scholar Google, ISI Web of
Knowledge, and Chinese National Knowledge Infrastructure (CNKI) databases for all articles before July 30, 2012. The
odds ratio (OR) corresponding to the 95% confidence interval (CI) was used to assess the association. The statistical
heterogeneity among studies was assessed with the I2 statistics. Begg's test and Egger's test were performed to
evaluate the publication bias. Eventually, twenty studies were selected for the meta-analysis. The IL-28B SNPs
rs12979860 genotype CC and rs8099917 genotype TT significantly positive associated with SVR in patients infected
chronic HCV genotype 1 to PEG-INF/RBV therapy (OR=4.473, 95% CI=3.814-5.246, OR=5.171, 95% CI=4.372-6.117
respectively). The results suggested that rs12979860 genotype CC and rs8099917 genotype TT could be used as
independent predictors of the HCV-1 infected patients. 2012 Elsevier B.V.
Background: Cutaneous melanoma is one of the most serious skin cancers. It is caused by neural crest-derived
melanocytes - pigmented cells normally present in the epidermis and, sometimes, in the dermis. Methods. We
performed a review of current knowledge on the risk factors of cutaneous melanoma. Relevant studies were
identified using the PubMed, Science Direct, Medline, Scopus, Scholar Google and ISI Web of Knowledge databases.
Results: Melanoma incurs a considerable public health burden owing to the worldwide dramatic rise in incidence
since the mid-1960s. Ultraviolet radiation exposure is the predominant environmental risk factor. The role of
geographical (latitude) and individual factors such as skin type, life style, vitamin D levels and antioxidant protection,
sunburn, and exposure to other environmental factors possibly contributing to melanoma risk (such as cosmetics
including sunscreen, photosensitising drugs, and exogenous hormones) are reviewed in this article. Recently, both
rare high risk susceptibility genes and common polymorphic genes contributing to melanoma risk have been
identified. Conclusions: Cutaneous melanoma is a complex cancer with heterogeneous aetiology that continues to
increase in incidence. Introduction of new biomarkers may help to elucidate the mechanism of pathogenesis and
individual susceptibility to the disease, and make both prevention and treatment more effective. 2012 Volkovova et
al; licensee BioMed Central Ltd.
Cutaneous melanoma is one of the most serious skin cancers. It is caused by neural crest-derived melanocytes -
pigmented cells normally present in the epidermis and, sometimes, in the dermis. We performed a review of current
knowledge on the risk factors of cutaneous melanoma. Relevant studies were identified using the PubMed, Science
Direct, Medline, Scopus, Scholar Google and ISI Web of Knowledge databases. Melanoma incurs a considerable
public health burden owing to the worldwide dramatic rise in incidence since the mid-1960s. Ultraviolet radiation
exposure is the predominant environmental risk factor. The role of geographical (latitude) and individual factors such
as skin type, life style, vitamin D levels and antioxidant protection, sunburn, and exposure to other environmental
factors possibly contributing to melanoma risk (such as cosmetics including sunscreen, photosensitising drugs, and
exogenous hormones) are reviewed in this article. Recently, both rare high risk susceptibility genes and common
polymorphic genes contributing to melanoma risk have been identified. Cutaneous melanoma is a complex cancer
with heterogeneous aetiology that continues to increase in incidence. Introduction of new biomarkers may help to
elucidate the mechanism of pathogenesis and individual susceptibility to the disease, and make both prevention and
treatment more effective.
AIM: A systematic literature review, covering publications from 1994 to 2009, was carried out to determine the
effects of teleconsultation regarding clinical, behavioral, and care coordination outcomes of diabetes care compared
to usual care. Two types of teleconsultation were distinguished: (1) asynchronous teleconsultation for monitoring
and delivering feedback via email and cell phone, automated messaging systems, or other equipment without face-
to-face contact; and (2) synchronous teleconsultation that involves real-time, face-to-face contact (image and voice)
via videoconferencing equipment (television, digital camera, webcam, videophone, etc.) to connect caregivers and
one or more patients simultaneously, e.g., for the purpose of education., METHODS: Electronic databases were
searched for relevant publications about asynchronous and synchronous tele-consultation [Medline, Picarta,
Psychinfo, ScienceDirect, Telemedicine Information Exchange, Institute for Scientific Information Web of Science,
Google Scholar]. Reference lists of identified publications were hand searched. The contribution to diabetes care was
examined for clinical outcomes [e.g., hemoglobin A1c (HbA1c), dietary values, blood pressure, quality of life], for
behavioral outcomes (patient-caregiver interaction, self-care), and for care coordination outcomes (usability of
technology, cost-effectiveness, transparency of guidelines, equity of access to care). Randomized controlled trials
with HbA1c as an outcome were pooled using standard meta-analytical methods., RESULTS: Of 2060 publications
identified, 90 met inclusion criteria for electronic communication between (groups of) caregivers and patients with
type 1 and 2 or gestational diabetes. Studies that evaluated teleconsultation not particularly aimed at diabetes were
excluded, as were those that described interventions aimed solely at clinical improvements (e.g., HbA1c or lipid
profiles). In 63 of 90 interventions, the interaction had an asynchronous teleconsultation character, in 18 cases
interaction was synchronously (videoconferencing), and 9 involved a combination of synchronous with asynchronous
interaction. Most of the reported improvements concerned clinical values (n = 49), self-care (n = 46), and satisfaction
with technology (n = 43). A minority of studies demonstrated improvements in patient-caregiver interactions (n = 28)
and cost reductions (n = 27). Only a few studies reported enhanced quality of life (n = 12), transparency of health
care (n = 7), and improved equity in care delivery (n = 4). Asynchronous and synchronous applications appeared to
differ in the type of contribution they made to diabetes care compared to usual care: asynchronous applications
were more successful in improving clinical values and self-care, whereas synchronous applications led to relatively
high usability of technology and cost reduction in terms of lower travel costs for both patients and care providers and
reduced unscheduled visits compared to usual care. The combined applications (n = 9) scored best according to
quality of life (22.2%). No differences between synchronous and asynchronous teleconsultation could be observed
Atomic force microscopy (AFM) is a three-dimensional topographic technique with a high atomic resolution to
measure surface roughness. AFM is a kind of scanning probe microscope, and its near-field technique is based on the
interaction between a sharp tip and the atoms of the sample surface. There are several methods and many ways to
modify the tip of the AFM to investigate surface properties, including measuring friction, adhesion forces and
viscoelastic properties as well as determining the Young modulus and imaging magnetic or electrostatic properties.
The AFM technique can analyze any kind of samples such as polymers, adsorbed molecules, films or fibers, and
powders in the air whether in a controlled atmosphere or in a liquid medium. In the past decade, the AFM has
emerged as a powerful tool to obtain the nanostructural details and biomechanical properties of biological samples,
including biomolecules and cells. The AFM applications, techniques, and -in particular-its ability to measure forces,
are not still familiar to most clinicians. This paper reviews the literature on the main principles of the AFM modality
and highlights the advantages of this technique in biology, medicine, and-especially-dentistry. This literature review
was performed through E-resources, including Science Direct, PubMed, Blackwell Synergy, Embase, Elsevier, and
Scholar Google for the references published between 1985 and 2010.
Atrial tachyarrhythmias are a common complication of atrial septal defects. The objective was to determine the
effect of atrial septal defect closure on pre-existing atrial tachyarrhythmias and to investigate if such an effect is
present after either surgical or percutaneous closure. Medline, EMBASE, Cochrane Library, and Google Scholar
databases were searched between 1967 and 2009. The search was expanded using the 'related articles' function and
reference lists of key studies. All studies reporting pre- and post- closure incidence (or prevalence) of atrial
tachyarrhythmias in the same patient groups were included. Data were independently extracted by two authors
according to a pre-defined protocol. Incongruities were settled by consensus decision. Twenty six studies were
identified including 1841 patients who underwent surgical closure and 945 who underwent percutaneous closure.
Meta-analysis using a random effects model demonstrated a reduction in the prevalence of atrial tachyarrhythmias
following atrial septal defect closure [OR = 0.66 (95% CI 0.57-0.77)]. This effect was demonstrated after both
percutaneous [OR = 0.49 (95% CI 0.32-0.76)] and surgical closure [OR = 0.72 (95% CI 0.60-0.87)]. Immediate (<30
days) and mid-term (30 days - 5 years) follow-up also demonstrated a reduction in AT prevalence [ORs of 0.80 (95%
CI 0.66-0.97) and 0.47 (95% CI 0.36-0.62) respectively]. Atrial septal defect closure, whether surgical or
percutaneous, is associated with a reduction in the post-closure prevalence of pre-existing atrial tachyarrhythmias
and atrial fibrillation in the short to medium term.
To review literature from Africa on the epidemiology of ADHD as well attention deficit hyperactivity symptoms and
associated co-morbid conditions among African children. A literature search was done through Pubmed/MEDLINE
and Google Scholar using then following terms, "attention deficit", "hyperactivity disorders", "epidemiology", "co-
morbid conditions", "Africa". Nine studies met the inclusion criteria with four studies coming from South Africa, two
each from Democratic Republic of Congo and Nigeria respectively and one from Ethiopia. The prevalence of ADHD
varied with rates of between 5.4% and 8.7%, amongst school children, 1.5% amongst children from the general
population between 45.5% to 100.0% amongst special populations of children with possible organic brain pathology.
Common associated co-morbid conditions were oppositional defiant disorder, conduct disorder as well as
anxiety/depressive symptoms. Published data from Africa is limited. For effective healthcare policy further studies
are needed to define the magnitude and burden of ADHD and other childhood neurodevelopmental disorders in
Africa.
The objective of this article is to review the attitudes of the different stakeholders (minors, healthcare professionals,
parents and relatives of affected individuals) towards carrier testing in minors. The databases Pubmed, Google
Scholar, Psychinfo, Biological Abstracts, Francis, Anthropological Index online, Web of Science, and Sociological
Abstracts were searched using key words for the period 1990-2004. Studies were included if they were published in a
peer reviewed journal in English and described the attitudes of minors, parents or healthcare professionals towards
carrier testing in minors in a family context. The results were presented in a summary form. In total 20 relevant
studies were retrieved (2 studies reported the attitudes of two stakeholders). Only one study reported the attitudes
of adolescents, two studies reported the attitudes of adults who had undergone carrier testing in childhood. In total
six studies have been retrieved discussing the parental attitudes towards carrier testing in their children. Over all
studies, most parents showed interest in detecting their children's carrier status and responded they wanted their
child tested before the age of majority; some parents even before 12 years. Eight studies were retrieved that
reported the attitudes of relatives of affected individuals. Most were in favor of carrier testing before 18 years. The
studies retrieved suggest that most parents are interested in the carrier status of their children and want their
children to be tested before they reach legal majority (and some even in childhood). This can lead to tensions
between parents and healthcare professionals regarding carrier testing in minors. Guidelines of healthcare
professionals advise to defer carrier testing on the grounds that children should be able to decide for themselves
later in life to request a carrier test or not.
Objectives: The objective of this article is to review the attitudes of different stakeholders (minors, parents,
healthcare professionals, and relatives of affected individuals) towards predictive genetic testing of minors for
familial breast cancer. Design: The databases PubMed, Google Scholar, Psychinfo, Biological Abstracts, Francis,
Anthropological Index online, Web of Science, and Sociological Abstracts were searched using relevant key words;
literature indexed up to May 2006 was considered. Studies were included if they were published in a peer-reviewed
journal written in English and if they described the attitudes of the different stakeholders towards predictive genetic
testing of minors for familial breast cancer. The results are presented in a summary form. Results: A total of 14
studies were included. The studies were very heterogeneous, using a variety of study populations, study designs,
sample sizes, and study measures. Substantial proportions of adolescents were interested in learning whether they
were at risk for familial breast cancer. The attitudes of healthcare professionals about testing minors diverged.
Conclusion: Our review has made clear that many respondents fail to understand potential risks related to predictive
genetic testing in minors. Respondents might have overly positive expectations about possibilities for genetic testing.
This emphasizes the need for genetic education and counselling about genetic testing in minors. 2007 Elsevier
Ireland Ltd. All rights reserved.
AIM: To undertake a review of the quantitative research literature, to determine emergency staff and public
attitudes, to support the implementation and practice of family presence during resuscitation in the emergency
department., BACKGROUND: FPDR although endorsed by numerous resuscitation councils, cardiac, trauma and
emergency associations, continues to be topical, the extent to which it is implemented and practiced remains
unclear., REVIEW METHODS: A review of the quantitative studies published between 1992 and October 2011 was
undertaken using the following databases: CINAHL, Ovid Medline, PSYCHINFO, Pro-Quest, Theses Database,
Cochrane, and Google Scholar search engine. The primary search terms were 'family presence', and 'resuscitation'.
The final studies included in this paper were appraised using the Critical Appraisal Skills Programme criteria.,
RESULTS: Fourteen studies were included in this literature review. These included quantitative descriptive designs,
pre and post-test designs and one randomized controlled trial (RCT). The studies were divided into three main
research areas; investigation of emergency staff attitudes and opinions, family and general public attitudes, and four
papers evaluating family presence programs in the emergency department. Studies published prior to 2000 were
included in the background., CONCLUSION: FPDR in the emergency department is well recognised and documented
among policy makers, the extent in which it is implemented and practiced remains unclear. Further research is
needed to assess how emergency staff are educated and trained in order to facilitate family presence during
resuscitation attempts. Copyright 2012. Published by Elsevier Ltd.
Objective This paper explores the literature related to attracting the Y Generation (Y Gen: people born between 1980
and 2000) to the nursing profession and retaining them in our current workforce. Design A comprehensive review of
the literature supported the need for further research. Three searches were conducted and all relevant literature
was reviewed by each researcher. Literature included in the review was chosen based on specific search-term
inclusion. Data sources Structured searches were conducted with no limitations on publication type, date or
language. Search engines used included: Australian Family and Society, CINAHL, Expanded Academic, Google Scholar,
Medline, ProQuest and PubMed. Results A critical review of the literature, particularly empirical work on the subject
has informed decision making regarding the research questions that remain to be explored. Conclusions The
literature revealed that the Y Gen is currently contributing to the nursing workforce demographics. Much discussion
exists surrounding the integration of the Y Gen into the workplace along with the other three generations of nurses.
There is also an abundance of descriptions of the Y Gen characteristics and values. There is, however, limited
reference relating to what attracted this generation to nursing or what might retain them in the nursing workforce.
Implications for nursing management The Y Gen is the largest generation to enter our workforce since the Baby
Boomers. Health services need to recognize the needs of the Y Gen nurses and develop strategies to move the
profession forward by preparing the current workforce and environment for a generation that is already here. The
focus should be on their strengths with development made to structure a workforce that will support the Y Gen in
their professional nursing role. Understanding what attracts the Y Gen to nursing, what managers can do to retain
the Y Gen in nursing and how the nursing profession can support the Y Gen to assume a role in nursing and nursing
governance will ensure that the retiring generation has left the nursing profession in capable hands. 2011 Blackwell
Publishing Ltd.
In Nepal, a number of private sector medical schools have opened recently; although sufficient numbers of doctors
are graduating there continues to be a doctor shortage in rural areas. This article analysed the rural doctor shortage
in Nepal and reviewed the international literature for strategies that may be suitable for use in Nepal. Original
research articles, reviews, magazine articles and project reports dealing with Nepal and other developing countries
during the period 1995 to 2010 were sourced via Google, Google Scholar and Pubmed. Full text access was obtained
via WHO's HINARI database. The health workforce in Nepal is unevenly distributed resulting in doctor shortages in
rural areas. The recent introduction of mandatory rural service for scholarship students was aimed to reduce the loss
of medical graduates to developed nations. High tuition fees in private medical schools and low Government wages
prevent recent graduates from taking up rural positions, and those who do face many challenges. Potential
corrective strategies include community-based medical education, selecting rural-background medical students, and
providing a partial or complete tuition fee waiver for medical students who commit to rural service. Traditional
healers and paramedical staff can also be trained for and authorized to provide rural health care. A range of
strategies developed elsewhere could be used in Nepal, especially community-oriented medical education that
involves rural doctors in training medical students. The reimbursement of tuition fees, assistance with relocation,
and provision of opportunities for academic and professional advancement for rural doctors should also be
considered. Government investment in improving working conditions in rural Nepal would assist rural communities
to attract and retain doctors.
The development of trait markers of schizophrenia would represent an important advance in understanding the
genetic architecture of the disease. To date, no candidate markers have satisfied all of the trait marker criteria, and
many are not specific to the schizophrenia spectrum. Abnormalities in visual scanpaths are frequently reported in
patients with schizophrenia and are emerging as a novel candidate for a schizophrenia biomarker. Here we review
the suitability of scanpath measures as a target for trait marker research in schizophrenia. Papers reporting scanpath
patterns in patients with schizophrenia were identified by PubMed and Google Scholar searches and by scanning
reference lists in relevant articles. Search terms included "schizophrenia," "psychosis," "scanpath," "scan path,"
"fixation," "saccade" and "eye movement." Scanpath abnormalities afford impressive sensitivity and specificity and
appear largely independent of psychotropic medications. Scanpaths may demonstrate some fluctuation with
symptomatology and may be useful in illuminating illness state or subtypes. However, there is evidence that viewing
behaviours remain atypical regardless of symptom remission and may be present in unaffected relatives of
individuals with schizophrenia. This research is in its early stages, and further investigation regarding patterns of
inheritance is required. Our findings support scanpath measures as a favourable topic for further investigation as a
trait marker.
The development of trait markers of schizophrenia would represent an important advance in understanding the
genetic architecture of the disease. To date, no candidate markers have satisfied all of the trait marker criteria, and
many are not specific to the schizophrenia spectrum. Abnormalities in visual scanpaths are frequently reported in
patients with schizophrenia and are emerging as a novel candidate for a schizophrenia biomarker. Here we review
the suitability of scanpath measures as a target for trait marker research in schizophrenia. Papers reporting scanpath
patterns in patients with schizophrenia were identified by PubMed and Google Scholar searches and by scanning
reference lists in relevant articles. Search terms included "schizophrenia," "psychosis," "scanpath," "scan path,"
"fixation, " "saccade"and "eye movement."Scanpath abnormalities afford impressive sensitivity and specificity and
appear largely independent of psychotropic medications. Scanpaths may demonstrate some fluctuation with
symptomatology and may be useful in illuminating illness state or subtypes. However, there is evidence that viewing
behaviours remain atypical regardless of symptom remission and may be present in unaffected relatives of
individuals with schizophrenia. This research is in its early stages, and further investigation regarding patterns of
inheritance is required. Our findings support scanpath measures as a favourable topic for further investigation as a
trait marker. 2011 Canadian Medical Association.
The aim of the study was to evaluate the evidence that serotonin1A (5-HT1A) receptor partial agonists of the
azapirone class, which are not antipsychotic, have benefits for adjunctive treatment of overall psychopathology,
positive and negative symptoms for patients with schizophrenia. We carried out a systematic review of the literature
available through PubMed, Cochrane Library, PsycINFO and Google Scholar during September 2012, followed by a
meta-analysis of randomized placebo-controlled trials. Risk ratio (RR), 95% confidence intervals (CI) and standardized
mean difference (s.m.d.) were calculated. Four studies, involving 163 patients with schizophrenia, met inclusion
criteria: Buspirone: Three trials and 137 patients; tandospirone: One trial and 26 patients. As adjunctive therapy, 5-
HT1A partial agonists were significantly superior to placebo for overall improvement in psychopathology (s.m.d.A =A -
0.46, CIA =A -0.79 to -0.13, pA =A 0.006, NA =A 4, nA =A 149) and marginally more effective to improve positive
symptoms (s.m.d.A =A -0.31, CIA =A -0.64 to 0.01, pA =A 0.06, NA =A 4, nA =A 149). However, 5-HT1A partial
agonists were not more efficacious than placebo as adjunctive therapy for improving negative symptoms (s.m.d.A =A
-0.09, CIA =A -0.60 to 0.42, pA =A 0.72, NA =A 4, nA =A 149). In addition, there was no significant difference in
discontinuation rates between 5-HT1A partial agonists and placebo (all cause: RRA =A 0.98, CIA =A 0.49-1.98, pA =A
0.96, NA =A 4, nA =A 153, side-effects: RRA =A 1.96, CIA =A 0.54-7.19, pA =A 0.31, NA =A 4, nA =A 153). 5-HT1A
partial agonists as adjunctive therapy improved overall psychopathology with a trend to improve positive symptoms
in patients with schizophrenia. Because the number of studies was small, additional controlled clinical trials with
larger numbers of patients are indicated. CINP 2013.
Purpose: The purpose of this quantitative review is to document effectiveness and complications of posterior
cruciate ligament (PCL) surgery and compare outcomes, advantages and disadvantages of reconstructive and
augmentation procedures. Methods: A systematic literature search was performed in PubMed, Medline, Ovid,
Google Scholar and Embase databases using the combined keywords "PCL reconstruction," "PCL augmentation,"
"clinical outcomes" and "functional outcomes" with no limit for year of publication. Articles were included if they
reported data on clinical, functional and imaging outcomes who had undergone reconstruction or augmentation of
the PCL for management of PCL injuries. Two authors screened the selected articles for title, abstract and full text in
accordance with predefined inclusion and exclusion criteria. The methodological quality of all articles was assessed
by two authors according to the Coleman methodology score. The critical appraisal was made using the
Physiotherapy Evidence Database (PEDro) scale. Results: A total of 34 studies, 22 retrospective, 9 prospective and 5
were randomized control trials were included by full text. The modified Coleman methodology score averaged 70. 8
(SD 6. 5), median 73 (range from 60 to 82). At IKDC assessment, the average rate of normal (A) and nearly normal (B)
outcomes was 89. 8 % (SD 4. 2) (from 85 to 93 %; median 91. 4) after PCL augmentation and 80. 1 % (SD 12. 4) after
PCL reconstruction (from 57. 2 to 100 %; median 81. 8 %) were rated as normal (A) and nearly normal (B). The
average Lysholm Knee Scores after PCL augmentation were 93. 1 points (SD 1. 9) and ranged from 82. 1 to 94. 2
(median 90. 5) after PCL reconstruction. The KT 1000 difference improved from an average preoperative difference
of 8. 8 mm (SD 0. 9) to an average postoperative of 2. 1 mm (SD 0. 6) after PCL augmentation (average improvement
of 6. 7 mm (SD 4. 7)) and from 8. 2 (SD 3. 6) to 2. 3 mm (SD 2. 0) (average improvement of 5. 9 mm SD 4. 2) after PCL
reconstruction. Postoperatively, the Telos stress radiographic side to side difference averagely improved by 8. 6 mm
(SD 6. 1) after PCL augmentation, from 11. 1 mm (SD 1. 4) to 2. 5 mm (SD 0. 4), and by 8. 0 mm (SD 5. 7) after PCL
reconstruction, from 11. 5 mm (SD 2. 2) to 3. 5 mm (SD 1. 3). Conclusions: Augmentation and reconstruction
procedures are grossly equivalent, but more data examining the long-term functional status, recovery to preinjury
daily and sport activities and occurrence of degenerative changes are needed. Level of evidence: IV. 2013 Springer-
Background and purpose: Tools of screening and diagnosis of autism result in early diagnosis in childhood which are
of great benefit for early intervention. This study investigated these tools from various aspects to provide a
comprehensive view. Materials and methods: This research was a narrative review study on tools of screening and
diagnosis of autism. A search was conducted using some databases including Iran medex, SID, Magiran, Google
scholar, Medline, Science Direct, Scopus and Web of Science. The tools were then investigated regarding the date of
publishing, age range of participants, method of administration/format, subscales, the duration of each test and
psychometric features. Results: In this study, 25 tests were reviewed of which 14 tests were related to screening and
11tests were used for diagnosis. The tests were all in forms of questionnaire, checklist, observation and interview.
The oldest test was invented in 1980 and the most recent one was developed in 2013. In terms of age, minimum and
maximum ages for implementation of test were listed six months old and 22 years old. The minimum and maximum
times to administrate were five minutes and 90-180 minutes, respectively. Conclusion: We found that some tests
have been used more because of their proficient subscales in recent years. Also, comparing recent tests to old tests
revealed their evolutionary path.
Introduction: Recently data has shown survival and response rates in small numbers of HIV patients receiving ASCT
for HL and NHL in the HAART era. We did a comprehensive review and meta-analysis of the literature to examine
collective therapeutic outcomes and survival. Methods: We searched OVID, PUBMED, Google Scholar (1980 -Sept
2009), ASH (2004-8), ASCO (2004-9), and BMT Tandem (2005-9) annual meeting abstracts for references. Articles
obtained were reviewed for additional references. Inclusion criteria: 1) Autol-ogous transplants for HIV/AIDS
associated lymphoma with HAART 2) Reported in English 3) Studies reporting: complete response rates (CR), and one
or more survival statistics. 4) Comprehensive trials, cohort studies or case series. Authors were queried for possible
patient overlap among studies. Primary outcome measures were response to ASCT and 2 year overall survival rates
(OS). Results: Out of 61 references, 14 studies were on ASCT in HIV related lymphoma and 13 case reports. 5 met
inclusion criteria. These included 35 Hodgkins and 83 NHL subjects. CR rates post ASCT 71% (95%CI 60-80), 2 year OS
of 71% (95%CI 61-79) (see Table). Subjects entering ASCT in CR had a post ASCT CR rate of 91%, and a 2 year OS rate
of 70%. Compared to subjects without CR when entering ASCT, those in CR at time of ASCT were 8-fold more likely to
be in CR post ASCT and 3fold likelihood of being alive at 2 years post ASCT. Difference in survival were not apparent
between transplantation in CR1, CR2, or greater than CR2. Achievement of CR appears to be predictive (Table
presented).of 2-year survival. Summary data regarding histologic subtype, stage, immune status, viral load at ASCT
and conditioning regimen will also be presented. Conclusion: ASCT for HIV(+) patients has a comparable response
and survival to the HIV(-) population for ASCT. Consideration of ASCT as an earlier therapeutic option in HIV related
lymphoma should be investigated. Additional prospective trials are necessary to determine optimal management of
this population.
IntroductionThe therapeutic use of interleukin 1 (IL-1) cytokine receptor antagonists (IL-1RA) has promoted the
development of new biological therapies for osteoarthritis (OA). Autologous conditioned serum (ACS) is an
alternative, safe and well-tolerated treatment in OA.Sources of dataWe performed a comprehensive search of
PubMed, Medline, Cochrane, CINAHL, Embase, SportDiscus, Pedro and Google scholar databases using keywords
such as 'interleukin 1', 'osteoarthritis' and 'autologous conditioned serum'.Areas of agreementACS, containing
endogenous anti-inflammatory cytokines including IL-1RA and several growth factors, could reduce pain and increase
function and mobility in mild to moderate knee OA.Area of controversyGiven the limited data available on the
composition of ACS, the mechanisms through which ACS produces clinical improvement, the duration of its effect
and the changes in cytokine levels after repeated injections are still unknown.Growing pointsAlthough previous
clinical data are encouraging and confirm the safety of this modality, given the limitations of current studies, there
should be additional, controlled trials to further confirm efficacy for the use of ACS in OA treatment.Area timely for
developing researchACS can lead to enhancement of tissue regeneration and to reduction of degenerative
mechanisms. 2012 Published by Oxford University Press. All rights reserved.
Malaria inflicts a huge health care burden in terms of mortality and morbidity worldwide. There has been evidence in
the literature where many unexpected/unexplained deaths turned out to be related to malaria on autopsy. The aim
of this study is to review autopsy diagnosed malaria related deaths in the literature with due stress to its biologic and
forensic aspects. A meticulous literature search was performed for " sudden malaria death" , " malaria death
postmortem diagnosis" and " unexplained death malaria" across PubMed, SCOPUS, Cochrane Database of Systematic
Reviews, Allied and Complementary Medicine, British Nursing Index, CINAHL, EMBASE, Ovid-MEDLINE and Google
Scholar. All the literature was thoroughly reviewed and analyzed with reference to the type of study, location, travel
history, age, gender, circumstance of death, method of diagnosis, species involved, chemoprophylaxis usage and
take home message from the particular study. Plasmodium falciparum was responsible in most of the cases. The
symptoms mimicked influenza in most of the case reports. Travel to endemic areas was common to most of the
victims. The travelers were from all over the world including USA, France, Switzerland, Spain, Portugal, Germany and
Asia (China and Japan). Vascular congestion with the presence of malarial pigment laden RBCs in capillaries of various
organs was the major histopathology finding. Such lesions were found in the brains of all subjects (100%), liver of
78% of the cases, spleen in 67%, lungs in 56% and myocardium in 43% of the cases. Peripheral smear and rapid
diagnostic test was of great aid to the autopsy in many cases. PCR was used for diagnosis as well as exclusion of
possibility of co-infection with other species in case of Plasmodium knowlesi related death. The postmortem and
histopathology findings in this case were similar to P. falciparum except for the fact that brain sections were negative
for intracellular adhesion molecule-1. Chemoprophylaxis was not taken by the victims except for two in whom
history of chloroquine based chemoprophylaxis was mentioned. Given the worldwide prevalence of the disease,
increasing international travel and rapidly developing drug resistance, malaria will continue to be an important
disease and should be considered in all cases of unexpected deaths particularly in malaria endemic regions or in
presence of travel history to endemic regions. 2012 Elsevier Ireland Ltd.
BackgroundWhen searching for renal literature, nephrologists must choose between several different bibliographic
databases. We compared the availability of renal clinical studies in six major bibliographic databases.MethodsWe
gathered 151 renal systematic reviews, which collectively contained 2195 unique citations referencing primary
studies in the form of journal articles, meeting articles or meeting abstracts published between 1963 and 2008. We
searched for each citation in three subscription-free bibliographic databases (PubMed, Google Scholar and Scirus)
and three subscription-based databases (EMBASE, Ovid-MEDLINE and ISI Web of Knowledge). For the subscription-
free databases, we determined which full-text journal articles were available free of charge via links to the article
source.ResultsThe proportion of journal articles contained within each of the six databases ranged from 96 to 97;
results were similar for meeting articles. Availability of meeting abstracts was poor, ranging from 0 to 37 (P < 0.01)
with ISI Web of Knowledge containing the largest proportion [37, 95 confidence interval (95 CI) 32-43]. Among the
subscription-free databases, free access to full-text articles was highest in Google Scholar (38 free, 95 CI 36-41), and
was only marginally higher (39) when all subscription-free databases were searched. After 2000, free access to full-
text articles increased to 49.ConclusionsOver 99 of renal clinical journal articles are available in at least one major
bibliographic database. Subscription-free databases provide free full-text access to almost half of the articles
published after the year 2000, which may be of particular interest to clinicians in settings with limited access to
subscription-based resources. 2012 The Author.
BACKGROUND: There have been very few studies concerning the Babkin reflex-opening of the mouth and flexion of
the arms in response to stimulation of the palms. We attempted to clarify the clinical significance and neural
mechanism of the reflex through systematic review., METHODS: Searches were conducted on Medline, Embase, and
Google Scholar from their inception through August 2012., RESULTS: In normal term infants, the Babkin reflex can be
elicited from the time of birth, becomes increasingly suppressed with age, and disappears in the great majority by
the end of the fifth month of age. A marked response in the fourth or fifth month of age and persistence of the reflex
beyond the fifth month of age are generally regarded as abnormal. On the other hand, because there are some
normal infants showing no response during the neonatal period or early infancy, the absence of the response during
these periods is not necessarily an abnormal finding., CONCLUSIONS: Infants with these abnormal findings should be
carefully observed for the appearance of neurological abnormalities including cerebral palsy and mental retardation.
It is most likely that the Babkin reflex is mediated by the reticular formation of the brainstem, which receives inputs
from the nonprimary motor cortices. On the basis of the hand-mouth reflex, more adaptive movement develops as
control of the nonprimary motor cortices over the reflex mechanism in the reticular formation increases. Soon it
evolves into the voluntary eye-hand-mouth coordination necessary for food intake as the control of the prefrontal
cortex over the nonprimary motor cortices becomes predominant. Copyright 2013 Elsevier Inc. All rights reserved.
Chronic heart failure (CHF) is a costly condition that places large demands on self-care. Failure to adhere with self-
care recommendations is common and associated with frequent hospitalization. Understanding the factors that
enable or inhibit self-care is essential in developing effective health care interventions. This qualitative review was
conducted to address the research question, "What are the barriers and facilitators to self-care among patients with
CHF?" Electronic databases including Medline, EMBASE, CINAHL, Web of Science, Scopus and Google scholar were
searched. Articles were included if they were peer reviewed (1995 to 2012), in English language and investigated at
least one contextual or individual factor impacting on self-care in CHF patients>18years. The criteria defined by
Kuper et al. including clarity and appropriateness of sampling, data collection and data analysis were used to
appraise the quality of articles. Twenty-three articles met the inclusion criteria. Factors impacting on self-care were
included factors related to symptoms of CHF and the self-care process; factors related to personal characteristics;
and factors related to environment and self-care system. Important factors such as socioeconomic situation and
education level have not been explored extensively and there were minimal data on the influence of age, gender,
self-confidence and duration of disease. Although there is an emerging literature, further research is required to
address the barriers and facilitators to self-care in patients with CHF in order to provide an appropriate guide for
intervention strategies to improve self-care in CHF.
Purpose: Chronic heart failure (CHF) is a common and costly condition globally that places large demands on self-
care. Failure to adhere with self-care recommendations is common. Understanding the factors that enable or inhibit
self-care is essential in developing effective health care interventions. This qualitative review was conducted to
address the research question, "What are the barriers and facilitators to self-care?" Methods: Medline, Embase,
CINAHL, Web of Science, Scopus and Google scholar were searched. A combination of Mesh terms and text words
were used with the key words related to "facilitators" or "barriers" Furthermore, keywords related to these terms,
recognized by screening articles retrieved during the primary investigation, were used. The reference lists of
retrieved papers were also hand searched for relevant articles. Articles were included if they were peer reviewed
(1995 to 2012), in the English language and investigated at least one contextual or individual factor impacting on
selfcare in CHF patients > 18 years. Also, we set out to apply the criteria from Kuper et al. for appraising critically the
quality of qualitative studies. Finally, the findings of qualitative studies were summarized, merged and synthesized.
Results: Among 1105 retrieved articles 23 titles met the inclusion criteria. Factors impacting on self-care included:
the syndrome of CHI patient factors; environmental factors; processes of self-care and the health care system.
Factors such as socioeconomic situation, education level have not been explored extensively and there is minimal
data on the influence of gender, culture and coping strategies. Conclusion: Self-care in patients with HF is complex
and challenging. This study shows although there is an emerging literature, further research is required to address
the barriers and facilitators of elf- care in patients with heart failure in detail to provide sustain applicable health
policy strategies.
Introduction: Electronic Medical Records (EMRs) are computerized medical information systems that collect, store
and display patient information. They are means to create legible and organized recordings and to access clinical
information about individual patients. Despite of the positive effects of the EMRs usage in medical practices, the
adoption rate of such systems is still low and meets resistance from physicians. The EHRs represent an essential tool
for improving both in the safety and quality of health care, though physicians must actively use these systems to
accrue the benefits. This study was unsystematic-review. Aim: The aim of this study was to express barriers
perceived y physicians to the adoption of the EHRs. Method of the study: This study was non-systematic reviewed
which the literature was searched on barriers perceived by physicians to the adoption of Electronic Health Records
(EHRs) with the help of library, books, conference proceedings, data bank, and also searches engines available at
Google, Google scholar. Discussion: For our searches, we employed the following keywords and their combinations:
physicians, electronic medical record, electronic health record, barrier, and adoption in the searching areas of title,
keywords, abstract, and full text. In this study, more than 100 articles and reports were collected and 27 of them
were selected based on their relevancy. Electronic health record use requires the presence of certain user and
system attributes, support from others, and numerous organizational and environment facilitators. AVICENA 2013.
Background: Barriers to participation in an HIV vaccine trial have been examined in many HIV vaccine preparedness
studies (VPS). These barriers can be understood in terms of the locus of the barrier (personal vs. social) and the
nature of the barrier (risk vs. cost). Another type of barrier is perceived misconceptions. Methods: We performed a
systematic review of HIV VPS using the Cochrane Database for Systematic Reviews, Medline/ Pubmed, Embase, and
Google Scholar. Two people independently searched the literature for HIV VPS that examined barriers of
participation in a hypothetical HIV vaccine trial, using the same search strategy. We categorize these barriers, and
compare barriers between the Organization for Economic Co-operation and Development (OECD) countries and the
non-OECD countries. Risk was operationalized in terms of possible outcomes; costs in terms of very probably
outcomes. Results: In the OECD countries, we retrieved 18 studies reporting personal risks (PR), 7 studies reporting
social risks (SR), 6 studies reporting personal costs (PC), and 15 studies reporting misconceptions. In the non-OECD
countries, we retrieved 22 studies reporting PR, 16 studies reporting SR, 14 studies reporting PC, 1 study reporting
social costs (SC), and 19 studies reporting misconceptions. Important PR were "adverse effects" and "vaccine-
induced seropositivity", and "temptation to have unsafe sex" in men who have sex with men (MSM).
"Discrimination" was a common SR. "Fear of needles" and "time commitment" were important PC, and "family
commitments" were a SC in one non- OECD country. "Distrust of institutions" and "HIV infection from the vaccine"
were common misconceptions. Conclusion: This is a comprehensive review to participation in an HIV vaccine trial.
Both the OECD and non-OECD countries have similar barriers, and people's decisions to participate in a clinical trial
involve multiple barriers. However, these barriers apply to hypothetical HIV vaccine trials, and barriers for actual
vaccine trials need more assessment.
Background: People living with chronic kidney disease will require renal dialysis or a kidney transplant to maintain
life. Although Indonesia has a developing healthcare industry, Indonesia's kidney transplant rates are lower than
comparable nations. Purpose: To explore the healthcare literature to identify barriers to kidney transplants in
particular in relation to Indonesia. Methods: Healthcare databases were searched (CINAHL, Medline, EBSCOhostEJS,
Blackwell Synergy, Web of Science, PubMed, Google Scholar and Proquest 5000) using the search terms: transplant,
kidney disease, renal, dialysis, haemodialysis, Indonesia and nursing. The search was limited to English and
Indonesian language data sources from 1997 to 2007. Reference lists of salient academic articles were hand
searched. Results: The results of our search identified six articles that met our criteria. Costs are the major barrier to
kidney transplant in Indonesia, followed by cultural beliefs, perception of the law, lack of information and lack of
infrastructure. In addition, kidney disease prevention strategies are required. Conclusions: There are many complex
socio-economic, geographical, legal, cultural and religious factors that contribute to low kidney transplant rates in
Indonesia. Although an increase in transplantation rates will require strategies from various agencies, healthcare
professionals, including nurses, can play a role in overcoming some barriers. Community education programmes,
improving their own education levels and by increasing empowerment in nursing we may contribute to improved
kidney transplant rates in Indonesia. 2009 International Council of Nurses.
Background: GPs are the gatekeepers to service provision for the elderly and the usual first point of contact with the
health system for individuals with dementia and their carers. Increasing evidence suggests that early diagnosis and
timely intervention is beneficial, both for patients and carers. Despite this, there remains a need to overcome GPs'
therapeutic nihilism surrounding dementia. GPs report that the most difficult problem with the management of
dementia is the communication and disclosure of the dementia diagnosis. Methods: An extensive literature review
was performed to determine the barriers and enablers for diagnosis of dementia by GPs. The Medline and Google
Scholar databases were searched for peer reviewed articles published in English from January 1996 to 2009. No
limitations were placed on sample size or response rate. Qualitative and quantitative studies were included. A
structured search methodology was used to locate the relevant body of publications and the search strategy allowed
for the fact that a number of terms are used inter-changeably in the literature. Additional references were identified
through hand searches of selected journals and bibliographies of relevant articles. Results: Forty-nine papers met the
inclusion criteria. Research indicates the barriers to the early diagnosis of dementia and diagnostic disclosure in
primary care include: Negative attitude to dementia care/therapeutic nihilism. Stigma, Difficulties in differentiating
normal ageing from dementia. The paucity of specialist diagnostic services, especially in rural areas, GPs lack of
confidence or training. Lack of a recognised, time-efficient screening tool. A perceived lack of need to determine a
specific diagnosis Limited time. Risk of misdiagnosis. The patient's impaired ability to provide an accurate history and
to participate in self-care. Perception that the patient cannot comprehend/cope with the diagnosis. Risk of damaging
the doctor-patient relationship. There is emerging evidence that the involvement of practice and community nurses
in the diagnostic process may overcome some of the barriers and improve detection rates. Conclusions: Compelling
evidence suggests that there are several structural and ideological obstacles that GPs encounter when attempting to
diagnose dementia. However, there is also evidence of factors which encourage diagnosis and disclosure. Future
educational supports for GPs need to concentrate on both these areas.
Diabetes Mellitus (DM) is a chronic disease that carries a significant disease burden in Australia and worldwide. The
aim of this paper is to identify current barriers in the management of diabetes, ascertain whether there is a benefit
from early detection and determine whether LDF has the potential to reduce the disease burden of DM by reviewing
the literature relating to its current uses and development. In this literature review search terms included; laser
Doppler flowmetry, diabetes mellitus, barriers to management, uses, future, applications, vasomotion,
subcutaneous, cost. Databases used included Google Scholar, Scopus, Science Direct and Medline. Publications from
the Australian government and textbooks were also utilised. Articles reviewed had access to the full text and were in
English.
Although many studies have demonstrated the benefits of reminder/recall (RR) measures to address patient under-
immunization and improve immunization coverage, they are not widely implemented by healthcare providers. We
identified providers' perceived barriers to their use from existing literature. We conducted a systematic review of
relevant articles published in English between January 1990 and July 2011 that examined the perceptions of
healthcare providers regarding barriers to tracking patient immunization history and implementing RR interventions.
We searched MEDLINE, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Academic
Search Premier, and PsychINFO. Additional strategies included hand-searching the references of pertinent articles
and related reviews, and searching keywords in Google Scholar and Google. Ten articles were included; all described
populations in the United States, and examined perceptions of family physicians, pediatricians, and other
immunization staff. All articles were of moderate-high methodological quality; the majority (n=7) employed survey
methodology. The most frequently described barriers involved the perceived human and financial resources
associated with implementing an RR intervention, as well as low confidence in the accuracy of patient immunization
records, given the lack of data sharing between multiple immunization providers. Changes to staff workflow, lack of
appropriate electronic patient-tracking functionalities, and uncertainty regarding the success of RR interventions
were also viewed as barriers to their adoption. Although transitioning to electronic immunization records and
registries should facilitate the implementation of RR interventions, numerous perceived barriers must still be
overcome before the full benefits of these methods can be realized.
BACKGROUND: Although many studies have demonstrated the benefits of reminder/recall (RR) measures to address
patient under-immunization and improve immunization coverage, they are not widely implemented by healthcare
providers. We identified providers' perceived barriers to their use from existing literature., METHODS: We conducted
a systematic review of relevant articles published in English between January 1990 and July 2011 that examined the
perceptions of healthcare providers regarding barriers to tracking patient immunization history and implementing RR
interventions. We searched MEDLINE, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature,
Academic Search Premier, and PsychINFO. Additional strategies included hand-searching the references of pertinent
articles and related reviews, and searching keywords in Google Scholar and Google., RESULTS: Ten articles were
included; all described populations in the United States, and examined perceptions of family physicians,
pediatricians, and other immunization staff. All articles were of moderate-high methodological quality; the majority
(n=7) employed survey methodology. The most frequently described barriers involved the perceived human and
financial resources associated with implementing an RR intervention, as well as low confidence in the accuracy of
patient immunization records, given the lack of data sharing between multiple immunization providers. Changes to
staff workflow, lack of appropriate electronic patient-tracking functionalities, and uncertainty regarding the success
of RR interventions were also viewed as barriers to their adoption., CONCLUSIONS: Although transitioning to
electronic immunization records and registries should facilitate the implementation of RR interventions, numerous
perceived barriers must still be overcome before the full benefits of these methods can be realized.
What is known and Objective: Thrombolysis is currently the only evidence-based pharmacological treatment
available for acute ischaemic stroke (AIS); however, its current utilization is suboptimal (administered to <3% of AIS
patients). The aim of this article was to identify the potential barriers to the use of thrombolysis via a review of the
available literature. Methods: Medline, Embase, International Pharmaceutical Abstracts and Google Scholar were
searched to identify relevant original articles, review papers and other literature published in the period 1995-2011.
Results and Discussion: Several barriers to the utilization of thrombolysis in stroke have been identified in the
literature and can be broadly classified as 'preadmission' barriers and 'post-admission' barriers. Preadmission barriers
include patient and paramedic-related factors leading to late patient presentation for treatment (i.e. outside the
therapeutic time window for the administration of thrombolysis). Post-admission barriers include in-hospital factors,
such as suboptimal triage of stroke patients and inefficient in-hospital acute stroke care systems, a lack of
appropriate infrastructure and expertise to administer thrombolysis, physician uncertainty in prescribing
thrombolysis and difficulty in obtaining informed consent for thrombolysis. Suggested strategies to overcome these
barriers include public awareness campaigns, prehospital triage by paramedics, hospital bypass protocols and
prenotification systems, urgent stroke-unit admission, on-call multidisciplinary acute stroke teams, urgent
neuroimaging protocols, telestroke interventions and risk-assessment tools to aid physicians when considering
thrombolysis. Additionally, greater pharmacists' engagement is warranted to help identify the people at risk of stroke
and support preventative strategies, and provide the public with information regarding the recognition of stroke, as
well as facilitate the access and use of thrombolysis. What is new and Conclusion: The most effective interventions
appear to be those comprising several strategies and those that target more than one barrier simultaneously.
Therefore, optimal utilization of thrombolysis requires a systematic, integrated multidisciplinary approach across the
continuum of acute care. 2012 Blackwell Publishing Ltd.
Introduction: Several countries and organizations have created research agendas in an effort to improve and focus
the EMS (emergency medical services) research enterprise. To date, results from these agendas have not been
compiled, which may hinder knowledge translation. Scoping reviews are used to map broad topics, summarize, and
disseminate research findings. This methodology was used to map reported research agenda methods, barriers and
facilitators to EMS research, recommendations made, and prioritize research topics/outcomes. Methods: A
combination of MeSH and keywords were used to search MEDLINE, EMBASE, CINAHL, Google Scholar, and grey
literature using Google. Search results were subject to two review rounds for inclusion: (1) title, weblink, and
abstract and (2) full article screening. Articles were included if they were a knowledge-generating project where a
group of national stakeholders in EMS research reached consensus on barriers, facilitators, recommendations, or
prioritization of research topics/outcomes. Results: A total of 3,618 titles, weblinks, and abstracts and 52 full-text
articles were reviewed. Ten distinct EMS research agendas reported in 19 articles were included, 15 articles from
peer-reviewed journals and 4 from non-peerreviewed sources. Agendas from Australia (n = 1), Canada (n = 1),
Europe (n = 1), Ireland (n = 1), UK (n = 1), and the USA (n = 5) used 13 unique methodologies to report 32 barriers
and 29 facilitators to EMS research. Agendas proffered 65 recommendations for improving the research enterprise
with some setting-specific implementation strategies, and 253 prioritized topics and outcomes. Conclusion: Multiple
EMS research agendas were identified employing a variety of methods revealing barriers, recommendations, and
priority research topics/outcomes, but few agendas reported facilitators. Translation of these results at the local
level may be a starting point for actionable changes to the EMS research enterprise. Future research should quantify
the impact that these agendas have had on improving the quality, quantity, and usefulness of EMS research.
Perioperative fluid, electrolyte and blood transfusion therapy for infants and children can be confusing due the
numerous opinions, formulas and clinical applications, which can result in a picture that is not practical and is often
misleading. Perioperatively, crystalloids, colloids and blood components are required to meet the ongoing losses and
for maintaining cardiovascular stability to sustain adequate tissue perfusion. Recently controversies have been raised
regarding historically used formulas and practices of glucose containing hypotonic maintenance crystalloid solutions
for perioperative fluid therapy in children. Paediatric intraoperative transfusion therapy, particularly the approach to
massive blood transfusion (blood loss >= one blood volume) can be quite complex because of the unique relationship
between the patient's blood volume and the volume of the individual blood product transfused. A meticulous fluid,
electrolyte and blood transfusion management is required in paediatric patients perioperatively because of an
extremely limited margin for error. This article reviews the basic concepts in perioperative fluid and blood
transfusion therapy for paediatric patients, along with recent recommendations. For this review, Pubmed, Ovid
MEDLINE, HINARI and Google scholar were searched without date restrictions. Search terms included the following
in various combinations: Perioperative, fluid therapy, paediatrics, blood transfusion, electrolyte disturbances and
guidelines. Only articles with English translation were used.
OBJECTIVE: To review clinical studies and other available literature regarding the development, pharmacology,
toxicology, pharmacokinetics/ pharmacodynamics, adverse effects, and place in therapy of bazedoxifene, a selective
estrogen receptor modulator (SERM), currently in Phase III clinical trials for the treatment and prevention of
postmenopausal osteoporosis. DATA SOURCES: A literature search was performed of PubMed (1966-February 2007),
International Pharmaceutical Abstracts (1970-February 2007), Web of Science (1975-February 2007), Biological
Abstracts (1926-2007), and Google Scholar (2001-February 2007) databases, using the search terms bazedoxifene,
TSE-424, Indole-33, WAY-140424, selective estrogen receptor modulator, and SERM. In addition, product
information was requested from the manufacturer, and www.clinicaltrials.gov was searched for unpublished Phase
III clinical trials in progress. STUDY SELECTION AND DATA EXTRACTION: Articles on Phase I and II trials were selected
for review, as well as articles discussing preclinical development of bazedoxifene. At the time of writing, no articles
on Phase III trials were available for review. Abstracts of unpublished data were reviewed, as was information
provided by the manufacturer. DATA SYNTHESIS: Bazedoxifene is a third-generation SERM currently in Phase III
clinical trials. It has been found to act as an agonist on skeletal tissue, with bone turnover reduced by 20-25% with
doses of 20 or 40 mg daily. In addition, bazedoxifene has been found to be an antagonist on breast tissue and uterine
tissue, demonstrating inhibition of breast tissue proliferation and decreased endometrial stimulation as the dose is
increased. CONCLUSIONS: Current literature suggests that bazedoxifene will likely be safe and effective when used in
the treatment of postmenopausal osteoporosis. Completion of Phase III clinical trials will more fully elucidate the
safety and efficacy profile of bazedoxifene, as well as more clearly define its place in therapy.
Background: Urinary incontinence (UI) in women adversely affects quality of life. Purpose: To conduct a systematic
literature review of drugs for urgency UI in women. Data Sources: MEDLINE, the Cochrane Central Register of
Controlled Trials, SCIRUS, and Google Scholar were searched for articles published from 1966 to November 2011.
Study Selection: Randomized, controlled trials (RCTs) reported in English. Data Extraction: Rates of outcomes and risk
of bias were extracted by using a standardized form to pool absolute risk differences and calculate the number of
attributable events per 1000 patients treated, with 95% CIs. Data Synthesis: 94 RCTs were eligible. Pooled analyses
showed that among drugs for urgency UI, per 1000 treated women, continence was restored in 130 with
fesoterodine (CI, 58 to 202), 85 with tolterodine (CI, 40 to 129), 114 with oxybutynin (CI, 64 to 163), 107 with
solifenacin (CI, 58 to 156), and 114 with trospium (CI, 83 to 144). Rates of treatment discontinuation due to adverse
effects were 31 per 1000 treated with fesoterodine (CI, 10 to 56), 63 with oxybutynin (CI, 12 to 127), 18 with
trospium (CI, 4 to 33), and 13 with solifenacin (CI, 1 to 26). The studies' inconsistent definitions of reduction in UI and
quality of life hampered synthesis of evidence. Limitation: Evidence for quality-of-life improvements and
comparative effectiveness with drugs was limited, and evidence for the effects of race, baseline severity of UI, and
comorbid conditions on treatment success was insufficient. Conclusion: Overall, drugs for urgency UI showed similar
small benefit. Therapeutic choices should consider the harms profile. Evidence for long-term adherence and safety of
treatments is lacking. 2012 American College of Physicians.
Background: Aggressive antiplatelet treatment is currently an established practice in patients with coronary artery
disease. Objective: This article discusses the evidence from clinical trials and registries concerning the benefits and
risks of clopidogrel in relation to the dose and timing of treatment and its use in particular patient populations
(stratified by risk factors for major adverse cardiovascular events). Methods: Human clinical trials, registries, and in
vitro human platelet studies were identified through searches of MEDLINE, Scopus, Google Scholar, and
ClinicalTrials.gov (January 1980-July 2008) using the terms clopidogrel in coronary artery disease, clopidogrel loading
dose, clopidogrel pretreatment, and antiplatelet therapy for coronary artery disease. For inclusion in the review,
publications had to compare clopidogrel administered at different doses and times across the spectrum of patients
with coronary artery disease; present outcome data on mortality, reinfarction, stroke, or their combination; and
report safety data pertaining to bleeding risk. Results: The results of randomized trials support the benefit of
administering a 300-mg loading dose of clopidogrel as part of both conservative and invasive strategies for the
management of acute coronary syndromes (ACS). In a small randomized trial in patients with non-ST-segment
elevation ACS, pretreatment with clopidogrel 600 mg >12 hours before coronary stenting was associated with
significantly fewer major adverse cardiovascular events compared with pretreatment with clopidogrel 300 mg (P =
0.020). A randomized trial in patients with ACS undergoing percutaneous coronary intervention (PCI) reported a
significant reduction in ischemic risk with prasugrel (60-mg loading dose, 10-mg/d maintenance dose) compared with
clopidogrel (300-mg loading dose, 75-mg/d maintenance dose) (P < 0.001); however, the clinical benefit with
prasugrel was accompanied by a significant increase in the risk of life-threatening bleeding (P = 0.01). Pretreatment
with a 300-mg clopidogrel loading dose administered at least 15 hours before elective PCI was associated with a
significant reduction in periprocedural ischemic events compared with 75 mg given after PCI (P = 0.028). In another
randomized trial in patients undergoing elective PCI, pretreatment with clopidogrel 600 mg before diagnostic
catheterization was associated with a significantly increased risk of minor bleeding complications (P = 0.027) without
a significant benefit in terms of the primary ischemic end point. Data from registries support the use of a 300-mg
loading dose of clopidogrel for the standard care of patients with ACS and indicate no significant benefit for
pretreatment with loading doses >300 mg. One study of registry data found that pretreatment with clopidogrel 300
mg before elective PCI was associated with a significant reduction in major adverse cardiovascular events compared
with a loading dose given immediately before or after the intervention (P = 0.002). Conclusions: Suppression of
platelet activity through the use of antithrombotic agents should be balanced against the risk of atherothrombotic
Data in medical records have in part been recorded in structured and coded forms for some decades. However, the
patient history is as yet largely recorded in an uncoded format. There is a need to consider the optimal balance of
use of free text and coded data in the patient history. This review protocol summarises our plans to identify, critically
appraise and synthesise evidence relating to approaches taken to introduce structure and coding within patient
histories in electronic health records, and the empirically demonstrated benefits and risks of structuring and coding
of patient histories in health records. To determine how structured and coded data are being introduced for the
recording of patient histories, the benefits observed where structuring and coding have been introduced and the
risks encountered when structuring and coding are introduced. We will search the following databases for evidence
of published and unpublished material: CINAHL; EMBASE; Google Scholar; IndMED; LILACS; MEDLINE; NIHR; Paklit
and PsycINFO. We will, depending on the study designs employed, use the Cochrane EPOC, Joanna Briggs Institute
(JBI) and Newcastle-Ottawa instruments to critically appraise studies. Data synthesis is likely to be undertaken using
a narrative approach, although meta-analysis will also be undertaken if appropriate and if the data allow this. This
protocol should represent a reproducible approach to reviewing the literature regarding structuring and coding in
patient histories. We anticipate that we will be able to report results in early 2011. The review should offer increased
clarity and direction on the optimal balance between structuring/coding and free text recording of data relating to
the patient history.
The controversial relationship between benign thyroid diseases and breast cancer (BC) has been investigated for over
50 years. Despite extensive population studies, the results as a whole have been inconsistent. The purpose of this
study was to collate and analyse available data, calculating a pooled odds ratio (OR) of the risk of BC in patients
diagnosed with benign thyroid diseases. Studies were obtained from a database search of MEDLINE, EMBASE,
PubMed, Current Contents Connect and Google Scholar with additional cross checking of reference lists. Inclusion
criteria required a confirmed diagnosis of a benign thyroid disease, reporting of an OR or data to calculate an OR
(and 95% confidence interval, CI) and the use of an internal control group as the comparator. Collated data was
assessed for heterogeneity and a pooled OR calculated. 28 studies were included in the meta-analysis. There was
significant evidence of an increased risk of BC in patients with autoimmune thyroiditis, evident in a pooled OR 2.92
(95% CI 2.13-4.01). In addition, the results supported an increased risk associated with the presence of anti-thyroid
antibodies (OR 2.02, 95% CI 1.63-2.50) and goitre (OR 2.26, 95% CI 1.39-3.69). Subgroup analysis of antibody
presence revealed increased risk associated with both anti-TPO (OR 2.64, 95% CI 1.82-3.83) and anti-TG (2.71, 95% CI
1.58-4.69). Quantitative analysis of hypothyroidism and hyperthyroidism was not significant. While these results
indicate an association between thyroid auto-immunity and BC, further prospective studies are required to
definitively prove causality. 2012 Springer Science+Business Media, LLC.
Importance of the field: The use of traditional medicines of natural origin is being encouraged for the treatment of
chronic disorders, as synthetic drugs in such cases may cause unpredictable adverse effects. Berberine, a traditional
plant alkaloid, is used in Ayurvedic and Chinese medicine for its antimicrobial and antiprotozoal properties.
Interestingly, current clinical research on berberine has revealed its various pharmacological properties and multi-
spectrum therapeutic applications. Areas covered in this review: An extensive search in three electronic databases
(Unbound Medline, PubMed and ScienceDirect) and internet search engines (Scirus and Google Scholar) were used
to identify the clinical studies on berberine, without any time constraints. This review elaborates the recent studies
which reveal that with time, the drug has evolved with superior therapeutic activities. In addition, this review will
also attract the attention of formulation scientists towards the issues and challenges associated in its drug delivery
and the probable approaches that may be explored to help patients reap the maximum benefit of this potentially
useful drug. What the reader will gain: A relatively large number of studies discussed here have revealed the possible
areas where this phytochemical constituent can exhibit its therapeutic activities in the treatment of chronic ailments
or diseases including diabetes, cancer, depression, hypertension and hypercholesterolemia. Take home message:
The potential of the drug remains to be harvested by designing a suitable formulation that could overcome its
inherent low bioavailability. 2010 Informa UK, Ltd.
BACKGROUND: Patient education is an essential component in quality management of the anticoagulated patient.
Because it is time consuming for clinicians and overwhelming for patients, education of the anticoagulated patient is
often neglected. We surveyed the medical literature in order to identify the best patient education strategies.
METHODS: Study Selection: Two reviewers independently searched the MEDLINE and Google Scholar databases (last
search March 2007) using the terms "warfarin" or "anticoagulation", and "patient education". The initial search
identified 206 citations, A total of 166 citations were excluded because patients were of pediatric age (4), the article
was not related to patient education (48), did not contain original data or inadequate program description (141), was
focused solely on patient self-testing (1), was a duplicate citation (3), the article was judged otherwise irrelevant (44),
or no abstract was available (25).Data Extraction: Clinical setting, study design, group size, content source, time and
personnel involved, educational strategy and domains, measures of knowledge retention. RESULTS: Data Synthesis: A
total of 32 articles were ultimately used for data extraction. Thirteen articles adequately described features of the
educational strategy. Five programs used a nurse or pharmacist, 4 used a physician, and 2 studies used other
personnel/vehicles (lay educators (1), videotapes (1)). The duration of the educational intervention ranged from 1 to
10 sessions. Patient group size most often averaged 3 to 5 patients but ranged from as low as 1 patient to as much as
11 patients. Although 12 articles offered information about education content, the wording and lack of detail in the
description made it too difficult to accurately assign categories of education topics and to compare articles with one
another. For the 17 articles that reported measures of patient knowledge, 5 of the 17 sites where the surveys were
administered were located in anticoagulation clinics/centers. The number of questions ranged from as few as 4 to as
many as 28, and questions were most often of multiple choice format. Three were self-administered, and 2 were
completed over the telephone. Two reports described instruments along with formal testing of the validity and
reliability of the instrument. CONCLUSION: Published reports of patient education related to warfarin anticoagulation
vary greatly in strategy, content, and patient testing. Prioritizing the educational domains, standardizing the
educational content, and delivering the content more efficiently will be necessary to improve the quality of
anticoagulation with warfarin.
Odontoid fractures are the most common odontoid injury and often cause atlantoaxial instability. Reports on
postoperative status of patients who underwent surgery for such injuries are limited to small case series, and it is
unclear whether any one technique produces better outcomes than another. We assessed the quality of the
available literature for management of Type II odontoid fractures and surgery-related parameters, including surgical
indications, clinical failure rate, and survivorship, postoperative ROM and function, neurologic deficits, complication
and death rates, and radiographic healing rates related to either anterior dens screw or posterior C1-C2 fusion. We
performed a systematic search in PubMed, Ovid, Cochrane Reviews, and Google Scholar databases. We used the
methodology score proposed by Coleman et al. to rate study quality. Postoperative imaging bone union rates were
extracted. Postoperative complications and neurologic impairment data were also collected. Sixteen retrospective
studies of overall low quality (average methodology score, 37.1) reporting a total of 518 patients were included. The
methodology score and publication year were positively associated. The bone union rate approximated 83% (range,
33%-100%), with higher nonunion rates among patients older than 65 years. The death rate ranged widely (0%-
28.6%) among different centers. Residual cervical pain was documented postoperatively from 10.5% to 26.7%, while
survivorship ranged from 72% to 96.6%. No ROM data were reported. Current data on patients who had surgery for
fracture of the dens did not allow us to establish superiority of one surgical approach over another.
OBJECTIVE: To provide a comparative overview of explicit criteria that have been developed since 2003 for
inappropriate prescribing in older adults and to contrast these newer criteria with the most recent Beers criteria,
published in 2003. DATA SOURCES: MEDLINE and Google Scholar searches were performed from 2003 through July
2010. Within MEDLINE, MeSH terms included aged, drug prescriptions, medication errors, and polypharmacy. Free-
text search terms included elderly, guideline adherence, inappropriate prescribing, and medications. Related articles,
as identified by MEDLINE, were used as well. Free-text search was performed on Google Scholar, using "potentially
inappropriate prescribing elderly." Additional articles were identified in reference lists of key articles. STUDY
SELECTION AND DATA EXTRACTION: Studies were selected if they were published after the most recent revision of
the Beers criteria in 2003 and addressed the development and application of explicit criteria for the elderly. We
independently reviewed pertinent literature to extract key information. DATA SYNTHESIS: The first explicit criteria
published were the Beers criteria, and most research regarding inappropriate medication use applied these criteria.
Criteria developed subsequent to the Beers criteria include the French Consensus Panel list, STOPP (Screening Tool of
Older Persons' Prescription) and START (Screening Tool to Alert doctors to Right Treatment), the Australian
Prescribing Indicators tool, and the Norwegian General Practice Criteria. Newer criteria offer several improvements
on the Beers criteria, namely drug-drug interactions, omission of potentially beneficial therapy, and more broadly
applicable criteria across international borders. CONCLUSIONS: Although no criteria may ever be globally applicable,
STOPP and START make significant advances. Regional drug availability, economic considerations, and clinical
practice patterns impact criteria selection. Research to validate the several newer criteria in various practice settings
and to explore the effect of adhering to the guidelines on patient outcomes is warranted. Data from such research
will aid practitioners in identifying preferred criteria.
OBJECTIVE: To provide a comparative overview of explicit criteria that have been developed since 2003 for
inappropriate prescribing in older adults and to contrast these newer criteria with the most recent Beers criteria,
published in 2003., DATA SOURCES: MEDLINE and Google Scholar searches were performed from 2003 through July
2010. Within MEDLINE, MeSH terms included aged, drug prescriptions, medication errors, and polypharmacy. Free-
text search terms included elderly, guideline adherence, inappropriate prescribing, and medications. Related articles,
as identified by MEDLINE, were used as well. Free-text search was performed on Google Scholar, using "potentially
inappropriate prescribing elderly." Additional articles were identified in reference lists of key articles., STUDY
SELECTION AND DATA EXTRACTION: Studies were selected if they were published after the most recent revision of
the Beers criteria in 2003 and addressed the development and application of explicit criteria for the elderly. We
independently reviewed pertinent literature to extract key information., DATA SYNTHESIS: The first explicit criteria
published were the Beers criteria, and most research regarding inappropriate medication use applied these criteria.
Criteria developed subsequent to the Beers criteria include the French Consensus Panel list, STOPP (Screening Tool of
Older Persons' Prescription) and START (Screening Tool to Alert doctors to Right Treatment), the Australian
Prescribing Indicators tool, and the Norwegian General Practice Criteria. Newer criteria offer several improvements
on the Beers criteria, namely drug-drug interactions, omission of potentially beneficial therapy, and more broadly
applicable criteria across international borders., CONCLUSIONS: Although no criteria may ever be globally applicable,
STOPP and START make significant advances. Regional drug availability, economic considerations, and clinical
practice patterns impact criteria selection. Research to validate the several newer criteria in various practice settings
and to explore the effect of adhering to the guidelines on patient outcomes is warranted. Data from such research
will aid practitioners in identifying preferred criteria.
Objective: To document one dimension of the impact of an epidemiological study through citations in scientific
journals. Methods: Two sets of articles from studies performed in France were considered. They presented original
results on occupational risk factors for low back pain and upper limb disorders. Citations of these articles were
retrieved through the Web of Science and Google Scholar, and selected according to several criteria. Most citations
present in the Web of Science were also retrieved from Google Scholar, except for the most recent articles. In the
Web of Science, after exclusion of self-citations and duplicates, the total number of citations was 109 from 23
different countries for the low back pain articles, with 96 citations from 18 countries for upper limb disorders. A
relatively large number of the citations belonged to clinical journals outside the fields of occupational health,
ergonomics and public health. Conclusion: This study suggests that results dealing with occupational health
disseminate into various fields of clinical research. However, this is only one dimension of the impact of a study.
OBJECTIVE: To document one dimension of the impact of an epidemiological study through citations in scientific
journals., METHODS: Two sets of articles from studies performed in France were considered. They presented original
results on occupational risk factors for low back pain and upper limb disorders. Citations of these articles were
retrieved through the Web of Science and Google Scholar, and selected according to several criteria. Most citations
present in the Web of Science were also retrieved from Google Scholar, except for the most recent articles. In the
Web of Science, after exclusion of self-citations and duplicates, the total number of citations was 109 from 23
different countries for the low back pain articles, with 96 citations from 18 countries for upper limb disorders. A
relatively large number of the citations belonged to clinical journals outside the fields of occupational health,
ergonomics and public health., CONCLUSION: This study suggests that results dealing with occupational health
disseminate into various fields of clinical research. However, this is only one dimension of the impact of a study.
Background: Inappropriate use of drugs is commonly observed in health care system throughout the world especially
in developing countries. The consequences of irrational use of drugs are enormous for patients and communities.
Proper interventions would have important financial and public health benefits. Several studies have been
performed about rational use of drugs in Iran. Objective: The objective of this study was to assess scientific output on
rational use of drugs in Iran using a bibliometric analysis of publications. Methods: A systematic search was
conducted for finding all papers (English and Persian) using Pubmed, Web of Science, Google Scholar, CINAHL,
Proquest, International Pharmaceutical Abstract and Persian databases including SID, Iran Medex and MagIran.
Retrieved articles were categorized by research topics and year of publication. Impact Factor of the journals, citation
analysis of first authors, most cited topics and average citations per item were analyzed. Results: A total of 668
articles were retrieved from all search engines after excluding irrelevant, 466 articles were included in the review.
Number of publications increased dramatically after 2001(more than 10 times). Evaluation of prescribing pattern
(15%), self-medication (11.3%) and adverse drug reaction (9.1%) were among the most studied topics. From the total
of 165 journals, 60 of them had Impact factors and 125 articles were published in these journals. Antimicrobial
resistance and adverse drug reaction were the most cited topic. Conclusion: Publication of articles on rational use of
drugs research in Iran has undergone an important increase during last decade. Further analysis of research outputs
is necessary to achieve rational use of medicines goal.
Background Bibliometrics provide surrogate measures of the quality and quantity of research undertaken by
departments and individuals. Previous reports have suggested that academic anaesthesia research in the UK is in
decline. We wished to provide a comprehensive description of current and historical published output of UK
anaesthesia researchers. Methods Bibliometric indices (Web of Science) were calculated for anaesthesia researchers
in the UK for the whole period covered by the database, and for 2004-8. A parallel search was made using the
Scholarometer tool, which parses output from Google Scholar. Calculated indices included total number of
publications; total number of citations; citations per paper; h-index; g-index; and modified impact index. Results One
hundred and four individuals and 23 academic departments were identified. Median values (inter-quartile range) for
the indices were: total papers 57 (24-95) (individuals for the whole period), 11 (6-20) (individuals 2004-8), 50 (30-70)
(departments 2004-8); total number of citations 571 (175-1328), 93 (38-207), 383 (239-845); h-index 13 (8-20), 6 (3-
8), 11 (9-14). Four departments were ranked in the top 5 for all indices. Conclusions The general distribution of
bibliometric data is similar to that seen in other specialities in Europe and North America. Four departments
contribute to more than 50 of published anaesthesia research output in this data set. These data provide useful
comparative tools for individuals, departments, and national bodies. The Author [2011].
Objectives: This study evaluates malaria vaccine research carried out in different parts of the world during 1972-
2004 using different bibliometric indicators. Method: Data have been downloaded from PubMed for the period 1972-
2004 using the keywords (malaria* or plasmodium or falciparum) and (vaccine*) in the title and abstract fields. The
study examined the pattern of growth of the output, its geographical distribution, profile of different countries in
different subfields and pattern of citations using GOOGLE Scholar. Results: Malaria vaccine research output is
gradually increasing. The USA, followed by the UK and Australia contributed the highest number of papers.
Publication activity has decreased in Switzerland and Sweden, but has increased in Brazil and China. The majority of
the countries have focused on the development of asexual blood stage malaria. Citations per paper and incidence of
high-quality papers for the USA, the UK, Papua New Guinea and Denmark are more than the average. The majority of
the prolific institutions are located in the USA, the UK, France and Australia. Conclusion: The last two decades have
witnessed considerable growth in research output in this field, while a successful malaria vaccine still remains
elusive. Interestingly, the countries like the USA, the UK and Australia that lead in the quantity, quality and citation of
this output are often not those directly affected by malaria. 2009 Health Libraries Group.
Central America is recognized as a mega diverse "hot-spot" and one of its smaller countries, Costa Rica, as one of the
world's leaders in the study and conservation of tropical biodiversity. For this study, inspired by the 60th anniversary
of the journal Revista de Biologia Tropical, we tabulated all the scientific production on Costa Rican biodiversity
published in Revista de Biologia Tropical between 2000 and 2010. Most articles are zoological (62%) and 67% of
authors had only one publication in the jounal within that period. A 54% of articles were published in English and
46% in Spanish. A 41% of articles were written in collaboration among Costa Rican institutions and 36% in
collaboration with foreign institutions. The Collaboration Index was 2.53 signatures per article. Visibility in American
sources was 56% in Google Scholar and 42.66% in the Web of Science, but the real visibility and impact are unknown
because these sources exclude the majority of tropical journals. Revista de Biologia Tropical is the main output
channel for Costa Rican biology and despite its small size, Costa Rica occupies the 10th. place in productivity among
Latin American countries, with productivity and impact levels that compare favorably with larger countries such as
Brazil, Mexico, Argentina and Chile.
The aim of this paper is to review the literature regarding bifrontal electroconvulsive therapy (ECT) and provide
recommendations for future research in this area. Original publications were retrieved using PubMeD, EMBASE,
PsycINFO, and Google Scholar. A systematic review and meta-analysis of randomised clinical trials examining efficacy
and/or cognitive effects of bifrontal ECT for the treatment of depression is the centrepiece of this paper. The
literature regarding bifrontal ECT is limited, with small patient numbers and treatment variation across studies
complicating result interpretation. However, our findings suggest that while bifrontal and bitemporal ECT may have
similar efficacy, bifrontal ECT is associated with less cognitive impairment immediately after a treatment course.
Bifrontal ECT may have greater efficacy than low-dose right unilateral ECT but less efficacy than high-dose right
unilateral ECT. Conversely, bifrontal ECT may affect cognition more adversely than low-dose right unilateral ECT, but
less so than high-dose right unilateral ECT. To further investigate the likely favourable benefit to cognitive risk profile
of bifrontal ECT, detailed cognitive testing should be undertaken as part of any future, large scale studies comparing
the efficacy of adequately-dosed bifrontal, bitemporal and right unilateral ECT. 2009 Bentham Science Publishers Ltd.
Introduction: Post-cholecystectomy clip migration (PCCM) is rare and can lead to complications which include clip-
related biliary stones. Most have been reported as case reports. This study reviews cases of clip migration reported
in the literatures. Method: Searches and reviews of the literatures from "PubMed," "EMBASE," and "Google Scholar"
search engines using the keywords "clip migration" and "bile duct stones" were carried out. Eighty cases from 69
publications were identified but details for only 69 cases were available for the study. Results: The median age at
presentations of PCCM was 60 years old (range, 31 to 88 years; female, 61. 8%) and the median time from the initial
cholecystectomy to clinical presentations was 26 months (range, 11 days to 20 years). Of primary surgeries, 23. 2%
was for complicated gallstones disease. The median number of clips placed during surgery was six (range, two to
more than ten clips). Common diagnoses at presentations of PCCM were obstructive jaundice (37. 7%), cholangitis
(27. 5%), biliary colic (18. 8%), and acute pancreatitis (8. 7%). The median number of migrated clip was one (range,
one to six). Biliary dilatation and strictures were encountered in 74. 1% and 28. 6%, respectively. Of the 69 cases of
PCCM-associated complications, 53 (77%) were successfully treated with endoscopic retrograde
cholangiopancreatography (ERCP), 14 (20. 2%) with surgery, and one (1. 4%) with successful percutaneous
transhepatic cholangiography treatment. One patient had spontaneous clearance of PCCM. There was no reported
mortality related to PCCM. Conclusion: PCCM can occur at any time but typically occur at a median of 2 years after
cholecystectomy. Clinical presentations are similar to those with primary or secondary choledocholithiasis. Most can
be managed successfully with ERCP. 2009 The Society for Surgery of the Alimentary Tract.
Biochemical monitoring of patients treated with antihypertensive therapy is recommended in order to identify
potential adverse reactions to treatment. We aimed to review the literature investigating the nature of biochemical
monitoring in adults treated in primary care with antihypertensive drugs. Specifically, we wished to establish (i) the
proportion of patients with biochemical baseline testing prior to the initiation of antihypertensive therapy; (ii) the
proportion of patients with biochemical monitoring after initiation of antihypertensive therapy; (iii) the patient
characteristics associated with biochemical monitoring; (iv) the frequency of biochemical monitoring after the
initiation of antihypertensive therapy; and (v) the relationship, if any, between biochemical monitoring and adverse
patient outcomes.We searched MEDLINE, EMBASE and Google Scholar from 1948 to 31 December 2010 using a
combination of text words and search terms. Retrospective and prospective cohort studies, cross-sectional studies,
randomized controlled trials or quasi-randomized controlled trials, and audits of current clinical practice were
included. Clinical trials, case reports and case series were excluded. Studies were included if they provided data on
the proportion of patients treated with antihypertensive therapy in primary care who had any biochemical
monitoring before or after the initiation of therapy. In total, 15 studies were included in our review, which used a
wide variety of definitions of monitoring prior to and after the initiation of antihypertensive therapy. From 17 to 81
of patients treated with antihypertensive drugs had a baseline biochemical test and from 20 to 79 had any follow-up
monitoring. In only 7 of the 12 studies that examined follow-up monitoring did more than half of the patients have
any monitoring.Overall, this systematic review provides evidence that monitoring as recommended by published
guidelines is not commonly undertaken. Only two studies were identified that examined patients with both baseline
testing and follow-up monitoring. Omission of one or the other limits the ability to analyse the effect of treatment on
electrolyte concentrations or renal function. There is limited research on the patient factors associated with
monitoring and further work is required to determine the impact of monitoring on adverse patient outcomes.
Important barriers to effective monitoring exist and this review emphasizes that these have not yet been overcome.
2011 Adis Data Information BV. All rights reserved.
Background/Aims: Dyssynergic defecation (DD) accounts for 30-40% of patients with chronic constipation and is
particularly prevalent in referral practices. Standard treatments (ST) including exercise, avoidance of constipating
drugs, and increasing fluid & fiber intake often fail to improve symptoms. Laxatives provide inconsistent relief of
constipation related symptoms, particularly in DD patients. Recent studies suggest that biofeedback (BF) therapy
provides an effective treatment for DD patients. Aims: To conduct a systematic review and meta-analysis of
randomized-controlled trials (RCTs) comparing BF therapy to standard treatments in DD patients. Methods: A search
of MEDLINE, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials, ACP Journal Club, DARE, CMR,
HTA, and abstracts from major GI meetings was performed. RCTs comparing the efficacy of BF vs. ST for weekly
bowel movement (BM) frequency or global satisfaction in patients with DD were selected. Meta-analysis was
performed using metan command in Strata 10.1. A funnel plot was created to assess for publication bias. The
heterogeneity of the pooled estimate was tested with the inconsistency index (I2) statistic. Subgroup analyses (type
of BF, duration of follow-up, study location, primary & secondary study outcomes, concurrent laxative use) were
performed to account for any observed heterogeneity. Results: Systematic review identified >1000 citations. Upon
detailed review, 7 treatment trials were identified of which 4 studies which randomized 241 patients with DD fulfilled
our inclusion criteria and were included in the meta-analysis. Patients treated with BF reported an increase of 1.30
BM/ week, compared to 0.87 BM/week for patients treated with ST (WMD: 01.11, 95% CI: -0.99-3.20). Significant
heterogeneity amongst studies was noted. Three studies reported data on patient satisfaction. The number of
patients reporting satisfaction with therapy was higher in the BF group compared to the ST group (75.0% vs. 36.7%,
RR: 2.15, 95% CI: 1.64-2.81, I2=81%). No other constipation-related outcomes were consistently reported amongst
the included trials. Conclusions: These results suggest that BF therapy offers benefits for global satisfaction in
patients with DD. Our analysis identified the need for further large, well designed clinical trials and the development
of a common set of outcome measures which can be applied to randomized trials evaluating the efficacy of BF
training for DD. Though stool frequency is commonly employed as the primary outcome measure in constipation
trials, our results raise questions about whether this endpoint is the most appropriate primary outcome for trials
evaluating BF for DD.
Objective: Biofilm-associated eye infections are increasingly being recognized as a diagnostic and therapeutic
problem. We sought to systematically review the relevant published literature on the clinical characteristics of these
infections. Methods: We searched in PubMed and Google Scholar to identify articles that provided clinical data on
patients with eye infections associated with the presence of bacterial or fungal biofilm, documented by electron
scanning microscopy. Results: We identified 12 articles involving 15 cases of documented biofilm-associated eye
infection. The infectious syndromes in regard were infectious crystalline keratopathy (6 cases), keratitis (4 cases),
endophthalmitis (2 cases), corneal abscess (1 case), conjunctivitis (1 case), and conjunctivitis with scleritis and
corneal perforation (1 case). All 15 patients had prior ophthalmologic surgery. In 8 of the 15 patients, the infection
was associated with the presence of a foreign body; the foreign body was a corneal suture (3 cases), intraocular lens
(3 cases), punctual plug (1 case) and soft contact lens (1 case). In the remaining 7 of the 15 included cases, the
biofilm-associated eye infection developed on native tissue; the presence of a biofilm was documented in corneal
biopsy specimen in 5 cases, extracted corneal tissue in 1 case, and extracted bacterial concretion in the remaining
case. Various causative pathogens were isolated. Treatment was eventually successful in all cases. In those with a
foreign body, cure was achieved only after foreign body removal. Regarding the 7 cases with no foreign bodies,
keratoplasty was required in 3 cases and evisceration of the eye 1 case. Conclusion: Our findings suggest that biofilm-
associated eye infections can develop on both foreign bodies and native tissue. Most of the published clinical cases
refer to infections of the anterior hemisphere of the eye and particularly the cornea. Yet, this could be related to the
diagnostic problems of the documentation of a biofilm. Further studies are need to better appreciate the particular
characteristics of these infections.
BACKGROUND: The use of bioidentical hormones, including progesterone, estradiol, and estriol, in hormone
replacement therapy (HRT) has sparked intense debate. Of special concern is their relative safety compared with
traditional synthetic and animal-derived versions, such as conjugated equine estrogens (CEE), medroxyprogesterone
acetate (MPA), and other synthetic progestins. Proponents for bioidentical hormones claim that they are safer than
comparable synthetic and nonhuman versions of HRT. Yet according to the US Food and Drug Administration and The
Endocrine Society, there is little or no evidence to support claims that bioidentical hormones are safer or more
effective. OBJECTIVE: This paper aimed to evaluate the evidence comparing bioidentical hormones, including
progesterone, estradiol, and estriol, with the commonly used nonbioidentical versions of HRT for clinical efficacy,
physiologic actions on breast tissue, and risks for breast cancer and cardiovascular disease. METHODS: Published
papers were identified from PubMed/MEDLINE, Google Scholar, and Cochrane databases, which included keywords
associated with bioidentical hormones, synthetic hormones, and HRT. Papers that compared the effects of
bioidentical and synthetic hormones, including clinical outcomes and in vitro results, were selected. RESULTS:
Patients report greater satisfaction with HRTs that contain progesterone compared with those that contain a
synthetic progestin. Bioidentical hormones have some distinctly different, potentially opposite, physiological effects
compared with their synthetic counterparts, which have different chemical structures. Both physiological and clinical
data have indicated that progesterone is associated with a diminished risk for breast cancer, compared with the
increased risk associated with synthetic progestins. Estriol has some unique physiological effects, which differentiate
it from estradiol, estrone, and CEE. Estriol would be expected to carry less risk for breast cancer, although no
randomized controlled trials have been documented. Synthetic progestins have a variety of negative cardiovascular
effects, which may be avoided with progesterone. CONCLUSION: Physiological data and clinical outcomes
demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and
cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts. Until
evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. Further randomized
controlled trials are needed to delineate these differences more clearly.
An adequate understanding of the relationship between periodontal tissues and restorative dentistry is paramount
to ensure adequate form, function, esthetics and comfort of the dentition. While most clinicians are aware of this
important relationship, uncertainty remains regarding specific concepts such as biologic width, its maintenance and
applications of crown lengthening in cases of biologic width violation. Relevant publications regarding biologic width,
its violation and management were identified up to August 2011 using manual and electronic database search in
Medline, Embase, Directory of Open Access Journals and Google Scholar. This review discusses the concept of
biologic width around tooth and its relationship to periodontal health and restorative dentistry.
The aim of this paper was to review the literature on the biological effects of a maternal eating disorder (ED) (and
relevant comorbidities) in pregnancy on mothers and in particular on the foetus. We also aimed to highlight possible
mechanisms of risk for long-term consequences in the offspring. Relevant literature was searched for using PubMed,
PsychInfo and Google Scholar and manually through relevant research papers. The consequences of maternal EDs in
pregnancy on EDs symptoms, psychopathology and perinatal outcomes are discussed. A developmental model of
possible risk mechanisms for adverse long-term nutritional and psychopathological outcomes in the offspring is
proposed. Maternal EDs during pregnancy are likely to have important long-term biological effects on the foetus.
Further research needs to clarify potential biological risk mechanisms highlighted in this review. Copyright 2009 John
Wiley & Sons, Ltd and Eating Disorders Association.
CONTEXT: Competitive swimming has become an increasingly popular sport in the United States. In 2007, more than
250 000 competitive swimmers were registered with USA Swimming, the national governing body. The average
competitive swimmer swims approximately 60 000 to 80 000 m per week. With a typical count of 8 to 10 strokes per
25-m lap, each shoulder performs 30 000 rotations each week. This places tremendous stress on the shoulder girdle
musculature and glenohumeral joint, and it is why shoulder pain is the most frequent musculoskeletal complaint
among competitive swimmers., EVIDENCE ACQUISITION: Articles were obtained through a variety of medical search
sources, including Medline, Google Scholar, and review articles from 1980 through January 2010., RESULTS: The
most common cause of shoulder pain in swimmers is supraspinatus tendinopathy. Glenohumeral instability and
labral tears have also been reported, but a paucity of information remains regarding prevalence and treatment in
swimmers., CONCLUSION: Because of the great number of stroke repetitions and force generated through the upper
extremity, the shoulder is uniquely vulnerable to injury in the competitive swimmer. Comprehensive evaluation
should include the entire kinetic chain, including trunk strength and core stability.
The literature contains a number of controversies regarding key questions: (1) When is a biopsy indicated? (2) How
should the biopsy be placed? (3) How should the biopsy be performed and which has the greatest diagnostic
accuracy? (4) Who should perform the biopsy? (5) What clinical parameters present the greatest diagnostic
difficulty? Using PubMed and Google Scholar we performed English-language literature searches of clinical studies
reporting biopsy of soft tissue masses. Thirty-two studies met the inclusion criteria but were only able to address
three of the five questions the authors had hoped to evaluate. Available evidence suggests open biopsy has the
highest diagnostic accuracy over core needle biopsy, which was higher than fine needle aspiration. There was no
evidence to address who is best suited to perform the biopsy (general surgeon, orthopaedic surgeon, radiologist,
pathologist) in terms of accuracy of diagnosis. Frozen section at the time of biopsy may improve diagnostic accuracy.
Diagnostic difficulty was associated with myxoid and round cell neoplasms, infections, and tumors located in the
paraspinal region. The limited number of references addressing these issues demonstrated the need for more Level I
research in the area of biopsy of soft tissue masses. Level of Evidence: Level III, therapeutic study. See Guidelines for
Authors for a complete description of levels of evidence. 2009 The Association of Bone and Joint Surgeons.
Birth is a significant human experience, which is defined by the social conditions of the living environment. The
biological birth is changing into social birth through a number of cultural and ritual impacts. For the new-born baby,
birth is part of his socialization, while for the mother, birth upgrades her social status. This bibliographic review aims
to study birth in different civilizations, non-western and western societies, the role of gender and the impact of
medical-authoritative knowledge on parturition. Pubmed, Scholar Google, POPLINE, Cochrane Library, Social Care
Online and Amazon were searched for between April to June of 2009. Sixty-one studies were found, foreign and
Greek, referring to birth in non-western, western and Greek society, the factors that influence parturition, the role of
gender and the medicalization of birth in the last century. It emerged that birth is not only a biological, but also a
social event, which is significantly affected by the social conditions of the cultural environment and has equivalent
impact on the social status of human. In the non-western societies labour takes place at home with the support of
women-relatives, friends and empirical midwives, who are highly respected members of their community. In western
societies, there has been a medicalization of reproduction. Pregnant women are under medical observation and give
birth in hospitals with the use of advanced technology and medical knowledge. In Greece, the impact from West is
obvious, as there has been medicalization, but it admits of several interpretations due to different social and cultural
conditions.
The birth environment appears to play a significant role to the beginning, the progress and the memory of labour.
For that reason, the creation of a home-like environment composes great part of birth planning. Unfortunately, in
many contemporary studies the mothers describe the delivery room as a cold, inhospitable, inconvenient, heavily-
illuminated room with no privacy, while they would prefer a home-like birth environment. The purpose of this study
is to define the term home-like birth environment and to study the short- and long-term effect on the mother and
the child. There has been a bibliographic research in the Pubmed and the Scholar Google, as well as in the scientific
journals British Journal of Midwifery and Midwifery Today, between May to June of 2009, using the words
environment, labour and childbirth as key words. There were found 14 studies, British and American, which are
related to the components of a home-like environment and the direct and indirect consequences to the mother and
the child. Conclusively, a home-like birth environment is characterised by quietness, privacy, familiarity, support,
freedom of movements, potentiality of light and temperature regulation, potentiality of hydration and light
nourishment, hygiene and technology for emergencies. The birth environment affects the labour progress, the pain
threshold, the need of medical intervention, the embryo's health and the women's satisfaction of labour experience.
Moreover, the birth environment may affect the future mental health of the mother and shape the child's life upon
certain principles.
OBJECTIVES: Legislation such as the Orphan Drug Act (ODA) in the United States (US), and Regulation 141/2000 in
the European Union (EU) have been successful in stimulating research and development and supporting regulatory
approval of orphan drugs that would not have otherwise been commercially viable. This success, however, has been
bittersweet. While increasing numbers of patients with rare diseases have gained access to potentially life-saving or
life-extending treatments, decision makers have struggled to mitigate the impact of expensive orphan drugs on
overall drug and healthcare budgets. The objective of this study was two-fold; 1) to explore the impact of orphan
drug legislation on patient access to drugs for rare diseases in the US and EU, and 2) to quantify the impact of costs
associated with orphan drugs on overall drug and healthcare budgets in the US and EU. METHODS: An exhaustive
literature search was performed to identify orphan drugs which are currently funded in the US or EU, determine the
prevalence of orphan diseases treated by these drugs, identify the costs associated with these drugs, and explore the
impact of these costs on overall drug and healthcare budgets. Literature searches were conducted using various
search engines, including PubMed, Google, and Google Scholar. RESULTS: Legislative initiatives directed at drugs for
rare diseases in the US and EU have resulted in the development and funding of an unprecedented number of drugs
for rare diseases. The recent approval of a multitude of new drugs for rare diseases in the US and EU has led to
notable increases in overall drug and healthcare budgets. CONCLUSIONS: Reimbursement and patient access for
orphan drugs will become increasingly more challenging as decision makers become more prohibitive in their
approval of new and expensive drugs. Criterion for the reimbursement of drugs for rare diseases needs to be clearly
established and communicated.
Aim: In the UK, it is known that screening inequalities exist involving ethnic minority groups such as Black women
(Patnick, 2009). To date, there is limited UK data on Black British women and breast health awareness. Black British
women appear to be an underrepresented group in breast cancer studies (Breast Cancer Care, 2004, 2005). This
literature review aimed to explore Black women's perceptions of breast health and factors that influence breast
cancer screening practices. Methods: A literature search for the period 1994 to September 2009 was undertaken
using BNI, CINAHL, PubMed, OSH-ROM, PsyInfo, Google scholar, and Scopus databases. Key words used included:
breast cancer, breast health, African American women, Black British women, black women, breast cancer screening,
qualitative studies. Hand-searching was also done, and reference lists of papers were examined for relevant studies.
Results: Black women hold a variety of views and perceptions on the risk that breast cancer poses. These perceptions
are strongly related to existing knowledge, related stigmatization, spiritual and religious beliefs, all of which can
adversely influence motivation to engage in self-breast examination and breast cancer screening. Conclusion: US
based studies identified several influential factors: religion, educational awareness of breast cancer screening, breast
health awareness. Breast health interventions and research are needed to increase breast health awareness in Black
British women. 2010 Elsevier Ltd.
Background: Many epidemiological studies and reviews have been performed to identify the causes of bladder
cancer. The aim of this review is to investigate the links between various environmental risk factors and cancer of the
bladder. Methods. A systematic literature search was performed using PubMed, Science Direct, Scopus, Scholar
Google and Russian Google databases to identify reviews and epidemiological studies on bladder cancer risk factors
associated with the environment published between 1998 and 2010. Only literature discussing human studies was
considered. Results: Smoking, mainly cigarette smoking, is a well known risk factor for various diseases, including
bladder cancer. Another factor strongly associated with bladder cancer is exposure to arsenic in drinking water at
concentrations higher than 300 g/l. The most notable risk factor for development of bladder cancer is occupational
exposure to aromatic amines (2-naphthylamine, 4-aminobiphenyl and benzidine) and 4,4'-methylenebis(2-
chloroaniline), which can be found in the products of the chemical, dye and rubber industries as well as in hair dyes,
paints, fungicides, cigarette smoke, plastics, metals and motor vehicle exhaust. There are also data suggesting an
effect from of other types of smoking besides cigarettes (cigar, pipe, Egyptian waterpipe, smokeless tobacco and
environmental tobacco smoking), and other sources of arsenic exposure such as air, food, occupational hazards, and
tobacco. Other studies show that hairdressers and barbers with occupational exposure to hair dyes experience
enhanced risk of bladder cancer. For example, a study related to personal use of hair dyes demonstrates an elevated
bladder cancer risk for people who used permanent hair dyes at least once a month, for one year or longer.
Conclusion: Smoking, in particular from cigarettes, exposure to arsenic in drinking water, and occupational exposure
to aromatic amines and 4,4'-methylenebis(2-chloroaniline) are well known risk factors for various diseases including
bladder cancer. Although the number of chemicals related to occupational exposure is still growing, it is worth noting
that it may take several years or decades between exposure and the subsequent cancer. 2012 Letaiova et al; licensee
BioMed Central Ltd.
Many epidemiological studies and reviews have been performed to identify the causes of bladder cancer. The aim of
this review is to investigate the links between various environmental risk factors and cancer of the bladder. A
systematic literature search was performed using PubMed, Science Direct, Scopus, Scholar Google and Russian
Google databases to identify reviews and epidemiological studies on bladder cancer risk factors associated with the
environment published between 1998 and 2010. Only literature discussing human studies was considered. Smoking,
mainly cigarette smoking, is a well known risk factor for various diseases, including bladder cancer. Another factor
strongly associated with bladder cancer is exposure to arsenic in drinking water at concentrations higher than 300
mug/l. The most notable risk factor for development of bladder cancer is occupational exposure to aromatic amines
(2-naphthylamine, 4-aminobiphenyl and benzidine) and 4,4'-methylenebis(2-chloroaniline), which can be found in
the products of the chemical, dye and rubber industries as well as in hair dyes, paints, fungicides, cigarette smoke,
plastics, metals and motor vehicle exhaust. There are also data suggesting an effect from of other types of smoking
besides cigarettes (cigar, pipe, Egyptian waterpipe, smokeless tobacco and environmental tobacco smoking), and
other sources of arsenic exposure such as air, food, occupational hazards, and tobacco. Other studies show that
hairdressers and barbers with occupational exposure to hair dyes experience enhanced risk of bladder cancer. For
example, a study related to personal use of hair dyes demonstrates an elevated bladder cancer risk for people who
used permanent hair dyes at least once a month, for one year or longer. Smoking, in particular from cigarettes,
exposure to arsenic in drinking water, and occupational exposure to aromatic amines and 4,4'-methylenebis(2-
chloroaniline) are well known risk factors for various diseases including bladder cancer. Although the number of
chemicals related to occupational exposure is still growing, it is worth noting that it may take several years or
decades between exposure and the subsequent cancer.
PURPOSE: To review different aspects of the bladder involvement in Behcet's disease as a rare complication.,
MATERIALS AND METHODS: We searched PubMed, Ovid, and Google Scholar for Behcet's and neuro-Behcet's
disease and neurogenic and neuropathic bladder, bladder involvement, voiding dysfunction, and urologic
manifestations. Fourteen full-texts and one abstract were retrieved., RESULTS: Most involved patients are young to
middle-aged men. Both bladder filling and emptying problems can be seen, with the storage symptoms being the
most common finding. Sphincter function could be normal, dyssynergic, or deficient. The most common urodynamic
finding is detrusor overactivity. In cystoscopic examination, ulcers or nodules due to vasculitis can be seen, which
along with neurologic causes give rise to the voiding symptoms. The rate of cancers does not increase in Behcet's
disease. Surgery and chemotherapy are tolerated well. However, radiotherapy may be associated with increased
complication rates., CONCLUSION: Treatment plan should be tailored according to the specific type of the bladder
involvement. Periodic re-evaluation is required because of the changing nature of the bladder behavior.
Purpose: To review different aspects of the bladder involvement in Behcet's disease as a rare complication. Materials
and Methods: We searched PubMed, Ovid, and Google Scholar for Behcet's and neuro-Behcet's disease and
neurogenic and neuropathic bladder, bladder involvement, voiding dysfunction, and urologic manifestations.
Fourteen full-texts and one abstract were retrieved. Results: Most involved patients are young to middle-aged men.
Both bladder filling and emptying problems can be seen, with the storage symptoms being the most common
finding. Sphincter function could be normal, dyssynergic, or deficient. The most common urodynamic finding is
detrusor overactivity. In cystoscopic examination, ulcers or nodules due to vasculitis can be seen, which along with
neurologic causes give rise to the voiding symptoms. The rate of cancers does not increase in Behcet's disease.
Surgery and chemotherapy are tolerated well. However, radiotherapy may be associated with increased
complication rates. Conclusion: Treatment plan should be tailored according to the specific type of the bladder
involvement. Periodic re-evaluation is required because of the changing nature of the bladder behavior.
Background: Selective serotonin recapture inhibitors (SSRI) are described to be potentially associated with an
increased risk of bleeding. However, observational studies have reported a wide range of results regarding this risk.
Objective: A meta-analysis was conducted to summarize observational studies and estimate the bleeding risk
associated to SSRI. Methods: Observational studies reported before February 28, 2009 investigating bleeding risk
under SRRI therapy (fluoxetine, sertraline, paroxetine, citalopram, escitalopram, fluvoxamine) were retrieved by
searching the MEDLINE, PASCAL, Cochrane Library database, Google Scholar and Scopus bases. The outcome of
interest was all bleeding events. We estimated univariate odds ratio (OR) and 95%CI and also retrieved adjusted-OR
in each study. Pooled estimates of univariate and adjusted-OR using an inverse-variance model were computed for
case-control and cohort studies for both. An OR >1 indicates that the use of SSRIs was associated with an increased
risk of bleeding. Sources of heterogeneity were investigated using subgroup analyses according to the
methodological quality of the studies (Newcastle Ottawa Assessment Scale (NOAS), suspected bias on matching
method or definition of SSRI exposition) and the site of bleeding. Results: A total of 768 papers was investigated and
23 relevant studies were included (21 case-controls studies and two cohort studies) for a total of 375 457 patients.
The meta-analysis of univariate OR of case-control studies (353 467 patients) shows that the use of SSRIs is
associated with an increased risk of bleeding (OR = 1.55 [1.37;1.76], random effect model, P < 0.001). The same
association is observed for cohort studies (OR = 1.56 [0.81;3.01], P = 0.18) despite a lack of statistical power (22 090
patients). The same result was found when pooling adjusted-OR of case-control studies (OR = 1.47 [1.29;1.69].
Subgroup investigations show the association is constant whatever the NOAS score, the matching method, the
definition of SSRI exposition. SSRIs were found to be associated with both gastro-intestinal tract bleeding risk (OR=
1.73 [1.64;1.82]) and intracranial haemorrhage risk (OR = 1.17 [0.95;1.43]) even if the incidence of the last ones is
too small to observe a statistically significant association. Conclusion: This meta-analysis shows that the use of SSRIs
is associated with a 50% higher risk of bleeding. This risk was previously described but never quantified precisely.
These antidepressant drugs should be cautiously prescribed in patients known at risk of bleeding.
Background: Bloating is a common and bothersome gastrointestinal symptom. Despite the high prevalence,
associated costs, and effects on the quality of life, very few studies have reported the epidemiology of bloating in
Iran. Through this systematic review, findings and limitations of current research will be discussed. Methods: In
March 2012, we searched PubMed, Google Scholar, Scientific Information Database, IranMedex, and Magiran to find
articles for inclusion. Two of the authors screened the articles on the basis of titles and abstracts. The full
manuscripts of these publications were then evaluated according to predefined criteria. Results: Fifteen articles were
included in the study, and data regarding the prevalence of bloating were extracted. The studies depict prevalence of
1.5% to 8.8% for bloating in Iranian general population. Two studies reported the prevalence of functional bloating to
be 1.5% and 10% according to Rome III and Rome II criteria, respectively. Female to male ratio remains >=1 for most
of the studies criteria. Conclusion: In Iran, data on the prevalence of bloating are limited, and have mostly been
gathered from highly selected populations. The results of the present study advocate the necessity to perform
further studies in the general population, which may help health policy makers in appropriate resource allocation.
Introduction: Patients who suffer hip fractures often require large doses of opiate analgesia during their initial
assessment. We performed a systematic review of the literature to determine the efficacy of the fascia iliaca block in
providing adequate analgesia to patients presenting with hip fracture in the emergency department. Methods:
EMBASE, PubMed, CINAHL, and Google Scholar were searched. Free text keywords for population, intervention, and
outcome were identified to create a search string. The reference lists from articles identified in the primary
electronic search were hand-searched. The search strategy was repeated using the System for Information on Grey
Literature in Europe. Potentially eligible studies were identified based on review of the title and abstract. If eligibility
was unclear from the title and abstract, the full text was examined. Randomized controlled trials comparing the
fascia iliaca block with standard analgesia were included. A standardized appraisal of the methodological quality of
the studies was performed. Results: Thirty-nine articles were identified, of which 13 were duplicates. Of the
remaining 26, 14 were relevant to the question and suitable for further sorting. Of these 14 papers, 2 were
randomized controlled trials, 5 were cohort studies, and 4 were reports of audit of practice. There were 3 abstracts
of conference submissions, which were descriptions of reviews or service development projects. The 2 randomized
controlled trials showed statistically significant superior or equal pain relief between the fascia iliaca block and other
forms of acute pain relief. Conclusion: The fascia iliaca block could have an important role in first-line pain control for
patients presenting to the emergency department with a hip fracture. There is potential to reform the acute
management of this common group of patients, which could lead to decreased opiate use in this elderly population.
Background: There is uncertainty about the efficacy and tolerability of blonanserin in schizophrenia. Method:
PubMed, the Cochrane Library databases, PsycINFO, and Google Scholar were searched up to September 2012. A
systematic review and meta-analysis of individual patient data from randomized, controlled trials comparing
blonanserin with other antipsychotics were conducted. The risk ratio (RR), 95% confidence intervals (CI), numbers-
needed-to-harm (NNH), and weighted mean difference (WMD) were calculated. Results: Four studies (total n = 1080)
were identified (vs. risperidone studies [n = 508], vs. haloperidol studies [n = 572]). Comparing blonanserin with
other pooled antipsychotics, there were no significant differences in the Positive and Negative Syndrome Scale
(PANSS) total score (p = 0.75), PANSS positive (p = 0.41), PANSS negative (p = 0.09), and PANSS general
psychopathology subscale scores (p = 0.96), and response rate (p = 0.72). However, blonanserin showed greater
efficacy in PANSS negative subscale scores compared with haloperidol (WMD = -1.29, CI = -2.29 to -0.30, p = 0.01, I2
= 0%). No significant differences were found in discontinuation rates between blonanserin and other pooled
antipsychotics (due to any cause: p = 0.29, inefficacy: p = 0.32, adverse events: p = 0.56). Blonanserin had a 0.31
lower risk of hyperprolactinemia than the other pooled antipsychotics (CI = 0.20-0.49, NNH = not significant). While
dizziness (RR = 0.47, CI = 0.23-0.93, NNH = not significant) and akathisia (RR = 0.54, CI = 0.32-0.90, NNH = 7) occurred
significantly less often with blonanserin than with haloperidol, blonanserin had a 1.62 higher risk of akathisia than
risperidone (CI = 1.18-2.22, NNH = 3). Conclusion: Our results suggest that although blonanserin has a more
beneficial effect on negative symptoms than haloperidol, there was a significant difference in the adverse events
profile between blonanserin and other antipsychotics. 2012 Elsevier Ltd.
Background: Boceprevir is a protease inhibitor indicated for the treatment of chronic hepatitis C virus (HCV)
genotype 1 infection in combination with peginterferon and ribavirin for treatment-naive patients and those who
previously failed to improve with interferon and ribavirin treatment. Objective: This article provides an overview of
the mechanism of action, pharmacologic and pharmacokinetic properties, clinical efficacy, and tolerability of
boceprevir. Methods: Relevant information was identified through a search of PubMed (1990-July 2012), EMBASE
(1990-July 2012), International Pharmaceutical Abstracts (1970-July 2012), and Google Scholar using the key words
boceprevir, SCH 503034, non-structural protein 3 (NS3) serine protease inhibitor, and direct-acting antiviral agent
(DAA). Additional information was obtained from the US Food and Drug Administration's Web site, review of the
reference lists of identified articles, and posters and abstracts from scientific meetings. Results: Clinical efficacy of
boceprevir was assessed in 2 Phase III trials, Serine Protease Inhibitor Therapy-2 (SPRINT-2) for treatment-naive
patients and Retreatment with HCV Serine Protease Inhibitor Boceprevir and PegIntron/Rebetol 2 (RESPOND-2) for
treatment-experienced patients. In SPRINT-2, patients were randomized to receive peginterferon + ribavirin (PR) or
peginterferon + ribavirin + boceprevir (PRB); duration of boceprevir therapy varied from 24, 32, to 44 weeks on the
basis of HCV RNA results. The primary endpoint was achievement of sustained virologic response (SVR; lower limit of
detection, 9.3 IU/mL). The addition of boceprevir was shown to be superior, with overall SVR rates ranging from 63%
to 66% compared with 38% with PR (P < 0.001). Results of SVR in SPRINT-2 were also reorganized to monitor SVRs in
black and non-black patients. Treatment-experienced patients were assessed in RESPOND-2; however, null
responders were excluded. Patients were again randomized to PR or PRB; duration of boceprevir therapy varied from
32 to 44 weeks on the basis of HCV RNA results. SVR was significantly higher in patients receiving boceprevir (59%-
66% vs 21% with PR; P < 0.001). This benefit was seen in both previous nonresponders (SVR, 40%-52% vs 7% with
PR), as well as previous relapsers (SVR, 69%-75% vs 29% with PR). Importantly, SVR could be attained with a
shortened course of therapy in almost one half of all treated patients in SPRINT-2 (44%) and RESPOND-2 (46%).
Conclusions: Boceprevir was well tolerated in clinical trials and a welcomed addition to our HCV armamentarium.
2012.
Background: Bochdalek hernias are a very rare form of diaphragmatic hernias. There are no robust studies that
reveal the true natural history of this disease process. The aim of this study was to summarize clinically relevant data
for the purpose of assisting surgeons with the work-up, diagnosis, and treatment of adult patients with Bochdalek
hernia. Methods: A literature search was performed using PubMed, Google scholar, EMBASE and the following
keywords: Bochdalek hernia, congenital diaphragmatic hernia, and posterolateral hernia. All case reports and series
after 1955 that pertained to adults were included in the review. The following data points were queried: age, sex,
presentation, studies utilized during work-up, laterality, surgical approach, hernia sac management, specific
minimally invasive surgical techniques, and follow-up. Results: A total of 124 articles comprising 173 patients met the
inclusion criteria. Based on the data provided, several conclusions regarding this disease process can be made. Most
patients present with symptoms related to their hernia (86%). Pain is the most common complaint (69%). While
laparotomy is the most widely used surgical approach (38%), minimally invasive surgical techniques have gained
popularity since their first report in 1995. Laparoscopic repair can be performed with a low complication rate (7%)
and short hospital stay (4 days). Conclusions: Using modern surgical techniques to include laparoscopy, repair can be
performed safely, with a short hospital stay, and with minimal morbidity or mortality. 2010 U.S. Government.
Background. Most women report vasomotor symptoms during the menopausal transition. Vasomotor symptoms are
sensations of intense heat accompanied by sweating and flushing. Potentially modifiable factors, such as current
smoking and obesity, may predispose a woman to more severe or frequent hot flashes. Early works hypothesized
that body fat protected against vasomotor symptoms because of the aromatization of androgens to estrogens in fat
tissue. Objectives. To assess the possible association between Body mass index and post-menopausal vasomotor
symptoms. Search strategy. We searched in the following sources: the Cochrane database, Medline, EBESCO, and
Google Scholar. Hand-searching of recent conference proceedings was also undertaken. Selection criteria.
Observational studies taking in consideration body mass index and vasomotor symptoms. Data collection and
analysis. Four reviewers independently extracted data from included trials onto a standard form and assessed trial
methodological quality. The data abstracted were relevant to predetermined measures (BMI greater or equal to 25
kg/m2, and presence of any vasomotor symptom). Where appropriate, a summary statistic was calculated: a odds
ratio for dichotomous data and a weighted mean difference for continuous data. Main results. We found Sixteen
studies that examined the relation between body mass index (BMI) and vasomotor symptoms. Only two studies
published before 1995 have found that lower BMI have greater risk of vasomotor symptoms, but they were not
eligible for the meta-analysis. Four eligible studies for the meta-analysis were identified. These included 5464
women, 51% of whom were with a BMI equal or greater than 25 kg/m2. The meta-analysis found that a BMI equal or
greater than 25 kg/m2 is a risk factor for vasomotor symptoms OR 1.31 (CI.95: 1.15-1.50). Conclusions. Evidence
indicates that overweight and obesity are associated with greater vasomotor symptom reporting, primarily hot
flashes. These findings are consistent with a thermo-regulatory model of vasomotor symptoms in which body fat acts
as an insulator, rendering vasomotor symptoms, a putative heat dissipation event, more likely.
Context: Renal graft recipients who develop post-transplant lymphoproliferative disorders (PTLD) that complicate
bone marrow (BM). Aims: To investigate features, predictors and prognosis of BM involvement by PTLD in renal
transplant patients. Settings and Design: A comprehensive search for the available data though PubMed and Google
Scholar for reports of PTLD localization in BM in renal allograft recipients. Materials and Methods: Data of 168 PTLD
cases in renal transplant context who have developed bone marrow PTLD gathered from 18 studies and were pooled
and analyzed. Statistical Analysis Used: Chi-square test, Student's t test and fissure's exact test were employed.
Results: Chi-square test showed that renal recipients with BM PTLD were significantly more likely to represent multi-
organ disease (P<0.001), and disseminated PTLD (P<0.001). BM PTLD was also more frequently seen among pediatric
renal recipients who had developed PTLD (P=0.016). PTLD, in BM PTLD renal recipients more significantly
complicated liver (P=0.008), but less commonly affected skin (P=0.045). BM PTLD lesions were relatively more likely
to be of monomorph phenomenon (P=0.06). Conclusions: Renal recipients with BM PTLD represent worse outcome
and more unfavorable histopathological phenomenon than in other organ involvements. Moreover, a concomitant
PTLD involvement site in liver was found which necessitates full hepatic evaluation for a potential complication by
the disease in renal recipients whose BM is involved.
Ethnopharmacological relevance: Apocynum venetum L. (Apocynaceae, Luobuma) has a long history as a Chinese
traditional medicine with uses to calm the liver, soothe the nerves, dissipate heat, and promote diuresis. Recently,
Luobuma tea has been commercialized as a sedative and anti-aging supplement that has become increasingly
popular in North American and East Asian health food markets. Aims of the review: The aim of this review is to
provide an up-to-date and comprehensive overview of the botany, chemical constituents, traditional uses,
pharmacological activities and safety aspects of Apocynum venetum in order to assess its ethnopharmacological use
and to explore its therapeutic potentials and future opportunities for research. Background and methods: The
accessible literature on Apocynum venetum written in English, Chinese and Japanese were collected and analyzed.
The literatures included ancient Chinese herbal classics, pharmacopoeias and articles that included in Pubmed, Web
of Science, Google Scholar and Wanfang. Key findings: Modern pharmacological studies demonstrated that
Apocynum venetum possess wide pharmacological activities that include antihypertensive, cardiotonic,
hepatoprotective, antioxidant, lipid-lowering, antidepressant and anxiolytic effects, which can be explained by the
presence of various flavonoid compounds in this plant. The traditional (Lop Nor region) use of Apocynum venetum
with tobacco as an agent to detoxify nicotine may receive interest as a possible therapeutic option to detoxify the
body from smoking. Based on animal studies and clinical trials, Apocynum venetum causes no severe side effects,
even in a stable daily dosage (50 mg/person/day) for more than three years. Conclusions: Apocynum venetum
potentially has therapeutic potential in the prevention and treatment for the cardiovascular and neurological
diseases, especially for high blood pressure, high cholesterol, neurasthenia, depression and anxiety. Further
investigations are needed to explore individual bioactive compounds responsible for these in vitro and in vivo
pharmacological effects and the mode of actions. Further safety assessments and clinical trials should be performed
before it can be integrated into medicinal practices. 2012 Elsevier Ireland Ltd. All rights reserved.
Ethnopharmacological relevance Waltheria indica L. (syn. Waltheria americana) is commonly used in traditional
medicine in Africa, South America and Hawaii, mainly against pain, inflammation, conditions of inflammation,
diarrhea, dysentery, conjunctivitis, wounds, abscess, epilepsy, convulsions, anemia, erectile dysfunctions, bladder
ailments and asthma. Aim of the review to provide an up-to-date overview of the botany, phytochemistry, traditional
uses, pharmacological activities and toxicity data of Waltheria indica. Additionally, studies providing an evidence for
local and traditional uses of Waltheria indica are discussed. Further phytochemical and pharmacological potential of
this species are suggested for future investigations. Materials and methods The information was collected from
scientific journals, books, theses and reports via academic libraries and electronic search. These sources include
Pubmed, Web of Science, Portal de Portales-Latindex, Science Research.com and Google scholar. These studies
about the medical botanical, traditional uses, chemical, pharmacological and toxicological data on Waltheria indica
were published in English, Portuguese, Spanish, German and French. Results Crude extracts and isolated compounds
from Waltheria indica were investigated and showed analgesic, anti-inflammatory, antibacterial, antifungal,
antimalarial, anti-anemic, anti-oxidant, sedative and anticonvulsant activities. The phytochemical investigations
showed the presence of cyclopeptid alkaloids, flavonoids (e.g., (-)-epicatechin, quercetin, kaempferol, kaempferol-3-
O-beta-d-(6-E-p- coumaryl)-glucopyranoside), tannins, sterols, terpenes, saponins, anthraquinones. Studies of acute
toxicity in animal indicated that Waltheria indica can be toxic. Conclusion Waltheria indica possess therapeutic
potential in the treatment of inflammation, malaria, infectious diseases (e.g., lungs infection due to Klebsiella
pneumoniae, diarrhea due to Candida albicans or Escherichia coli) and prevention of oxidative stress. Further studies
are necessary to explore pure compounds responsible for the pharmacological effects and the mechanisms of action.
Further investigations are also needed to provide an evidence base for traditional uses of this species against pain,
anemia, convulsions and epilepsy. In addition, there is a pressing need to investigate the other traditional uses such
as dysentery, syphilis, erectile dysfunctions and asthma. 2013 Elsevier Ireland Ltd. All rights reserved.
Objectives: This study reports on the Brazilian experience of developing a specialized bulletin, the Brazilian Health
Technology Assessment Bulletin (BRATS), on health technology assessments (HTA). Methods: The editorial process,
format, and dissemination strategy of the publication are presented. A critical appraisal of the available issues was
made using the checklist for HTA reports of the International Network of Agencies for Health Technology
Assessment. The initial impact was estimated based on a retrospective observational measurement of the types of
publications that cite the bulletin as a source of information. The publications citing BRATS were identified using
Google Scholar. Results: Since June 2008, fourteen issues of the bulletin have been produced. BRATS has not
presented any significant limitation that would compromise generalizations of its results within the Brazilian context.
The initial impact of the bulletin, however, has been small, which may be due to its exclusively electronic
dissemination format and technical language. We found nine publications citing BRATS in Google Scholar.
Conclusions: It is hoped that the bulletin will promote the continuity of HTA actions among health-sector managers
and professionals in Brazil. 2012 Cambridge University Press.
Background: Krokodil, a homemade injectable opioid, gained its moniker from the excessive harms associated with
its use, such as ulcerations, amputations and discolored scale-like skin. While a relatively new phenomenon, krokodil
use is prevalent in Russia and the Ukraine, with at least 100,000 and around 20,000 people respectively estimated to
have injected the drug in 2011. In this paper we review the existing information on the production and use of
krokodil, within the context of the region's recent social history. Methods: We searched PubMed, Google Advanced
Search, Google Scholar, YouTube and the media search engine www.Mool.com for peer reviewed or media reports,
grey literature and video reports. Survey data from HIV prevention and treatment NGOs was consulted, as well as
regional experts and NGO representatives. Findings: Krokodil production emerged in an atypical homemade drug
production and injecting risk environment that predates the fall of communism. Made from codeine, the active
ingredient is reportedly desomorphine, but - given the rudimentary 'laboratory' conditions - the solution injected
may include various opioid alkaloids as well as high concentrations of processing chemicals, responsible for the
localized and systemic injuries reported here. Links between health care and law enforcement, stigma and
maltreatment by medical providers are likely to thwart users seeking timely medical help. Conclusion: A
comprehensive response to the emergence of krokodil and associated harms should focus both on the substance
itself and its rudimentary production methods, as well as on its micro and macro risk environments - that of the on-
going syndemic of drug injecting, HIV, HCV, TB and STIs in the region and the recent upheaval in local and
international heroin supply. The feasibility of harm reduction strategies for people who inject krokodil may depend
more on political will than on the practical implementation of interventions. The legal status of opioid substitution
treatment in Russia is a point in case. 2013 Elsevier B.V.
BACKGROUND: Krokodil, a homemade injectable opioid, gained its moniker from the excessive harms associated
with its use, such as ulcerations, amputations and discolored scale-like skin. While a relatively new phenomenon,
krokodil use is prevalent in Russia and the Ukraine, with at least 100,000 and around 20,000 people respectively
estimated to have injected the drug in 2011. In this paper we review the existing information on the production and
use of krokodil, within the context of the region's recent social history., METHODS: We searched PubMed, Google
Advanced Search, Google Scholar, YouTube and the media search engine www.Mool.com for peer reviewed or
media reports, grey literature and video reports. Survey data from HIV prevention and treatment NGOs was
consulted, as well as regional experts and NGO representatives., FINDINGS: Krokodil production emerged in an
atypical homemade drug production and injecting risk environment that predates the fall of communism. Made from
codeine, the active ingredient is reportedly desomorphine, but - given the rudimentary 'laboratory' conditions - the
solution injected may include various opioid alkaloids as well as high concentrations of processing chemicals,
responsible for the localized and systemic injuries reported here. Links between health care and law enforcement,
stigma and maltreatment by medical providers are likely to thwart users seeking timely medical help., CONCLUSION:
A comprehensive response to the emergence of krokodil and associated harms should focus both on the substance
itself and its rudimentary production methods, as well as on its micro and macro risk environments - that of the on-
going syndemic of drug injecting, HIV, HCV, TB and STIs in the region and the recent upheaval in local and
international heroin supply. The feasibility of harm reduction strategies for people who inject krokodil may depend
more on political will than on the practical implementation of interventions. The legal status of opioid substitution
treatment in Russia is a point in case. Copyright 2013 Elsevier B.V. All rights reserved.
This study aimed to establish the safety of chemotherapy use in pregnant women with breast cancer, and to find
possible effects in the fetus. A search of MEDLINE/PubMed, LILACS, SciELO, Cochrane, UpToDate, and Google Scholar
databases was performed to identify publications, 86 articles published from 2001 to 2012 were retrieved and
evaluated by two readers in accordance predetermined exclusion and inclusion criteria; 39 articles were selected. All
the chemotherapy drugs used to treat breast cancer during pregnancy belonged to class D, and consisted of 5-
fluorouracil (F), doxorubicin (A) or epirubicin (E) and cyclophosphamide (C), or the combination doxorubicin and
cyclophosphamide (AC), a safe regimen when used after the first trimester of pregnancy. Few studies evaluated the
use of taxanes (T), such as docetaxel (D) and paclitaxel (P), with no increase in the occurrence of fetal defects and
other maternal complications when used in the second and third trimesters of pregnancy. The use of trastuzumab in
pregnant women is associated with oligohydramnios and anhydramnios; thus, it is not recommended during
pregnancy. As almost all studies were observational and retrospective, new prospective studies on the subject are
needed. Copyright 2013 Elsevier Editora Ltda. All rights reserved.
Introduction: The elderly population is rapidly increasing, and with cancer, particularly breast cancer, being most
prevalent in this group, its management is becoming increasingly important. A major aspect of breast cancer
treatment and subsequent quality of life is the opportunity for reconstructive surgery post-mastectomy. This is
particularly important as survival rates are improving, so a larger proportion of patients are living with the long term
consequences of their treatment. Evidence has shown that age itself is not a risk factor for poor surgical outcomes,
but concern over this causes surgeons to be wary of offering elderly patients the opportunity of reconstruction.
Elderly patients themselves are also less likely to request or accept reconstruction. Methods: Literature searches
using keywords 'breast reconstruction', 'older' and 'elderly' were carried out on Pubmed, Scopus and Google Scholar.
Results were limited to English language, and then manually searched to exclude irrelevant articles. Duplicates were
removed and a series of articles were reviewed. Results: Surgery was well tolerated in elderly patients, with
complication rates comparable to a younger group. Autogenous tissue produced better outcomes than implant
reconstruction. In areas such as social functioning and emotional wellbeing, patients with reconstructive surgery
showed better outcomes than those without. Discussion: The research on this topic is limited and only available in
the form of case series. Direct comparison between these series cannot be drawn. The available series lack a clear
assessment of the patient's frailty and do not define which patients should be offered breast reconstruction and
which ones should be denied. Despite this, the evidence strongly suggests that it would be beneficial to offer elderly
patients reconstructive surgery, dependent on their individual risk.A careful pre-operative assessment allows
selecting the appropriate candidate on the basis of fitness, particularly when long and complex reconstructive
procedures involving microvascular transfer such as DIEP or free TRAM flaps are considered. Reasons why patients
decide to decline breast reconstruction may have altered more recently with wider media coverage and information
especially on the internet. There are also real issues with availability of highly trained surgical teams capable of
performing microsurgical transfer procedures, theatre availability and constraints due the present economic
recession. Thus, there are multiple factors that influence breast reconstruction and patients, even in different parts
of a single country, may have variations in the algorithm of options offered for breast reconstruction. 2011 Elsevier
Ltd.
Background: Since 2010, five newly emerging economies collectively known as 'BRICS' (Brazil, India, Russia, China
and South Africa) have caught the imagination, and scholarly attention, of political scientists, economists and
development specialists. The prospect of a unified geopolitical bloc, consciously seeking to re-frame international
(and global) health development with a new set of ideas and values, has also, if belatedly, begun to attract the
attention of the global health community. But what influence, if any, do the BRICS wield in global health, and, if they
do wield influence, how has that influence been conceptualized and recorded in the literature?Methods: We
conducted a systematic literature review in (March-December 2012) of documents retrieved from the databases
EMBASE, PubMed/Medline, Global Health, and Google Scholar, and the websites of relevant international
organisations, research institutions and philanthropic organisations. The results were synthesised using a framework
of influence developed for the review from the political science literature.Results: Our initial search of databases and
websites yielded 887 documents. Exclusion criteria narrowed the number of documents to 71 journal articles and 23
reports. Two researchers using an agreed set of inclusion criteria independently screened the 94 documents, leaving
just 7 documents. We found just one document that provided sustained analysis of the BRICS' collective influence;
the overwhelming tendency was to describe individual BRICS countries influence. Although influence was
predominantly framed by BRICS countries' material capability, there were examples of institutional and ideational
influence - particularly from Brazil. Individual BRICS countries were primarily 'opportunity seekers' and region
mobilisers but with potential to become 'issue leaders' and region organisers.Conclusion: Though small in number,
the written output on BRICS influence in global health has increased significantly since a similar review conducted in
2010 found just one study. Whilst it may still be 'early days' for newly-emerging economies influence in global health
to have matured, we argue that there is scope to further develop the concept of influence in global health, but also
to better understand the ontology of groups of countries such as BRICS. The BRICS have made a number of important
commitments towards reforming global health, but if they are to be more than a memorable acronym they need to
start putting those collective commitments into action. Keywords BRICS, global health, influence, newly emerging
economies, Brazil, Russia, India, China, South Africa. 2013 Harmer et al.; licensee BioMed Central Ltd.
Objectives: Pedestrian injuries are a leading cause of the global death and injury burden, accounting for 65 percent
of the 1.2 million annual road deaths. The purpose of this brief literature review is to examine whether bull bars, a
rigid aftermarket accessory fitted to the front end of passenger vehicles, increase the risk of severe and fatal injuries
to vulnerable road users in the event of a collision.Methods: Applicable peer-reviewed research, review papers, and
grey literature were identified from a search of MEDLINE; the Transportation Research Board (TRB) database
composed of Transportation Research Information Services (TRIS) and International Transport Research
Documentation (TRID) databases; the Cochrane Database of Systematic Reviews; and Google Scholar. The following
search terms were used: "bull bars" OR "nudge bars" OR "sahara bars" AND "pedestrians" OR "vulnerable road
users" for 1948 to March 1, 2011. A secondary set of search terms was also included "bull bars" OR "nudge bars" OR
"sahara bars" OR "vehicle frontal protective systems" AND "pedestrians" OR "vulnerable road users" for 1948 to
March 1, 2011.Results: Neither the MEDLINE search nor the Cochrane Review search returned any relevant
literature. The TRID search returned 19 research articles, 9 of which were included. Searches using Google Scholar
returned 110 items, of which 21 were included in the present review after excluding patents and citations. Seven of
the articles from TRID were also found in the Google Scholar search, resulting in 23 unique articles being included in
this review. The studies used included 12 real-world studies, 3 computer modeling studies, and 8 laboratory testing
studies. Very few studies examined the road safety of pedal-cyclists and motorcyclists; therefore, we focused solely
on studies examining pedestrian safety.Conclusions: The literature reviewed in this study indicates that vehicles
fitted with bull bars, particularly those without deformable padding, concentrate crash forces over a smaller area of
vulnerable road users during collisions compared to vehicles not fitted with a bull bar. Rigid bull bars, such as those
made from steel or aluminum, stiffen the front end of vehicles and interfere with the vital shock absorption systems
designed in vehicle fronts. These devices therefore significantly alter the collision dynamics of vehicles, resulting in
an increased risk of pedestrian injury and mortality in crashes. This literature review shows that bull bars do indeed
increase the severity of injuries to vulnerable road users in the event of a collision and highlights the need for current
traffic safety policies to reflect the safety concerns surrounding the use of bull bars. 2012 Taylor and Francis Group,
LLC.
OBJECTIVES: Anti-venom is the only specific treatment to prevent neurological disorders, amputation and death in
snakebite envenoming, categorized as neglected tropical disease by WHO. Majority of victims are young and
economically productive. Hence, the economic impact of their disability is considerable. We reviewed the burden
and cost of snakebite envenoming: its incidence, morbidity and mortality rates, and the access to anti-venom
treatment. METHODS: The information was retrieved from 1985-2009 from MEDLINE, Google Scholar and WHO
website with search terms including "snakebite", "antivenom", "cost of antivenom" and "snakebite morbidity and
mortality". RESULTS: Snakebite as a tropical disease causes considerable morbidity and mortality worldwide with
global annual estimates for 2007 ranging from 1,200,000-5,500,000 for snakebite incidence to 42,1000-1,841,000
and 20,000- 94,000 for envenoming and deaths respectively. South Asia (121,000) has the highest number of
envenoming followed by Southeast Asia (111,000) and east-Sub-Saharan Africa (43,000). The price of anti-venom has
typically risen by 10 fold over the last 20 years. For example, the costs to Australian hospitals of CSL polyvalent and
taipan antivenoms were A$1833 and A$1577 in 2003 as compared to A$300 and A$245 in 1985, respectively. The
number of anti-venom vials increases with severity (upto 5, 10 and 20 for mild, moderate and severe cases
respectively) thereby increasing cost of treatment. Inadequate anti-venom supply further exaggerates this problem
as the current annual need amounts to 10,000,000 vials. Incidence is higher in rural areas, where incomes are
generally lower. In Nepal, out-of-pocket expenses (US$69) equal several months of income as most people have a
daily incomes of <1-2 US$, besides 15 days of working incapacity period. CONCLUSIONS: The excessive cost and
inadequate supply of anti-venom renders it inaccessible to most people in developing countries. Appropriate
measures should be taken to prevent the clinical and economic impact of this neglected disease.
Introduction: Dyslipidaemia has been recognized as a major risk factor for Cardiovascular Diseases (CVD), but its
significance in CVD in Sub-Saharan Africa (SSA) is less established. Objectives: Primaily to conduct a systematic
review of published studies to determine the prevalence of dyslipidaemia among hospitalised adult patients with
CVD in SSA. We also aimed at comparing the burden of dyslipidaemia between the various CVD types in SSA.
Methods: We searched Medline, Cochrane and Google Scholar Databases, as well as books and peerreviewed all
studies on dyslipidaemia among hospitalized adult patients with established CVD in SSA, up to May 2011. Studies
reporting data on dyslipidaemia or hypercholesterolaemia and established CVD, defined as ischemic heart disease
(IHD), heart failure (HF), stroke or chronic kidney disease (CKD) were included in the systematic review. We then
performed either random-effects or fixed-effects meta-analysis based on presence of heterogeneity as assessed with
2 tests on all the selected studies. Restricted analyses were then performed on data from studies on IHD, HF and
stroke separately. Sensitivity analysis investigating influence of single studies on overall estimates was conducted.
Publication bias was considered present when positive in 2 tests. Results: A total of 420 studies were screened, and
14 were eventually selected. When all the 14 studies with a total of 2532 persons were combined, the overall
prevalence of dyslipidaemia was 32.66% (95% confidence interval [CI] 20.95 -47.03%). The prevalence of
dyslipidaemia was higher among those with IHD (544/1165; 46.7%) than among those with stroke (79/383; 20.6%)
(Odds Ratio (OR)=3.37; 95% CI=2.57- 4.43; chi2>=80.37; p<0.0001) or HF (87/815; 10.7%) (OR=7.33; 95% CI=5.71-
9.42; chi2=284.9; p<0.0001). The prevalence was also higher among stroke patients than among those with heart
failure (OR=2.18; 95% CI=1.56 -3.03; chi2>=20.79; p<0.0001). The two studies on CKD were excluded from further
analysis because of relatively small sample sizes (total population>=99 subjects; prevalence of
dyslipidaemia>=54.55%). Conclusion: Prevalence of dyslipidaemia was high in hospitalized adult patients with
established CVD relative to the estimated prevalence in the general population in Africa. The burden in SSA was
highest in patients with IHD, followed by those with stroke and HF.
Nutrition labels are one strategy being used to combat the increasing prevalence of overweight and obesity in the
United States. The Patient Protection and Affordable Care Act of 2010 mandates that calorie labels be added to
menu boards of chain restaurants with 20 or more locations. This systematic review includes seven studies published
since the last review on the topic in 2008. Authors searched for peer-reviewed studies using PUBMED and Google
Scholar. Included studies used an experimental or quasi-experimental design comparing a calorie-labeled menu with
a no-calorie menu and were conducted in laboratories, college cafeterias, and fast food restaurants. Two of the
included studies were judged to be of good quality, and five of were judged to be of fair quality. Observational
studies conducted in cities after implementation of calorie labeling were imprecise in their measure of the isolated
effects of calorie labels. Experimental studies conducted in laboratory settings were difficult to generalize to real
world behavior. Only two of the seven studies reported a statistically significant reduction in calories purchased
among consumers using calorie-labeled menus. The current evidence suggests that calorie labeling does not have
the intended effect of decreasing calorie purchasing or consumption.
Introduction: The bar for developing new treatments for CNS disease is getting progressively higher and fewer novel
mechanisms are being discovered, validated and developed. The high costs of drug discovery necessitate early
decisions to ensure the best molecules and hypotheses are tested in expensive late stage clinical trials. The discovery
of brain imaging biomarkers that can bridge preclinical to clinical CNS drug discovery and provide a 'language of
translation' affords the opportunity to improve the objectivity of decision making. Areas covered: This review
discusses the benefits, challenges and potential issues of using a science based biomarker strategy to change the
paradigm of CNS drug development and increase success rates in the discovery of new medicines. The authors have
summarized PubMed and Google Scholar based publication searches to identify recent advances in functional,
structural and chemical brain imaging and have discussed how these techniques may be useful in defining CNS
disease state and drug effects during drug development. Expert opinion: The use of novel brain imaging biomarkers
holds the bold promise of making neuroscience drug discovery smarter by increasing the objectivity of decision
making thereby improving the probability of success of identifying useful drugs to treat CNS diseases. Functional
imaging holds the promise to: i) define pharmacodynamic markers as an index of target engagement; ii) improve
translational medicine paradigms to predict efficacy; iii) evaluate CNS efficacy and safety based on brain activation;
iv) determine brain activity drug dose-response relationships and v) provide an objective evaluation of symptom
response and disease modification. 2011 Informa UK, Ltd.
Objective: To examine if there is an increased participation in physical or sporting activities following an Olympic or
Paralympic games. Design: Overview of systematic reviews. Methods: We searched the Medline, Embase, Cochrane,
DARE, SportDISCUS and Web of Knowledge databases. In addition, we searched for 'grey literature' in Google,
Google scholar and on the International Olympic Committee websites. We restricted our search to those reviews
published in English. We used the AMSTAR tool to assess the methodological quality of those systematic reviews
included. Primary and secondary outcome measures: The primary outcome was evidence for an increased
participation in physical or sporting activities. Secondary outcomes included public perceptions of sport during and
after an Olympic games, barriers to increased sports participation and any other nonsporting health benefits.
Results: Our systematic search revealed 844 citations, of which only two matched our inclusion criteria. The quality
of these two reviews was assessed by three independent reviewers as 'good' using the AMSTAR tool for quality
appraisal. Both reviews reported little evidence of an increased uptake of sporting activity following an Olympic
Games event. Other effects on health, for example, changes in hospital admissions, suicide rates and drug use, were
cited although there was insufficient evidence to see an overall effect. Conclusion: There is a paucity of evidence to
support the notion that hosting an Olympic games leads to an increased participation in physical or sporting activities
for host countries. We also found little evidence to suggest other health benefits. We conclude that the true success
of these and future games should be evaluated by high-quality, evidence-based studies that have been
commissioned before, during and following the completion of the event. Only then can the true success and legacy
of the games be established.
Background: The Ottawa knee rule (OKR), a clinical decision aid is used to reduce unnecessary radiography. It is not
clear whether this rule can be applied to children. Objective: To establish whether the OKR had adequate sensitivity
and acceptable specificity in children to advocate widespread use. Methods: A systematic review and meta-analysis
was conducted of observational studies that examined the diagnostic characteristics of the OKR in children. Data
sources: Relevant English language articles were identified from Medline (1950 to date), EMBASE (1974 to date),
CINAHL (1982 to date), the Cochrane Library, Google Scholar and a hand search of bibliographies. Study selection:
Observational studies that included children and have used the OKR for ruling out fractures in children either
radiologically or in combination with followup. Results: Four relevant studies were identified. Three studies were
suitable for inclusion in the meta-analysis, representing 1130 children. The pooled negative likelihood ratio was 0.07
(95% CI 0.02 to 0.29), the pooled positive likelihood ratio was 1.94 (95% CI 1.60 to 2.36), the pooled sensitivity was
99% (CI 94.4 to 99.8) and the pooled specificity was 46% (CI 43.0 to 49.1). The reduction in radiography was between
30% and 40%. Conclusion: The OKR has high sensitivity and adequate specificity for children over the age of 5 years.
There are not enough good data to advocate application of the OKR in children less than 5 years.
PURPOSE: To assess the ability of anatomic double-bundle anterior cruciate ligament reconstruction in eliminating
the pivot-shift phenomenon when identified by a quantitative measuring system (computer navigation or magnetic
resonance imaging)., METHODS: Literature review. Medline, Google Scholar and Cochrane Reviews computerized
databases research using the keywords "pivot-shift," "anterior cruciate ligament reconstruction" and "double
bundle." Twelve (7 in vitro and 5 in vivo) studies met the inclusion criteria., RESULTS: There was a wide variation in
the absolute value of translation and rotation measured after anatomic double-bundle anterior cruciate ligament
reconstruction. There were also differences in fixation methods, pivot-shift execution conditions, applied stresses
during the pivot-shift, calculation methods and reference systems utilized by measurement systems., CONCLUSIONS:
The double-bundle reconstruction was shown to over-constrain the knee with respect to the intact value, especially
closer to knee extension. This review demonstrated that anatomic double-bundle anterior cruciate ligament
reconstruction is able to eliminate pathological translations and rotations during the pivot-shift phenomenon, as
identified by quantitative measurement systems., LEVEL OF EVIDENCE: Review of Level III studies, Level III.
Purpose: To assess the ability of anatomic double-bundle anterior cruciate ligament reconstruction in eliminating the
pivot-shift phenomenon when identified by a quantitative measuring system (computer navigation or magnetic
resonance imaging). Methods: Literature review. Medline, Google Scholar and Cochrane Reviews computerized
databases research using the keywords "pivot-shift," "anterior cruciate ligament reconstruction" and "double
bundle." Twelve (7 in vitro and 5 in vivo) studies met the inclusion criteria. Results: There was a wide variation in the
absolute value of translation and rotation measured after anatomic double-bundle anterior cruciate ligament
reconstruction. There were also differences in fixation methods, pivot-shift execution conditions, applied stresses
during the pivot-shift, calculation methods and reference systems utilized by measurement systems. Conclusions:
The double-bundle reconstruction was shown to over-constrain the knee with respect to the intact value, especially
closer to knee extension. This review demonstrated that anatomic double-bundle anterior cruciate ligament
reconstruction is able to eliminate pathological translations and rotations during the pivot-shift phenomenon, as
identified by quantitative measurement systems. Level of evidence: Review of Level III studies, Level III. 2012
Springer-Verlag.
Citations in peer-reviewed articles and the impact factor are generally accepted measures of scientific impact. Web
2.0 tools such as Twitter, blogs or social bookmarking tools provide the possibility to construct innovative article-level
or journal-level metrics to gauge impact and influence. However, the relationship of the these new metrics to
traditional metrics such as citations is not known. (1) To explore the feasibility of measuring social impact of and
public attention to scholarly articles by analyzing buzz in social media, (2) to explore the dynamics, content, and
timing of tweets relative to the publication of a scholarly article, and (3) to explore whether these metrics are
sensitive and specific enough to predict highly cited articles. Between July 2008 and November 2011, all tweets
containing links to articles in the Journal of Medical Internet Research (JMIR) were mined. For a subset of 1573
tweets about 55 articles published between issues 3/2009 and 2/2010, different metrics of social media impact were
calculated and compared against subsequent citation data from Scopus and Google Scholar 17 to 29 months later. A
heuristic to predict the top-cited articles in each issue through tweet metrics was validated. A total of 4208 tweets
cited 286 distinct JMIR articles. The distribution of tweets over the first 30 days after article publication followed a
power law (Zipf, Bradford, or Pareto distribution), with most tweets sent on the day when an article was published
(1458/3318, 43.94% of all tweets in a 60-day period) or on the following day (528/3318, 15.9%), followed by a rapid
decay. The Pearson correlations between tweetations and citations were moderate and statistically significant, with
correlation coefficients ranging from .42 to .72 for the log-transformed Google Scholar citations, but were less clear
for Scopus citations and rank correlations. A linear multivariate model with time and tweets as significant predictors
(P < .001) could explain 27% of the variation of citations. Highly tweeted articles were 11 times more likely to be
highly cited than less-tweeted articles (9/12 or 75% of highly tweeted article were highly cited, while only 3/43 or 7%
of less-tweeted articles were highly cited; rate ratio 0.75/0.07 = 10.75, 95% confidence interval, 3.4-33.6). Top-cited
articles can be predicted from top-tweeted articles with 93% specificity and 75% sensitivity. Tweets can predict
highly cited articles within the first 3 days of article publication. Social media activity either increases citations or
reflects the underlying qualities of the article that also predict citations, but the true use of these metrics is to
measure the distinct concept of social impact. Social impact measures based on tweets are proposed to complement
traditional citation metrics. The proposed twimpact factor may be a useful and timely metric to measure uptake of
research findings and to filter research findings resonating with the public in real time.
Tanning is socially highly valued and,like other forms of behaviour,can take on an addictive aspect. This finding is
based on the observations of many dermatologists who report an addictive relationship with tanning cabins in their
patients,despite the announcement of the diagnosis of malignant melanoma. This article attempts to synthesize the
existing literature on excessive indoor tanning and addiction to investigate possible associations. A literature review
was conducted from 1974 to 2012, using PubMed, Google Scholar, EMBASE, PsycInfo,and the following keywords
alone or combined: Tanning, Addiction, Dependence, and Sunbeds, to explore the possible relevance of the addictive
model. Excessive tanning is not present in the international classifications of Psychiatry, but may be related to
addiction. There is so far no consensus on the definition of the concept, or recommendations on the management of
this disorder. No study on psychopathology was found in the literature,although some hypotheses can be advanced.
Further studies must be performed, especially on clinical psychopathology, neurobiology and management to
improve our understanding of excessive indoor tanning.
Background: This article is a review of the literature regarding the state of oncology education for medical students
in developing countries, and possible solutions to the problems at hand. Methods: Ovid MEDLINE, PubMed, ERIC,
The Cochrane CENTRAL Register of Controlled Trials (CENTRAL) and Google Scholar were searched using the terms
oncology, undergraduate, cancer, education and teaching. Results: The search resulted in 40 relevant articles in total.
Ten articles showed that there is a lack of adequate knowledge in the scientific, clinical and psychological aspects of
oncology and palliative care amongst students and physicians in developing countries. Eight articles describe the
relevance and usefulness of summer schools, workshops and trainings. The rest of them discuss possible methods of
addressing the issue, the most important of which is the inclusion of a clinical oncology rotation in the
undergraduate syllabus. Conclusion: Graduated physicians and medical students are a long way from reaching the
standard knowledge and skills required in oncology. Thus, there is a pressing need to reform the undergraduate
medical curricula in developing countries in order to increase cancer awareness for better graduated future
physicians. 2012 Elsevier Ireland Ltd.
Objective Despite medical ad varices over the last decades, cancer is still a major cause of death worldwide. This
paper explores whether laser photobiomodulation, alone and/or combined with other therapies, may be developed
into a safe, effective treatment for various forms of cancer (solid tumors). Methods A literature search of English-
language articles in five databases (Medline, ISI Web of Knowledge, Cochrane, Google Scholar, Scirus) was conducted
using search terms relating to cancer (neoplasm, advanced cancer, palliative) in combination with
photobiomodulation and/or low-level laser therapy (LLLT) in the period from January 1990 to December 2010.
Controlled clinical trials with at least 1 year of follow up and minimum compliance of 90% were included. Clinical
studies evaluating linfaoedema, mucositis or pain were also included to illustrate post-LLLT responses to adverse
effects of chemo-radiotherapy. Uro and in studies were further considered as preliminary data for clinical trials.
Results Retrieved articles suggest that photobiomodulation can modulate anti-tumor effects and reduce adverse
effects of chemo-radiotherapy. Results are discussed giving particular attention to two mechanistic proposals with
potential anticancer applications, photo-m-frared pulsed biomodulation (PIPBM) and water oscillator (WO). Other
topics include cancer proliferation, Warburg effect, classic photobiomodulation hypothesis and ATP signaling.
Conclusion Translational research with laser photobiomodulation appears warranted.
Background Over the last 150 years, a little South American fish with alleged unsavory habits has become the stuff
legends are made of. With growing visitor numbers to the Amazon basin, the question of whether the animal poses a
threat to the many travelers to the region arises. Methods Scientific literature was identified by searching MEDLINE,
ScienceDirect, ProQuest, and Google Scholar. The reference lists of all obtained sources served to refine the search,
including the original historical writings where obtainable. Nonscientific material was discovered through extensive
web searches. Results First, the current popular understanding of the fish and its interaction with humans are
presented followed by an overview of the historical literature on which this understanding is based. Next, the fish
and its supposed attraction to humans are introduced. Finally, this review queries the evidence current medical
advice utilizes for the prevention of attacks and the treatment of unfortunate hosts. Conclusions Until evidence of
the fish's threat to humans is forthcoming, there appears to be no need for considering the candiru in health advice
for travelers to the Amazon. 2013 International Society of Travel Medicine.
BACKGROUND: Over the last 150 years, a little South American fish with alleged unsavory habits has become the
stuff legends are made of. With growing visitor numbers to the Amazon basin, the question of whether the animal
poses a threat to the many travelers to the region arises., METHODS: Scientific literature was identified by searching
MEDLINE, ScienceDirect, ProQuest, and Google Scholar. The reference lists of all obtained sources served to refine
the search, including the original historical writings where obtainable. Nonscientific material was discovered through
extensive web searches., RESULTS: First, the current popular understanding of the fish and its interaction with
humans are presented followed by an overview of the historical literature on which this understanding is based.
Next, the fish and its supposed attraction to humans are introduced. Finally, this review queries the evidence current
medical advice utilizes for the prevention of attacks and the treatment of unfortunate hosts., CONCLUSIONS: Until
evidence of the fish's threat to humans is forthcoming, there appears to be no need for considering the candiru in
health advice for travelers to the Amazon. 2013 International Society of Travel Medicine.
BACKGROUND: The association between cannabis and psychosis has long been a matter of debate, with cannabis
widely perceived as a harmless recreational drug., METHODS: Electronic bibliographic databases like PubMed and
Google Scholar were searched using the format "(psychosis or schizophrenia or synonyms) and (cannabis or
synonyms)". Cross-linked searches were made taking the lead from key articles. Recent articles and those exploring
the genetic factors or gene-environment interaction between cannabis use and psychosis were focussed upon.,
RESULTS: Heavy cannabis use at a n young age, in association with genetic liability to psychosis and exposure to
environmental stressors like childhood trauma and urban upbringing increases the risk of psychotic outcome in later
life., CONCLUSION: Cannabis acts as a component cause of psychosis, that is, it increases the risk of psychosis in
people with certain genetic or environmental vulnerabilities, though by itself, it is neither a sufficient nor a necessary
cause of psychosis. Although significant progress has been made over the last few years, we are yet to find all the
missing links. Further work is necessary to identify all the factors that underlie individual vulnerability to cannabis-
related psychosis and to elucidate the biological mechanisms underlying this risk. Copyright 2013 Elsevier B.V. All
rights reserved.
Introduction: Evidence supports teaching hands-only CPR for the initial treatment of cardiac arrest in adults. Unlike
adults, however, children and infants with cardiac arrest are more likely to have non-cardiac causes. Hypothesis: The
objective of this project was to conduct a structured literature review to answer the question, "In children and
infants with cardiac arrest treated in an out-of-hospital setting, does compression-only CPR, alone or with
supplemental oxygen, compared to CPR with rescue breathing lead to improved outcomes?" Methods: We
performed a MEDLINE search ("compression only"[Title/Abstract]) AND cardiopulmonary resuscitation[MeSH Terms]
with limits children (ages 0 -18). We also performed a search in the Cochrane database for systematic reviews, the
Central Register of Controlled Trials, and EMBASE using similar search terms. We also searched applicable
bibliographies and used the 'Cited By' function in Google Scholar. The study included papers if they evaluated the
difference between compression only CPR and CPR with rescue breathing in infants or children. Papers that reported
results from studies that used procedures that were beyond the basic life support level were excluded. Each paper
was evaluated using specific criteria to determine the level of evidence. Results: Sixty-nine records were identified
and screened. Fifty-four of these did not meet inclusion/exclusion criteria, leaving fifteen full-text articles that we
assessed for eligibility. Eleven of these did not meet inclusion/exclusion criteria, leaving four that we included in the
qualitative synthesis. Of these, one good quality study with level of evidence (LOE) 2a and 3 other studies (LOE 4) all
opposed the hypothesis. There is a relative paucity of published data on this subject. The majority of the papers
published describe evidence from animal models. Conclusions: In conclusion, rescuers should provide chest
compressions with rescue breathing to children and infants in cardiac arrest; rescuers unwilling or unable to provide
compressions with rescue breathing may provide chest compressions alone for these patients.
Objectives: A systematic review and a meta-analysis were performed to determine the association between public
smoking bans and risk for hospital admission for acute myocardial infarction (AMI). Background: Secondhand smoke
(SHS) is associated with a 30% increase in risk of AMI, which might be reduced by prohibiting smoking in work and
public places. Methods: PubMed, EMBASE, and Google Scholar databases plus bibliographies of relevant studies and
reviews were searched for peer-reviewed original articles published from January 1, 2004, through April 30, 2009,
using the search terms "smoking ban" and "heart" or "myocardial infarct." Investigators supplied additional data. All
published peer-reviewed original studies identified were included. Incidence rates of AMI per 100,000 person-years
before and after implementation of the smoking bans and incidence rate ratios (IRRs) with 95% confidence intervals
(CIs) were calculated. Random effects meta-analyses estimated the overall effect of the smoking bans. Funnel plot
and meta-regression assessed heterogeneity among studies. Results: Using 11 reports from 10 study locations, AMI
risk decreased by 17% overall (IRR: 0.83, 95% CI: 0.75 to 0.92), with the greatest effect among younger individuals
and nonsmokers. The IRR incrementally decreased 26% for each year of observation after ban implementation.
Conclusions: Smoking bans in public places and workplaces are significantly associated with a reduction in AMI
incidence, particularly if enforced over several years. 2009 American College of Cardiology Foundation.
Informal caring or caregiving is very common in our postindustrial society. Caregiving burden grows with the
worsening of cognitive impairment of the patient and is one of the factors influencing institutionalization.
Alzheimer's disease (AD) is a type of dementia that is chronic and deteriorative. The symptoms of this
neuropsychiatric disorder generally begin to manifest after the age of sixty and currently 8.9 million family caregivers
provide assistance to someone with AD or a related dementia. As the patient's condition worsens, it increases the
burden on the caregivers, due to the physical, psychological, and emotional stresses that result from caring for the
patient. A search of the literature was conducted on electronic database: PubMed, Google Scholar, Science direct,
CINAHL in a exploratory way. Inclusion criteria were: articles in English and Italian published between 1999-2011
which mentioned Alzheimer's caregivers, burden, stressors, and institutionalization. The exclusion criterion was
failure to mention the word "caregivers". About 100 titles were found and 30 articles abstracts with key words in the
title were reviewed. Of the 30 articles selected for further review based on the relevance to the study purpose, 17
articles were finally selected for inclusion in this literature review. Results display that caregiver burden is influenced
by patient behavioral and cognitive status, hours involved in care, stress, social isolation, gender, relationship to the
patient, availability of support resources, and caregiver characteristics. Assessment tools available to assess and
recognize risk factors and burden in caregivers are useful both in terms of caregivers health and decision on
istitutionalization. Literature suggests to provide information for health care providers to reduce burden and support
caregiver health and well-being. Assessment tools available to assess and recognize risk factors and burden in
caregivers should be used more often to contribute to reducing caregiver stress and the impact of
institutionalization.
The objective of this article is to review all published normative ethical and clinical guidelines concerning the genetic
carrier testing of minors. The databases Medline, Philosopher's Index, Biological Abstracts, Web of Science, and
Google Scholar were searched using keywords relating to the carrier testing of children. We also searched the
websites of the national bioethics committees indexed on the websites of WHO and the German Reference Center
for Ethics in the Life Sciences, the Human Genetics Societies of various nations indexed on the website of the
International Federation of Human Genetics Societies and related links, and the national medical associations
indexed on the website of the World Medical Association. We retrieved 14 guidelines emanating from 24 different
groups. All guidelines advanced the following preferences: (1) carrier testing should not be performed in children,
and (2) testing should be deferred until the child can give proper informed consent to be tested. The guidelines
varied in three areas: (a) the role of genetic services in ensuring that children are informed about their carrier status
and associated risks when they are older; (b) exceptions to the general rule of withholding or deferring carrier
testing; and (c) the communication of incidentally discovered carrier status. In the absence of compelling reasons,
carrier testing of a child can reasonably be deferred until the child has the intellectual capacity needed to discern if
and when to be tested. 2006 Nature Publishing Group All rights reserved.
The objective of this article is to review all published normative ethical and clinical guidelines concerning the genetic
carrier testing of minors. The databases Medline, Philosopher's Index, Biological Abstracts, Web of Science, and
Google Scholar were searched using keywords relating to the carrier testing of children. We also searched the
websites of the national bioethics committees indexed on the websites of WHO and the German Reference Center
for Ethics in the Life Sciences, the Human Genetics Societies of various nations indexed on the website of the
International Federation of Human Genetics Societies and related links, and the national medical associations
indexed on the website of the World Medical Association. We retrieved 14 guidelines emanating from 24 different
groups. All guidelines advanced the following preferences: (1) carrier testing should not be performed in children,
and (2) testing should be deferred until the child can give proper informed consent to be tested. The guidelines
varied in three areas: (a) the role of genetic services in ensuring that children are informed about their carrier status
and associated risks when they are older; (b) exceptions to the general rule of withholding or deferring carrier
testing; and (c) the communication of incidentally discovered carrier status. In the absence of compelling reasons,
carrier testing of a child can reasonably be deferred until the child has the intellectual capacity needed to discern if
and when to be tested.
Background: Beta-blockers, particularly propranol, decrease portal hypertension among cirrhotics. Carvedilol, a
nonselective betablocker with added alpha-1-blockade, potentially might have greater hypotensive effects. This
meta-analysis compares the efficacy of carvedilol vs propranolol in reduction of hepatic venous pressure gradient
(HVPG) and mean arterial pressure (MAP). Methods: Cochrane Library, Pubmed, EMBASE, Google Scholar, LILAC
databases were searched for randomized controlled trials (RCTs) published until October 2010 comparing carvedilol
and propranolol in the reduction of HVPG and MAP among cirrhotics. Two independent reviewers evaluated the
methodological criteria of each study using Jadad scale. A third reviewer settled any disputes. Mean differences of
HVPG and MAP were analyzed using Revman software. Results: Eight studies were retrieved initially but only three
RCTs were included in this analysis. Pooled data from 115 patients showed that carvedilol is superior to propranolol
in reducing HVPG (-8.36, 95% CI: -9.43 to -7.28, p<0.00001). However, reduction of MAP is significantly greater in
carvedilol than in propranolol, as well (- 8.62, 95% CI: -9.63 to -7.61, p<0.00001). Conclusions: Although carvedilol is
superior to propranolol in reducing portal hypertension, its overall hypotensive effect might preclude its use.
Furthermore, the lack of clinical endpoints that would impact survival and mortality necessitates additional studies in
the future.
Background and Objectives: Beta-blockers, particularly propranol, decrease portal hypertension among cirrhotics.
Carvedilol, a nonselective beta-blocker with added alpha-1-blockade, potentially might have greater hypotensive
effects. This meta-analysis compares the efficacy of carvedilol vs propranolol in reduction of hepatic venous pressure
gradient (HVPG) and mean arterial pressure (MAP). Methods: Cochrane Library, Pubmed, EMBASE, Google Scholar,
LILAC databases were searched for randomized controlled trials (RCTs) published until October 2010 comparing
carvedilol and propranolol in the reduction of HVPG and MAP among cirrhotics. Two independent reviewers
evaluated the methodologic criteria of each study using Jadad scale. A third reviewer settled any disputes. Mean
differences of HVPG and MAP were analyzed using Revman software. Results: Eight studies were retrieved initially
but only three RCTs were included in this analysis. Pooled data from 115 patients showed that carvedilol is superior
to propranolol in reducing HVPG (-8.36, 95% CI: -9.43 to -7.28, p < 0.00001). However, reduction of MAP is
significantly greater in carvedilol than in propranolol, as well (-8.62, 95% CI: -9.63 to -7.61, p < 0.00001). Conclusions:
Although carvedilol is superior to propranolol in reducing portal hypertension, its overall hypotensive effect might
preclude its use. Furthermore, the lack of clinical endpoints that would impact survival and mortality necessitates
further investigation.
Background: Challenging behaviors such as aggression, screaming, and apathy are often encountered when caring
for people with dementia in nursing homes. In this context, a case conference is often recommended for healthcare
professionals as an effective instrument to improve the quality of care. However, the subject case conference has
not had great consideration in scientific literature. The aim of this review is to describe the effects of case
conferences on people with dementia and challenging behavior and the staff in nursing homes. Methods: A search of
intervention studies in nursing homes in the German or English language was performed in the following databases:
Medline, Cinahl, PsycINFO, Cochrane library, Embase, and Google Scholar. The selection and the methodological
quality of the studies were assessed independently by two authors. The results were summarized and compared
based on categories such as study quality or outcomes. Results: Seven of 432 studies were included in the review. A
total of four of seven studies showed a reduction in the challenging behavior of people with dementia, and five
showed an influence on the competence, attitudes, and job satisfaction of the staff. However, due to the middle-
range quality of several studies, the methodological heterogeneity and differences in the interventions, the results
must be interpreted with caution. Conclusions: In summary, little evidence exists for the positive effects of case
conferences in the care of people with dementia. This review highlights the need for methodologically well-designed
intervention studies to provide conclusive evidence of the effects of case conferences. International Psychogeriatric
Association 2012.
Background: Over the last decade technology has rapidly changed the ability to provide home telehealth services. At
the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the
experiences of providing home telehealth services in pediatric palliative care is therefore important. Methods. A
literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were
identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each
paper was also inspected to identify any further studies. Results: There were 33 studies that met the inclusion
criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety,
substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for
telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of
home telehealth programs was limited by numerous challenges. Conclusion: Research in this area is challenging;
ethical issues and logistical factors such as recruitment and attrition because of patient death make determining
effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care
population should focus on the factors that influence acceptance of telehealth applications, including goals of care,
access to alternative modes of care, perceived need for care, and comfort with using technology. 2013 Bradford et
al; licensee BioMed Central Ltd.
Context: The practice of drug testing in the workplace has been adopted for US federal government employees, and
many state and local governments as well as private businesses have followed suit. However, a parallel industry
dedicated to subverting the results of urine drug testing has emerged with little or no regulation. Evidence
Acquisition: First, the case of a 19-year-old man who developed psychosis after the use of a detoxification kit is
presented. Second, a review of the existing literature on the techniques, risks, and regulations associated with the
use of drug tampering kits is provided. PubMed, Cochrane Database, and Google Scholar were searched using the
keywords UDS, urine toxicology, pass the drug test, and clean UA, with no restrictions on publication date. Case
reports, letters to the editor, and original research and review articles in multiple languages were reviewed, as were
federal regulations and acts on the topic. The search yielded 4,082 results, of which 49 articles were selected for
relevance. Some articles were later omitted as they had cited the original article and had nothing new to offer.
Results: Three commonly used tampering techniques are in vivo adulteration, urine substitution, and in vitro
adulteration. Review of the literature regarding the risks involved with use of tampering kits yielded no results. In
1986, an executive order was issued requiring all federal employees to refrain from illicit drug use, and the 1988
Drug-Free Workplace Act precipitated the Substance Abuse and Mental Health Services Administration guidelines
and their subsequent revisions. Recently, many states have made regulatory efforts to bring drug test defrauding
under the ambit of law. Conclusions: Clinicians need to be aware of the tampering techniques and the possibility of
false-negative urine drug tests. Cognizance of inherent risks involved with using these techniques including
psychiatric and/or medical complications is also warranted. The manufacture, sale, and use of these products have
little or no regulation by state or federal authorities, making them potentially dangerous and imposing new
challenges in testing for abused drugs. The extent of use of these products and techniques is not known at this time
and is an area that warrants further research. 2011 Physicians Postgraduate Press, Inc.
Objective: Subepidermal bullous lesions and toxic epidermal necrolysis-like (TEN-like) lesions can occur in patients
with systemic lupus erythematosus (SLE). In this report, we describe a case of a patient previously diagnosed with
SLE who experienced TEN-like skin lesions with unusual subacute progression in the context of the current literature.
Methods: We present a recent case of TEN-like lupus erythematosus and review of studies published in English
identifying SLE cases mimicking TEN, accessed via PubMed and Google Scholar databases. The keywords used in the
search were: TEN, SLE, TEN-like SLE, and TEN-like lesions. The search covered all articles from January 1980 to
November 2011. Results: A 52-year-old male presented with fatigue, weakness, and weight loss (23 kg in two
months). Skin redness started across nose and cheeks six months before admission. Bilateral pleural effusions were
observed in a thorax tomography taken in the referral hospital two months prior to admission. Because of articular
involvement, antinuclear antibody (ANA), and anti-dsDNA positivity, the patient was diagnosed with SLE. We initiated
a punch skin biopsy, and the findings were consistent with Stevens-Johnson syndrome. There was marked basal layer
necrosis in the epidermis, and there was predominantly lymphohistiocytic infiltrate in the dermis. A total of 22 cases,
including our case, with TEN-like lupus erythematosus were reported in the literature. In addition, cutaneous lupus
had positive ANAs in 18 of 22 patients (81.8%). The patients were aged 12 to 76 years; 21 cases were women and
only one patient was male. Discussion: Skin involvement, including the rare variant of TEN-like acute cutaneous SLE,
is very common among SLE patients. The acute syndrome of pan-epidermolysis or apoptotic pan-epidermolysis may
become a useful designation when considering a clinical diagnosis of drug-induced TEN or SLE. Further studies are
required to verify our findings. The Author(s), 2013. Reprints and permissions.
Descriptive case report of a 42-year old woman with coetaneous vasculitis, and severe abdominal pain, which was
led to diagnostic laparotomy. These presentations are probably as a side effect of Methocarbamol injection. This is
the first report according to our literature search (PubMed, google scholar, ISI web of knowledge, ProQuest, MD
consult, Science Direct, SCOPUS) about Methocarbamol related vasculitis from 1966 since now. Vasculitis is not a
known side effect of Methocarbamol. This case indicates, likely the potential for development of vasculitis with this
medication. 2011 Tehran University of Medical Sciences. All rights reserved.
OBJECTIVE: To review the pathogenesis as well as the clinical and laboratory features of catecholamine-induced
cardiomyopathy associated with pheochromocytoma and other disorders and discuss the various treatment options
available. METHODS: Materials used for this article were identified through MEDLINE, PubMed, and Google Scholar
searches of the relevant literature from 1955 to the present. RESULTS: Catecholamines and their oxidation products
cause a direct toxic effect on the myocardium. Catecholamines also exert a receptor-mediated effect on the
myocardium. Catecholamine-mediated myocardial stunning has been implicated in the pathogenesis of stress-
induced cardiomyopathy. Biopsy of the myocardium in patients with pheochromocytoma or those with stress-
induced cardiomyopathy shows similar pathologic findings. The clinical features in pheochromocytoma-related
cardiomyopathy include hypertension, dilated or hypertrophic cardiomyopathy, pulmonary edema due to
cardiogenic and noncardiogenic factors, cardiac arrhythmias, and even cardiac arrest. Stress-related cardiomyopathy
such as takotsubo cardiomyopathy occurs primarily in postmenopausal women. These patients may present with
clinical features suggestive of an acute myocardial infarction or a hemodynamically compromised state. The
definitive management of cardiomyopathy associated with pheochromocytoma includes medical treatment with
alpha-adrenergic blockade, possibly along with angiotensin converting enzyme blockers and beta1-adrenergic
receptor blockers, followed by excision of the tumor. Stress-induced cardiomyopathy is usually self-limiting; patients
may require support with nonadrenergic inotropes. CONCLUSION: Recognition of catecholamine-induced
cardiomyopathy, especially in patients with pheochromocytoma, before surgical treatment is important to minimize
morbidity and mortality.
Objective: To review the pathogenesis as well as the clinical and laboratory features of catecholamine-induced
cardiomyopathy associated with pheochromocytoma and other disorders and discuss the various treatment options
available. Methods: Materials used for this article were identified through MEDLINE, PubMed, and Google Scholar
searches of the relevant literature from 1955 to the present. Results: Catecholamines and their oxidation products
cause a direct toxic effect on the myocardium. Catecholamines also exert a receptor-mediated effect on the
myocardium. Catecholamine-mediated myocardial stunning has been implicated in the pathogenesis of stress-
induced cardiomyopathy. Biopsy of the myocardium in patients with pheochromocytoma or those with stress-
induced cardiomyopathy shows similar pathologic findings. The clinical features in pheochromocytoma-related
cardiomyopathy include hypertension, dilated or hypertrophic cardiomyopathy, pulmonary edema due to
cardiogenic and noncardiogenic factors, cardiac arrhythmias, and even cardiac arrest. Stress-related cardiomyopathy
such as takotsubo cardiomyopathy occurs primarily in postmenopausal women. These patients may present with
clinical features suggestive of an acute myocardial infarction or a hemodynamically compromised state. The
definitive management of cardiomyopathy associated with pheochromocytoma includes medical treatment with
alpha-adrenergic blockade, possibly along with angiotensin-converting enzyme blockers and beta1-adrenergic
receptor blockers, followed by excision of the tumor. Stress-induced cardiomyopathy is usually self-limiting; patients
may require support with nonadrenergic inotropes. Conclusion: Recognition of catecholamine-induced
cardiomyopathy, especially in patients with pheochromocytoma, before surgical treatment is important to minimize
morbidity and mortality. 2008 AACE.
Objective To understand the causes of child deaths in order to implement appropriate child survival interventions in
the country. We present a systematic review of studies reporting causes of child, infant, and neonatal deaths from
India for 1985 to 2008. Methods PubMed, EMBASE, Google Scholar, and WHO regional databases were searched
along with a hand search and personal communication with researchers in child health to obtain studies and reports
for the database. Study data was summarized and analyzed using appropriate statistical tools. Results We identified
28 published/unpublished studies and reports (6 multi-centric and 22 single sites). There was one nation wide study
and rest were from 15 unique sites in 9 different states of India. There were differences in study design and cause of
death assignment methods between the studies, which made comparisons and synthesis difficult. The median
percentage of causes of deaths in neonatal period were sepsis/pneumonia: 24.9% (Q1: 19.6% and Q3: 33.4%);
asphyxia: 18.5% (Q1: 14.2% and Q3: 21.9%); and pre-maturity/LBW: 16.8% (Q1: 12.5% and Q3: 26.5%). Amongst the
infants, sepsis/pneumonia, asphyxia, and prematurity/low birth weight (LBW) remain substantial causes of deaths.
The median proportional contribution of neonatal deaths to total infant deaths was 48.5% (Q1: 36.5- Q3: 57.5%). The
proportion of deaths due to infectious diseases like diarrhoea, pneumonia, and measles seem to be greater in
infancy, in comparison to that in neonatal period. There was no statistically significant difference in the proportional
contribution of neonatal deaths to total deaths occurring during infancy (<1 year) between the two equal periods
before and after 1996 (p=0.141). There also was no difference in the proportional contribution by cause of death
assignment method (Verbal autopsy vs. other methods; p=0.715) or by study setting (urban vs. rural; p= 0.175). The
median percentage of neonatal deaths by day 1 is 36.7% (Range: 20.0-58.0%). The median cumulative percentage of
neonatal deaths by day 3 was 49.7% (Range 35.0-64.6%), and 70.9% (Range: 46.5-92.3%) by day 7. In addition, the
timing of deaths during neonatal period seems to be static during the last 2 decades, with majority of deaths
occurring during first week of life. Conclusions This review demonstrates the need for more studies with consistent
methodological rigor investigating the causes of child death in India. We conclude that the structure of neonatal
causes of death in India may be different from the rest of the world and that interventions to reduce neonatal deaths
in first week of life may rapidly improve child survival in the country. Dr. K C Chaudhuri Foundation 2010.
Background: Ceftaroline is a cephalosporin with expanded gram-positive activity recently approved for clinical uses
by the US Food and Drug Administration. Objective: This article provides an overview of the in vitro and in vivo
activities, mechanism of action, pharmacologic and pharmacokinetic properties, clinical efficacy, and tolerability of
ceftaroline. Methods: Relevant information was identified through a search of PubMed (1990-April 2011), EMBASE
(1990-April 2011), International Pharmaceutical Abstracts (1970-April 2011), and Google Scholar using the key words
. ceftaroline, PPI-0903, PPI-0903M, T-91825, and . TAK-599. A review of the reference lists of identified articles, a
search of the US Food and Drug Administration Web site, and posters and abstracts from scientific meetings yielded
additional publications. Results: In vitro, ceftaroline exhibits activity against most aerobic gram-positive isolates,
common aerobic gram-negative respiratory pathogens, and some gram-positive anaerobes. The MIC range for most .
Staphylococcus aureus isolates, including vancomycin-resistant strains was between <=0.008 and 4 mug/mL. In
Phase III studies (CANVAS 1 and CANVAS 2), ceftaroline was found to be noninferior to vancomycin + aztreonam for
the treatment of complicated skin and skin-structure infections, with a clinical cure rate of 91.6% among clinically
evaluable patients (ceftaroline versus vancomycin + aztreonam: difference, -1.1; 95% CI, -4.2 to 2.0; . P = NS).
Ceftaroline's efficacy has also been assessed for the treatment of community-acquired pneumonia in 2 Phase III
studies (FOCUS 1 and FOCUS 2) and was equivalent to ceftriaxone, with cure rates of 84.3% and 77.7%, respectively,
among clinically evaluable patients in the combined analysis (ceftaroline versus ceftriaxone: difference, 6.7; 95% CI,
1.6 to 11.8). The recommended dosage for patients 18 years and older is 600 mg IV every 12 hours. Dosage
adjustment is necessary in patients with renal impairment (creatinine clearance <=50 mL/min). The pharmacokinetic
properties of ceftaroline in patients with hepatic impairments are currently unavailable. Ceftaroline appeared to be
well tolerated generally. The most frequently (>3%) reported adverse events were nausea, headaches, diarrhea,
pruritus, rash, and insomnia; all were usually mild to moderate, self-limiting, and of little clinical significance.
Conclusions: Ceftaroline is a cephalosporin with broad gram-positive activity, including Methicillin-resistant . S aureus
and vancomycin-resistant . S aureus. Its gram-negative activity includes common respiratory pathogens and
members of the Enterobacteriaceae. Clinical trials have reported that ceftaroline was noninferior to ceftriaxone, and
vancomycin + aztreonam for the treatment of community-acquired pneumonia and complicated skin and skin-
structure infections, respectively. 2012.
The safety of cell salvage in obstetrics has been questioned because of the presumed risk of precipitating amniotic
fluid embolism and, to a lesser extent, maternal alloimmunisation. For these reasons, experience in this field is
limited and has lagged far behind that in other surgical specialties. There has, however, been renewed interest in its
use over recent years, mainly as a result of problems associated with allogeneic blood transfusion. Our aim was to
review the medical literature to ascertain the principles of cell salvage, the ability of the process to remove
contaminants, and its safety profile in the obstetric setting. The search engines PubMed and Google Scholar were
used and relevant articles and websites hand searched for further references. Existing cell salvage systems differ in
their ability to clear contaminants and all require the addition of a leucocyte depletion filter. Although large
prospective trials of cell salvage with autotransfusion in obstetrics are lacking, to date, no single serious complication
leading to poor maternal outcome has been directly attributed to its use. Cell salvage in obstetrics has been
endorsed by several bodies based on current evidence. Current evidence supports the use of cell salvage in
obstetrics, which is likely to become increasingly commonplace, but more data are required concerning its clinical
use. 2007 Elsevier Ltd. All rights reserved.
This paper covers the studies relevant to neuroprotective activity of Centella asiatica (L.) Urban, also known as Gotu
Kola. The plant is native to the Southeast Asia and has been used traditionally as brain tonic in ayurvedic medicine.
The neuroprotective effect of C. asiatica has been searched using the key words Centella, Centella asiatica, gotu kola,
Asiatic pennywort, neuroprotection, and memory through the electronic databases including Sciencedirect, Web of
Science, Scopus, Pubmed, and Google Scholar. According to the literature survey, C. asiatica (gotu kola) has been
reported to have a comprehensive neuroprotection by different modes of action such as enzyme inhibition,
prevention of amyloid plaque formation in Alzheimer's disease, dopamine neurotoxicity in Parkinson's disease, and
decreasing oxidative stress. Therefore, C. asiatica could be suggested to be a desired phytopharmaceutical with
neuroprotective effect emerged from traditional medicine. Copyright 2012 Ilkay Erdogan Orhan.
Chronic musculoskeletal conditions are increasingly conceived as involving altered central nervous system
processing, and impaired nociceptive flexor reflex (NFR) appears to reflect altered central nervous system
processing. The primary objective was to synthesize the evidence for impaired NFR in these conditions. The
secondary objective was to evaluate the NFR stimuli parameters employed by reviewed studies. Electronic
databases: MEDLINE, CINAHL, Embase, PEDro, Google Scholar, and Cochrane library were searched from the mid-
1960s to June 2010. Experimental reports were systematically reviewed and meta-analysis (where possible) was
performed. NFR thresholds and parameters of NFR stimuli were extracted. Sixteen trials were identified, 11 of which
were suitable for inclusion in the meta-analysis. Compared to healthy controls, standardized mean differences in NFR
threshold were significantly lower in subjects with primary headache (-0.45; 95% confidence interval [CI] -0.77 to -
0.13, P = 0.005), fibromyalgia (-0.63; 95% CI -0.93 to -0.34, P < 0.0001), knee pain (-1.51; 95% CI -2.10 to -0.93, P <
0.00001) and whiplash (-0.73; 95% CI -1.11 to -0.35, P = 0.0002). Employed stimuli parameters vary between studies,
with inter-pulse duration (P = 0.044) being identified by multiple regression analysis as independent predictors of the
variability in NFR threshold in healthy controls. The results indicate that there is evidence of central hyperexcitability
in people with chronic musculoskeletal pain. Our review also suggests that shorter inter-pulse duration tends to yield
smaller variability in NFR threshold. However, further research investigating optimal stimulation parameters is still
warranted. Systematic analysis shows that despite variation in measurement parameters, nociceptive flexor reflex is
impaired in chronic musculoskeletal conditions, inferring involvement of spinal cord hyperexcitability. 2011
International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
BACKGROUND: Central venous access (CVA) is widely used. However, its thrombotic, stenotic and infectious
complications can be life-threatening and involve high-cost therapy. Research revealed that the risk of catheter-
related complications varied according to the site of CVA. It would be helpful to find the preferred site of insertion to
minimize the risk of catheter-related complications. This review was originally published in 2007 and was updated in
2011., OBJECTIVES: 1. Our primary objective was to establish whether the jugular, subclavian or femoral CVA routes
resulted in a lower incidence of venous thrombosis, venous stenosis or infections related to CVA devices in adult
patients.2. Our secondary objective was to assess whether the jugular, subclavian or femoral CVA routes influenced
the incidence of catheter-related mechanical complications in adult patients; and the reasons why patients left the
studies early., SEARCH METHODS: We searched CENTRAL (The Cochrane Library 2011, Issue 9), MEDLINE, CINAHL,
EMBASE (from inception to September 2011), four Chinese databases (CBM, WANFANG DATA, CAJD, VIP Database)
(from inception to November 2011), Google Scholar and bibliographies of published reviews. The original search was
performed in December 2006. We also contacted researchers in the field. There were no language restrictions.,
SELECTION CRITERIA: We included randomized controlled trials comparing central venous catheter insertion routes.,
DATA COLLECTION AND ANALYSIS: Three authors assessed potentially relevant studies independently. We resolved
disagreements by discussion. Dichotomous data on catheter-related complications were analysed. We calculated
relative risks (RR) and their 95% confidence intervals (CI) based on a random-effects model., MAIN RESULTS: We
identified 5854 citations from the initial search strategy; 28 references were then identified as potentially relevant.
Of these, we Included four studies with data from 1513 participants. We undertook a priori subgroup analysis
according to the duration of catheterization, short-term ( one month) defined according to the Food and Drug
Administration (FDA).No randomized controlled trial (RCT) was found comparing all three CVA routes and reporting
the complications of venous stenosis.Regarding internal jugular versus subclavian CVA routes, the evidence was
moderate and applicable for long-term catheterization in cancer patients. Subclavian and internal jugular CVA routes
had similar risks for catheter-related complications. Regarding femoral versus subclavian CVA routes, the evidence
was high and applicable for short-term catheterization in critically ill patients. Subclavian CVA routes were preferable
to femoral CVA routes in short-term catheterization because femoral CVA routes were associated with higher risks of
catheter colonization (14.18% or 19/134 versus 2.21% or 3/136) (n = 270, one RCT, RR 6.43, 95% CI 1.95 to 21.21)
and thrombotic complications (21.55% or 25/116 versus 1.87% or 2/107) (n = 223, one RCT, RR 11.53, 95% CI 2.80 to
47.52) than with subclavian CVA routes. Regarding femoral versus internal jugular routes, the evidence was
Central venous access (CVA) is widely used. However, its thrombotic, stenotic and infectious complications can be
life-threatening and involve high-cost therapy. Research revealed that the risk of catheter-related complications
varied according to the site of CVA. It would be helpful to find the preferred site of insertion to minimize the risk of
catheter-related complications. This review was originally published in 2007 and was updated in 2011. 1. Our primary
objective was to establish whether the jugular, subclavian or femoral CVA routes resulted in a lower incidence of
venous thrombosis, venous stenosis or infections related to CVA devices in adult patients.2. Our secondary objective
was to assess whether the jugular, subclavian or femoral CVA routes influenced the incidence of catheter-related
mechanical complications in adult patients; and the reasons why patients left the studies early. We searched
CENTRAL (The Cochrane Library 2011, Issue 9), MEDLINE, CINAHL, EMBASE (from inception to September 2011), four
Chinese databases (CBM, WANFANG DATA, CAJD, VIP Database) (from inception to November 2011), Google Scholar
and bibliographies of published reviews. The original search was performed in December 2006. We also contacted
researchers in the field. There were no language restrictions. We included randomized controlled trials comparing
central venous catheter insertion routes. Three authors assessed potentially relevant studies independently. We
resolved disagreements by discussion. Dichotomous data on catheter-related complications were analysed. We
calculated relative risks (RR) and their 95% confidence intervals (CI) based on a random-effects model. We identified
5854 citations from the initial search strategy; 28 references were then identified as potentially relevant. Of these,
we Included four studies with data from 1513 participants. We undertook a priori subgroup analysis according to the
duration of catheterization, short-term ( one month) defined according to the Food and Drug Administration
(FDA).No randomized controlled trial (RCT) was found comparing all three CVA routes and reporting the
complications of venous stenosis.Regarding internal jugular versus subclavian CVA routes, the evidence was
moderate and applicable for long-term catheterization in cancer patients. Subclavian and internal jugular CVA routes
had similar risks for catheter-related complications. Regarding femoral versus subclavian CVA routes, the evidence
was high and applicable for short-term catheterization in critically ill patients. Subclavian CVA routes were preferable
to femoral CVA routes in short-term catheterization because femoral CVA routes were associated with higher risks of
catheter colonization (14.18% or 19/134 versus 2.21% or 3/136) (n = 270, one RCT, RR 6.43, 95% CI 1.95 to 21.21)
and thrombotic complications (21.55% or 25/116 versus 1.87% or 2/107) (n = 223, one RCT, RR 11.53, 95% CI 2.80 to
47.52) than with subclavian CVA routes. Regarding femoral versus internal jugular routes, the evidence was
moderate and applicable for short-term haemodialysis catheterization in critically ill patients. No significant
Objective: Hypercoagulable state in patients with b-thalassemia could result in thromboembolic events in several
organs including the brain involvement which deserves particular attention. In this study, we summarized the
incidence of cerebral involvement in patients with b-thalassemia worldwide. Methods: We conducted an electronic
search on PUBMED (MEDLINE), SCOPUS, and Google Scholar databases through January 2011. Finally 24 relevant
articles were included in this systematic review. Data were abstracted independently by two investigators. Results: A
total of 11 791 thalassemic patients were investigated from 1972 to 2010. Overall 152 thalassemic patients with
cerebral throm-boembolic (TE) events and a proportion of 1.13% (134 of 11 770 patients) were recorded. From all
patients with cerebral TE events, 74 (48%) were splenectomized. Cerebral TE events were reported after transfusion
in six b-thalassemia major (bTM), and two bTI patients. Three bTM patients had irregular transfusion and 22 bTI
patients were not transfused. Thrombocytosis were determined in 11 bTM, 15 bTI patients. Cardiomyopathy was
present in 13 bTM and four bTI patients. Nine patients with bTM had diabetes. Conclusions: The brain involvement
appears to be associated with increasing age, transfusion naivety, splenectomy, thrombocytosis, intensive
transfusion, decreased protein C level, and having risk factors for cerebrovascular accident such as cardiomyopathy,
and diabe-tes.In light of these findings, diagnostic magnetic resonance imaging is recommended in high-risk groups
to screen for early asymptomatic brain damage.If brain ischemia is found, the administration of anti-platelet
aggregants or blood transfusion is likely to be beneficial. In addition, in thalassemic patients who complicated with a
TE event, secondary prophylaxis could be helpful to prevent cerebral events. The therapeutic implications of these
findings have still to be investigated.
A hypercoagulable state has been documented in patients with beta-thalassemia. It could result in thromboembolic
events in several organs including brain involvement, which deserves particular attention. We summarized the
prevalence of cerebral involvement in patients with beta-thalassemia worldwide. We conducted an electronic search
on PUBMED (MEDLINE), SCOPUS, and Google Scholar databases up to January 2011. Overall 152 thalassemic patients
with cerebral thromboembolic events and a proportion of 1.13% (134 of 11770) were recorded. From all patients
with cerebral thromboembolic events, 74 (48%) were splenectomized. Cerebral thromboembolic events were
reported after transfusion in six beta-thalassemia major, and two beta-thalassemia intermedia patients. Three beta-
thalassemia major patients had irregular transfusion and 22 beta-thalassemia intermedia patients were not
transfused. Thrombocytosis were determined in 11 beta-thalassemia major, and 15 beta-thalassemia intermedia
patients. Cardiomyopathy was present in 13 beta-thalassemia major and four beta-thalassemia intermedia patients.
Also, nine beta-thalassemia major patients had diabetes. Activated protein C resistant, decreased protein C or
protein S or plasminogen level was detected in eight beta-thalassemia major patients. Cerebral involvement appears
to be associated with increasing age, transfusion naivety, splenectomy, thrombocytosis, intensive transfusion,
decreased protein C level, and having risk factors for cerebrovascular accident such as cardiomyopathy, and
diabetes. In light of these findings, diagnostic MRI is recommended in high-risk groups to screen for early
asymptomatic brain damage. If brain ischemia is found, the administration of antiplatelet aggregants or blood
transfusion is likely to be beneficial. In addition, in thalassemic patients who complicated with a thromboembolic
event, secondary prophylaxis could be helpful to prevent cerebral thromboembolic events. 2012 Wolters Kluwer
Health | Lippincott Williams & Wilkins.
A hypercoagulable state has been documented in patients with -thalassemia. It could result in thromboembolic
events in several organs including brain involvement, which deserves particular attention. We summarized the
prevalence of cerebral involvement in patients with -thalassemia worldwide. We conducted an electronic search on
PUBMED (MEDLINE), SCOPUS, and Google Scholar databases up to January 2011. Overall 152 thalassemic patients
with cerebral thromboembolic events and a proportion of 1.13% (134 of 11770) were recorded. From all patients
with cerebral thromboembolic events, 74 (48%) were splenectomized. Cerebral thromboembolic events were
reported after transfusion in six -thalassemia major, and two -thalassemia intermedia patients. Three -thalassemia
major patients had irregular transfusion and 22 -thalassemia intermedia patients were not transfused.
Thrombocytosis were determined in 11 -thalassemia major, and 15 -thalassemia intermedia patients.
Cardiomyopathy was present in 13 -thalassemia major and four -thalassemia intermedia patients. Also, nine -
thalassemia major patients had diabetes. Activated protein C resistant, decreased protein C or protein S or
plasminogen level was detected in eight -thalassemia major patients. Cerebral involvement appears to be associated
with increasing age, transfusion naivety, splenectomy, thrombocytosis, intensive transfusion, decreased protein C
level, and having risk factors for cerebrovascular accident such as cardiomyopathy, and diabetes. In light of these
findings, diagnostic MRI is recommended in high-risk groups to screen for early asymptomatic brain damage. If brain
ischemia is found, the administration of antiplatelet aggregants or blood transfusion is likely to be beneficial. In
addition, in thalassemic patients who complicated with a thromboembolic event, secondary prophylaxis could be
helpful to prevent cerebral thromboembolic events.
Introduction Cervical disc arthroplasty and anterior cervical discectomy and fusion are nowadays considered as the
main surgical alternatives for the treatment of cervical disc herniation. The aim of this systematic review is to
evaluate which surgical procedure between these two gives better clinical and radiological results, and has lower
failure rates and surgical-related complications. Materials and methods A research in literature has been led using
PubMed, Cochrane and Google Scholar, setting as endpoint the 25th of February and inserting the following
keywords: Cervical spine arthroplasty, cervical spine replacement, cervical disc prosthesis versus anterior cervical
discectomy and fusion. We identified 56 articles published in indexed peer reviewed journals; among these we
included in this systematic review only I and II level evidence studies. Results We identified 13 clinical studies,
including about 3,000 patients, with a mean age of 44 years. Several kind of implants and surgical techniques of
segmental fusion have been employed to treat cervical disc herniation. We obtained good clinical results comparing
clinical scores, ROM and radiographic evaluations before and after surgery, despite in some studies we noticed
several differences considering failure rates, relapse and quality life index of patients. Conclusions Given the
relatively short follow-up time, the results of the two different techniques should be evaluated comprehending
studies with a longer follow-up (>36 months), in order to establish statistically significant differences and the primacy
of one of the two techniques in the treatment of patients affected by cervical disc herniation.
Cervical necrotizing fasciitis (CNF) can develop from odontogenic infections that spread to the deep fascial planes of
the neck. This polymicrobial infection is rapidly progressive, destructive, and often fatal. Prompt diagnosis,
recognition of acuity, aggressive, repeated surgical treatment, and medical management contribute to improved
survival. Nevertheless, the progression of the disease to descending mediastinitis and septic shock leads to a poor
prognosis and decreased survival. A comprehensive review of the current data regarding CNF was conducted using
MEDLINE, PubMed, Scopus, and Google Scholar. The diagnostic elements, comorbid conditions, treatment
modalities, complications, and survival rates were analyzed. CNF has a reported mortality rate of 7% to 20%,
depending on the extent of neck involvement. When the disease progresses into the thorax, such as in the subset of
patients with CNF complicated by descending necrotizing mediastinitis (DNM) of odontogenic origin, the mortality
rate increases to 41%. This is greater than the reported mortality rate of 22% for DNM in cardiothoracic studies.
When DNM is present, the risk of developing septic shock appears to be much greater, 22% versus 7%. In the
presence of CNF, DNM, and sepsis, the mortality rate increases to 64%. Those who survive CNF complicated by DNM
and sepsis have truly beaten the odds. CNF is an uncommon, but potentially fatal, condition that oral and
maxillofacial surgeons might be called on to manage emergently. Treatment includes surgery and medical intensive
care. Surgeons offer the best odds of patient survival by following these basic principles: airway security, early
aggressive incision and drainage plus debridement with thoracotomy, as needed, close surveillance with computed
tomography, and a low threshold for retreatment. In immunocompromised patients, even greater vigilance is
required. Antibiotic therapy should be adjusted as cultures and sensitivities become available. Advances in
interventional radiology might lead to improved survival by allowing guided minimally invasive drainage in critically ill
patients who cannot tolerate additional surgical insult. Despite the technologic advances in diagnosis and treatment,
CNF complicated by DNM mediastinitis and sepsis still results in astoundingly high mortality. 2012 American
Association of Oral and Maxillofacial Surgeons.
Continued innovation in surgery requires a knowledge and understanding of historical advances with a recognition of
successes and failures. To identify these successes and failures, we selectively reviewed historical literature on
cervical spine surgery with respect to the development of (1) surgical approaches, (2) management of degenerative
disc disease, and (3) methods to treat segmental instability. We performed a nonsystematic review using the
keywords "cervical spine surgery" and "history" and "instrumentation" and "fusion" in combination with "anterior
approach" and "posterior approach," with no limit regarding the year of publication. Used databases were PubMed
and Google Scholar. In addition, the search was extended by screening the reference list of all articles. Innovative
surgical approaches allowed direct access to symptomatic areas of the cervical spine. Over the years, we observed a
trend from posterior to anterior surgical techniques. Management of the degenerative spine has evolved from
decompressive surgery alone to the direct removal of the cause of neural impingement. Internal fixation of actual or
potential spinal instability and the associated instrumentation have continuously evolved to allow more reliable
fusion. More recently, surgeons have developed the basis for nonfusion surgical techniques and implants. The most
important advances appear to be (1) recognition of the need to directly address the causes of symptoms, (2) proper
decompression of neural structures, and (3) more reliable fusion of unstable symptomatic segments.
Scientific journals are still the most important media for dissemination of scientific information. Nowadays, on the
one side publishers and on the other side researchers are faced with variety of challenges. The scientific journals are
concerned with dissemination of correct results, on right time to right people. On the other hand, they undertake to
observe ethic and rules of publication. The researchers are concerned with publication of their results in a valuable
journal with high rank. It is important for every scientist to publish articles in the scientific journals in order to get
recognition for his/her work, earn his/her academic promotion, attract new funds for new research, and maximize
effects on present and future research. The aim of this study was to express challenges of author and publisher in
scientific journals. This study was unsystematic-review study. The literature was searched on evaluate the
"challenges of author and publisher in scientific journals "with the help of library, books, conference proceedings,
data bank, and also searches engines available at Google, Google scholar. For our searches, we employed the
following keywords and their combinations: challenge, author, publisher, fraud, plagiarism in the searching areas of
title, keywords, abstract, and full text. In this study, more than 100 articles and reports were collected and 16 of
them were selected based on their relevancy.
The purpose of this article is to review the effects of chronic mild dehydration and fluid consumption on specific
health outcomes including obesity. The electronic databases PubMed and Google Scholar were searched for relevant
literature published from the time of their inception to 2011, with results restricted to studies performed on human
subjects and reports in the English language. Key words included the following: dehydration, hypohydration, water
intake, fluid intake, disease, and the names of specific disease states. Strength of evidence categories were described
for 1) medical conditions associated with chronic dehydration or low daily water intake, and 2) randomized-
controlled trials regarding the effects of increased water consumption on caloric intake, weight gain, and satiety. This
process determined that urolithiasis is the only disorder that has been consistently associated (i.e., 11 of 13
publications) with chronic low daily water intake. Regarding obesity and type 2 diabetes, evidence suggests that
increased water intake may reduce caloric intake for some individuals. Recommendations for future investigations
include measuring total fluid intake (water+beverages+water in solid food), conducting randomized-controlled
experiments, identifying novel hydration biomarkers, and delineating hydration categories. 2012 International Life
Sciences Institute.
OBJECTIVE: To review the challenges of warfarin education for older patients (aged 65 years or older) in terms of
knowledge, access to warfarin education, and education resources., METHODS: A quasi-systematic review of the
literature was performed via electronic database searches (eg, Medline, Embase, Cumulative Index to Nursing and
Allied Health Literature, International Pharmaceutical Abstracts, Meditext, and Google Scholar) from 1990 to May
2011., RESULTS: The 62 articles reviewed found that improved patient knowledge results in better anticoagulation
control. The review also found that between 50% and 80% of older patients have inadequate knowledge about the
basic aspects of warfarin therapy (eg, action, benefits and risks, interactions with other drugs or foods, international
normalized ratio management). Demographic factors, such as advancing age, lower family income, and limited health
literacy, were found to inversely affect patients' warfarin knowledge, and access to warfarin education and
information resources were often suboptimal in different practice settings. Finally, a number of educational
strategies and resources that could be readily incorporated to improve the effectiveness of current warfarin
education programs were extracted from the review., CONCLUSION: This comprehensive review highlights that
education about warfarin in older patients is currently suboptimal and may in part contribute to poor therapeutic
outcomes. This review article also acknowledges the need to identify, target, and develop educational strategies and
resources to further improve older patients' knowledge about their warfarin therapy.
Background: Healthcare systems throughout the world are under increasing pressure to control and minimise costs.
The substitution of initially-prescribed drugs with cheaper equivalents is an obvious option which presents a rapid
and visible means to reduce these costs. Whether the substitution improves patient and/or population outcomes
must be appraised and this paper highlights the conditions under which therapeutic substitution may require
additional thought and consideration. Scope: In this paper, some of the medical evidence and the regulatory
environment for and against the three types of therapeutic substitution generic, within-class and between-class are
discussed. This article is not an exhaustive review of the literature, but captures some of the key clinical,
pharmacological, economic, policy and ethical issues regarding generic and therapeutic substitution. Search criteria
of the most commonly used terms, i.e. therapeutic substitution, switching, interchange, and bioequivalence, were
applied to Embase, PubMed and Google Scholar to identify relevant publications. Findings: Although population
studies support therapeutic substitution in principle, there is evidence that substitution may not always result in
therapeutic equivalence in individual patients, with the consequent potential for greater risks of decreased efficacy
and/or increased safety concerns. Factors such as patient choice and therapeutic equivalence also play an important
role in the effectiveness of the treatment and overall management of the patient. The pan-European regulatory
environment provides another contradiction, encouraging widespread cost containment through reduction in drug
acquisition costs, while simultaneously promoting an increased role for patients in defining and managing their own
treatment. Conclusions: There is a strong rationale for careful management in some patients with cardiovascular
disease. Treatment decisions should be transparent and based on strong clinical evidence. If not, drug substitution
on economic grounds alone cannot be considered to be in the individual patients interest and is therefore unethical.
2010 Informa UK Ltd All rights reserved.
Objective: The objective of the study wastoevaluate thecurrent state of clinical assays for estradiol in the context of
their applications. Participants: The participants were appointedbythe Council of The Endocrine Society and charged
with attaining the objective using published data and expert opinion. Evidence: Data were gathered from published
sources via online databases (principally PubMed, Ovid MEDLINE, Google Scholar), and the clinical and laboratory
experience of the participants. Consensus Process: The statement was an effort of the committee and was reviewed
by each member. The Clinical Affairs Committee, the Council of The Endocrine Society, and JCEM reviewers reviewed
the manuscript and made recommendations. Conclusions: The measurement of estradiol in biological
fluidsisimportant inhuman biology from cradleto grave. In addition to its centrality in sexual development, ithas
significant effectson skin, blood vessels, bone, muscle, coagulation, hepatic cells, adipose tissue, the kidney, the
gastrointestinal tract, brain, lung, and pancreas. Alterations in its plasma concentration have been implicated in
coronary artery disease, stroke, and breast cancer. Although modern immunoassays and liquid
chromatography/tandem mass spectrometry-based methods for estradiol are reasonably well suited to the diagnosis
and management of infertility (nonetheless, imprecision and method-to-method differences remain problematic),
the very low concentrations that appear to be crucial in nonreproductive tissues are a separate and more difficult
issue. Such levels of estradiol are too low to be routinely measured accurately or precisely, and further evolution of
analytical methods and the way in which estradiol is standardized is needed. Copyright 2013 by The Endocrine
Society.
OBJECTIVE: Recent epidemiological data have shown a significant increase in the prevalence of syphilis. If left
untreated, up to 30% of patients may develop tertiary syphilis, which can manifest as neurosyphilis. The aim of our
review is to evaluate psychiatric manifestations of neurosyphilis according to ICD-10., METHODS: A systematic
electronic search for published studies (1995-2010) was performed using the databases Medline, Embase, Cochrane
as well as the search engines Scopus and Google Scholar., RESULTS: 113 studies were used for detailed analysis.
Clinical manifestations of various forms of neurosyphilis are protean, numerous and non-specific and could be on the
differential diagnosis for many psychiatric presentations according to ICD-10., CONCLUSION: Due to our results, the
difficulties in diagnosing syphilis and current epidemiological data, routine screening tests are still mandatory in the
psychiatric field. Further, neurosyphilis still has to be considered in the differential diagnosis within the context of
psychiatric conditions and diseases. Georg Thieme Verlag KG Stuttgart . New York.
Objective Recent epidemiological data have shown a significant increase in the prevalence of syphilis. If left
untreated, up to 30% of patients may develop tertiary syphilis, which can manifest as neurosyphilis. The aim of our
review is to evaluate psychiatric manifestations of neurosyphilis according to ICD-10. Methods A systematic
electronic search for published studies (19952010) was performed using the databases Medline, Embase, Cochrane
as well as the search engines Scopus and Google Scholar. Results 113 studies were used for detailed analysis. Clinical
manifestations of various forms of neurosyphilis are protean, numerous and non-specific and could be on the
differential diagnosis for many psychiatric presentations according to ICD-10. Conclusion Due to our results, the
difficulties in diagnosing syphilis and current epidemiological data, routine screening tests are still mandatory in the
psychiatric field. Further, neurosyphilis still has to be considered in the differential diagnosis within the context of
psychiatric conditions and diseases.
Background and aim: Gastroesophageal reflux disease (GERD) is a major public health concern being a global chronic
disease with a significant negative impact on both quality of life and healthcare costs. According to reviews prior to
2005, the prevalence of GERD has been increasing in the western countries while a much lower prevalence was
reported in the Asian countries. We have updated the information on GERD epidemiology by collecting additional
studies from 2005 onwards. Material and methods: Studies were identified via searches performed in PubMed,
EMBASE, Cochrane library, and Google Scholar applying combinations of the following terms: gastroesophageal
reflux, GERD, reflux, or esophagitis, along with prevalence, incidence or epidemiology. Reference list of each selected
articles and of recent reviews on GERD epidemiology were also searched for useful references. Inclusion criteria
were imposed on the basis of those used in the previous systematic review of the epidemiology of GERD articles: 1 -
Survey of the general population; 2 - GERD defined by the presence of at least weekly heartburn or acid regurgitation
using a symptom questionnaire; 3 - response rate of at least 50%; 4 - minimum sample size of 200 subjects. Results:
Seventy-nine population-based studies that measured the GERD prevalence were identified, out of which 43 met the
inclusion criteria. Regarding the incidence of GERD only 12 studies met the inclusion criteria. Prevalence rates were
extracted and a regression model was constructed to examine the association between GERD prevalence and the
year in which the study was conducted (or published) and the geographic location of the study. A trend towards
increasing prevalence of GERD is evident in more recent studies. In particular, a definite trend toward increasing
prevalence is observed in North America, approaching a 30% prevalence. Similarly clear trend is present also in
Europe. What is probably even more relevant, the prevalence of GERD significantly increased in Asia in the last 5-10
years. Indeed, prior to 2005 the prevalence was always below 5%, whereas all studies published in the last seven
years, report rates above this percentage. Regarding the incidence of GERD, much less data are available and a clear
time trend is, therefore, difficult to identify. Conclusions: In US and Europe the prevalence of GERD is higher than in
Asia, and such the prevalence is still increasing in western countries and it is now clearly rising also in Asia.
Aim of the review To summarise the state of community pharmacy in India including: the provision of patient care,
pharmacy education, the pharmaceutical market, healthcare delivery, community pharmacy services, the
professional role of community pharmacists, and future developments. Method Medline, Scirus, and Google Scholar
databases and the journals "Indian Journal of Pharmaceutical Sciences" and "Indian Journal of Hospital Pharmacy"
were searched up to the end of December 2008. In addition to these, other available sources were used to identify
relevant articles. Results India has a fast growing pharmaceutical industry sector and a need for well educated
pharmacists. Domestic sale of medicines is estimated to be $5 billion during 2006 and increasing. The supply of
medicines to the population is undertaken by privately owned community pharmacies and sometimes also by
hospital pharmacies. Community pharmacists are involved only in dispensing medicines. Community pharmacists
have an opportunity to improve healthcare of the population, particularly of the disadvantaged section of the society
that does not have the resources to visit clinics (both the poor and rural population). However, important barriers to
the provision of pharmaceutical care exists, including lack of proper education and training of pharmacists, weak
implementation of existing laws, and lack of recognition of the pharmacy as a profession by the other healthcare
professionals. Conclusion The healthcare services in community pharmacies, currently insignificant, must undergo
reforms to meet the changing needs of modern medicines users. The pharmacist's role in patient care is expected to
grow as professional and educational standards develop. Although pharmacists' contributions to health care are not
yet recognized, there is every reason to be optimistic toward making patient care in community pharmacy setting a
success. For this, the educational system for pharmacists has to be adapted. 2009 Springer Science+Business Media
B.V.
Post-transplant lymphoproliferative disorders (PTLDs) can occur within the allograft, representing a differential
diagnosis for an acute rejection episode; in this study, we collected data from PTLD patients involving kidney
allografts, and compared their characteristics with other renal transplant patients from the same centers who
developed PTLDs localized elsewhere. A comprehensive search was made by Pubmed and Google Scholar for reports
of lymphoproliferative disorders after renal transplantation. Data from 17 studies were included into analysis. Having
at least 1 patient with renal allograft involvement by PTLD was inclusion criterion. Data for patients was collected by
use of a standard questionnaire. PTLD complicated renal allograft in 46 (37%) of our study population. Renal
transplant recipients with allograft localization of PTLD had better survival than other PTLD patients unless they
developed multi-organ involvement (p=0.007). Five-year survival rate was 73% for graft PTLD and 42% for other
localizations. Graft PTLD patients had shorter time from transplant to PTLD (p=0.01) and were more likely to present
as polyclonal and polymorph in their histological evaluations (p<0.05). Renal transplant recipients who develop
allograft dysfunction during the early post-transplantation period should get full evaluations for a potential PTLD
development at their allograft site. Before development of multi-organ involvement allograft PTLD in renal transplant
patients has a benign behavior; therefore it is crucial to evaluate renal recipients with initial symptoms of PTLDs.
BACKGROUND: Many medical schools require a student thesis before graduation. Publishing results in a peer-
reviewed journal could be an indicator of scientific value and acceptability by the scientific community. The
publication pattern of theses published by medical students in Peru is unknown. The aim of this study was to assess
the characteristics and publication pattern of theses in biomedical-indexed journals conducted by medical students
in a university with the highest research output in Peru. METHODS: Data from registered theses between 2000 and
2003 were obtained from the university library. Publication of theses in biomedical journals was assessed in 2008 by
a search strategy using PubMed, Google Scholar, LILACS, LIPECS and SciELO. RESULTS: Four hundred and eighty-two
medical theses were registered between 2000 and 2003; 85 (17.6%) were published in biomedical-indexed journals.
Of the published theses, 28 (5.8%) were published in MEDLINE-indexed journals, 55 (11.4%) in SciELO-indexed
journals, 61 (12.6%) in LILACS-indexed journals and 68 (14.1%) in LIPECS-indexed journals. Most of the published
theses (80%) were in Spanish and published in Peruvian journals; and 17 theses (20%) were published in foreign
journals (all of them indexed in MEDLINE). In addition, 37 (43.5%) belong primarily to internal medicine, and 24
(28.2%) belong primarily to infectious diseases. Medical students were first authors in 71 (83.5%) of the articles.
CONCLUSION: In this study, most of the published theses were in Spanish, published in local journals and indexed in
LIPECS. The percentage of published theses in biomedical journals at this university is comparable with others
coming from developed countries.
The placement of medical research news on a newspaper's front page is intended to gain the public's attention, so it
is important to understand the source of the news in terms of research maturity and evidence level. We searched
LexisNexis to identify medical research reported on front pages of major newspapers published from January 1, 2000
to December 31, 2002. We used MEDLINE and Google Scholar to find journal articles corresponding to the research,
and determined their evidence level. Of 734 front-page medical research stories identified, 417 (57%) referred to
mature research published in peer-reviewed journals. The remaining 317 stories referred to preliminary findings
presented at scientific or press meetings; 144 (45%) of those stories mentioned studies that later matured (i.e. were
published in journals within 3 years after news coverage). The evidence-level distribution of the 515 journal articles
quoted in news stories reporting on mature research (3% level I, 21% level II, 42% level III, 4% level IV, and 31% level
V) differed from that of the 170 reports of preliminary research that later matured (1%, 19%, 35%, 12%, and 33%,
respectively; chi-square test, P = .0009). No news stories indicated evidence level. Fewer than 1 in 5 news stories
reporting preliminary findings acknowledged the preliminary nature of their content. Only 57% of front-page stories
reporting on medical research are based on mature research, which tends to have a higher evidence level than
research with preliminary findings. Medical research news should be clearly referenced and state the evidence level
and limitations to inform the public of the maturity and quality of the source.
Background: The placement of medical research news on a newspaper's front page is intended to gain the public's
attention, so it is important to understand the source of the news in terms of research maturity and evidence level.
Methodology/Principal Findings: We searched LexisNexis to identify medical research reported on front pages of
major newspapers published from January 1, 2000 to December 31, 2002. We used MEDLINE and Google Scholar to
find journal articles corresponding to the research, and determined their evidence level. Of 734 front-page medical
research stories identified, 417 (57%) referred to mature research published in peer-reviewed journals. The
remaining 317 stories referred to preliminary findings presented at scientific or press meetings; 144 (45%) of those
stories mentioned studies that later matured (i.e. were published in journals within 3 years after news coverage). The
evidence-level distribution of the 515 journal articles quoted in news stories reporting on mature research (3% level
I, 21% level II, 42% level III, 4% level IV, and 31% level V) differed from that of the 170 reports of preliminary research
that later matured (1%, 19%, 35%, 12%, and 33%, respectively; chi-square test, P = .0009). No news stories indicated
evidence level. Fewer than 1 in 5 news stories reporting preliminary findings acknowledged the preliminary nature of
their content. Conclusions/Significance: Only 57% of front-page stories reporting on medical research are based on
mature research, which tends to have a higher evidence level than research with preliminary findings. Medical
research news should be clearly referenced and state the evidence level and limitations to inform the public of the
maturity and quality of the source. 2009 Lai, Lane.
Aims: Surgery elicits neuroendocrine stress response characterized by release of stress hormones and
neurotransmitters. Mild neuroendocrine stress response induces adaptation of the organism to surgical stress while
enhanced neuroendocrine stress response might be detrimental through immuno-suppression. This systematic
review aimed to review data on the effect of minimally invasive surgery on neurohormonal stress response of
experimental animals. Methods: Pubmed, Scopus, Google Scholar were searched with the appropriate search terms
up to and including January 2010. Inclusion criteria were full publications of animal studies. Papers comparing open
with laparoscopic surgery or different methods of minimally invasive surgery that provided preoperative and
postoperative measurements of at least one stress hormone were included in the study. Results: Two thousand
thirty trials were identified, the abstracts of fifty possibly relevant trials were reviewed. Sixteen trials fulfilled
inclusion criteria and were obtained in full text. Different animal models were used, ranging from rats, mice, pigs,
dogs to sea lions. Surgical operations included among others cholecystectomy, fundoplication, adrenalectomy,
colonic resection, liver hepatectomy, donor nephrectomy or insertion of pneumoperitoneum. In the majority of the
studies, cortisol was measured. All the trials showed that both open and minimally invasive surgery elicit
neuroendocrine stress response, but neuroendocrine stress response to minimally invasive surgery is less
pronounced. Hence, the time course of this response differs between minimally invasive and conventional surgery
with stress hormones returning to basic levels in a short time period after minimally invasive surgery. Conclusion:
Existing animal data suggest that stress stimuli generated by both open and laparoscopic surgery induce
neuroendocrine stress response. This response seems to be less pronounced following minimally invasive surgery.
The clinical significance of this difference needs to be elucidated.
The majority of children with disability live in low and middle income (LAMI) countries. Although a number of
important reviews of childhood disability in LAMI countries have been published, these have not, to our knowledge,
addressed the association between childhood disability and the home socio-economic circumstances (SEC). The
objective of this study is to establish the current state of knowledge on the SECs of children with disability and their
households in LAMI countries through a systematic review and quality assessment of existing research. Electronic
databases (MEDLINE; EMBASE; PUBMED; Web of Knowledge; PsycInfo; ASSIA; Virtual Health Library; POPLINE;
Google scholar) were searched using terms specific to childhood disability and SECs in LAMI countries. Publications
from organisations including the World Bank, UNICEF, International Monetary Fund were searched for. Primary
studies and reviews from 1990 onwards were included. Studies were assessed for inclusion, categorisation and
quality by 2 researchers. 24 primary studies and 13 reviews were identified. Evidence from the available literature on
the association between childhood disability and SECs was inconsistent and inconclusive. Potential mechanisms by
which poverty and low household SEC may be both a cause and consequence of disability are outlined in the reviews
and the qualitative studies. The association of poor SECs with learning disability and behaviour problems was the
most consistent finding and these studies had low/medium risk of bias. Where overall disability was the outcome of
interest, findings were divergent and many studies had a high/medium risk of bias. Qualitative studies were
methodologically weak. This review indicates that, despite socially and biologically plausible mechanisms underlying
the association of low household SEC with childhood disability in LAMI countries, the empirical evidence from
quantitative studies is inconsistent and contradictory. There is evidence for a bidirectional association of low
household SEC and disability and longitudinal data is needed to clarify the nature of this association.
Food allergy is a growing public health concern in the United States that affects an estimated 8% of children. Food
allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on
exposure to a specific food. Nearly 40% of children with food allergy have a history of severe reactions that if not
treated immediately with proper medication can lead to hospitalization or even death. The National Institute of
Allergy and Infectious Diseases (NIAID) convened an expert panel in 2010 to develop guidelines outlining evidence-
based practices in diagnosing and managing food allergy. The purpose of this review is to aid clinicians in translating
the NIAID guidelines into primary care practice and includes the following content domains: (1) the definition and
mechanism of childhood food allergy, (2) differences between food allergy and food intolerance, (3) the
epidemiology of childhood food allergy in the United States, (4) best practices derived from the NIAID guidelines
focused on primary care clinicians' management of childhood food allergy, (5) emerging food allergy treatments, and
(6) future directions in food allergy research and practice. Articles focused on childhood food allergy were considered
for inclusion in this review. Studies were restricted to the English language and to those published within the past 40
years. A cross-listed combination of the following words, phrases, and MeSH terms was searched in PubMed and
Google Scholar to identify relevant articles: food allergy, food hypersensitivity, child, pediatric, prevalence, and
epidemiology. Additional sources were identified through the bibliographies of the retrieved articles. Copyright 2013
Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
AIM: The increase of prostate-specific antigen (PSA) after radical retropubic prostatectomy (RP) or external beam
radiotherapy (EBRT) is the most sensitive tool for detecting prostate cancer (PCa) recurrence, although this measure
cannot distinguish between local, regional, or distant recurrence. The aim of this meta-analysis was to evaluate the
diagnostic performance of F-choline and C-choline PET or PET/CT in detection of locoregional or distant metastases
in PCa. MATERIALS AND METHODS: Medline, Web of Knowledge, and Google Scholar search was carried out in order
to select English-language articles dealing with diagnostic performance of both F-choline and C-choline PET for the
detection of PCa recurrence after RP or EBRT. Articles were included only if absolute numbers of true-positive, true-
negative, false-positive, and false-negative test results were available or derivable from the text and regarded local,
lymph node, and distant metastases. Reviews, clinical reports, and editorial articles were excluded. All complete
studies were re-analyzed thus performing a quantitative analysis. RESULTS: From the years 2000 to 2012, we found
53 complete articles that critically evaluated the role of choline PET in restaging patients with PCa recurrence. The
meta-analysis was carried out and dealt with 19 selected studies (12 studies for all sites of disease, 3 for lymph node
metastases, and 4 for local recurrence), with a total of 1555 patients. The meta-analysis provided a pooled sensitivity
of 85.6% (95% CI: 82.9%-88.1%) and pooled specificity of 92.6% (95% CI: 90.1%-94.6%) for all sites of disease
(prostatic fossa, lymph nodes, and bone), a pooled sensitivity of 75.4% (95% CI: 66.9%-82.6%) and pooled specificity
of 82% (95% CI: 68.6%-91.4%) for prostatic fossa recurrence, and a pooled sensitivity of 100% (95% CI: 90.5%-100%)
and pooled specificity of 81.8% (95% CI: 48.2%-97.7%) for lymph node metastases. The heterogeneity ranged
between 0.00% and 88.6%. The diagnostic odds ratios were 62.123 (95% CI: 24.783-155.72), 5.869 (95% CI: 1.818-
18.946), and 138.57 (95% CI: 11.27-1703.8), respectively, for all sites of disease, local recurrence, and lymph node
disease. CONCLUSIONS: Choline PET and PET/CT represent high sensitivity and specificity techniques for the
detection of locoregional and distant metastases in PCa patients with recurrence of disease. Moreover, a high
diagnostic odds ratio was found for the identification of lymph node disease in patients with biochemical recurrence
of PCa. 2013 by Lippincott Williams and Wilkins.
AIM: The increase of prostate-specific antigen (PSA) after radical retropubic prostatectomy (RP) or external beam
radiotherapy (EBRT) is the most sensitive tool for detecting prostate cancer (PCa) recurrence, although this measure
cannot distinguish between local, regional, or distant recurrence. The aim of this meta-analysis was to evaluate the
diagnostic performance of 18F-choline and 11C-choline PET or PET/CT in detection of locoregional or distant
metastases in PCa., MATERIALS AND METHODS: Medline, Web of Knowledge, and Google Scholar search was carried
out in order to select English-language articles dealing with diagnostic performance of both 18F-choline and 11C-
choline PET for the detection of PCa recurrence after RP or EBRT. Articles were included only if absolute numbers of
true-positive, true-negative, false-positive, and false-negative test results were available or derivable from the text
and regarded local, lymph node, and distant metastases. Reviews, clinical reports, and editorial articles were
excluded. All complete studies were re-analyzed thus performing a quantitative analysis., RESULTS: From the years
2000 to 2012, we found 53 complete articles that critically evaluated the role of choline PET in restaging patients
with PCa recurrence. The meta-analysis was carried out and dealt with 19 selected studies (12 studies for all sites of
disease, 3 for lymph node metastases, and 4 for local recurrence), with a total of 1555 patients. The meta-analysis
provided a pooled sensitivity of 85.6% (95% CI: 82.9%-88.1%) and pooled specificity of 92.6% (95% CI: 90.1%-94.6%)
for all sites of disease (prostatic fossa, lymph nodes, and bone), a pooled sensitivity of 75.4% (95% CI: 66.9%-82.6%)
and pooled specificity of 82% (95% CI: 68.6%-91.4%) for prostatic fossa recurrence, and a pooled sensitivity of 100%
(95% CI: 90.5%-100%) and pooled specificity of 81.8% (95% CI: 48.2%-97.7%) for lymph node metastases. The
heterogeneity ranged between 0.00% and 88.6%. The diagnostic odds ratios were 62.123 (95% CI: 24.783-155.72),
5.869 (95% CI: 1.818-18.946), and 138.57 (95% CI: 11.27-1703.8), respectively, for all sites of disease, local
recurrence, and lymph node disease., CONCLUSIONS: Choline PET and PET/CT represent high sensitivity and
specificity techniques for the detection of locoregional and distant metastases in PCa patients with recurrence of
disease. Moreover, a high diagnostic odds ratio was found for the identification of lymph node disease in patients
with biochemical recurrence of PCa.
INTRODUCTION: Cannabis is the most widely used illicit drug worldwide. As societies reconsider the legal status of
cannabis, policy makers and clinicians require sound knowledge of the acute and chronic effects of cannabis. This
review focuses on the latter. METHODS: A systematic review of Medline, PubMed, PsychInfo, and Google Scholar
using the search terms "cannabis," "marijuana," "marihuana," "toxicity," "complications," and "mechanisms"
identified 5,198 papers. This list was screened by hand, and papers describing mechanisms and those published in
more recent years were chosen preferentially for inclusion in this review. FINDINGS: There is evidence of psychiatric,
respiratory, cardiovascular, and bone toxicity associated with chronic cannabis use. Cannabis has now been
implicated in the etiology of many major long-term psychiatric conditions including depression, anxiety, psychosis,
bipolar disorder, and an amotivational state. Respiratory conditions linked with cannabis include reduced lung
density, lung cysts, and chronic bronchitis. Cannabis has been linked in a dose-dependent manner with elevated
rates of myocardial infarction and cardiac arrythmias. It is known to affect bone metabolism and also has teratogenic
effects on the developing brain following perinatal exposure. Cannabis has been linked to cancers at eight sites,
including children after in utero maternal exposure, and multiple molecular pathways to oncogenesis exist.
CONCLUSION: Chronic cannabis use is associated with psychiatric, respiratory, cardiovascular, and bone effects. It
also has oncogenic, teratogenic, and mutagenic effects all of which depend upon dose and duration of use.
The present study was designed to determine the association of the smoking with H. pylori infection by conducting a
meta analysis of literature. A comprehensive in depth search was conducted on following search engines: Pubmed,
EMBASE, Google Scholar, Medscape, Plosone and Scopus. The following terms were used as keywords in the
database search: "Helicobacter pylori", "Smoking", "association", "cohort", "case control", "observational", "cross
sectional" till June 2011. Only reports fulfilling the following inclusion criteria were included in the metaanalysis. In
the study conducted by Ahmad et al., 2006, the odds ratio was found out to be 1.371(0.760-2.471). The z value and p
value were computed to be equal to 1.048 and 0.295 respectively. In the study conducted by Brenner et al., 2007,
the odds ratio was found out to be 1.236(0.706-2.164). The z value and p value were computed to be equal to 0.743
and 0.458 respectively. In the study conducted by Karima et al., 2006, the odds ratio was found out to be 1.5(0.659-
3.413). The z value and p value were computed to be equal to -0.967 and 0.334 respectively. In the study conducted
by Modena et al., 2007, the odds ratio was found out to be 0.846(0.355-2.015). The z value and p value were
computed to be equal to -0.378 and 0.705 respectively. In the study conducted by Maoyeddi et al., 2002, the odds
ratio was found out to be 10.932(6.508-18.363). The z value and p value were computed to be equal to 9.038 and
0.07 respectively. In the study conducted by Nurgalieva et al., 2004, the odds ratio was found out to be 1.5(0.659-
3.413). The z value and p value were computed to be equal to -0.378 and 0.705 respectively. In the study conducted
by Pillay et al., 2007, the odds ratio was found out to be 6.768(4.398-10.415). The z value and p value were
computed to be equal to 8.695 and 0.06 respectively. In the study conducted by Khan et al., 2007, the odds ratio was
found out to be 1.236(0.706-2.164). The z value and p value were computed to be equal to 0.743 and 0.458
respectively. In the study conducted by Zhang et al., 2009, the odds ratio was found out to be 1.217(0.455- 3.260).
The z value and p value were computed to be equal to -0.391 and 0.696 respectively. Smoking has emerged as a
major risk factor in modulating the susceptibility of an individual suffering with ulcers to H. pylori infection. Hence, a
cue needs to be taken from the investigation and significant steps taken for its cessation to halt the progression of H.
pylori infection. Findings from this meta-analysis suggest that there is a close relationship between cigarette smoking
and H. pylori infection.
Context: Randomized controlled trials and meta-analyses have demonstrated that male circumcision reduces men's
risk of contracting human immunodeficiency virus (HIV) infection during heterosexual intercourse. Less is known
about whether male circumcision provides protection against HIV infection among men who have sex with men
(MSM). Objectives: To quantitatively summarize the strength of the association between male circumcision and HIV
infection and other sexually transmitted infections (STIs) across observational studies of MSM. Data Sources:
Comprehensive search of databases, including MEDLINE, EMBASE, ERIC, Sociofile, PsycINFO, Web of Science, and
Google Scholar, and correspondence with researchers, to find published articles, conference proceedings, and
unpublished reports through February 2008. Study Selection: Of 18 studies that quantitatively examined the
association between male circumcision and HIV/STI among MSM, 15 (83%) met the selection criteria for the meta-
analysis. Data Extraction: Independent abstraction was conducted by pairs of reviewers using a standardized
abstraction form. Study quality was assessed using the Newcastle-Ottawa Scale. Data Synthesis: A total of 53 567
MSM participants (52% circumcised) were included in the meta-analysis. The odds of being HIV-positive were
nonsignificantly lower among MSM who were circumcised than uncircumcised (odds ratio, 0.86; 95% confidence
interval, 0.65-1.13; number of independent effect sizes [k]=15). Higher study quality was associated with a reduced
odds of HIV infection among circumcised MSM (beta, -0.415; P=.01). Among MSM who primarily engaged in insertive
anal sex, the association between male circumcision and HIV was protective but not statistically significant (odds
ratio, 0.71; 95% confidence interval, 0.23-2.22; k=4). Male circumcision had a protective association with HIV in
studies of MSM conducted before the introduction of highly active antiretroviral therapy (odds ratio, 0.47; 95%
confidence interval, 0.32-0.69; k=3). Neither the association between male circumcision and other STIs (odds ratio,
1.02; 95% confidence interval, 0.83-1.26; k=8), nor its relationship with study quality was statistically significant
(beta, 0.265; P=.47). Conclusions: Pooled analyses of available observational studies of MSM revealed insufficient
evidence that male circumcision protects against HIV infection or other STIs. However, the comparable protective
effect of male circumcision in MSM studies conducted before the era of highly active antiretroviral therapy, as in the
recent male circumcision trials of heterosexual African men, supports further investigation of male circumcision for
HIV prevention among MSM. 2008 American Medical Association. All rights reserved.
This integrative literature review examines the long-term sensorineural hearing loss associated with cisplatin
chemotherapy treatment in children with cancer. CINAHL, PsychInfo, Medline, Google Scholar, and Google databases
were searched for research related to cisplatin-induced ototoxicity. The characteristics, prevalence, and underlying
mechanisms of cisplatin ototoxicity are discussed. Primary care implications, including how and when to monitor the
hearing of childhood cancer survivors, ways to provide family support, and education about the significance of
hearing losses, and an overview of the management for hearing impairments are presented.
Hirsch recently proposed the h-index as a single-number metric to describe the impact of an academic, combining
quality with quantity. An index of h indicates that an individual has h publications, which have been cited at least h
times. In this paper, the Google Scholar database and Publish or Perish software are used to generate citation
metrics of Australia-trained optometrists. We conclude that this analysis has considerable utility in defining and
contextualising the general landscape of Australian academic publishing in a national and international framework.
2011 The Authors. Clinical and Experimental Optometry 2011 Optometrists Association Australia.
Background: Citation analysis as one of the most widely used methods of bibliometrics can be used for computing
the various impact measures for scholars based on data from citation databases. Journal Citation Reports (JCR) from
Thomson Reuters provides annual report in the form of impact factor (IF) for each journal. Objectives: We aimed to
evaluate the citation parameters of Hepatitis Monthly by JCR in 2010 and compare them with GS and Sc. Materials
and Methods: All articles of Hepat Mon published in 2009 and 2008 which had been cited in 2010 in three databases
including WoS, Sc and GS gathered in a spreadsheet. The IFs were manually calculated. Results: Among the 104 total
published articles the accuracy rates of GS and Sc in recording the total number of articles was 96% and 87.5%. There
was a difference between IFs among the three databases (0.793 in ISI [Institute for Scientific Information], 0.945 in
Sc and 0.85 GS). The missing rate of citations in ISI was 4% totally. Original articles were the main cited types,
whereas, guidelines and clinical challenges were the least ones. Conclusions: None of the three databases succeed to
record all articles published in the journal. Despite high sensitivity of GS comparing to Sc, it cannot be a reliable
source for indexing since GS has lack of screening in the data collection and low specificity. Using an average of three
IFs is suggested to find the correct IF. Editors should be more aware on the role of original articles in increasing IF
and the potential efficacy of review articles in long term impact factor. 2012 Baqiyatallah Research Center for
Gastroentrology and liver diseases; Published by Kowsar Corp.
Introduction: Citation tracking is a bibliometrics method to analyze the scientific impact of journal articles which can
be done through Scopus (SC), Google Scholar (GS), or ISI web of knowledge (WOS). In the current study, we analyzed
the citations to 2006-2012 articles of Iranian Journal of Nuclear Medicine (IJNM) in the SC and GS. Methods: We
retrieved the relevant data from SC and GS official websites. The search was done on 10/2012. Total number of
citations, their overlap and unique citations of SC and GS were evaluated in detail. Results: SC and GS covered 100%
and 99% of articles and identified 53 and 62 citations to IJNM articles respectively with the overlap of 44 citations.
Original articles were the main types of cited articles followed by review articles. Conclusion: Despite considerable
overlap between GS and SC, they provide important unique citations to IJNM articles. Due to differences between
citation analysis information in each database, authors should consider all the indexing databases when evaluating
the scientific impact of the individual journal. Editors should consider original and review articles to increase long
term visibility and hopefully impact factor of IJNM in the future.
The Korean Journal of Urology began to be published exclusively in English in 2010 and is indexed in PubMed
Central/PubMed. This study analyzed a variety of citation indicators of the Korean Journal of Urology before and
after 2010 to clarify the present position of the journal among the urology category journals. The impact factor,
SCImago Journal Rank (SJR), impact index, Z-impact factor (ZIF, impact factor excluding self-citation), and Hirsch
Index (H-index) were referenced or calculated from Web of Science, Scopus, SCImago Journal & Country Ranking,
Korean Medical Citation Index (KoMCI), KoreaMed Synapse, and Google Scholar. Both the impact factor and the total
citations rose rapidly beginning in 2011. The 2012 impact factor corresponded to the upper 84.9% in the nephrology-
urology category, whereas the 2011 SJR was in the upper 58.5%. The ZIF in KoMCI was one fifth of the impact factor
because there are only two other urology journals in KoMCI. Up to 2009, more than half of the citations in the Web
of Science were from Korean researchers, but from 2010 to 2012, more than 85% of the citations were from
international researchers. The H-indexes from Web of Science, Scopus, KoMCI, KoreaMed Synapse, and Google
Scholar were 8, 10, 12, 9, and 18, respectively. The strategy of the language change in 2010 was successful from the
perspective of citation indicators. The values of the citation indicators will continue to increase rapidly and
consistently as the research achievement of authors of the Korean Journal of Urology increases. The Korean
Urological Association, 2013.
Background and Design: In this report, it has been aimed to investigate the citation rates of the online issues of the
"Turkdem" which has been indexed in the Web of Science since 2008. It is aimed also to have a base to comparing
with the results of the citations in the indexed years after 2008 in the future. Material and Method: It was searched
the articles published in the "review, original article, case report, continious education, letter to editor, surgical
prosedurs and what's your diagnosis" sections between 1999-2007 by Google scholar programme. The citations from
Ulaknet national medical index, ISI and the other online peer-review journals were grouped according to years and
article types. Results: Fourty-six % (n=165), 37% (n=131), 10% (n=35), 5% (n=17) and 1% (n=5) of the searched 356
articles were original articles, case reports, reviews, continous education and letters to editor, respectively. There
were also three reports, two and one of which were what's your diagnosis and surgical procedures, respectively.
Thirty seven, 30, 7, 5, and one of the cited 80 articles were in the sections of "original article, case report,
continiuous education, review and letter to editor", respectively. The number of self made citations was 13 (13%).
Although only five citations (5%) were determined in the journals with impact factors higher than 1.4 which have
been indexed by the Web of Science, 44 citations (44%) were established in national dermatology journals.
Conclusion: These results point out the low use rate of national references.
Scientific papers are often assessed by the number of citations they receive in subsequent years. We retrieved the
most cited articles published in 'Indian Pediatrics' by counting the number of citations on 'Google scholar'. 17
scientific papers received more than 50 citations; all except one were research articles. The maximum number of
most cited articles (six each) were related to neonatology and infectious diseases. Most of these articles made
significant impact in formulation of guidelines and/or change in practice and policy. 2013 Indian Academy of
Pediatrics.
Objective: To study variations in the number of times trials of nicotine replacement therapy (NRT) were cited, and
which characteristics of trials predicted the number of citations and the impact factors of journals in which articles
were published. Study Design and Setting: We used all 105 randomized controlled trials in the Cochrane review of
NRT for smoking cessation. We obtained impact factors from the Journal Citation Reports and the number of
citations from ISI Web of Knowledge and Google Scholar. Results: Trials were cited from 0 to 632 times (median 23
times). Trials were cited more often when results were statistically significant than when they were not (median = 41
vs. 17 times, P < 0.001), and when impact factors were higher (10.2 more citations per impact factor point, P <
0.001). Patch trials were cited more often than gum trials (median = 29 vs. 17 times, P = 0.001), and trials funded by
the pharmaceutical industry were cited more often than other trials (median = 28 vs. 16.5 times, P = 0.001). Trials
with statistically significant results were published in journals with higher impact factors than trials with
nonsignificant results (median impact factor = 2.80 vs. 1.81, P = 0.011). Conclusion: Citations were biased toward
trials with positive results and toward trials published in high-impact-factor journals. 2009 Elsevier Inc. All rights
reserved.
OBJECTIVE: To study variations in the number of times trials of nicotine replacement therapy (NRT) were cited, and
which characteristics of trials predicted the number of citations and the impact factors of journals in which articles
were published., STUDY DESIGN AND SETTING: We used all 105 randomized controlled trials in the Cochrane review
of NRT for smoking cessation. We obtained impact factors from the Journal Citation Reports and the number of
citations from ISI Web of Knowledge and Google Scholar., RESULTS: Trials were cited from 0 to 632 times (median 23
times). Trials were cited more often when results were statistically significant than when they were not (median=41
vs. 17 times, P<0.001), and when impact factors were higher (10.2 more citations per impact factor point, P<0.001).
Patch trials were cited more often than gum trials (median=29 vs. 17 times, P=0.001), and trials funded by the
pharmaceutical industry were cited more often than other trials (median=28 vs. 16.5 times, P=0.001). Trials with
statistically significant results were published in journals with higher impact factors than trials with nonsignificant
results (median impact factor=2.80 vs. 1.81, P=0.011)., CONCLUSION: Citations were biased toward trials with
positive results and toward trials published in high-impact-factor journals.
The authors have proposed the extended classification of enterostomy and colostomy complications, basing on the
analysis of Ukrainian and the other world special literature along last 15 years (including internet data bases Medline,
PubMed and Google scholar), dedicated to these problem.
In an aim to standardize the terminology used in patient safety research, the World Health Organization (WHO) has
recommended the use of internationally acceptable patient safety concepts for the collection and classification of
adverse events and near misses in health care settings worldwide. Objective: The principal aims of this study were to
clarify patient safety terminology and concepts, to suggest a comprehensible definition of medical error, and to
propose patient safety classifications for use in primary health care. Design: Systematic review and synthesis of the
international medical literature. Methods: In order to define "medical error" as a health care term and to identify
various published or unpublished classifications of medical errors, we searched the Medline, Web of Science,
Cochrane Library, Pascal, and French Data Bank of Public Health bibliographical medical databases for the years 2000
through 2011. A grey literature search was carried out using the Google and Google Scholar search engines. We used
the recommendations of WHO to analyze these classifications. The principal key words used were: primary care,
family practice, patient safety event, adverse event and taxonomy. Results: The online search identified 191
documents; among these, 51 articles, eight reports and two books were deemed appropriate. Twelve classifications
were analyzed and compared using WHO recommendations. Eight definitions of medical error were identified during
this analysis. Conclusion: The WHO Alliance for Patient Safety has clarified the definition of several terms - medical
error, adverse event, patient safety event, and near miss - through the development of the International Patient
Safety Event Classification. This conceptual framework and classification for patient safety should be applicable
across the full spectrum of health care, including primary health care 2011 Elsevier Masson SAS.
AIMS: To review the literature on infectious diseases and meteorological and climate change risk factors in the New
Zealand context and to describe a tentative research agenda for future work., METHODS: We performed literature
searches in May 2010 using Medline and Google Scholar. We also searched five health-related government agencies
in New Zealand for documentation on climate change and health., RESULTS: The effect of climate variability and
change on vector-borne disease has been considered in more detail than any other infectious disease topic (n=20+
journal articles and reports relating to New Zealand). Generally, concern has arisen around the risk of new mosquito
incursions and increased risks of dengue and Ross River fevers in the long term. For enteric diseases, the picture
from five New Zealand publications is somewhat mixed, although the data indicate that salmonellosis notifications
increase with higher monthly temperatures. One interpretation of the New Zealand data is that communities without
reticulated water supplies could be more vulnerable to the effects of climate change-mediated increases in
protozoan diseases. This information informed a tentative research agenda to address research gaps. Priorities
include the need for further work on a more integrated surveillance framework, vector-borne diseases, enteric
diseases, skin infections, and then work on topics for which we found no published New Zealand work (such as
influenza and leptospirosis). Finally, we found that health-related government agencies in New Zealand have
relatively little 'climate change and health' information on their websites., CONCLUSIONS: Although some
informative work has been done to date, much scope remains for additional research and planning to facilitate
prevention, mitigation, and adaptation responses in the New Zealand setting around climate change and infectious
disease risks. The tentative research agenda produced could benefit from a wider critique, and government agencies
in New Zealand could contribute to informed discussions by better documenting the current state of knowledge on
their websites.
Aims: To review the literature on infectious diseases and meteorological and climate change risk factors in the New
Zealand context and to describe a tentative research agenda for future work. Methods: We performed literature
searches in May 2010 using Medline and Google Scholar. We also searched five health-related government agencies
in New Zealand for documentation on climate change and health. Results: The effect of climate variability and
change on vector-borne disease has been considered in more detail than any other infectious disease topic (n=20+
journal articles and reports relating to New Zealand). Generally, concern has arisen around the risk of new mosquito
incursions and increased risks of dengue and Ross River fevers in the long term. For enteric diseases, the picture
from five New Zealand publications is somewhat mixed, although the data indicate that salmonellosis notifications
increase with higher monthly temperatures. One interpretation of the New Zealand data is that communities without
reticulated water supplies could be more vulnerable to the effects of climate change-mediated increases in
protozoan diseases. This information informed a tentative research agenda to address research gaps. Priorities
include the need for further work on a more integrated surveillance framework, vector-borne diseases, enteric
diseases, skin infections, and then work on topics for which we found no published New Zealand work (such as
influenza and leptospirosis). Finally, we found that health-related government agencies in New Zealand have
relatively little 'climate change and health' information on their websites. Conclusions: Although some informative
work has been done to date, much scope remains for additional research and planning to facilitate prevention,
mitigation, and adaptation responses in the New Zealand setting around climate change and infectious disease risks.
The tentative research agenda produced could benefit from a wider critique, and government agencies in New
Zealand could contribute to informed discussions by better documenting the current state of knowledge on their
websites. 2011 by Walter de Gruyter Berlin Boston.
Introduction. Functional 3D training originating in rehabilitation and physiotherapy routines, is modelled on the basis
of a patient's functional impairment and muscle function test results. 3-D functional rehabilitation comprises two key
components. The first is three-dimensional movements of the body and the second is restoration of function, The
aim of 3D training is not only to improve physical fitness and muscular coordination, it is recommended for all age
groups regardless of health status. The aim of this review is to highlight the main principles, roles and methods of 3D
functional training from a clinically-anatomical perspective and its application in clinical practice. Second, we present
a case study of 3d training in an obese boy. Methods. Database search using the lemmatization method and data
bases: Web of Knowledge, Web of Science, UpToDate, PubMed and Google Scholar for the years 2005-2011 Results
and Conclusions. Functional 3D training is an effective method for, among others, strengthening the postural
muscles of the human body, increasing articular stability, strengthening the ligaments and stability of muscle
groups,especially the back muscles and for improving lung capacity. The method of functional training is of
considerable significance in activating the pelvic floor muscles and the pelvic-trochanteric muscles for
gynegymnastics and incontinence prevention. It has application in the prevention of falls in patients with
neurodegenerative diseases and, as shown below, in the therapy of obesity.
INTRODUCTION: Functional 3D training originating in rehabilitation and physiotherapy routines, is modelled on the
basis of a patient's functional impairment and muscle function test results. 3-D functional rehabilitation comprises
two key components. The first is three-dimensional movements of the body and the second is restoration of
function, The aim of 3D training is not only to improve physical fitness and muscular coordination, it is recommended
for all age groups regardless of health status. The aim of this review is to highlight the main principles, roles and
methods of 3D functional training from a clinically-anatomical perspective and its application in clinical practice.
Second, we present a case study of 3d training in an obese boy., METHODS: Database search using the lemmatization
method and data bases: Web of Knowledge, Web of Science, UpToDate, PubMed and Google Scholar for the years
2005-2011., RESULTS AND CONCLUSIONS: Functional 3D training is an effective method for, among others,
strengthening the postural muscles of the human body, increasing articular stability, strengthening the ligaments and
stability of muscle groups,especially the back muscles and for improving lung capacity. The method of functional
training is of considerable significance in activating the pelvic floor muscles and the pelvic-trochanteric muscles for
gynegymnastics and incontinence prevention. It has application in the prevention of falls in patients with
neurodegenerative diseases and, as shown below, in the therapy of obesity.
Background Cardiac catheterisation plays a vital role in the diagnosis and evaluation of cardiac conditions. The goal of
management of patients after cardiac catheterisation is to reduce the risk of development of any local or prolonged
vascular complications, in particular bleeding and haematoma formation at the puncture site. Bed rest and
immobilisation of the affected leg are recommended practices to ensure adequate haemostasis at the femoral
arterial puncture site and prevent complications. Objectives The objective of this review was to present the best
available evidence for the optimal length of bed rest after trans-femoral diagnostic cardiac catheterisation. The main
outcome of interest was the incidence of bleeding and haematoma formation following varying periods of bed rest.
Search strategy We searched the following databases: CINAHL, Medline, Cochrane Library, Current Contents, EBSCO,
Web of Science, Embase, British Nursing Index, Controlled clinical trials database, Google Scholar. Reference lists of
relevant articles and conference proceedings were searched. We also contacted key organisations and researchers in
the field. Selection criteria All randomised and quasi-randomised controlled trials that compared the effects of
different lengths of bed rest following trans-femoral diagnostic cardiac catheterisation on patient outcomes were
considered for inclusion in the review. Data collection and analysis Eligibility of the trials for inclusion in the review,
details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers.
Odds ratios (OR) for dichotomous data and a weighted mean difference for continuous data were calculated with
95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately. Main results
Eighteen trials involving a total of 4294 participants were included in the review. One trial included three treatment
groups. In seven trials among 747 people there was no significant difference in the incidence of bleeding following
six or less than 6h of bed rest (OR 1.47; 95% CI 0.60, 3.64). Likewise, there was no significant difference in the
incidence of bleeding following bed rest at other time periods. In eight trials involving 2272 patients there was no
significant difference in the incidence of haematoma formation following 6 or less than 6h of bed rest (OR 0.82; 95%
CI 0.59, 1.16). Significantly fewer patients randomised to less than 6h of bed rest complained of back pain. The odds
of developing back pain at 4 (OR 24.60; 95% CI 1.29, 469) and 24h (OR 2.47; 95% CI 1.16, 5.23) following coronary
catheterisation was significantly higher among patients randomised to 6 compared with 3h of bed rest. Authors'
conclusions There is evidence of no benefit relating to bleeding and haematoma formation in patients who have
more than 3h of bed rest following trans-femoral diagnostic cardiac catheterisation. However, there is evidence of
benefit relating to decreased incidence and severity of back pain and cost-effectiveness following 3h of bed rest.
There is suggestive but inconclusive evidence of a benefit from bed rest for 2h following trans-femoral cardiac
OBJECTIVES: The aim of the present study was to review the pertinent literature with reference to the clinical
efficacy of antibiotics in the treatment of peri-implantitis., METHODS: To address the focused question 'Are locally
and systemically delivered antibiotics useful in the treatment of peri-implantitis?' PubMed/Medline and Google-
scholar databases were explored from 1992 until February 2013 using a combination of the following keywords:
'antibiotic,' 'dental implant,' 'inflammation,', 'peri-implantitis' and 'treatment'. Letters to the editor, case-reports and
unpublished data were excluded., RESULTS: Ten studies were included. In six studies, peri-implantitis was treated
using a non-surgical approach (scaling and root planing), whereas in four studies, a surgical approach was adopted
for treating peri-implantitis. In three studies systemic antibiotics were administered and in six studies locally
delivered antibiotics were used for treatment. One study used the oral route for antibiotic delivery. In three studies,
minocycline hydrochloride was locally delivered as an adjunctive therapy to non-surgical mechanical debridement of
infected sites. Nine studies reported that traditional peri-implantitis treatment with adjunct antibiotic therapy
reduces gingival bleeding, suppuration and peri-implant pocket depth. In one study, despite surgical debridement of
infected sites and systemic antibiotic cover, nearly 40% of the implants failed to regain stability. There was no
placebo or control group in eight out of the nine studies included., CONCLUSION: The significance of adjunctive
antibiotic therapy in the treatment of peri-implantitis remains debatable. 2013 FDI World Dental Federation.
OBJECTIVE: Glomerular filtration rate (GFR) is an important indicator of renal function. This meta-analysis aimed to
evaluate the diagnostic value of serum cystatin C (CysC) and serum creatinine (SCr) for estimating GFR in patients
with chronic kidney disease., METHODS: Google Scholar, PubMed, Cochrane Library and China National Knowledge
Infrastructure databases were searched, to identify randomized controlled trials that determined the diagnostic
value of CysC and SCr, for estimating GFR in patients with chronic kidney disease., RESULTS: The inclusion criteria
were met by 17 studies (total number of patients with chronic kidney disease, 2521). Meta-analysis showed that
when the diagnostic cut-off value of GFR was 80-90ml/min/1.73m(2), the heterogeneity was modest for CysC (I(2)
()=48%, summary sensitivity [SEN]=0.803, summary specificity [SPE]=0.821), but there was no heterogeneity for SCr
(I(2) ()=0.0%, SEN=0.697, SPE=0.787). Meta-analysis of the studies demonstrated a significant difference between
patients with chronic kidney disease and controls, for CysC and SCr., CONCLUSIONS: This meta-analysis
demonstrated significant correlations between CysC, SCr and GFR. CysC was more sensitive, but less specific, than
SCr for the estimation of GFR.
Context: Hepatitis delta virus (HDV) leads to the most severe form of chronic viral hepatitis. Objectives: To determine
the prevalence of HDV and create pooled estimations of possible risk factors, a systematic review was conducted to
collect all epidemiological studies on HDV among chronic hepatitis B patients in Iran. Data Sources: In this systematic
review, databases such as pubMed, embase, ISI, Google scholar, and Iranian databases (MagIran, Iranmedex, and
SID) were searched. Study Selection: Studies that clearly stated information about the number of HBsAg positive
patients infected with HDV were selected. Data Extraction: The name of the city, the author's name, year of study,
HDV detection method, sample size, HBsAg positive frequency, mean age, total prevalence of HDV, and risk factors
were extracted. Results: The pooled HDV prevalence was 7.8% (95% CI: 5.89 - 9.71). In the survey-data analysis, HDV
prevalence was 6.61%. HDV prevalence was 30.47% (95% CI: 9.76 to 51.19), 14.4% (95% CI: 7.72 to 21.07), and
4.94% (95% CI: 3.73 to 6.15) in cirrhotic, chronic-hepatitis, and inactivecarrier patients, respectively. pooled oRs were
calculated for several factors common to Iranian HBsAg-positive patients, including history of blood transfusion [oR:
1.1 (95% CI: 0.40 to 2.98)], intravenous drug abuse [oR: 1.6 (95% CI: 0.78 to 3.21)], previous hemodialysis [oR: 1.72
(95% CI: 0.79 to 3.76)], and HBeAg-positive status [oR: 1.26 (95% CI: 0.66 to 2.4)]. Conclusions: The prevalence of
HDV is less common in Iran than in endemic regions such as Italy and Turkey; however, it is a severe form of hepatitis
in HBsAg-positive patients. The most probable route of HDV transmission is hematologic, which suggests the
importance of blood screening for HDV, especially in groups with numerous blood transfusions. 2011 Kowsar M.P.Co.
All rights reserved.
CONTEXT: Hepatitis delta virus (HDV) leads to the most severe form of chronic viral hepatitis., OBJECTIVES: To
determine the prevalence of HDV and create pooled estimations of possible risk factors, a systematic review was
conducted to collect all epidemiological studies on HDV among chronic hepatitis B patients in Iran., DATA SOURCES:
In this systematic review, databases such as PubMed, Embase, ISI, Google scholar, and Iranian databases (MagIran,
Iranmedex, and SID) were searched., STUDY SELECTION: Studies that clearly stated information about the number of
HBsAg positive patients infected with HDV were selected., DATA EXTRACTION: The name of the city, the author's
name, year of study, HDV detection method, sample size, HBsAg positive frequency, mean age, total prevalence of
HDV, and risk factors were extracted., RESULTS: The pooled HDV prevalence was 7.8% (95% CI: 5.89 - 9.71). In the
survey-data analysis, HDV prevalence was 6.61%. HDV prevalence was 30.47% (95% CI: 9.76 to 51.19), 14.4% (95%
CI: 7.72 to 21.07), and 4.94% (95% CI: 3.73 to 6.15) in cirrhotic, chronic-hepatitis, and inactive-carrier patients,
respectively. Pooled ORs were calculated for several factors common to Iranian HBsAg-positive patients, including
history of blood transfusion [OR: 1.1 (95% CI: 0.40 to 2.98)], intravenous drug abuse [OR: 1.6 (95% CI: 0.78 to 3.21)],
previous hemodialysis [OR: 1.72 (95% CI: 0.79 to 3.76)], and HBeAg-positive status [OR: 1.26 (95% CI: 0.66 to 2.4)].,
CONCLUSIONS: The prevalence of HDV is less common in Iran than in endemic regions such as Italy and Turkey;
however, it is a severe form of hepatitis in HBsAg-positive patients. The most probable route of HDV transmission is
hematologic, which suggests the importance of blood screening for HDV, especially in groups with numerous blood
transfusions.
Objective: To review the research conclusions relating to clinical aspects of syndesmosis, the incidence and prognosis
of syndesmosis injuries, and the effectiveness of the history and clinical examination to reliably diagnose ankle
syndesmosis injury. Data Sources: Google Scholar search: Syndesmosis paired with incidence, prognosis, history, and
examination in turn. There was no time limit for the search. Articles were selected by reading titles, abstracts, and
the full article, if indicated, seeking original articles determining these clinical aspects of syndesmosis injuries.
Further articles were derived from the references of the primary articles. Main Results: The prognosis for isolated
syndesmosis injuries, including the time to functional recovery, is unknown. The incidence of acute syndesmosis
injury in moderate to severe ankle injuries requiring imaging is of the order of 5%. Historical features and special
clinical tests of syndesmosis injury have not been proven reliable by clinical studies using evidence-based diagnostic
criteria. Acute local tenderness of the anterior inferior tibiofibular ligament will indicate significant syndesmosis
injury in only approximately half of nonspecific ankle injuries. Conclusions: There is limited, evidence-based,
standard, published literature from which to draw conclusions regarding the validity or reliability of various clinical
special tests for syndesmosis injury. Literature assessing the incidence, prognosis, and clinical features is generally
not based on definitively confirmed syndesmosis injuries, which is a critical aspect of evidence-based medicine
before valid conclusions can be drawn. 2011 by Lippincott Williams & Wilkins.
BACKGROUND: Liver transplantation is the definite treatment for end-stage liver diseases with satisfactory results.
However, untoward effects of life-long immunosuppression prevent the development of alternative strategies to
achieve better long-term outcome. Achieving clinical operational tolerance is the ultimate goal. DATA SOURCES: A
PubMed and Google Scholar search using terms: "immune tolerance", "liver transplantation", "clinical trial",
"operational tolerance" and "immunosuppression withdrawal" was performed, and relevant articles published in
English in the past decade were reviewed. Full-text publications relevant to the field were selected and relevant
articles from reference lists were also included. Priority was given to those articles which are relevant to the review.
RESULTS: Because of the inherent tolerogenic property, around 20%-30% of liver transplantation recipients develop
spontaneous operational tolerance after immunosuppression withdrawal, and the percentage may be even higher in
pediatric living donor liver transplantation recipients. Several natural killer and T cell related markers have been
identified to be associated with the tolerant state in liver transplantation patients. Despite the progress, clinical
operational tolerance is still rare in liver transplantation. Reprogramming the recipient immune system by creating
chimerism and regulatory cell therapies is among newer promising means to achieve clinical liver transplantation
tolerance in the future. CONCLUSION: Although clinical operational tolerance is still rare in liver transplantation
recipients, ongoing basic research and collaborative clinical trials may help to decipher the mystery of
transplantation tolerance and extend the potential benefits of drug withdrawal to an increasing number of patients
in a more predictable fashion. 2013, Hepatobiliary Pancreat Dis Int.
BACKGROUND: Liver transplantation is the definite treatment for end-stage liver diseases with satisfactory results.
However, untoward effects of life-long immunosuppression prevent the development of alternative strategies to
achieve better long-term outcome. Achieving clinical operational tolerance is the ultimate goal., DATA SOURCES: A
PubMed and Google Scholar search using terms: "immune tolerance", "liver transplantation", "clinical trial",
"operational tolerance" and "immunosuppression withdrawal" was performed, and relevant articles published in
English in the past decade were reviewed. Full-text publications relevant to the field were selected and relevant
articles from reference lists were also included. Priority was given to those articles which are relevant to the review.,
RESULTS: Because of the inherent tolerogenic property, around 20%-30% of liver transplantation recipients develop
spontaneous operational tolerance after immunosuppression withdrawal, and the percentage may be even higher in
pediatric living donor liver transplantation recipients. Several natural killer and gammadeltaT cell related markers
have been identified to be associated with the tolerant state in liver transplantation patients. Despite the progress,
clinical operational tolerance is still rare in liver transplantation. Reprogramming the recipient immune system by
creating chimerism and regulatory cell therapies is among newer promising means to achieve clinical liver
transplantation tolerance in the future., CONCLUSION: Although clinical operational tolerance is still rare in liver
transplantation recipients, ongoing basic research and collaborative clinical trials may help to decipher the mystery
of transplantation tolerance and extend the potential benefits of drug withdrawal to an increasing number of
patients in a more predictable fashion.
Aim: Doppler-guided haemorrhoidal artery ligation (DGHL) has experienced wider uptake and has recently received
National Institute for Health and Clinical Excellence (NICE) approval in the UK. A systematic review of the literature
was conducted to assess its safety and efficacy. Method: This review was conducted in keeping with PRISMA
guidelines. MEDLINE, EMBASE, Google Scholar and Cochrane Library databases were searched. Studies describing
DGHL as a primary procedure and reporting clinical outcome were considered. Primary end-points were recurrence
and postoperative pain. Secondary end-points included operation time, complications and reintervention rates.
Studies were scored for quality with either Jadad score or NICE scoring guidelines. Results: Twenty-eight studies
including 2904 patients were included in the final analysis. They were of poor overall quality. Recurrence ranged
between 3% and 60% (pooled recurrence rate 17.5%), with the highest rates for grade IV haemorrhoids.
Postoperative analgesia was required in 0-38% of patients. Overall postoperative complication rates were low, with
an overall bleeding rate of 5% and an overall reintervention rate of 6.4%. The operation time ranged from 19 to 35
min. Conclusion: DGHL is safe and efficacious with a low level of postoperative pain. It can be safely considered for
primary treatment of grade II and III haemorrhoids. Colorectal Disease 2013 The Association of Coloproctology of
Great Britain and Ireland.
Objective: To study the major mutations in genes CYP2C8 and CYP2C9, their frequency in populations of diverse
ethnical descent, their analysis methods, and the major drugs with affected metabolism, with a special emphasis on
NSAIDs. Method: Repeated searches of Pubmed (January 1966-January 2006) and Scholar Google were performed.
All searches were restricted to studies in humans, and papers not written in Spanish or English were excluded.
Results: Ten allelic variants of CYP2C8 and 24 of CYP2C have been reported. Not all of them exert a relevant effect on
drug metabolism. In Caucasians 22% of CYP2C8 genes and 31% of CYP2C9 genes have mutations. In Asians fewer
than 1% and nearly 3% are mutated, respectively. Major identification methods include endonuclease digestion, PCR,
pyrosequencing, and microarrays. Not all NSAIDs are exclusive substrates for CYP2C8/9. The usefulness of allelic
variant analysis varies with each individual drug. The risk for digestive hemorrhage associated with the CYP2C9
genotype is particularly relevant when using aceclofenac, celecoxib, diclofenac, ibuprofen, indomethacin, lomoxicam,
piroxicam, or naproxen. Conclusions: Although CYP2C8/9 activity plays an essential role in the metabolism of and
clinical response to many NSAIDs, the use of pharmacogenomic techniques is not equally useful for all these drugs.
Copyright 2006 Aran Ediciones, S. L.
OBJECTIVE: To study the major mutations in genes CYP2C8 and CYP2C9, their frequency in populations of diverse
ethnical descent, their analysis methods, and the major drugs with affected metabolism, with a special emphasis on
NSAIDs., METHOD: Repeated searches of Pubmed (January 1966-January 2006) and Scholar Google were performed.
All searches were restricted to studies in humans, and papers not written in Spanish or English were excluded.,
RESULTS: Ten allelic variants of CYP2C8 and 24 of CYP2C have been reported. Not all of them exert a relevant effect
on drug metabolism. In Caucasians 22% of CYP2C8 genes and 31% of CYP2C9 genes have mutations. In Asians fewer
than 1% and nearly 3% are mutated, respectively. Major identification methods include endonuclease digestion, PCR,
pyrosequencing, and microarrays. Not all NSAIDs are exclusive substrates for CYP2C8/9. The usefulness of allelic
variant analysis varies with each individual drug. The risk for digestive hemorrhage associated with the CYP2C9
genotype is particularly relevant when using aceclofenac, celecoxib, diclofenac, ibuprofen, indomethacin,
lornoxicam, piroxicam, or naproxen., CONCLUSIONS: Although CYP2C8/9 activity plays an essential role in the
metabolism of and clinical response to many NSAIDs, the use of pharmacogenomic techniques is not equally useful
for all these drugs.
Objectives To discuss the clinical pharmacology of currently licensed veterinary NSAIDs and to review gastrointestinal
and renal adverse effects as well as drug-drug interactions that have been reported with these drugs. To review the
use of NSAIDs in the peri-operative setting and their use in patients with osteoarthritis. To further review the
reported effects of NSAIDs on canine articular cartilage and liver as well as the clinical relevance of a washout period.
Databases used PubMed, CAB abstracts and Google Scholar using dog, dogs, nonsteroidal anti-inflammatory drugs
and NSAID(s) as keywords. Conclusions A good understanding of the mechanisms by which NSAIDs elicit their
analgesic effect is essential in order to minimize adverse effects and drug-drug interactions. Cyclooxygenase (COX) is
present in at least two active isoforms in the body and is the primary pharmacologic target of NSAIDs. Inhibition of
COX is associated with the analgesic effects of NSAIDs. COX is present in the gastrointestinal tract and kidneys, along
with other areas of the body, and is also the likely reason for many adverse effects including gastrointestinal and
renal adverse effects. The newer veterinary approved NSAIDs have a lower frequency of gastrointestinal adverse
effects in dogs compared to drugs such as aspirin, ketoprofen and flunixin, which may be due to differential effects
on the COX isoforms. There are currently no published reports demonstrating that the newer NSAIDs are associated
with fewer renal or hepatic adverse effects in dogs. NSAIDs remain the cornerstone of oral therapy for osteoarthritis
unless contraindicated by intolerance, concurrent therapies or underlying medical conditions. NSAIDs are also
effective and frequently used for the management of post-operative pain. 2011 Pfizer. Veterinary Anaesthesia and
Analgesia. 2011 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists.
Background/Objectives: Summarize evidence on the prevalence, prognosis and functional implications of
impairments associated with cerebral palsy to provide parents and clinicians prognostic information for intervention
planning. Design: Systematic review. Participants and Setting: Published studies included: generated levels of
evidence 2b or higher with population-based samples; ascertained rates of associated impairments or future
implications and outcomes in the presence of anassociated impairment; and more than half the participants were
children or adults with cerebral palsy. Materials/Methods: The search was limited to studies published after 1999,
full-text available in English and included in the following electronic databases: PubMed, MEDLINE, CINAHL,
PscyINFO, Cochrane Database of Systematic Reviews and Google Scholar. 'Cerebral palsy' was combined with
'prognosis' or 'prevalence' and associated impairment terms. Articles were independently rated for quality by two
raters using the Oxford scale and 100% agreement was reached. Results: Seventy-two papers were retrieved
meeting eligibility criteria and were appraised. Most papers were level four evidence on the Oxford scale and were of
high quality. Clinical messages for parents about rates of impairment and the level of evidence were: (1) Behaviour:
one in four children with cerebral palsy have a behaviour disorder (High Grade), which was twice as high as the
population (Moderate Grade); (2) Eating: nine in 10 children with cerebral palsy have difficulty with feeding
(Moderate Grade), with one in two children choking during meals (Moderate Grade); (3) Hearing: one in 25 children
with cerebral palsy are deaf (High Grade); (4) Hips: one in three children with cerebral palsy have hip displacement
(High Grade); (5) Intellect: one in two children with cerebral palsy have an intellectual disability (High Grade), with
one in three having a severe intellectual disability (High Grade); (6) Pain: one in two children with cerebral palsy are
in pain (High Grade); (7) Seizures: one in four children with cerebral palsy have epilepsy (High Grade); (8) Sleep: one
in five children with cerebral palsy have a sleep disorder (Moderate Grade), which is five times higher than the
population (Moderate Grade); (9) Speech: one in four children with cerebral palsy cannot talk (High Grade); (10)
Toileting: one in four children with cerebral palsy have urinary incontinence (Moderate Grade) and one in three have
stool incontinence (Low quality Grade). Rate of incontinence are 2-3 times higher than the population (Low quality
Grade); (11) Vision: one in three children with cerebral palsy have a vision impairment (High Grade) with one in ten
being blind (High Grade); and (12) Walking: one in three children with cerebral palsy cannot walk (High Grade).
Conclusions/Significance: Clinicians can and should provide timely prognostic messages, to enable families of
children with CP to develop realistic expectations and goals for treatment and community participation.
OBJECTIVE: To evaluate and review the literature surrounding serotonin toxicity in patients receiving linezolid and
determine the clinical relevance of this reaction. DATA SOURCES: Literature was accessed via MEDLINE/PubMed and
Google Scholar (both through February 2013) using the search terms linezolid, serotonin syndrome, serotonin
toxicity, and adverse reaction. STUDY SELECTION AND DATA EXTRACTION: Relevant case reports, retrospective
studies, surveys, and review articles were included. Bibliographies of all relevant articles were reviewed for
additional sources. DATA SYNTHESIS: Linezolid exhibits mild, nonselective inhibition of monoamine oxidase and has
been associated with serotonin toxicity when used in combination with other serotonergic agents. Based on
published reports, the incidence of linezolid-associated serotonin toxicity is between 0.54% and 18.2%. Our review
identified 32 documented cases, including 3 fatalities. Most cases occurred in patients concurrently receiving
selective serotonin reuptake inhibitors. Receipt of multiple agents with serotonergic activity seems to increase the
risk of serotonin toxicity. Both onset and resolution of symptoms varied from hours to days. CONCLUSIONS: Current
Food and Drug Administration recommendations to avoid the use of linezolid in patients receiving select
serotonergic agents highlight the need to carefully balance the risk/benefit ratio in this situation. Although linezolid
has been available for 12 years, reports of serotonin toxicity with this agent are uncommon. While clinicians should
be aware of this potentially severe interaction and closely monitor patients who are receiving linezolid in
combination with serotonergic agents, our findings show that linezolid is not contraindicated in this situation. 1967-
2013 Harvey Whitney Books Co. All rights reserved.
Abstract Purpose: Controversy exists over how to 'clear' (we mean enable the clinician to safely remove spinal
precautions based on imaging and/or clinical examination) the spine of significant unstable injury among clinically
unevaluable obtunded blunt trauma patients (OBTPs). This review provides a clinically relevant update of the
available evidence since our last review and practice recommendations in 2004. Methods: Medline, Embase. Google
Scholar, BestBETs, the trip database, BMJ clinical evidence and the Cochrane library were searched. Bibliographies of
relevant studies were reviewed. Results: Plain radiography has low sensitivity for detecting unstable spinal injuries in
OBTPs whereas multidetector-row computerised tomography (MDCT) approaches 100%. Magnetic resonance
imaging (MRI) is inferior to MDCT for detecting bony injury but superior for detecting soft tissue injury with a
sensitivity approaching 100%, although 40% of such injuries may be stable and 'false positive'. For studies comparing
MDCT with MRI for OBTPs; MRI following 'normal' CT may detect up to 7.5% missed injuries with an operative
fixation in 0.29% and prolonged collar application in 4.3%. Increasing data is available on the complications
associated with prolonged spinal immobilisation among a population where a minority have an actual injury.
Conclusions: Given the variability of screening performance it remains acceptable for clinicians to clear the spine of
OBTPs using MDCT alone or MDCT followed by MRI, with implications to either approach. Ongoing research is
needed and suggestions are made regarding this. It is essential clinicians and institutions audit their data to
determine their likely screening performances in practice. Copyright jointly held by Springer and ESICM 2012.
BACKGROUND: Late intestinal toxicity after radiotherapy (LITAR) not only limits the radiation dose, which
subsequently leads to unfavorable clinical outcomes, but also significantly lowers the quality of life in an increasing
number of cancer survivors. Therefore, identifying clinical risk factors for LITAR is important for establishing a
predictive model in the clinical setting of decision-making for these patients. This review aims to systematically
summarize and clarify the clinical factors that can be potentially associated with an increased risk of
moderate/severe LITAR in patients with abdominal or pelvic malignancies., METHODS/DESIGN: MEDLINE, EMBASE,
Web of Science, Cochrane Central Register of Controlled Trials, Scopus, Google Scholar and Chinese BioMed will be
systematically searched to identify appropriate studies. Citations of the retrieved studies and recent reviews will also
be searched separately by case.The enrolled studies should at least have the following information: (1) a clear
definition and information on the LITAR severity; (2) assess clinical factors for moderate/severe toxicity with adjusted
risk estimates; (3) have a cohort, case-control, randomized controlled trial and controlled clinical trial study
design.Two authors will independently review the abstract and full text of retrieved studies, extract data from
eligible studies and assess the risk of bias. Disagreements will be discussed among reviewers until a consensus is
reached. The effect of identified risk factors will be displayed in forest plots. If the information is sufficient, results
will be synthesized by a meta-analysis with the random effects model to pool the estimate of risk posed by clinical
factors. Subgroup and sensitivity analysis will be used to explore the sources of heterogeneity., DISCUSSION: This
review will summarize the evidence of clinical risk factors for moderate/severe LITAR. The results may help guide
decision-making and minimize the side effects of therapeutic modalities in the clinical setting.
INTRODUCTION: Pregnancy, obesity, peritoneal dialysis, pneumoperitoneum, prone position and application of
positive end-expiratory pressure are associated with elevated intraabdominal pressure (lAP). OBJECTIVE:To review
the relation between these conditions and procedures, and intraabdominal hypertension (IAH) or abdominal
compartment syndrome (ACS). METHODS: Search of PubMed and Google Scholar and review of article
bibliographies. RESULTS AND CONCLUSION: Only obesity, peritoneal dialysis, and pneumoperitoneum are associated
with symptoms related to IAH and these symptoms are reversible.
The purpose of this paper was to analyse the causes, pathogenesis, diagnostic modalities and treatment outcomes of
microsporidial keratoconjunctivitis (MKC). Microsporidia are increasingly recognized as opportunistic infectious
pathogens in immunocompromized patients causing keratoconjunctivitis. In the recent years, there has been a surge
in reports of MKC in immunocompetent individuals presenting with stromal keratitis. A detailed literature search was
done using Medline, OVID, Cochrane Library, UptoDate and Google Scholar databases with the terms microsporidia,
keratitis, conjunctivitis, immunocompromized and immunocompetent. The articles were reviewed to determine the
spectrum of clinical presentation, disease course, investigations, treatment modalities and outcome. Thirty-six
publications were reviewed, and 151 cases of MKC were included for this review. The main presenting features
included pain, redness, photophobia, epiphora and blurring of vision. Duration of the symptoms lasted between 4
days and 18 months. Light microscopy with modified trichrome stain was most commonly used to diagnose MKC.
Resolution of symptoms was most commonly achieved with oral albendazole and/or topical fumidil B. Topical
fluoroquinolones are also effective as a monotherapy as suggested by recent studies. Clinical outcome was good
(visual acuity <= 6/12) for the patients who presented earlier (<=1 month) (75% of cases with documented final best-
corrected visual acuity). MKC occurs more commonly in immunocompetent individuals than expected and can be
diagnosed in earlier stages. From our review, we conclude that the patients, who were diagnosed early and treated,
had complete resolution of symptoms with a better clinical outcome. 2011 The Authors. Clinical and Experimental
Ophthalmology 2011 Royal Australian and New Zealand College of Ophthalmologists.
OBJECTIVE: Suspension trauma refers to the pathophysiologic syndrome that occurs when a victim is suspended
motionless in a vertical position for an extended period of time. This can occur in sports that use a harness system as
well as in various occupational activities including work on high wires or helicopter rescue operations. We reviewed
the scientific evidence published to date in order to improve the prevention and treatment of suspension trauma.,
METHODS: Medline, PreMedline, the Cochrane Library, and Google Scholar were searched for relevant information
about suspension trauma., RESULTS: Published data describing the pathophysiology of and the therapeutic approach
to suspension trauma are sparse and consist mainly of case reports and a limited number of human experimental
prospective studies. The pathophysiology of suspension trauma is related to hypovolemia induced by reduced
venous return and by vagal stimulation. It is also influenced by the type of harness used. Chest harnesses may induce
severe cardiorespiratory repercussions and have the lowest motionless suspension tolerance. Symptoms of
suspension trauma include presyncope and can lead to a loss of consciousness., CONCLUSIONS: Sports enthusiasts
and workers who use a body harness system should never act alone and should not use a simple chest harness. If a
victim shows symptoms of presyncope or is unconscious, he should be released from suspension as soon as is safely
possible. There is no clear evidence to support the idea that the return to the horizontal position may contribute to
the potential risk of rescue death. Copyright 2011 Wilderness Medical Society. Published by Elsevier Inc. All rights
reserved.
Suspension trauma refers to the pathophysiologic syndrome that occurs when a victim is suspended motionless in a
vertical position for an extended period of time. This can occur in sports that use a harness system as well as in
various occupational activities including work on high wires or helicopter rescue operations. We reviewed the
scientific evidence published to date in order to improve the prevention and treatment of suspension trauma.
Medline, PreMedline, the Cochrane Library, and Google Scholar were searched for relevant information about
suspension trauma. Published data describing the pathophysiology of and the therapeutic approach to suspension
trauma are sparse and consist mainly of case reports and a limited number of human experimental prospective
studies. The pathophysiology of suspension trauma is related to hypovolemia induced by reduced venous return and
by vagal stimulation. It is also influenced by the type of harness used. Chest harnesses may induce severe
cardiorespiratory repercussions and have the lowest motionless suspension tolerance. Symptoms of suspension
trauma include presyncope and can lead to a loss of consciousness. Sports enthusiasts and workers who use a body
harness system should never act alone and should not use a simple chest harness. If a victim shows symptoms of
presyncope or is unconscious, he should be released from suspension as soon as is safely possible. There is no clear
evidence to support the idea that the return to the horizontal position may contribute to the potential risk of rescue
death. Copyright 2011 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
Importance of the field: Carvedilol, a non-selective beta-blocker, has recently drawn attention because of its
therapeutic benefits over other prescribed analogues for the treatment of cardiovascular diseases (CVDs). Areas
covered in this review: The present review attempts to present the clinical efficacy of carvedilol in comparison to
other available beta-blockers. The literature search was carried out in three electronic databases (Unbound Medline,
Pubmed and Sciencedirect) and internet search engines (Scirus and Google Scholar) without time constraints to
ensure maximum literature coverage. What the reader will gain: A relatively large number of comparative studies
have revealed that carvedilol has advantage over traditional beta-blockers with respect to hemodynamic and
metabolic effects, due to its unique non-selective alpha-/beta-adrenoceptor affinity. Such results indicate its safe and
effective therapeutic application particularly in patients with complicated CVDs, even in pediatric and geriatric
patients. Take home message: The therapeutic profile of carvedilol indicates its suitability for treatment of
complicated CVDs than other non-selective beta-blockers. However, there is a limitation in terms of its dose due to
its low bioavailability (~ 25%). Therefore, there is still need for bioavailability enhancement and dose reduction to
further improve the therapeutic efficacy of the drug. 2010 Informa UK Ltd.
The medicinal leech, Hirudo medicinalis, is an excellent example of the use of invertebrates in the treatment of
human disease. Utilized for various medical indications since the ancient times, the medicinal leech is currently being
used in a narrow range of well-defined and scientifically-grounded clinical applications. Hirudotherapy is most
commonly used in the setting of venous congestion associated with soft tissue replantations and free flap-based
reconstructive surgery. This is a comprehensive review of current clinical applications of hirudotherapy, featuring a
comprehensive search of all major medical search engines (i.e. PubMed, Google Scholar, ScientificCommons) and
other cross-referenced sources. The authors focus on indications, contraindications, practical application/handling of
the leech, and therapy-related complications.
The medicinal leech, Hirudo medicinalis, is an excellent example of the use of invertebrates in the treatment of
human disease. Utilized for various medical indications since the ancient times, the medicinal leech is currently being
used in a narrow range of well-defined and scientifically-grounded clinical applications. Hirudotherapy is most
commonly used in the setting of venous congestion associated with soft tissue replantations and free flap-based
reconstructive surgery. This is a comprehensive review of current clinical applications of hirudotherapy, featuring a
comprehensive search of all major medical search engines (i.e. PubMed, Google Scholar, ScientificCommons) and
other cross-referenced sources. The authors focus on indications, contraindications, practical application/handling of
the leech, and therapy-related complications.
Introduction: Atrial fibrillation is a common cardiac rhythm abnormality with a considerable cardiovascular disease
burden worldwide. It is an independent major risk factor for stroke. Stroke prevention with anticoagulation or
antiplatelet agents has been an important area of clinical research. Warfarin is the most widely used antithrombotic
therapy for stroke prophylaxis for last several years, and now dabigatran (150 mg b.i.d.) is more effective than
warfarin in stroke prevention in individuals at increased of stroke. In addition, several studies have evaluated the
efficacy of clopidogrel for stroke prophylaxis either alone or in combination with aspirin. Areas covered: This review
summarizes the key findings of the trials looking at the efficacy of clopidogrel in stroke prevention. A literature
search was performed using PubMed and Google Scholar. The trials that evaluated the efficacy of clopidogrel in
preventing atherothrombotic events or stroke were also included. Expert opinion: Clopidogrel prevents more
vascular events, including stroke, in patients with a recent myocardial infarction, stroke or peripheral vascular
disease than aspirin. Combination of clopidogrel and aspirin provides a greater reduction of stroke than aspirin or
clopidogrel monotherapy, but at an increased risk of bleeding. Dual antiplatelet therapy (clopidogrel and aspirin) is
inferior to warfarin in primary stroke prevention for patient with atrial fibrillation and thus should be considered for
stroke prophylaxis only in patients ineligible for warfarin. However, with the advent of newer agents, like direct
thrombin inhibitors and Factor Xa inhibitors, the role of antiplatelet therapy for stroke prevention in atrial fibrillation
remains unclear. 2011 Informa UK, Ltd.
Cocaine is a powerful stimulant that gives users a temporary sense of euphoria, mental alertness, talkativeness, and
a decreased need for food and sleep. Cocaine intoxication is the most frequent cause of drug-related death reported
by medical examiners in the US, and these events are most often related to the cardiovascular manifestations of the
drug. Once playing a vital role in medicine as a local anesthetic, decades of research have established that cocaine
has the ability to cause irreversible structural damage to the heart, greatly accelerate cardiovascular disease, and
initiate sudden cardiac death. Although pathologic findings are often reported in the literature, few images are
available to support these findings, and reviews of cocaine cardiopathology are rare. We describe the major
pathologic findings linked to cocaine abuse in earlier research, their underlying mechanisms, and the treatment
approaches currently being used in this patient population.A MEDLINE search was conducted to identify all English
language articles from January 2000 to June 2008 with the subject headings and key words 'cocaine', 'heart',
'toxicity', and 'cardiotoxicity'. Epidemiologic, laboratory, and clinical studies on the pathology, pathophysiology, and
pharmacology of the effects of cocaine on the heart were reviewed, along with relevant treatment options.
Reference lists were used to identify earlier studies on these topics, and related articles from Google Scholar were
also included.There is an established connection between cocaine use and myocardial infarction (MI), arrhythmia,
heart failure, and sudden cardiac death. Numerous mechanisms have been postulated to explain how cocaine
contributes to these conditions. Among these, cocaine may lead to MI by causing coronary artery vasoconstriction
and accelerated atherosclerosis, and by initiating thrombus formation. Cocaine has also been shown to block K
channels, increase L-type Ca2 channel current, and inhibit Na influx during depolarization, all possible causes for
arrhythmia. Additionally, cocaine use has been associated with left ventricular hypertrophy, myocarditis, and dilated
cardiomyopathy, which can lead to heart failure if drug use is continued.Certain diagnostic tools, including ECG and
serial cardiac markers, are not as accurate in identifying MI in cocaine users experiencing chest pain. As a result,
clinicians should be suspicious of cocaine use in their differential diagnosis of chest pain, especially in the younger
male population, and proceed more cautiously when use is suspected.Treatment for cocaine-related cardiovascular
disease is in many ways similar to treatment for traditional cardiovascular disease. However use of beta-receptor
antagonists and class Ia and III anti-arrhythmics is strongly discouraged if the patient is likely to continue cocaine use,
because of documented adverse effects.The medical community is in urgent need of a pharmacologic adjunct to
cocaine-dependence treatment that can deter relapse and reduce the risks associated with cardiovascular disease in
these patients. 2009 Adis Data Information BV. All rights reserved.
Cocaine remains the second most used illicit drug in europe, after cannabis, though levels of use vary between
countries. This psychostimulant has become a noticeable part of the european drug scene. Cocaine dependence, a
chronic, relapsing and multifactorial disorder, is a significant worldwide public health problem with somatic, legal,
social, cognitive and psychological complications. The relationship between clinical psychotic symptoms and use of
specific substances other than cannabis has received minimal attention in the litterature. Psychotic symptoms and
experience of paranoia and suspiciousness are reported during the use and the withdrawal of cocaine. Furthermore,
although psychotic symptoms were found to be common among substance users, the risk for development of
chronic psychotic disorder was found. In the light of recent epidemiological data stating that there is an increased
cocaine use, that there is an increased number of patients entering drug treatment for primary cocaine use in europe
for several years and that cocaine users are an heterogeneous group, we made a review on the specific topic of
cocaine-induced psychotic disorders. This review is based on Medline, EMBASE, psycINFO and Google scholar
searches of english and French-language articles published between 1969 and February, 2010.
Introduction: Research on the prevalence, recognition and treatment of illicit drug use, such as cocaine, in elderly
adults remains rather limited despite noted increased trend of use among adults age 50+. Historically, most of the
existing data has focused on the identification and treatment of alcohol related disorders in this population. The
purpose of this study is to review if there are any validated screening tools for detecting cocaine use/abuse in elderly
adults and see if there are any common risk factors among reported elderly cocaine users that could be used for
future screening and diagnostic purposes. Methods: A literature review was done on Google Scholar and PubMed
using the following MESH terms: cocaine use and elderly, cocaine use and older adults, cocaine screening tools and
elderly. Using "related articles" link additional articles and case studies were screened for inclusion. Results: A total
of five case studies describing elderly adults with cocaine abuse/dependence were identified and findings are
summarized in a table. Five of the case studies were reported to be male and all patients were between ages of 64-
75 at time of treatment. Three of the five cases (60%) were new onset cocaine users. Being retired,
divorced/widowed and prior drug use were noted to be among most common risk factors among this group. These
findings seem similar to other published study by Rivers et al in which positive cocaine users were mostly male
(88.9% n=18), had mean age of 66.4 years and 11.1% (2/18) had prior drug use history. Review of available literature
found there are no current validated screening tools for identification of cocaine use in elderly adults. Hinkin et al
published a study in 2001 using a modified version of CAGE to screen for both alcohol and drug consumption which
was found to have high sentivity but low specificity. Further studies are needed to determine validity of this
particular screening tool in this population. Conclusions: There is a great need for future research in this topic,
particularly in terms of determining if there are any significant differences between early onset versus late onset
cocaine users. While sample size in these findings is limited, it appears that being male with divorced/widow status
and prior drug use history places elderly adult males at higher risk of cocaine use/abuse. In the absence of validated
screening tools, the modified version of the CAGE can be used to screen for cocaine and other illicit drug use. Bottom
line, it is important to ask elderly patients, regardless of age or sex, about cocaine use based on data that shows that
late onset cocaine use is just as possible as early onset.
The Cochrane systematic review promotes evidence-based outcome studies. This review was conducted to
determine reliable evidence concerning the effectiveness of tongue scraping or cleaning, compared with other
interventions for controlling halitosis. A competent search strategy was developed and used across several databases-
including the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials,
MEDLINE, EMBASE, and Google Scholar-to identify randomized controlled trials that compared different methods of
tongue cleaning to reduce mouth odor in adults with halitosis. Methodological quality of studies was assessed based
on criteria defined by the Cochrane Collaboration. Clinical outcome (expressed in terms of a reduction in mouth odor
in adults with halitosis) was examined. The review included two trials involving a total of 40 participants. Based on
the independent data from these two trials, the tongue cleaner or the tongue scraper demonstrated a statistically
significant difference in reducing levels of volatile sulfur compounds (VSCs) when compared with the toothbrush. The
findings indicate a small but statistically significant difference in reduction of VSC levels when tongue scrapers or
cleaners, rather than toothbrushes, are used to reduce halitosis in adults.
Coexistence of breast cancer and tuberculosis (TB) of the breast and/or axillary lymph nodes is uncommon. In this
article, we present a case of tuberculous axillary lymphadenitis existing simultaneously with invasive ductal
carcinoma of the left breast. We also conducted an extensive literature review of English language studies published
on the coexistence of breast cancer and TB of the breast and/or axillary lymph nodes from 1899 to 2011 using the
PubMed and Google Scholar databases. Twenty-nine cases of coexisting breast cancer and TB of the breast and/or
axillary lymph nodes have been published to date, including a 74-year-old female diagnosed with left breast cancer
and TB of the axillary lymph nodes. A tumor in the right breast was detected in 14 patients and in the left breast in
12 patients between the ages of 28 and 81 years, but no data were available regarding the side on which the tumor
occurred in three patients. Eighteen patients underwent a modified radical mastectomy, five patients underwent a
radical mastectomy, two a lumpectomy and an axillary lymph node dissection (ANLD), two a quadrantectomy (Q) and
an ALND, and two an applied excision. TB was detected at the axilla in all 21 patients in patients with no TB of the
breast, and TB was also detected in the axilla in five of eight patients with breast TB. Both a tumor and TB
lymphadenitis were detected following an axillary dissection in 14 patients, and both cancer metastasis and TB
lymphadenitis were detected at the same lymph nodes in six of these patients. The simultaneous occurrence of
these two major illnesses in the breast and/or axillary lymph nodes can produce many problems with respect to
diagnosis and treatment. Accurate diagnoses are necessary for down-staging carcinoma of the breast and for
identifying curable disease. 2011 Springer Science+Business Media, LLC.
Several reviews have concluded that graded exercise therapy (GET) and cognitive behavioral therapy (CBT) may be
efficacious treatments for chronic fatigue syndrome (CFS). The aim of the current metaanalyses was to extend these
reviews by directly comparing the two treatment approaches and addressing methodological limitations of previous
reviews. An additional aim was to explore possible moderators of treatment effects including treatment setting
(secondary versus primary care), individual versus group therapy, quality of study, and number of therapy. Published
and unpublished trials were identified through a systematic search of Medline, Biological Abstracts, Science Citation
Index, Social Science Citation Index, PsycINFO, PsycBOOKS, Cochrane Reviews, Cochrane Database of Clinical Trials,
ProQuest Dissertations & Theses, Dissertation Abstracts International and Google Scholar in April 2011. A total of 21
randomized-controlled trials met inclusion criteria; GET (n = 5) and CBT (n = 16). The standardized mean difference
coefficient (d) was used as the effect size (ES) statistic, adjusted using Hedge's correction, g. Overall effect sizes
suggested that GET (g = 0.28) and CBT (g = 0.33) were equally efficacious. Levels of fatigue were significantly reduced
compared with controls (g = 0.35, CI = 0.24, 0.46, p <.001), as were levels of functional impairment (g = 0.38, CI =
0.27, 0.49, p <.001), depression (g = 0.28, CI = 0.08, 0.49, p <.01), and anxiety (g = 0.16, CI = 0.02, 0.31, p <.05). CBT
effect sizes were lower in primary care settings and for treatments offering fewer hours of contact. CBT tended to
result in a greater reduction in depression and anxiety than GET, possibly reflecting the greater emphasis on the role
of emotional factors in the perpetuation of fatigue. The results suggested that both CBT and GET are promising
treatments for CFS, although CBT may be a more effective treatment when patients have co-morbid anxiety and
depressive symptoms. The results will be discussed in relation to recent meta-analysis of similar trials in chronic pain.
Introduction: Tobacco is an important source of somatic diseases and causes high mortality. It is associated with
cognitive disorders which tend to maintain addictive mechanisms. In the short term, the nicotine contained in
tobacco enhances attention and memory. Method: To realize this review, we made a research, we made a research
on medline, embase, psycinfo, google scholar using the single or combined key-words <>, <>, <>, <>, <>, <>, <>, <>,
<>. We selected English or French articles from 1987 to 2008 by privileging controlled studies. Results: This effect can
be observed in smokers (with or without withdrawal symptoms), non-smokers and in patients suffering from
cognitive disorders. In the long term, tobacco accelerates dementia processes. It is associated with an increased risk
of cognitive deterioration. This deterioration concerns mainly memory and processing speed. These results were
reported in prospective studies. They contradict early reports, that suggested smoking could actually be protective
against certain central neural system disorders. These early results relayed on case-control studies, which were
certainly biased by a "healthy survival effect". Further studies are required to evaluate nicotine's long term effect
and its potential efficacy in treating and preventing cognitive disorders or dementia. 2009 Elsevier Masson SAS. All
rights reserved.
INTRODUCTION: Tobacco is an important source of somatic diseases and causes high mortality. It is associated with
cognitive disorders which tend to maintain addictive mechanisms. In the short term, the nicotine contained in
tobacco enhances attention and memory., METHOD: To realize this review, we made a research, we made a research
on Medline, Embase, PsycInfo, Google Scholar using the single or combined key-words "tobacco", "nicotine",
"addiction", "dependence", "cognitive disorders", "executive function", "memory", "attention",
"neuropsychological". We selected English or French articles from 1987 to 2008 by privileging controlled studies.,
RESULTS: This effect can be observed in smokers (with or without withdrawal symptoms), non-smokers and in
patients suffering from cognitive disorders. In the long term, tobacco accelerates dementia processes. It is associated
with an increased risk of cognitive deterioration. This deterioration concerns mainly memory and processing speed.
These results were reported in prospective studies. They contradict early reports, that suggested smoking could
actually be protective against certain central neural system disorders. These early results relayed on case-control
studies, which were certainly biased by a "healthy survival effect". Further studies are required to evaluate nicotine's
long term effect and its potential efficacy in treating and preventing cognitive disorders or dementia.
BACKGROUND: Raynaud's Phenomenon is characterised by 3-phasic colour changes of fingers and/or toes caused by
vasospam of the digital arteries due to low temperature and/or psychological stress. These colour changes may be
accompanied by decreased skin temperature which can be identified by infrared thermal imaging. OBJECTIVE: To
identify procedures which address patient's preparation, temperature of the examination room, temperature and
duration of the immersion bath, position of hands, time of follow-up after the cold challenge and method of
evaluation METHOD: A computer assisted literature search was performed for publications related to thermographic
investigations of patients with suspected Raynaud's phenomenon in Embase, Medline, Google Scholar and the
literature archive of the author. RESULTS: Out of 170 hits in Google and 98 in Embase/Medline, in total 50 articles
and 6 reviews were included. The information on procedures performed was incomplete in the identified studies.
There was a wide variation in water temperature of the immersion bath and also of duration of immersion. More
than 20 different methods for evaluation of hand temperatures were reported CONCLUSION: The description of the
methodology must improve. A evidence based guideline for standard procedures of performing and evaluation of
thermal images from patients with Raynaud's phenomenon is needed.
Background. Increasing evidence from numerous research studies in internal medicine shows that adipocytes and
adipokines are involved in primary inflammatory processes and disease. CORS-26 (collagenous repeat- containing
sequence of 26 kDa protein) is a newly discovered adipokine of the C1q/TNF molecular superfamily C1q/TNF-related
protein-3 (CTRP-3) secreted, inter alia in murine monocytes and adipocytes and in human adipocytes. Reported
recently as a gene product of adipocyte differentiation, it shares structural similarity with the adipocyte, adiponectin.
CORS-26 is much less known than other adipocytes such as leptin and resistin. Knowledge of its various functions has
clinical and therapeutic implications especially in relation to obesity and the metabolic syndrome. Aims. This review
aims to provide current knowledge of this adipokine. Methods. Review; sources were scientific biomedical databases
Medline/PubMed, BioMedCentral, Google Scholar, Ovid, ProQuest from to 1998 to 2009. Conclusion. CORS-26 is an
adipokine that regulates the secretion of other adipokines. Its effects on adipokine secretion are most probably
independent of PPAR-. As CORS-26 up-regulates adiponectin secretion, it may be involved in metabolic and
immunologic pathways. The effect of recombinant CORS-26 on insulin signaling in the presence of the metabolic
syndrome needs to be investigated to further evaluate the physiological and pathophysiological role of this protein.
M. Svestak, L. Sporova, P. Hejduk, B. Lacnak, D. Stejskal.
BACKGROUND: Increasing evidence from numerous research studies in internal medicine shows that adipocytes and
adipokines are involved in primary inflammatory processes and disease. CORS-26 (collagenous repeat- containing
sequence of 26 kDa protein) is a newly discovered adipokine of the C1q/TNF molecular superfamily C1q/TNF-related
protein-3 (CTRP-3) secreted, inter alia in murine monocytes and adipocytes and in human adipocytes. Reported
recently as a gene product of adipocyte differentiation, it shares structural similarity with the adipocyte, adiponectin.
CORS-26 is much less known than other adipocytes such as leptin and resistin. Knowledge of its various functions has
clinical and therapeutic implications especially in relation to obesity and the metabolic syndrome., AIMS: This review
aims to provide current knowledge of this adipokine., METHODS: Review; sources were scientific biomedical
databases Medline/PubMed, BioMedCentral, Google Scholar, Ovid, ProQuest from to 1998 to 2009., CONCLUSION:
CORS-26 is an adipokine that regulates the secretion of other adipokines. Its effects on adipokine secretion are most
probably independent of PPAR-. As CORS-26 up-regulates adiponectin secretion, it may be involved in metabolic and
immunologic pathways. The effect of recombinant CORS-26 on insulin signaling in the presence of the metabolic
syndrome needs to be investigated to further evaluate the physiological and pathophysiological role of this protein.
Design: Systematic review. Data sources: A total of 21 electronic databases and other pertinent literature sources
were systematically surveyed to identify English peer-reviewed literature from 1960 to 2007 that addressed one or
more of the research questions (i.e., speech physiology, speech production, speech intelligibility). Searches were
based around 71 keywords that pertained to OME, swallowing, and speech treatment. In addition, searches of all
ASHA journals, Google Scholar, and a manual examination of pertinent publications were also carried out. There
were 899 publications that were identified initially. Study selection and assessment: Two of the authors
independently examined each abstract and identified criteria. The criteria included peer-reviewed articles written in
English and published during the review period that addressed one or more of the clinical research questions. The
agreement between the two authors was 91%. Following the initial identifi-cation, a second review was carried out
by the same two authors, and 250 of the 346 studies were eliminated, because either the aim of stud-ies was not
consistent with the research questions or the studies did not present original research data. There were 96 studies
remaining that were included for the review. In a third and final review, 15 studies of the 96 were identified as
addressing one or more of the three research questions. After the 15 studies were identified, the same two authors
independently rated the methodological quality of the studies. The methodological indicators included: study design,
assessor blinding, sampling/allocation, subject comparability/description, outcomes, significance, precision, and
intention to treat. Studies were awarded a point in each category if they met the highest established criterion for
that category. For example, a controlled trial investigation was ranked as the highest quality indicator in the study
design category and was awarded a point, while a cohort study or other experimental or quasi-experimental design
did not receive a point since it did not meet the rigor of a controlled trial. The highest score that could be awarded
was eight, as there were eight categories of methodological quality. Assessments by the two authors of the 15
studies were reviewed and re-analyzed by at least one of three additional authors who served as a three-member
evidence review panel. Their responsibilities were to verify that the studies addressed the clinical research
question(s) and that there was agreement of ratings of the methodological indicators. The three additional authors
were practitioner/ researchers with expertise in the areas of speech treatment and OME. Agreement between the
two original authors and the author panel was reported to be greater than 98%. Any difference in agreement
between the two groups was settled through consensus. In addition, each study was also classified as either efficacy
or exploratory research. An efficacy research study employed an experi-mental or quasi-experimental design, utilized
subjects from a disordered population, and measured the treat-ment outcome of OME. Studies not meeting one or
Aim: To describe systems for capturing and optimising collective knowledge and insight in areas of complexity and
uncertainty in surgical oncology, with particular reference to the Delphi process and related systems. Methods:
Internet search engines (Google, Google Scholar) and four databases (SCOPUS, PubMed, Medline and Embase) were
searched to find English language articles on the use of The Delphi Process and related systems in surgical oncology,
using a variety of search terms. Findings: There are a number of established systems for co-opting group knowledge
and facilitating collective decision-making. These find applications in commerce, industry, government and defence.
They have also been applied to problems in surgical oncology, for example using the Delphi process to optimise the
management of colorectal cancers and metastases. Conclusions: Collective decision making tools find practical
applications in the allocation of resources and in clinical decision making in fields of surgical oncology practice where
there is a wide range of evidence and expert opinion. Such methodologies set new standards for the collating of
professional expertise and for the writing of "best clinical practice" guidelines in the cancer subspecialities. 2010
Elsevier Ltd. All rights reserved.
Carcinoma of the colon and rectum is about the 2nd commonest cancer in the developed (western) world; however
in developing countries especially West Africa it has not yet reached such magnitude. This suggests that there may
be factors either anthropomorphic or environmental which may be responsible for this. The paper acknowledges the
reduced incidence of colorectal cancer in native West Africans living in Africa and endeavors to highlight the various
factors that produce this observation in medical literature. A compelling search through available literature on the
aetiology, epidemiology and comparative anthropology of colorectal cancer was done. Internet search using
Pubmed, British library online and Google scholar was also utilized. The rarity of adenomatous polyposis syndromes
in the native West African contributes to the reduced incidence of colorectal cancer. Cancer prevention and cancer-
protective factors are deemed to lie in the starchy, high-fiber, spicy, peppery foodstuff low in animal protein which
many West African nations consume. Lactose intolerance which many black races have is also suggested to be
protective, likewise exposure to sunlight and physical activity. The natural geographical location which ensures all-
year-round sunshine, avoidance of western-type diet and rarity of polyposis coli syndromes may continue to keep
the rates of colorectal cancer down (when compared to Caucasians) in the native West African.
Carcinoma of the colon and rectum is the 2nd commonest cancer in the United States; the leading cancer being lung
cancer. It has been estimated that 130,200 new cases of colorectal cancer will be diagnosed annually while 56,300
sufferers will die from the disease (Murphy et al., 2000). In developing countries especially West Africa, the rate has
not yet reached such magnitude. This suggests that there may be factors either anthropomorphic or environmental
which may be responsible for this. The paper acknowledges the reduced incidence of colorectal cancer in native
West Africans living in Africa and endeavours to highlight the various factors that produce this observation in medical
literature. A diligent search through available literature on the aetiology, epidemiology and comparative
anthropology of colorectal cancer was done. Internet search using Pubmed, British library online and Google scholar
was also utilized. The rarity of adenomatous polyposis syndromes in the native West African contributes to the
reduced incidence of colorectal cancer. Cancer prevention and cancer-protective factors are deemed to lie in the
starchy, high-fiber, spicy, peppery foodstuff low in animal protein which many West African nations consume.
Copyright 2011 David Omoareghan Irabor.
BACKGROUND: Mycobacterium tuberculosis is a leading cause of death worldwide. In multi-drug resistant
tuberculosis (MDR-TB) infectiousness is frequently prolonged, jeopardizing efforts to control TB. The conventional
tuberculosis drug susceptibility tests are sensitive and specific, but they are not rapid. The INNO-LiPA Rif. TB (LiPA) is
a commercial line probe assay designed to rapidly detect rifampicin resistance, a marker of MDR-TB. Although LiPA
has shown promising results, its overall accuracy has not been systematically evaluated., METHODS: We did a
systematic review and meta-analysis to evaluate the accuracy of LiPA for the detection of rifampicin-resistant
tuberculosis among culture isolates and clinical specimens. We searched Medline, Embase, Web of Science, BIOSIS,
and Google Scholar, and contacted authors, experts and the manufacturer. Fifteen studies met our inclusion criteria.
Of these, 11 studies used culture isolates, one used clinical specimens, and three used both. We used a summary
receiver operating characteristic (SROC) curve and Q* index to perform meta-analysis and summarize diagnostic
accuracy., RESULTS: Twelve of 14 studies that applied LiPA to isolates had sensitivity greater than 95%, and 12 of 14
had specificity of 100%. The four studies that applied LiPA directly to clinical specimens had 100% specificity, and
sensitivity that ranged between 80% and 100%. The SROC curve had an area of 0.99 and Q* of 0.97., CONCLUSION:
LiPA is a highly sensitive and specific test for the detection of rifampicin resistance in culture isolates. The test
appears to have relatively lower sensitivity when used directly on clinical specimens. More evidence is needed
before LiPA can be used to detect MDR-TB among populations at risk in clinical practice.
Background: Mycobacterium tuberculosis is a leading cause of death worldwide. In multi-drug resistant tuberculosis
(MDR-TB) infectiousness is frequently prolonged, jeopardizing efforts to control TB. The conventional tuberculosis
drug susceptibility tests are sensitive and specific, but they are not rapid. The INNO-LiPA Rif. TB (LiPA) is a
commercial line probe assay designed to rapidly detect rifampicin resistance, a marker of MDR-TB. Although LiPA has
shown promising results, its overall accuracy has not been systematically evaluated. Methods: We did a systematic
review and meta-analysis to evaluate the accuracy of LiPA for the detection of rifampicin-resistant tuberculosis
among culture isolates and clinical specimens. We searched Medline, Embase, Web of Science, BIOSIS, and Google
Scholar, and contacted authors, experts and the manufacturer. Fifteen studies met our inclusion criteria. Of these, 11
studies used culture isolates, one used clinical specimens, and three used both. We used a summary receiver
operating characteristic (SROC) curve and Q* index to perform meta-analysis and summarize diagnostic accuracy.
Results: Twelve of 14 studies that applied LiPA to isolates had sensitivity greater than 95%, and 12 of 14 had
specificity of 100%. The four studies that applied LiPA directly to clinical specimens had 100% specificity, and
sensitivity that ranged between 80% and 100%. The SROC curve had an area of 0.99 and Q* of 0.97. Conclusion: LiPA
is a highly sensitive and specific test for the detection of rifampicin resistance in culture isolates. The test appears to
have relatively lower sensitivity when used directly on clinical specimens. More evidence is needed before LiPA can
be used to detect MDR-TB among populations at risk in clinical practice. 2005 Morgan et al; license BioMed Central
Ltd.
The exact incidence of common post-operative complications in children is not known. Most common one is post-
operative nausea and vomiting followed by respiratory complications leading to hypoxia. Cardiac complications are
less in children without associated congenital cardiac anomaly. Post-operative shivering, agitation and delirium are
seen more often in children anaesthetised with newer inhalational agents like sevoflurane and desflurane. Urinary
retention in the post-operative period could be influenced by anaesthetic drugs and regional blocks. The purpose of
this article is to review the literature and present to the postgraduate students comprehensive information about the
current understanding and practice pattern on various common complications in the postoperative period. Extensive
literature was searched with key words of various complications from Pubmed, Google scholar and specific journal,
namely paediatric anaesthesia. The relevant articles, review article meta-analysis and editorials were the primary
source of information for this article.
This article aims to review ethical and clinical guidelines and policies addressing the communication of genetic
information in families. Websites of national and regional bioethics committees, national human genetics societies,
international health organisations, genetic interest groups and legal recommendations committees were searched
for guidelines and policies. The databases Medline, Web of Science and Google Scholar were also utilised to search
for additional guidelines relating to the communication of genetic information in families. The guidelines and policies
included in this review are limited to those available in English. The search resulted in guidelines from 18
international, regional and national organisations from six countries pertaining to family communication of genetic
information. The following ideals were common in their guidelines: (1) individuals have a moral obligation to
communicate genetic information to their family members; (2) genetic health professionals should encourage
individuals to communicate this information to their family members; and (3) genetic health professionals should
support individuals throughout the communication process. The difference between the organisations' guidelines
was the inclusion of information about the role of the health professional in supporting clients during the process of
communicating genetic information to their family members. Only two recommendations suggested that the health
professional should support their clients by identifying at-risk family members, but more guidelines recommended
that directive counselling should be undertaken to encourage clients to communicate genetic information to their
family members. In conclusion, the guidelines provide an overview of the role that genetic health professionals may
undertake; however, there are gaps that need to be addressed.
This article aims to review ethical and clinical guidelines and policies addressing the communication of genetic
information in families. Websites of national and regional bioethics committees, national human genetics societies,
international health organisations, genetic interest groups and legal recommendations committees were searched
for guidelines and policies. The databases Medline, Web of Science and Google Scholar were also utilised to search
for additional guidelines relating to the communication of genetic information in families. The guidelines and policies
included in this review are limited to those available in English. The search resulted in guidelines from 18
international, regional and national organisations from six countries pertaining to family communication of genetic
information. The following ideals were common in their guidelines: (1) individuals have a moral obligation to
communicate genetic information to their family members; (2) genetic health professionals should encourage
individuals to communicate this information to their family members; and (3) genetic health professionals should
support individuals throughout the communication process. The difference between the organisations' guidelines
was the inclusion of information about the role of the health professional in supporting clients during the process of
communicating genetic information to their family members. Only two recommendations suggested that the health
professional should support their clients by identifying at-risk family members, but more guidelines recommended
that directive counselling should be undertaken to encourage clients to communicate genetic information to their
family members. In conclusion, the guidelines provide an overview of the role that genetic health professionals may
undertake; however, there are gaps that need to be addressed.
This paper examines the structure, the principles, the skills and the training methods of communication for
midwives. There has been a research for relevant studies in Pubmed, Scholar Google, British Journal of Midwifery
and Midwifery Today. Twenty studies have been found, three of them referring to the effect of communication on
midwifery practice, four referring to the communication principles, four to the communication skills and nine to the
communication skills training. From the studies emerged the significance of communication between the health
worker and the mother/family, as communication seems to affect labour, women's satisfaction of perinatal care,
quality of clinical practice and the appearance of professional burnout. Health workers need to be aware of the
communication structure and principles and get communication skills training either during their nursing/midwifery
studies or during their career.
Background: Community-acquired pneumonia (CAP) is a frequent cause of hospitalization and death among the
elderly. Objective: This article reviews information on CAP among the elderly, including age-related changes,
predisposing risk factors, causes, treatment strategies, and prevention. Methods: Searches of MEDLINE (January
1990-November 2009), International Pharmaceutical Abstracts (January 1990-November 2009), and Google Scholar
were conducted using the terms community-acquired pneumonia, pneumonia, treatment guidelines, and elderly.
Additional publications were found by searching the reference lists of the identified articles. Studies that reported
diagnostic criteria as well as the treatment outcomes achieved in adult patients with CAP were selected for this
review. Results: Three practice guidelines, 5 reviews, and 43 studies on CAP in the elderly were identified in the
literature search. Based on those publications, risk factors that predispose the elderly to pneumonia include
comorbid conditions, poor functional and nutritional status, consumption of alcohol, and smoking. The clinical
presentation of pneumonia in the elderly (>=65 years of age) may be subtle, lacking the typical acute symptoms
(fever, cough, dyspnea, and purulent sputum) observed in younger adults. Pneumonia should be suspected in all
elderly patients who have fever, altered mental status, or a sudden decline in functional status, with or without
lower respiratory tract symptoms such as cough, purulent sputum, and dyspnea. Treatment of CAP in the elderly
should be guided by the latest recommendations of the Infectious Diseases Society of America and the American
Thoracic Society (IDSA/ATS), along with consideration of local rates and patterns of antimicrobial resistance, as well
as individual patient risk factors for acquiring less common or more resistant pathogens. Recommended empiric
antimicrobial regimens generally consist of either a beta-lactam plus a macrolide or a respiratory fluoroquinolone
alone. Adherence to the IDSA/ATS guidelines has been found to improve in-hospital mortality (adherence vs
nonadherence, 8%; 95% CI, 7%-10% vs 17%; 95% CI, 14%-20%; P< 0.01), length of hospital stay (8 days; interquartile
range [IQR], 5-15 vs 10 days; IQR, 6-24 days, respectively; P < 0.01), and time to clinical stability in elderly patients
with CAP (percentage of stable patients by day 7, 71%; 95% CI, 68%-74% vs 57%; 95% CI, 53%-61%, respectively; P <
0.01). All elderly patients should be vaccinated against pneumococcal disease and influenza based on
recommendations from the Centers for Disease Control and Prevention. Lifestyle modifications and nutritional
support are also important elements in the prevention of pneumonia in the elderly. Conclusion: Adherence to
established guidelines, along with customization of antimicrobial therapy based on local rates and patterns of
resistance and patient-specific risk factors, likely will improve the treatment outcome of elderly patients with CAP.
2010 Excerpta Medica Inc. All rights reserved.
While maternal, infant and under-five child mortality rates in developing countries have declined significantly in the
past two to three decades, newborn mortality rates have reduced much more slowly. While it is recognised that
almost half of the newborn deaths can be prevented by scaling up evidence-based available interventions such as
tetanus toxoid immunisation to mothers; clean and skilled care at delivery; newborn resuscitation; exclusive
breastfeeding; clean umbilical cord care; management of infections in newborns, many require facility based and
outreach services. It has also been stated that a significant proportion of these mortalities and morbidities could also
be potentially addressed by developing community-based packages interventions which should also be
supplemented by developing and strengthening linkages with the local health systems. Some of the recent
community-based studies of interventions targeting women of reproductive age have shown variable impacts on
maternal outcomes and hence it is uncertain if these strategies have consistent benefit across the continuum of
maternal and newborn care. To assess the effectiveness of community-based intervention packages in reducing
maternal and neonatal morbidity and mortality; and improving neonatal outcomes. We searched The Cochrane
Pregnancy and Childbirth Group's Trials Register (January 2010), World Bank's JOLIS (12 January 2010), BLDS at IDS
and IDEAS database of unpublished working papers (12 January 2010), Google and Google Scholar (12 January 2010).
All prospective randomised and quasi-experimental trials evaluating the effectiveness of community-based
intervention packages in reducing maternal and neonatal mortality and morbidities; and improving neonatal
outcomes. Two review authors independently assessed trial quality and extracted the data. The review included 18
cluster-randomised/quasi-randomised trials, covering a wide range of interventional packages, including two subsets
from one trial. We incorporated data from these trials using generic inverse variance method in which logarithms of
risk ratio estimates were used along with the standard error of the logarithms of risk ratio estimates. Our review did
not show any reduction in maternal mortality (risk ratio (RR) 0.77; 95% confidence interval (CI) 0.59 to 1.02, random-
effects (10 studies, n = 144,956), I2 39%, P value 0.10. However, significant reduction was observed in maternal
morbidity (RR 0.75; 95% CI 0.61 to 0.92, random-effects (four studies, n = 138,290), I2 28%; neonatal mortality (RR
0.76; 95% CI 0.68 to 0.84, random-effects (12 studies, n = 136,425), I2 69%, P value < 0.001), stillbirths (RR 0.84; 95%
CI 0.74 to 0.97, random-effects (11studies, n = 113,821), I2 66%, P value 0.001) and perinatal mortality (RR 0.80; 95%
CI 0.71 to 0.91, random-effects (10 studies, n = 110,291), I2 82%, P value < 0.001) as a consequence of
implementation of community-based interventional care packages. It also increased the referrals to health facility for
pregnancy related complication by 40% (RR 1.40; 95% CI 1.19 to 1.65, fixed-effect (two studies, n = 22,800), I2 0%, P
Aims: To review community-based participatory research (CBPR) studies addressing cancer control in Indigenous
populations. Specifically, this review aimed to assess the precise manner in which CBPR has been carried out, as well
as the extent to which successful outcomes have been facilitated by the adoption of CBPR and/or other
methodological approaches. Methods: Articles addressing Indigenous cancer control through some aspect of the
CBPR approach were identified via a search of the following electronic databases: MEDLINE (via Ovid and Pubmed),
Embase, psycINFO, psycARTTCLES, CINAHL, and Google Scholar. Studies considered relevant for inclusion were
analysed according to Green et al.'s (1995) guidelines for participatory research. Results: 41 articles reporting on 30
studies were selected for inclusion. The majority adopted aspects of the CBPR approach selectively, with only 12 of
the 30 studies providing some opportunity for community members to contribute physical or intellectual resources
to the research process, and 10 studies providing clear benefits to the communities involved. Research that resulted
in successful outcomes (such as the provision of health benefits, and facilitation of capacity-building and community
empowerment) tended to be initiated by Indigenous community members or organisations. Research linked with
successful program outcomes was fostered by the inclusion of community members in genuine roles within the
research team, from planning, to implementation, to presentation of results at conferences. Conclusions: This review
highlighted significant areas for improvement in CBPR studies addressing Indigenous cancer control. While a small
number of studies were enhanced by genuine engagement of community members throughout the research
process, the majority stopped at initial consultation with Indigenous community organisations, or simply engaged
Indigenous people as translators or data collectors. Increased attention to the philosophical underpinning of CBPR is
required in order to ensure that the benefits of this approach are translated to improved cancer control outcomes.
Introduction: Treatment and survival rates for patients with lung cancer in Scotland appear lower than in many other
European countries. Five-year survival is quoted at 6% to 7% compared with 8% to 15% in other European countries
and America. There also appear to be variations in treatment rates within Scotland. Although this variation in
treatment and survival is popularly interpreted as evidence of variation in facilities, access to care, and clinical
practice, it is possible that the increased comorbidity and poor performance status of the Scottish population may
contribute to the observed disparities in treatment and outcomes, although this has never been proven. The
demonstration that comorbidity influences treatment and survival rates will have important implications for the
targeting of health services resources, screening, interpretation of cancer statistics, and the assessment and
management of patients with lung cancer. Methods: In this article we have reviewed the tools currently available for
assessing comorbidity and in addition have identified published works which study the effect of comorbidity in lung
cancer. Conclusion: There is no currently validated measurement tool applicable specifically to lung cancer and thus
there remains a significant need for further work in this important area. Statement of Search Strategies Used and
Sources of Information: Literature searches were undertaken via PubMed and Google Scholar using various arrays of
the following keywords: cancer, comorbidity, lung lancer, performance status, survival, and tools. The search was
limited to articles published in peer-review journals with English as the language. 2011 Elsevier Inc. All rights
reserved.
Background Novel oral anticoagulants have been tested against warfarin for atrial fibrillation, yet no direct
comparison is available. We therefore performed pair-wise and warfarinadjusted network meta-analyses of novel
oral anticoagulants for atrial fibrillation. Materials and Methods CENTRAL, Google Scholar, MEDLINE/PubMed and
Scopus were searched for randomized warfarin-controlled trials of novel anticoagulants for nonvalvular atrial
fibrillation (updated September 2011). The primary end-point was stroke/systemic embolism at the longest available
follow up. Odds ratios (OR) with 95% intervals were computed with RevMan and WinBUGS using intentionto- treat
data. From 7,114 citations, 7 trials (52701 patients) were included, focusing on apixaban, dabigatran, edoxaban and
rivaroxaban. Studies were very similar, despite a higher baseline risk of patients in the rivaroxaban trial. Results Pair-
wise meta analysis showed that after a weighted average of 23 months these novel anticoagulants led to significant
reductions in the risk of stroke/systemic embolism (OR=0.81 [0.71-0.92]) and all cause death (OR=0.88 [0.82- 0.95])
in comparison to warfarin. Head-to-head comparisons showed that apixaban and dabigatran proved similarly
superior to warfarin in preventing stroke/systemic embolism (OR=0.78 [0.62-0.96] for apixaban and OR=0.66 [0.52-
0.84] for high-dose dabigatran vs. warfarin; OR for head-to-head comparison=1.17 [0.85-1.63]), but apixaban was
associated with fewer major bleedings (OR=0.73 [0.57-0.93]) and drug discontinuations (OR=0.64 [0.52-0.78]) than
dabigatran. Rivaroxaban did not reduce stroke/systemic embolism (OR=0.87 [0.71-1.07]) or major bleedings in
comparison to warfarin (OR=0.87 [0.71-1.07]) and was associated with more major bleedings in comparison to
apixaban (OR=1.52 [1.19-1.92]). Data for edoxaban were inconclusive. Conclusions Novel oral anticoagulants
represent a paradigm shift in the management of atrial fibrillation.
Background: Studies have found a relationship between decreased immunity and increased incidence of cancer.
Methods: A systematic review of observational studies evaluating the incidence of cancer in both organ recipients
and people with HIV/AIDS compared with the general population. Eligible studies were searched up to March 2011 in
the following databases: Pubmed, Embase, Scielo, Cancerlit and Google scholar. In this study, the standardized
incidence ratios (SIR) of cancer in people with HIV/AIDS and of organ transplant recipients were compared with those
found among the general population. Results: Twenty-five studies of transplant and HIV-associated cancer risk,
involving 866. 776 people with HIV/AIDS or organ recipients and 21. 260 new cases of cancer, were included. The risk
for the development of new cancer cases was higher among people with HIV/AIDS (SIR. =. 4, IC95% 3.78-4.24) and
who received organs (SIR. =. 3.28, IC95% 3.06-3.52) when compared with the general population. Conclusion: Similar
SIR in both immunocompromised populations suggests that the weakened immune system is responsible for the
increased risk of new cases of cancer among these groups. Research investments are needed to develop effective
cancer prevention strategies in these populations. 2011 Elsevier Ltd.
BACKGROUND: Studies have found a relationship between decreased immunity and increased incidence of cancer.,
METHODS: A systematic review of observational studies evaluating the incidence of cancer in both organ recipients
and people with HIV/AIDS compared with the general population. Eligible studies were searched up to March 2011 in
the following databases: Pubmed, Embase, Scielo, Cancerlit and Google scholar. In this study, the standardized
incidence ratios (SIR) of cancer in people with HIV/AIDS and of organ transplant recipients were compared with those
found among the general population., RESULTS: Twenty-five studies of transplant and HIV-associated cancer risk,
involving 866776 people with HIV/AIDS or organ recipients and 21260 new cases of cancer, were included. The risk
for the development of new cancer cases was higher among people with HIV/AIDS (SIR=4, IC95% 3.78-4.24) and who
received organs (SIR=3.28, IC95% 3.06-3.52) when compared with the general population., CONCLUSION: Similar SIR
in both immunocompromised populations suggests that the weakened immune system is responsible for the
increased risk of new cases of cancer among these groups. Research investments are needed to develop effective
cancer prevention strategies in these populations. Copyright A 2011 Elsevier Ltd. All rights reserved.
Objectives: (i) To review contributions and limitations of decision support systems for automatic recruitment of
patients to clinical trials (Clinical Trial Recruitment Support Systems, CTRSS). (ii) To characterize the important
features of this domain, the main classes of approach that have been used, and their advantages and disadvantages.
(iii) To assess the effectiveness and potential of such systems in improving trial recruitment rates. Data sources:: A
systematic MESH keyword-based search of Pubmed, Embase, and Scholar Google for relevant CTRSS publications
from January 1st 1998 to August 31st 2009 yielded 73 references, from which 33 relevant papers describing 28
distinct studies were chosen for review, based on their report of a novel decision support system for trial recruitment
which reused already available patient data. Method: The reviewed papers were classified using a modified version
of an existing taxonomy for clinical decision support systems, using 10 axes relevant to the trial recruitment domain.
Results: It proved possible and useful to characterize CTRSS on a relatively small number of dimensions and a
number of clear trends emerge from the study. Only nine papers reported a useful evaluation of the effectiveness of
the system in terms of trial pre-inclusion or enrolment rate. While all the systems reviewed re-use structured and
coded patient data none attempts the more difficult task of using unstructured patient notes to pre-screen for trial
inclusion. Few studies address acceptance of systems by clinicians, or integration into clinical workflow, and there is
little evidence of use of interoperability standards. Conclusions: System design, scope, and assessment methodology
vary significantly between papers, making it difficult to establish the impact of different approaches on recruitment
rate. It is clear, however, that the pre-screening phase of trial recruitment is the most effective part of the process to
address with CTRSS, that clinical workflow integration and clinician acceptance are critical for this class of decision
support, and that the current trends in this field are towards generalization and scalability. 2011 Elsevier Ireland Ltd.
INTRODUCTION: To compare the impact on overall survival (OS) of docetaxel-based chemotherapy versus vinca
alkaloid-based regimens for first-line therapy of advanced non-small cell lung cancer. METHODS: A meta-analysis of
all randomized, controlled trials comparing docetaxel- and vinca alkaloid-based chemotherapy was undertaken using
MEDLINE, CANCERLIT, MEDSCAPE, Google Scholar, the Cochrane Library, the National Institutes of Health
randomized, controlled trials register, and conference proceedings, supplemented by information from clinical study
reports. All published and unpublished randomized, controlled trials (in any language) were included. Analysis was
based on pooling individual logarithms of the hazard ratio for OS and the odds ratio (OR) for safety. RESULTS: From
eight potentially eligible trials, seven were selected (n = 2867). Docetaxel was administered with a platinum agent
(three trials), with gemcitabine (two trials), or as monotherapy (two trials). Vinca alkaloid (vinorelbine [six trials] and
vindesine [one trial]) was administered with cisplatin (six trials) or alone (one trial). The pooled estimate for OS
showed an 11% improvement in favor of docetaxel (hazard ratio = 0.89; 95% confidence interval: 0.82-0.96; p =
0.004). Sensitivity analyses considering only vinorelbine as a comparator or only the doublet regimens showed
similar improvements. Grade 3/4 neutropenia and grade 3/4 serious adverse events were less frequent with
docetaxel- versus vinca alkaloid-based regimens (OR = 0.59; 95% confidence interval: 0.38-0.89; p = 0.013 and OR =
0.68; 95% confidence interval: 0.55-0.84; p < 0.001, respectively). CONCLUSION: According to this meta-analysis,
docetaxel is superior to vinca alkaloid-based regimens in terms of OS and safety for first-line therapy of advanced
non-small cell lung cancer. 2007International Association for the Study of Lung Cancer.
INTRODUCTION: To compare the impact on overall survival (OS) of docetaxel-based chemotherapy versus vinca
alkaloid-based regimens for first-line therapy of advanced non-small cell lung cancer., METHODS: A meta-analysis of
all randomized, controlled trials comparing docetaxel- and vinca alkaloid-based chemotherapy was undertaken using
MEDLINE, CANCERLIT, MEDSCAPE, Google Scholar, the Cochrane Library, the National Institutes of Health
randomized, controlled trials register, and conference proceedings, supplemented by information from clinical study
reports. All published and unpublished randomized, controlled trials (in any language) were included. Analysis was
based on pooling individual logarithms of the hazard ratio for OS and the odds ratio (OR) for safety., RESULTS: From
eight potentially eligible trials, seven were selected (n = 2867). Docetaxel was administered with a platinum agent
(three trials), with gemcitabine (two trials), or as monotherapy (two trials). Vinca alkaloid (vinorelbine [six trials] and
vindesine [one trial]) was administered with cisplatin (six trials) or alone (one trial). The pooled estimate for OS
showed an 11% improvement in favor of docetaxel (hazard ratio = 0.89; 95% confidence interval: 0.82-0.96; p =
0.004). Sensitivity analyses considering only vinorelbine as a comparator or only the doublet regimens showed
similar improvements. Grade 3/4 neutropenia and grade 3/4 serious adverse events were less frequent with
docetaxel- versus vinca alkaloid-based regimens (OR = 0.59; 95% confidence interval: 0.38-0.89; p = 0.013 and OR =
0.68; 95% confidence interval: 0.55-0.84; p < 0.001, respectively)., CONCLUSION: According to this meta-analysis,
docetaxel is superior to vinca alkaloid-based regimens in terms of OS and safety for first-line therapy of advanced
non-small cell lung cancer.
Purpose To evaluate the safety and clinical efficacy of fibrin glue in pterygium surgery with conjunctival autografting.
Design The use of fibrin glue has been introduced in the treatment of pterygium. However, its role versus traditional
suturing is still a matter of debate. We performed a meta-analysis to compare the safety and clinical efficacy of fibrin
glue with suture for conjunctival autograft attachment in pterygium surgery. Participants A total of 342 participants
with 366 eyes in 7 studies were analyzed. Methods We searched Medline, EMBASE, Web of Science, Cochrane
Central Register of Controlled Trials, and Google Scholar for relevant randomized controlled trials (RCTs). Main
Outcome Measures The methodological quality of all the included trials was assessed with the Jadad score. The meta-
analysis was performed with the fixed-effects model for complication rate and recurrence rate, and random-effects
model for operating time. Results Fibrin glue was associated with a significantly decreased operating time (weighted
mean difference -17.61 minutes, 95% confidence interval [CI], -26.03 to -9.18, P < 0.0001) and was more effective in
reducing the recurrence rate (Peto odds ratio [OR] 0.33, 95% CI, 0.15-0.71, P = 0.004) compared with suture. There
were no significant differences in the complication rate (Peto OR 1.82, 95% CI, 0.63-5.27, P = 0.27) between the 2
groups. Conclusions Our meta-analysis supports the superiority of fibrin glue to suture in pterygium surgery with
conjunctival autografting in that the use of fibrin glue can significantly reduce the recurrence rate without increasing
the risk of complications. Ophthalmologists should consider the use of fibrin glue in pterygium surgery. Financial
Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article. 2011
American Academy of Ophthalmology.
PURPOSE: To evaluate the safety and clinical efficacy of fibrin glue in pterygium surgery with conjunctival
autografting., DESIGN: The use of fibrin glue has been introduced in the treatment of pterygium. However, its role
versus traditional suturing is still a matter of debate. We performed a meta-analysis to compare the safety and
clinical efficacy of fibrin glue with suture for conjunctival autograft attachment in pterygium surgery., PARTICIPANTS:
A total of 342 participants with 366 eyes in 7 studies were analyzed., METHODS: We searched Medline, EMBASE,
Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar for relevant randomized
controlled trials (RCTs)., MAIN OUTCOME MEASURES: The methodological quality of all the included trials was
assessed with the Jadad score. The meta-analysis was performed with the fixed-effects model for complication rate
and recurrence rate, and random-effects model for operating time., RESULTS: Fibrin glue was associated with a
significantly decreased operating time (weighted mean difference -17.61 minutes, 95% confidence interval [CI], -
26.03 to -9.18, P<0.0001) and was more effective in reducing the recurrence rate (Peto odds ratio [OR] 0.33, 95% CI,
0.15-0.71, P = 0.004) compared with suture. There were no significant differences in the complication rate (Peto OR
1.82, 95% CI, 0.63-5.27, P = 0.27) between the 2 groups., CONCLUSIONS: Our meta-analysis supports the superiority
of fibrin glue to suture in pterygium surgery with conjunctival autografting in that the use of fibrin glue can
significantly reduce the recurrence rate without increasing the risk of complications. Ophthalmologists should
consider the use of fibrin glue in pterygium surgery., FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or
commercial interest in any materials discussed in this article. Copyright 2011 American Academy of Ophthalmology.
Published by Elsevier Inc. All rights reserved.
Background: Older people (ie, those aged >65 years) often use multiple drugs with sedative properties. These include
drugs for intentional sedation and drugs that have sedation as an adverse reaction. Recent pharmacoepidemiologic
studies have investigated the risks of multiple or combined sedative drug use. Objective: The purpose of this
commentary was to describe, compare, and discuss 4 previously published pharmacoepidemiologic methods used to
quantify the cumulative effect of taking multiple drugs with sedative properties. Methods: A MEDLINE literature
search was conducted in January 2010 using Medical Subject Headings and the following search terms: hypnotics,
sedatives, benzodiazepines, GAGA-A receptors, model, load, measurement, index, burden, system, and aged. The
search was limited to English language, humans, and the year 2000 until present. Reports of methods that involved
simply counting the number of sedative or psychotropic drugs, or described sedative drug use in anesthesia, were
excluded. The search identified 4 methods. Research articles that have cited the descriptions of the 4 methods were
retrieved using MEDLINE, Google Scholar, Scopus, and the Web of Science. Results: The literature search identified
14 studies describing the use of 4 different methods to quantify the cumulative effect of taking multiple drugs with
sedative properties. The 4 methods are the sedative load model, the Sloane model, the Drug Burden Index, and the
central nervous system drug model. The methods differed with respect to the specific drugs or drug classes
considered, the sedative ratings assigned to each drug, the inclusion or exclusion of drug dose in the model, and each
model's likely ease of use in clinical practice. Adverse outcomes associated with taking multiple drugs with sedative
properties included impaired physical and cognitive function, and an increased risk of falls. Conclusions: Evidence is
accumulating in relation to a range of adverse outcomes associated with using multiple drugs with sedative
properties. However, no studies have been conducted using>1 method to quantify the cumulative effect of taking
multiple drugs with sedative properties. Each method has likely advantages and disadvantages. The usefulness of
each method in clinical practice remains to be determined. The models must be validated in different populations of
older people and may subsequently need to be refined. 2010 Elsevier HS Journals, Inc.
Introduction: In the current study, we compared the h-indices of Web of Science (WOS), SCOPUS, and GS of the
Iranian nuclear medicine scientists Methods: Full time members of two major nuclear medicine research centers of
Iran with more than 5 year of experience (Nuclear Medicine Research Center of Mashhad University of Medical
Sciences, and Research Institute for Nuclear Medicine of Tehran University of Medical Sciences) were included for h-
index evaluation. H-indices of SCOPUS, WOS and GS were retrieved using their specific websites. Correlations of h-
indices with each other were evaluated using spearman correlation coefficient. Results: Overall 11 researchers were
included in the study. SCOPUS, WOS, and GS provided somehow different h-indices for each researcher. Spearman's
correlation coefficients between different h-indices were high: 0.834, 0.817, 0.857 between SCOPUS and WOS,
SCOPUS and GS, and GS and WOS respectively. Rankings of researchers according to different database however,
were acceptably identical. Conclusion: H-indices provided by SCOPUS, Web of Science WOS, and Google Scholar (GS)
for Iranian nuclear medicine researchers can be used interchangeably. However these h-indices can be different
according to which database is used. Setting up "ReasercherID" in WOS and "User profile" in GS, as well as giving
regular feedback to SCOPUS managers can increase the accuracy of h-indices calculation.
Purpose of Study: Medical literature searches provide critical information both for clinicians and for researchers
(including residents). Given the ongoing development of new search engines, the best search strategy for identifying
relevant literature reporting the most current, high quality research is unclear. Methods Used: The authors used
PubMed Central and Google Scholar to identify literature relevant to four clinical questions of varying topics.
Abstracts from the first twenty citations for each search were reviewed and classified into three categories (relevant,
possibly relevant, and not relevant). The agreement between reviewers was measured using the Kappa statistic; the
agreement between search engines was calculated using percentage overlap. We also used descriptive statistics and
t-tests to compare the search engines by their articles' total number of citations and the corresponding journals'
impact factor. Summary of Results: Reviewers ranked 57 - 100% of the PubMed articles and 38-100% of the Google
Scholar articles as at least partially relevant. There was good agreement between the reviewers on abstract
classification (Kappa: 0.35 to 1.0; all p-values <0.05). The number of overlapping articles ranged from 0 to 9. On three
questions, the articles recovered by Google Scholar had higher median number of citations (p<0.05); on one
question, the articles recovered by Google Scholar had a higher median journal impact factor (p<0.05). Conclusions:
Searches using PubMed Central and Google Scholar can give substantially different results. Assuming that both
search the same body of literature, the small number of articles ranked by both in the top 20 indicates potentially
very different relevance ranking algorithms. Reviewers more often assigned higher relevance to articles found by
Google Scholar. Articles identified by Google Scholar have a higher median number of citations and may have higher
journal impact factors. These results likely reflect characteristics highly ranked by the Google Scholar search
algorithm, but the identification of frequently cited articles probably has value for initial searches.
BACKGROUND: Literature searches are essential to evidence-based respiratory care. To conduct literature searches,
respiratory therapists rely on search engines to retrieve information, but there is a dearth of literature on the
comparative efficiencies of search engines for researching clinical questions in respiratory care. OBJECTIVE: To
compare PubMed and Google Scholar search results for clinical topics in respiratory care to that of a benchmark.
METHODS: We performed literature searches with PubMed and Google Scholar, on 3 clinical topics. In PubMed we
used the Clinical Queries search filter. In Google Scholar we used the search filters in the Advanced Scholar Search
option. We used the reference list of a related Cochrane Collaboration evidence-based systematic review as the
benchmark for each of the search results. We calculated recall (sensitivity) and precision (positive predictive value)
with 2 x 2 contingency tables. We compared the results with the chi-square test of independence and Fisher's exact
test. RESULTS: PubMed and Google Scholar had similar recall for both overall search results (71% vs 69%) and full-
text results (43% vs 51%). PubMed had better precision than Google Scholar for both overall search results (13% vs
0.07%, P < .001) and full-text results (8% vs 0.05%, P < .001). CONCLUSIONS: Our results suggest that PubMed
searches with the Clinical Queries filter are more precise than with the Advanced Scholar Search in Google Scholar
for respiratory care topics. PubMed appears to be more practical to conduct efficient, valid searches for informing
evidence-based patient-care protocols, for guiding the care of individual patients, and for educational purposes.
The evolution of the electronic age has led to the development of numerous medical databases on the World Wide
Web, offering search facilities on a particular subject and the ability to perform citation analysis. We compared the
content coverage and practical utility of PubMed, Scopus, Web of Science, and Google Scholar. The official Web
pages of the databases were used to extract information on the range of journals covered, search facilities and
restrictions, and update frequency. We used the example of a keyword search to evaluate the usefulness of these
databases in biomedical information retrieval and a specific published article to evaluate their utility in performing
citation analysis. All databases were practical in use and offered numerous search facilities. PubMed and Google
Scholar are accessed for free. The keyword search with PubMed offers optimal update frequency and includes online
early articles; other databases can rate articles by number of citations, as an index of importance. For citation
analysis, Scopus offers about 20% more coverage than Web of Science, whereas Google Scholar offers results of
inconsistent accuracy. PubMed remains an optimal tool in biomedical electronic research. Scopus covers a wider
journal range, of help both in keyword searching and citation analysis, but it is currently limited to recent articles
(published after 1995) compared with Web of Science. Google Scholar, as for the Web in general, can help in the
retrieval of even the most obscure information but its use is marred by inadequate, less often updated, citation
information. FASEB.
BACKGROUND/AIMS: Our purpose was to assess the prophylactic antiemetic effects of ondansetron versus
granisetron for laparoscopic cholecystectomy. METHODS: We searched Medline, Cochrane Central Register of
Controlled Trials, PubMed, Embase, Science Citation Index Expanded, Foreign Medical Journal Full-Text Service,
China National Knowledge Infrastructure Whole Article Database, Chinese Biomedical Database, and the Google
Scholar. We calculated the risk ratio (RR) with 95% confidence interval (CI) for dichotomous data. The chi test and I
value were used to assess heterogeneity. RESULTS: The merged early incidence of postoperative nausea and
vomiting (PONV) in ondansetron group (42.9%) was higher than granisetron group (34.3%) (RR=1.25, 95% CI, 0.82-
1.92, P=0.31, I=48%). The merged total incidence of PONV in ondansetron group (38.7%) was higher than granisetron
group (34.2%) (RR=1.13, 95% CI, 0.82-1.56, P=0.46, I=39%), although these differences were not statistically
significant. CONCLUSIONS: Ondansetron is equivalent to granisetron for preventing early and total incidence of
PONV after laparoscopic cholecystectomy. Copyright 2013 by Lippincott Williams & Wilkins.
BACKGROUND/AIMS: Our purpose was to assess the prophylactic antiemetic effects of ondansetron versus
granisetron for laparoscopic cholecystectomy., METHODS: We searched Medline, Cochrane Central Register of
Controlled Trials, PubMed, Embase, Science Citation Index Expanded, Foreign Medical Journal Full-Text Service,
China National Knowledge Infrastructure Whole Article Database, Chinese Biomedical Database, and the Google
Scholar. We calculated the risk ratio (RR) with 95% confidence interval (CI) for dichotomous data. The chi(2) test and
I(2) value were used to assess heterogeneity., RESULTS: The merged early incidence of postoperative nausea and
vomiting (PONV) in ondansetron group (42.9%) was higher than granisetron group (34.3%) (RR = 1.25, 95% CI, 0.82-
1.92, P=0.31, I(2) = 48%). The merged total incidence of PONV in ondansetron group (38.7%) was higher than
granisetron group (34.2%) (RR = 1.13, 95% CI, 0.82-1.56, P = 0.46, I(2) = 39%), although these differences were not
statistically significant., CONCLUSIONS: Ondansetron is equivalent to granisetron for preventing early and total
incidence of PONV after laparoscopic cholecystectomy.
BACKGROUND AND OBJECTIVE: Conflicting results were found between the I-gelTM and the LMA-SupremeTM during
anesthesia, so we conducted a meta-analysis of randomized controlled trials (RCTs) to compare the effectiveness and
safety of the I-gelTM vs. the LMA-SupremeTMduring anesthesia., METHODS: A comprehensive search was
conducted using Pubmed, EMbase, ISI Web of Knowledge, the Cochrane Library, China Journal Full-text Database,
Chinese Biomedical Database, Chinese Scientific Journals Full-text Database, CMA Digital Periodicals, and Google
scholar to find RCTs that compare the LMA-STM with the i-gelTMduring anesthesia. Two reviewers independently
selected trials, extracted data, and assessed the methodological qualities and evidence levels. Data were analyzed by
RevMan 5.0 and comprehensive meta-analysis software., RESULTS: Ten RCTs were included. There were no
significant differences in oropharyngeal leak pressures (mean difference [MD] 0.72, 95% confidence interval [CI] -
1.10 2.53), device placement time (MD -1.3, 95%CI -4.07 1.44), first attempt insertion success (risk ratio [RR] 1.01,
95% CI 0.9 1.14), grade 3 and 4 fiberoptic view (RR 0.89, 95%CI 0.65 1.21), and blood on removal (RR 0.62, 95%CI
0.32 1.22) between the i-gelTM and the LMA-SupremeTM, respectively. However, the LMA-SupremeTMwas
associated with easier gastric tube insertion (RR 1.17, 95%CI 1.07 1.29), and more sore throat (RR 2.56, 95%CI 1.60
4.12) than the i-gelTM group., CONCLUSIONS: The LMA-SupremeTM and i-gelTM were similarly successful and
rapidly inserted. However, the LMA-SupremeTM was shown to be easier for gastric tube insertion and associated
with more sore throat compared with the i-gelTM.
CONTEXT: Until recently, Web of Science was the only database available to track citation counts for published
articles. Other databases are now available, but their relative performance has not been established. OBJECTIVE: To
compare the citation count profiles of articles published in general medical journals among the citation databases of
Web of Science, Scopus, and Google Scholar. DESIGN: Cohort study of 328 articles published in JAMA, Lancet, or the
New England Journal of Medicine between October 1, 1999, and March 31, 2000. Total citation counts for each
article up to June 2008 were retrieved from Web of Science, Scopus, and Google Scholar. Article characteristics were
analyzed in linear regression models to determine interaction with the databases. MAIN OUTCOME MEASURES:
Number of citations received by an article since publication and article characteristics associated with citation in
databases. RESULTS: Google Scholar and Scopus retrieved more citations per article with a median of 160
(interquartile range [IQR], 83 to 324) and 149 (IQR, 78 to 289), respectively, than Web of Science (median, 122; IQR,
66 to 241) (P < .001 for both comparisons). Compared with Web of Science, Scopus retrieved more citations from
non-English-language sources (median, 10.2% vs 4.1%) and reviews (30.8% vs 18.2%), and fewer citations from
articles (57.2% vs 70.5%), editorials (2.1% vs 5.9%), and letters (0.8% vs 2.6%) (all P < .001). On a log(10)-transformed
scale, fewer citations were found in Google Scholar to articles with declared industry funding (nonstandardized
regression coefficient, -0.09; 95% confidence interval [CI], -0.15 to -0.03), reporting a study of a drug or medical
device (-0.05; 95% CI, -0.11 to 0.01), or with group authorship (-0.29; 95% CI, -0.35 to -0.23). In multivariable
analysis, group authorship was the only characteristic that differed among the databases; Google Scholar had
significantly fewer citations to group-authored articles (-0.30; 95% CI, -0.36 to -0.23) compared with Web of Science.
CONCLUSION: Web of Science, Scopus, and Google Scholar produced quantitatively and qualitatively different
citation counts for articles published in 3 general medical journals.
Background We did a meta-analysis to assess factors associated with disparities in HIV infection in black men who
have sex with men (MSM) in Canada, the UK, and the USA. Methods We searched Embase, Medline, Google Scholar,
and online conference proceedings from Jan 1, 1981, to Dec 31, 2011, for racial comparative studies with
quantitative outcomes associated with HIV risk or HIV infection. Key words and Medical Subject Headings (US
National Library of Medicine) relevant to race were cross-referenced with citations pertinent to homosexuality in
Canada, the UK, and the USA. Data were aggregated across studies for every outcome of interest to estimate overall
effect sizes, which were converted into summary ORs for 106 148 black MSM relative to 581 577 other MSM.
Findings We analysed seven studies from Canada, 13 from the UK, and 174 from the USA. In every country, black
MSM were as likely to engage similarly in serodiscordant unprotected sex as other MSM. Black MSM in Canada and
the USA were less likely than other MSM to have a history of substance use (odds ratio, OR, 0 53, 95% CI 0 38-0 75,
for Canada and 0 67, 0 50-0 92, for the USA). Black MSM in the UK (1 86, 1 58-2 18) and the USA (3 00, 2 06-4 40)
were more likely to be HIV positive than were other MSM, but HIV-positive black MSM in each country were less
likely (22% in the UK and 60% in the USA) to initiate combination antiretroviral therapy (cART) than other HIV-
positive MSM. US HIV-positive black MSM were also less likely to have health insurance, have a high CD4 count,
adhere to cART, or be virally suppressed than were other US HIV-positive MSM. Notably, despite a two-fold greater
odds of having any structural barrier that increases HIV risk (eg, unemployment, low income, previous incarceration,
or less education) compared with other US MSM, US black MSM were more likely to report any preventive behaviour
against HIV infection (1 39, 1 23-1 57). For outcomes associated with HIV infection, disparities were greatest for US
black MSM versus other MSM for structural barriers, sex partner demographics (eg, age, race), and HIV care
outcomes, whereas disparities were least for sexual risk outcomes. Interpretation Similar racial disparities in HIV and
sexually transmitted infections and cART initiation are seen in MSM in the UK and the USA. Elimination of disparities
in HIV infection in black MSM cannot be accomplished without addressing structural barriers or differences in HIV
clinical care access and outcomes.
BACKGROUND: We did a meta-analysis to assess factors associated with disparities in HIV infection in black men who
have sex with men (MSM) in Canada, the UK, and the USA., METHODS: We searched Embase, Medline, Google
Scholar, and online conference proceedings from Jan 1, 1981, to Dec 31, 2011, for racial comparative studies with
quantitative outcomes associated with HIV risk or HIV infection. Key words and Medical Subject Headings (US
National Library of Medicine) relevant to race were cross-referenced with citations pertinent to homosexuality in
Canada, the UK, and the USA. Data were aggregated across studies for every outcome of interest to estimate overall
effect sizes, which were converted into summary ORs for 106,148 black MSM relative to 581,577 other MSM.,
FINDINGS: We analysed seven studies from Canada, 13 from the UK, and 174 from the USA. In every country, black
MSM were as likely to engage similarly in serodiscordant unprotected sex as other MSM. Black MSM in Canada and
the USA were less likely than other MSM to have a history of substance use (odds ratio, OR, 0.53, 95% CI 0.38-0.75,
for Canada and 0.67, 0.50-0.92, for the USA). Black MSM in the UK (1.86, 1.58-2.18) and the USA (3.00, 2.06-4.40)
were more likely to be HIV positive than were other MSM, but HIV-positive black MSM in each country were less
likely (22% in the UK and 60% in the USA) to initiate combination antiretroviral therapy (cART) than other HIV-
positive MSM. US HIV-positive black MSM were also less likely to have health insurance, have a high CD4 count,
adhere to cART, or be virally suppressed than were other US HIV-positive MSM. Notably, despite a two-fold greater
odds of having any structural barrier that increases HIV risk (eg, unemployment, low income, previous incarceration,
or less education) compared with other US MSM, US black MSM were more likely to report any preventive behaviour
against HIV infection (1.39, 1.23-1.57). For outcomes associated with HIV infection, disparities were greatest for US
black MSM versus other MSM for structural barriers, sex partner demographics (eg, age, race), and HIV care
outcomes, whereas disparities were least for sexual risk outcomes., INTERPRETATION: Similar racial disparities in HIV
and sexually transmitted infections and cART initiation are seen in MSM in the UK and the USA. Elimination of
disparities in HIV infection in black MSM cannot be accomplished without addressing structural barriers or
differences in HIV clinical care access and outcomes., FUNDING: None. Copyright 2012 Elsevier Ltd. All rights
reserved.
Objective: To summarize the information regarding pathogenetic factors of leiomyoma formation and growth, and to
make a simple integrated pathogenetic view of this tumor for further thinking to establish new therapeutic options.
Design: PubMed and Google Scholar searches were conducted to identify the relevant studies on pathogenesis of
uterine leiomyoma, which are hereby reviewed and discussed. Setting: Academic medical center. Patient(s): Not
applicable. Intervention(s): Not applicable. Main Outcome Measure(s): Not applicable. Result(s): To date, the
pathogenesis of uterine leiomyomas is not well understood. However, genetic alterations (especially MED12 and
HMGA2) and involvement of epigenetic mechanisms (DNA methylation, histone modifications, and microRNA) in
leiomyoma provide the clue of initiator of this tumor. Estrogens and P are considered as promoters of leiomyoma
growth, and growth factors, cytokines, and chemokines are thought to be as potential effectors of estrogens and P.
Extracellular matrix components are a major structural part of leiomyoma tissue that are abnormally orientated and
can modify mechanical stress on cells, which leads to activation of internal mechanical signaling and may contribute
to leiomyoma growth. Conclusion(s): Besides many genetics and epigenetic factors, the important link among the sex
steroids, growth factors, cytokines, chemokines, and extracellular matrix and their involvement in cell proliferation,
fibrotic processes, apoptosis, and angiogenesis are implicating a complex network in leiomyoma formation and
growth. Those findings could provide information to establish future therapeutic options for the management of this
tumor. Copyright 2013 Published by Elsevier Inc.
Context: The initial excitement about the laparoscopic treatment of renal masses has been tempered by concerns
related to increased operative time, technical complexity, and the suitability of laparoscopic approaches to oncologic
surgery. Objective: To provide a comprehensive review of intraoperative and postoperative complications and their
prevention and management during laparoscopic surgery of renal tumors. Evidence acquisition: A literature review
of the Medline and Google Scholar databases was performed, searching for renal cell carcinoma, renal mass,
laparoscopy, laparoscopic radical nephrectomy, open radical nephrectomy, laparoscopic partial nephrectomy, open
partial nephrectomy, laparoscopic cryoablation, laparoscopic radiofrequency ablation, complications, intra-operative,
and post-operative. English-language articles published between 1990 and 2008 were reviewed. Evidence synthesis:
Laparoscopic radical nephrectomy (LRN), whether transperitoneal or retroperitoneal, can be performed safely. The
overall complication rate is low and does not significantly differ from that of the open experience. Laparoscopic
partial nephrectomy (LPN), in contrast, is a technically challenging procedure. Although the intermediate oncologic
outcomes are comparable to those of the open experience, there are concerns related to warm ischemia time, and
there is a risk of major complications such as urinary leakage and hemorrhage requiring transfusion. Laparoscopic-
assisted ablative therapies (cryotherapy and radiofrequency) are being performed more commonly for the treatment
of small exophytic renal lesions with a low complication rate and intermediate oncologic outcomes similar to LRN
and LPN. Conclusions: Complications associated with the laparoscopic management of renal masses vary among the
different procedures and with surgeon experience. The rate of complication appears to be similar to that of open
surgery.
Purpose: The purpose of this systematic review was to address the incidence of complications associated with wrist
arthroscopy. Given the paucity of information published on this topic, an all-inclusive review of published wrist
arthroscopy complications was sought. Methods: Two independent reviewers performed a literature search using
PubMed, Google Scholar, EBSCO, and Academic Megasearch using the terms "wrist arthroscopy complications,"
"complications of wrist arthroscopy," "wrist arthroscopy injury," and "wrist arthroscopy." Inclusion criteria were (1)
Levels I to V evidence, (2) "complication" defined as an adverse outcome directly related to the operative procedure,
and (3) explicit description of operative complications in the study. Results: Eleven multiple-patient studies
addressing complications of wrist arthroscopy from 1994 to 2010 were identified, with 42 complications reported
from 895 wrist arthroscopy procedures, a 4.7% complication rate. Four case reports were also found, identifying
injury to the dorsal sensory branch of the ulnar nerve, injury to the posterior interosseous nerve, and extensor
tendon sheath fistula formation. Conclusions: This systematic review suggests that the previously documented rate
of wrist arthroscopy complications may be underestimating the true incidence. The report of various complications
provides insight to surgeons for improving future surgical techniques. Level of Evidence: Level IV, systematic review
of Levels I-V studies. 2012 Arthroscopy Association of North America.
Objective: Endophytes, microorganisms that reside in the tissues of living plants, are a promising source of novel
compounds with biological activity, or an alternative source of compounds originally isolated from higher plants. The
intent of this review is to provide insights into their occurrence in nature, the products that they make, and how
some of these organisms are beginning to show some potential for human use. Methods: Information for analysis of
endophytic microorganisms was obtained from libraries and Internet scientific databases such as Scirus, Google
Scholar, CAB-Abstracts, MedlinePlus, PubMed, SciFinder, Scopus and Web of Science. Results: Many of the
compounds reported here were isolated exclusively from endophytes in culture, while other compounds had been
previously reported as chemical constituents of higher plants. A survey of the literature shows endophytic
microorganisms are mainly known for their alkaloids with cytotoxic, chemopreventive, anti-metastatic and antitumor
properties used in the treatment of several types of cancer. The studies of these alkaloids highlight the existence of
various potential leads for the development of novel anti-cancer agents. Modern pharmacology studies
demonstrated that their crude extracts and active compounds possess wide pharmacological actions, especially for
anti-microbial drug discovery, with neuroprotective, antioxidant, nematicidal, antiplasmodium, anti-inflammatory
activities. Aim of the Review: This review summarizes the up-to-date and comprehensive information on compounds
from endophytes fungi from 1995 to 2011 that relates to 313 compounds isolated from endophytic microorganisms,
together with the botany, phytochemistry, pharmacology and toxicology, and discusses possible trends and the
scope for future research of endophytes. 2012 Bentham Science Publishers.
Purpose Millions of patients worldwide who undergo surgical procedures face significant morbidity and mortality
risks. Several systematic reviews have been performed on ancillary treatments aimed at improving surgical
outcomes, but their features and scholarly impact are unclear. We describe characteristics of meta-analyses on
ancillary treatments aimed at improving surgical outcomes and explore factors associated with scholarly citations.
Methods Systematic reviews published up to 2008 were searched without language restrictions in MEDLINE/Pub-
Med. Reviews focusing on nonsurgical treatments aimed at decreasing mortality or major cardiac complications were
included. Associations between content, quality, and bibliometric details and scholarly citations in several indexes
were systematically appraised. Results From 2,239 citations, 84 systematic reviews were identified. Patients most
commonly underwent cardiovascular surgery (40.2 %), and were tested for cardiovascular drugs (25.8 %), with
placebo acting as control (38.1 %). Internal validity appeared largely robust, as most (50.5 %) reviews were at low risk
of bias. Normalized yearly citations for the included reviews ranged between 5.6 in Google Scholar and 4.3 in Web of
Science. Multivariable analysis showed that citations were significantly and positively associated with number of
authors, North American corresponding author, number of studies included, number of patients included,
noncardiothoracic surgical scope, explicit funding, and lack of competing interests (all P < 0.05). Conclusions
Systematic reviews currently represent a key element in defining state of the art ancillary treatments of patients
undergoing surgery. However, the citation success of available meta-analyses is not significantly associated with
prognostically relevant findings or quality features. Japanese Society of Anesthesiologists 2012.
Although, positive role of special bacteria in induction of Inflammatory Bowel Disease (IBD) including Ulcerative
Colitis (UC) and Crohn's Disease (CD) have been demonstrated in several studies but the consensus on etiology of IBD
and beneficial effect of antibiotics has not been reached yet. And, also, no well-designed clinical trials in this regard
have been done yet. This review focuses on various clinical trials which have been done in according to beneficial use
of antibiotics in UC and CD from 1978 to date. For this purpose, all electronic databases such as PubMed, Scopus,
Google Scholar and Cochrane library were searched. The results of clinical trials suggested that metronidazole,
ciprofloxacin or the combinations of these antibiotics are effective in CD. However, ciprofloxacin is the first choice,
because it has good coverage on gram negative and anaerobic bacterium which plays an important role in CD.
However, there is a controversy on the use of antibiotics in UC and the efficacy of them in long-term treatment of UC
is still in doubt. Various antibiotics such as anti-tuberculosis, macrolides (clarithromycin), fluoroquinolones, 5-
nitroimidazoles, rifaximin, rifamycin derivatives (rifampin), aminoglycosides (tobramycin), rifabutin, clofazimine,
tetracyclines (tetracycline and doxycycline) and vancomycin have been under attention of researchers in the recent
years. Furthermore, other antibiotics with lower cost and adverse effects, effectiveness and availability are the third
generation of cephalosporins and gentamicin and also penicillin or clindamycin that should be evaluated in future
studies. 2012 Asian Network for Scientific Information.
OBJECTIVE: Research examining psychological and physiological benefits of Qigong and Tai Chi is growing rapidly. The
many practices described as Qigong or Tai Chi have similar theoretical roots, proposed mechanisms of action, and
expected benefits. Research trials and reviews, however, treat them as separate targets of examination. This review
examines the evidence for achieving outcomes from randomized controlled trials (RCTs) of both. DATA SOURCES:
The key words Tai Chi, Taiji, Tai Chi Chuan, and Qigong were entered into electronic search engines for the
Cumulative Index for Allied Health and Nursing (CINAHL), psychological literature (PsycINFO), PubMed, Cochrane
database, and Google Scholar. STUDY INCLUSION CRITERIA: RCTs reporting on the results of Qigong or Tai Chi
interventions and published in peer-reviewed journals from 1993 to 2007. DATA EXTRACTION: Country, type and
duration of activity, number/type of subjects, control conditions, and reported outcomes were recorded for each
study. SYNTHESIS: Outcomes related to Qigong and Tai Chi practice were identified and evaluated. RESULTS: Seventy-
seven articles met the inclusion criteria. The nine outcome category groupings that emerged were bone density (n =
4), cardiopulmonary effects (n = 19), physical function (n = 16), falls and related risk factors (n = 23), quality of life (n
= 17), self-efficacy (n = 8), patient-reported outcomes (n = 13), psychological symptoms (n = 27), and immune
function (n = 6). CONCLUSIONS: Research has demonstrated consistent, significant results for a number of health
benefits in RCTs, evidencing progress toward recognizing the similarity and equivalence of Qigong and Tai Chi.
Lichen planus (LP) is a relatively common disorder with no definitive cure that affects the skin, mucous membranes,
nails, hair, and rarely esophagus. We performed a systematic review of all systematic reviews and randomized
controlled trials (RCTs) on LP. All forms of LP were considered in this study. PubMed, EMBASE, all databases in the
Cochrane library, Google Scholar, and China National Knowledge Infrastructure (CNKI) were searched using explicit
search strategies. There were no language restrictions in this study. We identified 9 relevant systematic reviews and
62 RCTs. Meta-analysis was applied where indicated. Cutaneous LP: Eight RCTs were found for the treatment of
cutaneous LP. The following drugs were included: Oral prednisolone, topical hydrocortisone, acitretin, sulfasalazine,
griseofuvin, hydroxychloroquine and vitamin D analogues (KH1060 and calcipotriol). Mucosal LP: A total of 54 RCTs
(53 on oral LP, 1 on vulvar LP) met the criteria for mucosal LP. The treatment modalities included topical and
systemic corticosteroids, topical calcineurin inhibitors, topical and systemic retinoids, antifungals, psoralen plus
ultraviolet A (PUVA), topical thalidomide, Polysaccharide nucleic acid fraction of bacillus Calmette-Guerin (BCG-PSN),
curcuminoids, purslane, mesalazine, ultrasound, low-level laser therapy, aloe vera, amytriptiline, Ignatia, vitamin A,
mucoadhesive polymers, and hyaluronic acid. High quality evidence is widely lacking for the main therapeutic choices
of cutaneous LP. The meta-analysis was not possible for this subtype. Although topical corticosteroids are considered
as the mainstay of mucosal LP therapy, only two of them (betamethasone valerate and flucinolone) have been
proven to be more beneficial than placebo by performing meta-analyses. For many treatment options, there was
only one supporting trial and for many other drugs the evidence is weak. One of the main problems in many included
RCTs was the lack of a clear and accurate measurement of disease outcome or severity.
Glaucoma can create visual impairment with ongoing morbidity. Having an instrument that assesses the progression
of diseases of the eye and assesses treatment is necessary due to increased prevalence. OBJECTIVES: Evaluate the
psychometric properties (reliability, validity, responsiveness, and interpretability) of a short form of vision-specific
instrument VFQ-25 for glaucoma and other eye chronic diseases., Compare the VFQ-25 to the generic SF-36.
METHODS: We conducted an extensive literature review using Medline, OVID, Google Scholar, Cochrane Library,
ARVO and ISOQOL databases from the years 2000 to 2007. We included all articles that addressed the psychometric
properties of VFQ-25. If no psychometric properties were assessed, we excluded the article RESULTS: 8 articles and 2
abstracts relating to VFQ-25 met the inclusion criteria. Internal consistency reliability (Cronbach's alpha >0.70) was
high for most of all subscales, except driving. Ceiling scores were observed in all studies included in this systematic
review. However, no floor effect was detected. Discriminant and convergent validity were different for a few
subscales (driving, social function and ocular pain), for others they ranged from 86%-100%. Scale-scale correlations
between general health and other subscales were low (<0.3). In contrast, global score is moderately to highly
correlated with other subscales (0.5-0.9). Compared to SF-36, VFQ-25 was low correlated. Responsiveness of VFQ-25
was not measured in patients with glaucoma. The effect sizes were small to moderate (0.07-0.51). CONCLUSIONS:
The results suggest that VFQ-25 is a reliable and valid measure of health-related quality of life in glaucoma patients
and other chronic eye diseases. However, longitudinal studies should be done to assess responsiveness and
interpretability of the questionnaire. Our findings suggest that VFQ-25 and SF-36 are capturing different dimensions
of health.
The aim of this review was to appraise and synthesise the best available evidence on visitation models used in adult
intensive care units in acute care hospitals and to explicate their congruence with the core concepts of patient- and
family-centred care (PFCC). The review considered both quantitative and qualitative studies on visitation models
developed within the PFCC model in adult intensive care units in acute care hospitals. The search strategy sought
published and unpublished research papers limited to English for the years 1988 through 2009. An initial search of
the Joanna Briggs Institute for Evidence-Based Nursing and Midwifery, the Cochrane Library, and PubMed's Clinical
Inquiry/Find Systematic Review database was conducted, followed by an analysis of key words contained in the title,
abstract and index terms. Following this, an extensive three-stage search was conducted using PubMed, CINAHL,
HealthStar, ScienceDirect, Dissertation Abstracts International, DARE, PsycINFO, BioMedCentral, TRIP, Pre-CINAHL,
PsycARTICLES, Psychology and Behavioural Sciences Collection, ISI Current Contents, Science.gov, Web of
Science/Web of Knowledge, Scirus.com website. Included was a hand search of reference lists of identified papers to
capture all pertinent material as well as a search of relevant worldwide websites and search engines, such as Google
Scholar and the Virginia Henderson Library of Sigma Theta Tau International. Each paper was assessed independently
by two reviewers for methodological quality prior to inclusion in the review using the appropriate critical appraisal
instrument. Findings from the qualitative studies were extracted and a synthesis conducted using the QARI
(Qualitative Assessment and Review Instrument) software developed by the Joanna Briggs Institute. One synthesis
revealed that visiting hours were seen as guidelines for the benefit of nurse and patient, rather than rules or policy.
Due to the various types of designs in the available studies, it was not possible to pool quantitative research study
results into a statistical meta-analysis. Because statistical pooling was not possible, the findings are presented in a
narrative form. Following this, results are presented for their congruence with the principles of PFCC. Flexible visiting
policies provide the ability to incorporate the concepts of PFCC into practice. However, nurses believe that while
visiting is beneficial to patients, open and/or flexible visiting hours are an impediment to practice and increase their
workload. Recommendations for best practice were formulated based on the outcomes and include visiting hours
should be used as guidelines, not rules, that allow flexibility dependent upon individual patient/family situation. With
regard to congruence with PFCC, patient and family requests for information emerged as an unmet need that needs
to be addressed. 2011 The Authors. International Journal of Evidence-Based Healthcare. 2011 The Joanna Briggs
Institute.
The studies on the accuracy of femoral component in hip resurfacing arthroplasty with the help of computer-assisted
navigation were not consistent. This study aims to assess at the functional outcomes after computer navigation in hip
resurfacing arthroplasty by systematically reviewing and meta-analyzing the data, which were searched up to
December 2011 in PubMed, MEDLINE, EMBASE, MetaMed, EBSCO HOST, and the Web site of Google scholar. Totally,
197 articles about hip resurfacing arthroplasty were collected; finally, 7 articles met the inclusion criteria and were
included in this meta-analysis (520 patients with 555 hip resurfacing arthroplasty). The odds ratio for the number of
outliers was 0.155 (95% confidence interval, 0.048-0.498; P < .003). In conclusion, this meta-analysis suggests that
the computer-assisted navigation system makes the femoral component positioning in hip resurfacing arthroplasty
easier and more precise. 2013.
Objective: The purpose of this study was to examine the readability of published patient-related outcome (PRO)
questionnaires completed by persons with oral disease and to compare the readability results to existing data about
average reading levels for adults living in the United States. Methods: A search was conducted via Pubmed and
Google Scholar to identify PRO oral health-related questionnaires completed by patients. Reading grade levels were
analyzed for 10 oral health-related PRO questionnaires using three readability formulas. Results: The most significant
results were as follows:. *FORCAST formula of the ten PRO's examined, three were written at the 7th grade reading
level, two at the 8th grade reading level, two at the 9th grade reading level, and the remaining three at the 10th
grade reading level or higher.*Readability varied greatly across the questionnaires and formulas, with 17 of the 30
total calculations (52%) showing readability above the 5th to 6th grade level recommended by health literacy
experts. Conclusion: Developers of PRO questionnaires should consider readability as another testable construct.
Practice implications: To obtain the most useful information for treatment planning and outcomes assessments, the
dental professional should consider the reading level needed to understand a particular PRO questionnaire. 2012
Elsevier Ireland Ltd.
AIM: Professional commitment has been widely discussed during the last decade. There is no comprehensive
definition about "professional commitment in Iranian nurses." Hence, this study was conducted with the aim of
analyzing the concept of professional commitment in Iranian nurses., MATERIALS AND METHODS: Hybrid model was
used in three phases. Firstly, in the theoretical phase, data were retrieved from the CINHAl, MEDLINE, PubMed,
OVID, Google scholar, and SID databases. The literature search used the keywords "professional commitment" and
"nursing." The final sample included 27 papers published in English between 2001 and 2011.Secondly, in the
fieldwork phase, deep interviews with five clinical nurses were carried out, and thirdly, in the final analytical phase,
the obtained data from theoretical and fieldwork phases were combined and a comprehensive analysis was
conducted., RESULTS: Loyalty and tendency to remain in the profession and responsibility to the professional issues
were extracted in theoretical phase. Commitment to promote caring abilities, satisfying of being a nurse, and
belonging to the nursing profession were obtained in fieldwork phase. Finally, two main themes including
"commitment to offering the best nursing care" and "commitment to promotion of the nursing profession" were
extracted., CONCLUSION: Nursing is a humanistic profession; it has some particular characteristics due to the
profession's nature. In this paper, a definition composed of two main dimensions of professional commitment in
nursing has been introduced.
Aim. This article describes a new conceptual framework for acute care nurse practitioner role enactment, boundary
work and perceptions of team effectiveness. Background. Acute care nurse practitioners contribute positively to
patient care by enacting an expanded scope of practise. Researchers have found both positive and negative reactions
to the introduction of acute care nurse practitioners in healthcare teams. The process of role enactment, shifting role
boundaries, and perceptions of team effectiveness has been studied disparately. A framework linking team
structures and processes to desirable outcomes is needed. Data sources. Literature was obtained by searching
CINAHL, PsycInfo, MedLine, PubMed, British Nursing Index, Cochrane Library, JSTOR Archive, Web of Science, and
Google Scholar from 1985-2010. A descriptive multiple-case study was completed from March 2009-May 2009.
Discussion. A new conceptual framework describing how role enactment and boundary work affect perceptions of
team effectiveness was developed by combining theoretical and empirical sources. The framework proposes
proximal indicators used by team members to assess their team's performance. Implications for nursing. The
framework identifies the inter-related dimensions and concepts that different stakeholders need to consider when
introducing nurse practitioners in healthcare teams. Further study is needed to identify team-level outcomes that
reflect the contributions of all providers to quality patient care, and explore the patients' and families' perceptions of
team effectiveness following the introduction of acute care nurse practitioners. Conclusion. The new framework can
guide decision-making and research related to the structures, processes, and outcomes of nurse practitioner roles in
healthcare teams. 2012 Blackwell Publishing Ltd.
Background: Conductive energy devices (CEDs) have been temporally associated with morbidity and mortality in
police work, but the frequency of use and of complications is not certain. Methods: This is a literature review using
PubMed and Google Scholar searches to identify population-based CED studies, studies reporting morbidity and
mortality with CEDs, and studies in healthy volunteers. Results: Recent studies indicate that CEDs are used
approximately 83 to 338 times per million population per year in the United States. The subjects have a typical
profile, including young men with belligerent or bizarre behavior who often have a psychiatric disorder or are
intoxicated with drugs. The mortality estimates range from 0.0% to 1.4% of subjects controlled with CEDs. Limited
information from autopsy studies indicates that death is frequently associated with confounding factors, especially
intoxication with illicit drugs. Conclusions: Conductive energy devices are used frequently during police work and are
associated with a low but definite mortality rate. The use of CEDs and the management of at-risk subjects need more
study. 2011 by The American Federation for Medical Research.
OBJECTIVES: To examine the psychometric properties, adaptations, translations, and applications of the Confusion
Assessment Method (CAM), a widely used instrument and diagnostic algorithm for identification of delirium. DESIGN:
Systematic literature review. SETTING: Not applicable. MEASUREMENTS: Electronic searches of PubMED, EMBASE,
PsychINFO, CINAHL, Ageline, and Google Scholar, augmented by reviews of reference listings, were conducted to
identify original English-language articles using the CAM from January 1, 1991, to December 31, 2006. Two reviewers
independently abstracted key information from each article. PARTICIPANTS: Not applicable. RESULTS: Of 239 original
articles, 10 (4%) were categorized as validation studies, 16 (7%) as adaptations, 12 (5%) as translations, and 222
(93%) as applications. Validation studies evaluated performance of the CAM against a reference standard. Results
were combined across seven high-quality studies (N=1,071), demonstrating an overall sensitivity of 94% (95%
confidence interval (CI)=91-97%) and specificity of 89% (95% CI=85-94%). The CAM has been adapted for use in the
intensive care unit, emergency, and institutional settings and for scoring severity and subsyndromal delirium. The
CAM has been translated into 10 languages where published articles are available. In application studies, CAM-rated
delirium is most commonly used as a risk factor or outcome but also as an intervention or reference standard.
CONCLUSION: The CAM has helped to improve identification of delirium in clinical and research settings. To optimize
performance, the CAM should be scored based on observations made during formal cognitive testing, and training is
recommended. Future action is needed to optimize use of the CAM and to improve the recognition and management
of delirium. 2008, Copyright the Authors.
Objective : Congenital heart disease (CHD) is the leading cause of infant mortality. CHD is found in 8-10 of every
1,000 live births and nearly 2,50,000 children are born with CHD each year in India. Approximately 10% of present
infant mortality in India may be accounted for by CHD alone. There are a large number of children with CHD,
primarily because of lack of health awareness and inadequate health care facilities. The numbers of CHD is increasing
every year and impose a huge economic burden on India. Thus more research should be carried out for early
detection and finding therapeutic intervention against CHD to reduce infant mortality. However, number of research
studies conducted with congenital heart disease (CHD) in India is limited. The aim of this study is to find the
prevalence, scope and importance of congenital heart disease in India and to find future strategies to reduce CHD.
Method : We use Google scholar and PubMed to find the research articles related to CHD in Indian population. We
also collected and analyzed CHD data from our IICT and Innova Children's heart hospital, Hyderabad (collaboration
study). Results : We collected research papers related to prevalence of CHDs which are published during 1980 to
2010 in Indian population. Based on literature from 1980 to 2010 its prevalence of CHDs ranging from 0.8 to 26.4 per
1000 live births in different States. Similar to other studies in India, our study showed that out of 4098 acyanotic CHD
patients the percentage of different CHD patients are as follows; ASD:20.86%, VSD:21.32%, DORV: 13.46%, PDA:
8.61%, CoA: 8.27%. Again out of 3754 cyanotic CHD patients; TOF: 29.62%, SV: 18.3%. While most of the Indian
studies were carried out to find the prevalence of CHDs in Indian population, very few studies were conducted to
find SNPs from candidate genes for CHD. However, none of the study showed any novel mutation from Indian
population. Epigenetics of CHD is another area which has not been explored yet in Indian population. Conclusion :
CHD with Indian population is less explored and need in-depth research to find the heterogeneity of the disease and
approaches to reduce infant mortality.
Background: Consensus-based studies are increasingly used as decision-making methods, for they have a lower
production cost than other methods (observation, experimentation, modeling) and provide results more rapidly. The
objective of this paper is to describe the principles and methods of the four main methods - Delphi, nominal group,
consensus development conference and RAND/UCLA - their use as reported in peer-reviewed publications and
validation studies published in the healthcare literature. Methods: A bibliographic search was performed in
PubMed/MEDLINE, banque de donnees sante publique (BDSP), The Cochrane Library, Pascal and Francis. Keywords,
headings and qualifiers corresponding to a list of terms and expressions related to the consensus methods were
searched for in the thesauri and used in the literature search. A search with the same terms and expressions was
performed on Internet using the website Google Scholar. Results: All methods, precisely described in the literature,
are based on common basic principles such as definition of the subject, selection of experts and direct or remote
interaction processes. They sometimes use quantitative assessment for ranking items. Numerous variants of these
methods have been described. Few validation studies have been implemented. Not implementing these basic
principles and failing to describe the methods used to reach the consensus were both frequent reasons raising
suspicion regarding the validity of consensus methods. Conclusion: When it is applied to a new domain with
important consequences in terms of decision-making, a consensus method should first be validated. 2008 Elsevier
Masson SAS. All rights reserved.
Introduction: The conservative management of Achilles tendinopathy requires clinicians to combine clinical
reasoning with the underpinning evidence base. This study aimed to produce a multi-faceted description of clinical
practice and guide future research by combining an inclusive review of the current literature with a narrative of
expert physiotherapists' clinical reasoning. Methods: Electronic databases PubMed, ISI Web of Science, PEDro,
CINAHL, Embase, and Google Scholar were searched for papers published up to November 2011 evaluating
conservative management for mid-portion Achilles tendinopathy. Further searches of reference lists and citation
tracking were also completed. Each study was scored using the PEDro scale, with a score of > 8/10 considered of
excellent quality, 5-7/10 good, and < 4/10 poor. Evidence for each treatment modality was then graded according to
the number and quality of supporting studies: 'strong,' 'moderate,' 'limited,' 'conflicting, or 'no evidence'. Clinical
reasoning was explored in a purposive sample of consenting experienced physiotherapists using semi-structured
interviews until data saturation. Interviews were analysed using the framework method to reveal emerging themes,
with this data then being used to illustrate the systematic review data. Results: Initial searching yielded a total of
3497 studies. Forty seven of these met the inclusion criteria. In total, 11 separate treatment modalities were
identified, with strong evidence supporting eccentric exercises and extra-corporeal shockwave therapy (ESWT) and
moderate evidence for low-level laser therapy, and concentric exercises. Limited evidence was found for foot
orthoses and therapeutic ultrasound. Taping and soft-tissue mobilisation studies were only identified by case
studies/series rather than randomised controlled trials. There was conflicting evidence for topical glyceryl trinitrate.
Framework analysis of semi-structured interviews revealed common themes which highlighted that physiotherapists
were frequently utilising eccentric exercises, based on their strong evidence base. Manual therapy was also
frequently applied, and foot orthoses prescription was often considered. Barriers to translating the research into
practice included heterogeneous outcome measures employed in different studies, over-stringency of traditional
evidence synthesis approaches and lack of access to primary research reports. Discussion: The graded evidence
combined with qualitatively analysed clinical reasoning produced a novel guide for clinicians conservatively managing
mid-portion Achilles tendinopathy. Additionally, these findings allow experienced clinicians to review the evidence
base and reflect on their clinical reasoning. Key areas for future research include evaluating the efficacy of foot
orthoses, manual therapy, aetiological factors, how to manage different stages of presentation such as reactive or
degenerative tendinopathy and eccentric exercise protocol adaptation.
Clinicians manage midportion Achilles tendinopathy (AT) using complex clinical reasoning underpinned by a rapidly
developing evidence base. The objectives of the study were to develop an inclusive, accessible review of the
literature in combination with an account of expert therapists' related clinical reasoning to guide clinical practice and
future research. Searches of the electronic databases, PubMed, ISI Web of Science, PEDro, CINAHL, EMBASE, and
Google Scholar were conducted for all papers published from inception to November 2011. Reference lists and citing
articles were searched for further relevant articles. Inclusion required studies to evaluate the effectiveness of any
conservative intervention for midportion AT. Exclusion criteria included in vitro, animal and cadaver studies and
tendinopathies in other locations (e.g. patella, supraspinatus). From a total of 3497 identified in the initial search, 47
studies fulfilled the inclusion criteria. Studies were scored according to the PEDro scale, with a score of >= 8/10
considered of excellent quality, 5-7/10 good, and <= 4/10 poor. The strength of evidence supporting each treatment
modality was then rated as 'strong', 'moderate', 'limited', 'conflicting' or 'no evidence' according to the number and
quality of articles supporting that modality. Additionally, semi-structured interviews were conducted with
physiotherapists to explore clinical reasoning related to the use of various interventions with and without an
evidence base, and their perceptions of available evidence. Evidence was strong for eccentric loading exercises and
extracorporeal shockwave therapy; moderate for splinting/bracing, active rest, low-level laser therapy and
concentric exercises (i.e. inferior to eccentric exercise). In-shoe foot orthoses and therapeutic ultrasound had limited
evidence. There was conflicting evidence for topical glycerin trinitrate. Taping techniques and soft-tissue mobilization
were not yet examined but featured in case studies and in the interview data. Framework analysis of interview
transcripts yielded multiple themes relating to physiotherapists' clinical reasoning and perceptions of the evidence,
including the difficulty in causing pain while treating the condition and the need to vary research protocols for
specific client groups--such as those with the metabolic syndrome as a likely etiological factor. Physiotherapists were
commonly applying the modality with the strongest evidence base, eccentric loading exercises. Barriers to research
being translated into practice identified included the lack of consistency of outcome measures, excessive stringency
of some authoritative reviews and difficulty in accessing primary research reports. The broad inclusion criteria meant
some lower quality studies were included in this review. However, this was deliberate to ensure that all available
research evidence for the management of midportion AT, and all studies were evaluated using the PEDro scale to
compensate for the lack of stringent inclusion criteria. Graded evidence combined with qualitative analysis of clinical
reasoning produced a novel and clinically applicable guide to conservative management of midportion AT. This guide
Background: Before long-term intrathecal analgesic therapy is initiated, patients often undergo a spinal analgesia
trial. Ziconotide is a nonopioid intrathecal analgesic used to manage severe chronic pain, and a variety of methods
have been used to trial ziconotide. Objectives: The purpose of this review is to compare and discuss the different
methods of ziconotide trialing. Methods: Various databases (i.e., PubMed, Excerpta Medica, Cumulative Index to
Nursing and Allied Health Literature, Biological Abstracts, Cochrane Database of Systematic Reviews, EMBASE,
International Pharmaceutical Abstracts, and Google Scholar) and association meeting abstracts were searched with
the use of the terms ziconotide, Prialt, trial, and trialing. In addition, a search was conducted for abstracts/ posters
presented at a variety of association meetings. Results: Nine sources, including one expert opinion piece, were
identified. Three methods of ziconotide trialing were discovered: continuous infusion, limited-duration infusion, and
bolus injection. Results indicate that patients often achieve analgesia during trialing, regardless of the trialing
method. Adverse events reported during ziconotide trialing studies were similar to those reported during ziconotide
clinical trials. Preliminary evidence suggests that both effectiveness and safety may be dose-related. In 3 studies the
value of ziconotide trialing in predicting long-term patient response to ziconotide therapy was investigated; however,
the results were preliminary. The expert opinion piece from 2008 recommended trialing ziconotide via continuous
infusion, using a starting dose of 1.2 mcg/d and dose increases of 1.2 mcg/d every 12 to 24 hours, for up to 3 days;
the trial may be extended in some cases. Limitations: Given the small samples size and lack of controlled ziconotide
trialing studies, it is currently not possible to determine the relative safety and effectiveness of different methods of
ziconotide trialing, nor is it possible to determine if trialing is predictive of patient response to long-term ziconotide
therapy. Conclusions: All 3 methods of ziconotide trialing appear to be viable options, and no method can be
considered superior on the basis of the evidence presented in this review. Controlled studies comparing ziconotide
trialing methods may be warranted.
BACKGROUND: Before long-term intrathecal analgesic therapy is initiated, patients often undergo a spinal analgesia
trial. Ziconotide is a nonopioid intrathecal analgesic used to manage severe chronic pain, and a variety of methods
have been used to trial ziconotide., OBJECTIVES: The purpose of this review is to compare and discuss the different
methods of ziconotide trialing., METHODS: Various databases (i.e., PubMed, Excerpta Medica, Cumulative Index to
Nursing and Allied Health Literature, Biological Abstracts, Cochrane Database of Systematic Reviews, EMBASE,
International Pharmaceutical Abstracts, and Google Scholar) and association meeting abstracts were searched with
the use of the terms ziconotide, Prialt, trial, and trialing. In addition, a search was conducted for abstracts/posters
presented at a variety of association meetings., RESULTS: Nine sources, including one expert opinion piece, were
identified. Three methods of ziconotide trialing were discovered: continuous infusion, limited-duration infusion, and
bolus injection. Results indicate that patients often achieve analgesia during trialing, regardless of the trialing
method. Adverse events reported during ziconotide trialing studies were similar to those reported during ziconotide
clinical trials. Preliminary evidence suggests that both effectiveness and safety may be dose-related. In 3 studies the
value of ziconotide trialing in predicting long-term patient response to ziconotide therapy was investigated; however,
the results were preliminary. The expert opinion piece from 2008 recommended trialing ziconotide via continuous
infusion, using a starting dose of 1.2 mcg/d and dose increases of 1.2 mcg/d every 12 to 24 hours, for up to 3 days;
the trial may be extended in some cases., LIMITATIONS: Given the small samples size and lack of controlled
ziconotide trialing studies, it is currently not possible to determine the relative safety and effectiveness of different
methods of ziconotide trialing, nor is it possible to determine if trialing is predictive of patient response to long-term
ziconotide therapy., CONCLUSIONS: All 3 methods of ziconotide trialing appear to be viable options, and no method
can be considered superior on the basis of the evidence presented in this review. Controlled studies comparing
ziconotide trialing methods may be warranted.
DATA SOURCES: Studies were identified using searches with Medline, the Cochrane Library and Google Scholar.,
STUDY SELECTION: Studies were screened independently and were included if they evaluated the effect of one or
more chewing gums containing at least one polyol (xylitol, sorbitol, mannitol or maltitol) on caries development,
provided they supplied original data generated by means of a comparative design (experimental or observational)
and were published in English. Studies were excluded if only an abstract was available or they described only the
pharmacodynamic or pharmacokinetic properties of polyols or did not include a no-treatment arm in the study.
Randomised trial quality was assessed using the Jadad scale, and the US Preventive Services Task Force criteria to
grade the internal validity of individual nonrandomised studies., DATA EXTRACTION AND SYNTHESIS: Data were
extracted independently with only the final outcomes of a study being recorded. It was decided that surface rather
than tooth level data would be recorded. Incremental caries was converted to prevented fraction (PF; the
proportional reduction in dental caries in experimental groups relative to control groups) for meta-analysis. The
studies were grouped according to type of polyol and a separate meta-analysis performed. Data were pooled using
both a random and a fixed-effects model and heterogeneity assessed using I2., RESULTS: Of 231 articles identified 25
studies were initially selected with 19 being included in the review [six randomised controlled trials (RCT) of which
four were cluster RCT, nine controlled clinical trials (CCT) and four cohort studies]. Two RCT had a Jadad score of
three or higher. The mean preventive fraction for the four main gum types are shown in the table 1, results of all
except the sorbitol -mannitol blend were statistically significant. Sensitivity analyses confirmed the robustness of the
findings., CONCLUSIONS: Although research gaps exist, particularly on optimal dosing and relative polyol efficacy,
there is consistent evidence to support the use of xylitol- and sorbitol-containing chewing gum as part of normal oral
hygiene to prevent dental caries.
Background: Constipation is physically and mentally troublesome for many patients with adverse effects of their
quality of life. The aim of the present study was to review previous studies on the epidemiology of constipation in
Iran, systematically. Methods: Bibliographic databases including PubMed, Google Scholar, and Iranian databases
including Scientific Information Database, Iran Medex, and Magiran were searched to select studies that reported
prevalence of constipation in Iran. Results: Overall, 10 articles met the criteria to be included in the current study.
The prevalence of constipation in Iran ranged from 1.4-37 %, and prevalence of functional constipation was reported
to be 2.4-32.9 %. Female gender, age, socioeconomic status and educational level seem to have major effects.
Conclusion: The prevalence of constipation is high in Iran. A few data is available regarding the natural history,
quality of life and risk factors of constipation in our country. Conducting populationbased studies is necessary to
explore different epidemiological aspects of constipation in Iran.
Key attributes of the social research contributions on indigenous ecological knowledge (IEK), local ecological
knowledge (LEK), and traditional ecological knowledge (TEK) are analyzed using the most frequently cited literature
generated by the "ISI Web of Knowledge" and "Google Scholar" search engines. They are further exemplified by an
examination of two contrasting approaches to the analysis of IEK/LEK/TEK. The results show that IEK/LEK/TEK is
treated predominantly via definitions, and few articles examine concepts, research design, methods, or operational
attributes. Consequently, there is no consensus on the content of IEK/LEK/TEK, the primary components of which
await examination via focused research. These are fundamental issues, since IEK/LEK/TEK misrepresented by social
research would probably deepen disempowerment of those it purports to champion. Research topics are suggested
to address these issues. 2010 by the Ecological Society of America.
Objectives: To review the literature on consumers' knowledge, attitudes and opinions of the use of generic
medicines. Method: A narrative review of studies conducted from 1970 to 2008 on consumers' perceptions and
views towards generic medicines was performed. An extensive literature search was undertaken using indexing
services available at the authors' institution library. The following keywords were used for the search: brand, generic,
multisource, medications, medicines, drugs, pharmaceuticals and consumers, customers, and patients. Electronic
databases searched were Medline, Inside Web, ISI Web of Knowledge, Science Direct, Springer Link, JSTOR, Proquest,
Ebsco Host and Google Scholar. These electronic databases were searched for full text papers published in English
from 1970 to October 2008. Key findings: Twenty studies were identified. Eleven were from the USA, four were from
Europe, two were from Canada and one each was from Australia, Brazil and Malaysia. In general, consumers showed
mixed reactions towards the use of generic medicines. This was evident from the divergence of views observed by
country development level, consumers' socioeconomic characteristics, drug product characteristics, pharmaceutical
reimbursement system, policy environment, contact with health care professionals, past experience with
medications, and knowledge of the seriousness of a medical condition. Conclusions: Patient confidence and
knowledge pertaining to generic medicines use have increased over the past four decades, especially in developed
countries. Mass educational effort, financial incentives, and greater communication among patients and health care
professionals were seen as major drivers to the uptake of generic medicines among consumers.
OBJECTIVES: To review the literature on consumers' knowledge, attitudes and opinions of the use of generic
medicines., METHOD: A narrative review of studies conducted from 1970 to 2008 on consumers perceptions and
views towards generic medicines was performed. An extensive literature search was undertaken using indexing
services available at the authors' institution library. The following keywords were used for the search: brand, generic,
multisource, medications, medicines, drugs, pharmaceuticals and consumers, customers, and patients. Electronic
databases searched were Medline, Inside Web, ISI Web of Knowledge, Science Direct, Springer Link, JSTOR, Proquest,
Ebsco Host and Google Scholar. These electronic databases were searched for full text papers published in English
from 1970 to October 2008., KEY FINDINGS: Twenty studies were identified. Eleven were from the USA, four were
from Europe, two were from Canada and one each was from Australia, Brazil and Malaysia. In general, consumers
showed mixed reactions towards the use of generic medicines. This was evident from the divergence of views
observed by country development level, consumers' socioeconomic characteristics, drug product characteristics,
pharmaceutical reimbursement system, policy environment, contact with health care professionals, past experience
with medications, and knowledge of the seriousness of a medical condition., CONCLUSIONS: Patient confidence and
knowledge pertaining to generic medicines use have increased over the past four decades, especially in developed
countries. Mass educational efforts, financial incentives, and greater communication among patients and health care
professionals were seen as major drivers to the uptake of generic medicines among consumers.
Background: Reports of recurrence following restructuring of primary giant cell tumor (GCT) defects using
polymethyl methacrylate (PMMA) bone cementation or allogeneic bone graft with and without adjuvants for
intralesional curettage vary widely. Systematic review and meta-analysis were conducted to investigate efficacy of
PMMA bone cementation and allogeneic bone grafting following intralesional curettage for GCT.Methods: Medline,
EMBASE, Google Scholar, and Cochrane databases were searched for studies reporting GCT of bone treatment with
PMMA cementation and/or bone grafting with or without adjuvant therapy following intralesional curettage of
primary GCTs. Pooled risk ratios and 95% confidence intervals (CIs) for local recurrence risks were calculated by fixed-
effects methods.Results: Of 1,690 relevant titles, 6 eligible studies (1,293 patients) spanning March 2008 to
December 2011 were identified in published data. Treatment outcomes of PMMA-only (n = 374), bone graft-only (n =
436), PMMA with or without adjuvant (PMMA + adjuvant; n = 594), and bone graft filling with or without adjuvant
(bone graft + adjuvant; n = 699) were compared. Bone graft-only patients exhibited higher recurrence rates than
PMMA-treated patients (RR 2.09, 95% CI (1.64, 2.66), Overall effect: Z = 6.00; P <0.001), and bone graft + adjuvant
patients exhibited higher recurrence rates than PMMA + adjuvant patients (RR 1.66, 95% CI (1.21, 2.28), Overall
effect: Z = 3.15, P = 0.002).Conclusions: Local recurrence was minimal in PMMA cementation patients, suggesting
that PMMA is preferable for routine clinical restructuring in eligible GCT patients. Relationships between tumor
characteristics, other modern adjuvants, and recurrence require further exploration. 2013 Zuo et al.; licensee
BioMed Central Ltd.
Aim. This paper is a report of a scoping review of research on cognitive impairment in older adults who visit
Emergency Departments of acute care hospitals, followed by an integrative review that included a quality
assessment to determine the effectiveness of interventions for this population. Background. Being old and
cognitively impaired in the Emergency Department - a fast-paced intervention system - is a complex phenomenon
that challenges many healthcare professionals. The rise in the incidence and prevalence of dementia will have a large
impact on healthcare systems. Data sources. MEDLINE, EMBASE, CINAHL, PsycInfo, AgeLine, Abstracts in Social
Gerontology, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and
Google Scholar between 1990 and 2008, for qualitative or quantitative studies reporting extractable data on delirium
or dementia in non-institutionalized older people (65+ years) in the Emergency Department. Review methods. Titles
screened by a project researcher and checked against inclusion criteria by another researcher. Two reviewers
completed independent data extraction and synthesis of included studies. Quality assessment occurred using the
Critical Appraisal Skills Programme Tools. Results. Fifteen studies met the inclusion criteria for integrative review.
Analysis of these studies indicates that the prevalence of cognitive impairment is high and improvements are
needed. Contextual details and relevant features of an appropriate intervention are poorly explained. Conclusion.
Although the prevalence and incidence of cognitive impairment is recognized, appropriate interventions and
programmatic responses remain elusive. Quality improvements require more thorough examination of emergency
department context to identify modifiable influencing factors that are transferable across settings. 2011 Blackwell
Publishing Ltd.
BACKGROUND: A systematic literature review was carried out to study the benefits of teleconsultation and
videoconferencing on the multifaceted process of diabetes care. Previous reviews focused primarily on usability of
technology and considered mainly one-sided interventions. OBJECTIVE: The objective was to determine the benefits
and deficiencies of teleconsultation and videoconferencing regarding clinical, behavioral, and care coordination
outcomes of diabetes care. METHODS: Electronic databases (Medline, PiCarta, PsycINFO, ScienceDirect,
Telemedicine Information Exchange, ISI Web of Science, Google Scholar) were searched for relevant publications.
The contribution to diabetes care was examined for clinical outcomes (eg, HbA(1c), blood pressure, quality of life),
behavioral outcomes (patient-caregiver interaction, self-care), and care coordination outcomes (usability of
technology, cost-effectiveness, transparency of guidelines, equity of care access). Randomized controlled trials
(RCTs) with HbA(1c) as an outcome were pooled using standard meta-analytical methods. RESULTS: Of 852
publications identified, 39 met the inclusion criteria for electronic communication between (groups of) caregivers
and patients with type 1, type 2, or gestational diabetes. Studies that evaluated teleconsultation or
videoconferencing not particularly aimed at diabetes were excluded, as were those that described interventions
aimed solely at clinical improvements (eg, HbA(1c)). There were 22 interventions related to teleconsultation, 13 to
videoconferencing, and 4 to combined teleconsultation and videoconferencing. The heterogeneous nature of the
identified videoconferencing studies did not permit a formal meta-analysis. Pooled results from the six RCTs of the
identified teleconsultation studies did not show a significant reduction in HbA(1c) (0.03%, 95% CI = - 0.31% to 0.24%)
compared to usual care. There was no significant statistical heterogeneity among the pooled RCTs (chi(2) (7)= 7.99, P
= .33). It can be concluded that in the period under review (1994-2006) 39 studies had a scope broader than clinical
outcomes and involved interventions allowing patient-caregiver interaction. Most of the reported improvements
concerned satisfaction with technology (26/39 studies), improved metabolic control (21/39), and cost reductions
(16/39). Improvements in quality of life (6/39 studies), transparency (5/39), and better access to care (4/39) were
hardly observed. Teleconsultation programs involving daily monitoring of clinical data, education, and personal
feedback proved to be most successful in realizing behavioral change and reducing costs. The benefits of
videoconferencing were mainly related to its effects on socioeconomic factors such as education and cost reduction,
but also on monitoring disease. Additionally, videoconferencing seemed to maintain quality of care while producing
cost savings. CONCLUSIONS: The selected studies suggest that both teleconsultation and videoconferencing are
practical, cost-effective, and reliable ways of delivering a worthwhile health care service to diabetics. However, the
Objectives: The incidence of invasive group A streptococcal infections (iGAS) is increasing in Europe, with a
particularly high morbidity and mortality in the elderly. Control of outbreaks in care homes is therefore important;
but is unclear how best to manage these incidents. We attempted to identify which control measures are most likely
to be effective. Methods: We undertook literature searches using PubMed and Google Scholar and contacted
colleagues in Health Protection Units in England for unpublished outbreaks. Results: We identified 31 outbreaks; of
which 20 had sufficient detail for further analysis. Overall carriage rates of GAS in care home residents identified in
outbreak investigations were 4.7%, and in staff 3.2%. In 8 outbreaks mass antibiotic prophylaxis was offered, in 9
selective prophylaxis only and in 3 none at all. Surveillance swabbing had limited influence on decisions regarding
prophylaxis. A few papers mentioned the role of environmental contamination and the risk from an affected
roommate. Conclusions: Pooling of results from these outbreaks failed to suggest any clear advantage to either a
selective or mass antibiotic prophylaxis strategy in controlling spread. Systematic investigation and data collection
from future outbreaks could be of benefit in informing future policy. 2011 The British Infection Association.
Bone turnover is much important in normal homeostasis of body skeleton. Medications, nutritional status, and
systemic illnesses may affect bone metabolism by altering biochemical mediators. Prostaglandins, especially of E and
F series are much important in bone physiology by affecting osteoclastic activity and osteoblastic differentiation. In
bone fracture, production of prostaglandins affects fracture healing. There is the possibility that non-steroidal anti-
inflammatory drugs (NSAIDs) affect bone health by inhibiting cyclooxygenase (COX) enzymes which reduce synthesis
of prostaglandins. The aim of this paper is to review the effects of NSAIDs on bone by evaluating both animal and
human studies. Using key words such as bone, bone marker, bone mineral density, NSAIDs, COX inhibitor, bone
metabolism and search engines like Web of sciences, Scopus, Pubmed, and Google scholar, all relevant studies were
collected. Although NSAIDs showed anti-resorptive properties in animal studies and some few human studies, to
date no conclusive result has been observed in bone formation. Some limited studies reported higher bone mineral
density in daily users of NSAIDs.
Background: Increasing the living-donor pool by accepting donors with an isolated medical abnormality (IMA) can
significantly decrease the huge gap between limited supply and rising demand for organs. There is a wide range of
variation among different centres in dealing with these categories of donors. We reviewed studies discussing living
kidney donors with IMA, including greater age, obesity, hypertension, microscopic haematuria and nephrolithiasis, to
highlight the effect of these abnormalities on both donor and recipient sides from medical and surgical perspectives.
Methods: We systematically searched MEDLINE, ISI Science Citation Index expanded, and Google scholar, from the
inception of each source to January 2011, using the terms 'kidney transplant', 'renal', 'graft', 'living donor', 'old',
'obesity', 'nephrolithiasis', 'haematuria' and 'hypertension'. In all, 58 studies were found to be relevant and were
reviewed comprehensively. Results: Most of the reviewed studies confirmed the safety of using elderly, moderately
obese and well-controlled hypertensive donors. Also, under specific circumstances, donors with nephrolithiasis can
be accepted. However, persistent microscopic haematuria should be considered seriously and renal biopsy is
indicated to exclude underlying renal disease. Conclusion: Extensive examination and cautious selection with tailored
immunosuppressive protocols for these groups can provide a satisfactory short- and medium-term outcome. Highly
motivated elderly, obese, controlled hypertensive and the donor with a unilateral small stone (<1.5 cm, with normal
metabolic evaluation) could be accepted. Donors with dysmorphic and persistent haematuria should not be
accepted. A close follow-up after donation is crucial, especially for obese donors who developed microalbuminuria.
2011 Arab Association of Urology. Production and hosting by Elsevier B.V. All rights reserved.
Denture cleaning should be quick and easy to perform, especially in long-term care facilities. The lack of proper oral
hygiene can put older adults at higher risk from opportunistic oral infections, particularly fungal. As an alternative to
regular brushing, the use of a microwave oven has been suggested for cleaning and disinfecting dentures. To
synthesise and discuss the advantages and disadvantages of the use of a conventional microwave oven for cleaning
and disinfecting complete dentures. A brief literature search focused on papers dealing with microwave therapy for
denture cleaning through PubMed Central, Cochrane Database of Systematic Reviews, Google Scholar, Ovid
MEDLINE(R) In-Process, and Scifinder Scholar. One hundred and sixty-seven manuscripts published in English with
full text were found, and 28 were accepted and discussed in the light of the advantages and disadvantages of the use
of conventional microwave oven for cleaning and disinfecting complete dentures. There was no standardisation for
microwave use for denture cleaning. Manual cleaning still seemed to be the optimal method for controlling fungal
infection and denture stomatitis. However, such a daily routine appeared to be underused, particularly in long-term
care facilities. 2010 The Gerodontology Society and John Wiley & Sons A/S.
The main treatment available for restoration of the corneal endothelium is keratoplasty. This procedure is faced with
several difficulties, including the shortage of donor tissue, post-surgical complications associated with the use of
drugs to prevent immune rejection, and a significant increase in the occurrence of glaucoma. Recently, surgical
procedures such as Descemet's stripping endothelial keratoplasty have focused on the transplant of corneal
endothelium, yielding better visual results but still facing the need for donor tissue. The emergent strategies in the
field of cell biology and tissue cultivation of corneal endothelial cells Aim at the production of transplantable
endothelial cell sheets. Cell therapy focuses on the culture of corneal endothelial cells retrieved from the donor, in
the donor's cornea, followed by transplantation into the recipient. Recently, research has focused on overcoming the
challenge of harvesting human corneal endothelial cells and the generation of new biomembranes to be used as cell
scaffolds in surgical procedures. The use of corneal endothelial precursors from the peripheral cornea has also
demonstrated to be effective and represents a valuable tool for reducing the risk of rejection in allogeneic
transplants. Several animal model reports also support the use of adult stem cells as therapy for corneal diseases.
Current results represent important progresses in the development of new strategies based on alternative sources of
tissue for the treatment of corneal endotheliopathies. Different databases were used to search literature: PubMed,
Google Books, MD Consult, Google Scholar, Gene Cards, and NCBI Books. The main search terms used were: 'cornea
AND embryology AND transcription factors', 'human endothelial keratoplasty AND risk factors', '(cornea OR corneal)
AND (endothelium OR endothelial) AND cell culture', 'mesenchymal stem cells AND cell therapy', 'mesenchymal stem
cells AND cornea', and 'stem cells AND (cornea OR corneal) AND (endothelial OR endothelium)'. 2013 Macmillan
Publishers Limited All rights reserved.
Although coronary arterial fistula is rare, it is one of the most common among the coronary artery anomalies.
Coronary arterial fistula most commonly affects the right side of the heart. It may occur isolated or along with
congenital heart diseases. Angiography remains the best investigation for diagnosing the disease. Unless very large
and hemodynamically significant, it is usually asymptomatic in younger patients. With increasing age, symptoms
begin to appear, and the incidence of complication rises. Treatment by transcatheter or surgical closure gives the
best results, provided this is performed early in the course of the disease. This review was prepared by searching the
terms "coronary artery fistula," "coronary cameral fistula," "surgical management of coronary arterial fistula,"
"MDCT in coronary artery fistula," and "multiple coronary artery fistulae" in Google Scholar, PubMed, and PubMed
Central and exploring the related articles shown on the side of page. 2012 The Society of Thoracic Surgeons.
Background: The benefit of corticosteroids in community-acquired pneumonia( CAP) remains controversial. We did a
meta-analysis to include all the randomized controlled trials in which corticosteroids was used as adjunctive therapy.
We examined the benefits and risks of corticosteroids treatment in CAP. Methods: Databases including MEDLINE,
EMBASE, the Cochrane controlled trials register, the Cochrane Library and Google Scholar were searched to find
relevant trials. Two reviewers extracted data independently and included study design, patient characteristics,
interventions, mortality, morbidity outcomes and adverse events. The main outcome was all-cause mortality. The
pooled estimates were calculated using the random effects model. Results: Eight trials involving 862 patients were
included. Analysis(seven studies, n = 831) showed a trend toward all cause-mortality reduction(risk ratio 0.68, 95% CI
0.39-1.19; p = 0.18). There were reductions in need for mechanical ventilation, length of hospital stay and
improvements in PaO2/ FiO2ratios, concentrations of C-reactive protein. Corticosteroids increased the risk of
hyperglycemia(risk ratio 2.70, 95% CI 1.69-4.31; p < 0.0001) but without increasing the risk of gastroduodenal
bleeding(risk ratio 1.42, 95% CI 0.40-5.13; p = 0.59), superinfection(risk ratio 1.27, 95% CI 0.36-4.42; p = 0.71) and all
major adverse events(risk ratio 0.74, 95% CI 0.33-1.64; p = 0.45). Conclusion: Corticosteroids cannot reduce all cause-
mortality in adults with CAP. However, the use of corticosteroids was associated with improved morbidity outcomes
without increased major adverse reactions.
Background: The benefit of corticosteroids in community-acquired pneumonia (CAP) remains controversial. We did a
meta-analysis to include all the randomized controlled trials (RCTs) which used corticosteroids as adjunctive therapy,
to examine the benefits and risks of corticosteroids in the treatment of CAP in adults. Methods: Databases including
Pubmed, EMBASE, the Cochrane controlled trials register, and Google Scholar were searched to find relevant trials.
Randomized and quasi-randomized trials of corticosteroids treatment in adult patients with CAP were included.
Effects on primary outcome (mortality) and secondary outcomes (adverse events) were accessed in this meta-
analysis. Results: Nine trials involving 1001 patients were included. Use of corticosteroids did not significantly reduce
mortality (Peto odds ratio [OR] 0.62, 95% confidence interval [CI] 0.37-1.04; P = 0.07). In the subgroup analysis by the
severity, a survival benefit was found among severe CAP patients (Peto OR 0.26, 95% CI 0.11-0.64; P = 0.003). In
subgroup analysis by duration of corticosteroids treatment, significant reduced mortality was found among patients
with prolonged corticosteroids treatment (Peto OR 0.51, 95% CI 0.26-0.97; P = 0.04; I2 = 37%). Corticosteroids
increased the risk of hyperglycemia (Peto OR 2.64, 95% CI 1.68-4.15; P<0.0001), but without increasing the risk of
gastroduodenal bleeding (Peto OR 1.67, 95% CI 0.41-6.80; P = 0.47) and superinfection (Peto OR 1.36, 95% CI 0.65-
2.84; P = 0.41). Conclusion: Results from this meta-analysis did not suggest a benefit for corticosteroids treatment in
patients with CAP. However, the use of corticosteroids was associated with improved mortality in severe CAP. In
addition, prolonged corticosteroids therapy suggested a beneficial effect on mortality. These results should be
confirmed by future adequately powered randomized trials. 2012 Nie et al.
OBJECTIVE: To compare the cost effectiveness of percutaneous transluminal coronary artery stenting with minimally
invasive internal thoracic artery bypass for isolated lesions of the left anterior descending artery. DESIGN: Cost
effectiveness analysis. DATA SOURCES: Embase, Medline, Cochrane, Google Scholar, and Health Technology
Assessment databases (1966-2005), and reference sources for utility values and economical variables. METHODS:
Decision analytical modelling and Markov simulation were used to model medium and long term costs, quality of life,
and cost effectiveness after either intervention using data from referenced sources. Probabilistic sensitivity and
alternative analyses were used to investigate the effect of uncertainty about the value of model variables and model
structure. RESULTS: Stenting was the dominant strategy in the first two years, being both more effective and less
costly than bypass surgery. In the third year bypass surgery still remained more expensive but became marginally
more effective. As the incremental cost effectiveness was 1,108,130.40 pounds sterling (1 682,146.00 euros;
$2,179,194) per quality adjusted life year (QALY), the additional effectiveness could not be said to justify the
additional cost at this stage. By five years, however, the incremental cost effectiveness ratio of 28,042.95 pounds
sterling per QALY began to compare favourably with other interventions. At 10 years the additional effectiveness of
0.132 QALYs (range -0.166 to 0.430) probably justified the additional cost of 829.02 pounds sterling (range 205.56
pounds sterling to 1452.48 pounds sterling), with an incremental cost effectiveness of 6274.02 pounds sterling per
QALY. Sensitivity and alternative analysis showed the results were sensitive to the time horizon and stent type.
CONCLUSIONS: Minimally invasive left internal thoracic artery bypass may be a more cost effective medium and long
term alternative to percutaneous transluminal coronary artery stenting.
BACKGROUND: Breast cancer is the leading cause of malignancy among women. Screening using mammography is
proposed as an effective intervention for reducing early deaths due to breast cancer. We conducted a systematic
review to assess the cost-effectiveness of such screening programs. We searched Medline, Scopus and Google
Scholar and complemented it by other searches using sensitive search terms from 1993-2010. We screened the titles
and abstracts, assessed the full texts of the remaining studies, and extracted data to a pre-designed data extraction
sheet. Studies were categorized according to the age groups of the target population. We used narrative synthesis
approaches for analyzing the data. Twenty-eight articles met the minimum inclusion criteria, mostly from high
income settings. All studies used secondary data, and a variety of modeling techniques, age groups, screening
intervals and outcome measures. Cost per life year gained, ranging from $1,634 (once at the age of 50 in India) to
$65,000 (extending the lower age limit of screening to 40 Australian study), was the most commonly used outcome
measure. Biennial screening test for those aged 50-70 years seems to be the most cost-effective option ($2685).
Biennial screening for aged 50-70 years is the most cost-effective option among alternative scenarios. Screening
those aged less than 50 is not recommended. Further studies in low-income and middle-income countries, and cost
effectiveness studies along with randomized trials are required. To improve the comparability of the findings, future
studies should include biennial screening in 50-70 age groups as an alternative strategy.
Introduction: Schizophrenia represents a major burden for patients, their families, healthcare systems and societies.
The objective of this literature review is to document the economic burden of schizophrenia. Method: The literature
search was performed using the MEDLINE-PUBMED database and the following keywords: schizophrenia and cost,
burden of disease, qaly or price. The grey literature search was performed using several databases (e.g. Banque de
Donnees en Sante Publique) and the Google Scholar web search engine. The studies that met the following criteria
were included: published since 1998, written in English or French, studied OECD countries and presented costs data
that were given in monetary terms. The costs data identified in the literature were classified into the following five
main categories: cost for healthcare system, cost for social and medico-social system (medico-social system is a
French specificity), cost for prison and legal systems, cost of informal care given by family, and cost associated with
productivity losses. To improve comparability, costs were reported as a percentage of health care expenditures and
as a per-ten-thousand of GDP (gross domestic product). Results: Among the 201 articles identified as potentially
relevant to the topic, nine were included in the literature review. Schizophrenia health care costs ranged from four
(Ireland) to 140000 of GDP (Spain). Hospital care was the main health care cost driver but ranged from 19 (USA) to
92% (Belgium) demonstrating a great variability in treatment patterns. The costs for social and medico-social system
ranged from 1.3 (Korea) to 13.80000 of GDP (USA) and the costs of informal caregivers ranged from 1.2 (Australia) to
12.70000 of GDP (Spain). The productivity losses associated with unemployment ranged from 6.2 (Australia) to
21.30000 of GDP (USA). The productivity losses associated with premature mortality ranged from less than 0.01
(Canada) to 3.850000 (Ireland). Among others factors, such as targeted population, the choice of valuation method
between "Friction costs" and "Human Capital" could account for the heterogeneity of estimates. Discussion: Median
health care costs of schizophrenia represented 1.1% of total national health care expenditures. Productivity losses
associated with morbidity constituted the major cost burden of schizophrenia. Valuation method, costs items, target
populations and prevalence rates differed widely from study to study. Furthermore, the burden attributable to loss
of quality of life was not estimated in the studies. Conclusion: Cost-of-illness studies of schizophrenia provide
information about its burden on society. The external validity of such studies however is poor and justifies country-
specific data collection. 2013 LEncephale, Paris.
OBJECTIVES: The diabetic peripheral neuropathy (DPN) is the most common diabetic patients' complication which is
accompanied with substantial economic burden regarding the productivity loss and medical therapy. In this study we
analyzed the cost effectiveness of pregabalin for treatment of diabetic neuropathic pain in Iran. METHODS: To
evaluate the efficacy of pregabalin we designed a systematic review of published articles by searching on PubMed,
Scopus and Google scholar. Our keywords were: "pregabalin", "neuropathic pain", "diabetic peripheral neuropathy",
etc. The pain score was the outcome of interest for evaluation of the treatment efficacy in peripheral neuropathic
pain. For calculation of cost we only consider direct cost of treatment. RESULTS: Out of 8994, finally 5 articles were
included in the study which met our inclusion criteria. All of these reports were Randomized Clinical Trial (RCT) of the
comparison of pregabalin with placebo. Considering the efficacy extracted from the reports, pregabalin 75 mg/day
and 150 mg/day didn't have any significant efficacy in comparison with placebo thus the ICER for other treatment
doses was calculated. In pregabalin 300 mg/day the ICER for domestic produced generic pregabalin was 0.27 dollar
per day per pain score reduction and for imported Lyrica was 2.74 dollar per day per pain score reduction. The
results for pregabalin 600 mg/day were 0.62 and 4.37 respectively. CONCLUSIONS: Our analysis indicated pregabalin
300 mg/day and 600 mg/day as cost effective treatments. About the inclusion of pregabalin into insurance positive
list if the prescribers prefer to order pregabalin once a day (As we learned from the expert opinion) therefore only
300 mg and 600 mg dosage forms are eligible for including into the positive list.
OBJECTIVES: Fibromyalgia is a neuropathic syndrome which is more common in adult females. Pregabalin is the first
medicine which was approved by FDA for treatment of fibromyalgia. In this study we aim to evaluate the cost-
effectiveness of pregabalin in the treatment of fibromyalgia in Iran. METHODS: To evaluate the efficacy of
pregabalin, a systematic review by searching on PubMed, Scopus and Google scholar was conducted. The keywords
included "fibromyalgia" and "pregabalin". The outcome of interest in the reports was the score pain. To evaluate
costs of treatment, the direct costs were considered. RESULTS: Out of 8994 primary reports only three reports were
included in the study which all of them were Randomized Clinical Trial with placebo control. Considering the efficacy
extracted from the reports, the ICER for each treatment doses was calculated. In pregabalin 450 mg/day, the ICER for
domestic generic medicine was 0.72 dollar per day per pain score reduction and for imported brand (Lyrica) was 6.47
dollar per day per pain score reduction and for pregabalin 600 m/day these results were 0.78 and 5.53 respectively.
CONCLUSIONS: Our analysis indicated that pregabalin in the treatment doses of 300, 450, 600 mg/day is cost-
effective and could be included into insurance positive list.
Purpose: This study compares the articles cited in CINAHL, Scopus, Web of Science (WOS), and Google Scholar and
the h-index ratings provided by Scopus, WOS, and Google Scholar. Methods: The publications of 30 College of
Nursing faculty at a large urban university were examined. Searches by author name were executed in Scopus, WOS,
and POP (Publish or Perish, which searches Google Scholar), and the h-index for each author from each database was
recorded. In addition, the citing articles of their published articles were imported into a bibliographic management
program. This data was used to determine an aggregated h-index for each author. Results: Scopus, WOS, and Google
Scholar provided different h-index ratings for authors and each database found unique and duplicate citing
references. Conclusions: More than one tool should be used to calculate the h-index for nursing faculty because one
tool alone cannot be relied on to provide a thorough assessment of a researcher's impact. If researchers are
interested in a comprehensive h-index, they should aggregate the citing references located by WOS and Scopus.
Because h-index rankings differ among databases, comparisons between researchers should be done only within a
specified database. 2012 Elsevier Inc.
Introduction: Pediatric sleep-disordered breathing is a continuum, with primary snoring at one end, and complete
upper airway obstruction, hypoxemia, and obstructive hypoventilation at the other. The latter gives rise to
obstructive sleep apnea. An important predisposing factor in the development and progression of pediatric sleep-
disordered breathing might be craniofacial disharmony. The purpose of this systematic review and meta-analysis was
to elucidate the association between craniofacial disharmony and pediatric sleep-disordered breathing. Methods:
Citations to potentially relevant published trials were located by searching PubMed, Embase, Scopus, and the
Cochrane Central Register of Controlled Trials. The MetaRegister of controlled trials database was also searched to
identify potentially relevant unpublished trials. Additionally, hand-searching, Google Scholar searches, and contact
with experts in the area were undertaken to identify potentially relevant published and unpublished studies.
Inclusion criteria were (1) randomized controlled trials, case-control trials, or cohort studies with controls; (2) studies
in nonsyndromic children 0 to 18 years of age with a diagnosis of sleep-disordered breathing or obstructive sleep
apnea by either a sleep disorders unit, screening questionnaire, or polysomnography; and (3) principal outcome
measures of craniofacial or upper airway dimensions or proportions with various modalities of imaging for the
craniofacial and neck regions. The quality of the studies selected was evaluated by assessing their methodologies.
Treatment effects were combined by meta-analysis with the random-effects method. Results: Children with
obstructive sleep apnea and primary snoring show increased weighted mean differences in the ANB angle of
1.64degree (P <0.0001) and 1.54degree(P <0.00001), respectively, compared with the controls. An increased ANB
angle was primarily due to a decreased SNB angle in children with primary snoring by 1.4degree(P = 0.02). Children
with obstructive sleep apnea had a distance from the posterior nasal spine to the nearest adenoid tissue measured
along the PNS-basion line reduced by 4.17 mm (weighted mean difference) (P <0.00001) and a distance from the
posterior nasal spine to the nearest adenoid tissue measured along the line perpendicular to the sella-basion line
reduced by 3.12 mm (weighted mean difference) (P <0.0001) compared with the controls. Conclusions: There is
statistical support for an association between craniofacial disharmony and pediatric sleep-disordered breathing.
However, an increased ANB angle of less than 2degreein children with obstructive sleep apnea and primary snoring,
compared with the controls, could be regarded as having marginal clinical significance. Therefore, evidence for a
direct causal relationship between craniofacial structure and pediatric sleep-disordered breathing is unsupported by
this meta-analysis. There is strong support for reduced upper airway width in children with obstructive sleep apnea.
Larger well-controlled trials are required to address the relationship of craniofacial and upper airway morphology to
The level of bone crest surrounding the implant is of utmost significance to determine osseointegrated implant
success, as preservation of marginal bone height is highly important for long-term dental implant survival. Various
approaches have been described in the literature to prevent the crestal bone loss, including platform switching, non-
submerged approach, scalloped implants, implant design modifications, progressive loading, immediate implant
placement, etc. The purpose of this paper is to review all the possible methods to preserve the crestal bone, when
each method should be used and their success rates in an attempt to address this complex problem of crestal bone
resorption. "PubMed" and "Google Scholar" were used to find out any studies involving platform switching concept
from 1990 up to 2009. Twenty-four studies involving methods for preservation of crestal bone were evaluated,
which included 26% studies on platform switching, 22% on non-submerged approach, 17% on scalloped implants,
13% on progressive loading and 22% on immediate implant placement. Crestal bone preservation should be thought
of starting from the design of the implant to be placed. The technique to be followed in a given case will depend
upon the density of bone, force factors by the patient, bone volume and amount of soft tissues, etc. The best
possible method or the combination of the methods should be used to preserve the crestal bone for the long-term
success of the implants.
PURPOSE: Low-quality obstetric care in low- and middle-income countries contributes to high in-hospital maternal
mortality. Criterion-based clinical audits are increasingly used to measure and improve obstetric care in these
settings. This article systematically reviews peer-reviewed literature to determine if these audits are feasible, valid
and reliable measurement tools for assessing the quality of obstetric care., DATA SOURCES: PUBMED, Google Scholar
and Web of Science databases were searched for peer-reviewed articles published between 1995 and 2009 and
which used criterion-based clinical audits to measure the quality of obstetric care in low- and middle-income
countries., STUDY SELECTION: Sixty-nine studies were identified by key terms and subsequently reviewed. Ten were
retained based on inclusion/exclusion criteria., DATA EXTRACTION: (i) General characteristics of the study; (ii)
compliance with expected standards of care and on maternal/child health outcomes; (iii) selection of the study
population and sampling methods; and (iv) quality control and reliability., RESULTS OF DATA SYNTHESIS: Criterion-
based clinical audit is increasingly used in low- and middle-income countries. Most audits were conducted in sub-
Saharan Africa. Studies had cross-sectional study or before-and-after designs. Sampling methods were poorly
reported and selection bias was a concern. No studies compared audit against other measures of quality of care or
against patient outcomes., METHODS: for quality control and assurance were generally not documented and
reliability was mostly unaddressed., CONCLUSIONS: Criterion-based clinical audit appears feasible. No studies have
rigorously evaluated its measurement properties in low- and middle-income countries. Without such evaluation,
measurement properties of the audit remain under question.
Purpose. Low-quality obstetric care in low- and middle-income countries contributes to high in-hospital maternal
mortality. Criterion-based clinical audits are increasingly used to measure and improve obstetric care in these
settings. This article systematically reviews peer-reviewed literature to determine if these audits are feasible, valid
and reliable measurement tools for assessing the quality of obstetric care. Data sources. PUBMED, Google Scholar
and Web of Science databases were searched for peer-reviewed articles published between 1995 and 2009 and
which used criterion-based clinical audits to measure the quality of obstetric care in low- and middle-income
countries. Study selection. Sixty-nine studies were identified by key terms and subsequently reviewed. Ten were
retained based on inclusion/exclusion criteria. Data extraction. (i) General characteristics of the study; (ii) compliance
with expected standards of care and on maternal/ child health outcomes; (iii) selection of the study population and
sampling methods; and (iv) quality control and reliability. Results of data synthesis. Criterion-based clinical audit is
increasingly used in low- and middle-income countries. Most audits were conducted in sub-Saharan Africa. Studies
had cross-sectional study or before-and-after designs. Sampling methods were poorly reported and selection bias
was a concern. No studies compared audit against other measures of quality of care or against patient outcomes.
Methods for quality control and assurance were generally not documented and reliability was mostly unaddressed.
Conclusions. Criterion-based clinical audit appears feasible. No studies have rigorously evaluated its measurement
properties in low- and middle-income countries. Without such evaluation, measurement properties of the audit
remain under question. The Author 2011. Published by Oxford University Press in association with the International
Society for Quality in Health Care; all rights reserved.
OBJECTIVES: The HPV (human papillomavirus) vaccine has been one of the mostsuccessful vaccines in the past
decade, securing rapid inclusion onto national immunizationprogrammes (NIP). By contrast, the HZ (herpes zoster)
vaccine, anotherrecent launch, has failed to gain widespread coverage. The aim of this research is tocompare these
cases based on cost effectiveness in order to understand underlyingcriteria for successful vaccine uptake.
METHODS:Weconducted a literature reviewusing databases (Cochrane library, Medline and Google scholar) for the
time period1995 2010. Key search words included HPV, HZ, vaccination, economic evaluationand cost effectiveness.
Extracted studies were selected based on pre-determinedinclusion and exclusion criteria. RESULTS: Despite low
incidence rates for cervicalcancer in some countries, the HPV vaccine was considered to be cost effective withratios
ranging from $14,149 to $29,580/QALY. It provides long term protection in ayoung population. Although the HZ
vaccine displayed a similar CE range, $16,229 to$28,325/QALY, this was heavily dependent on age (optimal years
being 60-70). Consequently,the HZ vaccine is indicated for the elderly. It is also considered to providewaning
immunity after initial vaccination. From a public health point of view,the HZ vaccine was not as well received as the
HPV vaccine. CONCLUSIONS: Inaddition to vaccine efficacy, long term immunity and safety, there are
additionalfactors which influence vaccine uptake. For example there are substantial publicgood aspects of
vaccination with long term societal returns reflected in maximalpopulation coverage. In particular, awareness and
support from the medical profession,particularly general practitioners, also assist in the perception of societalvalue
that a vaccine can provide. These factors are all very important considerationsbeyond economic evaluation, and
therefore have great influence over inclusiononto NIPs.
Aims. To present a critique of the National League for Nursing/Jeffries simulation framework. Design. Fawcett's
criteria for theory analysis and evaluation are used. Background. Use of simulated learning experiences in nursing
education is widespread; a sound framework to guide educators across the globe in implementing these experiences
effectively is essential. The basic assertion of the National League for Nursing/Jeffries simulation framework is that
student-learning outcomes are influenced by the concepts of teacher, student, educational practices, and simulation
design characteristics. Data sources. A literature search was performed using Cumulative Index to Nursing and Allied
Health Literature, PubMed and Google Scholar to identify studies published in the English language, between 2005-
June 2011, where the National League for Nursing/Jeffries simulation framework was tested or used as a theoretical
framework for research. Discussion. Sixteen publications (two articles in press) from the USA and UK were identified
using the framework to guide research; outcomes included increased student satisfaction, confidence, and improved
skill performance. Implications for nursing. As a newer theoretical framework, the National League for
Nursing/Jeffries simulation framework offers promise to guide the construction and implementation of simulation
experiences resulting in positive student outcomes. Conclusion. Empirically supported definitions of concepts would
strengthen the framework and help educators to consistently produce and identify positive outcomes. Additional
rigorous research is necessary to further test relationships among concepts and the associated concept variables in
the framework. More studies outside of the United States are needed to confirm the framework is relevant to
nursing programs in other countries. 2012 Blackwell Publishing Ltd.
Aim To analyze the 2007 citation count of articles published by the Croatian Medical Journal in 2005-2006 based on
data from the Web of Science, Scopus, and Google Scholar. Methods Web of Science and Scopus were searched for
the articles published in 2005-2006. As all articles returned by Scopus were included in Web of Science, the latter list
was the sample for further analysis. Total citation counts for each article on the list were retrieved from Web of
Science, Scopus, and Google Scholar. The overlap and unique citations were compared and analyzed. Proportions
were compared using ?2-test. Results Google Scholar returned the greatest proportion of articles with citations
(45%), followed by Scopus (42%), and Web of Science (38%). Almost a half (49%) of articles had no citations and 11%
had an equal number of identical citations in all 3 databases. The greatest overlap was found between Web of
Science and Scopus (54%), followed by Scopus and Google Scholar (51%), and Web of Science and Google Scholar
(44%). The greatest number of unique citations was found by Google Scholar (n = 86). The majority of these citations
(64%) came from journals, followed by books and PhD theses. Approximately 55% of all citing documents were full-
text resources in open access. The language of citing documents was mostly English, but as many as 25 citing
documents (29%) were in Chinese. Conclusion Google Scholar shares a total of 42% citations returned by two others,
more influential, bibliographic resources. The list of unique citations in Google Scholar is predominantly journal
based, but these journals are mainly of local character. Citations received by internationally recognized medical
journals are crucial for increasing the visibility of small medical journals but Google Scholar may serve as an
alternative bibliometric tool for an orientational citation insight.
OBJECTIVE: To review the chemistry, pharmacology, pharmacokinetics, efficacy, and safety of crofelemer. DATA
SOURCES: A literature search using the terms SP-303, Provir, and crofelemer was performed with PubMed (up to
April 2010), Google Scholar, and selected Ovid bibliography searches. Additional references from the bibliographies
of articles included in the search, as well as company and Food and Drug Administration Web sites, were also
assessed. DATA EXTRACTION: English-language in vitro and clinical studies associated with the safety and efficacy of
crofelemer were included. DATA SYNTHESIS: Crofelemer is a first-in-class agent that may be useful for different types
of secretory diarrhea, since it prevents chloride and fluid secretion into the bowel by directly inhibiting 2 distinct
intestinal chloride channels. Crofelemer significantly brought about faster symptom resolution in patients with
traveler's diarrhea, along with lower rates of treatment failure compared to placebo-treated patients. In a post hoc
analysis, crofelemer compared to placebo also appears to have reduced abnormal stool weight and frequency in
patients with AIDS-associated diarrhea. In a third trial, crofelemer did not offer a significant benefit in improving
stool consistency after 12 weeks of treatment in patients with diarrhea-predominant irritable bowel syndrome.
However, a significant increase in pain-free days was noted in female patients. Preliminary studies also show that
crofelemer may reduce watery stool output in patients with infectious diarrhea such as cholera. Oral crofelemer
seemed to be well tolerated in clinical trials, with adverse effect profiles comparable to those with placebo.
CONCLUSIONS: Crofelemer possesses a novel mechanism of action that shows promise in treating secretory diarrhea
of several etiologies. However, results from further Phase 3 clinical trials are still needed in order to fully evaluate the
efficacy and safety of this agent.
BACKGROUND: Recess is at the heart of a vigorous debate over the role of schools in promoting optimal child
development and well-being. Reallocating time to accentuate academic concerns is a growing trend and has put
recess at risk. Conversely, pressure to increase activity in school has come from efforts to combat childhood obesity.
The purpose of this review was to examine the value of recess as an integral component of the school day.
METHODS: A comprehensive review of recess-specific literature was conducted, beginning with a Google Scholar
search, to cull definitions, position statements, and policy recommendations from national/international associations
and organizations. A multi-database search followed. Additional articles were selected from reference lists. RESULTS:
The search yielded a range of articles, from those focused on specific aspects of recess to those that examined
multiple factors, including how to structure and conduct recess. Several themes emerged supporting recess as
beneficial for children's cognitive, social, emotional, and physical functioning. Optimal recess was well-supervised
and safe. Crucial components were well-maintained playground equipment and well-trained supervisors.
CONCLUSION: Recess serves a critical role in school as a necessary break from the rigors of academic challenges.
Recess is a complement to, not a replacement for, physical education. Both promote activity and a healthy lifestyle;
however, recess-particularly unstructured recess and free play-provides a unique contribution to a child's creative,
social, and emotional development. From the perspective of children's health and well-being, recess time should be
considered a child's personal time and should not be withheld for academic or punitive reasons. 2010, American
School Health Association.
Objectives: Jean Cruveilhier has always been described as a pioneer in pathological anatomy. Almost nothing has
been reported concerning his exceptional methodology allying pre-mortem clinical description and syndromic
classification of neurological and neurosurgical diseases, and post-mortem meticulous dissections. Cruveilhier's
methodology announced the birth of the anatomoclinical method built up by Jean-Martin Charcot and the
neurological French school during the 19th century. The aim of our work is to extract the quintessence of
Cruveilhier's contributions to skull base pathology through his cogent clinical descriptions coupled with exceptional
lithographs of anterior skull base, suprasellar and cerebello-pontine angle tumors. Methods: We reviewed the
masterwork of Jean Cruveilhier on pathological anatomy and we selected the chapters dedicated to central nervous
system pathologies, mainly skull base diseases. A systematic review was performed on Pubmed/Medline and Google
Scholar using the keywords "Jean Cruveilhier", "Skull base pathology", "Anatomoclinical method". Results: Among his
descriptions, Cruveilhier dedicated large chapters to neurosurgical diseases including brain tumors, cerebrovascular
pathologies, malformations of the central nervous system, hydrocephalus, brain infections and spinal cord
compressions. Conclusion: This work emphasizes on the role of Jean Cruveilhier in the birth of the anatomoclinical
method particularly in neuroscience during a 19th century rich of epistemological evolutions toward an evidence-
based medicine, through the prism of Cruveilhier's contribution to skull base pathology. 2012 Elsevier B.V. All rights
reserved.
Background: In the popular media and even among clinicians the view prevails that crying is healthy and that the
inhibition of tears may increase the risk of psychosomatic disorders. However, the relationship between crying and
health can also be considered from other perspectives. For example, crying as a symptom of disease, crying as a sign
of disease, crying as the consequence of a diagnosis or as the result of treatment, crying as a treatment. This
contribution presents an overview of the literature on the connection between health and crying. Method: I have
reviewed the pertinent literature, searching scientific databases as Pubmed, PsychInfo, and Google Scholar and have
carefully checked the references of the identified publications. Search terms were tears, weeping, crying, health,
depression, disorder, illness and disease. Results: The popular conception that the inhibition of crying endangers
one's mental and/or somatic health status has not been examined adequately until now. The qualitative best
research literature was found for crying and neurological disorders and - in babies - crying and health status. In
addition, there was some attention for crying and depression and crying due to treatment (depression, prostate
cancer). Conclusion: The major claim that crying is healthy is not supported, nor disconfirmed by the research
literature. In terms of research most effort has been given to neurological disorders and pathological crying and less
to depression and crying. Crying is an understudied and poorly understood behavior that nevertheless may have the
potentially useful and clinically relevant information.
BACKGROUND: In preparation for the initial offering of the University of Alaska Fairbanks (UAF), Interior-Aleutians
Campus Rural Nutrition Services (RNS) program, a literature review was conducted to establish the need for the
proposed program and to substantiate the methodology for delivering integrated, culturally tailored postsecondary
education and extension to Alaska Natives and rural Alaskans. There was a striking absence of peer-reviewed journal
articles describing culturally tailored postsecondary health curricula for indigenous populations., OBJECTIVE: To
complete and discuss a current (November 2012) literature review for culturally tailored postsecondary health
curricula designed and delivered for indigenous populations., METHODS/DESIGN: The author conducted an
expanded online search that employed multiple configurations of key terms using Google and Google Scholar, as well
as pertinent sources. The author located archived reports in person and contacted authors by email., RESULTS: The
expanded search produced a modest amount of additional literature for review. A disappointing number of
publications describing or evaluating culturally tailored postsecondary health curricula in mainstream institutions are
available. Related resources on culturally tailored extension and resources for the development and delivery of
culturally tailored nutrition and health curricula were identified., CONCLUSIONS: The present results demonstrate a
significant absence of literature on the topic, which may or may not indicate the absence of sufficient culturally
tailored postsecondary health curricula for indigenous populations. There are indications that culturally tailored
postsecondary health curricula for indigenous populations have the potential to effectively address certain issues of
health literacy and health disparities.
This paper reviews and summarizes the available literature on Haitian mental health and mental health services. This
review was conducted in light of the Haitian earthquake in January 2010. We searched Medline, Google Scholar and
other available databases to gather scholarly literature relevant to mental health in Haiti. This was supplemented by
consultation of key books and grey literature relevant to Haiti. The first part of the review describes historical,
economic, sociological and anthropological factors essential to a basic understanding of Haiti and its people. This
includes discussion of demography, family structure, Haitian economics and religion. The second part of the review
focuses on mental health and mental health services. This includes a review of factors such as basic epidemiology of
mental illness, common beliefs about mental illness, explanatory models, idioms of distress, help-seeking behavior,
configuration of mental health services and the relationship between religion and mental health.
Objectives: To describe the advancement of Intraosseous (IO) infusion in the spectrum of resuscitative protocols and
to provide a systematic review on currently used semi-automatic IO infusion devices. The specific question
addressed was: " In patients undergoing resuscitation, does the use of semi-automatic IO infusion devices compared
to manual needles influence IO placement success rate, time for IO placement, and ease-of-use and user
preference?" Methods: The electronic databases PubMed and Embase were searched for articles published from
1997 to 2010 using the search terms (" intraosseous" ) AND (" needle" or " device" or " technique" ) AND (" infusion"
or " injection" or " access" ). The Internet search engine Google Scholar was searched using the search term "
intraosseous infusion device" to identify articles published in electronic journals, books, and scientific websites.
Articles were included only if they compared at least two types of semi-automatic devices, or compared one or more
semi-automatic device with one or more manual needles. Reviews, editorials, surveys, and case reports were
excluded. Results: The search strategy yielded 179 papers. Ten studies met full criteria for further review. Of these,
two were LOE 1 (randomized controlled trials), one was LOE 2 (non-randomized, concurrent controls), one was LOE 3
(retrospective controls), and six were LOE 5 (simulation-based study). One of the six LOE 5 studies was a non-peer
reviewed article. Conclusions: Only a few studies compared the performance of different types of IO infusion
devices, most of them have a low level of evidence. These studies suggested a superiority of the battery-powered IO
driver over manual needles, and other semi-automatic IO infuson devices. 2011 Elsevier Ireland Ltd.
Background: Comparative effectiveness research (CER) is an important tool for improving healthcare quality and
efficiency. The US government is funding a large amount of CER, including observational studies. Observational
studies, such as patient registries, can provide unique information on CER to complement randomized trial findings.
Objectives: This study evaluates current uses of registries for CER. It identifies existing registries in the priority
research areas of cancer, cardiovascular disease, dementia, developmental delays, diabetes, and functional
limitations and assesses their uses for CER. Methods: Comprehensive identification of registries (n=238) was
conducted through systematic searches of PubMed, Clinicaltrials.gov, Google Scholar, and other public information.
Interviews were conducted with payers, providers, patients, researchers, and government agencies (n=49) to
understand whether existing registries meet research needs and gather views on current research gaps and
opportunities for collaboration. Results: Interest and investment in registries for CER is evolving. Some registries are
designed explicitly to examine CER questions. Others are designed for different purposes, but can provide data to
support CER. The areas of cancer and cardiovascular disease are particularly mature in terms of registry
development, ability to support new CER, and current uses of registries for CER. Conclusions: In disease areas with
established registries, stakeholders are eager to leverage existing registries for CER. In areas without established
registries, investments in infrastructure (e.g., developing common data sets and building new registries) may be
necessary prior to funding CER. When investing in CER, stakeholders should consider leveraging existing registries by
analyzing current data sets, augmenting data collection, or linking data to other sources. These may be cost-effective
and efficient approaches for CER.
With the trend toward pay-for-performance standards plus the increasing incidence and prevalence of periprosthetic
joint infection (PJI), orthopaedic surgeons must reconsider all potential infection control measures. Both airborne
and nonairborne bacterial contamination must be reduced in the operating room. Analysis of airborne bacterial
reduction technologies includes evaluation of (1) the effectiveness of laminar air flow (LAF) and ultraviolet light
(UVL); (2) the financial and potential health costs of each; and (3) an examination of current national and
international standards, and guidelines. We systematically reviewed the literature from Ovid, PubMed (Medline),
Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, NHSEED, CINAHLPLUS, and Google Scholar published until
June 2010 focusing on ultraclean air, ultraviolet light, and laminar air. High-level data demonstrating substantial PJI
reduction of any infection control method may not be feasible as a result of the relatively low rates of occurrence
and the expense and difficulty of conducting a large enough study with adequate power. UVL has potentially
unacceptable health costs and the Centers for Disease Control and Prevention (CDC) recommends against its use.
European countries have standardized LAF and it is used by the majority of American joint surgeons. Both LAF and
UVL reduce PJI. The absence of a high level of evidence from randomized trials is not proof of ineffectiveness. The
historically high cost of LAF has decreased substantially. Only LAF has been standardized by several European
countries. The CDC recommends further study of LAF but recommends UVL not be used secondary to documented
potential health risks to personnel.
Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are two chronic intestinal diseases having a
mutual pathophysiological pathways with different manifestations. Generally, inflammatory mediators and cytokines
orchestrate the scenario that amongst them, tumor necrosis factor-alpha (TNF-alpha) is a cornerstone. Nowadays
different medications and drug classes are administered for treatment of IBD and IBS but there is no full cure and
side effects of drugs limit their usage. Concerning the novel suggestion of ATP in the treatment of bowel diseases, we
were invited to conduct a systematic review. MeSh keywords of IBD, IBS, TNF-alpha, IL-12, and ATP were searched in
search engines like Pubmed, Scopus, Web of sciences, Embase, and Google scholar. Comparing the common
medications with ATP in terms of side effects, efficacy, and other limitations lead us to the conclusion that ATP could
be a reasonable alternative that may replace all other medications in this field in the near future. ATP is prepared as
lyophilized form that is stable at room temperature for at least 1-3 years and can be used as intravenous infusion in
the setting of private homes without direct medical supervision. Other routes of administration include
intraperitoneal, subcutaneous, oral, topical, nasal, and sublingual. Also, it can be mixed with parenteral and enteral
nutrition cocktails. The review also discussed some recent patents relevant to the field. 2009 Bentham Science
Publishers Ltd.
Several studies have been published on the neutral zone regarding materials, techniques, and different prostheses;
however, the data are incongruent, and a literature review was necessary. This review summarizes the literature on
the neutral zone and identifies deficiencies suggesting future research. The English language peer-reviewed dental
literature was reviewed from the period January 1, 1900 to June 30, 2011. Articles were searched in Medline
(PubMed) and Google scholar for the term "neutral zone" and were supplemented by a hand search in prosthodontic
publications. Deficiencies in the literature were found, including materials and techniques for recording the neutral
zone, the comparison of different neutral zone dentures, and the effect of the period of edentulism on the neutral
zone. Copyright 2013 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights
reserved.
Aim This paper addresses the current status of the treatment of acute colonic diverticulitis by an evidence-based
review. Method A systematic search in PUBMED, MEDLINE, EMBASE and Google scholar on colonic diverticulitis was
performed. Diagnostic tools, randomized controlled trials, non-randomized comparative studies, observational
epidemiological studies, national and international guidelines, reviews of observational studies on elective and
emergency surgical treatment of diverticulitis, and studies of prognostic significance were reviewed. Criteria for
eligibility of the studies were diagnosis and classification, medical treatment, inpatients and outpatients, diverticulitis
in young patients, immunosuppression, recurrence, elective resection, emergency surgery, and predictive factors.
Results Some 92 publications were selected for comprehensive review. The review highlighted that computed
tomography is the most effective test in the diagnosis and staging of acute diverticulitis; outpatient treatment can be
performed for uncomplicated diverticulitis in patients without associated comorbidities; conservative treatment is
aimed at those patients with uncomplicated acute diverticulitis; elective surgery must be done on an individual basis;
laparoscopic approach for elective treatment of diverticulitis is appropriate but may be technically complex; in
perforated diverticulitis, resection with primary anastomosis is a safe procedure that requires experience and should
take into account strict exclusion criteria. Conclusion The heterogeneity of patients with colonic diverticular disease
means that both elective and urgent treatment should be tailored on an individual basis. 2011 The Authors.
Colorectal Disease 2011 The Association of Coloproctology of Great Britain and Ireland.
Diabetic retinopathy (DR) is one of the most debilitating disorders of microvasculature of the retina and one of the
leading causes of vision loss among the working class worldwide. At present, intravitreal anti-inflammatory
(corticosteroids) and anti-angiogenesis (anti-Vascular Endothelial Growth Factor) agents are being used as wide
options for the pharmacotherapy of DR and diabetic macular edema (DME). Anti-inflammatory agents
(Triamcinolone acetonide and other agents) have shown evidence-based clinical benefits in various randomized
clinical trials for the treatment of DR and DME, and also shown improvement in best corrected visual acuity.
However, direct intravitreal injections are associated with serious side-effects like cataract and elevation of Intra
Ocular Pressure. Despite this, corticosteroid therapy has been effective for DR and DME, therefore current focus is
on the development of novel intravitreal steroid delivery devices that release a small quantity over a prolonged
period of time. In addition to corticosteroids, anti-angiogenic agents are found to be effective for the treatment of
DR and DME. The most popular target of these agents is the subfamily of proteins known as VEGF, whose over-
expression is believed to play a role in numerous diseases including DR and Age-related Macular Degeneration.
Intravitreal bevacizumab (Avastin) and Ranibizumab (Lucentis) are gaining popularity as a clinical adjunct to
panretinal photocoagulation in patients with proliferative DR. Moreover, Lucentis has been recently approved by the
United States Food and Drug Administration for macular edema following retinal vein occlusion. Further, systemic
agents (specially, hypoglycemic, hypolipidemic and anti-hypertensive agents) have shown beneficial results in
reducing the progression of DR. In conclusion, it can be stated that for the present scenario systematic use of
available pharmacotherapy as an adjunct to laser photocoagulation, which is gold standard therapy, can be a useful
tool in the prevention of vision loss from DR and related disorders. This article summarizes the up-to-date
developments in the pharmacotherapy of DR. Method- Literature search was done on online database, Pubmed,
Google Scholar, clinitrials.gov and browsing through individual ophthalmology journals and leading pharmaceutical
company websites.
Osteoporosis as a common chronic disease is challenging human health. Although different therapeutic options are
routinely used for prevention/treatment of osteoporosis, their side effects and benefits are under question.
Increasing our knowledge about signaling pathways in bone and osteocytes as well as osteoblasts and osteoclasts will
help us in designing new therapeutic modalities for osteoporosis. In the present study, all new therapeutic measures
of osteoporosis have been reviewed. For this purpose, search engines like Pubmed, Web of Science, Scopus, Google
Scholar were searched and all relevant articles were found. The study was limited to the year 1998-2010.
Bisphosphonates are the cornerstone of osteoporosis treatment, but there are not enough relevant studies that
investigated their equivalencies in comparison with each other or the other medications. Therefore, medication
selection is empirical and subjective. Furthermore, no eminent study has compared certain combinations. There are
new hopes for treatment of osteoporosis, which are more specific with less harm. Our results show that new and
emerging therapies are more potent and target specified which more individualize osteoporosis treatment; however,
more investigations on their safety and efficacy in comparison with current medications are highly recommended.
2010 Springer-Verlag.
This short review summarizes the use of late-night salivary cortisol measurement in the diagnosis of Cushing's
syndrome, in the evaluation of patients with adrenal incidentalomas, and in monitoring of post-operative patients,
with a focus on the different assay methodologies currently in common use. The focus is on recent studies identified
by literature searches using Ovid Medline and Google Scholar as well as analysis of several recent review articles on
the topic. Measurement of late night salivary cortisol (LNSC) has an excellent sensitivity and specificity for the
diagnosis of Cushing's syndrome regardless of the assay methodology used. Immunoassays have the advantage of
simplicity, low cost, and small sample volume requirement, while liquid chromatography-tandem mass spectrometry
has the advantage of a high specificity for cortisol and the ability to measure cortisone. The overnight
dexamethasone suppression test appears to be superior to LNSC measurement in the evaluation of patients with
adrenal incidentalomas. LNSC measurement is an excellent approach to monitor post-operative Cushing's disease
patients for surgical failure or recurrence. Salivary cortisol is most useful as the initial test when Cushing's syndrome
is suspected and for periodic patient monitoring after pituitary surgery for Cushing's disease. 2011 Springer
Science+Business Media, LLC.
Objective: To identify the scientific literature on cutaneous melanoma in Latin America and compile all available
epidemiologic data to demonstrate the need for reliable regional and country-specific data on incidence and
mortality estimates. Methods: Literature searches were conducted in PubMed, Embase, LILACS, and Google Scholar
databases for epidemiologic studies from 1 January 2000 to 31 October 2010 related to melanoma in Argentina,
Brazil, Colombia, Mexico, Puerto Rico, and Venezuela. A final search on melanoma cases was carried out using
country-specific population-based cancer registries. No statistical analyses were conducted. Results: For all six
countries, most epidemiological research on cutaneous melanoma consists of hospital-based or case-control studies.
Very few studies report incidence and mortality rates. Attempts to estimate disease rates have relied on national
incidence and mortality data and information extracted from cancer registries. While predominance of European
ancestry is a known risk factor for developing melanoma, the association of melanoma and ethnicity is not well-
documented in some of the populations reviewed. Latin Americans are frequently exposed to ultraviolet (UV)
radiation due to the tropical weather, high altitude, and thinning ozone layer in some regions. Tanned skin is viewed
as healthy and beautiful. While melanoma public health campaigns have been under way in Latin America for
decades, increasing melanoma awareness remains imperative. Conclusions: There is an urgent need to collect
accurate epidemiologic melanoma data in Latin America. Future research in the region should include more
comprehensive, countryspecific, population-based studies to allow for comparative evaluation of incidence and
mortality rates.
There, likely, is no more controversial issue in reproductive medicine than the effects of autoimmunity on female
reproductive success. Published studies are, therefore, often biased. We performed PubMed, Google Scholar and
Medline searches for the years 2000-2010 under various key words and phrases, referring to effects of
autoimmunity/autoimmune diseases on pregnancy/pregnancy outcomes/pregnancy
rates/reproduction/reproductive outcomes/fertility/infertility/fertility treatments/infertility treatments, and a
number of similar terms. Reference lists of selected manuscripts were evaluated for additional, potential references.
All selected manuscripts were reviewed by at least one author (N.G.). Opinions were reached based on preferential
review of only selected studies, which offered data, primarily developed in pursuit of unrelated scientific questions.
Data from various medical fields point, surprisingly effectively, toward significant impacts of autoimmunity on female
reproductive success. Autoimmunity not only increases miscarriage risks but also reduces female fecundity and
infertility treatment success. A, likely, reason why differences of opinion have persisted is that effects are primarily
observed in genetically predisposed women, with specific fragile X mental retardation 1 (FMR1) genotypes. This
discovery coincides with recently increasing appreciation of the importance of the long arm of the X chromosome
(Xq) in control of functional ovarian reserve (reflective of female fertility) and autoimmunity, with FMR1at Xq27.3,
located at cross roads of both. Autoimmune effects on female reproductive success deserve recognition. Further
investigations must not ignore patient stratification, based on ovarian FMR1 genotypes. Genetic definition of high-
risk patients should lead to development of successful therapeutic interventions. 2011 Elsevier Ltd.
Several polymorphisms in genes that encode platelet components (receptors or enzymes), or cytochrome P450
enzyme isoforms, involved in clopidogrel metabolism, have been proposed as possible mechanisms for
nonresponsiveness to clopidogrel. Among them, a great deal of attention has been focused on the loss-of-function
CYP2C19 2 (or 681 GA) polymorphism. We performed a meta-analysis of all the prospective studies that have been
published, which analyze the role of such a polymorphism in recurrent cardiovascular events in patients with
coronary artery disease (CAD) being treated with clopidogrel. Studies were searched in MedLine, Embase, Web of
Science, The Cochrane Systematic Review Database, Google Scholar and bibliographies of retrieved articles up to
January 2010. The principal underlying hypothesis was that the presence of the 2 variant allele of the polymorphism
would be associated with an increased risk of clinical recurrence. Data were available for a total of 8043 patients
from seven cohort prospective studies, who were followed for a period of time ranging from 6 months to 8.3 years.
The summary risk ratios (RRs) for the prospective cohort studies included showed a significant association between
the CYP2C19 2 polymorphism and an increased risk of major adverse cardiovascular events in the follow-up (RR: 1.96
(1.14-3.37); P=0.02). When studies evaluating stent thrombosis (n4) for a total of 4975 patients were considered, the
presence of the variant allele was associated with an increased risk of stent thrombosis (RR: 3.82 (2.23-6.54);
P=0.0001). The current meta-analysis, carried out on nearly 8000 patients with CAD undergoing clopidogrel
treatment, shows that the CYP2C19 2 polymorphism is associated with an increased risk of major adverse
cardiovascular events and stent thrombosis. 2011 Macmillan Publishers Limited. All rights reserved.
Several polymorphisms in genes that encode platelet components (receptors or enzymes), or cytochrome P450
enzyme isoforms, involved in clopidogrel metabolism, have been proposed as possible mechanisms for
nonresponsiveness to clopidogrel. Among them, a great deal of attention has been focused on the loss-of-function
CYP2C19(*)2 (or 681 G > A) polymorphism. We performed a meta-analysis of all the prospective studies that have
been published, which analyze the role of such a polymorphism in recurrent cardiovascular events in patients with
coronary artery disease (CAD) being treated with clopidogrel. Studies were searched in MedLine, Embase, Web of
Science, The Cochrane Systematic Review Database, Google Scholar and bibliographies of retrieved articles up to
January 2010. The principal underlying hypothesis was that the presence of the (*)2 variant allele of the
polymorphism would be associated with an increased risk of clinical recurrence. Data were available for a total of
8043 patients from seven cohort prospective studies, who were followed for a period of time ranging from 6 months
to 8.3 years. The summary risk ratios (RRs) for the prospective cohort studies included showed a significant
association between the CYP2C19(*)2 polymorphism and an increased risk of major adverse cardiovascular events in
the follow-up (RR: 1.96 (1.14-3.37); P = 0.02). When studies evaluating stent thrombosis (n = 4) for a total of 4975
patients were considered, the presence of the variant allele was associated with an increased risk of stent
thrombosis (RR: 3.82 (2.23-6.54); P = 0.0001). The current meta-analysis, carried out on nearly 8000 patients with
CAD undergoing clopidogrel treatment, shows that the CYP2C19(*)2 polymorphism is associated with an increased
risk of major adverse cardiovascular events and stent thrombosis.
Introduction: HIV-1 is regarded most responsible for a neurodegenerative disease, called HIV-associated dementia
(HAD). The pathogenic trait of this severe complication of HIV-infection is still unclear, but disturbed systemic and
central nervous system immune function seem to be an important component. Cytokines are important mediators of
the human immune system. The review focusses on major cytokines and related immune modulators. Methods: For
literature research, the PubMed library, Ovid, Cochrane database, Scirus and Google scholar were used. Results: The
article discusses the importance of interferons, interleukins, chemokines, adhesion molecules, colony stimulating
factors and tumor necrosis factors. Conclusion: The role of cytokines in the development to HAD is still not clear.
Neither their diagnostical or therapeutical potentials nor the basic pathogenetic involvements are completely
understood, but the importance of those molecules is evident. 2009 Bentham Science Publishers Ltd.
PURPOSE: to identify valid guidelines for the approach of women with cytopathological diagnosis of undetermined
significance atypias in squamous cells (ASC), discussing its applicability to the Brazilian scenario. METHODS: an
electronic search of publications at PubMed, National Guidelines Clearinghouse and Scholar Google was carried out,
as well as a manual search of references from the texts found. The guidelines identified, and specifically related to
the theme, were evaluated according to its validity and the recommendations were criticized and summarized.
RESULTS: guidelines for the United Kingdom, France, Australia, the USA and New Zealand have been considered as
valid. These documents recommend repeating the cytology in six or twelve months, in ASCs of undetermined
significance (ASC-US) before referring to colposcopy, and immediate referral to colposcopy in ASCs, when it is not
possible to disregard high degree lesions (ASC-H). We have also found valid colposcopy recommendations for women
with ASC-US in special situations (immune deficient women requiring specialist assistance) and the use of oncogenic
HPV test, which, when present in women over 20, should motivate referral to colposcopy. CONCLUSIONS: the clinical
guidelines recommended for the Programa Nacional de Controle do Cancer do Colo do Utero in Brazil can be
improved with the referral to colposcopy in special situations (immune deficient women requiring specialist
assistance), the use of test for the detection of oncogenic HPV in women over 20 (when present, refer to
colposcopy), the investigation of vaginal lesions, the use of estrogens before the colposcopy in post-menopausal
women, and disregard biopsia in case of slighter alterations.
PURPOSE: to identify valid guidelines for the approach of women with cytopathological diagnosis of undetermined
significance atypias in squamous cells (ASC), discussing its applicability to the Brazilian scenario., METHODS: an
electronic search of publications at PubMed, National Guidelines Clearinghouse and Scholar Google was carried out,
as well as a manual search of references from the texts found. The guidelines identified, and specifically related to
the theme, were evaluated according to its validity and the recommendations were criticized and summarized.,
RESULTS: guidelines for the United Kingdom, France, Australia, the USA and New Zealand have been considered as
valid. These documents recommend repeating the cytology in six or twelve months, in ASCs of undetermined
significance (ASC-US) before referring to colposcopy, and immediate referral to colposcopy in ASCs, when it is not
possible to disregard high degree lesions (ASC-H). We have also found valid colposcopy recommendations for women
with ASC-US in special situations (immune deficient women requiring specialist assistance) and the use of oncogenic
HPV test, which, when present in women over 20, should motivate referral to colposcopy., CONCLUSIONS: the
clinical guidelines recommended for the Programa Nacional de Controle do Cancer do Colo do Utero in Brazil can be
improved with the referral to colposcopy in special situations (immune deficient women requiring specialist
assistance), the use of test for the detection of oncogenic HPV in women over 20 (when present, refer to
colposcopy), the investigation of vaginal lesions, the use of estrogens before the colposcopy in post-menopausal
women, and disregard biopsy in case of slighter alterations.
STATEMENT OF PROBLEM: Adverse reactions to the materials used for the fabrication and reline of removable
denture bases have been observed., PURPOSE: The purpose of this study was to systematically review the published
literature on the cytotoxicity of denture base and hard reline materials., MATERIAL AND METHODS: MEDLINE via
PubMed, Google Scholar, and Scopus databases for the period January 1979 to December 2009 were searched with
the following key words: (biocompatibility OR cytotoxic* OR allergy OR "burning mouth" OR "cell culture
techniques") AND ("acrylic resins" OR denture OR monomer OR relin* OR "denture liners"). The inclusion criteria
included in vitro studies using either animal or human cells, in which the cytotoxicity of the denture base and hard
chairside reline resins was tested. Studies of resilient lining materials and those that evaluated other parameters
such as genotoxicity and mutagenicity were excluded. Articles published in the English language and in peer-
reviewed journals focusing on the cytotoxicity of these materials were reviewed., RESULTS: A total of 1443 articles
were identified through the search. From these, 20 studies were judged to meet the selection criteria and were
included in the review. In the majority of the studies, continuous cell lines were exposed to eluates of specimens
made from the materials, and mitochondrial activity was used to estimate cell viability. The tested acrylic resins were
grouped according to 5 major categories: (1) heat-polymerized; (2) microwave-polymerized; (3) autopolymerizing; (4)
light-polymerized; and (5) hard chairside reliners., CONCLUSIONS: This review provided some evidence that the heat-
polymerized resins showed lower cytotoxic effects than autopolymerizing denture base acrylic resins and light or
dual polymerized reline resins. However, because of the large number of variables in the reviewed literature, a
definitive conclusion could not be drawn. Copyright 2012 The Editorial Council of the Journal of Prosthetic Dentistry.
Published by Mosby, Inc. All rights reserved.
Statement of problem: Adverse reactions to the materials used for the fabrication and reline of removable denture
bases have been observed. Purpose: The purpose of this study was to systematically review the published literature
on the cytotoxicity of denture base and hard reline materials. Material and methods: MEDLINE via PubMed, Google
Scholar, and Scopus databases for the period January 1979 to December 2009 were searched with the following key
words: (biocompatibility OR cytotoxic* OR allergy OR "burning mouth" OR "cell culture techniques") AND ("acrylic
resins" OR denture OR monomer OR relin* OR "denture liners"). The inclusion criteria included in vitro studies using
either animal or human cells, in which the cytotoxicity of the denture base and hard chairside reline resins was
tested. Studies of resilient lining materials and those that evaluated other parameters such as genotoxicity and
mutagenicity were excluded. Articles published in the English language and in peer-reviewed journals focusing on the
cytotoxicity of these materials were reviewed. Results: A total of 1443 articles were identified through the search.
From these, 20 studies were judged to meet the selection criteria and were included in the review. In the majority of
the studies, continuous cell lines were exposed to eluates of specimens made from the materials, and mitochondrial
activity was used to estimate cell viability. The tested acrylic resins were grouped according to 5 major categories: (1)
heat-polymerized; (2) microwave-polymerized; (3) autopolymerizing; (4) light-polymerized; and (5) hard chairside
reliners. Conclusions: This review provided some evidence that the heat-polymerized resins showed lower cytotoxic
effects than autopolymerizing denture base acrylic resins and light or dual polymerized reline resins. However,
because of the large number of variables in the reviewed literature, a definitive conclusion could not be drawn. 2012
The Editorial Council of the Journal of Prosthetic Dentistry.
objective: To determine the usefulness of coagulation assay monitoring for dabigatran etexilate in certain high-risk
clinical situations. data sources: Literature retrieval was accessed through MEDLINE (1948-February 2013), Web of
Science (1980-February 2013), International Pharmaceutical Abstracts (1977-February 2013), and Google Scholar
using the terms dabigatran, dabigatran etexilate, BIBR 1048, BIBR 953, direct thrombin inhibitor, therapeutic
monitoring, and atrial fibrillation. In addition, abstracts presented at the 2011-2012 American Society of Hematology,
American College of Cardiology, International Society of Thrombosis and Haemostasis, and European Society of
Cardiology annual meetings were reviewed. A search of Clinicaltrials.gov was performed to identify relevant ongoing
or completed research. Study selection and data extraction: All English-language articles identified from the data
sources were evaluated for inclusion. Priority was placed on all data derived from controlled clinical studies. Data
Synthesis: Of the 6 published Phase 3 studies, only the RE-LY (Randomized Evaluation of Long-Term Anticoagulation
Therapy) trial evaluated the safety and efficacy of dabigatran for the prevention of stroke in patients with
nonvalvular atrial fibrillation. Post hoc analyses of the RE-LY trial have provided additional information in special
situations. Several published reports highlight the potential for complications with dabigatran, the importance of
determining the most optimal candidates, and the need for therapeutic monitoring. Activated partial thromboplastin
time and thrombin time are effective qualitative assays for dabigatran. Ecarin clotting time and the dilute thrombin
time (ie, Hemoclot direct thrombin inhibitor) assays are suitable for quantitative measurement. The correlation
between coagulation-based assays and clinical out comes among dabigatran-treated patients has not been
definitively established. However, coagulation-based assays may be useful in the management of several clinical
scenarios. 1967-2013 Harvey Whitney Books Co. All rights reserved.
OBJECTIVES: To assess the availability of linked data on HPV vaccination, screening, and cervical cancer outcomes to
guide public health decision-making on cervical cancer prevention strategies. METHODS: MEDLINE and Google
Scholar (1/1/ 2006-12/31/2011) were searched using keywords HPV registry, linkage, and cervical cancer to identify
countries with national HPV vaccination. Australia, New Zealand, Denmark, Norway, Greenland, Sweden, Iceland, the
United Kingdom, Canada, Mexico, and the United States were selected for detailed analysis based on previous
review frameworks (Wong et al. 2010; Sander et al. 2012). Information on infrastructure, outcomes collected,
surveillance registries and data linkage for these countries through January 15, 2012 was extracted from official
health authority websites and government reports. Documents not publicly available or without data on these topics
were excluded. RESULTS: Twenty peer-reviewed articles and health authority documents were selected for review.
Of the 11 countries evaluated, 64% (7/11) have national HPV vaccination registries collecting vaccination data and
comprehensive cancer registries that include cervical cancer outcomes. Four out of the eleven participate in
theWHOHPV Laboratory Network that aims to develop an international reference system for HPV assays to monitor
performance of HPV vaccines. Five of the 11 countries have linkage of vaccination, cancer screening, and cancer
registry records at the national level; however, the other six countries have potential linkages at provincial/territorial
levels. None of the 11 countries had data on HPV DNA genotyping linked with other cervical cancer screening and
vaccination data. CONCLUSIONS: While fewer than half of the countries assessed had nationally linked data on HPV
vaccination, screening, and cervical cancer outcomes, the remaining countries have potential local-level linkages of
these data. Establishing data linkages across these sources of information can enable an evidence base to explore the
impact of national vaccination strategies and to inform cervical cancer prevention efforts. .
UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Erectile dysfunction has been
associated with urethroplasty operations, but the incidence of erectile dysfunction after anterior urethroplasty
operations is largely unknown. A 1% incidence of de novo erectile dysfunction after anterior urethropathy was found
with systematic review and meta analysis of 36 studies with 2323 patients. In most cases the erectile dysfunction
was transient and resolved within six to twelve months., OBJECTIVE: To evaluate the likelihood of developing de
novo erectile dysfunction (ED) after anterior urethroplasty and to determine if this likelihood is influenced by age,
stricture length, number of previous procedures or timing of evaluation., MATERIALS AND METHODS: PubMed,
Embase, Cochrane, and Google Scholar databases were searched for the terms 'urethroplasty', 'urethral obstruction',
'urethral stricture', 'sexual function', 'erection', 'erectile function', 'erectile dysfunction', 'impotence' and 'sexual
dysfunction'. Two reviewers evaluated articles for inclusion based on predetermined criteria., RESULTS: In a meta-
analysis of 36 studies with a total of 2323 patients, de novoED was rare, with an incidence of 1%. In studies that
assessed postoperative erectile function at more than one time point, ED was transient and resolved at between 6
and 12 months in 86% of cases., CONCLUSIONS: Men should be counselled regarding the possibility of transient or
permanent de novoED after anterior urethroplasty procedures. Increasing mean age was associated with an
increased likelihood of de novoED, but this was not statistically significant. 2013 BJU International.
BACKGROUND: High intracranial pressure (ICP) is the most frequent cause of death and disability after severe
traumatic brain injury (TBI). High ICP is treated by general maneuvers (normothermia, sedation etc) and a set of first
line therapeutic measures (moderate hypocapnia, mannitol etc). When these measures fail to control high ICP,
second line therapies are started. Among these, second line therapies such as barbiturates, hyperventilation,
moderate hypothermia or removal of a variable amount of skull bone (known as decompressive craniectomy) are
used. OBJECTIVES: To assess the effects of secondary decompressive craniectomy (DC) on outcome and quality of life
in patients with severe TBI in whom conventional medical therapeutic measures have failed to control raised ICP.
SEARCH STRATEGY: We searched the Cochrane Injuries Group's Trial Register, CENTRAL, MEDLINE, EMBASE, Best
Evidence, Clinical Practice Guidelines, PubMed, CINAHL, the National Research Register and Google Scholar. We also
handsearched relevant conference proceedings and contacted experts in the field and the authors of included
studies. SELECTION CRITERIA: Randomized or quasi-randomized studies assessing patients over the age of 12 months
with a severe TBI who underwent DC to control ICP refractory to conventional medical treatments. DATA
COLLECTION AND ANALYSIS: Two authors independently examined the electronic search results for reports of
possibly relevant trials and for retrieval in full. One author applied the selection criteria, performed the data
extraction and assessed methodological quality. Study authors were contacted for additional information. MAIN
RESULTS: We found one trial with 27 participants conducted in the pediatric population (>18 years). DC was
associated with a risk ratio (RR) for death of 0.54 (95% CI 0.17 to 1.72), and RR of 0.54 for death, vegetative status or
severe disability 6 to 12 months after injury (95% CI 0.29 to 1.07). AUTHORS' CONCLUSIONS: There is no evidence to
support the routine use of secondary DC to reduce unfavourable outcome in adults with severe TBI and refractory
high ICP. In the pediatric population DC reduces the risk of death and unfavourable outcome. Despite the wide
confidence intervals for death and the small sample size of the only study identified, this treatment maybe justified
in patients below the age of 18 when maximal medical treatment has failed to control ICP. To date, there are no
results from randomised trials to confirm or refute the effectiveness of DC in adults. However, the results of non-
randomized trials and controlled trials with historical controls involving adults, suggest that DC may be a useful
option when maximal medical treatment has failed to control ICP. There are two ongoing randomized controlled
trials of DC (Rescue ICP and DECRAN) that may allow further conclusions on the efficacy of this procedure in adults.
Ethnopharmacological relevance: Deer antler base (Cervus, Lu Jiao Pan) has been recorded in the Chinese medical
classics Shen Nong Ben Cao Jing () 2000 years ago and is believed to nourish the Yin, tonify the kidney, invigorate the
spleen, strengthen bones and muscles, and promote blood flow. In China, deer antler base has been extensively used
in traditional Chinese medicine (TCM) to treat a variety of diseases including mammary hyperplasia, mastitis, uterine
fibroids, malignant sores and children's mumps. Aim of the review: We provide an up-to-date and comprehensive
overview of the traditional uses, chemistry, pharmacology, toxicology and clinical trials of deer antler base in order to
explore its therapeutic potentials and future research needs. Background and methods: The pharmacological value of
deer antler base was ignored for many years while researchers concentrated on the pharmacological value of velvet
antler. However, more recently, scientists have carried out a great number of chemical, pharmacological and clinical
studies on deer antler base. The present review covers the literature available from 1980 to 2012. All relevant
information on deer antler base was collected from ancient Chinese herbal classics, pharmacopoeias, formularies,
scientific journals, books, theses and reports via a library and electronic search by using PubMed, Google Scholar,
Web of Science, Science Direct, and CNKI (in Chinese). Key findings: Both in vitro and in vivo pharmacological studies
have demonstrated that deer antler base possess immunomodulatory, anti-cancer, anti-fatigue, anti-osteoporosis,
anti-inflammatory, analgesic, anti-bacterial, anti-viral, anti-stress, anti-oxidant, hypoglycemic, hematopoietic
modulatory activities and the therapeutic effect on mammary hyperplasia. Although the mechanism of actions is still
not clear, the pharmacological activities could be mainly attributed to the major bioactive compounds amino acids,
polypeptides and proteins. Based on animal studies and clinical trials, deer antler base causes no severe side effects.
Conclusions: Deer antler base has emerged as a good source of traditional medicine. However, further investigations
are needed to explore individual bioactive compounds responsible for these in vitro and in vivo pharmacological
effects and its mechanism of actions. Further safety assessments and clinical trials in humans need to be performed
before it can be integrated into medicinal practices. The present review has provided preliminary information for
further studies and commercial exploitations of deer antler base. 2012 Elsevier Ireland Ltd.
Background: Methylmercury is an environmental pollutant that can cause irreversible effects on the development of
children. Although there is no doubt that high exposure can cause neurodevelopmental deficits, the threshold that
will adversely affect the developing fetus is not well defined. Our objective was to systematically review the evidence
of neurodevelopmental risks of methylmercury to the unborn child from maternal fish consumption to define the
lowest observable adverse effect hair concentration (LOAEHC). METHODS: A systematic review was conducted of all
original research reporting on the effects of methylmercury on the human fetus. A literature search was undertaken
using SCOPUS, Medline-Ovid, PubMed, Google Scholar, and EMBASE. Papers were selected based on the following
inclusion criteria: 1) child neurodevelopmental outcome; 2) comparison groups; and 3) methylmercury exposure
through fish consumption. RESULTS: Forty-eight publications met these inclusion criteria. Thirty articles reported on
longitudinal studies and 18 were cross-sectional studies. Variations in study design precluded formal meta-analysis.
Based on an evaluation of these studies, we defined the LOAEHC at 0.3 mug/g of maternal hair mercury. The
longitudinal studies yielded a LOAEHC of 0.5 mug/g. CONCLUSION: In the clinical context, the majority of pregnant
women consume mercury-containing fish in amounts that are lower than the LOAEHC defined in this study.
However, the LOAEHC is in the same order of magnitude of mercury exposure that occurs in significant numbers of
women. Hence, although it appears safe to suggest that eating the recommended types and amounts of fish poses
no measurable risks for neurodevelopmental deficits, analysis of hair mercury content before pregnancy might be
suggested because dietary modification can decrease body content and risk. 2009 by Lippincott Williams & Wilkins.
When the antecedents of health-promoting behavior are explored, the concept of health literacy is deemed a factor
of major influence. Originally defined as reading, writing and numeracy skills in the health domain, health literacy is
now considered a multidimensional concept. The ongoing discussion on health literacy reveals that no agreement
exists about which dimensions to include in the concept. To contribute to the development of a consistent and
parsimonious concept of health literacy, we conducted a critical review of concepts in other literacy domains. Our
review was guided by two research questions: (i) Which dimensions are included in the concepts of other literacy
domains? (ii) How can health literacy research profit from other literacy domains? Based on articles collected from
PubMed, PsycINFO, Communication & Mass Media Complete, CINAHL, SAGE Full-Text Collection, Cochrane Library
and Google Scholar as well as selected monographs and editions, we identified seven distinct dimensions. Some of
the dimensions recur across all reviewed literacy domains and first attempts have been made to operationalize the
dimensions. Expanding upon these dimensions, the paper discusses how they can prove useful for elaborating a
consistent and parsimonious concept of health literacy and foster the development of a more holistic measure.
When the antecedents of health-promoting behavior are explored, the concept of health literacy is deemed a factor
of major influence. Originally defined as reading, writing and numeracy skills in the health domain, health literacy is
now considered a multidimensional concept. The ongoing discussion on health literacy reveals that no agreement
exists about which dimensions to include in the concept. To contribute to the development of a consistent and
parsimonious concept of health literacy, we conducted a critical review of concepts in other literacy domains. Our
review was guided by two research questions: (i) Which dimensions are included in the concepts of other literacy
domains? (ii) How can health literacy research profit from other literacy domains? Based on articles collected from
PubMed, PsycINFO, Communication & Mass Media Complete, CINAHL, SAGE Full-Text Collection, Cochrane Library
and Google Scholar as well as selected monographs and editions, we identified seven distinct dimensions. Some of
the dimensions recur across all reviewed literacy domains and first attempts have been made to operationalize the
dimensions. Expanding upon these dimensions, the paper discusses how they can prove useful for elaborating a
consistent and parsimonious concept of health literacy and foster the development of a more holistic measure.
Objectives: To explore the literature for the definitions of informal payments in healthcare and critically analyze the
proposed definitions. This will serve in the process of getting to a coherent definition of informal payments, which
will further support acknowledging and addressing them globally. Methods: A search strategy was developed to
identify papers addressing informal payments on PubMed, ScienceDirect, Econlit, EconPapers and Google Scholar.
Results: 2225 papers were identified after a first search. 61 papers were included in the systematic review. Out of all
definitions provided, we selected three definitions as being original. All other definitions either cite these definitions
or do not provide new insight into the topic of informal payments. Although informal payments have been
nominated by various terms over the years, there is a tendency in recent years towards an agreement to use this
singular term. Definitions differ in terms of the relation of informal payments with other informal activities, their
legality and the motivation behind them. Conclusions: The variety of forms which informal payments may take makes
it difficult to define them in a comprehensive manner. However, we identified a definition that could serve as a
beginning in this process. More effort is needed to build on it and get to a commonly accepted and shared definition
of informal payments. 2013 Elsevier Ireland Ltd.
Background: For minority populations in the United States, especially African Americans, Hispanics, and Native
Americans, healthcare disparities are a serious problem. The literature documents racial and ethnic utilization
disparities with regard to THA and TKA. Questions/purposes: We therefore (1) defined utilization disparities for total
joint arthroplasty in racial and ethnic minorities, (2) delineated patient and provider factors contributing to the lower
total joint arthroplasty utilization, and (3) discussed potential interventions and future research that may increase
total joint arthroplasty utilization by racial and ethnic minorities. Methods: We searched the MEDLINE database and
identified 67 articles, 21 of which we excluded. By searching Google and Google Scholar and reference lists of the
included articles, we identified 40 articles for this review. Utilization disparities were defined by documented lower
utilization of THA or TKA in specific racial or ethnic groups. Results: Lower utilization of THA and TKA among some
racial and ethnic minority groups (African Americans, Hispanics) is not explained by decreased disease prevalence or
disability. At least some utilization disparities are independent of income, geographic location, education, and
insurance status. Causal factors related to racial and ethnic disparities may be related in part to patient factors such
as health literacy, trust, and preferences. Provider unconscious or conscious biases or beliefs also play a role in at
least some healthcare disparities. Conclusion: Racial and ethnic THA and TKA utilization disparities exist. These
disparities are not explained by lower disease prevalence. The existing data suggest patient education, improved
health literacy regarding THA and TKA, and a patient-provider relationship leading to improved trust would be
beneficial. Research providing a better understanding of the root causes of these disparities is needed. 2011 The
Association of Bone and Joint Surgeons.
BACKGROUND CONTEXT: Lumbar spondylosis is a common indication for surgery in elderly population. Number of
spine surgeries performed annually has increased 40% in the past decade. In this era of growing population and
technological advances with limited resources, focus has shifted on accountability for health care expenses.Recently,
the importance of measuring quality of life gains after surgical procedures has been revealed, as it will prove critical
for health policy makers to assess relative effectiveness and value of various surgical procedures and help direct
health care expenditure in an efficient and cost effective manner. PURPOSE: To (1) compare the baseline and
postoperative EQ-5D utility scores for common surgical procedures reported in the literature to obtain postoperative
quality-adjusted life year (QALY) gains and (2) establish the relative utility of lumbar spine surgery as compared to
other surgical procedures commonly performed in the U.S. health care system. STUDY DESIGN/SETTING: Systematic
literature review. PATIENT SAMPLE: All studies reporting preoperative/baseline EQ-5D scores as well as
postoperative EQ-5D scores. OUTCOME MEASURES: EQ-5D score, QALY gain. METHODS: A systematic literature
review of PubMed, Cochrane and Google Scholar was conducted to identify all studies reporting preference-based
general health state instrument EuroQol-5D (EQ-5D) after surgical procedures. Studies reporting
preoperative/baseline EQ-5D scores as well as postoperative EQ-5D scores were included. For each study, the
number of patients included and baseline/preoperative and follow-up mean EQ-5D index score was recorded. Mean
quality-adjusted life year (QALY) gain for each intervention was calculated. RESULTS: A total of 67 studies comprising
95,014 patients were identified. Patients with lumbar spondylosis had the lowest preoperative EQ-5D score of 0.36,
followed by knee osteoarthritis and hip osteoarthritis with preoperative EQ-5D scores of 0.37 and 0.39, respectively.
Higher baseline/ preoperative EQ-5D scores of 0.89 in prostate cancer, 0.83 in cataract, 0.79 in inguinal hernia, 0.77
in varicose vein, 0.77 in urethral stricture, 0.76 in colon cancer and 0.76 in BPH indicate that these diseases had less
impact on QOL of patients as measured by the EQ-5D. The greatest QALY gain was seen in patients undergoing hip
arthroplasty (0.38), knee arthroplasty (0.35) and lumbar spine surgery (0.32), nearly 2.5-fold greater QALY gained
than for all other surgical procedures. CONCLUSIONS: Patients with lumbar spondylosis have the worst reported
HRQOL at baseline compared to other surgical cohorts in the literature. This, coupled with the high prevalence of
lumbar spondylosis, incurs a detrimental impact on the overall health of U.S. population. Lumbar spine surgery leads
to significant QALY gains compared to other surgical procedures, highlighting the high utility and value of lumbar
spine surgery compared to other common surgical procedures.
Many scientists now manage the bulk of their bibliographic information electronically, thereby organizing their
publications and citation material from digital libraries. However, a library has been described as "thought in cold
storage," and unfortunately many digital libraries can be cold, impersonal, isolated, and inaccessible places. In this
Review, we discuss the current chilly state of digital libraries for the computational biologist, including PubMed, IEEE
Xplore, the ACM digital library, ISI Web of Knowledge, Scopus, Citeseer, arXiv, DBLP, and Google Scholar. We
illustrate the current process of using these libraries with a typical workflow, and highlight problems with managing
data and metadata using URIs. We then examine a range of new applications such as Zotero, Mendeley, Mekentosj
Papers, MyNCBI, CiteULike, Connotea, and HubMed that exploit the Web to make these digital libraries more
personal, sociable, integrated, and accessible places. We conclude with how these applications may begin to help
achieve a digital defrost, and discuss some of the issues that will help or hinder this in terms of making libraries on
the Web warmer places in the future, becoming resources that are considerably more useful to both humans and
machines.
Background: A small proportion of patients with hypertrophic cardiomyopathy (HCM) experience sudden cardiac
death (SCD) despite the absence of traditional risk factors. Therefore, additional predictors of SCD need to be
identified. Delayed contrast enhancement (DCE) on cardiac magnetic resonance imaging (MRI) has emerged as a
useful adjunct to current risk stratification schemes. However, published studies have demonstrated conflicting
results. Methods: Pubmed, Cochrane, Google Scholar and Web of Science Search databases were searched through
October, 2011 using the following terms: Magnetic resonance imaging, Hypertrophic Cardiomyopathy, Sudden
cardiac death, ventricular fibrillation / tachycardia, and implantable defibrillator therapy. Meta-analysis was
performed following the MOOSE recommendations using a random effects model. Results: A total of 969 abstracts
and 23 full text articles were reviewed; 6 studies with 1226 qualified for inclusion. The summary Odds ratio for
clinical VT/VF, appropriate defibrillator therapy or SCD was 1.68 (0.85-3.34; p=0.14) (Figure2). There was no
significant publication bias. As sensitivity analysis revealed that exclusion of one study with 108 patients resulted in
statistically significant increase in Odds ratio to 2.91 (1.22- 6.95; p=0.01). Conclusion: Based on this analysis, DCE on
cardiac MRI does not predict the occurrence of clinically relevant VT/VF or SCD though this needs to be interpreted
with caution in light of the sensitivity analysis.
Objective To review the scientific evidence about the impact of climate change and socio-environmental factors on
dengue transmission, particularly in the Asia-Pacific region. Methods Search of the published literature on PubMed,
ISI web of Knowledge and Google Scholar. Articles were included if an association between climate or socio-
environmental factors and dengue transmission was assessed in any country of the Asia-Pacific region. Results
Twenty-two studies met the inclusion criteria. The weight of the evidence indicates that global climate change is
likely to affect the seasonal and geographical distribution of dengue fever (DF) in the Asia-Pacific region. However,
empirical evidence linking DF to climate change is inconsistent across geographical locations and absent in some
countries where dengue is endemic. Conclusion Even though climate change may play an increasing role in the
transmission of DF, no clear evidence shows that such impact has already occurred. More research is needed across
countries to better understand the relationship between climate change and dengue transmission. Future research
should also consider and adjust for the influence of important socio-environmental factors in the assessment of the
climate change-related effects on dengue transmission. 2011 Blackwell Publishing Ltd.
BACKGROUND: Recently, biologically active compounds isolated from plants used in herbal medicine have been the
center of interest. Deoxypodophyllotoxin (DPT), structurally closely related to the lignan podophyllotoxin, is a potent
antitumor and anti-inflammatory agent. However, DPT has not been used clinically yet. Also, DPT from natural
sources seems to be unavailable. Hence, it is important to establish alternative resources for the production of such
lignan; especially that it is used as a precursor for the semi-synthesis of the cytostatic drugs etoposide phosphate and
teniposide., AIMS AND OBJECTIVES: The update paper provides an overview of DPT as an effective anticancer natural
compound and a leader for cytotoxic drugs synthesis and development in order to highlight the gaps in our
knowledge and explore future research needs., APPROACH AND METHODS: The present review covers the literature
available from 1877 to 2012. The information was collected via electronic search using Chinese papers and the major
scientific databases including PubMed, Sciencedirect, Web of Science and Google Scholar using the keywords. All
abstracts and full-text articles reporting database on the history and current status of DPT were gathered and
analyzed., RESULTS: Plants containing DPT have played an important role in traditional medicine. In light of the in
vitro pharmacological investigations, DPT is a high valuable medicinal agent that has anti-tumor, anti-proliferative,
anti-inflammatory and anti-allergic properties. Further, DPT is an important precursor for the cytotoxic aryltetralin
lignan, podophyllotoxin, which is used to obtain semisynthetic derivatives like etoposide and teniposide used in
cancer therapy. However, most studies have focused on the in vitro data. Therefore, DPT has not been used clinically
yet., CONCLUSIONS: DPT has emerged as a potent chemical agent from herbal medicine. Therefore, in vivo studies
are needed to carry out clinical trials in humans and enable the development of new anti-cancer agents. In addition,
DPT from commercial sources seems to be unavailable due to its rarity from natural sources and cumbersome
extraction procedures. Hence, it is important to establish alternative, cost-effective and renewable resources, such
plant cell cultures and (semi-) synthesis strategies for the production of DPT. Copyright 2013 Elsevier Ireland Ltd. All
rights reserved.
Background: Dermatomyositis and polymyositis (DP) are associated with an underlying malignancy. Early cancer
diagnosis may be possible. Objective: To determine if dermatologic symptoms can lead to early detection of ovarian
cancer (OC), and describe and characterized OC among patient with DP. Methods: We conducted a case control
analysis using all cases identified from PubMed and Google Scholar searches using the following key words:
"dermatomy-ositis," "polymyositis," "ovarian cancer," "case report," and combinations of those terms; in addition, a
manual search of included references was conducted. We only considered cases of DP with ovarian or breast and
ovary cancer. Cases identified were abstracted for age, stage, grade, histology, and level of Ca-125. "Cases" were OC
diagnosed after DP and were compared to "controls" (OC diagnosed before DP). Results: Forty-two articles were
found; 25 were excluded because of concurrent other malignancies or the fact that the articles not readily available.
From the remaining 18 articles, 46 patients were identified, including 35 cases and 11 controls. Mean age in the
cases was 57.5 years, and for controls was 58 years (P = NS). Only one case was stage I (3.70%). Most cases and
controls were in advanced stages (III-IV; 96.3% and 100%, respectively [P = NS]). Time from DP to OC diagnosis was
13.4 months (range, 1-68 mos) versus 15.4 months (range, 1-72 mos) fromOC to DP (P = NS). The median time from
initial presentation of DP to cancer was 10.5 versus 6 months for controls (P = NS). Ca-125 was 1304 (range, 44-7710)
in cases versus 1157 (range, 145-3200) in controls (P = NS). OC was otherwise asymptomatic except for DP and
diagnosis by screening test in 54.8% of cases. In control patients, where the initial diagnosis was OC followed by DP,
only 30% where asymptomatic for OC (P = NS). Conclusions: Despite a high risk for OC, woman with DP were not
diagnosed at an earlier stage or lower Ca-125 level. The small sample size limits our power. Additional cases will be
ascertained and presented. Current methods for early detection of ovarian carcinoma in DP patients are ineffective.
Early OC may "whisper," but it doesn't itch.
Internet considerably makes easierscientificalpapers researching. Advices about best using of Medline/Pubmed are
detailed: other search tools like Scholar Google are discussed. Assessed medical data reseach is important
concerning occupational practicing assessment. Useful sites are presented. Immediate information on the web
allows for the dermatologist a fast answer to patients questions: some examples are given. Sites concerning images
teleloading on Internet are described. Continuing education on line today develops and e-learning concept is
presented with examples. Setting up an occupational web server is completely accessible. Deontology rules are
reminded. Some tracks and useful references are cited. Important steps of realization are described: choice of field
name, harbouring, management, tree diagram, web pages creation, FTP transfer, referencing. Numerous sites are
dedicated for dermatology. The main sites useful for practicing are presented. Electronic mailing principle is
explained, specially security mailing for medical exchanges.
PURPOSE: To perform a literature review of barriers to and facilitators of parents' decisions to have their children
vaccinated. Both differences and similarities between the civilian sector and the military health system (MHS) were
explored., DATA SOURCES: Articles and documents were identified from the following databases: CINAHL, PubMed,
Defense Technical Information Center (DTIC), ISI, and Google Scholar. Reference lists from articles were reviewed.,
CONCLUSIONS: Common themes identified in the civilian sector and the MHS included an electronic registry, care
access issues, provider characteristics, and child illness. Several themes served as a barrier in one system while being
a facilitator in the other, such as provider characteristics. Literature addressing the MHS and factors affecting vaccine
coverage is scant; however, a large disparity in vaccination coverage exists between the MHS and the civilian sector.,
IMPLICATIONS: The theme of provider characteristics was seen as a barrier in both systems; a better understanding
of this theme (i.e., provider effectiveness at interacting with parents) would benefit primary care practice. An
electronic vaccine registry and targeted education and media campaign used to facilitate vaccinations in the MHS
should be piloted in the civilian sector. Additionally, future studies should be performed on identified themes in the
MHS. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.
UNLABELLED: Sustainability is a global issue that has worldwide attention but the role of ergonomics in designing for
sustainability is poorly understood and seldom considered. An analysis of the literature on ergonomics, design and
sustainability was conducted via a search of electronic databases: Scopus, Business Source Complete, Google
Scholar, Emerald Publishing, Academic Search Premiere, Web of Science, Discover and Ergonomics Abstracts, for the
years 1995-2012. A total of 1934 articles fulfilled the search criteria, but content analysis of the abstracts indicated
that only 14 refereed articles addressed the main search criteria. Of those seven were in ergonomics journals and
seven were in other journals (and were not written by ergonomists). It is concluded that the contribution of
ergonomics to sustainability and sustainable design has been limited, even though the goals of sustainability and
ergonomics are congruent. Ergonomists have not been at the forefront of research contributing to sustainability -
and it is time for them to 'seize the day' - 'carpe diem'., PRACTITIONER SUMMARY: This literature review shows that
ergonomics contribution to sustainability is limited but since there is congruence between the disciplines it calls for
ergonomists to become more involved and to seize the day - carpe diem.
Introduction: There is no single 'gold standard' clinical severity index in inflammatory bowel disease and each
investigator chooses or develops his own index. Therefore, there is a need to develop a single clinical severity index
that is valid and reliable. The aim of this study is to identify the required standards for a valid and reliable index.
Methods: Literature search was conducted using MEDLINE and Google scholar database from January 1947 to 2011
to identify the required standards for clinical severity indices in inflammatory bowel disease. We also reviewed the
commonly used clinical severity indices in inflammatory bowel disease and their validation studies. Personal
communications, websites, and major textbooks were critically reviewed to identify potentially relevant materials.
One hundred article was critically evaluated. Results: A new 10-point scoring checklist was developed and applied to
assess the disease severity indices in inflammatory bowel disease: 1. Face validity 2. Content validity 3. Items with
endorsement rate of 80% were identified and removed. 4. Items discrimination power 5. Items with item-total
correlation 0.2-0.86. Internal consistency is acceptable (e.g Cronbach alpha > 0.7).7. Inter-observer reliability >0.758.
Test-retest reliability >0.759. Construct validity >0.410. Responsiveness factor (sensitivity to change) >0.5. The higher
the score of the index, the more valid and reliable it is. However, we recommend that 7 is the minimum acceptable
score for clinical practice as non-empirical validity are judgmental and it is difficult to assess them properly. Item
discrimination power can be substituted by Item total correlation to remove redundant items. Inter-observer
reliability is closely related to test-retest reliability and one of them should be enough to assess the reliability of the
index. Conclusion: This article defined a 10-point checklist to systemically evaluate current and future indices. Using
this checklist will ensure that any new index is valid and reliable.
Purpose of Study: To develop the research protocol that will be employed by the community-academic partnership
guiding the creation of the photonovela intervention. Adolescent and young adult (AYA) cancer survivors can
experience medical and psychological late effects placing them at increased risk for morbidity and mortality
secondary to cancer treatment at a young age. Vulnerable populations, such as Latinos, may be at higher risk given
the lack of culturally-relevant, age appropriate health education materials. A non-profit organization serving the
Latino childhood cancer community (PADRES) and UCLA developed a research partnership to create an educational
intervention called a photonovela (illustrated booklet). The photonovela will address 4 key survivorship messages:
1)cancer stigma, 2)risk for late effects, 3)need for survivorship care plan/treatment summary, and 4)need for
continuous health insurance. Methods Used: Literature review was conducted to identify methodologies used in
photonovela development: a)the use of a community advisory group to explore key messages and b)consensus
methods to gain expert opinions on content. Inclusion criteria: a)search terms included photonovela, health
education, childhood cancer survivor, RAND consensus, and Delphi panel, b)search engines used were PubMed,
PsycINFO, CINAHL Plus, Web of Science, and Google Scholar, c)published between 1975 and 2011, and d)written in
English. Summary of Results: Key concepts identified were used in the protocol: 1)Characteristics of successful
photonovelas: language and health literacy level appropriate to audience, target audience identifies with characters/
storyline, entertainment-education strategy to incorporate educational messages; 2)Engage community members
using focus groups; 3)RAND modified Delphi method was identified as the most relevant consensus method to
determine key concepts in the photonovela. Conclusions: Using a systematic literature review a protocol was
adapted for use in the creation of the photonovela targeted toward Latino AYA cancer survivors and their families.
Background. Information overload, increasing time constraints, and inappropriate search strategies complicate the
detection of clinical practice guidelines (CPGs). The aim of this study was to provide clinicians with recommendations
for search strategies to efficiently identify relevant CPGs in SUMSearch and Google Scholar. Methods. We compared
the retrieval efficiency (retrieval performance) of search strategies to identify CPGs in SUMSearch and Google
Scholar. For this purpose, a two-term GLAD (GuideLine And Disease) strategy was developed, combining a defined
CPG term with a specific disease term (MeSH term). We used three different CPG terms and nine MeSH terms for
nine selected diseases to identify the most efficient GLAD strategy for each search engine. The retrievals for the nine
diseases were pooled. To compare GLAD strategies, we used a manual review of all retrievals as a reference
standard. The CPGs detected had to fulfil predefined criteria, e.g., the inclusion of therapeutic recommendations.
Retrieval performance was evaluated by calculating so-called diagnostic parameters (sensitivity, specificity, and
"Number Needed to Read" [NNR]) for search strategies. Results. The search yielded a total of 2830 retrievals; 987
(34.9%) in Google Scholar and 1843 (65.1%) in SUMSearch. Altogether, we found 119 unique and relevant guidelines
for nine diseases (reference standard). Overall, the GLAD strategies showed a better retrieval performance in
SUMSearch than in Google Scholar. The performance pattern between search engines was similar: search strategies
including the term "guideline" yielded the highest sensitivity (SUMSearch: 81.5%; Google Scholar: 31.9%), and search
strategies including the term "practice guideline" yielded the highest specificity (SUMSearch: 89.5%; Google Scholar:
95.7%), and the lowest NNR (SUMSearch: 7.0; Google Scholar: 9.3). Conclusion. SUMSearch is a useful tool to swiftly
gain an overview of available CPGs. Its retrieval performance is superior to that of Google Scholar, where a search is
more time consuming, as substantially more retrievals have to be reviewed to detect one relevant CPG. In both
search engines, the CPG term "guideline" should be used to obtain a comprehensive overview of CPGs, and the term
"practice guideline" should be used if a less time consuming approach for the detection of CPGs is desired. 2007
Haase et al; licensee BioMed Central Ltd.
Introduction: To assess IBD activity, many severity scales have been developed. Yet, most of them were not properly
validated and did not go through robust methodology. Using different scoring systems makes it difficult to compare
different trials especially when the end points are different. Because new therapies for IBD are rapidly emerging,
there is a need to optimise and standardise methodology for assessing of disease activity in clinical trials. With the
nationwide initiative to establish an IBD registry, a valid and easy to use activity measurement tool is needed. We
believe that having a single disease activity index that is suitable for all types and presentations of IBD will make it
very useful to monitor patients and assess their response to treatment. Methods: Literature search was conducted
using MEDLINE and Google scholar database from January 1947 to 2011 to identify the clinical severity indeces
commonly used in clinical trails. Seventeen indeces were identified for both Ulcerative coltis and Crohn's disease. We
followed a clini-metric approach to develop the simple IBD clinical severity index. Common items between Ulcerative
coltis and Crohn's disease were chosen. Few items were added to cover disease specific domains. The new index was
examined by gastroenterologists and methodologists in Swansea University to ensure good face and content validity.
The index was tested on 50 patients with different presentations of inflammatory bowel disease. Harvey Bradshaw
index and Simple clinical colitis index were used for construct validity. Responsivness was checked by repeating the
test within 2-week period. Results: The new index, simple IBD clinical severity index, showed good face and content
validity. It covers all presentations of IBD including Crohn's disease, ulcerative coltis and perianal disease. It has good
reliability and construct validity. It is easy to use in daily practice. Conclusion: Simple IBD clinical severity index is a
new tool to assess the clinical activity of IBD. It is valid, reliable, user friendly and non-invasive index. Further studies
are required to check how it performs on a wider range of patients.
BACKGROUND AND AIM: Strength and power are crucial components to excelling in all contact sports; and
understanding how a player's strength and power levels fluctuate in response to various resistance training loads is
of great interest, as it will inevitably dictate the loading parameters throughout a competitive season. This is a
systematic review of training, maintenance and detraining studies, focusing on the development, retention and
decay rates of strength and power measures in elite rugby union, rugby league and American football players.,
SEARCH STRATEGIES: A literature search using MEDLINE, EBSCO Host, Google Scholar, IngentaConnect, Ovid LWW,
ProQuest Central, ScienceDirect Journals, SPORTDiscus and Wiley InterScience was conducted. References were also
identified from other review articles and relevant textbooks. From 300 articles, 27 met the inclusion criteria and
were retained for further analysis. STUDY QUALITY: Study quality was assessed via a modified 20-point scale created
to evaluate research conducted in athletic-based training environments. The mean +/- standard deviation (SD)
quality rating of the included studies was 16.2 +/- 1.9; the rating system revealed that the quality of future studies
can be improved by randomly allocating subjects to training groups, providing greater description and detail of the
interventions, and including control groups where possible., DATA ANALYSIS: Percent change, effect size (ES = [Post-
Xmean - Pre-Xmean)/Pre-SD) calculations and SDs were used to assess the magnitude and spread of strength and
power changes in the included studies. The studies were grouped according to (1) mean intensity relative volume
(IRV = sets x repetitions x intensity; (2) weekly training frequency per muscle group; and (3) detraining duration. IRV
is the product of the number of sets, repetitions and intensity performed during a training set and session. The
effects of weekly training frequencies were assessed by normalizing the percent change values to represent the
weekly changes in strength and power. During the IRV analysis, the percent change values were normalized to
represent the percent change per training session. The long-term periodized training effects (12, 24 and 48 months)
on strength and power were also investigated., RESULTS: Across the 27 studies (n = 1,015), 234 percent change and
230 ES calculations were performed. IRVs of 11-30 (i.e., 3-6 sets of 4-10 repetitions at 74-88% one-repetition
maximum [1RM]) elicited strength and power increases of 0.42% and 0.07% per training session, respectively. The
following weekly strength changes were observed for two, three and four training sessions per muscle region/week:
0.9%, 1.8 % and 1.3 %, respectively. Similarly, the weekly power changes for two, three and four training sessions per
muscle group/week were 0.1%, 0.3% and 0.7 %, respectively. Mean decreases of 14.5% (ES = -0.64) and 0.4 (ES = -
0.10) were observed in strength and power across mean detraining periods of 7.2 +/- 5.8 and 7.6 +/- 5.1 weeks,
respectively. The long-term training studies found strength increases of 7.1 +/- 1.0% (ES = 0.55), 8.5 +/- 3.3% (ES =
There has been recent interest in using adjuncts to local anaesthetics to prolong analgesia after peripheral nerve
blockade for surgical procedures. 1 Dexamethasone has been an adjunct of particular focus in a number of
prospective randomized controlled trials (RCTs) examining its efficacy in brachial plexus block. This meta-analysis
examines the findings from these RCTs. The keywords: human, brachial plexus, interscalene, supraclavicular,
infraclavicular, nerve block, and dexamethasone were used to search Medline, EMBASE (from 1980 to 2011), and
Google Scholar to identify RCTs and published abstracts from scientific meetings. No language restrictions were
applied. The Jadad scale2 was used to assess the quality of the RCTs. RevMan statistical softwarew utilized inverse
variance and a random effect model to calculate weighted mean difference with 95% confidence intervals for
continuous variables. The primary outcome measure was duration of analgesia, with the secondary outcomes, times
to onset of maximum motor and sensory block, and to recovery of motor function. Seven studies comprising 563
patients published from2006 to 2011 were included. The Jadad score for the studies was 1-5. Addition of
dexamethasone to the local anaesthetic (levobupivacaine, mepivacaine, lidocaine+epinephrine, or a combination)
increased the duration of postoperative analgesia. Recovery of motor function was delayed in patients whoreceived
dexamethasone, but therewas no significant difference in time to onset of sensory or motor block (Table 7). The
addition of dexamethasone to brachial plexus blocks increases the length of analgesia with no delay in time to onset
of sensory or motor block. A delay in recovery of motor function may occur. Dexamethasone has a role as an adjunct
in brachial plexus blockade. (Table presented).
Diabetes is a growing worldwide problem, characterized by considerable ethnic variation and being particularly
common in modernizing populations. Modernization is accompanied by a variety of stressful sociocultural changes
that are believed to increase the risk of diabetes. Unfortunately, there is little accurate knowledge about impact of
stress on the risk of diabetes in the US-Mexico border area. Literature searches were performed in PubMed and
Google Scholar to identify anthropological studies on stress and diabetes. Snowball and opportunistic sampling were
used to expand the identified literature. In total, 30 anthropological studies were identified concerning the role of
stress and modernization on diabetes among Indigenous peoples. This article reviews the available information
regarding stress and diabetes in different populations from various anthropological perspectives. Four different
concepts of stress were indentified: physiological, psychological, psychosocial and nutritional stress. Unlike
physiological and nutritional theories of diabetes, psychological and psychosocial theories of stress and disease lack
etiological specificity. No study addressed all four concepts of stress and few studies addressed more than two
concepts. Most studies concerned nutritional stress and the developmental origins of diabetes. Most studies were
conducted on the Pima Indians of Arizona and Mexico. All four stress concepts have some evidence as determinants
of diabetes. These theoretical concepts and ethnographic results can provide the basis for developing
comprehensive research protocols and public health intervention targeted at diabetes. A comprehensive view of
stress can potentially explain the high prevalence of diabetes in developing countries and among Indigenous peoples.
These results can be used to inform public health interventions aimed at reducing diabetes in the US-Mexico border
region or similar areas, help identify at-risk individuals, and guide health education and promotion.
Background: The hyperinsulinaemia associated with type 2 diabetes and the known proliferative effects of insulin
lead to the hypothesis that diabetes mellitus increases the risk of breast cancer. The aim of this meta-analysis was to
collate and analyse all primary observational studies investigating the risk of breast cancer associated with diabetes.
In addition, we aimed to complete sub group analyses by both type of diabetes and gender of study participants to
further clarify the origin of any such association between the two. Method: Studies were obtained from a database
search of MEDLINE, EMBASE, PubMed, Current Contents Connect and Google Scholar with additional cross checking
of reference lists. Databases were searched using subject headings, keyword searches and text word searches
wherever possible using the search terms 'diabetes' AND 'breast cancer' OR 'breast carcinoma' OR 'breast neoplasm'.
Inclusion criteria required a confirmed diagnosis of both diabetes and breast cancer, reporting of an odds ratio or
data to calculate an unadjusted odds ratio (and 95% confidence interval) and the use of an internal control group as
the comparator. Collated data was assessed for heterogeneity and a pooled odds ratio calculated. Results: 34 studies
were included in the meta-analysis with 31 studies investigating breast cancer in women and 5 studies investigating
breast cancer in men. Overall, we found a significantly increased risk of breast cancer associated with diabetes in
both women (OR 1.25, 95% CI 1.13-1.38) and men (OR 1.40, 95% CI 1.10-1.79). The pooled odds ratio was consistent
across both case control studies (OR 1.25, 95% CI 1.06-1.46) and cohort studies (OR 1.26, 95% CI 1.09-1.45).
Heterogeneity was significant (I2 = 73.40, p < 0.001) and publication bias was present (p = 0.03). The 31 studies
investigating breast cancer in women were sub grouped by type of diabetes with the association strengthened by a
diagnosis of type 2 diabetes (OR 1.32, 95% CI 1.09-1.61) but nullified with gestational diabetes (OR 1.06, 95% CI 0.79-
1.40). There were insufficient studies to calculate a pooled odds ratio of the risk of breast cancer associated with
type 1 diabetes. Conclusion: Diabetes increases the risk of breast cancer in both women and men. This association is
strengthened in women with type 2 diabetes and supports the hypothesis that diabetes is an independent risk factor
for breast cancer.
The aim of this meta-analysis was to collate and analyse all primary observational studies investigating the risk of
breast cancer (BC) associated with diabetes. In addition, we aimed to complete subgroup analyses by both type of
diabetes and gender of study participants to further clarify the origin of any such association between the two.
Studies were obtained from a database search of MEDLINE, EMBASE, PubMed, Current Contents Connect and
Google Scholar with additional cross-checking of reference lists. Collated data were assessed for heterogeneity and a
pooled odds ratio (OR) calculated. Forty-three studies were included in the meta-analysis with 40 studies
investigating BC in women and six studies investigating BC in men. Overall, we found a significantly increased risk of
BC associated with diabetes in women (OR 1.20, 95% confidence interval (CI) 1.13-1.29). After subgroup analysis by
type of diabetes, the association was unchanged with type 2 diabetes (OR 1.22, 95% CI 1.07-1.40) and nullified with
gestational diabetes (OR 1.06, 95% CI 0.79-1.40). There were insufficient studies to calculate a pooled OR of the risk
of BC associated with type 1 diabetes. There was an increased risk of BC in males with diabetes mellitus; however,
the results did not reach statistical significance (OR 1.29, 95% CI 0.99-1.67). In conclusion, diabetes increases the risk
of BC in women. This association is confirmed in women with type 2 diabetes and supports the hypothesis that
diabetes is an independent risk factor for BC.
Diabetes mellitus is a common medical disorder in pregnancy. It contributes particularly to perinatal
morbidity/mortality, and maternal morbidity. This review aims at improving maternal and neonatal health care
especially in Sub-Saharan Africa by improving the knowledge of health practitioners on current evidences in the
classification and management of diabetes mellitus in pregnancy. Relevant texts as well as online data bases
including Pubmed, Google scholar, and African journal online, were searched for literatures related to the subject.
Classification of diabetes in pregnancy has been revised to reflect the various aetiological factors. Also, the diagnostic
value of fasting plasma glucose has been lowered to mark the point at which dramatic increase in the microvascular
complications of diabetes mellitus occurs. Morbidity and mortality associated with the condition would be reduced
through proper management that involves preconception care, early antenatal booking, dedicated multidisciplinary
antenatal care, and delivery in a center with neonatal facility. Furthermore, some oral glucose lowering agents have
shown some safety after the first trimester and they have been found to give comparable result to insulin therapy.
The classification of diabetes mellitus in pregnancy has been revised. Its optimal management should involve multi-
disciplinary inputs and may include oral hypoglycaemic agents. Knowledge of these by clinicians would improve
maternal and neonatal health.
PURPOSE: Studies have indicated that diabetes mellitus (DM) is a risk factor for bladder cancer; however, not all
evidence supports this conclusion. The aim of this meta-analysis was to collate and evaluate all primary observational
studies investigating the risk of bladder cancer associated with DM., METHODS: The PubMed and Google Scholar
databases were searched to identify studies that estimated the association of DM and bladder cancer. Summary
effect estimates were derived using a random-effects meta-analysis model., RESULTS: A total of 23 studies (8 case-
control studies, 15 cohort studies) including 643,683 DM and 4,819,656 non-DM cases were identified. Analysis of all
studies showed that DM was associated with an increased risk of bladder cancer compared with non-DM overall
(OR=1.68, 95% CI 1.32-2.13). Analysis of subgroups demonstrated this to be the case in both case-control studies
(OR=1.59, 95% CI 1.28-1.97, I2=58%) and cohort studies (RR=1.70, 95% CI 1.23-2.33, I2=96%). There was no gender
difference in DM-associated bladder cancer risk. Bladder cancer risk was increased in Asia and the North America
region, but not in Europe. Furthermore, DM-associated bladder cancer risk was obviously higher in Asia than North
America and Europe or in those with Caucasian ethnicity. With extension of follow-up time, the bladder cancer risk
was not increased for the patients with DM., CONCLUSIONS: This meta-analysis provided further evidence
supporting the DM association with a significantly higher risk of bladder cancer obtained from observational studies.
Cocaine remains the second most commonly used and trafficked illicit drug in the world after cannabis. This
psychostimulant drug has become an essential part of the world drug scene with a different use among countries.
Prevalence of cocaine use (lifetime, last year, last month use) is particulary high among males aged between 15 and
34 years. Five per cent of cocaine users will develop a substance-dependence during the first year of use, and 20% of
these will become long-term cocaine-dependent patients. The number of patients entering drug treatment for
primary cocaine use has been increasing in Europe for several years. Cocaine addiction is a worldwide public health
problem, which has somatic, psychological, psychiatric, socio-economic and judicial complications. This article aims
to provide the clinician with a detailed description of the clinical aspects, the adverse effects and the complications
of cocaine addiction. Literature searches were conducted for the period from January 1985 to February 2012 using
PubMed, EMBASE, PsycInfo, and Google Scholar. 2012 Bentham Science Publishers.
This review traces our understanding of the clinical manifestations and the laboratory methods commonly
considered in the diagnosis of tuberculous meningitis (TBM). In compiling this review, we searched electronic data
bases in PubMed, Science Direct, Biomedical Central and Google Scholar. Firstly, we evaluate the more traditional
diagnostic methods which have been commonly applied in the diagnostics of tuberculosis (TB). The role of direct
cerebrospinal fluid (CSF) examination for acid-alcohol fast bacilli, CSF culture for Mycobacterium tuberculosis, and
detection of mycobacterial nucleic acid in the CSF is evaluated. We also consider the role of brain imaging and chest
X-ray. Secondly, the review evaluates the current evidence on the role of some newly prospective diagnostic
techniques and the coverage is given to the role of CSF adenosine deaminase activity, Gen Probe amplified
Mycobacterium tuberculosis direct test, microscopic observation drug susceptibility (MODS) culture technique, ex
vivo Mycobacterium tuberculosis- specific enzyme-linked immunospot assay (ELISpot assay) and enzyme-linked
immunosorbent assay (ELISA) in the diagnosis of TBM.
Background: Observational trials suggest that ED-performed ocular ultrasound (OUS) has a high degree of accuracy in
the diagnosis of retinal detachment. Objectives: Test the hypothesis that the diagnostic accuracy of ED OUS is
sufficient for making the diagnosis of retinal detachment. Methods: We performed a systematic review conforming
to the recommendations from the Meta-analysis Of Observational Studies in Epidemiology statement (MOOSE). An
experienced medical librarian searched the following databases from their inception without language restrictions:
Ovid MEDLINE, PubMed, Embase, Cochrane Library, Emergency Medical Abstracts, and Google Scholar. Content
experts were contacted and bibliographies of relevant studies were reviewed to identify additional references.
Evidence quality was independently assessed by two investigators using the revised Quality Assessment Tool for
Diagnostic Accuracy Studies (QUADAS-2). Discrepancies were resolved by consensus or adjudication by a third
reviewer. Individual and summary ROC curves were constructed and corresponding AUCs calculated. Sensitivity and
specificity were calculated with 95% CIs. Results: Of 7,771 unique citations identified, 78 were selected for full text
review resulting in 4 trials assessed for quality. Agreement between authors' QUADAS-2 scoring was good (kappa =
0.63). Three trials were deemed to have a low risk of bias. They enrolled ED-based patients (N=199) and evaluated
clinician-performed bedside OUS using either 7.5 MHz or 10 MHz linear array probes. The prevalence of retinal
detachment ranged from 13%-38%. The AUCs ranged from 0.943 to 1.00; the summary AUC was 0.957. Sensitivity
and specificity ranged from 97%-100% and 83%-100% respectively (figure). Conclusion: Bedside OUS has a high
degree of accuracy in identifying retinal detachment based on three small prospective investigations. A larger
prospective validation of these findings would be valuable. (Table Presented).
To determine the accuracy of using nitroglycerine as a 'test of treatment' in the diagnosis of cardiac chest pain we
undertook a systematic review of studies of diagnostic accuracy. Databases searched included PubMed, Cochrane
Database, Google Scholar, Science Citation Index, EMBASE and manual searching of bibliographies of known primary
and review articles. Studies were included if sublingual nitroglycerine was the index test, its effect on the patient's
pain score was recorded and the reference test was performed on at least 80% of patients. The data from the five
papers were used to form 2x2 contingency tables. Five eligible studies were found, all in the acute setting (although
one paper collected its data in the follow-up setting, all patients had acute presentations). The sensitivity ranged
from 35% to 92% and the specificity from 12% to 63%. However, in all but one paper the Youden indices were close
to zero suggesting that the response to nitroglycerine is not useful as a diagnostic test. The combined sensitivity was
0.52 (95% CI 0.48 to 0.56) and combined specificity was 0.49 (95% CI 0.46 to 0.52). The diagnostic OR from the
combined studies was 1.2 (95% CI 0.97 to 1.5), which is not significantly different from 1. In the acute setting,
nitroglycerine is not a reliable test of treatment for use in the diagnosis of coronary artery disease. However, further
studies are needed to determine the diagnostic accuracy of nitroglycerine for recurrent exertional chest pain.
Aim: To determine the accuracy of computed tomography (CT) in detecting disease with invasion beyond the
muscularis propria (MP) and malignant lymph nodes. Materials and methods: A literature search of Ovid, Embase,
the Cochrane database, and Medline using Pubmed, Google Scholar and Vivisimo search engines was performed to
identify studies reporting on the accuracy of CT to predict the staging of colonic tumours. Publication bias was
demonstrated by Funnel plots. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using a
bivariate random effects model and hierarchical summary operating curves (HSROC) were generated. Results:
Nineteen studies fulfilled all the necessary inclusion criteria. The pooled sensitivity, specificity, DOR for detection of
tumour invasion were 86% (95% CI: 78-92%); 78% (95% CI: 71-84%); 22.4 (95% CI: 11.9-42.4). Similarly, the values for
nodal detection were 70% (95% CI: 63-73%); 78% (95% CI: 73-82%); 8.1(95% CI: 4.7-14.1). In the subgroup analysis,
the best results were obtained in studies utilizing multidetector CT (MDCT). Conclusion: Preoperative staging CT
accurately distinguishes between tumours confined to the bowel wall and those invading beyond the MP; however,
it is significantly poorer at identifying nodal status. MDCT provides the best results. 2010 Elsevier B.V. All rights
reserved.
Introduction: CT scanning is increasingly being used for preoperative staging of colon cancers and also to assess the
prognosis of the tumour by identifying poor prognostic features. The aim of this meta-analysis is to determine the
precision of CT scanning in identifying poor prognostic factors in colon cancers and highlight its limitations. Materials
and Methods: A literature search of Ovid, Embase, the Cochrane database, and Medline using Pubmed, Google
Scholar and Vivisimo search engines was performed to identify studies reporting on the precision of CT scan to
predict the staging of colonic tumors. The sensitivity, specificity, diagnostic odds ratio (DOR), and area under the
summary receiver operating characteristic (SROC) curve (AUC) for identifying tumour invasion beyond muscularis
propria (MP) and nodal involvement were calculated using random effects modeling. Results: 19 studies fulfilled all
the necessary inclusion criteria. The pooled sensitivity, specificity, DOR and AUC for detection of tumour invasion
were 81% (95% CI 0.78-0.84); 75% (95% CI 0.69-0.8); 16.46 (95% CI 9.46-28.62) and 0.86 respectively. Similarly the
values for nodal detection were 68% (95% CI 0.63-0.73); 78% (95% CI 0.73-0.82); 7.54 (95% CI 4.4-12.92) and 0.81
respectively. In the subgroup analysis the best results were obtained in studies utilizing multi detector CT.
Conclusion: Preoperative staging CT scanning may be a useful tool to be able distinguish between tumors confined to
the bowel wall and those invading beyond the MP with reasonable precision, however the ability of CT to accurately
identify nodal status is yet unproven and this parameter should not be used for any preoperative stratification.
Objective To evaluate available evidence on the diagnostic value of radioactivity-free cultivation and detection
technologies for rapid detection of rifampicin resistance in Mycobacterium tuberculosis. Methods A fully recursive
literature search was conducted in PubMed, EMBASE, Biosis, Web of Science (all 1990-2010), CBMWeb (1978-2010),
and Google Scholar. QUADAS items were used to evaluate the quality of included studies. Sensitivity, specificity,
Summary receiver-operating curve SEN, SPE, SROC, and related techniques were used to assess the diagnostic value
of radioactivity-free Mycobacterium tuberculosis cultivation and detection technologies. Results Six studies were
included in the final analysis. The MB/BacT, BACTEC MGIT 960, and Manual MGIT systems were highly sensitive and
specific for detecting rifampicin-resistant TB. The summary SEN and summary SPE of the MB/BacT and BACTEC MGIT
960 systems were 100%, 99%, 100%, and 96%, respectively. The SROC of the BACTEC MGIT 960 system was 0.9943.
Conclusion We recommended that the BACTEC 460 system be replaced by MB/BacT or BACTEC MGIT 960 as the final
diagnostic test for rifampicin resistance in Mycobacterium tuberculosis. More studies are needed on the diagnostic
value of other radioactivity-free cultivation and detection technologies to reliably determine their sensitivity and
specificity for this bacterium. 2011 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China
Hospital of Sichuan University.
OBJECTIVE: To evaluate available evidence on the diagnostic value of radioactivity-free cultivation and detection
technologies for rapid detection of rifampicin resistance in Mycobacterium tuberculosis., METHODS: A fully recursive
literature search was conducted in PubMed, EMBASE, Biosis, Web of Science (all 1990-2010), CBMWeb (1978-2010),
and Google Scholar. QUADAS items were used to evaluate the quality of included studies. Sensitivity, specificity,
Summary receiver-operating curve SEN, SPE, SROC, and related techniques were used to assess the diagnostic value
of radioactivity-free Mycobacterium tuberculosis cultivation and detection technologies., RESULTS: Six studies were
included in the final analysis. The MB/BacT, BACTEC MGIT 960, and Manual MGIT systems were highly sensitive and
specific for detecting rifampicin-resistant TB. The summary SEN and summary SPE of the MB/BacT and BACTEC MGIT
960 systems were 100%, 99%, 100%, and 96%, respectively. The SROC of the BACTEC MGIT 960 system was 0.9943.,
CONCLUSION: We recommended that the BACTEC 460 system be replaced by MB/BacT or BACTEC MGIT 960 as the
final diagnostic test for rifampicin resistance in Mycobacterium tuberculosis. More studies are needed on the
diagnostic value of other radioactivity-free cultivation and detection technologies to reliably determine their
sensitivity and specificity for this bacterium. 2011 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center,
West China Hospital of Sichuan University.
Background and Objective: Survivin has gradually become an important target in diagnosis, prognosis prediction and
treatment of tumor. There are many studies on urine-based survivin mRNA test using reverse transcription-
polymerase chain reaction (RT-PCR) as a noninvasive examination for bladder cancer. However, its clinical value
remains controversial. This study was to evaluate the diagnostic value of urine survivin mRNA detection with RT-PCR
for bladder cancer by a systematic review of related studies. METHODS: With the search terms such as bladder
neoplasm, survivin, RT-PCR, sensitivity, specificity and diagnosis, we systematically searched through PubMed,
EMBASE, SCI, Cochrane Library, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Full-text
Database (CSJD), China Journal Full-text Database (CJFD), Chinese Medical Association (CMA) digital periodicals and
Google Scholar totally from January 1997 to April 2009 for diagnostic trials with RT-PCR detection of urine survivin
mRNA for bladder cancer. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) items were used to
evaluate the quality of the included studies. Meta-disc software was used to calculate outcome indicators. RESULTS:
Twenty-six studies, totally 2 416 patients, were eligible. Meta-analysis showed that compared with pathologic
examination, the summary values of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and
summary receiver operating characteristic curve (SROC) of urine-based survivin mRNA test using RT-PCR for bladder
cancer were 88%, 94%, 14.56, 0.13 and 0.9736, respectively. Nested RT-PCR got the highest sensitivity, specificity
and SROC and the values were 91%, 95% and 0.9805, respectively. The sensitivity and specificity of general RT-PCR
were the second highest, which were 87% and 94%, respectively. The sensitivity of quantitative RT-PCR was 80% and
the specificity was 93%. CONCLUSIONS: Comparing with pathologic examination, the sensitivity and specificity of
urine-based survivin mRNA test using RT-PCR are relatively high. It can be used as an important adjunct method for
cystoscope in early screening and postoperative monitoring of bladder cancer.
BACKGROUND AND OBJECTIVE: Survivin has gradually become an important target in diagnosis, prognosis prediction
and treatment of tumor. There are many studies on urine-based survivin mRNA test using reverse transcription-
polymerase chain reaction (RT-PCR) as a noninvasive examination for bladder cancer. However, its clinical value
remains controversial. This study was to evaluate the diagnostic value of urine survivin mRNA detection with RT-PCR
for bladder cancer by a systematic review of related studies., METHODS: With the search terms such as bladder
neoplasm, survivin, RT-PCR, sensitivity, specificity and diagnosis, we systematically searched through PubMed,
EMBASE, SCI, Cochrane Library, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Full-text
Database (CSJD), China Journal Full-text Database (CJFD), Chinese Medical Association (CMA) digital periodicals and
Google Scholar totally from January 1997 to April 2009 for diagnostic trials with RT-PCR detection of urine survivin
mRNA for bladder cancer. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) items were used to
evaluate the quality of the included studies. Meta-disc software was used to calculate outcome indicators., RESULTS:
Twenty-six studies, totally 2 416 patients, were eligible. Meta-analysis showed that compared with pathologic
examination, the summary values of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and
summary receiver operating characteristic curve (SROC) of urine-based survivin mRNA test using RT-PCR for bladder
cancer were 88%, 94%, 14.56, 0.13 and 0.9736, respectively. Nested RT-PCR got the highest sensitivity, specificity
and SROC and the values were 91%, 95% and 0.9805, respectively. The sensitivity and specificity of general RT-PCR
were the second highest, which were 87% and 94%, respectively. The sensitivity of quantitative RT-PCR was 80% and
the specificity was 93%., CONCLUSIONS: Comparing with pathologic examination, the sensitivity and specificity of
urine-based survivin mRNA test using RT-PCR are relatively high. It can be used as an important adjunct method for
cystoscope in early screening and postoperative monitoring of bladder cancer.
Background: Historians have suggested that MacArthur had Parkinson disease (PD), and that this may have
influenced his military judgment. There is little evidence to support or to refute this suggestion. Objective: We aimed
in this article to review multiple cinematic images, as well as the personal writings of Douglas MacArthur to
determine the likelihood that he had PD. Methods: A complete review of the Western literature on Douglas
MacArthur, including YouTube, Google Scholar/Google Images/Google Video, PubMed, and HighWirePress was
undertaken. Over 200 minutes of film footage was analyzed, including such factors as MacArthur's facial profiles,
facial expression, gait, posture, and movement. Handwriting samples from over 6 decades were compared for
evidence of micrographia. Videos and handwriting samples were independently reviewed by 3 fellowship-trained
movement disorders neurologists. Results: Examination of video footage showed evidence of progression of head
tremors, postural action tremors, and voice tremors. There were no clear indications of a masked face, rigidity,
bradykinesia, or a resting tremor on film footage recorded from 1906 to 1964. There was no evidence of
micrographia in handwriting samples. Oral testimony and letters written by an attending gastroenterologist present
at MacArthur's death in 1964 revealed no evidence of parkinsonian features. Conclusions: We conclude that
MacArthur had mild essential tremor that was more evident in his postmilitary career. There was no evidence to
suggest that he had a clinical diagnosis of progressive PD. Copyright 2011 by AAN Enterprises, Inc.
BACKGROUND/AIMS: The incidence of inflammatory bowel disease (IBD) is increasing. Dietary factors such as the
spread of the "western" diet, high in fat and protein but low in fruits and vegetables, may be associated with the
rising incidence of IBD. A large number of studies have evaluated the association between diet and IBD risk;
however, there is no systematic review of this important topic. METHODS: We performed a systematic review using
guideline recommend methodology to evaluate the association of pre-illness intake of fats, carbohydrates, fruits,
vegetables, meats and protein intake and the risk of subsequent IBD diagnosis. Two investigators independently
identified eligible fully published studies through structured keyword searches in PubMed, Google Scholar, and
manual searches. No language restrictions were imposed. RESULTS: A total of nineteen studies were included
encompassing 2,609 patients with IBD (1,269 Crohn's disease (CD) and 1,340 ulcerative colitis (UC) patients); only
one was a cohort study and the other 18 studies were case-control. Twelve studies were performed in Europe, three
in Japan, two in Canada, one in Israel, and 1 cross-continental study included the US, Canada, and several European
countries. CD: Studies consistently reported a "positive" association between high intake of saturated fats,
monounsaturated fatty acids (MUFA), total polyunsaturated fatty acids (PUFA), total omega-3 fatty acids, omega-6
fatty acids, mono-and disaccharides, and meat with increased subsequent CD risk. Studies consistently reported a
"negative" association between dietary fiber and fruits and subsequent CD risk. [Table Presented].
OBJECTIVES: The incidence of inflammatory bowel disease (IBD) is increasing. Dietary factors such as the spread of
the Western diet, high in fat and protein but low in fruits and vegetables, may be associated with the increase.
Although many studies have evaluated the association between diet and IBD risk, there has been no systematic
review.METHODS: We performed a systematic review using guideline-recommended methodology to evaluate the
association between pre-illness intake of nutrients (fats, carbohydrates, protein) and food groups (fruits, vegetables,
meats) and the risk of subsequent IBD diagnosis. Eligible studies were identified via structured keyword searches in
PubMed and Google Scholar and manual searches.RESULTS: Nineteen studies were included, encompassing 2,609
IBD patients (1,269 Crohns disease (CD) and 1,340 ulcerative colitis (UC) patients) and over 4,000 controls. Studies
reported a positive association between high intake of saturated fats, monounsaturated fatty acids, total
polyunsaturated fatty acids (PUFAs), total omega-3 fatty acids, omega-6 fatty acids, mono-and disaccharides, and
meat and increased subsequent CD risk. Studies reported a negative association between dietary fiber and fruits and
subsequent CD risk. High intakes of total fats, total PUFAs, omega-6 fatty acids, and meat were associated with an
increased risk of UC. High vegetable intake was associated with a decreased risk of UC.CONCLUSIONS: High dietary
intakes of total fats, PUFAs, omega-6 fatty acids, and meat were associated with an increased risk of CD and UC. High
fiber and fruit intakes were associated with decreased CD risk, and high vegetable intake was associated with
decreased UC risk. 2011 by the American College of Gastroenterology.
Objective: Unlike irreversible MAOIs, linezolid is a weak, reversible MAOI. Recommended tyramine quantities for
patients receiving linezolid are <100 mg per meal, while recommended quantities for patients receiving other MAOIs
are <6 mg. The standard of care is to place patients receiving MAOIs on tyramine-restricted diets. The objective of
this study was to evaluate the possibility that the tyramine dietary restriction is not necessary for hospitalized
patients receiving linezolid. Previously, pharmacists were required to contact the Food & Nutrition department for
each patient placed on linezolid. This process and the volume of patients placed on linezolid resulted in a significant
time commitment for both the Pharmacy Department and the Food and Nutrition department. Thus, a second
objective was conservation of hospital resources. Methods: A literature search in MEDLINE, PubMed, and Google
Scholar was conducted to identify pertinent literature, including case reports describing an interaction between
linezolid and tyramine. The product manufacturer was also contacted for information and reported cases. Several
clinical studies evaluating the interaction between linezolid and tyramine were reviewed. The amount of tyramine in
a typical unrestricted diet for a hospitalized patient was reviewed. Results: No case reports were retrieved from the
literature and only one case had been reported to the manufacturer. However, the details of the case are unknown
except that the patient was an outpatient. Review of the amount of high tyraminecontaining foods and the quantity
required to provide 50 mg tyramine revealed that the foods would need to be consumed in large quantities, and
such quantities would not be found in meals for hospital patients. Conclusion: Although patients should avoid
consuming large amounts of foods containing high concentrations of tyramine, such foods in large amounts are not
components of meals for inpatients. We conclude that dietary tyramine restriction in hospitalized patients on
linezolid is not necessary. Original Citation: Nutrition in Clinical Practice Vol 25:265-269, June 2010.
Context: Exercise-induced improvements in cancer-related fatigue may be moderated differentially in patients during
and following treatment. These effects have not been reviewed systematically. In accordance with PRISMA
guidelines, the population effect size for exercise training on cancer-related fatigue during and following treatment
was estimated and the extent to which the effect is differentiated across the time course of treatment and recovery
was determined. Evidence acquisition: Articles published before August 2011 were retrieved using Google Scholar,
MEDLINE, PsycINFO, PubMed, and Web of Science databases. Seventy studies involving 4881 cancer patients during
or following treatment were selected. Articles included a cancer-related fatigue outcome measured at baseline and
post-intervention and randomized allocation to exercise or non-exercise comparison. From August to October 2011,
Hedges' d effect sizes were computed, study quality was evaluated, and random effects models were used to
estimate sampling error and population variance. Evidence synthesis: Exercise significantly reduced cancer-related
fatigue by a mean effect (95% CI) of 0.32 (0.21, 0.43) and 0.38 (0.21, 0.54) during and following cancer treatment,
respectively. During treatment, patients with lower baseline fatigue scores and higher exercise adherence realized
the largest improvements. Following treatment, improvements were largest for trials with longer durations between
treatment completion and exercise initiation, trials with shorter exercise program lengths, and trials using wait-list
comparisons. Conclusions: Exercise reduces cancer-related fatigue among patients during and following cancer
treatment. These effects are moderated differentially over the time course of treatment and recovery. Exercise has a
palliative effect in patients during treatment and a recuperative effect post-treatment. 2012 American Journal of
Preventive Medicine.
Maspin is a member of the serpin (serine protease inhibitor) family and was reported as a tumor suppressor gene in
breast and prostatic cancer. Maspin expression in normal cells is regulated by epigenetic modification in a cell type
specific manner and its tissue specific expression is closely associated with DNA methylation. The epigenetic
deregulation frequently participates in tumorigenesis by inactivation of tumor suppressor genes, and the association
of promoter hypermethylation and gene silencing is an established oncogenic process in cancer. This investigation
aimed to describe the role of tissue specific maspin expression in various cancers and its value as a prognostic
indicator. The Medline (via PubMed), Google Scholar and Scirus databases were searched using the subject keywords
maspin expression and its epigenetic regulation. We aimed to analyze the role of maspin gene expression in various
cancers and its importance as a prognostic indicator. Various studies showed that promoter methylation of the
maspin gene leads to gene silencing in cancers, such as breast, thyroid, skin, and colon. Maspinpositive cells
(mammary/prostatic epithelia and skin/oral keratinocytes) showed no methylation at the CpG islands of the
promoter region. In contrast, maspin-negative cells (skin fibroblasts, lymphocytes, heart, liver, and bone marrow)
showed extensive methylation. Aberrant expression of maspin protein related to DNA hypomethylation in the
promoter region is frequently observed in pancreatic and gallbladder carcinoma, whereas the non tumorous
gallbladder epithelium is maspin negative. Over expression was observed in pancreatic, gallbladder and ovarian
cancer, whereas normal tissue was maspin negative. Precancerous lesions also express maspin protein and its
regulation is correlated with malignant behavior. In these tumors maspin seems to behave as an oncogene rather
than a tumor suppressor gene. This suggests maspin gene as a potential prognostic marker to be studied.
Diffusion MRI (or dMRI) came into existence in the mid-1980s. During the last 25. years, diffusion MRI has been
extraordinarily successful (with more than 300,000 entries on Google Scholar for . diffusion MRI). Its main clinical
domain of application has been neurological disorders, especially for the management of patients with acute stroke.
It is also rapidly becoming a standard for white matter disorders, as diffusion tensor imaging (DTI) can reveal
abnormalities in white matter fiber structure and provide outstanding maps of brain connectivity. The ability to
visualize anatomical connections between different parts of the brain, non-invasively and on an individual basis, has
emerged as a major breakthrough for neurosciences. The driving force of dMRI is to monitor microscopic, natural
displacements of water molecules that occur in brain tissues as part of the physical diffusion process. Water
molecules are thus used as a probe that can reveal microscopic details about tissue architecture, either normal or in
a diseased state. 2011 Elsevier Inc.
Pharmaceuticals have been detected throughout the environment where at least in some cases, they have been
shown to have a detrimental effect. Many result from improper patient disposal of unused pharmaceuticals via
environmentally-unfriendly routes, such as the sink, toilet or rubbish bin. This review surveys the current peer-
reviewed literature on attitudes and practices to medicine disposal methods as reported by patients and the various
medication disposal and destruction systems around the world. A literature search was carried out using the
keywords 'medicines disposal', 'unused medicines', 'medicines wastage', and 'medication disposal' in the PubMed
TM, ISI Web of Knowledge TM, Google Scholar TM, Medline TM, Scopus TM and International Pharmaceuticals
Abstracts TM up to the end of May 2010. Twelve peer-reviewed articles with specified sample sizes were selected.
The most popular methods for medication disposal were in the garbage, toilet or sink. Liquid medications were more
likely to be rinsed down the sink, as opposed to solid tablets and capsules which were more likely deposited in the
rubbish bin. Much confusion exists about the 'proper' way of medication disposal as many countries do not have
standard medication disposal protocols. Furthermore, some pharmacies around the world refused to accept unused
medications or discouraged the practice. Patients with knowledge about the impact of pharmaceuticals in the
environment were more likely to return medications for proper disposal and destruction. It is concluded that it is of
paramount importance that a formalized protocol for patient disposal and destruction of pharmaceuticals be
implemented around the world. 2010 Elsevier Ltd.
Aim: The purpose of our study was to describe the dissemination of research into the clinical nursing literature.
Background: The literature provides a means of transferring knowledge from a research study through citations of
the work by other authors. Design: This was a citation analysis study to explore the dissemination of research into
the clinical nursing literature, beginning with the publication of an original research study and including all of the
citations to that article through 2009. Methods: The authors searched five academic nursing research journal titles,
using CINAHL, for original research reports that had clinical relevance and were published between 1990-1999. The
search process yielded a final data set of 28 research articles. For each of the articles, the authors searched three
databases, CINAHL, Web of Science and Google Scholar, to determine the citation patterns from the date of
publication to August 2009. Results: All of the research studies were cited in articles published in clinical journals
although there was a wide range in the number of citations, from 3-80. The 28 research articles had a total of 759
citations; 717 (94.5%) of those citations were in articles published in clinical nursing journals. The median length of
time between publication of the original study and the first citation was 1.5 years. Some of the studies were still
being cited for 18 years after publication of the original work. Conclusions: All of the original research reports
examined in this study were cited in articles in clinical journals, disseminating the research beyond the original work
to reach clinicians. Relevance to clinical practice: Clinical nursing journals keep readers up-to-date and informed
about new practices in nursing and serve another important role: they disseminate research that is clinically relevant
by publishing original studies and papers that cite research reports. 2010 Blackwell Publishing Ltd.
BACKGROUND: As health providers move towards higher levels of information technology (IT) integration, they
become increasingly dependent on the availability of the electronic health record (EHR). Current solutions of
individually managed storage by each healthcare provider focus on efforts to ensure data security, availability and
redundancy. Such models, however, scale poorly to a future of a planet-wide public health-care network (PWPHN).
Our aim was to review the research literature on distributed storage systems and propose methods that may aid the
implementation of a PWPHN., METHODS: A systematic review was carried out of the research dealing with
distributed storage systems and EHR. A literature search was conducted on five electronic databases:
Pubmed/Medline, Cinalh, EMBASE, Web of Science (ISI) and Google Scholar and then expanded to include non-
authoritative sources., RESULTS: The English National Health Service Spine represents the most established country-
wide PHN but is limited in deployment and remains underused. Other, literature identified and established
distributed EHR attempts are more limited in scope. We discuss the currently available distributed file storage
solutions and propose a schema of how one of these technologies can be used to deploy a distributed storage of EHR
with benefits in terms of enhanced fault tolerance and global availability within the PWPHN. We conclude that a
PWPHN distributed health care record storage system is technically feasible over current Internet infrastructure.
Nonetheless, the socioeconomic viability of PWPHN implementations remains to be determined.
OBJECTIVES: Acute otitis media (AOM) is a common childhood condition with viral and bacterial causation. Routine
immunization programs currently include 7-valent Pneumococcal Conjugate Vaccine (PCV-7), associated with AOM
reduction caused by Streptococcus pneumoniae only. The study objective was to conduct a systematic literature
review to identify current microbiological picture associated with AOM. METHODS: OVID (Medline, Current Content
and International Pharmaceutical Abstract databases), EMBASE, Google and Google Scholar engines were searched
with the following combination of key-words: "acute otitis media", "bacteria$" and "vir$". Eligible articles were in
English, published between 1995 and 2008, and described studies of pediatric AOM patients with cultures for
bacterial and viral isolates. RESULTS: Of the 398 articles screened, 24 separate studies were included (range =25-623
subjects). Based on a fi xed-effects meta-analysis across all studies, pathogens isolated were more frequently
bacterial (74%) than viral (19%). Compared with the 15 international studies, U.S. studies recorded a similar isolation
rate for bacterial (73% vs. 74%) and higher isolation rate for viral pathogens (23% vs. 17%). Twentythree studies
included data on the specifi c bacterial pathogens cultured. Based on a fi xed-effects meta-analysis of patients in
these studies, S. pneumoniae and Haemophilus infl uenzae were isolated with similar frequency (35% vs. 36%) and
Moraxella catarrhalis at 6%. Slightly higher isolation rates of M. catarrhalis (10%) and lower rates of H. infl uenzae
(31%) were observed in U.S. patients, compared with international patients. CONCLUSIONS: Bacterial pathogens are
frequently associated with AOM in pediatric populations worldwide and were isolated 3-times more often than viral
pathogens. S. pneumoniae and H. infl uenzae are the bacterial pathogens most commonly isolated in AOM cases,
with nearly equal frequency. A vaccine that addresses more than one cause of AOM would be expected to greatly
reduce the clinical and economic burden associated with this common condition.
Background: Road traffic deaths are a major global health and development problem. An understanding of the
existing burden of road traffic deaths in the population is necessary for developing effective interventions. Objectiva:
To outline systematically the global distribution of road traffic deaths by road user groups (pedestrians, bicyclists,
motorcyclists, motorised four-wheeler occupants). Methods: Comprehensive searches of PubMed, Google, Google
Scholar, TransportLink, grey literature and reference lists and communication with experts from international
organisations and country-level institutions were conducted to identify eligible studies and data sources. All data
sources that provided a breakdown of road traffic deaths by road user group at the national or sub-national level
were eligible for inclusion. A breakdown of road traffic deaths by road user group was constructed for 14
epidemiologically defined World Health Organization (WHO) sub-regions in addition to World Bank income
categories. In addition, the total number of road traffic fatalities by road user group in low-income, middle-income
and high-income countries was estimated. Results: The breakdown of road traffic deaths by road user group varies
dramatically across epidemiological WHO sub-regions. The magnitude of pedestrian fatalities ranges from more than
half in African sub-region AfrE (55%) to 15% or less in AmrA or EurA. The distribution also varies across low-income,
middle-income and high-income countries. 45% of road traffic fatalities in low-income countries are among
pedestrians, whereas an estimated 29% in middle-income and 18% in high-income countries are among pedestrians.
The burden of road traffic injuries on vulnerable road users differs substantially across income levels. An estimated
total of 227 835 pedestrians die in low-income countries, as opposed to 161 501 in middle-income countries and 22
500 in high-income countries each year. Conclusions: Ameliorating road safety requires the implementation of
context-specific solutions. This review of the road traffic injury literature provides strong evidence that the
distribution of road traffic fatalities varies dramatically across different parts of the world. Therefore, context-
appropriate and effective prevention strategies that protect the particular at-risk road user groups should be
carefully investigated.
DATA SOURCES: The Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register
of Controlled Trials, Medline, PubMed, Embase and other relevant databases (Cinhal.LILACS,KoreaMed, IndMed,
PakMediNet, theUK Clinical Research Network Portfolio Database (UKCRN), the World Health Organization
International Clinical Trials Registry Platform (ICTRP), Google Scholar, NLH ENT & Audiology Specialist Library and the
metaRegister of Controlled Trials (mRCT).) were utilised to identify possible trials., STUDY SELECTION: Randomised
controlled trials (RCT) were eligible for inclusion if antiviral agents alone or in combination with other therapies
(using different routes of administration and dosage schemes) had been taken as treatment for Ramsay Hunt
syndrome., DATA EXTRACTION AND SYNTHESIS: Two reviewers independently assessed eligibility and trial quality.,
RESULTS: Only one RCT was identified and included. It was of low quality and included only 15 participants. In this
1992 trial, treatment with intravenous aciclovir and corticosteroids was compared with corticosteroids alone.
Analysis found no statistically significant difference between the two groups., CONCLUSIONS: The use of antiviral
agents against herpes zoster infections in other parts of the body suggests that they could be useful in the case of
herpes zoster oticus. We found no evidence that they have a beneficial effect on outcomes in Ramsay Hunt
syndrome, despite their widespread use in this condition. As usual, however, the absence of positive evidence of
benefit (or, in this case, the 'negative' result of one small, statistically underpowered study) does not necessarily
indicate that antivirals are ineffective. The results of the review do suggest that the various adverse effects of
antivirals should be taken into consideration in the risk-benefit analysis that foregoes treatment.
Objective. To assess the evidence that treatment with corticosteroids improves the outcome in those exposed to
lung-damaging agents. Methods. We searched Pubmed, Toxnet, Cochrane database, Google Scholar, and Embase
from 1966 to January 2010 using the search terms "steroid", "corticosteroid", "lung injury", "lung damage", and
"inhalation". These searches identified 287 papers of which 118 contained information on animal studies. However,
most were reviews or case reports and only a few were controlled animal experiments of which 13 were considered
relevant. Role of corticosteroids: animal studies. Corticosteroids have no beneficial effect at the alveolar level on
acute lung injury, which is caused by inhalation of poorly water-soluble compounds (e.g. nitrogen dioxide, ozone,
phosgene) or following severe exposure to water-soluble compounds (e.g. chlorine, ammonia). In the recovery
phase, corticosteroids may even be harmful, because corticosteroids hamper the division of type II alveolar cells and
hamper the differentiation from type II into type I alveolar cells. The latter is important for the re-epithelialization of
the alveolus and removal of excess of water in the alveolus. Furthermore, the quality of animal studies does not
always allow extrapolation to human exposures. Differences between humans and animals in anatomy, pulmonary
defense systems, breathing physiology, as well as the way the animals have been exposed, and the timing and route
of corticosteroids in animal studies make predictions difficult. Role of corticosteroids: human studies. An abundance
of uncontrolled case reports and a few human crossover studies have evaluated the outcome of human volunteers
exposed to various lung-damaging agents. Only a few reports contained systematic information on corticosteroid
treatment. Data on the efficacy of corticosteroids after human exposure to lung-damaging agents are inconclusive.
Often the number of patients involved is small or the severity of exposure is unclear or not well determined. These
reports are therefore limited in their ability to establish a cause-effect relationship for the treatments involved. In
some studies involving mild to moderate exposure to water-soluble agents (e.g. chlorine, ammonia), corticosteroid
treatment was beneficial for some physiological parameters, such as airway resistance or arterial oxygen tension.
However, severe lung injury and inflammation appear not to be improved by corticosteroid treatment. The optimal
duration of treatment to obtain these beneficial effects has not been assessed adequately, but it only seems to be
useful in the first hours after exposure. Generally, studies evaluating exposure to water-soluble compounds have too
short a follow-up, which hampers the evaluation of the efficacy of corticosteroid treatment. The results of studies
with longer follow-up suggest that the initial slight improvement in some variables is lost several hours after
exposure. Conclusions. Clinical data on the efficacy of corticosteroids after human exposure to lung-damaging agents
are inconclusive as the number of well-structured controlled studies is small and the indications for administration of
The goal of this study was to perform a systematic quantitative comparison of the surgical outcomes between cystic
vestibular schwannomas (CVSs) and solid vestibular schwannomas (SVSs). A review of English-language literature
published between 1990 and 2011 was performed using various search engines including PubMed, Google Scholar,
and the Cochrane database. Only studies that reported surgical results of CVSs in comparison with SVSs were
included in the analysis. The primary end point of this study was surgical outcomes, defined by the following: 1) facial
nerve outcomes at latest follow-up; 2) mortality rates; or 3) non-facial nerve complication index. Secondary end
points included extent of resection and brainstem adherence. Nine studies comprising 428 CVSs and 1287 SVSs were
included in the study. The mean age of patients undergoing surgery was 48.3 +/- 6.75 and 47.1 +/- 9 years for CVSs
and SVSs, respectively (p = 0.8). The mean tumor diameter for CVSs was 3.9 +/- 0.84 cm and that for SVSs was 3.7 +/-
1.2 cm (p = 0.7). There was no significant difference in the extent of resection among CVSs and SVSs (81.2% vs 80.7%,
p = 0.87) Facial nerve outcomes were significantly better in the cohort of patients with SVSs than in those with CVSs
(52.1% vs 39%, p = 0.0001). The perioperative mortality rates for CVSs and SVSs were not significantly different (3%
and 3.8%, respectively; p = 0.6). No significant difference was noted between the cumulative non-facial nerve
complication rate (including mortality) among patients with CVSs and SVSs (24.5% and 25.6%, respectively; p = 0.75)
Facial nerve outcomes are worse in patients undergoing resection for CVSs than in patients undergoing resection for
SVSs. There were no significant differences in the extent of resection or postoperative morbidity and mortality rates
between the cohorts of patients with vestibular schwannomas.
Energy drinks (EDs) contain caffeine and are a new, popular category of beverage. It has been suggested that EDs
enhance physical and cognitive performance; however, it is unclear whether the claimed benefits are attributable to
components other than caffeine. A typical 235mL ED provides between 40 and 250mg of caffeine, equating to doses
that improve cognitive and, at the higher levels, physical performance. EDs often contain taurine, guarana, ginseng,
glucuronolactone, B-vitamins, and other compounds. A literature search using PubMed, Psych Info, and Google
Scholar identified 32 articles that examined the effects of ED ingredients alone and/or in combination with caffeine
on physical or cognitive performance. A systematic evaluation of the evidence-based findings in these articles was
then conducted. With the exception of some weak evidence for glucose and guarana extract, there is an
overwhelming lack of evidence to substantiate claims that components of EDs, other than caffeine, contribute to the
enhancement of physical or cognitive performance. Additional well-designed, randomized, placebo-controlled
studies replicated across laboratories are needed in order to assess claims made for these products. 2012
International Life Sciences Institute.
Introduction: Folate is an essential nutrient functioning in a variety of one-carbon transfer reactions, is necessary for
red blood cell formation and growth, and deficiency is known to cause megaloblastic anemia. The role of folate in
prevention of neural tube defects has been the driving force in public health measures leading to large-scale food
fortification in the United States starting in 1996. It is not known if folate fortification has an impact on hematologic
toxicities of patients undergoing chemotherapy. The goal of this study is to compare rates of leucopenia reported in
pre and post folic acid fortification randomized clinical trials of Adriamycin and Cyclophosphamide (AC)
chemotherapy in breast cancer. Methods: Randomized trials of breast cancer chemotherapy with AC conducted in
the United States were searched for in the Medline database, bibliographies, and using Google Scholar. Studies were
included if AC was used alone in any arm of study, at standard dosing. Only studies that included disease free survival
(DFS), overall survival (OS), and rates of grade III/IV leucopenia for the AC group were included. Studies were
eliminated if they included patients with known metastatic disease, "dose dense" or nonstandard AC regimens, or
included growth factor support. Rates of phase III/IV leucopenia were grouped in pre and post 1996 folate
fortification groups, and meta-analyzed in a random effects model using MIX, a comprehensive free software for
meta-analysis of causal research data. Results: Seven studies involving 14,386 patients were identified using the
defined search methodology. There was no significant difference in phase III/IV leucopenia rates between prefolate
(4.36% 95%CI 2.31-6.42%) and postfolate studies (7.07% 95%CI 5.41-8.73%). Conclusions: This review disclosed no
statistically significant difference in the rates of leucopenia in patients given AC for breast cancer before or after
1996. Postfolate studies did have 46% more leucopenia than those prior to folate fortification. The confidence
intervals of the leucopenia rates overlapped but approached significance. This is contradictory to our theory that
increased dietary folate might mitigate hematologic toxicities of chemotherapy. Further studies using individual
patient data from institutions administering AC pre and post fortification would further elucidate the role of dietary
folate in hematologic toxicities.
BACKGROUND: Psychological problems present a huge burden of illness in our community and GPs are the main
providers of care. There is evidence that longer consultations in general practice are associated with improved
quality of care; but this needs to be balanced against the fact that doctor time is a limited resource and longer
consultations may lead to reduced access to health care.The aim of this research was to conduct a systematic
literature review to determine whether management of psychological problems in general practice is associated with
an increased consultation length and to explore whether longer consultations are associated with better health
outcomes for patients with psychological problems. METHODS: A search was conducted on Medline (Ovid) databases
up to 7 June 2006. The following search terms, were used:general practice or primary health care (free text) or family
practice (MeSH)AND consultation length or duration (free text) or time factors (MeSH)AND depression or
psychological problems or depressed (free text).A similar search was done in Web of Science, Pubmed, Google
Scholar, and Cochrane Library and no other papers were found.Studies were included if they contained data
comparing consultation length and management or detection of psychological problems in a general practice or
primary health care setting. The studies were read and categories developed to enable systematic data extraction
and synthesis. RESULTS: 29 papers met the inclusion criteria. Consultations with a recorded diagnosis of a
psychological problem were reported to be longer than those with no recorded psychological diagnosis. It is not clear
if this is related to the extra time or the consultation style. GPs reported that time pressure is a major barrier to
treating depression. There was some evidence that increased consultation length is associated with more accurate
diagnosis of psychological problems. CONCLUSION: Further research is needed to elucidate the factors in longer
consultations that are associated with greater detection of psychological problems, and to determine the association
between the detection of psychological problems and the attitude, gender, age or training of the GP and the age,
gender and socioeconomic status of the patient. These are important considerations if general practice is to deal
more effectively with people with psychological problems.
OBJECTIVES: In the UK, Patient Access Schemes (PAS) have become more common in submissions to the National
Institute for Health and Clinical Excellence (NICE). The increase in PAS is a result of the essential role such schemes
play in enhancing the availability of high-cost treatments to payers. In published appraisals, minimal emphasis has
been placed upon the administrative burden of PAS, which is typically described as "acceptable." The aim of this
study was to assess the impact of administering PAS in the UK, using both primary research and existing literature to
identify key administrative challenges. METHODS: A literature search was conducted using PubMed and Google
Scholar. Freedom of information requests were sent to NICE for data on PAS administration. a pilot questionnaire
was distributed to all 19 contacts listed on the directory of NHS Chief Pharmacists in Wales, to assess the real-life
burden of PAS administration. RESULTS: Limited literature is available on the administration of PAS. However, the
literature search uncovered evidence that the administrative impact of PAS is being recognized. The creation of the
Patient Access Scheme Liaison Unit (PASLU) in October 2009 and the publication of the Pharmaceutical Price
Regulation Scheme (PPRS) are two such developments, both of which are steps toward a system that more
accurately reflects the needs of NHS administrators. The return rate for the questionnaire was low; however,
responders showed dissatisfaction with multiple aspects of PAS management. Responders emphasized the need to
address NHS requirements (both financial and temporal) in order to facilitate accurate PAS administration.
CONCLUSIONS: Encouraging steps have been taken to recognize the burden of PAS on the NHS; however, further
research is required to assess whether these recent developments are meaningful in everyday practice. Additional
support for appropriate PAS implementation must also be provided if these important schemes are to continue
effectively.
There is increasing concern that prescription stimulants may be associated with adverse cardiovascular events such
as stroke, myocardial infarction, and sudden death. Public health concerns are amplified by increasing use of
prescription stimulants among adults. The objective of this study was to conduct a systematic review of the evidence
of an association between prescription stimulant use and adverse cardiovascular outcomes. PUBMED, MEDLINE,
EMBASE and Google Scholar searches were conducted using key words related to these topics (MESH): ADHD;
Adults; Amphetamine; Amphetamines; Arrhythmias, Cardiac; Cardiovascular Diseases; Cardiovascular System;
Central Nervous Stimulants; Cerebrovascular; Cohort Studies; Case-control Studies; Death; Death, Sudden, Cardiac;
Dextroamphetamine; Drug Toxicity; Methamphetamine; Methylphenidate; Myocardial Infarction; Stimulant; Stroke;
Safety. Eligible studies were population-based studies of children, adolescents, or adults using prescription stimulant
use as the independent variable and a hard cardiovascular outcome as the dependent variable. Ten population-based
observational studies which evaluated prescription stimulant use with cardiovascular outcomes were reviewed. Six
out of seven studies in children and adolescents did not show an association between stimulant use and adverse
cardiovascular outcomes. In contrast, two out of three studies in adults found an association. Findings of an
association between prescription stimulant use and adverse cardiovascular outcomes are mixed. Studies of children
and adolescents suggest that statistical power is limited in available study populations, and the absolute risk of an
event is low. More suggestive of a safety signal, studies of adults found an increased risk for transient ischemic attack
and sudden death/ventricular arrhythmia. Interpretation was limited due to differences in population, cardiovascular
outcome selection/ascertainment, and methodology. Accounting for confounding and selection biases in these
studies is of particular concern. Future studies should address this and other methodological issues.
DoD2006, an updated version of Database of Databases is an online resource maintained collectively by ProGene
Biosciences and Department of Inorganic and Analytical Chemistry, Andhra University. It links to all molecular biology
databases that appeared in Nucleic Acids Research 2006 database issue. DoD2006 includes 873 databases, of which,
858 are derived from Nucleic Acids Research database issue and 15 are collected from In Silico Biology,
Bioinformation journals and Google Scholar search. Each database has a search option, keyword help and a brief
description with direct link to the database home page. The database is freely available online at
http://www.progenebio.in/DoD/index.htm.
BACKGROUND: Postoperative ileus is a temporary disturbance in gastric and bowel motility following surgery. The
risk for postoperative ileus following gastrointestinal and urinary ostomy surgery is significant because both
procedures require extensive surgical manipulation and reconstruction of the bowel. Chewing gum is advocated for
treatment because it acts as sham feeding, potentially stimulating gastric and bowel motility through repetitive
stimulation of the cephalic-vagal complex. OBJECTIVES: This Evidence-Based Report Card reviews and evaluates
evidence related to the safety and efficacy of chewing gum as an intervention to reduce the duration of
postoperative ileus. SEARCH STRATEGY: We systematically reviewed the electronic databases CINAHL and MEDLINE
from January 1996 to November 2009, using the terms "ileus" and "chewing gum." We also searched the ancestry of
the 21 articles returned by this review and searched Google Scholar. We included any study or meta-analysis of
multiple studies that compared chewing gum to no treatment in patients undergoing abdominal surgery and creation
of an intestinal or urinary stoma. We evaluated the following outcome measures: (1) time to passage of flatus, (2)
time to passage of stool, or (3) length of hospital stay. Three meta-analyses and 4 studies met inclusion criteria.
RESULTS: Results of meta-analyses support the use of chewing gum for treatment of postoperative ileus. Chewing
gum was consistently found to reduce time to passage of flatus and stool. One meta-analysis found that chewing
gum reduced hospital stay but two found no difference. Analysis of studies reveal mixed results when chewing gum
was compared to standard postoperative care in patients undergoing surgical reconstruction including ostomy
surgery or creation of an orthotopic neobladder. The studies we reviewed were characterized by multiple limitations
in design quality including small sample sizes, absence of multicenter trials, and lack of subanalyses of patients
undergoing ostomy surgery. IMPLICATIONS FOR PRACTICE: Current best evidence suggests that chewing gum should
be offered to selected patients with the intent of decreasing postoperative ileus. A careful nursing assessment of the
patient's mental status, aspiration risk, and dentition is needed before initiating the intervention. In addition, further
research is needed to develop more clearly defined parameters for chewing gum including frequency and duration of
chewing and its use in patients with nasogastric tubes. 2010 by the Wound, Ostomy and Continence Nurses Society.
The incidence of postoperative wound infection is usually not the cause of death but it increases the length of
hospital stay and cost of care and morbidity. Since their introduction a century ago there is still controversy about
primary purpose of the facemasks as whether they provide protection for the patient from surgical team or weather
they protect surgical team from the patient? The Objectives of this study were to critically analyze and systematically
review the randomized trials regarding effectiveness of surgical facemasks in preventing post operative wound
infection in elective surgery. Systematic literature review and analysis of all available trials (randomized controlled
trials) regarding use of surgical face masks in elective surgeries. Medline (1966-2007), Embase (1996-2007),
Cochrane database, Pubmed, Google Scholar, were searched for the selection of literature for the review. No
significance difference in the incidence of postoperative wound infection was observed between masks group and
groups operated with no masks (1.34, 95% CI, 0.58-3.07). There was no increase in infection rate in 1980 when
masks were discarded. In fact there was significant decrease in infection rate (p < 0.05). From the limited randomized
trials it is still not clear that whether wearing surgical face masks harms or benefit the patients undergoing elective
surgery.
Synthetic glucocorticoids are the mainstay treatment for stimulating lung maturation in threatened preterm delivery.
Animal studies suggest that in utero exposure to glucocorticoids leads to a reduction in birth size. Smaller
birthweight has been associated with higher risk of many chronic diseases. Therefore, the authors undertook a
systematic review of human studies examining the association between synthetic glucocorticoid treatment and birth
size. Medline, EMBASE, PubMed, Cochrane, Google scholar and Institute of Life Science databases were searched for
studies published between 1978 and 2009 investigating the association between synthetic glucocorticoids and
birthweight, head circumference, birth length and ponderal index. All studies controlling for gestational age were
examined. Seventeen studies were included in the analysis. Nine out of 17 studies reported a reduction in
birthweight (range 12-332 g), five of nine a reduction of head circumference (range 0.31-1.02 cm) and two of four a
reduction of 0.8 cm in birth length. Despite methodological inconsistencies and limitations that impede clear
conclusions, the evidence suggests an association between in utero exposure to synthetic glucocorticoids and
reduced birth size. 2010 Blackwell Publishing Ltd.
Synthetic glucocorticoids are the mainstay treatment for stimulating lung maturation in threatened preterm delivery.
Animal studies suggest that in utero exposure to glucocorticoids leads to a reduction in birth size. Smaller
birthweight has been associated with higher risk of many chronic diseases. Therefore, the authors undertook a
systematic review of human studies examining the association between synthetic glucocorticoid treatment and birth
size. Medline, EMBASE, PubMed, Cochrane, Google scholar and Institute of Life Science databases were searched for
studies published between 1978 and 2009 investigating the association between synthetic glucocorticoids and
birthweight, head circumference, birth length and ponderal index. All studies controlling for gestational age were
examined. Seventeen studies were included in the analysis. Nine out of 17 studies reported a reduction in
birthweight (range 12-332 g), five of nine a reduction of head circumference (range 0.31-1.02 cm) and two of four a
reduction of 0.8 cm in birth length. Despite methodological inconsistencies and limitations that impede clear
conclusions, the evidence suggests an association between in utero exposure to synthetic glucocorticoids and
reduced birth size. 2010 Blackwell Publishing Ltd.
INTRODUCTION: Cultural norms and family structures may slow the progression of dementia or even delay its onset.
The authors report a case of a Latino senior with dementia who remained cognitively stable longer than anticipated
due in part to the devotion of his family. CASE: In 2008, a 85 year old man with CHF, atrial fibrillation, CKD, DM, PVD,
gait impairment and memory loss for a year was seen by geriatrics and diagnosed with a moderate stage mixed
Alzheimer's and vascular dementia. As the years passed, occasional restlessness, insomnia and hallucinations
occurred and he was treated for depression; occasionally low dose antipsychotics were prescribed. Overall, he has
responded well to reorientation, cueing and cognitive/ social stimulation by his devoted family who never leave him
unattended. His dementia has progressed but he remains verbal, interactive, recognizes family and enjoys life
despite many admissions and functional decline. He recently even made a trip back to Puerto Rico to visit relatives.
DISCUSSION: Epidemiological data indicates the incidence and rate of dementia are higher for socially isolated elders.
Studies of African and Italian patients indicate that social integration and networks and cognitively challenging
leisure activities protect against dementia and some research suggests that occupational therapy approaches may
slow cognitive decline for dementia sufferers. Emotional support maintains cognitive reserves and enhances
recovery in stroke patients. However, a search of the literature using standard engines such as pubmed and google
scholar, found no studies analyzing whether preserved family life can prevent or slow dementia's inexorable course.
CONCLUSION: Living with loving families provides personalized care for frail elders and will decrease the public costs
of health care; strategies to support family-based care in the community thus may improve quality of life while
decreasing the state's financial burden. Additionally, elders living with families who involve them in decision making,
problem solving and ongoing social interaction will be stimulated cognitively and may maintain intellectual reserves
longer. There is a glaring gap in the literature; studies must be done to clarify whether family life delays the onset or
progression of dementia. The role of families in slowing cognitive decline in dementia patients is critically important
for the field of ethnogeriatrics.
Background: Atrial tachyarrhythmias are associated with patent foramen ovale. The objective was to determine the
anti-arrhythmic effect of patent foramen ovale closure on pre-existing atrial tachyarrhythmias. Methods: Medline,
EMBASE, Cochrane Library, and Google Scholar databases were searched between 1967 and 2010. The search was
expanded using the 'related articles' function and reference lists of key studies. All studies reporting pre- and post-
closure incidence (or prevalence) of atrial tachyarrhythmia in the same patient population were included. Random
and fixed effect meta-analyses were used to aggregate the data. Results: Six studies were identified including 2570
patients who underwent percutaneous closure. Atrial fibrillation was in fact the only AT reported in all studies. Meta-
analysis using a fixed effects model demonstrated a significant reduction in the prevalence of atrial fibrillation with
an OR of 0.43 (95% CI 0.26-0.71). When using the random-effects model, OR was 0.44 (95% CI 0.18-1.04) with a
statistically significant trend demonstrated (test for overall effect: Z = 1.87, p = 0.06). Conclusion: Closure of a patent
foramen ovale may be associated with reduction in the prevalence of atrial fibrillation. 2011 Elsevier Ireland Ltd.
BACKGROUND: Prolonged surgical wait times have significant effects on a patient's psychological well-being and a
negative impact on quality of life but the effect on long-term cancer control is controversial. We conducted a
systematic review of the bladder cancer literature to examine the best available evidence addressing the following
key questions: What is the reported time interval for bladder cancer patients from the decision to operate until the
day of bladder cancer surgery? Are there recommendations/guidelines in the urological cancer literature and, if so,
how do the Canadian times compare? Is there a known association between duration of wait time beyond the
recommended standard and clinical outcome (i.e., recurrence-free survival, overall survival)? METHODS: A
structured literature search PubMed, Embase, the Cochrane Database and Google Scholar from January 1965 to
January 2006 was conducted for published studies and international guidelines/consensus documents that evaluated
surgical wait times for bladder cancer. Data extracted from eligible studies included median time to bladder cancer
surgery from diagnosis and key patient outcomes, such as survival rate or adjusted hazard ratios (HR). RESULTS:
Eighteen studies evaluating wait times for bladder cancer surgery were identified, ten of which measured the
association between prolonged waiting time and overall survival or tumor grade. Differences in study data
availability, method of analysis and wait time definitions precluded statistical pooling of the findings. Median wait
times from various points of patient contact ranged from 29 days (urologist consultation to transurethral resection)
to 164 days (general practitioner referral to surgery). In the lone Canadian epidemiological study, which focused on
all types of urological cancer, median wait time was 64 days from referral to surgery. This was in contrast to national
and international guidelines, which recommended a maximum wait time between 2 and 4 weeks for all cancer
surgeries. The association between surgical delay and overall survival remained controversial with some studies
reporting a reduced overall survival in patients with prolonged delays, while others failed to find such associations.
However, the three studies that measured the association between a delay of (3) 3 months and tumor grade
reported that patients in the prolonged delay groups had an overall poorer tumor grade. CONCLUSIONS: In Canada, it
appears that current wait times for urological surgeries, such as for bladder cancer, are beyond the threshold
recommended by national and international expert bodies. Even though the association between surgical delay and
overall survival remains inconclusive, there is evidence to suggest that prolonged delays are associated with an
overall poorer tumor grade. To provide the necessary guidance and recommendations on these issues to the federal
and provincial governments, the surgical wait times (SWAT) initiative was developed. Through a partnership of the
key stakeholders, it is the vision of SWAT to ultimately improve the care and quality of life of bladder cancer patients
BACKGROUND: Prolonged surgical wait times have significant effects on a patient's psychological well-being and a
systematic review of the bladder cancer literature to examine the best available evidence addressing the following
key questions: What is the reported time interval for bladder cancer patients from the decision to operate until the
day of bladder cancer surgery? Are there recommendations/guidelines in the urological cancer literature and, if so,
how do the Canadian times compare? Is there a known association between duration of wait time beyond the
recommended standard and clinical outcome (i.e., recurrence-free survival, overall survival)?, METHODS: A
January 2006 was conducted for published studies and international guidelines/consensus documents that evaluated
surgical wait times for bladder cancer. Data extracted from eligible studies included median time to bladder cancer
surgery from diagnosis and key patient outcomes, such as survival rate or adjusted hazard ratios (HR)., RESULTS:
Eighteen studies evaluating wait times for bladder cancer surgery were identified, ten of which measured the
association between prolonged waiting time and overall survival or tumor grade. Differences in study data
availability, method of analysis and wait time definitions precluded statistical pooling of the findings. Median wait
times from various points of patient contact ranged from 29 days (urologist consultation to transurethral resection)
to 164 days (general practitioner referral to surgery). In the lone Canadian epidemiological study, which focused on
all types of urological cancer, median wait time was 64 days from referral to surgery. This was in contrast to national
and international guidelines, which recommended a maximum wait time between 2 and 4 weeks for all cancer
surgeries. The association between surgical delay and overall survival remained controversial with some studies
reporting a reduced overall survival in patients with prolonged delays, while others failed to find such associations.
However, the three studies that measured the association between a delay of (3) 3 months and tumor grade
reported that patients in the prolonged delay groups had an overall poorer tumor grade., CONCLUSIONS: In Canada,
it appears that current wait times for urological surgeries, such as for bladder cancer, are beyond the threshold
overall survival remains inconclusive, there is evidence to suggest that prolonged delays are associated with an
overall poorer tumor grade. To provide the necessary guidance and recommendations on these issues to the federal
and provincial governments, the surgical wait times (SWAT) initiative was developed. Through a partnership of the
key stakeholders, it is the vision of SWAT to ultimately improve the care and quality of life of bladder cancer patients
BACKGROUND: The wait times for prostate cancer surgery in Canada has increased over the past 2 decades.
Prolonged wait times have a negative impact on patient quality of life but the effect on long-term cancer control is
undefined. We conducted a systematic literature review to examine the best available evidence addressing the
following key questions: . What is the reported time interval for prostate cancer patients from the decision to
operate until the day of cancer surgery? . Are there recommendations/guidelines in the urological cancer literature
and, if so, how do the Canadian times compare? . Is there a known association between duration of wait time
beyond the recommended standard and clinical outcome (i.e. recurrence free survival, overall survival)? METHODS:
A structured literature search of Medline, Pubmed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews,
the Cochrane Database of Abstracts of Reviews of Effects, Healthstar and Google Scholar was performed from
January 1980 to January 2006 for published epidemiological studies and international guidelines/consensus
documents that evaluated surgical wait times for prostate cancer. Data extracted from eligible studies included
median time to prostate cancer surgery from the point of patient contact and adjusted hazard ratios (HR) for wait
times. All HR from the included studies were examined for the possibility of statistical pooling via meta analytic
techniques. RESULTS: Thirteen studies evaluating wait times for prostate cancers were identified, six of which
measured the HR for prostate specific antigen (PSA) recurrence in patients with prolonged wait times. Differences in
study data availability, method of analysis and wait time definitions precluded statistical pooling of the findings.
Median wait times from various points of patient contact ranged from 42 days to 244 days. In the six Canadian
studies identified, wait times ranged from 42 days (consultation to operation) to 83 days (consultation to hospital
admission). This was in contrast to national and international guidelines, which recommended a maximum wait time
for prostatectomy between 2 to 4 weeks. The association between surgical delay and disease recurrence remained
controversial where only two of six epidemiological studies reported at least a statistical trend for an increased risk
of PSA recurrence free survival in patients with surgical delays of 3 months or more. CONCLUSIONS: Unlike
comparable countries, surgical wait times in Canada appear to be increasing and are well beyond the threshold
disease recurrence remains unclear, there is an ongoing concern that the psychological impact of prolonged waiting
could negatively impact patient outcomes. To address these important issues, the surgical wait times (SWAT)
initiative is mandated to provide the necessary guidance and recommendations to the federal and provincial
governments. Through a partnership of the key stakeholders, it is the vision of SWAT to ultimately improve the care
BACKGROUND: The wait times for prostate cancer surgery in Canada has increased over the past 2 decades.
Prolonged wait times have a negative impact on patient quality of life but the effect on long-term cancer control is
undefined. We conducted a systematic literature review to examine the best available evidence addressing the
following key questions: . What is the reported time interval for prostate cancer patients from the decision to
operate until the day of cancer surgery? . Are there recommendations/guidelines in the urological cancer literature
and, if so, how do the Canadian times compare? . Is there a known association between duration of wait time
beyond the recommended standard and clinical outcome (i.e. recurrence free survival, overall survival)?, METHODS:
A structured literature search of Medline, Pubmed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews,
the Cochrane Database of Abstracts of Reviews of Effects, Healthstar and Google Scholar was performed from
January 1980 to January 2006 for published epidemiological studies and international guidelines/consensus
documents that evaluated surgical wait times for prostate cancer. Data extracted from eligible studies included
median time to prostate cancer surgery from the point of patient contact and adjusted hazard ratios (HR) for wait
times. All HR from the included studies were examined for the possibility of statistical pooling via meta analytic
techniques., RESULTS: Thirteen studies evaluating wait times for prostate cancers were identified, six of which
measured the HR for prostate specific antigen (PSA) recurrence in patients with prolonged wait times. Differences in
study data availability, method of analysis and wait time definitions precluded statistical pooling of the findings.
Median wait times from various points of patient contact ranged from 42 days to 244 days. In the six Canadian
studies identified, wait times ranged from 42 days (consultation to operation) to 83 days (consultation to hospital
admission). This was in contrast to national and international guidelines, which recommended a maximum wait time
for prostatectomy between 2 to 4 weeks. The association between surgical delay and disease recurrence remained
controversial where only two of six epidemiological studies reported at least a statistical trend for an increased risk
of PSA recurrence free survival in patients with surgical delays of 3 months or more., CONCLUSIONS: Unlike
comparable countries, surgical wait times in Canada appear to be increasing and are well beyond the threshold
disease recurrence remains unclear, there is an ongoing concern that the psychological impact of prolonged waiting
could negatively impact patient outcomes. To address these important issues, the surgical wait times (SWAT)
initiative is mandated to provide the necessary guidance and recommendations to the federal and provincial
BACKGROUND: Prolonged surgical wait times have significant effects on a patient's psychological well being and a
systematic review of the renal cancer literature to examine the best available evidence addressing the following key
questions: What is the reported time interval for renal cancer patients from the initial surgical consultation until the
day of renal cancer surgery? Are there recommendations/guidelines in the urological cancer literature and, if so, how
do the Canadian times compare? Is there a known association between duration of wait time beyond the
recommended standard and clinical outcome (i.e., recurrence-free survival, overall survival)? METHODS: A
October 2005 was conducted for published studies and international guidelines/consensus documents that
evaluated surgical wait times for renal cancer. Data extracted from eligible studies included median or mean time to
renal cancer surgery from diagnosis or referral, and key patient outcomes, such as survival rate or adjusted hazard
ratios (HR). RESULTS: Only three studies evaluating wait times for renal cancer surgery were identified. Differences in
study data availability, method of analysis and wait time definitions precluded statistical pooling of the findings. Wait
times from various points of patient contact ranged from a median delay of 26 days (diagnosis to radical surgery, i.e.,
nephrectomy) to 82 days (general practitioner referral to radical surgery). One study reported a mean of 23.6 days
between referral for surgery to hospital admission for nephrectomy. In the Canadian epidemiological study, which
focused on all types of urological cancer, median wait time was 64 days from referral to surgery. This was in contrast
to national and international guidelines, which recommended a maximum waiting time between 2 and 4 weeks for
all cancer surgeries. There were no epidemiological studies evaluating the association between surgical delay and
clinical outcomes such as overall survival. CONCLUSIONS: In Canada, it appears that current wait times for urological
surgeries, such as for renal cancer, are beyond the threshold recommended by national and international expert
bodies. Then again, the association between surgical delay and overall survival appears to be unexplored. Research in
this area is urgently needed. Notwithstanding, the surgical wait times (SWAT) initiative was developed to provide the
necessary guidance and recommendations on these issues to the federal and provincial governments. Through a
partnership of the key stakeholders, it is the vision of SWAT to ultimately improve the care and quality of life of
bladder cancer patients and their families.
BACKGROUND: Prolonged surgical wait times have significant effects on a patient's psychological well being and a
systematic review of the renal cancer literature to examine the best available evidence addressing the following key
questions: What is the reported time interval for renal cancer patients from the initial surgical consultation until the
day of renal cancer surgery? Are there recommendations/guidelines in the urological cancer literature and, if so, how
do the Canadian times compare? Is there a known association between duration of wait time beyond the
recommended standard and clinical outcome (i.e., recurrence-free survival, overall survival)?, METHODS: A
October 2005 was conducted for published studies and international guidelines/consensus documents that
evaluated surgical wait times for renal cancer. Data extracted from eligible studies included median or mean time to
renal cancer surgery from diagnosis or referral, and key patient outcomes, such as survival rate or adjusted hazard
ratios (HR)., RESULTS: Only three studies evaluating wait times for renal cancer surgery were identified. Differences
in study data availability, method of analysis and wait time definitions precluded statistical pooling of the findings.
Wait times from various points of patient contact ranged from a median delay of 26 days (diagnosis to radical
surgery, i.e., nephrectomy) to 82 days (general practitioner referral to radical surgery). One study reported a mean of
23.6 days between referral for surgery to hospital admission for nephrectomy. In the Canadian epidemiological
study, which focused on all types of urological cancer, median wait time was 64 days from referral to surgery. This
was in contrast to national and international guidelines, which recommended a maximum waiting time between 2
and 4 weeks for all cancer surgeries. There were no epidemiological studies evaluating the association between
surgical delay and clinical outcomes such as overall survival., CONCLUSIONS: In Canada, it appears that current wait
times for urological surgeries, such as for renal cancer, are beyond the threshold recommended by national and
international expert bodies. Then again, the association between surgical delay and overall survival appears to be
unexplored. Research in this area is urgently needed. Notwithstanding, the surgical wait times (SWAT) initiative was
developed to provide the necessary guidance and recommendations on these issues to the federal and provincial
and quality of life of bladder cancer patients and their families.
BACKGROUND: The wait times for urological cancer surgeries in Canada are beyond those recommended by the
Canadian Association of Surgical Oncology. Prolonged wait times have a negative impact on patient quality of life but
the effect on long-term cancer control is controversial. We conducted a systematic review of the testicular cancer
literature to examine the best available evidence addressing the following key questions: What is the reported time
interval for testicular cancer patients from the decision to operate until the day of testicular cancer surgery? Are
there recommendations/guidelines in the urological cancer literature and, if so, how do the Canadian times
compare? Is there a known association between duration of wait time beyond the recommended standard and
clinical outcome (i.e. recurrence free survival, overall survival)? METHODS: A structured literature search of Medline,
Pubmed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts of
Reviews of Effects, Healthstar and Google Scholar from January 1980 to September 2005 was conducted for
published epidemiological studies and international guidelines/consensus documents that evaluated surgical wait
times for testicular cancer. Data extracted from eligible studies included median time to diagnosis and to testicular
cancer surgery. RESULTS: Five studies evaluating different components of wait times (e.g. delay in diagnosis, delay in
orchiectomy) in testicular cancer patients were identified, four of which measured the impact of prolonged delays on
relapse free and overall survival. Differences in study data availability, method of analysis and wait time definitions
precluded statistical pooling of the findings. In one study from the United Kingdom, median wait time was 30 days
from general practitioner referral to surgery and 4 days from diagnosis to surgery. No Canadian studies specific to
testicular cancer were identified. The association between surgical delay and clinical outcomes remained
controversial where only one of five epidemiological studies reported an association between treatment delay and
relapse free and overall survival CONCLUSIONS: Even though the association between surgical delay and disease
related clinical outcomes remains controversial, there is an ongoing concern that the psychological impact of
prolonged waiting for urological cancer surgery could negatively impact patient outcomes. Additional research is
needed to identify the current wait times for testicular cancer in Canada and to develop guidelines and
recommendations on what appropriate wait times should be. To address these important issues, the surgical wait
times (SWAT) initiative is mandated to provide the necessary guidance and recommendations to the federal and
provincial governments. Through a partnership between the key stakeholders, it is the vision of SWAT to ultimately
improve the care and quality of life of cancer patients.
BACKGROUND: The wait times for urological cancer surgeries in Canada are beyond those recommended by the
Canadian Association of Surgical Oncology. Prolonged wait times have a negative impact on patient quality of life but
the effect on long-term cancer control is controversial. We conducted a systematic review of the testicular cancer
literature to examine the best available evidence addressing the following key questions: What is the reported time
interval for testicular cancer patients from the decision to operate until the day of testicular cancer surgery? Are
there recommendations/guidelines in the urological cancer literature and, if so, how do the Canadian times
compare? Is there a known association between duration of wait time beyond the recommended standard and
clinical outcome (i.e. recurrence free survival, overall survival)?, METHODS: A structured literature search of Medline,
Pubmed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts of
Reviews of Effects, Healthstar and Google Scholar from January 1980 to September 2005 was conducted for
published epidemiological studies and international guidelines/consensus documents that evaluated surgical wait
times for testicular cancer. Data extracted from eligible studies included median time to diagnosis and to testicular
cancer surgery., RESULTS: Five studies evaluating different components of wait times (e.g. delay in diagnosis, delay in
orchiectomy) in testicular cancer patients were identified, four of which measured the impact of prolonged delays on
relapse free and overall survival. Differences in study data availability, method of analysis and wait time definitions
precluded statistical pooling of the findings. In one study from the United Kingdom, median wait time was 30 days
from general practitioner referral to surgery and 4 days from diagnosis to surgery. No Canadian studies specific to
testicular cancer were identified. The association between surgical delay and clinical outcomes remained
controversial where only one of five epidemiological studies reported an association between treatment delay and
relapse free and overall survival, CONCLUSIONS: Even though the association between surgical delay and disease
related clinical outcomes remains controversial, there is an ongoing concern that the psychological impact of
prolonged waiting for urological cancer surgery could negatively impact patient outcomes. Additional research is
needed to identify the current wait times for testicular cancer in Canada and to develop guidelines and
recommendations on what appropriate wait times should be. To address these important issues, the surgical wait
times (SWAT) initiative is mandated to provide the necessary guidance and recommendations to the federal and
provincial governments. Through a partnership between the key stakeholders, it is the vision of SWAT to ultimately
improve the care and quality of life of cancer patients.
OBJECTIVES: It has been suggested that the random assignment of participants does not cause harm to patients in
clinical trials. However, in a recent study, patient preference affected the health outcome of the patients. It can
therefore be assumed that patients who are allocated at random may be affected by placebo effects that are
associated with the treatment of their choice. The aim of this study was to determine whether random participant
assignment in acupuncture trials causes fewer benefits to the participants., DATA SOURCES: The following
computerized databases were searched from their inception to December 2008: MEDLINE, SCOPUS, CINAHL,
Cochrane Registered Trial, British Library Direct, and Google Scholar. Review methods: This was a systematic review
of partially randomized acupuncture trials with adequate randomization generation and concealment of participant
group allocation as well as large enough sample sizes to satisfy a power calculation., RESULTS: Six (6) trials that met
the selection criteria were included. The randomized acupuncture group comprised patients with different
demographics and health outcomes than the observational group. Substantial numbers of eligible patients refused to
participate in the randomization. The baseline patient characteristics were different between the randomized
acupuncture group and the observational group. The proportion of patients who dropped out of or withdrew from
the study was also different between the groups, with significantly more dropping out from the observational group
than the randomized group. Patients in the observational group had significantly better health outcomes than
patients in the randomized group, with a standardized mean difference of 0.06 (95% confidence interval 0.03-0.09).,
CONCLUSIONS: We found that patients who were randomly assigned to treatment groups in acupuncture trials had
fewer health benefits than those who were nonrandomly assigned.
OBJECTIVES: It has been suggested that the random assignment of participants does not cause harm to patients in
clinical trials. However, in a recent study, patient preference affected the health outcome of the patients. It can
therefore be assumed that patients who are allocated at random may be affected by placebo effects that are
associated with the treatment of their choice. The aim of this study was to determine whether random participant
assignment in acupuncture trials causes fewer benefits to the participants. DATA SOURCES: The following
computerized databases were searched from their inception to December 2008: MEDLINE, SCOPUS, CINAHL,
Cochrane Registered Trial, British Library Direct, and Google Scholar. Review methods: This was a systematic review
of partially randomized acupuncture trials with adequate randomization generation and concealment of participant
group allocation as well as large enough sample sizes to satisfy a power calculation. RESULTS: Six (6) trials that met
the selection criteria were included. The randomized acupuncture group comprised patients with different
demographics and health outcomes than the observational group. Substantial numbers of eligible patients refused to
participate in the randomization. The baseline patient characteristics were different between the randomized
acupuncture group and the observational group. The proportion of patients who dropped out of or withdrew from
the study was also different between the groups, with significantly more dropping out from the observational group
than the randomized group. Patients in the observational group had significantly better health outcomes than
patients in the randomized group, with a standardized mean difference of 0.06 (95% confidence interval 0.03-0.09).
CONCLUSIONS: We found that patients who were randomly assigned to treatment groups in acupuncture trials had
fewer health benefits than those who were nonrandomly assigned.
Risk for Ovarian Malignancy Algorithm (ROMA) and Human epididymis protein 4 (HE4) appear to be promising
predictors for epithelial ovarian cancer (EOC), however, conflicting results exist in the diagnostic performance
comparison among ROMA, HE4 and CA125. Remote databases (MEDLINE/PUBMED, EMBASE, Web of Science,
Google Scholar, the Cochrane Library and ClinicalTrials.gov) and full texts bibliography were searched for relevant
abstracts. All studies included were closely assessed with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy
Studies-2). EOC predictive value of ROMA was systematically evaluated, and comparison among the predictive
performances of ROMA, HE4 and CA125 were conducted within the same population. Sensitivity, specificity, DOR
(diagnostic odds ratio), LR +/- (positive and negative likelihood ratio) and AUC (area under receiver operating
characteristic-curve) were summarized with a bivariate model. Subgroup analysis and sensitivity analysis were used
to explore the heterogeneity. Data of 7792 tests were retrieved from 11 studies. The overall estimates of ROMA for
EOC predicting were: sensitivity (0.89, 95% CI 0.84-0.93), specificity (0.83, 95% CI 0.77-0.88), and AUC (0.93, 95% CI
0.90-0.95). Comparison of EOC predictive value between HE4 and CA125 found, specificity: HE4 (0.93, 95% CI 0.87-
0.96) > CA125 (0.84, 95% CI 0.76-0.90); AUC: CA125 (0.88, 95% CI 0.85-0.91) > HE4 (0.82, 95% CI 0.78-0.85).
Comparison of OC predictive value between HE4 and CA125 found, AUC: CA125 (0.89, 95% CI 0.85-0.91) > HE4 (0.79,
95% CI 0.76-0.83). Comparison among the three tests for EOC prediction found, sensitivity: ROMA (0.86, 95%CI 0.81-
0.91) > HE4 (0.80, 95% CI 0.73-0.85); specificity: HE4 (0.94, 95% CI 0.90-0.96) > ROMA (0.84, 95% CI 0.79-0.88) >
CA125 (0.78, 95%CI 0.73-0.83). ROMA is helpful for distinguishing epithelial ovarian cancer from benign pelvic mass.
HE4 is not better than CA125 either for EOC or OC prediction. ROMA is promising predictors of epithelial ovarian
cancer to replace CA125, but its utilization requires further exploration.
Background: Laparoscopic rectal surgery continues to be challenging, especially in low rectal cancers, because the
technique has several limitations. Robotic rectal surgery could potentially address these limitations. However, it still
remains unclear whether robotic surgery should be accepted as the new standard treatment in rectal cancer surgery.
Objective: The aim of this study is to provide a comprehensive and critical analysis of the available literature to
assess if robotic rectal surgery offers improved early postoperative outcomes in comparison with standard
laparoscopic rectal surgery. Data Sources: A systematic review was conducted following the search of electronic
databases (PubMed, Science Direct, Google Scholar) for the period 2007 to 2011 by using the key words ";rectal
surgery,"; ";laparoscopic,"; ";robotic."; Study Selection: All studies reporting outcomes on laparoscopic and robotic
resection for extraperitoneal and intraperitoneal rectal cancer were included in the review process; all studies on
colonic cancer and benign disease were excluded. Interventions: A comparison was conducted of robotic vs standard
laparoscopic rectal cancer surgery. Main Outcome Measures: The primary outcome measured was the assessment of
whether robotic rectal cancer surgery provides improved short-term outcomes in comparison with standard
laparoscopic rectal surgery. Results: Robotic rectal surgery was associated with increased cost and operating time,
but lower conversion rates, even in obese individuals, distal rectal tumors, and Patients who had preoperative
chemoradiotherapy regardless of the experience of the surgeon. There is also marginally better outcome in
anastomotic leak rates, circumferential resection margin positivity, and perseveration of autonomic function, but this
did not reach statistical significance. Limitations: This review has some limitations because it relies on the analysis of
data collected from various nonrandomized controlled trials with variable quality and different methodology.
Conclusion: The current evidence suggests that robotic rectal surgery could potentially offer better short-term
outcomes especially when applied in selected Patients. Obesity, male sex, preoperative radiotherapy, and tumors in
the lower two-thirds of the rectum may represent selection criteria for robotic surgery to justify its increased cost.
The ASCRS 2013.
STUDY DESIGN. Systematic literature review of articles pertaining to quality of life (QOL) in neuromuscular scoliosis
patients that underwent spinal fusion. OBJECTIVE. To determine if QOL is improved by scoliosis surgery in
neuromuscular patients. SUMMARY OF BACKGROUND DATA. The primary focus of most prior studies on
neuromuscular scoliosis has been on the technical correction of spinal deformities, and not the child's postoperative
performance and function in activities of daily living. METHODS. Computer-based English literature search of Google
and PubMed databases. RESULTS. A total of 198 publications in the English literature between 1980 and 2006 were
identified from a PubMed and Google Scholar search of QOL in neuromuscular scoliosis patients that underwent
spinal fusion. CONCLUSION. Spinal fusion improves QOL in CP (Grade C recommendation). Spinal fusion improves
QOL in muscular dystrophy (Grade C recommendation). Spinal fusion does not improve QOL in spina bifida (Grade C
recommendation). 2007 Lippincott Williams & Wilkins, Inc.
CONTEXT: Ventilator-associated pneumonia (VAP) is a common and serious nosocomial infection. Accurate, timely
diagnosis enables affected patients to receive appropriate therapy and avoids mistreatment of patients having other
conditions. OBJECTIVE: To review the published medical literature describing the precision and accuracy of clinical,
radiographic, and laboratory data to diagnose bacterial VAP relative to a histological gold standard. DATA SOURCES:
English-language articles identified by a structured search strategy using MEDLINE (January 1966-October 31, 2006)
and Google Scholar. Additional articles were identified through the reference lists of studies and review papers
identified by the search strategy. STUDY SELECTION: Included studies described clinical findings associated with VAP
in 25 or more patients receiving mechanical ventilation who subsequently underwent pulmonary biopsy or autopsy.
Fourteen studies describing clinical findings in 655 patients met inclusion criteria. DATA EXTRACTION: Data were
abstracted onto a structured form, allowing calculation of the likelihood ratios (LRs) for each sign or combination of
findings. DATA SYNTHESIS: The presence or absence of fever, abnormal white blood cell count, or purulent
pulmonary secretions do not substantively alter the probability of VAP. However, the combination of a new
radiographic infiltrate with at least 2 of fever, leukocytosis, or purulent sputum increases the likelihood of VAP
(summary LR, 2.8; 95% confidence interval, 0.97-7.9). The absence of a new infiltrate on a plain chest radiograph
lowers the likelihood of VAP (summary LR, 0.35; 95% confidence interval, 0.14-0.87). Fewer than 50% neutrophils on
cell count analysis of lower pulmonary secretions makes VAP unlikely (LR range, 0.05-0.10). CONCLUSIONS: Routine
bedside evaluation coupled with radiographic information provides suggestive but not definitive evidence that VAP is
present or absent. Given the severity of VAP and the frequency of serious conditions that can mimic VAP, clinicians
should be ready to consider additional tests that provide further evidence for VAP or that establish another
diagnosis.
This article reviews the efficacy and safety of warfarin to prevent tunneled cuffed catheter (TCC) thrombosis in the
hemodialysis population. Literature searches of PubMed, EMBASE, the Cochrane Library and Google Scholar were
performed until April 1, 2007. Bibliographies of relevant articles were reviewed for additional publications. Minidose
(1 mg/day) warfarin is ineffective in preventing TCC malfunction. Warfarin titrated to an international normalized
ratio (INR) of 1.5-2.0, 1.8-2.5, and 2.0-3.0 was found to decrease the rate of thrombosis in selected patients. Early
initiation of warfarin after catheter placement may be advantageous. Despite evidence of efficacy, safety is of
greater concern. There were no major bleeds reported at an INR range of 1.5-2.5 specifically in catheter studies.
However, an increase in major bleeding episodes has been reported with INR ranging from 1.4 to 3.0 in patients
receiving warfarin for other indications (e.g., graft patency or cardiovascular indications). There is insufficient
evidence to recommend the routine use of warfarin to prevent TCC thrombosis in all patients, primarily because of
safety concerns. There is an increased risk of bleeding associated with warfarin use in the hemodialysis population. If
a decision is made to use warfarin on a case-by-case basis, literature to date suggests that an INR target of 1.5-2.5
should suffice. Bleeding must be monitored carefully in this population, especially in patients using antiplatelet
medications for concurrent conditions. Journal compilation 2007 Blackwell Publishing.
Introduction: Nowadays, domestic violence against women is considered as one of the most important of public
health problems. Study on domestic violence in pregnancy is essential to clarify the relationship between different
types of violence and its physical and mental health outcomes. The aim of this study was to review the outcomes of
domestic violence in pregnancy and it's considered strategies. Methods: PubMed, Science Direct, Google Scholar, SID
and Iran medex databases were searched and 110 related articles were found. Ultimately, 55 articles which
examined domestic violence consequences in pregnant women between 1995 to 2012 were evaluated. Results:
Domestic violence in pregnancy was associated with multiple complications such as miscarriage, preterm labor,
vaginal bleeding, preeclampsia, dystocia and postpartum depression. Although, the relationship did not exist in few
studies or it was not statistically significant, the correlation has reached to significant level with different design and
setting or doing the study in other location and period of time. Conclusions: Adverse effect of domestic violence on
pregnancy and evidence of the effectiveness of screening and intervention programs on domestic violence indicates
the necessity of using screening programs more. 2013 All Rights Reserved.
OBJECTIVES: There has long-been controversy about the possible superiority of norepinephrine compared to
dopamine in the treatment of shock. The objective was to evaluate the effects of norepinephrine and dopamine on
outcome and adverse events in patients with septic shock., DATA SOURCES: A systematic search of the MEDLINE,
Embase, Scopus, and CENTRAL databases, and of Google Scholar, up to June 30, 2011., STUDY SELECTION AND DATA
EXTRACTION: All studies providing information on the outcome of patients with septic shock treated with dopamine
compared to norepinephrine were included. Observational and randomized trials were analyzed separately. Because
time of outcome assessment varied among trials, we evaluated 28-day mortality or closest estimate. Heterogeneity
among trials was assessed using the Cochrane Q homogeneity test. A Forest plot was constructed and the aggregate
relative risk of death was computed. Potential publication bias was evaluated using funnel plots., METHODS AND
MAIN RESULTS: We retrieved five observational (1,360 patients) and six randomized (1,408 patients) trials, totaling
2,768 patients (1,474 who received norepinephrine and 1,294 who received dopamine). In observational studies,
among which there was significant heterogeneity (p < .001), there was no difference in mortality (relative risk, 1.09;
confidence interval, 0.84-1.41; p = .72). A sensitivity analysis identified one trial as being responsible for the
heterogeneity; after exclusion of that trial, no heterogeneity was observed and dopamine administration was
associated with an increased risk of death (relative risk, 1.23; confidence interval, 1.05-1.43; p < .01). In randomized
trials, for which no heterogeneity or publication bias was detected (p = .77), dopamine was associated with an
increased risk of death (relative risk, 1.12; confidence interval, 1.01-1.20; p = .035). In the two trials that reported
arrhythmias, these were more frequent with dopamine than with norepinephrine (relative risk, 2.34; confidence
interval, 1.46-3.77; p = .001)., CONCLUSIONS: In patients with septic shock, dopamine administration is associated
with greater mortality and a higher incidence of arrhythmic events compared to norepinephrine administration.
OBJECTIVES: There has long-been controversy about the possible superiority of norepinephrine compared to
dopamine in the treatment of shock. The objective was to evaluate the effects of norepinephrine and dopamine on
outcome and adverse events in patients with septic shock. DATA SOURCES: A systematic search of the MEDLINE,
Embase, Scopus, and CENTRAL databases, and of Google Scholar, up to June 30, 2011. STUDY SELECTION AND DATA
EXTRACTION: All studies providing information on the outcome of patients with septic shock treated with dopamine
compared to norepinephrine were included. Observational and randomized trials were analyzed separately. Because
time of outcome assessment varied among trials, we evaluated 28-day mortality or closest estimate. Heterogeneity
among trials was assessed using the Cochrane Q homogeneity test. A Forest plot was constructed and the aggregate
relative risk of death was computed. Potential publication bias was evaluated using funnel plots. METHODS AND
MAIN RESULTS: We retrieved five observational (1,360 patients) and six randomized (1,408 patients) trials, totaling
2,768 patients (1,474 who received norepinephrine and 1,294 who received dopamine). In observational studies,
among which there was significant heterogeneity (p < .001), there was no difference in mortality (relative risk, 1.09;
confidence interval, 0.84-1.41; p = .72). A sensitivity analysis identified one trial as being responsible for the
heterogeneity; after exclusion of that trial, no heterogeneity was observed and dopamine administration was
associated with an increased risk of death (relative risk, 1.23; confidence interval, 1.05-1.43; p < .01). In randomized
trials, for which no heterogeneity or publication bias was detected (p = .77), dopamine was associated with an
increased risk of death (relative risk, 1.12; confidence interval, 1.01-1.20; p = .035). In the two trials that reported
arrhythmias, these were more frequent with dopamine than with norepinephrine (relative risk, 2.34; confidence
interval, 1.46-3.77; p = .001). CONCLUSIONS: In patients with septic shock, dopamine administration is associated
with greater mortality and a higher incidence of arrhythmic events compared to norepinephrine administration.
Copyright 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Background: Meckel's diverticulum is the most common developmental anomaly of the gastrointestinal tract,
affecting 1-3% of the general population. This anomaly is caused by incomplete obliteration of the
omphalomesenteric duct during the 7th week of gestation and is located in the last meter of the ileum in 90% of
patients. Meckel's diverticulum is often an incidental finding during a laparotomy for other causes, such as acute
appendicitis, and occasional complications are bleeding, obstruction, diverticulitis, and perforation. Objective:
Primary aim of this study was to present and share an extremely rare case of double Meckel's diverticulum.
Methods: A 20-year-old woman who was admitted due to symptoms of right lower quadrant pain, nausea, and
vomiting. A laparotomy with a McBurney's incision was performed because of a presumed diagnosis of acute
appendicitis. The surgical exploration revealed a double Meckel's diverticulum localized 50 cm proximal to the
ileocecal valve, but no acute appendicitis. The operation was finished after a diverticulectomy and appendectomy.
No complications occurred during the postoperative follow-up. Conclusions: We conducted a literature review of
studies published in the English language on double Meckel's diverticulum, accessed via PubMed, Medline, and the
Google Scholar databases. We found only five case reports of such a Meckel's diverticulum variant. 2013 Published
by Elsevier Inc.
Background: Doxofylline, a methylxanthine derivative, has recently drawn attention because of its better safety
profile and similar efficacy over the most widely prescribed analogue, theophylline, indicated for asthma and chronic
obstructive pulmonary disease. Objective: This article attempts to discuss the pharmacodynamics/pharmacokinetics
and clinical efficacy of doxofylline. Method: An extensive search in three electronic databases (Unbound Medline,
Pubmed and Sciencedirect) and internet search engines (Scirus and Google Scholar) were used to identify the clinical
studies on doxofylline. The literature search was carried out without time constraints to ensure maximum coverage
of existing literature on doxofylline. Results/conclusion: In a relatively large number of comparative studies,
doxofylline is indicated to have less affinity for a1 and a2 receptors than theophylline. Unlike theophylline,
doxofylline does not antagonize calcium channels, nor does it interfere with the influx of calcium into the cells, which
probably reduces the cardiac side effects. Moreover, it does not affect sleep rhythm, gastric secretions, heart rate
and rhythm and CNS functioning. Numerous reports available regarding the better tolerability of doxofylline than
theophylline prove it as a potential bronchodilator with promising pharmacological behavior. However, despite its
superior safety and clinical efficacy, the potential of doxofylline has not been fully exploited. 2009 Informa UK Ltd. All
rights reserved.
OBJECTIVE. Guided by the Occupational Therapy Practice Framework: Domain and Process (2nd edition; American
Occupational Therapy Association, 2008), we conducted an evidence-based review on simulator sickness (SS).
METHOD. We searched Web of Science, PubMed, SafetyLit, Google Scholar, and recently published literature. We
used the American Academy of Neurology's classification criteria to extract data from 10 studies and assign each a
level of 1-4, with "1" indicating the highest level of evidence. We grouped studies that addressed SS into client
factors, context and environment factors, and activity demands. RESULTS. Client factors (i.e., older clients [>70 yr;
Level B], women [Level B]) and context/environment factors (e.g., refresh rates, scenario design and duration,
simulator configuration, and calibration; Level B) probably increase the rates of SS, whereas activity demands
(vection, speed of driving, and postural instability; Level C) possibly contribute to SS. CONCLUSION. We classified
factors contributing to SS and identified the need for randomized trials to identify causes of SS.
BACKGROUND: The CNS stimulatory agents amphetamine and methamphetamine are often detected in blood
samples from apprehended subjects driving under the influence of drugs. MATERIAL AND METHODS: Relevant
literature was identified through searches in PubMed and Google Scholar. The current state of knowledge regarding
effects of amphetamines on traffic behaviour is reviewed and discussed. RESULTS: Limited epidemiological data and
a small number of experimental studies using low doses of amphetamines are available. Low amphetamine doses
have been associated with enhanced performance in studies of sleep-deprived subjects. Theoretical considerations
and empirical observations suggest that higher doses may impede performance, but not in accordance with usual
concentration/effect relationships. INTERPRETATION: There is a conspicuous lack of data on how to handle cases of
driving under the influence of amphetamines.
Objective: The aim was to summarize the clinical literature on interactions between common illicit drugs and
prescription therapies. Methods: Medline, Iowa Drug Information Service, International Pharmaceutical Abstracts,
EBSCO Academic Search Premier, and Google Scholar were searched from date of origin of database to March 2011.
Search terms were cocaine, marijuana, cannabis, methamphetamine, amphetamine, ecstasy, N-methyl-3,4-
methylenedioxymethamphetamine, methylenedioxymethamphetamine, heroin, gamma-hydroxybutyrate, sodium
oxybate, and combined with interactions, drug interactions, and drugdrug interactions. This review focuses on
established clinical evidence. All applicable full-text English language articles and abstracts found were evaluated and
included in the review as appropriate. Results: The interactions of illicit drugs with prescription therapies have the
ability to potentiate or attenuate the effects of both the illicit agent and/or the prescription therapeutic agent, which
can lead to toxic effects or a reduction in the prescription agent's therapeutic activity. Most texts and databases
focus on theoretical or probable interactions due to the kinetic properties of the drugs and do not fully explore the
pharmacodynamic and clinical implications of these interactions. Clinical trials with coadministration of illicit drugs
and prescription drugs are discussed along with case reports that demonstrate a potential interaction between
agents. The illicit drugs discussed are cocaine, marijuana, amphetamines, methylenedioxymethamphetamine, heroin,
and sodium oxybate. Conclusion: Although the use of illicit drugs is widespread, there are little experimental or
clinical data regarding the effects of these agents on common prescription therapies. Scientific Significance: Potential
drug interactions between illicit drugs and prescription drugs are described and evaluated on the Drug Interaction
Probability Scale by Horn and Hansten. 2012 Informa Healthcare USA, Inc.
Tobacco smoke contains over 4,000 chemical compounds, e.g.: nicotine, carbon monoxide, acetone, benzopirene,
toluene, acrolein, N-nitrosodimethylamine, and hydrogen cyanide. These toxic compounds affect the
pharmacotherapy, strictly distribution, metabolism, and elimination of the drugs. The aim of the study was to analyze
the effect of cigarette smoke constituents on biotransformation of the commonly used drugs and their efficacy
among smoking patients. The work was based on the overview of publications on interactions between various drugs
metabolized by enzymatic system of cytochrome P-450 and constituents of cigarette smoke. We accessed
publications in Medline, Google Scholar databases, and medical online journals using combination of following key
words: "tobacco smoke", "drugs interactions", "cigarette smoke". We selected 51 papers and one monograph for
detailed analysis among 53 papers published between 1975 and 2010. The most important interactions were those
affecting the drug biotransformation, because of their frequency and significance for the therapy. They proceeded
via induction of drug metabolism through the polycyclic aromatic hydrocarbons (PAHs) involving modification of
cytochrome P-450 activity. Cigarette smoke constituents affect both pharmacodynamics and pharmacokinetics of the
drugs. The interactions might affect the effectiveness of therapy among smoking patients. 2010 Grupa dr. A. R.
Kwiecinskiego.
Background: Several medications that are insoluble in human urine are known to precipitate within the renal tubules.
Intratubular precipitation of either exogenously administered medications or endogenous crystals (induced by
certain drugs) can promote chronic and acute kidney injury, termed crystal nephropathy. Clinical settings that
enhance the risk of drug or endogenous crystal precipitation within the kidney tubules include true or effective
intravascular volume depletion, underlying kidney disease, and certain metabolic disturbances that promote changes
in urinary pH favoring crystal precipitation. Objective: Identify and review previously described and recently
recognized medications that cause crystal nephropathy. Method: A literature review was performed, using PubMed,
Ovid, and Google Scholar, focusing on drugs (sulfadiazine, acyclovir, indinavir, triamterene, methotrexate (MTX),
orlistat, oral sodium phosphate preparation, ciprofloxacin) that cause crystal nephropathy. Results/conclusion:
Sulfadiazine, acylcovir, indinavir, triamterene, and MTX are known to cause crystal nephropathy. Recently, several
medications, including orlistat, ciprofloxacin, and oral sodium phosphate solution, along with underlying risk factors
have been described as causing crystal nephropathy. 2008 Informa UK Ltd.
Purpose of review: New drugs are continuously being developed and some rheumatic syndromes have been
associated with specific drugs. As most of the rheumatic diseases are multisystem, it is worthwhile examining the
wider case report literature to see whether any recent studies signify new associations between drugs and the
rheumatic diseases. The last 2 years' case reports in English were scrutinized for noninfectious association with the
rheumatic diseases. Cross-referencing from MEDLINE was performed using several databases including Google
scholar; British Medical Journal (BMJ) case reports were also queried separately. Recent findings: Fifty-three articles
comprising 56 case reports are included in the review, with 27 (48.2%) associated with the vasculitides, eight (14.3%)
associated with lupus and 13 (23.2%) were associated with the myositis syndromes. The commonest four groups of
drugs to potentially induce rheumatic diseases were anti-tumour necrosis factor (TNF) drugs, oncology drugs,
propylthiouracil and interferons. Summary: It is important to recognise that drugs used in other specialties may
induce rheumatic disease and vigilance on making a diagnosis is the key. 2012 Wolters Kluwer Health | Lippincott
Williams & Wilkins.
Purpose: To collate evidence on nutrient deficiencies caused by drugs. Design: Search of Medline and other
databases, and published literature. Materials and methods: Medline, Scirus and Google Scholar databases, journal
articles and books. Results: There is evidence that many drugs, medicinal or recreational, produce deficiencies in
vitamins, minerals, fatty acids and/or amino acids. Some drugs cause multiple deficiencies. They may reduce
conversion of vitamins to their active forms, or inhibit the production of important metabolites. By killing beneficial
bacteria in the gut, they may cause vitamin deficiency. They may reduce absorption, or cause excretion of nutrients.
Conclusions: Many drugs have been identified, which appear to cause deficiencies in essential nutrients and their
metabolites. Nutrients could be prescribed with drugs, to limit the damage done, provided that this does not
undermine the action of the drugs. Further research is needed to confirm the results of those studies that have been
carried out, and to find out about nutrient depletion from new drugs. 2007 Informa UK Ltd.
Background: there are number of drugs in our community both as OTC as well as prescription which can influence
the driving performance. Material and methods: Relevant literature was identified through searches in Medline and
Google scholar. The current stage of knowledge regarding effect of commonly used drugs on driving behavior is
reviewed and discussed. Results: there are large numbers of drugs which can influence driving performance, among
them drug acting on CNS are more common. Elderly people are more susceptible for this effect. Theoretical
consideration and empirical observation suggest that higher doses may impede performance. Interpretation: There
are conspicuous lacks of data on all the drugs and more studies are required to corroborate the influence of drugs on
driving performance. 2011 by Sudarshan Publication.
Aim. Surveillance after endovascular aneurysm repair (EVAR) is essential in the detection of endoleaks. Conventional
surveillance uses contrast-enhanced computed tomography (CT) but this exposes patients to radiation and
nephrotoxic contrast agents as well as being relatively expensive. Duplex ultrasound (USS) is cheaper and does not
use nephrotoxic contrast agents but is considered less accurate. The aim of this study was to review the accuracy of
duplex ultrasound compared to the "gold-standard" of contrast enhanced CT for endoleak detection. Methods.
Medline, Google scholar and reference lists of articles were searched to identify trials with paired scan data
comparing USS and contrast enhanced CT for endoleak surveillance post-EVAR. Results. Twenty-nine studies
comparing 5343 paired scans were included. Pooled sensitivity of USS was 0.62 (95% CI 0.58-0.65) and pooled
specificity was 0.94 (95% CI 0.93-0.94). Pooled positive predictive value of USS was 0.67 (95% CI 0.63-0.69) and
negative predictive value was 0.94 (95% CI 0.93-0.94). Conclusion. USS has a relatively low sensitivity but a high
specificity for the detection of endoleak after EVAR compared with CT. It is good at detecting clinically significant
endoleaks.
Duplicate publication is considered unethical. It has several negative impacts. To estimate the frequency and
characteristics of duplicate publications in Korean medical journals, we reviewed some portion of Korean journal
articles. Among 9,030 articles that are original articles indexed in KoreaMed from January to December 2004, 455
articles (5%) were chosen by random sampling. PubMed, Google scholar, KMbase, and KoreaMed were searched by
two librarians. Three authors reviewed titles, abstracts, and full text of index articles and suspected articles
independently. Point of disagreement were reconciled by discussion. Criteria for a duplicate publication defined by
editors of cardiothoracic journals and International Committee of Medical Journal Editors were used. A total of 455
articles were evaluated, of which 27 (5.93%) index articles were identified with 29 duplicate articles. Among 27 index
articles, 1 was quadruple publication and 26 were double publications. Of 29 duplicated articles, 19 were classified as
copy, 4 as fragmentation, and 6 as disaggregation. The proportion of duplicate publications in Korean medical
journals appears to be higher than expected. Education on publication ethics to researchers is needed.
Duplicate publication is considered unethical. It has several negative impacts. To estimate the frequency and
characteristics of duplicate publications in Korean medical journals, we reviewed some portion of Korean journal
articles. Among 9,030 articles that are original articles indexed in KoreaMed from January to December 2004, 455
articles (5%) were chosen by random sampling. PubMed, Google scholar, KMbase, and KoreaMed were searched by
two librarians. Three authors reviewed titles, abstracts, and full text of index articles and suspected articles
independently. Point of disagreement were reconciled by discussion. Criteria for a duplicate publication defined by
editors of cardiothoracic journals and International Committee of Medical Journal Editors were used. A total of 455
articles were evaluated, of which 27 (5.93%) index articles were identified with 29 duplicate articles. Among 27 index
articles, 1 was quadruple publication and 26 were double publications. Of 29 duplicated articles, 19 were classified as
copy, 4 as fragmentation, and 6 as disaggregation. The proportion of duplicate publications in Korean medical
journals appears to be higher than expected. Education on publication ethics to researchers is needed. Copyright The
Korean Academy of Medical Sciences.
Background Dyspepsia is an upper gastrointestinal tract syndrome presenting with epigastric pain and discomfort,
fullness sensation, early satiety, nausea, vomiting, and belching. The prevalence of dyspepsia has been reported to
be high all over the world. Objectives In this study, we reviewed studies reporting the prevalence of dyspepsia in Iran
and discuss the probable risk factors of dyspepsia to shed a light on future research on this topic. Methods Four
electronic databases including PubMed, Google Scholar, IranMedex, and Scientific Information Database were
searched. Keywords for electronic search were "dyspepsia" and "Iran". A manual search of the reference lists of the
selected articles was also carried out. Two reviewers reviewed identified articles independently and relevant studies
were selected based on our inclusion and exclusion criteria. Results Nine articles reporting the prevalence of
dyspepsia in Iran were included. The reported prevalence ranged from 0.1% to 29.9%. The majority of studies have
reported the prevalence of dyspepsia to be higher in women. Conclusion Dyspepsia seems to be highly prevalent in
Iran. Considering the wide range of data reported in different studies, conducting further population-bases studies is
necessary to investigate the epidemiology and risk factors of dyspepsia among Iranians.
Context. A broad range of drugs and chemicals are capable of evoking acute kidney injury, which is conventionally
determined by rising serum creatinine concentrations. However there are important limitations to this approach, and
there has been interest in alternative biomarkers that might provide a more sensitive and rapid means of detecting
acute kidney injury. Most of the available clinical data have thus far been ascertained in patients requiring critical
care or with acute sepsis. However, if a sensitive indicator of acute kidney injury were developed, then this could
provide a significantly improved means of detecting the effects of acute drug or toxin exposure. Objective. To review
the available data concerning potential biomarkers of acute kidney injury and to assess their relative strengths and
weaknesses in comparison to existing methods based on serum creatinine concentrations. A large number of
possible biomarkers have been proposed. Evidence for individual biomarkers is reviewed with a particular emphasis
on those with potential application in clinical toxicology. Where available, comparative data are presented. Methods.
There were 236 papers identified using Medline, Embase, and Google Scholar databases, of which 52 were
considered directly relevant. Creatinine. Creatinine is subject to glomerular filtration and, to a lesser extent tubular
secretion. Serum concentrations are an insensitive marker of acute kidney injury, and the speed of an increase from
baseline depends on the magnitude of the acute injury and pre-existing kidney functional reserve. A wide range of
inter-individual concentrations means that single time-point determinations are difficult to interpret, and acute
kidney injury may not manifest as a detectable increase in serum creatinine concentrations until at least 2448 h after
the primary insult. Kidney enzymes. Enzymes are often localised to specific anatomical locations, and acute injury
may cause a detectable increase in urinary activity due to up-regulated activity or leakage due to cell membrane
disruption. Key examples include gamma-glutamyl transpeptidase (GGT), glutathione-S-transferase (GST), and N-
acetyl-glucosaminidase (NAG), which are found predominantly in the proximal tubule and urinary enzyme activity
increases after acute exposure to heavy metals and other nephrotoxins .Neutrophil gelatinase-associated lipocalin.
Neutrophil gelatinase-associated lipocalin (NGAL) is expressed by renal tubular epithelium, and a rise in urinary
concentrations may provide an indicator of acute renal injury caused by any one of a broad range of provoking
factors that is detectable before a rise in serum creatinine concentrations. Cystatin C. Serum and urinary cystatin C
concentrations are closely related to kidney function and, for example, in acute tubular necrosis allow better
prediction of the need for renal replacement therapy than serum creatinine concentrations. Kidney injury molecule
1. Kidney injury molecule 1 (KIM-1) is expressed in the proximal tubule in the setting of acute ischaemia. For
example, urinary KIM-1 concentrations becomes detectable within 24 h of acute tubular necrosis. Urinary KIM-1
Improving time to diagnosis and intervention has positively impacted outcomes in acute myocardial infarction,
stroke, and trauma through elucidating the early pathogenesis of those diseases. This insight may partly explain the
futility of time-insensitive immunotherapy trials for severe sepsis and septic shock. The aim of this study was to
examine the early natural history of circulatory biomarker activity in sepsis, relative to previous animal and human
outcome trials. We conducted a literature search using PubMed, MEDLINE, and Google Scholar to identify outcome
trials targeting biomarkers with emphasis on the timing of therapy. These findings were compared with the
biomarker activity observed over the first 72 h of hospital presentation in a cohort of severe sepsis and septic shock
patients. Biomarker levels in animal and human research models are elevated within 30 min after exposure to an
inflammatory septic stimulus. Consistent with these findings, the biomarker cascade is activated at the most
proximal point of hospital presentation in our patient cohort. These circulatory biomarkers overlap; some have
bimodal patterns and generally peak between 3 and 36 h while diminishing over the subsequent 72 h of observation.
When this is taken into account, prior outcome immunotherapy trials have generally enrolled patients after peak
circulatory biomarker concentrations. In previous immunotherapy sepsis trials, intervention was delayed after the
optimal window of peak biomarker activity. As a result, future studies need to recalibrate the timing of enrollment
and administration of immunotherapy agents that still may hold great promise for this deadly disease. Copyright
2012 by the Shock Society.
Objective: To review the literature regarding screening psychomotor tests for the early identification of
developmental problems. Sources: A search on SciELO, PubMed and Google Scholar was performed using the terms
"prematurity," "developmental delay," "cerebral palsy," "early diagnosis" and "evaluation tests." Summary of the
findings: A total of 455 references were listed, and 174 studies were selected for this review based on title,
relevance, and abstract. Only original and electronically available material, from 1985 forward, with information on
design, applicability, and psychometric properties of those tests was included. Conclusions: Screening testS are
important to speed the beginning of treatment measures in order to allow for better developmental outcome.
Among the many tests that can be employed for this purpose, the DENVER II and the Alberta Infant Motor Scale are
the most often used in Brazilian studies. The Movement Assessment of Infants is starting to be used in our country.
Two other tests are recommended in the literature due to their high sensibility and specificity: the Test of Infant
Motor Performance and the General Movements. Copyright 2008 by Sociedade Brasileira de Pediatria.
OBJECTIVE: To review the literature regarding screening psychomotor tests for the early identification of
developmental problems., SOURCES: A search on SciELO, PubMed and Google Scholar was performed using the
terms "prematurity," "developmental delay," "cerebral palsy," "early diagnosis" and "evaluation tests.", SUMMARY
OF THE FINDINGS: A total of 455 references were listed, and 174 studies were selected for this review based on title,
relevance, and abstract. Only original and electronically available material, from 1985 forward, with information on
design, applicability, and psychometric properties of those tests was included., CONCLUSIONS: Screening tests are
important to speed the beginning of treatment measures in order to allow for better developmental outcome.
Among the many tests that can be employed for this purpose, the DENVER II and the Alberta Infant Motor Scale are
the most often used in Brazilian studies. The Movement Assessment of Infants is starting to be used in our country.
Two other tests are recommended in the literature due to their high sensibility and specificity: the Test of Infant
Motor Performance and the General Movements.
Background: Post-transplant lymphoproliferative disease (PTLD) is a major complication after solid organ
transplantation and most frequently occurs during the first year post transplantation. We analyzed patient
characteristics, outcome and prognostic factors for survival of transplant patients who developed post transplant
lymphoproliferative disorders within one year after transplantation reported by 5 major studies worldwide.
Materials/Methods: We made a comprehensive search for the available data by Pubmed and Google scholar search
engines on post transplant lymphoproliferative disorders. A standard questionnaire was developed to collect data
from different published studies. Finally, trustable data of a total of 5 publishes were included in the final analysis.
For data analysis we used SPSS v. 13.0. Kaplan-Meier Method was used for survival analysis. P<0.05 was defined as
significant. Results: Data of 16 patients who developed PTLD during the early 12 months after transplantation (2 liver
and 14 renal) were recruited from 5 studies and entered into analysis. Mean age was 41.9+/-16.2 years. Univariate
survival analysis showed that localization of the PTLD in brain in PTLD patients induces a highly significant adverse
effect on the outcome of PTLD patients (P=0.008) but not for other localizations. We aso found that involvement of
the allograft (all kidney allograft) is associated with higher rate of remission (either partial or complete remission) of
PTLDs after anti-cancer therapy. No associations were found regarding other variables. Conclusions: Because of the
higher incidence rate and fatal nature, early onset PTLD is of extreme relevance. Screening all renal transplant
patients in the early post transplantation period for an early detection and treatment of PTLDs is crucial, particularly
in patients who are more likely to develop PTLDs. Ann Transplant, 2009.
Background: Studies assessing the timing of percutaneous coronary interventions (PCI) in patients with Non-ST
segment elevation Acute Coronary Syndromes (NSTE-ACS) have failed to generate a consensus on how early PCI
should be performed in such patients. Purpose: This meta-analysis compares clinical outcomes at 30 days in NSTE-
ACS patients undergoing PCI within 24 hours of presentation (early PCI) with those receiving PCI more than 24 hours
after presentation (delayed PCI). Data Sources: Data were extracted from searches of MEDLINE (1990-2010) and
Google scholar and from scrutiny of abstract booklets from major cardiology meetings (1990-2010). Study selection:
Randomized clinical trials (RCTs) that included the composite endpoint of death and non-fatal myocardial infarction
(MI) at 30 days after PCI were considered. Data Extraction: Two independent reviewers extracted data using
standard forms. The effects of early and delayed PCI were analyzed by calculating pooled estimates for death, non-
fatal MI, bleeding, repeat revascularization and the composite endpoint of death or non-fatal MI at 30 days.
Univariate analysis of each of these variables was used to create odds ratios. Data Synthesis: Seven studies with a
total of 13,762 patients met the inclusion criteria. There was no significant difference in the odds of the composite
endpoint of death or non-fatal MI at 30 days between patients undergoing early PCI and those receiving delayed PCI
(OR-0.83, 95%CI 0.62-1.10). Patients receiving delayed PCI experienced a 33% reduction in the odds of repeat
revascularization at 30 days compared to those undergoing early PCI (OR-1.33, 95%CI 1.14-1.56,
P=0.0004).Conversely, patients undergoing early PCI experienced lower odds of bleeding than those receiving
delayed PCI (OR-0.76, 95%CI 0.63-0.91, P = 0.0003). Conclusions: In NSTE-ACS patients early PCI doesn't reduce the
odds of the composite endpoint of death or non-fatal MI at 30 day. This strategy is associated with lower odds of
bleeding and higher odds of repeat revascularization at 30 days than a strategy of delayed PCI. Copyright 2012 Wiley
Periodicals, Inc.
BACKGROUND AND OBJECTIVES: The presentation time of post-transplantation lymphoproliferative disorders (PTLD)
are not well described because of the limited number of cases occurring at each center and lack of a reliable and
unequivocal classification together with the absence of multi-institutional prospective studies. We gathered
information on the histopathological and clinical features and prognosis of the disease in a very large number of
heart and lung transplant recipients, with data from 27 previous reports, with an emphasis of time of presentation.
DESIGN AND SETTING: Retrospective analysis of data for individual patients from published studies, entered into a
database and reanalyzed. METHODS: A comprehensive review of the literature by PubMed and Google Scholar was
performed to find all data available reports on PTLD after heart and lung transplantation. RESULTS: Data from 288
PTLD patients after heart or lung transplantation from 27 reports were entered into analysis. Heart and lung
recipients with early-onset PTLD compared with late-onset PTLD were significantly more likely to be of the B cell type
(100% vs. 89.8%, respectively; P=.05). PTLD in patients with early onset was less likely to involve the skin (P=.05) and
spleen (P=.015), but more frequently complications of the respiratory tract (P=.002). Morphology of PTLD lesions was
significantly different between the two groups with a priority for late-onset PTLD to represent non-Hodgkin lesions
(P=.009). No difference was found between the two groups in survival (P=.237). One and five-year survival rates for
early-onset PTLD patients were 65% and 46%, respectively; compared to 53% and 41%, respectively, for the late-
onset PTLD. CONCLUSION: Due to a higher incidence of respiratory tract involvement in the early-onset PTLD
patients and skin and spleen involvement in late-onset PTLD, we suggest that all heart/lung graft recipients should be
evaluated for potential multiorgan disease based early or late presentation. Further multi-institutional prospective
studies are needed to confirm our results.
The impacts of antiretroviral therapy (ART) on quality of life, mental health, labor productivity, and economic
wellbeing for people living with HIV/AIDS in developing countries are only beginning to be measured. We conducted
a systematic literature review to analyze the effect of ART on these economic and quality of life indicators in
developing countries and assess the state of research on these topics. We searched Ovid/Medline, PubMed, Psych
Info, Web of Science, Google Scholar, and the abstract database of the International AIDS Society Conference and
the Conference on Retroviruses and Opportunistic Infections. Both qualitative and quantitative studies were
included, as were peer-reviewed articles, gray literature, and conference abstracts and presentations. Findings are
reported from 21 publications, including 14 full-length articles, six abstracts, and one presentation (representing 16
studies). Compared to HIV-positive patients not yet on treatment, patients on ART reported significant
improvements in physical, emotional and mental health, and daily function. Work performance improved and
absenteeism decreased, with the most dramatic changes occurring in the first three months of treatment and then
leveling off. Little research has been done on the impact of ART on household wellbeing, with modest changes in
child and family wellbeing within households where adults are receiving ART reportrd so far. Most studies from
developing countries have not yet assessed economic and quality of life outcomes of therapy beyond the first year;
therefore, longitudinal outcomes are still unknown. Findings were limited geographically, with an emphasis on sub-
Saharan Africa and adult treatment. As ART roll out extends throughout high HIV prevalence, low-resource countries
and is sustained over years and decades, research on pediatric and differential gender economic and quality of life
outcomes will become increasingly urgent, as will systematic evaluation of ART programs.
Objective: Several systematic reviews have suggested that greater nurse staffing as well as a greater proportion of
registered nurses in the health workforce is associated with better patient outcomes. Others have found that nurses
can substitute for doctors safely and effectively in a variety of settings. However, these reviews do not generally
consider the effect of nurse staff on both patient outcomes and costs of care, and therefore say little about the cost-
effectiveness of nurse-provided care. Therefore, we conducted a scoping literature review of economic evaluation
studies which consider the link between nurse staffing, skill mix within the nursing team and between nurses and
other medical staff to determine the nature of the available economic evidence. Design: Scoping literature review.
D**Peter**peter.ata sources: English-language manuscripts, published between 1989 and 2009, focussing on the
relationship between costs and effects of care and the level of registered nurse staffing or nurse-physician
substitution/nursing skill mix in the clinical team, using cost-effectiveness, cost-utility, or cost-benefit analysis.
Articles selected for the review were identified through Medline, CINAHL, Cochrane Database of Systematic Reviews,
Database of Abstracts of Reviews of Effects and Google Scholar database searches. Review methods: After selecting
17 articles representing 16 unique studies for review, we summarized their main findings, and assessed their
methodological quality using criteria derived from recommendations from the guidelines proposed by the Panel on
Cost-Effectiveness in Health Care. Results: In general, it was found that nurses can provide cost effective care,
compared to other health professionals. On the other hand, more intensive nurse staffing was associated with both
better outcomes and more expensive care, and therefore cost effectiveness was not easy to assess. Conclusions:
Although considerable progress in economic evaluation studies has been reached in recent years, a number of
methodological issues remain. In the future, nurse researchers should be more actively engaged in the design and
implementation of economic evaluation studies of the services they provide. 2010 Elsevier Ltd.
This purpose of this article is to document ectopic bone formation (EBF) and extramedullary hematopoiesis (EMH) in
thyroidectomy specimens. We present a case of multinodular goiter with EMH and EBF, as well as a literature review
of studies published in the English language on EMH and/or bone formation in the thyroid gland, accessed through
PubMed and Google Scholar databases. Thirteen published cases of EMH and/or EBF in the thyroid gland were
evaluated, and a case of multinodular goiter with histopathologically proven EMH and EBF in a 54-year-old woman is
herein presented. In the reviewed literature, 12 patients were women, and 1 was a man (age range, 28-82 years;
median, 56.46 +/- 18 years). EMH was histopathologically detected in 8 patients, EMH and EBF were detected in 4
patients, and only bone formation was detected in 1 patient. Although a solitary nodule was detected in 7 patients,
multinodular goiter was detected in 6 patients. Fine needle aspiration cytology was used in the preoperative period
to arrive at a diagnosis in 6 of the 13 patients, but it was not possible to obtain proper biopsy material in the
remaining patients. Although no previously known hematologic disease was detected in 11 patients, 2 were known
to have myelofibrosis in the preoperative period. When EMH is pathologically detected in the thyroid, the question
of whether there is an underlying hematologic disease in the patient must be investigated. In addition, it must be
kept in mind during fine needle aspiration cytology and frozen section examinations that EMH maybe among the
differential diagnoses for anaplastic thyroid cancers.
OBJECTIVES: Randomized clinical trial (RCT) data reviewed for outcomes and processes associated with asthma
educational and behavioral interventions provided by different types of health professionals., METHODS: Cochrane
Collaboration, MEDLINE, PUBMED, Google Scholar search from 1998 to 2009 identified 1650 articles regarding
asthma educational and behavioral interventions resulting in 249 potential studies and following assessment
produced a final sample of 50 RCTs., RESULTS: Approaches, intended outcomes, and program providers vary greatly.
No rationale provided in study reports for the selection of specific outcomes, program providers, or program
components. Health care utilization and symptom control have been the most common outcomes assessed. Specific
providers favor particular teaching approaches. Multidisciplinary teams have been the most frequent providers of
asthma interventions. Physician-led interventions were most successful for outcomes related to the use of health
care. Multidisciplinary teams were best in achieving symptom reduction and quality of life. Lay persons were best in
achieving self-management/self-efficacy outcomes. Components most frequently employed in successful programs
are skills to improve patient-clinician communication and education to enhance patient self-management. Fifty
percent of interventions achieved reduction in the use of health care and one-third in symptom control. A
combination approach including self-management and patient-clinician communication involving multidisciplinary
team members may have the greatest effect on most outcomes., CONCLUSIONS: The extent to which and how
different providers achieve asthma outcomes through educational and behavioral interventions is emerging from
recent studies. Health care use and symptom control are evolving as the gold standard for intervention outcomes.
Development of self-management and clinician-patient communication skills are program components associated
with success across outcomes and providers.
Purpose: This paper aims to survey the literature relating to educational governance's application to healthcare. Its
purpose is to establish the extent to which this type of governance is recognised by healthcare staff, and to develop
an understanding of how it is defined and used. Design/methodology/approach: The starting point for the literature
review was an academic database search supplemented by a Google Scholar search. The results were sifted using
evidence strength criteria and filtered for relevance using secondary keywords. Findings: The educational
governance in healthcare literature search indicates that this is a relatively under-researched area. There are few
attempts to define educational governance, although several authors note similarities with clinical governance.
Authors cite educational governance as an important component of integrated approaches to healthcare
governance, noting inter-dependent relationships between areas such as clinical governance, organisational
development and risk management. Research limitation/implications: Given the diverse academic and grey literature
used for the review, it was difficult to apply conventional evidence-strength scales, especially because most articles
cited in the text are based on expert opinion rather than systematic review. Practical implications: The review
highlights educational governance's value to healthcare organisations and provides references for organisational
staff contemplating developing this area. Originality/value: The paper is the first known attempt to survey the
literature relating to National Health Service educational governance. Emerald Group Publishing Limited.
PURPOSE: Anti-rheumatic agents target common molecular pathways of inflammation in rheumatoid arthritis (RA)
and periodontitis. The purpose of this study was to determine the relative effect of anti-rheumatic agents on the
levels of inflammatory biomarkers and periodontal inflammation in RA patients with periodontitis., METHODS: A
systematic review and meta-analysis were conducted of studies comparing periodontal parameters of inflammation,
such as bleeding on probing, and biomarkers of inflammation in RA patients with periodontitis and healthy adults
with and without periodontitis. The search included the electronic databases MEDLINE, Cochrane Database of
Systematic Reviews, and Google Scholar, inclusive through October 2011, with no language restrictions. Hand
searches were conducted of the bibliographies of related journals and systematic reviews. Observational and
interventional studies assessing the effects of antirheumatic therapy qualified for inclusion. Two reviewers
performed independent data extraction and risk-of-bias assessment. Of the 187 identified publications, 13 studies
fulfilled the inclusion criteria., RESULTS: When compared to healthy adults without periodontitis, RA subjects were
found to have significantly higher levels of bleeding on probing and limited evidence of higher levels of interleukin-1
and tumor necrosis factor- (TNF-) in gingival crevicular fluid and saliva. No consistent differences were found in
periodontal parameters and inflammatory biomarkers between RA subjects and adults with periodontitis. Studies
evaluating the effect of anti-TNF- therapy in RA subjects with periodontitis have yielded inconsistent results.,
CONCLUSIONS: There are limited data, however, to suggest that anti-TNF- agents can reduce local production of
inflammatory cytokines and periodontal inflammation in RA patients with periodontitis.
This study was made to evaluate the effect of automatic continuous positive airway pressure (auto-CPAP) versus
fixed continuous positive airway pressure (fixed CPAP) in reducing the apnea-hypopnea index (AHI) and the mean
therapy pressure, improving subjective sleepiness, sleep architecture, patient compliance, and preference in patients
with obstructive sleep apnea. We searched the electronic databases MEDLINE, EMBASE, the Cochrane Library, and
Google Scholar. Randomized controlled trials comparing auto-CPAP with fixed CPAP were reviewed. Continuous
variables were presented as mean difference (MD), and dichotomous data as odds ratio (OR), both with 95%
confidence intervals (CI). We identified 19 studies consisting of 845 patients. Compared to fixed CPAP, the use of
auto-CPAP reduced mean therapy pressure (MD -1.64; 95% CI -2.46 to -0.82), improved patient compliance (MD
0.23; 95% CI 0.06 to 0.39), increased the percentage of total sleep time (TST) in slow wave sleep (MD 5.11; 95% CI
1.34 to 8.88), and decreased the percentage of TST in stage 2 sleep (MD -4.75; 95% CI -9.38 to -0.11). Moreover,
more patients preferred auto-CPAP therapy (OR 3.65; 95% CI 1.27 to 10.53). There were nonsignificant trends
towards better outcomes with auto-CPAP for AHI and Epworth Sleepiness Scale (MD -0.43; 95% CI -1.10 to 0.23, and
MD -0.24; 95% CI -0.74 to 0.25, respectively), though these are of questionable clinical significance. There are some
aspects of clinical care, such as a mild improvement in compliance, patient preference, and sleep architecture that
appear to favor the use of auto-CPAP compared to fixed CPAP. The clinical relevance of these findings requires
further study.
Cell cycle checkpoint kinase 2 (CHEK2) is a checkpoint kinase that plays an important role in the DNA damage
signaling network. Numerous epidemiological studies have evaluated the association between the CHEK2 I157T
variant and cancer susceptibility. However, the results of these studies on the association remain conflicting. The
main purpose of this study was to integrate previous results and explore whether the CHEK2 I157T variant is
associated with cancer susceptibility. PubMed, Embase (before 2012-10-1), Google Scholar, and CBMdisc were
searched for studies on the relationship of the CHEK2 I157T variant and the incidence of cancer. Eligible articles were
included for data extraction. The main outcome was the frequency of CHEK2 I157T polymorphisms between cases
and controls. Comparison of the distribution of SNP was mainly performed using Review Manager 5.0. The odds ratio
(OR) and its 95% confidence interval (95% CI) were used to assess the strength of association. In total, 26,336 cases
and 44,219 controls from 18 case-control studies were used in this meta-analysis, and significant associations of the
CHEK2 I157T variant with cancer susceptibility were found (OR, 1.39; 95% CI, 1.19-1.63; p<0.0001), breast cancer
(OR=1.58, 95% CI=1.42-1.75, p<0.00001) and colorectal cancer (OR=1.67, 95% CI=1.24-2.26, p=0.0008). We also
found an association of the CHEK2 I157T variant with familial cases (OR=1.85, 95% CI=1.51-2.26, p<0.00001).
However, the association was not established for other types of cancer (OR=1.09, 95% CI=0.75-1.57, p=0.66). This
meta-analysis demonstrates that the CHEK2 I157T variant was an important cancer gene, which increases cancer
risk, especially in breast and colorectal cancer in Caucasian, and the bioinformatic analysis showed this change was
mainly attributed to the decreased hydrophobicity of CHEK2 157T. Mary Ann Liebert, Inc. 2013.
Cell cycle checkpoint kinase 2 (CHEK2) is a checkpoint kinase that plays an important role in the DNA damage
signaling network. Numerous epidemiological studies have evaluated the association between the CHEK2 I157T
variant and cancer susceptibility. However, the results of these studies on the association remain conflicting. The
main purpose of this study was to integrate previous results and explore whether the CHEK2 I157T variant is
associated with cancer susceptibility. PubMed, Embase (before 2012-10-1), Google Scholar, and CBMdisc were
searched for studies on the relationship of the CHEK2 I157T variant and the incidence of cancer. Eligible articles were
included for data extraction. The main outcome was the frequency of CHEK2 I157T polymorphisms between cases
and controls. Comparison of the distribution of SNP was mainly performed using Review Manager 5.0. The odds ratio
(OR) and its 95% confidence interval (95% CI) were used to assess the strength of association. In total, 26,336 cases
and 44,219 controls from 18 case-control studies were used in this meta-analysis, and significant associations of the
CHEK2 I157T variant with cancer susceptibility were found (OR, 1.39; 95% CI, 1.19-1.63; p<0.0001), breast cancer
(OR=1.58, 95% CI=1.42-1.75, p<0.00001) and colorectal cancer (OR=1.67, 95% CI=1.24-2.26, p=0.0008). We also
found an association of the CHEK2 I157T variant with familial cases (OR=1.85, 95% CI=1.51-2.26, p<0.00001).
However, the association was not established for other types of cancer (OR=1.09, 95% CI=0.75-1.57, p=0.66). This
meta-analysis demonstrates that the CHEK2 I157T variant was an important cancer gene, which increases cancer
risk, especially in breast and colorectal cancer in Caucasian, and the bioinformatic analysis showed this change was
mainly attributed to the decreased hydrophobicity of CHEK2 157T.
PURPOSE: Chromium (Cr) as an essential trace element in metabolism of carbohydrate, lipid and protein is currently
prescribed to control diabetes mellitus (DM). The objective of this meta-analysis was to compare the effect of Cr
versus placebo (Pl) on glucose and lipid profiles in patients with type 2 DM., METHODS: Literature searches in
PubMed, Scopus, Scirus, Google Scholar and IranMedex was made by use of related terms during the period of 2000-
2012. Eligible studies were randomized clinical trials (RCTs) with intake of Cr higher than 250 g at least for three
months in type 2 DM. Glycated hemoglobin (HbA1c), fasting blood sugar (FBS), total cholesterol (TC), high-density
lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol
(VLDL-C), triglyceride (TG), and body mass index (BMI) were the main outcomes., RESULTS: Seven out of 13 relevant
studies met the criteria and were included in the meta-analysis. HbA1c change in diabetic patients in Cr supplement
therapy comparing to Pl was -0.33 with 95%CI= -0.72 to 0.06 (P= 0.1). Change of FBG in Cr therapy vs. Pl was -0.95
with 95%CI= -1.42 to -0.49 (P< 0.0001). TC change in Cr therapy vs. Pl was 0.07 with 95%CI= -0.16 to 0.31 (P= 0.54).
TG change in diabetic patients in Cr supplement therapy comparing to Pl was -0.15 with 95%CI= -0.36 to 0.07 (P=
0.18)., CONCLUSIONS: Cr lowers FBS but does not affect HbA1c, lipids and BMI.
Circumcision is one of the oldest and most frequently performed surgical procedures in the world. It is thought that
the beginning of the male circumcision dates back to the earliest times of history. Approximately 13.3 million boys
and 2 million girls undergo circumcision each year. In western societies, circumcision is usually performed in infancy
while in other parts of the world, it is performed at different developmental stages. Each year in Turkey, especially
during the summer months, thousands of children undergo circumcision. The motivations for circumcision include
medical-therapeutic, preventive-hygienic and cultural reasons. Numerous publications have suggested that
circumcision has serious traumatic effects on children's mental health. Studies conducted in Turkey draw attention to
the positive meanings attributed to the circumcision in the community and emphasize that social effects limit the
negative effects of circumcision. Although there are many publications in foreign literature about the mental effects
of the circumcision on children's mental health, there are only a few studies in Turkey about the mental effects of
the one of the most frequently performed surgical procedures in our country. The aim of this study is to review this
issue. The articles related to circumcision were searched by keywords in Pubmed, Medline, EBSCHOHost, PsycINFO,
Turkish Medline, Cukurova Index Database and in Google Scholar and those appropriate for this review were used by
authors.
BACKGROUND: The use of computers to deliver education and support strategies has been shown to be effective in a
variety of conditions. We conducted a systematic review and meta-analysis to evaluate the impact of computer-
based technology on interventions for reducing weight. METHODS: We searched MEDLINE, CENTRAL, CINAHL,
PsycINFO, Google Scholar and ClinicalTrials.gov (all updated through June 2010) for randomized controlled trials
evaluating the effect of computer-based technology on education or support interventions aimed at reducing weight
in overweight or obese adults. We calculated weighted mean differences (WMD) and 95% confidence intervals (CI)
using random effects models. RESULTS: Eleven trials with 13 comparisons met inclusion criteria. Based on six
comparisons, subjects who received a computer-based intervention as an addition to the standard intervention given
to both groups lost significantly more weight (WMD -1.48 kg, 95% CI -2.52, -0.43). Conversely, based on six
comparisons, subjects for whom computer-based technology was substituted to deliver an identical or highly
comparable intervention to that of the control group lost significantly less weight (WMD 1.47 kg, 95% CI 0.13, 2.81).
Significantly different weight loss seen in "addition" comparisons with less than six months of follow-up (WMD -1.95
kg, 95% CI -3.50, -0.40, two comparisons) was not seen in comparisons with longer follow-up (-1.08 kg, 95% CI -2.50,
0.34, four comparisons). Analyses based on quality and publication date did not substantially differ. CONCLUSIONS:
While the addition of computer-based technology to weight loss interventions led to statistically greater weight loss,
the magnitude (<1.5 kg) was small and unsustained. 2011 Society of General Internal Medicine.
OBJECTIVES: To establish whether perioperative low-dose dopexamine infusion (<=1 mug/kg/min) is associated with
a reduction in mortality and duration of hospital stay following major surgery. DATA SOURCE: Medline, EMBASE,
CINAHL, Cochrane Library, Google Scholar, and reference lists. STUDY SELECTION: Two reviewers independently
screened studies for inclusion, assessed trial quality, and extracted data. Eligible trials were randomized controlled
trials comparing dopexamine infusion to control treatment. Data are reported as odds ratios (ORs) or hazard ratios
(HRs) with 95% confidence intervals. DATA EXTRACTION: Systematic review and meta-regression analysis of
individual patient data. DATA SYNTHESIS: Five studies fulfilled the inclusion criteria. Analysis of pooled data from high-
and low-dose dopexamine groups identified a reduction in duration of hospital stay (median 14 vs. 15 days; HR 0.85
[0.73-0.91]; p = .03) but no improvement in mortality (9.1% vs. 12.3%; OR 0.78 [0.31-1.99]; p = .61). However, low-
dose dopexamine was associated with a 50% reduction in 28-day mortality (6.3% vs. 12.3%; OR 0.50 [0.28-0.88]; p =
.016) as well as a reduced duration of stay (median 13 vs. 15 days; HR 0.75 [0.64-0.88]; p = .0005). When high-dose
dopexamine groups were compared with controls, there was no difference in either mortality (OR 1.06 [0.60-1.87]; p
= .85) or duration of stay (HR 1.04 [0.94-1.16]; p = .36). CONCLUSIONS: For pooled data describing perioperative
dopexamine infusion at all doses, there was an improvement in duration of hospital stay but no survival benefit.
However, at low doses, dopexamine was associated with improved survival and reduced duration of stay. Further
clinical trials are warranted to confirm this observation. 2008 Lippincott Williams & Wilkins, Inc.
Violence is amongst the primary concerns of communities around the world and research has demonstrated links
between violence and the illicit drug trade, particularly in urban settings. Given the growing emphasis on evidence-
based policy-making, and the ongoing severe drug market violence in Mexico and other settings, we conducted a
systematic review to examine the impacts of drug law enforcement on drug market violence. We conducted a
systematic review using Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines.
Specifically, we undertook a search of English language electronic databases (Academic Search Complete, PubMed,
PsycINFO, EMBASE, Web of Science, Sociological Abstracts, Social Service Abstracts, PAIS International and Lexis-
Nexis), the Internet (Google, Google Scholar), and article reference lists, from database inception to January 24,
2011. Overall, 15 studies were identified that evaluated the impact of drug law enforcement on drug market
violence, including 11 (73%) longitudinal analyses using linear regression, 2 (13%) mathematical drug market models,
and 2 (13%) qualitative studies. Fourteen (93%) studies reported an adverse impact of drug law enforcement on
levels of violence. Ten of the 11 (91%) studies employing longitudinal qualitative analyses found a significant
association between drug law enforcement and drug market violence. Our findings suggest that increasing drug law
enforcement is unlikely to reduce drug market violence. Instead, the existing evidence base suggests that gun
violence and high homicide rates may be an inevitable consequence of drug prohibition and that disrupting drug
markets can paradoxically increase violence. In this context, and since drug prohibition has not meaningfully reduced
drug supply, alternative regulatory models will be required if drug supply and drug market violence are to be
meaningfully reduced. 2011 Elsevier B.V.
Background: Percutaneous revascularization of saphenous vein graft disease, is associated with a higher risk of major
adverse cardiac events (MACE) as a consequence of atherothrombotic emboli. Prior studies have shown conflicting
results regarding the efficacy of Embolic protection devices (EPD) in improving procedural outcomes and large
registries have shown low uptake of EPDs in clinical practice. Methods: PubMed, EMBASE, Cochrane database and
Google Scholar were searched using terms <>, <> and <>, yielding 7 studies comparing EPD use with usual PCI. 5
studies were prospective and 2 were retrospective. 30-day MACE as well as mortality outcomes were analyzed using
Comprehensive Meta-analysis software. Heterogeneity was assesed using I-square statistic. Both fixed and random
effect models were evaluated. The primary end-points for the analysis were 30-day MACE and mortality. Results: A
total of 21,615 patients were included in the analysis. 30-day mortality was similar between patients undergoing SVG
intervention with or without EPDs (O.R = 0.852, P = 0.326, I-square = 0, Fixed effect model). 30-day MACE was
significantly reduced in the cohort receiving embolic protection compared to those who did not (O.R = 0.686, P =
0.013, I-squre = 13, Fixed effect model). Results were consistent when random effects model was applied. No
significant publication bias was noted (Eggers 2-tailed P = 0.25). Conclusion: The available published literature shows
that use of EPDs during SVG PCI significantly lowers 30-day MACE, but not mortality. These data support the use of
EPDs during SVG PCI whenever feasible.
Objective To evaluate the effect of ephedrine on intubation conditions (ICs) one minute after anesthesia induction
using propofol and rocuronium. Methods: PubMed, EMbase, The Cochrane Library, ISI Web of Knowledge, Chinese
Biomedical Literature Database, Google Scholar, and other databases were searched from inception to September
2012 to collect relevant randomized clinical trials (RCTs). We evaluated the risk of bias of the included studies by the
Cochrane Collaboration's risk of bias tool and analyzed the data using RevMan 5.1. As the outcomes, excellent ICs,
clinically acceptable ICs and side effects were evaluated with risk ratios (RRs). Results: Five RCTs involving 396
patients were identified. The results of the meta-analysis demonstrated that ephedrine increased the rate of
excellent ICs (RR = 2.40, 95% CI 1.89 to 3.05), but had no effects on the rate of clinically acceptable ICs (RR = 1.15,
95% CI 0.93 to 1.42) and the incidence of side effects (RR = 2.00, 95% CI 0.19 to 21.36). Besides, the results of
subgroup analysis showed that both low dose and high dose of ephedrine increased the rate of excellent ICs, but
only low dose increased the rate of clinically acceptable ICs. The results of sensitive analysis showed that both
favored ephedrine (excellent ICs: RR = 2.54, 95% CI 1.69 to 3.83; clinically acceptable ICs: RR = 1.21, 95% CI 1.07 to
1.38). Conclusion: Ephedrine, without extra side effects, created superior ICs one minute after anesthesia induction
using propofol and rocuronium, and low dose (i.e., 70-100 mug/kg) is recommended as the possible optimal dose.
2012 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.
Changes in lower limb haemodynamics such as arterial pressure and/or flow have often been, and continue to be,
cited as possible mechanisms for the improvement in walking performance that occurs with exercise training in
individuals with peripheral arterial disease (PAD), but data are conflicting in this regard. There are a small number of
literature reviews examining the effects of exercise on PAD, however, there has been insufficient analysis
synthesizing possible mechanisms of effect, overall benefits and limitations of these trials. Our objective was
therefore to systematically review the evidence for the effect of exercise on lower limb haemodynamic measures of
resting and post-exercise ankle brachial index (ABI), resting toe pressure, and resting and reactive hyperaemic calf
blood flow in PAD. A systematic search of studies published between 1934 and March 2010 was conducted using
MEDLINE, EMBASE, AMED, SportDiscus, CINAHL, PEDro, Premedline, Google Scholar and Web of Knowledge
databases. Eligible studies included randomized controlled trials using an exercise intervention for the treatment of
intermittent claudication with haemodynamic measures of disease severity as outcomes. Relative effect sizes (ESs)
and 95% confidence intervals were calculated for outcomes. Correlation and regression analyses were performed to
establish relationships between symptoms and haemodynamic outcomes. Thirty-three trials including 1237 subjects
with mild to moderate claudication met the eligibility criteria. Exercise did not significantly change lower extremity
haemodynamics in most trials; nor were clinical improvements related to changes in resting ABI (mean ES 0.09 +/-
0.26; r = 0.02; p = 0.94), post-exercise ABI (mean ES 0.18 +/- 0.3; r = -0.33; p = 0.52) or reactive hyperaemic calf blood
flow (mean ES 0.38 +/- 0.67; r = 0.35; p = 0.26). A relationship may exist between a change in symptoms and changes
in resting toe pressure (mean ES 0.22 +/- 0.22; r = 0.75; p = 0.25) and resting calf blood flow (mean ES 0.09 +/- 0.16; r
= 0.59; p = 0.22). Changes in resting and post-exercise ABI and reactive hyperaemic calf blood flow do not appear to
explain the clinical benefits of exercise in PAD. More study is required in the areas of resting toe pressure and resting
calf blood flow.
BACKGROUND: Anxiety often remains unrecognized or untreated among patients with a chronic illness. Exercise
training may help improve anxiety symptoms among patients. We estimated the population effect size for exercise
training effects on anxiety and determined whether selected variables of theoretical or practical importance
moderate the effect. METHODS: Articles published from January 1995 to August 2007 were located using the
Physical Activity Guidelines for Americans Scientific Database, supplemented by additional searches through
December 2008 of the following databases: Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science. Forty
English-language articles in scholarly journals involving sedentary adults with a chronic illness were selected. They
included both an anxiety outcome measured at baseline and after exercise training and random assignment to either
an exercise intervention of 3 or more weeks or a comparison condition that lacked exercise. Two co-authors
independently calculated the Hedges d effect sizes from studies of 2914 patients and extracted information
regarding potential moderator variables. Random effects models were used to estimate sampling error and
population variance for all analyses. RESULTS: Compared with no treatment conditions, exercise training significantly
reduced anxiety symptoms by a mean effect Delta of 0.29 (95% confidence interval, 0.23-0.36). Exercise training
programs lasting no more than 12 weeks, using session durations of at least 30 minutes, and an anxiety report time
frame greater than the past week resulted in the largest anxiety improvements. CONCLUSION: Exercise training
reduces anxiety symptoms among sedentary patients who have a chronic illness.
Background: Physical inactivity and comorbid depressive symptoms are prevalent among patients with a chronic
illness. To our knowledge, randomized controlled trials of the effects of exercise training on depressive symptoms
among patients with a chronic illness have not been systematically reviewed.We estimated the population effect of
exercise training on depressive symptoms and determined whether the effect varied according to patient
characteristics and modifiable features of exercise exposure and clinical settings. Methods: Articles published before
June 1, 2011, were located using the Physical Activity Guidelines for Americans Scientific Database, Google Scholar,
MEDLINE, PsycINFO, PubMed, and Web of Science. Ninety articles involving 10 534 sedentary patients with a chronic
illness were selected. Included articles required (1) randomized allocation to an exercise intervention or nonexercise
comparison condition and (2) a depression outcome assessed at baseline and at mid- and/or postintervention.
Hedges d effect sizes were computed, study quality was evaluated, and random effects models were used to
estimate sampling error and population variance of the observed effects. Results: Exercise training significantly
reduced depressive symptoms by a heterogeneous mean effect size delta () of 0.30 (95% CI, 0.25-0.36). Larger
antidepressant effects were obtained when (1) baseline depressive symptoms were higher, (2) patients met
recommended physical activity levels, and (3) the trial primary outcome, predominantly function related, was
significantly improved among patients having baseline depressive symptoms indicative of mild-to-moderate
depression. Conclusions: Exercise reduces depressive symptoms among patients with a chronic illness. Patients with
depressive symptoms indicative of mild-to-moderate depression and for whom exercise training improves
functionrelated outcomes achieve the largest antidepressant effects. 2012 American Medical Association. All rights
reserved.
Background: Stenting of coronary bifurcation lesions provides excellent immediate outcomes, with higher rates of
major adverse cardiac events (MACE) at follow-up compared to lesions not at bifurcations. Final kissing balloon
inflation (FKBI) after stenting these bifurcations, appears to improve angiographic results, although concerns have
been raised regarding its effect on stent geometry. The impact of FKBI on MACE is not entirely clear. Methods:
Pubmed, Cochrane, Embase and Google scholar databases were searched for the terms <>, <> and <>. 65 studies
were retreived from the literature. 8 studies reported outcomes in cohorts with or without FKBI, using a 2-stent
strategy. MACE, stent thrombosis and side branch restenosis outcomes were analyzed using Comprehensive meta-
analysis software. Heterogeneity was assessed using the I-square statistic. Both random and fixed effects models
were evaluated. Results: A total of 2871 patients were included in the analysis. A significant reduction in side-branch
restenosis (O.R = 0.381, P = 0.0001, I-square = 69, random-effects model) as well as stent thrombosis (O.R = 0.371, P
= 0.026, I-square = 9, fixed effect model) was noted in patients receiving FKBI, compared to those who did not. A
significant reduction in 1 year MACE was noted in the cohort with FKBI, compared to control group (O.R = 0.395, P =
0.0001, I-square = 62, random effects model was used). Significant publication bias was noted (Egger's 2-tailed P =
0.0036) Conclusion: In patients with coronary bifurcation stenoses, undergoing PCI with two-stent strategy, a
significant reduction in side branch restenosis, stent thrombosis as well as 1 year MACE, is observed if final kissing
balloon inflation is performed.
OBJECTIVE: Several studies assessed the effect of glycemic index (GI) and glycemic load (GL) on energy intake in
children but findings are not consistent in this regard. The aim of this study is to summarize and assess the evidence
for the effect of GI and GL on energy intake by conducting a meta-analysis on published randomized clinical trials.,
METHOD: Our search process was conducted in PUBMED, Web of Science, and Google Scholar databases. The
following keywords were searched in any part of published articles: "glycemic index" OR "glycaemic index" OR
"glycemic load" OR "glycaemic load" OR "energy intake" AND "child" OR "children" OR "adolescent" OR "youth.",
RESULTS: We gathered 5099 articles. Non-clinical trial studies that did not intervene by GI or GL or those not
assessing energy intake as a dependent variable and those that were conducted on patients over age 18 y were
excluded. Each included study was evaluated three times and the exclusion criteria was checked. Eventually, six
studies from 1999 to 2012 met the criteria (213 participants ages 4-17.5 y). There is heterogeneity in the study's
participants in the present paper. Children with type 2 diabetes, obesity, or normal-weight children were recruited in
different studies. Overall effect of consuming low GI (LGI) and low GL (LGL) meals on energy intake was not
significant. Subgroup analysis showed that LGI (not LGL) meals decreased subsequent energy intake, whereas
heterogeneity was significant in the LGI group of studies. Although a slight asymmetry was shown by Begg's funnel
plot, the Egger's asymmetry was not significant. We did not find any evidence of publication bias for studies
assessing the effect of low GI or GL meals on energy intake., CONCLUSION: Consuming LGI diet (not LGL) has
favorable effect on reducing energy intake and obesity, subsequently. Copyright 2013 Elsevier Inc. All rights
reserved.
Background: Though promising progress has been made towards achieving the Millennium Development Goal four
through substantial reduction in under-five mortality, the decline in neonatal mortality remains stagnant, mainly in
the middle and low-income countries. As an option, health facility delivery is assumed to reduce this problem
significantly. However, the existing evidences show contradicting conclusions about this fact, particularly in areas
where enabling environments are constraint. Thus, this review was conducted with the aim of determining the
pooled effect of health facility delivery on neonatal mortality.Methods: The reviewed studies were accessed through
electronic web-based search strategy from PUBMED, Cochrane Library and Advanced Google Scholar by using
combination key terms. The analysis was done by using STATA-11. I2 test statistic was used to assess heterogeneity.
Funnel plot, Begg's test and Egger's test were used to check for publication bias. Pooled effect size was determined
in the form of relative risk in the random-effects model using DerSimonian and Laird's estimator.Results: A total of
2,216 studies conducted on the review topic were identified. During screening, 37 studies found to be relevant for
data abstraction. From these, only 19 studies fulfilled the preset criteria and included in the analysis. In 10 of the 19
studies included in the analysis, facility delivery had significant association with neonatal mortality; while in 9 studies
the association was not significant. Based on the random effects model, the final pooled effect size in the form of
relative risk was 0.71 (95% CI: 0.54, 0.87) for health facility delivery as compared to home delivery.Conclusion: Health
facility delivery is found to reduce the risk of neonatal mortality by 29% in low and middle income countries.
Expansion of health facilities, fulfilling the enabling environments and promoting their utilization during childbirth are
essential in areas where home delivery is a common practice. 2013 Tura et al; licensee BioMed Central Ltd.
A substantial proportion of antibiotic prescribing in Long Term Care Facilities (LTCF) may be inappropriate and not in
adherence to local guidelines(1). The objective of this systematic review was to identify and summarise the effect of
interventions aimed at reducing potentially inappropriate antibiotic prescribing in LTCF. A search for systematic
reviews and randomised controlled trials in The Cochrane Library, Pubmed, EMBASE, ISI Web of Knowledge, DARE,
HTA and Google Scholar was conducted (August 2012). The inclusion criteria were randomised controlled trials of
interventions to improve the quality or reduce the quantity of antibiotic prescribing in LTCF for the elderly. Studies of
interventions of a financial, regulatory and information and communication technology nature were excluded. Two
authors independently reviewed the results of the searches and conducted a risk of bias assessment according to the
Cochrane Collaboration's 'Risk of bias' table(2). Outcomes assessed were the prescribing of antibiotics. Due to the
heterogeneity of interventions and outcomes we employed a narrative approach. Four randomised controlled trials
were reviewed from 1904 evaluated references. The four studies implemented an educational component by
providing educational material. One study provided educational material and prescribing feedback to physicians only
and reduced the odds of non-adherence to the prescribing guide but this was not sustained after three months (post
intervention one Odds Ratio (OR) = 0.47, 95% Confidence Interval (CI) 0.21-1.05, post intervention two OR = 0.36,
95% CI = 0.18-0.73, after a further three months OR = 0.48, 95% CI = 0.23-1.02). The second study provided
educational sessions, material and prescribing feedback for physicians and nurses and had a modest effect on
quinolone prescribing (absolute risk reduction = 0.028 95% CI -0.193-0.249). The third study provided educational
sessions and material for physicians and nurses. The intervention group recorded less antibiotic use than the control
group (1.17 courses of antibiotics per 1000 resident days versus 1.59, weighted mean difference -9.6%, 95% CI -0.93
to -0.06) but this was not sustained after a twelve month follow up. The total antimicrobial use between the
intervention and control groups was not significantly different with a weighted mean difference of -0.37 (95% CI -
1.17 to 0.44). The fourth study provided educational sessions and material to a physician only group and a physician
and nurse group and did not find a significant difference in oral antibiotic prescribing after the intervention or
between the groups. Interventions with an educational component and providing antibiotic prescribing feedback
may help to reduce inappropriate antibiotic prescribing, but the quality of evidence is low. It was not possible to
attribute the success of any study to one particular type of intervention. The success of an intervention is more likely
to be sustained with regular or repeated implementation. The contributions of local consensus procedures when
developing guidelines, and presence of a local opinion leader, such as a pharmacist, to the success of an intervention
Background: The prevalence of antibiotic use in long-term care facilities (LTCF) is high and in many cases it may not
be in accordance with local guidelines. It is important to review interventions that aim to improve the quality of
antibiotic prescribing in this setting. Objective: The objective of this systematic review was to collect and interpret
the results of studies of interventions to improve the quality of, or appropriateness of antibiotic prescribing in LTCF in
order to determine the key components for a successful intervention. Data Sources: A search of The Cochrane
Library, PubMed, EMBASE, ISI Web of Knowledge, International Pharmaceutical Abstracts, the Database of Abstracts
of Review of Effects (DARE), the Health Technology Assessments (HTA) at the Centres for Reviews and Dissemination
(CRD) and Google Scholar was conducted from their inception to August 2012. A manual search of the grey literature
and relevant journals was also conducted. Study Selection: Studies were selected that were randomised controlled
trials of an intervention to improve the quality of antibiotic prescribing, or increase adherence to a prescribing
guideline or reduce the amount of antibiotic prescribing. All studies were conducted in the long-term care setting.
The search strategy found four randomised controlled trials that met the inclusion criteria, from an initial 1,904 titles.
Study Appraisal and Synthesis Methods: The risk of bias assessment of the included studies was conducted using the
Cochrane Risk of Bias Table. Due to the heterogeneity of the interventions, study designs and outcome measures, a
meta-analysis was not conducted. Results: Four studies met the inclusion criteria for this review. Three studies
directed educational material and sessions at physicians and nurses, with one of the three studies providing
prescribing feedback as well. The fourth study provided educational material and prescribing feedback for physicians
only. Due to the mixed and modest effects of the interventions and the variety of interventions implemented, it is
difficult to attribute the success of any intervention to just one component alone. It seems that a multifaceted
intervention involving small group educational sessions and the provision of educational materials is generally
acceptable to nurses and physicians in LTCF. The involvement of local consensus procedures when developing
guidelines and interventions may improve the success of the intervention. Limitations: A limitation of this systematic
review is the small number of studies that met the inclusion criteria. Conclusion: Interventions in the long-term care
setting involving local consensus procedures, educational strategies, and locally developed guidelines may improve
the quality of antibiotic prescribing, but the quality of the evidence is low. Due to the poor quality of evidence and
mixed results, no definitive conclusion can be reached about the effect of the interventions. Future research in this
area needs to include process evaluation research in order to define the characteristics contributing to the success or
failure of any intervention. The contribution of a multidisciplinary antibiotic management team, which could include
Objective: To evaluate the effect of low-protein diet on kidney function in patients with diabetic nephropathy.
Design: A systematic review and a meta-analysis of randomised controlled trials. Data sources: MEDLINE, EMBASE,
Cochrane Library, ClinicalTrials.gov, International Standard Randomised Controlled Trial Number (ISRCTN) Register
and University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) from inception to 10
December 2012. Internet searches were also carried out with general search engines (Google and Google Scholar).
Study selection: Randomised controlled trials that compared low-protein diet versus control diet and assessed the
effects on kidney function, proteinuria, glycaemic control or nutritional status. Primary and secondary outcome
measures and data synthesis: The primary outcome was a change in the glomerular filtration rate (GFR). The
secondary outcomes were changes in proteinuria, post-treatment value of glycated haemoglobin A1C (HbA1c) and
posttreatment value of serum albumin. The results were summarised as the mean difference for continuous
outcomes and pooled by the random effects model. Subgroup analyses and sensitivity analyses were conducted
regarding patient characteristics, intervention period, methodological quality and assessment of diet compliance.
The assessment of diet compliance was performed based on the actual protein intake ratio (APIR) of the low-protein
diet group to the control group. Results: We identified 13 randomised controlled trials enrolling 779 patients. A low-
protein diet was associated with a significant improvement in GFR (5.82 ml/min/ 1.73 m2, 95% CI 2.30 to 9.33,
I2=92%; n=624). This effect was consistent across the subgroups of type of diabetes, stages of nephropathy and
intervention period. However, GFR was improved only when diet compliance was fair (8.92, 95% CI 2.75 to 15.09, I
2=92% for APIR <0.9 and 0.03, 95% CI -1.49 to 1.56, I 2=90% for APIR <=0.9). Proteinuria and serum albumin were
not differed between the groups. HbA1c was slightly but significantly decreased in the low-protein diet group (-
0.26%, 95% CI -0.35 to -0.18, I2=0%; n=536).
Objective: Among patients with severe tetrodotoxin (pufferfish) poisoning, neostigmine has been suggested to
improve the patients' prognosis. Yet, the evidence base for this practice remains unclear. We aimed to systematically
review the available literature and to evaluate the effectiveness of neostigmine use on in-hospital mortality in
pufferfish-associated acute respiratory failure. Methods: We searched in PubMed, EMBASE, Google Scholar and
other databases for all case reports or series of acute pufferfish poisoning ever published up to December 2012. We
included only severe adult cases (age 16 years or older, with Fukuda grade IV severity or with acute respiratory
failure). The main exposure variable was the use of neostigmine or not. Primary outcome was in-hospital mortality.
Results: We identified 377 publications, retrieved 67 full-text articles and selected 34 articles, including 13 case
reports and 21 case series. We assessed the quality of reporting based on the completeness of key variables
described, resulting in 35 cases eligible for the pooled analysis. Although we did not observe a statistical association
between neostigmine use and in-hospital mortality, we noted that severely poisoned patients who used neostigmine
tended to have a shorter duration of ventilator support (median: 12 vs. 30 hours) or intensive care requirement
(median: 12 vs. 72 hours) than non-users did (p-value > 0.05). Most of the case reports and case series had the
following neostigmine regimen: neostigmine 0.05 mug/kg body weight along with atropine 0.025 mug/kg body
weight, six hourly for one day. Conclusion: There is insufficient evidence to recommend or discourage the use of
neostigmine in treating patients severely poisoned with pufferfish. Future investigations with rigorous design and
adequate reporting quality are needed to provide robust evidence for the clinical benefit of neostigmine use in
severe acute pufferfish poisoning.
Adverse health effects from exposure to occupational whole-body vibration (WBV) are common among drivers. In
particular some researchers consider that there is kinaesthetic and balance disturbance from WBV exposure in the
workplace and this might be one of the aetiological factors responsible for occupational low back pain in drivers. The
purpose of this study was to undertake a critical review of the literature to determine whether exposure to seated
occupational WBV can affect standing balance performance in an actual or simulated occupational environment.
Specific keywords and MeSH terms for three major areas included WBV, balance and occupation. These were used to
conduct a systematic search of the following databases; PubMed, EMBASE (Ovid), Medline (Ovid), CINAHL (EBSCO),
Academic Search Complete (ASC), AMED, Scopus, Web of Science, Science Direct, Proquest, Cochrane library(OVID),
IEEExplore and ProQuest Dissertations and thesis, Google Scholar, WorldCat and related conference proceedings.
Five articles met the inclusion criteria and were assessed for quality. Two were field studies conducted on actual
vehicles (a long haul freight truck and a bulldozer), while the other three were laboratory studies simulating the
characteristics of the following vehicles; long-haul-dump vehicle, underground mine shuttle car, and helicopter. The
systematic review scored the methodological quality of the included articles with an average and standard deviation
of 76 +/-12.3% (range 59- 93%) indicative of high quality. Three of the five studies (two field and one laboratory)
found evidence for seated WBV decreasing standing balance performance while two laboratory studies did not find
such effects. Thus there is modest evidence to suggest there is a decrease in standing balance performance following
exposure to seated occupational WBV. Relevance to industry: This systematic review suggests that balance deficits
may exist immediately following exposure to occupational seated WBV and may predispose driver/operator to low
back injury during manual material handling tasks immediately post driving. 2010 Elsevier B.V.
Background: Eating away from home has increased in prevalence among US adults and now comprises about 50% of
food expenditures. Calorie labeling on chain restaurant menus is one specific policy that has been proposed to help
consumers make better food choices at restaurants. The present review evaluates the available empirical literature
on the effects of calorie information on food choices in restaurant and cafeteria settings. Methods: Computer-
assisted searches were conducted using the PUBMED database and the Google Scholar world wide web search
engine to identify studies published in peer-review journals that evaluated calorie labeling of cafeteria or restaurant
menu items. Studies that evaluated labeling only some menu items (e.g. low calorie foods only) were excluded from
the review since the influence of selective labeling may be different from that which may be expected from
comprehensive labeling. Results: Six studies were identified that met the selection criteria for this review. Results
from five of these studies provide some evidence consistent with the hypothesis that calorie information may
influence food choices in a cafeteria or restaurant setting. However, results from most of these studies suggest the
effect may be weak or inconsistent. One study found no evidence of an effect of calorie labeling on food choices.
Each of the studies had at least one major methodological shortcoming, pointing toward the need for better
designed studies to more rigorously evaluate the influence of point-of-purchase calorie labeling on food choices.
Conclusion: More research is needed that meets minimum standards of methodological quality. Studies need to
include behavioral outcomes such as food purchase and eating behaviors. Also, studies need to be implemented in
realistic settings such as restaurants and cafeterias. 2008 Harnack and French; licensee BioMed Central Ltd.
Background: The potential benefit of preoperative weight loss in patients undergoing bariatric surgery has led many
bariatric surgeons to recommend an aggressive weight reduction regimen to their patients. Some surgeons might
withhold bariatric procedures if a certain threshold of preoperative weight loss is not achieved. It is unclear whether
this practice has any scientific evidence supporting it. Our study aimed to examine the current evidence surrounding
this issue in a systematic review. The setting was a university hospital. Methods: A systematic search of multiple
databases, including MEDLINE, Google Scholar, EMBASE, the Cochrane Library, and conference proceedings were
reviewed, yielding a final total of 27 studies. Of the 27 studies, 7 were prospective studies (2 randomized controlled
trials from the same patient population), 14 were retrospective studies (2 chart reviews from the same patient
population), 1 was an editorial, and a number were conference presentations. Results: A total of 17 trials, including
approximately 4611 patients, deemed preoperative weight loss beneficial, and 10 studies, including 2075 patients,
deemed preoperative weight loss to be of no benefit. The operative time was 12.5 minutes shorter for the
preoperative weight loss patients undergoing laparoscopic Roux-en-Y gastric bypass. With regard to the effects of
preoperative weight loss on postoperative weight loss, 9 studies (39%) reported a positive correlation, and 15
(62.5%) reported no benefit. Nine studies reporting perioperative complications (852 patients) revealed no
difference in the complication rates, and 2 studies (1234 patients) suggested a significant decrease was associated
with preoperative weight loss. Conclusion: This systematic review suggests little evidence is available to support or
refute the routine use of preoperative weight reduction in bariatric surgery. Clearly, a large-scale, multicenter,
randomized, controlled trial with sufficient power is necessary to clarify this significant aspect of preoperative care.
2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.
BACKGROUND: The prosthetic margin location relevant to the free gingival margin may influence the incidence of
secondary caries due to the differences that exist between the micro-environment within the gingival crevice
compared to the rest of the oral environment., OBJECTIVE: The purpose of this study was to systematically review
the effect of prosthetic margin placement on caries susceptibility of abutment teeth., METHOD: Two independent
authors identified cohort studies using MEDLINE, EMBASE, CDSR, CENTRAL, Google Scholar and Scopus through
March 2012. Reference lists were also scanned. Included studies had to report on caries incidence with regard to
location of prosthetic margins, with a minimum follow-up period of two years., RESULTS: A total of 5,541 references
were identified and, after application of the inclusion criteria, 22 studies were included in the systematic review.
Random-effects meta-analysis could be made in two studies, in which secondary caries incidence did not differ
between margins placed subgingivally compared to equi- or supragingivally placed margins for a follow-up period up
to ten years. Indications were found of a possible lower secondary caries rate at 15 years of follow up, based on one
study., CONCLUSION: This systematic review and meta-analysis failed to detect a significantly different secondary
caries rate of subgingivally located prosthetic margins in the short to mid-term (<=10 years). Due to the small
number and the limitations of the included studies the results do not provide conclusive evidence as to the effect of
prosthetic margin placement on the incidence of secondary caries.
Purpose: The purpose of this research was to evaluate the association between exposure to proton pump inhibitors
(PPIs) and the likelihood of hip fracture. Prior studies examining PPIs and various fractures have been widely
discrepant in terms of study focus and duration of exposure. Studies looking at short duration of exposure have often
shown minimal or no effect. We hypothesized that cumulative exposure would result in increased likelihood of hip
fracture. We made the assumption that the association of hip fracture is related to alteration in bone structure. With
this assumption and with consideration of the slow rate of bone turnover, we anticipated no effect in an early
exposure window of unclear duration, followed by a graded increase in the risk. Methods: A highly sensitive search
was performed for Medline, Embase, Google Scholar, CINHL, and LILAC through May 26, 2010. Multiple search terms
including osteoporosis, fracture, hip fracture and PPI were used. Clinical studies related to PPI use and hip fracture
were identified. Bibliographies of identified articles were reviewed for relevant articles. 8 observational studies met
the inclusion criteria for the review. All adjusted Odds Ratios (OR) corresponding to >= duration format were
incorporated into the analysis and displayed visually. Relative weights for fracture number were also displayed.
Results: Over 34,000 unique hip fractures were identified. The likelihood of hip fracture increased significantly at >=
4 years of exposure, the OR ranging between 1.62 and 4.55. The OR showed no increased risk, and remained at
approximately 1.0 up through the 3 year mark. Conclusion: The analysis supported the hypothesis that the duration
of exposure to a PPI is associated with an increased likelihood of hip fracture.
Background: Cancer patients are prone to experience acute and chronic stress as a result of their diagnosis. This
stress alone can lead to lower quality of life and, when coupled with cancer treatments, can lead to significant
immune system impairment resulting in increased susceptibility to infection and secondary cancers. The negative
impact of acute and chronic stress on the neuroendocrine and immune systems has been established and has given
rise to the scientific framework of psychoneuroimmunology (PNI). Psychosocial interventions have been developed
and tested to reduce stress and impact PNI based outcome measures, eg cortisol levels. The last systematic reviews
of these data were published in 1998, thus we aimed to update these reviews and report on interventions published
since 1998. Methods: The PubMED/Medline, PsychINFO, CINHAL, Communication Mass Media Complete, Google
Scholar and CANCERLIT online databases were searched using combinations of keywords obtained from previous
reviews of psychosocial interventions. Studies were included if they, a) were published between 1998-2011, b) were
conducted in cancer patients and c) reported psychological assessments and neuro-immune outcome measures.
Results: Of 14,700 titles identified, 20 cancer-specific, psycho-social interventions that used neuro-immune
outcomes were include in the review. Three major types of interventions emerged, 1) cognitive-behavioral, 2) yoga
and massage therapies, and 3) mindfulness-based stress reduction. Interventions durations ranged between 80
minutes and 11 days. There was little standardization of outcome measures across studies. Psychosocial
interventions demonstrated success in altering functional measures of the immune system, such as cytokines.
Conclusions: Research examining dose-response and resource allocation is needed to guide future interventions. A
collaborative effort to create a standardized panel of psychosocial instruments and biochemical measures for
researchers to use would greatly enhance the ability to compare findings across studies, collectively evaluate this
body of research, and examine the applications for clinical practice.
OBJECTIVE: To quantify the relation between food prices and the demand for food with specific reference to national
and household income levels., DESIGN: Systematic review with meta-regression., DATA SOURCES: Online databases
of peer reviewed and grey literature (ISI Web of Science, EconLit, PubMed, Medline, AgEcon, Agricola, Google,
Google Scholar, IdeasREPEC, Eldis, USAID, United Nations Food and Agriculture Organization, World Bank,
International Food Policy Research Institute), hand searched reference lists, and contact with authors., STUDY
SELECTION: We included cross sectional, cohort, experimental, and quasi-experimental studies with English
abstracts. Eligible studies used nationally representative data from 1990 onwards derived from national aggregate
data sources, household surveys, or supermarket and home scanners., DATA ANALYSIS: The primary outcome
extracted from relevant papers was the quantification of the demand for foods in response to changes in food price
(own price food elasticities). Descriptive and study design variables were extracted for use as covariates in analysis.
We conducted meta-regressions to assess the effect of income levels between and within countries on the strength
of the relation between food price and demand, and predicted price elasticities adjusted for differences across
studies., RESULTS: 136 studies reporting 3495 own price food elasticities from 162 different countries were
identified. Our models predict that increases in the price of all foods result in greater reductions in food consumption
in poor countries: in low and high income countries, respectively, a 1% increase in the price of cereals results in
reductions in consumption of 0.61% (95% confidence interval 0.56% to 0.66%) and 0.43% (0.36% to 0.48%), and a 1%
increase in the price of meat results in reductions in consumption of 0.78% (0.73% to 0.83%) and 0.60% (0.54% to
0.66%). Within all countries, our models predict that poorer households will be the most adversely affected by
increases in food prices., CONCLUSIONS: Changes in global food prices will have a greater effect on food
consumption in lower income countries and in poorer households within countries. This has important implications
for national responses to increases in food prices and for the definition of policies designed to reduce the global
burden of undernutrition.
Objective To quantify the relation between food prices and the demand for food with specific reference to national
and household income levels. Design Systematic review with meta-regression. Data sources Online databases of peer
reviewed and grey literature (ISI Web of Science, EconLit, PubMed, Medline, AgEcon, Agricola, Google, Google
Scholar, IdeasREPEC, Eldis, USAID, United Nations Food and Agriculture Organization, World Bank, International Food
Policy Research Institute), hand searched reference lists, and contact with authors. Study selection We included cross
sectional, cohort, experimental, and quasi-experimental studies with English abstracts. Eligible studies used
nationally representative data from 1990 onwards derived from national aggregate data sources, household surveys,
or supermarket and home scanners. Data analysis The primary outcome extracted from relevant papers was the
quantification of the demand for foods in response to changes in food price (own price food elasticities). Descriptive
and study design variables were extracted for use as covariates in analysis. We conducted meta-regressions to assess
the effect of income levels between and within countries on the strength of the relation between food price and
demand, and predicted price elasticities adjusted for differences across studies. Results 136 studies reporting 3495
own price food elasticities from 162 different countries were identified. Our models predict that increases in the
price of all foods result in greater reductions in food consumption in poor countries: in low and high income
countries, respectively, a 1% increase in the price of cereals results in reductions in consumption of 0.61% (95%
confidence interval 0.56% to 0.66%) and 0.43% (0.36% to 0.48%), and a 1% increase in the price of meat results in
reductions in consumption of 0.78% (0.73% to 0.83%) and 0.60% (0.54% to 0.66%). Within all countries, our models
predict that poorer households will be the most adversely affected by increases in food prices. Conclusions Changes
in global food prices will have a greater effect on food consumption in lower income countries and in poorer
households within countries. This has important implications for national responses to increases in food prices and
for the definition of policies designed to reduce the global burden of undernutrition.
BACKGROUND: There is increasing interest in using simulators for laparoscopic surgery training, and simulators have
rapidly become an integral part of surgical education., METHODS: We searched MEDLINE, EMBASE, Cochrane
Library, and Google Scholar for randomized controlled studies that compared the use of different types of simulators.
The inclusion criteria were peer-reviewed published randomized clinical trials that compared simulators versus
standard apprenticeship surgical training of surgical trainees with little or no prior laparoscopic experience. Of the
551 relevant studies found, 17 trials fulfilled all inclusion criteria. The effect sizes (ES) with 95 % confidence intervals
[CI] were calculated for multiple psychometric skill outcome measures., RESULTS: Data were combined by means of
both fixed- and random-effects models. Meta-analytic combined effect size estimates showed that novice students
who trained on simulators were superior in their performance and skill scores (d = 1.98, 95 % CI: 1.20-2.77; P < 0.01),
were more careful in handling various body tissue (d = 1.08, 95 % CI: 0.36-1.80; P < 0.01), and had a higher accuracy
score in conducting laparoscopic tasks (d = 1.38, 95 % CI: 0.30-2.47; P < 0.05)., CONCLUSION: Simulators have been
shown to provide better laparoscopic surgery skills training for trainees than the traditional standard apprenticeship
approach to skill development. Surgical residency programs are highly encouraged to adopt the use of simulators in
teaching laparoscopic surgery skills to novice students.
Background: There is increasing interest in using simulators for laparoscopic surgery training, and simulators have
rapidly become an integral part of surgical education. Methods: We searched MEDLINE, EMBASE, Cochrane Library,
and Google Scholar for randomized controlled studies that compared the use of different types of simulators. The
inclusion criteria were peer-reviewed published randomized clinical trials that compared simulators versus standard
apprenticeship surgical training of surgical trainees with little or no prior laparoscopic experience. Of the 551
relevant studies found, 17 trials fulfilled all inclusion criteria. The effect sizes (ES) with 95 % confidence intervals [CI]
were calculated for multiple psychometric skill outcome measures. Results: Data were combined by means of both
fixed- and random-effects models. Meta-analytic combined effect size estimates showed that novice students who
trained on simulators were superior in their performance and skill scores (d = 1.98, 95 % CI: 1.20-2.77; P < 0.01),
were more careful in handling various body tissue (d = 1.08, 95 % CI: 0.36-1.80; P < 0.01), and had a higher accuracy
score in conducting laparoscopic tasks (d = 1.38, 95 % CI: 0.30-2.47; P < 0.05). Conclusion: Simulators have been
shown to provide better laparoscopic surgery skills training for trainees than the traditional standard apprenticeship
approach to skill development. Surgical residency programs are highly encouraged to adopt the use of simulators in
teaching laparoscopic surgery skills to novice students. Springer Science+Business Media, LLC 2012.
Objective: To estimate the effect of statins use on the prevention of venous thromboembolism (VTE). Methods: We
systematically searched MEDLINE (1980-June 2012), EMBASE (1980-June 2012), Google Scholar, Cochrane Library,
and ISI Web of Science, manually reviewed references, and contacted experts. Case-control studies and cohort
studies that compared any dose of statin with no statin or placebo are included. Data extraction and study quality
evaluation were independently conducted in duplicate. Results: 12 studies including four cohort studies and eight
case-control studies were identified and eligible for meta-analysis. Upon meta-analysis, statin use was associated
with a statistically significant reduction in the odds of developing VTE (OR 0.91, 95% CI 0.86-0.96). Conclusion: This
meta-analysis of current and available literature suggests that statins can reduce patient's risk of developing VTE.
Due to the limitations of observational study, this conclusion should be considered with caution, and additionally,
specifical well-designed trials are needed. 2012 The Editorial Board of Journal of Medical Colleges of PLA. E-edition
published by Elsevier (Singapore) Pte Ltd.
Objective: To evaluate the risk of postoperative bleeding and reintervention with the use of systemic steroids in
patients undergoing tonsillectomy. Design: Systematic review and meta-analysis of randomised controlled trials.
Data sources: Medline, Embase, Cochrane Library, Scopus, Web of Science, Intute, Biosis, OpenSIGLE, National
Technical Information Service, and Google Scholar were searched. References from reviews identified in the search
and from included studies were scanned. Review methods: Randomised controlled trials comparing the
administration of systemic steroids during tonsillectomy with any other comparator were eligible. Primary outcome
was postoperative bleeding. Secondary outcomes were the rate of admission for a bleeding episode, reintervention
for a bleeding episode, blood transfusion, and mortality. Results: Of 1387 citations identified, 29 randomised
controlled trials (n=2674) met all eligibility criteria. Seven studies presented a low risk of bias, but none was
specifically designed to systematically identify postoperative bleeding. Administration of systemic steroids did not
significantly increase the incidence of post-tonsillectomy bleeding (29 studies, n=2674 patients, odds ratio 0.96 (95%
confidence interval 0.66 to 1.40), I 2=0%). We observed a significant increase in the incidence of operative
reinterventions for bleeding episodes in patients who received systemic steroids (12, n=1178, 2.27 (1.03 to 4.99),
I2=0%). No deaths were reported. Sensitivity analyses were consistent with the findings. Conclusions Although
systemic steroids do not appear to increase bleeding events after tonsillectomy, their use is associated with a raised
incidence of operative reinterventions for bleeding episodes, which may be related to increased severity of bleeding
events. Systemic steroids should be used with caution, and the risks and benefits weighed, for the prevention of
postoperative nausea and vomiting after tonsillectomy before further research is performed to clarify their condition
of use.
Introduction: More than two-thirds of children undergoing tonsillectomy will suffer from postoperative nausea and
vomiting (PONV)(1). Systemic steroids (SS) are one of the recommended drugs to prevent PONV. However, a recent
randomized controlled trial (RCT) showed an increased risk of post-tonsillectomy bleeding following intraoperative
use of dexamethasone (2). The objective of this study was to evaluate the risk of postoperative bleeding following SS
use in patients undergoing tonsillectomy by conducting a meta-analysis of RCTs. Methods: A systematic search was
performed using MEDLINE, EMBASE, Cochrane Library, SCOPUS, Web-of-science, Intute and BIOSIS databases, while
gray literature was searched using OpenSIGLE, NTIS and Google Scholar. References of identified reviews were also
manually searched. All RCTs comparing the administration of SS during tonsillectomy with any other comparator
were included. The primary outcome was any postoperative bleeding. Secondary outcomes were the need for
reintervention, hospitalisation, blood transfusion and mortality. Two reviewers independently screened all citations
and extracted data using a standardized form. We evaluated the methodological quality of studies using the
Cochrane Collaboration tool for assessing the risk of bias (3). Data were presented as Odds Ratio (OR) and analyzed
using peto fixed-effects models for rare events (4). An OR greater than 1 implies greater risk in the SS group, and an
OR less than 1 implies greater risk in the control group. We assessed heterogeneity using I2 values (5). A series of
sensitivity analyses based on clinical features (surgical technique, dosage regimen, timing of bleeding) and on
methodological features (methodological quality of studies, sample size, duration of follow-up) were performed to
understand potential sources of heterogeneity, if present, and to evaluate the robustness of our findings. Results:
From 1222 citations identified by the literature search, 25 trials (n=2201) met all eligibility criteria. Seven RCTs
presented a low risk of bias, but none was designed to systematically measure postoperative bleeding.
Administration of SS did not significantly increase the risk of post- tonsillectomy bleeding (OR 1.05, 95%CI = 0.69-
1.62, I2 = 12%). However, we observed a significant increased incidence of reintervention in SS group (OR 3.47,
95%CI = 1.34-9.01, I2 = 0%). Results of sensitivity analyses were consistent with our findings. There was no difference
in hospitalisation for bleeding. No transfusion or death was reported in any of the studies. Discussion: In our
systematic review, we did not observe an increased risk of post-tonsillectomy bleeding following the administration
of SS. However, there was an important and significant increased incidence of reintervention that may represent
greater bleeding severity. The majority of studies was of limited methodological quality and did not systematically
measure and report the risk of bleeding. Because of potential harm and the quality of evidence, SS should be used
with caution for the prevention of PONV following tonsillectomy.
Objective: To systematically examine the literature assessing the effect of uridine 5'-diphospho-
glucuronosyltransferase (UGT)1A1*28 genetic poly mor phisms on atazanavir-associated hyperbilirubinemia. Data
sources: MEDLINE (1948-November 2012), EMBASE (1980-November 2012), International Pharmaceutical Abstracts
(1970-November 2012), Google, and Google Scholar were searched using combinations of the following terms:
glucuronosyltransferase, glucuronosyltransferase 1A1, atazanavir, atazanavir plus ritonavir, or polymorph$. The
reference lists of all identified articles were manually searched. Study selection and data extraction: Studies were
included if at least 1 group of patients received atazanavir therapy and assessed the effect of UGT1A1*28 variants on
bilirubin concentrations or atazanavir discontinuation rates. The quality of each study was ranked according to the
US Preventive Services Task Force 1996 clas sification system. Information extracted included study design, baseline
characteristics, treatment regimens, UGT1A1*28 genotype frequencies, bilirubin con centrations, incidence of
hyperbilirubinemia, and atazanavir discontinuation rates. Data synthesis: Our search produced 12 studies, of which 9
were included (6 full manuscripts [level II-2], 2 abstracts, and 1 letter to the editor [level III]). Reported UGT1A1*28
homozygote genotype frequencies (0.8-23.8%) were in general agreement with the literature for the diverse ethnic
population captured in the 9 studies. An association between the incidence of hyperbilirubinemia and UGT1A1*28
genotype (homozygotes > heterozygotes > wild-type) was demon strated in all studies that reported such data (6 of 9
studies). However, the cal cu lated positive predictive value for homozygosity and hyperbilirubinemia from pooled
data was low (40.3%). Only 2 studies (levels II-2 and III) reported rates of ataza n avir discontinuation due to
hyperbilirubinemia and showed some positive correlation with presence of the UGT1A1*28 allele. Conclusions:
Based on the available evidence, homozygosity of the UGT1A1*28 allele does not strongly predict the incidence of
severe hyper bili ru bine mia. Thus, until large, prospective trials demonstrate otherwise, UGT1A1*28 testing does
not appear to provide additional information to aid clinical decisionmaking when initiating atazanavir treatment in
HIV-infected patients. 1967-2013 Harvey Whitney Books Co. All rights reserved.
The objective of this study was to evaluate the effects of repetitive Transcranial Magnetic Stimulation (rTMS) on
motor signs in Parkinson's disease (PD). Medline, Embase, CINAHL, Web of Science, Scopus bibliographic, and Google
Scholar databases were searched. Relevant controlled clinical trials published between January 1985 and October
2007 were extracted, reviewed, and validated according to the study protocol. The outcome of interest was the
motor section of the Unified Parkinson's Disease Rating Scale (UPDRS). We calculated the effect size for the included
studies. Sensitivity analysis was performed to further assess factors that may change the results. Ten randomized,
controlled clinical trials were included in the meta-analysis. Pooling of the results from these trials yielded an effect
size of -0.58 in UPDRS for high-frequency rTMS studies and no signi.cant effects for low-frequency rTMS studies. The
benefit of high-frequency rTMS on motor signs in PD was con.rmed by the meta-analysis. Lower frequency rTMS had
little effect on motor signs in PD. 2008 Movement Disorder Society.
size of -0.58 in UPDRS for high-frequency rTMS studies and no significant effects for low-frequency rTMS studies. The
benefit of high-frequency rTMS on motor signs in PD was confirmed by the meta-analysis. Lower frequency rTMS had
little effect on motor signs in PD. (c) 2008 Movement Disorder Society.
size of -0.58 in UPDRS for high-frequency rTMS studies and no significant effects for low-frequency rTMS studies. The
benefit of high-frequency rTMS on motor signs in PD was confirmed by the meta-analysis. Lower frequency rTMS had
little effect on motor signs in PD. (c) 2008 Movement Disorder Society.
Context: It has been postulated that subjects with weak hip abductors and external rotators may demonstrate
increased knee valgus, which may in turn raise risk of injury to the lower extremity. Recent studies have explored the
potential link between hip strength and knee kinematics, but there has not yet been a review of this literature.
Objective: To conduct a systematic review assessing the potential link between hip-abductor or external-rotator
strength and knee-valgus kinematics during dynamic activities in asymptomatic subjects. Evidence Acquisition: An
online computer search was conducted in early February 2011. Databases included Medline, EMBASE, CINAHL,
SPORTDiscus, and Google Scholar. Inclusion criteria were English language, asymptomatic subjects, dynamometric
hip-strength assessment, single or multicamera kinematic analysis, and statistical analysis of the link between hip
strength and knee valgus via correlations or tests of differences. Data were extracted concerning subject
characteristics, study design, strength measures, kinematic measures, subject tasks, and findings with regard to
correlations or group differences. Evidence Synthesis: Eleven studies were selected for review, 4 of which found
evidence that subjects with weak hip abductors or external rotators demonstrated increased knee valgus, and 1
study found a correlation to the contrary. Conclusions: There is a small amount of evidence that healthy subjects
with weak hip abductors and perhaps weak external rotators demonstrate increased knee valgus. However, due to
the variation in methodology and lack of agreement between studies, it is not possible to make any definitive
conclusions or clinical recommendations based on the results of this review. Further research is needed. 2012
Human Kinetics, Inc.
Purpose: To identify the aspects of harm reduction school based substance misuse programs for children and young
people that are effective or ineffective according to the literature. Methods: A review of the literature using four key
databases (OVID, CINAHL, PubMed and Google Scholar) was undertaken to identify relevant articles. The search
terms used were harm reduction, efficacy, evaluation, effectiveness, drugs, schools, school programs, children,
young people, and comparison. Using these terms the literature that explored school based harm reduction
substance misuse programs were identified. Each article title and abstract was read and the full article accessed if
deemed relevant. The author then screened each article for inclusion by color coding relevant data. Results: Of the
papers retrieved, 12 papers focused upon harm reduction school based substance misuse programs for children and
young people. From these the following categories emerged, approach of programs/content of programmed;
teaching and teachers; child and young people, and guidance/recommendations for schools. For each of these
categories aspects of the program that were effective or ineffective were identified. Conclusions: Interactive skills
focused programs were the most effective form of school-based interventions for the prevention of early drug use in
children and young people.
To summarize evidence on effective home programme intervention for adults and describe characteristics of
successful home programmes. A search was conducted of MEDLINE, CINAHL, PsycINFO, EMBASE, DARE, The
Physiotherapy Evidence Database, Cochrane Database of Systematic Reviews, OTSeeker and Google Scholar and
references in manuscripts retrieved. Two independent reviewers determined whether retrieved study abstracts met
inclusion criteria: human subjects; adults; home programme intervention; systematic reviews, randomized controlled
trials or controlled trials. Included papers were appraised for study design, participants, type and intensity of
intervention, and outcomes. Methodological quality of trials was rated using the PEDro scale (1-10 highest). Thirty-
two papers were retrieved (6 systematic reviews, 26 trials). The 23 randomized controlled trials and 3 controlled
trials were appraised. All the retrieved papers were level 1a, 1b or 2b evidence. Major findings were: (a) home
programme intervention was more effective than no intervention at all; (b) home programme intervention was
equally effective to expert-provided therapy, except when therapeutic modalities were used; and (c) different
instruction formats produced similar outcomes. Home programmes with favourable outcomes were more likely to:
involve the patients in establishing the programme; intervene on the person, task and environment; and provide
feedback about progress. Dose did not appear to be related to outcome. There is grade 1A evidence supporting the
effectiveness of home programmes for adults. Home programmes are as effective as expert-provided therapy.
Purpose: Given that osteoarthritis is a disease causing chronic pain, an evaluation of interventions for pain control
and function modification in individuals with osteoarthritis was performed. Methods: Evaluation of the published
literature, utilizing PubMed/ Medline, PEDro and Google Scholar data bases, was performed. Preference was given to
reviews such as Cochrane reviews, followed by well designed studies not addressed in such reviews. Literature
review was limited to nonsurgical therapies and to those addressing peripheral joints. Results: The WOMAC, AUSCAN
and OGI are validated standards of knee/hip, hand and global outcomes in osteoarthritis, and have been widely
utilized in studies of osteoarthritis. These have provided an opportunity to compare a variety of interventions from
different studies. Exercise therapies have been shown to have a consistent benefit although methods of delivery
remain variable. Splinting methods suffer from lack of controlled data. Medications, either prescription or over-the-
counter, remain have been shown to be of either limited or of no value. Most studies are directed at knee and hip,
with fewer in the area of hands and feet. Conclusion: Osteoarthritis, while a disease process, which is not amenable
to specific disease-modifying interventions for the underlying pathologic process, can be modified, in terms of pain
and function, by a variety of non-surgical interventions.
The Diabetic Peripheral Neuropathy (DPN) is the most common complication in diabetic patients which is
accompanied with substantial economic burden regarding the productivity loss and medical therapy. In this study,
we analyzed the cost efficacy of pregabalin for treatment of diabetic neuropathic pain in Iran. To evaluate the
efficacy of pregabalin, we conducted a systematic review of published articles by searching on PubMed, Scopus and
Google scholar. The keywords were: "pregabalin", "neuropathic pain", "diabetic peripheral neuropathy". The "mean
pain score" and also "percentage of patients with more than 50% pain reduction" were the outcome of interest for
evaluation of efficacy of drug in peripheral neuropathic pain. For calculation of cost, only direct medical costs were
evaluated. The Incremental Cost Effectiveness Ratio (ICER) was compared with one and three times of Gross
Domestic Product (GDP) per capita as threshold to evaluate if the treatment is "highly cost effective", "cost effective"
and "not cost effective". Out of 8476 evaluated papers, finally five articles were included in the study which met our
inclusion criteria. All of these reports were Randomized Controlled Trial (RCT) of the comparison of pregabalin with
placebo. Considering the efficacy extracted from the reports, pregabalin 75 and 150 mg day-1 did not have any
significant efficacy in comparison with placebo. In pregabalin 300 mg day-1, the ICER range for generic and brand
pregabalin were 6-200 and 63-2059, respectively. Accordingly, for generic and brand pregabalin (600 mg day-1), they
were 11-755 and 78-5333 US Dollars (USD) per one more score reduction in mean pain score compared with placebo
that could be seen as highly cost effective treatment. Our analysis indicated that pregabalin (300 mg day-1 or 600 mg
day-1) is highly cost effective treatments in both generic and brand forms. Considering the same efficacy of generic
and brand pregabalin, it seems more rational to include generic pregabalin in positive list of reimbursement,
although both of them are cost effective. 2012 Asian Network for Scientific Information.
Objective: A review of systematic reviews of the effectiveness and feasibility of videoconference-based
telepsychiatry services for resource constrained environments was conducted. Specifically with the aim of producing
an evidence-based review of the effectiveness and feasibility of videoconference-based telepsychiatry services in
resource constrained countries like South Africa. Methods: Eight key questions on telepsychiatry effectiveness and
feasibility were identified and inclusion and exclusion criteria were developed. Review of citations from 2000-2011
from CINAHL, Medline, Pubmed, PsycInfo, EBSCOhost, SABINET, Cochrane Database of Systematic Reviews (CCTR),
Cochrane Controlled Trial Registry (CCTR), Database of Abstracts of Reviews of Effectiveness (DARE), unpublished
abstracts through NEXUS and internet search engines (Google/Google scholar) was conducted. Results: Ten
systematic reviews were included for review. Despite the methodological limitations and heterogeneity of the
systematic reviews, there appears to be good evidence of effectiveness (reliability and improved outcomes) and
feasibility (use, satisfaction, acceptability and cost) for videoconference-based telepsychiatry internationally. The
application of this evidence in lower middle income countries is dependent on the integration of telepsychiatry into
local health system contexts. Conclusion: Based on the evidence, resource constrained countries such as South Africa
should be encouraged to develop telepsychiatry programs along with rigorous evaluation methods.
Millions of people around the world are suffering from debilitating pain and physical limitations of more than a
hundred forms of arthritis. Thus, this study aims at reviewing therapeutic evidence on Etanercept as an effective
treatment for different forms of inflammatory arthritis in general and RA in particular. Methods: In this study,
databases including Cochrane Library (HTA database, DARE, NHS EED, Cochrane Database of Systematic Reviews and
CENTRAL) and Google Scholar were searched for relevant secondary studies. Using specific search query, 33 hints
were retrieved. After eliminating the irrelevant studies and duplications, 12 articles entered the review based on
predetermined inclusion and exclusion criteria. Full-papers of all these 12 articles were also retrieved. Results:
Findings of 12 selected articles, all of them published between 2009 and 2011, were categorized in three groups,
namely: safety, effectiveness and economic evaluations with 3, 6 and 3 articles respectively. Conclusion: Based on
different studies on safety of anti-TNF drugs, Etarnercept safety profile is acceptable particularly in treatment of
Rheumatoid Arthritis. However, long-term complications including TB, Cancers and Heart diseases are in need of
further investigation. Etanercept is effective in treating Rheumatoid Arthritis, Psoriatic Arthritis and Psoriatic Plaque
and has been efficacious in alleviating signs and symptoms of early and severe Rheumatoid Arthritis. The review
suggests that Etanercept is cost-effective in treating these three forms of arthritis compare to other relevant
alternatives.
Introduction: Acute diarrhea continues to be a leading cause of morbidity, hospitalization and mortality worldwide
and probiotics have been proposed as a complementary therapy in the treatment of acute diarrhea. Regarding the
treatment of acute diarrhea, a few probiotics including Saccharomyces boulardii seem to be promising therapeutic
agents. Areas covered: We performed a systematic review and meta-analysis regarding the use of S. boulardii in the
treatment of acute infectious diarrhea with relevant studies that searched with the PubMed, Embase, Scopus,
Google Scholar, the Cochrane Controlled Trials Library, and the Cochrane Database of Systematic Reviews through
October 2011. This review describes the effects of S. boulardii on the duration of diarrhea, the risk of diarrhea during
the treatment (especially at the third day) and duration of hospitalization in patients with acute infectious diarrhea.
This review also focused on the potential effects of S. boulardii for acute infectious diarrhea due to different
etiological causes. Expert opinion: S. boulardii significantly reduced the duration of diarrhea approximately 24 h and
that of hospitalization approximately 20 h. S. boulardii shortened the initial phase of watery stools; mean number of
stools started to decrease at day 2; moreover, a significant reduction was reported at days 3 and 4. This systematic
review and meta-analysis of the efficacy of S. boulardii in the treatment of acute infectious diarrhea show that there
is strong evidence that this probiotic has a clinically significant benefit, whatever the cause, including in developing
countries. Therefore, with S. boulardii, the shortened duration of diarrhea and the reduction in hospital stay result in
social and economic benefits. 2012 Informa UK, Ltd.
arts-based interventions, which aim to foster understanding of the patient's perspective and to enhance
communication skills, have been part of the medical curriculum for several years. This review aims to evaluate the
available evidence base for their effectiveness and to suggest the nature of future work. the MEDLINE, Google
Scholar and ISI Web of Knowledge databases were searched for published articles on studies that have attempted to
evaluate the efficacy of an arts-based approach in undergraduate medical education. Further articles were identified
through cross-referencing, discussion with colleagues and hand-searching key journals. One mixed, 10 qualitative
and four quantitative studies were reviewed. some studies claim that arts-based interventions are effective in
altering attitudes, but poor descriptions of methodology and results make it difficult to judge these claims. No
studies consider the effects on behaviour. The evidence base for using arts-based interventions to foster diagnostic
observation skills is stronger. However, their effect on other clinical skills has not been studied. there is a need for
further studies to produce a rigorous evaluation of arts-based interventions in terms of their effects on attitudes,
behaviour and technical skills other than those involved in observation.
Purpose. To examine the effectiveness of patient-centered care (PCC) models, which incorporate a cultural
competence (CC) perspective, in improving health outcomes among culturally and linguistically diverse patients. Data
sources. The search included seven EBSCO-host databases: Academic Search Complete, Academic Search Premier,
CINAHL with Full Text, Global Health, MEDLINE with Full Text, PsycINFO PsycARTICLES, PsycEXTRA, Psychology and
Behavioural Sciences Collection and Pubmed, Web of Knowledge and Google Scholar. Study selection. The review
was undertaken following the preferred reporting items for systematic reviews and meta-analyses, and the critical
appraisals skill program guidelines, covering the period from January 2000 to July 2011. Data extraction. Data were
extracted from the studies using a piloted form, including fields for study research design, population under study,
setting, sample size, study results and limitations. Results of data synthesis. The initial search identified 1450
potentially relevant studies. Only 13 met the inclusion criteria. Of these, 11 were quantitative studies and 2 were
qualitative. The conclusions drawn from the retained studies indicated that CC PCC programs increased practitioners'
knowledge, awareness and cultural sensitivity. No significant findings were identified in terms of improved patient
health outcomes. Conclusion. PCC models that incorporate a CC component are increased practitioners' knowledge
about and awareness of dealing with culturally diverse patients. However, there is a considerable lack of research
looking into whether this increase in practitioner knowledge translates into better practice, and in turn improved
patient-related outcomes. More research examining this specific relationship is, thus, needed. The Author 2013.
Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights
reserved.
PURPOSE: To examine the effectiveness of patient-centered care (PCC) models, which incorporate a cultural
competence (CC) perspective, in improving health outcomes among culturally and linguistically diverse patients.,
DATA SOURCES: The search included seven EBSCO-host databases: Academic Search Complete, Academic Search
Premier, CINAHL with Full Text, Global Health, MEDLINE with Full Text, PsycINFO PsycARTICLES, PsycEXTRA,
Psychology and Behavioural Sciences Collection and Pubmed, Web of Knowledge and Google Scholar., STUDY
SELECTION: The review was undertaken following the preferred reporting items for systematic reviews and meta-
analyses, and the critical appraisals skill program guidelines, covering the period from January 2000 to July 2011.
Data extraction Data were extracted from the studies using a piloted form, including fields for study research design,
population under study, setting, sample size, study results and limitations., RESULTS OF DATA SYNTHESIS: The initial
search identified 1450 potentially relevant studies. Only 13 met the inclusion criteria. Of these, 11 were quantitative
studies and 2 were qualitative. The conclusions drawn from the retained studies indicated that CC PCC programs
increased practitioners' knowledge, awareness and cultural sensitivity. No significant findings were identified in
terms of improved patient health outcomes., CONCLUSION: PCC models that incorporate a CC component are
increased practitioners' knowledge about and awareness of dealing with culturally diverse patients. However, there
is a considerable lack of research looking into whether this increase in practitioner knowledge translates into better
practice, and in turn improved patient-related outcomes. More research examining this specific relationship is, thus,
needed.
Background: Low-dye taping used commonly to treat plantar fasciitis for heel pain has been considered in the past as
inflammation of the plantar fascia or a complaint of heel pain, is now considered as an unknown pathology and
plantar fascious which is micro tears of the medial column of the plantar fascia, Merck Manual 2007. Objective: To
assess the evidence for the effectiveness of low-dye taping for the treatment of pain in the plantar aspect of the
heel, over a short period of time. Methods: A systematic review of published literature. Electronic search of
databases of clinical trials, included Medline, Cochrane Library, CINHAL, Pub Med, PEDRo and Google Scholar. An
assessment of the quality of studies was conducted using the NHMRC (National Health and Medical Research
Council) Hierarchy of evidence, due to the limitation of articles we were required to use the McMasters Critical
Appraisal Tool to evaluate the low hierarchy studies appropriately. Foreign language papers were excluded. Results:
Two randomised controlled trials were included in the review. These evaluated the improvement of pain for the
short term by using low-dye taping for a period of a week. Using the visual analogue scale (VAS), it was reported that
there was an improvement in pain at the final outcome measure. Even though, the other three studies were
regarded as lowevidence, they reported improvement in pain scores at the final outcome measure. The sample sizes
and concealment of treatment allocation to the study population were considered weak, possibly preventing the
researchers to state that lowdye taping is effective in treating plantar fasciitis. Conclusion: Plantar fasciitis is a topic
discussed, written and researched in abundance. The few randomised controlled trials involve small sample sizes and
there is inconclusive evidence of the effectiveness of low-dye taping especially as the techniques have been modified
from the original 'Dye rest strap'.
STUDY DESIGN: Systematic review of randomized clinical trials., OBJECTIVE: Review of current literature regarding
the effectiveness of manual therapy in the treatment of cervical radiculopathy., BACKGROUND: Cervical
radiculopathy (CR) is a clinical condition frequently encountered in the physical therapy clinic. Cervical radiculopathy
is a result of space occupying lesions in the cervical spine: either cervical disc herniations, spondylosis, or
osteophytosis. These affect the pain generators of bony and ligamentous tissues, producing radicular symptoms (i.e.
pain, numbness, weakness, paresthesia) observed in the upper extremity of patients with cervical nerve root
pathology. Cervical radiculopathy has a reported annual incidence of 83.2 per 100000 and an increased prevalence in
the fifth decade of life among the general population., RESULTS: Medline and CINAHL via EBSCO, Cochrane Library,
and Google Scholar were used to retrieve the randomized clinical trial studies for this review between the years of
1995 and February of 2011. Four studies met inclusion criteria and were considered to be high quality (PEDro scores
of 5). Manual therapy techniques included muscle energy techniques, non-thrust/thrust manipulation/mobilization
of the cervical and/or thoracic spine, soft-tissue mobilization, and neural mobilization. In each study, manual therapy
was either a stand-alone intervention or part of a multimodal approach which included therapeutic exercise and
often some form of cervical traction. Although no clear cause and effect relationship can be established between
improvement in radicular symptoms and manual therapy, results are generally promising., CONCLUSION: Although a
definitive treatment progression for treating CR has not been developed a general consensus exists within the
literature that using manual therapy techniques in conjunction with therapeutic exercise is effective in regard to
increasing function, as well as AROM, while decreasing levels of pain and disability. High quality RCTs featuring
control groups are necessary to establish clear and effective protocols in the treatment of CR.
Study design: Systematic review of randomized clinical trials. Objective: Review of current literature regarding the
effectiveness of manual therapy in the treatment of cervical radiculopathy. Background: Cervical radiculopathy (CR)
is a clinical condition frequently encountered in the physical therapy clinic. Cervical radiculopathy is a result of space
occupying lesions in the cervical spine: either cervical disc herniations, spondylosis, or osteophytosis. These affect
the pain generators of bony and ligamentous tissues, producing radicular symptoms (i.e. pain, numbness, weakness,
paresthesia) observed in the upper extremity of patients with cervical nerve root pathology. Cervical radiculopathy
has a reported annual incidence of 83.2 per 100 000 and an increased prevalence in the fifth decade of life among
the general population. Results: Medline and CINAHL via EBSCO, Cochrane Library, and Google Scholar were used to
retrieve the randomized clinical trial studies for this review between the years of 1995 and February of 2011. Four
studies met inclusion criteria and were considered to be high quality (PEDro scores of >5). Manual therapy
techniques included muscle energy techniques, non-thrust/thrust manipulation/mobilization of the cervical and/or
thoracic spine, soft-tissue mobilization, and neural mobilization. In each study, manual therapy was either a stand-
alone intervention or part of a multimodal approach which included therapeutic exercise and often some form of
cervical traction. Although no clear cause and effect relationship can be established between improvement in
radicular symptoms and manual therapy, results are generally promising. Conclusion: Although a definitive treatment
progression for treating CR has not been developed a general consensus exists within the literature that using
manual therapy techniques in conjunction with therapeutic exercise is effective in regard to increasing function, as
well as AROM, while decreasing levels of pain and disability. High quality RCTs featuring control groups are necessary
to establish clear and effective protocols in the treatment of CR. W. S. Maney & Son Ltd 2011.
Introduction and hypothesis Mixed urinary incontinence (MUI) is a coexistence of stress (SUI) and urgency urinary
incontinence (UUI). There is conflicting evidence on the effectiveness of midurethral slings (MUS) in this condition.
The objective of this study is to evaluate the effectiveness of MUS in women with MUI by systematic review of the
literature. Methods Systematic literature search was carried (June 2010) using relevant search terms in Medline,
EMBASE, CENTRAL and Google Scholar. Relevant randomised controlled trials (RCT) and prospective studies were
selected and then analysed by two independent reviewers. Meta-analysis was performed with random effects model
using STATA 8. Results There were six randomised trials and seven prospective studies with average to good quality
included in this systematic review. There was heterogeneity in outcomes reported. The overall subjective cure from
seven prospective nonrandomised studies that included patients with symptomatic+/- urodynamically proven MUI
was found to be 56.4% (95% confidence interval 45.7-69.6%) at 34.9+/-22.9 months follow-up. The overall cure of
urgency and UUI component was 30-85%at a follow-up of few months up to 5 years.Most of the studies described
that this cure does not persist over the time. The cure rate of SUI following MUS varies from85%to 97%. On meta-
analysis of five RCTs which included women with MUI symptoms, the odds of overall subjective cure with TVT versus
transobturator tapes are similar at 6-33 months follow-up (OR, 0.9; 95% CI, 0.63-1.27). This was true when a
subgroup analysis was performed on women with MUI who were negative for DO on UDS (OR, 1.21; 95% CI, 0.7-
2.08) Conclusions There is evidence of persistent and good cure of stress component following MUS in women with
MUI. The cure of the urge component is variable but less than stress component. Methodologically sound RCTs of
retropubic and transobturator tapes with long-term follow-up are needed specifically for women with
urodynamically proven and symptomatic mixed incontinence. The International Urogynecological Association 2011.
Objective: To evaluate the effectiveness of midurethral slings in women with mixed urinary incontinence (MUI) by
systematic review of the literature and meta-analysis. Methods: Systematic literature search was carried (up to
February 2010) using relevant search terms in Medline, EMBASE, CENTRAL and Google Scholar. Relevant randomised
controlled trials (RCT) & prospective studies were selected and data was collated by two independent reviewers.
Main results: There was 6 randomized trial and 7 prospective studies with average to good quality included. There
was heterogeneity in outcomes reported. The overall subjective cure from 7 prospective studies was found to be
56.4% (95% confidence interval 45.7-69.6%) at 34.9+/- 22.9 months follow up. The overall cure of UUI component
was 30-85% at a follow-up of few months up to 5 years. Most of the studies described that this cure does not persist
over the time. The cure rate of SUI following MUS varies from 85% to 97%. Long-term follow-up revealed persistent
cure of stress component over time. The follow up period for the RCTs varied between 6-31 months. The odds ratio
for overall cure of symptomatic MUI with or without USI+DO confirmed on UDS (5 studies, 641 women), was similar
in women who underwent TVT vs. TOT (OR 0.96; 95% CI 0.42-2.13). Conclusion: The midurethral slings (TVT vs. TOT)
offer similar overall cure in MUI. The evidence from nonrandomized studies suggests, persistent and good cure of
stress component & the cure of the urge component is variable but less than stress component.
Introduction and hypothesis: Midurethral slings (MUS) are the gold standard primary procedure for the surgical
treatment of stress urinary incontinence (SUI). There is no robust evidence on the success with MUS in the treatment
of recurrent SUI. Our objective was to evaluate the effectiveness and complications of MUS in women with recurrent
SUI by systematic review and meta-analysis of the literature. Methods: A systematic literature search was carried out
(up to August 2011) using relevant search terms in MEDLINE, EMBASE, CENTRAL and Google Scholar. Relevant
randomised controlled trials (RCT) and prospective studies were selected and then analysed by two independent
reviewers. Meta-analysis of cure stated in prospective cohort studies was performed with a random effects model
using Stata 8. Results: There was 1 randomised trial and 11 good quality prospective studies included in this
systematic review. The overall subjective cure rate per meta-analysis of prospective cohort studies following MUS for
recurrent SUI after any previous surgery was found to be 78.5 % [95 % confidence interval (CI) 69-88] at the follow-
up of 29.72+/-29.49 months. The subjective cure rate following MUS after previous failed MUS was 73.3 % (95 % CI
55-97) at the follow-up of 15.7+/- 7.7 months. Conclusions: The studies report good cure rates of SUI after MUS
surgery following previous incontinence surgery (62-100 %). There seems to be a lower cure rate with trans-
obturator compared to the retropubic tape for recurrent SUI after previous surgery. The International
Urogynecological Association 2012.
Background: Unintentional falls are particularly prevalent among older people and constitute a public health
concern. Not much is known about the implications of multifaceted intervention programs implemented in
residential care settings. Objectives: To evaluate the effectiveness of multifaceted intervention programs in reducing
the number of falls, fallers, recurrent fallers, and injurious falls among older people living in residential care facilities.
Search strategy: Comprehensive searches of Medline, PubMed, and EMBASE up to July 2007, the cited literature lists
of each included study, and the internet engines Google Scholar, Yahoo, and Dogpile were performed to identify
eligible studies. Selection criteria: Eligible studies for this review were those that had randomized, controlled trials
with adequate follow-up study components in their design. Studies that included elderly people in residential care
who participated in multifaceted falls-prevention programs were included. Data collection and analysis: Two authors
independently extracted the necessary data. Studies were assessed for quality by the criteria of Downs and Black.
The results of the included studies have been reviewed narratively. Main results: From 21 articles potentially
relevant to the topic, five studies met the inclusion criteria and all were reasonably well conducted. Three reported
significant reductions in the number of recurrent fallers, two reported significant reductions in the number of falls,
and one reported significant reductions in the number of fallers. One other reported a reduction in the number of
injurious falls in those who received the multifaceted prevention program compared with the control group.
However, the analyses of this specific study were not based on intent-to-treat, so the effect of intervention on the
number of injurious falls remains inconclusive. No study reported on adverse events, costs, or sustainability of the
interventions. Conclusions: Multifaceted programs that encompass a wide range of intervention strategies have
shown some evidence of efficacy. However, more well-designed research is required that assesses effects on
injurious falls, quality of life, cost-effectiveness, and sustainability.
Objective Tissue-specific stem cells divide to generate different cell types for the purpose of tissue repair in the
adult. The aim of this study was to detect the significance of neurogenesis in the central nervous system in patients
with cerebral palsy (CP). Materials & Methods A search was made in Medline, CINAHL, PubMed, ISI Web of Science
and Google Scholar from 1995 to February 2011. The outcomes measured in the review were classified to origins,
proliferation, and migration of new neurons, and neurogenesis in CP. Results According to the review of articles,
neurogenesis persists in specific brain regions throughout lifetime and can be enhanced from endogenous progenitor
cells residing in the subventricular zone by growth factors or neurotrophic factors and rehabilitation program.
Conclusion Most of the studies have been conducted in the laboratory and on animals, more work is required at the
basic level of stem cell biology, in the development of human models, and finally in well-conceived clinical trials.
Introduction: The aim of this study was to analyze the current literature for the best evidence (randomized clinical
trials) about the efficacy of functional appliances on mandibular growth in the short term. Methods: A survey of
articles published up to September 2009 was performed by using the following electronic databases: PubMed,
Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, and Google Scholar.
The reference lists of the retrieved articles were hand-searched for possible missing articles. No language restriction
was applied during the identification of the published studies. A methodologic scoring process was developed to
identify which randomized clinical trials were stronger methodologically. The selection process and the quality
assessment were undertaken independently and in duplicate by 2 authors. A meta-analysis was attempted by using
random-effects models. Clinical and statistical heterogeneity was examined, and a sensitivity analysis was
performed. Results: Electronic searches identified the following items: 146 articles were retrieved from PubMed, 45
from Cochrane Central Register of Controlled Trials, 29 from Ovid, 42 from LILACS, 628 from Web of Science, and
1000 from Google Scholar. Thirty-two articles fulfilled the specific inclusion criteria and were identified as potentially
appropriate randomized clinical trials to be included in this meta-analysis. Only 4 articles, based on data from 338
patients (168 treated vs 170 controls) with Class II malocclusion in the mixed dentition, were selected for the final
analysis. The quality analysis of these studies showed that the statistical methods were at the medium-high level.
The outcome measurements chosen to evaluate the efficacy of the various functional appliances were Co-Pg, Pg/Olp
+ Co/Olp, and Co-Gn and the values were annualized and standardized to a uniform scale with the standardized
mean differences (SMD). The results of the meta-analysis from the random-effects model showed a statistically
significant difference of 1.79 mm in annual mandibular growth of the treatment group compared with the control
group (SMD = 0.61, 95% CI, 0.30 to -0.93; chi-square test, 5.34; 3 df; P = 0.15; I2 = 43.9%; test for overall effect, Z =
3.83 and P = 0.0001). The sensitivity analysis showed a substantially similar outcome of 1.91 mm (SMD = 0.65, 95%
CI, 0.25 to 1.25; chi-square test, 4.96; 2 df; P = 0.08; I2 = 59.7%; test for overall effect, Z = 3.19 and P = 0.001).
Conclusions: The analysis of the effect of treatment with functional appliances vs an untreated control group showed
that skeletal changes were statistically significant, but unlikely to be clinically significant. Copyright 2011 by the
American Association of Orthodontists.
Aim To evaluate the effectiveness of posterior percutaneous tibial nerve stimulation (PTNS) in treating overactive
bladder (OAB) symptoms by systematic review of the literature. Methods Systematic literature search was carried
out (up to April 2011) using relevant search terms in Medline, EMBASE, CINAHL, CENTRAL, National Library for
Health, MetaRegister of controlled trials, LILACS, and Google Scholar. Relevant randomized controlled trials (RCTs)
and prospective studies were selected and then analyzed by two-independent reviewers. Meta-analysis was
performed with random effects model using STATA 8 for non-randomized prospective studies and with Review
Manager 5.1 for RCTs. Results The studies report variable initial success rates (37-82%) for treating OAB symptoms
with PTNS. Four randomized trials compared PTNS with Sham treatment showing a significant difference favoring
PTNS [RR 7.02 95% confidence interval (CI) 1.69-29.17]. Two randomized trials compared PTNS with antimuscarinic
medication with no significant difference in the change in bladder diary parameters between the treatments. Ten
prospective non-randomized studies were included. The definitions of success were varied. The pooled subjective
success rate was 61.4% (95% CI 57.5-71.8) and objective success rate was 60.6% (95% CI 49.2-74.7). Conclusion
There is evidence of significant improvement in OAB symptoms using PTNS which is comparable to the effect of
antimuscarinics but with a better side effect profile. The studies included in the review only considered short-term
outcomes after initial treatment. In order to recommend PTNS as a practical treatment option, long-term data and
health economic analysis are needed. Neurourol. Urodynam. 31:1206-1216, 2012. 2012 Wiley Periodicals, Inc.
Background: Positron emission tomography (PET) scan is a non-invasive, complicated and expensive medical imaging
technology used for diagnosis and treatment of various diseases including cancers. This study aimed to evaluate the
safety and effectiveness of this technology. Methods: The major medical electronic databases including Cochrane
Library, Google Scholar, MEDLINE and Iran Medex were searched. The studies that compared PET-scan with other
diagnostic methods in terms of sensitivity, specificity and safety were considered in this review. Findings: PET-scan
has been found to be a non-invasive and safe procedure for diagnosing metastatic NSCLC with a sensitivity and
specificity of 74-95% and 81-97%, respectively. On the other hand, the sensitivity and specificity of computed
tomography (CT) scan have been reported as 60-67% and 73-77%, respectively. The corresponding values for
mediastinoscopy have been 78% and 100%. In lymphoma, the specificity and sensitivity of PET-scan (90% and 79-
100%, respectively) have been higher than those of gamma scan. Although PET-scan is not an appropriate method
for screening and diagnosis of cancer, it can contribute to staging and follow-up processes in cases of NSCLC and
lymphoma. This technology adds 0.046 years (about 17 days) to the patient's life. Conclusion: PET-scan is a safe
technology that has better diagnostic performance in comparison with similar technologies. The application of this
method in staging and follow-up of NSCLC and lymphoma can prevent unnecessary surgeries and add a few years to
the lives of patients.
OBJECTIVE: To determine whether interventions tailored specifically to particular immigrant groups from developing
to developed countries decrease the risk of obesity and obesity-related diseases. DESIGN: Databases searched were
MEDLINE (1966-September 2008), CINAHL (1982-September 2008) and PsychINFO (1960-September 2008), as well
as Sociological Abstracts, PsychARTICLES, Science Direct, Web of Knowledge and Google Scholar. Studies were
included if they were randomised control trials, 'quasi-randomised' trials or controlled before-and-after studies. Due
to the heterogeneity of study characteristics only a narrative synthesis was undertaken, describing the target
population, type and reported impact of the intervention and the effect size. RESULTS: Thirteen studies met the
inclusion criteria. Ten out of thirteen (77 %) studies focused on diabetes, seven (70 %) of which showed significant
improvement in addressing diabetes-related behaviours and glycaemic control. The effect on diabetes was greater in
culturally tailored and facilitated interventions that encompassed multiple strategies. Six out of the thirteen studies
(46 %) incorporated anthropometric data, physical activity and healthy eating as ways to minimise weight gain and
diabetes-related outcomes. Of the six interventions that included anthropometric data, only two (33 %) reported
improvement in BMI Z-scores, total skinfold thickness or proportion of body fat. Only one in three (33 %) of the
studies that included cardiovascular risk factors reported improvement in diastolic blood pressure after adjusting for
baseline characteristics. All studies, except four, were of poor quality (small sample size, poor internal consistency of
scale, not controlling for baseline characteristics). CONCLUSIONS: Due to the small number of studies included in the
present review, the findings that culturally tailored and facilitated interventions produce better outcomes than
generalised interventions, and that intervention content is more important than the duration or venue, require
OBJECTIVE: To determine whether interventions tailored specifically to particular immigrant groups from developing
to developed countries decrease the risk of obesity and obesity-related diseases., DESIGN: Databases searched were
MEDLINE (1966-September 2008), CINAHL (1982-September 2008) and PsychINFO (1960-September 2008), as well
as Sociological Abstracts, PsychARTICLES, Science Direct, Web of Knowledge and Google Scholar. Studies were
included if they were randomised control trials, 'quasi-randomised' trials or controlled before-and-after studies. Due
to the heterogeneity of study characteristics only a narrative synthesis was undertaken, describing the target
population, type and reported impact of the intervention and the effect size., RESULTS: Thirteen studies met the
inclusion criteria. Ten out of thirteen (77 %) studies focused on diabetes, seven (70 %) of which showed significant
improvement in addressing diabetes-related behaviours and glycaemic control. The effect on diabetes was greater in
culturally tailored and facilitated interventions that encompassed multiple strategies. Six out of the thirteen studies
(46 %) incorporated anthropometric data, physical activity and healthy eating as ways to minimise weight gain and
diabetes-related outcomes. Of the six interventions that included anthropometric data, only two (33 %) reported
improvement in BMI Z-scores, total skinfold thickness or proportion of body fat. Only one in three (33 %) of the
studies that included cardiovascular risk factors reported improvement in diastolic blood pressure after adjusting for
baseline characteristics. All studies, except four, were of poor quality (small sample size, poor internal consistency of
scale, not controlling for baseline characteristics)., CONCLUSIONS: Due to the small number of studies included in the
present review, the findings that culturally tailored and facilitated interventions produce better outcomes than
generalised interventions, and that intervention content is more important than the duration or venue, require
Introduction: Probiotics are 'live microorganisms' that are able to promote good health through establishing a
balance in intestinal micro flora and through its immuneregulatory effects, it's use in the prevention or treatment of
certain diseases have been reported in many studies. Purpose: To conduct a review in order to determine the
effectiveness of Probiotics in health and diseases of Children. Materials and methods: The review was conducted on
various published reports on double-blind, placebo-controlled trials and papers related to the use of Probiotics in
Children. To identify the original trials, search was made in MEDLINE, PUBMED, GOOGLE SCHOLAR, EBSCOHOST,
COCHRANE LIBRARY databases and the retrieved articles were screened to meet the inclusion criteria. All the
selected studies were conducted between 1900 and 2010. Results: Viable Bifidobacterium lactis Bb12, added to
acidified infant formula, was found to have protective effects against acute diarrhoea in healthy children. Clinically
significant benefit of Probiotics was observed in the treatment of acute infectious diseases, particularly in rota viral
gastroenteritis. Lactobacillus GG showed most consistent effect. The overall analysis of the included studies suggests
that probiotics are efficacious in preventing acute diarrhoea showing a reduction of at least 21%.Effectiveness in
treatment and/or prevention of probiotics was also seen in antibiotic associated diarrhoea and Clostridium difficile
infections, necrotizing entero-colitis, allergic diseases and inflammatory bowel disorders. Probiotics mixtures were
also reported to reduce symptoms of constipation. Conclusions: Probiotics might function as 'surrogate' for adequate
colonization and help to prevent and/or treat certain clinical diseases.
The aim of this study was to provide a systematic review of studies that investigated the effectiveness of robot-
assisted therapy on ankle motor and function recovery from musculoskeletal or neurologic ankle injuries. Thirteen
electronic databases of articles published from January, 1980 to June, 2012 were searched using keywords 'ankle*',
'robot*', 'rehabilitat*' or 'treat*' and a free search in Google Scholar based on effects of ankle rehabilitation robots
was also conducted. References listed in relevant publications were further screened. Eventually, twenty-nine
articles were selected for review and they focused on effects of robot-assisted ankle rehabilitation. Twenty-nine
studies met the inclusion criteria and a total of 164 patients and 24 healthy subjects participated in these trials. Ankle
performance and gait function were the main outcome measures used to assess the therapeutic effects of robot-
assisted ankle rehabilitation. The protocols and therapy treatments were varied, which made comparison among
different studies difficult or impossible. Few comparative trials were conducted among different devices or control
strategies. Moreover, the majority of study designs met levels of evidence that were no higher than American
Academy for Cerebral Palsy (CP) and Developmental Medicine (AACPDM) level IV. Only one study used a Randomized
Control Trial (RCT) approach with the evidence level being II. All the selected studies showed improvements in terms
of ankle performance or gait function after a period of robot-assisted ankle rehabilitation training. The most effective
robot-assisted intervention cannot be determined due to the lack of universal evaluation criteria for various devices
and control strategies. Future research into the effects of robot-assisted ankle rehabilitation should be carried out
based on universal evaluation criteria, which could determine the most effective method of intervention. It is also
essential to conduct trials to analyse the differences among different devices or control strategies.
OBJECTIVE: To evaluate the effectiveness of temporary anchorage device (TAD)-anchored maxillary protraction (MP)
in terms of the skeletal and dentoalveolar changes and to compare it with traditional tooth-anchored MP.,
MATERIALS AND METHODS: A computerized literature search for relative randomized controlled trials and
prospective controlled trials was performed in PubMed, MEDLINE, Cochrane Central Register of Controlled Trials,
Embase, CNKI, and Google Scholar, complemented with manual search. Data extraction and quality assessment were
carried out by two reviewers independently. Meta-analysis was followed when possible; otherwise, description was
done., RESULTS: Forty articles were found, among which four trials were qualified for meta-analysis. The results
showed that there was significant difference between TAD-anchored MP and untreated control in terms of maxillary
advancement (weighted mean differences (WMD) 3.08 mm; 95% CI: 1.61 to approximately 4.56; P < .0001), but
there were no consistent points in terms of mandibular rotation. Also, there were significant differences between
both treatment patterns regarding maxillary advancement (WMD 1.41 mm; 95% CI: 0.47 to approximately 2.35; P =
.003), mandibular rotation (WMD -1.39, 95% CI: -2.47 to approximately -0.31; P = .01), proclination of maxillary
incisors (WMD -2.29; 95% CI: -4.41 to approximately -0.17; P = .03), and extrusion of maxillary molars (WMD -1.68
mm; 95% CI: -2.51 to approximately -0.85; P < .0001)., CONCLUSIONS: According to the present results, TAD-
anchored MP might have a greater maxillary advancement effect and might reduce skeletal and dental side effects,
compared with tooth-anchored MP.
Objective: To evaluate the effectiveness of temporary anchorage device (TAD)-anchored maxillary protraction (MP)
in terms of the skeletal and dentoalveolar changes and to compare it with traditional tooth-anchored MP. Materials
and Methods: A computerized literature search for relative randomized controlled trials and prospective controlled
trials was performed in PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Embase, CNKI, and Google
Scholar, complemented with manual search. Data extraction and quality assessment were carried out by two
reviewers independently. Meta-analysis was followed when possible; otherwise, description was done. Results: Forty
articles were found, among which four trials were qualified for meta-analysis. The results showed that there was
significant difference between TAD-anchored MP and untreated control in terms of maxillary advancement
(weighted mean differences (WMD) 3.08 mm; 95% CI: 1.61 to approximately 4.56; P < .0001), but there were no
consistent points in terms of mandibular rotation. Also, there were significant differences between both treatment
patterns regarding maxillary advancement (WMD 1.41 mm; 95% CI: 0.47 to approximately 2.35; P = .003),
mandibular rotation (WMD -1.39degree, 95% CI: -2.47 to approximately -0.31; P = .01), proclination of maxillary
incisors (WMD -2.29degree; 95% CI: -4.41 to approximately -0.17; P = .03), and extrusion of maxillary molars (WMD -
1.68 mm; 95% CI: -2.51 to approximately -0.85; P < .0001). Conclusions: According to the present results, TAD-
anchored MP might have a greater maxillary advancement effect and might reduce skeletal and dental side effects,
compared with toothanchored MP. 2012 by The EH Angle Education and Research Foundation, Inc.
Objective To examine whether genetic testing for smoking-related diseases benefits smoking cessation. Data sources
PubMed, EMBASE, ERIC, PsycINFO, PsychArticles, CiNAHL and socINDEX databases, the search engine Google
Scholar, and key-author and reference list searches. Study selection Randomised controlled smoking cessation
interventions using genetic testing for smoking-related diseases. Data extraction Consistent with the Cochrane
guidelines, two reviewers completed the review process (initial n=139) in three phases, title selection (n=56),
abstract selection (n=28) and whole paper selection (n=9). From these nine studies, each reviewer extracted
information about outcome measures and statistical and methodological quality. Data synthesis Relevant data were
abstracted from included papers and were subsequently subjected to meta-analysis. Results Interest in genetic
testing was relatively high with 60-80% of smokers reporting to be interested. The authors observed positive short-
term effects on risk perception, motivation to quit smoking and smoking cessation, but these effects fade at longer
follow-ups. Importantly, the authors did not find any evidence of adverse effect of testing negative on the risk-
predisposing gene. Conclusions This systematic review does not provide solid evidence for the proposed beneficial
effects of genetic testing for smoking-related diseases on smoking cessation, but does suggest the presence of an
immediate motivational effect, such that genetic testing resulted in higher risk perception and more motivation to
quit smoking.
Objective: To assess the effectiveness of short-wave diathermy (SWD) treatment in the management of knee
osteoarthritis (KOA) and to assess whether the effects are related to the induction of a thermal effect. Methods: A
systematic literature search was conducted in PubMed, CINAHL, PEDro, EMBASE, SPORTdiscus and Scholar Google.
Included were trials that compared the use of SWD treatment in patients diagnosed with KOA with a control group
(placebo SWD treatment or no intervention) and studies that used high-frequency electromagnetic energy (i.e.,
27.12 MHz) with sufficient information regarding treatment dosage. Methodological quality of the included studies
was assessed in accordance with the PEDro classification scale. A minimum of a 6/10 score was required for
inclusion. Results: Seven studies were included in the final analysis. Treatment protocols (dosage, duration, number
of treatments) varied extensively between studies. The meta-analysis of the studies with low mean power did not
favour SWD treatment for pain reduction, while the results of studies employing some thermal effect were
significant. No treatment effect on functional performance measures was determined. Conclusion: This meta-
analysis found small, significant effects on pain and muscle performance only when SWD evoked a local thermal
sensation. However, the variability in the treatment protocols makes it difficult to draw definitive conclusions about
the factors determining the effectiveness of SWD treatment. More research (using comparable protocols and
outcome measurements) is needed to evaluate possible long-term effects of thermal SWD treatment and its cost
effectiveness in patients with KOA. 2012 Osteoarthritis Research Society International.
Objective: To examine the efficacy of yoga therapy as a complementary treatment for psychiatric disorders such as
schizophrenia, depression, anxiety, and posttraumatic stress disorder (PTSD). Data Sources: Eligible trials were
identified by a literature search of PubMed/MEDLINE, Cochrane Control Trials Register, Google Scholar, and EBSCO
on the basis of criteria of acceptable quality and relevance. The search was performed using the following terms:
yoga for schizophrenia, yoga for depression, yoga for anxiety, yoga for PTSD, yoga therapy, yoga for psychiatric
disorders, complementary treatment, and efficacy of yoga therapy. Trials both unpublished and published with no
limitation placed on year of publication were included; however, the oldest article included in the final meta-analysis
was published in 2000. Study Selection: All available randomized, controlled trials of yoga for the treatment of
mental illness were reviewed, and 10 studies were eligible for inclusion. As very few randomized, controlled studies
have examined yoga for mental illness, this meta-analysis includes studies with participants who were diagnosed
with mental illness, as well as studies with participants who were not diagnosed with mental illness but reported
symptoms of mental illness. Trials were excluded due to the following: (1) insufficient information, (2) inadequate
statistical analysis, (3) yoga was not the central component of the intervention, (4) subjects were not diagnosed with
or did not report experiencing symptoms of one of the psychiatric disorders of interest (ie, schizophrenia,
depression, anxiety, and PTSD), (5) study was not reported in English, and (6) study did not include a control group.
Data Extraction: Data were extracted on participant diagnosis, inclusion criteria, treatment and control groups,
duration of intervention, and results (pre-post mean and standard deviations, t values, and f values). Number, age,
and sex ratio of participants were also obtained when available. Data Synthesis: The combined analysis of all 10
studies provided a pooled effect size of -3.25 (95% CI, -5.36 to -1.14; P=.002), indicating that yoga-based
interventions have a statistically significant effect as an adjunct treatment for major psychiatric disorders. Findings in
support of alternative and complementary interventions may especially be an aid in the treatment of disorders for
which current treatments are found to be inadequate or to carry severe liabilities. Conclusions: As current
psychopharmacologic interventions for severe mental illness are associated with increased risk of weight gain as well
as other metabolic side effects that increase patients' risk for cardiovascular disease, yoga may be an effective, far
less toxic adjunct treatment option for severe mental illness. Copyright 2011 Physicians Postgraduate Press, Inc.
PURPOSE: Bacterial eye infections are commonly treated with topical antibiotics, despite limited evidence of
effectiveness. Azithromycin 1% in DuraSite((R)) is a new formulation of azithromycin in a gel polymer designed for
use in acute bacterial conjunctivitis., METHODS: We conducted systematic searches of the Cochrane Database of
Clinical Trials, PubMed and Google Scholar to find randomized controlled trials of "azithromycin DuraSite((R))". These
searches of published literature were supplemented with searches for unpublished trials and trials in progress.,
RESULTS: We found six reports of randomized controlled trials investigating the role of azithromycin 1% in
DuraSite((R)) for the management of acute bacterial conjunctivitis. The quality of these trials was judged to be
moderate to high. These trials assessed effectiveness, tolerability and safety outcomes, but we found no trials
looking at cost-effectiveness. DuraSite((R)) is a relatively stable formulation and so azithromycin 1% in DuraSite((R))
has a simpler dosing schedule than other available topical antibiotics. It appears to be similar to other topical
antibiotics in its effectiveness, but minor side effects are quite common., CONCLUSION: Acute bacterial conjunctivitis
is a relatively mild, typically self-limiting, infection. Antibiotics should seldom be required. If, however, a decision to
prescribe antibiotics is made, azithromycin 1% in DuraSite((R)) is likely to be broadly comparable in its effectiveness
to most other antibiotics used to treat acute bacterial conjunctivitis. Further research is needed to determine its cost-
effectiveness.
Incorrect bicycle configuration may predispose athletes to injury and reduce their cycling performance. There is
disagreement within scientific and coaching communities regarding optimal configuration of bicycles for athletes.
This review summarizes literature on methods for determining bicycle saddle height and the effects of bicycle saddle
height on measures of cycling performance and lower limb injury risk. Peer-reviewed journals, books, theses and
conference proceedings published since 1960 were searched using MEDLINE, Scopus, ISI Web of Knowledge, EBSCO
and Google Scholar databases, resulting in 62 references being reviewed. Keywords searched included 'body
positioning', 'saddle', 'posture, 'cycling' and 'injury'. The review revealed that methods for determining optimal
saddle height are varied and not well established, and have been based on relationships between saddle height and
lower limb length (Hamley and Thomas, trochanteric length, length from ischial tuberosity to floor, LeMond, heel
methods) or a reference range of knee joint flexion. There is limited information on the effects of saddle height on
lower limb injury risk (lower limb kinematics, knee joint forces and moments and muscle mechanics), but more
information on the effects of saddle height on cycling performance (performance time, energy expenditure/oxygen
uptake, power output, pedal force application). Increasing saddle height can cause increased shortening of the vastii
muscle group, but no change in hamstring length. Length and velocity of contraction in the soleus seems to be more
affected by saddle height than that in the gastrocnemius. The majority of evidence suggested that a 5% change in
saddle height affected knee joint kinematics by 35% and moments by 16%. Patellofemoral compressive force seems
to be inversely related to saddle height but the effects on tibiofemoral forces are uncertain. Changes of less than 4%
in trochanteric length do not seem to affect injury risk or performance. The main limitations from the reported
studies are that different methods have been employed for determining saddle height, small sample sizes have been
used, cyclists with low levels of expertise have mostly been evaluated and different outcome variables have been
measured. Given that the occurrence of overuse knee joint pain is 50% in cyclists, future studies may focus on how
saddle height can be optimized to improve cycling performance and reduce knee joint forces to reduce lower limb
injury risk. On the basis of the conflicting evidence on the effects of saddle height changes on performance and
lower limb injury risk in cycling, we suggest the saddle height may be set using the knee flexion angle method (25-
30degree) to reduce the risk of knee injuries and to minimize oxygen uptake.
BACKGROUND: The current and projected crisis because of a shortage of health workers in low and middle-income
countries (LMICs) requires that effective strategies for expanding the numbers of health workers are quickly
identified in order to inform action by policymakers, educators, and health managers. OBJECTIVES: To assess the
effect of changes in the pre-licensure education of health professionals on health-worker supply. SEARCH STRATEGY:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 3),
EMBASE, Ovid (1980 to week 3, October 2007), MEDLINE, Ovid (1950 to week 3, October 2007), CINAHL (October
2007), LILACS (week 4, November 2007), ERIC (1966 to week 3, February 2008), and Sociological Abstracts (October
2007). We searched WHO (WHOLIS) (February 2008), World Bank, Google Scholar, and human resources on health-
related websites to obtain grey literature. Key experts in human resources for health were contacted to identify
unpublished studies. The reference lists of included studies were searched for additional articles. SELECTION
CRITERIA: Randomised controlled trials, non-randomised controlled trials, controlled before and after studies, and
interrupted time-series studies that measured increased numbers of health workers ultimately available for
recruitment into the health workforce or improved patient to health professional ratios as their primary outcomes
were considered. Although the focus of the review was on LMIC, we included studies regardless of where they were
done. DATA COLLECTION AND ANALYSIS: Heterogeneity between the two included studies precluded meta-analysis;
therefore, data were presented separately for each study. MAIN RESULTS: Two studies of the 7880 identified from
searching the electronic databases met the inclusion criteria. Both studies were controlled before and after studies,
of moderate to high risk of bias, that explored the effects of interventions to improve retention of minority groups in
health professional training institutions. These studies reported that an intervention comprising of a package of
student support activities including social, academic, and career guidance and mentorship resulted in an increase in
the number of minority students who enrolled and graduated from health training institutions. AUTHORS'
CONCLUSIONS: The evidence to estimate the likely effects of interventions in pre-licensure education to increase
health-worker supply is generally insufficient or unavailable, particularly in LMICs. Promising innovations from a high-
income country include providing financial support to health professional students or introducing mechanisms to
identify and encourage potential students and offering support to 'at risk' students. These and other promising
interventions should be evaluated in LMIC.
Importance: Creative arts therapies (CATs) can reduce anxiety, depression, pain, and fatigue and increase quality of
life (QOL) in patients with cancer. However, no systematic review of randomized clinical trials (RCTs) examining the
effects of CAT on psychological symptoms among cancer patients has been conducted. Objectives: To estimate the
effect of CAT on psychological symptoms andQOLin cancer patients during treatment and follow-up and to
determine whether the effect varied according to patient, intervention, and design characteristics. Evidence Review:
We searched ERIC, Google Scholar, MEDLINE, PsycInfo, PubMed, and Web of Science from database inception to
January 2012. Studies included RCTs in which cancer patients were randomized to a CAT or control condition and
anxiety, depression, pain, fatigue and/or QOL were measured pre- and post-intervention. Twenty-seven studies
involving 1576 patients were included. Weextracted data on effect sizes, moderators, and study quality. Hedges d
effect sizes were computed, and random-effects models were used to estimate sampling error and population
variance. Findings : During treatment, CAT significantly reduced anxiety (= 0.28 [95% CI, 0.11-0.44]), depression
(=0.23 [0.05-0.40]), and pain (=0.54 [0.33-0.75]) and increased QOL (= 0.50 [0.25-0.74]). Pain was significantly
reduced during follow-up (= 0.59 [95% CI, 0.42-0.77]). Anxiety reductions were strongest for studies in which (1) a
non-CAT therapist administered the intervention compared with studies that used a creative arts therapist and (2) a
waiting-list or usual-care comparison was used. Pain reductions were largest during inpatient treatment and for
homogeneous cancer groups in out-patient settings; significantly smaller reductions occurred in heterogeneous
groups in outpatient settings. Conclusions and Relevance: Exposure to CAT can improve anxiety, depression, and pain
symptoms and-QOL among cancer patients, but this effect is reduced during follow-up. 2013 American Medical
Association. All rights reserved.
Objective: Type 2 diabetes is a major public health problem. The Dietary Approaches to Stop Hypertension (DASH)
eating pattern may contribute to managing risk factors of type 2 diabetes. The objective of this study was to conduct
a systematic review and meta-analysis on randomized controlled trials (RCTs) that examine the effects of DASH diet
consumption on the indices of glycemic control such as fasting blood glucose (FBG), serum fasting insulin level, and
Homeostatic Model Assessment insulin resistance (HOMA-IR). Methods: We searched Pubmed, EMBASE, Science
direct, ISI web of science, and Google Scholar forRCTs until July 2012. In total we found 20 articles that examine the
effect of DASH diet on FBG (n=9), fasting insulin (n=7) and HOMA-IR (n=4) met the inclusion criteria, respectively.
Results: Meta-analysis showed that the DASH diet can significantly reduce fasting insulin concentration (mean
difference -0.15; 95% confidence interval [CI], -0.22 to -0.08; P<0.001). Subgroup analysis based on the study period
showed that the DASH diet could significantly reduce fasting insulin levels when prescribed for more than 16 wk
(mean difference -0.16; 95% CI, -0.23 to -0.08; P<0.001). Meta-analysis could not show a beneficial effect of the
DASH diet on FBG (mean difference -0.26; 95% CI, -0.56 to 0.05; P=0.1), and HOMA-IR (mean difference -0.26; 95%
CI, -0.56 to 0.05; P=0.1). Conclusions: The DASH dietary pattern may lead to an improvement in insulin sensitivity
independent of weight loss. The DASH diet may play an important role in glycemic control in long- term
interventions. Additional prospective studies regarding the association between DASH diet and risks for type 2
diabetes are necessary. 2013 Elsevier Inc.
OBJECTIVE: To provide a quantitative synthesis of randomized controlled trials examining the effect of exercise
training on symptomatic fatigue in persons with multiple sclerosis (MS). METHODS: Electronic databases (Web of
Science, PubMed, PsycInfo, and Google Scholar) were searched for articles published between 1960 and October
2012 by using the key words "fatigue," OR "tiredness," OR "energy," OR "mood," OR "lassitude," AND "exercise," OR
"physical activity," OR "rehabilitation," OR "fitness" WITH "multiple sclerosis." The initial search resulted in 311
articles, of which 74 were reviewed in detail and 17 met the inclusion criteria and provided enough data to compute
effect sizes (ESs; Cohen d). The meta-analysis was conducted using a meta-analysis software program, and a random-
effects model was used to calculate the overall ES, expressed as Hedge g. RESULTS: The weighted mean ES from 17
randomized controlled trials with 568 participants with MS was 0.45 (standard error = 0.12, 95% confidence interval
= 0.22-0.68, z = 3.88, p <= .001). The weighted mean ES was slightly heterogeneous (Q = 29.9, df = 16, p = .019).
CONCLUSIONS: The cumulative evidence supports that exercise training is associated with a significant small
reduction in fatigue among persons with MS. Copyright 2013 by the American Psychosomatic Society.
Introduction: The flavonoids are a large group of dietary plant compounds with suggested health benefits. There is
accumulating evidence that many of these flavonoids can interact with the major drug transporters (and
metabolizing enzymes) in the body, leading to alterations in the pharmacokinetics of substrate drugs, and thus their
efficacy and toxicity. Areas covered: This review summarizes and updates the reported in vitro and in vivo
interactions between common dietary flavonoids and the major drug-effluxing ABC transporters; these include P-
glycoprotein, breast cancer resistance protein and multidrug resistance proteins 1 and 2. In contrast to previous
reviews, the ADME of flavonoids are considered, along with their glycosides and Phase II conjugates. The authors
also consider their possible interactions with the ABC transporters in the oral absorption, distribution into
pharmacological sanctuaries and excretion of substrate drugs. Electronic databases, including PubMed, Scopus and
Google Scholar were searched to identify appropriate in vitro and in vivo ABC transporter-flavonoid interactions,
particularly within the last 10 years. Expert opinion: Caution is advised when taking flavonoid-containing
supplements or herbal remedies concurrently with drugs. Further clinical studies are warranted to explore the
impact of flavonoids and their metabolites on the pharmacokinetics, efficacy and toxicity of drugs. 2013 Informa UK,
Ltd.
The purpose of this inquiry was to explore, analyze, and synthesize the current research findings regarding the role of
low health literacy in asthma self-management. The authors obtained relevant articles by conducting a search in the
following databases: Cumulative Index of Nursing and Allied Health (CINAHL), MEDLINE (Ovid), PubMed Plus, and
Google Scholar. Search terms included combinations of asthma, peak flow, inhaler, asthma action plan,
management, and literacy. The search was restricted to English-language publications and to studies recently
conducted in the United States. Ten articles were retained that met these inclusion and exclusion criteria. Taken
together, these data indicate that low health literacy is associated with less accurate metered-dose inhaler
technique, less use of peak flow meters and asthma action plans, less ability to calculate peak flow zones, higher
rates of emergency department visits and hospitalizations for asthma, and less desire to participate in decision
making. Low health literacy is common and is a barrier to effective asthma self-management. Asthma educators are
uniquely prepared to evaluate health literacy and to develop novel training programs that maximize the individual's
potential for independent asthma self-management. 2010 The Author(s).
Objective: The purpose of this study was to review the scientific literature on the effects of manual therapy
interventions on falls and balance. Methods: This systematic review included randomized and quasi-randomized
controlled trials that investigated the effects of manual therapy interventions on falls or balance. Outcomes of
interest were rate of falls, number of fallers reported, and measures of postural stability. Data sources included
searches through June 2011 of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic
Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, Allied and Complimentary Medicine, Current Controlled Trials,
Manual Alternative and Natural Therapy Index System, Index to the Chiropractic Literature, National Institutes of
Health (USA), and Google Scholar. Results: Eleven trials were identified that met the inclusion criteria. Most trials had
poor to fair methodological quality. All included trials reported outcomes of functional balance tests or tests that
used a computerized balance platform. Nine of the 11 trials reported some statistically significant improvements
relating to balance after an intervention that included a manual therapy component. The ability to draw conclusions
from a number of the studies was limited by poor methodological quality or very low participant numbers. A meta-
analysis was not performed due to heterogeneity of interventions and outcomes. Only 2 small trials included falls as
an outcome measure, but as a feasibility study and a pilot study, no meaningful conclusions could be drawn about
the effects of the intervention on falls. Conclusion: A limited amount of research has been published that supports a
role for manual therapy in improving postural stability and balance. More well-designed controlled trials with
sufficient participant numbers are required to draw meaningful clinical conclusions about the role that manual
therapies may play in preventing falls or improving postural stability and balance. 2012 National University of Health
Sciences.
The long term effects of maternal smoking during pregnancy on the cognitive development of the child are not well
understood due to conflicting findings in past research. The aim of this paper was to provide an up to date, critical
review of the literature to determine whether there is evidence of a relationship between tobacco smoke exposure
in utero and cognitive functioning. We systematically reviewed observational studies (dated 2000-2011) that
examined associations between tobacco smoke exposure in utero due to maternal smoking and performance on
cognitive, intelligence, neurodevelopmental and academic tests. Eligible studies were identified through searches of
Web of Knowledge, Medline, Science Direct, Google Scholar, CINAHL, EMBASE, Zetoc and Clinicaltrials.gov
databases. The review found evidence of a relationship between tobacco smoke exposure in utero and reduced
academic achievement and cognitive abilities independent of other variables. Maternal smoking during pregnancy
may therefore be a modifiable risk factor for reduced cognitive abilities later in the life of the child. Giving up
smoking during pregnancy should be initiated as early as possible to reduce the impact on the child's cognitive
development. 2012 Elsevier Inc.
Aim The aim of this review paper was to determine the effects of physical exercise on reducing body weight and
body composition of persons between 40 and 64 years of age on the basis of collected data and analyzed papers
published between 1998 and 2010 year. Methods Literature search was made using the following search bases:
MEDLINE, Google Scholar, CINHAL, EMBASE, Kobson, DOAJ. Papers were selected based on several criteria. The
reduction of body mass and body composition were particularly emphasized, that subjects were not suffering from
other diseases except they were obese and that study only involves physical activity (exercise) and physical activity
combined with diet during weight reduction of obese. In addition to the request that study included middle-aged
people between 40 and 64 year and that they were over-weight (BMI> 25 kg/m2) or obese(BMI> 30 kg/m2), was the
criteria that study was longitudinal. Results The combination of exercise (either aerobic or resistance training) and
diet has shown the best results in the reduction of body weight. Statistically significant differences (p <0.01) was not
found between continuous and interval work when the volume and intensity of exercise was equal. Conclusion
Moderate physical activity for middle aged people (40-64 year) in combination with reduced calorie intake has
positive impact on body fat and body weight reduction.
Background and Aims: Probiotic supplementation seems to provide beneficial effects in the prevention and
treatment of radiationinduced diarrhea. We performed a systematic review and metaanalysis to estimate the
efficacy of probiotic supplementation for prevention and treatment of radiation-induced diarrhea. Methods: Two
reviewers independently searched PubMed, EMBASE, Cochrane Library, Google Scholar and on-line clinical trials
registers (up to January 2009) for randomized controlled trials that evaluated the efficacy of probiotic
supplementation for the prevention and treatment of radiation-induced diarrhea. Each clinical trial was separately
evaluated for study characteristics, methodologic quality and outcomes. Results of the randomized controlled trials
were pooled in a meta-analysis. Results: Four randomized controlled trials were included. Three clinical trials, with a
total of 632 subjects, evaluated the preventive effects of probiotic supplementation and 1 study evaluated the
therapeutic role. Random effects meta-analysis of the preventive trials did not show significant differences between
probiotic supplementation and control groups (odds ratio 0.47; 95% confidence interval: 0.13-1.67). However, the
few available trials and the presence of significant clinical and statistical heterogeneity limited the analysis. Similarly,
the therapeutic clinical trial did not show significant differences between active and placebo groups. No major
adverse events owing to probiotic supplementation were reported in any study. Conclusions: Probiotic
supplementation showed beneficial effect in the prevention and treatment of radiation-induced diarrhea in
experimental animal studies. Encouraging results have been observed in humans; however, the few available clinical
studies do not allow firm conclusions. More well-performed, randomized placebo-controlled studies are needed.
Copyright 2009 by Lippincott Williams & Wilkins.
Objective: Reducing the priming volume is an effective means of decreasing hemodilution and blood transfusion
during cardiopulmonary bypass (CPB). The patient's own blood was used to replace the crystalloid in the CPB circuit
by retrograde autologous priming (RAP) in order to decrease the priming volume. Therefore, we performed a
metaanalysis to investigate whether RAP could reduce blood transfusion and improve clinical outcomes. Materials
and Methods: A comprehensive search was conducted for randomized, controlled trials (RCTs) exploring RAP in
PubMed, Embase, The Cochrane Library, Google Scholar and Chinese literature databases (WanFang, WeiPu and
CNKI). Clinical parameters and outcomes were focused on the lowest hematocrit (Hct) during CPB, the number of
patients transfused blood intraoperatively, the number of patients transfused blood perioperatively, the number of
blood units transfused, 24-hour chest tube drainage, hours to extubation, length of ICU stay, and length of hospital
stay. Results: Ten trials, with a total of 1123 patients, were included. The number of patients transfused blood
intraoperatively (RR = 0.39, 95% CI = [0.29, 0.53], p<0.00001, I2 = 40%) and perioperatively (RR = 0.53, 95% CI =
[0.43, 0.66], p<0.00001, I2 = 0%) and the number of blood units transfused (SMD = -0.53, 95% CI = [-0.73, -0.33],
p<0.00001, I2 = 14%) were all significantly reduced in the RAP group. No differences in the hours to extubation (SMD
= -0.11, 95% CI = [-0.33, 0.12], p=0.37, I2 = 0%) and the length of ICU stay (SMD = -0.17, 95% CI = [-0.41, 0.08],
p=0.18, I2 = 0%) were observed between the two groups. Conclusion: Compared to conventional priming, RAP could
reduce transfusion in adults significantly, but had no effect on clinical outcomes, comparing to conventional priming.
Further studies involving RAP are expected to investigate if this technique is beneficial to the patient. The Author(s)
2013.
BACKGROUND: Comprehensive smoke-free legislation has been implemented in many countries. The current study
quantitatively examined the reduction in risk of acute myocardial infarction (MI) occurrence following the legislations
and the relationship with the corresponding smoking prevalence decrease., METHODS: PubMed, EMBASE, and
Google Scholar databases and bibliographies of relevant studies and reviews were searched for potential original
studies published from January 1, 2004, through October 31, 2011. Meta-analysis was performed using a random
effect model to estimate the overall effects of the smoking-free legislations. Meta-regression was used to investigate
possible causes of heterogeneity in risk estimates., RESULTS: A total of 18 eligible studies with 44 estimates of effect
size were used in this study. Meta-analysis produced a pooled estimate of the relative risk of 0.87 (95% confidence
interval (CI): 0.84 to 0.91). There was significant heterogeneity in the risk estimates (overall I2 = 96.03%, p<0.001). In
meta-regression analysis, studies with greater smoking prevalence decrease produced larger relative risk (adjusted
coefficient -0.027, 95% CI: -0.049 to -0.006, p=0.014)., CONCLUSION: Smoke-free legislations in public and work
places were associated with significant reduction in acute MI risk, which might be partly attributable to reduced
smoking prevalence.
Objective: Considered as a significant ultrafiltration technology during cardiopulmonary bypass (CPB), zero-balance
ultrafiltration (Z-BUF) has always received controversial support regarding its effectiveness in reducing inflammatory
mediators in plasma. Therefore, we conducted a meta-analysis to evaluate the clinical effect of Z-BUF through
screening all relevant published randomized controlled trials (RCTs). Methods: A comprehensive search was
conducted to screen all RCTs of Z-BUF. Three trained investigators searched databases, including PubMed, Embase,
the Cochrane Library, Google scholar, and Chinese literature databases (CNKI, WanFang, WeiPu). RCTs that
compared Z-BUF with non-ultrafiltration were included. We focused on clinical outcomes such as length of stay in
ICU, duration of ventilation, hospital stay, total amount of chest tube drainage and mortality. Finally, a total of 7
studies containing appropriate criteria were divided into an adult group and a pediatric group. A random effects
model was used to calculate weighted mean difference with 95% confidence intervals. Results: In the adult group,
the benefits of Z-BUF in duration of ventilation (WMD=-2.77, 95% CI = [-6.26, 0.72], I2=71%, p=0.12) and the length
of ICU stay (WMD=-4.13, 95% CI = [-10.09, 1.84], I 2=77%, Z=1.36, p=0.17) were not apparent, with significant
heterogeneity existing in the statistical results. The rest of the clinical parameters could not be evaluated due to
insufficient data. In the pediatric group, combined analysis showed Z-BUF could reduce the duration of mechanical
ventilation (WMD=3.07; 95%CI= [-7.56, -3.46], I2=17%, p=0.27). The advantage of Z-BUF was not observed in other
clinical outcomes. Conclusion: The benefits of Z-BUF were not apparent, according to the report. Further studies
involving combined ultrafiltration are expected to provide improved ultrafiltration during CPB.
Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children and adolescents.
Stimulants are commonly prescribed for ADHD management. There is clinical trial evidence that some medications
with noradrenergic properties such as atomoxetine are effective. It is of theoretical and practical importance if other
agents with noradrenergic properties display a comparable pattern of efficacy. This paper is a systematic review of
the efficacy and safety of venlafaxine for treating children and adolescents with ADHD. MEDLINE, Google scholar,
Scopus, and Web of science (ISI) databases were electronically searched in July 2012, updated on November 2012.
Time and language of publication were not exclusion criteria. Efficacy outcomes were assessed by a valid and reliable
parent- and/or teacher-reported instrument to evaluate clinical symptoms. Adverse effects were also evaluated.
There were three uncontrolled trials and only two double blind controlled clinical trials. Venlafaxine appeared
effective for treating ADHD. The rates of some adverse effects of venlafaxine were less than those documented for
methylphenidate. While one of the two small controlled trials did not find difference between venlafaxine ad
methylphenidate, the other trial reported lower efficacy for venlafaxine. Headache, insomnia, and nausea were
among the most common adverse effects. This systematic review provides preliminary support that venlafaxine may
have short term utility in treating ADHD in children and adolescents. However, before recommending venlafaxine for
treatment, more robust and larger clinical trials, in particular providing evidence of its long-term efficacy, safety and
tolerability are required. 2012 Bentham Science Publishers.
Background: Nonpharmacological therapies are often recommended as a first-line treatment for neuropsychiatric
symptoms (NPS) of dementia in long term care (LTC); however, little is known about which nonpharmacological
interventions are most effective for NPS in LTC or the feasibility of interventions, given the availability of resources in
typical LTC environments. Methods: We searched the electronic databases MEDLINE, EMBASE, PsychINFO (1980-
2010), the Cochrane Library, and Google Scholar using keywords and medical subject headings for randomized,
controlled trials evaluating nonpharmacological interventions for NPS conducted in LTC settings. Change in severity
of NPS symptoms was evaluated through the NPS outcomes measures reported in studies. We assessed study quality
and described the feasibility of interventions based on various aspects of study design. Results: A total of 40 studies
met inclusion criteria. Sixteen (40%) of 40 included studies reported statistically significant results in favor of
nonpharmacological interventions on at least one measure of NPS. These interventions included staff training in NPS
management strategies, mental health consultation and treatment planning, exercise, recreational activities, and
music therapy or other forms of sensory stimulation. Many of the studies had methodological limitations that placed
them at potential risk of bias. Most interventions (n = 30, 75%) required significant resources from services outside
of LTC or significant time commitments from LTC nursing staff for implementation. Conclusions: There are several
nonpharmacological interventions that may be effective for NPS in LTC, although there are a limited number of large-
scale, high-quality studies in this area. The feasibility of some interventions will be limited in many LTC settings and
further research into practical and sustainable interventions for NPS in LTC is required to improve usage of these
important treatments. 2012 American Medical Directors Association.
Anal fistula is an abnormal connection between the anal or rectal lumen and perianal skin that reduce quality of life.
There are various surgical options for treatment with variable success rate. A novel treatment is to seal the fistula
tract using biomaterials (fibrin glue and fibrin plug). Objective of this study was to evaluate the healing efficacy and
incontinence rate of biomaterials (fibrin glue and fibrin plug) in comparison to surgical interventions in the treatment
of cryptoglandular perianal fistula using meta-analysis of randomized controlled trials. PubMed, Scopus, Google
Scholar and Web of Science were searched for clinical trial studies investigated the effects of biomaterials in the
treatment of fistula-in-ano. Studies on patient with anal fistulae underwent fibrin glue, fibrin plug or other
biomaterials application and surgical management for healing of fistula were included. Clinical response and
incontinence were the key outcomes of interest. Six randomized placebo-controlled clinical trials consisting 315
patients in various arms met our criteria (comparing biomaterial with surgical interventions) and were included in the
analysis. Pooling of data showed that effectiveness of biomaterials in comparison to surgical interventions was non-
significant with relative risk (RR) of 0.73 (95% CI of 0.31-0.89, p= 0.096). The incontinence rate RR in biomaterials and
intervention was also nonsignificant with RR of 0.35 (95% CI = 0.05-2.28, p = 0.27). The included clinical trials had
different follow-up durations, causes of fistula and method of intervention in treated patients. This meta-analysis
demonstrates that the effectiveness and incontinence rate of biomaterials and conservative treatment is not
significantly different. 2012 Asian Network for Scientific Information.
Background: Hepatocellular carcinoma (HCC) is a common cancer associated with a poor prognosis. Bevacizumab is a
monoclonal antibody that binds vascular endothelial growth factor, a mediator of tumor angiogenesis. Bevacizumab
is currently under investigation as treatment for HCC. We performed a systematic review of the efficacy and safety of
bevacizumab for the treatment of advanced HCC. Methods: PubMed, the Cochrane Library, and Google Scholar were
searched using the terms "bevacizumab AND hepatocellular carcinoma AND (advanced OR unresectable)". Phase II
trials of bevacizumab for the treatment of advanced HCC were included. Outcomes of interest included progression-
free and overall survival (PFS and OS), tumor response, and toxicities. Results: A total of 26 records were identified.
Of these, 18 were excluded. Hence, eight trials involving 300 patients were included. Bevacizumab was given as
monotherapy (n = 1 trial) or in combination with erlotinib (n = 4 trials), capecitabine (n = 1 trial),
capecitabine+oxaliplatin (n = 1 trial), or gemcitabine+oxaliplatin (n = 1 trial). Most trials (five of eight) reported
median PFS and OS between 5.3 months and 9.0 months and 5.9 and 13.7 months, respectively. The disease control
rate was consistent in five of eight trials, ranging from 51.1% to 76.9%. The response and partial response rates
ranged from 0 to 23.7%, but were around 20% in four trials. Only one patient had a complete response. Frequently
reported Grade 3/4 toxicities were increased aspartate transaminase/alanine transaminase (13%), fatigue (12%),
hypertension (10%), diarrhea (8%), and neutropenia (5%). Thirty patients experienced gastrointestinal bleeding
(grade 1/2 = 18, grade 3/4 = 12), typically due to esophageal varices. Conclusions: Bevacizumab shows promise as an
effective and tolerable treatment for advanced HCC. The reported efficacy of bevacizumab appears to compare
favorably with that of sorafenib, the only currently approved treatment for unresectable HCC. Phase III trials are
warranted to comprehensively examine the efficacy and safety of bevacizumab for treatment of advanced HCC. 2012
Fang et al.
BACKGROUND: Hepatocellular carcinoma (HCC) is a common cancer associated with a poor prognosis. Bevacizumab
is a monoclonal antibody that binds vascular endothelial growth factor, a mediator of tumor angiogenesis.
Bevacizumab is currently under investigation as treatment for HCC. We performed a systematic review of the
efficacy and safety of bevacizumab for the treatment of advanced HCC., METHODS: PubMed, the Cochrane Library,
and Google Scholar were searched using the terms "bevacizumab AND hepatocellular carcinoma AND (advanced OR
unresectable)". Phase II trials of bevacizumab for the treatment of advanced HCC were included. Outcomes of
interest included progression-free and overall survival (PFS and OS), tumor response, and toxicities., RESULTS: A total
of 26 records were identified. Of these, 18 were excluded. Hence, eight trials involving 300 patients were included.
Bevacizumab was given as monotherapy (n=1 trial) or in combination with erlotinib (n=4 trials), capecitabine (n=1
trial), capecitabine+oxaliplatin (n=1 trial), or gemcitabine+oxaliplatin (n=1 trial). Most trials (five of eight) reported
median PFS and OS between 5.3 months and 9.0 months and 5.9 and 13.7 months, respectively. The disease control
rate was consistent in five of eight trials, ranging from 51.1% to 76.9%. The response and partial response rates
ranged from 0 to 23.7%, but were around 20% in four trials. Only one patient had a complete response. Frequently
reported Grade 3/4 toxicities were increased aspartate transaminase/alanine transaminase (13%), fatigue (12%),
hypertension (10%), diarrhea (8%), and neutropenia (5%). Thirty patients experienced gastrointestinal bleeding
(grade 1/2=18, grade 3/4=12), typically due to esophageal varices., CONCLUSIONS: Bevacizumab shows promise as
an effective and tolerable treatment for advanced HCC. The reported efficacy of bevacizumab appears to compare
favorably with that of sorafenib, the only currently approved treatment for unresectable HCC. Phase III trials are
warranted to comprehensively examine the efficacy and safety of bevacizumab for treatment of advanced HCC.
The authors performed a systematic review and meta-analysis of data from randomized controlled trials (RCTs) to
evaluate the efficacy and safety of certolizumab pegol. Methods: The authors searched PubMed, MEDLINE via
Medscape, BioMed Central, Google Scholar, China National Knowledge Infrastructure (CNKI), the Cochrane library,
and the Directory of Open Access Journals. The outcomes of interest were response and remission rates and the
treatment-related toxicity rate. Results: A total of five RCTs, involving 1,891 participants, were included. The meta-
analysis revealed that certolizumab significantly increased the overall (induction + maintenance therapy) response
[odds ratio (OR) 1.565, 95% CI 1.056-2.321, P = 0.026] and remission rates (OR 1.626, 95% CI 1.297-2.038, P < 0.001)
compared with placebo. Certolizumab significantly increased the response and remission rates when given as
maintenance therapy (OR 2.171, 95% CI 1.644-2.866, P < 0.001 and OR 1.888, 95% CI 1.390-2.565, P < 0.001), but
not as induction therapy (OR 1.234, 95% CI 0.912-1.671, P = 0.173 and OR 1.361, 95% CI 0.974-1.901, P = 0.071).
Certolizumab (induction + maintenance therapy) did not significantly increase the treatment-related toxicity rate
compared with placebo (OR 0.985, 95% CI 0.799-1.214, P = 0.887). Conclusion: Certolizumab may be an efficacious
treatment for Crohn's disease as maintenance therapy and appears to have a favorable safety profile. 2013 Springer
Healthcare.
Background: Tremor is a frequent complication of multiple sclerosis and can be severely disabling in up to 15% of MS-
patients. DBS is cost effective in tremor of Parkinson's disease and has been used in patients with MS. However its
efficacy and safety in this condition is not well documented. We reviewed the literature to evaluation DBS effecacy
and saftey in rubral tremor. Methods: English literature was searched for studies published on the used of DBS in MS
using Medline, EMBASE, Pubmed, google scholar and the Cochrane database. A seconday search was carried out
using the refrences of papers detected in the primary search to make sure that all relevant papers were included.
Studies were included if the patients treated were treated by DBS for MS-tremor and the outcome or safety results
were published. Duplicate publications were discarded. Results: A total of 151 MS-tremor patients treated with DBS
were found in 28 studies. Inclusion criteria were refractory tremor, MS stable for last six months, extended disability
status scale of >7 and MMSE of >24. 98/115 (85.2%) had significant tremor supression at six weeks compared to
38/55 (69.1%) at one year. 60/80 (75%) had gained significant improvement in activities of daily living compred to
19/29 (65.5%) at one year. Symptomatic cerebral haematoma occurred in 4 (2.6%), permanent neurological deficit
was noted in 4 (2.6%), tranisent neurological deficit (lasted up to 3 months) in 2.6%, seizures in 5.6% with infection in
3.85%. DBS surgery in these patients was also associated with MS relapse in four patients (2.6%). Conclusion: DBS in
MS-tremor seems to be wothwhile in the short term, longer term studies with economic models are required to
establish its cost effective in these patients.
Objective: This review focuses on the efficacy and safety of effective herbal medicines in the management of
hyperlipidemia in human. Methods: PubMed, Scopus, Google Scholar, Web of Science, and IranMedex databases
were searched up to 11th May 2010. The search terms were "hyperlipidemia" and ("herbal medicine" or "medicine
traditional", "extract plant") without narrowing or limiting search elements. All of the human studies on the effects
of herbs with the key outcome of change in lipid profiles were included. Results: Fifty three relevant clinical trials
were reviewed for efficacy of plants. This study showed significant decrease in total cholesterol and LDL cholesterol
after treatment with Daming capsule (DMC), chunghyul-dan, Glycyrrhiza glabra, garlic powder (Allicor), black tea,
green tea, soy drink enriched with plant sterols, licorice, Satureja khuzestanica, Monascus purpureus Went rice,
Fenugreek, Commiphora mukul (guggul), Achillea wilhelmsii C. Koch, Ningzhi capsule (NZC), cherry, compositie
salviae dropping pill (CSDP), shanzha xiaozhi capsule, Ba-wei-wan (hachimijiogan), rhubarb stalk, Silybum marianum,
Rheum Ribes and Jingmingdan granule (primrose oil). Conflicting data exist for red yeast rice, garlic and guggul. No
significant adverse effect or mortality were observed except in studies with DMC, guggul, and Terminalia belerica,
Terminalia chebula, Emblica officinalis, ginger, and garlic powder (Allium sativum). Conclusion: Amongst reviewed
studies, 22 natural products were found effective in the treatment of hyperlipidemia that deserve further works to
isolate and characterization of their constituents to reach novel therapeutic and more effective agents. 2010
Bentham Science Publishers Ltd.
OBJECTIVE: To review the efficacy and safety of modafinil in the treatment of cancer-related fatigue (CRF). DATA
SOUCES: Literature was accessed via MEDLINE (1950-week 3, November 2008), International Pharmaceutical
Abstracts, and Google Scholar using the terms modafinil, cancer, and fatigue. Reference citations from articles
identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: All English-language publications identified
were analyzed for significance. Studies relevant to the objective were used, including 2 prospective open-label
studies, one randomized double-blind, dose-controlled trial with an open-label extension, and one Phase 3
randomized, placebo-controlled, double-blind trial. DATA SYNTHESIS: Fatigue is a nearly universal adverse effect of
cancer and its treatment that is unrelated to physical exertion, is not relieved by sleep or rest, and negatively affects
quality of life. Modafinil is a central nervous system stimulant with minimal toxicity and a low propensity for abuse.
Clinical data demonstrate that modafinil significantly reduces fatigue in patients who have received cancer treatment
or are currently undergoing chemotherapy. Additional benefits include improvement in cognitive function, mood,
general activity, walking ability, normal work ability, relations with other people, and enjoyment of life. Limitations of
the available data include open-label design in 3 of the 4 studies; the absence of numerical results of fatigue
assessments in the abstract of 1 trial, preventing the determination of clinical significance; and the full
inclusion/exclusion criteria, which were not included in the published abstracts. These limitations leave readers
without a clear picture of the study populations. Finally, different patient populations at different points in treatment
with varying durations of therapy were used, which makes extrapolation of data to the general population
challenging. CONCLUSIONS: Further randomized placebo-controlled trials are necessary to amass evidence for the
effective and safe use of modafinil for CRI however, if traditional therapies have failed or are intolerable, modafinil
can be considered a treatment option.
To review data on efficacy and safety of second-generation antipsychotics (SGAs) in children and adolescents with
psychotic and bipolar spectrum disorders. Methods: Medline. /PubMed/Google Scholar search for studies comparing
efficacy and/or tolerability: (i) between two or more SGAs; (ii) between SGAs and placebo; and (iii) between at least
one SGA and one first-generation antipsychotic (FGA). The review focused on three major side-effect clusters: 1.
body weight, body mass index, and cardiometabolic parameters, 2. prolactin levels, and 3. neuromotor side effects.
Results: In total, 34 studies with 2719 children and adolescents were included. Studies lasted between 3. weeks and
12. months, with most studies (79.4%) lasting 3. months or less. Nine studies (n = 788) were conducted in patients
with schizophrenia, 6 (n = 719) in subjects with bipolar disorder, and 19 (n = 1212) in a mixed population. Data on
efficacy showed that, except for clozapine being superior for refractory schizophrenia, there were no significant
differences between SGAs. By contrast, safety assessments showed relevant differences between SGAs. Mean
weight gain ranged from 3.8. kg to 16.2. kg in patients treated with olanzapine (n = 353), from 0.9. kg to 9.5. kg in
subjects receiving clozapine (n = 97), from 1.9. kg to 7.2. kg in those on risperidone (n = 571), from 2.3. kg to 6.1. kg
among patients taking quetiapine (n = 133), and from 0. kg to 4.4. kg in those treated with aripiprazole (n = 451).
Prolactin levels increased the most in subjects on risperidone (mean change ranging from 8.3. ng/mL to 49.6. ng/mL),
followed by olanzapine (-1.5. ng/mL to +. 13.7. ng/mL). Treatment with aripiprazole was associated with decreased
prolactin levels, while clozapine and quetiapine were found to be mostly neutral. With respect to neuromotor side
effects, SGAs were associated with less parkinsonism and akathisia than FGAs. Most of the studies comparing
neuromotor side effects between SGAs found no significant differences. Conclusions: SGAs do not behave as a
homogeneous group in children and adolescents with psychotic and mood disorders. Except for clozapine, the
heterogeneity within the SGA group is mainly due to differences in the rates and severity of adverse events,
especially regarding weight gain as a proxy for the risk of cardiometabolic disturbances. 2011.
Background: The persistence of a patent ductus arteriosus (PDA) in preterm infants complicates their clinical course
and may contribute to increased morbidity. Intravenous preparations of ibuprofen constitute one of the standard
therapies for closure of a PDA. However, the unavailability of intravenous ibuprofen in certain regions of the world
and the availability of inexpensive oral preparations has led to off-label nasogastric administration of oral ibuprofen
in preterm infants with PDA. Objective: This article reviews and comments on the evidence for the enteral use of oral
formulations of racemic ibuprofen for PDA closure in preterm infants, with a focus on the risk of necrotizing
enterocolitis (NEC). Methods: MEDLINE, Current Contents, and Google Scholar were searched in April 2010 for trials
of enteral ibuprofen in the treatment of PDA in preterm or low-birth-weight infants using the terms treatment,
pharmacokinetics, ibuprofen, oral, enteral, patent ductus arteriosus, PDA, preterm, premature, low birth weight,
infant, and newborn. Relevant congress Web sites were also searched for relevant abstracts. Results: The literature
search identified 2 pharmacokinetic studies involving 32 infants and 13 clinical efficacy studies involving 306 infants
treated with enteral ibuprofen. The clinical studies reported some benefit for enteral ibuprofen relative to the
comparators. However, these studies had methodologic limitations, including small numbers of subjects, lack of
blinding, inclusion of preterm infants with a higher gestational age, customized treatment regimens, and second-
order statistical error that prevented conduct of a systematic review. When the results of all studies were pooled,
NEC was reported in a total of 46 of 281 infants (16%) receiving enteral ibuprofen and 21 of 83 infants (25%)
receiving indomethacin. This rate of NEC with enteral ibuprofen was twice that reported for intravenous ibuprofen in
a recent meta-analysis (27/356 [8%]). Conclusions: The evidence supporting the off-label use of enteral ibuprofen for
PDA in preterm infants is weak. Well-designed, appropriately powered pharmacologic and controlled clinical studies
are needed before use of enteral ibuprofen can be recommended. In countries where an intravenous formulation of
racemic ibuprofen is approved, off-label use of enteral racemic ibuprofen cannot be supported. 2010 Excerpta
Medica Inc.
BACKGROUND: The persistence of a patent ductus arteriosus (PDA) in preterm infants complicates their clinical
course and may contribute to increased morbidity. Intravenous preparations of ibuprofen constitute one of the
standard therapies for closure of a PDA. However, the unavailability of intravenous ibuprofen in certain regions of
the world and the availability of inexpensive oral preparations has led to off-label nasogastric administration of oral
ibuprofen in preterm infants with PDA., OBJECTIVE: This article reviews and comments on the evidence for the
enteral use of oral formulations of racemic ibuprofen for PDA closure in preterm infants, with a focus on the risk of
necrotizing enterocolitis (NEC)., METHODS: MEDLINE, Current Contents, and Google Scholar were searched in April
2010 for trials of enteral ibuprofen in the treatment of PDA in preterm or low-birth-weight infants using the terms
treatment, pharmacokinetics, ibuprofen, oral, enteral, patent ductus arteriosus, PDA, preterm, premature, low birth
weight, infant, and newborn. Relevant congress Web sites were also searched for relevant abstracts., RESULTS: The
literature search identified 2 pharmacokinetic studies involving 32 infants and 13 clinical efficacy studies involving
306 infants treated with enteral ibuprofen. The clinical studies reported some benefit for enteral ibuprofen relative
to the comparators. However, these studies had methodologic limitations, including small numbers of subjects, lack
of blinding, inclusion of preterm infants with a higher gestational age, customized treatment regimens, and second-
order statistical error that prevented conduct of a systematic review. When the results of all studies were pooled,
NEC was reported in a total of 46 of 281 infants (16%) receiving enteral ibuprofen and 21 of 83 infants (25%)
receiving indomethacin. This rate of NEC with enteral ibuprofen was twice that reported for intravenous ibuprofen in
a recent meta-analysis (27/356 [8%])., CONCLUSIONS: The evidence supporting the off-label use of enteral ibuprofen
for PDA in preterm infants is weak. Well-designed, appropriately powered pharmacologic and controlled clinical
studies are needed before use of enteral ibuprofen can be recommended. In countries where an intravenous
formulation of racemic ibuprofen is approved, off-label use of enteral racemic ibuprofen cannot be supported.
Copyright A 2010 Excerpta Medica Inc. All rights reserved.
Objective: This meta-analysis of randomized controlled trials was conducted to evaluate the efficacy and tolerability
of two drug groups (immunoregulators and antibiotics) in the treatment of fistula in Crohn's disease (CD). Methods:
PubMed, Embase, Scopus, Google Scholar, and Web of Science were searched for clinical trial studies investigated
the effects of immunoregulators and antibiotics in the treatment of fistulizing CD. Clinical response and adverse
effects were the key outcomes of interest. Data were searched from the time period of 1966 through June 2010.
Result: Eleven randomized placebo-controlled clinical trials that met our criteria (nine in different immunoregulators
and two in antibiotics) were included in the analysis. Pooling of data showed that immunoregulators and antibiotics
are significantly effective for at least a 50% reduction from baseline in the number of open actively draining fistulas
with relative risk (RR) of 2.57 (95% CI of 1.55-4.25, P=0.0003) in four trials and 2.05 (95% CI of 1.03-4.08, P= 0.0414)
in two trials respectively. The summary of RR for complete closure of fistulas in nine trials was 2.65 with a 95% CI of
1.66-4.22 and a significant RR (P < 0.0001). In regard to the tolerability, both immunoregulators and antibiotics
showed insignificant adverse effects in comparison to placebo with an RR of 1.11 (95% CI of 0.96-1.27, P= 0.1513)
and 0.6 (95% CI of 0.36-1, P= 0.0515), respectively and discontinuation because of these adverse effects in drug-
treated groups was the same as placebo. Data about severe adverse effects were only available for
immunoregulators that showed a significantly higher incidence when compared to placebo (RR= 2.24 with a 95% CI
of 1.05-4.79; significant at P= 0.0374). Conclusion: This meta-analysis demonstrates the efficacy of
immunoregulators and antibiotics in fistulizing CD. Regarding the safety, mild to moderate adverse effects were the
same in both antibiotic and immunoregulators groups in comparison to the placebo but incidence of severe adverse
effects in immunoregulator groups was higher than that of antibiotics. 2010 Bentham Science Publishers Ltd.
OBJECTIVES: Pouchitis is the most frequent long-term complication of ileal pouchanal anastomosies (IPAA) surgery
for ulcerative colitis (UC) which is a nonspecific infl ammation of the ileal reservoir. Its clinical frequency varies
depending on the definition and the follow up but is approximately 50% after a decade. Antibiotics and probiotics are
currently the most widely accepted treatment in pouchitis patients. Objective of this study was to meta-analyze
efficacy of probiotics and antibiotics in the management of pouchitis. METHODS: All databases specially Pubmed,
Web of Science, Scopus, Cochrane, and Google Scholar were searched between 1965 and December 2009, and
relevant controlled clinical trials were extracted, reviewed, and validated according to the study protocol. The
outcome of interest was defined by a pouchitis disease activity index (PDAI) < 7. Thirteen clinical trials were included
in the meta-analysis. RESULTS: Pooling of the results from eight trials yielded a relative risk (RR) of 5.33 with a 95% CI
of 2.12-13.35 and a significant RR (P = 0.0004) in the treatment group in comparison with the placebo group.
Summary RR for clinical improvement in 6 trials was 14.17 with a 95% CI of 1.19-168.93 (P = 0.036) in efficacy of
VSL#3 (all doses) comparing to placebo and slightly more effective for VSL#3 (6 g/day) comparing to placebo with RR
of 20.35 with a 95% CI of 6.16- 67.22 (P < 0.0001). Efficacy of antibiotics comparing to placebo showed a summary
RR of 2.68 with a 95% CI of 0.4-17.99 and P = 0.3107 for clinical improvement in three trials. The summary RR for
efficacy of ciprofl oxacin comparing to metronidazole was 0.68 with a 95% CI of 0.44-1.06 (P = 0.8913).
CONCLUSIONS: In conclusion, alongside the benefit of probiotics and antibiotics in the management of pouchitis,
effects of probiotics and antibiotics on pouchitis vary according to different mixtures of microorganisms strains in
probiotics and different spectrums of antibiotics.
Persistent pain disorders are usually not adequately alleviated by nonsteroidal anti-inflammatory drugs or other
simple analgesics. Use of antidepressants as adjuvant therapy for the control of persistent pain is currently being
practiced in disorders such as fibromyalgia, neuropathic pain, rheumatoid conditions, low back pain, and headache.
This review describes the various mechanisms of analgesic activity of antidepressants along with their efficacy and
tolerability profiles. Meta-analyses and clinical studies of these agents were retrieved through the use of MEDLINE,
Google scholar, and Cochrane databases. Antidepressants are effective in both neuropathic and non-neuropathic
pain and have diverse mechanisms independent of their antidepressant effects. Tricyclic antidepressants
(amitryptiline, nortryptiline, desipramine) are effective compounds in the treatment of neuropathic pain,
fibromyalgia, low back pain, and headaches. Studies are ongoing for the dual serotonin norepinephrine reuptake
inhibitors (duloxetine, venlafaxine) in several persistent pain conditions and these may be recommended in
neuropathic pain, migraines, and fibromyalgia. Evidence suggests that although the analgesic effects of selective
serotonin reuptake inhibitors (fluoxetine, paroxetine, citalopram) are limited and inconsistent, yet they have a
superior tolerability profile compared with tricyclic antidepressants. 2012 American College of Clinical Pharmacology,
Inc.
Background: Several randomized controlled clinical trials have evaluated the efficacy of baclofen in alcohol-
dependent patients on abstinence and craving compared to placebo. However, no meta-analysis is available to
precisely quantify the baclofen effect in alcohol dependence. In this way, we conducted a meta-analysis of
randomized controlled trials in order to estimate the efficacy of baclofen compared to placebo or active treatments
on the maintenance of abstinence and the decrease of craving in alcohol-dependant patients. Methods: Using
Medline, Embase, Science Direct, Google scholar, registries of clinical trials, proceeding of congresses of addictology
and psychiatry, through June 2012, we searched for randomized studies without restriction of language. All
randomized controlled clinical trials assessing baclofen for at least 4 weeks' treatment duration vs. placebo or other
comparators in alcohol-dependent patients according to the DSM-IV or ICD-10 classification were eligible for
inclusion. The primary outcome measure was the percentage of patients who had not consumed alcohol at the end
of the treatment. Measures of cumulative abstinence days, indexes of craving, as well as the variation of craving
between the inclusion of patients and the end of the study measured by Obsessive Compulsive Drinking Scale (OCDS)
and Penn Alcohol Drinking Scale (PACS) were also assessed. Meta-analysis was performed by pooling the logarithm
of the relative risks for binary outcomes or mean differences for quantitative scale weighted by the inverse of the
variance of each trial. A random-effect model was used when unexplained heterogeneity was found using a fixed-
effect model. Results: Data from from randomized controlled clinical trials involving 272 patients were included. Four
studies compared baclofen vs. placebo, while one study compared baclofen vs. acamprosate. Compared to placebo
(three studies, 203 patients), baclofen was associated with a significant increase of 179% in the percentage of
abstinent patients at the end of the trial [RR 2.79; 95% CI (1.79; 4.34); P < 0.05], without heterogeneity (P = 0.81; I2 =
0%). For secondary outcome measures as cumulative abstinent days involving three trials (203 patients) or craving
measured by OCDS involving two trials (123 patients), a statistically significant heterogeneity was observed. Based on
a random-effect model, no significant effect of baclofen was observed compared to placebo, neither cumulative
abstinent days [Standardized Mean Difference 3.69; 95% CI (-0.74; 8.11); P = 0.10], nor craving measured by OCDS
[Standardized Mean Difference -1.6; 95% CI (-3.59; 0.39); P = 0.12]. Only one randomized clinical trial was available
for craving measured by PACS and for the variation of craving between the inclusion of patients and the end of the
study measured by OCDS, thus no metaanalysis has been realized for these outcome measures. Interpretation: Our
meta-analysis brings support towards an efficacy of low dosages of baclofen on the maintenance of abstinence in
alcohol-dependent patients, but the robustness of the result is very weak. Results on craving needs to be confirmed
Study Objective. To assess the efficacy of botulinum toxin type A in lowering the frequency of migraine headaches in
patients with episodic migraines. Design. Meta-analysis of eight randomized, double-blind, placebo-controlled trials.
Patients. A total of 1601 patients with a history of episodic migraine headaches classified as those experiencing
headaches fewer than 15 times/month over a 3-month period. Measurements and Main Results. PubMed, Google
Scholar, and the Cochrane Library were searched from inception to October 2007 in order to locate randomized,
double-blind, placebo-controlled trials that compared the efficacy of pericranial botulinum toxin A injections with
placebo in the prevention of migraines in patients with a history of episodic migraine headaches. The primary
outcome of interest was change from baseline to end point in migraine frequency (number of migraines/month). A
random effects model was used to combine study results, and the standardized mean difference (Cohen's d) in
migraine frequency between the placebo and botulinum toxin A groups was reported. Effect sizes (d) less than 0.2
were considered small. Quality assessment was performed by using the Downs and Black scale. Eight randomized,
double-blind, placebocontrolled clinical trials (1601 patients) presented a quantitative assessment of the efficacy of
botulinum toxin A versus placebo. The overall treatment effect size of botulinum toxin A over placebo for 30, 60, and
90 days after injection was d -0.06 (95% confidence interval [CI] - 0.14-0.03, z=1.33, p=0.18), d -0.05 (95% CI -0.14-
0.03, z=1.22, p=0.22), and d -0.05 (95% CI -0.13-0.04, z=1.07, p=0.28), respectively. Even after controlling for a high
placebo effect, and after dose stratification, no significant effect of botulinum toxin A in reducing migraine
frequency/ month was seen over placebo. Conclusion. Botulinum toxin A for the prophylactic treatment of episodic
migraine headaches was not significantly different from placebo, both from a clinical and statistical perspective.
Introduction: Venous thromboembolism (VTE) is an important and potentially avoidable cause of morbidity and
mortality in hospitalized patients. The management of deep vein thrombosis (DVT) prophylaxis in medical intensive
care unit patients (MICU) is limited by the lack of studies specific to this patient population. Objectives: To review
clinical trials of efficacy of thromboprophylaxis in MICU patients and to provide summary recommendations.
Methods: Systemic review of an online search of PubMed, Medline, Cochrane Library, Google Scholar, and selected
studies. Results: Randomized placebo-controlled trials reported the incidence of DVT in MICU patients is
approximately 30%. Thromboprophylaxis significantly decreased the rate of DVT by more than 50% to approximately
11%-15%. The prevalence of asymptomatic proximal DVT on admission to MICU is 2%-3%. The incidence of
objectively documented DVT in MICU patients receiving thromboprophylaxis varied from 10%-33%, while the
incidence of proximal DVT varied from 7% to 16%. Most clinical trials examined low dose unfractionated heparin
twice daily for DVT prophylaxis while low molecular weight heparin was used in one randomized clinical trial in MICU
patients. Several trials included mixed medical and surgical ICU patients. Data regarding the efficacy of mechanical
thromboprophylaxis in MICU patients is limited. Doppler ultrasonography is the most commonly used screening
method to detect DVT in MICU patients, while the use of venography to detect or confirm DVT is uncommon.
Conclusion: There is limited data assessing risk and efficacy of DVT prophylaxis in the MICU. Current
pharmacoprophylaxis is effective in reducing the incidence of DVT in MICU patients although these events continue
to occur in patients receiving prophylaxis. Further randomized, blinded studies to assess VTE risk and most effective
prophylactic regimen are needed.
The objective of this study was to carry out a meta-analysis of the efficacy of gemcitabine+platinum agent regimens
in the treatment of advanced biliary tract cancer (BTC). PubMed and Google Scholar were searched using the
following combination of search terms: gemcitabine, oxaliplatin, cholangiocarcinoma, biliary, gallbladder, bile duct.
Studies were eligible for inclusion in the meta-analysis if they were randomized trials on the use of gemcitabine plus
a platinum agent for the treatment of advanced (unresectable or metastatic cancer) BTC. Outcomes of interest were
response rate, overall survival, and progression-free survival. Pooled odds ratios/differences in median survival and
95% confidence intervals (CIs) were determined for each outcome. A total of 47 records were identified in the initial
search. Ultimately, three open-label randomized trials (two phase 2 and one phase 3) met the eligibility criteria and
were included in the meta-analysis. Two studies compared gemcitabine plus cisplatin with gemcitabine alone,
whereas the other study compared gemcitabine plus oxaliplatin with fluorouracil-folinic acid. The total number of
patients in the studies ranged from 54 to 410. The overall analyses revealed that all survival outcomes assessed were
significantly more favorable for patients treated with gemcitabine plus platinum agents than for patients not treated
with this combination. Response rates: odds ratio=2.639, 95% CI=1.210-5.757, Z=2.439, P=0.015; pooled difference
in median overall survival=3.822 months, 95% CI=1.798-5.845 months, Z=3.702, P<0.001; pooled difference in
median progression-free survival=3.268 months, 95% CI=1.996-4.541 months, Z=5.035, P<0.001. Patients with
advanced BTC who are treated with gemcitabine plus platinum agents may experience better survival outcomes
compared with patients who are not treated with this combination of chemotherapy. 2013 Wolters Kluwer Health |
Lippincott Williams &Wilkins.
The objective of this study was to carry out a meta-analysis of the efficacy of gemcitabine+platinum agent regimens
in the treatment of advanced biliary tract cancer (BTC). PubMed and Google Scholar were searched using the
following combination of search terms: gemcitabine, oxaliplatin, cholangiocarcinoma, biliary, gallbladder, bile duct.
Studies were eligible for inclusion in the meta-analysis if they were randomized trials on the use of gemcitabine plus
a platinum agent for the treatment of advanced (unresectable or metastatic cancer) BTC. Outcomes of interest were
response rate, overall survival, and progression-free survival. Pooled odds ratios/differences in median survival and
95% confidence intervals (CIs) were determined for each outcome. A total of 47 records were identified in the initial
search. Ultimately, three open-label randomized trials (two phase 2 and one phase 3) met the eligibility criteria and
were included in the meta-analysis. Two studies compared gemcitabine plus cisplatin with gemcitabine alone,
whereas the other study compared gemcitabine plus oxaliplatin with fluorouracil-folinic acid. The total number of
patients in the studies ranged from 54 to 410. The overall analyses revealed that all survival outcomes assessed were
significantly more favorable for patients treated with gemcitabine plus platinum agents than for patients not treated
with this combination. Response rates: odds ratio=2.639, 95% CI=1.210-5.757, Z=2.439, P=0.015; pooled difference
in median overall survival=3.822 months, 95% CI=1.798-5.845 months, Z=3.702, P<0.001; pooled difference in
median progression-free survival=3.268 months, 95% CI=1.996-4.541 months, Z=5.035, P<0.001. Patients with
advanced BTC who are treated with gemcitabine plus platinum agents may experience better survival outcomes
compared with patients who are not treated with this combination of chemotherapy.
Objective: To review outcomes of randomized controlled clinical trials exploring the efficacy of different types of
diets containing various amounts of fiber in the management of type 2 diabetes mellitus. Methods: We searched
PubMed, Medline, and Google Scholar for published data from the past decade (through December 2009) on dietary
patterns and risk of type 2 diabetes mellitus. Only randomized controlled trials investigating the effect of whole
grains, fiber, or vegetarian diets on type 2 diabetes were included. Search criteria included whole grain, fruit,
vegetable, fiber, and meat intake regarding insulin sensitivity and glycemic responses in healthy, prediabetic, and
diabetic persons. Results: A total of 14 randomized clinical trials were included. Addition of insoluble or soluble fiber
to meals, increased consumption of diets rich in whole grains and vegetables, and vegan diets improve glucose
metabolism and increase insulin sensitivity. The greatest improvement in blood lipids, body weight, and hemoglobin
A1c level occurred in participants following low-fat, plant-based diets. Conclusions: Increased consumption of
vegetables, whole grains, and soluble and insoluble fiber is associated with improved glucose metabolism in both
diabetic and nondiabetic individuals. Improvements in insulin sensitivity and glucose homeostasis were more evident
in participants following a plant-based diet compared with other commonly used diets. Copyright 2011 AACE.
Purpose: Our aim was to undertake a comprehensive systematic review on the efficacy of information interventions
on reducing anxiety in patients and family members on transfer from a critical care setting to a general ward.
Materials and methods: MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, and Google Scholar
databases from 1990 to January 1, 2011, were searched. Bibliographies of identified articles were reviewed. Only
high-quality randomized controlled trials comparing an intervention to reduce transfer anxiety with standard care,
where transfer anxiety is measured by the validated State Trait Anxiety Inventory, were included. Data were
extracted to estimate standard mean differences (SMDs), pooled odds ratios (ORs), and 95% confidence intervals
(CIs) using both fixed and random effects model. Results: Of 266 studies identified in the primary search, 5 studies
enrolling 629 participants met the inclusion criteria, family members' transfer anxiety was significantly reduced in
the intervention arm of information provision (OR, 1.70; 95% CI, 1.15-2.52; P = .01) compared with those who
received standard care (OR, 0.42; 95% CI; 0.276-0.625; P < .001), and patients' transfer anxiety was significantly
reduced in one study. Conclusions: Providing information to understand a future ward environment can significantly
reduce patients' and family members' transfer anxiety from the critical care setting when compared with standard
care. 2012 Elsevier Inc.
Epilepsy is a brain disorder which affects about 50 million people worldwide. Ineffectiveness of the drugs in some
cases and the serious side effects and chronic toxicity of the antiepileptic drugs lead to use of herbal medicine as a
form of complementary and alternative medicine. In this review modern evidences for the efficacy of antiepileptic
medicinal plants in Traditional Iranian Medicine (TIM) will be discussed. For this purpose electronic databases
including PubMed, Scopus, Sciencedirect, and Google Scholar were searched for each of the antiepileptic plants
during 1970-February 2013.Anticonvulsant effect of some of the medicinal plants mentioned in TIM like Anacyclus
pyrethrum, Pimpinella anisum, Nigella sativa, and Ferula gummosa was studied with different models of seizure. Also
for some of these plants like Nigella sativa or Piper longum the active constituent responsible for antiepileptic effect
was isolated and studied. For some of the herbal medicine used in TIM such as Pistacia lentiscus gum (Mastaki),
Bryonia alba (Fashra), Ferula persica (Sakbinaj), Ecballium elaterium (Ghesa-al Hemar), and Alpinia officinarum
(Kholanjan) there is no or not enough studies to confirm their effectiveness in epilepsy. It is suggested that an
evaluation of the effects of these plants on different epileptic models should be performed. 2013 Mehri Abdollahi
Fard and Asie Shojaii.
Hepatorenal syndrome (HRS) is a type of renal failure occurring in patients with cirrhosis, ascites and liver failure.
Among the pharmacological treatment available, terlipressin has been found to be most efficacious vasoconstrictor
agent in improving renal function. Though terlipressin has significant HRS reversal benefits, it lacks long term
mortality benefits. Evidences on mortality benefits and renal failure reversal efficacy of midodrine plus octreotide in
HRS are insufficient and controversial. The primary and secondary objectives of the study were to analyze mortality
benefits and HRS reversal efficacy of midodrine plus octreotide in HRS respectively. Electronic databases were
searched for the relevant articles in PUBMED, The Cochrane Register for Controlled trials, SCIRUS and Google scholar
with MeSH search terms'midodrine' 'octreotide' and 'hepatorenal syndrome'. Studies comparing mortality benefits
of midodrine plus octreotide with control group were eligible to be included under analysis. Of the total 26 studies
found relevant and deemed further screening only three studies met the eligibility criteria and were included in
analysis. With total 309 patients included in analysis there was significant decrease in odds of occurrence of death at
three months (Odds Ratio, OR = 0.17; 95% CI= 0.03 to 0.96) in midodrine plus octreotide treated group. Results of
the study suggest that mortality benefits of midodrine plus octreotide appear to be significant even at three months.
Though HRS reversal efficacy of this combination remains inconclusive, this combination may have HRS reversal
benefits in terms of retarding the progression of the HRS rather than reversing it.
Multimodal treatment of postoperative pain using adjuncts such as gabapentin is becoming more common.
Pregabalin has anti-hyperalgesic properties similar to gabapentin. In this systematic review, we evaluated
randomized, controlled trials (RCTs) for the analgesic efficacy and opioid-sparing effect of pregabalin in acute
postoperative pain. A systematic search of Medline (1966-2010), the Cochrane Central Register of Controlled Trials
(CENTRAL), and Google Scholar was performed. We identified 11 valid RCTs that used pregabalin for acute
postoperative pain. Postoperative pain intensity was not reduced by pregabalin. Cumulative opioid consumption at
24 h was significantly decreased with pregabalin. At pregabalin doses of >=300 mg, there was a reduction of 8.8 mg
[weighted mean difference (WMD)]. At pregabalin doses <300 mg, cumulative opioid consumption was even lower
(WMD, -13.4 mg). Pregabalin reduced opioid-related adverse effects such as vomiting [risk ratio (RR) 0.73; 95%
confidence interval (CI) 0.56-0.95]. However, the risk of visual disturbance was greater (RR 3.29; 95% CI 1.95-5.57).
Perioperative pregabalin administration reduced opioid consumption and opioid-related adverse effects after
surgery. The Author [2010]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All
rights reserved.
Objectives: To assess the effect of Traditional Chinese Herbal Medicine (CHM) in the management of female
infertility and on pregnancy rates compared with Western Medical (WM) treatment. Methods: We searched the
Medline and Cochrane databases and Google Scholar until February 2010 for abstracts in English of studies
investigating infertility, menstrual health and Traditional Chinese Medicine (TCM). We undertook meta-analyses of
(non-)randomised controlled trials (RCTs) or cohort studies, and compared clinical pregnancy rates achieved with
CHM versus WM drug treatment or in vitro fertilisation (IVF). In addition, we collated common TCM pattern diagnosis
in infertility in relation to the quality of the menstrual cycle and associated symptoms. Results: Eight RCTs, 13 cohort
studies, 3 case series and 6 case studies involving 1851 women with infertility were included in the systematic
review. Meta-analysis of RCTs suggested a 3.5 greater likelihood of achieving a pregnancy with CHM therapy over a 4-
month period compared with WM drug therapy alone (odds ratio = 3.5, 95% CI: 2.3, 5.2, p< 0.0001, n= 1005). Mean
(SD) pregnancy rates were 60 +/- 12.5% for CHM compared with 32 +/- 10% using WM drug therapy. Meta-analysis
of selected cohort studies (n= 616 women) suggested a mean clinical pregnancy rate of 50% using CHM compared
with IVF (30%) (p< 0.0001). Conclusions: Our review suggests that management of female infertility with Chinese
Herbal Medicine can improve pregnancy rates 2-fold within a 4 month period compared with Western Medical
fertility drug therapy or IVF. Assessment of the quality of the menstrual cycle, integral to TCM diagnosis, appears to
be fundamental to successful treatment of female infertility. 2011 Elsevier Ltd.
Background: Caudal block is a common local anaesthetic (LA) technique in paediatric anaesthesia. Duration of
analgesia after single shot caudal bupivacaine ranges from 4-8 h.1 The addition of opioids can prolong the duration
of analgesia but their use is limited by side-effects. Tramadol is an opioid that has no respiratory depressant effect
and has been shown to prolong duration of analgesia in randomised controlled trials (RCTs). A meta-analysis was
performed to explore the effects of the addition of tramadol to caudal bupivacaine. Methods: RCTs on Medline,
EMBASE and Google Scholar were sought using the keywords: caudal, tramadol. Bibliographies of relevant reviews
and RCTs were searched. Published abstracts from 2000-10 were reviewed. Manuscripts were rated for quality using
the Jadad scale.2 RevMan statistical sofware utilised inverse variance and random effect to calculate weighted mean
difference (WMD) for continuous variables and odds ratio using the Mantel-Haenszel test with 95% confidence
intervals for dichotomous variables. Primary outcome was duration of analgesia; secondary outcomes were nausea
and vomiting (PONV), respiratory rate and urinary retention. Results: 16 RCTs were identified of which 12 (634
patients) published between 1997 and 2010 met the inclusion criteria. The quality of the manuscripts ranged
between 3-5 on the Jadad scale. Duration of analgesia in the tramadol plus LA group was prolonged by 4 h compared
to LA alone. PONV was higher in the tramadol group but there was no significant effect on respiratory rate or urinary
retention. (Table Presented) Discussion: This meta-analysis suggests that caudal tramadol prolongs duration of
analgesia by 4 h. However, due to the high heterogeneity between studies, the results should be treated with
caution. More RCTs are needed in this respect.
Background The recurrence of pterygium after surgery is high. A variety of adjunctive treatment approaches have
been developed to improve the clinical efficacy and many related articles have been published. This study aimed to
determine the risk for postoperative pterygium recurrence comparing autologous conjunctival transplantation (ACT)
versus mitomycin C (MMC). Methods Relevant literature published until December 2010 in Medline, Embase,
Cochrane, Cochrane library, Science Citation Index, and Google Scholar were searched. Qualified random clinical trial
(RCT) studies on the comparison of recurrence rate of pterygium after ACT and MMC treatment were included in this
study. Results Eight RCTs with 663 eyes entered the final analysis. The recurrent rate of pterygium was 8.7% (30/343)
for ACT and 18.75% (60/320) for MMC. Using fixed-effect meta analysis, we found that the recurrence was
significantly lower after ACT than MMC treatment (odds ratio (OR)=0.40, 95% confidence index (CI), 0.25-0.63, P
<0.0001). In sensitivity analyses, we employed random-effects model and excluded studies of low quality or studies
in which MMC was administrated after the operation. All the sensitivity analyses confirmed that ACT led to lower
recurrence rates than MMC. Sub-group analysis revealed that the recurrence rate was 20.2% (20/99) and 27.65%
(26/94) for conjunctival autograft (CA) and MMC respectively, and no significant difference in the recurrence rate
was detected (OR=0.65, 95% CI 0.33-1.28, P=0.22). However, we found that conjunctival limbal autograft (CLA) had
lower recurrence rate than MMC (OR=0.26, 95% CI 0.14-0.48, P=0.0001). Conclusion CLA has better therapy efficacy
against the recurrence of pterygium than MMC.
BACKGROUND: The recurrence of pterygium after surgery is high. A variety of adjunctive treatment approaches have
been developed to improve the clinical efficacy and many related articles have been published. This study aimed to
determine the risk for postoperative pterygium recurrence comparing autologous conjunctival transplantation (ACT)
versus mitomycin C (MMC)., METHODS: Relevant literature published until December 2010 in Medline, Embase,
Cochrane, Cochrane library, Science Citation Index, and Google Scholar were searched. Qualified random clinical trial
(RCT) studies on the comparison of recurrence rate of pterygium after ACT and MMC treatment were included in this
study., RESULTS: Eight RCTs with 663 eyes entered the final analysis. The recurrent rate of pterygium was 8.7%
(30/343) for ACT and 18.75% (60/320) for MMC. Using fixed-effect meta analysis, we found that the recurrence was
significantly lower after ACT than MMC treatment (odds ratio (OR) = 0.40, 95% confidence index (CI), 0.25 - 0.63, P <
0.0001). In sensitivity analyses, we employed random-effects model and excluded studies of low quality or studies in
which MMC was administrated after the operation. All the sensitivity analyses confirmed that ACT led to lower
recurrence rates than MMC. Sub-group analysis revealed that the recurrence rate was 20.2% (20/99) and 27.65%
(26/94) for conjunctival autograft (CA) and MMC respectively, and no significant difference in the recurrence rate
was detected (OR = 0.65, 95%CI 0.33 - 1.28, P = 0.22). However, we found that conjunctival limbal autograft (CLA)
had lower recurrence rate than MMC (OR = 0.26, 95%CI 0.14 - 0.48, P = 0.0001)., CONCLUSION: CLA has better
therapy efficacy against the recurrence of pterygium than MMC.
Background. Virtual reality (VR) simulators for surgical training might possess the properties needed for basic training
in laparoscopy. Evidence for training efficacy of VR has been investigated by research of varying quality over the past
decade. Objective. To review randomized controlled trials regarding VR training efficacy compared with traditional or
no training, with outcome measured as surgical performance in humans or animals. Data sources. In June 2011
Medline, Embase, the Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar were
searched using the following medical subject headings (MeSh) terms: Laparoscopy/standards, Computing
methodologies, Programmed instruction, Surgical procedures, Operative, and the following free text terms: Virtual
real* OR simulat* AND Laparoscop* OR train* Limits: Controlled trials. Study eligibility criteria. All randomized
controlled trials investigating the effect of VR training in laparoscopy, with outcome measured as surgical
performance. Methods. A total of 98 studies were screened, 26 selected and 12 included, with a total of 241
participants. Results. Operation time was reduced by 17-50% by VR training, depending on simulator type and
training principles. Proficiency-based training appeared superior to training based on fixed time or fixed numbers of
repetition. Simulators offering training for complete operative procedures came out as more efficient than
simulators offering only basic skills training. Conclusions. Skills in laparoscopic surgery can be increased by
proficiency-based procedural VR simulator training. There is substantial evidence (grade IA - IIB) to support the use
of VR simulators in laparoscopic training. 2012 Nordic Federation of Societies of Obstetrics and Gynecology.
Background: Virtual reality (VR) simulators for surgical training might possess the properties needed for basic training
in laparoscopy. Evidence of VR training efficiency has been investigated in research of various quality over the past
decade. Objective: To review the randomized controlled trials regarding the efficiency of VR training compared to
traditional or no training,with outcomemeasured on surgical performance in humans or animals. Data sources: In
June 2011 Medline, Embase, the Cochrane Central Register of Controlled Trials web of science, Google Scholar were
searched using the following MeSH terms: Laparoscopy/standards Computing Methodologies, Programmed
Instruction as topic, Surgical Procedures, Operative, and the following free text terms: Virtual real. OR simulat. AND
Laparoscop. OR train. Limits: Controlled trials. Study eligibility criteria: All randomized controlled trials investigating
the effect of virtual reality training in laparoscopy, with outcome measured on the surgical performance. A total of
98 studies were screened, 26 selected and 12 studies included, with a total of 241 participants. Results: Operation
time was reduced from 17 to 50% by virtual reality simulator training, depending on simulator type and training
principle. Proficiency based training appear superior to training based on fixed time or fixed number of repetitions.
Simulators offering training of complete operation procedures come out more efficient than simulators offering only
basic skills training. Conclusions: Skills in laparoscopic surgery can be increased by proficiency based procedural
virtual reality simulator training. There is substantial evidence (grade IA . IIB) to support the use of virtual reality
simulators in laparoscopic training.
Background: Drug research and surveillance after approval becomes more and more important. Non-interventional
studies are effective in studying safety and effectiveness in "real life settings". Lack of specific regulatory
requirements for source data verification (SDV) leaves sponsors to determine the method and level of SDV to ensure
quality. It is more a company's decision to decide whether to do 100% SDV for all patients or to do 100% SDV of key
data or otherwise. Objectives: A literature review was performed to determine the current methods of SDV in
published observational studies. Methods: Google Scholar and Pubmed searches were used to retrieve relevant
publications. The term "source data verification" was used in combination with the terms "observational study" and
"non-interventional study". Articles readily available in full text were included for analysis. The methods sections
were screened to determine the level of SDV applied. If multiple publications referred to a single study or registry,
only one representative publication was selected for inclusion. Results: Of the observational studies detected, 21
studies elaborated briefly on the way SDV was performed in their study. No SDV was performed in five studies, the
remaining 16 studies performed 100% SDV on a percentage of the patients (median 10%). Generally, studies larger
than 1,000 subjects sought to verify data sources for up to 10% of their population. One of these sixteen studies
additionally performed SDV on a number of critical data points. Conclusions: The way SDV is performed in non-
interventional studies is not routinely specified in the methods section of publications. In those publications that did
elaborate on study quality, the level of SDV ranges between 0% and 100%, with large (n > 1,000 subjects)
observational studies restricting the level of SDV to a maximum of 10%. The investigators rather preferred to
perform 100% SDV for all data for a certain percentage of patients then do 100% SDV of certain key variables only.
Introduction. Electromagnetic fields (EMF) may be applied to the human body with rehabilitative goals. Injury to
peripheral nerve tissue differs from the lesion in the central nervous system because it presents a great potential for
axonal regeneration. physiological effects are associated to exposure to EMFs, such as analgesia, vasodilation,
muscle contraction and, especially, tissue regeneration. Objective. The paper aim is present and explore new
applications of EMF in the rehabilitation of peripheral nerve tissue. Method. Literature search was undertaken on the
bases Springer, ScienceDirect, PubMed, Google Scholar, CAPES periodicals portal between the years 1972 to 2009,
using the terms: Magnetic fields; Nerve regeneration; Peripheral nerve; Axonal regeneration; Electrical regeneration;
Peripheral nerve regeneration. Results. The selected parameters for EMFs vary widely: for electric fields, it is used
pulse width (on time) from 65 mumus up to 100 mumus, frequency range up to 250 Hz and amplitude varying from
0,1 V/m to 4 V/m. For magnetic fields, intensity varies between 4.35 muT and 8 T and frequency, between 0 and 54
GHz. Conclusion. results related to axonal elongation and guidance, protein increment, genetic changes and
reduction of the total time of regeneration. The application produces no physical damage and few transient adverse
effects when safe magnitudes are yielded.
Aims: To conceptualize Electronic Patient Record, and to discuss its advantages and disadvantages, the importance of
its implementation in medical and hospital services, the ethical aspects involved and the challenges for the medical
use of this tool, in order to support decision making about the use or nonuse of Electronic Patient Records in medical
practice. Source of data: Scientific papers, PhD theses, dissertations and web sites. Following databases: Medline,
LiLACS and Google Scholar. Keywords searched: medical records; electronic medical records; information systems.
The research conducted between December 2009 and August 2010 identified 300 abstracts. Forty-six papers,
intrinsically related to the purposes of this paper, were selected to be read in full. Summary of findings: The
Electronic Patient Record can optimize the physician's work, because it allows faster access to patient information,
can document the services rendered throughout life, and provides legibility of the data and integration with other
information systems. However, difficulties in its implementation are also reported, especially with regard to ethical
aspects, lack of standardization between the systems and handling of software. Conclusions: Despite the difficulties
reported, we believe that is extremely important to create information systems that include Electronic Patients
Records in the Brazilian health system in order to identify users, facilitate the management of services and
communication, sharing information and, most importantly, to improve the quality of care provided to the
population.
Email is a popular and commonly-used method of communication, but its use in healthcare is not routine. Where
email communication has been utilised in health care, its purposes have included use for clinical communication
between healthcare professionals, but the effects of using email in this way are not known. This review assesses the
use of email for two-way clinical communication between healthcare professionals. To assess the effects of
healthcare professionals using email to communicate clinical information, on healthcare professional outcomes,
patient outcomes, health service performance, and service efficiency and acceptability, when compared to other
forms of communicating clinical information. We searched: the Cochrane Consumers and Communication Review
Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1
2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (1967 to
January 2010), CINAHL (EbscoHOST) (1982 to February 2010), and ERIC (CSA) (1965 to January 2010). We searched
grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used
additional search methods: examining reference lists, contacting authors. Randomised controlled trials, quasi-
randomised trials, controlled before and after studies and interrupted time series studies examining interventions in
which healthcare professionals used email for communicating clinical information, and that took the form of 1)
unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all
settings were considered. Two authors independently assessed studies for inclusion, assessed the included studies'
risk of bias, and extracted data. We contacted study authors for additional information. We report all measures as
per the study report. We included one randomised controlled trial involving 327 patients and 159 healthcare
providers at baseline. It compared an email to physicians containing patient-specific osteoporosis risk information
and guidelines for evaluation and treatment with usual care (no email). This study was at high risk of bias for the
allocation concealment and blinding domains. The email reminder changed health professional actions significantly,
with professionals more likely to provide guideline-recommended osteoporosis treatment (bone density
measurement and/or osteoporosis medication) when compared with usual care. The evidence for its impact on
patient behaviours/actions was inconclusive. One measure found that the electronic medical reminder message
impacted patient behaviour positively: patients had a higher calcium intake, and two found no difference between
the two groups. The study did not assess primary health service outcomes or harms. As only one study was identified
for inclusion, the results are inadequate to inform clinical practice in regard to the use of email for clinical
communication between healthcare professionals. Future research needs to use high-quality study designs that take
Email is a popular and commonly-used method of communication, but its use in health care is not routine. Where
email communication has been demonstrated in health care this has included its use for communication between
patients/caregivers and healthcare professionals for clinical purposes, but the effects of using email in this way is not
known.This review addresses the use of email for two-way clinical communication between patients/caregivers and
healthcare professionals. To assess the effects of healthcare professionals and patients using email to communicate
with each other, on patient outcomes, health service performance, service efficiency and acceptability. We searched:
the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of
Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE
(OvidSP) (1980 to January 2010), PsycINFO (OvidSP) (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February
2010) and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials
registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists,
contacting authors. Randomised controlled trials, quasi-randomised trials, controlled before and after studies and
interrupted time series studies examining interventions using email to allow patients to communicate clinical
concerns to a healthcare professional and receive a reply, and taking the form of 1) unsecured email 2) secure email
or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered. Two
authors independently assessed the risk of bias of included studies and extracted data. We contacted study authors
for additional information. We assessed risk of bias according to the Cochrane Handbook for Systematic Reviews of
Interventions. For continuous measures, we report effect sizes as mean differences (MD). For dichotomous outcome
measures, we report effect sizes as odds ratios and rate ratios. Where it was not possible to calculate an effect
estimate we report mean values for both intervention and control groups and the total number of participants in
each group. Where data are available only as median values it is presented as such. It was not possible to carry out
any meta-analysis of the data. We included nine trials enrolling 1733 patients; all trials were judged to be at risk of
bias. Seven were randomised controlled trials; two were cluster-randomised controlled designs. Eight examined
email as compared to standard methods of communication. One compared email with telephone for the delivery of
counselling. When email was compared to standard methods, for the majority of patient/caregiver outcomes it was
not possible to adequately assess whether email had any effect. For health service use outcomes it was not possible
to adequately assess whether email has any effect on resource use, but some results indicated that an email
intervention leads to an increased number of emails and telephone calls being received by healthcare professionals.
As medical care becomes more complex and the ability to test for conditions grows, pressure on healthcare
providers to convey increasing volumes of test results to patients is driving investigation of alternative technological
solutions for their delivery. This review addresses the use of email for communicating results of diagnostic medical
investigations to patients. To assess the effects of using email for communicating results of diagnostic medical
investigations to patients, compared to SMS/ text messaging, telephone communication or usual care, on outcomes,
including harms, for health professionals, patients and caregivers, and health services. We searched: the Cochrane
Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials
(CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980
to January 2010), PsycINFO (OvidSP) (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010), and ERIC
(CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and
Google Scholar (searched July 2010). We used additional search methods: examining reference lists and contacting
authors. Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted
time series studies of interventions using email for communicating results of any diagnostic medical investigations to
patients, and taking the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare
professionals, patients and caregivers in all settings were considered. Two review authors independently assessed
the titles and abstracts of retrieved citations. No studies were identified for inclusion. Consequently, no data
collection or analysis was possible. No studies met the inclusion criteria, therefore there are no results to report on
the use of email for communicating results of diagnostic medical investigations to patients. In the absence of
included studies, we can draw no conclusions on the effects of using email for communicating results of diagnostic
medical investigations to patients, and thus no recommendations for practice can be stipulated. Further well-
designed research should be conducted to inform practice and policy for communicating patient results via email, as
this is a developing area.
Email is a popular and commonly-used method of communication, but its use in health care is not routine. Where
email communication has been utilised in health care, its purposes have included the coordination of healthcare
appointments and attendance reminders, but the effects of using email in this way are not known. This review
considers the use of email for the coordination of healthcare appointments and reminders for attendance;
particularly scheduling, rescheduling and cancelling healthcare appointments, and providing prompts/reminders for
attendance at appointments. To assess the effects of using email for the coordination of healthcare appointments
and attendance reminders, compared to other forms of coordinating appointments and reminders, on outcomes for
health professionals, patients and carers, and health services, including harms. We searched: the Cochrane
Consumers and Communication Review Group Specialised Register, the Cochrane Central Register of Controlled
Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP)
(1980 to January 2010), PsycINFO (OvidSP) (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February
2010),and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials
registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists and
contacting authors. Randomised controlled trials, quasi-randomised trials, controlled before and after studies and
interrupted time series studies of interventions that use email for scheduling health appointments, for reminders for
a scheduled health appointment or for ongoing coordination of health appointments and that took the form of 1)
unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all
settings were considered. Two review authors independently assessed the titles and abstracts of retrieved citations.
No studies were identified for inclusion. Consequently, no data collection or analysis was possible. No studies met
the inclusion criteria, therefore there are no results to report on the use of email for the coordination of healthcare
appointments and attendance reminders. No conclusions on the effects of using email for the coordination of
healthcare appointments and attendance reminders could be made and thus no recommendations for practice can
be stipulated. Given the significant theoretical opportunities that email presents, there is a need for rigorous studies
addressing the review question, but this may involve addressing barriers concerning trial development and
implementation.
Email is a popular and commonly used method of communication, but its use in health care is not routine. Its
application in health care has included the provision of information on disease prevention and health promotion, but
the effects of using email in this way are not known. This review assesses the use of email for the provision of
information on disease prevention and health promotion. To assess the effects of email for the provision of
information on disease prevention and health promotion, compared to standard mail or usual care, on outcomes for
healthcare professionals, patients and caregivers, and health services, including harms. We searched: the Cochrane
Consumers and Communication Review Group Specialised Register (January 2010), the Cochrane Central Register of
Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (1950 to January 2010), EMBASE (1980 to
January 2010), CINAHL (1982 to February 2010), ERIC (1965 to January 2010) and PsycINFO (1967 to January 2010).
We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July
2010). We used additional search methods: examining reference lists, contacting authors. Randomised controlled
trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies examining
interventions where email is used by healthcare professionals to provide information to patients on disease
prevention and health promotion, and taking the form of 1) unsecured email 2) secure email or 3) web messaging.
We considered healthcare professionals or associated administrative staff as participants originating the email
communication, and patients and caregivers as participants receiving the email communication, in all settings. Email
communication was one-way from healthcare professionals or associated administrative staff originating the email
communication, to patients or caregivers receiving the email communication. Two authors independently assessed
the risk of bias of included studies and extracted data. We contacted study authors for additional information. We
assessed risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. For continuous
outcome measures, we report effect sizes as mean differences (MDs). For dichotomous outcome measures, we
report effect sizes as odds ratios (ORs). We conducted a meta-analysis for one primary health service outcome,
comparing email communication to standard mail, and report this result as an OR. We included six randomised
controlled trials involving 8372 people. All trials were judged to be at high risk of bias for at least one domain. Four
trials compared email communication to standard mail and two compared email communication to usual care. For
the primary health service outcome of uptake of preventive screening, there was no difference between email and
standard mail (OR 0.93; 95% CI 0.69 to 1.24). For both comparisons (email versus standard mail and email versus
usual care) there was no difference between the groups for patient or caregiver understanding and support. Results
The ancient use of medicinal plants has shown over the years that certain plants have potentially dangerous
substances. From a scientific point of view, some studies have shown that many of these plants contain aggressive
substances and therefore should be used with caution, respecting their toxicological risks. The most important
effects of the indiscriminate use of medicinal plants are embryotoxic, teratogenic and abortifacient since the plant
constituents can cross the placenta, reaching the fetus and leading to one of these effects. This study aimed to
provide a list of the major medicinal plants that have proven embryotoxic, teratogenic and abortifacient effects,
including the used plant parts and their respective scientific names, in order to warn pregnant women about the risks
of its use. Searches were carried out in the electronic databases SciELO, PubMed, MEDLINE, LILACS, CAPES and
Google Scholar. Results indicated that plants such as mountain arnica (Arnica montana), mugwort (Artemisia
vulgaris), fringed rue (Ruta chalepensis / Ruta graveolens), "Barbatimao" (Stryphnodendron polyphyllum) and
"Boldo" (Vernonia condensata) are likely to generate such an effect. This study shows that for most medicinal plants
there are not data regarding the safety of their use during pregnancy.
Purpose: To examine prevalence and correlates of waterpipe use among U.S. college students and explore
differences between 4-year schools and 2-year community colleges. Methods: Google Scholar with its 'cited by' tool
was used to conduct a literature search of U.S. collegiate waterpipe use studies; no studies at community colleges
have been published. A fall 2011 crosssectional in-classroom survey (n = 1,207) was undertaken at two
demographically diverse (43% Latino, 25% White, 14% Multirace, 9% African American, 4% Asian) community
colleges, 1 urban, and 1 suburban, in San Bernardino, Southern California. SPSS 20 was used to run descriptive
statistics and univariate logistic regression to identify variables for processing fully adjusted multiple logistic models.
Results: From 2004 to 2011, 15 peer-reviewed studies reported on 4-year college student waterpipe use. Lifetime
prevalence ranges from 11% to 61% and current 30-day use from 5% to 30%. Common correlates of use are younger
age (18-19), male gender, White race, past and concurrent substance use, the belief that the waterpipe is less
harmful and addictive than cigarettes, and seeing it as highly socially acceptable. Results from each of the 15 studies
are summarized in a table highlighting demographic correlates, tobacco and substance use correlates, and waterpipe
beliefs and behaviors. Results from the community college study (n=1,207) found waterpipe use in the higher range
of the collegiate literature (55.5%) reported ever using the waterpipe, and more than 1 in 3 (34.1%) used it in the
previous year. No gender differences in use were found. More students haveexperimented with the waterpipe than
a cigarette; "ever" cigarette use was 48.8%. Current waterpipe use (10.8%) is associated with current alcohol use
(AOR = 2.8; p> .001), current cigar use (AOR = 2.5; p> .01), current cigarette use (AOR = 1.8; p> .05), and female
binge drinking (AOR = 1.8; p> .05). Compared to African Americans, Whites are 2.9 times (p > .05) more likely to be
current users. Students believing waterpipe use very socially acceptable are 21 times (p > .001) more likely to be
current users than those who believe it not at all acceptable. No associations were found between smokeless
tobacco and illegal drugs and any measure of waterpipe use. While "ever" use of marijuana (56.2%) was correlated
with "ever" waterpipe use, current marijuana use (16.8%) was not associated with any waterpipe use. Economic
variables such as receipt of financial aid, first generation to attend college, and number of hours worked each week
had no bearing on use. Students who spent the least amount of money ($0) per week on entertainment and those
who spent more than $21 were more likely to have used the waterpipe than those who spent $0. Conclusions: Our
findings raise the possibility that the community college is a high risk environment for waterpipe use, adding a new
dimension to this growing trend. Waterpipe health education and cessation programs are needed, as well as more
stringent campus and municipal tobacco control measures. Regulations and ordinances must specifically reference
Clostridium difficile infection (CDI) is the leading identifiable gastrointestinal disease in healthcare institutions, but
the response rates to the two standard therapies for CDI are declining and so innovative therapies are being
developed for CDI. The purpose of this paper is to review the data on the efficacy and safety of emerging therapies
for CDI and assess their potential for effectiveness based on the clinical phase of development and marketing
challenges. Areas covered: Emerging therapies for CDI are reviewed including new antibiotics, peptides, immune
regulators, probiotics and toxin binders. PubMed, Medline and Google Scholar and online clinical trial registers are
searched from 1976 to 2010 for articles unrestricted by language. Secondary searches by author, manufacturing
companies and FDA websites are also performed. Expert opinion: Of the emerging therapies for CDI, several may
ultimately reduce the incidence of CDI and the economic burden of this disease on the healthcare system. Several
emerging treatments (fidaxomicin, rifaximin and mAbs) show the most promise, although only one is currently being
actively developed. Use of other clostridial strains, probiotic strains and immune enhancers have great potential as
therapies, but require further development. 2011 Informa UK, Ltd.
Background: This study assessed emotional adjustment of infertile couples and the psychological outcomes of
infertility (depression, anxiety, relationship and sexual problems, and personality disorders) in different phases of
treatment. References used include studies which have been performed within the last two decades. The articles
were invested on data bases at Pub med, Scholar, Google, Scpous and Amazon and key words include (infertility OR
pregnancy OR depression OR anxiety OR psychology disorder OR marital satisfaction OR psychiatric & psychology
interventions AND personality disorder or ....). Each one of them was used in abstract and keywords, according to
articles selected which were published before 2006. Almost all of accessible articles were obtained, and other
inappropriate articles were not considered. Results: Results derived from most studies show that more than half of
infertile people (women, men, and couples) learn to cope with this problem to some extent. Conclusion: However, a
significant percentage of people show clinical signs such as inability to adjust with the problem and inappropriate
emotional reactions, which highlights the importance of psychological inventions and psychotherapy.
Objective: To systematically assess the potential association of fibromyalgia syndrome (FMS) with emotional,
physical, and sexual abuse. Methods: The databases EMBase, Google Scholar, Medline, and PsycINFO (through April
2010) and the reference sections of original studies were searched for eligible studies. Eligible studies were cohort or
case-control studies that assessed at least one type of emotional, physical, or sexual abuse in childhood or adulthood
in patients with FMS and in controls. Two authors independently extracted descriptive, quality, and outcome data
from included studies. Methodologic quality was assessed by the Newcastle-Ottawa Quality Assessment Scale. Odds
ratios (ORs) and 95% confidence intervals (95% CIs) were pooled across studies by using the random-effects model.
Heterogeneity was assessed by I2 statistics. Results: The search identified 18 eligible case-control studies with 13,095
subjects. There were significant associations between FMS and self-reported physical abuse in childhood (OR 2.49
[95% CI 1.81-3.42], I 2 = 0%; 9 studies) and adulthood (OR 3.07 [95% CI 1.01-9.39], I 2 = 79%; 3 studies), and sexual
abuse in childhood (OR 1.94 [95% CI 1.36-2.75], I2 = 20%; 10 studies) and adulthood (OR 2.24 [95% CI 1.07-4.70], I2 =
64%; 4 studies). Study quality was mostly poor. Low study quality was associated with higher effect sizes for sexual
abuse in childhood, but not with other effect sizes. Conclusion: The association of FMS with physical and sexual
abuse could be confirmed, but is confounded by study quality. 2011, American College of Rheumatology.
OBJECTIVES:Recent treatment guidelines recommend two first-line therapies for Helicobacter pylori infection:
proton pump inhibitor (PPI), bismuth, tetracycline, and metronidazole (quadruple therapy) or PPI, clarithromycin, and
amoxicillin (triple therapy). We performed a systematic review and meta-analysis to compare the efficacy and
tolerability of these regimens as first-line treatment of H. pylori.METHODS:A search of MEDLINE, EMBASE, Google
Scholar, the Cochrane Central Register of Controlled Trials, ACP Journal Club, the Database of Abstracts of Reviews of
Effectiveness, Cochrane Methodology Register, Health Technology Assessment Database, and abstracts from
prominent gastrointestinal scientific meetings was carried out. Randomized controlled trials (RCTs) comparing
bismuth quadruple therapy to clarithromycin triple therapy were selected for meta-analysis. Two independent
reviewers extracted data, using standardized data forms. Meta-analysis was carried out with the metan command in
Stata 10.1. Funnel plots and subgroup analyses were carried out.RESULTS:Nine RCTs (N1,679) were included.
Although dosing regimens of clarithromycin triple therapy were quite consistent between trials, dosing regimens
varied considerably for bismuth quadruple therapy. Bismuth quadruple therapy achieved eradication in 78.3% of
patients, whereas clarithromycin triple therapy achieved an eradication rate of 77.0% (risk ratio (RR)1.002, 95%
confidence interval (CI): 0.936-1.073). There was moderate heterogeneity and no evidence for significant publication
bias. Subgroup analyses by study location, treatment duration, and study population did not account for the
heterogeneity. There were no statistically significant differences in side effects yielded by quadruple vs.
clarithromycin triple therapy (RR1.04, 95% CI: 1.04-1.14).CONCLUSIONS: Quadruple and triple therapies yielded
similar eradication rates as primary therapy for H. pylori infection. Both therapies yielded suboptimal eradication
rates. Patient compliance and side effects are similar for quadruple and triple therapies. 2010 by the American
College of Gastroenterology.
This paper was prepared for the Employment Conditions and Health Inequalities Knowledge Network (EMCONET),
part of the WHO Commission on the Social Determinants of Health. We describe the Brazilian context of
employment conditions, labor conditions and health, their characteristics and causal relationships. The social,
political and economic factors that influence these relationships are also presented with an emphasis on social
inequalities, and how they are reproduced within the labor market and thereby affect the health and wellbeing of
workers. A literature review was conducted in SciELO, LILACS, Google and Google Scholar, MEDLINE and the CAPES
Brazilian thesis database. We observed that there are more workers operating in the informal sector than in the
formal sector and these former have no social insurance or any other social benefits. Work conditions and health are
poor in both informal and formal enterprises since health and safety labor norms are not effective. The involvement
of social movements and labor unions in the elaboration and management of workers' health polices and programs
with universal coverage, is a promising initiative that is underway nationwide.
This paper was prepared for the Employment Conditions and Health Inequalities Knowledge Network (EMCONET),
part of the WHO Commission on the Social Determinants of Health. We describe the Brazilian context of
employment conditions, labor conditions and health, their characteristics and causal relationships. The social,
political and economic factors that influence these relationships are also presented with an emphasis on social
inequalities, and how they are reproduced within the labor market and thereby affect the health and wellbeing of
workers. A literature review was conducted in SciELO, LILACS, Google and Google Scholar, MEDLINE and the CAPES
Brazilian thesis database. We observed that there are more workers operating in the informal sector than in the
formal sector and these former have no social insurance or any other social benefits. Work conditions and health are
poor in both informal and formal enterprises since health and safety labor norms are not effective. The involvement
of social movements and labor unions in the elaboration and management of workers' health polices and programs
with universal coverage, is a promising initiative that is underway nationwide.
Exposure to cancer and its treatments, including chemotherapy and radiotherapy, may result in late adverse effects
including endocrine dysfunction. Endocrine disorders are the most commonly reported long-term complications of
cancer treatment, especially by adult survivors of childhood cancers. This review will explore the endocrinologic
adverse effects from non-endocrine cancer therapies. Searches including various Internet-based medical search
engines such as PubMed, Medline Plus, and Google Scholar were conducted for published articles. One hundred sixty-
nine journal articles met the inclusion criteria. They included case reports, systematic analyses, and cohort reports.
Endocrine disorders including hypothalamus dysfunction, hypopituitarism, syndrome of inappropriate anti-diuretic
hormone secretion, diabetes insipidus, growth hormone disorders, hyperprolactinemia, gonadotropin deficiency,
serum thyroid hormone-binding protein abnormalities, hypothyroidism, hyperthyroidism, hypomagnesium,
hypocalcemia, hyperparathyroidism, hyperparathyroidism, adrenal dysfunction, gonadal dysfunction,
hypertriglyceridemia, hypercholesterolemia, diabetes mellitus, and glycosuria were identified and their association
with cancer therapies were outlined. The journal articles have highlighted the association of cancer therapies,
including chemotherapy and radiotherapy, with endocrine dysfunction. Some of the dysfunctions were more often
experienced than others. Especially in patients treated with radiotherapy, some endocrinologic disorders were
progressive in nature. Recognition and awareness of endocrine sequelae of cancer treatments may permit for early
detection and appropriate follow-up care for cancer survivors, thus improving their overall health and quality of life.
2007 Springer Science+Business Media, LLC.
OBJECTIVE: To understand some of the cross-cultural issues in providing palliative care to aboriginal patients.
SOURCES OF INFORMATION: MEDLINE (1966 to 2005), CINAHL, PsycINFO, Google Scholar, and the Aboriginal Health
Collection at the University of Manitoba were searched. Studies were selected based on their focus on both general
cross-cultural caregiving and, in particular, end-of-life decision making and treatment. Only 39 relevant articles were
found, half of which were opinion pieces by experienced nonaboriginal professionals; 14 were qualitative research
projects from nursing and anthropologic perspectives. MAIN MESSAGE: All patients are unique. Some cultural
differences might arise when providing palliative care to aboriginal patients, who value individual respect along with
family and community. Involvement of family and community members in decision making around end-of-life issues
is common. Aboriginal cultures often have different approaches to telling bad news and maintaining hope for
patients. Use of interpreters and various communication styles add to the challenge. CONCLUSION: Cultural
differences exist between medical caregivers and aboriginal patients. These include different assumptions and
expectations about how communication should occur, who should be involved, and the pace of decision making.
Aboriginal patients might value indirect communication, use of silence, and sharing information and decision making
with family and community members.
Studies investigating the association between endothelial nitric oxide synthase (eNOS) gene polymorphisms and
preeclampsia reported contradictory or nonconclusive results. We performed a meta-analysis of 18 genetic
association studies that examined the relationship between preeclampsia and the G894T, 4a/b and T-786C
polymorphisms of the eNOS gene. Subgroup analysis by ethnicity and potential sources of heterogeneity and bias
were explored. The MEDLINE, EMBASE, and Google Scholar databases were searched to access the relevant genetic
association studies up to June 2011. For the allelic analysis of the G894T variant, all studies showed no significant
association. For the genotypic analysis, the combined studies of the G allele showed negative significance (odds ratio
[OR]=0.56; 95% confidence interval [CI]: 0.33-0.97), all the studies showed positively significance when the T allele
was combined (OR=1.17; 95% CI: 1.01-1.36), and results were also positively significant in non-Asian populations
(OR=1.20; 95% CI: 1.02-1.43). For the allelic analysis of the 4b/a variant, all studies showed no significant association,
but results were negatively significant in non-Asian populations (OR=0.67; 95% CI: 0.46-0.98). For the genotype
analysis, combined studies of the b allele showed negative significance (OR=0.55; 95% CI: 0.36-0.84). Moreover, non-
Asian studies showed negatively significant results (OR=0.45; 95% CI: 0.28-0.72). For the analysis of the T-786C
variant, none of the studies showed significant results. The synthesis of available evidence supports the fact that
intron 4a allele, homozygosity for the 894T and intron 4a of eNOS are positively associated with preeclampsia. Large,
multiethnic confirmatory, and well-designed studies are needed to determine the relation between preeclampsia
and polymorphisms of the eNOS gene. Copyright 2012, Mary Ann Liebert, Inc.
Fracture healing is a complex physiological process. Local vascularity at the site of the fracture has been established
as one of the most important factors influencing the healing process, and lack of vascularity has been implicated in
atrophic non unions. Existing research has primarily involved utilising Mesenchymal Stem Cells (MSCs) to augment
bone healing but there remains much scope to explore the role of stem cells in the vascularisation process.
Endothelial Progenitor Cells (EPCs) and other Endothelial Cellular populations (ECs) could constitute a valid
alternative to MSCs. This systematic review is examining the importance of co-implantation of MSCs and EPCs/ECs
for bone healing. A literature search was performed using the Cochrane Library, OVID Medline, OVID EMBASE and
Google Scholar, searching for combinations of the terms 'EPCs', 'Endothelial progenitor cells', 'angiogenesis',
'fracture', 'bone' and 'healing'. Finally 18 articles that fulfilled our criteria were included in this review. ECs could be
of value for the treatment of critical size bone defects as they are known to be capable of forming ectopic,
vascularised bone. The co-implantation of ECs with MSCs is more intriguing when we take into account the vast array
of complex reciprocal interactions between ECs and MSCs. 2012 Bentham Science Publishers.
A subarachnoid hemorrhage (SAH) is a serious and potentially life-threatening condition where blood leaks out of
blood vessels over the surface of the brain. Delayed ischemic neurological deficit (DIND) and the related feature of
vasospasm, where patients experience a delayed deterioration, have long been recognized as the leading potentially
treatable cause of death and disability in patients with SAH. Endothelin is a potent, long-lasting endogenous
vasoconstrictor that has been implicated in the pathogenesis of DIND. Therefore, endothelin receptor antagonists
(ETAs) have emerged as a promising therapeutic option for SAH-induced cerebral vasospasm. To assess the efficacy
and tolerability of ETAs for SAH. We searched the Cochrane Stroke Group Trials Register (December 2011), the
Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 11), MEDLINE (1950 to
December 2011), EMBASE (1946 to December 2011) and the Chinese Biomedical Database (1978 to December
2011). In an effort to identify further published, unpublished and ongoing trials we searched additional Chinese
databases, ongoing trials registers, Google Scholar and Medical Matrix, handsearched journals, scanned reference
lists, and contacted researchers and pharmaceutical companies. We only included randomized controlled trials
(RCTs) that compared an ETA with placebo for SAH in adult (18 years of age or older) patients who met the diagnostic
criteria for SAH based on clinical symptoms, with confirmation on computerized tomography scan results or
angiography. Two review authors independently selected RCTs according to the inclusion criteria. We resolved
disagreements by discussion with a third review author. Two review authors independently selected relevant articles
and assessed their eligibility according to the inclusion and exclusion criteria. We resolved disagreements by
discussion with a third review author. We used the random-effects model and expressed the results as risk ratio (RR)
for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CI).
We included four RCTs with 2024 participants that compared ETAs with placebo for SAH. All RCTs were multicenter,
double-blind studies with a low risk of bias. ETAs reduced the incidence of DIND (RR 0.80; 95% CI 0.67 to 0.95) and
angiographic vasospasm (RR 0.62; 95% CI 0.52 to 0.72) but did not reduce the incidence of unfavorable outcomes
(RR 0.87; 95% CI 0.74 to 1.02) or mortality (RR 1.05; 95% CI 0.77 to 1.45). ETAs increased the incidence of
hypotension (RR 2.53; 95% CI 1.77 to 3.62) and pneumonia (RR 1.56; 95% CI 1.23 to 1.97). ETAs appear to reduce
DIND and angiographic vasospasm but there were adverse events and the impact on clinical outcome is unclear.
Additional well-designed RCTs are needed.
The term "energy drink" designates "any product in the form of a drink or concentrated liquid, which claims to
contain a mixture of ingredients having the property to raise the level of energy and vivacity." The main brands, Red
Bull, Dark Dog, Rockstar, Burn, and Monster, are present in food stores, sports venues, and bars among other soft
drinks and fruit juices. Their introduction into the French market raised many reluctances, because of the presence
of taurine, caffeine and glucuronolactone. These components present in high concentrations, could be responsible
for adverse effects on health. The association of energy drinks and spirits Is widely found among adolescents and
adults who justify drinking these mixed drinks by their desire to drink more alcohol while delaying drunkenness.
Given the Importance of the number of incidents reported among the energy drinks consumers, it seemed
appropriate to make a synthesis of available data and to establish causal links between the use of these products and
the development of health complications. For a literature review, we selected scientific articles both in English and
French published between 2001 and 2011 by consulting the databases Medline, Embase, PsycINFO and Google
Scholar. The words used alone or in combination are "energy dinks", "caffeine," "taurine," "toxicity," "dependence".
An occasional to a moderate consumption of these drinks seems to present little risk for healthy adults. However,
excessive consumption associated with the use of alcohol or drugs in amounts that far exceed the manufacturers
recommended amount, could be responsible for negative consequences on health, particularly among subjects with
cardiovascular disease.
INTRODUCTION: Undernutrition directly affects critically ill patient's clinical outcome and mortality rates.,
OBJECTIVE: Interdisciplinar algorithm creation aiming to optimize the enteral nutrition therapy for critically ill adult
patients., DATA SOURCE: Pubmed, SciELO, Scholar Google, Web of Science, Scopus, with research of these key
words: protocols, enteral nutrition, nutritional support, critical care, undernutrition, fasting., SETTING: Intensive Care
Unit, Hospital de Clinicas, Federal University of Uberlandia, MG, Brazil., MEASUREMENTS AND MAIN RESULTS: Were
established in the algorithm a following sequential steps: After a clinical-surgical diagnosis, including the assessment
of hemodynamic stability, were requested passage of a feeding tube in post-pyloric position and a drainage tube in
gastric position. After hemodynamic stability it should be done the nutritional status diagnosis, calculated nutritional
requirements, as well as chosen formulation of enteral feeding. Unless contraindicated, aiming to increase tolerance
was started infusion with small volumes (15 ml/h) of a semi-elemental diet, normocaloric, hypolipidic (also
hyperproteic, with addition of glutamine). To ensure infusion of the diet, as well as the progressive increase of
infusion rates, the patient was monitored for moderate or severe intestinal intolerance. The schedule and infusion
rates were respected and diet was not routinely suspended for procedures and diagnostic tests, unless indicated by
the medical team., CONCLUSIONS: For nutrition therapy success it is essential routine monitoring and extensive
interaction between the professionals involved. Nutritional conducts should be reevaluated and improved, seeking
complete and specialized care to the critically ill patients. Adherence to new practices is challenging, though
instruments such as protocols and algorithms help making information more accessible and comprehensible.
Background Primary eosinophilic gastrointestinal disorders, a spectrum of inflammatory conditions, occurs when
eosinophils selectively infiltrate the gut in the absence of known causes for such tissue eosinophilia. These may be
classified into eosinophilic esophagitis, eosinophilic gastroenteritis and eosinophilic colitis (EC). This review focuses
on EC: its pathogenesis, epidemiology, clinical presentation, diagnosis and current approach to treatment. Sources of
dataA literature review published in English was performed using Pubmed, Ovid, Google scholar search engines with
the following keywords: eosinophilic gastrointestinal disorder, EC, eosinophils, colitis and gastrointestinal. Areas of
agreementThe basis for primary EC appears related to increased sensitivity to allergens, principally as a food allergy
in infants and a T lymphocyte-mediated event in adults. Endoscopic changes are generally modest, featuring edema
and patchy granularity. Areas of controversyClear clinical and pathological diagnostic criteria of EC and its
management strategy. Growing pointsIntestinal involvement of EC is primarily mucosal, presenting as a mild self-
limited proctitis in infants and self-limited colitis in young adults. Therapeutic approaches based on case reports tend
to use either elimination diets to avoid a presumed allergen; agents traditionally used in inflammatory disease or
targeted drugs like anti-histamines or leukotriene receptor antagonists. Areas timely for developing
researchProspective randomized controlled trials addressing the disease natural history, possible preventive
methods and effective medical approach and long-term prognosis are required. 2011 The Author.
Hypertension is a major risk factor for many cardiovascular diseases in developing countries. A comprehensive
review of the prevalence of hypertension provides crucial information for the evaluation and implementation of
appropriate programmes. The PubMed and Google Scholar databases were searched for published articles on the
population-based prevalence of adult hypertension in Ghana between 1970 and August 2009, supplemented by a
manual search of retrieved references. Fifteen unique population-based articles in non-pregnant humans were
obtained. In addition, two relevant unpublished graduate student theses from one university department were
identified after a search of its 1996-2008 theses. The age and sex composition of study populations, sampling
strategy, measurement of blood pressure, definition of hypertension varied between studies. The prevalence of
hypertension (BP > or = 140/90 mmHg +/- antihypertensive treatment) ranged from 19% to 48% between studies.
Sex differences were generally minimal whereas urban populations tended to have higher prevalence than rural
population in studies with mixed population types. Factors independently associated with hypertension included
older age group, over-nutrition and alcohol consumption. Whereas there was a trend towards improved awareness,
treatment and control between 1972 and 2005, less than one-third of hypertensive subjects were aware they had
hypertension and less than one-tenth had their blood pressures controlled in most studies. Hypertension is clearly an
important public health problem in Ghana, even in the poorest rural communities. Emerging opportunities such as
the national health insurance scheme, a new health policy emphasising health promotion and healthier lifestyles and
effective treatment should help prevent and control hypertension.
Bangladesh is one of the four major malaria-endemic countries in South-East Asia having approximately 34% of its
population at risk of malaria. This paper aims at providing an overview of the malaria situation in this country.
Relevant information was retrieved from published articles and reports in PubMed and Google Scholar. Malaria in
Bangladesh is concentrated in 13 districts with a prevalence ranging between 3.1% and 36%, and is mostly caused by
Plasmodium falciparum. Geographical conditions pose a potential risk for Plasmodium knowlesi malaria. Resistance
to a number of drugs previously recommended for treatment has been reported. Low socio-economic status, poor
schooling and close proximity to water bodies and forest areas comprise important risk factors. Despite the
significant steps in Long Lasting Insecticide Net (LLIN)/Insecticide Treated Net (ITN) coverage in Bangladesh, there are
still many challenges including the extension of malaria support to the remote areas of Bangladesh, where malaria
prevalence is higher, and further improvements in the field of referral system and treatment.
Hepatitis B virus prevalence is increasing in Pakistani population. National level estimates regarding the prevalence
are missing. People are unaware of the risk factors involved in HBV transmission. The objective of the study was to
review the prevalence, genotypes, and risk factors associated with HBV transmission in Pakistani Population.
Literature search was done by using keyword HBV prevalence, genotypes and risk factors from Pakistani population
at Pubmed, PakMediNet and Google scholar. Six different studies showed that the percentage prevalence of HBV in
general population was 4.61 +/-0.73%, and 21 different studies showed the percentage prevalence of 2.33 +/-0.46%
in blood donors. High prevalence of 7.94 +/-1.49% and 12.86 +/-4.52% were observed in multi transfused and IDU
populations. Six different studies showed that the major prevalent genotype was D. Awareness regarding various risk
factors involved in-viral transmission was very low. Prevalence of HBV was very high in multitransfused populations
due to non-implementations of international standards regarding blood transfusions. Barbers were unaware of the
risk factors associated with their shops in viral transmission. Practices of unsterilized dental and surgical instruments
and recycling of syringes were major factors in viral transmission. Massive awareness and vaccination programs are
required to decrease the future burden of HBV from Pakistani population.
Background and Aims: Hepatitis E virus is a major cause of outbreaks and sporadic cases of viral hepatitis in
developing countries. Methods: Literature search using the Medline (1966 to July 2008), EMBASE/ Excerpta Medica
(1980 to July 2008), OVID (1966 to July 2008), Google Scholar (for Local websites and medical journals), SID, websites
of Iranian universities and IranMedex was done. Results: The prevalence of hepatitis E infection in Iranian general
population is increasing significantly with age. The prevalence in Iran is less than Pakistan. Consumption of
contaminated water is an important mean for the spread of this enteric transmissible disease. Pigs and animals have
a low role in HEV infection in our region. Conclusions: Primary prevention of HEV infection is the cornerstone of HEV
control in our region and purely depends upon the improvement of the sanitary conditions of the society, provision
of sanitary water, proper disposal of waste, and avoidance of contamination of food.
Objective: The Middle East and North Africa (MENA) region continues to be perceived as a region with very limited
HIV epidemiological data, raising many controversies about the status of the epidemic in this part of the world. The
objective of this review and synthesis was to address the dearth of strategic interpretable data on HIV in MENA by
delineating a data-driven overview of HIV epidemiology in this region. Methods: A comprehensive systematic review
of HIV, sexually transmitted infections (STIs) and risk behavior studies in MENA, irrespective of design, was
undertaken. Sources of data included Medline for peer-reviewed publications, Google Scholar for other scientific
literature published in nonindexed local and regional journals, international organizations reports and databases,
country-level reports and database including governmental and nongovernmental organizations publications, as well
as various other institutional documents. Results: Over 5000 sources of data related to HIV and STIs were identified
and reviewed. The quality of data and nature of study designs varied substantially. There was no evidence for a
sustainable HIV epidemic in the general population in any of the MENA countries, except possibly for southern
Sudan. The general pattern in different countries in MENA points towards emerging epidemics in high-risk
populations including injecting drug users, men who have sex with men (MSM) and to a lesser extent female sex
workers, with heterogeneity between countries on the relative role of each of these high-risk groups. Exogenous HIV
exposures among nationals linked to travel abroad appeared to be the dominant HIV transmission pattern in a few
MENA countries with no evidence for much epidemic or endemic transmission. The role of bridging populations in
bridging the HIV infection to the general population was found to be very limited. Conclusion: Although they do not
provide complete protection against HIV spread, near universal male circumcision and possibly the prevailing
sexually conservative cultural norms seemed to have played so far a protective role in slowing and limiting HIV
transmission in MENA relative to other regions. If the existing social and epidemiological context remains largely the
same, HIV epidemic transmission is likely to remain confined to high-risk populations and their sexual partners, in
addition to exogenous exposures. HIV prevention efforts in this region, which continue to be stymied by stigma
associated with HIV/AIDS and related risk behaviors, need to be aggressively expanded with a focus on controlling
HIV spread along the contours of risk and vulnerability. There is still a window of opportunity to control further HIV
transmission among high-risk groups in MENA that, if missed, may entail a health and socioeconomic burden that the
region, in large part, is unprepared for. 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
CONTEXT: Competitive swimmers are predisposed to musculoskeletal injuries of the upper limb, knee, and spine.
This review discusses the epidemiology of these injuries, in addition to prevention strategies that may assist the
physician in formulating rehabilitation programs for the swimmer following an injury., EVIDENCE ACQUISITION: A
literature search was performed by a review of Google Scholar, OVID, and PubMed articles published from 1972 to
2011., RESULTS: This study highlights the epidemiology of injuries common to competitive swimmers and provides
prevention strategies for the sports health professional., CONCLUSIONS: An understanding of swimming
biomechanics and typical injuries in swimming aids in early recognition of injury, initiation of treatment, and design
of optimal prevention and rehabilitation strategies.
The objective of this review was to summarize the epidemiological literature for surfboard riding (surfing), kite
surfing and personal watercraft (PWC) riding injuries and describe the incidence and nature of these injuries,
common risk factors, and strategies for prevention. The databases searched for relevant publications included
Medline, ScienceDirect, ProQuest International, PubMed, Academic Search Premier as well as Google Scholar to
identify additional, non-indexed studies. Overall, there was a lack of good quality descriptive studies for these three
sports and many of the studies reviewed involved the use of administrative datasets or case-series designs. Among
the few studies to provide incidence estimates, there were inconsistencies in how injury was defined, the inclusion
criteria, and the reporting of incidence rates, making comparisons within and between the sports difficult. While the
reported incidence rates were generally low, head and lower extremity injuries were common across all three sports.
Only two studies reported evidence for postulated risk factors. Bigger waves and surfing over rock or reef sea floor
increased the risk of injury among competitive surfers, while older age and having more experience increased the
risk of significant injuries among recreational surfers. No evaluations of preventative measures were identified. This
review demonstrates the need for well-designed epidemiological research, especially studies that focus on the
accurate measurement and description of incidence, nature, severity and circumstances of injuries. Once this has
occurred, interventions targeted at reducing the incidence of injuries among these sports can be designed,
implemented and evaluated. Copyright 2012 S. Karger AG, Basel.
The objective of this article is to provide an overview of the current knowledge related to the epidemiology of injury
in selected adventure and extreme sports. PubMed and Google Scholar were searched using the terms
'epidemiology', 'injury,' 'adventure sports' and 'extreme sports'. Publications from the past 10 years were largely
selected, but commonly referenced or highly regarded older publications were also included. References lists of
articles identified in the search strategy were also searched and articles selected that were judged to be relevant.
Important aspects of the epidemiology of injury related to adventure and extreme sports are discussed including
occurrence of injury, who is affected by injury, where and when injury occurs, injury outcome, risk factors, inciting
events, prevention and further research. Given the life-changing impact injury can have in sports (personal, social,
financial, psychological, political, and medical), the current paucity of well-designed descriptive and particularly
analytical epidemiological studies in some adventure and extreme sports is disturbing. The importance of
denominator-based and longitudinal data collection in obtaining an accurate picture of injury risk and severity and as
a basis for testing risk factors and evaluating preventive measures is emphasized. Copyright 2012 S. Karger AG, Basel.
The purpose of this report is to review the available literature to provide an epidemiological overview of
skateboarding injuries, as well as to suggest possible areas for future research. A literature search was performed
with the databases of PubMed, Sport Discus, Google and Google Scholar using the search terms 'skateboard',
'skateboarding', 'injury' and 'injuries', with all articles published in refereed journals in the English language being
considered. An ancestry approach was also used. Articles from non-juried journals were also infrequently included to
provide anecdotal information on the sport. Comparison of study results was compromised by the diversity of
different study populations and variability of injury definitions across studies. The majority of injuries affect young
males although conflicting arguments arise over the issues of age and experience in relation to injury severity. Most
injuries are acutely suffered, and the most commonly affected body part was the wrist and forearm, with lower leg
and ankle injuries also common. The incidence was relatively high but reports on severity differed. Clear conclusions
could not be drawn on environmental location and risk factors. Most injuries tend to occur from a loss of balance
leading to a fall, in more recent times due to a failed trick. Research on injury prevention is not conclusive although
protective equipment and skatepark use are recommended. Further research using more rigorous study designs is
required to gain a clearer picture of the incidence and determinants of injury, and to identify risk factors and viable
injury countermeasures. Copyright 2012 S. Karger AG, Basel.
OBJECTIVES: Staphylococcus aureus (S. aureus) is a prevalent pathogen worldwide. Methicillin resistant S. aureus
(MRSA), which is usually multi-resistant in hospitals, has been a daunting challenge for clinicians for more than half a
century. The aim of this systematic review and meta-analysis is to determine the relative frequency (R.F.) of MRSA in
different regions of Iran., MATERIALS AND METHODS: Search terms "Staphylococcus aureus", "Methicillin", "mecA"
and "Iran" were used in PubMed, Scirus and Google Scholar. Two Persian scientific search engines and ten recent
national congresses were also explored. Articles/abstracts, which used clinical specimens and had done PCR to
detect the mecA gene, were included in this review. Comprehensive Meta-Analysis and Meta-Analyst software were
used for statistical analysis., RESULTS: Out of 2690 results found in the mentioned databases, 48 articles were
included in the final analysis. These studies were done in Ahvaz, Falavarjan, Fasa, Gorgan, Hamedan, Isfehan, Kashan,
Mashhad, Sanandaj, Shahrekord, Shiraz, Tabriz, Tehran and Tonekabon. Pooled estimation of 7464 S. aureus samples
showed that 52.7%+/-4.7 (95% confidence interval [CI]) of strains were mecA positive. MRSA R.F. in different studies
varied from 20.48% to 90% in Isfehan and Tehran, respectively. We found a moderate heterogeneity (I(2)= 48.5%) of
MRSA R.F. among studies conducted in Tehran (ranging from 28.88% to 90%, mean 52.7% [95% CI: 46.6%+/-
0.58.8%])., CONCLUSION: According to the results of this study, MRSA R.F. in Iran is in the high range. Thus,
measures should be taken to keep the emergence and transmission of these strains to a minimum.
Objective(s) Staphylococcus aureus is a prevalent pathogen worldwide. Methicillin resistant S. aureus (MRSA), which
is usually multi-resistant in hospitals, has been a daunting challenge for clinicians for more than half a century. The
aim of this systematic review and meta-analysis is to determine the relative frequency (RF) of MRSA in different
regions of Iran. Materials and Methods Search terms "Staphylococcus aureus", "Methicillin", "mecA" and "Iran" were
used in PubMed, Scirus and Google Scholar. Two Persian scientific search engines and ten recent national congresses
were also explored. Articles/abstracts, which used clinical specimens and had done PCR to detect the mecA gene,
were included in this review. Comprehensive Meta-Analysis and Meta-Analyst software were used for statistical
analysis. Results Out of 2690 results found in the mentioned databases, 48 articles were included in the final analysis.
These studies were done in Ahvaz, Falavarjan, Fasa, Gorgan, Hamedan, Isfahan, Kashan, Mashhad, Sanandaj,
Shahrekord, Shiraz, Tabriz, Tehran and Tonekabon. Pooled estimation of 7464 S. aureus samples showed that
52.7%+/-4.7 (95% confidence interval [CI]) of strains were mecA positive. MRSA RF in different studies varied from
20.48% to 90% in Isfahan and Tehran, respectively. We found a moderate heterogeneity (I2= 48.5%) of MRSA RF
among studies conducted in Tehran (ranging from 28.88% to 90%, mean 52.7% [95% CI: 46.6%+/-58.8%]). Conclusion
According to the results of this study, MRSA RF in Iran is in the high range. Thus, measures should be taken to keep
the emergence and transmission of these strains to a minimum.
BACKGROUND: Thyroid disorders are common endocrine disorders encountered in the African continent.
Environmental and nutritional factors are often implicated in the occurrence of some thyroid disorders that occur in
this part of the world. This is a narrative review that seeks to document the pattern, prevalence, and management of
thyroid disorders in the continent., MATERIALS AND METHODS: The search engine used for this review were PubMed
and Google scholar. All available articles on thyroid disorders from the sub-African continent, published until May
2011, were included., RESULTS: Iodine deficiency disorders (IDD) which top the list of thyroid disorders and remain
the commonest cause of thyroid disorders in the continent is often affected not only by the iodine status in the
region but sometimes also by selenium deficiency and thiocyanate toxicity. The reported prevalence rates of
endemic goiter range from 1% to 90% depending on the area of study with myxedematous cretinism still a
prominent feature of IDD in only a few regions of the continent. The extent of autoimmune thyroid disorders
remains unknown because of underdiagnosis and underreporting but the few available studies note a prevalence
rate of 1.2% to 9.9% of which Graves diseases is the commonest of these groups of disorders. Rarer causes of thyroid
dysfunction such as thyroid tuberculosis and amiodarone related causes are also documented in this review. The
onset of new thyroid diseases following amiodarone usage was documented in 27.6% of persons treated for
arrhythmia. Reports on thyroid malignancies (CA) in Africa abound and differentiated thyroid malignancies are noted
to occur more commonly than the other forms of thyroid CA. The documented prevalence rates of thyroid CA in the
African continent are as follows (papillary: 6.7-72.1%, follicular: 4.9-68%, anaplastic: 5-21.4%, and medullary: 2.6%-
13.8%). For the differentiated thyroid CA, there is a changing trend toward the more frequent occurrence of papillary
CA compared to follicular CA and this may be attributable to widespread iodization programs. Our review shows that
diagnosis and evaluation of thyroid disorders are reliant in most regions of the continent on clinical acumen and
suboptimal diagnostic facilities and expertise are what obtain in many practices. The frequently employed
management options of thyroid disorders in the continent are pharmacological and surgical treatment modalities.,
CONCLUSION: Diagnosis and management of thyroid disorders in the African continent remain suboptimal. Thyroid
registries may be helpful to determine the scope of the burden of thyroid disorders since this knowledge may help
change policies on the approach to the management of these disorders.
Hepatocarcinogenesis is a complex process that may be influenced by many factors, including polymorphism in the
epidermal growth factor (EGF) gene. Previous work suggests an association between the EGF 61*A/G polymorphism
(rs4444903) and susceptibility to hepatocellular carcinoma (HCC), but the results have been inconsistent. Therefore,
we performed a meta-analysis of several studies covering a large population to address this controversy. PubMed,
EMBASE, Google Scholar and the Chinese National Knowledge Infrastructure databases were systematically searched
to identify relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed
to examine the association between EGF 61*A/G polymorphism and susceptibility to HCC. Odds ratios (ORs) and 95%
confidence intervals (95% CIs) were calculated. Eight studies were chosen in this meta-analysis, involving 1,304 HCC
cases (1135 Chinese, 44 Caucasian and 125 mixed) and 2,613 controls (1638 Chinese, 77 Caucasian and 898 mixed).
The EGF 61*G allele was significantly associated with increased risk of HCC based on allelic contrast (OR = 1.29, 95%
CI = 1.16-1.44, p<0.001), homozygote comparison (OR = 1.79, 95% CI = 1.39-2.29, p<0.001) and a recessive genetic
model (OR = 1.34, 95% CI = 1.16-1.54, p<0.001), while patients carrying the EGF 61*A/A genotype had significantly
lower risk of HCC than those with the G/A or G/G genotype (A/A vs. G/A+G/G, OR = 0.66, 95% CI = 0.53-0.83,
p<0.001). The 61*G polymorphism in EGF is a risk factor for hepatocarcinogenesis while the EGF 61*A allele is a
protective factor. Further large and well-designed studies are needed to confirm this conclusion.
BACKGROUND: Hepatocarcinogenesis is a complex process that may be influenced by many factors, including
polymorphism in the epidermal growth factor (EGF) gene. Previous work suggests an association between the EGF
61*A/G polymorphism (rs4444903) and susceptibility to hepatocellular carcinoma (HCC), but the results have been
inconsistent. Therefore, we performed a meta-analysis of several studies covering a large population to address this
controversy., METHODS: PubMed, EMBASE, Google Scholar and the Chinese National Knowledge Infrastructure
databases were systematically searched to identify relevant studies. Data were abstracted independently by two
reviewers. A meta-analysis was performed to examine the association between EGF 61*A/G polymorphism and
susceptibility to HCC. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated., RESULTS: Eight
studies were chosen in this meta-analysis, involving 1,304 HCC cases (1135 Chinese, 44 Caucasian and 125 mixed)
and 2,613 controls (1638 Chinese, 77 Caucasian and 898 mixed). The EGF 61*G allele was significantly associated
with increased risk of HCC based on allelic contrast (OR = 1.29, 95% CI = 1.16-1.44, p<0.001), homozygote
comparison (OR = 1.79, 95% CI = 1.39-2.29, p<0.001) and a recessive genetic model (OR = 1.34, 95% CI = 1.16-1.54,
p<0.001), while patients carrying the EGF 61*A/A genotype had significantly lower risk of HCC than those with the
G/A or G/G genotype (A/A vs. G/A+G/G, OR = 0.66, 95% CI = 0.53-0.83, p<0.001)., CONCLUSION: The 61*G
polymorphism in EGF is a risk factor for hepatocarcinogenesis while the EGF 61*A allele is a protective factor. Further
large and well-designed studies are needed to confirm this conclusion.
Background and Purpose: Although in the past cervical vertigo was considered a myth by some, recent studies using
dynamic imaging have established the association between vertigo and cervical spondylosis demonstrated by
rotational vertebral artery occlusion (RVAO). However the subject of spondylotic RVAO still remains controversial.
The purpose of this study is to review the literature on the vascular mechanisms for cervical vertigo. Methods: A
systematic review of the literature was conducted according to the Center for Reviews and Dissemination Guidelines
using Pubmed and Google Scholar databases. 86 publications describing vascular mechanisms for cervical vertigo
were included. Articles that were neither related to cervical vascular pathology nor written in English or German
language were excluded. Data was extracted on vascular mechanisms of cervical vertigo and the interrelationship
among the quartet of vertigo, head rotation, cervical spondylosis and vascular risk factors. Results: The occurrence of
the tetrad has been described in literature even though no specific attempt has been made to associate them as a
possible syndrome such that the occurrence of cervical vertigo would prompt investigations for spondylosis and
vascular risk factors. Discussion and Conclusions: RVAO resulting from cervical spondylosis in the presence of
atherosclerosed collateral vessels is a cause of posterior circulation insufficiency manifesting as vertigo. Attention
should be paid to the control of modifiable vascular risk factors. The proposed syndrome of cervical vertigo tetrad
requires further study to fully highlight its pathophysiology and develop excellent diagnostic, therapeutic and
prophylactic guidelines for its management. 2002 African Journal of Neurological Sciences. All rights reserved.
Background: Epithelial mesenchymal transition (EMT) may be physiological as part of embryological development, or
pathological as part of cancer development. It is one of the key initiating events in the metastatic cascade. EMT has
profound effects on tumour cell invasiveness, proliferation and motility. In the present article we aimed to review
the potential role of EMT as a process to explain colorectal cancer progression and resistance to neoadjuvant
therapy. Methods: Extensive literature searches were performed in Pubmed, EMBASE and Google Scholar databases
to identify relevant articles published before March 2012. Results: There is adequate evidence to support the
complex upstream signalling alterations needed for EMT to occur in colorectal cancers. Changes of EMT are likely to
be found at the tumour invasive front: the deepest, growing tumour margin. Loss of E-cadherin at the cell membrane
causes loss of cellular integrity, with subsequent migration of malignant cells and tumour budding. These processes
are associated with metastases and recurrence of colorectal cancer. There is early evidence from a limited number of
studies that resistance to neoadjuvant therapy in colorectal cancer is associated with changes of EMT. However,
there is a lack of supporting evidence originating from human colorectal cancer tissues. Conclusions: Emerging
evidence demonstrates that development of EMT in colorectal cancer leads to an aggressive phenotype that may
promote metastatic spread, and augment treatment resistance during neoadjuvant therapy. A clearer understanding
of the processes and role of EMT in colorectal cancer may also highlight novel therapeutic strategies. 2012 Elsevier
Ltd. All rights reserved.
OBJECTIVE: To review the chemistry, pharmacology, pharmacokinetics, safety, and efficacy of eribulin (Halaven).
DATA SOURCES: A literature search (up to December 2011) using the terms eribulin, Halaven, ER-086526, and E7389
was performed with PubMed, Google Scholar, selected Ovid bibliography searches, and the abstract search tool from
the American Society of Clinical Oncology Annual Meetings and the San Antonio Breast Cancer Symposia. Additional
references from the bibliographies of these articles were also assessed. DATA EXTRACTION: English-language
preclinical and clinical studies on the chemistry, pharmacology, pharmacokinetics, safety, and efficacy of eribulin
were reviewed. DATA SYNTHESIS: Eribulin is a novel microtubule inhibitor with a unique mechanism of action, which
involves interaction with a distinct binding site on b-tubulin leading to G2/M phase cell-cycle arrest and apoptosis.
Eribulin has been approved by the Food and Drug Administration for the treatment of metastatic breast cancer in
patients who have been previously treated with an anthracycline and a taxane. In a pivotal Phase 3 study conducted
in patients with metastatic breast cancer, eribulin 1.4 mg/m2, administered over 2-5 minutes as an intravenous
infusion on days 1 and 8 of 21-day cycles, was associated with a significantly increased median overall survival of
13.1 months compared to the median overall survival of 10.6 months in the therapy of physician's choice. Eribulin
has also shown activity in Phase 2 studies in other types of cancers, such as non-small cell lung cancer, prostate
cancer, urothelial cancer, soft tissue sarcomas, and platinum-susceptible ovarian, fallopian tube, or peritoneal
cancers. The most severe (grade 3/4) adverse effects associated with eribulin include neutropenia, leukopenia, and
peripheral neuropathy. Common toxicities include fatigue, neutropenia, alopecia, anemia, and peripheral
neuropathy. CONCLUSIONS: Eribulin is a promising new cytotoxic chemotherapy agent due to its ability to treat
cancers that are refractory or resistant to other drugs as well as its manageable toxicity profile.
In 1963, Rowell et al described four adult female patients characterized by long-standing discoid lupus
erythematosus (DLE), chilblain lupus, and skin lesions resembling those of erythema multiforme (EM). Laboratory
abnorma lities included antinuclear antibodies (ANA) in a speckled pattern, antisaline extracts of human tissues (anti-
SjT) antibodies, and positive rheumatoid factor. However, the very existence and nosographic independence of so-
called "Rowell syndrome" has been often questioned. The aim of our study was to describe a new case series and
review systematically the worldwide literature in the attempt to better define the features of EM in the setting of LE.
We searched the available literature into PubMed, EMBASE.com, SCOPUS, Google Scholar, and other biomedical
search engines. Including ours, 100 cases of EM-like lesions in the setting of LEwere identified. Themedian age at
diagnosis of patientswas 32.0 years (range, 9-87). Seventypercent of patientswerewhite and the overall female:male
ratiowas 9.0.EM-like lesions involved in variable extent all mucutaneous surfaces without any clear preferential
localization. In 34.37% of patients, EM-like lesions were associated with DLE, in 5.21% with subacute cutaneous LE
(SCLE), and in 15.07% with acute cutaneous LE (ACLE). Chilblains/erythrocyanosis was described in 30.21% of cases,
representing the only cutaneous sign of LE in 9.37%. Systemic LE (SLE)was diagnosed in 68.75% of cases.
Histopathologic examination of both EM-like and LE-specific skin lesionswas performed in the vast majority of cases
and revealed features compatible with EM and CLE, respectively. Analysis of cases grouped by CLE subpattern
identified a conspicuous subgroup characterized by the occurrence, most often diachronical, of EM-like lesions and
chronic CLE (DLE or chilblains LE).We suggest that the eponym"Rowell syndrome" may still be properly used to
define this entity, which additional features include: (1) speckled ANA and/or positive anti-RO/SSA and/or anti-
La/SSB; (2) negative direct immunofluorescence assayonEM-like lesional skin; and (3) mild and infrequent systemic
involvement (about one third of cases), most often consisting of a hematologic disorder. The remaining patients
reviewed may be better referred to as "EM-like SCLE/ACLE" and placed at themilder end of the LE-specific bullous
skin disease spectrum, ofwhich toxic epidermal necrolysis-like SCLE/ACLE constitutes the more severe counterpart.
OBJECTIVE: The aim of this review is to give comprehensive summary of erythrocyte alloimunization of pregnant
women, laboratory dignostics and clinical importance., DESIGN: Review., SETTING: University Hospital Olomouc,
Transfusion Department, Department of Obstetrics and Gynecology., SUBJECT AND METHOD: Based on literature
analysis using database search engines PubMed, Google Scholar, Ovid in field of erythrocyte antibodies, laboratory
diagnostics and clinical importance up-to-date knowledge., CONCLUSION: Erythrocyte alloimunization anti-D
antibodies decreases in connection with the introduction of immunoprofylaxis. Immunization of non RhD antibodies
with impossibility using of immunoprofylaxis remains still clinical problem.
OBJECTIVES: To assess the incidence and distribution of infectious diseases which have been markedly affected by
climate change. METHODS: Literature searches were performed using Embase, MEDLINE, Google Scholar, and WHO
website. RESULTS: Current evidence suggests that inter-annual and inter-decadal climate variability have a direct
impact on the epidemiology of infectious diseases. According to WHO, since mid-1970s, climatic changes have
caused annually over 150 000 deaths and an approximately 5 million disability-adjusted life-years, mainly in
developing countries. Malaria has been considered as an extremely climate-sensitive disease. A temperature rise of
2degreeC-3degreeC increases the risk of malaria by 3%-5%. Across the world, the incidence cases of malaria
increased from 233 000 in 2000 to 244 000 in 2005, with highest incidence observed in Africa. The West Nile virus
(WNV) disease is considered as an emerging epidemic in the US. More than 7000 neuroinvasive WNV disease cases
were reported in the US from 1999-2004. Parallel to rising temperatures, the US has recorded a 41% increase in
vibrio infection rate from 1996-2006. In continental Europe, a temperature rise of 6degreeC above the mean
resulted in an estimated 30% reported cases of salmonellosis. In Russia, rising temperatures from 2001 have
increased the incidence of tick-borne encephalitis (TBE) by 10-fold within a decade. Korea's climatic variability has
also been positively correlated with the incidence cases of malaria, Vibrio vulnificus sepsis, scrub typhus,
leptospirosis, and Hantavirus infection during 2001-2008. Further, in 2009- 2010, government officials of Europe
have predicted that borreliosis, WNV fever, TBE, and salmonellosis are likely to be majorly affected by climate
change. CONCLUSIONS: Accelerating climate change carries a profound threat for the increased burden of infectious
diseases worldwide. To attain the maximum disease prevention, an understanding of the ecology of infectious
diseases must be developed in order to protect vulnerable populations, rather than focussing on single agent of
disease.
AIM: Eastern Europe experienced epidemic levels of syphilis after the collapse of the Soviet Union. Presently data are
less comprehensive outside the European Union (EU) and European Free Trade Association (EFTA). This review aims
to identify published papers with suitable data to estimate a regional burden of disease for syphilis in the 19 member
countries of Eastern Europe., METHODS: A systematic literature review was conducted to identify published data
relating to syphilis incidence in Eastern Europe through Web of Knowledge, PubMed and Google Scholar databases in
addition to the latest surveillance report from the European Center for Disease Prevention and Control. A total of
381 papers fitted our search criteria; 30 papers were subjected to full text analysis., RESULTS: Seven papers were
included in this study and provided useable data for 13 out of 19 member countries. There was a high level of
heterogeneity observed in the incidence rates from the member countries. Gross, population weighted and
geographically subdivided incidence rate estimates were carried out but the comprehensiveness of some of the
included data is doubtful., CONCLUSIONS: Despite the limits of the data, the incidence of syphilis in Eastern Europe is
still substantially larger than that observed in the EU15 countries. This indicates that efforts to control syphilis in
Eastern Europe can be enhanced; however, such goals would require significant investment in infrastructure,
technology and surveillance mechanisms.
BACKGROUNDS: The number of hip fractures, the most common complication of osteoporosis, has increased rapidly
over the past decades. The goal of this study is to estimate the avoidable burden of certain modifiable risk factor of
the condition using the Generalized Impact Fraction (GIF) model, which has been suggested and used by
epidemiologists to overcome the drawbacks associated with the use of Attributable Fraction index. In addition to
preventing a risk factor or the avoidable fraction of burden, this index can also calculate the change in the burden,
when a risk factor is altered., METHODS: International databases were searched through PubMed, CINAHLD, Embase
using OVID and Google scholar. National resources were searched through IranDoc, IranMedex, SID and Journal sites.
Other resources include abstract books and articles sent to the IOF congress. The following search strategy was used:
("Osteoporotic fracture" OR "Fragility Hip fracture" OR "Calcium" OR "vitamin D" OR "BMI" OR "lean body weight"
OR "Physical activity" OR "exercise" OR "Smoke") AND ("prevalence" OR "incidence" OR "relative risk") and limited to
"humans.", RESULTS: With regards to different scenarios already explained in modifying the studied risk factors, the
greatest impact in reducing the prevalence of risk factors on osteoporotic hip fractures, was seen in low serum
vitamin D levels, low physical activity and low intake of calcium and vitamin D, respectively. According to the fact
that interventions for low serum vitamin D and low intake of calcium and vitamin D, are related to each other, it can
be concluded that implementing interventions to change these two risk factors, in the easy, moderate and difficult
scenarios, would result in approximately a 5%, 11% and 17% decrease in the burden of osteoporotic hip fractures,
respectively. The addition of interventions addressing low physical activity in the easy, moderate and difficult
scenarios, an 8%, 21% and 35% reduction in the burden of osteoporotic hip fractures would be reported,
respectively., CONCLUSION: Improving serum vitamin D levels, recommending the consumption of calcium and
vitamin D supplementations and advocating physical activity are the most effective interventions to reduce the risk
of osteoporotic hip fractures.
Aim. This aim of the review was to describe differences in ethical approaches to research on Internet communication
during illness and to report conclusions drawn relevant to a proposed narrative analysis of parent blogs of childhood
illness. Background. As the study of the online expression of illness experiences becomes more expansive, discussion
of related ethical issues is central to promoting research trustworthiness and rigour. Ethical considerations are
central to the patient-provider relationship. Data sources. The EBSCO Host, CINAHL, Medline, Communication &
Mass Media Complete, and Google Scholar databases were searched from January 1990 to September 2009 using
the terms 'Internet research and ethics', 'Internet research, illness and ethics' and 'blog, Internet research and
ethics'. Of the 4114 references found, 21 met the inclusion criteria for the review. Review methods. The review was
designed to be a comprehensive assessment of the concepts analysed and the qualitative research measures taken
concerning ethics in Internet research across formats. Results. Three main approaches to ethical conduct in Internet
research on illness experiences were found: human subjects, representation and open source approaches.
Conclusion. The personal and sensitive nature of online illness narratives demand their consideration in health care
as 'human subjects' research. The best hope for ethical treatment of author-participants is the creation of a
comprehensive plan for addressing any and all potential ethical conflicts that may arise in the collection, analysis and
reporting of data, taking into consideration rapid changes in technology. 2011 Blackwell Publishing Ltd.
To determine whether the ethnicity of UK trained doctors and medical students is related to their academic
performance. Systematic review and meta-analysis. Online databases PubMed, Scopus, and ERIC; Google and Google
Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and
medical education conference abstracts. The included quantitative reports measured the performance of medical
students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments.
Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only
dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes.
Results 23 reports comparing the academic performance of medical students and doctors from different ethnic
groups were included. Meta-analyses of effects from 22 reports (n = 23,742) indicated candidates of "non-white"
ethnicity underperformed compared with white candidates (Cohen's d = -0.42, 95% confidence interval -0.50 to -
0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate
assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical
assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a
meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses. Ethnic differences in
academic performance are widespread across different medical schools, different types of exam, and in
undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local
problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More
detailed information to track the problem as well as further research into its causes is required. Such actions are
necessary to ensure a fair and just method of training and of assessing current and future doctors.
Objective: To determine whether the ethnicity of UK trained doctors and medical students is related to their
academic performance. Design: Systematic review and meta-analysis. Data sources: Online databases PubMed,
Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific
searches of medical education journals and medical education conference abstracts. Study selection: The included
quantitative reports measured the performance of medical students or UK trained doctors from different ethnic
groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained
candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling
bias, or insufficient details of ethnicity or outcomes. Results: 23 reports comparing the academic performance of
medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports
(n=23 742) indicated candidates of "non-white" ethnicity underperformed compared with white candidates (Cohen's
d=-0.42, 95% confidence interval -0.50 to -0.34; P<0.001). Effects in the same direction and of similar magnitude
were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked
written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments
with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present
in all meta-analyses. Conclusion: Ethnic differences in academic performance are widespread across different
medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many
years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably
affects all of UK medical and higher education. More detailed information to track the problem as well as further
research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of
assessing current and future doctors.
Ethnopharmacological relevance: Desmodium gangeticum (L.) DC. and Desmodium adscendens (Sw.) DC. are two
important and well explored species of genus Desmodium (Fabaceae (alt. Leguminosae) subfamily: Faboideae).
Desmodium gangeticum is used as a tonic, febrifuge, digestive, anticatarrhal, antiemitic, in inflammatory conditions
of chest and in various other inflammatory conditions in the Ayurvedic System of Medicine while Desmodium
adscendens is widely used for the treatment of asthma in Ghana, Africa. Aim of the review: The aim of this review is
to provide comprehensive information on the botany, traditional uses, phytochemistry, pharmacological research
and toxicology of Desmodium gangeticum and Desmodium adscendens to explore their therapeutic potential and
future research opportunities. Materials and methods: All the available information on Desmodium gangeticum and
Desmodium adscendens was collected via electronic search (using Pubmed, SciFinder, Scirus, Google Scholar,
JCCC@INSTIRC and Web of Science) and a library search for articles published in peer-reviewed journals. Results:
About 25 different species of Desmodium including Desmodium gangeticum and Desmodium adscendens are used
ethnomedicinally all over the world. Phytochemical research on Desmodium gangeticum and Desmodium
adscendens has led to the isolation of alkaloids, pterocarpans, phospholipids, sterols, flavones and flavonoid
glycosides from Desmodium gangeticum and triterpenoid saponins, phenylethylamines and indole-3-alkyl amines
from Desmodium adscendens. Crude extracts, fractions and isolated components of Desmodium gangeticum and
Desmodium adscendens showed a wide spectrum of in vitro and in vivo pharmacological activities like
antileishmanial, immunomodulatory, antiasthmatic, smooth muscle relaxant, anti-inflammatory, anti-ulcer, cardio-
protective, antidiabetic, antiamnesic, antiviral, antioxidant and hepatoprotective activities. Conclusions: Desmodium
gangeticum and Desmodium adscendens have emerged as a good source of traditional medicine. Desmodium
gangeticum possesses the ability to scavenge the free radicals generated during ischaemia and ischaemia reperfusion
thereby preserving the mitochondrial respiratory enzymes that eventually lead to cardio-protection and has potential
prophylactic and therapeutic efficacy against Leishmania infection. Desmodium adscendens is useful against chronic
bronchitis and asthma. However, there is a need to search for individual secondary metabolites responsible for these
actions and study their mode of actions, bioavailability, pharmacokinetics and physiological pathways in sufficient
detail. The promising results should be further substantiated by clinical trials. 2011 Elsevier Ireland Ltd. All rights
reserved.
To review the etiology and pathogenesis of anterior open bite malocclusion. Review of literature was affected
through Pubmed, Google scholar and Science direct. References identified from articles found from the primary
search were also reviewed. Published data on etiology and pathogenesis of anterior open bite over the last five
decades (1960-2009) were utilised. Full articles, abstracts and relevant book chapters were read and analysed to
determine the relevant material for this article. All relevant articles were reviewed in full and necessary information
eextracted as necessary. A clear understanding of the etiology and pathogenesis of anterior open bite is essential in
the diagnosis, prevention and management of this malocclusion.
OBJECTIVE: To review the etiology and pathogenesis of anterior open bite malocclusion., DATA SOURCE: Review of
literature was affected through Pubmed, Google scholar and Science direct. References identified from articles found
from the primary search were also reviewed., STUDY SELECTION: Published data on etiology and pathogenesis of
anterior open bite over the last five decades (1960-2009) were utilised., DATA EXTRACTION: Full articles, abstracts
and relevant book chapters were read and analysed to determine the relevant material for this article., DATA
ANALYSIS: All relevant articles were reviewed in full and necessary information eextracted as necessary.,
CONCLUSION: A clear understanding of the etiology and pathogenesis of anterior open bite is essential in the
diagnosis, prevention and management of this malocclusion.
Objective: Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis, a clinicopathological entity of unknown
etiology, is a rare and benign cause of cervical lymphadenopathies. The aim of this study was to review
systematically the articles related to Kikuchi-Fujimoto disease reported from Turkey in national and international
journals within the last 11 years with pooled-analysis method. Material and Methods: The articles related with
Kikuchi-Fujimoto disease were retrieved by search of four national (Ulakbim Turkish Medical literature databases,
http://www.turkishmedline.com, http://medline.pleksus.com.tr and www.atifdizini.com) and three international
databases [Pub-Med, Science Citation Index (SCI) and Google scholar]. Results: Between the years 2000-2011,
Kikuchi-Fujimoto disease cases have been published in a total of 38 articles (11 international, 27 national). The
articles that were presented as a case report included 44 Kikuchi-Fujimoto disease cases (72.7% female, 27.3% male;
median age 27.5 years). The distribution of the lymph nodes involved was determined in all cases and the most
commonly involved areas were cervical (88.6%), axillary (29.5%) and submandibular (11.3%) areas. In 40.9% of the
patients more than one lymph node was involved. The most common complaints were neck swelling (97.7%), fever
(70.4%) and fatigue (43.2%) at admission. The most common signs were lymphadenitis (97.7%), fever (40.9%) and
skin eruption (18.2%). Kikuchi-Fujimoto disease was identified in all cases by histopathological examination.
Conclusion: Since the diagnosis is difficult in Kikuchi-Fujimoto disease and not available in all centers, evaluation of
the patients' history and clinical findings are of great importance. This pooled analysis which enabled the evaluation
of a large number of Kikuchi-Fujimoto disease cases, indicated that careful evaluation of clinical findings and
histopathological investigation would provide valuable support for diagnosis and treatment of Kikuchi-Fujimoto
disease. 2013 by Turkiye Klinikleri.
Background: Traditional Chinese Medicine (TCM), an important part of health care in China and with increased
popularity worldwide, has received extensive attention from governments at all levels. With the current emphasis on
clinical efficacy and cost-effectiveness, TCM, as indeed do all other treatments, requires rigorous evidence to be
considered in reimbursement decision-making. Nevertheless, despite the fact that TCM treatment has always been
considered to possess the advantage of improving the health-related quality of life (HRQOL) of patients, there is a
lack of systematic study about available evidence to assess the impact of TCM treatments on HRQOL of patients.
Objectives: The current study aimed to perform a review of available literature to evaluate whether sufficient
evidence existed to allow an assessment of the impact on HRQOL and cost effectiveness of TCM treatments. This
information would support a recommendation for wider use of TCM in the clinical setting as well as its consideration
for reimbursement. Methods: A structured search was performed using data sources including MEDLINE, Cumulative
Index for Allied Health and Nursing (CINAHL), PubMed, Cochrane database, EBSCO, SciSearch, Embase, and Google
Scholar from 2000 to 2010. The search was supplemented with manual search after relevant articles were retrieved.
Results: After culling, a total 31 articles covering a range of TCM therapies applied to a variety of conditions were
retrieved. The measurement tools used in these studies to assess impact in patient's HRQOL were mainly SF-36-
based scales, but the results of HRQOL/patient preference studies were inconsistent and inconclusive. Of the 10
articles of cost-effectiveness evaluation of TCM treatments, the majority reported that TCM treatments resulted in
better outcomes at a higher cost, but the incremental cost-effectiveness ratio was below the usually recommended
thresholds. The overall results showed acupuncture and t'ai chi to be the most studied TCM-related therapies.
Conclusions: The current review showed that there is a relative lack of cost-effectiveness research in TCM. For those
few empirical research available, the major emphasis is for acupuncture or t'ai chi showing the acceptance of these
branches of TCM that are better understood by the scientific community. The current results also showed the need
for studies with better designs and longer duration to ascertain the actual impact of TCM on patients' HRQOL as well
as a need for a generic HRQOL instrument that is specific for TCM. 2012 Mary Ann Liebert, Inc.
BACKGROUND: Traditional Chinese Medicine (TCM), an important part of health care in China and with increased
popularity worldwide, has received extensive attention from governments at all levels. With the current emphasis on
clinical efficacy and cost-effectiveness, TCM, as indeed do all other treatments, requires rigorous evidence to be
considered in reimbursement decision-making. Nevertheless, despite the fact that TCM treatment has always been
considered to possess the advantage of improving the health-related quality of life (HRQOL) of patients, there is a
lack of systematic study about available evidence to assess the impact of TCM treatments on HRQOL of patients.,
OBJECTIVES: The current study aimed to perform a review of available literature to evaluate whether sufficient
evidence existed to allow an assessment of the impact on HRQOL and cost effectiveness of TCM treatments. This
information would support a recommendation for wider use of TCM in the clinical setting as well as its consideration
for reimbursement., METHODS: A structured search was performed using data sources including MEDLINE,()
Cumulative Index for Allied Health and Nursing (CINAHL), PubMed, Cochrane database, EBSCO, SciSearch, Embase,
and Google Scholar from 2000 to 2010. The search was supplemented with manual search after relevant articles
were retrieved. Results: After culling, a total 31 articles covering a range of TCM therapies applied to a variety of
conditions were retrieved. The measurement tools used in these studies to assess impact in patient's HRQOL were
mainly SF-36-based scales, but the results of HRQOL/patient preference studies were inconsistent and inconclusive.
Of the 10 articles of cost-effectiveness evaluation of TCM treatments, the majority reported that TCM treatments
resulted in better outcomes at a higher cost, but the incremental cost-effectiveness ratio was below the usually
recommended thresholds. The overall results showed acupuncture and t'ai chi to be the most studied TCM-related
therapies., CONCLUSIONS: The current review showed that there is a relative lack of cost-effectiveness research in
TCM. For those few empirical research available, the major emphasis is for acupuncture or t'ai chi showing the
acceptance of these branches of TCM that are better understood by the scientific community. The current results
also showed the need for studies with better designs and longer duration to ascertain the actual impact of TCM on
patients' HRQOL as well as a need for a generic HRQOL instrument that is specific for TCM.
To describe the evidence that has accrued for interventions targeting weight loss in postmenopausal women, and to
assess the strengths and limitations of weight loss interventions in postmenopausal women using the framework of
evaluation theory, including definition of the problem and the use of theoretical framework and mediators.Electronic
databases were used, including CINAHL, EBSCO Host, Google scholar, Medline, and the Science Citation Index,
Expanded, in the Web of Science from 1995 to December 2009. Keyword searches included the terms obesity,
obese, overweight, menopause, and weight management interventions. Searches were combined to find reports
addressing 1 or more keywords.Experimental design studies that examined physical activity or dietary intervention
effects on weight loss or body composition changes in postmenopausal women were selected for review. Reports of
15 intervention studies met inclusion criteria from the list of 120 generated through the database searches.Each
article was evaluated for 1) effects produced as a result of the intervention, 2) the characteristics of the problem of
postmenopausal obesity, 3) specification of theoretical constructs and critical inputs that guide the design of an
intervention, and 4) link of the theoretical predictors and the outcome measures selected.Four types of interventions
were tested in the 15 research reports. Only 5 of the 15 used theories or models to guide the interventions. All of the
interventions resulted in some positive weight management outcome, such as lowered body mass index, fat mass,
waist circumference, systolic blood pressure, glucose, and cholesterol.Overall, the reviewed research showed
efficacy of varying intensities of exercise when combined with hypocaloric diet or meal replacement therapy in
producing low body weight, low fat, improved insulin sensitivity, glycemic control, and cardio-respiratory fitness. The
external validity of the 15 studies was limited in reporting of a clear delineation of the problem, theoretical
frameworks, and application of the findings. 2010 Mosby, Inc.
To describe the evidence that has accrued for interventions targeting weight loss in postmenopausal women, and to
assess the strengths and limitations of weight loss interventions in postmenopausal women using the framework of
evaluation theory, including definition of the problem and the use of theoretical framework and mediators.
Electronic databases were used, including CINAHL, EBSCO Host, Google scholar, Medline, and the Science Citation
Index, Expanded, in the Web of Science from 1995 to December 2009. Keyword searches included the terms obesity,
obese, overweight, menopause, and weight management interventions. Searches were combined to find reports
addressing 1 or more keywords. Experimental design studies that examined physical activity or dietary intervention
effects on weight loss or body composition changes in postmenopausal women were selected for review. Reports of
15 intervention studies met inclusion criteria from the list of 120 generated through the database searches. Each
article was evaluated for 1) effects produced as a result of the intervention, 2) the characteristics of the problem of
postmenopausal obesity, 3) specification of theoretical constructs and critical inputs that guide the design of an
intervention, and 4) link of the theoretical predictors and the outcome measures selected. Four types of
interventions were tested in the 15 research reports. Only 5 of the 15 used theories or models to guide the
interventions. All of the interventions resulted in some positive weight management outcome, such as lowered body
mass index, fat mass, waist circumference, systolic blood pressure, glucose, and cholesterol. Overall, the reviewed
research showed efficacy of varying intensities of exercise when combined with hypocaloric diet or meal
replacement therapy in producing low body weight, low fat, improved insulin sensitivity, glycemic control, and cardio-
respiratory fitness. The external validity of the 15 studies was limited in reporting of a clear delineation of the
problem, theoretical frameworks, and application of the findings. Copyright 2010 Mosby, Inc. All rights reserved.
OBJECTIVES: This meta-analysis of randomized controlled trials was conducted to evaluate the efficacy and
incontinence rate of biomaterials (fibrin glue and fibrin plug) in comparison to conservative and other interventional
therapy in the treatment of perianal fistula. METHODS: PubMed, Embase, Scopus, Google Scholar, and Web of
Science were searched for clinical trial studies investigated the effects of biomaterials in the treatment of fistul in-
ano. Clinical response and incontinence were the key outcomes of interest. Data were searched from the time period
of 1966 through June 2012. RESULTS: Eight randomized placebo-controlled clinical trials that met our criteria (six
comparing biomaterial with conservative treatment and two with other interventions) were included in the analysis.
Pooling of data showed biomaterials effectiveness in comparison to other interventions was non significant with
relative risk (RR) of 1.23 (95% CI of 0.31-4.84, P= 0.77). The RR for biomaterials comparing with conservative was non
significant (RR= 0.73 with 95% CI = 0.31-0.89, P= 0.096). The incontinence rate RR in biomaterials and intervention
was also non significant with RR of 0.35 (95% CI = 0.05-2.28, P = 0.27). CONCLUSIONS: This meta-analysis
demonstrates that the effectiveness of biomaterials and conservative treatment was not different. The biomaterials
in comparison to other interventional therapies did not show any difference in regard to effectiveness and also
incontinence rate.
Introduction: Children are a particularly challenging group of patients when trying to ensure the safe use of drugs.
However, medication errors may occur in all stages of medication process including prescription, dispensing and
administration. Purpose: The aim of this study is to meta-analyze studies that have assessed the medication errors
rate (MER) in pediatric patients. Material - Methods: Sixteen original studies were included in the analysis. The
authors conducted a systematic review and random effects meta-analysis of studies related to medication errors in
pediatric patients, including publications in Pubmed, Cohrane, Google Scholar and electronic libraries of Athens
University from 1 January 2001 to 31 December 2010. Results: The combined MER for prescribing errors to
medication orders - nine out of 16 studies - was equal to 0.301 [with 95% confidence intervals (CI) 0.281-0.292] - five
out of 16 studies - for prescribing errors to total medication errors was 0.267 with 95%CI: 0.280-0.316, for dispensing
errors to total medication errors was 0,136 with 95%CI: 0.057-0.290 and for administration errors to total medication
errors was 0.422 with 95%CI: 0.197-0.684. Furthermore, including five out of sixteen studies the combined MER for
administration errors to drug administrations was equal to 0.193 with 95%CI: 0.135-0.270. Conclusions: Medication
errors do constitute a reality in health care services. Medication process is significantly prone to errors, especially in
pediatric patients, according to the reported rates. Implementation of medication errors reduction strategies needs
to be done in order to increase the safety and quality in pediatric health care delivering.
Cannabis is the most widely used illicit substance, and multiple treatment options and avenues exist for managing its
use. There has been an increase in the development of clinical practice guidelines (CPGs) to improve standards of
care in this area, many of which are disseminated online. However, little is known about the quality and accessibility
of these online CPGs. The purpose of study 1 was to determine the extent to which cannabis-related CPGs
disseminated online adhere to established methodological standards. The purpose of study 2 was to determine if
treatment providers are familiar with these guidelines and to assess their perceived quality of these guidelines. Study
1 involved a systematic search using the Google Scholar search engine and the National Drugs Sector Information
Service (NDSIS) website of the Alcohol and Other Drugs Council of Australia (ADCA) to identify CPGs disseminated
online. To be included in the current study, CPGs needed to be free of charge and provide guidance on psychological
interventions for reducing cannabis use. Four trained reviewers independently assessed the quality of the 7
identified guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Study 2 assessed
166 Australian cannabis-use treatment providers' (mean age = 45.47 years, SD 12.14) familiarity with and opinions of
these 7 guidelines using an online survey. Treatment providers were recruited using online advertisements that
directed volunteers to a link to complete the survey, which was posted online for 6 months (January to June 2012).
Primary study outcomes included quality scores and rates of guideline familiarity, guideline use, and discovery
methods. Based on the AGREE II, the quality of CPGs varied considerably. Across different reporting domains,
adherence to methodological standards ranged from 0% to 92%. Quality was lowest in the domains of rigor of
development (50%), applicability (46%), and editorial independence (30%). Although examination of AGREE II domain
scores demonstrated that the quality of the 7 guidelines could be divided into 3 categories (high quality, acceptable
to low quality, and very low quality), review of treatment providers' quality perceptions indicated all guidelines fell
into 1 category (acceptable quality). Based on treatment providers' familiarity with and usage rates of the CPGs, a
combination of peer/colleagues, senior professionals, workshops, and Internet dissemination was deemed to be
most effective for promoting cannabis use CPGs. Lack of time, guideline length, conflicts with theoretical orientation,
and prior content knowledge were identified as barriers to guideline uptake. Developers of CPGs should improve
their reporting of development processes, conflicts of interest, and CPGs' applicability to practice, while remaining
cognizant that long guidelines may deter implementation. Treatment providers need to be aware that the quality of
cannabis-related CPGs varies substantially.
Evans' syndrome, the coexistence of immune thrombocytopenia (ITP) with autoimmune haemolytic anaemia (AIHA),
is rare in pregnancy, with a few published cases. Concerns about the teratogenic effect of pharmacological agents
used in the management of Evans' syndrome limit the treatment options in pregnancy. In this paper we performed a
systematic review of the literature of all published cases with Evans' syndrome in pregnancy and we report two new
cases. The review was performed by searching the electronic databases PubMed, EMBASE, Cochrane Library and
Google scholar up to the end of December 2008. The selection criteria were Evans' syndrome in pregnancy;
autoimmune haemolytic anaemia; immune thrombocytopenia. Thirteen papers reporting 14 pregnancies in women
with Evans' syndrome have been published: 7 papers are written in English. Evans' syndrome can be diagnosed with
a full blood count, film and Coombs testing. It runs a more benign course in pregnancy than in non-pregnant state
(notably neutropenia does not occur) and very often resolves post-delivery. The fetal outcome may be less
favourable: a minority of fetuses are affected by transplacental passage of antibody and have a significant morbidity
and mortality. With appropriate treatment, women with Evans' syndrome can have successful pregnancies, with a
good response to conventional treatment. More detailed studies of Evans' syndrome in pregnancy, especially of fetal
outcome, are required. 2009 Elsevier Ireland Ltd. All rights reserved.
DATA SOURCES: Medline, CINAHL, PsycINFO, SCI, SSCI, Cochrane Database of Systematic Reviews, Business Source
Premier, Google scholar., STUDY SELECTION: Primary or secondary reports and studies, published in English, after
1993, likely to include data relevant to direct access, report on empirical data relating to the operation of that
system., DATA EXTRACTION AND SYNTHESIS: After initial screening, titles and abstracts were assessed by two
reviewers, and disagreements resolved by the third. Full texts of these eligible ones were then assessed by the team
until consensus reached. Data extraction by one reviewer was checked by a second and disagreements resolved by
discussion with the third. Study quality was assessed through reference to CASP or SIGN checklists. Descriptive
analyses and synthesis of findings were given., RESULTS: From the 1,733 studies yielded from the search, over 100
research dental and other health-related papers were identified as relevant. Thirty-five studies were eligible for
inclusion under dental health care direct access and 57 under non-dental health care direct access literature. The
quality of the evidence was varied but on the whole assessed as moderately good quality.There was no evidence of
increased risk to patient safety in any of the included seven studies. Four studies on appropriateness of DCP referrals
reported a high proportion of over-referral, one study found under-referral and one good agreement regarding
referral decisions.Six of the seven studies looking at DCPs' knowledge or support to patients for smoking cessation,
diabetes, child abuse and domestic violence found deficiencies in DCPs' knowledge or support to patients, but these
studies didn't have evidence to suggest how this compared to dentists.Increasing access to dental therapists and
hygienists (whether indirect, general or without supervision of a dentist) according to ten studies, resulted in greater
access to and use of dental services by underserved populations. Three studies suggested variable and, at most,
modest cost savings to patients and service providers. High levels of patient satisfaction were found in all eight
studies reporting this, and DCP job satisfaction was reported to be higher with direct access., CONCLUSIONS:
Although over-referral of patients to dentists was suggested and a need for training on assessment and referral skills,
there was no evidence of significant issues of patient safety from the clinical activities of DCPs. There was strong
evidence of improved access to dental care with direct access arrangements, cost benefits to patients/service
providers and high levels of patient satisfaction.
INTRODUCTION: Social Support (SS) therapy can be an effective method of weight loss compared with conventional
treatment (CT)., OBJECTIVE: To evaluate RCT's using SS therapy on weight in subjects with overweight or obesity.,
METHODOLOGY: We reviewed all original articles published in MEDLINE/PubMed, SciELO, EBSCO, Google Scholar,
from 2000 to August 2011, and one referred in a previous metanalisis, of RCT's of the effect of SS therapy on weight
loss, with at least five months of treatment, compared with another therapy or a CT., RESULTS: Eight articles were
analyzed. It was observed heterogeneity in the design, differences in the components of the interventions, and
cultural characteristics of the population. The difference between groups in weight loss in five out of seven studies,
ranged from 2.3 kg (24 m) to 8.3 kg (12 m). However, the treatment in the control groups did not meet the accepted
recommended guidelines. There was no allocation concealment in two studies, and no blindness in four. Most
studies showed large dispersion in the results. Therefore, the quality of the evidence is low., CONCLUSIONS: These
results warrant further and better design and longer term studies to generate higher quality evidence.
Arachnoiditis is a relatively rare and under-diagnosed condition that can affect many patients differently. Most cases
are incidentally discovered on radiologic imaging.1 After treating a patient in our institution with lumbar
arachnoiditis, we performed a literature review to determine the epidemiology and the most optimal treatment plan
for arachnoiditis. The term "arachnoiditis" was used as the search subject, and no distinction was given for cervical,
thoracic, or lumbosacral anatomic location. The following medical search databases were utilized: Pubmed, Cochrane
Library, United States National Library of Medicine, MDConsult, Medscape, Google and Google Scholar, Merck
Manual,Web Directory of Medical Education, and UpToDate. After examination of the resulting papers and reports,
30 publications were found that the abstract's authors felt were of clinical relevance towards our case patient. Due
to the relatively rare prevalence of arachnoiditis, randomized clinical trials are not available to formulate a
recommended treatment algorithm.2 Multiple etiologies were suggested in our literature review including, but not
limited to, prior spinal surgery, neuraxial anesthesia or steroid injections, infection, lumbar puncture, subarachnoid
hemorrhage, and syringomyelia. Magnetic resonance imaging is currently the recommended imaging modality of
choice.1,3,4 Treatment options include non-steroidal anti-inflammatory drugs, narcotics, steroids, spinal cord
stimulators, and microsurgery. Arachnoiditis is a rare condition, and treatment often needs to be individualized for
each patient. Further research on arachnoiditis will likely be beneficial in determining optimal treatment plans for
these patients.
Background: The type of stent used for the management of patients with malignant dysphagia is chosen according to
subjective physician's preference. There is no recent study available to provide updated evidence on early outcomes
related to the use of different types of stents. Methods: A literature search was performed using Embase, MEDLINE,
Cochrane Library, and Google Scholar databases for comparative studies assessing different types of stents. The
primary end point was stent-related mortality; secondary end points included: stent-related morbidity, successful
palliation of dysphagia, and 30-day mortality. A random-effects model was used and heterogeneity was assessed.
Results: Twelve studies that included 911 patients compared metallic (46.54%) and plastic stents (53.45%), and eight
studies that included 564 patients compared covered (43.26%) and uncovered metal stents (56.73%). Meta-analysis
of randomized, controlled trials showed that metallic stents were associated with significantly reduced stent-related
mortality (1.7% vs. 11.1% for the plastic group, odds ratio (OR), 0.2; 95% confidence interval (CI), 0.06-0.74; P = 0.02),
morbidity in the form of reduced esophageal perforation (1.4% vs. 9.4% for plastic stent, OR, 0.27; 95% CI, 0.08-0.89;
P = 0.03), and stent migration, yet increased rate of tumor in-growth (13% vs. 1.6% for plastic stents, OR, 4.84; 95%
CI, 0.99-23.76; P = 0.05). Covered metallic stents had significantly less tumor in-growth than the uncovered and an
increased migration rate. There was no significant difference between metallic and plastic stents in terms of any
other stent-related morbidity and 30-day mortality. Conclusion: Self-expanding metallic stents are superior to plastic
stents in terms of stent insertion-related mortality, morbidity, and quality of palliation. The uncovered variety is
disadvantaged by high rate of tumor in-growth; adequately designed randomized, controlled trials need to examine
outcomes and cost-effectiveness of covered versus uncovered metallic stents. 2008 Societe Internationale de
Chirurgie.
Object Evidence-based medicine is used to examine the current treatment options, timing of surgical intervention,
and prognostic factors in the management of patients with traumatic central cord syndrome (TCCS). Methods A
computerized literature search of the National Library of Medicine database, Cochrane database, and Google Scholar
was performed for published material between January 1966 and February 2013 using key words and Medical
Subject Headings. Abstracts were reviewed and selected, with the articles segregated into 3 main categories: surgical
versus conservative management, timing of surgery, and prognostic factors. Evidentiary tables were then assembled,
summarizing data and quality of evidence (Classes I-III) for papers included in this review. Results The authors
compiled 3 evidentiary tables summarizing 16 studies, all of which were retrospective in design. Regarding surgical
intervention versus conservative management, there was Class III evidence to support the superiority of surgery for
patients presenting with TCCS. In regards to timing of surgery, most Class III evidence demonstrated no difference in
early versus late surgical management. Most Class III studies agreed that older age, especially age greater than 60-70
years, correlated with worse outcomes. Conclusions No Class I or Class II evidence was available to determine the
efficacy of surgery, timing of surgical intervention, or prognostic factors in patients managed for TCCS. Hence, there
is a need to perform well-controlled prospective studies and randomized controlled clinical trials to further
investigate the optimal management (surgical vs conservative) and timing of surgical intervention in patients
suffering from TCCS.
The purpose of the research was to conduct a quality indicator analysis of studies exploring the effects of antecedent
exercise on self-stimulatory behaviors of individuals with autism spectrum disorders (ASD). Educational Resources
Information Center (ERIC), Google Scholar, SPORTDiscus, PsychINFO, and PubMed/MedLine databases from 1980 to
October 2010 and reference lists of included articles were searched. Twelve research studies employing group
experimental (Gersten et al.; 2005) or single-subject designs (Horner et al.; 2005) met inclusion criteria. Each study
was assessed for the presence and clarity of quality indicators. Group experimental and single-subject designs met
48% and 82% of quality indicators, respectively. This suggests that the effects of antecedent exercise on self-
stimulatory behaviors of individuals with ASD is incomplete and claims of exercise being an evidence-based practice
are premature. Several indicators were difficult to interpret or lacking clear definitions. Recommendations for
clarifying and applying the quality indicators are offered. 2012 Elsevier Ltd. All rights reserved.
Objective. To review the literature on fat modifying dietary supplements commonly used for weight loss. Methods.
Recently published randomized, placebo-controlled trials were identified in PubMed, MEDLINE, International
Pharmaceutical Abstracts, Cochrane Database, and Google Scholar using the search terms dietary supplement,
herbal, weight loss, obesity, and individual supplement names. Discussion. Data for conjugated linoleic acid (CLA),
Garcinia cambogia, chitosan, pyruvate, Irvingia gabonensis, and chia seed for weight loss were identified. CLA,
chitosan, pyruvate, and Irvingia gabonensis appeared to be effective in weight loss via fat modifying mechanisms.
However, the data on the use of these products is limited. Conclusion. Many obese people use dietary supplements
for weight loss. To date, there is little clinical evidence to support their use. More data is necessary to determine the
efficacy and safety of these supplements. Healthcare providers should assist patients in weighing the risks and
benefits of dietary supplement use for weight loss.
Many medicinal plants have been identified in Traditional Iranian Medicine (TIM) for the treatment of Peptic Ulcer
(PU) but they are still unknown to scientific community. In the present study anti PU activity of these remedies were
systematically reviewed and identified. For this purpose, medicinal plants proposed for the management of PU in
TIM were collected from TIM sources and they were searched in modern medical databases like PubMed, Scirus,
Sciencedirect and Google Scholar to find studies confirmed their efficacy. Findings from modern investigations
support the claims of TIM about the efficacy of many of these plants in PU. For example, the oleogum resin
oBoswellia carterii and B. serrata as a beneficial remedy for PU in TIM were demonstrated to have wound healing,
cytoprotective, antisecretory, antacid, prostaglandin production and inflammatory modulating properties. Fruit and
leaves oiMyrtus communis was found to be antioxidant, anti H. pylori wound healing, antisecretory, antacid and
cytoprotective. The aerial part from Melissa officinalis exerts its beneficial effects in PU by antioxidant, anti H. pylori,
prostaglandin elevating, cytoprotective, antisecretory, antacid and leukotriene reducing properties. Furthermore,
Polygonum species demonstrated its function on PU with prostaglandin enhancement, inflammatory modulation,
wound healing, cytoprotection, antacid, antioxidant and anti-H. pylori activity. In contrast, for some of herbal
remedies used in TIM such as Dolichos lablab flower, Symphytum species, Zizyphus spina-christi fruit, Alisma
plantago-aquatica, Cupressus sempervirens fruit, Acacia Arabica gum, Cyperus species root, Althaea officinalis flower
and Nymphaea alba flower there is no enough evidence in modern medicine to prove their effectiveness in the
management of PU. Pharmacological and clinical studies for evaluation of efficacy of these herbs in PU and their
possible mechanisms of action are recommended. 2013 Asian Network for Scientific Information.
Objective: What is the evidence for the effectiveness of palliative medicine? Method: A search of the PubMed
database for clinical trials using search terms "Palliative Care" or "Palliative Medicine" or "Hospice" or "end of life"
and "effectiveness" was conducted, and 63 articles were returned. Of these, 10 were related to outcomes of interest
related to components of palliative medicine such as quality of life, length of life, or healthcare utilization. None
were randomized, controlled trials looking at a global measure of effectiveness of palliative medicine. Consequently,
additional searches using Google and Google Scholar, and searching bibliographies of published articles and
presentations, were conducted. Results: There were not enough studies with which to perform a structured review.
The findings from single trials of satisfactory methodological quality are summarized and presented. Conclusion:
Palliative care has been proven to be more effective than standard approaches to care. The thrust of research must
now turn to ways to ensure that palliative care is part of standard care. 2012 American Association for Geriatric
Psychiatry.
INTRODUCTION AND OBJECTIVES: The prostate gland has been studied for many centuries. We hypothesised that
over time the anatomical knowledge on the prostate has advanced in tandem with the urological procedures carried
out. METHODS: We performed a literature review using PubMed and Google scholar and reviewed 19th & 20th
century texts, to identify the thoughts, controversies and conclusions of pioneer surgeons and scientists who
contributed to our understanding of prostatic anatomy and its treatment. RESULTS: The trigger for the great interest
in the prostatic origin, anatomy, pathology and treatment was bladder outflow obstruction symptoms. In Ancient
Greece during catheterization and lithotomy, there was referral to a bladder base soft tissue mass. Herophilus during
human dissections, described "glandular assistants"; later some scholars believed these to be the prostate gland.
Subsequently in 1536, Niccolo Massa "re-discovered" the prostate gland. In 1538, Andreas Vesalius first published a
detailed drawing of the prostate in his "Tabulae Anatomicae Sex". However, surgeons could only feel but not see the
prostate, so Ambrose Pare attributed the cause of bladder neck obstruction to urethral "carnosities". In 1575 he was
credited with performing the first definite operative prostate procedure, using a sharp cutting sound to scrape them
away. Similarly, Guthrie and Mercier in the early 19th century blindly tore away pieces of the bladder neck. Max
Nitze's cystoscope in 1877 allowed visualisation of the prostatic "lobes" in vivo. Oswald Lowsley in 1911 described
the embryological development of the human prostate and suggested a 5-lobar composition. Subsequently, the
lobes were targeted transurethrally by means of the "cold punch", the resectoscope and diathermy. In 1968, McNeal
introduced the zonal concept of prostatic anatomy, and the development of Trans-Rectal Ultrasound at the same
time, rendered these anatomical zones visible to the surgeon. Lately, Patrick Walsh's detailed description of prostatic
neuroanatomy permitted the development of nervesparing prostatectomy, which is nowadays performed by robotic
means. CONCLUSIONS: Early lower urinary tract surgery was carried out blindly but even when the prostate was
identified it was confused with urethral lesions or a bladder neck bar. The cystoscope allowed visualisation of the
prostate and its lobes and the ultrasound its zones. Surgery and anatomy have always been necessarily close
disciplines each complimenting the other as the management of prostatic disease advances from the earliest reed
catheter to the latest robot.
The future direction of American health care has become increasingly controversial during the last decade. As
healthcare costs, quality, and delivery have come under intense scrutiny, physicians play evolving roles as
"advocates" for both their profession and patients via healthcare policy. Hospital-physician alignment is critical to the
future success of advocacy among orthopaedic surgeons, as both hospitals and physicians are key stakeholders in
health care and can work together to influence major health policy decisions. We (1) define the role of advocacy in
medicine, specifically within orthopaedic surgery; (2) explore the history of physician advocacy and its evolution; (3)
examine the various avenues of involvement for orthopaedic surgeons interested in advocacy; and (4) reflect on the
impact of such activities on the future of orthopaedic surgery as it relates to hospital-physician alignment. We
performed a comprehensive review of the literature through a bibliographic search of MEDLINE() and Google Scholar
databases from January 2000 to December 2010 to identify articles related to advocacy and orthopaedic surgery.
Advocacy among orthopaedic surgeons is critical in guiding the future of the American healthcare system. In today's
world, advocacy necessitates a wider effort to improve healthcare access, quality, and delivery for patients on a
larger scale. The nature of physician advocacy among orthopaedic surgeons is grounded in the desire to serve
patients and alleviate their suffering. Participation in medical societies and political campaigns are two avenues of
involvement. The increasing role of government in American health care will require a renewed commitment to
advocacy efforts from orthopaedic surgeons. The role of advocacy is rapidly redefining the continuum of care to a
trinity of clinical excellence, innovative research, and effective advocacy. Failure to recognize this growing role of
advocacy limits the impact we can have for our patients.
BACKGROUND: The future direction of American health care has become increasingly controversial during the last
decade. As healthcare costs, quality, and delivery have come under intense scrutiny, physicians play evolving roles as
"advocates" for both their profession and patients via healthcare policy. Hospital-physician alignment is critical to the
future success of advocacy among orthopaedic surgeons, as both hospitals and physicians are key stakeholders in
health care and can work together to influence major health policy decisions., QUESTIONS/PURPOSES: We (1) define
the role of advocacy in medicine, specifically within orthopaedic surgery; (2) explore the history of physician
advocacy and its evolution; (3) examine the various avenues of involvement for orthopaedic surgeons interested in
advocacy; and (4) reflect on the impact of such activities on the future of orthopaedic surgery as it relates to hospital-
physician alignment., METHODS: We performed a comprehensive review of the literature through a bibliographic
search of MEDLINE() and Google Scholar databases from January 2000 to December 2010 to identify articles related
to advocacy and orthopaedic surgery., RESULTS: Advocacy among orthopaedic surgeons is critical in guiding the
future of the American healthcare system. In today's world, advocacy necessitates a wider effort to improve
healthcare access, quality, and delivery for patients on a larger scale. The nature of physician advocacy among
orthopaedic surgeons is grounded in the desire to serve patients and alleviate their suffering. Participation in medical
societies and political campaigns are two avenues of involvement., CONCLUSIONS: The increasing role of government
in American health care will require a renewed commitment to advocacy efforts from orthopaedic surgeons. The role
of advocacy is rapidly redefining the continuum of care to a trinity of clinical excellence, innovative research, and
effective advocacy. Failure to recognize this growing role of advocacy limits the impact we can have for our patients.
Purpose: This article reviews the diagnosis and current treatment options for gastroesophageal reflux disease (GERD)
available to nurse practitioners, with a focus on advances in proton pump inhibitor (PPI) therapy. Data Sources:
Review of scientific literature and clinical management guidelines for GERD treatment and PPI therapy from the
PubMed database, Google Scholar, and other World Wide Web resources. Conclusions: A number of safe and
effective treatment options exist for GERD. Recent developments in PPI technology may begin to address unmet
needs in PPI therapy. Implications for Practice: GERD is commonly diagnosed and treated by nurse practitioners in
the primary care setting. Acid suppression therapy is the primary medical therapy for GERD. PPI therapy provides
symptomatic relief of heartburn and regurgitation, as well as effective healing and maintenance of erosive
esophagitis. Newer PPIs lengthen the duration of acid suppression and allow for more flexibility in dosing, which may
improve medication adherence and decrease episodes of acid breakthrough. 2010 The Author(s) Journal compilation
2010 American Academy of Nurse Practitioners.
OBJECTIVE: To identify changes in the definition and usage of the term "autism" in the 20th century. BACKGROUND:
Autism is now considered a general term for a group of complex disorders of brain development. While autism is
considered a common diagnosis, it is still poorly understood and the clinical features required for diagnosis have
evolved over time. Our current diagnostic criteria for autism have provided greater consistency in diagnosis, but at
the same time, are often quite different from those used when the condition was first identified. We will describe
the changing patterns of autism diagnosis, from a term used for withdrawn schizophrenics to its current DSM-IV
definition. Understanding these changes will provide a framework for understanding the current "epidemic" of
autism. DESIGN/METHODS: Pubmed and Google Scholar search with review of DSM. RESULTS: Autism was first
introduced in the medical literature in 1910 (Bleuler) to describe a behavior seen in schizophrenic patients. That view
of autism as being related to schizophrenia prevailed (Kanner, 1943; DSM-I, 1952; Bettelheim, 1967) until the 1970s.
The thinking that autism is a developmental disorder with early onset and due to an intrinsic disability of social
awareness and difficulty with social engagement gained acceptance only in the latter half of the 20th century. A
detailed timeline of key publications and their effects on autism thinking will be presented. CONCLUSIONS: The
definition and use or the term "autism" has greatly evolved over the course of the last century to the currently
defined by DSM IV criteria. These changes, in turn, have affected the diagnosis and management of this condition.
Specialized drug shops such as pharmacies and drug shops are increasingly becoming important sources of
treatment. However, knowledge on their regulatory performance is scarce. We set out to systematically review
literature on the characteristics, knowledge and practices of specialized drug shops in Sub-Saharan Africa. We
searched PubMed, EMBASE, WEB of Science, CAB Abstracts, PsycINFO and websites for organizations that support
medicine policies and usage. We also conducted open searches using Google Scholar, and searched manually
through references of retrieved articles. Our search included studies of all designs that described characteristics,
knowledge and practices of specialized drug shops. Information was abstracted on authors, publication year, country
and location, study design, sample size, outcomes investigated, and primary findings using a uniform checklist.
Finally, we conducted a structured narrative synthesis of the main findings. We obtained 61 studies, mostly from
Eastern Africa, majority of which were conducted between 2006 and 2011. Outcome measures were heterogeneous
and included knowledge, characteristics, and dispensing and regulatory practices. Shop location and client demand
were found to strongly influence dispensing practices. Whereas shops located in urban and affluent areas were more
likely to provide correct treatments, those in rural areas provided credit facilities more readily. However, the latter
also charged higher prices for medicines. A vast majority of shops simply sold whatever medicines clients requested,
with little history taking and counseling. Most shops also stocked popular medicines at the expense of policy
recommended treatments. Treatment policies were poorly communicated overall, which partly explained why staff
had poor knowledge on key aspects of treatment such as medicine dosage and side effects. Overall, very little is
known on the link between regulatory enforcement and practices of specialized drug shops. Evidence suggests that
characteristics and practices of specialized drug shops differ across rural and urban locations, and that these
providers are highly responsive to client demand. However, there is a dearth in knowledge on how regulatory
enforcement influences their characteristics and practices, and what strategies can be employed to strengthen the
governance of the retail pharmaceutical sector.
Objectives. Characteristics of children with autism spectrum disorders (ASDs) in Africa are not known because of
unavailability of large-scale epidemiological studies in this region. This review explored the age at first presentation
to orthodox clinical practice of African children with ASDs and their expressive language ability at presentation.
Methods. A literature search of case series and case reports of ASDs from Africa was done through
PubMed/MEDLINE, Google Scholar, African Journals Online (AJOL), and archives of the Nigerian Journal of Psychiatry.
Six articles included content relating to age of the child at first presentation to orthodox clinical practice and
symptoms at presentation related to expressive language ability and therefore fulfilled the inclusion criteria.
Suggestions are made to explain the observations emanating from the review. Results. An excess of non-verbal over
verbal cases of ASDs have been presenting to orthodox clinical practice and there is a common denominator of late
presentation/diagnosis and in turn late intervention, with most cases presenting for the first time well above 8 years
of age. Attempts to explain these observations included low levels of knowledge and awareness about ASDs in Africa;
problems with help-seeking behaviour; and lack of mental healthcare facilities and trained personnel. Conclusions.
Enhancement of processes directed at ensuring early diagnosis and interventions, especially interventions aimed at
improving speech and language development well and sufficiently early, may bring about a shift in the trend of
excess non-verbal cases of ASDs over verbal cases presenting to orthodox clinical practice.
OBJECTIVE: To review the evidence about whether physical activity exercise programs improve health indicators in
adult patients after they have completed their main treatment related to cancer., DATA SOURCES: PubMed, CINAHL
and Google Scholar were searched up to September, 2011. This search was supplemented by searching the Cochrane
Library for systematic reviews and examining the reference lists of all selected studies., STUDY SELECTION:
Randomised controlled trials involving adult patients who had completed their main treatment for cancer but who
might still be receiving hormonal therapy. The effect of an exercise program was assessed on physical functions,
physiological parameters, psychosocial outcomes, and quality of life compared with sedentary or no-exercise control
groups., DATA EXTRACTION: Two reviewers independently extracted data and discrepancies were resolved by
consensus. Risk of bias in selected studies was assessed using a checklist developed by the Scottish Inter-Collegiate
Guidelines Network., DATA SYNTHESIS: Of 1505 studies initially identified by the search and 387 studies identified
from additional sources, 34 studies were included for review and meta-analysis. Most studies focused on patients
with breast cancer (65%) and investigated aerobic exercise programs (86%), while a smaller number investigated
resistance training interventions (14%). The median duration of the exercise programs was 13 weeks. Based on
quantitative pooling of available data there were statistically significant improvement in insulin-like growth factor-I,
muscle strength, fatigue, depression, and quality of life in favour of exercise for patients with breast cancer. Based
on quantitative pooling of data from studies of different types of cancer, there were improvements in favour of
exercise in body mass index, body weight, peak oxygen consumption, distance walked in 6 minutes, handgrip
strength and quality of life. For example, there was a weighted mean difference of 29m (95% CI 4 to 55) for the 6
minute walk distance in favour of exercise. Significant differences were not found on the remaining outcomes,
including lean mass and flexibility., CONCLUSION: Exercise programs for patients who have completed their
treatment for cancer result in positive effects in a range of health indicators including physical functioning and
quality of life. Copyright 2013 Australian Physiotherapy Association. Published by .. All rights reserved.
BACKGROUND: Exercise therapy is considered an important component of the treatment of arthritis. The efficacy of
exercise therapy has been reviewed in adults with rheumatoid arthritis but not in children with juvenile idiopathic
arthritis (JIA). OBJECTIVES: To assess the effects of exercise therapy on functional ability, quality of life and aerobic
capacity in children with JIA. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (CENTRAL),
Cochrane Database of Systematic Reviews (The Cochrane Library), MEDLINE (January 1966 to April 2007), CINAHL
(January 1982 to April 2007), EMBASE (January 1966 to October 2007), PEDro (January 1966 to October 2007),
SportDiscus (January 1966 to October 2007), Google Scholar (to October 2007), AMED (Allied and Alternative
Medicine) (January 1985 to October 2007), Health Technologies Assessment database (January 1988 to October
2007), ISI Web Science Index to Scientific and Technical Proceedings (January 1966 to October 2007) and the
Chartered Society of Physiotherapy website (http://www.cps.uk.org) were searched and references tracked.
SELECTION CRITERIA: Randomised controlled trials (RCTs) of exercise treatment in JIA. DATA COLLECTION AND
ANALYSIS: Potentially relevant references were evaluated and all data were extracted by two review authors working
independently. MAIN RESULTS: Three out of 16 identified studies met the inclusion criteria, with a total of 212
participants. All the included studies fulfilled at least seven of 10 methodological criteria. The outcome data of the
following measures were homogenous and were pooled in a meta-analysis: functional ability (n = 198; WMD -0.07,
95% CI -0.22 to 0.08), quality of life (CHQ-PhS: n = 115; WMD -3.96, 95% CI -8.91 to 1.00) and aerobic capacity (n =
124; WMD 0.04, 95% CI -0.11 to 0.19). The results suggest that the outcome measures all favoured the exercise
therapy but none were statistically significant. None of the studies reported negative effects of the exercise therapy.
AUTHORS' CONCLUSIONS: Overall, based on 'silver-level' evidence (www.cochranemsk.org) there was no clinically
important or statistically significant evidence that exercise therapy can improve functional ability, quality of life,
aerobic capacity or pain. The low number of available RCTs limits the generalisability. The included and excluded
studies were all consistent about the adverse effects of exercise therapy; no short-term detrimental effects of
exercise therapy were found in any study. Both included and excluded studies showed that exercise does not
exacerbate arthritis. The large heterogeneity in outcome measures, as seen in this review, emphasises the need for a
standardised assessment or a core set of functional and physical outcome measurements suited for health research
to generate evidence about the possible benefits of exercise therapy for patients with JIA. Although the short-term
effects look promising, the long-term effect of exercise therapy remains unclear.
Background: Exercise therapy is considered an important component of the treatment of arthritis. The efficacy of
exercise therapy has been reviewed in adults with rheumatoid arthritis but not in children with juvenile idiopathic
arthritis (JIA). Objectives: To assess the effects of exercise therapy on functional ability, quality of life and aerobic
capacity in children with JIA. Search strategy: The Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane
Database of Systematic Reviews (The Cochrane Library), MEDLINE (January 1966 to April 2007), CINAHL (January
1982 to April 2007), EMBASE (January 1966 to October 2007), PEDro (January 1966 to October 2007), SportDiscus
(January 1966 to October 2007), Google Scholar (to October 2007), AMED (Allied and Alternative Medicine) (January
1985 to October 2007), Health Technologies Assessment database (January 1988 to October 2007), ISI Web Science
Index to Scientific and Technical Proceedings (January 1966 to October 2007) and the Chartered Society of
Physiotherapy website (http://www.cps.uk.org) were searched and references tracked. Selection criteria:
Randomised controlled trials (RCTs) of exercise treatment in JIA. Data collection and analysis: Potentially relevant
references were evaluated and all data were extracted by two review authors working independently. Main results:
Three out of 16 identified studies met the inclusion criteria, with a total of 212 participants. All the included studies
fulfilled at least seven of 10 methodological criteria. The outcome data of the following measures were homogenous
and were pooled in a meta-analysis: functional ability (n = 198; WMD -0.07, 95% CI -0.22 to 0.08), quality of life (CHQ-
PhS: n = 115; WMD -3.96, 95% CI -8.91 to 1.00) and aerobic capacity (n = 124; WMD 0.04, 95% CI -0.11 to 0.19). The
results suggest that the outcome measures all favoured the exercise therapy but none were statistically significant.
None of the studies reported negative effects of the exercise therapy. Authors' conclusions: Overall, based on 'silver-
level' evidence (www.cochranemsk.org) there was no clinically important or statistically significant evidence that
exercise therapy can improve functional ability, quality of life, aerobic capacity or pain. The low number of available
RCTs limits the generalisability. The included and excluded studies were all consistent about the adverse effects of
exercise therapy; no short-term detrimental effects of exercise therapy were found in any study. Both included and
excluded studies showed that exercise does not exacerbate arthritis. The large heterogeneity in outcome measures,
as seen in this review, emphasises the need for a standardised assessment or a core set of functional and physical
outcome measurements suited for health research to generate evidence about the possible benefits of exercise
therapy for patients with JIA. Although the short-term effects look promising, the long-term effect of exercise
therapy remains unclear. Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
BACKGROUND: There is little published information regarding postoperative management of patients with Chronic
Exertional Compartment Syndrome (CECS). Reports of recurrence of symptoms following surgical decompression
exist, and are not uncommon depending on the specific technique used. Recurrence suggests that more time and
effort may need to be spent on implementing strategic post-operative rehabilitation management in order to avoid
repeat surgical intervention or prolonged symptoms., OBJECTIVE: To summarize relevant literature regarding CECS
and propose scientifically-based guidelines for rehab following compartment release with the rationale based on
tissue healing, muscle loading, and scar tissue formation and consideration of all tissues contained in the involved
compartment., LITERATURE REVIEW: A LITERATURE SEARCH WAS PERFORMED IN PUBMED, SPORTDISCUS, CINAHL,
PEDRO, AND GOOGLE SCHOLAR USING THE PHRASE: "chronic exertional compartment syndrome.", RESULTS: No
specific rehabilitation guidelines following surgical compartment release for lower extremity CECS were found in the
literature search performed for this clinical commentary., DISCUSSION: The development of the proposed post-
operative guidelines may allow for improved long-term outcomes following anterior compartment release.,
SUMMARY: Adequate description of long-term follow-up of outcomes following compartment release for CECS is
lacking in current literature. The proposed guidelines for rehab following compartment release include consideration
of tissue healing, muscle loading, scar tissue formation, and consideration of soft tissues contained in the involved
compartment. Utilization of the proposed guidelines may allow for future research to be performed in order to
assess outcomes following surgical intervention for CECS.
Context: Existential and spiritual concerns in relation to palliative end-of-life care have received increasing attention
over the past decade. Objectives: To review the literature specifically related to existential suffering in palliative care
in terms of the significance of existential suffering in end-of-life care, definitions, conceptual frameworks, and
interventions. Methods: A systematic approach was undertaken with the aim of identifying emerging themes in the
literature. Databases using CINAHL (1980-2009), MEDLINE (1970-2009), and PsychINFO (1980-2009) and the search
engine of Google Scholar were searched under the key words existential suffering, existential distress, existential
pain, palliative and end of life care. Results: The search yielded a total of 156 articles; 32% were peer-reviewed
empirical research articles, 28% were peer-reviewed theoretical articles, and 14% were reviews or opinion-based
articles. After manually searching bibliographies and related reference lists, 64 articles were considered relevant and
are discussed in this review. Overall analysis identifies knowledge of the following: 1) emerging themes related to
existential suffering, 2) critical review of those identified themes, 3) current gaps in the research literature, and 4)
recommendations for future research. Findings from this comprehensive review reveal that existential suffering and
deep personal anguish at the end of life are some of the most debilitating conditions that occur in patients who are
dying, and yet the way such suffering is treated in the last days is not well understood. Conclusion: Given the broad
range of definitions attributed to existential suffering, palliative care clinicians may need to be mindful of their own
choices and consider treatment options from a critical perspective. 2011 U.S. Cancer Pain Relief Committee.
Published by Elsevier Inc. All rights reserved.
Introduction: There has been considerable controversy and several changes in guidelines for the basic life support
(BLS) management of choking since the introduction of the Heimlich procedure in 1974. Hypothesis: The objective of
this project was to conduct a structured literature review to answer the question, "For adults, either conscious or
unconscious, with obstructed airway, does any specific resuscitation techniques compared to currently
recommended techniques, lead to different outcomes?" Methods: We searched MEDLINE using a complex search
criterion. We performed further searches on the basis of articles cited in references and by using the 'Cited by'
function in Google Scholar. We included articles if they addressed a therapy for choking in adults. We excluded
articles if they addressed only pediatric patients, if there was no comparison group, or if the skills involved were
beyond BLS. We collected data using a standardized study selection and data extraction form. This included specific
criteria to grade the level of evidence (LOE) and quality of each paper. Results: We identified 475 records after
duplicates were removed; we screened all of these and excluded 454. This left 22 full-text articles which we assessed
for eligibility; we excluded 19 of these, leaving 3 studies that we included in qualitative synthesis. Of these, data from
one fair quality LOE 3b study suggests that peak airway pressures developed by chest compressions are significantly
higher than the pressure from abdominal thrusts. Data from one poor quality LOE 4 study suggests that for conscious
adults with an obstructed airway, abdominal thrusts generate higher peak airway pressures when delivered when
the victim is supine as compared to seated and that back blows do not generate any significant change in airway
pressure. We could not identify any other papers that compared BLS techniques for managing obstructed airways in
adults. Clearly, there is a dearth of evidence to support basic life support treatment guidelines for this important
problem. Conclusions: In conclusion, rescuers attempting to resolve a complete airway obstruction in a conscious or
unconscious adult should provide abdominal thrusts or chest compressions.
Background. Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung
cancer. Aim. To examine the experience of lung cancer in this population and identify reasons for poorer outcomes
and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for
early intervention. Method. Literature was sought via electronic database searches and journal hand-searching for
the period from January 1995 to July 2010. Databases used included Indigenous HealthInfoNet, SCOPUS, PsycInfo,
Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, HealthInsite and Google Scholar.
Findings. Exposure to risk factors, cultural and spiritual values, remoteness and geographic characteristics,
entrenched socioeconomic inequalities and racism contribute to reduced service access and poor outcomes. The
review highlighted a complex interplay of individual, social, health system and environmental factors that impact on
optimal lung cancer care and lung cancer outcomes. Considering the burden of lung cancer within a framework of
social determinants of health is necessary for policy-making and service planning and delivery. Conclusions. It is
imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is
addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service
providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range
of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce
risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples'
engagement and control at the core of any strategy. This review has indicated that multifaceted interventions,
supported by enabling policies that target individuals, communities and health professionals, are necessary to
improve lung cancer outcomes and disparities. What is known about the topic? Aboriginal Australians suffer a
disproportionate burden of ill health including poor outcomes from lung cancer. What does this paper add? This
paper reports the outcomes of an integrative literature review. The paper identifies potential barriers to optimal lung
cancer care and management for Aboriginal Australians. This paper describes barriers within the context of individual
beliefs and behaviours, healthcare systems issues and environmental issues. The authors conclude that
acknowledging entrenched inequality and addressing factors at the patient, provider and system level are needed to
reduce the lung cancer burden in Aboriginal Australians. What are the implications for practitioners? This paper
highlights the need for a greater focus on lung cancer care, awareness and diagnosis within the Aboriginal Australian
population. Addressing culturally appropriate smoking-cessation initiatives is of particular importance. Primary care
practitioners are key to reducing the burden of lung cancer in Aboriginal Australians. AHHA 2013.
The traditional role of health librarians as expert searchers is under challenge. The purpose of this review is to
establish health librarians' views, practices and educational processes on expert searching. The search strategy was
developed in LISTA and then customised for ten other databases: ALISA, PubMed, Embase, Scopus, Web of Science,
CINAHL, ERIC, PsycINFO, Cochrane Library and Google Scholar. The search terms were (expert search* OR expert
retriev* OR mediated search* OR information retriev*) AND librar*. The searches, completed in December 2010 and
repeated in May 2011, were limited to English language publications from 2000 to 2011 (unless seminal works).
Expert searching remains a key role for health librarians, especially for those supporting systematic reviews or
employed as clinical librarians answering clinical questions. Although clients tend to be satisfied with searches
carried out for them, improvements are required to effectively position the profession. Evidence-based guidelines,
adherence to transparent standards, review of entry-level education requirements and a commitment to accredited,
rigorous, ongoing professional development will ensure best practice. 2012 The authors. Health Information and
Libraries Journal 2012 Health Libraries Group.
Alzheimer's disease (AD) is common among older adults and leads to significant disability. Volatile anesthetic gases
administered during general anesthesia (GA) have been hypothesized to be a risk factor for the development of AD.
The objective of this study is to systematically review the association between exposure to GA and risk of AD. We
searched electronic databases including MEDLINE, Embase, and Google scholar for observational studies examining
the association between exposure to GA and risk of AD. We examined study quality using a modified version of the
Newcastle-Ottawa risk of bias assessment for observational studies. We used standard meta-analytic techniques to
estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup and sensitivity analyses were
undertaken to evaluate the robustness of the findings. A total of 15 case-control studies were included in the review.
No cohort studies were identified that met inclusion criteria. There was variation in the methodological quality of
included studies. There was no significant association between any exposure to GA and risk of AD (pooled OR: 1.05;
95% CI: 0.93 - 1.19, Z = 0.80, p = 0.43). There was also no significant association between GA and risk of AD in several
subgroup and sensitivity analyses. A history of exposure to GA is not associated with an increased risk of AD although
there are few high-quality studies in this area. Prospective cohort studies with long-term follow-up or randomized
controlled trials are required to further understand the association between GA and AD.
Background: Lateral pelvic lymph-node metastases occur in 10-25% of patients with rectal cancer, and are associated
with higher local recurrence and reduced survival rates. A meta-analysis was undertaken to assess the value of
extended lateral pelvic lymphadenectomy in the operative management of rectal cancer. Methods: We searched
Medline, Embase, Ovid, Cochrane Library, and Google Scholar for studies published between 1965 and 2009 that
compared extended lymphadenectomy (EL) with standard rectal resection. 20 studies, which included 5502 patients
from one randomised, three prospective non-randomised, and 14 retrospective case-control studies published
between 1984 and 2009, met our search criteria and were assessed. 2577 patients underwent EL and 2925
underwent non-EL for rectal cancer. Random and fixed-effects meta-analytical models were used where indicated,
and between-study heterogeneity was assessed. End-points evaluated included peri-operative outcomes, 5-year
survival and recurrence rates. Findings: Operating time was significantly longer in the EL group by 767 min (95% CI
1877-13468; p=00096). Intra-operative blood loss was greater in the EL group by 5365 mL (95% CI 3537-7192;
p<00001). Peri-operative mortality (OR 081, 95% CI 034-193; p=063) and morbidity (OR 145, 95% CI 089-235; p=013)
were similar between the two groups. Data from individual studies showed that male sexual dysfunction and urinary
dysfunction (three studies: OR 370, 95% CI 166-823; p=00012) were more prevalent in the EL group. There were no
significant differences in 5-year survival (hazard ratio [HR] 109, 95% CI 078-150; p=062), 5-year disease-free survival
(HR 123, 95% CI 075-203, p=041), and local (OR 083, 95% CI 061-113; p=023) or distant recurrence (OR 093, 95% CI
072-121; p=060). Interpretation: Extended lymphadenectomy does not seem to confer a significant overall cancer-
specific advantage, but does seem to be associated with increased urinary and sexual dysfunction. Funding: The
National Institute for Health Research Biomedical Research Centre, London, UK. 2009 Elsevier Ltd. All rights reserved.
BACKGROUND: Lateral pelvic lymph-node metastases occur in 10-25% of patients with rectal cancer, and are
associated with higher local recurrence and reduced survival rates. A meta-analysis was undertaken to assess the
value of extended lateral pelvic lymphadenectomy in the operative management of rectal cancer., METHODS: We
searched Medline, Embase, Ovid, Cochrane Library, and Google Scholar for studies published between 1965 and
2009 that compared extended lymphadenectomy (EL) with standard rectal resection. 20 studies, which included
5502 patients from one randomised, three prospective non-randomised, and 14 retrospective case-control studies
published between 1984 and 2009, met our search criteria and were assessed. 2577 patients underwent EL and 2925
underwent non-EL for rectal cancer. Random and fixed-effects meta-analytical models were used where indicated,
and between-study heterogeneity was assessed. End-points evaluated included peri-operative outcomes, 5-year
survival and recurrence rates., FINDINGS: Operating time was significantly longer in the EL group by 76.7 min (95% CI
18.77-134.68; p=0.0096). Intra-operative blood loss was greater in the EL group by 536.5 mL (95% CI 353.7-719.2;
p<0.0001). Peri-operative mortality (OR 0.81, 95% CI 0.34-1.93; p=0.63) and morbidity (OR 1.45, 95% CI 0.89-2.35;
p=0.13) were similar between the two groups. Data from individual studies showed that male sexual dysfunction and
urinary dysfunction (three studies: OR 3.70, 95% CI 1.66-8.23; p=0.0012) were more prevalent in the EL group. There
were no significant differences in 5-year survival (hazard ratio [HR] 1.09, 95% CI 0.78-1.50; p=0.62), 5-year disease-
free survival (HR 1.23, 95% CI 0.75-2.03, p=0.41), and local (OR 0.83, 95% CI 0.61-1.13; p=0.23) or distant recurrence
(OR 0.93, 95% CI 0.72-1.21; p=0.60)., INTERPRETATION: Extended lymphadenectomy does not seem to confer a
significant overall cancer-specific advantage, but does seem to be associated with increased urinary and sexual
dysfunction.
Purpose: This systematic review updates one conducted in 2008 into extended scope practice (ESP) in physiotherapy
in orthopedics. Methods: A comprehensive open-ended search was conducted using electronic library databases and
Google Scholar to identify any primary study design reporting on physiotherapists working in ESP roles within
orthopedic settings. Studies were allocated to the National Health and Medical Research Council hierarchy of
evidence, although only studies in levels I, II, or III_1 were critically appraised using a purpose-built critical appraisal
tool. Information was extracted on the country of origin, ESP tasks, relevant training, patient types, health, process,
and cost measures. Results: 1071 studies were identified, and twelve were included in the review (including
diagnostic and evaluative research). The hierarchy of evidence ranged from II to IV, from which only two diagnostic
studies met the criteria for critical appraisal. ESP tasks included injection therapy, removing k-wires, and requesting
investigations. The education of ESP physiotherapists varied widely, and included formal and informal training. The
positive outcomes of ESP initiatives were reported, in diagnostic ability, reduced costs and waiting times, and
improved health outcomes. Conclusion: Despite the positive results, the generally low level of evidence and the
range of outcome measures reported, constrained clear conclusions regarding the health, process, and cost
implications of ESP physiotherapy roles in orthopedic settings. The need for formalized, widely recognized training
was highlighted, to give ESP physiotherapy roles credibility. 2012 Stanhope et al, publisher and licensee Dove
Medical Press Ltd.
Introduction: The standard anatomical description of the extensor pollicis brevis tendon provided in textbooks of
anatomy is at odds with that of published anatomical studies. It is crucial to the hand surgeon that he or she has a
clear understanding of its anatomy, including its variations. The aim of this study was to provide a comprehensive
review of the current literature on the anatomy and variants of the extensor pollicis brevis. It is hoped that this
review will be indispensable to the hand surgeon in informing him or her about the anatomy and variants
encountered when dealing with the extensor pollicis brevis. Methods: Inclusion and exclusion criteria were defined
and a literature search was carried out on MEDLINE, PubMed, Embase, and Google Scholar from inception to March
2013 for studies on the topic of extensor pollicis brevis anatomy. The following key words were used: "extensor
pollicis brevis," "anatomy," "anatomic variations," "cadaveric study," "clinical study," "case report," and "dissection".
Results: The search retrieved a total of 52 studies following removal of duplicates. Forty-five studies were excluded
following screening of the title and abstract. Three studies were excluded as they did not meet the eligibility criteria,
leaving 4 cadaveric studies for inclusion in the review. Conclusion: We recommend the use of ultrasound scanning to
determine anatomy of the extensor pollicis brevis before reconstructive procedures involving the extensor pollicis
brevis, as well as in traumatic injuries to the extensor pollicis brevis. There appears to be ethnicity-related variations
in the anatomy of the extensor pollicis brevis, and further study into these variations may be indicated.
Introduction: External cardiac mechanical stimulation is one of the fastest resuscitative manoeuvres possible in the
emergency setting. Precordial thump (PT), initially reported for treatment of atrio-ventricular block, has been
subsequently described to cardiovert also ventricular tachycardia (VT) and fibrillation (VF). PT efficacy, mechanics
and mechanisms remain poorly characterized. Sources of data: Appropriate MESH and free terms were searched on
PubMed, Embase and the Cochrane Library. Cross-referencing from articles and reviews, and forward search using
SCOPUS and Google scholar have also been performed. Pre-set inclusion and exclusion criteria were applied to
retrieved references on PT, which were then reviewed, summarized and interpreted. Areas of agreement: PT is not
effective in treating VF, and of limited use for VT, although it has a very good safety profile (97% no
changed/improved rhythm). If delivered, PT should be applied as early as possible after cardiac arrest, and cardio-
pulmonary resuscitation (CPR) should begin with no delay if not effective. Areas of controversy: A relatively large
fraction of reported positive outcomes (both for PT and the less forceful but serially applied precordial percussion) in
witnessed asystole should be considered when critically reviewing present CPR recommendations. In addition,
mechanisms, energy requirements and timing are analysed and discussed. Growing points and areas timely for
developing research: The 2005 ALS guidelines recommend PT delivery only by healthcare professionals trained in the
technique. The use of training aids should therefore be explored, regardless of whether they are based on stand-
alone devices or integrated within resuscitation mannequins. The Author 2009. Published by Oxford University Press.
Introduction: H1N1 influenza can cause severe acute lung injury (ALI). Extracorporeal membrane oxygenation
(ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still
controversial. We conducted a systematic review and meta-analysis on ECMO for H1N1-associated ALI.Methods:
CENTRAL, Google Scholar, MEDLINE/PubMed and Scopus (updated 2 January 2012) were systematically searched.
Studies reporting on 10 or more patients with H1N1 infection treated with ECMO were included. Baseline,
procedural, outcome and validity data were systematically appraised and pooled, when appropriate, with random-
effect methods.Results: From 1,196 initial citations, 8 studies were selected, including 1,357 patients with
confirmed/suspected H1N1 infection requiring intensive care unit admission, 266 (20%) of whom were treated with
ECMO. Patients had a median Sequential Organ Failure Assessment (SOFA) score of 9, and had received mechanical
ventilation before ECMO implementation for a median of two days. ECMO was implanted before inter-hospital
patient transfer in 72% of cases and in most patients (94%) the veno-venous configuration was used. ECMO was
maintained for a median of 10 days. Outcomes were highly variable among the included studies, with in-hospital or
short-term mortality ranging between 8% and 65%, mainly depending on baseline patient features. Random-effect
pooled estimates suggested an overall in-hospital mortality of 28% (95% confidence interval 18% to 37%; I2 =
64%).Conclusions: ECMO is feasible and effective in patients with ALI due to H1N1 infection. Despite this, prolonged
support (more than one week) is required in most cases, and subjects with severe comorbidities or multiorgan failure
remain at high risk of in-hospital death. 2013 Zangrillo et al.; licensee BioMed Central Ltd.
Ureteral stones frequently cause renal colic, and if left untreated, can lead to obstructive uropathy. Extracorporeal
shock wave lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the most common
interventions used to treat ureteral stones. ESWL treatment is less invasive than ureteroscopy, but has some
limitations such as a high retreatment rate, and is not available in all centres. Recent advances in ureteroscopy have
increased success rates and reduced complication rates. To examine evidence from randomised controlled trials
(RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. We searched the Cochrane
Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March
2011), EMBASE (1980 to March 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and
abstracts from conference proceedings, all without language restriction. RCTs that compared ESWL with
ureteroscopic retrieval of ureteric stones were included in this review. Study participants were adults with ureteric
stones requiring intervention. Published and unpublished sources were considered for inclusion. Three authors
independently assessed study quality, risk of bias, and extracted data. Statistical analyses were performed using the
random-effects model. Results were expressed as risk ratios (RR) for dichotomous outcomes or mean differences
(MD) for continuous data, both with 95% confidence intervals (CI). Seven RCTs (1205 patients) were included in the
review. Stone-free rates were lower in patients who underwent ESWL (7 studies, 1205 participants: RR 0.84, 95% CI
0.73 to 0.96) but re-treatment rates were lower in ureteroscopy patients (6 studies, 1049 participants: RR 6.18, 95%
CI 3.68 to 10.38. ESWL-treated patients had less need for auxiliary treatment (5 studies, 751 participants: RR 0.43,
95% CI 0.25 to 0.74; fewer complications (7 studies, 1205 participants: RR 0.54, 95% CI 0.33 to 0.88); and shorter
length of hospital stay (2 studies, 198 participants: MD -2.55 days, 95% CI -3.24 to -1.86).Three studies adequately
described the randomisation sequence, three studies were unclear on how they randomised, while one study had a
high risk of selection bias. All the studies had an unclear risk of performance bias and detection bias, while all had a
low risk of attrition bias, reporting bias, or other sources of bias identified. Compared with ESWL, ureteroscopic
removal of ureteral stones achieves a greater stone-free state, but with a higher complication rate and longer
hospital stay.
Ureteral stones frequently cause renal colic, and if left untreated, can lead to obstructive uropathy. Extracorporeal
shock wave lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the most common
interventions used to treat ureteral stones. ESWL treatment is less invasive than ureteroscopy, but has some
limitations such as a high retreatment rate, and is not available in all centres. Recent advances in ureteroscopy have
increased success rates and reduced complication rates. To examine evidence from randomised controlled trials
(RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. We searched the Cochrane
Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March
2011), EMBASE (1980 to March 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and
abstracts from conference proceedings, all without language restriction. RCTs that compared ESWL with
ureteroscopic retrieval of ureteric stones were included in this review. Study participants were adults with ureteric
stones requiring intervention. Published and unpublished sources were considered for inclusion. Three authors
independently assessed study quality, risk of bias, and extracted data. Statistical analyses were performed using the
random-effects model. Results were expressed as risk ratios (RR) for dichotomous outcomes or mean differences
(MD) for continuous data, both with 95% confidence intervals (CI). Seven RCTs (1205 patients) were included in the
review. Stone-free rates were lower in patients who underwent ESWL (7 studies, 1205 participants: RR 0.84, 95% CI
0.73 to 0.96) but re-treatment rates were lower in ureteroscopy patients (6 studies, 1049 participants: RR 6.18, 95%
CI 3.68 to 10.38. ESWL-treated patients had less need for auxiliary treatment (5 studies, 751 participants: RR 0.43,
95% CI 0.25 to 0.74; fewer complications (7 studies, 1205 participants: RR 0.54, 95% CI 0.33 to 0.88); and shorter
length of hospital stay (2 studies, 198 participants: MD -2.55 days, 95% CI -3.24 to -1.86).Three studies adequately
described the randomisation sequence, three studies were unclear on how they randomised, while one study had a
high risk of selection bias. All the studies had an unclear risk of performance bias and detection bias, while all had a
low risk of attrition bias, reporting bias, or other sources of bias identified. Compared with ESWL, ureteroscopic
removal of ureteral stones achieves a greater stone-free state, but with a higher complication rate and longer
hospital stay.
Background Urinary stones frequently cause renal colic and if left untreated can cause obstructive uropathy. Shock
Wave Lithotripsy (SWL) and ureteroscopy are the two most commonly offered for the management of calculi.
However, there is no evidence to suggest which treatment option is more successful. Therefor a systematic review
was aimed to compare the two modalities.Search methods We searched the Cochrane Central Register of Controlled
Trials, MEDLINE, EMBASE, CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from
conference proceedings without language restriction. Selection criteria RCTs comparing ESWL with ureteroscopic
retrieval of ureteric stones were included. Participants were adults with ureteric stones requiring intervention.
Published and unpublished sources were considered.RESULTS: Seven RCTs (1205 patients) were included. The stone-
free rates were lower in the ESWL group (P = 0.01; RR 0.84 95% CI 0.73 to 0.96). The retreatment rates were lower in
the ureteroscopy group (P < 0.00001; RR 6.18 95% CI 3.68 to 10.38) however the need for auxiliary treatment were
lower in the ESWL group (P = 0.003; RR 0.43 95% CI 0.25 to 0.74). The rate of complications was lower in the ESWL
group (P = 0.01; RR 0.54 95% CI 0.33 to 0.88). Length of hospital stay was less for ESWL treatment (P < 0.00001; MD -
2.55 95% CI - 3.24 to - 1.86). CONCLUSIONS: Ureteroscopic removal of ureteral stones achieves a higher stone-free
state in addition to a lower retreatment rate, but with a higher complication rate and a longer hospital stay.
Introduction: Rosai-Dorfman disease (RDD) is a rare proliferative histiocytic disorder of unknown etiology. RDD
typically presents with generalized lymphadenopathy and polymorphic histiocytic infiltration of the lymph node
sinuses; however, occurrences of extranodal soft tissue RDD may rarely occur when masquerading as a soft tissue
sarcoma.Materials and methods: A comprehensive search of all published cases of soft tissue RDD without
associated lymphadenopathy was conducted using PubMed and Google Scholar for the years 1988 to 2011.
Ophthalmic RDD was excluded.Results: Thirty-six cases of extranodal soft tissue RDD, including the current one, have
been reported since 1988. Anatomical distribution varied among patients. Four (11.1%) patients presented with
bilateral lesions in the same anatomic region. Pain was the most common symptom in six (16.8%) patients. Sixteen
(41.6%) patients were managed surgically, of which one (2.8%) case experienced recurrence of disease.Conclusion:
RDD is a rare inflammatory non-neoplastic process that should be considered in the differential diagnosis of a soft
tissue tumor. Thus, differentiation of extranodal RDD from more common soft tissue tumors such as soft tissue
sarcoma or inflammatory myofibroblastic tumor is often difficult and typically requires definitive surgical excision
with histopathological examination. While the optimal treatment for extranodal RDD remains ill-defined and
controversial, surgical excision is typically curative. 2013 Komaragiri et al.; licensee BioMed Central Ltd.
Objective: The Intensive Care Collaborative project was established with the specific aim of developing
recommendations for clinical practice that are underpinned by the best available evidence to support the objective
of improving the standard of care delivered in NSW Intensive Care Units. The eyecare clinical practice guideline for
intensive care patients were developed as a result of this initiative. Methods: Search: The bibliographic databases
(PubMed; The Cummulative Index of Nursing and Allied Health Literature (CINAHL); Medline and The Cochrane
Library) were searched. The search terms used alone and in combination were: intensive care; prevention; eye;
eyecare; and guidelines. In addition, reference lists of relevant papers were assessed to identify additional studies
and Google Scholar was searched using the keywords eyecare and intensive care. The search strategy was limited to
the English language but was not limited by year of publication. Study selection criteria: All relevant observational
and interventional studies were included, regardless of study design. Review process: Each paper was reviewed by at
least two Guideline Development Network (GDN) members independently using a data extraction tool. Papers were
assessed against the National Health and Medical Research Council (NHMRC) levels of evidence. Recommendations
were assigned using a modified Delphi process to ensure consensus. Summary of recommendations: We recommend
that each patient is assessed for the risk factors of iatrogenic ophthalmologic complications; the ability to maintain
eyelid closure; for iatrogenic ophthalmologic complications. It is also recommended that; the rates of iatrogenic
ophthalmologic complications are monitored; referral is made in a timely manner for any suspected iatrogenic
ophthalmologic complications; eyelid closure is maintained if eyelid closure cannot be maintained passively; all
patients who cannot achieve eyelid closure independently should receive eye care every 2 h. Conclusions: The
recommendations from this clinical practice guideline were peer-reviewed and examined by ophthalmology experts.
Despite the heavy reliance on only a small number of studies and low level of evidence, the recommendations have
the potential to positively affect patient outcomes by encouraging clinicians to assess and monitor for
ophthalmological complications and to provide appropriate preventative interventions if implemented extensively.
2007 Australian College of Critical Care Nurses Ltd.
BACKGROUND: Childhood vaccination (also described as immunisation) is an important and effective way to reduce
childhood illness and death. However, there are many children who do not receive the recommended vaccines
because their parents do not know why vaccination is important, do not understand how, where or when to get their
children vaccinated, disagree with vaccination as a public health measure, or have concerns about vaccine
safety.Face to face interventions to inform or educate parents about routine childhood vaccination may improve
vaccination rates and parental knowledge or understanding of vaccination. Such interventions may describe or
explain the practical and logistical factors associated with vaccination, and enable parents to understand the
meaning and relevance of vaccination for their family or community., OBJECTIVES: To assess the effects of face to
face interventions for informing or educating parents about early childhood vaccination on immunisation uptake and
parental knowledge., SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL)
(The Cochrane Library 2012, Issue 7); MEDLINE (OvidSP) (1946 to July 2012); EMBASE + Embase Classic (OvidSP)
(1947 to July 2012); CINAHL (EbscoHOST) (1981 to July 2012); PsycINFO (OvidSP) (1806 to July 2012); Global Health
(CAB) (1910 to July 2012); Global Health Library (WHO) (searched July 2012); Google Scholar (searched September
2012), ISI Web of Science (searched September 2012) and reference lists of relevant articles. We searched for
ongoing trials in The International Clinical Trials Registry Platform (ICTRP) (searched August 2012) and for grey
literature in The Grey Literature Report and OpenGrey (searched August 2012). We also contacted authors of
included studies and experts in the field. There were no language or date restrictions., SELECTION CRITERIA:
Randomised controlled trials (RCTs) and cluster RCTs evaluating the effects of face to face interventions delivered to
individual parents or groups of parents to inform or educate about early childhood vaccination, compared with
control or with another face to face intervention. Early childhood vaccines are all recommended routine childhood
vaccines outlined by the World Health Organization, with the exception of human papillomavirus vaccine (HPV)
which is delivered to adolescents., DATA COLLECTION AND ANALYSIS: Two authors independently reviewed database
search results for inclusion. Grey literature searches were conducted and reviewed by a single author. Two authors
independently extracted data and assessed the risk of bias of included studies. We contacted study authors for
additional information., MAIN RESULTS: We included six RCTs and one cluster RCT involving a total of 2978
participants. Three studies were conducted in low- or middle-income countries and four were conducted in high-
income countries. The cluster RCT did not contribute usable data to the review. The interventions comprised a mix of
single-session and multi-session strategies. The quality of the evidence for each outcome was low to very low and
Objectives: To identify factors that influence the initial plan and final decision to choose a rural area as first
employment location in final-year nursing students or newly graduated nurses. Design: We conducted a mixed-
methods review of the literature, including both published and gray literature, using established criteria. Two
reviewers performed data extraction of relevant information independently. Data sources: We retrieved empirical
studies from the following databases: PubMED, Embase, CINAHL (EBSCO), Web of Science (SCI and SSCI), The
Cochrane Library, Business Source Premier (EBSCO), ERIC, Proquest and PsychInfo. We also searched for empirical
studies in the technical and gray literature and reviewed journals related to rural health. Additionally, we conducted
searches in websites such as the Center for Health Workforce Planning and Analysis, as well as Google and Google
Scholar search engines. Results: Of the 523 studies thus screened, 15 were included for data extraction. We
identified more than 40 factors associated with initial plans and final decision to settle in a rural area among nursing
graduates. Conclusions: Only limited literature is currently available on the factors associated with the intention of
nursing students or newly graduated nurses of practicing in rural areas and on the relationship between intention
and effective behavior. This review highlights the needs for further research in this field. 2012 Elsevier Ltd.
OBJECTIVES: To identify factors that influence the initial plan and final decision to choose a rural area as first
employment location in final-year nursing students or newly graduated nurses., DESIGN: We conducted a mixed-
methods review of the literature, including both published and gray literature, using established criteria. Two
reviewers performed data extraction of relevant information independently., DATA SOURCES: We retrieved empirical
studies from the following databases: PubMED, Embase, CINAHL (EBSCO), Web of Science (SCI and SSCI), The
Cochrane Library, Business Source Premier (EBSCO), ERIC, Proquest and PsychInfo. We also searched for empirical
studies in the technical and gray literature and reviewed journals related to rural health. Additionally, we conducted
searches in websites such as the Center for Health Workforce Planning and Analysis, as well as Google and Google
Scholar search engines., RESULTS: Of the 523 studies thus screened, 15 were included for data extraction. We
identified more than 40 factors associated with initial plans and final decision to settle in a rural area among nursing
graduates., CONCLUSIONS: Only limited literature is currently available on the factors associated with the intention
of nursing students or newly graduated nurses of practicing in rural areas and on the relationship between intention
and effective behavior. This review highlights the needs for further research in this field. Copyright 2012 Elsevier Ltd.
Objective To identify factors causing delayed diagnosis and treatment for tuberculosis in high tuberculosis (TB)/HIV
burden African countries. Methods We searched Ovid Medline, CINAHL, PsychInfo, Scopus and Sabinet-South African
journals and reference lists, Google, Google Scholar and Google SA for reports in English, >=1992, of original data
from sub-Saharan countries on patient or system delay in TB diagnosis or treatment with populations >=15years old.
Two reviewers extracted data independently for each study. We categorized independent variables as predisposing,
enabling or reinforcing (PRECEDE model). Meta-analysis was conducted for factors associated with delay in >=2
studies. Results Of 20 eligible studies, 12 assessed both sources of delay; 1, system delay; and 7, patient delay only.
Most were cross-sectional surveys (k=13) with samples of consecutive patients (k=13) and bivariate analyses (k=11).
Starting and endpoints for patient delay were consistent, but not system delay. Patient characteristics were studied
frequently; HIV stigma and enabling factors were studied infrequently, although the last were most often associated
with delay. Consulting traditional healers first - usually by rural residents - consistently led to patient delay; OR=3.45
(1.91-6.21). Travel time for the return visit was consistently associated with system delay OR=1.87 (1.378-2.531).
Conclusions We recommend partnerships with traditional healers and research emphasizing HIV and system factors,
standard definitions of delay and qualitative and cohort studies to identify enabling and reinforcing factors related to
delay. 2011 Blackwell Publishing Ltd.
Abstract Introduction The first decade of the 21st century has witnessed three major influenza public health
emergencies: (1) the severe acute respiratory syndrome of 2002-2003; (2) the avian flu of 2006; and (3) the 2009
H1N1 pandemic influenza. An effective public health response to an influenza public health emergency depends on
the majority of uninfected health care personnel (HCP) continuing to report to work. The purposes of this study were
to determine the state of the evidence concerning the willingness of HCP to work during an influenza public health
emergency, to identify the gaps for future investigation, and to facilitate evidence-based influenza public health
emergency planning. Methods A systemic literature review of relevant, peer-reviewed, quantitative, English
language studies published from January 1, 2001 through June 30, 2010 was conducted. Search strategies included
the Cochrane Library, PubMed, PubMed Central, EBSCO Psychological and Behavioral Sciences Collection, Google
Scholar, ancestry searching of citations in relevant publications, and information from individuals with a known
interest in the topic. Results Thirty-two studies met the inclusion criteria. Factors associated with a willingness to
work during an influenza public health emergency include: being male, being a doctor or nurse, working in a clinical
or emergency department, working full-time, prior influenza education and training, prior experience working during
an influenza emergency, the perception of value in response, the belief in duty, the availability of personal protective
equipment (PPE), and confidence in one's employer. Factors found to be associated with less willingness were: being
female, being in a supportive staff position, working part-time, the peak phase of the influenza emergency, concern
for family and loved ones, and personal obligations. Interventions that resulted in the greatest increase in the HCP's
willingness to work were preferential access to Tamiflu for the HCP and his/her family, and the provision of a vaccine
for the individual and his/her family. Conclusions Understanding the factors that contribute to the willingness of HCP
to report to work during an influenza public health emergency is critical to emergency planning and preparedness.
Information from this review can guide emergency policy makers, planners, and implementers in both understanding
and influencing the willingness of HCP to work during an influenza public health emergency. Copyright World
Association for Disaster and Emergency Medicine 2012.
The authors critically reviewed the literature regarding factors influencing consent to having videotaped mental
health sessions. The authors searched the literature in PubMed, PsycINFO, Google Scholar, and Web of Science from
the mid-1950s through February 2009. The authors identified 27 studies, of which 19 (73%) examined general
practice. Only 4 (15%) were in mental health. Most patients agree to be videotaped when asked. Those who did not
consent tended to be female and younger, with previous psychiatric history or psychological distress. The data are
mixed about whether psychiatric patients felt inhibited in videotaped sessions. The mental health literature in this
area is limited and dated. Implications for practice are drawn inferentially from the general-practice literature.
Recommendations for increasing the consent rate include building a relationship with patients before asking them
for videotaping and, when asking, explaining the educational value and specific purpose of the recording.
Background: Chronic obstructive pulmonary disease is a common, chronic and burdensome condition requiring the
individual to engage in a range of self-management strategies. The capacity to engage in self-management is
dependent on a range of internal (e.g. personal) and external (e.g. health service) factors. Objectives: This paper
seeks to define self-management, identify the determinants which influence the individual's ability to cope and
adjust to living with chronic obstructive pulmonary disease in the community, and identify implications for clinical
practice and research. Design: Integrative review. Data sources: Medline, Embase, PubMed, CINAHL, Google Scholar.
Review methods: Integrative review using prospective research questions. Papers were included in the review if they
were published in peer reviewed journals and written in English between 2000 and 2010. Articles were accepted for
inclusion if they discussed the determinants that influenced self-management of chronic obstructive pulmonary
disease in the community. Confirmation of results and discussion themes was validated by specialists in chronic
obstructive pulmonary disease and complex care. Findings: Self-management is less well characterised in chronic
obstructive pulmonary disease compared with other chronic conditions. Functional limitation and the need to
balance disease management with everyday life are the two key elements that patients face in managing their
condition. Provider characteristics, socioeconomic status and health literacy are sparsely discussed yet are known to
influence chronic obstructive pulmonary disease self-management. Conclusions: Chronic obstructive pulmonary
disease self-management must be a key focus internationally as the disease incidence increases. Collaborative care is
required between patients and health providers in order facilitate patients in confident management of their
condition. 2011 Elsevier Ltd.
CONTEXT: Passive stretching exercise protocols, as part of outpatient treatment or home exercise programs, are
used to improve hypomobility. Despite the cosmopolitan use of stretching exercises, little is known about the forces
being applied to the joint during these routine treatments., TYPE OF STUDY: Clinical review., EVIDENCE ACQUISITION:
Articles were identified using MEDLINE and Google Scholar databases, with searches initially limited to those articles
published after 1995. Seminal articles that were referenced were also included., RESULTS: Many factors contribute
to the clinical success of a stretching program, including the frequency, intensity, and duration of the stretching
exercises, as well as patient- and joint-specific factors., CONCLUSIONS: The goal of a stretching protocol is to
maximize total end-range time both in the clinic and at home. Higher intensity, prolonged, and frequent stretching
(10- to 15-minute bouts, 3 to 6 times per day) used as an adjunct to high-grade mobilizations may be beneficial for
certain hypomobility conditions.
BACKGROUND: The family medical history is an important risk factor for several common chronic diseases but
challenges remain in efficiently identifying individuals at increased risk. Family history questionnaires (FHQs) may
have an important role in primary care as a screening tool to support tailored disease prevention. AIMS: To
systematically review studies reporting on the use and outcomes of FHQs in a clinical setting. METHODS: Studies
were identified through electronic searches of Medline, EMBASE, CINAHL, PsychInfo, and Google Scholar until
December 2007. Due to the heterogeneity of the included papers, formal synthesis was not possible. We therefore
developed a taxonomy based on the principal objectives and design of each study. Results: A plethora of FHQs were
identified but few had been formally evaluated. Forty-four publications were reviewed. Sixteen papers met our
inclusion criteria reporting 14 different FHQs. The majority of FHQs focused on 1 or more cancers. Twelve papers
reported on the evaluation of a FHQ in a non-referred population, predominantly in primary care practice. Four
papers reported a formal validation of a FHQ against a reference standard, demonstrating reasonable accuracy. Six
further papers showed that a FHQ can be used to identify populations at increased risk of cancer, many of whom had
not been previously identified. Two papers found a positive impact of using a FHQ on subsequent cancer screening,
and a further 3 found no significant psychological long-term harm associated with their use. CONCLUSIONS: Despite
the abundance of available FHQs, few have been formally evaluated. Several short single-cancer specific FHQs exist,
but there are no simple, short generic FHQs suitable for use in primary care practice. FHQs can be used to obtain
reasonably accurate family history information and to identify populations at increased disease risk. They have been
shown to have a positive impact on cancer screening and are not associated with long-term psychological harm.
Copyright 2008 S. Karger AG, Basel.
AIMS AND OBJECTIVES: To understand the needs of critically ill patient families', seeking to meet those needs and
explore the process and patterns of involving family members during routine care and resuscitation and other
invasive procedures., METHODS: A structured literature review using Cumulative Index to Nursing and Allied Health
Literature, Pubmed, Proquest, Google scholar, Meditext database and a hand search of critical care journals via
identified search terms for relevant articles published between 2000 and 2010., RESULTS: Thirty studies were
included in the review either undertaken in the Intensive Care Unit or conducted with critical care staff using
different methods of inquiry. The studies were related to family needs; family involvement in routine care; and
family involvement during resuscitation and other invasive procedures. The studies revealed that family members
ranked both the need for assurance and the need for information as the most important. They also perceived their
important needs as being unmet, and identified the nurses as the best staff to meet these needs, followed by the
doctors. The studies demonstrate that both family members and healthcare providers have positive attitudes
towards family involvement in routine care. However, family members and healthcare providers had significantly
different views of family involvement during resuscitation and other invasive procedures., CONCLUSION: Meeting
Intensive Care Unit family needs can be achieved by supporting and involving families in the care of the critically ill
family member. More emphasis should be placed on identifying the family needs in relation to the influence of
cultural values and religion held by the family members and the organisational climate and culture of the working
area in the Intensive Care Unit. 2013 Blackwell Publishing Ltd.
PURPOSE: To review the literature on the use of extreme lateral interbody fusion (XLIF) in adult spinal deformity, to
discuss on its limits and advantages and to propose a guide to surgical strategy., METHODS: Surgical technique XLIF is
a minimally invasive surgery (MIS) technique to anteriorly access the spine from midthoracic to L5. Important aspects
of the technique are a muscle splitting approach through the psoas, use of advanced neuromonitoring to detect the
lumbar plexus within the psoas, bilateral annulus release and large footprint interbody cages, supported by the
stronger bone of ring apophyses. Large, laterally inserted cages provide strong correction of coronally asymmetrical
disc spaces. Literature review MEDLINE database, the Web using Google Scholar and proceedings of the Society for
Lateral Access Surgery meetings were searched for relevant articles on technique, results and complications.,
RESULTS: XLIF with posterior percutaneous pedicle screw instrumentation provides 40-75% correction of coronal
curves, with modest increase of lordosis. Only anterior XLIF can provide less correction. Self-limited thigh symptoms
are frequent after transpsoas access. Permanent neural deficit and visceral complications have also been reported.
Combined XLIF-MIS could have a lower complication compared to open circumferential surgery in historical series.,
CONCLUSIONS: XLIF is a promising MIS option for adult deformity. Specific surgical strategies are needed to avoid
imbalance and define ideal fusion levels and methods. An XLIF-based MIS strategy with a reduced number of levels
of lumbar scoliosis can lead to significant advantages. Evaluation of the incidence, complications, their avoidance and
real impact on patients' outcomes is necessary to better understand the advantages of this approach. Studies
comparing effectiveness and safety of traditional versus XLIF approaches are needed to assist evidence-based
decision making.
Fascia is virtually inseparable from all structures in the body and acts to create continuity amongst tissues to enhance
function and support. In the past fascia has been difficult to study leading to ambiguities in nomenclature, which
have only recently been addressed. Through review of the available literature, advances in fascia research were
compiled, and issues related to terminology, descriptions, and clinical relevance of fascia were addressed. Our
multimodal search strategy was conducted in Medline and PubMed databases, with other targeted searches in
Google Scholar and by hand, utilizing reference lists and conference proceedings.IN AN EFFORT TO ORGANIZE
NOMENCLATURE FOR FASCIAL STRUCTURES PROVIDED BY THE FEDERATIVE INTERNATIONAL COMMITTEE ON
ANATOMICAL TERMINOLOGY (FICAT), WE DEVELOPED A FUNCTIONAL CLASSIFICATION SYSTEM WHICH INCLUDES
FOUR CATEGORIES OF FASCIA: i) linking, ii) fascicular, iii) compression, and iv) separating fasciae. Each category was
developed from descriptions in the literature on gross anatomy, histology, and biomechanics; the category names
reflect the function of the fascia.An up-to-date definition of fascia is provided, as well as descriptions of its function
and clinical features. Our classification demonstrates the use of internationally accepted terminology in an ontology
which can improve understanding of major terms in each category of fascia.
Introduction: Erlotinib is an agent in the class of oral epidermal growth factor receptor (EGFR) tyrosine kinase
inhibitors. Although this class of agents is considered to be relatively safe, the most serious, but rare, adverse
reaction is drug-associated interstitial lung disease (ILD). This potentially fatal adverse reaction has been often
described with gefitinib, but has been less well described for erlotinib. We here describe a case report of fatal
interstitial lung disease in a Caucasian man associated with erlotinib and high erlotinib and metabolite plasma levels
and discuss it in the context of all documented cases of erlotinib associated ILD. Methods: Our case was described
and for the literature review a Pubmed and Google Scholar search was conducted for cases of erlotinib associated
ILD. The retrieved publications were screened for relevant literature. Results: Besides our case, a total of 19 cases of
erlotinib-associated ILD were found. Eleven out 19 cases had a fatal outcome and in only one case erlotinib plasma
concentrations were measured and found to be high. Conclusion: Erlotinib-associated ILD is a rare, serious and often
fatal adverse reaction. Most likely, the cause for erlotinib-associated ILD is multifactorial and high drug levels may be
present in patients without serious adverse reactions. However, considering the pharmacology of EGFR inhibitors,
high drug and metabolite levels may play a role and future studies are warranted to identify risk factors and to
investigate the role of elevated levels of erlotinib and its metabolites in the development of pulmonary toxicity. 2011
Elsevier Ireland Ltd.
Background: To study the dimensions of fatigue in multiplesclerosis, its pathophysiology, the efficacy, tolerability and
safety of drug and non-drug treatments and measurement of fatigue. Methods: Relevant articles from PubMed and
Google scholar search engines from January 1987 until September 2006 were studied to compose a short clinical
update (not a systematic review) and make the required clinical information available for the clinicians. Results:
There is evidence that fatigue is very common in all types and stages of multiple sclerosis, but its pathophysiology is
not well explained. Consequently, few drug options have been offered for its treatment. Amantadine is the best-
known drug, though its efficacy and duration of action are limited. Pernoline and modafinil. are alternatives and have
some effects on fatigue. DAP (diaminopyridine), ASA (acetylsalicylic acid), methylphenidate and fluoxetine are other
possible options but await finther confirmation. Neurorehabilitation, regular exercise and cooling are confirmed to
be of value in MS treatment. Measurement of fatigue is a complicated issue. At present fatigue does not have a
laboratory marker. Conclusions: The results of this short clinical update provide guidelines for diagnosing MS-related
fatigue and differentiating it from other similar physical d sychological conditions. It also examines prescription drug
options and other therapies for MS patients with fatigue.
Background: The first robotic adrenalectomy in humans was reported in 2001 by Horgan and Vanuno. The robotic
approach is an interesting option for overcoming the limitations of laparoscopic adrenalectomy as it offers three
dimensional view and faster learning curve. However, evidence on the role of robotic adremalectomy is limited. This
study is a systematic review that aims to summarize data on the feasibility and safety of robot-assisted
adrenalectomy. Methods: Pubmed, Scopus, Google Scholar were searched with the appropriate search terms up to
and including December 2010. Clinical trials randomized or not, retrospective studies, case series, case reports,
cadaver and experimental studies were all included. Papers published only in abstract form or presented in
congresses were excluded. Extracted data included type of study, number of patients, indication of adrenalectomy,
surgical technique applied, operative time, final pathology, conversion rate, complications. Results: Thirty six trials
were identified and they were obtained in full text. Seven publications were previous double or multiple publications
of smaller series and therefore were excluded. Most of the trials were retrospective studies, case series and case
reports, that described the author's experience in robot assisted adrenalectomy. One randomized clinical trial (RCT)
was identified, that compared robot-assisted with laparoscopic adrenalectomy. Two experimental studies were also
included. According to available data, two hundred eighty two patients have been submitted to robot assisted
adrenalectomy. Operations performed included left sided robot-assisted transperitoneal adrenalectomy, right sided
robot-assisted transperitoneal adrenalectomy, bilateral robot-assisted adrenalectomy, robotic posterior
retroperitoneal adrenalectomy, robotic partial adrenalectomy. Indications included glucocorticoid secreting
adenoma, adrenal hyperplasia (one bilateral), incidentaloma, cortical adenomas, multilocular haemorrhagic cysts,
pheochromocytoma, aldosteronoma, myelolipoma, non functioning adenomas, ganglioneuroma, lymphangioma,
adrenocortical carcinoma, metastatic lesions (colorectal cancer, adrenal carcinoma). Robotic resection of
pheochromocytoma in the second trimester of pregnancy has also been reported. A limited number of complications
were reported. Intra-operative complications included intraoperative bleeding in three patients, due to injury to the
spleen in one patient with 6 cm left pheochromocytoma, from right renal vein injury in an obese patient with a 2 cm
right incidentalloma, and from the right adrenal vein in an obese patient with Cushing's adenoma, intraoperative
capsular tear and in two patients with large phaeochromocytomas (6 and 7.5 cm). Post-operative complications
included one death in a patient with pheochromocytoma due to fatal arrhythmia following myocardial infarct,
diarrhea due to Clostridium difficile, pneumonia, urinary tract infection, wound trauma. The rate of conversion from
robotic assisted to laparoscopic or open adrenalectomy ranges from 0 to 5%. However, in the RCT, that included ten
Background: Robotic thyroidectomy is a new approach to thyroid surgery, that offers the benefit of eliminating the
anterior neck incision utilized in traditional approaches. Additional advantages include three dimensional working
field, a magnified view, tremor filtering system, multiarticulated instruments. However, no level I evidence exists to
strongly support the robotic approach to thyroid surgery. This study is a systematic review that aims to summarize
data on the feasibility and safety of robotic thyroidectomy. Methods: Pubmed, Scopus, Google Scholar were
searched with the appropriate search terms up to and including December 2010. Clinical trials randomized or not,
retrospective studies, case series, case reports, cadaver and experimental studies were all included. Papers published
only in abstract form or presented in congresses were excluded. Extracted data included type of study, number of
patients, indication of thyroidectomy, surgical technique applied, operative time, number of lymph nodes extracted
in case of dissection, final pathology, conversion rate, complications. Results: Twenty eight papers were identified
including multiple publications of the same series. There were no randomized clinical trials. Most of the trials were
retrospective studies, case series and case reports, that described the author's experience in robotic thyroidectomy.
One small clinical trial compared robot assisted endoscopic with open thyroidectomy and one small retrospective
study compared conventional endoscopic with robotic thyroidectomy. Patient selection criteria varied among
different studies. Thus, robot assisted thyroidectomy was applied for predominant benign nodules <4 cm or <5 cm
and for malignant or potentially malignant nodules <2 or <4 cm at its largest diameter. The thyroid gland was
approached laterally using the gasless trans-axillary approach, unilateral axillarybreast approach, the bilateral axillary-
breast approach. Direct transoral approach to the thyroid gland was applied in two cadavers. Robot assisted
operations performed included total thyroidectomy, lobectomy, total thyroidectomy with modified lateral neck
dissection, total thyroidectomy with central node dissection, subtotal thyroidectomy with central node dissection.
Indications included well differentiated thyroid carcinoma with lateral node metastasis, multinodular goiter with
predominant nodule, indeterminate nodules. Operative time ranged from 67 to 279 min. Approximately 25% of the
time was spent docking and setting the robot machine. Complications included transient recurrent laryngeal nerve
palsy, transient hypocalcaemia, permanent ipsilateral recurrent laryngeal nerve palsy, permanent
hypoparathyroidism, transient hoarseness, Horner's syndrome, postoperative muscle flap hemorrhage, tracheal
injury, wound seroma, wound erythema, brachial plexus neuropraxia due to traction injury. A drawback of robotic
thyroidectomy observed in a number of studies was a remnant little thyroid tissue (>1-2 gr) at Berry's ligament or the
upper pole of the contralateral side due to an insufficient surgical angle. Concerning comparison with open or
INTRODUCTION: Heller myotomy for achalasia is associated with a recurrence rate of around 10%, thus reoperative
surgery is often necessitated. This paper aims to review the available literature on laparoscopic reoperation for
achalasia in order to assess its feasibility and effectiveness., MATERIAL & METHODS: A Medline, Embase, Ovid,
Cochrane database and Google(TM) Scholar search was performed with the following Mesh terms: "laparoscopic",
"redo", "reoperative", "Heller's", "esophagomyotomy" and "achalasia". Outcomes of interest included patient
demographics and details of primary procedure, operative details, intra- and post operative complications and
symptom scores., RESULTS: Seven studies reported outcomes from 54 cases. Conversion occurred in 7% (4/54) of
cases. Thirteen percent (7/54) of patients sustained intra-operative gastric or oesophageal perforation; however
these were all noted and repaired intra-operatively leading to no subsequent morbidity. No deaths were reported.
Pre- and post operative symptom scores were heterogeneous, however did appear to improve after the procedure.,
DISCUSSION: This review demonstrates that laparoscopic reoperation for achalasia is feasible and safe with
complication rates comparable to the primary laparoscopic operation. It is recommended that laparoscopic
reoperative Heller's myotomy should only be performed by surgeons with special interest in oesophagogastric
surgery and adequate experience in laparoscopic surgery for achalasia.
Background: The present study deals with different aspects of PTLD in a very large number of liver transplant
recipients, whose data recruited from 30 previous reports, with regard to their presentation time. Material/Methods:
We conducted a comprehensive search for the available data by Pubmed and Google scholar search engines for
reports indicating presentation time in PTLD patients. Data from 30 previously published studies were included into
analysis. Finally, 231 recipients of liver allograft were included into analysis. Results: Recipients with early onset PTLD
were significantly more likely to represent EBV positive test results (p=0.0003). Recipients with late onset PTLD
represented a significantly higher risk of disseminated disease (p=0.049). Late onset PTLD more frequently
represented monomorphic lesions (p=0.005). Hodgkin and Hodgkin like diseases also had a trend to occur in the late
period after transplantation (p=0.076), although it did not reach significance level. Liver allograft involvement was
more often observed in the early onset PTLD (p<0.0001), while colon involvement in the late onset disease (p=0.04).
One and five years survival rates for early onset PTLD patients were 64% and 54%, respectively; compared to 73%
and 50%, respectively, for the control group (p>0.1). Conclusions: Due to a higher incidence of liver involvement in
the early onset PTLD patients and colon involvement in late onset PTLD, authors suggest that liver graft recipients
should receive enough evaluations for a potential multi organ disease based on their presentation time. Further
multi-institutional prospective studies are needed to confirm our results. Ann Transplant.
OBJECTIVE: The Female Sexual Function Index (FSFI) is a 19-item self-report inventory designed to assess female
sexual function. It comprises six domains: desire [two items], arousal [four items], lubrication [four items], orgasm,
satisfaction, pain [three items each]. The purpose of this review was to identify the number and focus of published
articles that use the FSFI to assess therapeutically-induced change in sexual functioning in order to determine its
level of acceptance by the scientific community. DESIGN: Systematic and comprehensive literature review.
MATERIALS AND METHODS: The key terms "Female Sexual Function Index" and "FSFI" were used with eight
databases (Ovid Current Contents, Ovid Medline, Ovid EMBASE, PubMed, Scopus, PsychInfo, Google Scholar and
CMDI) to identify English language articles published between Apr-Jun 2000 (date of initial FSFI publication) to July
2008. Articles (and reference lists) were hand searched for relevancy. RESULTS: A total of 211 original publications
were identified, of which 79 assessed the effects of interventions on female sexual function. The FSFI has been used
to assess the effects of several interventions in women with Female Sexual Dysfunction including pharmacological
(n=11), psychological (n=4), physical (n=2) and dietary (n=1) therapy. The tool has also been used to assess the
effects of other interventions on sexual function in other populations of women including: gynaecological and non-
gynaecological surgery (n=37); pharmacological (n=10), psychological (n=4) or physical (n=6) therapy; and treatment
of erectile dysfunction or prostate cancer biopsy in their partner (n=4). CONCLUSIONS: Validation of a scientific
measure is a continuous process that accumulates evidence from numerous studies. The results of this review show
that the FSFI is sensitive to therapeutically-induced change and has become the de facto "gold standard" in the
assessment of female sexual function.
Femoral neuropathy following primary or revision total hip arthroplasty (THA) is a rare but acknowledged
complication. Treatment of femoral neuropathy has long been debated and there is a paucity of accepted principles
on which to base management. Currently, no definitive management protocol exists in the literature. A literature
search was performed by a review of PubMed, Google Scholar and OVID articles published from 1972-2011. The
literature reports an incidence rate of femoral neuropathy following THA ranging from 0.1 to 2.4 percent.
Determining the precise aetiology, establishing a diagnosis and subsequent treatment of femoral nerve injury
remains a difficult task, with conservative management remaining the treatment benchmark. In this review, we aim
to summarise the aetiologies and risk factors associated with femoral neuropathy following THA and provide
management guidelines. 2012, Acta Orthopaedica Belgica.
Purpose: This review explores the scientific evidence for clinical, functional and imaging outcomes after surgical
management of Femoroacetabular Impingement (FAI) syndrome, and assesses the methodological quality of the
published literature reporting this issue. Methods: The medical literature databases of Pubmed, Medline, Ovid,
Google Scholar and Embase were searched for articles published in English, Spanish, French and Italian, using a
combination of the keywords 'femoro-acetabular impingement syndrome', 'postoperative outcomes', 'open surgery',
and 'arthroscopic management'. To address three main questions, we extracted data on demographic features,
operative techniques, postoperative rehabilitation regimens, imaging features, pre and postoperative hip scores.
Complications and conversion to arthroplasty were also investigated. Results: Thirty-one studies published have
reported clinical, functional and imaging outcomes after open and arthroscopic management of FAI syndrome. The
modified Coleman methodology score (CMS) averaged 56.2 (range, 30-81). From extracted data, it was shown that
arthroscopy, open surgery and arthroscopic surgery followed by mini open surgery are comparable for functional
results, biomechanics, and return to sport. Progression of OA and conversion to hip arthroplasty are dependent on
preoperative status of cartilage and osteoarthritis and type of management. Debridement and osteoplasty provide
better results than debridement only. Significantly improved outcomes have been recorded in patients undergoing
labral refixation than resection. The Coleman methodology score showed great heterogeneity in terms of study
design and outcome assessment, and generally low methodological quality. Conclusion: Although open and
minimally invasive procedures allow athletes to return to professional sports activity, they are contraindicated in
patients with severe osteoarthritis and cartilage degeneration. Springer-Verlag 2011.
Objective: Because at present no pharmacologic prevention or treatment of acute kidney injury seems to be
available, the authors updated a meta-analysis to investigate the effects of fenoldopam in reducing acute kidney
injury in patients undergoing cardiac surgery, focusing on randomized placebo-controlled studies only. Design: A
meta-analysis of randomized, placebo-controlled trials. Setting: Hospitals. Participants: A total of 440 patients from 6
studies were included in the analysis. Interventions: None. The ability of fenoldopam to reduce acute kidney injury in
the perioperative period when compared with placebo was investigated. Measurements and Main Results: Google
Scholar and PubMed were searched (updated January 1, 2012). Authors and external experts were contacted. Pooled
estimates showed that fenoldopam consistently and significantly reduced the risk of acute kidney injury (odds ratio
[OR] = 0.41; 95% confidence interval [CI], 0.23-0.74; p = 0.003), with a higher rate of hypotensive episodes and/or
use of vasopressors (30/109 [27.5%] v 21/112 [18.8%]; OR = 2.09; 95% CI, 0.98-4.47; p = 0.06) and no effect on renal
replacement therapy, survival, and length of intensive care unit or hospital stay. Conclusions: This analysis suggests
that fenoldopam reduces acute kidney injury in patients undergoing cardiac surgery. Because the number of the
enrolled patients was small and there was no effect on renal replacement therapy or survival, a large, multicenter,
and appropriately powered trial is needed to confirm these promising results. 2012 Elsevier Inc. All rights reserved.
Objective: Acute renal failure is a common and threatening complication in patients undergoing cardiovascular
surgery. To determine the efficacy of fenoldopam in the prevention of acute renal failure, the authors performed a
systematic review of randomized, controlled trials and propensity-matched studies in patients undergoing
cardiovascular surgery. Design: Meta-analysis. Setting: Hospitals. Participants: A total of 1,059 patients from 13
randomized and case-matched studies were included in the analysis. Interventions: None. Measurements and Main
Results: Google Scholar, PubMed, and scientific sessions were searched (updated November 2006). Authors and
external experts were contacted. Four unblinded reviewers selected controlled trials that used fenoldopam in the
prevention or treatment of acute renal failure in cardiovascular surgery. Four reviewers independently abstracted
patient data, treatment characteristics, and outcomes. Pooled estimates showed that fenoldopam consistently and
significantly reduced the need for renal replacement therapy (odds ratio = 0.37 [0.23-0.59], p < 0.001) and in-hospital
death (odds ratio = 0.46 [0.29-0.75], p = 0.01). These benefits were associated with shorter intensive care unit stay
(weighted mean difference [WMD] = -0.93 days [-1.27; -0.58], p = 0.002). Sensitivity analyses, tests for small study
bias, and heterogeneity assessment further confirmed the main analysis. Conclusions: This meta-analysis provides
evidence that fenoldopam may confer significant benefits in preventing renal replacement therapy and reducing
mortality in patients undergoing cardiovascular surgery. 2008 Elsevier Inc. All rights reserved.
Background: Overactive bladder (OAB) is a chronic condition affecting both men and women, with prevalence
increasing with age. Antimuscarinics form the cornerstone of treatment of OAB. Fesoterodine, a nonselective
muscarinic-receptor antagonist, was approved by the US Food and Drug Administration in late 2008 for once daily,
oral administration in the treatment of OAB to relieve the symptoms of urinary urge incontinence, urgency, and
frequency.Objective: The aim of this review was to provide an overview of the mechanism of action of and clinical
trial data for fesoterodine, and to discuss the present status of fesoterodine in the management of OAB.Methods:
The MEDLINE and Google Scholar databases were searched (June 1, 1999-December 1, 2009) using the terms
fesoterodine, overactive bladder, and muscarinic antagonists. Full-text articles in English were selected for reference,
and articles presenting the mechanism of action, pharmacokinetics, and data from clinical trials were included. The
parameters measured were tolerability, efficacy, and health-related quality of life (HRQoL). Trials involving animals
and Phase I studies were excluded.Results: The initial literature search yielded 48 papers. A total of 20 articles
fulfilled the inclusion criteria. In two 12-week, randomized, multicenter, Phase III clinical trials involving patients with
increased micturition frequency and urgency and/or urinary urge incontinence (n = 836 and 1132 in each trial), both
fesoterodine 4 and 8 mg were associated with significantly improved symptoms of OAB (frequency of micturition,
urgency, and urge incontinence) compared with placebo (P < 0.05). In a post hoc analysis of pooled data of the Phase
III trials, HRQoL improved significantly with both doses. In a 12-week, Phase Illb trial, fesoterodine 4 and 8 mg led to
treatment satisfaction in ~80% of patients (of 516 enrolled) who were initially unsatisfied with their previous
treatment.Conclusion: A review of the literature suggests that fesoterodine is an efficacious and well-tolerated
treatment option for patients with OAB. 2010 Elsevier HS Journals, Inc.
The purpose of this article is to review the evidence linking depression with inflammation, to examine the bi-
directional relationship between the neuro-humeral circuitry of depression and the inflammatory response, and
point out new treatment implications of these ideas. The evidence available is in areas of genetic links, association of
depression with raised inflammatory markers such as Tumour Necrosis Factor (TNF)-alpha, Interleukin (IL)-1, IL-6, co-
morbidity of depression with inflammatory medical illnesses, administration of cytokines leading to depression, and
the recognition that anti-depressants have antiinflammatory and neuro-protective properties. Inflammatory
response and mood regulation constitute a system of bi-directional communication such that inflammatory cytokines
can penetrate the CNS and influence behavior. Activation of the CNS cytokine network leads to a cascade of effects
such as disturbed metabolism of amino acids, neurotoxicity, diminished neurotrophic support, decreased
neurogenesis, impaired negative feedback regulation of HPA axis function and glucocorticoid resistance. Treatment
implications include strategies to screen for patients with increased inflammatory activity, possible treatment with
anti-inflammatory agents, and the recognition of new target areas for antidepressant medications. Methods: A
literature search for articles published during the last ten years was conducted using various combinations of key
words ('depression', 'inflammation', 'cytokines', 'immune system', 'interleukins') utilizing the databases Google
Scholar and PubMed. An outline of the most relevant aspects of the role of inflammatory processes in depression
was created. Major papers, including other review articles, were identified in accordance with our outline. These
articles were subsequently hand searched and reviewed individually for further references of significance.
Conclusion: The inflammatory response leading to formation of inflammatory cytokines plays a significant role in the
pathophysiology of depression, and this has important implications with regards to new and personalized treatment
of depression.
Purpose: Prof. Otto Wichterle was one of the most important pioneers of modern soft contact lens industry; his work
has made a significant impact on the ophthalmic world. Fifty years ago, in 1961, Wichterle produced the first soft
contact lenses. Due to his work, nowadays millions of people around the world enjoy comfortable vision correction
with soft contact lenses. This poster honours Wichterle' s scientific achievements. Methods: Our poster is based on
an intensive literature research of current and historic literature via PubMed, Google Scholar and Google in order to
document the life and to evaluate the scientific impact of Wichterle's work. Results: Our poster gives an overview of
life and the impact on ophthalmology by the Czechoslovakian chemist Prof. Otto Wichterle born in 1913. The most
important steps in the development of soft contact lenses will be shown and the impact on the visual correction of
millions of people with refractive errors will be discussed. Today contact lenses gain more and more importance
again when the visual function needs to be improved while suffering from complications after refractive surgery.
Conclusions: Prof. Otto Wichterle was an outstanding man of honour and a remarkable scientist. His vision of life
without glasses became reality by his tenacity and exceptional commitment to science, even under adverse
conditions for which he was not responsible. Due to his achievement of creating soft, hydrophilic contact lenses,
millions of people suffering from refractive errors have been able to achieve natural vision again. From Prague
around the world - in only 50 years Otto Wichterle's invention conquered the globe!.
Benign prostatic hyperplasia (BPH), a non-malignant enlargement of the prostate in aging men, can cause
bothersome urinary symptoms (intermittency, weak stream, straining, urgency, frequency, incomplete emptying).
Finasteride, a five-alpha reductase inhibitor (5ARI), blocks the conversion of testosterone to dihydrotestosterone,
reduces prostate size, and is commonly used to treat symptoms associated with BPH. To compare the clinical
effectiveness and harms of finasteride versus placebo and active controls in the treatment of lower urinary tract
symptoms (LUTS). We searched The Cochrane Library (which includes CDSR (Cochrane Database of Systematic
Reviews), DARE (Database of Abstracts of Reviews of Effects), HTA (Heath Technology Assessments), and CENTRAL
(Cochrane Central Register of Controlled Trials, and which includes EMBASE and MEDLINE), LILACS (Latin American
and Caribbean Center on Health Sciences Information) and Google Scholar for randomized, controlled trials (RCTs).
We also handsearched systematic reviews, references, and clinical-practice guidelines. Randomized trials in the
English language with placebo and/or active arms with a duration of at least 6 months. JT extracted the data, which
included patient characteristics, outcomes, and harms. Our primary outcome was change in a validated, urinary
symptom-scale score, such as the AUA/IPSS. A clinically meaningful change was defined as 4 points. We also
categorized outcomes by trial lengths of <= 1 year (short term) and > 1 year (long term). Finasteride consistently
improved urinary symptom scores more than placebo in trials of > 1 year duration, and significantly lowered the risk
of BPH progression (acute urinary retention, risk of surgical intervention, >= 4 point increase in the AUASI/IPSS). In
comparison to alpha-blocker monotherapy, finasteride was less effective than either doxazosin or terazosin, but
equally effective compared to tamsulosin. Both doxazosin and terazosin were significantly more likely than
finasteride to improve peak urine flow and nocturia, versus finasteride. Versus tamsulosin, peak urine flow and QoL
improved equally well versus finasteride. However, finasteride was associated with a lower risk of surgical
intervention compared to doxazosin, but not to terazosin, while finasteride and doxazosin were no different for risk
of acute urinary retention. Two small trials reported no difference in urinary symptom scores between finasteride
and tamsulosin. Finasteride + doxazosin and doxazosin monotherapy improved urinary symptoms equally well (>= 4
point improvement).For finasteride, there was an increased risk of ejaculation disorder, impotence, and lowered
libido, versus placebo. Versus doxazosin, finasteride had a lower risk of asthenia, dizziness, and postural hypotension,
and versus terazosin, finasteride had a significant, lower risk of asthenia, dizziness, and postural hypotension.
Finasteride improves long-term urinary symptoms versus placebo, but is less effective than doxazosin. Long-term
combination therapy with alpha blockers (doxazosin, terazosin) improves symptoms significantly better than
Aims: To provide an overview over empirical evidence regarding stepped care approaches that include
psychotherapies. To present own preliminary study results in alcohol dependent patients. Methods: Publications
were searched in the databases Medline, PsycINFO and the internet search engine Google Scholar. Inclusion criteria
were psychosocial treatment and psychiatric disorders. Our own study consists of two steps. In step 1 patients
receive anti-craving medication or placebo and Medical Management (MM). After a relapse to heavy drinking
patients can step up and after randomization they either continue with the same treatment or they receive
additional alcoholism specific psychotherapy (ASP). Results: Evidence suggests that stepped care might be efficacious
in patients with obsessive-compulsive behavior and depression. There is no evidence for efficacy in problem drinkers.
Results of our own study show that the completer rate in MM alone is higher than in ASP with MM, but there are no
significant differences concerning age, sex and disease severity between completer and non-completer in both study
arms. Conclusions: Further research with regard to stepped care in alcohol dependent patients is needed. An
introduction of the psychotherapy at earlier stages might be sensible. Copyright 2008 John Wiley & Sons, Ltd.
AIMS: To provide an overview over empirical evidence regarding stepped care approaches that include
psychotherapies. To present own preliminary study results in alcohol dependent patients. METHODS: Publications
were searched in the databases Medline, PsycINFO and the internet search engine Google Scholar. Inclusion criteria
were psychosocial treatment and psychiatric disorders. Our own study consists of two steps. In step 1 patients
receive anti-craving medication or placebo and Medical Management (MM). After a relapse to heavy drinking
patients can step up and after randomization they either continue with the same treatment or they receive
additional alcoholism specific psychotherapy (ASP). RESULTS: Evidence suggests that stepped care might be
efficacious in patients with obsessive-compulsive behavior and depression. There is no evidence for efficacy in
problem drinkers. Results of our own study show that the completer rate in MM alone is higher than in ASP with
MM, but there are no significant differences concerning age, sex and disease severity between completer and non-
completer in both study arms. CONCLUSIONS: Further research with regard to stepped care in alcohol dependent
patients is needed. An introduction of the psychotherapy at earlier stages might be sensible. 2008 John Wiley &
Sons, Ltd
Background The Vector Control Working Group of Asia Pacific Malaria Elimination Network posed the question Do
we know enough about the use of larviciding as a vector control method in elimination environments to provide
evidence to APMEN Country Partners?. This paper summarises our approach to addressing these question and the
findings from that literature review. Materials and methods From October 2011 - March 2012, a web based search
using the key words: vector control, elimination, malaria, guidelines, standard operating procedures, larviciding,
vector management, biological control, was conducted using Google Scholar, PubMed and Scopus. In addition, grey
literature was sought through the World Health Organization (WHO) library. A database of literature collected by a
research group undertaking a Cochrane Systematic review of vector control was shared with the group. Articles were
sought in any language, with abstracts of materials in languages other than English translated by colleagues and
members of the vector working group fluent in the required languages, to see if it fulfilled the criteria for inclusion.
The date range used for the search was from 1955 - 2012, in order to allow earlier references and manuals regarding
larviciding and the use of vector control in the eradication period to be included in the review. In total, 347 articles,
books and manuals (12) were reviewed of which 117 met the inclusion criteria. Results There is a large body of
literature on a range of larvicides and their suitability for a range of environmental and vectoral contexts that occur
in the Asia Pacific region. Very few have been explicitly tested or referred to as suitable in elimination settings nor in
many of the Asia Pacific regional countries. Some of these articles, books and guidelines provide useful operational
data on the use of larvicides, their safe handling and storage, and other operational details. Only a few discussed
monitoring and evaluation aspects of the use of larvicides in programmes. None of the literature reviewed discussed
detailed costs, compared cost eff ectiveness or made cost comparisons between diff erent larvicides and/or between
diff erent vector control methods Conclusions The recent Interim position paper on larviciding in Subsaharan Africa
noted that "in general larviciding should be considered for malaria control (with or without other interventions) only
in areas where the breeding sites are few, fixed and findable" (1. pg 3). Although in SSA many of the larval breeding
sites were noted not fulfil these three basic criteria for success, in the APMEN region there are some vectoral species
that do have these characteristics and are promising vector targets for larval source management. Challenges
identified are the lack of published literature operational aspects of larval control/environmental management;
although larvicides may not have been considered cost eff ective in control environments, when moving towards
elimination, these remaining larval sources of primary and sometimes the secondary incriminated vectors becomes
the "last push". Without firm evidence it will be hard to convince policy makers and funders to invest in larval source
Background Imported malaria is no longer a challenge only for malaria free countries, but for countries implementing
in malaria elimination strategies and seeking to address cross-border transmission. Mobility is frequently mentioned
as a risk factor and a barrier to elimination by malaria researchers and policy makers. However, only a small body of
research has engaged in a detailed analysis of the links between mobility and malaria transmission, and attempts to
incorporate these findings into policy are rarer still. This paper presents the findings of a literature review on malaria
and human mobility supported by the Asia Pacific Malaria Elimination Network (APMEN). It attempts to shift the
agenda from identifying human mobility as a risk factor, to finding strategies to work collaboratively with mobile
populations towards the goal of malaria elimination. Materials and methods The objectives of the literature review
were to highlight key trends in the ways in which the published malaria literature discusses human mobility identify
lessons to be learned from the ways that other infectious disease control programmes such as HIV/ AIDS and polio
have addressed human mobility identify potential ways forward, so that it becomes possible to address human
mobility within malaria elimination initiatives. The review focused upon published, peer-reviewed literature on
malaria and mobility sourced through PubMed and ProQuest, and grey literature sourced though Google Scholar.
Results The paper will present a brief taxonomy of mobility, since there are many diff erent form of behaviour that
are often grouped together as 'mobility'. It then discusses the three key themes that most frequently recur within
the published malaria literature, namely: mobility, land use and economic change; borders; and accessing mobile
populations. The paper then discusses the ways in which other infectious disease control programmes such as
HIV/AIDS and polio have addressed human mobility, and to identify the key lessons to be learned from these
programmes Conclusions Recommendations, methodologies, and areas that APMEN partners and other
organisations may consider for future work, in order to move towards a more productive engagement with mobile
populations.
Background: Several techniques have been described for the management of fistula-in-ano, but all carry their own
risks of recurrence and incontinence. Technology has evolved over the past 2 decades that may enable surgeons to
deal with this troublesome issue with greater success. This review summarizes the history of fistula-in-ano
management, the current techniques available, and describes new technologies. Methods: Medline searches were
performed using the PubMed, Ovid, Embase, Cochrane, and Google Scholar databases to identify articles reporting
on fistula-in-ano management using surgery alone, fibrin glues, and fistula plugs. Forty-one articles reporting on the
history of fistula-in-ano management and the use of new technologies were included. Results: Conventional fistula
surgery techniques have their place, but new technologies such as fibrin glues and the anal fistula plugs offer an
alternative approach, with initial studies reporting good success rates. Conclusions: New technologies provide
promising alternatives to traditional methods of management. There is, however, a real need for high-quality
randomized control trials. 2008 Elsevier Inc. All rights reserved.
Iran as a developing nation is in epidemiological transition from communicable to noncommunicable diseases.
Although, cancer is the third cause of death in Iran, it's mortality are on the rise during recent decades. This mini-
review was carried out to provide a general viewpoint on common cancers incidence in Iran and to explain incidental
differences that may help us to establish early detection programs and investigate population risk factors. A detailed
Pub Med, Scopus and Google scholar search were made from 2000 to 2009. The basic inclusion criteria were all
relevant studies focused on cancer epidemiological data from Iran. Overall age-standard incidence rate per 100,000
population according to primary site is 110.43 in males and 98.23 in females. The five most common cancers (except
skin cancer) are stomach, esophagus, colon-rectum, bladder and leukemia in males, and in females are breast,
esophagus, stomach, colon-rectum and cervix uteri. The incidence rates of gastrointestinal cancers are high in Iran (it
is one of the known areas with a high incidence of GI cancers). Breast cancer mainly affects Iranian women about a
decade earlier than Western countries and younger cases are affected by an increasing rate of colorectal cancer in
Iran, near the Western rates.
Objectives: The Mental Health Act 2001 (MHA 2001) was implemented in November 2006. Since that time, there has
been considerable research into its impact, including the impact on service provision, use of coercive practices and
the perceptions by key stakeholders. Our objective is to present a summary of research into the MHA 2001 since its
implementation in the Irish state in the context of international standards and practice. Methods: We reviewed the
literature presented on Medline and Google Scholar, directly assessed relevant journals and sought abstract
information from the College of Psychiatry of Ireland. Results: There has been a small decrease in the rate of
involuntary admission since implementation but there has been no change in the representativeness of diagnoses of
individuals admitted involuntarily. Mental Health Tribunals were held for 57% of those admitted involuntarily and
46% of service users found that the Mental Health Tribunal made the involuntary admission easier to accept. One
year after discharge, 60% of service users reflected that their involuntary admission had been necessary. Professional
groups have expressed concerns regarding workload, training time for junior doctors and paperwork. Conclusions:
The MHA 2001 has brought the practice of involuntary admission further into line with international standards.
However, five years after the implementation of the Act international guidelines and practice have highlighted areas
in need of further reform, including capacity legislation and consideration of advance directives and community
treatment orders. Further research is also lacking on caregivers' or family members' perceptions of the MHA 2001.
2012 Elsevier Ltd.
OBJECTIVE: To compare the safety and efficacy at long-term follow-up of coronary artery bypass grafting (CABG) with
percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in patients with unprotected left main
coronary artery (ULMCA) disease., METHODS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar
and reference lists of relevant articles were searched for clinical studies that reported outcomes at 5-year follow-up
after PCI with DES and CABG for the treatment of ULMCA stenosis. Five studies (1 randomized controlled trial and 4
observational studies) were identified and included a total of 2914 patients (1300 for CABG and 1614 for PCI with
DES)., RESULTS: At 5-year follow-up, there was no significant difference between the CABG and PCI-DES groups in
the risk for death (odds ratio [OR] 1.159, P=0.168 for random effect) or the composite endpoint of death, myocardial
infarction, or stroke (OR 1.214, P=0.083). The risk for target vessel revascularization (TVR) was significantly lower in
the CABG group compared to the PCI-DES group (OR 0.212, P<0.001). The risk of major adverse cardiac and
cerebrovascular events (MACCE) was significantly lower in the CABG group compared to the PCI-DES group (OR
0.526, P<0.001). It was observed no publication bias about outcomes and considerably heterogeneity effect about
MACCE., CONCLUSION: CABG surgery remains the best option of treatment for patients with ULMCA disease, with
less need of TVR and MACCE rates at long-term follow-up.
Background: Fluid resuscitation is not only used to prevent acute kidney injury (AKI) but fluid management is also a
cornerstone of treatment forpatients with established AKI and renal failure. Ultraffitration removes volume initially
from the intravascular compartment inducing a relative degree of hypovolemia. Normal reflex mechanisms attempt
to sustain blood pressure constant despite marked changes in blood volume and cardiac output. Thus, compensated
shock with a normal blood pressure is a major cause of AKI or exacerbations of AKI during ultrafiltration. Methods:
We undertook a systematic review of the literature using MEDLINE, Google Scholar and PubMed searches. We
determined a list of key questions and convened a 2-day consensus conference to develop summary statements via a
series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and
generated clinical practice recommendations and/or directions for future research. Results: We defined three
aspects of fluid monitoring: i) normal and pathophysiological cardiovascular mechanisms, ii) measures of volume
responsiveness and impending cardiovascular collapse during volume removal, and, iii) measured indices of each
using non-invasive and minimally invasive continuous and intermittent monitoring techniques. The evidence
documents that AKI can occur in the setting of normotensive hypovolemia and that under-resuscitation represents a
major cause of both AKI and mortality ion critically ill patients. Traditional measures of intravascular volume and
ventricular filling do not predict volume responsiveness whereas dynamic functional hemodynamic markers, such as
pulse pressure or stroke volume variation during positive pressure breathing or mean flow changes with passive leg
raising are highly predictive of volume responsiveness. Numerous commercially-available devices exist that can
acquire these signals. Conclusions: Prospective clinical trials using functional hemodynamic markers in the diagnosis
and management of AKI and volume status during ultrafiltration need to be performed. More traditional measure of
preload be abandoned as marked of volume responsiveness though still useful to assess overall volume status.
Wichtig Editore, 2008.
Context: The diagnosis of the cause and the establishment of the manner of death in submersion cases are routine
challenge for forensic pathologists as it presents considerable diagnostic difficulties. Objective: To concisely review
the main questions during a submersion death investigation and to give the respective documented answers. Data
sources: The search strategy included a literature search of PubMed, Medline and Google Scholar databases, as well
as a review of the cited references by the identified studies and a hand search of relevant textbooks and reference
works. Conclusions: A complete autopsy, histopathological examination and full toxicological screening are important
to determine whether death indeed followed submersion in the water, or to see whether any natural disease or
substance use have contributed or caused death. In ambiguous situations, the co-estimation of circumstantial
evidence may be of invaluable importance toward the conclusion concerning the cause and the manner of death.
The thorough forensic investigation of the submersion deaths not only serves the justice administration, but it also
presents considerable benefits for the public health. 2009 Blackwell Publishing Ltd.
Objective: South Africa has a shortage of facilities and psychiatrists to assess adjudicative competence of prisoners
awaiting assessment under sections 77 to 79 of the Criminal Procedures Act of 1977. Various solutions have been
proposed by the Department of Health. The recent linking of a Magistrate's court and a prison by videoconferencing
offers the opportunity to implement a forensic telepsychiatry service. The literature on forensic telepsychiatry for
assessment of adjudicative competence was reviewed. Method: The electronic databases, PubMed, Scopus, Cinahl
and Google Scholar were searched for papers on forensic telepsychiatry. The inclusion criterion was papers reporting
the use of videoconferencing for assessment of adjudicative competence or for assessment for referral out of the
judicial system, by psychiatrists or psychologists. Results: 411 papers were found of which 13, published between
1997 and 2008 were relevant. The use of videoconferencing for forensic psychiatric assessment was reported from
four countries. The courts in those jurisdictions have accepted the use of videoconferencing for assessment and no
successful appeals have been mounted on the basis of the use of videoconferencing for assessment. User
satisfaction has not been reported for assessing adjudicative competence. Forensic telepsychiatry has been found to
be cost effective, improve access to scarce specialist skills and reduce transport of prisoners under guard to hospitals
or psychiatrists to prisons. Conclusion: There is nothing in the literature to suggest that a forensic telepsychiatry
service is not feasible in South Africa and a pilot project is being planned.
In this paper, we take a bibliometric tour of the last forty years of health economics using bibliographic " metadata"
from EconLit supplemented by citation data from Google Scholar and our own topical classifications. We report the
growth of health economics (we find 33,000 publications since 1969-12,000 more than in the economics of
education) and list the 300 most-cited publications broken down by topic. We report the changing topical and
geographic focus of health economics (the topics 'Determinants of health and ill-health' and 'Health statistics and
econometrics' both show an upward trend, and the field has expanded appreciably into the developing world). We
also compare authors, countries, institutions and journals in terms of the volume of publications and their influence
as measured through various citation-based indices (Grossman, the US, Harvard and the JHE emerge close to or at
the top on a variety of measures). 2012 World Bank.
Objectives: To systematically review applications of fractal geometry in different aspects of dental practice. In this
review, we present a short introduction to fractals and specifically address the following topics: treatment and
healing monitoring, dental materials, dental tissue, caries, osteoporosis, periodontitis, cancer, Sjogren's syndrome,
diagnosis of several other conditions and a discussion on the reliability of FD determinations from dental
radiographs. Sources: Google Scholar, Ovid MEDLINE, ScienceDirect, etc. (up to August 2010). Study selection: The
review considered original studies, reviews and conference proceedings, published in English or Spanish. Abstracts
and posters were not taken into account. Conclusions: Fractal geometry has found plenty of applications in several
branches of dental practice. It provides a way to quantify the complexity of structures. Whereas one desires to study
a radiograph, an histological section or the signal from a transducer, there are several methods available to
determine the degree of complexity using fractal analysis. Several pathological conditions can alter the complexity of
anatomical structures, and this change can be detectable with the help of fractal parameters. Although during the
last two decades there have been plenty of works on the field, reported cases having enough reproducibility, with
different groups showing similar results are not very common. Further replications are needed before we can
establish statistically significant correlations amongst fractal parameters and pathological conditions. 2011 Elsevier
Fracture repair has not been fully optimised and there is opportunity to increase the healing rate and reduce the
number of complications using pharmacological means. While most anti-osteoporosis drugs have been widely tested
for their ability to decrease the risk of osteoporotic fractures, fragility fractures still occur in patients under medical
intervention. The primary purpose of this systematic review is to understand these underlying mechanisms between
bone and drug therapies in osteoporosis and the overall promotion of fracture healing and callus formation.
Databases such as MEDLINE, Google Scholar, EMBASE and CINAHL were searched and nine articles met all inclusion
criteria. We report that there is still large controversy and a need for clinical trials to address the deficiencies found
in animal models. There is no clear evidence yet as to whether complications during the course of healing are
attributable to implant anchorage problems in osteoporotic bone or to possibly delayed healing in the aged.
Ceramic bearing surfaces are increasingly used for total hip replacement, notwithstanding that concern is still related
to ceramic brittleness and its possible mechanical failure. The aim of this systematic review is to answer three
questions: (1) Are there risk factors for ceramic component fracture following total hip replacement? (2) Is it possible
to perform an early diagnosis of ceramic component failure before catastrophic fracture occurs? (3) Is it possible to
draw guidelines for revision surgery after ceramic components failure? A PubMed and Google Scholar search was
performed and reference citations from publications identified in the literature search were reviewed. The use of 28
mm short-neck femoral head carries an increased risk of fracture. Acetabular component malposition might increase
the risk of ceramic liner fractures. Synovial fluid microanalysis and CT scan are promising in early diagnosis of ceramic
head and liner failure. Early revision is suggested in case of component failure; no consensus exists about the better
coupling for revision surgery. Ceramic brittleness remains a major concern. Due to the increased number of ceramic
on ceramic implants, more revision surgeries and reports on ceramic components failure are expected in the future.
An algorithm of diagnosis and treatment for ceramic hip failure is proposed. 2013 Francesco Traina et al.
UNLABELLED: Both 'disasters' and 'global health in crisis' research has dramatically grown due to the ever-increasing
frequency and magnitude of crises around the world. Large volumes of peer-reviewed literature are not only a
testament to the field's value and evolution, but also present an unprecedented outpouring of seemingly
unmanageable information across a wide array of crises and disciplines. Disaster medicine, health and humanitarian
assistance, global health and public health disaster literature all lie within the disaster and global health in crisis
literature spectrum and are increasingly accepted as multidisciplinary and transdisciplinary disciplines. Researchers,
policy makers, and practitioners now face a new challenge; that of accessing this expansive literature for decision-
making and exploring new areas of research. Individuals are also reaching beyond the peer-reviewed environment to
grey literature using search engines like Google Scholar to access policy documents, consensus reports and
conference proceedings. What is needed is a method and mechanism with which to search and retrieve relevant
articles from this expansive body of literature. This manuscript presents both a framework and workable process for
a diverse group of users to navigate the growing peer-reviewed and grey disaster and global health in crises
literature., METHODS: Disaster terms from textbooks, peer-reviewed and grey literature were used to design a
framework of thematic clusters and subject matter 'nodes'. A set of 84 terms, selected from 143 curated terms was
organized within each node reflecting topics within the disaster and global health in crisis literature. Terms were
crossed with one another and the term 'disaster'. The results were formatted into tables and matrices. This process
created a roadmap of search terms that could be applied to the PubMed database. Each search in the matrix or table
results in a listed number of articles. This process was applied to literature from PubMed from 2005-2011. A
complementary process was also applied to Google Scholar using the same framework of clusters, nodes, and terms
expanding the search process to include the broader grey literature assets., RESULTS: A framework of four thematic
clusters and twelve subject matter nodes were designed to capture diverse disaster and global health in crisis-related
content. From 2005-2011 there were 18,660 articles referring to the term [disaster]. Restricting the search to human
research, MeSH, and English language there remained 7,736 identified articles representing an unmanageable
number to adequately process for research, policy or best practices. However, using the crossed search and matrix
process revealed further examples of robust realms of research in disasters, emergency medicine, EMS, public health
and global health. Examples of potential gaps in current peer-reviewed disaster and global health in crisis literature
were identified as mental health, elderly care, and alternate sites of care. The same framework and process was then
applied to Google Scholar, specifically for topics that resulted in few PubMed search returns. When applying the
Both 'disasters' and 'global health in crisis' research has dramatically grown due to the ever-increasing frequency and
magnitude of crises around the world. Large volumes of peer-reviewed literature are not only a testament to the
field's value and evolution, but also present an unprecedented outpouring of seemingly unmanageable information
across a wide array of crises and disciplines. Disaster medicine, health and humanitarian assistance, global health and
public health disaster literature all lie within the disaster and global health in crisis literature spectrum and are
increasingly accepted as multidisciplinary and transdisciplinary disciplines. Researchers, policy makers, and
practitioners now face a new challenge; that of accessing this expansive literature for decision-making and exploring
new areas of research. Individuals are also reaching beyond the peer-reviewed environment to grey literature using
search engines like Google Scholar to access policy documents, consensus reports and conference proceedings.
What is needed is a method and mechanism with which to search and retrieve relevant articles from this expansive
body of literature. This manuscript presents both a framework and workable process for a diverse group of users to
navigate the growing peer-reviewed and grey disaster and global health in crises literature. Methods: Disaster terms
from textbooks, peer-reviewed and grey literature were used to design a framework of thematic clusters and subject
matter 'nodes'. A set of 84 terms, selected from 143 curated terms was organized within each node reflecting topics
within the disaster and global health in crisis literature. Terms were crossed with one another and the term 'disaster'.
The results were formatted into tables and matrices. This process created a roadmap of search terms that could be
applied to the PubMed database. Each search in the matrix or table results in a listed number of articles. This process
was applied to literature from PubMed from 2005-2011. A complementary process was also applied to Google
Scholar using the same framework of clusters, nodes, and terms expanding the search process to include the broader
grey literature assets. Results: A framework of four thematic clusters and twelve subject matter nodes were
designed to capture diverse disaster and global health in crisis-related content. From 2005-2011 there were 18,660
articles referring to the term [disaster]. Restricting the search to human research, MeSH, and English language there
remained 7,736 identified articles representing an unmanageable number to adequately process for research, policy
or best practices. However, using the crossed search and matrix process revealed further examples of robust realms
of research in disasters, emergency medicine, EMS, public health and global health. Examples of potential gaps in
current peer-reviewed disaster and global health in crisis literature were identified as mental health, elderly care,
and alternate sites of care. The same framework and process was then applied to Google Scholar, specifically for
topics that resulted in few PubMed search returns. When applying the same framework and process to the Google
The objective of this paper is to provide a comprehensive evidence based model aimed at addressing multi-level risk
factors influencing tobacco use among children and adolescents with multi-level policy and programmatic
approaches in India. Evidences around effectiveness of policy and program interventions from developed and
developing countries were reviewed using Pubmed, Scopus, Google Scholar and Ovid databases. This evidence was
then categorized under three broad approaches: Policy level approaches (increased taxation on tobacco products,
smoke-free laws in public places and work places, effective health warnings, prohibiting tobacco advertising,
promotions and sponsorships, and restricting access to minors); Community level approaches (school health
programs, mass media campaigns, community based interventions, promoting tobacco free norms) and Individual
level approaches (promoting cessation in various settings). This review of literature around determinants and
interventions was organized into developing the IMPACT framework. The paper further presents a comparative
analysis of tobacco control interventions in India vis a vis the proposed approaches. Mixed results were found for
prevention and control efforts targeting youth. However, this article suggests a number of intervention strategies
that have shown to be effective. Implementing these interventions in a coordinated way will provide potential
synergies across interventions. Pediatricians have prominent role in advocating and implementing the IMPACT
framework in countries aiming to prevent and control tobacco use among adolescents and children.
Free radicals are highly reactive and unstable compounds. These highly reactive molecules cause oxidative damage
to cellular components such as DNA, proteins and lipids. They play central role in the mechanism of cell injury and
cell death. Free radical scavengers either prevent these reactive species from being formed, or remove them before
they can damage vital components of the cell. Oxidative stress defines an imbalance in production of oxidizing
chemical species and their effective removal by protective antioxidants and scavenger enzymes. Evidence of massive
oxidative stress is well established in critical illnesses characterized by tissue ischaemia-reperfusion injury and by an
intense systemic inflammatory response such as during sepsis and acute respiratory distress syndrome, acute lung
injury. Several clinical trials have been performed in order to reduce oxidative stress by supplementation of
antioxidants alone or in combination with standard therapies. Antioxidant supplementation at an early stage of
illness may lead to improved therapies in the treatment of critically ill patients. Several intravenous anaesthetic drugs
act as reactive oxygen species scavengers. Anaesthetic preconditioning is of particular interest to anaesthesiologist,
in which lasting protection of myocardium is elicited by brief exposure to a inhalational anaesthetic agent. These
anasthetics may also mediate protective effects in other organs, such as the brain and kidney It is important for the
anaesthesiologist to understand the mechanism of damage caused by free radicals and how free radical scavengers
work so that this knowledge can be applied to varied pathological conditions. The topic was hand searched in text
books and electronically searched from PubMed and Google scholar using text words.
BACKGROUND: The authors analyzed the literature critically to determine the frequency and nature of incidental
findings (IFs) in cone-beam computed tomographic (CBCT) scans of the head and neck region., TYPES OF STUDIES
REVIEWED: The authors conducted a systematic search of several electronic databases (MEDLINE, Embase, PubMed,
Scopus, Web of Science, the Cochrane Library) through July 14, 2012, as well as a limited gray-literature search (in
Google Scholar). Inclusion criteria encompassed the frequency of reports of IFs in the head and neck region in CBCT
imaging, regardless of the sample origin. The authors used no search limitations. They evaluated methodological
quality according to 15 criteria related to study design, population characteristics and statistical analysis., RESULTS:
Initially, the authors identified 66 articles from the electronic database searches and another one via the gray-
literature search. Once they applied the final selection criteria, they found that only five articles satisfied the
inclusion criteria. In articles in which investigators reported the number of IFs as the absolute number of IFs
detected, the frequency ranged from 1.3 to 2.9 IFs per CBCT scan. Conversely, in articles in which authors reported
the number of IFs as the number of scans containing IFs, the frequency ranged from 24.6 to 93.4 percent of CBCT
scans. Methodological quality averaged 77.2 percent (range, 60-93 percent) of the maximum possible score.,
CONCLUSIONS AND CLINICAL IMPLICATIONS: IFs are detected relatively frequently in CBCT imaging, and considerable
variation is evident in their frequency and nature. The majority are extragnathic findings (that is, those found outside
the region of the dentition and alveolus), thus emphasizing the need for complete and proper review of the entire
image, regardless of field of view or region of interest.
Background: Clinical practice committees have incorporated data from phase III clinical trials presented in abstract
form in guideline development. If valid, a notable benefit of abstract incorporation into guidelines is that they may
reduce publication bias and provide early treatment alterations that may have significant impact on morbidity and
mortality in IBD patients. Our objectives were to: 1) evaluate publication rates of complete articles after abstract
presentation; 2) examine factors that predict publication success; 3) evaluate consistency in the results between
abstracts and successive journal publication. Methods: All abstracts accepted at the Digestive Diseases Week
between 1999 and 2003 describing phase III randomized controlled trials (RCTs) in IBD therapeutics were identified.
Medline, EMBASE, Pubmed (1997-current), and Google Scholar were searched for all subsequent publications in
English. We abstracted the following characteristics of the abstracts and papers: number of authors and centers,
significance of results, funding, whether the abstract was selected for oral presentation, time to publication, study
design issues (e.g. objective and/or hypothesis, sample size, statistical methodology, primary outcome). Results: Our
search of over 19,000 abstracts yielded 82 eligible abstracts and of these 64 were subsequently published (78%
publication success rate). Studies showing positive results were more likely to be published than those with negative
findings (91% vs. 50%; odds ratio 10.2; p<0.001). Abstracts selected for oral presentation also had 3-fold higher odds
of becoming published (89% vs. 69%; P=0.03). Factors such as number of centers, funding source, sample size,
number of authors, and validity of statistical method, were not significant predictors for publication. Of those studies
published, 28% underwent a significant change in the results of the primary outcome compared to the initial
abstract. Multicenter studies were more likely to have consistent results between publication and abstract (OR 3.4;
95%CI: 1.03-11.1) than single-center ones. The mean journal impact factor of subsequent publications was 7.5 +/- 7.6
(SD) and the average time to publication was 24.7 +/-14.9 (SD) months. Conclusions: Our study suggests substantial
publication bias favoring IBD clinical trials with positive findings. Implementation of data from abstracts may
ameliorate this bias. However, nearly a third of abstracts had a significant change in outcome results by the time of
publication. Thus, clinicians must exercise caution in implementing data from abstracts into clinical practice and
guidelines.
To give an overview of publications directly referencing the International Medical Informatics Association (IMIA) in
2008. Systematic search for references to IMIA over the two official IMIA journals, and reports of the recent IMIA
General Assembly and Board meetings, using PubMed/Medline, supplemented by searches with Google Scholar and
Google Books. Beyond the IMIA Yearbook 2008, 38 IMIA-referencing publications were found by these searches,
encompassing a broad range of topics, ranging from ambient assisted living technologies in home environments to
global information management methodologies. In 2008 IMIA-referencing publications found through both medical
and general search engines were predominantly in journals. In years where IMIA's world congress on medical
informatics, Medinfo take place, it could be expected that the Medinfo proceedings will also play an important role
in referencing IMIA explicitly.
Aim: To study the proportion of abstracts presented at annual IRA that get published as full scientific paper.
Introduction/Background: Research and scientific writing is important for improving quality of training and patient
care. Annual conferences provide a platform to know the work being done in the country. However publication of
data in a peer-reviewed journal helps in dissemination of the knowledge to a wider audience.
Methods/Materials/Analytical Procedures: All abstracts presented at Annual meeting of Indian Rheumatology
Association during 2007, 2009, 2010 meetings were included for analysis. PubMed, IndMed and Google scholar
search was done using the first authors name to extract full paper publication. The data was also analyzed separately
for case reports, institution etc. Results: A total of 271 papers were present during the 3 meetings. Of these only 19
got published till July 2012. Year wise conversion of abstracts to full paper was 2/60 for 2008, 11/105 for 2009 and
6/106 for 2010. The full paper publication rate was higher for oral presentations than for poster presentations (15%
versus 4%). Conclusions: Only 7% of abstracts get converted to full scientific papers and this proportion is higher for
oral presentation. The possible reasons could be lack of time, lack of training in scientific writing and poor scientific
content.
Context: The user interface development of assistive robotic manipulators can be traced back to the 1960s. Studies
include kinematic designs, cost-efficiency, user experience involvements, and performance evaluation. This paper is
to review studies conducted with clinical trials using activities of daily living (ADLs) tasks to evaluate performance
categorized using the International Classification of Functioning, Disability, and Health (ICF) frameworks, in order to
give the scope of current research and provide suggestions for future studies. Methods: We conducted a literature
search of assistive robotic manipulators from 1970 to 2012 in PubMed, Google Scholar, and University of Pittsburgh
Library System - PITTCat. Results: Twenty relevant studies were identified. Conclusion: Studies were separated into
two broad categories: user task preferences and user-interface performance measurements of commercialized and
developing assistive robotic manipulators. The outcome measures and ICF codes associated with the performance
evaluations are reported. Suggestions for the future studies include (1) standardized ADL tasks for the quantitative
and qualitative evaluation of task efficiency and performance to build comparable measures between research
groups, (2) studies relevant to the tasks from user priority lists and ICF codes, and (3) appropriate clinical functional
assessment tests with consideration of constraints in assistive robotic manipulator user interfaces. In addition, these
outcome measures will help physicians and therapists build standardized tools while prescribing and assessing
assistive robotic manipulators. The Academy of Spinal Cord Injury Professionals, Inc. 2013.
CONTEXT: The user interface development of assistive robotic manipulators can be traced back to the 1960s. Studies
include kinematic designs, cost-efficiency, user experience involvements, and performance evaluation. This paper is
to review studies conducted with clinical trials using activities of daily living (ADLs) tasks to evaluate performance
categorized using the International Classification of Functioning, Disability, and Health (ICF) frameworks, in order to
give the scope of current research and provide suggestions for future studies., METHODS: We conducted a literature
search of assistive robotic manipulators from 1970 to 2012 in PubMed, Google Scholar, and University of Pittsburgh
Library System - PITTCat., RESULTS: Twenty relevant studies were identified., CONCLUSION: Studies were separated
into two broad categories: user task preferences and user-interface performance measurements of commercialized
and developing assistive robotic manipulators. The outcome measures and ICF codes associated with the
performance evaluations are reported. Suggestions for the future studies include (1) standardized ADL tasks for the
quantitative and qualitative evaluation of task efficiency and performance to build comparable measures between
research groups, (2) studies relevant to the tasks from user priority lists and ICF codes, and (3) appropriate clinical
functional assessment tests with consideration of constraints in assistive robotic manipulator user interfaces. In
addition, these outcome measures will help physicians and therapists build standardized tools while prescribing and
assessing assistive robotic manipulators.
Background: Advances in diagnostic and treatment regimens that aim to reduce fracture incidence will benefit from
a better understanding of how bone morphology and tissue quality define whole-bone mechanical properties.
Questions/purposes: The goal of this article was to review what is known about the interactions among morphologic
and tissue quality traits and how these interactions contribute to bone quality (ie, whole-bone mechanical function).
Several questions were addressed. First, how do interactions among morphology and tissue quality traits relate to
functional adaptation? Second, what are the emergent patterns of functionally adapted trait sets in long bones?
Third, how effective is phenotypic integration at establishing function across a population? Fourth, what are the
emergent patterns of functionally adapted trait sets in corticocancellous structures? Fifth, how do functional
interactions change with aging? Methods: A literature review was conducted with papers identified primarily
through citations listed in reference sections as well as general searches using Google Scholar and PubMed. Results:
The interactions among adult traits or phenotypic integration are an emergent property of the compensatory
mechanisms complex systems used to establish function or homeostasis. Traits are not regulated independently but
vary simultaneously (ie, covary) in specific ways to establish function. This covariation results in individuals acquiring
unique sets of traits to establish bone quality. Conclusions and Clinical Relevance: Biologic constraints imposed on
the skeletal system result in a population showing a pattern of trait sets that is predictable based on external bone
size and that can be used to identify individuals with reduced bone quality relative to their bone size and body size.
2010 The Association of Bone and Joint Surgeons.
Background: The increase in the incidence of obesity has a substantial societal health impact. Contrasting reports
have been published on whether overweight and obesity affect male fertility. To clarify this, we have reviewed
published data on the relation between overweight/obesity, semen parameters, endocrine status and human male
fertility. Subsequently, we have used results obtained in animal models of obesity to explain the human data.
Methods: Pubmed, Scopus,Web of Science and Google Scholar databases were searched between September 2009
and October 2010 for a comprehensive publication record. Available studies on adult human males were examined.
The included animal studies examined obesity and fertility, and focused on leptin, leptin receptor signaling,
kisspeptins and/or NPY. Results: Most overweight/obese men do not experience significant fertility problems,
despite the presence of reduced testosterone alongside normal gonadotrophin levels. Only a subgroup of subjects
suffers from hypogonadotropic hypogonadism. Animal models offer several explanations and show that reduced
leptin signaling leads to reduced GnRH neuronal activity. This may be due to decreased hypothalamic Kiss1
expression, a potent regulator of GnRH/LH/FSH release. As the Kiss1 neurons express leptin receptors, the Kiss1
system may participate in transmitting metabolic information to the GnRH neurons, thus providing a bridge between
metabolic regulation and fertility. Conclusions: Infertility in overweight/obese males may be explained by leptin
insensitivity. This implies a possible role for the KISS1 system in human obesity-related male infertility. If
substantiated, it will pave the way for methods to restore fertility in these subjects. The Author 2011. Published by
Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights
reserved.
BACKGROUND: To assess IBD activity, many severity scales have been developed. Yet, most of them were not
properly validated and did not go through robust methodology. Using different scoring systems makes it difficult to
compare different trials especially when the end points are different. Because new therapies for IBD are rapidly
emerging, there is a need to optimize and standardize methodology for assessing of disease activity in clinical trials.
With the nationwide initiative to establish an IBD registry, a valid and easy to use activity measurement tool is
needed. We believe that having a single disease activity index that is suitable for all types and presentations of IBD
will make it very useful to monitor patients and assess their response to treatment. METHODS: Literature search was
conducted using MEDLINE and Google scholar database from January 1947 to 2011 to identify the clinical severity
indices commonly used in clinical trials. Seventeen indices were identified for both ulcerative colitis and Crohn's
disease. We followed a clini-metric approach to develop the simple IBD clinical severity index. Common items
between Ulcerative colitis and Crohn's disease were chosen. Few items were added to cover disease specific
domains. The new index was examined by gastroenterologists and methodologists in Swansea University to ensure
good face and content validity. The index was tested on 50 patients with different presentations of inflammatory
bowel disease. Harvey Bradshaw index and Simple clinical colitis index were used for construct validity.
Responsiveness was checked by repeating the test within 2-week period. RESULTS: The new index, simple IBD clinical
severity index, showed good face and content validity. It covers all presentations of IBD including Crohn's disease,
ulcerative colitis and perianal disease. It has good reliability and construct validity. It is easy to use in daily practice
CONCLUSION(S): Simple IBD clinical severity index is a new tool to assess the clinical activity of IBD. It is valid,
reliable, user friendly and non-invasive index. Further studies are required to check how it performs on a wider range
of patients.
Background:Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst
fractures. However, it remains unclear whether additional fusion could improve clinical and radiological outcomes.
This meta-analysis was performed to evaluate the effectiveness of fusion as a supplement to pedicle screw fixation
for thoracolumbar burst fractures.Methodology/Principal Findings:MEDLINE, OVID, Springer, and Google Scholar
were searched for relevant randomized and quasi-randomized controlled trials that compared the clinical and
radiological efficacy of fusion versus nonfusion for thoracolumbar burst fractures managed by posterior pedicle
screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. We generated
pooled risk ratios or weighted mean differences across studies. Based on predefined inclusion criteria, 4 eligible trials
with a total of 220 patients were included in this meta-analysis. The mean age of the patients was 35.1 years. 96.8%
of the fractures were located at T12 to L1 level. Baseline characteristics were similar between the fusion and
nonfusion groups. No significant difference was identified between the two groups regarding radiological outcome,
functional outcome, neurologic improvement, and implant failure rate. The pooled data showed that the nonfusion
group was associated with significantly reduced operative time (p<0.0001) and blood loss (p =
0.0003).Conclusions/Significances:The results of this meta-analysis suggested that fusion was not necessary when
thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with
high quality are still needed in the future. 2013 Tian et al.
BACKGROUND: Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst
fractures. However, it remains unclear whether additional fusion could improve clinical and radiological outcomes.
This meta-analysis was performed to evaluate the effectiveness of fusion as a supplement to pedicle screw fixation
for thoracolumbar burst fractures., METHODOLOGY/PRINCIPAL FINDINGS: MEDLINE, OVID, Springer, and Google
Scholar were searched for relevant randomized and quasi-randomized controlled trials that compared the clinical
and radiological efficacy of fusion versus nonfusion for thoracolumbar burst fractures managed by posterior pedicle
screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. We generated
pooled risk ratios or weighted mean differences across studies. Based on predefined inclusion criteria, 4 eligible trials
with a total of 220 patients were included in this meta-analysis. The mean age of the patients was 35.1 years. 96.8%
of the fractures were located at T12 to L1 level. Baseline characteristics were similar between the fusion and
nonfusion groups. No significant difference was identified between the two groups regarding radiological outcome,
functional outcome, neurologic improvement, and implant failure rate. The pooled data showed that the nonfusion
group was associated with significantly reduced operative time (p<0.0001) and blood loss (p =0.0003).,
CONCLUSIONS/SIGNIFICANCES: The results of this meta-analysis suggested that fusion was not necessary when
thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with
high quality are still needed in the future.
Background: Primary care physicians are in short supply worldwide, and Thailand is no exception. The current
economic crisis contributes further to this situation. Thailand does not yet have a formally defined and certifying
family practice board. In addition, there are two opposing trends in Thailand which stress an adequate supply
ofproviders: 1) Inadequate formal training for primary care doctors; and 2) The 'brain drain' caused by the higher
salaries in the private sector and the effort to make Thailand a key hub for 'Medical Tourism'. From one perspective
of primary care, Thailand is a developing or transitional country rooted in hospital/specialist care, yet seeking ways to
improve overall quality and cost-effectiveness for its people. Objectives: To ascertain the current and future
potential for increasing the number of primary care providers in Thailand, and to encourage further research on this
question in the context of economic reality and the cultural background of medical care in Thailand. Methods:
Literature search of Thai and other international medical journals for 'Primary care Thailand'; Google Scholar search
for 'Primary care Thailand'; Pubmed search using MeSH terms 'Primary care' AND 'Thailand'. In addition, physicians
and administrative staff in Bangkok from private general-travel medicine practice, an academic medical center, two
non-profit facilities, and four investor-owned institutions were interviewed. The literature review was completed 13
March 2009, and the interviews were conducted in person during the author's visit to Bangkok in January 2009.
Results: Although there is some interest in promoting primary care more effectively, the majority of medical practice
is still hospital-specialist oriented, at least in Bangkok. One exception was in one of the smaller private hospitals,
where several well-trained primary care physicians practiced. In addition, some of the larger hospitals noted for
medical tourism are developing sections for local Thai patients, and this may encourage recruitment of fully trained
family doctors or specialists in general internal medicine. Conclusions: The future of primary care in Thailand remains
in question. It needs the change by the political establishment and medical leadership to define formally primary
care or a recognized and certified medical specialty. Furthermore, careful research of both national and regional
health needs and practices is a critical factor for success.
Background: Gabapentin is an antiepileptic drug used in a variety of chronic pain conditions. Increasing numbers of
randomized trials indicate that gabapentin is effective as a postoperative analgesic. This procedure-specific
systematic review aims to analyse the 24-hour postoperative effect of gabapentin on acute pain in adults. Methods:
Medline, The Cochrane Library and Google Scholar were searched for double-blind randomized placebo controlled
trials of gabapentin for postoperative pain relief compared with placebo, in adults undergoing a surgical procedure.
Qualitative analysis of postoperative effectiveness was evaluated by assessment of significant difference (P > 0.05) in
pain relief using consumption of supplemental analgesic and pain scores between study groups. Quantitative
analyses of combined data from similar procedures, were performed by calculating the weighted mean difference
(WMD) of 24-hour cumulated opioid requirements, and the WMD for visual analogue scale (VAS) pain, (early (6 h)
and late (24 h) postoperatively), between study groups. Side-effects (nausea, vomiting, dizziness and sedation) were
extracted for calculation of their relative risk (RR). Results: Twenty-three trials with 1529 patients were included. In
12 of 16 studies with data on postoperative opioid requirement, the reported 24-hour opioid consumption was
significantly reduced with gabapentin. Quantitative analysis of five trials in abdominal hysterectomy showed a
significant reduction in morphine consumption (WMD - 13 mg, 95% confidence interval (CI) -19 to -8 mg), and in
early pain scores at rest (WMD - 11 mm on the VAS, 95% CI -12 to -2 mm) and during activity (WMD -8 mm on the
VAS; 95% CI -13 to -3 mm), favouring gabapentin. In spinal surgery, (4 trials), analyses demonstrated a significant
reduction in morphine consumption (WMD of - 31 mg (95%CI - 53 to -10 mg) and pain scores, early (WMD - 17 mm
on the VAS; 95 % CI - 31 to -3 mm) and late (WMD -12 mm on the VAS; 95% CI -23 to -1 mm) also favouring
gabapentin treatment. Nausea was improved with gabapentin in abdominal hysterectomy (RR 0.7; 95 % CI 0.5 to
0.9). Other side-effects were unaffected. Conclusion: Perioperative use of gabapentin has a significant 24-hour
opioid sparing effect and improves pain score for both abdominal hysterectomy and spinal surgery. Nausea may be
reduced in abdominal hysterectomy. 2007 Mathiesen et al; licensee BioMed Central Ltd.
The increased availability of PET facilities worldwide has sparked renewed interest in the use of generator-produced
tracers such as gallium-68 (Ga). Imaging with Ga provides exciting opportunities in terms of new ligand-labelling
possibilities and the exploration of novel clinical applications. The aim of the study was to summarize and appraise
what has been published on the clinical applications of Ga outside oncology practice. This systematic review was
based on the PRISMA guidelines. Databases searched include PubMed, Medline, Scopus, Web of Science and Google
Scholar. The following search strategy was used: 'Ga' OR 'Gallium' (all fields) NOT the following (title and abstract):
Oncology/NET/neuroendocrine tumour/tumor/DOTATOC, DOTATATE, DOTANOC. These results were further limited
to English publications, which resulted in 205 publications on PubMed. After duplicates and irrelevant articles were
removed, 72 publications remained for inclusion. Only those studies in which compounds were labelled with Ga for
applications other than in oncology-related indications were included. Publications in which the focus was on
oncology-related applications of Ga imaging or in which the emphasis was on aspects relating to generators,
radiochemistry or physics were excluded. Although a multitude of tracers have been labelled with Ga over several
decades, it has not been established in routine clinical practice yet. In addition, neuroendocrine and other
oncological applications have dominated the field until relatively recently following reports of applications in
infection and inflammation. The majority of publications to date involve small numbers of subjects in mainly
preclinical settings. Differences in methodology preclude grouping of studies to reach a clear conclusion. There is
wide scope for Ga tracer application outside oncological practice, which remains greatly underutilized. Larger clinical
trials are needed to validate these applications.
BACKGROUND: The negative consequences of pathological gambling are related to social, economical and relational
problems. Few studies are available on possible associations between gambling and suicidal behaviour. Updated
literature reviews are needed. MATERIAL AND METHODS: PsychInfo, ISI and Google Scholar were searched for
relevant literature and 38 publications were found. RESULTS AND INTERPRETATION: Problem gamblers seeking
treatment often report suicidal thoughts or attempted suicide. Those with suicidal behaviour more often report
mental health problems, alcohol or drug problems, relational difficulties and financial problems than other problem
gamblers. Population surveys suggest that suicidal behaviour tends to occur more frequently among problem
gamblers than among others. Studies of the association between gambling and suicidal behaviour at the aggregate
level have provided ambiguous results. It is not clear whether gambling per se may increase the risk of suicidal
behaviour. However, the high prevalence of suicidal behaviour among problem gamblers suggests that suicide risk
should be considered when they present for treatment.
OBJECTIVES: Antiplatelet therapies with aspirin, ADP receptor inhibitors, and glycoprotein Ilb/IIIa inhibitors play an
important role in management of acute coronary syndromes and chronic coronary heart disease. An assessment of
the literature was conducted to identify evidence gaps and critical unmet needs in antiplatelet therapy in the
management of ACS and chronic CHD. METHODS: A targeted literature search was conducted on antiplatelet therapy
with a focus on ADP receptor inhibitors using PubMed, Medline and Google Scholar. Parallel searches were initiated
for the ACS and chronic CHD. Additional references were identified and included based on citations from reviewed
articles. A total of 179 articles were reviewed. Article types considered in the study included review articles, clinical
trials, observational studies, and economic evaluations. RESULTS: The review identified gaps and unmet needs in
drug therapy for ACS and chronic CHD using established (aspirin, clopidogrel, and glycoprotein IIb/IIIa agents) and
newer drugs (prasugrel and ticagrelor). Key evidentiary gaps were identified on the impact of clopidogrel resistance,
antiplatelet associated major, minor and nuisance bleeding risk, impact on humanistic outcomes, long term cost-
effectiveness, impact on elderly patients and other high risk subpopulations. Our assessment revealed that current
antiplatelet therapies are associated with significant downsides, such as increased bleeding risks as well as other
untoward effects. CONCLUSIONS: Our assessment revealed important gaps and areas of unmet need associated with
current and new antiplatelet therapies in the management of ACS and chronic CHD. Further studies should be
conducted to address these evidentiary gaps, while unmet patient needs should be taken into consideration in future
drug development.
INTRODUCTION: The burden of acute respiratory infections (ARIs) among Moroccan children remains presumably
important despite progresses in treatment and preventive strategies. Little information is available regarding the
epidemiology and the etiology of ARI in Morocco. OBJECTIVES To describe the burden of ARI among children under 5
years of age in Morocco. METHODS: Pubmed , Hinari , Google Scholar , official reports of the Moroccan Ministry of
Health (MOH) was searched and publications from 1997 to 2011 reviewed. Search queries included: Respiratory
Tract Infections, epidemiology, etiology, microbiology, mortality and Morocco. RESULTS: Ten published articles and
reports were found. In 2008, ARIas remained the leading cause of death among children under five (17.2% among
total under five deaths), constituting around half of the consultations at health facilities and a third of admissions in
an urban pediatric teaching hospital. ARIs are managed according to the integrated management of childhood
illnesses (IMCI) program since 1998. The two principal microorganisms identified among hospitalized children with
ARIs in Casablanca were Streptococcus pneumoniae (38%) and Haemophilus influenzae (Hib) (15%). In its preventive
strategy, MOH introduced Hib vaccines into the national immunization programme (PNI) in 2007. The 13-valent
vaccine against pneumococcus has been added in 2010. The national first line antibiotics prescribed are Amoxicillin
(oral treatment, outpatients) and Ampicilline associated to Gentamicin (parenteral, inpatients). Studies of antibiotic
resistance among isolates causing ARIS, showed a high and increasing rate of penicillin non-susceptibility among
Streptococcus pneumoniae from 1998 to 2008 (21.4- 43.3% increase). Viral respiratory infections remain poorly
characterized, with the exception of the H1N1 epidemic episode of 2010, which affected 29% of children under five
who attended the university hospital of Rabat. CONCLUSION Efforts should be made towards the development of
adequate surveillance programs to further clarify the epidemiology, etiology and sensitivity patterns of the different
causes of ARI.
Introduction: Gastroesophageal reflux disease (GERD) is one of the most prevalent disorders affecting
gastrointestinal tract with a wide range of frequency around the world. In this study, we aimed to review all of the
published studies about GERD's prevalence in Iran systematically. Methods: We searched bibliographic databases
including PubMed and Google Scholar and local databases (Scientific Information Database and Iran Medex) to ach
ieve all articles relevant to our subject and included them based on predefined inclusion criteria. Results: Twenty-two
articles were included in the study in order to estimate the prevalence of GERD in Iran. Based on these articles, the
prevalence of GERD in Iran was within the range of 1.9 to 52%. Conclusion: Due to the differences between studies,
such as characteristics of the sampled population and the diagnostic criteria, the reported prevalence of GERD in
varied remarkably in the studies reviewed. Nonetheless, because of the high prevalence of GERD in Iran, conducting
large-scale epidemiological studies to determine factors associated with the prevalence of GERD should be
considered in order to prevent and control this disease.
Background: Men and women differ in their experience of diabetes mellitus (DM). For optimal prevention and
treatment of the disease, these differences must be acknowledged. Unfortunately, most studies of diabetes have
focused almost exclusively on men. Objective: The purpose of this review was to survey the literature about the sex-
specific features of DM and to make recommendations for the gender-specific care of patients. Methods: An initial
literature search was performed with Google Scholar and MEDLINE (1995-2005) using the search terms sex/gender,
women, diabetes mellitus, and coronary artery disease, and specific topic headings such as polycystic ovary
syndrome. The bibliographies of articles were used extensively to augment the search, and more specific search
terms were included. The strength of each recommendation was assessed. Results: Even when women were
included in clinical trials, investigators typically made no attempt to assess the impact of sex differences on the
reported results. Existing studies, however, reveal several differences between men and women with diabetes. The
prevalence of DM is growing fastest for older minority women. Women with diabetes, regardless of menopausal
status, have a 4- to 6-fold increase in the risk of developing coronary artery disease (CAD), whereas men with
diabetes have a 2- to 3-fold increase in risk. Women with diabetes have a poorer prognosis after myocardial
infarction and a higher risk of death overall from cardiovascular disease than do men with diabetes. Women with
type 2 DM experience more symptoms of hyperglycemia than do their male counterparts. Obesity, an important
contributor to type 2 DM, is more prevalent in women. Women with diabetes have an increased risk of hypertension
compared with men with diabetes. Women have a more severe type of dyslipidemia than do men (low levels of high-
density lipoprotein cholesterol, small particle size of low-density lipoprotein cholesterol, and high levels of
triglycerides), and these risk factors for CAD have a stronger influence in women. Oxidative stress may confer a
greater increase in the risk of CAD for women with diabetes than for men with diabetes. Many other sex differences
in DM are due to women's reproductive physiology. Polycystic ovary syndrome is an important correlate of insulin
resistance and the metabolic syndrome. Gestational diabetes mellitus (GDM) increases the risk of cardiovascular
disease and type 2 DM. Women are less likely than men to receive aggressive treatment for CAD and to achieve
treatment goals. Critical recommendations for women include exercise, testing for CAD, daily aspirin to counteract
the prothrombotic state, depression screening, careful treatment to avoid weight gain, long-term follow-up of
children of women with GDM, control of risk factors for CAD, and aggressive treatment with coronary angioplasty for
CAD. Disease management programs for patients with diabetes have been shown to save money and improve
outcomes, and should continue to incorporate information about sex-specific differences in DM as it becomes
BACKGROUND: Men and women differ in their experience of diabetes mellitus (DM). For optimal prevention and
treatment of the disease, these differences must be acknowledged. Unfortunately, most studies of diabetes have
focused almost exclusively on men., OBJECTIVE: The purpose of this review was to survey the literature about the sex-
specific features of DM and to make recommendations for the gender-specific care of patients., METHODS: An initial
literature search was performed with Google Scholar and MEDLINE (1995-2005) using the search terms sex/gender,
women, diabetes mellitus, and coronary artery disease, and specific topic headings such as polycystic ovary
syndrome. The bibliographies of articles were used extensively to augment the search, and more specific search
terms were included. The strength of each recommendation was assessed., RESULTS: : Even when women were
included in clinical trials, investigators typically made no attempt to assess the impact of sex differences on the
reported results. Existing studies, however, reveal several differences between men and women with diabetes. The
prevalence of DM is growing fastest for older minority women. Women with diabetes, regardless of menopausal
status, have a 4- to 6-fold increase in the risk of developing coronary artery disease (CAD), whereas men with
diabetes have a 2- to 3-fold increase in risk. Women with diabetes have a poorer prognosis after myocardial
infarction and a higher risk of death overall from cardiovascular disease than do men with diabetes. Women with
type 2 DM experience more symptoms of hyperglycemia than do their male counterparts. Obesity, an important
contributor to type 2 DM, is more prevalent in women. Women with diabetes have an increased risk of hypertension
compared with men with diabetes. Women have a more severe type of dyslipidemia than do men (low levels of high-
density lipoprotein cholesterol, small particle size of low-density lipoprotein cholesterol, and high levels of
triglycerides), and these risk factors for CAD have a stronger influence in women. Oxidative stress may confer a
greater increase in the risk of CAD for women with diabetes than for men with diabetes. Many other sex differences
in DM are due to women's reproductive physiology. Polycystic ovary syndrome is an important correlate of insulin
resistance and the metabolic syndrome. Gestational diabetes mellitus (GDM) increases the risk of cardiovascular
disease and type 2 DM. Women are less likely than men to receive aggressive treatment for CAD and to achieve
treatment goals. Critical recommendations for women include exercise, testing for CAD, daily aspirin to counteract
the prothrombotic state, depression screening, careful treatment to avoid weight gain, long-term follow-up of
children of women with GDM, control of risk factors for CAD, and aggressive treatment with coronary angioplasty for
CAD. Disease management programs for patients with diabetes have been shown to save money and improve
outcomes, and should continue to incorporate information about sex-specific differences in DM as it becomes
The knockout gene technology is an excellent tool to investigate gene function. In 2005, we reviewed 83 gene
knockouts that were reported to affect female fertility. This article is an update of the previous review published in
early 2005. It describes genes discovered (2004-2010) since the last review that affect female fertility. Using the
database search in the Pubmed and Google Scholar search engines, 67 new genes were discovered using knockout
technology that have been reported to affect female fertility. These genes were grouped into three main categories
based upon the aspect of female reproductive biology that is affected by their knockout. Some of these genes may
provide novel targets for developing better methods for contraception and specific diagnosis and treatment of
female infertility.
Background: Peripheral arterial disease remains a significant global health burden despite revolutionary
improvements in endovascular techniques over the past decade. The durability of intervention for critical limb
ischaemia is poor, and the condition is associated with high morbidity and mortality rates. To address this deficiency,
alternative therapeutic options are being explored. Advances in the fields of gene therapy and therapeutic
angiogenesis have led to these being advocated as potential future treatments. Methods: Relevant medical literature
from PubMed, Embase, the Cochrane Library and Google Scholar from the inception of these databases to June 2011
was reviewed. Results: Encouraging outcomes in preclinical trials using a variety of proangiogenic growth factors
have led to numerous efficacy and safety studies. However, no clinical study has shown significant benefit for gene
therapy over placebo. Conclusion: Identifying the optimal site for gene delivery, choice of vector and duration of
treatment is needed if gene therapy is to become a credible therapeutic option for peripheral arterial disease.
Copyright 2011 British Journal of Surgery Society Ltd.
Introduction. Bipolar Disorder (BD) is a serious mood disorder, the aetiology of which is still unclear. The disorder is
characterised by extreme mood variability in which patients fluctuate between markedly euphoric, irritable, and
elevated states to periods of severe depression. The current research literature shows that BD patients demonstrate
compromised neurocognitive ability in addition to these mood symptoms. Viable candidate genes implicated in
neurocognitive and socioemotional processes may explain the development of these core emotion abnormalities.
Additionally, links between faulty neurocognition and impaired socioemotional ability complement genetic
explanations of BD pathogenesis. This review examines associations between cognition indexing prefrontal neural
regions and socioemotional impairments including emotion processing and regulation. A review of the effect of
COMT and TPH2 on these functions is also explored. Methods. Major computer databases including PsycINFO,
Google Scholar, and Medline were consulted in order to conduct a comprehensive review of the genetic and
cognitive literature in BD. Results. This review determines that COMT and TPH2 genetic variants contribute
susceptibility to abnormal prefrontal neurocognitive function which oversees the processing and regulation of
emotion. This provides for greater understanding of some of the emotional and cognitive symptoms in BD.
Conclusions. Current findings in this direction show promise, although the literature is still in its infancy and further
empirical research is required to investigate these links explicitly. 2013 Taylor and Francis Group, LLC.
Background and Objectives: The GSTM1, GSTT1 and GSTP1 polymorphisms might be involved in inactivation of
procarcinogens that contribute to the genesis and progression of cancers. However, studies investigating the
association between GSTM1, GSTT1 or GSTP1 polymorphisms and prostate cancer (PCa) risk report conflicting
results, therefore, we conducted a meta-analysis to re-examine the controversy. Methods: Published literature from
PubMed, Embase, Google Scholar and China National Knowledge Infrastructure (CNKI) were searched (updated to
June 2, 2012). According to our inclusion criteria, studies that observed the association between GSTM1, GSTT1 or
GSTP1 polymorphisms and PCa risk were included. The principal outcome measure was the odds ratio (OR) with 95%
confidence interval (CI) for the risk of PCa associated with GSTM1, GSTT1 and GSTP1 polymorphisms. Results: Fifty-
seven studies involving 11313 cases and 12934 controls were recruited. The overall OR, which was 1.2854 (95% CI =
1.1405-1.4487), revealed a significant risk of PCa and GSTM1 null genotype, and the similar results were observed
when stratified by ethnicity and control source. Further, the more important is that the present study first reported
the high risks of PCa for people who with dual null genotype of GSTM1 and GSTT1 (OR = 1.4353, 95% CI = 1.0345-
1.9913), or who with GSTT1 null genotype and GSTP1 A131G polymorphism (OR = 1.7335, 95% CI = 1.1067-2.7152).
But no association was determined between GSTT1 null genotype (OR = 1.102, 95% CI = 0.9596-1.2655) or GSTP1
A131G polymorphism (OR = 1.0845, 95% CI = 0.96-1.2251) and the PCa risk. Conclusions: Our meta-analysis
suggested that the people with GSTM1 null genotype, with dual null genotype of GSTM1 and GSTT1, or with GSTT1
null genotype and GSTP1 A131G polymorphism are associated with high risks of PCa, but no association was found
between GSTT1 null genotype or GSTP1 A131G polymorphism and the risk of PCa. Further rigorous analytical studies
are highly expected to confirm our conclusions and assess gene-environment interactions with PCa risk. 2012 Gong
et al.
Acute rheumatic fever is considered to be a heritable condition, but the magnitude of the genetic effect is unknown.
The objective of this study was to conduct a systematic review and meta-analysis of twin studies of concordance of
acute rheumatic fever in order to derive quantitative estimates of the size of the genetic effect. We searched
PubMed/MEDLINE, ISI Web of Science, EMBASE, and Google Scholar from their inception to 31 January 2011, and
bibliographies of retrieved articles, for twin studies of the concordance for acute rheumatic fever or rheumatic heart
disease in monozygotic versus dizygotic twins that used accepted diagnostic criteria for acute rheumatic fever and
zygosity without age, gender or language restrictions. Twin similarity was measured by probandwise concordance
rate and odds ratio (OR), and aggregate probandwise concordance risk was calculated by combining raw data from
each study. ORs from separate studies were combined by random-effects meta-analysis to evaluate association
between zygosity status and concordance. Heritability was estimated by fitting a variance components model to the
data. 435 twin pairs from six independent studies met the inclusion criteria. The pooled probandwise concordance
risk for acute rheumatic fever was 44% in monozygotic twins and 12% in dizygotic twins, and the association
between zygosity and concordance was strong (OR 6.39; 95% confidence interval, 3.39 to 12.06; P<0.001), with no
significant study heterogeneity (P = 0.768). The estimated heritability across all the studies was 60%. Acute
rheumatic fever is an autoimmune disorder with a high heritability. The discovery of all genetic susceptibility loci
through whole genome scanning may provide a clinically useful genetic risk prediction tool for acute rheumatic fever
and its sequel, rheumatic heart disease.
Aim. This paper reports a literature review exploring genetics education for nursing professionals. The aim was to
contribute to the debate about the future direction of such education. Background. Advances in genetics science and
technology have profound implications for health care and the growing importance and relevance of genetics for
everyday nursing practice is increasingly recognized. Method. A search was conducted in February 2005 using the
CINAHL and Google Scholar databases and the keywords nurse, midwife, health visitor, education and genetics.
Papers were included if they were published in English between 1994 and 2005 and included empirical data about
genetics education in nursing. In addition, attempts were made to access the grey literature, with requests for
information on research, for example, to members of the Association of Genetic Nurses and Counsellors and
searches of relevant websites. Findings. Agreement on the relevance of genetics for nursing practice is extensive.
Empirical evidence of the learning needs of practitioners highlights widespread deficits in knowledge and skills, and
low confidence levels. Provision of nursing education in genetics is patchy and insubstantial across a number of
countries, further hampered by lack of strategic development. Significant progress has been made in the
identification of learning outcomes for nurses. Research on the delivery of genetics education is limited, but the role
of skills-based training, use of clinical scenarios, and importance of assessment have all been identified as factors
that can promote learning. Conclusion. Whilst areas of good performance were revealed, many studies identified
gaps in professional competence and/or education. New initiatives are underway to support genetics education and
its integration into professional practice, but further research is needed on the most effective forms of educational
delivery, and an international collaborative approach to this should be considered. 2006 Blackwell Publishing Ltd,.
Background: Menarche is the first menstrual period of a girl at puberty. The timing of menarche is important for
health in later life. Age at menarche is a complex trait and has a strong genetic component. This review summarizes
the results of the genetic studies of age at menarche conducted to date, highlights existing problems in this area and
outlines prospects of future studies on genetic factors for the trait. Methods: PubMed and Google Scholar were
searched until May 2011 using the keywords: 'menarche', 'puberty' and 'age at menarche' in combination with the
keywords 'polymorphism', 'candidate gene', 'genome-wide association study' and 'linkage'. Results: Our search
yielded 170 papers, 35 of which were selected for further analysis. Several large-scale genome-wide association
studies along with a powerful meta-analysis of their aggregated data identified about 50 candidate genes for the
trait. Some genes were replicated in different studies of Caucasians (e.g. LIN28B, TMEM38B) or in different
ethnicities (e.g. SPOCK, RANK and RANKL). However, despite the large volume of results obtained, there is a huge
gap in relevant data on ethnic groups other than Caucasians. Conclusions: The reviewed studies laid a solid basis for
future research on genetics of age at menarche. However, as yet specific genes for this trait have not been identified
consistently in all ethnicities and types of studies. We suggest expanding the research to different ethnicities and
propose several methodologies to increase the efficiency of studies in this area, including a systems approach, which
combines existing high-throughput methods in a single pipeline. The Author 2012. Published by Oxford University
Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
Introduction: About 2% of the general population have an intracranial aneurysm (IA) with rupture resulting in a
subarachnoid haemorrhage (SAH). Uncertainty remains about the nature and number of genes contributing to risk of
the aneurysm. We sought to undertake a comprehensive genetic meta-analysis of all case-control studies of
ruptured and unruptured intra-cranial aneurysms. Method: Electronic searches using PubMed, Google Scholar,
Yahoo and EMBASE were used to identify all published case-control studies evaluating any candidate gene in
intracranial aneurysms and subarachnoid haemorrhage in humans published until and including June 2008. Data
were analysed using RevMan v4.2. A pooled odds ratio (OR) was calculated for each gene variant using fixed- and
random- effects models. Results: In total, 30 publications addressing 13 polymorphisms in eight genes met the
inclusion criteria (6622 cases and 13, 339 controls). The mean number of studies per polymorphism was 3.5. Four of
the 10 meta-analyses had more than 500 cases, and seven had a total participant sample size greater than 1000.
Conclusion: Three (eNOS T786C, IL-6 G572C and IL-6 G174C) of the polymorphisms analysed in two genes were
significantly associated with ruptured/unruptured IA. The eNOS gene SNPs increased the risk of IA while IL-6/G174C
seemed protective. The individual risk provided by these polymorphisms was moderate except in the case of IL-6
G572C (OR, 7.21). If these estimates hold true, they suggest that common variants in the genes may alone contribute
to between 180 and 320 aneurysms in the UK alone each year.
Ethnopharmacological relevance: The resinous exudates of the Commiphora species, known as 'myrrh', are used in
traditional Chinese medicine for the treatment of trauma, arthritis, fractures and diseases caused by blood
stagnation. Myrrh has also been used in the Ayurvedic medical system because of its therapeutic effects against
inflammatory diseases, coronary artery diseases, gynecological disease, obesity, etc. Aim of the review: Based on a
comprehensive review of traditional uses, phytochemistry, pharmacological and toxicological data on the genus
Commiphora, opportunities for the future research and development as well as the genus' therapeutic potential are
analyzed. Methods: Information on the Commiphora species was collected via electronic search (using Pubmed,
SciFinder, Scirus, Google Scholar and Web of Science) and a library search for articles published in peer-reviewed
journals. Furthermore, information also was obtained from some local books on ethnopharmacology. This paper
covers the literature, primarily pharmacological, from 2000 to the end of December 2011. Results: The resinous
exudates from the bark of plants of the genus Commiphora are important indigenous medicines, and have a long
medicinal application for arthritis, hyperlipidemia, pain, wounds, fractures, blood stagnation, in Ayurvedic medicine,
traditional Chinese medicine and other indigenous medical systems. Phytochemical investigation of this genus has
resulted in identification of more than 300 secondary metabolites. The isolated metabolites and crude extract have
exhibited a wide of in vitro and in vivo pharmacological effects, including antiproliferative, antioxidant, anti-
inflammatory and antimicrobial. The bioactive steroids guggulsterones have attracted most attention for their potent
hypolipidemic effect targeting farnesoid X receptor, as well as their potent inhibitory effects on tumor cells and anti-
inflammatory efficiency. Conclusions: The resins of Commiphora species have emerged as a good source of the
traditional medicines for the treatment of inflammation, arthritis, obesity, microbial infection, wound, pain,
fractures, tumor and gastrointestinal diseases. The resin of C. mukul in India and that of C. molmol in Egypt have
been developed as anti-hyperlipidemia and antischistosomal agents. Pharmacological results have validated the use
of this genus in the traditional medicines. Some bioassays are difficult to reproduce because the plant materials used
have not been well identified, therefore analytical protocol and standardization of extracts should be established
prior to biological evaluation. Stem, bark and leaf of this genus should receive more attention. Expansion of research
materials would provide more opportunities for the discovery of new bioactive principles from the genus
Commiphora. 2012 Elsevier Ireland Ltd.
ETHNOPHARMACOLOGICAL RELEVANCE: The resinous exudates of the Commiphora species, known as 'myrrh', are
used in traditional Chinese medicine for the treatment of trauma, arthritis, fractures and diseases caused by blood
stagnation. Myrrh has also been used in the Ayurvedic medical system because of its therapeutic effects against
inflammatory diseases, coronary artery diseases, gynecological disease, obesity, etc., AIM OF THE REVIEW: Based on
a comprehensive review of traditional uses, phytochemistry, pharmacological and toxicological data on the genus
Commiphora, opportunities for the future research and development as well as the genus' therapeutic potential are
analyzed., METHODS: Information on the Commiphora species was collected via electronic search (using Pubmed,
SciFinder, Scirus, Google Scholar and Web of Science) and a library search for articles published in peer-reviewed
journals. Furthermore, information also was obtained from some local books on ethnopharmacology. This paper
covers the literature, primarily pharmacological, from 2000 to the end of December 2011., RESULTS: The resinous
exudates from the bark of plants of the genus Commiphora are important indigenous medicines, and have a long
medicinal application for arthritis, hyperlipidemia, pain, wounds, fractures, blood stagnation, in Ayurvedic medicine,
traditional Chinese medicine and other indigenous medical systems. Phytochemical investigation of this genus has
resulted in identification of more than 300 secondary metabolites. The isolated metabolites and crude extract have
exhibited a wide of in vitro and in vivo pharmacological effects, including antiproliferative, antioxidant, anti-
inflammatory and antimicrobial. The bioactive steroids guggulsterones have attracted most attention for their potent
hypolipidemic effect targeting farnesoid X receptor, as well as their potent inhibitory effects on tumor cells and anti-
inflammatory efficiency., CONCLUSIONS: The resins of Commiphora species have emerged as a good source of the
traditional medicines for the treatment of inflammation, arthritis, obesity, microbial infection, wound, pain,
fractures, tumor and gastrointestinal diseases. The resin of C. mukul in India and that of C. molmol in Egypt have
been developed as anti-hyperlipidemia and antischistosomal agents. Pharmacological results have validated the use
of this genus in the traditional medicines. Some bioassays are difficult to reproduce because the plant materials used
have not been well identified, therefore analytical protocol and standardization of extracts should be established
prior to biological evaluation. Stem, bark and leaf of this genus should receive more attention. Expansion of research
materials would provide more opportunities for the discovery of new bioactive principles from the genus
Commiphora. Copyright 2012 Elsevier Ireland Ltd. All rights reserved.
Objectives Natural remedies are becoming increasingly popular and important in the public and scientific
communities. Historically, natural remedies have been shown to present interesting biological and pharmacological
activity and are used as chemotherapeutic agents. For centuries Cordyceps, which is a genus of more than 400
species in the family Clavicipitaceae, has been used in traditional Chinese medicine. This study highlights the
chemistry and pharmacology of Cordyceps, especially Cordyceps sinensis (Berk.) Sacc. and C. militaris (Fr.) L.
Information was obtained from Google Scholar and the journal databases PubMed and Scopus. Key findings Many
bioactive components of Cordyceps have been extracted, such as cordycepin, cordycepic acid, ergosterol,
polysaccharides, nucleosides and peptides. Studies show that Cordyceps and its active principles possess a wide
range of pharmacological actions, such as anti-inflammatory, antioxidant, antitumour, antihyperglycaemic,
antiapoptosis, immunomodulatory, nephroprotective, and hepatoprotective. Summary More research is required to
discover the full extent of the activity of Cordyceps. 2012 The Authors. JPP 2012. Royal Pharmaceutical Society.
Ethnopharmacological relevance: Species of the genus Cynomorium (Cynomoriaceae), including C. songaricum Rupr.
and C. coccineum L.; have a long history of use in traditional medicine to treat various ailments such as impotence,
premature ejaculation, kidney-yang deficiency, spermatorrhea, colic, and stomach ulcers. In addition, these species
are used in health foods, tea, and cosmetics. Aim of the review: The aim of this review is to provide comprehensive
information on the botany, traditional uses, phytochemistry, pharmacological research, and toxicology of C.
songaricum and C. coccineum and to explore the therapeutic potential and future research opportunities of these
species. Materials and methods: All available information on C. songaricum and C. coccineum was collected via
electronic search (using PubMed, ACS, CNKI, Google Scholar, Baidu Scholar, and Web of Science). Results: The
ethnomedical uses of C. songaricum and C. coccineum in Saudi Arabia, China, Afghanistan, Mongolia, and Iran for
several types of ailments were recorded. A phytochemical investigation revealed the presence of flavonoids,
terpenoids, phloroglucinol adducts, saccharides, phenylpropanoids, steroids, organic acids, and other compounds.
The crude extracts and pure compounds from C. songaricum and C. coccineum exhibited a wide spectrum of in vitro
and in vivo pharmacological activity, including anti-fatigue, anti-hypoxia, anti-oxidation, anti-diabetic, immune
system modulating, and antiviral activity. Conclusions: Cynomorium species have emerged as a source of traditional
medicine. Many studies have provided evidence for the therapeutic efficacy of these species in treating various
conditions and possible mechanisms. However, further research is required for the development of new drugs and
therapies for the treatment of various diseases, especially cancer and diabetes. Therefore, this review on the
ethnopharmacology, phytochemistry, and toxicity of Cynomorium species will provide helpful data for further studies
and commercial exploitation of the species. 2013 Elsevier Ireland Ltd.
Ethnopharmacological relevance: The vast genus Rhododendron includes species that have been used in traditional
medicine for the treatment of inflammatory conditions, pain, gastro-intestinal disorders, common cold, asthma, skin
disease, etc. Rhododendrons are also well known for their toxicity and some species have been traditionally used as
poison. Aim of the review: The work reviews and analyses the traditional use, biological activities with the
corresponding chemical constituents, and toxicological data on Rhododendron species. The review aims at
characterizing the ethnopharmacology of the genus in relation to its toxicity in order to identify the therapeutic
potential of Rhododendron species and future directions for research. Methods: Data regarding Rhododendron spp.
was collected using electronic databases (SciFinder, PubMed, Google Scholar) and library search for selected peer-
reviewed articles. Plant taxonomy was validated by the databases The Plant List, Tropicos, eFloras, Flora Iberica and
Flora Europaea (RBGE). Additional information on traditional use and botany was obtained from published books.
The review encompasses literature, mainly regarding biological activity and toxicological data, from 1898 to the end
of December 2012. Results: Rhododendrons have been used in Asian, North American and European traditional
medicine mainly against inflammation, pain, skin ailments, common cold and gastro-intestinal disorders. In vivo and
in vitro testing of plant extracts and isolated compounds determined diverse biological activities including anti-
inflammatory, analgesic, anti-microbial, anti-diabetic, insecticidal and cytotoxic activity. Rhododendron spp. can
cause intoxications in humans following intake of rhododendron honey or medicinal preparations. The toxicity is due
to grayanotoxins, diterpenes which activate voltage-gated sodium channels and lead to gastro-intestinal, cardiac and
central nervous system symptoms. Conclusion: Rhododendron species are useful traditional remedies for the
treatment of inflammation, pain, skin ailments, common cold and gastro-intestinal disorders. Pharmacological data
has validated most indications of rhododendrons in ethnomedicine and toxicology studies have confirmed the
toxicity observed by traditional use. Ethnopharmacological data point to the therapeutic potential of the genus
Rhododendron for the treatment of inflammatory conditions and pain and, thus, research should focus on
identification of active compounds and related mechanistic studies. Prolonged and high dose intake of traditional
formulations containing rhododendrons should be avoided until more in depth toxicity studies become available.
2013 Elsevier Ireland Ltd.
This symposium will introduce AAGP conference attendees to helpful tools for finding useful clinical information on
the Web and the Internet. This session will cover tips for more efficient searching of the evidence-based medical and
geriatric literature. The symposium is open to all, and will be presented in a combination of demonstration and
presentation. Participants will be introduced to basic and advanced techniques for using MEDLINE via both PubMed
and Ovid, AgeLine and PsycInfo, as well as Google and Google Scholar. Special attention will be given to evaluating
retrieval for quality and clinical applicability, and to techniques for using full-text and open access resources. At the
conclusion of the symposium, participants will be able to decide when to use a specific version or feature of
MEDLINE, how to retrieve clinically significant articles, how to stay current with specific topics, and when to use and
not use a search engine. Note: this is a revision and expansion of a similar symposium presented at the 2007 AAGP
meeting in New Orleans.
Constipation is a common syndrome, afflicting millions - that has so far defied a definitive cure, causing millions of
physician visits per year, spending millions of dollars on over the counter medication, having economic consequences
to the community/ individuals and decreasing the quality of life. Hypothesis: Can a proper application of
wellness/lifestyle medicine decrease the risk of development of constipation, reverse the already establish
constipation and improve the quality of life? Methods: We investigated the public health problem with constipation
in 21st century. We reviewed the recent literature on constipation from the perspectives of epidemiology, statistics,
economic consequences, SES (social economic status), health literacy and education level, geographic area, gender,
eating behavior, physical activity, stress level, co-morbidities, medication use and basic principles of the nature. Two
reviewers performed reference search on Scholar Google and PubMed. Results: We developed a theoretical model
of constipation - the public health problem in the 21st century from the perspectives of risk factors, prevention,
treatment and application of wellness/lifestyle medicine (tab. 1). Conclusion: Constipation needs to be seen from
completely different perspectives. We propose a new wellness/lifestyle medicine approach for prevention and
treatment of constipation. It is necessary that health care providers will start to apply this approach into their
medical model of treatment. We also suggest that constipation should not be seen as an isolated symptom, but as a
first signal of potential biochemical imbalances in the body, which can lead to development of chronic diseases.
BACKGROUND: The authors reviewed and compared gingival retraction techniques used for implants and teeth.
TYPES OF STUDIES REVIEWED: The authors searched the literature using article databases Ovid MEDLINE up to May
2008, PubMED and Google Scholar (advanced search) and the following search terms: gingival retraction, implant
abutment, impressions, cement-retained implant restoration, impression coping, peri-implant tissue, emergence
profile and tissue conditioning. RESULTS: The authors found insufficient evidence relating to gingival displacement
techniques for impression making for implant dentistry. Gingival retraction techniques and materials are designed
primarily for peridental applications; the authors considered their relevance to peri-implant applications and
determined that further research and new product development are needed. CLINICAL IMPLICATIONS: The use of
injectable materials that form an expanding matrix to provide gingival retraction offers effective exposure of
preparation finish lines and is suitable for conventional impression-making methods or computer-aided
design/computer-aided manufacturing digital impressions in many situations. There are, however, limitations with
any retraction technique, including injectable matrices, for situations in which clinicians place deep implants.
Little attention has been focused on the most common risk factors for post-operative glenohumeral arthropathy in
patients undergoing open and arthroscopic stabilization. We performed a literature search using Medline, Cochrane
and Google Scholar using the keywords: 'Shoulder instability surgery' in combination with 'glenohumeral
osteoarthrosis', 'recurrent shoulder dislocation' in combination with 'surgery' and 'complications'. We identified 33
published studies. There is evidence of long-term postoperative glenohumeral arthropathy in patients undergoing
surgical management for shoulder instability. The Coleman methodology score showed great heterogeneity in terms
of study design, patient characteristics, management methods and outcome assessment and generally low
methodological quality. Follow-up length, age at first dislocation episode and limited external rotation have been
shown to be strongly associated with shoulder arthropathy. There is no univocal outcome assessment available. To
define the risk factors responsible for development of postoperative glenohumeral arthropathy, controversial
findings have been detected. A common validated scale for clinical and imaging measurements for shoulder
arthropathy is needed, so as to allow easier and more reliable comparison of outcomes in different studies. Patients
should receive controlled imaging assessment (MR and radiographs) in addition to clinical examination. There is a
need to perform appropriately powered randomized clinical trials comparing clinical and imaging related outcomes in
patients undergoing open, arthroscopic and conservative management for shoulder instability. Standard diagnostic
assessment, common and validated clinical and imaging scoring systems are needed. 2010 The Author.
Objectives: To assess prevalence of ultrasound use for point of care management through review of medical
publications from countries with high maternal mortality ratios (MMR). Materials: We performed a search for
medical articles published in the English language, after the year 2000, identified through 4 databases. PubMed,
Global Health, CINAHL and Google Scholar, databases were queried with search terms of ultrasound, obstetrics,
pregnancy, maternal services, extrauterine pregnancy, embryo implantation, pregnancy toxemia, eclampsia, and
pregnancy complications. The search terms were cross referenced with Africa, Asia, Latin America, and Caribbean to
identify published papers. The maternal mortality report (MMR) of 2005 authored by WHO, UNICEF, UNFPA and
World Bank was used to identify all countries with high MMR, arbitrarily defined as >100/100,000 live births. Only
clinical trials, case reports, and ultrasound utilization studies were considered. Methods: Papers were systematically
reviewed to identify country of origin, origin of investigators, how sonography was used for pregnancy management,
and an assessment of benefit or harm. Results: The search resulted in 513 articles. After exclusion 59 articles
remained. There were 25 countries represented in publications whose MMR ranged from 100-2100/100,000 live
births. The most common use of ultrasound was antenatal diagnosis in all trimesters, establishment of normative
data for fetal growth and cervical length, gestational age assessment/pregnancy dating, and fetal weight assessment.
Only 6 articles reported ultrasound influenced management. Conclusions: Although there is demonstrated use of
ultrasound in countries with high MMR indicating availability, there is minimal evidence of point of care ultrasound in
the management of the pregnant woman. Further studies are needed to determine if point of care sonography will
influence the maternal mortality ratios.
Objectives: Over a decade ago, the World Health Organization identified ultrasound as a low cost, portable
technology and advocated for widespread teaching and application. We evaluated the use of obstetric ultrasound in
countries with high maternal mortality ratios (MMR). We evaluated the use of obstetric ultrasound in countries with
high maternal mortality ratios (MMR). Materials: We performed a systematic review of the English language
literature through PubMed, Global Health, CINAHL (Nursing and Allied Health) and Google Scholar, databases. We
searched the terms "ultrasound", "obstetrics", "pregnancy", "maternal services", "extrauterine pregnancy", "embryo
implantation", "pregnancy toxemia", "eclampsia", and "pregnancy complications" to identify all published papers
from 2000-2011. These terms were cross referenced with "Africa, Asia, Latin America, and the Caribbean". The
maternal mortality report of 2005 from WHO, UNICEF, UNFPA and World Bank was used to identify all countries with
MMR of >100/100,000 live births. Methods: We systematically reviewed papers that described the use of obstetric
ultrasound. We categorized usage into groups based on maternal mortality reduction, prenatal diagnosis/anomaly
detection and ultrasound practice patterns. Results: We identified 85 articles meeting the search criteria. The most
commonly described obstetric categories included nomogram development, policy issues/social impact of
ultrasound, and anomaly detection (Table 1). When clinical environments were specified, 36 publications identified
hospital (60%), clinic/ community based (35%), or refugee camps (5%) as the setting for ultrasound evaluations.
Conclusions: Few studies in the world's literature address the use of obstetric ultrasound for maternal mortality
reduction. In countries with high MMRs, this work remains an important focus for investigation. (Table presente).
Introduction: Over a decade ago, the World Health Organization identified ultrasound as a low cost, portable
technology and advocated for widespread teaching and application. Outcome data related to the use of ultrasound,
however, is limited in low income countries. Objectives: We evaluated the global use of obstetric ultrasound for
management of hypertensive disorders in pregnancies in countries with high maternal mortality ratios (MMR).
Methods: We performed a systematic review of the English language literature through PubMed, Global Health,
CINAHL (Nursing and Allied Health) and Google Scholar, databases. We searched the terms ''ultrasound'',
''obstetrics'', ''pregnancy'', ''maternal services'', ''extrauterine pregnancy'', ''embryo implantation'', pregnancy
toxemia'', ''eclampsia'', and ''pregnancy complications'' to identify all published papers from 2000 to 2011. These
terms were cross referenced with ''Africa, Asia, Latin America, and the Caribbean''. The maternal mortality report of
2005 from WHO, UNICEF, UNFPA and World Bank was used to identify all countries with MMR of >=100/100,000 live
births. We systematically reviewed papers that described the use of obstetric ultrasound. We categorized usage into
groups based on maternal mortality reduction, prenatal diagnosis/anomaly detection and ultrasound practice
patterns. Results: We identified 85 articles meeting the search criteria. The most commonly described obstetric
categories included nomogram development, policy issues/social impact of ultrasound, and anomaly detection
(Table 1). Six (Table presented) papers in the literature described maternal/perinatal outcomes, however, none
described ultrasound use in the management of hypertensive diseases in pregnancy. Conclusion: Hypertensive
diseases in pregnancy remain leading causes of maternal mortality worldwide. Few studies in the world's literature
address the use of obstetric ultrasound for maternal and perinatal mortality reduction in high MMR regions. Further
research and publications are needed in this area.
Objectives: Severe viral hepatitis B is a disease associated with significant morbidity and mortality. Clinical controlled
trials show that the efficacy of treatment of severe viral hepatitis B with glucocorticoids remains debatable.
Therefore, we carried out this meta-analysis to evaluate the safety, efficacy, and side effects of glucocorticoid
therapy for severe viral hepatitis B. Methods: We searched PubMed, Medline, Embase, Cochrane Library, and Google
Scholar for randomized-controlled trials published before April 2012 in which glucocorticoid therapy was compared
with routine treatment for severe viral hepatitis B. The primary outcome was the survival rate of the two groups.
Results: We selected eight controlled clinical trials, which included 597 patients. We recorded a benefit of
glucocorticoid treatment on the survival rate of patients with severe viral hepatitis B (597 patients) [risk ratio
(RR)=1.188, 95% confidence interval (CI) 1.030-1.369, P=0.018]. The benefit was most noticeable in patients at the
stage of preliver failure (409 patients) (RR=1.275, 95% CI 1.077-1.510, P=0.005), whereas there was no efficacy for
patients with liver failure (188 patients) (RR=1.008, 95% CI 0.774-1.312, P=0.955). Glucocorticoid treatment was not
associated with the development of secondary infection and bleeding. Conclusion: Treatment with glucocorticoids
can significantly increase the survival rate of patients with severe hepatitis B. The benefit was most noticeable in
patients at the stage of preliver failure. However, the incidence of secondary infection and bleeding did not change
significantly. This finding suggests that prompt and timely glucocorticoid treatment is crucial. 2013 Wolters Kluwer
Health | Lippincott Williams & Wilkins.
OBJECTIVES: Severe viral hepatitis B is a disease associated with significant morbidity and mortality. Clinical
controlled trials show that the efficacy of treatment of severe viral hepatitis B with glucocorticoids remains
debatable. Therefore, we carried out this meta-analysis to evaluate the safety, efficacy, and side effects of
glucocorticoid therapy for severe viral hepatitis B., METHODS: We searched PubMed, Medline, Embase, Cochrane
Library, and Google Scholar for randomized-controlled trials published before April 2012 in which glucocorticoid
therapy was compared with routine treatment for severe viral hepatitis B. The primary outcome was the survival rate
of the two groups., RESULTS: We selected eight controlled clinical trials, which included 597 patients. We recorded a
benefit of glucocorticoid treatment on the survival rate of patients with severe viral hepatitis B (597 patients) [risk
ratio (RR)=1.188, 95% confidence interval (CI) 1.030-1.369, P=0.018]. The benefit was most noticeable in patients at
the stage of preliver failure (409 patients) (RR=1.275, 95% CI 1.077-1.510, P=0.005), whereas there was no efficacy
for patients with liver failure (188 patients) (RR=1.008, 95% CI 0.774-1.312, P=0.955). Glucocorticoid treatment was
not associated with the development of secondary infection and bleeding., CONCLUSION: Treatment with
glucocorticoids can significantly increase the survival rate of patients with severe hepatitis B. The benefit was most
noticeable in patients at the stage of preliver failure. However, the incidence of secondary infection and bleeding did
not change significantly. This finding suggests that prompt and timely glucocorticoid treatment is crucial.
There is growing evidence to support the association of gluteal muscle strength deficits in individuals with
patellofemoral pain syndrome (PFPS) and the effectiveness of gluteal strengthening when treating PFPS. In additiona,
an impressive body of work evaluating gluteal electromyography (EMG) has recently emerged, further supporting
the importance of gluteal muscle function in PFPS. This systematic review synthesises these EMG findings in order to
better understand the role of gluteal muscle activity in the aetiology, presentation and management of PFPS.
MEDLINE, EMBASE, CINAHL, Web of Knowledge and Google Scholar databases were searched in September 2011 for
prospective and case-control studies evaluating the association of gluteal EMG with PFPS. Two independent
reviewers assessed each paper for inclusion and quality. Means and SDs were extracted from each included study to
allow effect size calculations and comparison of results. Ten case-control, but no prospective studies were identified.
Moderate-to-strong evidence indicates gluteus medius (GMed) activity is delayed and of shorter duration during stair
negotiation in PFPS sufferers. In addition, limited evidence indicates GMed activity is delayed and of shorter duration
during running, and gluteus maximus (GMax) activity is increased during stair descent. Delayed and shorter duration
of GMed EMG may indicate impaired ability to control frontal and transverse plane hip motion. Further research
evaluating the value of gluteal muscle activity screening in identifying individuals most likely to develop PFPS, and
the effectiveness of interventions targeting changes to gluteal muscle activation patterns is needed.
To determine the clinical effectiveness of real time continuous glucose monitoring compared with self monitoring of
blood glucose in type 1 diabetes. Meta-analysis of randomised controlled trials. Cochrane database for randomised
controlled trials, Ovid Medline, Embase, Google Scholar, lists of papers supplied by manufacturers of continuous
glucose monitors, and cited literature in retrieved articles. Studies reviewed Randomised controlled trials of two or
more months' duration in men and non-pregnant women with type 1 diabetes that compared real time continuous
glucose monitoring with self monitoring of blood glucose and where insulin delivery was the same in both arms.
Analysis Two step meta-analysis of individual patient data with the primary outcome of final glycated haemoglobin
(HbA(1c)) percentage and area under the curve of hypoglycaemia (glucose concentration <3.9 mmol/L) during either
treatment, followed by one step metaregression exploring patient level determinants of HbA(1c) and hypoglycaemia.
Six trials were identified, consisting of 449 patients randomised to continuous glucose monitoring and 443 to self
monitoring of blood glucose. The overall mean difference in HbA(1c) for continuous glucose monitoring versus self
monitoring of blood glucose was -0.30% (95% confidence interval -0.43% to -0.17%) (-3.0, -4.3 to -1.7 mmol/mol). A
best fit regression model of determinants of final HbA(1c) showed that for every one day increase of sensor usage
per week the effect of continuous glucose monitoring versus self monitoring of blood glucose increased by 0.150%
(95% credibility interval -0.194% to -0.106%) (1.5, -1.9 to -1.1 mmol/mol) and every 1% (10 mmol/mol) increase in
baseline HbA(1c) increased the effect by 0.126% (-0.257% to 0.0007%) (1.3, -2.6 to 0.0 mmol/mol). The model
estimates that, for example, a patient using the sensor continuously would experience a reduction in HbA(1c) of
about 0.9% (9 mmol/mol) when the baseline HbA(1c) is 10% (86 mmol/mol). The overall reduction in area under the
curve of hypoglycaemia was -0.28 (-0.46 to -0.09), corresponding to a reduction in median exposure to
hypoglycaemia of 23% for continuous glucose monitoring compared with self monitoring of blood glucose. In a best
fit regression model, baseline area under the curve of hypoglycaemia was only weakly related to the effect of
continuous glucose monitoring compared with self monitoring of blood glucose on hypoglycaemia outcome, and
sensor usage was unrelated to hypoglycaemia at outcome. Continuous glucose monitoring was associated with a
significant reduction in HbA(1c) percentage, which was greatest in those with the highest HbA(1c) at baseline and
who most frequently used the sensors. Exposure to hypoglycaemia was also reduced during continuous glucose
monitoring. The most cost effective or appropriate use of continuous glucose monitoring is likely to be when
targeted at people with type 1 diabetes who have continued poor control during intensified insulin therapy and who
frequently use continuous glucose monitoring.
Background: Early diagnosis is crucial for management of patients with suspected acute myocardial infarction (AMI).
Among innovative and promising biomarkers, the recent interest raised on glycogen phosphorylase isoenzyme BB
(GPBB) has prompted us to perform a meta-analysis of published studies. Materials and methods: A systematic
electronic search was carried out on PubMed, Web of Science and Google Scholar, with no date restriction, to
retrieve all articles that have investigated the early diagnostic performance of GPBB in patients with suspected AMI,
and directly reported or allowed calculation of sensitivity and specificity. A meta-analysis of the reported sensitivity
and specificity of each study and pooled area under the curve (AUC) was then performed by random effect approach.
Heterogeneity was assessed by I-square statistics. Results: Eight studies were finally selected for analysis (941
subjects; 506 cases and 435 controls), with a high heterogeneity (I-squared, 86.3%). The resulting pooled estimates
and 95% confidence interval were 0.854 (0.801-0.891) for sensitivity, 0.767 (0.713-0.815) for specificity, 0.826 (0.774-
-0.870) for negative predictive value, 0.802 (0.754-0.844) for positive predictive value, and 0.754 (0.602-0.907) for
AUC. In those studies that have simultaneously assessed GPBB and a troponin immunoassay, the combination of
these biomarkers did not significantly improve the performance of troponin alone. Conclusion: GPBB does not meet
the current requirements for an efficient diagnosis of AMI when used as a stand-alone test, whereas its combination
with troponin merits further investigation in larger trials.
BACKGROUND: Gaucher disease (GD) is a highly heterogeneous disorder with multisystem involvement. Specific
therapeutic goals for each manifestation of type 1 GD (GD1) were established in 2004 by an international panel of
experts, to facilitate better management of GD1 patients. The goals were defined based on experience with enzyme
replacement therapy (ERT) using imiglucerase. Miglustat, a small iminosugar, is the only commercially available
substrate reduction therapy (SRT) for patients with GD1. Several clinical studies have demonstrated the beneficial
effects of miglustat on cardinal disease manifestations of GD1. OBJECTIVE: To review the currently available data on
miglustat, and provide guidance on the attainment of the GD therapeutic goals with miglustat therapy. METHODS: A
literature search identified publications on miglustat using MEDLINE, HighWire Press, and Google Scholar databases.
Articles were identified using the terms 'miglustat' and 'Gaucher disease type 1'. FINDINGS: Improvements in
hematological manifestations and organomegaly can be expected with miglustat therapy, with disease stabilization
achievable over the long term. Recent data suggest that miglustat can maintain stability in patients with mild to
moderate GD1 who have been previously treated with ERT. Miglustat may be beneficial with regards to bone
manifestations, with reduction in the incidence of patients reporting bone pain and improvements in bone mineral
density seen within the first 24 months of therapy. CONCLUSIONS: Several of the therapeutic goals for patients with
GD1 can be achieved with miglustat therapy. In select cases, miglustat can be considered an alternative to ERT for
the treatment of patients with GD1. Long-term experience with the use of miglustat will help define its overall safety
and efficacy; this information will be useful in determining the role of SRT using miglustat in the management of the
general adult GD1 patient population.
Searching on Internet looking for clinically relevant medical information, used as a clinical decision aid tool, for self-
learning or for research, is currently a common practice in Radiology. This task has been strengthened by the
technological environment where radiologists work with direct access to information sources from the Workstation.
The aim of this paper is to review the basic features of information searching tools in order to understand their
functions and to optimize medical information searching on Internet. Google, Google Scholar and PubMed are
reviewed as models for that purpose. 2012 SERAM. Publicado por Elsevier Espana, S.L. Todos los derechos
reservados.
The aim of this study is to review the features, benefits and limitations of the new scientific evaluation products
derived from Google Scholar, such as Google Scholar Metrics and Google Scholar Citations, as well as the h-index,
which is the standard bibliometric indicator adopted by these services. The study also outlines the potential of this
new database as a source for studies in Biomedicine, and compares the h-index obtained by the most relevant
journals and researchers in the field of intensive care medicine, based on data extracted from the Web of Science,
Scopus and Google Scholar. Results show that although the average h-index values in Google Scholar are almost 30%
higher than those obtained in Web of Science, and about 15% higher than those collected by Scopus, there are no
substantial changes in the rankings generated from one data source or the other. Despite some technical problems,
it is concluded that Google Scholar is a valid tool for researchers in Health Sciences, both for purposes of information
retrieval and for the computation of bibliometric indicators. 2012 Elsevier Espana, S.L. and SEMICYUC.
BACKGROUND: Google Scholar (GS) has been noted for its ability to search broadly for important references in the
literature. Gehanno et al. recently examined GS in their study: 'Is Google scholar enough to be used alone for
systematic reviews?' In this paper, we revisit this important question, and some of Gehanno et al.'s other findings in
evaluating the academic search engine., METHODS: The authors searched for a recent systematic review (SR) of
comparable size to run search tests similar to those in Gehanno et al. We selected Chou et al. (2013) contacting the
authors for a list of publications they found in their SR on social media in health. We queried GS for each of those
506 titles (in quotes ""), one by one. When GS failed to retrieve a paper, or produced too many results, we used the
allintitle: command to find papers with the same title., RESULTS: Google Scholar produced records for ~95% of the
papers cited by Chou et al. (n=476/506). A few of the 30 papers that were not in GS were later retrieved via PubMed
and even regular Google Search. But due to its different structure, we could not run searches in GS that were
originally performed by Chou et al. in PubMed, Web of Science, Scopus and PsycINFO. Identifying 506 papers in GS
was an inefficient process, especially for papers using similar search terms., CONCLUSIONS: Has Google Scholar
improved enough to be used alone in searching for systematic reviews? No. GS' constantly-changing content,
algorithms and database structure make it a poor choice for systematic reviews. Looking for papers when you know
their titles is a far different issue from discovering them initially. Further research is needed to determine when and
how (and for what purposes) GS can be used alone. Google should provide details about GS' database coverage and
improve its interface (e.g., with semantic search filters, stored searching, etc.). Perhaps then it will be an appropriate
choice for systematic reviews.
background: Google Scholar linked more visitors to biomedical journal Web sites than did PubMed after the
database's initial release; however, its usefulness in locating primary literature articles is unknown. objective: To
assess in both databases the availability of primary literature target articles; total number of citations: availability of
free, full-text journal articles; and number of primary literature target articles retrieved by year within the first 100
citations of the search results. methods: Drug information question reviews published in The Annals of
Pharmacotherapy Drug Information Rounds column served as targets to determine the retrieval ability of Google
Scholar and PubMed searches. Reviews printed in this column from January 2006 to June 2007 were eligible for
study inclusion. Articles were chosen if at least 2 key words of the printed article were included in the PubMed
Medical Subject Heading (MeSH) database, and these terms were searched in both databases. results: Twenty-two of
33 (67%) eligible Drug Information Rounds articles met the inclusion criteria. The median number of primary
literature articles used in each of these articles was 6.5 (IQR 4.8, 8.3; mean +/- SD 8 +/- 5.4). No significant
differences were found for the mean number of target primary literature articles located within the first 100
citations in Google Scholar and PubMed searches (5.1 +/- 3.9 vs 5.3 +/- 3.3; p = 0.868). Google Scholar searches
located more total results than PubMed (2211.6 +/- 3999.5 vs 44.2 +/- 47.4; p = 0.019). The availability of free, full-
text journal articles per Drug Information Rounds article was similar between the databases (1.8 +/- 1.7 vs 2.3 +/-
1.7; p = 0.325). More primary literature articles published prior to 2000 were located with Google Scholar searches
compared with PubMed (62.8% vs 34.9%; p = 0.017); however, no statistically significant differences between the
databases were observed for articles published after 2000 (66.4 vs 77.1 ; p = 0.074). conclusions: No significant
differences were identified in the number of target primary literature articles located between databases. PubMed
searches yielded fewer total citations than Google Scholar results; however, PubMed appears to be more specific
than Google Scholar for locating relevant primary literature articles.
Background: Gossypiboma is a term used to describe a retained surgical swab in the body after a surgical procedure.
Gossypiboma is a rare surgical complication, but can cause significant morbidity and mortality. It may be a diagnostic
dilemma with associated medico-legal implications, and is usually discovered during the first few days after surgery;
however, it may remain undetected for many years. Methods: We present a gossypiboma case immigrating to small
intestine, as well as a literature review of studies published in the English language on intraluminal migration of
gossypiboma, accessed through PubMed and Google Scholar databases. Results: Case of a 51-year-old man who was
admitted due to vomiting, abdominal distension, and pain. He had a history of abdominal trauma 8 years previously,
and surgery had been performed at another hospital. The physical examination revealed muscular guarding and
rebound tenderness in the right lower quadrant. A splenic hydatid cyst and ileal calcified mass were suspected based
on results of abdominal computed tomography. Therefore, a laparotomy was performed. Segmental ileal resection,
end-to-end anastomosis, and splenectomy were performed. The final diagnosis was gossypiboma in both the spleen
and ileum. We performed a systemic review of the English-language literature between 2000 and 2010 in PubMed
and Google Scholar, and we found 45 cases of transmural migration of surgical sponges following abdominal surgery.
Three cases in which the gossypiboma was located in the spleen are also discussed. Conclusion: Gossypiboma should
be considered as a differential diagnosis of any postoperative patient who presents with pain, infection, or a palpable
mass. 2011 The Society for Surgery of the Alimentary Tract.
BACKGROUND: Gossypiboma is a term used to describe a retained surgical swab in the body after a surgical
procedure. Gossypiboma is a rare surgical complication, but can cause significant morbidity and mortality. It may be
a diagnostic dilemma with associated medico-legal implications, and is usually discovered during the first few days
after surgery; however, it may remain undetected for many years., METHODS: We present a gossypiboma case
immigrating to small intestine, as well as a literature review of studies published in the English language on
intraluminal migration of gossypiboma, accessed through PubMed and Google Scholar databases., RESULTS: Case of
a 51-year-old man who was admitted due to vomiting, abdominal distension, and pain. He had a history of abdominal
trauma 8years previously, and surgery had been performed at another hospital. The physical examination revealed
muscular guarding and rebound tenderness in the right lower quadrant. A splenic hydatid cyst and ileal calcified mass
were suspected based on results of abdominal computed tomography. Therefore, a laparotomy was performed.
Segmental ileal resection, end-to-end anastomosis, and splenectomy were performed. The final diagnosis was
gossypiboma in both the spleen and ileum. We performed a systemic review of the English-language literature
between 2000 and 2010 in PubMed and Google Scholar, and we found 45 cases of transmural migration of surgical
sponges following abdominal surgery. Three cases in which the gossypiboma was located in the spleen are also
discussed., CONCLUSION: Gossypiboma should be considered as a differential diagnosis of any postoperative patient
who presents with pain, infection, or a palpable mass.
Aim: To determine the factors affecting mortality in patients who developed graft-versus-host disease (GvHD) after
liver transplantation (LT). Methods: We performed a review of studies of GvHD following LT published in the English
literature and accessed the PubMed, Medline, EBSCO, EMBASE, and Google Scholar databases. Using relevant search
phrases, 88 articles were identified. Of these, 61 articles containing most of the study parameters were considered
eligible for the study. Risk factors were first examined using a univariate Kaplan-Meier model, and variables with a
significant association (P < 0.05) were then subjected to multivariate analyses using a Cox proportional-hazards
model. Results: The 61 articles reported 87 patients, 58 male and 29 female, mean age, 40.4 +/- 15.5 years (range: 8
mo to 74 years), who met the inclusion criteria for the present study. Deaths occurred in 59 (67.8%) patients,
whereas 28 (32.2%) survived after a mean follow-up period of 280.8 +/- 316.2 d (range: 27-2285 d). Among the most
frequent symptoms were rash (94.2%), fever (66.6%), diarrhea (54%), and pancytopenia (54%). The average time
period between LT and first symptom onset was 60.6 +/- 190.1 d (range: 2-1865 d). The Kaplan-Meier analysis
revealed that pancytopenia (42.8% vs 59.3%, P = 0.03), diarrhea (39.2% vs 61.0%, P = 0.04), age difference between
the recipient and the donor (14.6 +/- 3.1 years vs 22.6 +/- 2.7 years, P < 0.0001), and time from first symptom
occurrence to diagnosis or treatment (13.3 +/- 2.6 mo vs 15.0 +/- 2.3 mo, P < 0.0001) were significant factors
affecting mortality, whereas age, sex, presence of rash and fever, use of immunosuppressive agents, acute rejection
before GvHD, etiological causes, time of onset, and donor type were not associated with mortality risk. The Cox
proportional-hazards model, determined that an age difference between the recipient and donor was an
independent risk factor (P = 0.03; hazard ratio, 7.395, 95% confidence interval, 1.2-46.7). Conclusion: This study
showed that an age difference between the recipient and donor is an independent risk factor for mortality in
patients who develop GvHD after LT. 2012 Baishideng. All rights reserved.
Purpose: The purpose of this study was to determine the factors affecting on mortality in patient who developed
graft-versus-host disease (GvHD) after liver transplantation(LT). Methods: We performed a review studies about
GvHD following LT published in the English literature and accessed via the PubMed and Google Scholar databases.
The key words used were GvHD, GvHD after LT, GvHD following LT, and GvHD and solid organ transplantation. The
search covered all articles from 1988 to 2011. Results: Sixty-one articles reporting on 87 patients, 58 of whom were
male and 29 female, with ages ranging from 8 months to 74 years (mean, 40.4 +/- 15.5 years), met the inclusion
criteria for the present study. Mortality occurred in 59 (67.8%) cases, leaving 28 patients (32.2%) who completed the
studies. Among the most frequent symptoms were rash (94.2%), fever (66.6%), diarrhea (54%), and pancytopenia
(54%). The average time period that elapsed between LT and first symptom onset was 60.6 +/- 190.1 days (range, 2-
1830 days), and time from the first symptom occurrence to diagnosis or treatment varied from 1 to 65 days (mean,
14.3 +/- 14.3 days). A Kaplan-Meier analysis to determine the factors affecting mortality in patients revealed that
pancytopenia (p = 0.03), diarrhea (p = 0.04), age difference between the recipient and the donor (p < 0.0001), time
period between onset of symptoms and establishing the diagnosis (p < 0.0001) were significant factors, whereas age,
gender, presence of rash and fever, use of immunosuppressive agents, acute rejection before GVHD, etiological
causes, time of onset (POD), and donor type were not associated with the risk for mortality. A further risk analysis
was performed utilizing a multivariate Cox proportional hazards model to ascertain whether those risk factors
specified by the univariate analysis were also independent risk factors. The results showed that age difference
between the recipients and donors was an independent risk factor (p = 0.03; hazard ratio, 7.395; 95% confidence
interval, 1.2-46.7). Conclusion: GvHD is a rare and the mortality is still very high. Skin lesions and clinical features
represent an important tool for early diagnosis. Further research is needed to clarify the pathogenesis of GvHD and
to provide new therapeutic agents for treating this condition effectively.
Gastric cancer (GC) is one of the leading causes of cancer death in the world. Numerous efforts are being made to
find chemoprotective agents able to reduce its risk. Amongst these, green tea has been reported to have a protective
effect against stomach cancer. This article aims to critically evaluate all epidemiologi-cal studies reporting an
association between green tea consumption and GC risk. MEDLINE, EBSCOHOST and Google Scholar were used to
search for clinical trials of green tea and its correlation to stomach cancer. Studies include cohort and case-control
studies. Outcome of interests are inverse association, no association, and positive association. Seventeen
epidemiologic studies were reviewed. Eleven studies were conducted in Japan, five in China, and one with Japanese
descendent in Hawaii. Ten case-control studies and seven cohort studies were included. The relative risks or odds
ratio of GC for the highest level of green tea consumption was compared. Seven studies suggested no association,
eight an inverse association, and one a positive association. One study had shown a significantly lowered GC risk
when tea was served warm to cold. Another study also showed a significantly risk with lukewarm tea. All studies that
analyzed men and women separately have suggested a reduced risk in women than in men, albeit no significant
difference. This review demonstrates that there is insufficient information to support green tea consumption
reduces the risk of GC. More studies on the subject matter are warranted. 2013 Baishideng. All rights reserved.
Objective: The subject of religion and spirituality has attracted little attention in psychiatric research so far. The aim
of the study was to give an overview of the attitudes of patients as well as psychiatrists towards regarding the
importance of religion and spirituality in the treatment of mental illness. Furthermore we tried to give a description
of established ideas involving both dimensions into the treatment of psychiatric patients. Methods: We performed a
search for relevant literature using the electronic databases Medline, PubMed, Psyndex and Embase. In addition we
used the internet search engines Scopus and Google Scholar. Results: Patients mention religion twice as often as an
important factor in their lives as compared to psychiatrists. Consecutively, particular emphasis should be paid to the
integration of both dimensions into clinical treatment. Additionally, the education of mental health professionals,
consultation and the enrolment of religious or spiritual needs of patients when taking their medical history are
essential factors. Religious coping and positive and negative components in matters of mental health are highlighted.
Conclusions: More attention should be paid to the "religiosity gap" between patients and their psychiatrists. The
entirety of a human being includes a physical, emotional, social as well as a spiritual dimension. Mental health
professionals ignoring one of these aspects may delay recovery. 2007 Dustri-Verlag Dr. Karl Feistle.
OBJECTIVE: The subject of religion and spirituality has attracted little attention in psychiatric research so far. The aim
of the study was to give an overview of the attitudes of patients as well as psychiatrists towards regarding the
importance of religion and spirituality in the treatment of mental illness. Furthermore we tried to give a description
of established ideas involving both dimensions into the treatment of psychiatric patients., METHODS: We performed
a search for relevant literature using the electronic databases Medline, PubMed, Psyndex and Embase. In addition
we used the internet search engines Scopus and Google Scholar., RESULTS: Patients mention religion twice as often
as an important factor in their lives as compared to psychiatrists. Consecutively, particular emphasis should be paid
to the integration of both dimensions into clinical treatment. Additionally, the education of mental health
professionals, consultation and the enrollment of religious or spiritual needs of patients when taking their medical
history are essential factors. Religious coping and positive and negative components in matters of mental health are
highlighted., CONCLUSIONS: More attention should be paid to the "religiosity gap" between patients and their
psychiatrists. The entirety of a human being includes a physical, emotional, social as well as a spiritual dimension.
Mental health professionals ignoring one of these aspects may delay recovery.
Background: Growth factors are proteins secreted by a number of cell types that are capable of modulating cellular
growth, proliferation and cellular differentiation. It is well accepted that uterine cellular events such as proliferation
and differentiation are regulated by sex steroids and their actions in target tissues are mediated by local production
of growth factors acting through paracrine and/or autocrine mechanisms. Myometrial mass is ultimately modified in
pregnancy as well as in tumour conditions such as leiomyoma and leiomyosarcoma. Leiomyomas, also known as
fibroids, are benign tumours of the uterus, considered to be one of the most frequent causes of infertility in
reproductive years in women. Methods: For this review, we searched the database MEDLINE and Google Scholar for
articles with content related to growth factors acting on myometrium; the findings are hereby reviewed and
discussed. RESULTS: Different growth factors such as epidermal growth factor (EGF), transforming growth factor-
alpha (TGF-alpha), heparin-binding EGF (HB-EGF), acidic fibroblast growth factor (aFGF), basic fibroblast growth
factor (bFGF), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), platelet-derived growth
factor (PDGF) and TGF-beta perform actions in myometrium and in leiomyomas. In addition to these growth factors,
activin and myostatin have been recently identified in myometrium and leiomyoma. Conclusions: Growth factors play
an important role in the mechanisms involved in myometrial patho-physiology. The Author 2011. Published by
reserved.
BACKGROUND: HIV-associated lipodystrophy is a disorder of fat metabolism that occurs in patients with HIV
infection. It can cause metabolic derangements and negative self-perceptions of body image, and result in
noncompliance with highly active antiretroviral therapy (HAART). Growth hormone (GH) axis drugs have been
evaluated for treatment of this disorder, but no systematic review has been conducted previously., OBJECTIVES: The
aim of the review was to compare the effects of GH axis drugs vs. placebo in changing visceral adipose tissue (VAT),
subcutaneous adipose tissue (SAT) and lean body mass (LBM) in patients with HIV-associated lipodystrophy., SEARCH
METHODS: We searched MEDLINE (1996-2009), CENTRAL (Issue 4, 2009), Web of Science, Summons, Google Scholar,
the Food and Drug Administration (FDA) website, and Clinicaltrials.gov from 13 October 2009 to 7 June 2010. We
excluded newspaper articles and book reviews from the Summons search; this was the only search limitation
applied. We also manually reviewed references of included articles., SELECTION CRITERIA: Inclusion criteria were as
follows: randomized placebo-controlled trial (RCT); study participants with HIV-associated lipodystrophy;
intervention consisting of GH, growth hormone releasing hormone (GHRH), tesamorelin or insulin-like growth factor-
1 (IGF-1); study including at least one primary outcome of interest: change in VAT, SAT or LBM., DATA COLLECTION
AND ANALYSIS: Two independent reviewers extracted data and assessed study quality using a standardized form.
The authors of one study were contacted for missing information. The main effect was calculated as a summary of
the mean differences in VAT, SAT and LBM between the intervention and placebo groups in the included studies.
Subgroup analyses were performed to assess different GH axis drug classes., RESULTS: Ten RCTs including 1511
patients were included in the review. All had a low risk of bias and passed the test of heterogeneity for each primary
outcome. Compared with placebo, GH axis treatments decreased VAT [weighted mean difference (WMD) -
25.20cm(2) ; 95% confidence interval (CI) -32.18 to -18.22cm(2) ; P<0.001] and increased LBM (WMD 1.31kg; 95% CI
1.00 to 1.61kg; P<0.001], but had no significant effect on SAT mass (WMD -3.94cm(2) ; 95% CI -10.88 to 3.00cm(2) ;
P=0.27]. Subgroup analyses showed that GH had the most significant effects on VAT and SAT, but none on LBM. The
drugs were well tolerated but statistically significant side effects included arthralgias and oedema., CONCLUSIONS:
Our review indicates that, based on the findings of the 10 included studies, GH axis treatments are effective in
reducing VAT and increasing LBM in patients with HIV-associated lipodystrophy. However, clinicians must decide
whether the attributed benefits are clinically significant, considering the costs and potential risks of GH axis
treatments. A limitation of this study is the small number of studies available of each GH axis drug class. 2011 British
HIV Association.
Background: HIV-associated lipodystrophy is a disorder of fat metabolism that occurs in patients with HIV infection. It
can cause metabolic derangements and negative self-perceptions of body image, and result in noncompliance with
highly active antiretroviral therapy (HAART). Growth hormone (GH) axis drugs have been evaluated for treatment of
this disorder, but no systematic review has been conducted previously. Objectives: The aim of the review was to
compare the effects of GH axis drugs vs. placebo in changing visceral adipose tissue (VAT), subcutaneous adipose
tissue (SAT) and lean body mass (LBM) in patients with HIV-associated lipodystrophy. Search methods: We searched
MEDLINE (1996-2009), CENTRAL (Issue 4, 2009), Web of Science, Summons, Google Scholar, the Food and Drug
Administration (FDA) website, and Clinicaltrials.gov from 13 October 2009 to 7 June 2010. We excluded newspaper
articles and book reviews from the Summons search; this was the only search limitation applied. We also manually
reviewed references of included articles. Selection criteria: Inclusion criteria were as follows: randomized placebo-
controlled trial (RCT); study participants with HIV-associated lipodystrophy; intervention consisting of GH, growth
hormone releasing hormone (GHRH), tesamorelin or insulin-like growth factor-1 (IGF-1); study including at least one
primary outcome of interest: change in VAT, SAT or LBM. Data collection and analysis: Two independent reviewers
extracted data and assessed study quality using a standardized form. The authors of one study were contacted for
missing information. The main effect was calculated as a summary of the mean differences in VAT, SAT and LBM
between the intervention and placebo groups in the included studies. Subgroup analyses were performed to assess
different GH axis drug classes. Results: Ten RCTs including 1511 patients were included in the review. All had a low
risk of bias and passed the test of heterogeneity for each primary outcome. Compared with placebo, GH axis
treatments decreased VAT [weighted mean difference (WMD) -25.20cm2; 95% confidence interval (CI) -32.18 to -
18.22cm2; P<0.001] and increased LBM (WMD 1.31kg; 95% CI 1.00 to 1.61kg; P<0.001], but had no significant effect
on SAT mass (WMD -3.94cm2; 95% CI -10.88 to 3.00cm2; P=0.27]. Subgroup analyses showed that GH had the most
significant effects on VAT and SAT, but none on LBM. The drugs were well tolerated but statistically significant side
effects included arthralgias and oedema. Conclusions: Our review indicates that, based on the findings of the 10
included studies, GH axis treatments are effective in reducing VAT and increasing LBM in patients with HIV-
associated lipodystrophy. However, clinicians must decide whether the attributed benefits are clinically significant,
considering the costs and potential risks of GH axis treatments. A limitation of this study is the small number of
studies available of each GH axis drug class. 2011 British HIV Association.
Background: The use of simulation-based medical education (SBME) has become widespread in emergency medicine.
Some specialties now mandate the use of SBME for graduate medical education and for maintenance of certification.
However, there are few opportunities available for medical educators to receive specialized training and credentials
in SBME. Although post-graduate programs in simulation have been developed, information about programs can be
difficult to find. Objectives: The goal of this research is to identify, catalog, and describe available medical simulation
fellowship programs in the United States and Canada. Methods: Data were collected from June 2011-November
2012. Programs were identified through literature search (Google Scholar, PubMed, and Ovid), review of relevant
professional society websites (Society of Academic Emergency Medicine, American Society of Anesthesiologists, and
Society for Simulation in Healthcare), and through the Google search engine. Up to 100 responses per query were
included. Program information was collected through review of program websites and by e-mail and phone contact
with program directors. Results: We identified 32 programs offering training programs in medical simulation. We
were unable to obtain complete information on six programs due to a lack of response. Of the 26 programs (81%
response rate) for which we were able to obtain complete information, 18 programs require the candidate to hold an
MD degree or equivalent, while two are open only to registered nurses. The remaining six programs are open to a
wide range of health care professionals. Of those programs that are open only to physicians, 11 programs require or
prefer the candidate to have completed a residency in EM, two require or prefer anesthesiology, and one program
requires surgical training. Four programs are two years in duration, nine are one year, and 13 are flexible. Four
programs require completion of a concurrent degree, while 14 programs offer an optional master's degree.
Conclusion: This comprehensive list of post-graduate programs will be useful for health care providers seeking
further training in SBME as well as those seeking to develop a simulation fellowship. Further inquiry is necessary to
determine which aspects of these programs contribute to successful outcomes and whether more standardization
would benefit training in SBME.
Purpose: The nomenclature in clinical nutrition differs locally, between (para)medical disciplines, nationally and
internationally. The inconsistencies hamper public, professional and scientific discussions. The main aim was to work
out German consensus definitions for pertinent terms in clinical nutrition to unify their use in all chapters of the 2013
guideline update "Clinical Nutritiono" of the German Society of Nutritional Medicine (DGEM). It should facilitate
correct interpretation of recommendations. Methods: The definitions were developed based on national and
international hard print technical literature (medical dictionaries, text books for clinical nutrition, national and
international guidelines) and online research (PubMed, Embase, CINAHL, Google Scholar, Internet in general).
National and international consensus definitions were preferentially treated. Results: In total 46 definitions were
developed and organised in five categories: 1. General definitions (clinical nutrition, medical nutrition, care catering,
dietetics, nutritional support, nutrition support team, obesity team, nutrition steering committee, malnutrition
screening, nutritional assessment), 2. Nutritional status (disease-related malnutrition, cachexia, sarcopenia, specific
nutrient deficiencies, refeeding syndrome), 3. Interventions (nutritional care, nutrition, diet, regular diet, fortified
food, artificial nutrition, oral nutritional supplementation, enteral nutrition = tube feeding, parenteral nutrition,
dietary advice, nutritional intervention/therapy, nutritional support therapy, nutrition intervention/therapy plan), 4.
Products/techniques for oral nutritional supplementation and enteral nutrition (tube feeding techniques, oral
nutritional supplements and enteral formulae, nutritionally complete formulae, nutritionally incomplete formulae,
whole protein formulae, peptide-based formulae, elemental formulae, standard formulae, disease specific formulae),
5. Products/techniques for parenteral nutrition (parenteral techniques, total parenteral nutrition, partial parenteral
nutrition, home parenteral nutrition, total nutrient admixture, multi-chamber systems, multi bottle systems).
Conclusion: For the first time, a comprehensive, science-based terminology for clinical nutrition was created, which is
to support the communication among experts and formulating guidelines. Georg Thieme Verlag KG Stuttgart New
York.
Purpose: Quality photographs are essential for clinical documentation, research, and publication in scientific journals
and teaching. Oftentimes, non-ideal lighting and a sterile environment restrict the medical photographer, resulting in
lower-quality photographs. This article aims to provide a clear and comprehensible guideline for medical
photography in an orthopaedic setting. Methods: This article is based on extensive photographic involvement in
operating and laboratory settings, in close collaboration with medical professionals from the Steadman Clinic (Vail,
Colorado, USA), Gothenburg University (Goteborg, Sweden) and Erasmus MC (Rotterdam, the Netherlands).
Background literature was searched through Google Scholar and PubMed. Results: Three relevant journal articles,
and one book on medical photography, were used to write this paper. Seventeen Internet articles were used for
background information. Conclusion: A relevant, up-to-date and comprehensive guideline to medical photography
for medical professionals, with or without photographic experience, is provided. Level of evidence: Expert opinion,
Level V. 2012 Springer-Verlag.
BACKGROUND: Several tooth whiteners are available on the market, and the ideal choice should be determined by
efficacy and optimal clinical results., OBJECTIVES: The purpose of this study was to compare the reported clinical
success rates of different tooth whitening products., SEARCH STRATEGY: The relevant literature (1998 - 2011) was
studied, using as sources the databases: Google Scholar, Science Direct, Medline and Pubmed. Selection criteria: The
material was clearly identified, the manufacturers' instructions were respected and the sample size stated., RESULTS
AND CONCLUSIONS: This descriptive report on 49 papers focuses on the total colour change, measured with a
calibrated shade guide and also numerically (colourimeter, chromameter or spectrophotometer), the relapse of the
colour change and tooth sensitivity. In general, the dentist-supervised at-home bleaching and the in-office treatment
gave approximately the same initial percentage improvement of tooth whitening. However, the relapse after a four
week or longer period was significantly higher for the in-office treatment. The treatment of choice should be a
dentist supervised at-home bleaching product which generally contains approximately 10% carbamide peroxide
applied over about 14 days for about eight hours per night. Tooth sensitivity should not be a general problem
although some subjects might choose to discontinue treatment as a result of sensitivity.
A delay in the diagnosis of paediatric acute and subacute haematogenous osteomyelitis can lead to potentially
devastating morbidity. There are no definitive guidelines for diagnosis, and recommendations in the literature are
generally based on expert opinions, case series and cohort studies. All articles in the English literature on paediatric
osteomyelitis were searched using MEDLINE, CINAHL, EMBASE, Google Scholar, the Cochrane Library and reference
lists. A total of 1854 papers were identified, 132 of which were examined in detail. All aspects of osteomyelitis were
investigated in order to formulate recommendations. On admission 40% of children are afebrile. The tibia and femur
are the most commonly affected long bones. Clinical examination, blood and radiological tests are only reliable for
diagnosis in combination. Staphylococcus aureus is the most common organism detected, but isolation of Kingella
kingae is increasing. Antibiotic treatment is usually sufficient to eradicate the infection, with a short course
intravenously and early conversion to oral treatment. Surgery is indicated only in specific situations. Most studies
were retrospective and there is a need for large, multicentre, randomised, controlled trials to define protocols for
diagnosis and treatment. Meanwhile, evidencebased algorithms are suggested for accurate and early diagnosis and
effective treatment 2012 British Editorial Society of Bone and Joint Surgery.
A delay in the diagnosis of paediatric acute and subacute haematogenous osteomyelitis can lead to potentially
devastating morbidity. There are no definitive guidelines for diagnosis, and recommendations in the literature are
generally based on expert opinions, case series and cohort studies. All articles in the English literature on paediatric
osteomyelitis were searched using MEDLINE, CINAHL, EMBASE, Google Scholar, the Cochrane Library and reference
lists. A total of 1854 papers were identified, 132 of which were examined in detail. All aspects of osteomyelitis were
investigated in order to formulate recommendations. On admission 40% of children are afebrile. The tibia and femur
are the most commonly affected long bones. Clinical examination, blood and radiological tests are only reliable for
diagnosis in combination. Staphylococcus aureus is the most common organism detected, but isolation of Kingella
kingae is increasing. Antibiotic treatment is usually sufficient to eradicate the infection, with a short course
intravenously and early conversion to oral treatment. Surgery is indicated only in specific situations. Most studies
were retrospective and there is a need for large, multicentre, randomised, controlled trials to define protocols for
diagnosis and treatment. Meanwhile, evidence-based algorithms are suggested for accurate and early diagnosis and
effective treatment.
Introduction: Presented here is a case encountered in clinical practice of haemobilia arising due to intrahepatic
pseudoaneurysm formation at the site of radiofrequency ablation. Subsequently, a review of the literature
surrounding haemobilia and pseudoaneurysms following RFA is discussed. Methods: The case was reviewed by
retrospective analysis of the hospital notes, laboratory results, radiology images and reports, and procedural reports.
The case was then discussed with the primary clinicians involved in the patient's care. The literature review was
conducted using database searches of Pubmed, Embase, Medline and Google Scholar and through searching
references of articles deemed to be significant. Results: The published literature on haemobilia following RFA
consists mainly of a retrospective analysis of a single institution's experience. This concludes haemobilia to be a rare
(0.3%) and minor complication occurring in the early post procedural period (days 1-4) which is self limiting. In
contrast, scattered case reports (including the one presented here) have noted haemobilia to be a presenting
symptom of a bleeding intrahepatic pseudoaneurysm, a serious and potentially fatal condition requiring urgent
intervention. Our case also describes this event occurring later in the post operative course and in the context of
intercurrent sepsis. Summary: Although rare, haemobilia can be a life threatening complication following RFA and
suspicion for pseudoaneurysm formation is warranted in those patients presenting with symptomatic malaena post
procedure.
Background: Immunosuppressive therapy constitutes the backbone of therapy in inflammatory bowel diseases. The
major therapy-induced adverse events are represented by the potential development of malignancies, demyelinating
disorders, and infections. These latter complications may be complicated further by the life-threatening HLH
syndrome. Methods: We reviewed the literature over the past 30 years (medline, unbound medline, Google Scholar,
and within reviews) with the following search terms: haemophagocytic lymphohistiocytic syndrome, HLH,
macrophage activation syndrome, opportunistic infections, adverse events, thiopurines, biologic therapies. Results:
We identified 35 cases of HLH syndrome in patients with IBD. Nine cases were described until 2006, the following 24
in the past 5 years (fifteen cases in the first 9 months of 2011), pointing to an increased awareness of
gastroenterologists. Mortality was 8/35 (23%) (compared to HSTCL: 36 cases, mortality over 90%). There was no
preponderance of any gender (15 female, 14 male, 6 undefined) and 74% were adults (aged from 19 to 76 years). CD
represented 83% of the underlying bowel disease of the whole series, but 100% of the 9 pediatric cases. Treatment
with thiopurines was reported in 28/35 patients with a duration that ranged from 6 months to 8 years. In 8/28
patients thiopurines have been associated with infliximab and triple immunosuppression (with steroids) in 2 of them.
Isolated reports indicated salazopyrin (1 case), steroids (2 cases), steroids + Infliximab (1 case), steroids +
azathioprine (1 case) and steroids + colectomy (1 case) as underlying therapy for IBD. In one report the underlying
treatment was not indicated. As etiologic agent precipitating HLH, CMV was identified in 17 patients and EBV in 11
patients. Isolated cases were associated with histoplasmosis, tuberculosis, or with Acinetobacter sepsis. In 3 cases
the triggering agent was not identified or not reported. 6-TGN levels and 6-MMP metabolites, when measured, were
found within the normal range. Conclusions: HLH syndrome represents a severe complication of infections with a
high mortality in immunocompromised IBD patients. The preponderance in CD is not clear but may reflect the larger
use of immunosuppressors in CD, although genetic reasons cannot be ruled out. Where caused by thiopurines it
appears unrelated to abnormal metabolite levels. Regular control of blood parameters cannot prevent this
complication.
Purpose: To establish guidelines for contact lens wearers' hand hygiene practices which achieve a balance between
minimising risk of infection and reasonable expectations on the ability of patients to follow them. Methods: Evidence
has been obtained from publications via PubMed, Advanced Medline Search, Cochrane Reviews, Google Scholar and
using the key words hand hygiene, washing and contact lens. Results: Guidelines for effective hand washing and the
bother involved vary according to the level of hygiene required. High levels of non-compliance with hand hygiene
practices, even among healthcare workers, gives an indication of how important the level of bother involved when
following guidelines can be in contributing to non-compliance. Conclusions: Better patient education to improve
hand washing techniques as well as patient attitudes toward hand hygiene are needed to reduce high non-
compliance levels. Better hand hygiene techniques and higher frequency of their application give the prospect of
reduced risk of infection and of any discomfort that arises from increased lens and ocular bioburden. In order that
adoption rates might be maximised, the guidelines which have been distilled from this review attempt to strike a
balance between technique redundancy and the associated higher levels of hygiene achieved and the possibility that
the perception of too much bother involved could reduce participation rates. The guidelines have been expanded by
the inclusion of suggested explanatory information in the expectation that helping patients to understand why the
recommendations are made will have the effect of increasing their adoption. 2011 British Contact Lens Association.
Objective To assess the effectiveness and safety of hand-suture vs. stapling anastomosis in esophagogastrostomy.
Methods The following databases such as CBM (1978 to February 2012), VIP (1989 to February 2012), CNKI (1994 to
February 2012), WanFang Data (1980 to February 2012), The Cochrane Library, PubMed (1966 to February 2012),
EMbase (1974 to February 2012), and relevant webs of clinical trials were searched to collect the randomized
controlled trials (RCTs) and quasi-RCTs about hand-suture vs. stapling anastomosis in the incidence of anastomotic
leakage following esophagogastrostomy. Moreover, relevant references and grey literature were retrieved on web
engines including Google Scholar and Medical Martix, and the Chinese periodicals e.g. Chinese Journal of Oncology
were also handsearched. According to the inclusion and exclusion criteria, the literature, was screened, the data
were extracted, and the quality of the included studies was assessed. Then meta-analysis was conducted using
RevMan 5.0 software. Results A total of 9 RCTs involving 2 202 patients were included. The result of meta-analysis
was as follows: the incidence of anastomotic leakage in the stapling anastomosis group was lower than that in the
hand-suture anastomosis group (OR=0.43, 95%CI 0.26 to 0.71, P<0.01). Conclusion Stapling anastomosis is superior
to hand-suture anastomosis in reducing the incidence of anastomotic leakage following esophagogastrostomy. For
the limited quality and quantity of the included studies, this conclusion has to be further proved by more high-quality
studies. 2012 Editorial Board of Chin J Evid-based Med.
Background: Following a warning issued this summer by the German Robert Koch-Institute regarding a new peak of
notified cases of Hantavirus infections and corresponding media reports there were also inquiries by anxious
patients. Methods: A Google Scholar and PubMed literature search was performed. Facts about Hantavirus deseases
considered to be the most relevant to family doctors in Germany were collected and a statistical query about
incidence of the disease in Germany was performed at SurfStat (Robert Koch-Institute). Results: Despite a rather
fluctuating incidence between 0,1 and 2,8 per 100 000 hemorrhagic fever with renal syndrome (nephropathia
epidemica) remains a fairly rare disease in Germany. Serious outcomes with epidemic character are restricted to
Eastern Europe, Asia and the Americas. Conclusions: The low incidence together with a wide range of outcomes from
very mild to lethal makes this zoonosis a differential diagnosis we should have on our list. Deutscher Arzte-Verlag.
Background Several studies have confirmed that laparoscopic colorectal surgery (LCS) has superior short-term
outcomes when compared to open colorectal surgery. However, the evidence for cost-effectiveness of LCS is less
clear. Aim The aim of this study is to explore the cost-effectiveness of LCS over time since it was first developed in
1991. Methods Systematic review of the literature was conducted. Electronic databases (PubMed, ScienceDirect and
Google Scholar) were searched for studies from 1991 to 2010 using the keywords "laparoscopic, colorectal surgery
cost, economic evaluation". Results Fifteen economic evaluations met the inclusion criteria. The percentage cost
difference between open and laparoscopic surgery varied widely between different studies. The general trend when
observing all the included economic evaluations is that there is a moderate negative correlation between
progression of time and the size of the cost gap between laparoscopic and open surgery (R-value=-0.44). This
correlation is even stronger (R-value=-0.64, P=0.046) if the studies are subdivided by the country where the surgery
was carried out in. Western healthcare systems, even though they had a heterogeneous set of results (SD=27%),
showed a decline in costs of laparoscopic surgery with time. Conclusion From the current trends, it is projected that
the results of future economic evaluations will unequivocally show that laparoscopic surgery is cheaper than open
surgery. The initial higher costs of laparoscopic surgery training may be worth the savings made in the long term if it
is practised in settings where postoperative care is expensive. Springer-Verlag 2012.
Background: We aimed to analyze the risk of an increased surgical indication rate in patients with benign tumors of
the liver since the development of laparoscopy. Previous articles have reported increased numbers of laparoscopic
procedures in different surgical fields. Methods: A literature search of MEDLINE (PubMed), Google Scholar, and The
Cochrane Library was carried out. All articles that analyzed benign liver tumors (hemangiomas, focal nodular
hyperplasia, and adenoma) were divided in two groups: group I included all manuscripts with open procedures
between 1971 at 1990, and group II included all manuscripts with open or laparoscopic procedures between 1991
and 2010. Group II articles were divided into two subgroups. Subgroup IIA patients were treated by open or
laparoscopic procedures between 1991 and 2000, and subgroup IIB patients were treated by open or laparoscopic
procedures between 2001 and 2010. Results: Specific analysis of each kind of tumor observed in the two groups
showed fewer surgically treated patients for hepatic hemangioma and hepatic adenoma in group II compared with
group I and a greater number of patients for focal nodular hyperplasia. Fewer patients were treated with
laparoscopic procedures in subgroup IIA than in subgroup IIB. A chi-square test with Yates' correction gave a P value
of <0.001. Conclusion: Laparoscopy has increased the rate of hepatic resection for benign tumors with doubtful
indications. 2012 Springer-Verlag Berlin Heidelberg.
Introduction: Single incision laparoscopic surgery (SILS) represents the next step in laparoscopic surgery in further
reducing the invasiveness of surgical procedures with cosmetic advantages. Recalling the increased rates of major
complications at the advent of laparoscopic cholecystectomy 20 years ago, however, it is clear that appropriate
training is required before adopting a new technique. This study aims to review the current evidence for training and
skills acquisition for SILS. Methods: A comprehensive database search of PubMED, MEDLINE, EMBASE and Google
Scholar was carried out. Studies considered for inclusion were those addressing SILS learning curves, skills
acquisition, or training. Results: 21 studies were included in the final analysis. Ten clinical case series with analysis of
SILS learning curve demonstrated a significant learning curve for conventional multiport laparoscopic (LAP)-trained
surgeons over the course of initial SILS cases, with several studies reporting increased risk of conversion and
complication rates. Five laboratory-based studies demonstrated differences in SILS skills acquisition compared with
LAP. Six studies describing SILS-specific training curricula were analysed, but none included a robust validation of the
curriculum. Conclusions: Clinical case series and laboratory-based skills acquisition studies demonstrate the unique
requirements of SILS, with skill sets and ergonomic demands which cannot be directly adapted from existing LAP
experience. Some studies have already reported higher complication rates in initial SILS cases. To avoid repeating the
mistakes of the past, the implementation of an evidence- and competency-based SILS curriculum is necessary to
ensure appropriate training of future SILS surgeons. 2012 Springer Science+Business Media New York.
OBJECTIVES: To ascertain the rate of occurrence of unintentional injections from epinephrine autoinjectors used in
the first aid treatment of anaphylaxis and to provide information about the resulting needle stick injuries., DATA
SOURCES: A systematic review was performed. The MEDLINE, Scirus, CINAHL, ISI Web of Science, and Google Scholar
databases were searched by title and abstract to identify reports of unintentional injections from epinephrine
autoinjectors published in peer-reviewed journals., STUDY SELECTION: Publications were selected for inclusion based
on predefined strict criteria., RESULTS: In 26 reports published during the past 20 years, we identified 69 people with
an unintentional injection of epinephrine from an autoinjector. More than 68% of them were reported in the past 6.3
years, 58% were female, 42% were injured in the home, and 91% sustained injury to a finger or thumb. More than
65% of the 69 individuals were evaluated in an emergency department; 13% of the 69 were not treated or were
treated only with observation. Warming of the injured part was used in 25%, nitroglycerin paste application in 9%,
local injections of phentolamine and/or lidocaine in 22%, and other treatments in 20%; treatment, or lack thereof,
was not described in 12%. No permanent sequelae were reported., CONCLUSIONS: The true rate of occurrence of
unintentional injection of epinephrine from autoinjectors is unknown but is increasing. People at risk for anaphylaxis
need regular coaching in how to use epinephrine autoinjectors correctly and safely. Improved autoinjector design
will address the safety concerns identified in this review.
Objectives: To ascertain the rate of occurrence of unintentional injections from epinephrine autoinjectors used in the
first aid treatment of anaphylaxis and to provide information about the resulting needle stick injuries. Data Sources:
A systematic review was performed. The MEDLINE, Scirus, CINAHL, ISI Web of Science, and Google Scholar databases
were searched by title and abstract to identify reports of unintentional injections from epinephrine autoinjectors
published in peer-reviewed journals. Study Selection: Publications were selected for inclusion based on predefined
strict criteria. Results: In 26 reports published during the past 20 years, we identified 69 people with an unintentional
injection of epinephrine from an autoinjector. More than 68% of them were reported in the past 6.3 years, 58% were
female, 42% were injured in the home, and 91% sustained injury to a finger or thumb. More than 65% of the 69
individuals were evaluated in an emergency department; 13% of the 69 were not treated or were treated only with
observation. Warming of the injured part was used in 25%, nitroglycerin paste application in 9%, local injections of
phentolamine and/or lidocaine in 22%, and other treatments in 20%; treatment, or lack thereof, was not described in
12%. No permanent sequelae were reported. Conclusions: The true rate of occurrence of unintentional injection of
epinephrine from autoinjectors is unknown but is increasing. People at risk for anaphylaxis need regular coaching in
how to use epinephrine autoinjectors correctly and safely. Improved autoinjector design will address the safety
concerns identified in this review.
Health care practitioners have increasingly used the Internet to obtain health and medication information. The vast
number of Internet Web sites providing such information and concerns with their reliability makes it essential for
users to carefully select and evaluate Web sites prior to use. To this end, this article reviews the general principles to
consider in this process. Moreover, as cost may limit access to subscription-based health and medication information
resources with established reputability, freely accessible online resources that may serve as an invaluable addition to
one's reference collection are highlighted. These include government- and organization-sponsored resources (eg, US
Food and Drug Administration Web site and the American Society of Health-System Pharmacists' Drug Shortage
Resource Center Web site, respectively) as well as commercial Web sites (eg, Medscape, Google Scholar). Familiarity
with such online resources can assist health care professionals in their ability to efficiently navigate the Web and may
potentially expedite the information gathering and decision-making process, thereby improving patient care. The
Author(s) 2013.
Objective: Vaccination of measles is a part of almost every health care system. However, the question how
information and knowledge transfer on vaccination for measles is handled between patient and health care
professionals is still a challenging controversy. One important factor in the culture of communication is given by the
attitudes and opinions of the health care professionals towards this topic. Aim: We aimed at reviewing
surveys/studies on Health care professionals' attitudes and opinions on vaccination of measles. Method:Asystematic
search has been performed in Medline, EMBASE, CAMbase, AMED and Google Scholar. Keywords and their
combination were (Attitudes OR Opinions OR Views OR Beliefs) in combination with (Vaccination AND Measles) and
(Physicians OR Nurses OR Practitioners). We also cross checked the references of articles found that way. Studies on
parental attitudes were excluded. Results: We found a total of 12 papers from 1990 to 2009 matching our inclusion
and exclusion criteria originated in Europe (n = 7), USA (n = 4) and Australia (n = 1) from a total of 4383 health care
professionals (mean response rate 72%, mainly family physicians and pediatricians). Opinions on safety and efficacy
profiles were heterogeneous. In most surveys the wish for further training and professional support was raised by
the health care professionals. Main reasons were concerns regarding side effects and the felt difficulty of being up to
date with recent developments in vaccination. Discussion: Vaccination of measles is a highly important topic which
according to this reviewis still a matter of discussion between patients and health care professionals.We were able to
show that there are different views and opinions and that there is the need to develop a culture of informed decision
making. Supportive tools for patients, physicians and nurses should be a major part of this process. The dependency
of opinions on sociocultural background and the underlying health care system and its legal aspects has to be further
discussed.
BACKGROUND: There is a significant global health burden associated with acute rheumatic fever (ARF) and
rheumatic heart disease (RHD), especially in developing countries. ARF and RHD most often strike children and young
adults living in impoverished settings, where unhygienic conditions and lack of awareness and knowledge of
streptococcal infection progression are common. Secondary prophylactic measures have been recommended in the
past, but primary prevention measures have been gaining more attention from researchers frustrated by the
perpetual prevalence of ARF and RHD in developing countries. Health education aims to empower people to take
responsibility for their own well-being by gaining control over the underlying factors that influence health. We
therefore conducted a review of the current best evidence for the use of health education interventions to increase
awareness and knowledge of streptococcal pharyngitis and ARF., METHODS AND DESIGN: This article describes the
protocol for a systematic review of the effectiveness of health education interventions aimed at increasing
awareness and knowledge of the symptoms, causes and consequences of streptococcal pharyngitis, rheumatic fever
and/or rheumatic heart disease. Studies will be selected in which the effect of an intervention is compared with
either a pre-intervention or a control, targeting all possible audience types. Primary and secondary outcomes of
interest are pre-specified. Randomized controlled trials, quasi-randomized trials, controlled before-after studies and
controlled clinical trials will be considered. We will search several bibliographic databases (for example, PubMed,
EMBASE, World Health Organization Library databases, Google Scholar) and search sources for gray literature. We
will meta-analyze included studies. We will conduct subgroup analyses according to intervention subtypes: printed
versus audiovisual and mass media versus training workshops., DISCUSSION: This review will provide evidence for
the effectiveness of educational components in health promotion interventions in raising public awareness in regard
to the symptoms, causes and consequences of streptococcal pharyngitis, ARF and/or RHD. Our results may provide
guidance in the development of future intervention studies and programs.
Availability of online health information in the Arab world is growing rapidly, as well as the demand for it. Today, the
Arab health consumer is searching for health information that is in Arabic and is culturally relevant. The purpose of
this paper is to document the various initiatives around the development of online health information in the Arab
world. The paper highlights the status of online health information in Arab counties with a specific focus on Saudi
Arabia. A comprehensive search of both academic and gray literature was conducted in October 2012. Google
Scholar, PubMed, the Google search engines were searched. Results show that there has been an increase in the
number of health information websites being created in Saudi Arabia, Egypt, Jordan and the United Arab Emirates.
Examples of some these initiatives are discussed. Future challenges to the growth of health information content in
the Arab world are also discussed.
Health information technology (HIT) has potential to support continuous quality improvement (CQI) of antiretroviral
ARV) programs. The fields of CQI and HIT, however, have yet to become fully integrated. To narrow this gap an
assessment of various types of HIT used in CQI was conducted. A comprehensive systematic literature review of
PubMed, Google Scholar, ACM Digital Library and IEEE Explore was performed to develop a compendium of HIT
approaches for CQI. Resources were included if they addressed the feasibility, implementation, or evaluation of
innovative HIT that directly supported CQI of ARV programs or patient outcomes in low and middle income countries.
The literature review identified 379 articles addressing HIT and HIV programs or outcomes since 2002; 15% (57) used
HIT for CQI. At the programmatic level (n=21), geographic information services, health information management
systems and electronic medical records are methods to longitudinally track program and facility characteristics to
assess overall performance, determine best practices and facilitate planning. At the clinic level (n=15); electronic
medical records and cellular phones provide tools to aide clinical decision-making and more efficiently manage
patient information leading to improve patient outcomes. At the patient level (n=21); cellular phones can be used to
remind patients about adherence as well as clinic follow-up and electronic adherence monitors can provide a
mechanism to remotely monitor and promote ARV adherence. Special consideration must be given to the local
context, including the technical expertise and physical infrastructure required to implement, sustain and potentially
modify the technology. HIT can facilitate CQI to better inform program planning and support clinical care. When
implemented with due planning, these technologies can be powerful tools to longitudinally track the quality of HIV
care and facilitate solutions for improvement.
Introduction: This article describes the impact of health literacy on women's health and provides strategies for
addressing this public health issue. Methods: A comprehensive literature review was conducted of peer-reviewed
journals. Multiple electronic databases were used, including CINAHL, MEDLINE, PubMed, and Google Scholar. Key
words were used to identify articles and were combined to include health literacy, health behavior, women's health,
patient education, and professional role. Additional articles were identified as a result of reviewing reference lists
found during the electronic search. Results: Health literacy is a complex issue that affects many women and can
adversely affect women's knowledge, ability to adhere to clinical plans of care, and health outcomes for women and
their children. It is estimated that 36% of adults in the United States possess limited health literacy skills. Effective
strategies can be used by health care providers to address this serious problem, including clear and effective
communication, development of health education materials, professional education, and development of
community partnerships. Discussion: Health literacy is a serious problem. Effective approaches can be employed to
blunt the adverse effect on women's health. Health care providers are well positioned to demonstrate leadership
within the health care system regarding health literacy. 2013 by the American College of Nurse-Midwives.
Objective: To systematically review current health literacy (HL) instruments for use in consumer-facing and mobile
health information technology screening and evaluation tools. Design: The databases, PubMed, OVID, Google
Scholar, Cochrane Library and Science Citation Index, were searched for health literacy assessment instruments using
the terms " health" , " literacy" , " computer-based," and " psychometrics" All instruments identified by this method
were critically appraised according to their reported psychometric properties and clinical feasibility. Results: Eleven
different health literacy instruments were found. Screening questions, such as asking a patient about his/her need
for assistance in navigating health information, were evaluated in seven different studies and are promising for use
as a valid, reliable, and feasible computer-based approach to identify patients that struggle with low health literacy.
However, there was a lack of consistency in the types of screening questions proposed. There is also a lack of
information regarding the psychometric properties of computer-based health literacy instruments. Limitations: Only
English language health literacy assessment instruments were reviewed and analyzed. Conclusions: Current health
literacy screening tools demonstrate varying benefits depending on the context of their use. In many cases, it seems
that a single screening question may be a reliable, valid, and feasible means for establishing health literacy. A
combination of screening questions that assess health literacy and technological literacy may enable tailoring
eHealth applications to user needs. Further research should determine the best screening question(s) and the best
synthesis of various instruments' content and methodologies for computer-based health literacy screening and
assessment. 2012 Elsevier Inc..
Context: Opportunities for young people to be sedentary have increased during leisure time, study time, and
transportation time. Purpose: This review paper focuses on sedentary behaviors among young people aged 218 years
and includes evidence of the relationship between sedentary behavior and health risk indicators, an overview of
public health recommendations, the prevalence of key sedentary behaviors, evidence of correlates of sedentary
behavior and the effectiveness of interventions to reduce sedentary behaviors. Evidence acquisition: Although this is
a narrative style review and not systematic, where possible, findings from relevant review papers were summarized
and a search of more recent literature was performed using computer-based databases such as PubMed, Google
Scholar, ERIC, PsycINFO, Social Science Index, SportDiscus, and Health Reference Center Academic. Evidence
synthesis: Young people spend 24 hours per day in screen-based behaviors and 510 hours per day sedentary.
Ethnicity, sociodemographic status, having a TV set in the bedroom, and parental behavior appear to be the most
consistent correlates of TV viewing time; however, few recent studies aiming to reduce TV viewing or sedentary time
among young people have been successful. Conclusions: A growing body of evidence supports the development of
public health recommendations to limit the time spent in screen-based behaviors. More research is needed to
examine the prospective and experimental evidence of associations between overall sedentary time and health,
determinants of sedentary behaviors other than screen-based behaviors, and interventions to reduce overall
sedentary time or even alternative sedentary behaviors, such as transport- or education-related sitting time. 2011
American Journal of Preventive Medicine.
Objective To identify the underlying systemic drivers of the development and ongoing expansion of hospitalist
programs in Canada. Data sources MEDLINE and Google Scholar were searched using combinations of the terms
hospitalist, hospital medicine, and Canada. Study selection All publications that addressed the study question,
including review articles, original research, editorials, commentaries, and letters or news articles, were included in
the review. Synthesis Constant comparative methodology was used to analyze and code the articles and to
synthesize the identified codes into broader themes. Three broad categories were identified: physician-related
drivers, health system- related drivers, and patient-related drivers. Within each category, we identified a number of
drivers. Conclusion Many drivers have been cited in the literature as reasons behind the emergence and growth of
the hospitalist model in the Canadian health care system. While their interplay makes simple causeand- effect
conclusions difficult, these drivers demonstrate that hospitalist programs in Canada have developed in response to a
complex set of provider, system, and patient factors.
BACKGROUND: Health workforce needs-based shortages and skill mix imbalances are significant health workforce
challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly
tailored training, is a potential strategy to address these challenges. This study uses an economics perspective to
review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose
a research agenda., METHODS: Studies primarily from low-income countries published between 2006 and
September 2010 were found using Google Scholar and PubMed. Keywords included terms such as skill mix, task
shifting, assistant medical officer, assistant clinical officer, assistant nurse, assistant pharmacist, and community
health worker. Thirty-one studies were selected to analyze, based on the strength of evidence., RESULTS: First, the
studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce
shortages and skill mix imbalances. For example, in Mozambique, surgically trained assistant medical officers, who
were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as
compared to physician obstetricians and gynaecologists. Second, although task shifting is promising, it can present its
own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and
safety concerns, professional and institutional resistance, and the need to sustain motivation and performance.
Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to
compare the new cadre's results to the results from the care that would have been provided--if any care at all--had
task shifting not occurred., CONCLUSIONS: Task shifting is a promising policy option to increase the productive
efficiency of the delivery of health care services, increasing the number of services provided at a given quality and
cost. Future studies should examine the development of new professional cadres that evolve with technology and
country-specific labour markets. To strengthen the evidence, skill mix changes need to be evaluated with a rigorous
research design to estimate the effect on patient health outcomes, quality of care, and costs.
This literature review identifies and categorises, from an organisational management perspective, barriers to the use
of HIT or ICT for health. Based on the review, it offers policy interventions. This systematic literature review was
carried out during December 2009 and January 2010. Additional on-going reviews of updates through automated
system alerts took place up until this paper was submitted. A total of thirty-one sources were searched including nine
software platforms/databases, fifteen specialised websites/targeted databases, Google Scholar, ISI Science Citation
Index and five journals hand-searched. The study covers seventy-nine articles on organisational barriers to ICT
adoption by healthcare professionals. These are categorised under five main headings - (I) Structure of healthcare
organisations; (II) Tasks; (III) People policies; (IV) Incentives; and (V) Information and decision processes. A total of
ten subcategories are also identified. By adopting an organisational management approach, some recommendations
to remove organisational management barriers are made. Despite their apparent promise, health information
technologies (HIT) have proved difficult to implement. This systematic review reveals the implementation barriers
associated to organisational management and their interrelations. Several important future directions in the field are
also suggested: (1) there is a need for further research providing evidence of HIT cost-effectiveness as well as the
development of optimal HIT applications; (2) more information is needed regarding organisational change,
incentives, liability issues, end-users HIT competences and skills, structure and work process issues involved in
realising the benefits from HIT. Future policy interventions should consider the five dimensions identified when
addressing the impact of HIT in healthcare organisational systems, and how the impact of an intervention aimed at a
particular dimension would interrelate with others. 2011 Elsevier Ireland Ltd. All rights reserved.
Cardiovascular diseases contribute substantially to the poor health and reduced life expectancy of Indigenous
Australians. Heart failure is a common, disabling, progressive and costly complication of these disorders. The
epidemiology of heart failure and the adequacy of relevant health service provision in Indigenous Australians are not
well delineated. A systematic search of the electronic databases PubMed, Embase, Web of Science, Cinahl Plus,
Informit and Google Scholar was undertaken in April 2012 for peer-reviewed journal articles relevant to the topic of
heart failure in Indigenous Australians. Additionally, a website search was done to identify other pertinent
publications, particularly government reports. There was a paucity of relevant peer-reviewed research, and
government reports dominated the results. Ten journal articles, 1 published conference abstract and 10 reports were
eligible for inclusion. Indigenous Australians reportedly have higher morbidity and mortality from heart failure than
their non-Indigenous counterparts (age-standardised prevalence ratio 1.7; age-standardised hospital separation ratio
>=3; crude per capita hospital expenditure ratio 1.58; age-adjusted mortality ratio >2). Despite the evident
disproportionate burden of heart failure in Indigenous Australians, the accuracy of estimation from administrative
data is limited by poor indigenous identification, inadequate case ascertainment and exclusion of younger subjects
from mortality statistics. A recent journal article specifically documented a high prevalence of heart failure in Central
Australian Aboriginal adults (5.3%), noting frequent undiagnosed disease. One study examined barriers to health
service provision for Indigenous Australians in the context of heart failure. Despite the shortcomings of available
published data, it is clear that Indigenous Australians have an excess burden of heart failure. Emerging data suggest
that undiagnosed cases may be common in this population. In order to optimise management and to inform policy,
high quality research on heart failure in Indigenous Australians is required to delineate accurate epidemiological
indicators and to appraise health service provision.
Background: Almost one-fourth of older adults hospitalized with heart failure (HF) are discharged to skilled nursing
facilities (SNFs). The purpose of this review was to evaluate knowledge about HF patients discharged to SNFs to
provide a foundation for future studies. Methods and Results: A search was conducted of Medline, CINAHL, PubMed,
and Google Scholar. Key words were heart failure, congestive heart failure, skilled care, skilled nursing care, skilled
nursing facilities, nursing home, postacute care, postacute services, and subacute care. Publications (n = 37) were
reviewed and categorized into case studies, editorials, clinical care, evaluation projects, and data-based publications.
Of 29 data-based publications, 6 were focused on factors associated with hospital readmission from postacute
settings, 3 on trends in hospitalizations, 12 on hospital discharge to postacute services, 5 on rehabilitation services in
postacute settings, 1 on cost, and 2 on interventions. Patients discharged to SNFs were at high risk for mortality and
multiple hospitalizations. No HF-specific care or guidelines were found at SNFs. Only 1 study evaluated quality of life
at SNFs. Conclusions: Prospective studies are needed to evaluate the clinical condition of HF patients discharged to
SNFs and the interventions they receive. 2012 Elsevier Inc. All rights reserved.
BACKGROUND: Almost one-fourth of older adults hospitalized with heart failure (HF) are discharged to skilled nursing
facilities (SNFs). The purpose of this review was to evaluate knowledge about HF patients discharged to SNFs to
provide a foundation for future studies., METHODS AND RESULTS: A search was conducted of Medline, CINAHL,
PubMed, and Google Scholar. Key words were heart failure, congestive heart failure, skilled care, skilled nursing care,
skilled nursing facilities, nursing home, postacute care, postacute services, and subacute care. Publications (n= 37)
were reviewed and categorized into case studies, editorials, clinical care, evaluation projects, and data-based
publications. Of 29 data-based publications, 6 were focused on factors associated with hospital readmission from
postacute settings, 3 on trends in hospitalizations, 12 on hospital discharge to postacute services, 5 on rehabilitation
services in postacute settings, 1 on cost, and 2 on interventions. Patients discharged to SNFs were at high risk for
mortality and multiple hospitalizations. No HF-specific care or guidelines were found at SNFs. Only 1 study evaluated
quality of life at SNFs., CONCLUSIONS: Prospective studies are needed to evaluate the clinical condition of HF
patients discharged to SNFs and the interventions they receive. Copyright 2012 Elsevier Inc. All rights reserved.
Objective. To summarize the evidence from epidemiological studies examining the association between Helicobacter
pylori infection and hyperemesis gravidarum. Design. Systematic review and meta-analysis of casecontrol studies.
Material and methods. We searched the Medline/PubMed, Embase, Cinahl, ISI Web of Science and Biological
Abstracts databases from 1966 to 17 June 2008 and finally Google Scholar. A total of 25 casecontrol studies were
identified. Both fixed-effect and random-effect models were used to synthesize the results of individual studies. The
Cochran Q, 2 of between-study variance and index of heterogeneity (I2) were used to evaluate heterogeneity.
Heterogeneity between studies was examined by subgroup and random effect meta-regression analyses. Publication
bias was evaluated. Results. Publication bias was not observed. The random model pooled estimate was odds ratio
3.32, 95 % confidence interval (CI): 2.254.90. A high heterogeneity was pinpointed (I2 80 %, 95 % CI: 6589). Subgroup
analysis and meta-regression showed a weaker association in studies with a clear definition of hyperemesis
gravidarum compared to studies without this condition, and weaker association in recent studies compared to earlier
studies. Meta-regression showed that these two study characteristics explained 40% of heterogeneity between
studies. Conclusions. Exposure to H. pylori appears to be associated with an increased risk of hyperemesis
gravidarum. The residual heterogeneity might have different reasons. Given the high prevalence of H. pylori, the
public health consequence of H. pylori with regard to hyperemesis gravidarum may be important. 2009 Informa UK
Ltd.
OBJECTIVE: To summarize the evidence from epidemiological studies examining the association between
Helicobacter pylori infection and hyperemesis gravidarum., DESIGN: Systematic review and meta-analysis of case-
control studies., MATERIAL AND METHODS: We searched the Medline/PubMed, Embase, Cinahl, ISI Web of Science
and Biological Abstracts databases from 1966 to 17 June 2008 and finally Google Scholar. A total of 25 case-control
studies were identified. Both fixed-effect and random-effect models were used to synthesize the results of individual
studies. The Cochran Q, tau(2) of between-study variance and index of heterogeneity (I(2)) were used to evaluate
heterogeneity. Heterogeneity between studies was examined by subgroup and random effect meta-regression
analyses. Publication bias was evaluated., RESULTS: Publication bias was not observed. The random model pooled
estimate was odds ratio = 3.32, 95 % confidence interval (CI): 2.25-4.90. A high heterogeneity was pinpointed (I(2) =
80 %, 95 % CI: 65-89). Subgroup analysis and meta-regression showed a weaker association in studies with a clear
definition of hyperemesis gravidarum compared to studies without this condition, and weaker association in recent
studies compared to earlier studies. Meta-regression showed that these two study characteristics explained 40% of
heterogeneity between studies., CONCLUSIONS: Exposure to H. pylori appears to be associated with an increased risk
of hyperemesis gravidarum. The residual heterogeneity might have different reasons. Given the high prevalence of
H. pylori, the public health consequence of H. pylori with regard to hyperemesis gravidarum may be important.
Background: Attempts at early identification of hepatobiliary cancers have failed due to non-availability of a sensitive
test. Prevention offers the best chance to reduce the morbidity and mortality from these. Identification of an
etiological agent and especially if the potentially identified cause can be eradicated like Helicobacter sp. infection,
will not only reduce incidence but also the mortality. Methods: This article reviews 15 studies on Helicobacter
species in hepatobiliary cancers identified on pubmed, scopus and google scholar search. Of these, Five were single
group and 10 were case control. These 10 case control studies were included in the meta analysis, which was carried
out using odds ratio and both a fixed and random effect model, 95% confidence intervals for odds ratio was
calculated. Chi square test for heterogeneity was employed. The overall effect was calculated using Z test. Results:
The cumulative sample size of cases was 205, of which 115 were positive (56%) for Helicobacter, while among 263
controls 53 (20%) were found to be positive for Helicobacter infection. The positivity rate in case control studies was
higher than that observed in single group studies. The cumulative odds ratio for the study sample was 8.72 (95% CI
4.78-15.91) (Z = 7.07; p < 0.00001). Conclusions: There is enough evidence to suggest a possible role of Helicobacter
species in hepatobiliary tract cancers. However, the results from different regions of the world differ. Studies also
differ on method of Helicobacter detection, subsite of cancer with in the hepatobiliary tract and choice of controls
thus introducing heterogeneity. Further case control studies with larger sample size are required to settle the
question. 2008 Elsevier Ltd. All rights reserved.
Introduction: Accumulating evidence suggests that, in critically ill patients, a lower hemoglobin transfusion threshold
is safe. However, the optimal hemoglobin level and associated transfusion threshold remain unknown in
neurocritically ill patients.Methods: We conducted a systematic review of comparative studies (randomized and
nonrandomized) to evaluate the effect of hemoglobin levels on mortality, neurologic function, intensive care unit
(ICU) and hospital length of stay, duration of mechanical ventilation, and multiple organ failure in adult and pediatric
neurocritically ill patients. We searched MEDLINE, The Cochrane Central Register of Controlled Trials, Embase, Web
of Knowledge, and Google Scholar. Studies focusing on any neurocritical care conditions were included. Data are
presented by using odds ratios for dichotomous outcomes and mean differences for continuous outcomes.Results:
Among 4,310 retrieved records, six studies met inclusion criteria (n = 537). Four studies were conducted in traumatic
brain injury (TBI), one in subarachnoid hemorrhage (SAH), and one in a mixed population of neurocritically ill
patients. The minimal hemoglobin levels or transfusion thresholds ranged from 7 to 10 g/dl in the lower-Hb groups
and from 9.3 to 11.5 g/dl in the higher-Hb groups. Three studies had a low risk of bias, and three had a high risk of
bias. No effect was observed on mortality, duration of mechanical ventilation, or multiple organ failure. In studies
reporting on length of stay (n = 4), one reported a significant shorter ICU stay (mean, -11.4 days (95% confidence
interval, -16.1 to -6.7)), and one, a shorter hospital stay (mean, -5.7 days (-10.3 to -1.1)) in the lower-Hb groups,
whereas the other two found no significant association.Conclusions: We found insufficient evidence to confirm or
refute a difference in effect between lower- and higher-Hb groups in neurocritically ill patients. Considering the lack
of evidence regarding long-term neurologic functional outcomes and the high risk of bias of half the studies, no
recommendation can be made regarding which hemoglobin level to target and which associated transfusion strategy
(restrictive or liberal) to favor in neurocritically ill patients. 2012 Turgeon et al.; licensee BioMed Central Ltd.
INTRODUCTION: Accumulating evidence suggests that, in critically ill patients, a lower hemoglobin transfusion
threshold is safe. However, the optimal hemoglobin level and associated transfusion threshold remain unknown in
neurocritically ill patients., METHODS: We conducted a systematic review of comparative studies (randomized and
nonrandomized) to evaluate the effect of hemoglobin levels on mortality, neurologic function, intensive care unit
(ICU) and hospital length of stay, duration of mechanical ventilation, and multiple organ failure in adult and pediatric
neurocritically ill patients. We searched MEDLINE, The Cochrane Central Register of Controlled Trials, Embase, Web
of Knowledge, and Google Scholar. Studies focusing on any neurocritical care conditions were included. Data are
presented by using odds ratios for dichotomous outcomes and mean differences for continuous outcomes., RESULTS:
Among 4,310 retrieved records, six studies met inclusion criteria (n = 537). Four studies were conducted in traumatic
brain injury (TBI), one in subarachnoid hemorrhage (SAH), and one in a mixed population of neurocritically ill
patients. The minimal hemoglobin levels or transfusion thresholds ranged from 7 to 10 g/dl in the lower-Hb groups
and from 9.3 to 11.5 g/dl in the higher-Hb groups. Three studies had a low risk of bias, and three had a high risk of
bias. No effect was observed on mortality, duration of mechanical ventilation, or multiple organ failure. In studies
reporting on length of stay (n = 4), one reported a significant shorter ICU stay (mean, -11.4 days (95% confidence
interval, -16.1 to -6.7)), and one, a shorter hospital stay (mean, -5.7 days (-10.3 to -1.1)) in the lower-Hb groups,
whereas the other two found no significant association., CONCLUSIONS: We found insufficient evidence to confirm
or refute a difference in effect between lower- and higher-Hb groups in neurocritically ill patients. Considering the
lack of evidence regarding long-term neurologic functional outcomes and the high risk of bias of half the studies, no
recommendation can be made regarding which hemoglobin level to target and which associated transfusion strategy
(restrictive or liberal) to favor in neurocritically ill patients.
Objective: Hemorrhage within a hepatic cyst (hemorrhagic hepatic cyst, HHC) is a complication of liver cysts that is
difficult to differentiate from other neoplastic entities on imaging. Even when accurately diagnosed, there has been a
lack of consensus on the optimal treatment strategy. After presenting our experience with a patient treated via
laparoscopy, we aimed to conduct a review of the literature on HHCs. Methods: A computerized search in Medline,
PubMed, Google Scholar, and The Cochrane Collaboration was carried out for journal articles or abstracts published
from 1950 to 2011. Results: A total of 24 patients with HHCs were identified from 1983 to 2011. The cohort had an
even gender distribution with a mean age of 62. 7 years. Most patients presented with abdominal pain (80 %), while
three (14 %) patients were asymptomatic at the time of presentation. CT imaging and ultrasound were unable to
accurately diagnose HHC, whereas hyperintensity on MRI was a reliable diagnostic tool. Three (13 %) patients were
managed conservatively with observation. Seven (30 %) patients had percutaneous transhepatic drainage. Among
these, two patients experienced recurrence that required repeat treatment. Two (9 %) patients underwent open
unroofing of their HHC and one (4 %) laparoscopically, without recurrences. Seven (30 %) patients underwent hepatic
resection, whereas six (26 %) patients had a cyst enucleation for their HHCs. All patients had uneventful recoveries,
with a mean follow-up of 25 months. Conclusions: MRI is a reliable diagnostic tool in the setting of an HHC.
Laparoscopic unroofing of HHCs may represent a less morbid and safe treatment modality with low recurrence rates.
Given the low level of clinical evidence available so far, these results should be interpreted with caution. 2012 The
Society for Surgery of the Alimentary Tract.
Introduction: Acute pancreatitis is a common complication after ERCP with an incidence that has been reported as
high as 10%. Heparin has been reported to inhibit pancreatic proteases in both plasma and pancreatic tissue and also
inhibits tumor necrosis factor (TNF)-induced interactions of leukocytes and endothelium, thereby reducing
inflammation. We assessed the clinical outcome of patients undergoing ERCP treated with prophylactic heparin
compared to those patients given placebo. Methods: We performed a systematic search of Medline, EMBASE, and
Cochrane Central Register of Controlled Trials using Pubmed, Ovid and Google Scholar as search engines without
language restriction. We also hand searched the references of original/review articles and evaluated symposia
proceedings, poster presentations, and abstracts from major gastrointestinal and surgical meetings. Relative risks
were calculated for individual trials and data pooled using a fixed effects model. Relative risk reduction (RRR) and
absolute risk reduction (ARR) were calculated and are reported with 95% confidence intervals when the relative risk
was significant. Results were subjected to sensitivity analysis in order to determine heterogeneity among studies.
Results: Three studies from which we pooled 1368 patients met eligibility criteria. Patient mean age ranged from 58-
64.6 years. Indications for ERCP were not clearly described in all studies. 540 patients were randomized to receive
prophylactic heparin or LMWH, while 828 were randomized to the placebo arm. Overall, there was not a protective
effect of prophylactic heparin administration in regards to prevention of post-ERCP pancreatitis (RR: 0.66 95% CI:
0.43-1.02), bleeding (RR: 0.73 95% CI: 0.29-1.83), or mortality (RR: 1.02 95% CI: 0.18-5.86). Sensitivity analysis
indicated lack of significant heterogeneity in subgroups. Conclusions: Using strict pre-defined criteria, current
guidelines, and a weighted method we demonstrate that heparin prophylaxis for ERCP procedures does not reduce
the incidence of pancreatitis, bleeding or mortality. Further high quality studies should focus on alternative
therapeutic agents.
Background: It is speculated that different localizations of lymphoproliferative disorder after solid organ
transplantation (PTLD) have different features and represent specific behavior as well as prognostic individualities.
Objectives To compare characteristics of hepatic PTLD (H-PTLD) with non-hepatic PTLD (NH-PTLD) in liver transplant
recipients. Materials and methods We searched PubMed and Google Scholar for all published reports of PTLD in liver
recipients within their liver. Reported characteristics of H-PTLD and NH-PTLD were compared. Results: A total of 21
studies from various countries were found. Overall, 169 liver recipients with PTLD were included in the analysis, of
whom 83 (49%) had H-PTLD. Patients with H-PTLD were more likely to test positive for Epstein-Barr virus (EBV) (p
<0.0001), be older at the time of transplantation (p = 0.009), have a shorter time to PTLD development (80 vs. 41%
early-onset PTLD; p< 0.001), and have bone marrow involvement (p = 0.03). Multivariate linear regression showed
that H-PTLD and EBV positivity, but not age at transplant, were independently associated with time to PTLD
development (p = 0.003, p <0.0001, and p = 1.0, respectively). Conclusions: Liver transplant patients exhibiting early
deterioration of graft function or other hepatic symptoms should, in addition to assessment for rejection, be
evaluated for H-PTLD. In addition, all H-PTLD patients should be evaluated for bone marrow involvement, especially if
they are EBV positive. Prospective studies with large patient populations are needed to confirm our results. Asian
Pacific Association for the Study of the Liver 2011.
Hepatic involvement by posttransplant lymphoproliferative disorders (PTLD) is an important but rarely investigated
issue. In the current study, we aimed to pool data of cases of PTLD localization in liver (L-PTLD) among renal allograft
recipients from different series to find new perspectives on the disease. We conducted a comprehensive search for
the available data through PubMed and Google Scholar for reports of PTLD localization in the liver and surrounding
lymph nodes in renal allograft recipients. Data of 232 cases from 26 international studies have been pooled and
reanalyzed. Patients with L-PTLD were significantly more likely to be of male gender (P=0.02). Death due to PTLD was
higher in L-PTLD patients (P=0.06). Disseminated PTLD, based on our definition, was significantly more prevalent in L-
PTLD than in none-liver-PTLD (NL-PTLD) (P < 0.001); the same finding was noted with multi-organ involvement which
was significantly higher in L-PTLD (P<0.001). L-PTLD was significantly more likely to complicate heart (P=0.03), bone
marrow (P=0.002), spleen (P=0.01), and kidney allograft Involvement (P=0.04). We conclude that renal transplant
patients exhibiting liver localization for PTLD should be carefully followed for multi-organ involvement. Most notably,
bone marrow biopsy should be considered, and evaluations for renal allograft, heart and spleen localization for PTLD
should be executed. Due to the unfavorable characters of liver localization by PTLD in renal recipients, we propose
higher levels of evaluations and follow up for these patients. Prospective studies with larger patient populations are
needed to confirm our results.
Introduction: Hepatitis B virus (HBV) infection is a major global public health problem with the World Health
Organization reporting about 350 million people with chronic HBV infection with the highest rates seen in Asia and
Africa. Multiple studies have attempted to show an association between HBV infection and non-Hodgkin lymphoma
(NHL) but have had conflicting results. Objectives: The primary aim of our study was to evaluate the association
between HBV infection and the incidence of NHL using a meta-analysis of epidemiological studies. Secondary aims
were to evaluate such association in NHL subtypes and by geographical region. Methods: A MEDLINE and Google
Scholar search through July 2012 were undertaken using (Hepatitis B or hepatitis) AND (lymphoma OR "risk of
lymphoma" OR "hematologic malignancies" OR "lymphoproliferative disorders" OR "non Hodgkin lymphoma"). Only
epidemiological studies reporting on HBV infection and NHL were included. Hepatitis B status confirmation method
was recorded. Meta-analyses were performed for NHL in general, by NHL subtypes, and according to geographical
region. The outcome was calculated as odds ratio (OR). The random effects model (REM) was used to calculate the
outcome. Heterogeneity was assessed by the I2 statistic. Publication bias was assessed by the trim-and-fill analysis.
Literature search and data gathering were performed independently by at least 2 of the investigators. All graphs and
calculations were obtained using Comprehensive Meta-Analysis version 2 (Biostat, Englewood, NJ). Results: Our
search yielded 21 studies; 17 case-control studies accounted for 38,630 cases and 1,659,449 controls, and 4
prospective cohort studies accounted for 1,258 cases indentified in a cohort of over 2.4 million individuals. HBV
infection was confirmed by seropositivity in 81% of studies (n=17). HBV infection patients had an OR 2.30 (95% CI
1.87-2.84; p=<0.001) of developing NHL. OR was significant in patients from Asian countries (OR 2.31, 95% CI 1.87-
2.86, p<0.001) and in patients from American/European/Australian countries (OR 2.58, 95% CI 1.43-4.62, p=0.002).
In subgroup analysis, HBV infection patients had an OR 2.10 (95% CI 1.27-3.49, p=0.004) of developing diffuse large B-
cell lymphoma (DLBCL). In patients from Asian countries, HBV infection was associated with an increased risk of
DLBCL (OR 3.05, 95% CI 1.86-5.00, p<0.001); an association was not found in patients from Europe or Australian
studies. Patients with HBV infection had increased risk to develop follicular lymphoma (OR 1.966, 95% CI 1.211-
3.193, p<0.001) and B-cell lymphomas (OR 2.67, 95% CI 2.08-3.43, p<0.001). Patients with HBV infection did not have
increased risk to develop chronic lymphocytic leukemia/small cell lymphoma (OR 1.58, 95% CI 0.70-3.62, p=0.27) or T-
cell lymphomas (OR 1.37, 95% CI 0.95-1.98, p=0.091). Conclusions: The results of this meta-analysis suggest a
positive association between HBV infection and NHL, DLBCL, follicular lymphoma, and B-cell lymphoma. There was
no association between HBV infection and chronic lymphocytic leukemia/small cell lymphoma or T-cell lymphomas.
In Pakistan, there are estimated 7-9 million carriers of hepatitis B virus (HBV) with a carrier rate of 3-5%. This article
reviews the available literature about the prevalence, risk factors, awareness status and genotypes of the HBV in
Pakistan by using key words; HBV prevalence, risk factors, awareness status and genotypes in Pakistani population in
PubMed, PakMediNet, Directory of Open Access Journals (DOAJ) and Google Scholar. One hundred and six different
studies published from 1998 to 2010 were included in this study. Weighted mean and standard deviation were
determined for each population group. The percentage of hepatitis B virus infection in general population was
4.3318% +/- 1.644%, healthy blood donors (3.93% +/- 1.58%), military recruits (4.276% +/- 1.646%), healthcare
persons (3.25% +/- 1.202%), pregnant women (5.872% +/- 4.984), prisoners (5.75% +/- 0.212%), surgical patients
(7.397% +/- 2.012%), patients with cirrhosis (28.87% +/- 11.90%), patients with HCC (22% +/- 2.645%), patients with
hepatitis (15.896% +/- 14.824%), patients with liver diseases (27.54% +/- 6.385%), multiple transfused patients
(6.223% +/- 2.121%), opthalmic patients (3.89% +/- 1.004%) and users of injectable drugs (14.95% +/- 10.536%).
Genotype D (63.71%) is the most prevalent genotype in Pakistani population. Mass vaccination and awareness
programs should be initiated on urgent basis especially in populations with HBV infection rates of more than 5%.
Introduction. Based on very limited data, it has been recently suggested that hepatitis B virus infection can play
significant roles in post transplantation lymphoproliferative disorders. In the current study pooling data of PTLD in
HBV positive liver recipients gathered from the existing literature, we sought to analyze and compare characteristics,
behavior and prognosis of PTLD arising in HBV positive liver graft recipients. Methods. A comprehensive search for
the available data though PubMed and Google Scholar for reports of PTLD and HBV infection in liver recipients was
conducted. Data of 18 different studies were pooled and analyzed. Results. Liver recipients with HBV positive-PTLD
were comparable to their HBV negative counterparts in gender, age at transplantation, time from transplantation to
PTLD development, lymphoma cell type, histopathology of lesions, remission episodes, mortality rate, multi-organ
involvement, and disseminated PTLD (p > 0.1 for all). HBV positive PTLD patients were significantly less likely to
complicate spleen (0 vs. 23%, respectively; p = 0.015). Survival of the two patient groups were comparable (p = 0.8).
Conclusion. HBV infection has no significant impact on inducing some distinct types of PTLD and represents no
survival effect in PTLD setting. Future prospective studies are needed for confirming our findings.
In Pakistan more than 10 million people are living with Hepatitis C virus (HCV), with high morbidity and mortality. This
article reviews the prevalence, genotypes and factors associated with HCV infection in the Pakistani population. A
literature search was performed by using the keywords; HCV prevalence, genotypes and risk factors in a Pakistani
population, in Pubmed, PakMediNet and Google scholar. Ninety-one different studies dating from 1994 to May 2009
were included in this study, and weighted mean and standard error of each population group was calculated.
Percentage prevalence of HCV was 4.95% +/- 0.53% in the general adult population, 1.72% +/- 0.24% in the pediatric
population and 3.64% +/- 0.31% in a young population applying for recruitment, whereas a very high 57% +/- 17.7%
prevalence was observed in injecting drug users and 48.67% +/- 1.75% in a multi-transfused population. Most
prevalent genotype of HCV was 3a. HCV prevalence was moderate in the general population but very high in
injecting drug users and multi-transfused populations. This data suggests that the major contributing factors towards
increased HCV prevalence include unchecked blood transfusions and reuse of injection syringes. Awareness
programs are required to decrease the future burden of HCV in the Pakistani population. 2009 The WJG Press and
Baishideng. All rights reserved.
Objectives: Hepatitis C virus infection has a 10.5% frequency in liver transplant posttransplant lymphoproliferative
disorders. Studies have suggested that hepatitis C virus infection plays a role in developing posttransplant
lymphoproliferative disorders. Pooling data of posttransplant lymphoproliferative disorders developing in liver
recipients from the literature, we analyzed and compared characteristics, behavior, and prognoses of posttransplant
lymphoproliferative disorders arising in hepatitis C virus-positive versus negative liver graft recipients. Materials and
Methods: We conducted a search for the available data though PubMed and Google Scholar for reports of
posttransplant lymphoproliferative disorders and hepatitis C virus infection in liver transplant recipients. Overall, 29
studies were found and their data are included in the analyses. Results: Overall, data of 212 liver transplant patients
were included. Sixty-three percent were male. No difference was found between hepatitis C viruspositive liver
transplant patients with posttransplant lymphoproliferative disorders compared to their hepatitis C virus-negative
counterparts regarding sex, time from transplant to lymphoma development, lymphoma cell type, remission,
mortality rate, multiorgan involvement, disseminated posttransplant lymphoproliferative disorders, and
histopathologic evaluations (P >.1 for all). Hepatitis C virus-positive liver transplant recipients representing
posttransplant lymphoproliferative disorders who were concomitantly positive for Epstein-Barr virus were
significantly more likely to develop lymphomas in the early posttransplant period (26 [67%] vs 16 [40%]; P =.024) and
to complicate liver (19 [63%] vs 8 [30%]; P =.017) than hepatitis C virus-/Epstein-Barr virus+ patients. Conclusions:
Hepatitis C virus infection alone has no significant effect on lymphoproliferative disorders after liver transplant; but
when combined with Epstein-Barr virus infection, it represents some significant different presentations of the
disease. However, no survival effect was found for hepatitis C virus with or without simultaneous Epstein-Barr virus
infection, in the posttransplant lymphoproliferative disorders setting. Future prospective studies are needed for
confirming our results. Baskent University 2012.
Background: Hepatitis E virus (HEV) infection is a self-limited viral disease that causes acute hepatitis epidemics in
developing countries. The common route of transmission for HEV is supposedly fecal-oral. Serological evidence may
be unexpectedly found in hemodialysis (HD) patients and kidney transplant recipients. Although the route of HEV
transmission is not usually determined in HD subjects, this virus seems to be transmitted either directly through HD
or nosocomially. In this study, we gathered the published information on HEV infection in HD patients and kidney
transplant recipients. Methods: For this review, we collected the relevant articles by searching through Medline and
Google Scholar from January 1980 up to September 2009. Results: Some variables including older age, low
education, living in rural versus urban areas and the duration of HD seem to be risk factors for HEV infection in HD
patients. Compared with non-HD subjects, HEV infection may be specifically associated with poor outcome in HD
patients. Specific considerations seem to be required to prevent transmission of HEV to HD patients. Conclusion:
More extensive investigations are required to determine the disease burden of HEV infection in HD subjects in
countries which experience outbreaks of HEV infection. Copyright 2010 S. Karger AG, Basel.
Purpose Herbal medicines have been increasingly used worldwide. However, the potential harms of these herbs have
been noticed most recently following hepatotoxicity with ingestion of herbal remedies. The aim of this review is to
evaluate the evidence of hepatotoxic effects linked to use of herbal preparations. Method. Electronic search was
performed by searching several databases: PubMed, HerbMed, Google Scholar, Scopus, Cochrane Database of
Systematic Reviews and Cochrane Library using both Latin and common names of several herbs. Language was
restricted to English and articles were selected for relevance reporting incidence of hepatotoxicity associated with
use of herbal products in human. Results. From a total of 565 relevant reviews and articles, 254 met our inclusion
criteria and were analyzed. Serious hepatotoxic events associated with various herbal products alone or in
combination with other drugs have been reported. Linking to herbal constituents the spectrum of liver toxicity
includes elevated liver enzymes, acute or chronic hepatitis, cholestasis, hepatic necrosis, fibrosis, and cirrhosis, as
well as acute liver failure and hepatic veno-occlusive disease. Conclusion. The hepatotoxicity of herbs was
extensively acknowledged. As the use of natural medicine increases, the risk of liver toxicity and drug interaction
increase as well. Accordingly, herbal remedies have been known as hepatotoxins causing several liver damages.
Further scientific studies with high and good quality are needed to identify toxic compounds and understand the
exact mechanism of hepatotoxicity-induced by herbs. The adverse effects of herbal products must be fully reported
as well as extensive education of healthcare providers must be provided in order to reduce danger of alternative
medicines.
Abstract Context: In Iran, conventional production methods of herbal oils are widely used by local practitioners.
Administration of oils is rooted in traditional knowledge with a history of more than 3000 years. Scientific evaluation
of these historical documents can be valuable for finding new potential use in current medicine. Objective: The
current study (i) compiled an inventory of herbal oils used in ancient and medieval Persia and (ii) compared the
preparation methods and therapeutic applications of ancient times to current findings of medicinal properties in the
same plant species. Materials and methods: Information on oils, preparation methods and related clinical
administration was obtained from ancient Persian documents and selected manuscripts describing traditional
Persian medicine. Moreover, we investigated the efficacy of medicinal plant species used for herbal oils through a
search of the PubMed, Scopus and Google Scholar databases. Results: In Iran, the application of medicinal oils date
back to ancient times. In medieval Persian documents, 51 medicinal oils produced from 31 plant species, along with
specific preparation methods, were identified. Flowers, fruits and leaves were most often used. Herbal oils have
been traditionally administered via oral, topical and nasal routes for gastrointestinal, musculoskeletal, and neural
diseases, respectively. According to current investigations, most of the cited medicinal plant species were used for
their anti-inflammatory and analgesic properties. Conclusions: Medicinal oils are currently available in Iranian
medicinal plant markets and are prepared using traditional procedures for desirable clinical outcomes. Other than
historical clarification, the present study provides data on clinical applications of the oils that should lead to future
opportunities to investigate their potential medicinal use.
Context: Herbal remedies are used to treat a large variety of diseases, including blood-related disorders. However, a
number of herbal preparations have been reported to cause variations in clotting time, this is mainly by disruption of
the coagulation cascade. Objective: The compiling of plants investigated for effects on the coagulation cascade.
Methods: Information was withdrawn from Google Scholar and the journal databases Scopus and PubMed. Results:
Sixty-five herbal remedies were identified with antiplatelet, anticoagulant, or coagulating ability. Bioactive
compounds included polyphenols, taxanes, coumarins, saponins, fucoidans, and polysaccharides. Conclusion:
Although research has been conducted on the effect of herbal remedies on coagulation, most information relies on
in vitro assays. Contradictory evidence is present on bleeding risks with herbal uses, though herbdrug interactions
pose a threat. As the safety of many herbals has not been proven, nor their effect on blood parameters determined,
the use of herbal preparations before undergoing any surgical procedure should discontinued. 2012 Informa
Healthcare USA, Inc.
AIMS: The efficacy of endovenous treatments for venous reflux has been demonstrated in numerous randomised
clinical trials, although significant heterogeneity may exist between studies. The aim of this study was to assess the
heterogeneity in reporting between randomised clinical trials investigating endovenous treatments for patients with
varicose veins., METHODS: A literature search of the Pubmed, Cochrane and Google Scholar databases was
performed using appropriate search terms. Randomised clinical trials published between January 1968 and June
2009 evaluating endovenous interventions for varicose veins were included and relevant abstracts and full text
articles were reviewed. Published study reports were evaluated against recommended reporting standards published
by the American Venous Forum in 2007., RESULTS: Twenty-eight randomised trials fulfilled the inclusion criteria.
Median patient age (reported in 20/28 studies) ranged from 33 to 54 years. The CEAP classification was presented in
17/28 studies and the proportion of patients with C2 disease ranged from 6.3% to 83.5%. A total of 31 different
outcome measures were utilised. This included 13 different questionnaires, varicose vein recurrence at 38 time
points and 30 categories of complications. Duplex ultrasonography was used in 21/28 trials to assess recurrence.
Quality of life was only evaluated in 11 studies and the follow-up period ranged from 3 weeks to 10 years.,
CONCLUSIONS: Meaningful comparison across randomised studies of endovenous treatments is made difficult by
considerable variations in study populations and outcome measures between trials. This highlights the need for the
use of prospectively agreed population selection, and reporting standards for outcome measures in randomised
clinical assessments of new treatments. Copyright 2010 European Society for Vascular Surgery. Published by Elsevier
Aims: The efficacy of endovenous treatments for venous reflux has been demonstrated in numerous randomised
clinical trials, although significant heterogeneity may exist between studies. The aim of this study was to assess the
heterogeneity in reporting between randomised clinical trials investigating endovenous treatments for patients with
varicose veins. Methods: A literature search of the Pubmed, Cochrane and Google Scholar databases was performed
using appropriate search terms. Randomised clinical trials published between January 1968 and June 2009 evaluating
endovenous interventions for varicose veins were included and relevant abstracts and full text articles were
reviewed. Published study reports were evaluated against recommended reporting standards published by the
American Venous Forum in 2007. Results: Twenty-eight randomised trials fulfilled the inclusion criteria. Median
patient age (reported in 20/28 studies) ranged from 33 to 54 years. The CEAP classification was presented in 17/28
studies and the proportion of patients with C2 disease ranged from 6.3% to 83.5%. A total of 31 different outcome
measures were utilised. This included 13 different questionnaires, varicose vein recurrence at 38 time points and 30
categories of complications. Duplex ultrasonography was used in 21/28 trials to assess recurrence. Quality of life was
only evaluated in 11 studies and the follow-up period ranged from 3 weeks to 10 years. Conclusions: Meaningful
comparison across randomised studies of endovenous treatments is made difficult by considerable variations in
study populations and outcome measures between trials. This highlights the need for the use of prospectively agreed
population selection, and reporting standards for outcome measures in randomised clinical assessments of new
treatments. 2010 European Society for Vascular Surgery.
The burden of post-malaria cognitive impairment is often overlooked. Given the large number of infections occurring
worldwide, the magnitude of the problem is likely to be substantial. The objectives of this paper are; (i) to assess the
evidence on post malarial cognitive impairment or impact on school education; (ii) to assess the possible positive
impact of malaria drug prophylaxis on cognition; and (iii) to suggest recommendations on minimizing the burden of
post-malarial cognitive impairment. PUBMED and SCOPUS were searched for all articles with the key word 'Malaria'
in the title field and 'cognitive impairment' in any field. Google Scholar was searched for the same keywords
anywhere in the article. The search was restricted to articles published in English within the last 15 years (1995-
2010). After filtering of abstracts from the initial search, 44 papers had research evidence on this topic. Cognitive
abilities and school performance were shown to be impaired in sub-groups of patients (with either cerebral malaria
or uncomplicated malaria) when compared with healthy controls. Studies comparing cognitive functions before and
after treatment for acute malarial illness continued to show significantly impaired school performance and cognitive
abilities even after recovery. Malaria prophylaxis was shown to improve cognitive function and school performance
in clinical trials when compared to placebo groups. The implications of these findings are discussed.
There is still a high burden of protein-energy malnutrition in Nigeria. The severe forms of the disease are usually
associated with high level of mortality even in the tertiary health facilities. To review the cost-effective health
promotional strategies at community levels that could aid prevention, early detection, and prompt treatment of
protein-energy malnutrition. The strategy used for locating articles used for this review was to search databases like
Google, Google scholar, relevant electronic journals from the universities' libraries, including PubMed and Scirus,
Medline, Cochrane library and WHO's Hinari. We believe that strategies beyond the health care setting have
potential of significantly reducing the morbidity and mortality associated with protein-energy malnutrition in Nigeria.
Introduction. High-dose insulin therapy, along with glucose supplementation, has emerged as an effective treatment
for severe beta-blocker and calcium channel-blocker poisoning. We review the experimental data and clinical
experience that suggests high-dose insulin is superior to conventional therapies for these poisonings. Presentation
and general management. Hypotension, bradycardia, decreased systemic vascular resistance (SVR), and cardiogenic
shock are characteristic features of beta-blocker and calcium-channel blocker poisoning. Initial treatment is primarily
supportive and includes saline fluid resuscitation which is essential to correct vasodilation and low cardiac filling
pressures. Conventional therapies such as atropine, glucagon and calcium often fail to improve hemodynamic status
in severely poisoned patients. Catecholamines can increase blood pressure and heart rate, but they also increase SVR
which may result in decreases in cardiac output and perfusion of vascular beds. The increased myocardial oxygen
demand that results from catecholamines and vasopressors may be deleterious in the setting of hypotension and
decreased coronary perfusion. Methods. The Medline, Embase, Toxnet, and Google Scholar databases were searched
for the years 1975-2010 using the terms: high-dose insulin, hyperinsulinemia-euglycemia, beta-blocker, calcium-
channel blocker, toxicology, poisoning, antidote, toxin-induced cardiovascular shock, and overdose. In addition, a
manual search of the Abstracts of the North American Congress of Clinical Toxicology and the Congress of the
European Association of Poisons Centres and Clinical Toxicologists published in Clinical Toxicology for the years 1996-
2010 was undertaken. These searches identified 485 articles of which 72 were considered relevant. Mechanisms of
high-dose insulin benefit. There are three main mechanisms of benefit: increased inotropy, increased intracellular
glucose transport, and vascular dilatation. Efficacy of high-dose insulin. Animal models have shown high-dose insulin
to be superior to calcium salts, glucagon, epinephrine, and vasopressin in terms of survival. Currently, there are no
published controlled clinical trials in humans, but a review of case reports and case series supports the use of high-
dose insulin as an initial therapy. High-dose insulin treatment protocols. When first introduced, insulin doses were
cautiously initiated at 0.5 U/kg bolus followed by a 0.5-1 U/kg/h continuous infusion due to concern for
hypoglycemia and electrolyte imbalances. With increasing clinical experience and the publication of animal studies,
high-dose insulin dosing recommendations have been increased to 1 U/kg insulin bolus followed by a 1-10 U/kg/h
continuous infusion. Although the optimal regimen is still to be determined, bolus doses up to 10 U/kg and
continuous infusions as high as 22 U/kg/h have been administered with good outcomes and minimal adverse events.
Adverse effects of high-dose insulin. The major anticipated adverse events associated with high-dose insulin are
hypoglycemia and hypokalemia. Glucose concentrations must be monitored regularly and supplementation of
Background/Purpose: Calcific tendonitis (CT) and noncalcific tendonitis (NCT) of the shoulder is a common cause of
shoulder pain and can be unresponsive to conventional therapies. Based on several randomized controlled studies
(RCTs), extracorporeal shock wave therapy (ESWT) has been considered an effective alternative treatment. We
performed an updated meta-analysis using all available data to analyze the efficacy of ESWT on CT and NCT.
Methods: We searched Medline, Cochrane database, and Google Scholar from inception to May 2012 for human
RCTs comparing ESWT versus placebo for shoulder pain due to CT or NCT. We hand searched review articles,
manuscripts, and medical journal supplements for additional references. Inclusion criteria were outcome measures
of pain (VAS score; low score = less pain), functional assessment (Constant score; high score = better function), and
resolution of calcifications (for CT trials). Two reviewers independently determined eligibility, assessed the quality of
each trial, and extracted means and variances for these outcome measures. We computed effect sizes for mean
change from baseline to 6 months or 3 months if not reported, using Hedges' g statistic. Effect sizes were pooled
using random effects model. We assessed heterogeneity and performed sensitivity analyses removing the outlier
trials. Subgroup analyses for CT and NCT, and high energy (HE) and low energy (LE) trials were also performed.
Results: Fifteen trials met inclusion criteria; 11 for CT, 4 for NCT. Overall there were 1221 participants with mean age
of 51 years (range 46-56). The proportion of women was 56% (range 39%-76%). Among all trials, the effect size (ES)
for VAS pain favored HE (-2.17; 95%CI [-2.85, -1.49]; I2 51%, p=0.15) and LE showed no effect (-1.15; [-2.63, 0.32]; I2
96%, p=0.00) and the ES for Constant score favored HE (1.77; [1.41, 2.14]; I2 29%, p=0.24) and LE (0.53; [0.16, 0.89];
I2 28%, p=0.24). In CT trials, any level of ESWT improved VAS scores (-2.18; [-3.55, -0.8]; I2 95%, p=0.00) and
Constant scores (1.39, [0.81, 1.97]; I2 84%, p=0.00). In NCT trials, any level of ESWT had no effect on VAS scores (-
0.15; [-0.57, 0.27]; I2 0%, p=0.35) or Constant scores (0.65; [-0.51, 1.82], I2 75%, p=0.04). Among CT, effect sizes for
VAS, Constant scores and resolution of calcifications favored HE over LE (VAS: -0.57; [-1.10,-0.03]; I2 74%, p=0.01;
Constant: 0.57; [0.28, 0.87]; I2 56%, p=0.03; Resolution of calcifications: 3.95; [1.55, 10.03]; I2 70%, p <0.01).
Sensitivity analysis removing outlier trials yielded comparable results. The overall trial quality was moderate. (Table
Presented) Conclusion: High energy shock wave therapy is effective for improving pain and shoulder function in
patients with chronic calcific shoulder tendonitis, and can result in complete resolution of calcifications. Limitations
include the heterogeneous nature of the included studies. Despite this, ESWT may be an underutilized therapy for a
condition that is difficult to manage otherwise.
Background: The role of bone structure, one component of bone quality, has emerged as a contributor to bone
strength. The application of high-resolution imaging in evaluating bone structure has evolved from an in vitro
technology for small specimens to an emerging clinical research tool for in vivo studies in humans. However, many
technical and practical challenges remain to translate these techniques into established clinical outcomes.
Questions/purposes: We reviewed use of high-resolution CT for evaluating trabecular microarchitecture and cortical
ultrastructure of bone specimens ex vivo, extension of these techniques to in vivo human imaging studies, and
recent studies involving application of high-resolution CT to characterize bone structure in the context of skeletal
disease. Methods: We performed the literature review using PubMed and Google Scholar. Keywords included CT,
MDCT, micro-CT, high-resolution peripheral CT, bone microarchitecture, and bone quality. Results: Specimens can be
imaged by micro-CT at a resolution starting at 1 mum, but in vivo human imaging is restricted to a voxel size of 82
mum (with actual spatial resolution of ~ 130 mum) due to technical limitations and radiation dose considerations.
Presently, this mode is limited to peripheral skeletal regions, such as the wrist and tibia. In contrast, multidetector CT
can assess the central skeleton but incurs a higher radiation burden on the subject and provides lower resolution
(200-500 mum). Conclusions: CT currently provides quantitative measures of bone structure and may be used for
estimating bone strength mathematically. The techniques may provide clinically relevant information by enhancing
our understanding of fracture risk and establishing the efficacy of antifracture for osteoporosis and other bone
metabolic disorders. 2011 The Author(s).
BACKGROUND: A trauma registry is an integral component of modern comprehensive trauma care systems. Trauma
registries have not been established in most developing countries, and where they exist are often rudimentary and
incomplete. This review describes the role of trauma registries in the care of the injured, and discusses how lessons
from developed countries can be applied toward their design and implementation in developing countries.,
METHODS: A detailed review of English-language articles on trauma registry was performed using MEDLINE and
CINAHL. In addition, relevant articles from non-indexed journals were identified with Google Scholar., RESULTS: The
history and development of trauma registries and their role in modern trauma care are discussed. Drawing from past
and current experience, guidelines for the design and implementation of trauma registries are given, with emphasis
on technical and logistic factors peculiar to developing countries., CONCLUSION: Improvement in trauma care
depends on the establishment of functioning trauma care systems, of which a trauma registry is a crucial component.
Hospitals and governments in developing countries should be encouraged to establish trauma registries using proven
cost-effective strategies.
Objective: To review the discoveries underpinning the introduction of cerebral PET scanning and highlight its modern
applications. Background: Important discoveries in neurophysiology, brain metabolism, and radiotracer development
in the post-World War II period provided the necessary infrastructure for the first cerebral PET scan. Methods: A
complete review of the literature was undertaken to search for primary and secondary sources on the history of PET
imaging. Searches were performed in PubMed, Google Scholar, and select individual journal Web sites. Written
autobiographies were obtained through the Society for Neuroscience Web site at www.sfn.org. A reference book on
the history of radiology, Naked to the Bone, was reviewed to corroborate facts and to locate references. The
references listed in all the articles and books obtained were reviewed. Results: The neurophysiologic sciences
required to build cerebral PET imaging date back to 1878. The last 60 years have produced an evolution of
technological advancements in brain metabolism and radiotracer development. These advancements facilitated the
development of modern cerebral PET imaging. Several key scientists were involved in critical discoveries and among
them were Angelo Mosso, Charles Roy, Charles Sherrington, John Fulton, Seymour Kety, Louis Sokoloff, David E. Kuhl,
Gordon L. Brownell, Michael Ter-Pogossian, Michael Phelps, and Edward Hoffman. Conclusions: Neurophysiology,
metabolism, and radiotracer development in the postwar era synergized the development of the technology
necessary for cerebral PET scanning. Continued use of PET in clinical trials and current developments in PET-CT/MRI
hybrids has led to advancement in diagnosis, management, and treatment of neurologic disorders. 2013 American
Academy of Neurology.
Introduction: There is a large and robust literature on the spinal use of opioids and non-opioids alike, but unless one
is my age and older, very few persons know how we got here. This small history offering tells us how we got to
where we are today regarding the science, clinical uses, and management of intraspinal analgesia. Methods: I have
reviewed the literature bases of Google Scholar and the National Library of Medicine using the key words: history,
opium, spinal analgesia, spinal morphine, intrathecal (IT), opioid receptors, endogenous opioids, IT delivery of
opioids, and IT side-effects/complications. Results: In this personal review of the history of intraspinal analgesia, I
relate my own early and later experiences of the science and clinical uses of intraspinal morphine, other opioids, and
non-opioids alike to a historical context. This review outlines a rather small history of opium, the historical use of
opium and its various compounds, and the search for and answer to the question,"why was the poppy created for
wondrous medicinal uses for mankind?" This search led to the discovery of endogenous opioid like chemicals, the
discovery of opiate receptors for these endogenous opioids, the first uses of intraspinal opioids in animal models and
man, and, finally, our understanding of the appropriate and inappropriate clinical uses of intraspinal analgesia.
Within this paper, I acknowledge the works of my colleagues and the "heroes" who have laid the foundation for our
understanding of intraspinal analgesia. Conclusions: The history of the use of intraspinal analgesia is rich and guides
us to advance the science and clinical use of intraspinal analgesia without reinventing the wheel. 2012 International
Neuromodulation Society.
Introduction: Hodgkin lymphoma (HL) is one of the most common non-acquired immunodeficiency syndrome (AIDS)-
defining tumors in human immunodeficiency virus (HIV)-infected patients. Studies have shown that HIV infected
individuals have approximately a 7.5-fold (Goedert et al 1998) to nearly 13-fold increased risk for HL compared with
the general population (Biggar et al. 2006, Engels 2006). The outcomes for patients with HL and HIV (HIV-HL) were
described as inferior to HIV-negative patients. The existing literature regarding response and survival data is mainly
comprised of small and/or retrospective studies. We reviewed the literature for the purpose of examining a larger
HIV HL cohort for response rates and survival in the HAART era. Methods: We searched PUBMED, OVID & Google
Scholar (1980- July 2009) and ASH (2004-2008) & ASCO (2004-2009) Annual Meeting Abstracts. Key words used were
'Hodgkin's Lymphoma', 'Hodgkin's Disease',' HIV/AIDS', HAART, therapeutic outcomes, concomitant chemotherapy &
HAART/antiretroviral therapy, non AIDS malignancies. Criteria for inclusion of studies were: 1) Upfront treatment of
HL HIV infected patients with chemotherapy, with or without radiotherapy, with or without antiretroviral drugs/
HAART. 2) Reported in English 3) Studies with outcome measures of treatment for HIV-HL patients such as complete
response (CR) rates, and/or at least one type of survival statistic. We also examined references from above articles as
well as review articles, studies on pathogenesis & histologic features of HIV-HL, and epidemiologic studies for
additional references. Studies that did not clearly report on a comprehensive cohort were excluded given increased
probability of reporting bias. Primary outcome measures were CR rates, and 1- and 2-year overall survival rates. The
data extracted included pre-treatment patient characteristics such as median age, sex, histological diagnosis, clinical
staging, site of involvement, median CD4 cell counts, treatment regimen used, use or not of antiretrovirals/HAART &
prophylactic agents with chemotherapy, response to treatment, toxicity, opportunistic infections, median follow up
time, relapse, disease progression, death from treatment or infections. Summary CR and OS estimates were
calculated based on the assumption of fixed effects and using the Mantel-Haenszel method. Results: 12 articles met
inclusion criteria for meta-analysis of CR and/or OS. The overall CR rate was 72% (95% CI 67-77%) with 1- and 2-year
OS of 78% (95% CI 73-82%) and 69% (95% CI 67-77%), respectively (Figure 1). Advanced stage was present in 63%,
and histology other than nodular sclerosing in 76%. Mean baseline CD4 count was 212 (3-887); 59% of subject
received HAART with chemotherapy. Death during treatment occurred in 7% and relapse was reported in 14%.
Conclusions: Adverse baseline characteristics including advanced disease and histology other than NS persist in the
HAART era. Response and survival rates are improved compared to pre-HAART era but remain lower than rates
found in the HIV-negative population. Further prospective trials need to be done to examine improvements in
This review examines the interactions of financial status and HIV and its implications for women. MEDLINE and
Google scholar were searched using the keywords 'women', 'poverty' and 'HIV' in any field of the article. The search
was limited to articles published in English over the last 10 years. The first section of the article tries to establish
whether poverty or wealth is a risk factor for HIV. There is credible evidence for both arguments. While wealth shows
an increased risk for both sexes, poverty places women at a special disadvantage. The second section explains how
the financial status interacts with other 'non biological' factors to put women at increased risk. While discrimination
based on these factors disadvantage women, there are some paradoxical observations that do not fit with the
traditional line of explanation (e.g. paradoxical impact of wealth and education on HIV). The final section assesses the
impact of HIV in driving poverty and the role of women in interventional programmes. The specific impact of poverty
on females in families living with HIV is less explored. Though microfinance initiatives to empower women are a good
idea in theory, the actual outcome of such a programme is less convincing. 2009 Royal Society of Tropical Medicine
and Hygiene.
A variety of studies have evaluated the associations between polymorphisms in the promoter regions of the hMLH1
and cancer risk. However, the results remain inconclusive. To better understand the roles of the hMLH1
polymorphisms and cancer risk, we conducted a comprehensive meta-analysis to investigate the association
between the hMLH1 -93G/A and 1151T/A (Val384Asp) polymorphisms and cancer risk in Asian population. We
performed a meta-analysis by conducting searches of the published studies in Pub Med, CNKI, CBM, ISI web of
knowledge and Google scholar search databases. Finally, 12 studies were included into our meta-analysis. Overall
and subgroup analyses were performed. Odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the
associations between hMLH1 polymorphisms and cancer risk. Statistical analysis was performed with Review
Manager 5.0. Twelve studies addressing two hMLH1 polymorphisms were analyzed among a total of 4128 cancer
cases and 4678 controls. For hMLH1 -93G/A, there was no evidence that the hMLH1 -93G/A polymorphism was
significantly associated with an increased cancer risk (P>0.05) in Asian populations (heterozygote comparison:
OR=0.89 [95% CI (0.75, 1.060)] P=0.20; dominant model comparison: OR=0.98 [95% CI (0.83, 1.15)] P=0.79). In
subgroup analysis based on cancer types and the sources of control, no associations were found in colorectal cancer,
gastric cancer and "other cancers" under the any gene model except for lung cancer (recessive model comparison:
OR=1.69 [95% CI (1.30, 2.19)] P<0.0001). For hMLH1 1151T/A, the polymorphism significantly associated with an
increased cancer risk in Asians: OR=1.88 [95% CI (1.49, 2.25)], P<0.0001, and OR=1.87 [95% CI (1.49, 2.25)],
P<0.0001. Our investigations demonstrated that the hMLH1 -93G/A polymorphism is not a candidate for
susceptibility to overall cancers, and that the hMLH1 1151T/A polymorphism is significantly associated with higher
cancer risk in Asian populations. Further studies with large sample size for hMLH1 should be conducted. Copyright
2013 Elsevier B.V. All rights reserved.
Many eHealth technologies are not successful in realizing sustainable innovations in health care practices. One of the
reasons for this is that the current development of eHealth technology often disregards the interdependencies
between technology, human characteristics, and the socioeconomic environment, resulting in technology that has a
low impact in health care practices. To overcome the hurdles with eHealth design and implementation, a new,
holistic approach to the development of eHealth technologies is needed, one that takes into account the complexity
of health care and the rituals and habits of patients and other stakeholders. The aim of this viewpoint paper is to
improve the uptake and impact of eHealth technologies by advocating a holistic approach toward their development
and eventual integration in the health sector. To identify the potential and limitations of current eHealth frameworks
(1999-2009), we carried out a literature search in the following electronic databases: PubMed, ScienceDirect, Web of
Knowledge, PiCarta, and Google Scholar. Of the 60 papers that were identified, 44 were selected for full review. We
excluded those papers that did not describe hands-on guidelines or quality criteria for the design, implementation,
and evaluation of eHealth technologies (28 papers). From the results retrieved, we identified 16 eHealth frameworks
that matched the inclusion criteria. The outcomes were used to posit strategies and principles for a holistic approach
toward the development of eHealth technologies; these principles underpin our holistic eHealth framework. A total
of 16 frameworks qualified for a final analysis, based on their theoretical backgrounds and visions on eHealth, and
the strategies and conditions for the research and development of eHealth technologies. Despite their potential, the
relationship between the visions on eHealth, proposed strategies, and research methods is obscure, perhaps due to a
rather conceptual approach that focuses on the rationale behind the frameworks rather than on practical guidelines.
In addition, the Web 2.0 technologies that call for a more stakeholder-driven approach are beyond the scope of
current frameworks. To overcome these limitations, we composed a holistic framework based on a participatory
development approach, persuasive design techniques, and business modeling. To demonstrate the impact of eHealth
technologies more effectively, a fresh way of thinking is required about how technology can be used to innovate
health care. It also requires new concepts and instruments to develop and implement technologies in practice. The
proposed framework serves as an evidence-based roadmap.
BACKGROUND: Many eHealth technologies are not successful in realizing sustainable innovations in health care
practices. One of the reasons for this is that the current development of eHealth technology often disregards the
interdependencies between technology, human characteristics, and the socioeconomic environment, resulting in
technology that has a low impact in health care practices. To overcome the hurdles with eHealth design and
implementation, a new, holistic approach to the development of eHealth technologies is needed, one that takes into
account the complexity of health care and the rituals and habits of patients and other stakeholders., OBJECTIVE: The
aim of this viewpoint paper is to improve the uptake and impact of eHealth technologies by advocating a holistic
approach toward their development and eventual integration in the health sector., METHODS: To identify the
potential and limitations of current eHealth frameworks (1999-2009), we carried out a literature search in the
following electronic databases: PubMed, ScienceDirect, Web of Knowledge, PiCarta, and Google Scholar. Of the 60
papers that were identified, 44 were selected for full review. We excluded those papers that did not describe hands-
on guidelines or quality criteria for the design, implementation, and evaluation of eHealth technologies (28 papers).
From the results retrieved, we identified 16 eHealth frameworks that matched the inclusion criteria. The outcomes
were used to posit strategies and principles for a holistic approach toward the development of eHealth technologies;
these principles underpin our holistic eHealth framework., RESULTS: A total of 16 frameworks qualified for a final
analysis, based on their theoretical backgrounds and visions on eHealth, and the strategies and conditions for the
research and development of eHealth technologies. Despite their potential, the relationship between the visions on
eHealth, proposed strategies, and research methods is obscure, perhaps due to a rather conceptual approach that
focuses on the rationale behind the frameworks rather than on practical guidelines. In addition, the Web 2.0
technologies that call for a more stakeholder-driven approach are beyond the scope of current frameworks. To
overcome these limitations, we composed a holistic framework based on a participatory development approach,
persuasive design techniques, and business modeling., CONCLUSIONS: To demonstrate the impact of eHealth
technologies more effectively, a fresh way of thinking is required about how technology can be used to innovate
health care. It also requires new concepts and instruments to develop and implement technologies in practice. The
proposed framework serves as an evidence-based roadmap.
Objective: To systematically review placebo-controlled randomized trials of homeopathy for psychiatric conditions.
Data Sources: Eligible studies were identified using the following databases from database inception to April 2010:
PubMed, CINAHL, PsycINFO, Hom-Inform, Cochrane CENTRAL, National Center for Complementary and Alternative
Medicine grantee publications database, and ClinicalTrials.gov. Gray literature was also searched using Google,
Google Scholar, the European Committee for Homeopathy, inquiries with homeopathic experts and manufacturers,
and the bibliographic lists of included published studies and reviews. Search terms were as follows: (homeopath* or
homoeopath*) and (placebo or sham) and (anxiety or panic or phobia or post-traumatic stress or PTSD or obsessive-
compulsive disorder or fear or depress* or dysthym* or attention deficit hyperactivity or premenstrual syndrome or
premenstrual disorder or premenstrual dysphoric disorder or traumatic brain injury or fibromyalgia or chronic fatigue
syndrome or myalgic encephalitis or insomnia or sleep disturbance). Searches included only English-language
literature that reported randomized controlled trials in humans. Study Selection: Trials were included if they met 7
criteria and were assessed for possible bias using the Scottish Intercollegiate Guidelines Network (SIGN) 50
guidelines. Overall assessments were made using the Grading of Recommendations Assessment, Development and
Evaluation procedure. Identified studies were grouped into anxiety or stress, sleep or circadian rhythm complaints,
premenstrual problems, attention-deficit/hyperactivity disorder, mild traumatic brain injury, and functional somatic
syndromes. Results: Twenty-five eligible studies were identified from an initial pool of 1,431. Study quality according
to SIGN 50 criteria varied, with 6 assessed as good, 9 as fair, and 10 as poor. Outcome was unrelated to SIGN quality.
Effect size could be calculated in 16 studies, and number needed to treat, in 10 studies. Efficacy was found for the
functional somatic syndromes group (fibromyalgia and chronic fatigue syndrome), but not for anxiety or stress. For
other disorders, homeopathy produced mixed effects. No placebo-controlled studies of depression were identified.
Meaningful safety data were lacking in the reports, but the superficial findings suggested good tolerability of
homeopathy. A funnel plot in 13 studies did not support publication bias (chi21 = 1.923, P = .166). Conclusions: The
database on studies of homeopathy and placebo in psychiatry is very limited, but results do not preclude the
possibility of some benefit. Copyright 2011 Physicians Postgraduate Press, Inc.
Context: Identification of clinically relevant biomarkers is required for better diagnosis, prevention and treatment of
tuberculosis. Objective: In this review, potential host biomarkers in blood or blood cells in tuberculosis were
identified by a systematic approach. Methods: A total of 55 articles were selected from PubMed and Google Scholar
that analyzed gene and or protein expression in humans in active and or latent TB. Articles were scored according to
certain criteria and categorized as strong or weak studies. Biomarkers reported by more than one article or by a
single strong article were identified as potential biomarkers. Results: Six most promising markers (IP-10, IL-6, IL-10, IL-
4, FOXP3 and IL-12) were identified based on their presence in both mycobacterial antigen-stimulated and -
unstimulated samples. Conclusions: With this review we hope to provide a reliable guideline for biomarker studies in
tuberculosis. 2012 Informa UK, Ltd.
DATA SOURCES: PubMed, CINAHL, Cochrane Library, National Guidelines Clearinghouse, Web of Science and Google
Scholar databases were searched., STUDY SELECTION: Experimental and non-experimental English language studies
in adults in hospitalised and non-hospitalised patients were included., DATA EXTRACTION AND SYNTHESIS: A
qualitative summary of the included studies was presented., RESULTS: Seven experimental and three descriptive
studies were included. All of the studies examined toothbrush contamination and found significant bacterial
retention and survival on toothbrushes after use. A number of decontamination techniques were studied and a
range of active agents reduced bacterial load. Closed storage containers generally increased bacterial load or survival
times. Toothbrush design was also seen to have varying impact on bacterial load., CONCLUSIONS: The selected
studies found that toothbrushes of healthy and oral diseased adults become contaminated with pathogenic bacteria
from dental plaque, design, environment or a combination of factors. There are no studies that specifically examine
toothbrush contamination and the role of environmental factors, toothbrush contamination, and vulnerable
populations in the hospital setting (eg critically ill adults) and toothbrush use in nursing clinical practice.
DATA SOURCES: Medline, the Cochrane Library, TRIP database and Google Scholar, hand searching of articles,
reviews and textbooks., STUDY SELECTION: Articles in any language about endodontic procedures, (initial treatment
or retreatment and surgical or nonsurgical but not pulpotomy, partial pulpectomy or pulp capping) in permanent
teeth that reported on pain at a minimum of six months were included. The main outcome was the presence of all-
cause pain, with no differentiation on the basis of aetiologies. The outcome of all-cause pain was considered positive
if reported by either the patient or the practitioner. Pain could be spontaneous or provoked by biting, palpation or
percussion., DATA EXTRACTION AND SYNTHESIS: Data were extracted independently by two reviewers and STROBE
criteria (www.strobe-statement.org) used to assess quality. A summary estimate of persistent all-cause pain
frequency was established by using a random-effects meta-analysis. The influence of treatment approach
(surgical/nonsurgical), longitudinal study design (prospective/retrospective), follow-up rate and duration, initial
treatment versus retreatment, and quality of reporting on the pain frequency estimate was assessed in subgroup
analyses., RESULTS: 26 studies that included 5777 teeth with 2996 (51.9%) having follow-up pain information met
the inclusion criteria. 168 teeth with pain were identified giving a frequency of 5.3% (95% confidence interval, 3.5%-
7.2%, p < 0.001) for persistent all-cause pain. High and statistically significant heterogeneity among studies (I(2) =
80%) was present. In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives
studies (0.9%). Quality of study reporting was identified as the most influential reason for study heterogeneity.,
CONCLUSIONS: The frequency of all-cause persistent pain after endodontic procedures was estimated to be 5.3%,
with higher report quality studies suggesting >7%.
Background: Chemotherapy treatment in premenopausal women is associated with an increased risk of premature
ovarian failure (POF) but the exact mechanism through which this occurs is uncertain. In this review we examine the
current evidence for the direct action of chemotherapeutic agents on the ovary and discuss possible molecular
pathways through which follicle loss may occur. Methods: A systemic search of the databases, PubMed and Google
Scholar, was made for all English language articles through to 2011 in each subject area discussed. Results: POF
results from the loss of primordial follicles but this is not necessarily a direct effect of the chemotherapeutic agents.
Instead, the disappearance of primordial follicles could be due to an increased rate of growth initiation to replace
damaged developing follicles. Likewise, the loss of oocytes need not necessarily be a direct result of damage:
evidence suggests that chemotherapy drugs can also induce oocyte death indirectly via damage to somatic cells.
Specific molecular mechanisms and likely ovarian targets are discussed for some of the anti-cancer drugs most
commonly used to treat premenopausal women. Finally, we consider current and prospective methods of preserving
fertility. Conclusions: It is likely that different chemotherapeutic drugs act through a range of mechanisms and on
different target cells. More research into the cellular mechanisms underpinning chemotherapy-induced follicle loss
could lead to the generation of treatments specifically designed to prevent POF. The Author 2012. Published by
reserved.
Objective: To assess the prevalence of preterm birth among low birthweight babies in low and middle-income
countries. Methods: Major databases (PubMed, LILACS, Google Scholar) were searched for studies on the prevalence
of term and preterm LBW babies with field work carried out after 1990 in low- and middle-income countries.
Regression methods were used to model this proportion according to LBW prevalence levels. Results: According to
47 studies from 27 low- and middle-income countries, approximately half of all LBW babies are preterm rather than
one in three as assumed in studies previous to the 1990s. Conclusions: The estimate of a substantially higher number
of LBW preterm babies has important policy implications in view of special health care needs of these infants. As for
earlier projections, our findings are limited by the relative lack of population-based studies.
OBJECTIVE: To assess the prevalence of preterm birth among low birthweight babies in low and middle-income
countries., METHODS: Major databases (PubMed, LILACS, Google Scholar) were searched for studies on the
prevalence of term and preterm LBW babies with field work carried out after 1990 in low- and middle-income
countries. Regression methods were used to model this proportion according to LBW prevalence levels., RESULTS:
According to 47 studies from 27 low- and middle-income countries, approximately half of all LBW babies are preterm
rather than one in three as assumed in studies previous to the 1990s., CONCLUSIONS: The estimate of a substantially
higher number of LBW preterm babies has important policy implications in view of special health care needs of these
infants. As for earlier projections, our findings are limited by the relative lack of population-based studies.
Background The publication rate of presentations at medical international meetings has ranged from 11% to 78%
with an average of 45%. To date, there are no studies about the final rate of publications at scientific meetings
associated with plastic surgery from Korea. The present authors investigated the publication rate among the
presentations at meetings associated with plastic surgery. Methods The titles and authors of the abstracts from oral
and poster presentations were collected from the program books of the Congress of the Korean Society of Plastic
and Reconstructive Surgeons (CKSPRS) for 2005 to 2007 (58th-63rd). All of the abstracts presented were searched
for using PubMed, KoreaMed, KMbase, and Google Scholar. The titles, key words from the titles, and the authors'
names were then entered in database programs. The parameters reviewed included the publication rate, type of
presentation including running time, affiliation, subspecialty, time to publication, and publication journal. Results A
total of 1,176 abstracts presented at the CKSPRS from 2005 to 2007 were evaluated. 38.7% of the abstracts, of which
oral presentations accounted for 41.0% and poster presentations 34.8%, were published as full papers. The mean
time to publication was 15.04 months. Among journals of publication, the Journal of the Korean Society of Plastic and
Reconstructive Surgeons was most used. Conclusions Brilliant ideas and innovative approaches are being discussed
at CKSPRS. The 38.7% publication rate found from this research appeared a bit lower than the average rate of
medical meetings. If these valuable presentations are not available as full papers, the research would be a waste of
time and effort. 2012 The Korean Society of Plastic and Reconstructive Surgeons.
Background: Vitamin D is critical for musculoskeletal health and has been implicated in the risk of extraskeletal
diseases, including cancer, cardiovascular diseases, and autoimmune diseases, as well as overall mortality. Although
numerous studies deal and have dealt with vitamin D deficiency and its consequences, experts cannot agree on the
right 25-hydroxyvitamin D levels. This survey aims to shed light on the ongoing vitamin D controversy from different
angles. Questions/purposes: We discuss the minimum threshold for the 25-hydroxyvitamin D level to guarantee
optimal health, why vitamin is D critical to musculoskeletal and extraskeletal functions, and new evidence for the
success of prevention measures such as food fortification. Methods: We searched PubMed, Google Scholar, and
reference lists of articles using several keywords. The most recent search was in February 2011. Results: While the
use of parathyroid hormone as a surrogate measure did not lead to a consensus concerning the required 25-
hydroxyvitamin D serum level, the combined analysis of bone mineralization and vitamin D status has established
minimum levels of more than 75 nmol/L (30 ng/mL) to guarantee at least skeletal health. An effective measure to
approach this status is food fortification, which has been demonstrated by countries such as Canada, the United
States, and Finland. Conclusions: Given the health economic implications of failure to maintain a balanced vitamin D
status, action is recommended to integrate current scientific knowledge on vitamin D into physicians treatment of
patients and governmental policies on food fortification. 2011 The Association of Bone and Joint Surgeons.
Objective: We sought to assess the relationship between patient cost sharing; medication adherence; and clinical,
utilization, and economic outcomes. Methodology:We conducted a literature review of articles and abstracts
published from January 1974 to May 2008. Articles were identified using PubMed, Ovid, MEDLINE, Web of Science,
and Google Scholar databases. The following terms were used in the search: adherence, compliance, copay, cost
sharing, costs, noncompliance, outcomes, hospitalization, utilization, economics, income, and persistence. Results:
We identified and included 160 articles in the review. Although the types of interventions, measures, and
populations studied varied widely, we were able to identify relatively clear relationships between cost sharing,
adherence, and outcomes. Of the articles that evaluated the relationship between changes in cost sharing and
adherence, 85% showed that an increasing patient share of medication costs was significantly associated with a
decrease in adherence. For articles that investigated the relationship between adherence and outcomes, the
majority noted that increased adherence was associated with a statistically significant improvement in outcomes.
Conclusion: Increasing patient cost sharing was associated with declines in medication adherence, which in turn was
associated with poorer health outcomes.
BACKGROUND: It is unclear whether or not untreated bounded edentulous spaces (BES) can cause patients problems
because of migration of unopposed and adjacent teeth., OBJECTIVES: To quantitatively assess BES-related occlusal
changes and the level of evidence available., MATERIAL AND METHODS: A systematic search of the literature was
conducted in triplicate in the PubMed and Cochrane Register of Controlled Trials (CENTRAL) databases up to and
including February 2010 to assess studies related to the topic. The LILACS database also was searched by one of the
authors (CMF). Quantitative mesio-distal changes and overeruption were the outcome measures. Manual searching
of the reference lists of studies retrieved from the electronic databases was also conducted. Google Scholar in
English, French, German, Greek, Italian, Portuguese, and Spanish was also searched to retrieve potential studies.
Grey literature was searched in OpenSIGLE (System for Information on Grey Literature in Europe) for more potential
papers. The quality of the retrieved literature and the strength of recommendations were assessed by use of the
GRADE system. A decision-tree-like scheme was produced to depict treatment options., RESULTS: The available
evidence demonstrated that for most cases occlusal changes in BES after tooth loss might be limited (on average up
to 2mm). The quality of evidence was regarded as very low, however., CONCLUSIONS: Tooth replacement should not
necessarily be regarded as the mainstay of therapy for posterior BES, although more robust studies are necessary to
clarify the long-term effects of non-treatment. The GRADE approach may be useful for enhancing the transparency
of the decision-making process in dentistry, especially when evidence of only limited quality is available. Copyright A
2010 Elsevier Ltd. All rights reserved.
It is unclear whether or not untreated bounded edentulous spaces (BES) can cause patients problems because of
migration of unopposed and adjacent teeth. To quantitatively assess BES-related occlusal changes and the level of
evidence available. A systematic search of the literature was conducted in triplicate in the PubMed and Cochrane
Register of Controlled Trials (CENTRAL) databases up to and including February 2010 to assess studies related to the
topic. The LILACS database also was searched by one of the authors (CMF). Quantitative mesio-distal changes and
overeruption were the outcome measures. Manual searching of the reference lists of studies retrieved from the
electronic databases was also conducted. Google Scholar in English, French, German, Greek, Italian, Portuguese, and
Spanish was also searched to retrieve potential studies. Grey literature was searched in OpenSIGLE (System for
Information on Grey Literature in Europe) for more potential papers. The quality of the retrieved literature and the
strength of recommendations were assessed by use of the GRADE system. A decision-tree-like scheme was produced
to depict treatment options. The available evidence demonstrated that for most cases occlusal changes in BES after
tooth loss might be limited (on average up to 2mm). The quality of evidence was regarded as very low, however.
Tooth replacement should not necessarily be regarded as the mainstay of therapy for posterior BES, although more
robust studies are necessary to clarify the long-term effects of non-treatment. The GRADE approach may be useful
for enhancing the transparency of the decision-making process in dentistry, especially when evidence of only limited
quality is available. Copyright A 2010 Elsevier Ltd. All rights reserved.
BACKGROUND: Although a host of clinical severity indices has been developed for inflammatory bowel disease, none
has been appropriately validated. This variation made it difficult to compare the outcomes of different clinical trials.
There is no single ''gold standard'' clinical severity index and each investigator chooses or develops his own index.
Therefore, there is a need to develop a single clinical severity index in inflammatory bowel disease that is valid and
reliable. The aim of this study is to identify the required standards for a valid and reliable severity index in
inflammatory bowel disease and apply them to evaluate the commonly used clinical severity indices in inflammatory
bowel disease. METHODS: Literature search was conducted using MEDLINE and Google scholar database from
January 1947 to 2011 to identify the required standards for clinical severity indices in inflammatory bowel disease.
We also reviewed the commonly used clinical severity indices in inflammatory bowel disease and their validation
studies. Personal communications, websites, and major textbooks were critically reviewed to identify potentially
relevant materials. One hundred article was critically evaluated. RESULTS: A new 10-point scoring checklist was
developed and applied to assess the disease severity indices in inflammatory bowel disease. The scoring system
covers items selection, validity, reliability and responsiveness of the indices. Below is the scoring table. A score is
given if the standard is met. 1. Face validity for the items was checked 2.Content validity was assessed by experts.
3.Items with endorsement rate of 80% were identified and removed. 4.Items with discrimination power 5.Items with
item-total correlation 6.Internal consistency is acceptable (eg, Cronbach alpha >0.7). 7.Inter-observer reliability >0.75
8.Test-retest reliability >0.75 9.Construct validity >0.4 10. Responsiveness factor (sensitivity to change) >0.5 The
higher the score of the index, the more valid and reliable it is. However, we recommend that 7 is the minimum
acceptable score for clinical practice as non-empirical validity are judgmental and it is difficult to assess them
properly. Item discrimination power can be substituted by Item total correlation to remove redundant items. Inter-
observer reliability is closely related to test-retest reliability and one of them should be enough to assess the
reliability of the index. CONCLUSION(S): This study defined the required standards for developing disease severity
indices in inflammatory bowel disease and developed a 10-point checklist to systematically evaluate current and
future indices. Using this checklist will ensure that any new index is valid and reliable.
Programmes of assessment should measure the various components of clinical competence. Clinical reasoning has
been traditionally assessed using written tests and performance-based tests. The script concordance test (SCT) was
developed to assess clinical data interpretation skills. A recent review of the literature examined the validity
argument concerning the SCT. Our aim was to provide potential users with evidence-based recommendations on
how to construct and implement an SCT. A systematic review of relevant databases (MEDLINE, ERIC [Education
Resources Information Centre], PsycINFO, the Research and Development Resource Base [RDRB, University of
Toronto]) and Google Scholar, medical education journals and conference proceedings was conducted for references
in English or French. It was supplemented by ancestry searching and by additional references provided by experts.
The search yielded 848 references, of which 80 were analysed. Studies suggest that tests with around 100 items (25-
30 cases), of which 25% are discarded after item analysis, should provide reliable scores. Panels with 10-20 members
are needed to reach adequate precision in terms of estimated reliability. Panellists' responses can be analysed by
checking for moderate variability among responses. Studies of alternative scoring methods are inconclusive, but the
traditional scoring method is satisfactory. There is little evidence on how best to determine a pass/fail threshold for
high-stakes examinations. Our literature search was broad and included references from medical education journals
not indexed in the usual databases, conference abstracts and dissertations. There is good evidence on how to
construct and implement an SCT for formative purposes or medium-stakes course evaluations. Further avenues for
research include examining the impact of various aspects of SCT construction and implementation on issues such as
educational impact, correlations with other assessments, and validity of pass/fail decisions, particularly for high-
stakes examinations. Blackwell Publishing Ltd 2012.
There is a controversy about the efficacy of hyperbaric oxygen (HBO) therapy for the treatment of autism. This study
systematically reviews the current evidences for treating of autism with HBO therapy. According to PRISMA
guidelines for a systematic review, the databases of MEDLINE/Pubmed, Google Scholar, and Randomised Controlled
Trials in Hyperbaric Medicine were electronically searched. In addition, medical subject heading terms and text
words for hyperbaric oxygen therapy and autism were used. The main inclusion criteria were published studies which
reported the original data from the trials conducted on the patients with autism and assessed outcomes with a valid
and reliable instrument. A quality assessment was also conducted. The electronically search resulted in 18 title of
publications. Two studies were randomized, double-blind, controlled-clinical trials. While some uncontrolled and
controlled studies suggested that HBO therapy is effective for the treatment of autism, these promising effects are
not replicated. Therefore, sham-controlled studies with rigorous methodology are required to be conducted in order
to provide scientific evidence-based HBO therapy for autism treatment. 2012 Ghanizadeh; licensee BioMed Central
Ltd.
Type: Therapeutic Case Report. Background: Use of supplements as energy boosters and performance enhancers for
athletes has been a topic of concern, particularly the potential for supplements to adversely affect cardiovascular
(CV) function. Under the Dietary Supplement Health and Education Act of 1994, the manufacturer of a dietary
supplement is charged with ensuring the safety of the product, but no Food and Drug Administration approval is
needed. The ingredients of dietary supplements marketed for increased endurance may be associated with a variety
of potentially adverse effects on CV function, particularly heart rate and blood pressure. Often little evidence-based
research is available to support claims for the ingredients or provide guidance for clinicians regarding potential
effects if combinations are used. Patient-History: A 17-year old adolescent male presented for a preseason sports
physical. Upon physical exam, his blood pressure was 210/120 mm Hg. Lisinopril 10 mg daily was initiated. He was
referred to the pediatric hypertension for follow-up. A thorough medication history was done. During the course of
the evaluation, the patient acknowledged using performance-enhancing supplements and caffeine-containing drinks
in an effort to augment athletic performance. Following discontinuation of the supplements, his hypertension
resolved and lisinopril discontinued with no adverse blood pressure consequences. Review of Literature: Literature
retrieval was accessed through Ovid, Google Scholar, MEDLINE, and PubMed (1965-August 2012) Reports of CV
adverse event or CV-related effects, defined as changes in heart rate and/or blood pressure for this case report,
were reviewed for individual ingredients in the supplements. Reports of adverse effects were found for nine of the
supplement ingredients. Caffeine was a component of five of the nine ingredients. Conclusions: Clinicians are
encouraged to obtain a thorough patient history, including asking specific questions regarding any recent or chronic
use of performance-enhancing supplements or energy drinks. The potential for adverse effects from supplements
may be under-estimated by users.
Hypoxic hepatitis (HH), one of the most common causes of acute liver injury, has a prevalence of up to 10% of
admissions in intensive care units across the world. Inadequate oxygen uptake by the hepatocytes resulting in
centrilobular necrosis associated with abnormally raised levels of the serum transaminases (ALT, AST) in patients
with clinical history of cardiac, respiratory, or circulatory failures is the key feature of this condition. Abstracts,
reviews, case reports, and research letters from various sources such as Pubmed, Proquest, Ovid, Google Scholar,
and ISI Web of Knowledge dating from 1970 to 2011 were read and analyzed thoroughly. A study of 100 patients
with HH, carried out from 2009 to 2010 at Tongji Hospital of Tongji University, Shanghai, People's Republic of China,
is also documented. The contributing factors leading to HH are passive congestion, ischemia, and arterial hypoxemia
of the liver. Ischemia/reperfusion injury also has a major role in HH. Some of its complications are spontaneous
hypoglycemia, a high level of serum ammonia, and respiratory insufficiency due to hepatopulmonary syndrome. The
therapy of HH lies mainly in the treatment of the main underlying causes, and this leads to the successful reversion
of HH. The aim of this review is to present a simplified concept about the etiology, pathophysiology, mechanism,
clinical manifestations, diagnosis, and treatment of HH. Asian Pacific Association for the Study of the Liver 2012.
Purpose Iatrogenic femoral nerve injury is a recognized complication of abdominal and pelvic surgery. It causes
distress and disability and may lead to permanent motor and/or sensory sequelae. The aim of this systematic review
was to explore the contemporary spectrum of this injury reported in the literature. Methods A systematic review of
iatrogenic femoral nerve injuries reported between 2000 and October 2010 was undertaken using the electronic
databases Medline, Pub- Med, Cochrane Library, and Google Scholar. The context, frequency, mechanism of injury,
and outcome were recorded. Relevant clinical and anatomical literature was reviewed to provide an overview of the
surgical anatomy. Results Iatrogenic femoral nerve injury is not rare, occurring as a complication of common
abdominal, pelvic, and orthopedic operations and after femoral nerve blocks and femoral artery puncture.
Mechanisms of injury are diverse and include direct trauma and ischemia from retraction or stretching of the nerve.
Variant anatomy is very rarely the source of the problem. Although the prognosis in most cases is good some
affected patients require nerve repair or grafting and some are left with permanent residual neurologic deficits.
Conclusions A wider awareness of this complication, particularly the context in which it may occur, together with an
appropriate understanding of the anatomy of the femoral nerve may help to reduce the frequency of this distressing
and disabling iatrogenic complication. Springer-Verlag 2011.
Purpose: Peripheral nerve injuries are among the most frequent iatrogenic complications and are responsible for
considerable morbidity and litigation. Most occur within surgical settings and upper limb nerves are most frequently
involved. Methods: A systematic review of major iatrogenic upper limb nerve injuries was undertaken to evaluate
the contemporary spectrum of such injuries. The electronic databases MEDLINE, PubMed, Cochrane Library and
Google Scholar were searched for relevant articles listed between January 2000 and May 2010. Iatrogenic injuries to
the brachial plexus, radial, axillary, ulnar, median, musculocutaneous and major cutaneous nerves were analysed,
focusing on context, mechanisms of injury and incidence. Results: Iatrogenic upper limb nerve injuries are relatively
common and can affect patients in any surgical specialty. Even patients undergoing diagnostic procedures under
general anaesthesia are at risk. Orthopaedic surgery and plastic and reconstructive surgery figure prominently in
these complications. The spectrum of iatrogenic peripheral nerve injuries has changed in parallel with technological
advances in surgery, anaesthesia and medicine. Conclusions: Some iatrogenic upper limb peripheral nerve injuries
may be unavoidable, but most cases are probably preventable by an adequate knowledge of surgical anatomy and an
awareness of the types of procedures in which peripheral nerves are particularly vulnerable. 2010 The Authors. ANZ
Journal of Surgery 2010 Royal Australasian College of Surgeons.
The International Classification of Functioning, Disability and Health (ICF) holds great promise for providing the
rehabilitation disciplines with a universal language. However, the ICF is still highly complex and questions remain
about its practicability. The aims of this review were to (i) identify how the ICF is integrated in the clinical activity of
physiotherapists, (ii) discuss advantages and limits of the use of the ICF, and (iii) suggest further possibilities for
implementing the ICF by physiotherapists. A literature search on Medline, Cochrane, CINAHL and PEDro (key words:
ICF, physiotherapy, physical therapy, clinical application, clinical use) was carried out, together with a check for
articles on Google Scholar. Of 155 identified articles, 22 were specific to physiotherapy. These articles described the
utility of the ICF to facilitate decision-making for physiotherapists; to classify the evaluation of therapy outcomes; to
ensure that all aspects of human functioning are represented while testing the effectiveness and the reliability of
these outcomes; to structure the documentation of assessments and interventions, as well as to ameliorate the
communication. ICF has a clinical relevance for physiotherapists, although the limited reliability of the qualifier
system for the feasibility of its implementation was shown. The authors emphasize that the ICF is a tool that
facilitates the decision of what to measure but not how to measure.
Purpose: Pulsatile tinnitus (PT) is a relatively uncommon complaint in patients presenting to otolaryngology clinics.
Contemporary advice is that all patients with this symptom should be investigated completely. This generalisation
can lead to a notable delay in the ultimate diagnosis in these patients. Some of these patients may have a potentially
life-threatening condition, where a delay in diagnosis could have disastrous consequences. The purpose of this study
was to assess factors that could help to identify this high-risk group. Materials and methods: A literature review was
performed using Medline/Pubmed and Google Scholar search engines. We searched for words including hearing loss,
deafness, vertigo, dizziness, imbalance, headache, trauma, cranial nerve palsy, bruit, otalgia, earache and age in
combination with PT. These findings were retrospectively applied to a series of fifty patients presenting to our
department with PT. Results: Pulsatile tinnitus associated with cranial never palsy, hearing loss, occipital headache or
trauma is most commonly associated with an underlying clinically sinister condition. However, the combination of
pulsatile tinnitus with otalgia, dizziness or age above 60 years is less likely to be due to a life-threatening condition. In
our series of fifty patients, five (10%) were found to have a serious underlying cause for their PT. All of these five
patients presented with one or the other of the above-mentioned symptoms associated with PT. Conclusion: The
most likely cause of a delay in diagnosis seems to be a lack of red-flag criteria to channel patients with PT for further
investigations. Our results show that when patients with pulsatile tinnitus present with a history of trauma to the
head and neck, headache or cranial nerve palsy, a serious underlying pathology is more likely to be present and
clinicians should perform the relevant investigations promptly.
Introduction: This paper sought to determine the levels of evidence associated with treatment for specific diagnostic
categories and the prognosis of treatment. Materials and Methods: A review of the literature was conducted using
MEDLINE, PubMed, Google Scholar and the Cochrane Database. The Journal of Endodontics, International Journal of
Endodontics, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, Endodontic Topics,
and Dental Traumatology were also searched. The bibliographies of relevant articles were manually searched.
Conclusion: The review found a low level of evidence to assess clinical treatment modalities. The development of
higher levels of evidence to facilitate the selection of appropriate treatment modalities for each diagnostic category
is recommended. 2009 American Association of Endodontists.
Introduction: Previous studies have indicated that educationally influential physicians' (EIPs) interactions with peers
can lead to practice changes and improved patient outcomes. However, multiple approaches have been used to
identify and investigate EIPs' informal or formal influence on practice, which creates study outcomes that are difficult
to compare. The purposes of this systematic literature review were to (1) compare approaches used to identify EIPs
and (2) identify and compare shared characteristics of EIPs as defined by the included studies. Methods: Articles in
English were obtained from PubMed, CINAHL Plus, ERIC, PsycINFO, Web of Science, Google Scholar databases, and
reference lists of identified articles. Studies were compared and contrasted based on terminology, identification
approach, selection criteria, and EIP characteristics according to Cresswell's 5 steps in conducting a literature review.
Results: Thirty-one studies met the inclusion criteria. Sociometric questionnaires and peer informants were used
most frequently to identify EIPs. Multiple and varied criteria, including physician ranking, nomination by peers,
percentage of nominations received, and number of votes were used by researchers to select physicians who were
classified as EIPs. The identified characteristics of EIPs varied by study, with some researchers adhering to
characteristics previously described by Hiss, and others adding to or deviating from those characteristics, at times
based on physician specialty. Conclusion: Selection of an EIP identification approach requires agreement on EIPs'
characteristics, consistent approaches and identification criteria, and common terms and definitions. Additional
research is needed to compare characteristics of EIPs and study outcomes based on the identification method
employed. 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical
Education, and the Council on CME, Association for Hospital Medical Education.
Background: Iloprost, a prostacyclin analogue, has been efficacious reducing contrast-induced nephropathy (CIN)
among patients undergoing coronary angiography. We hypothesized prostaglandin analogues are protective against
contrast media-induced vasoconstriction and hypoxemia in the kidneys due to vasodilation. Methods: We searched
MEDLINE, Clinical Trials.Gov, The Cochrane Library, and Google Scholar for randomized trials using iloprost in renal
protection for contrast-induced nephropathy and renal transplantation. Two authors independently reviewed,
graded, and extracted the data. Relative risk (RR) was calculated for CIN and the weighted mean difference (WMD)
for the mean change in creatinine clearance (CrCl). Results: We retrieved 11 articles reporting randomized controlled
trials examining the effects of iloprost versus control in renal protection. Two studies reported on iloprost and CIN.
Iloprost was found to be renoprotective in patients with baseline renal insufficiency who underwent coronary
angiography for CIN (Figure A: RR 0.32, 95%CI:0.16, 0.67) and increased the weighted mean difference change in CrCl
(Figure B: 4.56, 95%CI: 1.82, 7.30). Conclusions: Our meta-analysis demonstrated that iloprost reduces CIN and
improves renal function in cardiac catheterization patients. More large randomized controlled trials are necessary to
determine the clinical efficacy of iloprost. (Table Presented).
OBJECTIVES: The optimal timing of initiation of Antiretroviral Therapy (ART) in ART naive patients with HIV and TB co-
infection remains inconclusive. IRIS incidence is one of the most important outcomes that we need to consider when
making a decision on the time of initiating ART. This study compared the IRIS incidence in patients initiating ART
earlier (>=2 months after the start of tuberculosis therapy) versus later (>2 months after the start of tuberculosis
therapy). We also examined the differences of IRIS incidence between early and late arms in the Resources limited
settings (RLS) and the Non Resources limited settings (NRLS). METHODS: Data for this meta-analysis were extracted
from Pubmed/Medline, Embase, Cochrane database of systematic review, Cochrane Central Register of Controlled
Trials, International Pharmaceutical Abstracts, ClinicalTrials.gov and Google Scholar from year 1986 to 2011. We
searched by using a combination of terms: HIV, HIV infections, acquired immunodeficiency syndrome, tuberculosis,
TB, HAART, highly active antiretroviral therapy, ART, antiretroviral therapy. Out of the 11300 studies found in the
search, five cohort studies met the inclusion criteria. Among the five studies, two were located in RLS and three were
located in NRLS. We conducted a meta-analysis of these five studies by using STATA SE version 12. RESULTS: Meta-
analysis results showed that overall, people treated with ART earlier during TB therapy had a 12.9% lower risk of IRIS
incidence compared to people treated later (RR, 0.871; 95% CI, 0.831-0.912). In addition, the differences of IRIS
incidence between early and late arms were significant in both the Resources limited settings (RLS) and the Non
Resources limited settings (NRLS). CONCLUSIONS: Initiating antiretroviral therapy less than 2 months after the start
of tuberculosis therapy is associated with a significantly lower risk of IRIS incidence, regardless of the locations.
A large body of literature suggests that certain polysaccharides affect immune system function. Much of this
literature, however, consists of in vitro studies or studies in which polysaccharides were injected. Their immunologic
effects following oral administration is less clear. The purpose of this systematic review was to consolidate and
evaluate the available data regarding the specific immunologic effects of dietary polysaccharides. Studies were
identified by conducting PubMed and Google Scholar electronic searches and through reviews of polysaccharide
article bibliographies. Only articles published in English were included in this review. Two researchers reviewed data
on study design, control, sample size, results, and nature of outcome measures. Subsequent searches were
conducted to gather information about polysaccharide safety, structure and composition, and disposition. We found
62 publications reporting statistically significant effects of orally ingested glucans, pectins, heteroglycans,
glucomannans, fucoidans, galactomannans, arabinogalactans and mixed polysaccharide products in rodents. Fifteen
controlled human studies reported that oral glucans, arabinogalactans, heteroglycans, and fucoidans exerted
significant effects. Although some studies investigated anti-inflammatory effects, most studies investigated the
ability of oral polysaccharides to stimulate the immune system. These studies, as well as safety and toxicity studies,
suggest that these polysaccharide products appear to be largely well-tolerated. Taken as a whole, the oral
polysaccharide literature is highly heterogenous and is not sufficient to support broad product structure/function
generalizations. Numerous dietary polysaccharides, particularly glucans, appear to elicit diverse immunomodulatory
effects in numerous animal tissues, including the blood, GI tract and spleen. Glucan extracts from the Trametes
versicolor mushroom improved survival and immune function in human RCTs of cancer patients; glucans,
arabinogalactans and fucoidans elicited immunomodulatory effects in controlled studies of healthy adults and
patients with canker sores and seasonal allergies. This review provides a foundation that can serve to guide future
research on immune modulation by well-characterized polysaccharide compounds.
Background: Advances have been made in the field of cancer immunotherapy in understanding the role of the host
immune response in affecting tumor progression and response to various treatments. Through these advances, two
novel immunotherapies were introduced in the clinic for melanoma and prostate cancer. Methods: This review
discusses the available data regarding the immune-modulating effects of various treatments and how they can be
utilized in the treatment of breast cancer. Databases including PubMed and Google Scholar were searched using
terms including breast cancer, vaccines, and immunotherapy. Results: There is increasing evidence to support that
certain breast tumors are intrinsically more immunogenic than others. Tumors that elicit more potent cytotoxic T-cell
responses tend to have a more favorable prognosis and respond better to chemotherapy than less immunogenic
tumors. Many standard treatments used in breast cancer rely in part on their immunogenic effects for their success
in eradicating disease. Understanding how to use these agents to effectively augment the antitumor immune
response may lead to better outcomes. Finally, many new immunomodulatory agents and vaccines that can reverse
the immunosuppression caused by established tumors are in development. Combining these novel agents with
current therapies may boost their efficacy. Conclusions: Immunotherapeutic approaches combined with novel
sequences of chemotherapies, radiation, vaccines, and immunomodulating agents hold promise for enhancing the
treatment of breast cancer.
This paper traces the evolution of measures and parameters for the evaluation of science and scientific journals from
the first attempts during the early part of the last century to the development of the most popular, current and
widely used metrics viz., citations, impact factor (IF) etc. The identification of measures of evaluation in science and
scientific reporting paralled the post-war increase in funding in the United States of America. Biomedical and medical
sciences continue to garner a major share, estimated to be almost two-thirds of total research and development
funding of over US$ 350 billion. There has been a concomitant growth in the publications in learned journals. About
1.4 million papers are published every year in an estimated 20,000 journals. In India there are an estimated 100
journals in medical sciences. With a steady increase of about 10% every year, the competition for grants, awards,
rewards etc., is fierce. This unrelenting increase in number of scientists and the resultant competition, the limitation
of peer review was felt. A search was on for new quantifiable measures for informed decision making for funding,
awards, rewards, etc. Now virtually all major decisions all over the world are based on some data linked to
publications and/or citations. The concept of citations as tool for 'evaluating' science was first proposed by Eugene
Garfield in 1955. The availability of Science Citation Index (SCI), Journal Citation Reports (JCR), Web of Science etc.
and the relative ease with which they could be used (and abused) has spawned an entirely new area
bibliometrics/scientometrics. As only a limited number of journals could be included in the Thomson Reuters (TR)
databases (currently numbering about 10500), analyses based on such a limited dataset (also selected in a non-
transparent way by the TR) has been widely and severely criticized by both the developed and developing countries.
Yet, studies have shown that citation-based data and indicators (warts and all) could still be put to productive use for
purposes of evaluation (as scientists just love numbers). There were simultaneous efforts to find alternative
indicators using the TR databases, and through other innovative methods. Some of these include Google Scholar,
PageRank, H-index, Y-factor, Faculty of 1000, Eigen Factor etc. The advantages and limitations of these indices are
discussed. There is a need for a more critical look at these parameters from the Indian perspective to compute/
device/adapt these measures to suit our needs. There are 205 journals under the category Physiology and 201 in the
Pharmacology category listed in the JCR. There are four major Indian journals under the category of Physiology and
Pharmacology and none of them are listed in the TR databases reflecting the limitation of these databases.
Eventually, and in the long run, the quality of our journals needs to be improved as the current era of globalization
and web-access provides both a challenge and an opportunity for the science and scientific journals published from
India to get increased global visibility.
OBJECTIVES: Over the last decade, federal and state initiatives have encouraged the adoption of electronic-medical-
record (EMR) systems in hospitals, emergency departments, and physician offices and clinics. These systems may
have the potential to prevent adverse drug events, decrease health care costs, as well as improve care itself.
Although accumulated evidence suggests that a basic EMR system with patient demographics and laboratory results
improves health care over no system, less evidence is available on the relative advantages, if any, of a more
advanced system, which also allows electronic reminders for interventions and screenings. Hence, the objective of
the study was to conduct a meta-analysis of the available evidence to measure the impact of an advanced EMR
system relative to a basic system on the quality of patient care given by providers. METHODS: Electronic databases,
including MEDLINE and Google-Scholar, were searched for randomized controlled trials related to the objective. The
composite outcome measure, termed quality of patient care, was defined as whether screening, diagnosis, providing
recommended treatment, or counseling were provided during the visit. Sub-group analyses were performed for
screening and providing recommended treatment. Studies with large variances were excluded. Heterogeneity was
assessed using the I2 statistic. Because I2 exceeded 50%, a random-effects model was used. RESULTS: Ten studies
which included 1,867 providers were included. The odds of care were 1.77 (95% CI: 0.98-3.21; p=0.059) times higher
for providers with an advanced EMR system compared to those with a basic system. Sub-group analyses showed that
the odds of screening patients were 1.07 (95% CI: 1.02-1.13; p=0.005) times higher and providing recommended
treatment were 1.11 (95% CI: 0.91-1.35; p=0.32) times higher, compared to the basic system. CONCLUSIONS:
Relative to providers with basic EMR systems, those with advanced systems were only slightly more effective in
terms of the overall care rate and the screening rate.
AIMS: To assess the impact of alcohol advertising and media exposure on future adolescent alcohol use. METHODS:
We searched MEDLINE, the Cochrane Library, Sociological Abstracts, and PsycLIT, from 1990 to September 2008,
supplemented with searches of Google scholar, hand searches of key journals and reference lists of identified papers
and key publications for more recent publications. We selected longitudinal studies that assessed individuals'
exposure to commercial communications and media and alcohol drinking behaviour at baseline, and assessed alcohol
drinking behaviour at follow-up. Participants were adolescents aged 18 years or younger or below the legal drinking
age of the country of origin of the study, whichever was the higher. RESULTS: Thirteen longitudinal studies that
followed up a total of over 38,000 young people met inclusion criteria. The studies measured exposure to advertising
and promotion in a variety of ways, including estimates of the volume of media and advertising exposure, ownership
of branded merchandise, recall and receptivity, and one study on expenditure on advertisements. Follow-up ranged
from 8 to 96 months. One study reported outcomes at multiple time-points, 3, 5, and 8 years. Seven studies provided
data on initiation of alcohol use amongst non-drinkers, three studies on maintenance and frequency of drinking
amongst baseline drinkers, and seven studies on alcohol use of the total sample of non-drinkers and drinkers at
baseline. Twelve of the thirteen studies concluded an impact of exposure on subsequent alcohol use, including
initiation of drinking and heavier drinking amongst existing drinkers, with a dose response relationship in all studies
that reported such exposure and analysis. There was variation in the strength of association, and the degree to which
potential confounders were controlled for. The thirteenth study, which tested the impact of outdoor advertising
placed near schools failed to detect an impact on alcohol use, but found an impact on intentions to use.
CONCLUSIONS: Longitudinal studies consistently suggest that exposure to media and commercial communications on
alcohol is associated with the likelihood that adolescents will start to drink alcohol, and with increased drinking
amongst baseline drinkers. Based on the strength of this association, the consistency of findings across numerous
observational studies, temporality of exposure and drinking behaviours observed, dose-response relationships, as
well as the theoretical plausibility regarding the impact of media exposure and commercial communications, we
conclude that alcohol advertising and promotion increases the likelihood that adolescents will start to use alcohol,
and to drink more if they are already using alcohol.
Background: Many countries in sub-Saharan Africa have the highest risk of developing chronic diseases and are the
least able to cope with them. Aims: To assess the current knowledge of the prevalence and impact of asthma and
chronic obstructive pulmonary disease (COPD) in sub-Saharan Africa. Methods: A literature search was conducted
using Medline (1995-2010) and Google Scholar. Results: Eleven studies of the prevalence of asthma in sub-Saharan
Africa were identified, all of which showed a consistent increase, particularly in urban regions. The data on asthma
show a wide variation (5.7-20.3%), with the highest prevalence in 'westernised' urban areas. Only two studies of the
prevalence of COPD in sub-Saharan Africa have been performed. Nevertheless, COPD has become an increasing
health problem in sub-Saharan Africa due to tobacco smoking and exposure to biomass fuels. In most countries of
sub-Saharan Africa, 90% of the rural households depend on biomass fuel for cooking and heating, affecting young
children (acute lower respiratory infections) and women (COPD). This is the cause of significant mortality and
morbidity in the region. Conclusions: Asthma and COPD in sub-Saharan Africa are under-recognised, under-
diagnosed, under-treated, and insufficiently prevented. A major priority is to increase the awareness of asthma and
COPD and their risk factors, particularly the damage caused by biomass fuel. Surveys are needed to provide local
healthcare workers with the possibility of controlling asthma and COPD. 2011 Primary Care Respiratory Society UK.
Introduction: The objective was to identify published quality of life assessments in patients with constipation and to
place the impact of constipation within the context of other chronic conditions. Aims and Methods: A systematic
review was carried out using MEDLINE, EMBASE, Cochrane Library and Google Scholar, supplemented by hand
searching of journals. Studies that assessed health-related quality of life (HRQoL) in patients of any age with chronic
functional constipation were identified. The results were then limited to those studies that used a generic, rather
than gastrointestinal-specific assessment tool. Results: The search identified 14 studies that fulfilled the inclusion
criteria. Eight adult studies used the short form 36 (SF-36) questionnaire, one the short form 12 (SF-12) and two the
psychological general well being index. Two studies in children used the PedsQL questionnaire and one the CHQ-
PF50. All studies showed reduced HRQoL in patients with constipation compared with population norms. Pooled and
normalised results from studies using the SF-36 and SF-12 showed quality of life impairment compared with control
populations on both the mental composite (Table presented) score (MCS; 45.8 vs 48.8) and the physical composite
score (PCS; 47.5 vs 51.3). Although scores were reduced across all domains, the main reductions contributing to this
difference were in the domains: general health, mental health and social functioning. The table compares the results
for MCS and PCS in constipation with values obtained for other common chronic conditions.1 These findings were
consistent with the results from studies using other HRQoL tools and were noted equally in adult and elderly
populations. The paediatric studies yielded similar qualitative results. Conclusion: The impairment in HRQoL observed
in chronic functional constipation is comparable with that seen in conditions that might be regarded as more
"serious", such as osteoarthritis, rheumatoid arthritis and diabetes. Unlike in these conditions, constipation is
amenable to alleviation using a range of wellestablished, safe and low-cost treatments. Given that the population
prevalence of constipation is approximately 15%, the adoption of strategies to improve management may be
expected to yield significant gains in quality of life in a cost-effective fashion.
Buruli ulcer (BU) is a cutaneous neglected tropical disease caused by Mycobacterium ulcerans. Participation of
Community Health Workers (CHWs) is an integral part of the management of BU, yet their impact has not been
systematically evaluated in sub-Saharan Africa. METHODS: Our objectives were to summarize the evidence on the
impact of CHWs on the control of BU in sub-Saharan Africa by looking at their recruitment, training, non-
governmental support and performance. We searched the following electronic databases from January 1998 to July
2012: Medline, EMBASE (Excerpta Medica Database), The Cochrane Library, Google Scholar, CINAHL (Cumulative
Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin
American and Caribbean Literature on Health Sciences) and contacted experts in the field. There were no restrictions
to language or publication status. All study designs that could provide the information we sought were eligible,
provided the studies were conducted in sub-Saharan Africa. Critical appraisal of all identified citations was done
independently by two authors to establish the possible relevance of the articles for inclusion in the review. Of 195
hits, 17 papers met the inclusion criteria. For the management of Buruli Ulcer, CHWs are often recruited from the
communities they will serve. Communities play a role in CHW selection. Larger numbers of CHWs are needed in
order to improve the detection and management of cases. One of the major obstacles to the control of BU is
inadequate and poorly- equipped health facilities in the affected areas. Evidence from this review suggests that CHW
programmes can have large impacts on the control of BU in sub-Saharan Africa. Large-scale rigorous studies,
including RCTs, are needed to assess whether the CHWs programs promote equity and access. Marius Zambou
Vouking et al.
Dental trauma constitutes a public health problem with a marked prevalence among Brazilian children and
adolescents. Furthermore, it can lead to irreparable dental loss, which makes it important to evaluate this condition
using instruments of oral health related to quality of life (OHRQoL). Based on this, a review of the literature sought to
expose indices that may assess the evaluation of quality of life among Brazilians with dental trauma, as well as
discuss the state of the art of publications about this condition on their OHRQoL followed by a discussion of the
output encountered on the subject. With this in mind the articles published from 1980 to June/2011 located on
databases (Pubmed, VHL, Google Scholar) or manually in the references of selected publications were prioritized. It
was revealed that there is no specific instrument for dental trauma. It is therefore necessary to assess the OHRQoL in
children and adolescents with indices found in the literature. Once this has been done, as yet unresolved questions
about the impact of dental trauma on OHRQoL can be answered.
The aim of this review is to evaluate what is known about the impact on children of parental deployment to Iraq or
Afghanistan. We searched for relevant studies with a minimum sample size of 50 which were published between
2003 and 2010 using Google Scholar, MEDLINE, PubMed, PsycINFO and Web of Science. Bibliographies of retrieved
articles were also searched. Nine US-based studies were identified for inclusion in the review, five were cross-
sectional, two were longitudinal and two were analyses of routinely collected data. Researchers found an increase in
emotional and behavioral problems in children when a parent was deployed. Several mediating factors were
identified, such as the family demographics and the number and duration of parental deployments. Parental
psychopathology was most consistently identified as a risk factor for childhood emotional and behavioral disorders in
the research. Limitations of the current research and subsequent recommendations for future research are also
outlined. 2011 Institute of Psychiatry.
Although economic theory indicates that it should not be necessary to intervene in the generic drug market through
price regulation, most EU countries intervene in this market, both by regulating the maximum sale price of generics
(price cap) and by setting the maximum reimbursement rate, especially by means of reference pricing systems.We
analyse current knowledge of the impact of direct price-cap regulation of generic drugs and the implementation of
systems regulating the reimbursement rate, particularly through reference pricing and similar tools, on dynamic price
competition between generic competitors in Europe.A literature search was carried out in the EconLit and PubMed
databases, and on Google Scholar. The search included papers published in English or Spanish between January 2000
and July 2009. Inclusion criteria included that studies had to present empirical results of a quantitative nature for EU
countries of the impact of price capping andor regulation of the reimbursement rate (reference pricing or similar
systems) on price dynamics, corresponding to pharmacy sales, in the generic drug market.The available evidence
indicates that price-cap regulation leads to a levelling off of generic prices at a higher level than would occur in the
absence of this regulation. Reference pricing systems cause an obvious and almost compulsory reduction in the
consumer price of all pharmaceuticals subject to this system, to a varying degree in different countries and periods,
the reduction being greater for originator-branded drugs than for generics. In several countries with a reference
pricing system, it was observed that generics with a consumer price lower than the reference price do not undergo
price reductions until the reference price is reduced, even when there are other lower-priced generics on the market
(absence of price competition below the reference price). Beyond the price reduction forced by the price-cap andor
reference pricing regulation itself, the entry of new generic competitors is useful for lowering the real transaction
price of purchases made by pharmacies (dynamic price competition at ex-factory level), although this effect is
weaker or non-significant for official ex-factory prices and consumer prices in some countries. When maximum
reimbursement systems such as reference pricing or similar types are applied, pharmacies are seen to receive large
discounts on the price they pay for the pharmaceuticals, although these discounts are not transferred to the
consumer price. The percentage discount offered to pharmacies in a country that uses a price-cap system combined
with reference pricing is positively and significantly related to the number of generic competitors in the market for
the pharmaceutical (dynamic price competition at ex-factory level). 2010 Adis Data Information BV. All rights
reserved.
Objective: The adequate attainment and maintenance of good hemoglobin A1c control in diabetes are major
challenges. Although insulin use as the mainstay of diabetes treatment has resulted in favorable treatment
outcomes, poor adherence/compliance occurs due to factors such as fear of insulin or fear of injection. This study
was undertaken to conduct a systematic review of the impact of fear of insulin/injection on the treatment outcomes
of diabetes patients. Methods: A structured search of EMBASE, Ovid MEDLINE, PubMed, and PsycINFO for the years
1990-2008 was conducted to identify published English-language articles addressing fear of insulin or fear of
injection in diabetes. The following key words and their combinations were used in the search: diabetes, insulin,
injection, fear, phobia, and psychological insulin resistance. Google Scholar website was used to search for any
additional references. Manual searches on the references of retrieved articles were also performed to find additional
studies. Results: Six studies were selected for in depth assessment. The treatment outcomes included hemoglobin
A1c in two studies, complications of diabetes in two studies, general health and psychological comorbidities in two
studies, and mortality in one study. Although the number of studies was limited, all identified adverse treatment
outcomes in diabetes patients with fear of insulin or fear of injection. No studies with outcomes of resource
utilizations or costs were identified. Limitations: Most of the studies we reviewed had a cross-sectional design, where
the findings primarily presented associations without firm determinations of the impact of fear of insulin/injection on
the treatment outcomes of diabetes. Conclusions: Fear of insulin or fear of injection is associated with poor glycemic
control, clinical complications, psychological comorbidities, poor general well-being and health status, and increased
risk of mortality for diabetes patients. 2009 Informa UK Ltd. All rights reserved.
Background: Fetal and neonatal malnutrition impacts the timing of the onset of puberty. The timing of puberty onset
has been shown to be a rough indicator of noncommunicable disease (NCD) risk. Recent advances in understanding
the various inter-related neurochemical and genetic controls underpinning puberty onset have shed new light on
these interesting and important phenomena. These studies have suggested that developmental trajectory is set very
early by epigenetic mechanisms that serve to adjust phenotype to environment. Objective: The aims of this article
are to review the most recent research into the proximate mechanisms that initiate puberty; to explore how the
activation of those mechanisms could be affected by nutritional cues received during fetal and neonatal life; and,
finally, to briefly explore the ramifications for public health. Methods: An extensive literature review was performed
using PubMed (1950 to September 2010) and Google Scholar (1980 to September 2010) using the search terms
"puberty onset", "perinatal", and "neonatal malnutrition". English language, original research, and review articles
were examined; pertinent citations from these articles were also assessed. Results: Literature detailing biochemical
pathways and evolutionary explanations of human puberty itself led quickly to a noteworthy connection between
neonatal malnutrition, puberty onset, and NCD risk. A strong connection was found between maternal malnutrition
during critical windows (followed by catch-up growth in childhood) and an accelerated onset of puberty. Children
subject to early nutritional insult not only are likely to undergo puberty earlier but also show an increase in their risk
of developing NCDs in later life. Several authors have suggested that this relationship may show potential as an early
proxy indicator of susceptibility to these types of diseases, which are an increasing concern in both affluent and
developing countries. Conclusions: More attention should be paid to fetal and neonatal nutrition and puberty onset
if we are to meaningfully curb the troubling growth of NCDs now and in the future. Efforts to improve maternal
conditions among vulnerable poor groups as well as more affluent groups worldwide should be explored, especially
among groups undergoing rapid nutritional transition. 2011 Connor, publisher and licensee Dove Medical Press Ltd.
Several studies have reported the prognostic strength of HIV-1 DNA with variable results however. The aims of the
current study were to estimate more accurately the ability of HIV-1 DNA to predict progression of HIV-1 disease
toward acquired immunodeficiency syndrome (AIDS) or death, and to compare the prognostic information obtained
by HIV-1 DNA with that derived from plasma HIV-1 RNA. Eligible articles were identified through a comprehensive
search of Medline, ISI Web of Science, Scopus, and Google Scholar. The analysis included univariate and bivariate
random-effects models. The univariate meta-analysis of six studies involving 1074 participants showed that HIV-1
DNA was a strong predictive marker of AIDS [relative risk (RR): 3.01, 95% confidence interval (CI): 1.88-4.82] and of
all-cause mortality (RR: 3.49, 95% CI: 2.06-5.89). The bivariate model using the crude estimates of primary studies
indicated that HIV-1 DNA was a significantly better predictor than HIV-1 RNA of either AIDS alone (ratio of RRs=1.47,
95% CI: 1.05-2.07) or of combined (AIDS or death) progression outcomes (ratio of RRs=1.51, 95% CI: 1.11-2.05). HIV-
1 DNA is a strong predictor of HIV-1 disease progression. Moreover, there is some evidence that HIV-1 DNA might
have better predictive value than plasma HIV-1 RNA. 2012, Mary Ann Liebert, Inc.
The purpose of this review is to provide a summary of studies on the effectiveness nutrition education interventions
used by college students. Electronic databases such as Medline, Science Direct, CINAHL (EBSCOhost), and Google
Scholar were explored for articles that involved nutrition education interventions for college students and that were
published between 1990 and 2011. Fourteen studies, which involved a total of 1668 college students as respondents,
were identifed and met the inclusion criteria. The results showed that there were 3 major forms of nutrition
education interventions: web-based education, lectures, and supplement provisions. Dietary intake measures were
used in almost all studies and were primarily collected with food records, recall, food frequency questionnaires, and
dietary habit questionnaires. The outcome measures varied among the studies, with indicators such as consumption
of food, nutrition knowledge, dietary habits, physical activity, and quality of life. Methodological issues were also
identifed. In general, college students experienced signifcant changes in their dietary habits after the interventions
were employed. The highlighted methodological issues should be considered to improve the quality of similar
research in future. Penerbit Universiti Sains Malaysia.
The purpose of this review is to provide a summary of studies on the effectiveness nutrition education interventions
used by college students. Electronic databases such as Medline, Science Direct, CINAHL (EBSCOhost), and Google
Scholar were explored for articles that involved nutrition education interventions for college students and that were
published between 1990 and 2011. Fourteen studies, which involved a total of 1668 college students as respondents,
were identified and met the inclusion criteria. The results showed that there were 3 major forms of nutrition
education interventions: web-based education, lectures, and supplement provisions. Dietary intake measures were
used in almost all studies and were primarily collected with food records, recall, food frequency questionnaires, and
dietary habit questionnaires. The outcome measures varied among the studies, with indicators such as consumption
of food, nutrition knowledge, dietary habits, physical activity, and quality of life. Methodological issues were also
identified. In general, college students experienced significant changes in their dietary habits after the interventions
were employed. The highlighted methodological issues should be considered to improve the quality of similar
research in future.
Policies consisting of or including prior authorisation (PA) of pharmaceutical prescriptions have been increasingly
implemented by public and private insurers in the last decade, especially in the US, in order to control drug spending.
We conducted a systematic review of published articles determining the effects of these policies on drug use,
healthcare utilisation, healthcare expenditures and health outcomes. A literature search was carried out in the
electronic databases PubMed (which includes MEDLINE), EconLit, Web of Science and online sources including
Google Scholar, from 1 January 1985 to 12 September 2006. Reference lists of retrieved articles were also searched.
Peer-reviewed studies that provided empirical results about the impact of pharmaceutical PA policies, including
randomised and non-randomised controlled trials, repeated measures studies, interrupted time series analyses and
before-and-after studies were included. Use of, and expenditure on, directly affected drugs per patient, and overall
drug expenditure, significantly decreased after PA implementation, or increased after PA removal. Health outcome
changes attributed to PA policies were not directly evaluated. In most cases, except for cimetidine, PA
implementation was not associated with significant changes in the utilisation of other medical services. Although the
literature indicates a reduction in drug expenditure and a non-negative impact on use of other health services, policy
recommendations still require improved study designs, and evidence cannot be easily transferred from one setting
to another. The evidence still remains mainly limited to US Medicaid settings and to a small number of drug classes.
There is a lack of consideration of implications of PA policies as heterogeneous interventions, outcome
measurements require improvement, and there is a notable lack of evidence of medium-and long-term policy
effects. 2007 Adis Data Information BV. All rights reserved.
Background. The authors conducted a systematic review of original studies that was designed to assess the impact of
polyol-containing chewing gum on dental caries compared with the effect with no chewing gum. Review Methods.
The authors searched MEDLINE, The Cochrane Library and Google Scholar up to May 2008 to identify peer-reviewed
articles that compared polyol-containing chewing gum with no chewing gum. The authors extracted study
characteristics, data on incremental dental caries and quality by consensus. Data on prevented fraction (PF) were
pooled across studies. Results. The results of 19 articles with data from 14 study populations showed that the use of
xylitol, xylitol-sorbitol blend and sorbitol were associated with mean PF (95 percent confidence interval) of 58.66
percent (35.42-81.90), 52.82 percent (39.64-66.00) and 20.01 percent (12.74-27.27), respectively. For the sorbitol-
mannitol blend, it was 10.71 percent (-20.50-41.93), which was not statistically significant. Sensitivity analyses
confirmed the robustness of the findings. Clinical Implications. Although research gaps exist, particularly on optimal
dosing and relative polyol efficacy, research evidence supports using polyol-containing chewing gum as part of
normal oral hygiene to prevent dental caries.
To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on
objective measures of medical education and clinical outcome. Systematic review. Medline, Embase, ISI Web of
Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between
1990 and December 2010. Reference lists and citations of selected articles. Studies that assessed the impact of a
change in duty hours using any objective measure of outcome related to postgraduate medical training, patient
safety, or clinical outcome. Any study design was eligible for inclusion. 72 studies were eligible for inclusion: 38
reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working
hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have
adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of
European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting
results, meaning that firm conclusions cannot be made. Reducing working hours to less than 80 a week has not
adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than
56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required,
particularly in the European Union, using large multicentre evaluations of the impact of duty hours' legislation on
objective educational and clinical outcomes.
Objective To systematically review evaluations of the impact of sexually transmissible infection (STI) programs
delivered by primary health care serVICes in remote Aboriginal communities. Methods: PubMed, Google Scholar,
InfoNet, Cochrane Controlled Trials Register, Australian New Zealand Clinical Trial Registry, conference proceedings
and bulletins were searched to April 2011 using variations of the terms 'Aboriginal', 'programs' and 'STI'. The primary
outcome of interest in the review was the change in bacterial STI infection prevalence in the target age group
assessed through cross-sectional screening studies over a 5-year period or more. The characteristics of the primary
health care serVICe, STI programs and other clinical serVICe outcomes were also described. Results: Twelve reports
described four distinct STI programs in remote communities and their impact on STI prevalence. In the Anangu
Pitjantjatjara Yankunytjatjara (APY) lands of northern South Australia, there was a reduction in the age-adjusted
chlamydia and gonorrhoea prevalence by 58% and 67%, respectively (19962003). In the Tiwi Islands of Northern
Territory (NT), chlamydia and gonorrhoea positivity decreased by 94% and 34%, respectively (20022005). In the
Ngaanyatjarra Lands of Western Australia, crude chlamydia and gonorrhoea prevalence decreased by 36% and 48%,
respectively (20012005), and in the central Australian region of NT, there was no sustained decline in crude
prevalence (20012005). Conclusion: In three of the four programs, there was some evidence that clinical best
practice and well coordinated sexual health programs can reduce STI prevalence in remote Aboriginal communities.
OBJECTIVE: To systematically review evaluations of the impact of sexually transmissible infection (STI) programs
delivered by primary health care services in remote Aboriginal communities., METHODS: PubMed, Google Scholar,
InfoNet, Cochrane Controlled Trials Register, Australian New Zealand Clinical Trial Registry, conference proceedings
and bulletins were searched to April 2011 using variations of the terms 'Aboriginal', 'programs' and 'STI'. The primary
outcome of interest in the review was the change in bacterial STI infection prevalence in the target age group
assessed through cross-sectional screening studies over a 5-year period or more. The characteristics of the primary
health care service, STI programs and other clinical service outcomes were also described., RESULTS: Twelve reports
described four distinct STI programs in remote communities and their impact on STI prevalence. In the Anangu
Pitjantjatjara Yankunytjatjara (APY) lands of northern South Australia, there was a reduction in the age-adjusted
chlamydia and gonorrhoea prevalence by 58% and 67%, respectively (1996-2003). In the Tiwi Islands of Northern
Territory (NT), chlamydia and gonorrhoea positivity decreased by 94% and 34%, respectively (2002-2005). In the
Ngaanyatjarra Lands of Western Australia, crude chlamydia and gonorrhoea prevalence decreased by 36% and 48%,
respectively (2001-2005), and in the central Australian region of NT, there was no sustained decline in crude
prevalence (2001-2005)., CONCLUSION: In three of the four programs, there was some evidence that clinical best
practice and well coordinated sexual health programs can reduce STI prevalence in remote Aboriginal communities.
The SREBR is the most comprehensive review of the stroke rehabilitation research literature available anywhere in
the world. Research Output: The 12th edition of the SREBR includes reviews of over 3,400 articles including 956 RCTs
and over 400 levels of evidence as well as 8 new Educational Modules. Knowledge Translation: The SREBR received
over 24,000 Internet visits over the past year from 114 countries. There have been 93 publications including 65 peer-
reviewed articles. Large sections of the SREBR have been translated into Japanese. The SREBR or its publications
have been cited 600 times in Medline journals with over 1250 citations in Google Scholar. The SREBR has recently
been the recipient of 8 recognition awards including 1 international, 4 national, 2 provincial and 1 local award. There
have been 15 studentship and graduate student awards provided. The SREBR has become a training focus for the
next generation of stroke rehabilitation researchers and clinicians. Clinical Implementation: The SREBR has also
focused as the platform for a number of clinical guidelines and development of research priorities. SREBR served as
the basis for SCORE guidelines, a multi-centered trial examining the application of best evidence in a clinical setting.
More recently we have been examining the economic cost-benefits of implementing key best evidence based on key
principles of stroke rehabilitation. SREBR is a phenomenon which is like nothing else in stroke rehabilitation providing
a unique and vital infrastructure for stroke rehabilitation in Canada and the world.
Over the last 20 years, interest in medical need at mass events has increased. Many studies have been published
identifying the characteristics of such events that significantly impact the number of patients who seek care.
Investigators agree that weather is one of the most important variables. We performed a literature search using
several biomedical databases (MEDLINE via PubMed, the Cochrane database, BMJ's Clinical Evidence compendium,
and Google Scholar) for articles addressing the effect of weather on medical need at mass events. This search
resulted in 8 focused articles and several other resources from the reference sections of these publications. We
found that the early literature is composed of case reports and predominantly subjective observations concerning
the impact of weather on medical need. Most investigators agree upon a positive relationship between
heat/humidity and the frequency of patient presentation. More recent authors make attempts at quantifying the
relationship and propose prediction models for patient volume and medical personnel requirements. We present an
ancestral review of these studies, discuss their results collectively, and propose a simplified algorithm for predicting
patient volume at mass events. This review is intended for event planners and mass event emergency medical
personnel for planning future events. We also hope to stimulate further study to develop and verify prediction
models. 2010 Elsevier Inc. All rights reserved.
BACKGROUND: This review examines postoperative pain (POP) management from the perspectives of healthcare
providers, patients, and institutions. It summarizes current thought about POP, including difficulties and recent
improvements in the field. METHODS: Studies were identified from PubMed, MEDLINE, and the search engine
Google Scholar and by hand-searching reference lists from review articles and research papers (1998-2009). The
search was limited to articles published in the English language. Given the broad review of POP, a complete review of
all the potential articles was not possible. Thus, an inclusion criterion was defined, and we retrieved only those
studies that included the term postoperative pain treatment, together with 1 or more of the following terms: adult
patients, education, interdisciplinary teams, attitudes, physicians, and nurses. Two hundred twenty studies were
retrieved, and 93 studies were sufficiently close to the topic of this review. They were organized according to the
following themes: POP management as it relates to healthcare providers, patients, and institutions; changing trends
in healthcare education in relation to various POP interventions; and the role of policy makers concerning
improvements and challenges in the management of POP. RESULTS: Interdisciplinary teams are needed to
implement multimodal methods to treat POP in ways that will provide patients with interventions that will improve
their ability to cope with the physical and psychosocial aspects of POP. This is hindered by a lack of hospital financial
resources, a lack of educational programs, a lack of knowledge regarding diverse pharmacological options, and
lingering negative attitudes toward certain treatments, especially opioids. CONCLUSIONS: Successful POP
management depends on providers' receiving education and information. Policy makers and organizations are called
upon to actively intervene by formulating programs and promoting a feedback system, or else POP will remain a
neglected issue.
The aim of this study was to critically examine the current guidance for conducting ethics analysis in health
technology assessment (HTA) and to offer recommendations for how to improve this practice. MEDLINE,
Philosopher's Index, and Google Scholar were searched for articles and reports using the keywords "ethics" and
"health technology assessment" and related terms. Bibliographies of all relevant articles were also examined for
additional references. A philosophical analysis of the existing guidance was conducted. We offer three
recommendations for improving ethics analysis in HTA. First, ethical and legal issues must be clearly separated so
that all policy-relevant questions that the technology raises can be considered clearly and systematically. Second,
analysts must make better use of ethics theory and discuss better how particular theoretical approaches and
associated analytic tools are selected to make transparent which alternative approaches were considered and why
they were rejected. Third, the necessity for philosophical expertise to adequately conduct ethics analysis needs to be
acknowledged. To act on these recommendations for ethics analysis, we offer these three steps forward:
acknowledge and use relevant expertise, further develop models for conducting and reporting ethics analyses, and
make use of untapped resources in the literature.
Introduction: Cigarette smoke has negative effects on bone metabolism and fracture repair. However, no study has
reviewed effects of nicotine on bone and fracture repair independent of other constituents of cigarette smoke. The
authors review the existing evidence of the effect of nicotine on 'bone' and 'bone cells' and fracture repair, drawing
conclusions relevant to clinical practice and future research. Areas covered: A literature review was conducted using
PRISMA guidelines and PubMed, Cochrane, MEDLINE/OVID, EMBASE, NHS Evidence and Google scholar databases.
Articles were included if they specifically investigated the effects of nicotine on 'bone' or fracture repair in animal or
human models or in vitro effects on 'bone cells'. A total of 64 papers were included in this review, of which 15 were
human in vitro studies and 49 animal studies wherein 9 were in vitro and 40 in vivo. In vivo studies of the effects of
nicotine in animals demonstrated widespread effects on bone including osteoneogenesis, osseointegration, steady-
state skeletal bone and genes and cytokines relevant to bone cell physiology and bone homeostasis. In these studies,
nicotine's effects are predominately negative, inhibiting bone cell metabolism and fracture repair, whereas most in
vitro studies reported biphasic responses in all bone cells except osteoclastic cells. Expert opinion: The review
suggests that nicotine has effects on osteoneogenesis, osseointegration and steady-state skeletal bone in animal in
vivo models, as well as effects on all 'bone cells', via several mechanisms in both animal and human cell in vitro
studies. The effect of nicotine is dose-dependent, with higher concentrations having predominantly negative effects,
whereas at low concentrations a stimulatory effect is seen. Stimulatory effects on certain cells may indicate a
possible, limited therapeutic role; advice regarding smoking cessation perioperatively should remain due to the other
harmful components of cigarette smoke, but there may be scope for allowing the use of nicotine patches instead of
complete abstention. Further research into clinical outcomes is required before the exact response of bone and
fracture repair in humans to nicotine is known. 2013 Informa UK, Ltd.
Background: Although the traditional operative therapy for tendon defect could relieve the suffering of patients, the
functional reconstruction was usually not optimistic. With the development of tissue-engineering tendon, using
engineered tendon to repair tendon defect was becoming a new therapeutic method. Objective: To summarize the
advances of seed cells, scaffolds, and the ways to construct tissue-engineered tendon, implantation in vivo and
detection. Retrieve Strategy: A computer-based online search of Medline, EBSCO and google scholar based search
was undertaken to identify the articles on tissue-engineered tendon published in English from February 1990 to May
2007 with the key words of "tissue engineering, engineered tissue, tissue-engineered tendon, scaffold, implantation
in vivo, seed cells". Meanwhile, VIP Database was searched for the related articles published in Chinese from
February 1990 to May 2007 with the key words of "tissue engineering, engineered tissue, seed cell, scaffold,
implantation in vivo, tissue-engineered tendon" in Chinese. Inclusive criteria included that the study should be basic
and/ or clinical research on constructing engineered tendon and implantation in vivo. Exclusive criteria included
articles about the gamete, embryo, tissue-engineered bone and tissue-engineered blood vessel. Literature
Evaluation: 1 The source of literatures contained RCT, the systematic review of evidence-based medicine, meta-
analysis, case of a particular disease and symposium. 2 Totally 214 articles about seed cells, scaffolds and the
methods to construct engineered tendon were found in these database, among which 14 were closely associated
with the study and 45 were indirectly related. Finally, 35 articles met with inclusive criteria were selected. Data
Synthesis: At present seed cells used in tissue-engineered tendon include mesenchymal stem cells, embryonic stem
cells and fibroblasts. Polylactic acid and polyglycolic acid and their copolymer are utilized as scaffolds. Dynamic
mechanical drag in construction of cell-scaffold compound in vitro can make tendon have better biodynamic
intensity after repair. Except general observation and histological detection, mechanic performance determination is
also necessary after implantation of tissue-engineered tendon. Besides, molecular biology technology is also widely
applied in the research. Conclusion: Tissue-engineered tendon may become a new method to repair tendon defect.
However, it is necessary to find the suitable seed cells, scaffolds, culture conditions and detection methods after
implantation in vivo.
PURPOSE: This study sought to provide a review of the contemporary literature regarding computer access for
persons with severe and multiple disabilities using assistive technology (AT). Anecdotally, persons with severe
disabilities are assumed to be underserved by the AT community, and the causalities behind this perception were
explored. METHOD: An online comprehensive search of literature pertaining to computer access for persons with
severe and multiple disabilities was initiated. Due to the fact that personal computers (PCs) have been widely been
available for nearly 25 years, 'contemporary literature' was defined as any source(s) from that era relevant to
persons with severe disabilities accessing a computer. Databases including the Educational Resources Information
Center (ERIC) and the United States National Institutes of Heath (PubMed) were accessed for information in scholarly
journals and for Web Postings. Additionally, the Coleman Institute's Assistive Technology Literature Database which
provides a comprehensive listing of AT Journals was utilized, and each of the Websites of these journals was
accessed and searched. Search engines on the web including Google Scholar, Altavista, Infomine, and Scirus were
utilized as well. CONCLUSION: The study depicts the evolution from a 'medical model' to a 'social model' in rendering
AT services for these individuals. Prescribing the proper device to enable computer access to persons with severe
disabilities is a complex undertaking, and services have been inadequate. Technological advances that enable
computer access for persons with disabilities have not reached those persons that need it most, particularly those
with severe disabilities, for a number of reasons. The literature is replete with explanations for the underutilization of
AT for computer access including prejudicial views towards persons with disabilities, inadequate assessments, lack of
a person-centered approach, and methods for practice that are not evidence based.
Aim. To examine the evidence for incentives and barriers to lifestyle interventions for people with severe mental
illness. Background. People with severe mental illnesses, particularly those with schizophrenia, have poorer physical
health than the general population with increased mortality and morbidity rates. Social and lifestyle factors are
reported to contribute to this health inequality, though antipsychotic therapy poses additional risk to long-term
physical health. Many behavioural lifestyle interventions including smoking cessation, exercise programmes and
weight-management programmes have been delivered to this population with promising results. Surprisingly little
attention has been given to factors that may facilitate or prevent engagement with these interventions in this
population. Data sources. Eight electronic databases were searched [1985-March 2009] along with the Cochrane
Library and Google Scholar. Electronic 'hand' searches of key journals and explosion of references were undertaken.
Review methods. A narrative synthesis of qualitative, quantitative and mixed-methods studies was undertaken.
Results. No studies were identified that specifically explored the incentives and barriers to participation in lifestyle
intervention for this population. Existing literature report some possible incentives and barriers including: illness
symptoms, treatment effects, lack of support and negative staff attitudes as possible barriers; and symptom
reduction, peer and staff support, knowledge, personal attributes and participation of staff as possible incentives.
Conclusions. Healthcare professionals, in particular nurses, should consider issues that may hinder or encourage
individuals in this clinical group to participate in lifestyle interventions if the full benefits are to be achieved. Further
research is needed to explore possible incentives and barriers from the service users' own perspective. 2011
Blackwell Publishing Ltd.
BACKGROUND: While Western literature has mostly reported the incidence of deep vein thrombosis (DVT) and
pulmonary embolism (PE) after TKA with chemoprophylaxis, the Asian literature still has mostly reported the
incidence without chemoprophylaxis. This may reflect a low incidence of DVT and PE in Asian patients, although
some recent studies suggest the incidence after TKA in Asian patients is increasing. Moreover, it is unclear whether
the incidence of DVT and PE after TKA is similarly low among different Asian countries., QUESTIONS/PURPOSES: We
therefore determined the overall incidence of symptomatic PE and DVT without chemoprophylaxis after TKA in the
Asian population, determined whether the incidence had a tendency to increase over time in Asia, and compared the
incidence of symptomatic PE and DVT among Asian countries through a meta-analysis., METHODS: We searched the
PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar websites for prospective studies published
between 1996 and 2011. A total of 1947 patients from 18 studies were reviewed for meta-analysis., RESULTS: The
incidence of symptomatic PE was 0.01%. The incidences of overall DVT, proximal DVT, and symptomatic DVT were
40.4%, 5.8% and 1.9%, respectively. We found no difference in incidence of symptomatic PE among Asian countries
and no trends in changes of the incidence over time., CONCLUSIONS: The incidence of symptomatic PE and DVT after
TKA without prophylaxis is low in Asian countries and has not changed over time, despite Westernizing lifestyles and
an aging populace. Further investigation with large randomized studies is necessary to confirm our findings and
identify risk factors predisposing to DVT.
Background: While Western literature has mostly reported the incidence of deep vein thrombosis (DVT) and
pulmonary embolism (PE) after TKA with chemoprophylaxis, the Asian literature still has mostly reported the
incidence without chemoprophylaxis. This may reflect a low incidence of DVT and PE in Asian patients, although
some recent studies suggest the incidence after TKA in Asian patients is increasing. Moreover, it is unclear whether
the incidence of DVT and PE after TKA is similarly low among different Asian countries. Questions/purposes: We
therefore determined the overall incidence of symptomatic PE and DVT without chemoprophylaxis after TKA in the
Asian population, determined whether the incidence had a tendency to increase over time in Asia, and compared the
incidence of symptomatic PE and DVT among Asian countries through a meta-analysis. Methods: We searched the
PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar websites for prospective studies published
between 1996 and 2011. A total of 1947 patients from 18 studies were reviewed for meta-analysis. Results: The
incidence of symptomatic PE was 0.01%. The incidences of overall DVT, proximal DVT, and symptomatic DVT were
40.4%, 5.8% and 1.9%, respectively. We found no difference in incidence of symptomatic PE among Asian countries
and no trends in changes of the incidence over time. Conclusions: The incidence of symptomatic PE and DVT after
TKA without prophylaxis is low in Asian countries and has not changed over time, despite Westernizing lifestyles and
an aging populace. Further investigation with large randomized studies is necessary to confirm our findings and
identify risk factors predisposing to DVT. 2012 The Association of Bone and Joint Surgeons.
Objective: To determine the incidence of anal incontinence after the use of cutting seton treatment for anal fistula.
Method: Literature searches were performed on PubMed, MEDLINE and Google Scholar using the words 'cutting
seton(s)', 'seton(s)'and 'anal fistula'. An analysis of the data in the collected references was performed. Result: The
average rate of incontinence following cutting seton use was 12%. The rate of incontinence increased as the location
of the internal opening of the fistula moved more proximally. In the studies that described the types of incontinence,
liquid stool was the most common followed closely by flatus incontinence. Incontinence associated with the
treatment of fistulas defined as nonspecific cryptoglandular in nature was 18%. Conclusions: The high incontinence
rates that result from the use of cutting setons suggest that this commonly used therapy can damage the continence
musculature. Other techniques that do not involve cutting the sphincter, when available, should be preferred,
especially for higher fistulas. Journal compilation 2009 The Association of Coloproctology of Great Britain and Ireland.
Background. First implantation of a totally implantable venous access device (TIVAD) was performed in 1982 with
surgical technique. Since then, these devices have permitted infusion of total parenteral nutrition, antibiotics, blood
products, and, above all, they have definitively changed the quality of life of patients with cancer. However, with the
increase of percutaneous procedures, we have assisted with a concomitant raise of immediate postprocedural life-
threatening complications. The aim of this study was to review the literature during a 27-year period, with regard to
the changes of incidence of immediate complications after percutaneous or surgical cutdown for TIVAD's implant.
Materials and Methods. An extensive search of relevant literature was carried out by using MEDLINE (PubMed) and
Google Scholar. We gathered articles from 1982 to 2009 that quoted patient's number, type of pathology, specialist
involved, number of devices implanted, site and technique of implantation (surgical cutdown or percutaneous
technique), and immediate complications occurrence. Results. A total of 952 reports were screened, and finally only
45 articles addressing all inclusion criteria were used for the present study. A total of 11,430 TIVADs implanted in
11,381 patients were analyzed. Pneumothorax, hemothorax, arterial puncture, and hemoptysis developed only after
percutaneous procedures. Atrial fibrillation, hematomas, and malpositioning were more frequent after percutaneous
approach. The total amount of immediate complications in patients submitted to percutaneous implant was 4.5%,
compared with 0.9% subsequent to cutdown technique. Conclusions. Despite the increased use of percutaneous
technique for TIVADs' implantation, surgical cutdown, because of its safety, remains the best approach to avoid
possible fatal immediate complications. Society of Surgical Oncology 2010.
Background: Great part of the scientific production presented in congresses is not published. Even in developed
countries, figures show an expressive difference between presentations and publications. Objective: To evaluate the
number of published and indexed articles, based on available national and international databases, searching for
titles and authors of papers and panels from Brazilian vascular surgery congresses held in 2001 and 2003. Methods:
Searches were performed on the abstracts presented on the XXXIV Brazilian Congress of Angiology and Vascular
Surgery, in 2001, and XXXV Congress of Angiology and Vascular Surgery in 2003, respectively 541 and 567
presentations. A computerized search was performed using the following databases: Scirus, Bireme, LILACS, SciELO,
MEDLINE-PubMed, Cochrane, Google Scholar and Jornal Vascular Brasileiro indexes. The articles were classified as
national or international and as original or modified. Results: Twenty-one (3.89%) and 49 (8.64%) articles from the
Brazilian Congresses of Vascular Surgery of 2001 and 2003 were found, respectively. The average publication rate of
papers presented in both congresses was 6.32%. Conclusions: The number of publications in this sample show how
much research in Brazil is put aside. Many papers are not published because of lack of priority and tradition in
writing, lack of time, effort and encouragement. Copyright 2008 by Sociedade Brasileira de Angiologia e de Cirurgia
Vascular.
Background Nearly 3 billion people live without electricity today. This energy poverty means that they have to resort
to biomass fuels for their household energy needs. When burned, these fuels release a mixture of toxic chemicals in
their smoke, which is often over twenty times greater than World Health Organization (WHO) and Environmental
Protection Agency recommended guideline limits. Aim This review details factors that contribute to indoor air
pollution, its effects on health, and discusses corrective measures to consider when planning intervention strategies
to stem the high morbidity and mortality trend. Methods The term developing countries is defined using the 2008
United Nations Conferences on Trade and Development Handbook. PubMed, Google Scholar and Science Direct
databases from 1990 to 2011 were searched using the key terms: indoor air pollution, biomass fuel, particulate
matter, health risks, and developing countries. Bibliographies of all relevant articles were also screened to find
further eligible articles. Inclusion criteria were peerreviewed articles and technical reports from global health
organizations such as the WHO and United Nations Development Program. Exclusion criteria were articles focused on
modern energy, developed countries, and non-English publications. Results The review discusses the extent of indoor
air pollution related to use of biomass for cooking and assesses its impact on various health and social problems,
including lung diseases, adverse pregnancy outcomes and human development, especially in vulnerable populations.
It also offers strategies to mitigate problems related to indoor air pollution. Conclusions Biomass fuel is a major cause
of indoor air pollution and is a significant health hazard in developing countries. A thorough understanding of the
connection between choice of fuel for household needs and health impact of long-term exposure to pollutants from
smoke generated during use of biomass for cooking is required so that appropriate intervention strategies and
policies can be established to protect vulnerable populations. Springer-Verlag 2012.
OBJECTIVES: To assess the strength of evidence in published articles for an association between indoor solid fuel
combustion and tuberculosis. METHODS: PubMed, a private database and Google Scholar were searched up to May
2008, as was the Cochrane Library (2008, issue 4), to identify articles on the association between indoor air pollution
and tuberculous infection, tuberculosis disease and tuberculosis mortality. Each article initially chosen as acceptable
for inclusion was reviewed for data extraction by three different reviewers using a standard format. Strength of
evidence was determined by pre-determined criteria. RESULTS: The full texts of 994 articles were examined for a
final selection of 10 possible articles, of which six met the inclusion criteria. All articles investigated the association
between exposure to solid fuel (coal and biomass) smoke and tuberculosis disease. Three (50%) of the six studies
included in the systematic review showed a significant effect of exposure to solid fuel combustion and tuberculosis
disease - one high-quality case-control study and two cross-sectional studies. CONCLUSION: Despite the plausibility
of an association, available original studies looking at this issue do not provide sufficient evidence of an excess risk of
tuberculosis due to exposure to indoor coal or biomass combustion. Because the number of studies identified was
small, new studies are needed before more definitive conclusions can be reached. 2010 The Union.
OBJECTIVES: To describe the appropriateness and safety of induction immunosuppression for patients at risk for fatal
rejection, and to describe the safety and effectiveness profiles of the induction regimens available in the United
States. DATA SOURCES: MEDLINE/PubMed database, EMBASE database, Google Scholar; references from pertinent
articles were also reviewed to identify additional data. STUDY SELECTION: A systematic literature review from
January 1, 1980, through June 30, 2008, was performed. Included articles ranged from case series to prospective
randomized controlled double-blind placebo-controlled trials that detailed the following topics with respect to
induction immunosuppression: risk of fatal rejection, renal sparing, malignancy, OKT3, rabbit or equine
antithymocyte globulin, daclizumab, basiliximab, and alemtuzumab. RESULTS: Patients at highest risk for fatal
rejection experienced a survival benefit from induction immunosuppression, whereas all other patients experienced
no benefit or harm. Most of the early data detail positive experiences with polyclonal antibody regimens. Several
newer trials compare the use of polyclonal strategies with the use of anti-CD25 targeted monoclonal antibodies. Few
researchers have assessed the usefulness of an anti-CD52 approach. Overall, induction therapy remains a poorly
studied and widely variable practice among the major US heart transplant centers. CONCLUSION: At present, the
unrestricted use of induction for all patients does not seem prudent. Induction should be individualized for each
patient on the basis of a well-designed protocol, careful analysis of the transplant center's demographics, and the
effectiveness and safety profiles of the regimens used.
OBJECTIVES: To describe the appropriateness and safety of induction immunosuppression for patients at risk for fatal
rejection, and to describe the safety and effectiveness profiles of the induction regimens available in the United
States., DATA SOURCES: MEDLINE/PubMed database, EMBASE database, Google Scholar; references from pertinent
articles were also reviewed to identify additional data., STUDY SELECTION: A systematic literature review from
January 1, 1980, through June 30, 2008, was performed. Included articles ranged from case series to prospective
randomized controlled double-blind placebo-controlled trials that detailed the following topics with respect to
induction immunosuppression: risk of fatal rejection, renal sparing, malignancy, OKT3, rabbit or equine
antithymocyte globulin, daclizumab, basiliximab, and alemtuzumab., RESULTS: Patients at highest risk for fatal
rejection experienced a survival benefit from induction immunosuppression, whereas all other patients experienced
no benefit or harm. Most of the early data detail positive experiences with polyclonal antibody regimens. Several
newer trials compare the use of polyclonal strategies with the use of anti-CD25 targeted monoclonal antibodies. Few
researchers have assessed the usefulness of an anti-CD52 approach. Overall, induction therapy remains a poorly
studied and widely variable practice among the major US heart transplant centers., CONCLUSION: At present, the
unrestricted use of induction for all patients does not seem prudent. Induction should be individualized for each
patient on the basis of a well-designed protocol, careful analysis of the transplant center's demographics, and the
effectiveness and safety profiles of the regimens used.
Oxidative stress has a critical role in the pathophysiology of several kidney diseases, and many complications of these
diseases are mediated by oxidative stress, oxidative stress-related mediators, and inflammation. Several systemic
diseases such as hypertension, diabetes mellitus, and hypercholesterolemia; infection; antibiotics,
chemotherapeutics, and radiocontrast agents; and environmental toxins, occupational chemicals, radiation, smoking,
as well as alcohol consumption induce oxidative stress in kidney. We searched the literature using PubMed,
MEDLINE, and Google scholar with "oxidative stress, reactive oxygen species, oxygen free radicals, kidney, renal
injury, nephropathy, nephrotoxicity, and induction". The literature search included only articles written in English
language. Letters or case reports were excluded. Scientific relevance, for clinical studies target populations, and
study design, for basic science studies full coverage of main topics, are eligibility criteria for articles used in this
paper.
Objective: The most recent scientific literature indicates that alcohol advertising influences behavior, particularly
early and higher alcohol consumption by children and adolescents. From a public health perspective, alcohol
advertising should be restricted. In many countries, as well as in Brazil, limits to alcohol advertising are established by
industry self-regulation (e.g. controlled by the advertising community itself). We examined in this review all articles
on the subject of industry self-regulation of alcohol advertising published in the international literature. Method: A
systematic literature review was conducted on articles investigating the effectiveness of self-regulation of alcohol
advertisings. The search was conducted in Medline, SciELO, Camy and Google Scholar, between the years of 1991
and 2010. In addition, the "snowball" technique for the indication of the main authors on the subject was employed.
From the articles found, 11 focused on the subject discussed here. Discussion: The set of articles obtained indicates
that industry self-regulation of alcohol advertising does not show evidence of efficacy. In other words, such a
regulation does not prevent, for instance, alcohol advertising directed at children and adolescents. Conclusion:
Further measures should be considered for the control and the broadcast of alcohol advertising, such as independent
monitoring, legal control.
State of the art: Coping with immunization stress in infants and toddlers has several implications. First, it helps to
prevent that parents avoid immunizations for their children. Second, it allows lowering the pain due to the injection
itself. Third, it prevents children to live the medical exam as a traumatic experience. However, literature in this
domain is scarce and most often devoted to children aged of 6 years and beyond. The aim of this paper is to operate
a synthesis of the existing researches in order to highlight the variables upon which practitioners may act upon to
help children to cope with the stress of the immunization. Method: We propose in this paper a review of the
research literature by selecting prominent references in the scientific databases (e.g. PsycInfo, PubMed, Google
Scholar). Results: Fundamental researches have shown that children coping in medical settings depends on individual
(e.g. temperament) and relational (e.g. attachment) factors. Applied researches have allowed to test preparatory
procedures at a physiological (e.g. topical anesthetics) or at a psychological level (e.g. distraction). They show that
the parent may be coached to help the child to cope with the immunization stress. Conclusion: The synthesis of the
researches shows the overall efficacy of preparatory procedures. There is however an individual variability
depending on the regulation skills of the child and of the parent, and on their attachment relationship. Practitioners
should take these factors into account to choose which preparatory procedure, if any, is to be applied. 2011 Elsevier
Masson SAS. All rights reserved.
AIMS: Inflammatory disorders of the parathyroid gland are very rare as compared with those of other endocrine
organs. The aim of this study was to provide the first systematic review of this condition., METHODS AND RESULTS: A
42-year-old patient underwent surgery for recurrent secondary hyperparathyroidism. Histology showed hyperplastic
parathyroiditis defined by a mixed inflammatory infiltrate with active germinal centres. Molecular markers revealed
significant upregulation of CD68 in an ischaemic background (hypoxia-inducible factor 1 upregulation) with
mitochondrial reaction (malate dehydrogenase 2 upregulation) and hyperparathyroidism (carbonic anhydrase 4
upregulation). Our case demonstrates true intraparathyroid inflammation with terminal B-cell differentiation. We
searched PubMed, ISI Thompson and Google Scholar up to January 2011, using the terms 'parathyroiditis',
'inflammation of parathyroid gland', 'lymphocytic infiltrate', 'tuberculosis of the parathyroid', 'sarcoidosis', and
'graulomatous inflammation'. Three autopsy series, 27 articles and 96 case reports with inflammatory parathyroid
disorders were identified. Autopsy series showed lymphocytic infiltrates in up to 16% of all cases. The entire material
reported lymphocytic infiltrates (n=69), parathyroiditis with germinal centres (n=15), sarcoidosis (n=6), tuberculosis
(n=4), and other granulomatous diseases (n=2)., CONCLUSIONS: Distinct inflammatory and granulomatous processes
in the parathyroid gland are rare. Scanty lymphocytic infiltrates are common, and occur in generalized inflammatory
conditions or venous congestion. We note the surprising absence of an association between histological proof of
parathyroiditis and hypoparathyroidism. 2011 Blackwell Publishing Limited.
Aims: Inflammatory disorders of the parathyroid gland are very rare as compared with those of other endocrine
organs. The aim of this study was to provide the first systematic review of this condition. Methods and results: A 42-
year-old patient underwent surgery for recurrent secondary hyperparathyroidism. Histology showed hyperplastic
parathyroiditis defined by a mixed inflammatory infiltrate with active germinal centres. Molecular markers revealed
significant upregulation of CD68 in an ischaemic background (hypoxia-inducible factor 1 upregulation) with
mitochondrial reaction (malate dehydrogenase 2 upregulation) and hyperparathyroidism (carbonic anhydrase 4
upregulation). Our case demonstrates true intraparathyroid inflammation with terminal B-cell differentiation. We
searched PubMed, ISI Thompson and Google Scholar up to January 2011, using the terms 'parathyroiditis',
'inflammation of parathyroid gland', 'lymphocytic infiltrate', 'tuberculosis of the parathyroid', 'sarcoidosis', and
'graulomatous inflammation'. Three autopsy series, 27 articles and 96 case reports with inflammatory parathyroid
disorders were identified. Autopsy series showed lymphocytic infiltrates in up to 16% of all cases. The entire material
reported lymphocytic infiltrates (n=69), parathyroiditis with germinal centres (n=15), sarcoidosis (n=6), tuberculosis
(n=4), and other granulomatous diseases (n=2). Conclusions: Distinct inflammatory and granulomatous processes in
the parathyroid gland are rare. Scanty lymphocytic infiltrates are common, and occur in generalized inflammatory
conditions or venous congestion. We note the surprising absence of an association between histological proof of
parathyroiditis and hypoparathyroidism. 2011 Blackwell Publishing Limited.
Objectives To determine the relationship between the use of combined oral contraceptives (COCs) and sexual desire
based on a systematic review of the literature. Methods MEDLINE Complete, Google Scholar and the Cochrane
Library were searched for articles published between 1975 and 2011, reporting the effects of oral contraceptives on
sexual desire. Reports fully meeting all the predefined criteria were analysed and included in a final reference list. In
addition, a review of the reference list of selected articles was carried out. Results We evaluated 36 studies (1978-
2011; 13,673 women). Of the COC users (n = 8,422), 85% reported an increase (n = 1,826) or no change (n = 5,358) in
libido and 15% reported a decrease (n = 1,238). We found no significant difference in sexual desire in the case of
COCs with 20-35 mug ethinylestradiol; libido decreased only with pills containing 15 mug ethinylestradiol.
Conclusions The majority of COC users report no significant change in libido although in most studies a decline in
plasma levels of free testosterone and an increase in those of sex hormone binding globulin were observed. 2013
The European Society of Contraception and Reproductive Health.
Background: The assessment of post-surgical outcomes among patients with Workers' Compensation is challenging
as their results are typically worse compared to those who do not receive this compensation. These patients' time to
return to work is a relevant outcome measure as it illustrates the economic and social implications of this
phenomenon. In this meta-analysis we aimed to assess the influence of this factor, comparing compensated and non-
compensated patients.Findings: Two authors independently searched MEDLINE (Ovid), Embase (Ovid), CINAHL,
Google Scholar, LILACS and the Cochrane Library and also searched for references from the retrieved studies. We
aimed to find prospective studies that compared carpal tunnel release and elective rotator cuff surgery outcomes for
Workers' Compensation patients versus their non-compensated counterparts. We assessed the studies' quality using
the Guyatt & Busse Risk of Bias Tool. Data collection was performed to depict included studies characteristics and
meta-analysis. Three studies were included in the review. Two of these studies assessed the outcomes following
carpal tunnel release while the other focused on rotator cuff repair. The results demonstrated that time to return to
work was longer for patients that were compensated and that there was a strong association between this outcome
and compensation status - Standard Mean Difference, 1.35 (IC 95%; 0.91-1.80, p < 0.001).Conclusions: This study
demonstrated that compensated patients have a longer return to work time following carpal tunnel release and
elective rotator cuff surgery, compared to patients who did not receive compensation. Surgeons and health
providers should be mindful of this phenomenon when evaluating the prognosis of a surgery for a patient receiving
compensation for their condition.Type of study/level of evidence: Meta-analysis of prospective Studies/ Level III.
2013 Moraes et al.; licensee BioMed Central Ltd.
OBJECTIVE: Low-intensity laser therapy (LILT) is defined to supply direct biostimulative light energy to the cells. While
several studies have demonstrated that LILT has stimulating effects on bone cells and can accelerate the repair
process of the bone, others reported delayed fracture healing or no effects after LILT. The aim of this article was to
review the studies evaluating the biomodulation effects of LILT on bone-derived stem cells., MATERIALS AND
METHODS: To access relevant articles, searching in three electronic databases including PubMed, Google Scholar and
Science Direct was conducted until April 2012. The key words used were low-level laser, low-intensity laser, low-
power laser therapy, stem cell, bone marrow stem cell, bone and osteoblast. The articles that met the eligibility
criteria were included in this review of literature., RESULTS: Twenty-five relevant articles (13 in vitro and 12 animal
studies) were included. Eleven in vitro studies showed positive results with regard to acceleration of cell proliferation
and differentiation. All animal studies showed improved bone healing in sites irradiated with low-intensity laser.,
CONCLUSION: Based on the results of the reviewed articles, low intensity laser therapy can accelerate bone healing
in extraction sites, bone fracture defects and distraction osteogenesis, provided proper parameters were applied.
Introduction: In psychiatry, the many instruments for assessment are all dependent on collecting information.
Assessments should characterize the patients and less just a product of evaluations. GAF is an assessment
instrument known worldwide and rates severity of illness. For GAF, we find problems with reliability, validity,
sensitivity and generic properties (Aas 2010; 2011). Aims: To indentify factors concerning collection of information
relevant for rating GAF. Methods: Systematic literature review with an encompassing hand search and search in the
databases: PubMed, PsycINFO and Google Scholar. Results: (1) Sources of information. Every single source of
information can diverge substantially from every other potential source. GAF's anchor points show relevance for all
sources of information. (2) Methods for information collection are interviews of patients and informants, self-report
version for GAF, reading of medical records, observation and a combination of methods. Research concerning the
importance of sources and methods of information collection for scored GAF value is difficult to find. Conclusions:
Rating GAF is open to interpretation of information, subjectivity and synthesis. Differences in information can explain
some of the discrepancy in scored GAF values. Use of several sources have the potential to corroborate, complement
or correct each other.
We are immersed in a new paradigm for scientific information access that, in the future, will be only be available and
transmitted in electronic format. The concept of using internet as information storage has changed, with emphasis
on its interactivity and possibility to share contents. The Web 2.0 has revolutionized the way of internet is
understood, promoting the participation of those who access it, collaborating in its construction per se through
intuitive and easy-to-use tools. Medicine 2.0 means supposes the participation of the user in the design, selection
and evaluation of the contents. The future of access to information is through Medicine 2.0 services. The aim of this
paper is to review the tools and instruments available for health care professionals to access scientific information,
with special emphasis on web 2.0 tools. 2009 Elsevier Espana, S.L. All rights reserved.
BACKGROUND: The scale-up of treatment for HIV and multidrug-resistant tuberculosis (MDR-TB) in developing
countries requires a long-term relationship with the patient, accurate and accessible records of each patient's
history, and methods to track his/her progress. Recent studies have shown up to 24% loss to follow-up of HIV
patients in Africa during treatment and many patients not being started on treatment at all. Some programs for
prevention of maternal-child transmission have more than 80% loss to follow-up of babies born to HIV-positive
mothers. These patients are at great risk of dying or developing drug resistance if their antiretroviral therapy is
interrupted. Similar problems have been found in the scale-up of MDR-TB treatment. OBJECTIVES: The aim of the
study was to assess the role of medical information systems in tracking patients with HIV or MDR-TB, ensuring they
are promptly started on high quality care, and reducing loss to follow-up. METHODS: A literature search was
conducted starting from a previous review and using Medline and Google Scholar. Due to the nature of this work and
the relative lack of published articles to date, the authors also relied on personal knowledge and experience of
systems in use and their own assessments of systems. RESULTS: Functionality for tracking patients and detecting
those lost to follow-up is described in six HIV and MDR-TB treatment projects in Africa and Latin America. Preliminary
data show benefits in tracking patients who have not been prescribed appropriate drugs, those who fail to return for
follow-up, and those who do not have medications picked up for them by health care workers. There were also
benefits seen in providing access to key laboratory data and in using this data to improve the timeliness and quality
of care. Follow-up was typically achieved by a combination of reports from information systems along with teams of
community health care workers. New technologies such as low-cost satellite Internet access, personal digital
assistants, and cell phones are helping to expand the reach of these systems. CONCLUSIONS: Effective information
systems in developing countries are a recent innovation but will need to play an increasing role in supporting and
monitoring HIV and MDR-TB projects as they scale up from thousands to hundreds of thousands of patients. A
particular focus should be placed on tracking patients from initial diagnosis to initiation of effective treatment and
then monitoring them for treatment breaks or loss to follow-up. More quantitative evaluations need to be
performed on the impact of electronic information systems on tracking patients.
Background: The scale-up of treatment for HIV and multidrug-resistant tuberculosis (MDR-TB) in developing
countries requires a long-term relationship with the patient, accurate and accessible records of each patient's
history, and methods to track his/her progress. Recent studies have shown up to 24% loss to follow-up of HIV
patients in Africa during treatment and many patients not being started on treatment at all. Some programs for
prevention of maternal-child transmission have more than 80% loss to follow-up of babies born to HIV-positive
mothers. These patients are at great risk of dying or developing drug resistance if their antiretroviral therapy is
interrupted. Similar problems have been found in the scale-up of MDR-TB treatment. Objectives: The aim of the
study was to assess the role of medical information systems in tracking patients with HIV or MDR-TB, ensuring they
are promptly started on high quality care, and reducing loss to follow-up. Methods: A literature search was
conducted starting from a previous review and using Medline and Google Scholar. Due to the nature of this work and
the relative lack of published articles to date, the authors also relied on personal knowledge and experience of
systems in use and their own assessments of systems. Results: Functionality for tracking patients and detecting those
lost to follow-up is described in six HIV and MDR-TB treatment projects in Africa and Latin America. Preliminary data
show benefits in tracking patients who have not been prescribed appropriate drugs, those who fail to return for
follow-up, and those who do not have medications picked up for them by health care workers. There were also
benefits seen in providing access to key laboratory data and in using this data to improve the timeliness and quality
of care. Follow-up was typically achieved by a combination of reports from information systems along with teams of
community health care workers. New technologies such as low-cost satellite Internet access, personal digital
assistants, and cell phones are helping to expand the reach of these systems. Conclusions: Effective information
systems in developing countries are a recent innovation but will need to play an increasing role in supporting and
monitoring HIV and MDRTB projects as they scale up from thousands to hundreds of thousands of patients. A
particular focus should be placed on tracking patients from initial diagnosis to initiation of effective treatment and
then monitoring them for treatment breaks or loss to follow-up. More quantitative evaluations need to be
performed on the impact of electronic information systems on tracking patients. Hamish SF Fraser, Christian Allen,
Christopher Bailey, Gerry Douglas, Sonya Shin, Joaquin Blaya.
Purpose: To report a systematic review of the literature published on the outcomes of stenting for below-the-knee
disease in patients with critical limb ischemia (CLI). Methods: Potentially relevant studies of stent implantation in the
infragenicular arteries in >=5 patients with >=1-month follow-up were systematically sought in BioMedCentral,
ClinicalTrials.gov, The Cochrane Collaboration Register of Controlled Trials (CENTRAL), Google Scholar, and PubMed.
Data were abstracted and pooled with a random-effect model to generate risk estimates with 95% confidence
intervals (CI). Interaction tests were performed to compare different stent types. A risk of bias assessment was
conducted separately, as were appraisals for small study bias, statistical heterogeneity, and inconsistency. Results:
Eighteen nonrandomized studies were retrieved comprising 640 patients. After a median follow-up of 12 months,
binary in-stent restenosis occurred in 25.7% (95% CI 11.6% to 40.0%), primary patency in 78.9% (95% CI 71.8% to
86.0%), improvement in Rutherford class in 91.3% (95% CI 85.5% to 97.1%), target vessel revascularization in 10.1%
(95% CI 6.2% to 13.9%), and limb salvage in 96.4% (95% CI 94.7% to 98.1%). Head-to-head comparisons showed that
sirolimus-eluting stents were superior to balloon-expandable bare metal stents in preventing restenosis and
increasing primary patency (both p<0.001); sirolimus-eluting stents were also better than paclitaxel-eluting stents in
terms of primary patency (p<0.001) and repeat revascularizations (p=0.014). Conclusion: Percutaneous infragenicular
stent implantation after failed or unsuccessful balloon angioplasty is associated with favorable clinical results in
patients with CLI. Notwithstanding limitations of primary studies, sirolimus-eluting stents appear superior to bare
metal and paclitaxel-eluting stents in terms of angiographic and/or clinical outcomes. 2009 by the International
Society of Endovascular Specialists.
Background: It is hypothesised that infusion of calcium and magnesium (Ca/Mg) can reduce the occurrence of
oxaliplatin-related sensory neurotoxicity. However, more recent data have drawn a controversial picture concerning
this topic. Methods: A comprehensive literature search was performed using Medline, Embase, Cochrane Library and
Google Scholar database up to 1st August 2011. Keywords for the search were: calcium, magnesium and oxaliplatin.
The odd ratio (OR) for neurotoxicity and relative risk (RR) for tumour response rate were calculated. Results: Seven
studies (four randomised controlled trials (RCTs) and three cohorts) including a total of 1238 participants met our
criteria. Meta-analysis of three RCT studies that reported in National Cancer Institute-Common Toxicity Criteria (NCE-
CTC) showed that OR for neurotoxicity of Grade >=2 was not significant (OR 0.47; 95% confidence interval (CI) 0.22-
1.00, P homogeneity =.729). The OR was also not significant in All Grades (OR 3.15, 0.32-31.35, P homogeneity =.952)
and Grade 3 subgroup (OR 1.64, 0.30-9.00, P homogeneity =.656). No statistically significant difference was observed
in RR for tumour response rate. (RR = 0.91, 0.78-1.06, P homogeneity =.33) Conclusions: This meta-analysis does not
support the hypothesis that infusion of Ca/Mg reduces the occurrence of neurotoxicity in oxaliplatin-treated patients
with colorectal cancer measuring with NCE-CTC criteria. On the other hand, our results support the hypothesis that
administrations of Ca/Mg do not impair the efficacy of oxaliplatin-based chemotherapy. However, large-scale
randomised, controlled clinical trials will be required to confirm these hypotheses. 2012 Elsevier Ltd. All rights
reserved.
Background: Germ-line mutations of the CDH1 gene have been extensively studied in hereditary DGC (diffuse gastric
cancer) families. We report a large family harboring a deleterious CDH1 germ-line mutation with predominant ILBC
(invasive lobular breast cancer) cases but without pathological confirmed DGC cases. Considering the up-date
literature, this is the first strong hint of the involvement of germ-line CDH1 mutations in inherited ILBC. Material and
Methods: The family is of Caucasian origin, with 5 women affected by breast cancers, 3 of them are histological
confirmed ILBCs, including 2 bilateral ILBCs. There is no DGC diagnosis in the history of the family. Complete
screening of CDH1, BRCA1 and BRCA2 genes was performed on 7 cases. Expression of E-cadherin was evaluated on
available paraffin preserved tumour samples using standard immunohistochemical techniques. Key words "CDH1,
germ-line mutation, lobular breast cancer, diffuse gastric cancer" were employed for searching literatures in
Pubmed. and Google scholar. Cases with pathologically confirmed LBC and DGC reported in the literatures were
identified for comparison. Results: No BRCA1 and BRCA2 mutations were found in the family. A CDH1 Q95X germ-
line mutation was found in all the 3 living women with ILBC and in a 71-year-old healthy male member. The mutation
was also present in 2 obligate carriers, one of whom developed pancreatic cancer at the age of 56, the other die of
accident. Immunohistochemistry showed that tumour cell in all the samples were negative for E-cadherin expression,
while adjacent normal breast tissue was positive. The literatures reported one synchronous and four metachronous
ILBC and DGC cases, all from HDGC families; the lapse from the diagnosis of ILBC to DGC was 3-9 years, with ILBC
always occurring first in metachronous cases. Two of the three living ILBC cases in the present family were diagnosed
more than 10 years ago. In each previously reported family, the CDH1 germ-line mutation was confirmed in only one
case of confirmed ILBC, which may be due by chance and precludes any firm conclusion about its role in the inherited
ILBC. Conclusions: Many biological results suggest CDH1 mutations are key events in the ILBC genesis. We report the
first case confirming the involvement of CDH1 germ-line mutation in inherited ILBC without DGC cases, that
therefore may be considered to be a special phenotype of CDH1 germ-line mutation. The recommended systematic
prophylactic gastrectomy in CDH1 mutations carriers should therefore be discussed according to the cancer family
histories.
Objectives: Lateral epicondylitis can be chronic and difficult to manage with conservative measures such as physical
therapy and corticosteroid injection. We attempted to determine the efficacy of botulinum toxin for the treatment
of chronic lateral epicondylitis. Methods: We searched PubMed, MEDLINE, CINAHL, Google Scholar, EMBASE, PEDro,
and ISI web of Science databases from inception until November 2009. Studies were included if they used any
formulation of botulinum toxin A for treatment of chronic lateral epicondylitis and reported at least 1 pain outcome.
One author extracted the relevant data using a standardized data extraction sheet and a second author checked the
data. We performed a meta-analysis by computing effect sizes for each study separately for pain and grip strength at
3 months after injection. Impact of bias was assessed independently by 2 authors. Results: The search found 10
studies relevant to the question. Four of these were randomized controlled trials that could be pooled in a meta-
analysis. Results showed a moderate effect for pain favoring botulinum toxin (effect size -0.5, 95% CI -0.9, -0.1, I2 =
56%) at 3 months and a no effect for grip strength. Qualitative analysis of the studies that could not be pooled also
showed improvement in pain, but was limited by potential bias. Conclusions: Present literature provides support for
use of botulinum toxin A injections into the forearm extensor muscles (60 units) for treatment of chronic treatment-
resistant lateral epicondylitis. It is minimally invasive and can be performed in an outpatient setting. 2011 Elsevier
Inc.
PURPOSE: Breast cancer is an important cause of cancer-related death in women. Numerous studies have evaluated
the association between the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene
and breast cancer risk. However, the specific association is still controversial rather than conclusive. Therefore, we
performed a meta-analysis of related studies to address this controversy., METHODS: PubMed, EMBASE, Google
Scholar and the Chinese National Knowledge Infrastructure databases were systematically searched to identify
relevant studies. A meta-analysis was performed to examine the association between the I/D polymorphism in the
ACE gene and susceptibility to breast cancer. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were
calculated., RESULTS: 10 separate studies of 7 included articles with 10,888 subjects on the relation between the I/D
polymorphism in the ACE gene and breast cancer were analyzed by meta-analysis, and our results showed no
association between the I/D polymorphism in the ACE gene and breast cancer in total population and different
populations. No publication bias was found in the present study., CONCLUSIONS: The ACE I/D polymorphism may not
be associated with breast cancer risk. Further large and well-designed studies are needed to confirm this conclusion.
Purpose: Breast cancer is an important cause of cancer-related death in women. Numerous studies have evaluated
the association between the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene
and breastcancer risk. However, the specific association is still controversial rather than conclusive. Therefore, we
performed a meta-analysis of related studies to address this controversy. Methods: PubMed, EMBASE, Google
Scholar and the Chinese National Knowledge Infrastructure databases were systematically searched to identify
relevant studies. A meta-analysis wasperformed to examine the association between the I/D polymorphism in the
ACE gene and susceptibility to breast cancer. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were
calculated. Results: 10 separate studies of 7 included articles with 10,888 subjects on the relation between the I/D
polymorphism in the ACE gene and breast cancer were analyzed by meta-analysis, and our results showed no
association between the I/D polymorphism in the ACE gene and breast cancer intotal population and different
populations. No publication bias was found in the present study. Conclusions: The ACE I/D polymorphism may not be
associated with breast cancer risk. Further large and well-designed studies are needed to confirm this conclusion.
Background There is increasing evidence to suggest an association between insomnia and cardiovascular disease. We
performed a systematic review with meta-analysis of all the available prospective studies that investigated the
association between insomnia and risk of developing and/or dying from cardiovascular disease. Materials and
Methods We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science,
The Cochrane Library, and bibliographies of retrieved articles up to December 2011. Studies were included if they
were prospective, had assessment of insomnia or sleep complaints at baseline, evaluated subjects free of
cardiovascular disease at baseline and measured the association between insomnia and risk of developing and/or
dying from cardiovascular disease. Results After the review process, 16 prospective studies (13 cohorts of patients)
were included in the final analysis. These studies included 122,501 subjects followed for a time ranging from three to
20 years. A total of 6,332 cardiovascular events occurred during follow up. Insomnia was assessed through a
questionnaire and defined as either difficulty in initiating or maintaining sleep or presence of restless, disturbed
nights. The cumulative analysis for all the studies under a random effects model showed that insomnia showed an
increased risk (+45%) of developing or dying from cardiovascular disease during follow up (RR 1.45, 95%CI 1.29-1.62;
p<0.00001), with no evidence of heterogeneity across the studies (I2: 19%; p=0.14). Conclusion Insomnia is
associated with an increased risk of developing and/or dying from cardiovascular disease.
Introduction: Intussusception remains one of the most frequent causes of bowel obstruction in infants. Enema
reduction in stable patients is the standard of care and has been reported with varying rates of success. While
pneumatic reduction has become increasingly popular, no summary datasets have systematically evaluated success
rates in comparison to hydrostatic enema. Methods: We reviewed our institutional dataset from 2000 - 2010,
comparing failure rates of enema reduction using contrast medium vs. air. A systematic review was also undertaken
querying with the following databases: Google Scholar, Medline, Embase, CINAHL and Cochrane library. Hand search
of identified studies was performed and corresponding authors were sought for missing data. Inclusion criteria were
comparative studies evaluating Pneumatic (oxygen or Air) versus Hydrostatic (any contrast medium) reduction with a
reported success rate. Critical appraisal was performed using the MINORS scale for observational studies, Jadad
score for randomized trials (RCTs). Meta-analysis was carried out using REVMAN 5.1. The Patient Expected Event
Rate (PEER) was calculated based on tabulated data; the number needed to treat (NNT) was subsequently derived.
Results: Institutional data revealed a failed reduction rate of 20.4% with air (20/98), 30.8% with contrast reduction
(8/26). Nine-hundred and twenty-seven abstracts were identified via our search strategy, with 19 publications
ultimately included for analysis. Studies were of a variable size (mean patient number: 291 [57-1046]) and quality: 2
RCTs (Jadad score 3), 2 prospective cohorts, 1 historical case-control and 14 retrospective reviews; the overall mean
MINORS score was 18.4 (14-22). There were 3423 hydrostatic reductions included in this review, 2125 pneumatic
reductions. Meta-analysis of failure rates favored pneumatic reduction (OR 0.47 [0.41-0.55], albeit with considerable
study heterogeneity (see figure). Sensitivity analysis of RCTs alone yielded similar results (OR 0.33 [0.15-0.71]). A
PEER of 30.3% was tabulated based on cumulative results, yielding a NNT of 8 (7-9) favoring pneumatic reduction to
eliminate one failure. There were 17 reported perforations in the hydrostatic group, 8 in the pneumatic group (OR
0.98 [0.48-2.01]. Conclusions: Our review suggests that pneumatic reduction is more likely to successfully reduce
intussusception in children without evidence of increased morbidity. However, reduction protocols are not
standardized across studies and enema reduction success is partially dependant on operator skill and experience.
Pneumatic enema reduction should be the method of choice for the treatment of intussusception barring a clear
indication for initial operative intervention. (Figure Presented).
Objective: The aim of this commentary was to evaluate the current evidence regarding the use of synthetic insulin
analogues in the 'real-world' clinic setting for the treatment of type 2 diabetes mellitus (T2DM). Methods: Relevant
publications were searched on PubMed MEDLINE, EMBASE, Cochrane Register of Controlled Trials Google Scholar,
NLM Gateway, Science Direct, Web of Science and OVID for the period of January 2007 to June 2010. Articles were
included if they (a) provided specific study results on the use of insulin analogues in T2DM and (b) gave sufficiently
clear methodology details to establish treatment strategies, diagnosis and diagnostic criteria using an observational
study (OS) design. Results: Twenty one articles specifically addressing both type 2 diabetes management and the use
of synthetic insulin analogues were identified. Results from recently published OS in patients with T2DM have
shown, in the patient populations tested, the effective initiation, optimization and switch to use of insulin analogues
in routine clinical settings (day-to-day common practice), with a good safety profile. Conclusions: OS can provide
clinicians with additional insights into the management of T2DM patients in their practices. However, the selection
and initiation of insulin analogue regimens should be tailored to the individual patient and be one that the physician
is comfortable using. 2011 Informa UK.
Background: Insulin degludec (IDeg) is a neutral, ultralong-acting new generation basal insulin analog developed by
NovoNordisk currently in Phase III clinical development. IDeg offers a duration of action of more than 42 hours in
adults, much longer than current basal insulin formulations. Objective: The aim of this review is to assess the efficacy
and safety data of IDeg in the treatment of type 1 and type 2 diabetes mellitus. Methods: Relevant English language
articles from 2010 to 2012 were identified through MEDLINE, PubMed, EMBASE, Scopus, BIOSIS, and Google Scholar.
Online conference proceedings of the 71st ADA Scientific Sessions and the 47th EASD Annual Meeting were
reviewed. Studies were compared in terms of their study designs, primary and secondary efficacy parameters, and
tolerability data. Results: There are a total of nine published trials investigating the clinical efficacy and safety of IDeg
in over 3000 subjects with type 1 and 2 diabetes. Only three trials were published in full. All were open-label,
randomized multicenter trials with durations of 16 to 52 weeks. IDeg and coformulations of IDeg with insulin aspart
(IAsp) were compared to insulin glargine (IGlar), detemir, and biphasic IAsp 30 (BIAsp 30). Conclusion: Based upon
the available evidence, there appear to be no reported differences between IDeg and IGlar, detemir, or BIAsp 30 in
the reduction of the primary efficacy end-points of HbA1c and mean fasting plasma glucose (FPG) concentrations.
Only flexible dosing of IDeg provided a significant reduction in FPG compared to IGlar. IDeg demonstrated a
significant reduction in nocturnal hypoglycemia in type 1 diabetes. In type 2 diabetes, IDeg reduced the incidence of
hypoglycemia by 18% and 58% compared to IGlar and BIAsp 30, respectively. 2012 Wang et al, publisher and licensee
Dove Medical Press Ltd.
The metabolic syndrome is a combination of metabolic and clinical features that aggregate in individuals and
increase cardiovascular disease (CVD) risk considerably. It is believed, although sometimes controversially, that the
underlying basis for this syndrome is insulin resistance (IR) and accompanying compensatory hyperinsulinemia.
Insulin and insulin-like growth factors (IGFs) have significant homology and interact with differing affinity with the
same receptors. Therefore, their actions can be complementary, and this becomes particularly significant clinico-
pathologically when their circulating levels are altered. This review of currently available information attempts to
answer the following questions: (1) Is there any evidence for changes in the components of the IGF system in
individuals with established CVD or with increased CVD risk as with the metabolic syndrome? (2) What are the
underlying mechanisms for interactions, if any, between insulin and the IGF system, in the genesis of CVD? (3) Can
knowledge of the pathophysiological changes in the IGF system observed in macrosomic newborn infants and growth
hormone (GH)-treated children and adults explain some of the observations in relation to the IGF system and the
metabolic syndrome? (4) Can the experimental and clinical evidence adduced from the foregoing be useful in
designing novel therapies for the prevention, treatment, and assignment of prognosis in metabolic syndrome-
associated disease, particularly ischemic heart disease? To answer these questions, we have performed a literature
review using bibliographies from PubMed, Medline, and Google Scholar published within the last 10 years. We
suggest that IGF-1 levels are reduced consistently in individuals with the metabolic syndrome and its components
and in those with ischemic CVD. Such changes are also seen with GH deficiency in which these changes are partially
reversible with GH treatment. Furthermore, changes are seen in levels and interactions of IGF-binding proteins in
these disorders, and some of these changes appear to be independent of IGF-binding capability and could potentially
impact on risk for the metabolic syndrome and CVD. The promising therapeutic implications of these observations
are also discussed. 2012, Mary Ann Liebert, Inc.
Even though health informatics (HI) education is an essential component of the undergraduate nursing curriculum, it
remains controversial with no clear consensus on which knowledge and skills should be integrated in a baccalaureate
nursing program. The purpose of this review article is to integrate literature on HI education in the nursing
curriculum by examining previous and current literature on this topic, synthesizing the findings, and recommending
guidelines and future directions for nurse educators. The computerized databases of CINAHL, MEDLINE, ERIC,
Academic Search Premier, and Google Scholar were used to generate relevant literature. Nineteen studies published
between 2000 and 2010 on HI education were included in this review, and from the critical and synthesis of those
reports emerged four overarching themes: (a) lack of consensus on HI education; (b) impact on patient care
outcomes; (c) faculty development through organizational collaboration; and (d) global disparities in HI education.
Implications for nursing education and patient outcomes in clinical practice are also discussed. Further studies are
warranted to promote the understanding and awareness of HI education in undergraduate nursing curriculum. 2011
Elsevier Ltd.
This integrative literature review describes the educational background, clinical training, and certification process of
the International Board Certified Lactation Consultant (IBCLC). The evidence for use or non-use of IBCLCs in
breastfeeding support in the primary care setting and in the care of early parenting families is presented. Medline,
PsychInfo, CINAHL, and Google Scholar were searched for research related to IBCLCs. The search was limited to
research that studied the use vs. non-use of IBCLCs in outpatient settings and excluded studies that were solely
conducted in the hospital environment. This search yielded five studies comparing IBCLC use vs. nonuse in outpatient
settings. Study authors suggested a positive correlation between IBCLC use and breastfeeding duration; however, the
reliability and validity of the outcomes of these studies could not be ascertained due, in part, to small homogenous
sample sizes and other limitations of study design. More research regarding IBCLC use in primary care settings is
needed. Limited data available suggest that IBCLCs may promote a longer duration of breastfeeding postpartum
when utilized in primary care settings.
Every year nearly 400,000 children are infected with HIV through mother-to-child transmission (MTCT), which is
responsible for more than 90% of HIV infections in children. In high-income countries, the MTCT rate is less than 1%
through perinatal prevention of mother-to-child HIV transmission (PMTCT) interventions. In low- and middle-income
countries, PMTCT programme coverage remains low and consequently transmission rate high. The World Health
Organisation recommends integration of PMTCT programmes with other healthcare services to increase access and
improve uptake of these interventions. To assess the effect of integration of perinatal PMTCT measures with other
health care services on coverage and service uptake compared to stand-alone PMTCT programmes and healthcare
services or partially integrated PMTCT interventions. We searched the following databases, for the time period of
January 1990 to August 2010: MEDLINE, EMBASE, the WHO Global Health Library, CAB abstracts, CINAHL, POPLINE,
PsycINFO, Sociological Abstracts, ERIC, AEGIS, Google Scholar, New York Academy of Medicine Grey Literature, Open
SIGLE, British Library Catalogue, ProQuest Dissertation & Theses Database and U.S. National Library of Medicine
Gateway system. We also searched the Cochrane Database of Systematic Reviews (the Cochrane Library 2010, Issue
7), the Cochrane Central Register of Controlled Trials (the Cochrane Library 2010, Issue 7), Database of Abstracts of
Reviews on Effects (the Cochrane Library 2010, Issue 7). We also searched for ongoing trials in the WHO
International Clinical Trials Registry and Controlled clinical trials (January 1990 to July 2010). We performed ISI Web
of Knowledge Cited Reference Search and scanned the reference lists of the included articles for additional relevant
studies. We contacted authors to locate additional eligible studies. To maximise sensitivity we did not employ any
methodological filters. Randomised controlled trials (RCT), cluster-randomised controlled trials (cluster RCT),
controlled clinical trials (CCT), controlled before and after (CBA) studies and interrupted time series (ITS) studies
comparing integrated PMTCT interventions to non-integrated or partially integrated care for pregnant women,
mothers and their infants in low- and middle-income countries. Two review authors independently ran the searches,
selected studies, assessed methodological quality, and extracted data. The third review author resolved any
disagreements. Only one study met the inclusion criteria. A cluster-randomised trial (12 clusters, n=7664), compared
mother-infant nevirapine coverage at labour ward between intervention clinics implementing rapid HIV testing with
structured nevirapine assessment and control clinics implementing informal assessment of nevirapine adherence.
The authors measured nevirapine coverage in all clinics at baseline and after the implementation of the intervention.
An increase of 10% (range of difference in coverage from -10% to +33%) was observed in the intervention sites
compared to 10% decline in mother-infant coverage in the control sites (range of difference in coverage from -13%
Context: Recommended daily physical activity accumulated in short intervals (e.g., <10 minutes) may be more
feasible and appealing to the relatively sedentary populace than longer bouts. The purpose of this paper is to present
a systematic review of the evidence for the effectiveness of short activity bouts incorporated into organizational
routine as part of the regular "conduct of business." Evidence acquisition: PubMed, MEDLINE, and Google Scholar
databases were searched in August 2009 (updated search in February and July 2010) to identify relevant, peer-
reviewed journal articles and abstracts on school-, worksite-, and faith-based interventions of short, structurally
integrated physical activity breaks. Evidence synthesis: The majority of interventions implemented daily physical
activity bouts of 1015 minutes in length. Schools were the most common settings among the 40 published articles
included in this review. The rigor of the studies varied by setting, with more than 75% of worksite versus 25% of
school studies utilizing RCT designs. Studies focused on a broad range of outcomes, including academic/work
performance indicators, mental health outcomes, and clinical disease risk indicators, in addition to physical activity
level. Physical activity was the most commonly assessed outcome in school-based studies, with more than half of
studies assessing and observing improvements in physical activity outcomes following the intervention. About a
quarter of worksite-based studies assessed physical activity, and the majority found a positive effect of the
intervention on physical activity levels. About half of studies also observed improvements in other relevant outcomes
such as academic and work performance indicators (e.g., academic achievement, cognitive performance, work
productivity); psychosocial factors (e.g., stress, mood); and clinical disease risk indicators (e.g., blood pressure, BMI).
The average study duration was more than 1 year, and several reported outcomes at 3-6 years. Conclusions:
Interventions integrating physical activity into organizational routine during everyday life have demonstrated modest
but consistent benefits, particularly for physical activity, and these are promising avenues of investigation. The
proportionately longer-term outcomes available in these studies compared with individual-level studies suggest that
physical activity promotion strategies at the organizational level may be more sustainable. 2011 American Journal of
Preventive Medicine.
Anxiety and fear are among the most frequently reported emotional responses to hospitalization and are known to
be contributing factors to pain and other negative patient outcomes. The first step in confronting unnecessary
anxiety and fear is to identify valid and clinically feasible assessment instruments. The purpose of this paper is to
review and evaluate instruments that measure children's fear or anxiety associated with hospitalization or painful
procedures. A search was conducted of published English-language literature from 1980 through 2010 with the use
of Ovid Health and Psychosocial Instruments, Medline, Nursing/Academic Edition, Cinahl, and Google Scholar.
Inclusion criteria specified that the self-report instrument: 1) was developed in English; 2) was developed for and/or
widely used with hospitalized children or children undergoing medical procedures or treatment; and 3) had research
evidence of psychometric properties from at least five different studies. A comprehensive review of the literature
revealed only five fear or anxiety instruments with adequate testing for evaluation of reliability and validity. Although
all instruments have beginning psychometric adequacy, no one tool stands out as superior to the others. Therefore,
we recommend that researchers and clinicians exercise caution in choosing assessment instruments, balancing
potential strengths with reported limitations. Using more than one tool (triangulating) may be one way to achieve
more credible results. Knowledge of credible existing instruments alerts us to what is possible today and to the
imperative for research that will improve communication with children tomorrow. Copyright 2012 American Society
for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Anxiety and fear are among the most frequently reported emotional responses to hospitalization and are known to
be contributing factors to pain and other negative patient outcomes. The first step in confronting unnecessary
anxiety and fear is to identify valid and clinically feasible assessment instruments. The purpose of this paper is to
review and evaluate instruments that measure children's fear or anxiety associated with hospitalization or painful
procedures. A search was conducted of published English-language literature from 1980 through 2010 with the use
of Ovid Health and Psychosocial Instruments, Medline, Nursing/Academic Edition, Cinahl, and Google Scholar.
Inclusion criteria specified that the self-report instrument: 1) was developed in English; 2) was developed for and/or
widely used with hospitalized children or children undergoing medical procedures or treatment; and 3) had research
evidence of psychometric properties from at least five different studies. A comprehensive review of the literature
revealed only five fear or anxiety instruments with adequate testing for evaluation of reliability and validity. Although
all instruments have beginning psychometric adequacy, no one tool stands out as superior to the others. Therefore,
we recommend that researchers and clinicians exercise caution in choosing assessment instruments, balancing
potential strengths with reported limitations. Using more than one tool (triangulating) may be one way to achieve
more credible results. Knowledge of credible existing instruments alerts us to what is possible today and to the
imperative for research that will improve communication with children tomorrow. 2012 American Society for Pain
Management Nursing.
Hepatitis C virus (HCV) is an important human pathogen that causes acute and chronic hepatitis, cirrhosis and
hepatocellular carcinoma worldwide. This positive stranded RNA virus is extremely efficient in establishing persistent
infection by escaping immune detection or hindering the host immune responses. Recent studies have discovered
two important signaling pathways that activate the host innate immunity against viral infection. One of these
pathways utilizes members of Toll-like receptor (TLR) family and the other uses the RNA helicase retinoic acid
inducible gene I (RIG-I) as the receptors for intracellular viral double stranded RNA (dsRNA), and activation of
transcription factors. In this review article, we summarize the interaction of HCV proteins with various host
receptors/sensors through one of these two pathways or both, and how they exploit these interactions to escape
from host defense mechanisms. For this purpose, we searched data from Pubmed and Google Scholar. We found
that three HCV proteins; Core (C), non structural 3/4 A (NS3/4A) and non structural 5A (NS5A) have direct
interactions with these two pathways. Core protein only in the monomeric form stimulates TLR2 pathway assisting
the virus to evade from the innate immune system. NS3/4A disrupts TLR3 and RIG-1 signaling pathways by cleaving
Toll/IL-1 receptor domain-containing adapter inducing IFN-beta (TRIF) and Cardif, the two important adapter
proteins of these signaling cascades respectively, thus halting the defense against HCV. NS5A downmodulates the
expressions of NKG2D on natural killer cells (NK cells) via TLR4 pathway and impairs the functional ability of these
cells. TLRs and RIG-1 pathways have a central role in innate immunity and despite their opposing natures to HCV
proteins, when exploited together, HCV as an ever developing virus against host immunity is able to accumulate
these mechanisms for near unbeatable survival. 2012 Imran et al.; licensee BioMed Central Ltd.
The purpose of this comprehensive literature review it to explore cross-cultural issues in occupational rehabilitation
and work disability prevention. A literature review on cross-cultural issues was performed in medicine, health
sciences, and social sciences databases (PubMed, Ingenta, Canadian Centre for Occupational Health and Safety,
Ergonomics Abstract, Google Scholar, OSH Update and the Quebec Workers' Compensation Board data base). A total
of 27 documents published until 2010 in English or French were selected and analyzed. Cross-cultural issues in
occupational rehabilitation show that representations of pain, communication and therapist-patient relationship and
intercultural competence could be presented as the major topics covered in the selected literature. As for the
general topic of immigrant workers and OSH, barriers were identified revealing personal, relational, contextual and
structural levels that put immigrant and minority workers in situation of vulnerability (ex. linguistic and cultural
barriers, lack of knowledge of the system, precarious work or exposition to higher risk hazards, etc.). Cultural issues
in occupational rehabilitation put less attention to work-related contextual factors but emphasized on attitude and
pain behaviours, perceptions of illness and appropriate treatment, therapist-patient relationship and cultural
competences among OT professionals. The growth of immigration in countries such as Canada poses a real challenge
to the delivery of health care and rehabilitation services. Despite growing concerns in providing culturally
appropriate heath cares, intervention models, tools and training tools are still lacking in occupational rehabilitation
and disability management. Nevertheless, cultural competence seems to be a promising concept to be implemented
in work rehabilitation and disability management.
The aim of this report is to examine clues of a suspected link between the artificial ingestion of human growth
hormone (rh- GH) and resulting interdental spaces in adult athletes. We conducted an electronic search in the
German-language versions of the search engines Google and Google Scholar as well as in the database PubMed.
While no explicit articles could be identified in PubMed, the search in Google and Google Scholar produced 1370 and
6 hits, respectively. Original quotes from 20 sources show that in the media the wearing of orthodontic multibracket
appliances among athletes is largely attributed to changes in tooth position as a consequence of the illegal ingestion
of rhGH. On the other hand, there are few references to the possibility that orthodontic treatments with fixed
appliances might be carried out for reasons unrelated to doping. CONCLUSION: A definitive assessment of this issue
is not possible at present. In view of its major importance of the subject, the relationships depicted here should be
investigated in greater depth.
The advent of HIV and AIDS has brought about many diagnostic and management challenges regarding multiple J
opportunistic infections. Pneumocystis jirovecii pneumonia (PCP) is a common presentation in patients with AIDS
who are not on prophylaxis or highly active antiretroviral therapy (HAART). Herpes simplex 1 virus (HSV-1) is a
ubiquitous virus that mainly causes benign disease during primary infection. However, it is known to cause severe
pneumonia and disseminated disease in the immunocompromised.1 We present a case of HSV-1 pneumonitis and
PCP co-infection in an HIV-positive patient with respiratory failure. To the best of our knowledge, based on Pubmed
and Google Scholar searches, this is the first case to be reported in the English language literature.
Introduction: A significant part computer game players and internet users show clinical features of abuse and
addiction (loss of control, withdrawal symptoms, tolerance, continuation of game play even with increasing negative
consequence in social and academic life). Similar mechanisms are suggested to underlie the pathogenesis and
maintenance of internet and computer game addiction and substance-related addictions. Objectives: Neuroscientific
research on internet and computer game addiction is sparse, yet emerging. To review previous studies is the
objective of the present project. Aims: We aim to identify common findings regarding the neurophysiological
processes underlying internet and computer game addiction. This could be helpful for establishing a sound model for
these emerging disorders. Methods: Neuroscientific studies on internet and computer game addiction were
systematically searched in "Pubmed", "Google scholar" and "PsychInfo". Titles were examined first to screen
potential articles, followed by abstracts, and then manuscripts were downloaded. The reference sections of
downloaded manuscripts were examined for additional references not located in the searches. Results:
Neuroscientific research on internet and computer game addiction is mainly located in the Asian area, probably due
to a higher regional prevalence. Methodologies range from ERP, resting state EEG, resting state fMRI, VBM to PET,
investigating very different concepts of addiction, including impulsivity, craving, reward processing and cue-
reactivity. Conclusions: Addicted internet and computer game users are overall suggested to have altered brain
mechanisms similar to individuals with substance addictions. However, a sound model on the neurophysiologic
alterations has not been established yet.
The general aim of this study was to review the scientific literature concerning the Internet and suicidality and to
examine the different pathways by which suicidal risks and prevention efforts are facilitated through the Internet. An
online literature search was conducted using the MEDLINE and Google Scholar databases. The main themes that
were investigated included pathological Internet use and suicidality, pro-suicide websites, suicide pacts on the
Internet, and suicide prevention via the Internet. Articles were screened based on the titles and abstracts reporting
on the themes of interest. Thereafter, articles were selected based on scientific relevance of the study, and included
for full text assessment. The results illustrated that specific Internet pathways increased the risk for suicidal
behaviours, particularly in adolescents and young people. Several studies found significant correlations between
pathological Internet use and suicidal ideation and non-suicidal self-injury. Pro-suicide websites and online suicide
pacts were observed as high-risk factors for facilitating suicidal behaviours, particularly among isolated and
susceptible individuals. Conversely, the evidence also showed that the Internet could be an effective tool for suicide
prevention, especially for socially-isolated and vulnerable individuals, who might otherwise be unreachable. It is this
paradox that accentuates the need for further research in this field. 2011 by the authors. Licensee MDPI, Basel,
Switzerland.
BACKGROUND: The Internet has become a regular part of daily life for the majority of people in many parts of the
world. It now offers an additional means of effecting changes to behaviour such as smoking. OBJECTIVES: To
determine the effectiveness of Internet-based interventions for smoking cessation. SEARCH STRATEGY: We searched
the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE, EMBASE, CINAHL,
PsycINFO, and Google Scholar. There were no restrictions placed on language of publication or publication date. The
most recent search was in June 2010. SELECTION CRITERIA: We included randomized and quasi-randomized trials.
Participants were people who smoked, with no exclusions based on age, gender, ethnicity, language or health status.
Any type of Internet-based intervention was eligible. The comparison condition could be a no-intervention control or
a different Internet site or programme. DATA COLLECTION AND ANALYSIS: Methodological and study quality details
were extracted using a standardised form. We selected smoking cessation outcomes at short term (one to three
months) and long term (6 months or more) follow up, and reported study effects as a risk ratio with 95% confidence
intervals. Only limited meta-analysis was performed, as the heterogeneity of the data for populations, interventions
and outcomes allowed for very little pooling. MAIN RESULTS: Twenty trials met the inclusion criteria. There were
more female than male participants. Some Internet programmes were intensive and included multiple outreach
contacts with participants, whilst others relied on participants to initiate and maintain use.Ten trials compared an
Internet intervention to a non-Internet based smoking cessation intervention or to a no intervention control. Six of
these recruited adults, one recruited young adult university students and three recruited adolescents. Two trials of
the same intensive automated intervention in populations of adult who smoked showed significantly increased
cessation compared to printed self-help materials at 12 months. In one of these, all trial participants were provided
with nicotine replacement therapy (NRT). Three other trials in adults did not detect significant long term effects. One
of these provided access to a website as an adjunct to counselling and bupropion, one compared web-based
counselling, proactive telephone-based counselling or a combination of the two as an adjunct to varenicline. The
third only provided a list of Internet resources. One further short-term trial did show a significant increase in quit
rates at 3 months. A trial in college students increased point prevalence abstinence after 30 weeks but had no effect
on sustained abstinence. Two small trials in adolescents did not detect an effect on cessation compared to control,
whilst a third small trial did detect a benefit of a web-based adjunct to a group programme amongst adolescents.Ten
trials, all in adult populations, compared different Internet sites or programmes. There was some evidence that sites
that were tailored and interactive might be more effective than static sites, but this was not detected in all the trials
Background: The number of Hispanics/Latinos living with dementia in the United States is expected to rise from
200,000 to 1.3 million by 2050, which will result in large numbers of Hispanics/Latinos assuming the role of caregiver.
The demands of caregiving can negatively impact caregivers' health. The purpose of this review was to identify
intervention strategies that can help Hispanics/Latinos deal with the burden associated with providing care for older
adults with dementia. Methods: The authors critically reviewed and analyzed the literature for interventions and
their relevance to these caregivers. The search engines and electronics databases of Google Scholar; Social
Gerontology; Health Source: Nursing/Academic Edition; MEDLINE; PsycARTICLES; CINAHL; and PubMed, were used to
locate articles published between 1999 and 2011. Results: Ten intervention studies published between 2000 and
2011 were identified that targeted Hispanic/Latino caregivers: most were from one clinical trial (REACH). Discussion:
Future studies should consider culturally tailoring interventions for Hispanic/Latino caregivers from differing
subcultures, utilizing relevant technology in studies, and evaluating the functional level of the care receiver and
assess where he/she is in the disease process continuum. A better understanding of within-group differences among
Hispanic/Latino caregivers, especially with respect to acculturation, could lead to better tailoring of interventions.
Future research should consider the possibility of discovery-based participatory approaches. Few studies have
addressed these areas of concern in this population. The Author(s) 2012.
Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma. In MF a multitude of
therapeutic options are described in the literature mainly without thorough research evidence backing these up. In
2008 the Cochrane Skin Group as a research part of the internationally active Cochrane Collaboration priorized the
need for a systematic review about interventions for mycosis fungoides by an international voting. Within the same
year on the German National Level the Joint Committee for Quality Assurance of the Professional Organization of the
German Dermatologists (BvDD) and the German Dermatological Society DDG independently judged this title via a
blinded delphi-process conducted by this research team as one of the most relevant research issues for a systematic
review. As a result of this a protocol for a systematic Cochrane review has been developed that will be used to
search, summarise and assess the flood of research articles concerning therapeutic interventions for MF. We will
include randomised controlled trials of adults with histologically proven mycosis fungoides classical 'Alibert-Bazin'
type which compared any local or systemic therapy with either another local or systemic therapy or with placebo.
We will search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, GOOGLE scholar
and available databases of ongoing trials. Two review authors will independently screen titles and abstracts of
studies identified from the above sources for the eligibility criteria stated previously. We will attempt to obtain data
that were not reported directly from the original researchers. In order to assess for possible reporting bias, we will
examine a funnel plot for asymmetry. We will explore potential causes of heterogeneity by performing sensitivity
and subgroup analysis. Where possible, we will conduct a meta-analysis of trials and subgroups, or both, using
random effect models. We will present data in the form of forest plots.
Background: Numbers of street-connected children and young people run into many millions worldwide and include
children and young people who live or work in street environments. Whether or not they remain connected to their
families of origin, and despite many strengths and resiliencies, they are vulnerable to a range of risks and are
excluded from mainstream social structures and opportunities. Objectives: To summarise the effectiveness of
interventions for street-connected children and young people that promote inclusion and reintegration and reduce
harms. To explore the processes of successful intervention and models of change in this area, and to understand how
intervention effectiveness may vary in different contexts. Search methods: We searched the following bibliographic
databases, from inception to 2012, and various relevant non-governmental and organisational websites: Cochrane
Central Register of Controlled Trials (CENTRAL); MEDLINE and PreMEDLINE; EMBASE and EMBASE Classic; CINAHL;
PsycINFO; ERIC; Sociological Abstracts; Social Services Abstracts; Social Work Abstracts; Healthstar; LILACS; System
for Grey literature in Europe (OpenGrey); ProQuest Dissertations and Theses; EconLit; IDEAS Economics and Finance
Research; JOLIS Library Catalog of the holdings of the World Bank Group and IMF Libraries; BLDS (British Library for
Development Studies); Google, Google Scholar. Selection criteria: The review included data from harm reduction or
reintegration promotion intervention studies that used a comparison group study design and were all randomised or
quasi-randomised studies. Studies were included if they evaluated interventions aimed to benefit street-connected
children and young people, aged 0 to 24 years, in all contexts. Data collection and analysis: Two review authors
independently extracted data and assessed the risk of bias of included studies. Data were extracted on intervention
delivery, context, process factors, equity and outcomes. Outcome measures were grouped according to whether
they measured psychosocial outcomes, risky sexual behaviours or substance use. A meta-analysis was conducted for
some outcomes though it was not possible for all due to differences in measurements between studies. Other
outcomes were evaluated narratively. Main results: We included 11 studies evaluating 12 interventions from high
income countries. We did not find any sufficiently robust evaluations conducted in low and middle income countries
(LMICs) despite the existence of many relevant programmes. Study quality overall was low to moderate and there
was great variation in the measurement used by studies, making comparison difficult. Participants were drop-in and
shelter based. We found no consistent results on a range of relevant outcomes within domains of psychosocial
health, substance misuse and sexual risky behaviours despite the many measurements collected in the studies. The
interventions being evaluated consisted of time limited therapeutically based programmes which did not prove more
effective than standard shelter or drop-in services for most outcomes and in most studies. There were favourable
Numbers of street-connected children and young people run into many millions worldwide and include children and
young people who live or work in street environments. Whether or not they remain connected to their families of
origin, and despite many strengths and resiliencies, they are vulnerable to a range of risks and are excluded from
mainstream social structures and opportunities. To summarise the effectiveness of interventions for street-
connected children and young people that promote inclusion and reintegration and reduce harms. To explore the
processes of successful intervention and models of change in this area, and to understand how intervention
effectiveness may vary in different contexts.. We searched the following bibliographic databases, from inception to
2012, and various relevant non-governmental and organisational websites: Cochrane Central Register of Controlled
Trials (CENTRAL); MEDLINE and PreMEDLINE; EMBASE and EMBASE Classic; CINAHL; PsycINFO; ERIC; Sociological
Abstracts; Social Services Abstracts; Social Work Abstracts; Healthstar; LILACS; System for Grey literature in Europe
(OpenGrey); ProQuest Dissertations and Theses; EconLit; IDEAS Economics and Finance Research; JOLIS Library
Catalog of the holdings of the World Bank Group and IMF Libraries; BLDS (British Library for Development Studies);
Google, Google Scholar. The review included data from harm reduction or reintegration promotion intervention
studies that used a comparison group study design and were all randomised or quasi-randomised studies. Studies
were included if they evaluated interventions aimed to benefit street-connected children and young people, aged 0
to 24 years, in all contexts. Two review authors independently extracted data and assessed the risk of bias of
included studies. Data were extracted on intervention delivery, context, process factors, equity and outcomes.
Outcome measures were grouped according to whether they measured psychosocial outcomes, risky sexual
behaviours or substance use. A meta-analysis was conducted for some outcomes though it was not possible for all
due to differences in measurements between studies. Other outcomes were evaluated narratively. We included 11
studies evaluating 12 interventions from high income countries. We did not find any sufficiently robust evaluations
conducted in low and middle income countries (LMICs) despite the existence of many relevant programmes. Study
quality overall was low to moderate and there was great variation in the measurement used by studies, making
comparison difficult. Participants were drop-in and shelter based. We found no consistent results on a range of
relevant outcomes within domains of psychosocial health, substance misuse and sexual risky behaviours despite the
many measurements collected in the studies. The interventions being evaluated consisted of time limited
therapeutically based programmes which did not prove more effective than standard shelter or drop-in services for
most outcomes and in most studies. There were favourable changes from baseline in outcomes for most particpants
BACKGROUND: Numbers of street-connected children and young people run into many millions worldwide and
include children and young people who live or work in street environments. Whether or not they remain connected
to their families of origin, and despite many strengths and resiliencies, they are vulnerable to a range of risks and are
excluded from mainstream social structures and opportunities., OBJECTIVES: To summarise the effectiveness of
interventions for street-connected children and young people that promote inclusion and reintegration and reduce
harms. To explore the processes of successful intervention and models of change in this area, and to understand how
intervention effectiveness may vary in different contexts.., SEARCH METHODS: We searched the following
bibliographic databases, from inception to 2012, and various relevant non-governmental and organisational
websites: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE and PreMEDLINE; EMBASE and
EMBASE Classic; CINAHL; PsycINFO; ERIC; Sociological Abstracts; Social Services Abstracts; Social Work Abstracts;
Healthstar; LILACS; System for Grey literature in Europe (OpenGrey); ProQuest Dissertations and Theses; EconLit;
IDEAS Economics and Finance Research; JOLIS Library Catalog of the holdings of the World Bank Group and IMF
Libraries; BLDS (British Library for Development Studies); Google, Google Scholar., SELECTION CRITERIA: The review
included data from harm reduction or reintegration promotion intervention studies that used a comparison group
study design and were all randomised or quasi-randomised studies. Studies were included if they evaluated
interventions aimed to benefit street-connected children and young people, aged 0 to 24 years, in all contexts.,
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias of
included studies. Data were extracted on intervention delivery, context, process factors, equity and outcomes.
Outcome measures were grouped according to whether they measured psychosocial outcomes, risky sexual
behaviours or substance use. A meta-analysis was conducted for some outcomes though it was not possible for all
due to differences in measurements between studies. Other outcomes were evaluated narratively., MAIN RESULTS:
We included 11 studies evaluating 12 interventions from high income countries. We did not find any sufficiently
robust evaluations conducted in low and middle income countries (LMICs) despite the existence of many relevant
programmes. Study quality overall was low to moderate and there was great variation in the measurement used by
studies, making comparison difficult. Participants were drop-in and shelter based. We found no consistent results on
a range of relevant outcomes within domains of psychosocial health, substance misuse and sexual risky behaviours
despite the many measurements collected in the studies. The interventions being evaluated consisted of time limited
therapeutically based programmes which did not prove more effective than standard shelter or drop-in services for
BACKGROUND: Care from the family physician is generally interrupted when patients with cancer come under the
care of second-line and third-line healthcare professionals who may also manage the patient's comorbid conditions.
This situation may lead to fragmented and uncoordinated care, and results in an increased likelihood of not receiving
recommended preventive services or recommended care., OBJECTIVES: To classify, describe and evaluate the
effectiveness of interventions aiming to improve continuity of cancer care on patient, healthcare provider and
process outcomes., SEARCH METHODS: We searched the Cochrane Effective Practice and Organization of Care Group
(EPOC) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE,
CINAHL, and PsycINFO, using a strategy incorporating an EPOC Methodological filter. Reference lists of the included
study reports and relevant reviews were also scanned, and ISI Web of Science and Google Scholar were used to
identify relevant reports having cited the studies included in this review., SELECTION CRITERIA: Randomised
controlled trials (including cluster trials), controlled clinical trials, controlled before and after studies and interrupted
time series evaluating interventions to improve continuity of cancer care were considered for inclusion. We included
studies that involved a majority (> 50%) of adults with cancer or healthcare providers of adults with cancer. Primary
outcomes considered for inclusion were the processes of healthcare services, objectively measured healthcare
professional, informal carer and patient outcomes, and self-reported measures performed with scales deemed valid
and reliable. Healthcare professional satisfaction was included as a secondary outcome., DATA COLLECTION AND
ANALYSIS: Two reviewers described the interventions, extracted data and assessed risk of bias. The authors
contacted several investigators to obtain missing information. Interventions were regrouped by type of continuity
targeted, model of care or interventional strategy and were compared to usual care. Given the expected clinical and
methodological diversity, median changes in outcomes (and bootstrap confidence intervals) among groups of studies
that shared specific features of interest were chosen to analyse the effectiveness of included interventions., MAIN
RESULTS: Fifty-one studies were included. They used three different models, namely case management, shared care,
and interdisciplinary teams. Six additional interventional strategies were used besides these models: (1) patient-held
record, (2) telephone follow-up, (3) communication and case discussion between distant healthcare professionals,
(4) change in medical record system, (5) care protocols, directives and guidelines, and (6) coordination of
assessments and treatment.Based on the median effect size estimates, no significant difference in patient health-
related outcomes was found between patients assigned to interventions and those assigned to usual care. A limited
number of studies reported psychological health, satisfaction of providers, or process of care measures. However,
Care from the family physician is generally interrupted when patients with cancer come under the care of second-
line and third-line healthcare professionals who may also manage the patient's comorbid conditions. This situation
may lead to fragmented and uncoordinated care, and results in an increased likelihood of not receiving
recommended preventive services or recommended care. To classify, describe and evaluate the effectiveness of
interventions aiming to improve continuity of cancer care on patient, healthcare provider and process outcomes. We
searched the Cochrane Effective Practice and Organization of Care Group (EPOC) Specialised Register, the Cochrane
Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, and PsycINFO, using a strategy
incorporating an EPOC Methodological filter. Reference lists of the included study reports and relevant reviews were
also scanned, and ISI Web of Science and Google Scholar were used to identify relevant reports having cited the
studies included in this review. Randomised controlled trials (including cluster trials), controlled clinical trials,
controlled before and after studies and interrupted time series evaluating interventions to improve continuity of
cancer care were considered for inclusion. We included studies that involved a majority (> 50%) of adults with cancer
or healthcare providers of adults with cancer. Primary outcomes considered for inclusion were the processes of
healthcare services, objectively measured healthcare professional, informal carer and patient outcomes, and self-
reported measures performed with scales deemed valid and reliable. Healthcare professional satisfaction was
included as a secondary outcome. Two reviewers described the interventions, extracted data and assessed risk of
bias. The authors contacted several investigators to obtain missing information. Interventions were regrouped by
type of continuity targeted, model of care or interventional strategy and were compared to usual care. Given the
expected clinical and methodological diversity, median changes in outcomes (and bootstrap confidence intervals)
among groups of studies that shared specific features of interest were chosen to analyse the effectiveness of
included interventions. Fifty-one studies were included. They used three different models, namely case
management, shared care, and interdisciplinary teams. Six additional interventional strategies were used besides
these models: (1) patient-held record, (2) telephone follow-up, (3) communication and case discussion between
distant healthcare professionals, (4) change in medical record system, (5) care protocols, directives and guidelines,
and (6) coordination of assessments and treatment.Based on the median effect size estimates, no significant
difference in patient health-related outcomes was found between patients assigned to interventions and those
assigned to usual care. A limited number of studies reported psychological health, satisfaction of providers, or
process of care measures. However, they could not be regrouped to calculate median effect size estimates because
The Substance Use Risk Education (SURE)Meta-Analytic Team aims to promote the health of college students by
conducting research syntheses with an emphasis on evaluating interventions to reduce alcohol consumption and/or
alcohol-related problems. We have reviewed over 260 studies evaluating alcohol-related interventions. We find that
interventions are eective in reducing alcohol consumption and alcohol-related problems compared with controls.
The magnitudes of the eect sizes are stronger when interventions are compared with assessment-only controls vs.
more intensive comparison conditions.Moderators associated with intervention ecacy include face-to-face
intervention delivery and providing personalized normative feedback.Meta-analyses of this literature are not without
limitations. First,more studies with longer follow-ups are needed to determine the long-term impact of interventions
for college students.We see that interventions reduce alcohol consumption and related problems in the short term
(typically <3 months) with some limited evidence of longer-term ecacy (>=6 months), but we cannot determine if
these interventions have a lasting impact without new studies assessing the outcomes for at least one-year post-
intervention. Second, details regarding the study, sample, intervention, and outcomes need to be more fully
reported. Reporting standards (e.g., CONSORT, JARS) have improved the information available in primarylevel
studies. Nonetheless, some alcohol intervention studies do not report key information such as baseline alcohol
consumption, duration of intervention, or the statistical outcomes from all intervention conditions and assessment
intervals. Supplemental content, made available on journal websites, can help to overcome this limitation. Finally,
wemay not be able to address certain questions involving complex models using the data provided in primary-level
studies. These questions may be addressed withmeta-analyses of individual participant data (IPD).Meta-analyses of
aggregated data and IPD could complement each other. The literature on college alcohol interventions has
burgeoned over the past decade. A keyword search in Google Scholar with alcohol, intervention, and college showed
an average rate of increase of 1,444 manuscripts per year from 2002 to 2012. Despite the limitations of the
literature,meta-analytic procedures provide an excellent tool for synthesizing data gathered from a large number of
studies.
Background: End-stage chronic obstructive pulmonary disease (COPD) is a debilitating, life-limiting condition. A
palliative approach is appropriate for individuals with end-stage COPD, yet currently few interventions embrace this
holistic, multidisciplinary and inclusive perspective. Objective: To describe interventions to support a palliative care
approach in patients with end-stage COPD. Design: Integrative review. Data sources and review method: Peer
reviewed articles meeting the search criteria were accessed from Medline, PsychINFO, CINAHL and Google Scholar
databases as well as Caresearch online resource. The domains of quality palliative care developed by Steinhauser
were used as the conceptual framework to synthesise information. Results: This review has shown that a range of
palliative interventions are used to address the needs of individuals with end-stage COPD. Although evidence exists
for discrete elements of palliative management in this patient group, there is limited evidence for health service
coordination and models that integrate the multiple domains of palliative care with active management. Conclusion:
Further investigation is required to address the complex personal, provider and system elements associated with
managing end-stage COPD. A comprehensive and collaborative approach is required to address the complex and
varied needs of individuals with end-stage COPD and their families. 2012 Elsevier Ltd.
Objectives: To perform a systematic review to provide rationale for intracoronary (IC) abciximab administration in
patients with ST-segment elevation myocardial infarction (STEMI), to summarize recent studies comparing IC vs.
intravenous (IV) abciximab administration in this setting and to define questions that need to be answered in future
trials determining the optimal abciximab regimen. Methods: A search covering the period from January 1993 to June
2011 was conducted by two independent investigators using MEDLINE, CENTRAL and Google Scholar databases.
Proceedings from the scientific sessions of ACC, AHA, ESC, TCT and EuroPCR were also considered. Results: IC
administration allows one to obtain a much higher concentration of abciximab than IV injection at the culprit lesion.
Therefore it is hypothesized that IC abciximab administration provides more efficient GP IIb/IIIa receptor inhibition
and more pronounced additional dose-dependent antiplatelet, antithrombotic, and anti-inflammatory effects when
compared to the IV route. Numerous observational and randomized studies comparing IC vs. IV abciximab in STEMI
patients indicated improvement in different surrogate end points (infarct size, obstruction of coronary
microcirculation, ST segment resolution, inflammatory mediators and markers of platelet activation) related to IC
administration. The evidence supporting clinical benefits associated with IC injection of abciximab comes from one
randomized and several non-randomized trials as most of the studies were underpowered to assess clinical
outcomes. No difference in bleeding complications was observed between IC and IV regimens. Issues that need to be
addressed in future studies include: the use of IC abciximab in combination with thrombectomy, the role of selective
delivery systems, and the necessity of a prolonged IV infusion of abciximab after IC bolus administration.
Conclusions: An accumulating body of evidence suggests the superiority of IC over IV abciximab administration in
STEMI patients. However, further trials are warranted to establish the optimal strategy of abciximab treatment in this
setting. 2011 Informa UK Ltd.
Due to its non-invasive mode of administration, intranasal (IN) application of drugs may be a valuable alternative to
non-invasive pain management. With characteristics that appear to be ideal for IN application, IN fentanyl may have
a place in the out-of-hospital treatment and the paediatric population. The objective of this systematic review was to
evaluate the current evidence of IN fentanyl in the treatment of acute pain. Reports of randomized controlled trials
(RCTs) of IN fentanyl in treatment of pain were systematically sought using the PubMed database, Embase, Google
scholar, Cochrane database, and Cumulative Index to Nursing and Allied Health Literature. Reports were considered
for inclusion if they were double-blinded randomized controlled trials (RCTs) of IN fentanyl in the treatment of acute
pain. Thirty-two RCTs were identified, and 16 were included in the final analysis. No significant analgesic differences
between IN fentanyl and intravenous (IV) fentanyl were demonstrated in treatment of acute and post-operative
pain. Significant analgesic effect of IN fentanyl was demonstrated in the treatment of breakthrough pain in cancer
patients. In the paediatric population, results demonstrated some analgesic effect of IN fentanyl following
myringotomy, no analgesic effect following voiding cystourethrography, and finally, no significant analgesic
difference after long bone fractures, in burns patients, and in post-operative pain relief when compared to IV
morphine, oral morphine, or IV fentanyl, respectively. Significant analgesic effect of IN fentanyl was demonstrated in
the treatment of breakthrough pain in cancer patients. However, the significant deficiencies in trials investigating
acute and post-operative pain, and the paediatric population makes firm recommendations impossible. 2012 The
Acta Anaesthesiologica Scandinavica Foundation.
Due to its non-invasive mode of administration, intranasal (IN) application of drugs may be a valuable alternative to
non-invasive pain management. With characteristics that appear to be ideal for IN application, IN fentanyl may have
a place in the out-of-hospital treatment and the paediatric population. The objective of this systematic review was to
evaluate the current evidence of IN fentanyl in the treatment of acute pain. Reports of randomized controlled trials
(RCTs) of IN fentanyl in treatment of pain were systematically sought using the PubMed database, Embase, Google
scholar, Cochrane database, and Cumulative Index to Nursing and Allied Health Literature. Reports were considered
for inclusion if they were double-blinded randomized controlled trials (RCTs) of IN fentanyl in the treatment of acute
pain. Thirty-two RCTs were identified, and 16 were included in the final analysis. No significant analgesic differences
between IN fentanyl and intravenous (IV) fentanyl were demonstrated in treatment of acute and post-operative
pain. Significant analgesic effect of IN fentanyl was demonstrated in the treatment of breakthrough pain in cancer
patients. In the paediatric population, results demonstrated some analgesic effect of IN fentanyl following
myringotomy, no analgesic effect following voiding cystourethrography, and finally, no significant analgesic
difference after long bone fractures, in burns patients, and in post-operative pain relief when compared to IV
morphine, oral morphine, or IV fentanyl, respectively. Significant analgesic effect of IN fentanyl was demonstrated in
the treatment of breakthrough pain in cancer patients. However, the significant deficiencies in trials investigating
acute and post-operative pain, and the paediatric population makes firm recommendations impossible. 2012 The
Authors. Acta Anaesthesiologica Scandinavica 2012 The Acta Anaesthesiologica Scandinavica Foundation.
Coronary artery bypass surgery can offer excellent results when performed with cardiopulmonary bypass (on pump)
or without cardiopulmonary bypass (off pump). The debate as to which technique is superior remains unanswered.
Intra-operative conversion from offto on-pump coronary surgery is a relatively unexplored phenomenon, which
cannot be assessed within randomised controlled trial design. We aimed to assess the effect of off-pump conversion
on patient mortality. Medline, Embase, Cochrane and Google Scholar databases were systematically reviewed for
studies published between 1980 and 2010that compared the incidence of mortality between converted and non-
converted off-pump patients. Publication bias and heterogeneity were assessed and data were extracted
independently by multiple observers. We undertook a meta-analysis of these studies using random effects
modelling. A total of 17 studies fulfilled our inclusion criteria, containing data for 18,870 off-pump coronary artery
bypass operations spanning a decade (1998- 2008), involving 920 cases of conversion. Overall, conversion increased
mortality by an odds ratio of 6.18 (95% confidence interval 4.65-8.20), whereas emergency conversion further raised
the odds ratio of mortality to 6.99 (95% confidence interval 5.18-9.45). The conversion from off-to on-pump cardiac
surgery may significantly increase the chance of an adverse outcome, whereas emergency conversion confers a
significant rise in mortality. The risk of conversion should be discussed when obtaining the patient's informed
consent and its prevention warrants serious consideration by cardiac surgeons and cardiac surgical training
programmes. The Author 2011. Published by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
BACKGROUND: Every dental ceramic system can experience failure of the veneering porcelain. However, the
increasing popularity of all-ceramic crowns and fixed dental prostheses (FDPs) seems to have led to an increasing
need to repair chipped veneering porcelain., OBJECTIVES: The authors compared different methods to repair
fractured ceramic restorations (porcelain-fused-to-metal and all-ceramic) and explain the basic principles of adhesion
in these systems. They also evaluated the frequency and causes of failure in dental ceramic systems., METHODS: This
review is based on the results of PubMed and Google Scholar searches, as well as on a hand search of the scientific
literature, resulting in 300 articles from 1977 to 2012. The authors used multiple key words (ceramic, repair,
bonding, hydrofluoric acid, air abrasion, silane, phosphates, silicon dioxide) and different strategies (connecting
different key words with OR, NOR and AND and truncation of the stem of words) to search the databases., RESULTS:
Because of differences in the material composition of ceramic systems (composed of metal, alumina or zirconia, glass-
ceramics and feldspathic ceramics), different treatments are required for the exposed material surfaces after
chipping. Use of hydrofluoric acid etching, air abrasion, tribochemical coating, silanization and metal primers or
zirconia primers seem to be the most successful conditioning methods for durable bonding and repair.,
CONCLUSIONS AND CLINICAL IMPLICATIONS: Intraoral repair of a restoration offers a satisfying option for the patient
when the restoration cannot be removed or replaced. Its success depends largely on the conditioning methods used
for the fractured surfaces.
Background and aims: The efficacy and safety of intrathecal magnesium as analgesic adjuvant has been tested by
several clinical trials in recent years. We performed a meta-analysis of the available literature. Methods: Randomized
clinical trials comparing a 50 to 100 mg dose of intrathecal magnesium sulfate vs. placebo in addition to an
intrathecal local anesthetic and/or opiate for a below-umbilicus procedure were included. MEDLINE, LILACS,
Cochrane Library and Google Scholar databases were searched. A random analysis was performed and heterogeneity
was tested for. The size of the effect for quantitative outcomes was calculated as standard mean difference (SMD,
neutral=0); and as odds ratio (OR, neutral=1) for dichotomous outcomes. Results: 12 studies totaling 817 patients
were included. The Time to first analgesia request was longer when intrathecal magnesium was included in the
intervention (SDM 0.94, 95%CI 0.51 to 1.37, p< 0.001). The Onset time to sensory block (SDM 0.64, 95%CI 0.15 to
1.12, p=0.01) and the Time to maximal motor block (SDM 0.97, 95%CI 0.28 to 1.67, p=0.006) were slower with
intrathecal magnesium. There was no difference in Time to full motor recovery, incidence of pruritus, postoperative
nausea and vomiting, bradicardia, low blood pressure and urinary retention. There were no cases of respiratory
depression or neurotoxicity. Conclusions: The inclusion of 50 to 100 mg of intrathecal magnesium in a spinal
anesthetic behaves as an effective and safe analgesic adjuvant.
Background. The efficacy and safety of intrathecal magnesium as analgesic adjuvant has been tested by several
clinical trials in recent years. We performed a meta-analysis of the available literature. Methods. Randomized clinical
trials comparing a 50 to 100 mg dose of intrathecal magnesium sulfate versus placebo in addition to an intrathecal
local anesthetic and/or opiate for a below-umbilicus procedure were included. Medline, LILACS, Cochrane Library
and Google Scholar databases were searched. A random analysis was performed and heterogeneity was tested for.
The size of the effect for quantitative outcomes was calculated as standard mean difference (SMD, neutral=0); and as
odds ratio (OR, neutral= 1) for dichotomous outcomes. Results. Twelve studies totaling 817 patients were included.
The "time to first analgesia request" was at least 35 minutes longer when intrathecal magnesium was included in the
intervention (SDM 0.94, 95%CI 0.51 to 1.37, P<0.001). The "onset time to sensory block" (SDM 0.64, 95%CI 0.15 to
1.12, P=0.01) and the "time to maximal motor block" (SDM 0.97, 95%CI 0.28 to 1.67, P=0.006) were 2.4 minutes
slower with intrathecal magnesium. There was no difference in "time to full motor recovery, incidence of pruritus,
postoperative nausea and vomiting, bradicardia, low blood pressure and urinary retention". No cases of respiratory
depression or neurotoxicity were recorded in these studies. Conclusion. The inclusion of 50 to 100 mg of intrathecal
magnesium in a spinal anesthetic prolongs opiate analgesia duration; no safety concerns have been identified by the
included clinical studies but additional evidence is advised.
Introduction: Conflicting outcomes have been reported after intrathecal administration of bupivacaine or ropivacaine
over the time taken to obtain anaesthesia for caesarean section. This meta-analysis examines the time taken to
reach surgical anaesthesia in the obstetric population, and the incidence of hypotension, ephedrine use, umbilical
artery pH and recovery characteristics of the two local anaesthetics in prospective randomised controlled trials
(RCTs). Methods: The keywords ropivacaine, bupivacaine, intrathecal, spinal, subarachnoid, Caesarean and Cesarean
were used to search Medline, EMBASE and Google Scholar to identify RCTs and published abstracts, using the Jadad
Scale to assess the quality of the RCTs. RevMan statistical software utilised inverse variance and a random effect
model to calculate standardised mean difference (SMD), with 95% CI for continuous variables and odds ratio and the
Mantel-Haenszel method for dichotomous variables. The primary outcome was time to surgical anaesthesia.
Secondary outcomes were: time to complete motor block, incidence of hypotension, ephedrine use, duration of
sensory block, and umbilical artery pH. Results: Ten RCTs comprising 618 patients were included. Fentanyl, morphine
and sufentanil were the commonest opioids used. The Jadad score ranged from 2-5. There was no significant
difference in time taken to surgical anaesthesia with ropivacaine compared to bupivacaine ( P=0.14). Time to
complete motor block was significantly shorter with bupivacaine (P=0.008). There was no difference between the
two groups with regard to the incidence of hypotension (P=0.12), duration of sensory block (P=0.16), ephedrine use
(P=0.06) or umbilical artery pH (P=0.14). Discussion: Intrathecal ropivacaine is a suitable alternative to bupivacaine
for caesarean section. This meta -analysis suggests it has a similar onset of surgical anaesthesia with no increase in
the incidence of hypotension or ephedrine use. As previously demonstrated, time to complete motor block is longer
using ropivacaine, but duration of sensory block is similar with both drugs. There was no difference between the two
groups in terms of the umbilical artery pH. (Figure Presented).
Intrathecal ropivacaine has been associated with a shorter duration of motor block than intrathecal bupivacaine,1
but a recent meta-analysis2 suggested a delayed onset of sensory block with ropivacaine for knee arthroscopy. This
meta-analysis examines the onset and recovery characteristics of the two local anaesthetics in prospective
randomized controlled trials (RCTs). The keywords, ropivacaine, bupivacaine, intrathecal spinal, and Caesarean
section, were used to search Medline, EMBASE (1980-2011) and Google Scholar to identify RCTs and published
abstracts, without language restrictions. The Jadad scale3 was used to assess the quality of the RCTs. RevMan
statistical softwarew utilized inverse variance and a random effect model to calculate weighted mean difference
(WMD), with 95% confidence intervals for continuous variables and odds ratio and the Mantel-Haenszel (M-H)
method for dichotomous variables. The primary outcome was time to onset of sensory block. Secondary outcomes
were: time to complete motor block, duration of motor block, duration of sensory block, time to first request for
analgesic, time to mobilization, and incidence of hypotension. Seventeen RCTs comprising 1014 patients published
from 2001 to 2011 were included. Fentanyl, morphine and sufentanil were the most common opioids used.
Caesarean sections, abdominal, urological, and orthopaedic procedures with or without intrathecal opioids were
studied. The Jadad score ranged from 2 to 5. There was no difference in time to onset of sensory block (P=0.3). Time
to complete motor block was quicker and duration of motor block was significantly longer with bupivacaine. Duration
of sensory block was prolonged, as was the time to first request for analgesic in the bupivacaine group. Time to
mobilization was significantly longer for bupivacaine with an increased incidence of hypotension (Table 8).
Intrathecal ropivacaine has advantages over bupivacaine with a shorter duration of motor block and time to (Table
presented) mobilization, and a reduced incidence of hypotension. The onset of sensory block is similar with both
drugs.
Clara cell secretary protein (CCSP) is an immune-modulating and anti-inflammatory agent. CCSP is available
synthetically as recombinant human Clara cell protein (rhCC10). It has been shown in animal models to reduce lung
injury, improve pulmonary compliance and oxygenation, decrease systemic inflammation and up-regulate surfactant
protein and vascular endothelial growth factor expression. These properties makes intratracheally administered CCSP
a potential agent in prevention of chronic lung disease (CLD). To determine the effect of intratracheal CCSP
administration compared to placebo or no treatment on morbidity and mortality in preterm infants with or at risk of
respiratory distress syndrome (RDS). We searched CENTRAL (The Cochrane Library, October 2010), MEDLINE and
PREMEDLINE (1950 to October 2010), EMBASE (1980 to October 2010) and CINAHL (1982 to October 2010). We
searched proceedings of scientific meetings, Google Scholar and reference lists of identified studies, and contacted
expert informants and surfactant manufacturers. Published, unpublished and ongoing randomised controlled, cluster-
randomised or quasi-randomised trials of intratracheal CCSP administration, compared to placebo or no treatment
on morbidity and mortality in preterm infants at risk of RDS. Two authors independently assessed studies for
eligibility and quality, and extracted data. One pilot study was identified and included. This study enrolled 22 preterm
infants 700 to 1300g with established RDS who required ventilation for surfactant administration. Infants received
one intratracheal dose of placebo (n = 7), 1.5 mg/kg (n = 8) or 5 mg/kg (n = 7) rhCC10 within four hours of surfactant
treatment. At either dose of rhCC10, no significant difference was reported in CLD (36 weeks postmenstrual age or
28 days), mortality, intraventricular haemorrhage, periventricular leukomalacia, patent ductus arteriosus, necrotising
enterocolitis, sepsis or days supplemental oxygen compared to placebo. A significant increase in days mechanical
ventilation was reported for infants receiving rhCC10 5mg/kg (mean difference 12.00, 95% confidence interval 0.39
to 23.61) but not at the lower dose. The study reported that a single intratracheal dose of rhCC10 was well tolerated
and resulted in a significant reduction in tracheal aspirate neutrophil and total cell count, and lung protein
concentration. There was no significant difference reported in tracheal aspirate cytokine levels between groups.
There are insufficient data to determine the role of rhCC10 in clinical practice. Further studies are required to
determine if rhCC10 reduces lung inflammation in infants at risk of CLD, and to determine dose and dosing strategy.
To determine the evidence for efficacy of intratympanic (IT) steroid treatment for the management of idiopathic
sudden sensorineural hearing loss through a systematic review of the existing literature. Online databases consisting
of PubMed, Medline, OVID, Google Scholar, Cochrane Review, and collected additional publications cited in
bibliographies. Literature search by both authors with structured criteria to select studies evaluated for systematic
review. The authors identified 176 articles, of which 32 represented studies of initial or salvage intratympanic steroid
injections for sudden hearing loss that included 6 randomized trials and only 2 randomized controlled trials. Despite
the paucity of well-executed trials, the vast majority of studies of intratympanic steroids for salvage treatment in all
tiers demonstrated a benefit of intratympanic steroid therapy. A limited meta-analysis of the higher quality studies
revealed a mean difference in improvement of 13.3 dB (95% confidence interval [CI], 7.7-18.9; P < .0001). Although
statistically significant, it is still unclear if this difference is clinically significant. Initial intratympanic therapy was
equivalent to standard therapy in the existing literature of all qualities. Intratympanic steroid treatment as primary
treatment for sudden sensorineural hearing loss appears equivalent to treatment with high-dose oral prednisone
therapy. As salvage therapy, intratympanic steroids offer the potential for some degree of additional hearing
recovery, although it remains uncertain if this improvement is clinically significant and what percentage of patients is
likely to show benefit.
Objective: To assess the effectiveness of intrauterine local anesthesia in reducing pain associated with outpatient
gynecologic procedures. Data Sources: We searched online databases PubMed or MEDLINE, Embase, Google Scholar,
and Clinicaltrials.gov and hand-searched reference lists from reviews evaluating pain-control methods for
gynecologic office procedures. We identified randomized controlled trials using intrauterine local anesthetic in
gynecologic procedures. Methods: Titles and abstracts were screened for 1,236 articles. We identified 45 potential
articles for inclusion. We excluded 22 of these studies because: 1) they were not randomized controlled trials; 2) they
did not describe a quantifiable dose of medication used in the study; 3) they did not investigate an intrauterine
anesthetic; 4) they did not study a potentially awake, outpatient procedure; and 5) they did not clearly report results
or represented duplicate publication. Twenty-three articles were ultimately included for review. TABULATION,
INTEGRATION, AND Results: Two authors independently reviewed full search results and assessed eligibility for
inclusion and independently abstracted data from all articles that met criteria for inclusion. Disagreements regarding
eligibility or abstraction data were adjudicated by a third independent person. Our primary end point was the
reported effect of intrauterine local anesthesia on patient-reported pain scores. As a result of heterogeneity in study
methods, outcome measures, and reporting of outcomes, results could not be combined in a meta-analysis. Good
evidence supports use of intrauterine anesthesia in endometrial biopsy and curettage, because five good-quality
studies reported reduced pain scores, whereas only one good-quality study reported negative results. We found
moderate evidence to support intrauterine anesthesia in hysteroscopy, because one good-quality study and two fair
or poor quality studies reported reduced pain scores, whereas two good-quality studies had negative results. Good
evidence suggests that intrauterine anesthesia is not effective in hysterosalpingography; three good-quality studies
reported that pain scores were not reduced, and no good quality studies showed a beneficial effect in that
procedure. Evidence was insufficient concerning first-trimester abortion, saline-infusion ultrasonogram, tubal
sterilization, and intrauterine device insertion. Conclusion: Intrauterine local anesthesia can reduce pain in several
gynecologic procedures including endometrial biopsy, curettage, and hysteroscopy and may be effective in other
procedures as well. 2012 by The American College of Obstetricians and Gynecologists. Published by Lippincott
Williams &Wilkins.
OBJECTIVE: To review clinical trials of intravenous opioids for severe acute pain in the emergency department (ED)
and to provide an approach for optimization of therapy. DATA SOURCES: Articles were identified through a search of
Ovid/MEDLINE (1948-August 2010), PubMed (1950-August 2010), Cochrane Central Register of Controlled Trials
(1991-August 2010), and Google Scholar (1900-August 2010). The search terms used were pain, opioid, and
emergency department. STUDY SELECTION AND DATA EXTRACTION: The search was limited by age group to adults
and by publication type to comparative studies. Studies comparing routes of administration other than intravenous
or using non-opioid comparators were not included. Bibliographies of all retrieved articles were reviewed to obtain
additional articles. The focus of the search was to identify original research that compared intravenous opioids used
for treatment of severe acute pain for adults in the ED. DATA SYNTHESIS: At equipotent doses, randomized
controlled trials have not shown clinically significant differences in analgesic response or adverse effects between
opioids studied. Single opioid doses less than 0.1 mg/kg of intravenous morphine, 0.015 mg/kg of intravenous
hydromorphone, or 1 mug/kg of intravenous fentanyl are likely to be inadequate for severe, acute pain and the need
for additional doses should be anticipated. In none of the randomized controlled trials did patients develop
respiratory depression requiring the use of naloxone. Future trials could investigate the safety and efficacy of higher
doses of opioids. Implementation of nurse-initiated and patient-driven pain management protocols for opioids in the
ED has shown improvements in timely provision of appropriate analgesics and has resulted in better pain reduction.
CONCLUSIONS: Currently, intravenous administration of opioids for severe acute pain in the ED appears to be
inadequate. Opioid doses in the ED should be high enough to provide adequate analgesia without additional risk to
the patient. EDs could implement institution-specific protocols to standardize the management of pain.
AIM: To give an overview of the literature on intussusception due to inflammatory fibroid polyp (IFP). METHODS: We
present a new case of ileal intussusception due to IFP and a literature review of studies published in English language
on intussusception due to IFP, accessed via PubMed and Google Scholar databases. For the search, the keywords
used were: intussusception, IFP, intussusception and IFP, intussusception due to IFP, and IFP presenting as
intussusception. The search covered all articles from 1976 to November 2011. RESULTS: We present a 38-year-old
woman who was admitted 10 d after experiencing abdominal pain, vomiting, and nausea. Ultrasonography
demonstrated small bowel intussusception. An ileal intussusception due to a mass lesion 50 cm proximal to the
ileocecal junction was found during laparotomy. Partial ileal resection and anastomosis were performed. A diagnosis
of ileal IFP was made based on the immunohistochemical findings. In addition, a total of 56 reports concerning 85
cases of intussusception due to IFP meeting the aforementioned criteria was included in the literature review. The
patients were aged 4 to 81 years (mean, 49 +/- 16.2 years); 44 were women (mean, 51.8 +/- 14.3 years) and 41 were
men (mean, 46 +/- 17.5 years). According to the location of the IFP, ileal intussusception was found in 63 patients,
while 17 had jejunal, three had colonic, and two had ileojejunal intussusception. CONCLUSION: Although IFPs are
rare and benign, surgery is the only solution in case of intestinal obstruction. Differential diagnosis should be made
via immunohistochemical examination. 2012 Baishideng. All rights reserved.
Background: With a trend that renal tumors are being detected at an earlier stage, classical radical nephrectomy is
being reconsidered. More conservative techniques are being proposed. To clarify the indication for synchronous
adrenalectomy in radical nephrectomy for renal cell carcinoma which has been questioned since the 1980s, this
study evaluates the role of adrenalectomy and recommends a new indication for adrenalectomy in renal cell
carcinoma. Methods: A systemic search was performed, using PubMed and Google Scholar, of all English language
studies published up to March 2012 that compared adrenalectomy with adrenal-sparing surgery, in surgery for renal
cell carcinoma. We assessed preoperative imaging for adrenal involvement and the relationship of tumor location
with adrenal metastases. Twenty-one studies (20 retrospective and 1 prospective) involving 11 736 patients were
included. Results: The mean incidence of ipsilateral adrenal involvement from renal cell carcinoma was 4.5%.
Synchronous adrenalectomy did not alter survival (hazard ratio (HR)=0.89, 95% confidence interval (CI) 0.67-1.19,
P=0.43; odds ratio (OR)=1.10, 95% CI 0.84-1.44, P=0.49). Upper pole tumors were not associated with a higher
incidence of ipsilateral adrenal metastases. Pooled preoperative imaging: sensitivity, specificity, positive predictive
value and negative predictive value were 92% (95% CI 0.84-0.97), 95% (95% CI 0.93-0.96), 71.6% and 98.5%
respectively. Conclusions: Adrenal involvement from renal cell carcinoma is rare, even in advanced tumours.
Synchronous adrenalectomy does not offer any benefit, even for "high risk" patients. We suggest that only patients
with a positive preoperative adrenal finding on preoperative imaging for a solitary adrenal metastasis should
undergo adrenalectomy as part of the radical nephrectomy.
BACKGROUND: With a trend that renal tumors are being detected at an earlier stage, classical radical nephrectomy is
being reconsidered. More conservative techniques are being proposed. To clarify the indication for synchronous
adrenalectomy in radical nephrectomy for renal cell carcinoma which has been questioned since the 1980s, this
study evaluates the role of adrenalectomy and recommends a new indication for adrenalectomy in renal cell
carcinoma., METHODS: A systemic search was performed, using PubMed and Google Scholar, of all English language
studies published up to March 2012 that compared adrenalectomy with adrenal-sparing surgery, in surgery for renal
cell carcinoma. We assessed preoperative imaging for adrenal involvement and the relationship of tumor location
with adrenal metastases. Twenty-one studies (20 retrospective and 1 prospective) involving 11 736 patients were
included., RESULTS: The mean incidence of ipsilateral adrenal involvement from renal cell carcinoma was 4.5%.
Synchronous adrenalectomy did not alter survival (hazard ratio (HR) = 0.89, 95% confidence interval (CI) 0.67 - 1.19, P
= 0.43; odds ratio (OR) = 1.10, 95%CI 0.84 - 1.44, P = 0.49). Upper pole tumors were not associated with a higher
incidence of ipsilateral adrenal metastases. Pooled preoperative imaging: sensitivity, specificity, positive predictive
value and negative predictive value were 92% (95%CI 0.84 - 0.97), 95% (95%CI 0.93 - 0.96), 71.6% and 98.5%
respectively., CONCLUSIONS: Adrenal involvement from renal cell carcinoma is rare, even in advanced tumours.
Synchronous adrenalectomy does not offer any benefit, even for "high risk" patients. We suggest that only patients
with a positive preoperative adrenal finding on preoperative imaging for a solitary adrenal metastasis should
undergo adrenalectomy as part of the radical nephrectomy.
BACKGROUND Irritable bowel syndrome (IBS) is a common gastrointestinal disorder. Due to its high prevalence and
absence of curative therapy, IBS has the potential to create tremendous burden on the health care system.
OBJECTIVES Herein, we systematically reviewed the published literature to investigate the epidemiology of Irritable
bowel syndrome in Iran. METHODS Studies reviewed in this article were primarily identified by searching four online
bibliographic databases including PubMed, Google Scholar, IranMedex, and Scientific Information Database. Manual
search of reference lists from studies with relevant abstracts and also recent reviews was also carried out to identify
any additional studies that may have been missed. Potentially related studies were retrieved and the selection
criteria applied. Eligible articles were reviewed. RESULTS From the 4176 studies identified, 18 eligible studies were
included. In Iran, IBS has a wide reported prevalence range from 1.1% to 25% and is more prevalent in women. There
is a minimal difference in IBS prevalence within different age groups. CONCLUSION According to the results, reported
prevalence of IBS in Iran has a wide range. Since there are not enough population-based studies, researchers should
focus on developing well-designed population-based studies to determine the epidemiology of IBS in Iran. Moreover,
cohort studies should be conducted in order to investigate the natural history of IBS. Investigating the etiology of IBS
and attempts to plan health promotion programs are highly suggested.
Introduction: The efficacy of additional complex fractionated atrial electrograms (CFAEs) ablation added to
pulmonary vein antrum isolation (PVAI) in patients with atrial fibrillation remains controversial. The meta-analysis
was performed to assess the additional efficacy of CFAEs ablation after a single procedure without antiarrhythmic
drugs. Methods: Four electronic databases were searched: MEDLINE, Cochrane Library, Embase, Google Scholar;
articles regarding longterm outcomes of CFAEs ablation in patients with AF were reviewed; references in relevant
studies were manual retrieved. Six controlled trials (total 526 patients with atrial fibrillation (AF), 263 patients
underwent PVAI + CFAEs ablation and 263 patients underwent PVAI alone) were included in the meta-analysis. The
rates of sinus rhythm maintenance were analyzed with a random effects model. Results: In an overall pooled
estimate, 68% in PVAI + CFAEs group and 59% in PVAI group were in sinus rhythm (RR 1.13, 95% confidence intervals
(CI): 0.97, 1.31) after at least a mean followup of 10 months. In the subgroup paroxysmal AF patients, 86.7% in PVAI
+ CFAEs and 85% in PVAI group were in sinus rhythm (RR, 1.02 95% CI: 0.90-1.16); in the subgroup nonparoxysmal AF
patients, 59.2% in PVAI + CFAEs and 45.8% in PVAI group were in sinus rhythm (RR, 1.28 95% CI: 1.00-1.64).
Conclusions: Adjuvant CFAEs ablation in addition to standard PVAI hardly increased the rate of long-term sinus
rhythm maintenance in paroxysmal AF patients after a single procedure without antiarrhythmic drugs, however we
can not excluded that additional CFAEs ablation might resulted in a trend towards higher rates of sinus rhythm
maintenance in nonparoxysmal AF patients.
A systematic review to compare the effectiveness of the use of cartilage (with or without perichondrium) with
temporalis fascia used in tympanoplasty. The following databases were searched for relevant studies: MEDLINE,
Embase, CINAHL, the Cochrane Library including the Cochrane Central Register of Controlled Trials, Google scholar,
and the PubMed. There was no restriction as to the design or date of publication. We selected randomized
controlled trials (RCTs) and retrospective studies comparing cartilage and temporalis fascia tympanoplasty in relation
to 2 outcomes: morphological and functional success. Initial search identified 2,091 publications. All titles and
abstracts were reviewed by 2 of the authors, and 103 relevant articles were studied. However, only 14 studies met
the inclusion criteria for this review. These included 3 RCTs, 10 retrospective studies, and 1 literature review. Three
level 1 (RCTs) and 11 level 3 and 4 evidence-based studies were included (n = 1,475 patients). One RCT and 3
retrospective studies showed a statistically significant better morphological success, that is, intact ear drum with
cartilage graft with or without perichondrium. There was, however, no statistically significant difference between
cartilage and temporalis fascia tympanoplasty regarding function, namely, hearing outcome. The need for revision
rates was approximately 10% with cartilage and 19% with fascia tympanoplasty. Tympanoplasty using cartilage with
or without perichondrium has better morphological outcome than tympanoplasty using temporalis fascia. However,
there was no statistically significant difference in hearing outcomes between the 2 grafts.
OBJECTIVE: A systematic review to compare the effectiveness of the use of cartilage (with or without perichondrium)
with temporalis fascia used in tympanoplasty., DATA SOURCE: The following databases were searched for relevant
studies: MEDLINE, Embase, CINAHL, the Cochrane Library including the Cochrane Central Register of Controlled
Trials, Google scholar, and the PubMed. There was no restriction as to the design or date of publication., STUDY
SELECTIONS: We selected randomized controlled trials (RCTs) and retrospective studies comparing cartilage and
temporalis fascia tympanoplasty in relation to 2 outcomes: morphological and functional success. Initial search
identified 2,091 publications. All titles and abstracts were reviewed by 2 of the authors, and 103 relevant articles
were studied. However, only 14 studies met the inclusion criteria for this review. These included 3 RCTs, 10
retrospective studies, and 1 literature review., RESULTS: Three level 1 (RCTs) and 11 level 3 and 4 evidence-based
studies were included (n = 1,475 patients). One RCT and 3 retrospective studies showed a statistically significant
better morphological success, that is, intact ear drum with cartilage graft with or without perichondrium. There was,
however, no statistically significant difference between cartilage and temporalis fascia tympanoplasty regarding
function, namely, hearing outcome. The need for revision rates was approximately 10% with cartilage and 19% with
fascia tympanoplasty., CONCLUSION: Tympanoplasty using cartilage with or without perichondrium has better
morphological outcome than tympanoplasty using temporalis fascia. However, there was no statistically significant
difference in hearing outcomes between the 2 grafts.
Rationale: Although citrulline appears to be a marker of enterocyte mass, it is not clear whether it functions as a
successful absorption biomarker. The aim of this paper is to synthesize quantitative data from the available nutrition
literature. Methods: A systematic literature review was performed in Pubmed, EMBASE and Google Scholar. All
studies (full papers and abstracts) reporting correlation coefficients (CCs) of citrulline plasma levels with absorptive
markers were taken into consideration. A random-effects model was employed to produce a pooled estimate of CCs,
which was the effect size in the current analysis. Fisher's Z transformation of the CCs was needed for the analysis. All
computations were executed with Stata 10.0. Results: We identified 202 studies in our search and only 8 were
eligible for meta-analysis (n = 327). Studies included patients with short bowel syndrome, celiac disease and who had
undergone anti-neoplastic treatment. The pooled CC of citrulline levels with carbohydrates absorption, mainly
quantified by D-xylose test, was 0.326 (95% CI 0.166 -0.507, n = 7, range -0.047 -0.560); with protein absorption the
pooled estimate was 0.293 (95% CI 0.107 -0.460, n = 5, range 0.053 0.480). Publication bias was not present in either
analyses (Egger's test p > 0.05), however Failsafe N was only 28 in the carbohydrate absorption estimate and 7 in
protein absorption estimate. Heterogeneity was also not present in both analyses (Q = 7.23, df =6, p = 0.300; I2 =
17.0%, = 0.09; Q = 6.03, df =4, p = 0.197; I2 = 33.6%, t = 0.13). Conclusion: Although a previous meta-analysis of ours
supports that citrulline is a marker of enterocyte mass, it is not clear whether static measurements of citrulline
reflect absorption. This implies a need for studies examining the absorptive capacity per se of citrulline
measurements with better experimental designs.
Background The current recommendation for patients with cutaneous melanoma and a positive sentinel lymph node
(SLN) biopsy is a complete lymph node dissection (CLND). However, metastatic melanoma is not present in
approximately 80% of CLND specimens. A meta-analysis was performed to identify the clinicopathological variables
most predictive of non-sentinel node (NSN) metastases when the sentinel node is positive in patients with
melanoma. Methods A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents
Connect, Cochrane library, Google scholar, Science Direct, and Web of Science. The search identified 54 relevant
articles reporting the frequency of NSN metastases in melanoma. Original data was abstracted from each study and
used to calculate a pooled odds ratio (OR) and 95% confidence interval (95% CI). Findings The pooled estimates that
were found to be significantly associated with the high likelihood of NSN metastases were: ulceration (OR: 1.88, 95%
CI: 1.53-2.31), satellitosis (OR: 3.25, 95% CI: 1.86-5.66), neurotropism (OR: 2.51, 95% CI: 1.39-4.53), >1 positive SLN
(OR: 1.77, 95% CI: 1.2-2.62), Starz 3 (old) (OR: 1.83, 95% CI: 0.89-3.76), Angiolymphatic invasion (OR: 2.46, 95% CI:
1.34-4.54), extensive location (OR: 2.22, 95% CI: 1.74-2.81), macrometastases >2 mm (OR: 1.95, 95% CI: 1.61-2.35),
extranodal extension (OR: 3.38, 95% CI: 1.79-6.40) and capsular involvement (OR: 3.16, 95% CI: 1.37-7.27). There
were 3 characteristics not associated with NSN metastases: subcapsular location (OR: 0.51, 95% CI: 0.38-0.67),
Rotterdam Criteria <0.1 mm (OR: 0.29, 95% CI: 0.17-0.50) and Starz I (new) (OR: 0.44, 95% CI: 0.22-0.91). Other
variables including gender, Breslow thickness 2-4 mm and extremity as primary site were found to be equivocal.
Interpretation This meta-analysis provides evidence that patients with low SLN tumor burden could probably be
spared the morbidity associated with CLND. We identified 9 factors predictive of non-SLN metastases that should be
recorded and evaluated routinely in SLN databases. However, further studies are needed to confirm the standard
criteria for not performing CLND. 2013 Elsevier Ltd. All rights reserved.
Background: The current recommendation for patients with cutaneous melanoma and a positive sentinel lymph
node (SLN) biopsy is a complete lymph node dissection (CLND). However, metastatic melanoma is not present in
approximately 80% of CLND specimens. A meta-analysis was performed to identify the clinicopathological variables
most predictive of non-sentinel node (NSN) metastases when the sentinel node is positive in patients with
melanoma. Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents
Connect, Cochrane library, Google scholar, Science Direct, and Web of Science. The search identified 52 relevant
articles reporting the frequency of NSN metastases in melanoma. Original data was abstracted from each study and
used to calculate a pooled odds ratio (OR) and 95% confidence interval (95% CI). Results: The pooled estimates that
were found to be significantly associated with the high likelihood of NSN metastases were: ulceration (OR = 1.95,
95% CI: 1.58-2.40), satellitosis (OR = 3.25, 95% CI: 1.86-5.66), neurotropism (OR = 2.49, 95% CI: 1.25-4.97), > 1
positive SLN (OR = 1.77, 95% CI: 1.20-2.62), Starz 3 (old) (OR = 1.94, 95% CI: 0.68-5.58), extensive location (OR = 2.22,
95% CI: 1.74-2.81), macrometastases > 2 mm (OR = 1.95, 95% CI: 1.61-2.35), extranodal extension (OR = 3.8, 95% CI:
1.92-7.52), and capsular involvement (OR = 2.46, 95% CI: 1.34-4.54). There were 3 characteristics not associated with
NSN metastases: subcapsular location (OR = 0.50, 95% CI: 0.38-0.67), Rotterdam Criteria < 0.1 mm (OR = 0.29, 95%
CI: 0.17-0.50), and Starz I (new) (OR = 0.43, 95% CI: 0.19-0.95). Other variables including gender, Breslow thickness 2-
4 mm and extremity as primary site were not associated with NSN metastases. Conclusions: This meta-analysis
provides evidence that patients with low SLN tumour burden could probably be spared the morbidity associated with
CLND. We identified 9 factors predictive of non SLN metastases that should be recorded and evaluated routinely in
SLN databases. However, further studies are needed to confirm the standard criteria for not performing CLND.
Objective We conducted a meta-analysis to examine whether Ginkgo biloba (G. biloba) enhances cognitive function
in healthy individuals. Methods Scopus, Medline, Google Scholar databases and recent qualitative reviews were
searched for studies examining the effects of G. biloba on cognitive function in healthy individuals. We identified
randomised controlled trials containing data on memory (K = 13), executive function (K = 7) and attention (K = 8)
from which effect sizes could be derived. The analyses provided measures of memory, executive function and
attention in 1132, 534 and 910 participants, respectively. Results Effect sizes were non-significant and close to zero
for memory (d = -0.04: 95%CI -0.17 to 0.07), executive function (d = -0.05: 95%CI -0.17 to 0.05) and attention (d = -
0.08: 95%CI -0.21 to 0.02). Meta-regressions showed that effect sizes were not related to participant age, duration of
the trial, daily dose, total dose or sample size. Conclusions We report that G. biloba had no ascertainable positive
effects on a range of targeted cognitive functions in healthy individuals. Copyright 2012 John Wiley & Sons, Ltd.
Copyright 2012 John Wiley & Sons, Ltd.
Introduction Open esophagectomy for cancer is a major oncological procedure, associated with significant morbidity
and mortality. Recently, thoracoscopic procedures have offered a potentially advantageous alternative because of
less operative trauma compared with thoracotomy. The aim of this study was to utilize meta-analysis to compare
outcomes of open esophagectomy with those of minimally invasive esophagectomy (MIE) and hybrid minimally
invasive esophagectomy (HMIE). Methods Literature search was performed using Medline,Embase, Cochrane Library,
and Google Scholar databases for comparative studies assessing different techniques of esophagectomy. A random-
effects model was used for meta-analysis, and heterogeneity was assessed. Primary outcomes of interest were 30-
day mortality and anastomotic leak. Secondary outcomes included operative outcomes,other postoperative
outcomes, and oncological outcomes in terms of lymph nodes retrieved. Results A total of 12 studies were included
in the analysis. Studies included a total of 672 patients for MIE and HMIE, and 612 for open esophagectomy. There
was no significant difference in 30-day mortality; however, MIE had lower blood loss, shorter hospital stay, and
reduced total morbidity and respiratory complications. For all otheroutcomes, there was no significant difference
between the two groups. Conclusion Minimally invasive esophagectomy is a safe alternative to the open technique.
Patients undergoing MIE may benefit from shorter hospital stay, and lower respiratory complications and total
morbidity compared with open esophagectomy. Multicenter, prospective large randomized controlled trials are
required to confirm these findings in order to base practice on sound clinical evidence. Springer Science+Business
Media, LLC 2010.
Background: Nasal packing is routinely used after septoplasty because it is believed to decrease risk of postoperative
bleeding, hematomas, and adhesions. Multiple studies have shown, however, that there are numerous complications
associated with nasal packing. The purpose of this work was to perform a meta-analysis on the existing literature to
evaluate the role of nasal packing after septoplasty. Methods: Two independent reviewers conducted a literature
search using EMBASE, OVID, Medline, PubMed, Google scholar, Cochrane Library, and reference list review from
1966 to August 2010 to identify studies assessing nasal packing after septoplasty. All papers were reviewed for study
design, results, and were assigned an Oxford level of evidence grade, Detsky score, and Methodological Index for
Nonrandomized Studies (MINORS) score. Results: Sixteen papers were identified that met the inclusion criteria.
Eleven papers were randomized control trials, 3 were prospective, and 2 were retrospective studies. Nasal packing
did not show benefit in reducing postoperative bleeding, hematomas, septal perforations, adhesions, or residual
deviated nasal septum. There was, however, an increase in postoperative infections. Two studies using fibrin
products as nasal packing showed a decreased bleeding rate. Conclusion: Nasal packing after septoplasty does not
show any postoperative benefits. Fibrin products show a possibility of decreasing postoperative bleeding. Routine
use of nasal packing after septoplasty is not warranted. This is the first meta-analysis conducted on this topic. 2013
ARS-AAOA, LLC.
Objective: to determine the effects of power training with high movement velocity compared with conventional
resistance training with low movement velocity for older community-dwelling people. Design: systematic review of
randomised controlled trials. Data sources: the Cochrane Central Register of Controlled Trials, PubMed (Medline),
EMBASE, CINAHL, PEDro and Scholar-Google. Trials: all randomised or quasi-randomised trials investigating power
training with high movement velocity versus conventional resistance training with low movement velocity in elderly
persons over the age of 60 years. The primary outcomes were measures of functional outcomes; secondary
outcomes were balance, gait, strength, power, muscle volume and adverse effects. Results: eleven trials were
identified involving 377 subjects. The pooled effect size for the follow-up values of the functional outcomes was 0.32
in favour of the power training (95% CI 0.06 to 0.57) and 0.38 (95% CI -0.51 to 1.28) for the change value. The pooled
effect from three studies for self-reported function was 0.16 in favour of power training (95% CI -0.17 to 0.49).
Conclusion: power training is feasible for elderly persons and has a small advantage over strength training for
functional outcomes. No firm conclusion can be made for safety. The Author 2011. Published by Oxford University
Press on behalf of the British Geriatrics Society. All rights reserved.
AIM: To discuss and demonstrate the use of reflexivity in interpretive phenomenological analysis., BACKGROUND:
Interpretative phenomenological analysis focuses on understanding individual experiences through interpretation. A
double hermeneutic is created as the researcher makes sense of participants' experiences. It is crucial to undergo a
process of reflexivity to provide a credible and plausible explanation of participants' accounts and avoid
assumptions., DATA SOURCES: Research undertaken with six sub-Saharan African healthcare professionals., REVIEW
METHODS: Articles were selected from Cumulative Index to Nursing and Allied Health, Medline and Google Scholar.
Searches were based on relevance and with priority to those dated over the past five years., DISCUSSION: This article
has reviewed pertinent literature and personal examples of reflexivity in research practice to aid nurse researcher
understanding and encourage its use, particularly when employing interpretative methodologies., CONCLUSION:
Reflexivity is an active process that may, at times, be difficult and probing, but which is crucial to becoming self-
aware and thus able to see any influences that could affect data collection or analysis. This process will increase
understanding and allow for a more rigorous approach., IMPLICATIONS FOR PRACTICE: Many practical examples are
offered for using reflexivity. Nurse researchers may choose one or a mixture of the options offered, such as use of
time and space to distance themselves from their research, aspects of practical self-presentation, or a reflexive diary.
Venous thromboembolism (VTE) is one of the most common preventable cause of morbidity and mortality after
trauma. Though most of the western countries have their guidelines for thromboprophylaxis in these patients, India
still does not have these. The increasing detection of VTE among Indian population, lack of awareness,
underestimation of the risk, and fear of bleeding complications after chemical prophylaxis have made deep vein
thrombosis (DVT) a serious problem, hence a standard guideline for thromboprophylaxis after trauma is essential.
The present review article discusses the incidence of DVT and role of thromboprophylaxis in Indian patients who
have sustained major orthopedic trauma. A thorough search of 'PubMed' and 'Google Scholar' revealed 10 studies
regarding venous thromboembolism in Indian patients after major orthopedic trauma surgery (hip or proximal femur
fracture and spine injury). Most of these studies have evaluated venous thromboembolism in patients of arthroplasty
and trauma. The incidence, risk factors, diagnosis and management of VTE in the subgroup of trauma patients (1049
patients) were separately evaluated after segregating them from the arthroplasty patients. Except two studies, which
were based on spinal injury, all other studies recommended screening/ thromboprophylaxis in posttraumatic
conditions in the Indian population. Color Doppler was used as common diagnostic or screening tool in most of the
studies (eight studies, 722 patients). The incidence of VTE among thromboprophylaxis-receiving group was found to
be 8% (10/125), whereas it was much higher (14.49%, 40/276) in patients not receiving any form of prophylaxis.
Indian patients have definite risk of venous thromboembolism after major orthopedic trauma (except spinal injury),
and thromboprophylaxis either by chemical or mechanical methods seems to be justified in them.
Background: In 1999, two teenagers opened fire on their classmates at Columbine High School (USA) and then
committed suicide. Anglo-Saxon literature on school shootings aims at preventing them by determining the common
clinical assessment criteria of shooting threats. In France, the extensive media coverage of various violent acts
creates the impression that school violence is on the rise. Two case reports of threats of serious school violence
made us feel we had to analyze the problem. Method: Firstly, we conducted a literature review in order to identify
common clinical assessment criteria of profile of a school shooter. We searched the Medline database from 1999 to
2009 and selected studies analysing more than five school shootings. We also performed a search of school
shootings that received media coverage through Google and Google Scholar networks, and the Federal Bureau for
Investigations website. Secondly, we compared the identified criteria with those observed in the two case reports.
Results: We found eight retrospective descriptive studies published between 1999 and 2009, which collected more
than five cases of school shootings. Analysis of the grey literature allowed us to identify 17 cases of school shootings
with extensive coverage by the media. The criteria taken into consideration for defining the profile of a school
shooter included acute psychiatric individual factors (e.g.: depression, schizophrenia), personality factors (e.g.:
interests in arms or violence), relational factors (e.g.: difficulty in socializing), community factors (e.g.: past school
bullying experience) and societal factors (e.g.: legislation on arms). On the basis of the two case reports, we debate
the relevance of the proposed criteria and their applicability. Conclusion: The study highlights some criteria that can
be used by school and health professionals in determining menacing individuals who are at risk of behaving violently.
Particular attention has been paid, among other things, to the consequences of school bullying. 2011 Elsevier
Masson SAS.
BACKGROUND: In searches for clinical trials and systematic reviews, it is said that Google Scholar (GS) should never
be used in isolation, but in addition to PubMed, Cochrane, and other trusted sources of information. We therefore
performed a study to assess the coverage of GS specifically for the studies included in systematic reviews and
evaluate if GS was sensitive enough to be used alone for systematic reviews., METHODS: All the original studies
included in 29 systematic reviews published in the Cochrane Database Syst Rev or in the JAMA in 2009 were
gathered in a gold standard database. GS was searched for all these studies one by one to assess the percentage of
studies which could have been identified by searching only GS., RESULTS: All the 738 original studies included in the
gold standard database were retrieved in GS (100%)., CONCLUSION: The coverage of GS for the studies included in
the systematic reviews is 100%. If the authors of the 29 systematic reviews had used only GS, no reference would
have been missed. With some improvement in the research options, to increase its precision, GS could become the
leading bibliographic database in medicine and could be used alone for systematic reviews.
In searches for clinical trials and systematic reviews, it is said that Google Scholar (GS) should never be used in
isolation, but in addition to PubMed, Cochrane, and other trusted sources of information. We therefore performed a
study to assess the coverage of GS specifically for the studies included in systematic reviews and evaluate if GS was
sensitive enough to be used alone for systematic reviews. All the original studies included in 29 systematic reviews
published in the Cochrane Database Syst Rev or in the JAMA in 2009 were gathered in a gold standard database. GS
was searched for all these studies one by one to assess the percentage of studies which could have been identified
by searching only GS. All the 738 original studies included in the gold standard database were retrieved in GS (100%).
The coverage of GS for the studies included in the systematic reviews is 100%. If the authors of the 29 systematic
reviews had used only GS, no reference would have been missed. With some improvement in the research options,
to increase its precision, GS could become the leading bibliographic database in medicine and could be used alone
for systematic reviews.
OBJECTIVE: Growing evidence suggests that patients with bipolar disorder (BD) are impaired in their ability to
process non-verbal emotion, although few comprehensive reviews of the behavioural literature exist, and there has
been little consideration of methodological issues that may account for discrepant empirical findings. This review
examines the behavioural facial, prosodic and multimodal processing literature in BD and discusses methodological
issues in the context of this evidence., METHOD: Major computer databases including Google Scholar and PsychINFO
were consulted to conduct a comprehensive review of quantitative behavioural differences in the emotion-
processing literature in BD. Articles were accepted only if the target population sample met criteria for a DSM-III,
DSM-IV or ICD-10 diagnosis, and they contained a healthy control group., RESULTS: The current literature suggests
that facial emotion processing is impaired, and there is preliminary evidence for some behavioural impairment in the
processing of emotional prosody., CONCLUSION: The specificity or generalisability of impairments in facial emotion
processing and the effects of mood state are unclear. Similarly, the lack of clarity around the impact of auditory
processes on emotional prosody processing warrants a comprehensive examination of the auditory profile in BD.
2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Objective: The concept of the pelviureteric junction has existed for more than a century and yet there is no clear
anatomical definition of this junction. This systematic review addresses the question of whether the human
pelviureteric junction is a discrete anatomical entity. Methods: A systematic literature review was undertaken to
investigate the normal gross and microscopic anatomy of the pelviureteric junction using the electronic databases
MEDLINE, PubMed, Cochrane Library and Google Scholar. Results: In most individuals there is a gradual transition
between the renal pelvis and ureter with no external features indicating the presence of a discrete pelviureteric
'junction'. Internally, however, luminal mucosal folds are prominent in this region. There is no consensus on the
arrangement of muscle fibers at the pelviureteric junction (which may be age-dependent) although some studies
suggest a focal thickening in the muscle wall consistent with physiological observations suggesting a high pressure
zone capable of regulating urine flow. Studies of innervation have shown no evidence of specialization at this site.
Conclusions: There is some evidence that a pelviureteric region can be delineated anatomically and physiologically.
However, although it may be a useful clinical concept, there is no sound anatomical basis for an actual pelviureteric
junction. 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Abstract Asthma prevalence has increased very considerably in recent decades such that it is now one of the
commonest chronic disorders in the world. Recent evidence from epidemiological studies, however, suggests that
the prevalence of asthma may now be declining in many parts of the world, which, if true is important for health
service planning and also because this offers the possibility of generating and testing new aetiological hypotheses.
Our objective was to determine whether the prevalence of asthma is declining worldwide. We undertook a
systematic search of EMBASE, Medline, Web of Science and Google Scholar, for high quality reports of cohort
studies, repeat cross-sectional studies and analyses of routine healthcare datasets to examine international trends in
asthma prevalence in children and adults for the period 1990-2008. There were 48 full reports of studies that
satisfied our inclusion criteria. The large volume of data identified clearly indicate that there are, at present, no
overall signs of a declining trend in asthma prevalence; on the contrary, asthma prevalence is in many parts of the
world still increasing. The reductions in emergency healthcare utilization being reported in some economically
developed countries most probably reflect improvements in quality of care. There remain major gaps in the
literature on asthma trends in relation to Africa and parts of Asia. There is no overall global downward trend in the
prevalence of asthma. Healthcare planners will for the foreseeable future, therefore, need to continue with high
levels of anticipated expenditure in relation to provision of asthma care. 2009 John Wiley & Sons A/S.
Purpose: The aims of this critical review are to firstly, determine the effect of patient selection on the clinical
outcome of APBI, and secondly, to assess the effect of treatment modality selection on the relationship between
patient selection and the clinical outcome of APBI. Materials: The literature search was performed using Pubmed,
Embase, Google Scholar and Science Direct. The reference lists of clinical trials, related articles and European and
American clinical trial registers were also reviewed. The last search was carried out on the 02.12.09. Published
prospective single-arm clinical trials and published randomised clinical trials were eligible for this review. Studies only
reported In abstract form were not included. Studies where APBI was used as a boost following conventional EBRT
are not included. Trials including the use of adjuvant therapies have been included. Reviews, non-English articles and
papers on re-irradiation or metastatic breast cancer are also excluded. Included studies report a median follow up of
at least six months. Selection criteria for patients receiving APBI are the interventions in this study, including patient
age, tumour size, nodal and surgical margin status, histological type and grade. Primary outcomes were tumour
recurrence and toxicity. The secondary outcome examined whether treatment modality selection affects the
relationship between patient selection criteria and the clinical outcome of APBI.The titles and abstracts of all studies
resulting from the search process were reviewed and irrelevant and ineligible studies were eliminated. Data was
extracted using a data collection form regarding the patient selection criteria, outcome and treatment modality used.
Results: No recurrences were observed in studies which required patients to be 45 or older, or in eight of the nine
studies which required participants to have node negative disease. Studies where patients had a tumour measuring
2cm or less in maximum diameter observed a low recurrence rate, as did studies which required negative surgical
margins. No correlation was observed between histologic grade and tumour recurrence. Invasive ductal carcinomas
were the most commonly treated histologic type. There was no correlation between patient selection criteria and
the time to recurrence. Interstitial brachytherapy is the treatment modality for APBI with the longest follow up. It
was difficult to ascertain a relationship between patient selection criteria and the toxicity of APBI. Conclusions: There
does not seem to be a consensus on the correct patient selection for APBI. The risk of IBTR appears lower in patients
who are aged 45 or older, with T1 tumours, node negative disease and negative surgical margins. No correlation was
observed between patient selection criteria and APBI toxicity. Further research is required to assess the outcomes of
the various treatment modalities.
Aim: More recent reports have shown that LCR could be more cost effective when compared to OCS. However, there
has been no comparison of cost effectiveness of LCS between developed and developing countries. The aim of this
study is to explore if there is a difference in cost-effectiveness of laparoscopic colorectal surgery over time between
developed and developing countries. Method: Systematic review of the literature was conducted. Electronic
databases (Pubmed, Science Direct, Google Scholar) were searched from 1991 to 2009. The search terms used where
'laparoscopic colorectal surgery cost economic evaluation'. Results: The comparison of trends shows that cost
savings provided by LCS over time increased in developed countries when compared to developing countries. We
believe that this is due to the reduction of the relatively expensive post operative care that is considerably cheaper in
developing countries. Conclusion: In developing countries operative costs overshadow the cost savings gained by
reduced hospital stay. Therefore, LCS will remain more expensive in developing countries compared OCS until
manufacturers can reduce intra-operative equipment cost. This might put patients in developing countries at
underprivileged position regarding access to LCS.
Objective: To conduct a systematic examination of the relationship between depression and crying by reviewing all
relevant theory and empirical data including the performance of crying items in measures of depression. Method:
Review of the extant literature on depression and crying using PubMed, PsychInfo and Google Scholar databases.
Results: Scores on crying items of depression inventories correlate moderately with overall depression severity.
Otherwise, there is surprisingly little evidence for the widespread claim that depression leads to more frequent
and/or easier crying. There is also little empirical support for the competing claim that severely depressed individuals
lose their capacity to cry. Conclusion: Current claims about the relationship between depression and crying lack a
robust empirical foundation. Assessment instruments and diagnostic systems for mood disorders are inconsistent in
how they handle crying as a symptom. Further work to investigate the causes and the context of crying in depressed
patients is needed. 2007 The Authors.
Objective: To compare the efficacy of blood versus crystalloid cardioplegia for myocardial protection in patients
undergoing cardiac surgery. Methods: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and
reference lists of relevant articles were searched for clinical studies that reported in-hospital outcomes after blood or
crystalloid cardioplegia for myocardial protection during cardiac surgery procedures from 1966 to 2011. The principal
summary measures were risk ratio (RR) for blood compared to crystalloid cardioplegia with 95% Confidence Interval
(CI) and P values (considered statistically significant when <0.05). The RRs were combined across studies using the
DerSimonian-Laird random effects model and fixed effects model using the Mantel-Haenszel model - both models
were weighted. The meta-analysis was completed using the software Comprehensive Meta-Analysis version 2
(Biostat Inc., Englewood, New Jersey). Results: Thirty-six studies (randomized trials) were identified and included a
total of 5576 patients (2834 for blood and 2742 for crystalloid). There was no significant difference between the
blood and crystalloid groups in the risk for death (risk ratio [RR] 0.951, 95% CI 0.598 to 1.514, P=0.828, for both
effect models) or myocardial infarction (RR 0.795, 95% CI 0.547 to 1.118, P=0.164, for both effect models) or low
cardiac output syndrome (RR 0.765, 95% CI 0.580 to 1.142, P=0.094, for the fixed effect model; RR 0.690, 95% CI
0.480 to 1.042, P=0.072, for the random effect model). It was observed that there was no publication bias or
heterogeneity of effects about any outcome. Conclusion: We found evidence that argues against any superiority in
terms of hard outcomes between blood or crystalloid cardioplegia for myocardial protection during cardiac surgery.
2012 The Author(s).
PURPOSE: The purpose of this article was to estimate the proportion of patients with asymptomatic third molars
(M3s) and evidence of disease at baseline and to measure the health risks of retained M3s in the long term.,
MATERIALS AND METHODS: A literature search was conducted using Google Scholar. Search terms included third
molars and periodontitis, pericoronitis, caries, odontogenic cysts or tumors, and infections. To be included in this
review, studies were limited to prospective studies with samples of at least 50 subjects and a follow-up longer than 1
year., RESULTS: Periodontal pathology was associated with asymptomatic M3s. At baseline, 25% of 329
asymptomatic subjects enrolled in studies had at least 1 probing depth (PD) of at least 5 mm in the M3 region, distal
of the second molars, or around the M3s, with at least 1-mm attachment lost in each patient. PDs deeper than 5 mm
were associated with an attachment loss of at least 2 mm in 80 of 82 subjects. The clinical findings of increased
periodontal PDs and periodontal attachment loss coupled with the colonization of periodontal pathogens supported
the concept that clinical and microbial changes associated with the initiation of periodontitis may present first in the
M3 region in young adults. For subjects with a baseline PD of at least 4 mm in the M3 region or baseline "orange and
red" complex periodontal bacteria of at least 10(5), the odds were significantly increased for the progression of
periodontal disease in the M3 region. The visible presence of M3s in young adults was significantly associated with
periodontal inflammatory disease in non-M3s., CONCLUSION: The data suggest that the absence of symptoms
associated with retained M3s does not equal the absence of disease or pathology. The clinical implications of these
findings suggest that patients who elect to retain their M3s should have regular periodic clinical and radiographic
examinations to detect disease before it becomes symptomatic. Copyright 2012 American Association of Oral and
Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
The purpose of this article was to estimate the proportion of patients with asymptomatic third molars (M3s) and
evidence of disease at baseline and to measure the health risks of retained M3s in the long term. A literature search
was conducted using Google Scholar. Search terms included third molars and periodontitis, pericoronitis, caries,
odontogenic cysts or tumors, and infections. To be included in this review, studies were limited to prospective
studies with samples of at least 50 subjects and a follow-up longer than 1 year. Periodontal pathology was associated
with asymptomatic M3s. At baseline, 25% of 329 asymptomatic subjects enrolled in studies had at least 1 probing
depth (PD) of at least 5 mm in the M3 region, distal of the second molars, or around the M3s, with at least 1-mm
attachment lost in each patient. PDs deeper than 5 mm were associated with an attachment loss of at least 2 mm in
80 of 82 subjects. The clinical findings of increased periodontal PDs and periodontal attachment loss coupled with
the colonization of periodontal pathogens supported the concept that clinical and microbial changes associated with
the initiation of periodontitis may present first in the M3 region in young adults. For subjects with a baseline PD of at
least 4 mm in the M3 region or baseline "orange and red" complex periodontal bacteria of at least 105, the odds
were significantly increased for the progression of periodontal disease in the M3 region. The visible presence of M3s
in young adults was significantly associated with periodontal inflammatory disease in non-M3s. The data suggest that
the absence of symptoms associated with retained M3s does not equal the absence of disease or pathology. The
clinical implications of these findings suggest that patients who elect to retain their M3s should have regular periodic
clinical and radiographic examinations to detect disease before it becomes symptomatic. 2012 American Association
of Oral and Maxillofacial Surgeons.
OBJECTIVE: In response to a request for a medicolegal opinion from an orthopaedic technician with pacinian
neuroma of the hand, we conducted a systematic review of reported cases designed to assess whether this rare
disease could be considered to be work-related., METHODS: We used Medline, Embase, Google Scholar, Google, and
a manual search to identify reports of histologically confirmed pacinian neuroma of the hand manifesting after 15
years of age. Cases with available information (from article/authors) on personal history were considered eligible.
We tabulated information on age/gender; localization and histopathologic features; signs/symptoms; history of local
trauma; occupation, sports/hobbies or other physical exposures; right- or left-handedness; and outcome., RESULTS:
We found 44 eligible cases (including the present referral). Of these, 21 (48%) followed a trauma [<6 months from
onset/presentation (N=7); 0.5-2 years from onset (N=6); >= 2 years from onset (N=7); and timing unknown (N=1)]
involving the same anatomic site. Three of these 21 traumas definitely occurred at work, and a further 2 cases
occurred at the site of definite work-related repetitive microtrauma., CONCLUSIONS: The results reinforce the
concept that pacinian neuroma of the hand can follow local trauma or repetitive microtrauma. Implicated traumas
were either recent or remote, and they sometimes occurred while performing manual tasks at work. We concluded
that the referred case could plausibly be considered work-related.
Objective In response to a request for a medicolegal opinion from an orthopaedic technician with pacinian neuroma
of the hand, we conducted a systematic review of reported cases designed to assess whether this rare disease could
be considered to be work-related. Methods We used Medline, Embase, Google Scholar, Google, and a manual search
to identify reports of histologically confirmed pacinian neuroma of the hand manifesting after 15 years of age. Cases
with available information (from article/authors) on personal history were considered eligible. We tabulated
information on age/gender; localization and histopathologic features; signs/symptoms; history of local trauma;
occupation, sports/hobbies or other physical exposures; right- or left-handedness; and outcome. Results We found
44 eligible cases (including the present referral). Of these, 21 (48%) followed a trauma [<6 months from
onset/presentation (N=7); 0.5-2 years from onset (N=6); >=2 years from onset (N=7); and timing unknown (N=1)]
involving the same anatomic site. Three of these 21 traumas definitely occurred at work, and a further 2 cases
occurred at the site of definite work-related repetitive microtrauma. Conclusions The results reinforce the concept
that pacinian neuroma of the hand can follow local trauma or repetitive microtrauma. Implicated traumas were
either recent or remote, and they sometimes occurred while performing manual tasks at work. We concluded that
the referred case could plausibly be considered work-related.
Aim: Factors associated with the survival of truth of clinical conclusions in the medical literature are unknown. We
hypothesized that publications from a first author with a higher h (h = number of publications "h" cited at least h
times in the literature), which quantify an individual's scientific research output, should have longer half-live.
Methods: We used 472 original articles concerning cirrhosis or hepatitis published from 1945 to 1999. with an
identified first author, previously assessed (Annals Internal Medicine 2002). The survival of the main conclusions
have been updated in 2009. h was computed using Google scholar, Scopus, and an home made algorithm (HepaTop)
to reduce false positive/negative rates combining Medline and hand searching. By definition h is highly related to the
authors' age. Truth survival (percentage of studies not being false or obsolete) was assessed by Kaplan Meier method
(stratified by median date of publication) and Cox model including factors (design, journal, methods) associated with
h or conclusions' survival. Results: In 2009, 282 out of 472 conclusions (60%) were still considered true, 91 were
obsolete (19%) and 99 (21 %) false. The half-life of truth was 55 years. The median h of first author was 24 (range 1-
85). Authors with true conclusions had significantly higher h (median h=28) than those with obsolete (h=19; P=0.002)
or false conclusion (h=19; P=0.01). Factors associated with h were publications after 1980 (h=26 vs 14; P<0.0001),
methodological quality (h=36 vs 20; P<0.0001), and therapeutic (h=25) or diagnostic (h = 26) versus cognitive studies
(h = 20; P =0.003). Before 1980, the 50 year survival of conclusions derived from authors with h>24 (n=88) was 62+/-
6% (m+/-SE) vs 65+/-6% in those (n=141) with h<24 (P=0.31). After 1980, the 30 year survival of conclusions derived
from authors with h>24 (n=144) was 50+/-7% vs 29+/-9% for those with h<=24 (n=99; P = 0.13). Using multivariate
analysis, three factors were associated with true conclusions survival (odds ratio; P significance): methodological
quality (3.21; P< 0.0001), negative conclusions (1.43; P=0.008), and h > 24 (1.35; P =0.02). Conclusions: In Hepatology
the scientific output of authors (h-index) is positively associated with the methodological quality and the survival of
their studies' conclusions.
During periods of extreme heat individuals with diabetes have greater rates of heat-related morbidity and mortality
compared to their non-diabetic counterparts. The reason for this discrepancy is currently unknown. Furthermore,
there is a lack of information about whether or not individuals with type 1 diabetes are at a thermoregulatory
disadvantage during strenuous physical activity especially when performed in the heat. Purpose: This review
discusses the current literature pertaining to thermoregulatory responses in individuals with type 1 diabetes.
Methods: We included 14 reviews and 95 original research articles identified by searches of PubMed and Google
Scholar and deemed relevant to our subject by three independent readers. Results: Individuals with poorly controlled
type 1 diabetes may have impaired heat sensation, and a reduced capacity to dissipate heat due to lower skin blood
flow and sweating responses and a greater tendency towards dehydration compared to individuals without diabetes.
Impairments may be attenuated or absent in those with good blood glucose control. We found no published studies
examining thermoregulatory responses to physical activity in the heat in individuals with type 1 diabetes.
Conclusions: Type 1 diabetes may cause impairments in heat loss resulting in a greater level of thermal strain.
Advancement in our understanding about the effects of type 1 diabetes on the heat stress response, especially
during different challenges to human heat balance associated with changes in both environmental heat load and
metabolic heat production (physical activity), will help us to determine where the risk of heat-illness/injury actually
exists. 2013 Bentham Science Publishers.
TOPIC: Concept analysis of isolation., PURPOSE: This article uses Walker and Avant's methodological approach in
distinguishing the concept of isolation between the normal, ordinary language usage and the scientific usage of the
concept., BACKGROUND: The importance of social contact has long been recognized as a fundamental need for
humans. The concept of isolation is used throughout the lay and scientific literature and has a primarily negative
connotation for humans. The experience is sometimes severe enough to result in serious reductions in adaptation
and performance., DATA SOURCES: The Medline, CINAHL, and Google Scholar databases were searched using the key
terms of concept analysis, human, and isolation with no restriction on the year of publication. English language
reports were used exclusively., CONCLUSION: Three attributes were identified: sensory deprivation, social isolation,
and confinement. Antecedents included individual perception and situational dimensions. Consequences included
anxiety, depression, mood disturbances, anger, loneliness, and adverse health events. Through this concept analysis,
isolation has been theoretically defined as a state in which an individual experiences a reduction in the level of
normal sensory and social input with possible involuntary limitations on physical space or movement. Systematic
studies of isolation using this concept can ultimately enhance nurses' knowledge base and contribute to the quality
of life for isolated persons. 2013 Wiley Periodicals, Inc.
Mortenson WB, Miller WC, Auger C. Issues for the selection of wheelchair-specific activity and participation outcome
measures: a review. Objectives: To use the World Health Organization's International Classification of Functioning,
Disability and Health as a framework to identify and to evaluate wheelchair-specific outcome instruments that are
useful for measuring activity and participation. Data Sources: CINHAL, PsychInfo, EMBASE, Google Scholar,
Dissertation Abstracts Medline databases, and conference proceedings. Study Selection: Activity and participation
measures that were specifically intended for adults who use wheelchairs and that were published in English in a peer-
reviewed journal were included in this review. Based on electronic database searches using a variety of search terms,
articles were identified by title, and appropriate abstracts were retrieved. Articles were obtained for all relevant
abstracts. For peer-reviewed measures included in the review, we obtained any instruction manuals and related
publications, frequently published in conference proceedings and theses or available electronically, on the
development and testing of the measure. Data Extraction: Tools included in the review were evaluated based on
their conceptual coverage, reliability, validity, responsiveness, usefulness, and wheelchair contribution, which
indicated how well the tool isolated the effect of the wheelchair on activity and participation outcomes. Data
Synthesis: A number of conceptual, psychometric, and applicability issues were identified with the 11 wheelchair-
specific measures included in the review. A majority of the measures were mobility focused. No single tool received
excellent ratings in all areas of the review. Some of the most frequent issues identified included a failure to account
for differences attributable to different wheelchairs and wheelchair seating, limited psychometric testing, and high
administrative and respondent burden. Conclusions: Good reliability evidence was reported for most of the
measures, but validity information was only available for 6 of the 11 measures, and responsiveness information for 3.
This review suggests that these measures could be improved with further psychometric testing and with some
modification to ensure that the contribution of the wheelchair to activity and participation outcomes is clearly
identified. 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and
Rehabilitation.
OBJECTIVES: To report clinical burden of Japanese encephalitis (JE) in Asia and cost-effectiveness of JE vaccination
program. METHODS: Systematic literature searches were conducted using Embase, MEDLINE, WHO, and Google
scholar platforms to identify relevant studies in patients with JE. Eligibility of trials was assessed by two reviewers
with any discrepancy reconciled by a third, independent reviewer. RESULTS: A total of 10 studies out of 41 retrieved,
met the inclusion criteria for the clinical review. Approximately 35,000-50,000 JE cases and 10,000- 15,000 deaths
due to JE were reported every year in Asia. Incidence of JE was high in China and India, with China accounting for
50% of the JE cases reported worldwide. The incidence of JE in China was reported to be 0.01-1.53
residents/year/100,000. The number of JE cases reported in China, India, Nepal, Sri Lanka, and Bangladesh were
5,000-10,000, 1,500-4,000, 1,000-3,000, 100-200, and 56, respectively. JE caused 12,038 and 2,496 deaths in
Southeast Asia and Western Pacific, respectively (2008). JE was associated with 491,797 disability-adjusted life years
(DALYs) in the Southeast Asia and 185,573 DALYs in the Western Pacific region (2004). Four studies out of 59
retrieved, met the eligibility criteria for evaluating cost-effectiveness of JE vaccination. JE vaccination prevented 117
cases and 12 deaths (Vietnam), 103 cases and 18 deaths (Thailand), 420 cases and 105 deaths (China), and 175-316
cases and 36-65 deaths (India). Total savings in the direct medical costs witnessed as a consequence of JE vaccination
were $51,122 (Vietnam), $58,776 (Thailand), $614,762 (China), and $178,558-$319,627 (India). CONCLUSIONS: JE
has lead to significant morbidity in survivors and mortality in Asian countries. Existing evidence from cost-
effectiveness studies demonstrated that vaccination program markedly reduced the burden of JE in Asia.
Juvenile mental health courts for adjudicated youth. To describe the role of psychiatric nurses in reducing mental
health disparities for adjudicated youth via juvenile mental health courts. ISI Web of Knowledge; Sage Journals
Online; HighWire; PubMed; Google Scholar and Wiley Online Library and websites for psychiatric nursing
organizations. Years included: 2000-2010. Juvenile mental health courts may provide a positive and effective
alternative to incarceration for youth with mental health problems with psychiatric nurses playing a key role in
program implementation. 2011 Wiley Periodicals, Inc.
Kangaroo mother care (KMC), originally defined as skin-to-skin contact between a mother and her newborn,
frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an
alternative to conventional neonatal care for low birthweight (LBW) infants. To determine whether there is evidence
to support the use of KMC in LBW infants as an alternative to conventional neonatal care. The standard search
strategy of the Cochrane Neonatal Group was used. This included searches of MEDLINE, EMBASE, LILACS, POPLINE,
CINAHL databases (from inception to January 31, 2011), and the Cochrane Central Register of Controlled Trials (The
Cochrane Library, Issue 1, 2011). In addition, we searched the web page of the Kangaroo Foundation, conference and
symposia proceedings on KMC, and Google scholar. Randomized controlled trials comparing KMC versus
conventional neonatal care, or early onset KMC (starting within 24 hours after birth) versus late onset KMC (starting
after 24 hours after birth) in LBW infants. Data collection and analysis were performed according to the methods of
the Cochrane Neonatal Review Group. Sixteen studies, including 2518 infants, fulfilled inclusion criteria. Fourteen
studies evaluated KMC in LBW infants after stabilization, one evaluated KMC in LBW infants before stabilization, and
one compared early onset KMC with late onset KMC in relatively stable LBW infants. Eleven studies evaluated
intermittent KMC and five evaluated continuous KMC. At discharge or 40 - 41 weeks' postmenstrual age, KMC was
associated with a reduction in the risk of mortality (typical risk ratio (RR) 0.60, 95% confidence interval (CI) 0.39 to
0.93; seven trials, 1614 infants), nosocomial infection/sepsis (typical RR 0.42, 95% CI 0.24 to 0.73), hypothermia
(typical RR 0.23, 95% CI 0.10 to 0.55), and length of hospital stay (typical mean difference 2.4 days, 95% CI 0.7 to
4.1). At latest follow up, KMC was associated with a decreased risk of mortality (typical RR 0.68, 95% CI 0.48 to 0.96;
nine trials, 1952 infants) and severe infection/sepsis (typical RR 0.57, 95% CI 0.40 to 0.80). Moreover, KMC was
found to increase some measures of infant growth, breastfeeding, and mother-infant attachment. The evidence from
this updated review supports the use of KMC in LBW infants as an alternative to conventional neonatal care mainly in
resource-limited settings. Further information is required concerning effectiveness and safety of early onset
continuous KMC in unstabilized LBW infants, long term neurodevelopmental outcomes, and costs of care.
Aim. This paper presents a discussion of the use of structuration theory to facilitate understanding and improvement
of safety culture in healthcare organizations. Background. Patient safety in healthcare organizations is an important
problem worldwide. Safety culture has been proposed as a means to keep patients safe. However, lack of
appropriate theory limits understanding and improvement of safety culture. Data sources. The proposed
structuration theory of safety culture was based on a critique of available English-language literature, resulting in
literature published from 1983 to mid-2009. CINAHL, Communication and Mass Media Complete, ABI/Inform and
Google Scholar databases were searched using the following terms: nursing, safety, organizational culture and safety
culture. Discussion. When viewed through the lens of structuration theory, safety culture is a system involving both
individual actions and organizational structures. Healthcare organization members, particularly nurses, share these
values through communication and enact them in practice, (re)producing an organizational safety culture system
that reciprocally constrains and enables the actions of the members in terms of patient safety. This structurational
viewpoint illuminates multiple opportunities for safety culture improvement. Implications for nursing. Nurse leaders
should be cognizant of competing value-based culture systems in the organization and attend to nursing agency and
all forms of communication when attempting to create or strengthen a safety culture. Conclusion. Applying
structuration theory to the concept of safety culture reveals a dynamic system of individual action and organizational
structure constraining and enabling safety practice. Nurses are central to the (re)production of this safety culture
system. 2011 Blackwell Publishing Ltd.
Objective: To review the evidence for the use of ketamine in adult emergency medicine for procedural sedation and
analgesia (PSA) and rapid sequence intubation (RSI), as well as to focus on the issues of recovery agitation,
combination with propofol for PSA, and the use of ketamine as an induction agent in patients with acute head injury
in need of definitive airway management. Data Sources: PubMed (1949-July 2011), EMBASE (1980-July 2011), Google
Scholar (to July 2011), International Pharmaceutical Abstracts (1964-July 2011), and Cochrane databases were
searched independently. A manual search of references was also performed. STUDY SELECTION: English-language,
full reports of experimental and observational studies evaluating ketamine in adults undergoing PSA and RSI in the
emergency department (ED) were included if they reported efficacy or safety outcomes. Data Extraction: Two
reviewers independently assessed each article for inclusion, data extraction, and study limitations. Data Synthesis:
Six studies that used ketamine for PSA were included. The majority reported adequate sedation with high patient
satisfaction and lack of pain and procedural recall. There is no evidence to support the superiority of a combination
of ketamine and propofol compared to propofol alone for PSA in adults. Recovery agitation is common but can be
minimized with premedication with midazolam (number needed to treat 6). Two studies were identified that
evaluated the role of ketamine for induction during RSI in the ED. Although ketamine is not a first-line agent for RSI,
it is an alternative and may be used as an induction agent in patients requiring endotracheal intubation. Conclusions:
Ketamine is an effective agent in adults undergoing PSA and RSI in the ED. The best available evidence provides
sufficient confidence to consider use of this agent in the ED.
Ketamine consumption in on the increase as a recreational abuse substance. It is reported to cause lower urinary
tract symptoms (LUTS), and published accounts of its deleterious effects are increasing. We reviewed the available
literature regarding the urological impact of ketamine abuse and its management. Twenty-two publications were
found in total after a search of all databases including Pubmed, Medline and Google Scholar using the words
'ketamine', 'bladder' and 'cystitis' with no limits imposed. There are approximately 110 cases reported in the
literature in the form of case series, case reports and letters. The effect of ketamine abuse on the bladder is
universally similar; however, there is no uniform method adopted in reporting the symptoms, diagnosis and
management. Very little is known regarding the pathogenesis of its effects on the urinary tract. Patients with severe
irritative LUTS, a positive history of ketamine abuse and the absence of any other aetiology should be considered to
have ketamine-induced vesicopathy. Effort must be made to elicit the history of drug abuse in those with no found
cause of LUTS, especially in the young. Presently, ketamine cessation is the only effective treatment modality to
prevent deterioration of the renal function and indeed offer the possibility of symptom resolution. Management akin
to that formulated for interstitial cystitis patients would appear to offer the greatest opportunity for effective
treatment. 2010 Blackwell Publishing Ltd.
Introduction and Objective: Approximately 20%-30% of ketamine abusers suffer from lower urinary tract symptoms.
To increase the awareness among the urologists we present a case report about ketamine induced vesico-pathy (KIV)
and reviewed the available literature regarding KIV and its management. Materials and Methods: A 38-year-old man
initially presented with frequency urgency and dysuria. He only admitted to chronic ketamine use (5 years) after his
symptoms became miserable. Among multiple admissions only one urine sample showed growth of coliforms.
Ultrasound scan showed left hydronephrosis and thickened bladder wall. Cystoscopy showed diffusely inflamed
bladder with a 50 milliliters capacity. Biopsy was nonspecific. His symptoms became intractable and were resistant to
anticholinergics. Finally a supravesical diversion was performed to ease his symptoms. A close follow up is kept on
the upper tract of this non-compliant patient. Extensive literature search in Pubmed, Medline and Google Scholar
using the key words "ketamine". 'bladder" and "cystitis" was done. Results: About 22 publications involving 111
patients were found. KIV does not exhibit any gender bias. The symptoms of KIV include a range of irritative
symptoms (onset of symptoms ranged from days to years following abuse), while haematuria is seen with ulcerative
cystitis (severity a abuse). Symptom scoring, Frequency Volume charts and Urodynamic studies are useful to
document the symptom severity, bladder compliance and capacity issues. Radiology showed hydronephrosis in 56%
of cases in addition demonstrating thickened bladder wall with reduced capacity. Cystoscopy performed in 74%
showed inflammation in addition to small capacity bladder with many unable to tolerate the procedure. Biopsy
performed in 26% showed ulceration, inflammatory cell infiltrate and varying degrees of fibrosis. Advice regarding
ketamine cessation along with or without intravesical hyaluron or pentosan has been tried with variable
symptomatic relief in about 50% patients. Intractable cases needed urinary diversions (2 cases) or augmentation
procedures (2 cases). Conclusions: KIV reporting is on the rise. Complying with cessation of use seems to be the only
common working advice. Ketamine abuse must be kept in mind in young severe idiopathic cystitis patients.
Objective: This review aims to highlight the key components and procedures pertaining to the development and
implementation of anticoagulation clinic through education and training. Method: Two reviewers independently
searched the MEDLINE, EMBASE and Google Scholar databases using relevant terms. Data extracted included
information regarding anticoagulation clinic setting and implementation, anticoagulation therapy management,
pharmacy education, training, competences teaching, healthcare professional teaching and training, study design,
content source, time and personnel involved educational strategy, and measures of knowledge and pharmacist's
competencies. Results: A total of 84 articles were ultimately used for data extraction. Fifty-two articles adequately
described features of the anticoagulation therapy management. While some papers emphasized the impact of the
pharmacist-managed anticoagulation clinic, others highlighted the competencies of the clinical pharmacist,
healthcare professionals teaching and training programs and offered information about the importance of
anticoagulation educational certification. Conclusion: Anticoagulation therapy, although potentially life-saving, has
inherent risks. Establishing special clinical pharmacist competencies is important to achieve effective anticoagulation
therapy outcomes. The clinical competencies are maintained and further developed through practice, continued
professional development and formalised education and training. This review addresses important issues for the
establishment of an anticoagulation clinic. It highlights the key components to consider before developing a high
quality standard anticoagulation clinic from a pharmacy teaching and training approach. 2013 FIP.
Potentials of data mining is not sufficiently utilised in food microbiological practice. Publicly accessible sources can
give first impression on trends and patterns that may coincide with intuition but may sometimes provide
unforeseeable conclusions. The results can be, of course, biased, depending on the source of the data, the objective
of the study and the resolution of the database. However, knowing the bias can also give means to correct it.
Network science methods are useful where many data are available and those are systematically formatted, so that
automated programs can browse them. The data can be summarised in tables, diagrams, networks. Network science
methods are especially suitable to reveal patterns and trends behind links and relations shown by the data. Here
examples are shown for simple web-based methods how to draw conclusions on the research interest and available
data on the interactions between food-borne bacteria and moulds, as well as the food harbouring them. The global
research interest is also demonstrated, and the nature of available data based on Google Scholar search as well as on
a specific database on the microbial responses to food environments (ComBase). Data mining can be utilized in any
organization that needs to find patterns or relationship in their data. Results of data mining: forecasting what may
happen in the future; clustering things into groups based on their attributes; associating what events are likely to
occur together.
Introduction: Modern lung cancer care involves a multidisciplinary team (MDT). A challenge for these clinicians is
how to keep up to date with the emerging literature base and how to efficiently search for evidence to solve a
clinical problem. This project seeks to identify optimal way(s) to ask relevant clinical questions of the publicly
available medical literature. Hypothesis A structured framework can be developed to effectively formulate clinical
queries for interrogating literature silos such as PubMed. Aim: To formulate a PICO (population, intervention,
comparator, outcome) template using National Library of Medicine (NLM) resources and test the validity of this
framework with real-life examples from the TPCH lung cancer MDT. Methods: With a medical librarian, we (a)
developed a simple PICO based clinical search strategy and framework, and (b) evaluated common front-end
interfaces available for interrogating PubMed/MEDLINE with this template. Then we modeled three questions in this
tailored PICO structure and undertook pilot testing of the public databases. Results: A PICO framework was
developed that enabled the asking of clinical lung cancer queries. A systematic evaluation of Ovid, Google Scholar,
HubMed, PubMed and the NLM PICO front ends was undertaken by: (a) theoretical comparison using pre-defined
criteria and (b) PICO model testing using three standardised clinical questions. Front end/ database combinations
were judged and ranked for utility in descending order, as follows: PubMed, HubMed, Ovid, NLM PICO and Google
Scholar. Key facets that determined the final results were features of universal access, search strategy modification,
personalized searching and storage and automatic linking to MeSH terms. Conclusions: The PICO format facilitates
clinical query database searching. In our hands, PICO based searching is most easily and effectively undertaken with
the updated version of PubMed, and this finding is planned for prospective validation with the TPCH lung cancer
MDT.
Introduction: Acute inguinal hernias are a common presentation as surgical emergencies, which have been routinely
managed with open surgery. In recent years, the laparoscopic approach has been described by several authors but
has been controversial amongst surgeons. We describe the laparoscopic approach to incarcerated/strangulated
inguinal hernias based on a review of the literature with regards to its feasibility in laparoscopically managing the
acute hernia presentation. Methods: A systematic literature search was carried out including Medline with PubMed
as the search engine, and Ovid, Embase, Cochrane Collaboration, and Google Scholar databases to identify articles
reporting on laparoscopic treatment, reduction, and repair of incarcerated or strangulated inguinal hernias from
1989 to 2008. Results: Forty-three articles were found, and 7 were included according to the inclusion criteria set.
Articles reporting on the use of laparoscopy for the evaluation of the hernia but not reducing and repairing it, the use
of the open technique, elective hernia repairs, pediatric series, review articles, and other kinds of hernias were
excluded after title and abstract review. This resulted in 16 articles that were reviewed in full. Of these 16 articles, 7
reported on the use of the laparoscopic approach exclusively. From these 7 studies, there were 328 cases reported, 6
conversions, average operating time of 61.3 minutes (SD+/-12.3), average hospital stay of 3.8 days (SD+/-.2), 34
complications (25 of which were reported as minor), and 17 bowel resections performed either laparoscopically or
through a minilaparotomy incision guided laparoscopically. Conclusion: The laparoscopic repair is a feasible
procedure with acceptable results; however, its efficacy needs to be studied further, ideally with larger multicenter
randomized controlled trials. 2009 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. Published by the
Society of Laparoendoscopic Surgeons, Inc.
Introduction: The benefits of laparoscopic surgery are well recognised. Initially there was resistance to performing
liver resections laparoscopically, due to concerns regarding difficult mobilisation, risks of major haemorrhage and
dissemination of tumour. Despite these concerns, many units are now performing laparoscopic liver resection. This
study aimed to review the clinical benefits and cost effectiveness of liver resection in colorectal metastases (CRLM),
comparing open with laparoscopic technique. Methods: A literature search was carried out using the following
databases - Pubmed, Athens, Medline and Google scholar search engine. The following key words were used - cost
effectiveness, liver or hepatic resection, laparoscopic, colorectal cancer, colorectal liver metastases - singly or in
combination. In order to ensure an up-to-date literature search, it was restricted to 2000-2009. To maximise this
search, backward chaining of reference lists from retrieved papers was also undertaken. The search was limited to
English language, but no restriction according to the type of study. A total of 34 papers were identified, with 15
papers excluded and 19 papers reviewed. Results: Level 2 evidence supports laparoscopic liver resection in large
volume centres. There was reduced operative time, analgesic requirements and blood loss, and a shorter hospital
stay, with no increased morbidity or mortality. Laparoscopic CRLM resection margins are similar to open surgery,
with no port site or intra-abdominal seedlings. Studies with 5-year follow-up showed no difference between the 2
techniques. Laparoscopic liver resection is cost effective. Capital investment in specialised equipment is offset in
reduced hospital bed days, thus gaining life-years. Evidence strongly supports laparoscopic liver resection improving
survival, with a learning curve highlighting the need for adequate training and exposure to this technique.
Conclusion: Literature suggested laparoscopic liver resection is safe, feasible, oncologically effective and cost
effective in certain circumstances. This is especially the case for wedge resections or segmentectomies, with limited
data supporting the use of laparoscopic surgery for major resections. Prior to a laparoscopic approach becoming gold
standard for liver resection, larger prospective randomized studies with long-term follow-up are required to validate
this technique.
Purpose: Spigelian hernias are rare, and their treatment has traditionally been by open surgery. Laparoscopic
management is however, becoming more popular. The aim of our review is to examine the existing evidence
regarding the safety and effectiveness of the laparoscopic approach to the management of spigelian hernias.
Methods: A systematic literature search was carried out including Medline with PubMed as the search engine, and
Ovid, Embase, Cochrane Collaboration, and Google Scholar databases to identify articles in English language
reporting on laparoscopic management of spigelian hernias. Results: Thirty-three articles were found, with a total
number of 84 successfully managed cases, reported from 1992 to 2009. No recurrences (0%) and minimal morbidity
(2.3%) are reported. Furthermore, the reported hospital stay of patients was remarkably short. Conclusions: Current
data suggest that the laparoscopic approach to the management of spigelian hernias is safe and effective, both in the
elective and emergency setting. 2011 by Lippincott Williams & Wilkins.
What's known on the subject? and What does the study add? The literature yielded only four studies on the subject;
however, no clear outcome can be taken from individual studies. This review adds a meta-analysis of these four
studies to make the patient cohort larger and to allow for a greater understanding of the procedure in this select
group of patients. To compare the safety and efficacy of laparoscopic partial nephrectomy (LPN) in obese and non-
obese patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to
November 2011), EMBASE (1980 to November 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of
articles and abstracts from conference proceedings without language restriction for studies comparing LPN in obese
and non-obese patients. Four observational cohort studies were included for 256 obese patients compared with 403
non-obese patients who underwent LPN. There was no difference in operative duration (mean difference [MD] 5.64,
95% confidence interval [CI]-3.80 to 15.09), warm ischaemic time (MD -1.04, 95% CI -2.68 to 0.59), estimated blood
loss (MD 53.73, 95% CI 0.72-106.74) or hospital stay (MD -0.04, 95% CI -0.30 to 0.22). There was no difference in
complications in total (odds ratio [OR] 1.02, 95% CI 0.70-1.49), intraoperative complications (OR 0.68, 95% CI 0.30-
1.53), or postoperative complications (OR 1.15, 95% CI 0.75-1.77). The obese group had significantly more Clavien
grade III complications (OR 3.95, 95% CI 1.36-11.42), despite the low absolute incidence, with 4.3% (11/256) in the
obese group vs 1.5% (6/403) in the non-obese group. Experienced laparoscopic surgeons can safely and efficiently
perform PN for obese patients with comparable results to those of non-obese patients. The likelihood of major
(Clavien Classification >= III) complications is higher for the obese patient. 2012 the authors. BJU International.
What's known on the subject? and What does the study add? The literature yielded only four studies on the subject;
however, no clear outcome can be taken from individual studies. This review adds a meta-analysis of these four
studies to make the patient cohort larger and to allow for a greater understanding of the procedure in this select
group of patients. * To compare the safety and efficacy of laparoscopic partial nephrectomy (LPN) in obese and non-
obese patients. * We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to
November 2011), EMBASE (1980 to November 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of
articles and abstracts from conference proceedings without language restriction for studies comparing LPN in obese
and non-obese patients. * Four observational cohort studies were included for 256 obese patients compared with
403 non-obese patients who underwent LPN. * There was no difference in operative duration (mean difference [MD]
5.64, 95% confidence interval [CI]-3.80 to 15.09), warm ischaemic time (MD -1.04, 95% CI -2.68 to 0.59), estimated
blood loss (MD 53.73, 95% CI 0.72-106.74) or hospital stay (MD -0.04, 95% CI -0.30 to 0.22). * There was no
difference in complications in total (odds ratio [OR] 1.02, 95% CI 0.70-1.49), intraoperative complications (OR 0.68,
95% CI 0.30-1.53), or postoperative complications (OR 1.15, 95% CI 0.75-1.77). * The obese group had significantly
more Clavien grade III complications (OR 3.95, 95% CI 1.36-11.42), despite the low absolute incidence, with 4.3%
(11/256) in the obese group vs 1.5% (6/403) in the non-obese group. * Experienced laparoscopic surgeons can safely
and efficiently perform PN for obese patients with comparable results to those of non-obese patients. * The
likelihood of major (Clavien Classification >= III) complications is higher for the obese patient. 2012 THE AUTHORS.
BJU INTERNATIONAL 2012 BJU INTERNATIONAL.
Aim: This systematic review aimed to evaluate the efficacy, morbidity and mortality of laparoscopic peritoneal lavage
for patients with perforated diverticulitis. Method: We searched PubMed, EMBASE, Web of Science, the Cochrane
Library and CINAHL databases, Google Scholar and five major publisher websites without language restriction. All
articles which reported the use of laparoscopic peritoneal lavage for patients with perforated diverticulitis were
included. Results: Two prospective cohort studies, nine retrospective case series and two case reports reporting 231
patients were selected for data extraction. Most (77%) patients had purulent peritonitis (Hinchey III). Laparoscopic
peritoneal lavage successfully controlled abdominal and systemic sepsis in 95.7% of patients. Mortality was 1.7%,
morbidity 10.4% and only four (1.7%) of the 231 patients received a colostomy. Conclusion: There have been no
publications of high methodological quality on laparoscopic peritoneal lavage for patients with perforated colonic
diverticulitis. The published papers do, however, show promising results, with high efficacy, low mortality, low
morbidity and a minimal need for a colostomy. 2010 The Authors. Journal Compilation 2010 The Association of
Coloproctology of Great Britain and Ireland.
Aim Currently in the UK the standard surgical practice for the management of perforated sigmoid diverticulitis is a
Hartmann's procedure. There have been a number of recent publications on the use of laparoscopic peritoneal
lavage for perforated sigmoid diverticulitis, as an alternative to the emergency Hartmann's procedure, with its
associated morbidity and mortality. We aim to review the current literature on this topic. Method A search was
made on the electronic database MEDLINE from PubMed, EMBASE and the Cochrane library. The keywords
'diverticulitis', 'perforated' and 'laparoscopy' were searched for in the titles and abstracts without language
restrictions. Further studies were identified from searches on Google Scholar, as well as manual searches through
reference lists of the relevant studies found. All included studies were quality assessed. Results Twelve relevant
studies were included. A total of 301 patients were reported, with a mean age of 57 years. All were non-randomized
studies. The majority of patients were of Hinchey classification III. All were treated with intravenous antibiotics
followed by laparoscopic lavage and insertion of intra-abdominal/pelvic drains. The mean conversion rate was 4.9%
and mean length of hospital stay was 9.3days. The mean complication rate was 18.9% and the overall mortality rate
was 0.25%. Subsequent elective resections with primary anastamosis were performed in 51% of patients and the
majority were completed laparoscopically. Conclusion Laparoscopic peritoneal lavage for perforated sigmoid
diverticulitis appears to be a potentially effective and more conservative alternative to a Hartmann's procedure.
Randomized control trials are needed to better evaluate its role. 2011 The Authors. Colorectal Disease 2011 The
Association of Coloproctology of Great Britain and Ireland.
Background: Laparoscopic antireflux surgery is an accepted treatment for persistent gastroesophageal reflux but
about 4% of patients will eventually require revision surgery. Methods: We searched The Cochrane Collaboration,
Medline, and EMBASE databases, augmented by Google Scholar and PubMed related articles from January 1, 1990,
to November 22, 2010. Twenty studies met the inclusion criteria, reporting on 930 surgeries. Results: The mean
surgical duration was 166 minutes and conversion to open revision fundoplication was required in 7% of cases.
Complications were reported in 14% of cases and the mean length of stay varied between 1.2 and 6 days. A good to
excellent result was reported for 84% of surgeries and 5% of patients required a further revisional procedure.
Conclusions: Laparoscopic revision antireflux surgery appears to be feasible and safe, but subject to somewhat
greater risk of conversion, higher morbidity, longer hospital stay, and poorer outcomes than primary laparoscopic
fundoplication. 2011 Elsevier Inc.
Laryngeal mask airway (LMA) administration is one way of delivering surfactant to the infant lung, with the potential
benefit of avoiding endotracheal intubation and ventilation, ventilator induced lung injury and bronchopulmonary
dysplasia (BPD). To determine the effect of LMA surfactant administration either as prophylaxis or treatment
compared to placebo, no treatment, or intratracheal surfactant administration on morbidity and mortality in preterm
infants with, or at risk of, respiratory distress syndrome (RDS). We searched CENTRAL (The Cochrane Library, October
2010), MEDLINE and PREMEDLINE (1950 to October 2010), EMBASE (1980 to October 2010) and CINAHL (1982 to
October 2010). We also searched proceedings of scientific meetings, clinical trial registries, Google Scholar and
reference lists of identified studies, as well as contacting expert informants and surfactant manufacturers.
Randomised, cluster-randomised or quasi-randomised controlled trials of laryngeal mask surfactant administration
compared to placebo, no treatment, or other routes of administration (nebulised, pharyngeal instillation of
surfactant before the first breath, thin endotracheal catheter surfactant administration or intratracheal surfactant
instillation) on morbidity and mortality in preterm infants at risk of RDS. We considered published, unpublished and
ongoing trials. Two review authors independently assessed studies for eligibility and quality, and extracted data. We
found no studies of prophylactic or early LMA surfactant administration. A single small study of late rescue LMA
surfactant was identified as eligible for inclusion. The study enrolled 26 preterm infants born >= 1200 g with RDS on
continuous positive airway pressure (nCPAP). LMA surfactant administration compared to no treatment resulted in a
reduction in mean FiO(2) required to maintain oxygen saturation between 88% and 92% for 12 hours after the
intervention. No significant difference was reported in subsequent mechanical ventilation and endotracheal
surfactant, pneumothorax, days on intermittent positive airway pressure (IPPV), and days on IPPV or oxygen. There is
evidence from a single small trial that LMA surfactant administration in preterm infants >= 1200 g with established
RDS may have a short term effect in reducing oxygen requirements although the study is underpowered to detect
important clinical effects. Adequately powered trials are required to determine the effect of LMA surfactant
administration for prevention or treatment of RDS in preterm infants. LMA surfactant administration should be
limited to clinical trials.
Objective: Laryngomalacia is widely described as having an association with acid reflux. Many otolaryngologists
therefore employ empiric treatment with anti-reflux medication in this setting. This study aims to identify and
appraise the evidence for this association, and to explore the potential role for treatment of reflux in the
management of laryngomalacia. Method: A predefined protocol was employed to search Medline, EMBASE, the
Cochrane Library, and Google Scholar. Included studies were those that explored the potential for an association
between laryngomalacia and gastro-esophageal and/or laryngopharyngeal reflux. The Oxford Centre for Evidence
Based Medicine (CEBM) guidelines were applied to assess study quality of evidence. Results: A total of 26 studies,
representing 1295 neonates with laryngomalacia, were included. Study quality varied from CEBM 2a (n = 3 to 4 (n =
20). No randomized controlled trials were identified. While reflux definitions were diverse, overall reflux prevalence
in this group was 59%. Evidence supporting an association between reflux and laryngomalacia included: the near
ubiquity of acid reflux in dual-probe pH monitoring in children with laryngomalacia (3 studies); case series and
reports of laryngomalacia improvement with anti-reflux therapy (5 studies); histologic evidence of reflux-related
laryngeal inflammation in children with laryngomalacia (2 studies); and implication of reflux as a cofactor in
laryngomalacia symptom severity (12 studies). Conclusion: The literature shows a co-existence between acid reflux
and laryngomalacia, but the evidence for causal association is limited. In view of the widespread use of anti-reflux
treatment in laryngomalacia, an RCT of anti-reflux medication vs placebo appears well-justified. This review provides
a rational foundation for such an endeavor.
Background: Anticancer drugs directed at single specific molecular targets tend to induce transitory responses,
followed by relapses. Laser photobiomodulation may offer the possibility of targeting multiple hallmarks of cancer by
using fit-for-purpose electromagnetic (EM) energy aiming to restore homeostasis-homeokinesis. Methods/Principal
Findings: A literature search of English-language articles in five databases (Medline, ISI Web of Knowledge, Cochrane,
Google Scholar, Scirus) was conducted using search terms relating to cancer (neoplasm, advanced cancer, palliative)
in combination with photobiomodulation and/or low-level laser therapy (LLLT) in the period from January 1990 to
January 2013. Controlled clinical trials with at least 1year of follow up and minimum compliance of 90% were
included. Clinical studies evaluating lymphedema, mucositis or pain were also included to illustrate post-LLLT
responses to adverse effects of chemo-radiotherapy. In vitro and in vivo studies were considered as preliminary data
for clinical trials. Retrieved articles suggest that photobiomodulation can modulate anti-tumor effects and reduce the
adverse effects of chemo-radiotherapy. Results are discussed giving particular attention to two mechanistic
proposals with potential anticancer applications, photo-infrared pulsed biomodulation (PIPBM) and water oscillator
(WO). Conclusions/Significance: Translational research with laser photobiomodulation as a multi-target (multi-
hallmark) therapy in cancer and other complex diseases appears warranted.
Purpose: How to identify, by fixation on the retina, the last image a person appears to see before dying and its use in
criminology was first explored in the 17th Century and then at the end of the 20th Century when the forensic use of
optography was still a matter of research. This poster illustrates the history of optography. Methods: Selective
literature, research of books and articles in journals via PubMed, Google Scholar and Google, in close co-operation
with the Museum of Optography. Results: In the middle of the 17th Century, the monk Christopher Schiener
discovered by chance, on the retina of a frog, an image of a flame. This he interpreted as the last thing the frog had
seen before it had died. This last image on the retina became known as an 'optogram' (optography: the process,
optogram: the product). In the 260 years of history of optography the region of Heidelberg has mainly been its
centre of research: Heidelberg's physiologist Wilhelm Kuhne produced the first identifiable optograms. In 1880 he
uncovered in the eye of an executed man in Bruchsal the first human optogram. In 1975 due to improved knowledge
and modern techniques the importance of optography for criminology has been evaluated again by ophthalmologists
from Heidelberg and conclusively assessed in the negative. Conclusions: If any, the scientific importance and benefit
of optography is rated as minimal today. Historical considerations of using optography as a forensic instrument were
not realised. Meanwhile, as a subject for the visual and literary imagination, optography has been a fruitful area of
investigation, often interpreting this fascinating borderline between life and death in new and exciting ways.
Background and Aim: Cirrhosis is a state of accelerated starvation with impaired protein synthesis. Increased rate of
gluconeogenesis and alterations in skeletal muscle signaling pathways result in anabolic resistance and consequent
loss of muscle mass or sarcopenia in cirrhosis. Late evening snack (LES) is an intervention to reduce the
postabsorptive (fasting) phase with the potential to improve substrate utilization and reverse sarcopenia. Published
reports were evaluated to examine the effect of LES on regulation of substrate utilization (short-term studies) and
nutritional outcomes (long-term studies). Methods: PubMed, EMBASE, Google scholar and OVID databases were
searched. All studies published on LES in cirrhosis were included. Studies that included few (n<3) subjects and
patients with hepatocellular carcinoma were excluded. Results: Late evening snack decreased lipid oxidation and
improved nitrogen balance, irrespective of the composition or type of formulation used. Daytime isocaloric
isonitrogenous snacks did not have the metabolic or clinical benefit of LES. LES decreased skeletal muscle proteolysis.
No studies have examined its effect on muscle protein synthesis. There was inconsistent translation into an increase
in lean body or skeletal muscle mass. Improved quality of life occurs but decreased mortality or need for
transplantation has not been reported. The optimal composition of LES has not been defined, but based on
mechanistic considerations, a branched chain supplemented LES holds most promise. Conclusions: Late evening
snack holds the most promise as an intervention to reverse anabolic resistance and sarcopenia of cirrhosis with
improved quality of life in patients with cirrhosis. Long term benefit and improved survival need critical evaluation.
2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
Background: Organ transplantation increases the risk of cancer including lymphomas through various and insidious
mechanisms. In this study, we aimed to gather and analyze data of 5 international studies on late onset
lymphoprolifeialive disorders after renal and liver transplantation. Material/Methods: We conducted a
comprehensive search for the available data bv Pubmed and Google scholar .search engines on post transplant
lyniphoproliferative disorders. A standard questionnaire was developed to collect data from different published
studies, finally, trustable data of a votai of 5 publishes were included in the final analysis. We reviewed all their
characteristics and various factors available which may affect outcome. We also compared outcome of patients with
very late onset FTLD (>10 years) and late PTLDs. For data analysis we used SRSS v. 13.0. KaplanMeier Method was
used for survival analysis and Students' t test and chi2 tests were used where appropriate. P<0.05 was defined as
significant. Results: overall 55 cases of PTLD from 5 international reports were entered into analysis, There were 32
(58%) males and 23 (42%) female patients. Mean age at diagnosis of PTLD was 39+/-12 years. The mean interval
between transplantation and the diagnosis of PTLD was 86+/-54 whereas follow up time after diagnosis of PTLD was
34+/-99 month. Exteranodal involvement was 6;5%. There were no significant differences in outcomes of patients
with late and very late onset PTLDs. Despite discontinuation or reduction of immunosuppressive agents, surgical
therapy, chemotherapy, and radiotherapy, 55% of the patients died. Conclusions: Late onset PTLD has its highest
relevance within the first year after diagnosis. Controlling infections in PTLD patients during this time period could
have beneficial effects on patients' survival. Long post-transplant latency period, aggressive behavior and poor
response to treatment necessitate early diagnosis and treatment of late onset post-transplant lymphomas in kidney
transplant recipients. Ann Transplant, 2009.
Latex allergy remains a significant problem, expecially among certain professional categories, and specific
immunotherapy has been suggested as a suitable therapeutic option. The objective of the this article is to review the
available literature on clinical trials of specific immunotherapy in latex allergy. Literature databases (PubMed,
Embase, Google Scholar) were searched for latex immunotherapy clinical trials. Clinical trials (either open or
randomized controlled) using subcutaneous or sublingual immunotherapy with latex extracts were selected. Only
articles published in English in peer-reviewed journals were considered. Case reports quoted in the clinical trials were
also described, when pertinent. Eleven clinical trials (3 with subcutaneous and 8 with sublingual immunotherapy)
were identified. Two of the 3 randomized trials of subcutaneous immunotherapy reported some benefit in adults but
a remarkable occurrence of side effects. Concerning sublingual immunotherapy (SLIT), there were 6 randomized
placebo-controlled (1 in children), 1 randomized open, and 1 open trials. All but 1 trial reported positive results, and
the safety profile was overall superior to injection immunotherapy. The overall quality of the study was moderate,
and the number of subjects studied was low. Although guidelines do not consider allergy to latex as an accepted
indication to desensitization, SLIT can be offered, in addition to symptomatic treatment, to selected patients, when
avoidance measures are not feasible or effective. 2012 American College of Allergy, Asthma & Immunology.
Background: In the medical literature the Lazarus phenomenon is defined as the spontaneous return of circulation
(SROC) after cessation of cardio-pulmonary resuscitation. Based on published literature recommendations
concerning the treatment of patients after cessation of resuscitation and reasons for the Lazarus phenomenon are
discussed. Methods: A literature search in Medline, PubMed, Embase, Google Scholar and Google from 1982 to 2009
was carried out for the terms "Lazarus phenomenon", "cessation of cardiopulmonary resuscitation and return of
spontaneous circulation (ROSC)", "spontaneous return of circulation (SROC)", "resuscitation and spontaneous
defibrillation", "spontaneous recovery and cardiopulmonary resuscitation". Related secondary literature which was
cited in the relevant articles was included as well as publications found in our personal literature base. Results: More
than 10,000 articles and comments could be recovered and of these 45 were considered to be medically relevant
articles (letters to the Editor, abstracts, case reports and literature reviews). Conclusions: In the relevant medical
literature, the Lazarus phenomenon is a rare occurrence. It seems to be a phenomenon which has often been
described in non-medical literature but not published in medical literature. The pathophysiological mechanisms are
poorly understood. In the literature several mechanisms are discussed which could be important for this
phenomenon, e.g. autopositive end-expiratory pressure, hyperventilation and alkalosis, hyperkalemia, delayed action
of drugs and unobserved minimal vital signs. In the literature it is recommended that patients should be passively
monitored for at least 10 min after cessation of resuscitation. However, more scientific experimental investigations
seem to be necessary to gain a better understanding of this phenomenon. 2010 Springer Medizin Verlag.
OBJECTIVE: To review the evidence supporting the efficacy and safety of Lcarnitine in the management of acute
valproic acid overdose. DATA SOURCES: MEDLINE (1950-May 2010), EMBASE (1980-May 2010), and Google Scholar
(to May 2010) were searched, using the terms carnitine, valproic acid, and carnitine for valproic acid overdose.
Reference citations from identified publications were reviewed. STUDY SELECTION AND DATA EXTRACTION: Full-text
publications evaluating the use of L-carnitine for management of valproic acid overdose in humans were sought. All
studies, regardless of design, case series, and case reports reporting efficacy or safety endpoints were included. All
languages were included. Two authors extracted primary data elements including patient demographics, presenting
features, clinical management, and outcomes. DATA SYNTHESIS: Seven articles discussing 8 patients and 1 reporting
safety data from records of 674 patients were reviewed. Reports covered both pediatric and adult patients with
acute exposures to valproic acid mono- and polydrug overdose who were treated with various regimens of L-
carnitine. All patients recovered clinically and no adverse effects were noted. CONCLUSIONS: Published evidence of
the efficacy and safety of L-carnitine as an antidote for acute valproic acid overdose is limited. Based on the available
evidence, it is reasonable to consider L-carnitine for patients with acute overdose of valproic acid who demonstrate
decreased level of consciousness. We recommend intravenous administration of 100 mg/kg once, followed by
infusions of 50 mg/kg (to a maximum of 3 g per dose) every 8 hours thereafter, continuing until ammonia levels are
decreasing (if they were elevated initially) and the patient demonstrates signs of clinical improvement or until
adverse events associated with L-carnitine occur.
Background: Undergraduate students of the twenty-first century are widely regarded as 'technologically savvy' and
have embraced the electronic information world. The literature, however, describes undergraduate students as using
a limited range of electronic information sources and not critically evaluating the information they retrieve from
internet searches. Aims: The aim was to evaluate a purposefully designed intervention that sought to expand the
information search and evaluation practices of undergraduate students. The intervention scaffolded an independent
learning activity in the form of a group-based project. Methods: Survey methodology was used to collect data from
student pre- and post-intervention for two cohorts of students who undertook the intervention in 2005 and 2006
involving a total of 71 students. Percentages were used to describe survey findings and chi-square analysis and
Fisher's exact test examined differences between groups. Results: Questionnaires were completed by 59 students
(response rate 83) pre-intervention and 49 students (response rate 69) post-intervention. Post-intervention there
were positive and statistically significant differences in database searching behaviour (p 0.000), use of Google Scholar
(p 0.035) and number of criteria used to evaluate information retrieved from the internet (p 0.000) by students.
Conclusion: By positively reshaping the electronic information search and evaluation practices of students we are
helping students to find informed information sources as they engage in independent learning activities at university
and as future health professionals. 2009 Informa UK Ltd All rights reserved.
Title. Learning for holistic care: addressing practical wisdom (phronesis) and the spiritual sphere. Aim. This paper is a
discussion of practical wisdom (phronesis) and spirituality in holistic caring and strategies to facilitate their
application in nurse education. Background. Phronesis, with its inherent spiritual qualities, is an established aspect of
the persona of excellent clinical leaders. There is a strong case for recognizing the value of this characteristic in all
nurses, and a strategy is required for engendering the development of phronesis during nurse education. Data
sources. Electronic searches of Google Scholar and CINAHL were conducted for English language publications in the
period 1996-2008. Search terms included combinations of phronesis, spirituality, health, education, pharmacology,
medicines and medication education, holistic care and spiritual care. Selection of items for inclusion was based on
their pertinence to the arguments being developed and their value as leads to earlier material. Discussion. The links
between the attributes of effective clinical leaders and those required for holistic caring are explicated and related to
phronesis, the acquisition of which involves spiritual development. An explanatory account of phronesis and its
applicability to nursing leads to an explanation of how its spiritual aspects in particular might be incorporated into
learning for holistic care. Reference to research in medicines-related education illustrates how the principles can be
applied in nurse education. Conclusion. Nursing quality could be enhanced if adequate opportunities for acquiring
phronesis through experiential learning were provided in nursing curricula. Phronesis and spiritual care could be
incorporated into existing models of nursing care or new models devised to use these critical concepts. 2009
The clinical, social and economical impact of failure in medicine [i. e., adverse health care events (AHCE)] is
overwhelming. Respiratory and intensive care medicine are strongly relevant to AHCE, particularly in cases
associated with respiratory failure, mechanical ventilation and pharmacotherapy. In spite of the obvious necessity to
learn from AHCE, its realisation in health-care organisations is still rare. This conceptual review therefore aims to (i)
clarify the most relevant terminology, (ii) identify obstacles related to this health-care topic, and (iii) present possible
strategies for solving the problems, thereby enabling respiratory and intensive care medicine to systematically and
effectively learn from failure. A review of the literature (effective as of June 2013) derived from the electronic
databases Medline via PubMed, EMBASE, ERIC and Google Scholar identified the following relevant obstacles (ii): a
so-called blame culture associated with concealing failure, missing system analyses (vs. individual breakdown), and
(economically) misdirected incentives. Possible strategies to overcome these obstacles (iii) include acknowledging
the importance of leadership, a safe environment, open reporting, an effective feedback culture, and detection (e. g.,
trigger-tools), analysis and discussion (e. g., double loop learning) of failure. The underlying reasons for the
occurrence of AHCE are based on structural, organisational and human shortcomings, and affect all categories of
caregivers. Approaches to solving the problem should therefore focus primarily on the entire system, rather than on
the individual alone. Georg Thieme Verlag KG Stuttgart New York.
Background: We sought to evaluate whether patients with sickle cell anemia (SCA) have left ventricular (LV) systolic
dysfunction. Methods and Results: We conducted a Medline, Embase, Ebscohost, and Google scholar literature
search articles published before April 2010. All studies that compared any measure of LV function (eg, ejection
fraction [EF], fractional shortening [FS], or cardiac index [CI]) between normal control subjects and SCA (hemoglobin
SS) patients were included. Among 57 studies that qualified for review, 19 studies including 841 SCA patients and
554 control subjects met the inclusion criteria. There were no significant differences in either LVEF (Hedge g = 0.15;
95% confidence interval -0.84 to 1.14; P =.76) or FS (P = .28) between SCA patients and control subjects. CI was
significantly higher (P <.001) and LV end-systolic stress-volume index (load independent) was significantly lower (P
<.001) in SCA patients. All LV systolic measures inversely correlated with age (all P <.001). LV end-systolic and -
diastolic dimensions were significantly higher in SCA patients and increased with age. Conclusions: SCA patients have
similar load-dependent but lower load-independent measures of LV systolic function than control subjects. SCA is
associated with LV dilation. LV structural and functional abnormalities appear to be age dependent with progressive
LV dilation and impairment over time. 2013 Elsevier Inc. All rights reserved.
Background: Situs inversus (SI) and midgut malrotation (MM) are uncommon anatomic anomalies that complicate
diagnosis and management of acute abdominal pain. Methods: We present two cases of left-sided acute appendicitis
with situs inversus totalis and a literature review of studies published in English language on left-sided acute
appendicitis, accessed via Pubmed and Google Scholar database. Results: Sixty-three published cases of left-sided
acute appendicitis were evaluated, and two patients (M:16 yr, F:17 yr) who presented to our clinic with left lower
quadrant pain caused by left-sided acute appendicitis were reported. Thirty-five of the patients were male and 30
were female (including our patients) with age range from 8 to 63 years and median age of 26.7 +/- 14.0 years. Fifty-
three patients had situs inversus totalis (SIT), 8 had MM and two were with malrotation of the caecum. Thirty-eight
patients had applied to the hospital with left lower quadrant pain, 12 with right and 6 with bilateral lower quadrant
pain. Thirty patients were diagnosed as having SIT or MM, while the diagnosis in 12 patients was established during
the intraoperative period. Eleven patients with SIT were aware of having this anomaly. Five of the patients
underwent laparoscopic appendectomy and in two patients laparoscopic appendectomy and cholecystectomy were
performed in one session. Preoperative diagnosis has been easier to achieve after 1985, when ultrasonography(USG)
and computed tomography(CT) were introduced into the medical practice. Conclussion: SIT and MM should be taken
into consideration in patients with findings of the physical examination suspicious for left-sided acute appendicitis. X-
ray, USG, CT and diagnostic laparoscopy are beneficial in developing the differential diagnosis. 2010 The Society for
Surgery of the Alimentary Tract.
AIM: To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus
totalis (SIT) and midgut malrotation (MM). METHODS: We present a new case of LSAA with SIT and a literature
review of studies published in the English language on LSAA, accessed via PubMed and Google Scholar databases.
RESULTS: Ninety-five published cases of LSAA were evaluated and a 25-year-old female, who presented to our clinic
with left lower abdominal pain caused by LSAA, is reported. In the reviewed literature, fiftyseven patients were male
and 38 were female with an age range of 8 to 82 years and a median age of 29.1 +/- 15.9 years. Sixty-six patients had
SIT, 23 had MM, three had cecal malrotation, and two had a previously unnoted congenital abnormality. Fifty-nine
patients had presented to the hospital with left lower, 14 with right lower and seven with bilateral lower quadrant
pain, and seven subjects complained of left upper quadrant pain. The diagnosis was established preoperatively in 49
patients, intraoperatively in 19, and during the postoperative period in five; 14 patients were aware of having this
anomaly. The data of eight patients were not unavailable. Eleven patients underwent laparoscopic appendectomy,
which was combined with cholecystectomy in two cases. Histopathological examination of the appendix specimens
revealed adenocarcinoma in only two of 95 patients. CONCLUSION: The diagnosis of left lower quadrant pain is
based on well-established clinical symptoms, physical examination and physician's experience. 2010 Baishideng.
Few studies have examined the issues faced by lesbian, gay, bisexual, and transgender (LGBT)-parented families in
relation to their access to and satisfaction with healthcare services for their children. It is thought that LGBT
individuals have experienced negative interactions with the healthcare environment. To systematically review the
literature investigating the experience of LGBT parents seeking health care for their children. A search of the
following databases: Cochrane Library, CINAHL, Embase, Google Scholar, Medline, PsychInfo, Science Direct,
Sociological Abstracts, Proquest, Scopus, and Web of Science was conducted. Using the PRISMA flow chart and
processes of the United Kingdom Centre for Reviews and Dissemination, we selected and analysed relevant studies.
Four studies that met the inclusion criteria were identified. Studies showed that while the experience of LGBT
parents seeking health care was largely positive, strategies need to be implemented to improve the quality of
healthcare services for LGBT families and ensure that their needs are met. Although many LGBT parents have
positive experiences of health care, some still experience discrimination and prejudice. Implications for practice:
Specific educational interventions are needed to support LGBT parents seeking health care for their children. Further
research is required to explore LGBT-parented families' experiences of healthcare services, and this should include
children's experiences. 2012 Sigma Theta Tau International.
Objectives To review studies of novel multitargeted kinase inhibitors studied in patients with medullary thyroid
cancer (MTC). Materials and methods Search of relevant references in PubMed and Google Scholar on
"chemotherapy" and "medullary thyroid cancer". Results Multitargeted kinase inhibitors have revolutionized the role
of chemotherapy for progressive MTC, providing for the first time tolerable therapeutic options that can improve
outcomes in patients with progressive disease. Drugs thought to inhibit the RET kinase have advanced the furthest
for this disease, but these agents also target the VEGF receptor along with other kinases that may be relevant to
both beneficial and adverse effects. Vandetanib improved progression-free survival from 19.3 to 30.5 months
compared with placebo in patients with metastatic disease, whereas cabozantinib improved progression-free survival
from 4.0 months to 11.2 months in a population with more aggressive disease. However, "cure" remains elusive,
adverse events frequent, and exactly how such "targeted" agents actually function within MTC remains unclear.
Conclusions New approaches to clinical trial design and the preclinical development of targeted agents may be
required to optimize the combination of maximum efficacy with minimal toxicity for patients with metastatic MTC.
2013 Elsevier Ltd. All rights reserved.
Persons with chronic obstructive pulmonary disease (COPD), performing some level of regular physical activity, have
a lower risk of both COPD-related hospital admissions and mortality. COPD patients of all stages seem to benefit
from exercise training programs, thereby improving with respect to both exercise tolerance and symptoms of
dyspnea and fatigue. Physical inactivity, which becomes more severe with increasing age, is a point of concern in
healthy older adults. COPD might worsen this scenario, but it is unclear to what degree. This literature review aims to
present the extent of the impact of COPD on objectively-measured daily physical activity (DPA). The focus is on the
extent of the impact that COPD has on duration, intensity, and counts of DPA, as well as whether the severity of the
disease has an additional influence on DPA. A literature review was performed in the databases PubMed [MEDLINE],
Picarta, PEDRO, ISI Web of Knowledge and Google scholar. After screening, 11 studies were identified as being
relevant for comparison between COPD patients and healthy controls with respect to duration, intensity, and counts
of DPA. Four more studies were found to be relevant to address the subject of the influence the severity of the
disease may have on DPA. The average percentage of DPA of COPD patients vs. healthy control subjects for duration
was 57%, for intensity 75%, and for activity counts 56%. Correlations of DPA and severity of the disease were low
and/or not significant. From the results of this review, it appears that patients with COPD have a significantly
reduced duration, intensity, and counts of DPA when compared to healthy control subjects. The intensity of DPA
seems to be less affected by COPD than duration and counts. Judging from the results, it seems that severity of COPD
is not strongly correlated with level of DPA. Future research should focus in more detail on the relation between
COPD and duration, intensity, and counts of DPA, as well as the effect of disease severity on DPA, so that these
relations become more understandable.
BACKGROUND: Persons with chronic obstructive pulmonary disease (COPD), performing some level of regular
physical activity, have a lower risk of both COPD-related hospital admissions and mortality. COPD patients of all
stages seem to benefit from exercise training programs, thereby improving with respect to both exercise tolerance
and symptoms of dyspnea and fatigue. Physical inactivity, which becomes more severe with increasing age, is a point
of concern in healthy older adults. COPD might worsen this scenario, but it is unclear to what degree. This literature
review aims to present the extent of the impact of COPD on objectively-measured daily physical activity (DPA). The
focus is on the extent of the impact that COPD has on duration, intensity, and counts of DPA, as well as whether the
severity of the disease has an additional influence on DPA., RESULTS: A literature review was performed in the
databases PubMed [MEDLINE], Picarta, PEDRO, ISI Web of Knowledge and Google scholar. After screening, 11
studies were identified as being relevant for comparison between COPD patients and healthy controls with respect
to duration, intensity, and counts of DPA. Four more studies were found to be relevant to address the subject of the
influence the severity of the disease may have on DPA. The average percentage of DPA of COPD patients vs. healthy
control subjects for duration was 57%, for intensity 75%, and for activity counts 56%. Correlations of DPA and
severity of the disease were low and/or not significant., CONCLUSIONS: From the results of this review, it appears
that patients with COPD have a significantly reduced duration, intensity, and counts of DPA when compared to
healthy control subjects. The intensity of DPA seems to be less affected by COPD than duration and counts. Judging
from the results, it seems that severity of COPD is not strongly correlated with level of DPA. Future research should
focus in more detail on the relation between COPD and duration, intensity, and counts of DPA, as well as the effect
of disease severity on DPA, so that these relations become more understandable.
OBJECTIVE: To determine the adherence levels needed for HIV virologic suppression with newer antiretroviral (ARV)
medications, including darunavir, etravirine, and raltegravir. DATA SOURCES: Literature searches of PubMed,
MEDLINE (1950-October 2010), and Google Scholar were performed using the following key words in multiple
combinations: antiretroviral, HIV, AIDS, adherence, darunavir, raltegravir, and etravirine. A review of the
bibliographies of retrieved articles was performed to identify additional references. STUDY SELECTION AND DATA
EXTRACTION: All articles in English were identified from the data sources and evaluated. Studies that did not state
names of medications or drug classes studied were excluded. DATA SYNTHESIS: There are differing levels of
adherence needed to maintain virologic suppression, depending on the ARV class used. The adherence level needed
for unboosted protease inhibitors (PIs) has been established as greater than 95%, but recent studies have shown that
greater than 80% adherence to boosted PIs may be sufficient. Nonnucleoside reverse transcriptase inhibitors
(NNRTIs) could require lower adherence rates than boosted PIs; however, study results are varied and NNRTIs carry a
potential for developing resistance with nonadherence. Studies assessing the adherence needed for raltegravir have
yet to be performed. CONCLUSIONS: Studies have shown differing levels of adherence needed among ARV classes of
medications. With the advent of boosted PIs and potent medications, the amount of adherence needed has dropped
since the 1990s. Although the current data are useful, there are discrepancies in the results due to the methods of
adherence measurement. Knowing what adherence levels are needed is valuable in helping to determine the optimal
ARV regimen for patients, given their adherence barriers. This knowledge can also help determine which patients
require in-depth adherence counseling. Further research with a reliable method of measuring adherence is essential
to determine adherence levels needed for newer ARV medications, including darunavir, etravirine, and raltegravir.
Objective: To perform a systematic review of published data with the aim of evaluating the levels of IgA antibodies to
Candida albicans in HIV-infected adult patients. Methods: The search strategy was based on PubMed, Web of
Science, Google Scholar, Cochrane and EMBASE databases. Also, the reference lists of included studies were
searched. All abstracts found by electronic searches were independently scrutinized by two reviewers. To be eligible
for review, the controlled studies had to present the following characteristics: samples of both HIV-infected adults
and noninfected adults; appropriate HIV-diagnostic tests for both patient groups (case and control); IgA-diagnostic
test applied to a similar population sample. Results: Of 144 studies found, only six met the initial eligibility criteria,
but three were excluded after a thorough analysis. To assess the methodological quality of the three remaining
studies, they were categorized according the risk of bias. The three selected studies revealed that the levels of C.
albicans-specific IgA antibody were higher in HIV-infected individuals compared with the control group. Conclusion:
Adequate IgA antibody responses to C. albicans appear to be maintained, since the levels of these antibodies were
higher in all studies selected. Although the findings of this systematic review are encouraging, the scientific evidence
should be interpreted carefully because there are only a few reports in the literature, mostly because of the lack of
important methodological details or the varying methodologies employed. 2009 Elsevier Ltd. All rights reserved.
Purpose: To provide a systematic review of the published studies pertaining to the lifestyle modification, dietary,
nutritional and vitamins supplements for preventing occurrence or halting deterioration of age-related macular
degeneration (AMD). Methods: The literature searches from 1990 to December 2010 with following keywords, 'age
related macular degeneration', 'nutrition', 'antioxidant', 'diet' and 'vitamins supplements' using search engines
Pubmed, Google Scholar, Medline and the Cochrane Library. Meta-analyses, population-based cohort studies and
case-controlled trials were reviewed, whereas small cases series, case reports, commentaries, abstracts in
proceedings or personal observations were excluded. Results: Smoking and obesity are identified risk factors for
AMD. High dietary intakes of omega-3 fatty acids, and macular xanthophylls lutein and zeaxanthin have been
associated with a lower risk of prevalence and incidence in AMD. Vitamin B and extracts from wolfberry, Gingko
biloba and berry anthocyanins were also subjects of intense research interests, but there has been no concluding
scientific evidence yet. The Age-Related Eye Disease study (AREDS) is the only large-scale randomized controlled
clinical trial to show beneficial effect of AREDS formulation of vitamins C, E, beta-carotene and zinc with copper in
reducing the risk progression to advanced AMD in patients with intermediate AMD or with advanced AMD in one
eye. Conclusion: Quit smoking is an important advice to patients to prevent or slow the progress of AMD. There is no
recommendation for routine nutritional or vitamins supplementation for primary prevention. However, patients with
documented intermediate risk of AMD or advanced AMD in one eye are recommended to take AREDS-type vitamin
supplements. 2012 The Authors. Acta Ophthalmologica 2012 Acta Ophthalmologica Scandinavica Foundation.
Introduction: Behavioral addictions are new forms of dependence that do not involve the use of chemical
substances. The object of the addiction is a behavior or activity that is lawful or socially accepted. These types of
addiction are manifested by the urgent need to engage in the activity, and they may eventually undermine the very
existence of the individual and his/her relational system, becoming a true illness with symptoms similar to those
associated with drug or alcohol addiction. This review will provide a description of three new diseases that are
becoming widespread in industrialized countries. All 3 are characterized by obsession with the body. Orthorexia is
characterized by the spasmodic search for food that is authentic, natural, free of herbicides, pesticides, and other
artificial substances. Bigorexia or muscle dysmorphia is an obsessive focus on physical fitness and muscular
development, which leads the patient to engage in continuous physical exercise, unbalanced dietary practices,
and/or use of doping substances. Finally, tanorexia or compulsive sun-tanning syndrome, is the obsession with
tanning at all costs. Materials and methods: The search engines Cilea and Google Scholar were searched using the
following keywords orthorexia, muscle dysmorphia, and tanning addiction. The articles returned were then selected
to include the more recent publications that focused on psychopathological aspects of these disorders. We also
consulted texts by authors in Italy and abroad who first dealt with these new diseases. Conclusions: The growing
interest in these new diseases should stimulate efforts to increase our understanding of the problems and find
effective strategies for their management. What is needed is a profound ethical renewal in which the existing
emphasis on "appearances" in our culture is countered with "a culture of being.". 2010 Elsevier Srl. All rights
reserved.
The objective of this article is to assess the availability and validity of economic evaluations of carotid artery stenosis
(CS) diagnosis and treatment. Design: Systematic review of economic evaluations of the diagnosis and treatment of
CS. Methods: Systematic review of full economic evaluations published in Medline and Google Scholar up until 28
February 2012. Based on economic checklists (Evers and Philips), the identified studies were classified as high,
medium, or low quality. Results: Twenty-three evaluations were identified. The study quality ranged from 26% to
84% of all achievable points (Evers). Seven studies were of high, eight of medium and eight of low quality. No
comparison was made between carotid angioplasty and stenting (CAS) and best medical treatment (BMT). For
subjects with severe stenosis, comparisons of carotid endarterectomy (CEA) and BMT were also missing. Three of
five studies dealing with pre-operative imaging found that duplex Doppler ultrasound (US) was cost-effective
compared with carotid angiogram (AG). Conclusions: There is a huge lack of high-quality studies and of studies that
confirm published results. Also, for a given study quality, the most cost-effective treatment strategy is still unknown
in some cases ('CAS' vs. 'BMT', 'US combined with magnetic resonance angiography supplemented with AG' vs. 'US
combined with computer tomography angiography'). 2012 European Society for Vascular Surgery.
INTRODUCTION: The intranasal (IN) mode of application may be a valuable asset in non-invasive pain management.
Fentanyl demonstrates pharmacokinetic and pharmacodynamic properties that are desirable in the management of
acute pain, and IN fentanyl may be of value in the prehospital setting. The aim of this systematic review was to
evaluate the current evidence for the use of IN fentanyl in the emergency department and prehospital setting.
METHOD: Reports of trials of IN fentanyl in emergency department and prehospital treatment of pain were
systematically sought using the PubMed database, Embase, Google scholar, the Cochrane database and the
Cumulative Index to Nursing and Allied Health Literature. RESULTS: Twelve studies of IN fentanyl in the emergency
department (ED) and prehospital setting were included in the final analysis. In the ED, analgesic non-inferiority and
superiority were demonstrated when comparing IN fentanyl with intravenous (IV) and intramuscular morphine,
respectively. Non-blinded, non-controlled studies demonstrated an analgesic effect of IN fentanyl in patients with
moderate and severe pain. In the prehospital setting, both analgesic inferiority and non-inferiority were
demonstrated when IN fentanyl was compared with IV morphine. Finally, a significant analgesic effect of IN fentanyl
was demonstrated when IN fentanyl was compared with methoxyflurane. CONCLUSION: Only limited quality
evidence exists for the efficacy of IN fentanyl in the ED and in the prehospital setting, and more double-blinded,
randomised, controlled trials are urgently needed to validate the use of IN fentanyl in this context.
The intranasal (IN) mode of application may be a valuable asset in non-invasive pain management. Fentanyl
demonstrates pharmacokinetic and pharmacodynamic properties that are desirable in the management of acute
pain, and IN fentanyl may be of value in the prehospital setting. The aim of this systematic review was to evaluate
the current evidence for the use of IN fentanyl in the emergency department (ED) and prehospital setting. Reports of
trials of IN fentanyl in (ED) and prehospital treatment of pain were systematically sought using the PubMed
database, Embase, Google scholar, the Cochrane database and the Cumulative Index to Nursing and Allied Health
Literature. Twelve studies of IN fentanyl in the (ED) and prehospital setting were included in the final analysis. In the
ED, analgesic non-inferiority and superiority were demonstrated when comparing IN fentanyl with intravenous (IV)
and intramuscular morphine, respectively. Non-blinded, non-controlled studies demonstrated an analgesic effect of
IN fentanyl in patients with moderate and severe pain. In the prehospital setting, both analgesic inferiority and non-
inferiority were demonstrated when IN fentanyl was compared with IV morphine. Finally, a significant analgesic
effect of IN fentanyl was demonstrated when IN fentanyl was compared with methoxyflurane. Only limited quality
evidence exists for the efficacy of IN fentanyl in the ED and in the prehospital setting, and more double-blinded,
randomised, controlled trials are urgently needed to validate the use of IN fentanyl in this context.
To assess the scholarly output of grants funded by the Agency for Healthcare Research and Quality (AHRQ) that
published knowledge relevant to the impact of health information technologies on patient safety and quality of care
outcomes. We performed a bibliometric analysis of the identified scholarly articles, their journals, and citations. In
addition, we performed a qualitative review of the full-text articles and grant documents. Papers published by AHRQ-
funded investigators were retrieved from MEDLINE, journal impact factors were extracted from the 2010 Thompson
Reuters Journal Citation Report, citations were retrieved from ISI's Web of Knowledge and Google Scholar. Seventy-
two articles met the criteria for review. Most articles addressed one or more of AHRQ's outcome goals and focus
priorities. The average impact factor for the journals was 4.005 (range: 0.654-28.899). The articles, and their
respective grants, represented a broad range of health information technologies. This set of AHRQ-funded research
projects addressed the goals and priorities of AHRQ, indicating notable contributions to the scientific knowledge
base on the impact of information system use in healthcare.
BACKGROUND AND PURPOSE - The relationship between elevated lipoprotein (a) levels[Lp(a)] and stroke is
controversial. We systematically reviewed the literature to determine whether Lp(a) is a risk factor for stroke.
METHODS - We searched MEDLINE (1966 to 2006), EMBASE (1974 to 2006), and Google scholar for articles on Lp(a)
and cerebrovascular disease. From potentially relevant references retrieved, we excluded uncontrolled studies,
studies of children with stroke, studies investigating carotid atherosclerosis, and studies lacking adequate data.
RESULTS - Thirty-one studies comprising 56 010 subjects with >4609 stroke events met all inclusion criteria and were
included in the meta-analysis. In case-control studies (n=23 with 2600 strokes) unadjusted mean Lp(a) was higher in
stroke patients (standardized mean difference, 0.39; 95% CI, 0.23 to 0.54) and was more frequently abnormally
elevated (OR, 2.39; 95% CI, 1.57 to 3.63). Sensitivity analysis and meta-regression did not find any influence of study
design, measurement period of Lp(a) in relationship to stroke episode, subtype, age, and sex to explain the
substantial heterogeneity between studies (I=83.7%; P<0.001). There was no evidence of publication bias. In nested
case-control studies (n=3 with 364 strokes) Lp(a) was not a risk factor for incident stroke (OR, 1.04; 95% CI, 0.6 to
1.8). In prospective cohort studies (n=5 with >1645 strokes), incident stroke was more frequent in patients in the
highest tertile of Lp(a) distribution compared with the lowest tertile of Lp(a) (RR, 1.22; 95% CI, 1.04 to 1.43). There
was no publication bias or heterogeneity in the prospective studies (I=0.00%; P=0.67). CONCLUSION - This meta-
analysis suggests that elevated Lp(a) is a risk factor for incident stroke. 2007 American Heart Association, Inc.
Objective: To conduct a comprehensive, systematic review of studies assessing the significance of lipoprotein-
associated phospholipase A2 in cardiovascular diseases (CVDs). Material and methods: A review of the literature was
performed using the search term "Lipoprotein-associated phospholipase A2 (Lp-PLA2)" and each of the following
terms: "cardiovascular risk," "cardiovascular death," "atherosclerotic disease," "coronary events," "transient
ischemic attack (TIA)," "stroke," and "heart failure." The searches were performed on Medline, Google Scholar and
ClinicalTrails.gov. Results: The majority of published studies showed a significant association between Lp-PLA2 levels
and cardiovascular events after multivariate adjustment. The association was consistent across a wide variety of
subjects of both sexes and different ethnic backgrounds. Conclusions: The role of Lp-PLA2 as a significant biomarker
of vascular inflammation was confirmed, and Lp-PLA2 seems to be closely correlated to cardiovascular events. It may
be an important therapeutic target and may have an important role in prevention, risk stratification and personalised
medicine. 2012 Informa UK, Ltd.
We sought to critically assess the role of lipoprotein-associated phospholipase A2 (Lp-PLA2) in the prediction of
cardiovascular events in primary and secondary prevention settings. The inclusion criteria for our study included
population-based epidemiologic studies and the presence of clinical outcomes of interest, including atherosclerotic
disease, coronary events, stroke, and cardiovascular death. Studies that lacked clinical outcomes or that involved
animals were excluded. We included primary and secondary prevention studies of subjects in all ethnic groups and of
either sex, with no age limitation. We searched Medline, Google Scholar, and the Cochrane Library for studies with
publication dates from January 1970 through July 2009, and we searched major cardiology meeting abstracts from
2000 through 2009. From each study, we used predictive ability-including relative risk, hazard ratio, odds ratio, and
prevalence of high Lp-PLA2 levels, with adjustment- along with baseline population characteristics. Of 33 studies that
met our inclusion criteria, 30 showed a significant association between Lp-PLA2 and cardiovascular events. Most of
the studies had been adjusted for major Framingham risk factors and other variables that might influence the effect
under question. After multivariate adjustments in cohort and nested case-control studies, increased levels of Lp-PLA2
remained a significant predictor of cardiovascular events. The available body of evidence suggests that Lp-PLA2 is a
reliable marker of risk for cardiovascular events. 2010 by the Texas Heart Institute, Houston.
Background: While it is evident that a surgeon must master medical knowledge and technical skill, there are other
soft skills that are essential to a successful surgeon. One of these skills is professionalism. The challenge in surgical
education lies in developing an effective professionalism curriculum and a related method of evaluation. Objective:
Our review updates the literature and provides recommendations for improving instruction and evaluation of
professionalism. Design: A literature review was conducted using PubMed, Google Scholar, and Web of Knowledge.
We restricted our search to documents published from 2009 to 2012 that address methods of teaching and tools for
assessing professionalism in surgical education. Results: Sixty-three documents were reviewed, with 14 fitting our
search criteria for professionalism in surgical education completely. Other articles focused on the topics of
professionalism in surgery, medical professionalism, and professionalism education in medical specialties other than
surgery. Conclusions: Development of a professionalism curriculum for surgical residents might begin with defining
professionalism in terms of tangible behaviors. The program might also include a precurriculum preparatory course
and simulation-based training. Residency programs must also maintain professionalism among its faculty.
Assessment in the form of multisource feedback that is consistent with observable behavioral definitions of
professionalism should also be considered in evaluating resident professionalism. 2013 Association of Program
Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Aims. This integrated literature review seeks to identify the key considerations in conducting focus groups and
discusses the specific considerations for focus group research with culturally and linguistically diverse groups.
Background. The focus group method is a technique of group interview that generates data through the opinions
expressed by participants. Focus groups have become an increasingly popular method of data collection in health
care research. Although focus groups have been used extensively with Western populations, they are a particularly
useful tool for engaging culturally and linguistically diverse populations. The success of focus groups in this context is
dependent upon the cultural competence of the research team and the research questions. Methods. The electronic
databases Medline, CINAHL, Embase, Psychlit and the Internet using the Google Scholar search engine were explored
using the search terms 'focus group', 'cultural sensitivity', 'transcultural nursing', 'transcultural care', 'cultural
diversity' and 'ethnic groups'. Hand searching of reference lists and relevant journals was also undertaken. English
language articles were selected for the review if they discussed the following issues: (i) methodological implications
of the focus group method; (ii) strengths and limitations of the focus group method; (iii) recommendations for
researchers and (iv) use of the focus group in culturally and linguistically diverse groups. Conclusions were drawn
from each of the articles and consensus regarding a summary of recommendations was derived from a minimum of
two authors. Results. Findings from this review revealed several key issues involving focus group implementation
including recruitment, sample size, data collection, data analysis and use within multicultural populations. Strengths
and limitations of the focus group method were also identified. Conclusions. Focus groups are a useful tool to expand
existing knowledge about service provision and identify consumer needs that will assist in the development of future
intervention programmes, particularly within multicultural populations. Careful planning related to methodological
and pragmatic issues are critical in deriving effective data and protecting participants. Relevance to clinical practice.
Focus groups can facilitate increased understanding of perspectives of culturally and linguistically diverse groups and
thereby shape clinical practice to better meet the needs of these groups. 2007 The Authors. Journal compilation
2007 Blackwell Publishing Ltd.
BACKGROUND: Within the context of a European network dedicated to the study of sarcoma the relevant literature
on sarcoma risk factors was collected by searching PubMed and Google Scholar, the two information storage and
retrieval databases which can be accessed without charge. The present study aims to appraise the relative
proficiency of PubMed and Google Scholar., FINDINGS: Unlike PubMed, Google Scholar does not allow a choice
between "Human" and "Animal" studies, nor between "Classical" and other types of studies. As a result, searches
with Google Scholar produced high numbers of citations that have to be filtered. Google Scholar resulted in a higher
sensitivity (proportion of relevant articles, meeting the search criteria), while PubMed in a higher specificity
(proportion of lower quality articles not meeting the criteria, that are not retrieved). Concordance between Google
Scholar and PubMed was as low as 8%., CONCLUSIONS: This study focused just on one topic. Although further
studies are warranted, PM and GS appear to be complementary and their integration could greatly improve the
search of references in medical research.
Background: Liver abscess (LA) in the pediatric population has become relatively uncommon in developed countries
but it continues to have a high incidence among children in developing countries. This article aims to review the
trends in all aspects of LA in children, both temporally and geographically. Data sources: The PubMed and Google
Scholar database were searched with the keywords "liver abscess", "children", "predisposing causes", "clinical signs
and symptoms", "treatment" from 1975 to 2009 and all kinds of retrospective and prospective studies, reviews, case
series were included. Results: Pyogenic LA constitutes the majority of cases, followed by amebic and fungal LA.
Staphylococcus aureus is the most common pathogen worldwide. Ultrasonography (US) and computed tomography
(CT) are widely used as diagnostic tools. There are varying opinions regarding the treatment of LA in children. The
general trend is towards less invasive modalities of treatment like percutaneous drainage along with antimicrobial
drug therapy. However, in selected patients, open surgical drainage still plays an important role. The mortality rate
for pyogenic LA has shown a decline from about 40% before the 1980s to less than 15% in the recent years. At the
same time, the mortality rate of amebic LA cases reported to be around 11%-14% before 1984 has reduced to less
than 1% at present. Conclusions: Etiological pattern of LA in children has remained the same over the years, and in
most regions, it is associated with Staphylococcus aureus and amebic LA is quite uncommon. US or CT scan is the
most frequently employed diagnostic modality for LA, and follow-up is usually performed by serial US scans.
Antimicrobial therapy along with, if necessary, drainage of the abscess by either percutaneous or open surgical route
remains the treatment of choice. 2010 Children's Hospital, Zhejiang University School of Medicine and Springer-
The aim of this study was to review the literature regarding the rupture of hydatid cysts into the abdominal cavity
after trauma. We present both a new case of hydatid cyst rupture that occurred after blunt abdominal trauma and a
literature review of studies published in the English language about hydatid cyst rupture after trauma; studies were
accessed from PubMed, Google Scholar, EBSCO, EMBASE, and MEDLINE databases. We identified 22 articles
published between 2000 and 2011 about hydatid cyst rupture after trauma. Of these, 5 articles were excluded
because of insufficient data, duplication, or absence of intra-abdominal dissemination. The other 17 studies included
68 patients (38 males and 30 females) aged 8 to 76 years who had a ruptured hydatid cyst detected after trauma.
The most common trauma included traffic accidents and falls. Despite optimal surgical and antihelmintic therapy, 7
patients developed recurrence. Complications included biliary fistula in 5 patients, incisional hernia in 2 patients, and
gastrocutaneous fistula in 1 patient. Death occurred from intraoperative anaphylactic shock in 1 patient and
gastrointestinal bleeding and pulmonary failure in 1 patient. Rupture of a hydatid cyst into the peritoneal cavity is
rare and challenging for the surgeon. This condition is included in the differential diagnosis of the acute abdomen in
endemic areas, especially in young patients.
Introduction: The testis importance in homeostasis was recognized for millennia, but a consistent interest in
exploring their endocrine function only goes back to about a century. Aim: The aim of this study is to provide a
succinct perspective of the events leading to the discovery of testosterone, the mind-boggling early attempts at
therapy and today's situation. Method: The literature was reviewed with searches in OvidSP Medline, PubMed, and
Google Scholar under the headings of testosterone/androgens history. Due to the explosion of reports between the
late 19th and early 20th centuries, a manual review of the collection of the period's journals at the university's library
was performed. Pertinent books were consulted for specific biographical details. Results: There is a robust body of
literature dealing with testicular function for the period starting in the late 1800s. It is illustrative to learn the painful
efforts of many well-intentioned and honest scientists with more conviction and determination than knowledge.
Among them, unfortunately, a number of charlatans and profiteers tainted the concept of hypogonadism and its
treatment with repercussions lasting until this day. The discovery and synthesis of testosterone represent the effort
of brilliant minds (two Nobel Prizes) in various countries and frequently working for the pharmaceutical industry.
Shortly after testosterone became available, controversy arose about its application, use, abuse, and potential
detrimental effects. Over the decades, the hullabaloo about hypogonadism and its treatment has focused on a
variety of issues ranging from absurd efficacy claims to solid studies and from doubts of its existence to convincing
proof of a detrimental age-associated deficit in testosterone production. Conclusions: The history of testosterone
discovery, synthesis, and introduction into the therapeutic armamentarium is an outstanding example of human
curiosity, ingenuity, greed, and skepticism. Despite the vast progress in the field, many issues remain unresolved, but
thoughtful science augurs well for its future. 2013 International Society for Sexual Medicine.
BACKGROUND: Long-acting beta(2) agonists (LABAs) are effective second-line bronchodilator controller agents in
asthma, although they may also increase the risk of hospitalization and asthma-related death in certain situations.
Despite the interesting findings obtained with short-acting beta(2) agonists (SABAs), negative studies are available
with LABAs in the treatment of allergic rhinitis. This is quite surprising given that there is now clear documentation of
the link between asthma and allergic rhinitis. OBJECTIVE: The aim of this review is to examine the role of beta(2)
agonists in patients with asthma who also suffer from allergic rhinitis and to try to explain the differences observed
between SABAs and LABAs in rhinitis. METHODS: SCOPUS, GOOGLE SCHOLAR and MEDLINE were searched for
abstracts and papers; the search was completed in March 2008. No restriction was placed on language.
CONCLUSION: The intriguing united airway concept led to the hypothesis that common therapies may influence both
and asthma and allergic rhinitis. Consequently, better designed studies with LABAs in allergic rhinitis are now
mandatory. In particular, further studies are necessary to investigate clinically relevant anti-inflammatory synergy
between inhaled corticosteroids and LABAs in upper airways. It will also be interesting to assess whether ultra-LABAs
(once-daily LABAs) are active in allergic rhinitis, although the information we have seems to exclude a role for these
agents.
Aim: A systematic review was carried out to analyse continence at 2 years or more after lateral internal
sphincterotomy (LIS) for chronic anal fissure (CAF). Method: PubMed, MEDLINE, Scopus, Embase, Ovid, SCI, Cochrane
Central Register of Controlled Trials (CENTRAL) and Google Scholar were used to search the literature from 1969-
2012 for studies reporting a follow-up of more than 2 years after LIS for CAF. The primary outcome parameter
analysed was continence. The secondary outcome parameters included success rate, recurrence, incidence of
postoperative abscess and fistula formation and patient satisfaction. Results: Of 324 studies screened, 22 (n = 4512)
were included. The mean follow-up period ranged from 24-124 months. The overall continence disturbance rate was
14% (95% CI 0.09-0.2). Weighted analysis showed flatus incontinence in 9% (95% CI 0.04-0.16), soilage/seepage in
6% (95% CI 0.03-0.1), accidental defaecation in 0.91% (95% CI 0.003-0.02), incontinence to liquid stool in 0.67% (95%
CI 0.001-0.02) and incontinence to solid stool in 0.83% (95% CI 0.003-0.02) of patients. Conclusion: The long-term
risk of continence disturbance after lateral internal sphincterotomy is significant. Randomized controlled trials with a
long follow-up are needed to substantiate these findings and to redefine its role in the treatment of chronic anal
fissure. 2013 The Association of Coloproctology of Great Britain and Ireland.
Background: Results of studies investigating the long-term effects of intrauterine exposure to antiepileptic drugs
(AEDs) on cognitive functioning are limited and conflicting. Objective: To estimate intellectual development of
children prenatally exposed or unexposed to AEDs by assessing IQ scores in a systematic review and meta-analysis.
Methods: A literature search using Pubmed, EMBASE and Google Scholar from inception to 30 April 2009 was
performed to identify all original cohort studies that investigated cognitive functioning after in utero exposure to
AEDs. Studies had to include at least one group exposed to an AED and one unexposed group. Data from drug
exposed and unexposed controls were combined using a random effects model. Results: Eleven studies met the
inclusion criteria. Eight studies (three for valproic acid and five for carbamazepine) evaluated IQ as a measure of
cognitive development. IQwas assessed by the Wechsler, Bayley orMcCarthy intelligence scales, depending on age.
One study investigated phenytoin and one study investigated phenobarbital (phenobarbitone). Because one study
was reported in two different publications, seven studies were included in the meta-analysis. In total, the seven
selected studies included 67 children exposed in utero to valproic acid and 151 exposed to carbamazepine, and 494
unexposed controls born to healthy women or to women with untreated epilepsy. The mean full-scale IQ (FSIQ),
verbal IQ (VIQ) and performance IQ (PIQ) scores in children exposed to valproic acid in utero were 83.9 (95% CI 64.2,
103.6), 93.7 (95% CI 72.6, 114.7) and 88.3 (95% CI 69.9, 106.9), respectively. The mean FSIQ, VIQ and PIQ scores in
the control group were 102 (95% CI 90, 116), 101 (95% CI 87, 114) and 99 (95% CI 90, 117), respectively. The mean
FSIQ, VIQ and PIQ were all significantly lower in the valproic acid group compared with the unexposed group. The
FSIQ and VIQ of children exposed to carbamazepine were not statistically different from those of the unexposed
control group. In a sub-analysis of carbamazepine exposure in three studies using the Wechsler intelligence scale,
PIQ was significantly lower in children exposed to carbamazepine than in unexposed children. Conclusions: Although
our analysis revealed no evidence that untreated maternal epilepsy was associated with a lower IQ in the child, there
may have been confounding factors, such as milder epilepsy, in this group. Exposure to valproic acid in pregnancy is
associated with significantly reduced intelligence in children whose mothers were treated for epilepsy. Exposure to
carbamazepine in pregnancy does not appear to be associated with reduced FSIQ and VIQ in children, although PIQ
was lower in the sub-analysis. Clinicians should inform families of the potential cognitive adverse effects of valproic
acid. More studies are needed to corroborate these findings. 2010 Adis Data Information BV. All rights reserved.
Results of studies investigating the long-term effects of intra-uterine exposure to antiepileptic drugs (AEDs) on
cognitive functioning are limited and conflicting. To estimate intellectual development of children prenatally exposed
or unexposed to AEDs by assessing IQ scores in a systematic review and meta-analysis. A literature search using
Pubmed, EMBASE and Google Scholar from inception to 30 April 2009 was performed to identify all original cohort
studies that investigated cognitive functioning after in utero exposure to AEDs. Studies had to include at least one
group exposed to an AED and one unexposed group. Data from drug exposed and unexposed controls were
combined using a random effects model. Eleven studies met the inclusion criteria. Eight studies (three for valproic
acid and five for carbamazepine) evaluated IQ as a measure of cognitive development. IQ was assessed by the
Wechsler, Bayley or McCarthy intelligence scales, depending on age. One study investigated phenytoin and one
study investigated phenobarbital (phenobarbitone). Because one study was reported in two different publications,
seven studies were included in the meta-analysis. In total, the seven selected studies included 67 children exposed in
utero to valproic acid and 151 exposed to carbamazepine, and 494 unexposed controls born to healthy women or to
women with untreated epilepsy. The mean full-scale IQ (FSIQ), verbal IQ (VIQ) and performance IQ (PIQ) scores in
children exposed to valproic acid in utero were 83.9 (95% CI 64.2, 103.6), 93.7 (95% CI 72.6, 114.7) and 88.3 (95% CI
69.9, 106.9), respectively. The mean FSIQ, VIQ and PIQ scores in the control group were 102 (95% CI 90, 116), 101
(95% CI 87, 114) and 99 (95% CI 90, 117), respectively. The mean FSIQ, VIQ and PIQ were all significantly lower in the
valproic acid group compared with the unexposed group. The FSIQ and VIQ of children exposed to carbamazepine
were not statistically different from those of the unexposed control group. In a sub-analysis of carbamazepine
exposure in three studies using the Wechsler intelligence scale, PIQ was significantly lower in children exposed to
carbamazepine than in unexposed children. Although our analysis revealed no evidence that untreated maternal
epilepsy was associated with a lower IQ in the child, there may have been confounding factors, such as milder
epilepsy, in this group. Exposure to valproic acid in pregnancy is associated with significantly reduced intelligence in
children whose mothers were treated for epilepsy. Exposure to carbamazepine in pregnancy does not appear to be
associated with reduced FSIQ and VIQ in children, although PIQ was lower in the sub-analysis. Clinicians should
inform families of the potential cognitive adverse effects of valproic acid. More studies are needed to corroborate
these findings.
Untreated pain can negatively influence children's brain cytoarchitecture and may lessen concentration ability and
cognitive performance. Effective management of pain is a crucial factor in promoting healthy child development. Use
of opioids in the management of pain and its' consequences in children presents a substantial challenge. A significant
concern in pediatric pain management is the long-term neuropsychological consequences of opioids. Authors aims to
provide a descriptive review of the current literature surrounding the neuropsychological impact of opioid use in
children, along with possible extrapolations from their use in adults and animal models. The electronic review for
papers published between January 1992 and July 2012 was conducted using Medline/Pubmed, PsychInfo, CINAHL,
the Cochrane Library database and Google Scholar. Limited studies assessing pediatric pain patients treated with
opioids did not find any differences in intelligence, behavior, vocabulary, or motor skills. One reported a decrease in
an IQ subset (visuo-constructional ability) which measured higher order executive function. Studies from prenatal
illicit opioid exposure found poorer performance on measures of language, verbal ability, mathematics, reading,
impulse control, and school readiness skills. In lieu of evidence from the pediatric population, knowledge regarding
the use of opioid medication may be extrapolated from adult and animal studies. The literature from adult
prescribed opioid users has mixed results. Some showed impairment in the neuropsychological domains of memory,
decision making, attention, concentration, information processing, psycho-motor speed, visual special skills, and
hand-eye coordination, while others found no differences or revealed improved perceptual-cognitive status, possibly
due to the removal of pain as a stressor. Opioid medications have the potential to produce long-lasting
neuropsychological side effects. However, given the negative consequences of untreated pain , the potential benefit
may offset their risk. More studies are needed to clarify this complex interaction.
Ethnopharmacological relevance: Lonicera japonica Thunb. (Caprifoliaceae), a widely used traditional Chinese
medicine, was known as Jin Yin Hua (Chinese:), Ren Dong and Japanese honeysuckle. It was taken to treat the
exopathogenic wind-heat, epidemic febrile diseases, sores, carbuncles and some infectious diseases. At the same
time, Lonicera japonica could be used as healthy food, cosmetics, ornamental groundcover, and so on. Aim of the
review: The present paper reviewed the ethnopharmacology, the biological activities, toxicology and phytochemistry
of Lonicera japonica. Materials and methods: Information on Lonicera japonica was gathered via the Internet (using
Google Scholar, Baidu Scholar, Elsevier, ACS, Medline Plus, CNKI and Web of Science) and libraries. Additionally,
information also was obtained from some local books and brilliant scholars on ethnopharmacology. Results: More
than 140 chemical compounds have been isolated, and the main compositions are essential oils, organic acids and
flavones, etc. Lonicera japonica and its active principles possess wide pharmacological actions, such as anti-
inflammatory, antibacterial, antiviral, antioxidative and hepatoprotective activities. Conclusions: As an important
traditional Chinese medicine, further studies on Lonicera japonica can lead to the development of new drugs and
therapeutics for various diseases, and how to utilize it better should be paid more attentions. 2011 Elsevier Ireland
Ltd.
Citation metrics are commonly used as a proxy for scientific merit and relevance. Papers published in English,
however, may exhibit a higher citation frequency than research articles published in other languages, though this
issue has not yet been investigated from a Swiss perspective where English is not the native language. To assess the
impact of publication language on citation frequency we focused on oral surgery papers indexed in PubMed
MEDLINE that were published by Swiss Dental Schools between 2002 and 2007. Citation frequency of research
papers was extracted from the Institute for Scientific Information (ISI) and Google Scholar database. A univariate and
multivariate logistic regression model was used to assess the impact of publication language (English versus
German/French) on citation frequency, adjusted for journal impact factor, number of authors and research topic.
Papers published in English showed a 6 (ISI database) and 7 (Google Scholar) times higher odds for being cited than
research articles published in German or French. Our results suggest that publication language substantially
influences the citation frequency of a research paper. Researchers should publish their work in English to render
them accessible to the international scientific community.
This literature review was performed to evaluate the relationship of systolic blood pressure (SBP) and preserved
systolic function on morbidity and mortality in individuals older than 65 years with heart failure (HF). When
prolonged, high SBP, defined as measurements greater than 140 to 160 mm Hg, is associated with increased risk of
developing HF. Medications to lower SBP measurements to Joint National Committee VII goals of less than 140 mm
Hg are often prescribed on the assumption that treatment guidelines result from a systematic analysis of clinical
trials and efficacy of drug treatments. Lower limits of SBP are less defined in current guidelines optimizing HF. The
electronic databases PubMed, CINAHL, and Google Scholar are searched for keywords heart failure, prognosis,
preserved systolic function, and blood pressure (BP). Five scholarly research articles investigated the effects of
variables, notably SBP and confirmed preserved systolic function, on HF, published in the English language between
July 2006 and January 2009. Inclusion criteria were study samples consisting of individuals 65 years and older
referred in this article as elders, with the diagnosis of HF with a focus on variables measuring SBP and systolic
function when assessing outcomes. Low SBP is a risk factor for adverse outcomes in HF elders. Additionally, female
elders more commonly had preserved systolic function, but presented with less classic symptoms of HF and were
less likely to receive cardiology consultation. Considerations for future research are the inclusion of participants
presenting with SBP of less than 110 mm Hg in clinical trials and updated evidence-based guidelines, defining
acceptable increased target BP ranges, for sex- and age-adjusted HF patients with preserved systolic function.
To determine the proportion of abstracts presented at the Congreso Peruano de Gastroenterologia (the major
Peruvian gastroenterological scientific meeting), that had been published in scientific journals, the date of
publication and its associated factors. Longitudinal retrospective and analytic study; the publicationrate of all the
abstracts presented in the biennial Congreso Peruano de Gastroenterologia between 1998 and 2008 was assessed.
Google Scholar engine was used. The searching strategy performed included: ("Study location" AND "population
studied" AND "main outcome") AND (autor:First OR autor:Second OR autor:Last). Logistic regression was used,
considering p<0.05 statistically significant. Publication rate was 8.2% (34/217), statistically significant differences
were found among meeting years (p<0.001). There were also differences between study design, objectives (more in
analytic studies) and measurement (more in longitudinal studies (p<0.001). 82.4% were published in the Revista de
Gastroenterologia del Peru. The median time for publication was 10.8+/-10.4 months; this variable and the meeting
year, study type, journal of publication or accordance between the abstract and publication characteristic showed no
statistical differences. The mean authors' number was 5.02+/-2.4; analytic studies have less authors than the
descriptive ones (3.6 vs 6.1; p=0.012). The Congreso Peruano de Gastroenterologia presents a low publication rate of
the abstracts presented, which can be used as a quality indicator of the abstracts and the reviewing process.
OBJECTIVE: To evaluate the efficacy and safety of low-dose intravenous ketamine in addition to intravenous propofol
for procedural sedation and analgesia in the emergency department (ED). DATA SOURCES: Articles were identified
using PubMed (1949-February 2007), MEDLINE (1966-February 2007), EMBASE (1980-February 2007), BioMed
Central (to February 2007), the Cochrane Library (to February 2007), International Pharmaceutical Abstracts, and
Google Scholar (until February 2007). Reference citations from retrieved publications were also reviewed. Search
terms included ketamine, propofol, ketamine-propofol, ketofol, combination, sedation, procedural sedation,
conscious sedation, and emergency department. STUDY SELECTION AND DATA EXTRACTION: All articles on
prospective procedural sedation that were published or translated into English and that compared combination
ketamine-propofol with an appropriate comparator group were included. Clinically relevant safety endpoints
included the frequency of significant hemodynamic and respiratory compromise warranting medical intervention,
nausea, vomiting, and emergence reactions. Time until hospital discharge criteria were met and patient satisfaction
scores were efficacy endpoints of interest. DATA SYNTHESIS: Of the 11 trials included in this review, most had small
sample sizes and were conducted in non-ED settings. The ketamine-propofol combination demonstrated no
additional efficacy over propofol in terms of time to discharge. Although fewer patients given the ketamine-propofol
combination experienced significant hemodymamic and respiratory compromise, need for active interventions,
including fluid or vasopressor administration, supplemental oxygen, or assisted ventilation did not differ between
groups. Patients who received higher doses of adjuvant ketamine reported an increased incidence of nausea,
vomiting, and emergence reactions following the procedure. Few studies reported patient satisfaction scores
postprocedure, and effect of ketamine-propofol on time-to-discharge criteria met was inconclusive. CONCLUSIONS:
At this time, insufficient clinical evidence exists to recommend the routine use of low-dose ketamine with propofol
for procedural sedation in the ED setting.
Background and objectives: Due to the limited incidence of posttransplant lymphoproliferative disorders (PTLD) in
pediatric liver graft recipients, there is a scarcity of data on the characteristics of the disease in this population. We
aimed to analyze the special features and behavior of PTLD arising after pediatric liver transplantation. Design: A
comprehensive search of the literature was conducted for the available data on PTLD in pediatric liver recipients
pediatric PTLD through a search of Pubmed and Google Scholar using appropriate terms. Methods: We sought data
on liver recipients younger than 18 years of age at the time of transplantation. From 51 reports, 43 fulfilled the
inclusion criteria. Overall 250 cases of PTLD (212 pediatric PTLD) were found from 43 reports. Data on pediatric
patients was compared to adults. Results: Pediatric PTLD lesions were more likely of the polymorphic type (P=.004)
and polyclonal (when age cut-off was defined at 12 years; P=.023). Remission rates, metastasis frequency and organ
involvements were not different between the groups (P>.1 for all). Survival analysis showed no disparity between
pediatric PTLD and adult patients (P>.1); but when data was reanalyzed for patients surviving at least 4 months post
diagnosis, the log rank test showed that pediatric patients have a superior outcome compared to adults (P=.045).
Conclusions: Pediatric liver recipients developing PTLD have relatively better disease presentation and behavior than
that in adults. Stomach involvement was also more frequently seen in patients younger than 12 years, and should be
more intensively evaluated. Future studies with a prospective approach and larger population size are needed for
confirming our results.
Madarosis is a terminology that refers to loss of eyebrows or eyelashes. This clinical sign occurs in various diseases
ranging from local dermatological disorders to complex systemic diseases. Madarosis can be scarring or non-scarring
depending upon the etiology. Appropriate diagnosis is essential for management. Follicular unit transplantation has
been found to be a useful method of treating scarring madarosis and the procedure relevant to eyebrow and eyelash
reconstruction has been discussed. A useful clinical approach to madarosis has also been included for bedside
diagnosis. The literature search was conducted with Pubmed, Medline, and Google scholar using the keywords
madarosis, eyebrow loss, and eyelash loss for articles from 1960 to September 2011. Relevant material was also
searched in textbooks and used wherever appropriate.
Magnesium sulfate (MgSO4) has been considered as an adjunct therapy for severe and life-threatening asthma
exacerbation. The literature search was performed using MEDLINE, EMBASE, Cochrane Library and Google Scholar to
summarize the current state of knowledge regarding magnesium therapy in acute exacerbation of adult asthma. A
total of 16 trials and 4 meta-analyses were identified. As results, intravenous MgSO4 was beneficial in severe
exacerbation, but evidence for nebulized magnesium was insufficient. However, larger trials are required to draw
confirmative conclusions on the efficacy. Regarding the safety concern, the risk of major toxicity appears to be very
low at usual doses described in the literature. Additionally, results from 4 surveys were examined on the gaps
between knowledge and practice, and on the barrier to the use of MgSO4 at emergency departments. This literature
review summarized the up-to-date evidence on the issues regarding the use of MgSO4 for acute asthma. We expect
more studies to be conducted for evidence making in the Asian-Pacific regions. 2012. Asia Pacific Association of
Allergy, Asthma and Clinical Immunology.
Magnesium sulfate (MgSO(4)) has been considered as an adjunct therapy for severe and life-threatening asthma
exacerbation. The literature search was performed using MEDLINE, EMBASE, Cochrane Library and Google Scholar to
summarize the current state of knowledge regarding magnesium therapy in acute exacerbation of adult asthma. A
total of 16 trials and 4 meta-analyses were identified. As results, intravenous MgSO(4) was beneficial in severe
exacerbation, but evidence for nebulized magnesium was insufficient. However, larger trials are required to draw
confirmative conclusions on the efficacy. Regarding the safety concern, the risk of major toxicity appears to be very
low at usual doses described in the literature. Additionally, results from 4 surveys were examined on the gaps
between knowledge and practice, and on the barrier to the use of MgSO(4) at emergency departments. This
literature review summarized the up-to-date evidence on the issues regarding the use of MgSO(4) for acute asthma.
We expect more studies to be conducted for evidence making in the Asian-Pacific regions.
Background The majority of benign and malignant lesions of the breast are thought to arise from the epithelium of
the terminal duct-lobular unit (TDLU). Although modern mammography, ultrasound, and MRI have improved
diagnosis, a final pathological diagnosis currently relies on percutaneous methods of sampling breast lesions. The
advantage of mammary ductoscopy (MD) is that it is possible to gain direct access to the ductal system via the
nipple. Direct visualization of the duct epithelium allows the operator to precisely locate intraductal lesions, enabling
accurate tissue sampling and providing guidance to the surgeon during excision. The intraductal approach may also
have a role in screening individuals who are at high risk of breast cancer. Finally, in spontaneous nipple discharge
(SND), as biopsy instruments improve and intraductal therapeutics, such as intraductal excision and laser ablation,
become a possibility, normal or benign ductoscopic findings may help minimize surgery in selected patients. As MD
technology is rapidly advancing, a comprehensive review of current practice will be a valuable guide for clinicians
involved in the management of breast disease. Methods This is a review of current ductoscopic practice based on an
exhaustive literature search of Pubmed, Google Scholar, and conference proceedings. The search terms
"ductoscopy", "duct endoscopy", "mammary", "breast," and "intraductal" were used. Results/conclusions Duct
endoscopes have become smaller in diameter with working channels and improved optical definition. Currently, the
role of MD is best defined in the management of SND facilitating targeted surgical excision, potentially avoiding
unnecessary surgery, and limiting the extent of surgical resection for benign disease. The role of MD in breast-cancer
screening and breast conservation surgery has yet to be fully defined. Few prospective randomized trials exist in the
literature, and these would be crucial to validate current opinion, not only in the benign setting but also in breast
oncologic surgery. Springer Science+Business Media, LLC 2010.
BACKGROUND: The authors conducted a systematic review to determine the clinical prognosis of and methods of
managing ankylosed primary molars with permanent successors., METHODS: The authors searched electronic
databases (PubMed, Scopus, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science,
Cochrane Database of Systematic Reviews and Google Scholar) up to April 2012 with the assistance of a librarian
specializing in health sciences databases. They also searched the gray literature. They selected clinical studies in
which investigators assessed the prognosis of ankylosed primary molars with permanent successors; they also hand
searched references of the selected articles to identify any additional studies that the electronic search may have
missed., RESULTS: The authors identified 3,529 original articles from the electronic database search and none from
the hand search. Once selection criteria were applied, only four articles met all inclusion criteria and were included.
The number of patients studied ranged from 15 to 107. The number of ankylosed primary molars investigated ranged
from 26 to 263., CONCLUSIONS: Ankylosed primary molars often manifest with mild to moderate progressive
infraocclusion. Conservative monitoring of ankylosed primary molars is recommended. The clinician should consider
extraction if the permanent successor has an altered path of eruption, if the ankylosed primary molar is severely
infraoccluded with the adjacent teeth tipping to prevent the successor from erupting, or both. The ankylosed molar
often exfoliates spontaneously within six months; however, when exfoliation is more delayed, arch-length loss,
occlusal disturbance, hooked roots or impaction of permanent successors may occur. Practical Implications.
Ankylosed primary molars initially should be monitored closely for up to six months. If they do not exfoliate
spontaneously, they should be removed, because arch-length loss, alveolar bone defects, impacted permanent
successors and occlusal disturbances often occur when the removal is delayed.
Introduction: The optimal management of calcaneal fractures is controversial, as correlation between anatomical
restoration and outcome has not been proven, and complications after surgery are frequent. Sources of data:
MEDLINE, EMBASE, CINAHL, Google scholar, the Cochrane Controlled Trials Register, and the Cochrane
Musculoskeletal Injuries Group Trials Register were searched using the keywords 'calcaneal' and 'fractures', without
time limits or restriction to language. Randomized and quasi-randomized trials were included. Two separate
comparisons were identified in the trials: operative versus non-operative management (five studies), and impulse
compression versus no impulse compression (one study). Two reviewers independently assessed trial quality, with a
12-item scale used by the Cochrane Collaboration. Areas of agreement: Results showed no difference in residual
pain, but favoured surgical management on ability to return to the same work and to wear the same shoes as before
the fracture. Surgery reduced the need for subsequent subtalar fusion. workers' compensation affected
outcome.Areas of controversyIt is unclear whether general health outcome measures, injury specific scores and
radiographic parameters improve after operative management, and whether the benefits of surgery outweigh the
risks.Growing pointsThe existing trials are of relatively poor quality.Areas timely for developing researchThere is still
a need for a carefully designed large-scale trial comparing surgery and non-operative management. Other forms of
fixation (external fixation or minimally invasive internal fixation) should be compared with 'conventional' surgery.
Trials investigating joint reconstruction versus primary subtalar fusion for highly comminuted fractures, and impulse
compression versus placebo could be of value.
Background: Chronic cough is a disruptive and exhausting symptom, reported as very distressing in a quarter of those
in their last year of life. Existing guidelines for management of chronic cough primarily deal with the commonest
benign causes of cough: asthma; eosinophilic bronchitis; gastro-oesophageal reflux disease; rhinosinusitis.
Aim/design: to examine what literature evidence exists and formulate recommendations for managing chronic cough
in patients with advanced, progressive, life-limiting illnesses. Data sources: Electronic databases (MEDLINE, EMBASE,
CINAHL, Cochrane Library, Google Scholar); hand-search; grey literature. Results: Of 11 initially eligible studies, 5
provided evidence at level 2 or better. The small size of these studies, heterogeneity of study population and
diversity of interventions and outcome measures used meant that comparison across studies and compilation of
guidelines based on high-quality evidence was not possible. Pragmatic recommendations based on available
evidence were formulated, drawing on the included studies and, in addition, extrapolating from two other well-
designed studies involving patients with chronic cough. They also took into consideration convenience, toxicity and
minimizing burden and harm of intervention, as well as considering the potential for disease-directed treatment and
the possibility of pharmacological and co-existing benign causes of chronic cough. Conclusions: These
recommendations (Grade D) include simple linctus, therapeutic trial of sodium cromoglycate and then prescription of
an opioid or opioid derivative (dextromethorphan, morphine or codeine). Further research is clearly and urgently
required in this area for more effective approaches to managing cough, tested in trials that have sufficient size,
power and validity.
Introduction: The optimal management for combined anterior cruciate ligament-medial collateral ligament (ACL-
MCL) injuries is controversial. Sources of data: We performed a literature search using Medline, Cochrane and
Google Scholar using the keywords: 'ACL' and 'MCL' in combination with 'surgery treatment', 'conservative
treatment', 'surgery management', 'conservative management', 'surgical treatment' and 'surgical management'. We
identified 23 published studies. Areas of agreement: Conservative and surgical management for combined ACL-MCL
injuries resulted in different functional outcomes. The Coleman Methodology Score showed great heterogeneity in
terms of study design, patient characteristics, management methods and outcome assessment and generally low
methodological quality. Areas of controversy: Given the heterogeneity in terms of treatment and results, we did not
find a univocal trend over the years regarding MCL management (conservative or surgical). The use of several scoring
systems did not allow us to compare outcomes in the different studies. Growing points: There is a need for a
common validated scale for clinical measurements for ACL-MCL injuries, so as to allow easier and more reliable
comparison of outcomes in different studies. To improve diagnostic certainty of combined ACL-MCL injuries, all
patients should have imaging assessment (MR and stress-radiography) in addition to clinical examination. Areas
timely for developing research: There is a need to perform appropriately powered randomized clinical trials of
conservative and surgical treatment of combined ACL-MCL injuries, using standard diagnostic assessment, common
and validated scoring system comparing reported outcomes and duration of follow-up more than 2 years. The
Author 2009. Published by Oxford University Press. All rights reserved.
Context. Envenomations during pregnancy pose all the problems of envenomation in the nonpregnant state with
additional complexity related to maternal physiologic changes, medication use during pregnancy, and the well-being
of the fetus. Objective. We review the obstetric literature and management options available to prevent maternal
morbidity and mortality while limiting adverse obstetric outcomes after envenomation in pregnancy. Methods. In
January 2012, we searched the U.S. National Library of Medicine Medline/PubMed, Toxline, Reprotox, Google
Scholar and Micromedex databases, core surgery and internal medicine textbooks, and references of retrieved
articles for the years 1966 through 2011. Search terms included "envenomation in pregnancy," "stings in pregnancy,"
"antivenom use in pregnancy," "anaphylaxis in pregnancy," and variants of these with known venomous animals.
Reference lists generated further case reports and articles. We included English language articles and abstracts.
Levels of Evidence (LOE) for the reports cited and Grades of Recommendations (GOR) based on LOE for our
recommendations use the National Guidelines Clearinghouse metric of the US DHHS. Results. Recommendations for
the management of envenomation in pregnancy are guided primarily by studies on nonpregnant persons and case
reports of pregnancy. Clinically significant envenomations in pregnancy are reported for snakes, spiders, scorpions,
jellyfish, and hymenoptera (bees, wasps, hornets, and ants). Adverse obstetric outcomes including miscarriage,
preterm birth, placental abruption, and stillbirth are associated with envenomation in pregnancy. The limited
available literature suggests that adverse outcomes are primarily related to venom effects on the mother.
Optimization of maternal health such as management of anaphylaxis and antivenom administration is likely the best
approach to improve fetal outcomes despite potential risks to the fetus of medication administration during
pregnancy. Obstetric evaluation and fetal monitoring are imperative in cases of severe envenomation. Conclusion.
The medical literature regarding envenomation in pregnancy includes primarily retrospective reviews and case
series. The limited available evidence suggests that optimal management includes a venom-specific approach,
including supportive care, antivenom administration in appropriate cases, treatment of anaphylaxis if present, and
fetal assessment. The current available evidence suggests that antivenom use is safe in pregnancy and that what is
good for the mother is good for the fetus. Further research is needed to clarify the optimal management schema for
envenomation in pregnancy. Copyright 2013 Informa Healthcare USA, Inc.
Aims: Vesicant extravasation is a relatively rare but serious complication of chemotherapy administration which can
affect patient wellbeing and survival. Access to evidence-based protocols may minimise the risk of extravasation, and
lead to timely recognition, management and decreased morbidity should extravasation occur. The aim of this work
was to provide clinicians with a current and evidence based extravasation management protocol on the eviQ Cancer
Treatments Online website.Methods: A systematic literature review was undertaken including CINAHL, Medline,
Embase, Cochrane, Clinical Evidence, EBMR Pubmed and Google Scholar, hospital based protocols, professional
organisation and consultation with experts in the field. Results: An immediate management protocol and assessment
chart for IV cytotoxic extravasations and subsequent wound care was developed by clinicians. Over the past 3
months this protocol has received 2,159 visits on the eviQ website. Feedback has been overwhelmingly positive with
many facilities endorsing this protocol as hospital policy. Numerous questions remain unanswered about the issues
surrounding extravasation management. Although several drugs and substances have been evaluated as vesicant
extravasation antidotes and treatments, data on their safety and efficacy are limited and largely based on the results
of animal studies and case reports. In addition, local and international protocols have conflicting recommendations
and show a wide variation in clinical practice. This has highlighted the importance of collecting case reports
systematically on extravasation injuries and treatment outcomes. Conclusions: eviQ is an effective platform for
providing clinicians with an extravasation management protocol. eviQ is designing a study to collect extravasation
injury case reports. Information collected will include types of catheters, fluid and medications, antidotes and
treatment outcomes. This information will build on current knowledge, maintain and improve current management
protocols and ultimately lead to better patient outcomes.
Cervical cancer is the second most common cancer among women worldwide, despite having great potential for
prevention and cure when early diagnosed and treated, which can reduce the mortality rate among the affected.
Since there is no consensus among the therapeutic measures in high grade cervical squamous intraepithelial lesions
(HGSIL), we discuss its approach when dealing with adult women who have HGSIL and the follow-up after the
adopted procedure. We performed electronic searches of MEDLINE (through PubMed), National Guidelines
Clearinghouse, Google Scholar and Lilacs. The guidelines identified were evaluated according to their validity and
recommendations. In relation to after-care, the European use cytology every 6 months, the Australians, cytology and
colposcopy every 6 months, the Americans advocate the realization of hybrid capture in six to 12 months or cytology
every 6 months. The Brazilian Guidelines Project, on its turn, recommends that clinical reassessments and Pap smear
should be performed every three or four months during the first two years of follow-up. Studies comparing the
method "See and Treat" with the three steps one (histology, colposcopy, biopsy) concluded that the latter is
indicated for women ASCUS/LSIL before undergoing the excision of the transformation zone (ETZ), while the "View
and Treat" is indicated in women with proven HGSIL in cytology and suggestive in colposcopy, because it presents
advantages such as low cost and immediate solution. All the guidelines are unanimous in stating that when facing
proven HGSIL, excision of the injury through ablation or conization or ETZ is indicated.
Cervical cancer is the second most common cancer among women worldwide, despite having great potential for
prevention and cure when early diagnosed and treated, which can reduce the mortality rate among the affected.
Since there is no consensus among the therapeutic measures in high grade cervical squamous intraepithelial lesions
(HGSIL), we discuss its approach when dealing with adult women who have HGSIL and the follow-up after the
adopted procedure. We performed electronic searches of MEDLINE (through PubMed), National Guidelines
Clearinghouse, Google Scholar and Lilacs. The guidelines identified were evaluated according to their validity and
recommendations. In relation to after-care, the European use cytology every 6 months, the Australians, cytology and
colposcopy every 6 months, the Americans advocate the realization of hybrid capture in six to 12 months or cytology
every 6 months. The Brazilian Guidelines Project, on its turn, recommends that clinical reassessments and Pap smear
should be performed every three or four months during the first two years of follow-up. Studies comparing the
method "See and Treat" with the three steps one (histology, colposcopy, biopsy) concluded that the latter is
indicated for women ASCUS/LSIL before undergoing the excision of the transformation zone (ETZ), while the "View
and Treat" is indicated in women with proven HGSIL in cytology and suggestive in colposcopy, because it presents
advantages such as low cost and immediate solution. All the guidelines are unanimous in stating that when facing
proven HGSIL, excision of the injury through ablation or conization or ETZ is indicated.
There is a rapid raise in the metabolic risk factors in the general population and non-alcoholic fatty liver disease has
become the most common cause of liver disease worldwide. Early detection of hepatotoxicity is extremely important
because continued ingestion of the drug is often associated with a poor prognosis. Insulin resistance play a central
role in the pathogenesis of Non Alcoholic Fatty Liver Disease (NAFLD); thus obesity, diabetes and the metabolic
syndrome are frequently associated with the disease. Consequently, as these metabolic conditions emerge as major
health problems in Western society, it is now accepted that NAFLD is the most common chronic liver condition in the
Western world. The pathogenesis of non-alcoholic fatty liver disease is not completely understood and even if insulin
resistance is a chief pathogenetic key, many other factors are implicated in both liver fat accumulation and disease
progression to non-alcoholic steatohepatitis. There is, as up till now no firm evidence-based treatment for NAFLD.
Therapy is currently directed at treating components of the metabolic syndrome which may also be valuable for the
liver. Management is further complex by the inability to predict which patients will develop liver-related morbidity
and thus benefit from treatment. Data were located, selected and extracted from SCI database, Medline, Pubmed,
Highwire and Google Scholar. 2011 Asian Network for Scientific Information.
BACKGROUND: Prolonged post-operative ileus (PPOI) occurs in up to 25% of patients following major elective
abdominal surgery. It is associated with a higher risk of developing post-operative complications, prolongs hospital
stay and confers a significant financial load on health-care institutions. Literature outlining best-practice
management strategies for PPOI is nebulous. The aim of this text was to review the literature and provide concise
evidence-based recommendations for its management., METHODS: A literature search through the Ovid MEDLINE,
EMBASE, Google Scholar and Cochrane databases was performed from inception to July 2012 using a combination of
keywords and MeSH terms. Review of the literature was followed by synthesis of concise recommendations for
management accompanied by Strength of Recommendation Taxonomy (either A, B or C)., RESULTS:
Recommendations for management include regular evaluation and correction of electrolytes (B); review of analgesic
prescription with weaning of narcotics and substitution with regular paracetamol, regular non-steroidal anti-
inflammatory drugs if not contraindicated, and regular or as-required Tramadol (A); nasogastric decompression for
those with nausea or vomiting as prominent features (C); isotonic dextrose-saline crystalloid maintenance fluids
administered within a restrictive regimen (B); balanced isotonic crystalloid replacement fluids containing
supplemental potassium, in equivalent volume to losses (C); regular ambulation (C); parenteral nutrition if unable to
tolerate an adequate oral intake for more than 7 days post-operatively (A) and exclusion of precipitating pathology or
alternate diagnoses if clinically suspected (C)., CONCLUSIONS: Recommendations have a variable and frequently
inconsistent evidence base. Further research is required to validate many of the outlined recommendations and to
investigate novel interventions that may be used to shorten duration of PPOI. 2013 The Authors. ANZ Journal of
Surgery 2013 Royal Australasian College of Surgeons.
INTRODUCTION: One in ten patients with rectal cancer presents with synchronous colorectal liver metastases. We
present an up-to-date review of the different surgical strategies available for rectal cancer patients with synchronous
colorectal liver metastases., METHOD: A literature review of MEDLINE, Cochrane and Google scholar was
performed., RESULTS: Twenty retrospective studies comparing staged versus simultaneous resections were found.
Overall survival was similar for both approaches whilst the length of stay was decreased in simultaneous resections.
Only two studies comparing the 'reverse' versus staged or simultaneous resections were found. The studies
investigating resection versus non-resection for rectal primaries with unresectable liver metastases were limited.,
CONCLUSION: Simultaneous resections are a reasonable alternative to staged resections for either advanced rectal
cancers with limited liver disease or early rectal cancers with extensive liver disease. Currently, staged resections are
favoured over simultaneous resections in patients with locally advanced rectal cancers with extensive liver disease.
There are too few studies to determine the safety of reverse resections in the context of locally advanced rectal
cancers. A resection of the primary tumour or a non-surgical intervention can be justified in the management of the
rectal cancer primary in the presence of unresectable liver metastases.
Introduction: One in ten patients with rectal cancer present with synchronous colorectal liver metastases. We
present an up to date review of the different surgical strategies available for rectal cancer patients with synchronous
colorectal liver metastases. Method: A literature review of MEDLINE, Cochrane and Google scholar was performed.
Results: Twenty retrospective studies comparing staged versus simultaneous resections were found. Overall survival
was similar for both approaches, whilst the length of stay was decreased in simultaneous resections. Only two
studies comparing the 'reverse' versus staged or simultaneous resections were found. The studies investigating
resection versus non-resection for rectal primaries with unresectable liver metastases were limited. Conclusion:
Simultaneous resections are a reasonable alternative to staged resections for either advanced rectal cancers with
limited liver disease or early rectal cancers with extensive liver disease. Currently, staged resections are favoured
over simultaneous resections in patients with locally advanced rectal cancers with extensive liver disease. There are
too few studies to determine the safety of reverse resections in the context of locally advanced rectal cancers. A
resection of the primary tumour or a non-surgical intervention can be justified in the management of the rectal
cancer primary in the presence of unresectable liver metastases.
Introduction: Greater trochanteric pain syndrome (GTPS) is a debilitating condition characterized by lateral hip pain
located at or around the greater trochanter.Source of data:We performed a comprehensive search of Pubmed,
Medline, Ovid, Google Scholar and Embase databases, from inception of the database to 20th of June 2011, using a
variety of keywords. We identified 52 relevant abstracts of articles published in peer-reviewed journals. Fourteen
studies reporting the outcomes of patients undergoing conservative and surgical management of GTPS were
selected.Areas of agreement: Significant pain relief and improved outcomes were observed after conservative and
surgical management of GTPS. The modified Coleman methodology score averaged 44.7 (range from 14 to 82),
evidencing an overall low-to-moderate quality of the studies. Repetitive low-energy radial shock wave therapy and
home training approach provide beneficial effect over months, with almost 80 success rate at 15 months.Areas of
controversy: Poor available data extracted from small studies do not allow definitive conclusions to be drawn on the
besttreatment for GTPS.Growing points: Further multi-centre prospective studies are necessary to confirm the
general validity of the findings reported.Areas timely for developing research: Future research and trials should focus
on the application and effectiveness of the various conservative modalities for management of GTPS.Conclusion: The
effectiveness of the various treatment modalities needs to be tested in carefully conducted randomized controlled
trials. 2011 The Author.
Many Americans have replaced home-cooked meals with fast food and restaurants meals. This contributes to
increased incidences of overweight and obesity. Implementing policies that require restaurants to disclose nutrition
information has the potential to improve nutrition knowledge and food behaviors. The purpose of this paper was to
examine the potential health benefits of nutrient menu labeling in restaurants, the progress of this legislation and to
provide results regarding the implementation of these policies. Data sources were obtained from a search of multiple
databases including PubMed, Science Direct, Academic Search Premier, and Google Scholar. Study inclusion criteria
were publication in the past ten years, obesity prevention, and utilization of nutrition labeling on menus in
restaurants. The initial policies to provide consumers with nutrition information in restaurant settings began at the
state levels in 2006. These laws demonstrated success, other states followed, and a national law was passed and is
being implemented. Mandating nutrient menu disclosure has the potential to influence a large number of people;
this legislation has the opportunity to impact Americans who dine at a fast food or chain restaurant. Given the
growing obesity epidemic, continued research is necessary to gauge the effectiveness of this new law and its effects
on the health status of the American people.
To review the published literature in order to address clinical questions regarding the indications, effects and
outcomes of mandibular incisor extraction in orthodontics. Data sources: Three electronic databases were searched:
PubMed (1950-January 2011), Ovid Embase+Ovid Embase Classic (1947-January 2011) and Cochrane library (6
Cochrane databases, 1996-January 2011). The following journals were additionally searched: American Journal of
Orthodontics and Dentofacial Orthopedics (1960-January 2011), Angle Orthodontist (1960-January 2011), European
Journal of Orthodontics (1970-January 2011) and Journal of Orthodontics (1974-January 2011). Grey literature was
searched using Google Scholar and System for Information on Grey Literature in Europe. Secondary search of the
references cited in the relevant articles was also conducted. Data selection: Articles in vivo, in Humans, in English,
concerning treatment of malocclusion with mandibular incisor extractions or missing mandibular incisors. Fifty-four
publications met these inclusion criteria and were reviewed. Data extraction: Data were extracted independently by
two reviewers with regard to: (1) indications; (2) contraindications; (3) effects; (4) outcomes; and (5) factors
associated with successful outcomes. Data synthesis: Considering the descriptive nature of the studies found, a
narrative synthesis was undertaken. Conclusions: The descriptive nature of published articles precludes making
strong evidence-based recommendations regarding this extraction choice, but it is clear that mandibular incisor
extraction can be effectively used in the resolution of crowding, as well as intermaxillary malocclusion in carefully
selected cases. Several factors that could lead to good outcomes of orthodontic treatment following mandibular
incisor extraction were identified. Mild-to-moderate class III malocclusion, an edge-to-edge anterior occlusion or
anterior crossbite, with mild anterior mandibular tooth size excess, and minimal open bite tendencies were the
clinical situations most frequently treated with this unique extraction choice. On the other hand, clinicians should be
careful to avoid poor outcomes such as gingival recession, open interproximal gingival embrasures, increased overjet
and overbite. 2011 British Orthodontic Society.
Objective The purpose of this study was to complete a systematic review of manual and manipulative therapy (MMT)
for common upper extremity pain and disorders including the temporomandibular joint (TMJ). Methods A literature
search was conducted using the Cumulative Index of Nursing Allied Health Literature, PubMed, Manual, Alternative,
and Natural Therapy Index System (MANTIS), Physiotherapy Evidence Database (PEDro), Index to Chiropractic
Literature, Google Scholar, and hand search inclusive of literature from January 1983 to March 5, 2012. Search limits
included the English language and human studies along with MeSH terms such as manipulation, chiropractic,
osteopathic, orthopedic, and physical therapies. Inclusion criteria required an extremity peripheral diagnosis (for
upper extremity problems including the elbow, wrist, hand, finger and the (upper quadrant) temporomandibular
joint) and MMT with or without multimodal therapy. Studies were assessed using the PEDro scale in conjunction with
modified guidelines and systems. After synthesis and considered judgment scoring was complete, evidence grades of
"A, B, C and I" were applied. Results Out of 764 citations reviewed, 129 studies were deemed possibly to probably
useful and/or relevant to develop expert consensus. Out of 81 randomized controlled or clinical trials, 35 were
included. Five controlled or clinical trials were located and 4 were included. Fifty case series, reports and/or single-
group pre-test post-test prospective case series were located with 32 included. There is Fair (B) level of evidence for
MMT to specific joints and the full kinetic chain combined generally with exercise and/or multimodal therapy for
lateral epicondylopathy, carpal tunnel syndrome, and temporomandibular joint disorders, in the short term.
Conclusion The information from this study will help guide practitioners in the use of MMT, soft tissue technique,
exercise, and/or multimodal therapy for the treatment of a variety of upper extremity complaints in the context of
the hierarchy of published and available evidence. 2013 National University of Health Sciences.
Objective: The objective of this review is to evaluate the evidence on the effects of Spinal Manipulative Therapy
(SMT) on back pain and other related symptoms during pregnancy. Data Sources: A literature search was conducted
using Pubmed, Manual, Alternative and Natural Therapy Index System, Cumulated Index to Nursing and Allied
Health, Index to Chiropractic Literature, the Cochrane Library, and Google Scholar. In addition hand searches and
reference tracking were also performed, and the citation list was assessed for comprehensiveness by content
experts. Methods of Study Selection: This review was limited to peer-reviewed manuscripts published in English from
1966 until September 2008. The initial search strategy yielded 140 citations of which 12 studies were reviewed for
quality. Tabulation, Integration, and Results: The methodological quality of the included studies was assessed
independently using quality checklists of the Scottish Intercollegiate Guidelines Network and Council on Chiropractic
Guidelines and Practice Parameters. The review indicates that the use of SMT during pregnancy to reduce back pain
and other related symptoms is supported by limited evidence. Conclusion: Overall, this body of evidence is best
described as emergent. However, since effective treatments for pregnancy-related back pain are limited, clinicians
may want to consider SMT as a treatment option, if no contraindications are present. Target Audience: Obstetricians
& Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to
describe the concepts of spinal manipulative therapy and types of symptoms for which it might be considered in
pregnancy, explain the quality of available research on the use of spinal manipulative therapy, and plan to discuss
this therapy with interested pregnant patients. Copyright 2009 by Lippincott Williams & Wilkins.
OBJECTIVE: The objective of this review is to evaluate the evidence on the effects of Spinal Manipulative Therapy
(SMT) on back pain and other related symptoms during pregnancy. DATA SOURCES: A literature search was
conducted using Pubmed, Manual, Alternative and Natural Therapy Index System, Cumulated Index to Nursing and
Allied Health, Index to Chiropractic Literature, the Cochrane Library, and Google Scholar. In addition hand searches
and reference tracking were also performed, and the citation list was assessed for comprehensiveness by content
experts. METHODS OF STUDY SELECTION: This review was limited to peer-reviewed manuscripts published in English
from 1966 until September 2008. The initial search strategy yielded 140 citations of which 12 studies were reviewed
for quality. TABULATION, INTEGRATION, AND RESULTS: The methodological quality of the included studies was
assessed independently using quality checklists of the Scottish Intercollegiate Guidelines Network and Council on
Chiropractic Guidelines and Practice Parameters. The review indicates that the use of SMT during pregnancy to
reduce back pain and other related symptoms is supported by limited evidence. CONCLUSION: Overall, this body of
evidence is best described as emergent. However, since effective treatments for pregnancy-related back pain are
limited, clinicians may want to consider SMT as a treatment option, if no contraindications are present. TARGET
AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article,
the reader should be able to describe the concepts of spinal manipulative therapy and types of symptoms for which
it might be considered in pregnancy, explain the quality of available research on the use of spinal manipulative
therapy, and plan to discuss this therapy with interested pregnant patients.
Aim: To review the literature on visual impairment in children in order to determine which manneristic behaviors are
associated with visual impairment, and to establish why these behaviors occur and whether severity of visual
impairment influences these behaviors. Methods: A literature search utilizing PubMed, OVID, Google Scholar, and
Web of Knowledge databases was performed. The University of Liverpool (www.liv.ac.uk/orthoptics/research) and
local library facilities were also searched. Results: The main manneristic or stereotypic behaviors associated with
visual impairment are eye-manipulatory behaviors, such as eye poking and rocking. The degree of visual impairment
influences the type of behavior exhibited by visually impaired children. Totally blind children are more likely to adopt
body and head movements whereas sight-impaired children tend to adopt eye-manipulatory behaviors and rocking.
The mannerisms exhibited most frequently are those that provide a specific stimulation to the child. Theories to
explain these behaviors include behavioral, developmental, functional, and neurobiological approaches. Although
the precise etiology of these behaviors is unknown, it is recognized that each of the theories is useful in providing
some explanation of why certain behaviors may occur. The age at which the frequency of these behaviors decreases
is associated with the child's increasing development, thus those visually impaired children with additional
disabilities, whose development is impaired, are at an increased risk of developing and maintaining these behaviors.
Certain manneristic behaviors of the visually impaired child may also help indicate the cause of visual impairment.
Conclusions: There is a wide range of manneristic behaviors exhibited by visually impaired children. Some of these
behaviors appear to be particularly associated with certain causes of visual impairment or severity of visual
impairment, thus they may supply the practitioner with useful information. Further research into the prevalence of
these behaviors in the visually impaired child is required in order to provide effective management. 2011 Informa
Healthcare USA, Inc.
This literature review aimed to investigate whether Maori with aphasia and their whanau are being included in
research. A second aim was to identify what, if any, specific outcomes or concerns have been reported. Although the
prevalence and incidence of aphasia in the Maori population is unknown, it is likely to be relatively high, given the
high rate of stroke among Maori. We provide a background to Maori health, stroke, aphasia and rehabilitation. A
standard review of the literature was conducted in the online databases PsycINFO, ScienceDirect, PubMed,
MEDLINE, CINAHL Plus, and Google Scholar. We searched "Maori" AND "aphasia" and "Maori" AND "dysphasia" as
"anywhere in text" and as a keyword with no limits placed on publication dates. The search revealed no articles that
involve Maori with aphasia and none that address aphasia in the Maori population. Four articles involved Maori
participants with stroke or a condition linked to communication disorders and specifically addressed either culture or
ethnicity in their observations or results. We consider possible explanations for this apparent lack of Maori with
aphasia as participants in research, and conclude that the investigation of aphasia in Maori requires an approach that
involves Maori with aphasia and their whanau, in a way that is culturally appropriate enabling them to have a voice.
Map of Medicine is an evidence-based online clinical knowledge resource. Procured at significant cost by healthcare
providers in the UK, Sweden and Denmark, it is important to establish the beneficial impact that investment has had
on healthcare practise and, ultimately, on patient outcomes. The objective of this study is to review the evidence for
the impact of the Map of Medicine on clinical practice. A systematic review of peer-reviewed and grey literature was
conducted. Nine healthcare databases, Google Scholar and Google were searched for articles containing the terms
'map of medicine'. The search identified 133 articles. Eleven of the articles identified met the inclusion criteria. The
main finding of the study is the paucity of evidence available on the impact of the Map of Medicine and the variable
quality of that which does exist. There are some encouraging early indications for the Map of Medicine as a tool
within service redesign, leading to an increase in appropriate referrals to secondary care, decreased patient waiting
times and considerable cost savings. Further research with study designs that can generate high quality evidence for
the impact of Map of Medicine is essential in order to support policy decisions. 2011 The authors. Health Information
and Libraries Journal 2011 Health Libraries Group.
Purpose: An operational definition of dementia-related wandering is proposed to aid in clinical recognition, to
promote research precision and validity, and to provide a pathway toward standardization of language in wandering
science. Design and Methods: (1) One-hundred-and-eighty-three journal articles from multiple databases (Medline,
OVID, CSA Journals, OCLC First Search, Google Scholar, PubMed, EBSCO) were reviewed to extract alternative terms
and definitions for wandering or wandering-related behaviours; (2) terms and definitions were ordered
alphabetically into a glossary; (3) a consensus approach was used to group glossary terms with related meanings into
possible domains of wandering; (4) four domains (locomotion, drive, space and time) were found sufficient to
encompass all wandering definitions; (5) wandering terms were placed into a conceptual map bounded by the four
domain concepts and (6) a new provisional definition of wandering was formulated. Results: An empirically-based,
operational definition improves clinical and research approaches to wandering and explicates historical inattention
to certain beneficial aspects of the behaviour. Implications: Adoption of the proposed operational definition of
wandering behaviour provides a platform upon which dementia care may be improved and standardized language
may evolve in wandering science. 2007 Taylor & Francis.
Background: Outbreaks of vaccine preventable diseases (VPDs) occur in unimmunized communities. When clustered,
such communities are at continual risk from re-introduction of these diseases. Objectors who are interspersed
among vaccinated individuals are also at higher risk of infection. A three part project was undertaken in British
Columbia to describe, map, and understand conscientious objectors in BC. This abstract describes findings from part
one. Purpose: To conduct a literature review on vaccine refusing communities. Methods: Scientific journal database
searches of PubMed and Google Scholar, as well as archive searches of ProMed, CCDR and MMWR were conducted.
Search terms included: unimmunized, unvaccinated, vaccine exemption, vaccine refusal, orthodox, Waldorf,
anthroposophic, conscientious objector, Dutch Reformed, independently or in combination with 'outbreak'. The
search was limited to western world literature. Results: Twenty six papers (15 outbreak reports, 5 cross-sectional
studies, 2 outbreak reports/retrospective cohort studies, 2 retrospective cohort studies, 1 case-control study, and 1
literature review) were retrieved. Four papers examined association between vaccination status and VPD risk. All
found a risk between lack of vaccination and risk of contracting measles, rubella, and pertussis. Two papers analyzed
characteristics of unvaccinated and vaccinated individuals, with opposing findings related to race, income, and
household size. Among 17 outbreak reports, 15 involved religious exemptions and 16 reported vaccination status.
Collectively, 88.6% (4215/4759) of VPD cases were eligible for vaccines but unimmunized. Most cases were residents
of the unimmunized community. One paper found a strong association between pertussis rates and geographic
clustering of unvaccinated persons. Conclusion: Published literature suggests a significantly higher risk of VPDs
among unimmunized. Herd immunity provides greater protection to individual objectors within vaccinated
communities but not to geographically clustered communities. No publications were found to enumerate and map
unimmunized populations. Further analysis will be done in BC to locate and describe vulnerable groups and
individuals.
Massage therapy is widely used by patients with fibromyalgia seeking symptom relief. We performed a review of all
available studies with an emphasis on randomized controlled trials to determine whether massage therapy can be a
viable treatment of fibromyalgia symptoms. Extensive narrative review. PubMed, PsychInfo, CINAHL, PEDro, ISI Web
of Science, and Google Scholar databases (inception-December 2009) were searched for the key words "massage",
"massotherapy", "self-massage", "soft tissue manipulation", "soft tissue mobilization", "complementary medicine",
"fibromyalgia" "fibrositis", and "myofascial pain". No language restrictions were imposed. The reference lists of all
articles retrieved in full were also searched. The effects of massage on fibromyalgia symptoms have been examined
in two single-arm studies and six randomized controlled trials. All reviewed studies showed short-term benefits of
massage, and only one single-arm study demonstrated long-term benefits. All reviewed studies had methodological
problems. The existing literature provides modest support for use of massage therapy in treating fibromyalgia.
Additional rigorous research is needed in order to establish massage therapy as a safe and effective intervention for
fibromyalgia. In massage therapy of fibromyalgia, we suggest that massage will be painless, its intensity should be
increased gradually from session to session, in accordance with patient's symptoms; and the sessions should be
performed at least 1-2 times a week. Springer-Verlag 2009.
Introduction: Spermatorrhoea, the involuntary loss of semen, was once considered to be "a subject of more
importance, as regards human health and happiness, than perhaps any other that can be mentioned". Materials and
Methods: A literature search for articles and textbooks on spermatorrhoea was performed using the Wellcome
Trust's and RSM's databases, and Medline and Google scholar websites. Results: The French professor Claude
Lallemand wrote in 1835 of "a disease that degrades man, poisons the happiness of his best days, and ravages
society". Soon, throughout the Western world many a young man "terminated a short-lived, miserable existence by
suicide, or dragged out his life in a state of idiotic imbecility". The cause: "long continued and frequent self-abuse",
the cure: Cauterization of the prostatic urethra and spiked penile rings. At the end of the century surgeons
questioned the very existence of spermatorrhoea, which had become "to the public a term of terror", and it faded
from prominence. Such conditions, however, are still "treated" in Eastern societies which have similar views on
sexuality to our pious 19th century forefathers. Conclusion: The mass delusion of spermatorrhoea is a cautionary
example of the power of medics to both falsely judge and harm their patients.
BACKGROUND: Obesity among pregnant women is highly prevalent worldwide and is associated in a linear manner
with markedly increased risk of adverse outcome for mother and infant. Obesity in the mother may also
independently confer risk of obesity to her child. The role of maternal metabolism in determining these outcomes
and the potential for lifestyle modification are largely unknown. METHODS: Relevant studies were identified by
searching PubMed, the metaRegister of clinical trials and Google Scholar without limitations. Sensitive search
strategies were combined with relevant medical subject headings and text words. RESULTS: Maternal obesity and
gestational weight gain have a significant impact on maternal metabolism and offspring development. Insulin
resistance, glucose homeostasis, fat oxidation and amino acid synthesis are all disrupted by maternal obesity and
contribute to adverse outcomes. Modification of lifestyle is an effective intervention strategy for improvement of
maternal metabolism and the prevention of type 2 diabetes and, potentially, gestational diabetes. CONCLUSIONS:
Maternal obesity requires the development of effective interventions to improve pregnancy outcome. Strategies
that incorporate a detailed understanding of the maternal metabolic environment and its consequences for the
health of the mother and the growth of the child are likely to identify the best approach.
Background: Although several studies have investigated the association between maternal serum vitamin D levels
and risk of pre-eclampsia, findings are inconsistent. This systematic review and meta-analysis of published
observational studies was conducted to summarize the evidence on the association between maternal serum vitamin
D levels and risk of pre-eclampsia. Methods: PubMed, ISI (Web of science), SCOPUS, SCIRUS, Google Scholar, and
EMBASE databases were searched to identify related articles published through December 2012. For systematic
review, we found 15 articles that assessed the association between maternal serum vitamin D levels and risk of pre-
eclampsia. The meta-analysis was done on 8 studies that reported odds ratios or relative risks for pre-eclampsia.
Between-study heterogeneity was examined using Cochran's Q test and I(2). Subgroup analysis and meta-regression
were used to find possible sources of heterogeneity. Results: The meta-analysis on 8 relevant papers revealed an
overall significant association between vitamin D deficiency and risk of pre-eclampsia; however, there was significant
between-study heterogeneity (I(2) = 52.7%; P = .039). In the subgroup analysis, we found that the overall effect was
significant for studies that defined vitamin D deficiency as 25(OH)D <= 50 nmol/L (20 ng/mL), but not for those that
considered it as <38 nmol/L (15.2 ng/mL). The association was seen for "cohort or nested case-control studies" as
well as for "cross-sectional or case-control studies" (2.78; 1.45-5.33; P = .002). When the analysis was done by study
location, the associations remained significant only for studies that came from the United States. Conclusion: There
was a significant relationship between vitamin D deficiency and increased risk of pre-eclampsia. Further studies are
required, particularly in developing countries.
Aims. This paper is a report of a methodological review conducted to analyse, evaluate and synthesize the rigour of
measures found in nursing and health-related literature used to assess and evaluate patient spirituality as more than
religiosity. Background. Holistic healthcare practitioners recognize important distinctions exist about what
constitutes spiritual care needs and preferences and what constitutes religious care needs and preferences in patient
care practice. Data sources. Databases searched, limited to the years 1982 and 2009, included AMED, Alt Health
Watch, CINAHL Plus with Full Text, EBSCO Host, EBSCO Host Religion and Philosophy, ERIC, Google Scholar, HAPI,
HUBNET, IngentaConnect, Mental Measurements Yearbook Online, Ovid MEDLINE, Social Work Abstracts and Hill
and Hood's Measures of Religiosity text. Review methods. A methodological review was carried out. Measures
assessing spirituality as more than religiosity were critically reviewed including quality appraisal, relevant data
extraction and a narrative synthesis of findings. Results. Ten measures fitting inclusion criteria were included in the
review. Despite agreement among nursing and health-related disciplines that spirituality and religiosity are distinct
and diverse concepts, the concept of spirituality was often used interchangeably with the concept religion to assess
and evaluate patient spirituality. The term spiritual or spirituality was used in a preponderance of items to assess or
evaluate spirituality. Conclusions. Measures differentiating spirituality from religiosity are grossly lacking in nursing
and health-related literature. 2011 Blackwell Publishing Ltd.
AIMS: This paper is a report of a methodological review conducted to analyse, evaluate and synthesize the rigour of
measures found in nursing and health-related literature used to assess and evaluate patient spirituality as more than
religiosity., BACKGROUND: Holistic healthcare practitioners recognize important distinctions exist about what
constitutes spiritual care needs and preferences and what constitutes religious care needs and preferences in patient
care practice., DATA SOURCES: Databases searched, limited to the years 1982 and 2009, included AMED, Alt Health
Watch, CINAHL Plus with Full Text, EBSCO Host, EBSCO Host Religion and Philosophy, ERIC, Google Scholar, HAPI,
HUBNET, IngentaConnect, Mental Measurements Yearbook Online, Ovid MEDLINE, Social Work Abstracts and Hill
and Hood's Measures of Religiosity text. Review methods: A methodological review was carried out. Measures
assessing spirituality as more than religiosity were critically reviewed including quality appraisal, relevant data
extraction and a narrative synthesis of findings., RESULTS: Ten measures fitting inclusion criteria were included in the
review. Despite agreement among nursing and health-related disciplines that spirituality and religiosity are distinct
and diverse concepts, the concept of spirituality was often used interchangeably with the concept religion to assess
and evaluate patient spirituality. The term spiritual or spirituality was used in a preponderance of items to assess or
evaluate spirituality., CONCLUSIONS: Measures differentiating spirituality from religiosity are grossly lacking in
nursing and health-related literature. 2011 Blackwell Publishing Ltd.
Objectives: To compare H index scores for healthcare researchers returned by Google Scholar, Web of Science and
Scopus databases, and to assess whether a researcher's age, country of institutional affiliation and physician status
influences calculations. Subjects and Methods: One hundred and ninety-five Nobel laureates in Physiology and
Medicine from 1901 to 2009 were considered. Year of first and last publications, total publications and citation
counts, and the H index for each laureate were calculated from each database. Cronbach's alpha statistics was used
to measure the reliability of H index scores between the databases. Laureate characteristic influence on the H index
was analysed using linear regression. Results: There was no concordance between the databases when considering
the number of publications and citations count per laureate. The H index was the most reliably calculated
bibliometric across the three databases (Cronbach's alpha = 0.900). All databases returned significantly higher H
index scores for younger laureates (p < 0.0001). Google Scholar and Web of Science returned significantly higher H
index for physician laureates (p = 0.025 and p = 0.029, respectively). Country of institutional affiliation did not
influence the H index in any database. Conclusion: The H index appeared to be the most consistently calculated
bibliometric between the databases for Nobel laureates in Physiology and Medicine. Researcher-specific
characteristics constituted an important component of objective research assessment. The findings of this study call
to question the choice of current and future academic performance databases. 2013 S. Karger AG, Basel.
BACKGROUND/OBJECTIVE: Depression has been studied extensively among people with spinal cord injury (SCI).
However, basic questions persist regarding the reliability and validity of depression measurement in the context of
SCI. The objective of this study was to evaluate the state of knowledge of depression measurement in persons with
SCI. METHODS: English-language peer-reviewed citations from MEDLINE, CINAHL, PsycINFO, ProQuest, Google
Scholar, and Web of Science from 1980 to present. Two reviewers screened 377 abstracts on SCI and depression
topics to identify 144 containing classifiable psychometric data. All 144 were reviewed by 6 reviewers. Twenty-four
studies reporting psychometric data on 7 depression measures in SCI samples were identified, including 7 validity
studies. RESULTS: Reliability data were limited to internal consistency and were consistently good to excellent across
19 studies. Validity data were limited to concurrent validity, construct validity, and/or clinical utility in 10 studies.
Measures were comparable with respect to internal consistency, factor structure, and clinical utility. Results are
limited to peer-reviewed, English literature, and studies were not judged for quality. CONCLUSIONS: Greater
attention should be paid to the psychometric evaluation of established measures. Although existing evidence may
not justify universal screening, we recommend depression screening in clinical practice when patients may be seen
by nonpsychology personnel. There is insufficient evidence to recommend one screening measure over another.
Therefore, selection of measures will depend on clinician preferences. Psychometric studies are needed to show test-
retest reliability, criterion validity, and sensitivity to change to improve depression recognition and treatment.
Current evidence indicates that women with young children are less active than women without children. In this
review the authors investigated the methods of measuring physical activity employed in studies of women with
young children (aged 1-5 years) and the associated challenges in measurement. Articles from databases (MEDLINE,
OVID, CINAHL, Google Scholar) and manual searches were limited to English peer-reviewed journals published from
1990 to 2010. Studies that included measurement of physical activity in samples of women with young childrenwere
selected. Measurement properties were extracted, and original reliability and validity articles were reviewed for
physical activity measurement tools used by 15 samples. The evidence base was dominated by self-report
measurement tools, many of which assessed leisure-time physical activity only. Use of motion sensors to assess
physical activity in this population was limited. It is likely that much of the habitual physical activity performed by
women with young children has not been captured by self-report measures. Further investigation should be
undertaken using tools that capture adequatelyall health enhancing physical activity among women with young
children. Copyright Taylor & Francis Group, LLC.
To identify methods used to assess physical activity and sedentary behaviour at the workplace and review the
validity and reliability of these measures. Databases were searched for relevant published articles including
MEDLINE, SPORT Discus, ProQuest and Google Scholar. Keywords used were physical-activity, workplace, sedentary-
behaviour, measurement and questionnaire. Studies included were original, written in English, published between
1990 and 2009, and focused on validated physical activity and sedentary behaviour measures at work. Eleven papers
were identified in which three used criterion standards, three objective measures, and five subjective measures. The
most common method of data collection was through self-report, surveys or questionnaires. Physical activity
measured with motion sensors, ranged from 4,422 to 10,334 steps/day (pedometers) and sedentary time ranged
from 1.8 to 6 hours/day (h/d) (accelerometers). Self-report measures provided information relevant to the
perception of physical activity at work (~ 0.5 h/d), sitting time (> 3 h/d) and calculated energy expenditure (< 800
kcal/d). Physical activity levels at work were low while sedentary behaviour was high. This was largely a function of
occupation (white-collar vs. blue-collar). None of the studies assessed validity or reliability of measures used
however, instruments as assessed by others showed moderate to strong validity and reliability values.
Purpose: To identify from the literature, and to critically evaluate, all validated instruments currently available to
measure self-harming behaviour in adults. Materials and methods: Medline, Embase, PsycInfo, Health and
Psychosocial Instruments and Google scholar were searched, grey literature was sought and the reference lists of
relevant articles were checked to identify instruments. Results: A total of seven validated instruments which met our
inclusion criteria were identified and data were extracted regarding each instrument's format, administration
method, psychometric properties and number of items and domains included. Considerable variation was observed
in the overall quality of these instruments. Fourteen other instruments were identified which did not describe their
psychometric properties or had not been published and were subsequently excluded from our review. Discussion:
Although many instruments were identified in our search, only a small number had been validated with published
psychometric properties. Of the identified instruments, the Suicide Attempt Self-Injury Interview (SASII) appears to
be the most robust and comprehensive instrument currently available. Despite the absence of psychometric data,
numerous other instruments have been used in published studies, including clinical trials. Conclusion: Our results
highlight the pressing need for a standardized, empirically validated and versatile measure of intentional self-
harming behaviour for use in both clinical and research settings. The optimum characteristics of such an instrument
are discussed. 2011 Elsevier Masson SAS.
The aim of this paper was to conduct a systematic review of the published literature to address the question: "In pre-
hospital adult cardiac arrest (asystole, pulseless electrical activity, pulseless Ventricular Tachycardia and Ventricular
Fibrillation), does the use of mechanical Cardio-Pulmonary Resuscitation (CPR) devices compared to manual CPR
during Out-of-Hospital Cardiac Arrest and ambulance transport, improve outcomes (e.g. Quality of CPR, Return Of
Spontaneous Circulation, Survival)". Databases including PubMed, Cochrane Library (including Cochrane database for
systematic reviews and Cochrane Central Register of Controlled Trials), Embase, and AHA EndNote Master Library
were systematically searched. Further references were gathered from cross-references from articles and reviews as
well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included manikin and
human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case
series and case reports. Out of 88 articles identified, only 10 studies met the inclusion criteria for further review. Of
these 10 articles, 1 was Level of Evidence (LOE) 1, 4 LOE 2, 3 LOE 3, 0 LOE 4, 2 LOE 5. 4 studies evaluated the quality
of CPR in terms of compression adequacy while the remaining six studies evaluated on clinical outcomes in terms of
return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and Cerebral
Performance Categories (CPC). 7 studies were supporting the clinical question, 1 neutral and 2 opposing. In this
review, we found insufficient evidence to support or refute the use of mechanical CPR devices in settings of out-of-
hospital cardiac arrest and during ambulance transport. While there is some low quality evidence suggesting that
mechanical CPR can improve consistency and reduce interruptions in chest compressions, there is no evidence that
mechanical CPR devices improve survival, to the contrary they may worsen neurological outcome.
AIMS: The aim of this paper was to conduct a systematic review of the published literature to address the question:
"In pre-hospital adult cardiac arrest (asystole, pulseless electrical activity, pulseless Ventricular Tachycardia and
Ventricular Fibrillation), does the use of mechanical Cardio-Pulmonary Resuscitation (CPR) devices compared to
manual CPR during Out-of-Hospital Cardiac Arrest and ambulance transport, improve outcomes (e.g. Quality of CPR,
Return Of Spontaneous Circulation, Survival)"., METHODS: Databases including PubMed, Cochrane Library (including
Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials), Embase, and AHA
EndNote Master Library were systematically searched. Further references were gathered from cross-references from
articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review
included manikin and human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were
review articles, case series and case reports., RESULTS: Out of 88 articles identified, only 10 studies met the inclusion
criteria for further review. Of these 10 articles, 1 was Level of Evidence (LOE) 1, 4 LOE 2, 3 LOE 3, 0 LOE 4, 2 LOE 5. 4
studies evaluated the quality of CPR in terms of compression adequacy while the remaining six studies evaluated on
clinical outcomes in terms of return of spontaneous circulation (ROSC), survival to hospital admission, survival to
discharge and Cerebral Performance Categories (CPC). 7 studies were supporting the clinical question, 1 neutral and
2 opposing., CONCLUSION: In this review, we found insufficient evidence to support or refute the use of mechanical
CPR devices in settings of out-of-hospital cardiac arrest and during ambulance transport. While there is some low
quality evidence suggesting that mechanical CPR can improve consistency and reduce interruptions in chest
compressions, there is no evidence that mechanical CPR devices improve survival, to the contrary they may worsen
neurological outcome.
Background: Consumption of high fat diet and obesity has been reported to increase small intestinal permeability. In
addition to the usual function of digestion and absorption of nutrients, gastrointestinal mucosa functions as a barrier
to prevent the entrance of harmful agents into the systemic circulation and protects living organisms from different
noxious agents. Any disruption of the gut barrier function might play a role in high fat diet and obesity induced
intestinal and extra intestinal pathology. Underlying mechanisms of this process is poorly understood. Objectives: To
review the mechanisms underlying high fat diet and or obesity induced higher intestinal permeability. Methods: We
searched the related articles in PubMed, Scopus and Google Scholar from January 1980 till August 2011. Results: We
found 58 studies using the key words high fat diet, obesity, gut barrier, intestinal permeability, claudin, occludin,
junctional adhesion molecule and intestinal tight junction proteins. Only 6 of them evaluated intestinal permeability.
Consumption of high fat diet and or obesity was found to be associated with compromised intestinal tight junction
proteins. Conclusion: Understanding the mechanisms and modulation of tight junction proteins by nutrients or
pharmaceutical agents will prevent different intestinal and extra intestinal pathologies. 2012 Japan International
Cultural Exchange Foundation and Japan Health Sciences University.
Dyslipidemia and following atherosclerosis as a chronic affection remain one major cause of death all over the world.
Given multiple reports on positive effects of melatonin on dyslipidemia, there is a need for reviewing all these
studies in order to reach a convincing conclusion. Towards this goal, we have reviewed all previous investigations on
use of melatonin in dyslipidemia found from PubMed, Cochrane, Google Scholar, Scopus and web of Science up to
January 2012. Of the publications identified in the initial database, 11 clinical trials and 43 nonclinical trials (18 in
vitro and 25 animal studies) were included and reviewed. Most of the results reveal the potency of melatonin as an
antioxidant in preventing lipid peroxidation through different mechanisms and therefore, improving the lipid profile.
Melatonin has anti-inflammatory and antioxidative effects, neutralizes free radicals, increases antioxidative enzymes
and glutathione levels, prevents electron leakage from the mitochondrial respiratory chain, acts synergistically with
vitamin C, E and glutathione, reduces levels of pro-inflammatory cytokines and therefore prevents Low-density
Lipoprotein (LDL) oxidation and decreases lipid peroxidation. The results indicate a need for further studies on
safety/efficacy measures if melatonin was used in long-term. 2012 Asian Network for Scientific Information.
Medical ethics has a long history worldwide, and the move towards a trans-cultural ethics must be based on an
appreciation of the civilizations' history. It is often thought that medical ethics history has begun by Hippocrates,
however it is much older. It is clear that various cultures such as Babylonia, ancient Egypt, Greece, and the Persians
have attempted to regulate medicine and to protect patients' rights in the known ancient world. One of the earliest
written provisions in this field, which comes back to about 1750 BC, is the code of Hammurabi written by Babylonian.
In this paper we aimed to explore the roots of medical ethics in Persian history, particularly, after adherence of
Iranians to Islam. In this article, we used related books of great Iranian and non-Iranian historians, and examined
some authentic articles collected through searches of databases such as Medline and Ovid and search engines such
as Google Scholar. History of medicine in Iran has begun about fourth century BCE. Great Iranian physicians had paid
special attention to ethics in their practices, teachings and manuscripts. There was a gap between the ancient
civilizations and the Renaissance era in Europe, commonly called the dark ages (Medieval). The immense strides have
been made by the Persians in that long interval which is briefly reviewed.
The Internet provides a quick access to a plethora of the medical literature, in the form of journals, databases,
dictionaries, textbooks, indexes, and e-journals, thereby allowing access to more varied, individualized, and
systematic educational opportunities. Web search engine is a tool designed to search for information on the World
Wide Web, which may be in the form of web pages, images, information, and other types of files. Search engines for
internet-based search of medical literature include Google, Google scholar, Yahoo search engine, etc., and databases
include MEDLINE, PubMed, MEDLARS, etc. Commercial web resources (Medscape, MedConnect, MedicineNet) add
to the list of resource databases providing some of their content for open access. Several web-libraries (Medical
matrix, Emory libraries) have been developed as meta-sites, providing useful links to health resources globally.
Availability of specific dermatology-related websites (DermIs, DermNet, and Genamics Jornalseek) is useful addition
to the ever growing list of web-based resources. A researcher must keep in mind the strengths and limitations of a
particular search engine/database while searching for a particular type of data. Knowledge about types of literature
and levels of detail available, user interface, ease of access, reputable content, and period of time covered allow
their optimal use and maximal utility in the field of medicine.
Medical literature searches provide critical information for clinicians. However, the best strategy for identifying
relevant high-quality literature is unknown. We compared search results using PubMed and Google Scholar on four
clinical questions and analysed these results with respect to article relevance and quality. Abstracts from the first 20
citations for each search were classified into three relevance categories. We used the weighted kappa statistic to
analyse reviewer agreement and nonparametric rank tests to compare the number of citations for each article and
the corresponding journals' impact factors. Reviewers ranked 67.6% of PubMed articles and 80% of Google Scholar
articles as at least possibly relevant (P = 0.116) with high agreement (all kappa P-values < 0.01). Google Scholar
articles had a higher median number of citations (34 vs. 1.5, P < 0.0001) and came from higher impact factor journals
(5.17 vs. 3.55, P = 0.036). PubMed searches and Google Scholar searches often identify different articles. In this
study, Google Scholar articles were more likely to be classified as relevant, had higher numbers of citations and were
published in higher impact factor journals. The identification of frequently cited articles using Google Scholar for
searches probably has value for initial literature searches. 2012 The authors. Health Information and Libraries Journal
2012 Health Libraries Group.
BACKGROUND: Alternative dispute resolution (ADR) refers to techniques used to resolve conflicts without going to
the courtroom. As healthcare and malpractice costs continue to rise, there is growing interest in tactics such as early
apology, mediation, and arbitration in the medical arena., QUESTIONS/PURPOSES: (1) Why is ADR needed? (2) Is ADR
useful in health care? (3) What are the current legal and political developments favoring ADR? (4) What obstacles
remain?, METHODS: We performed MEDLINE, PubMed, and Google Scholar searches with key words "medical
malpractice", "ADR", and "alternative dispute resolution" to obtain public policy studies, law review articles, case
analyses, ADR surveys, and healthcare review articles., RESULTS: Early apology and disclosure programs report 50%
to 67% success in avoiding litigation as well as substantial reductions in the amount paid per claim. Mediation boasts
75% to 90% success in avoiding litigation, cost savings of $50,000 per claim, and 90% satisfaction rates among both
plaintiffs and defendants. Arbitration is viewed as less satisfying and less efficient than mediation but still more time-
and cost-effective than litigation. The current legal environment is favorable to ADR with recent court decisions
upholding pretreatment arbitration clauses. The main obstacle to ADR is the mandatory reporting requirement of the
National Practitioner Data Bank (NPDB)., CONCLUSIONS: ADR has the potential to help reform the current tort
system, reducing cost and increasing both parties' satisfaction. Easing the reporting requirements for the NPDB
would lead to more widespread acceptance of ADR among physicians.
Background: Alternative dispute resolution (ADR) refers to techniques used to resolve conflicts without going to the
courtroom. As healthcare and malpractice costs continue to rise, there is growing interest in tactics such as early
apology, mediation, and arbitration in the medical arena. Questions/purposes: (1) Why is ADR needed? (2) Is ADR
useful in health care? (3) What are the current legal and political developments favoring ADR? (4) What obstacles
remain? Methods: We performed MEDLINE, PubMed, and Google Scholar searches with key words "medical
malpractice", "ADR", and "alternative dispute resolution" to obtain public policy studies, law review articles, case
analyses, ADR surveys, and healthcare review articles. Results: Early apology and disclosure programs report 50% to
67% success in avoiding litigation as well as substantial reductions in the amount paid per claim. Mediation boasts
75% to 90% success in avoiding litigation, cost savings of $50,000 per claim, and 90% satisfaction rates among both
plaintiffs and defendants. Arbitration is viewed as less satisfying and less efficient than mediation but still more time-
and cost-effective than litigation. The current legal environment is favorable to ADR with recent court decisions
upholding pretreatment arbitration clauses. The main obstacle to ADR is the mandatory reporting requirement of the
National Practitioner Data Bank (NPDB). Conclusions: ADR has the potential to help reform the current tort system,
reducing cost and increasing both parties' satisfaction. Easing the reporting requirements for the NPDB would lead to
more widespread acceptance of ADR among physicians. 2011 The Association of Bone and Joint Surgeons.
OBJECTIVES: The objective of this article is to provide an overview of current trends in medical multimedia retrieval.
This state of the art is then compared with trends and techniques in the Web 2.0 field that addresses several of the
problems of current multimedia retrieval and may help in solving them. METHODS: The article uses a review of the
current literature on medical imaging and medical multimedia retrieval from the Pubmed and Google scholar
literature search engines. Other sources include popular Web 2.0 web pages and articles on Web 2.0 describing the
main concepts of these technologies in the medical domain. RESULTS: Web 2.0 has significantly changed the way we
interact with the Internet and has created an important added-value by promoting activities of users and interactions
between users. In the medical field, there are many examples of adoption of these methods and multimedia retrieval
can play an important role in this field by supplying the right data at the right time. CONCLUSIONS: Medical
multimedia retrieval still has a long way to go to become an everyday tool in the medical field and in clinical practice.
Still, when reusing and linking much of the electronic patient record's data, image retrieval can be a technology to
help extract important knowledge and navigate through the large amounts of data. Key challenges for more
widespread adoption of these technologies involve legal rules for secondary use of medical data because currently
only very few image data sets with ground truth have been made available.
The overactive bladder is a common and distressing condition that has a significant impact on the quality of life of
millions of people worldwide. Despite its high prevalence, it is a disorder poorly known and not usually tackled in
daily clinical practice. The underlying pathophysiology that leads to OAB syndrome is, as yet, incompletely
characterized. Non-pharmacological intervention is the foundation of treatment for overactive bladder. Traditional
non-harmacological tools and lifestyle modification should be provided consistently as part of a balanced program
for improving target symptom control. In the past, the entire pharmacotherapeutic scenario of OAB had been
dependent on modulation of muscarinic receptors. These receptors, although important to intrinsic detrusor
function, do not appear to be completely responsible for OAB, given the incomplete therapeutic responses obtained
with current agents. Anti-muscarinics remain the first line in pharmacotherapy. However, these agents produce
variable efficacy and/or are often associated with considerable adverse effects resulting in treatment failure. Thus,
there is a need for more effective treatments. Prospective therapies aimed at novel targets with novel mechanisms
of action are currently at different stages of clinical development. With the exception of botulinum toxin, however,
few newer therapies have emerged showing clinical benefits. Objective: The aim of this review is to provide an
overview of the various drug therapies available for the anagement of OAB. Non pharmacological therapies are being
outlined briefly. Methods: MEDLINE, Medscape, and Google scholar databases were searched using the relevant
terms. Full text articles in English regarding the current literature on the management of OAB with major emphasis
on pharmacotherapy were selected for reference. 2012 Bentham Science Publishers.
BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) is a common hematologic disorder caused by immune-
mediated thrombocytopenia. The magnitude of the maternal-fetal risk of ITP during pregnancy is controversial.
Labour management of pregnant women with ITP remains controversial. Management of ITP during pregnancy is
complex because of the disparity between maternal and fetal platelet counts. OBJECTIVES: To assess the
effectiveness and safety of corticosteroids, intravenous immunoglobulin, vinca alkaloids, danazol, dapsone, and any
other types of pharmacological treatments for the treatment of idiopathic thrombocytopenic purpura during
pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register
(February 2009), LILACS (1982 to 8 February 2009), ClinicalTrials.gov (8 February 2009), Current Controlled Trials (16
February 2009), Google Scholar (16 February 2009) and ongoing and unpublished trials cited in the reference lists of
relevant articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) on any medical treatments for idiopathic
thrombocytopenia purpura during pregnancy. DATA COLLECTION AND ANALYSIS: Two review authors independently
evaluated methodological quality and extracted trial data. Any disagreement was resolved by discussion or by
consulting a third review author. MAIN RESULTS: This review included one RCT in which 38 women (41 pregnancies)
were randomised, with only 26 women (28 pregnancies) being analysed.This RCT comparing the effect of
betamethasone (1.5 mg/day) with no medication found no statistically significant difference in neonatal
thrombocytopenia (risk ratio (RR) 1.12, 95% confidence interval (CI) 0.62 to 2.05) and neonatal bleeding (RR 1.00,
95% CI 0.24 to 4.13). Review authors conducted an intention-to-treat analysis which showed similar findings: RR
1.18, 95% CI 0.57 to 2.45 and RR 1.05, 95% CI 0.24 to 4.61, respectively. Maternal death, perinatal mortality,
postpartum haemorrhage and neonatal intracranial haemorrhage were not studied by this RCT. AUTHORS'
CONCLUSIONS: Current evidence indicates that compared to no medication, betamethasone did not reduce the risk
of neonatal thrombocytopenia and neonatal bleeding in ITP during pregnancy. There is insufficient evidence to
support the use of betamethasone for treating ITP. This Cohrane review does not provide evidence about other
medical treatments for ITP during pregnancy. This systematic review also identifies the need for well-designed,
adequately powered randomised clinical trials for this medical condition during pregnancy. Unless randomised
clinical trials provide evidence of a treatment effect and the trade off between potential benefits and harms are
established, policy-makers, clinicians, and academics should not use betamethasone for ITP in pregnant women. Any
future trials on medical treatments for treating ITP during pregnancy should test a variety of important maternal,
neonatal or both outcome measures, including maternal death, perinatal mortality, postpartum haemorrhage and
BACKGROUND: After an acute cardiac event, adhering to recommendations for pharmacologic therapy is important
in achieving optimal health outcomes. Considering the impressive evidence base for cardiovascular
pharmacotherapy, strategies for promoting adherence are less well developed. Furthermore, accessing reliable,
valid, and cost-effective mechanisms of monitoring adherence in the research and clinical settings is challenging.
AIM: The aim of this article was to review published self-report measures assessing and monitoring medication
adherence in cardiovascular disease and provide recommendations for research into medication adherence.
METHODS: The electronic databases CINAHL, Medline, and Science Direct were searched using the key search terms
medication adherence and/or compliance, cardiovascular, self-report measures, and questionnaires. The World Wide
Web was searched using the Google and Google Scholar search engines, and reference lists of retrieved documents
were reviewed. The search strategy was verified by a health librarian. Instruments were included if they specifically
addressed medication adherence as a discrete construct rather than a disease-specific or a generic health status
measurement. FINDINGS: Despite of the problems with medication adherence identified in the literature, only 7
instruments met the search criteria. There was limited use of instruments across studies and settings to enable
comparison across populations and extensive psychometric evaluation. CONCLUSIONS: Medication adherence is a
complex, multifaceted construct dependent on a range of physical, social, economic, and psychological
considerations. In spite of the importance of adherence in ensuring optimal cardiovascular outcomes, conceptual
underpinnings and methods of assessing medication adherence require further discussion and debate.
Ethnopharmacological relevance In the genus Curculigo, Curculigo orchioides Gaertn, Curculigo capitulata (Lour) O.
Ktze and Curculigo pilosa (Schumach. & Thonn.) Engl are often used in traditional medicine. Curculigo orchioides is
used for the treatment of impotence, limb limpness, arthritis of the lumbar and knee joints, and watery diarrhea in
traditional Chinese medicine, and also used as a potent immunomodulator and aphrodisiac in the Ayurvedic medical
system. Curculigo capitulata is used for the treatment of consumptive cough, kidney asthenia, impotence and
spermatorrhea, hemorrhoids, asthma, jaundice, diarrhea, colic and gonorrhea in traditional Chinese and India
medicine, and to treat urinary tract infection, acute renal pelvis and nephritis, nephritis-edema, cystitis,
nephrolithiasis, hypertension and rheumatic arthritis in traditional Dai medicine. Curculigo pilosa are applied to treat
gastrointestinal and heart diseases in Africa. Aim of the review This review aims to exhibit up-to-date and
comprehensive information about traditional uses, phytochemistry, pharmacology and toxicology of medicinal plants
in the genus Curculigo, and has an insight into the opportunities for the future research and development of
Curculigo plant. Methods A bibliographic investigation was performed by analyzing the information available on
Curculigo plant from worldwide accepted scientific databases (Pubmed, Scopus and Web of Science, SciFinder,
Google Scholar, Yahoo). Furthermore, information also was obtained from some local and foreign books on
ethnobotany and ethnomedicines. Results Curculigo orchioides, Curculigo capitulata and Curculigo pilosa have been
used as traditional medicine to treat kinds of diseases such as impotence, limb limpness, gastrointestinal and heart
diseases, etc. Phytochemical investigation of eight species of the genus Curculigo has resulted in identification of
more than 110 compounds. The content of curculigoside is used as an indicator to evaluate the quality of rhizome of
Curculigo orchioides. The medicinal plants have showed a wide spectrum pharmacological activities, including
adaptive, immunostimulatory, taste-modifying and sweet-tasting, antioxidant, mast cell stabilization, antihistaminic
and antiasthmatic, hepatoprotective and neuroprotective activity. Toxicological test indicated that Curculigo
orchioides at the dose of 120 g/kg after administrating rats for 180 days may cause injury of liver and kidney.
Conclusion The medicinal plants of genus Curculigo have emerged as a good source of the traditional medicines.
Some uses of these plants in the traditional medicines have been validated by pharmacological investigation.
However, the mechanism of their actions should be further elucidated; the particular constituent responsible for
toxicity should be isolated and identified, and the target tissue and mechanism of toxic ingredients also deserve to be
further investigated; more reference substances should be prepared, and sophisticated analytical technologies
should be developed to comprehensively assess the quality of Curculigo herbs. These investigations will be helpful
The aim of this study was to present the implications of the use of herbs during pregnancy, pointing out those that
should be avoided during this condition because of their abortifacient and/or teratogenic potential. We carried out
searches in the databases ScienceDirect, Scielo and Google Scholar, adopting as criteria for inclusion: book chapters
and/or complete articles (with abstract), available in English, Portuguese or Spanish, published from 1996 to in 2011.
After a pre-selection of 83 articles, 49 bibliographies were used in the manufacturing end of the article, where 25
were from the Scielo database, 18 from ScienceDirect and 6 from Google Scholar. From the articles studied, we
identified the four most commonly used plants as emmenagogue/abortifacient agents by patients of the Department
of Prenatal SUS: senne, arruda, boldo and buchinha-do-norte or cabacinha. Thus, we conclude that people often
adhere to the maxim "if it's natural, it does no harm" in their rational use of natural products, without the right
guidance, believing that these products are safe to use. This usage is even more worrisome among the elderly,
pregnant women and children. Regarding the safety of these products, some information and reliable data are scarce
or contradictory.
Ethnopharmacological relevance: Callicarpa L. (Verbenaceae) has been used for centuries in Traditional Chinese
Medicine (TCM) for the prevention and treatment of a wide number of health disorders such as inflammation,
rheumatism, hematuria, fracture, hematemesis, menoxenia, gastrointestinal bleeding, scrofula, etc. Aims of the
review: To assess the scientific evidence for therapeutic Callicarpa in TCM and to identify future research needs.
Methods: The available information on the ethnopharmacological uses in Chinese medicine, phytochemistry,
pharmacology and clinical practice of Callicarpa species was collected via a library and electronic search (PubMed,
ScienceDirect, Google Scholar and CNKI). Results: A variety of ethnomedical use of Callicarpa has been recorded in
many ancient Chinese books. Phytochemical investigation of this genus has resulted in identification of more than
200 chemical constituents, among which diterpenes, triterpenoids and flavonoids are the predominant groups. The
isolates and crude extract have exhibited a wide spectrum of in vitro and in vivo pharmacological effects involving
anti-inflammatory, hemostatic, neuroprotective, anti-amnesic, antitubercular, antioxidant, antimicrobial and Background: The causes of ovarian cancer are complex and may be influenced by many factors, including
polymorphism in the microsomal epoxide hydrolase (mEH) gene. Previous work suggests an association between the
Tyr113His mEH polymorphism rs1051740 and susceptibility to ovarian cancer, but the results have been inconsistent.
Methods. PubMed, EMBASE, Google Scholar, and Chinese National Knowledge Infrastructure databases were
systematically searched to identify relevant studies. A meta-analysis was performed to examine the association
between Tyr113His mEH polymorphism and susceptibility to ovarian cancer. Odds ratios (ORs) and 95% confidence
intervals (CIs) were calculated. Results: Five studies involving 2,566 cases and 2,839 controls were included. Although
the polymorphism did not affect ovarian cancer risk in the allelic contrast model (OR = 0.99, 95% CI = 0.83-1.17, P =
0.86), the mutant CC genotype was significantly associated with increased risk in the homozygote comparison (OR = BACKGROUND: The causes of ovarian cancer are complex and may be influenced by many factors, including
polymorphism in the microsomal epoxide hydrolase (mEH) gene. Previous work suggests an association between the
Tyr113His mEH polymorphism rs1051740 and susceptibility to ovarian cancer, but the results have been
inconsistent., METHODS: PubMed, EMBASE, Google Scholar, and Chinese National Knowledge Infrastructure
databases were systematically searched to identify relevant studies. A meta-analysis was performed to examine the
association between Tyr113His mEH polymorphism and susceptibility to ovarian cancer. Odds ratios (ORs) and 95%
confidence intervals (CIs) were calculated., RESULTS: Five studies involving 2,566 cases and 2,839 controls were
included. Although the polymorphism did not affect ovarian cancer risk in the allelic contrast model (OR=0.99, 95%
CI=0.83-1.17, P=0.86), the mutant CC genotype was significantly associated with increased risk in the homozygote Aim The aim of this study was to investigate melatonin-related findings in autism spectrum disorders (ASD), including
autistic disorder, Asperger syndrome, Rett syndrome, and pervasive developmental disorders, not otherwise
specified. Method Comprehensive searches were conducted in the PubMed, Google Scholar, CINAHL, EMBASE,
Scopus, and ERIC databases from their inception to October 2010. Two reviewers independently assessed 35 studies
that met the inclusion criteria. Of these, meta-analysis was performed on five randomized double-blind, placebo-
controlled studies, and the quality of these trials was assessed using the Downs and Black checklist. Results Nine
studies measured melatonin or melatonin metabolites in ASD and all reported at least one abnormality, including an
abnormal melatonin circadian rhythm in four studies, below average physiological levels of melatonin and/or
melatonin derivates in seven studies, and a positive correlation between these levels and autistic behaviors in four
studies. Five studies reported gene abnormalities that could contribute to decreased melatonin production or
adversely affect melatonin receptor function in a small percentage of children with ASD. Six studies reported
improved daytime behavior with melatonin use. Eighteen studies on melatonin treatment in ASD were identified;
these studies reported improvements in sleep duration, sleep onset latency, and night-time awakenings. Five of
these studies were randomized double-blind, placebo-controlled crossover studies; two of the studies contained
blended samples of children with ASD and other developmental disorders, but only data for children with ASD were This paper reviews melatonin as an overlooked factor in the developmental etiology and maintenance of
schizophrenia; the neuroimmune and oxidative pathophysiology of schizophrenia; specific symptoms in
schizophrenia, including sleep disturbance; circadian rhythms; and side effects of antipsychotics, including tardive
dyskinesia and metabolic syndrome. Electronic databases, i.e. PUBMED, Scopus and Google Scholar were used as
sources for this review using keywords: schizophrenia, psychosis, tardive dyskinesia, antipsychotics, metabolic
syndrome, drug side effects and melatonin. Articles were selected on the basis of relevance to the etiology, course
and treatment of schizophrenia. Melatonin levels and melatonin circadian rhythm are significantly decreased in
schizophrenic patients. The adjunctive use of melatonin in schizophrenia may augment the efficacy of antipsychotics
through its anti-inflammatory and antioxidative effects. Further, melatoninwould be expected to improve sleep
disorders in schizophrenia and side effects of anti-psychotics, such as tardive dyskinesia, metaboilic syndrome and
This article is intended to focus on the need for the use of rehabilitation services, for children with meningitis in
Papua New Guinea, which is one of largest developing country in The Pacific with diverse culture and landscape.
Meningitis is the fifth leading disease that results in disability in the country. The first line of treatment is usually
antibiotics, administration of vaccination is also recommended. Currently community based rehabilitation workers
and Physiotherapist offer the rehabilitation services. There is a need for the other rehabilitation professionals and
appropriate education to the CBR workers, caregivers for providing effective Rehabilitation. Articles related to
meningitis were recruited through various electronic database such as Ovid SP, MEDLINE, CINHAL, Google Scholar
and HINARI and EBSCOhost for full text. The search includes journal articles, editorials, research reports, systematic BackgroundIn meniscal root tears (MRTs), the disruption of collagen fibers that provide hoop strength results in
extrusion of the menisci, altering their biomechanical properties. Clinical diagnosis is difficult, but magnetic
resonance imaging usually allows to identify the lesion. Located into the vascularized zone of the meniscus,
management is preferentially arthroscopic, aimed at repairing the lesions with arthroscopic transosseous sutures or
suture anchors.Sources of dataPubMed, Cochrane Library, Google Scholar and Ovid Medline were searched in July
2012 to find literature on MRT tears. We reviewed the literature on biomechanics, imaging features and current
treatments of these tears. Twenty-seven appropriate articles were identified and included in the study: 6
biomechanical studies, 11 imaging-based investigations for diagnosis, 1 study on clinical diagnosis and 9 studies
about treatment.Areas of agreementMRTs are infrequent, accounting for 10.1% of all arthroscopic meniscectomies.
When the damage occurs to the roots, the transmission of the circumferential hoop tension is impaired and, Introduction: This review defines the recognized risk factors responsible for the development of knee osteoarthritis
after surgical management of meniscal tears. Sources of data: We performed a literature search using Medline, Ovid,
Cochrane and Google Scholar using the keywords: 'Meniscal tears', 'meniscectomy', 'osteoarthritis', 'complications'
and 'risk factors'. Thirty-two published studies were identified. Areas of agreement: In the long term, osteoarthritis
develops in the knee of patients undergoing surgery for meniscal tears. The Coleman methodology score showed
great heterogeneity in terms of patient characteristics and outcome assessment. Amount of meniscus removed,
duration of pre-operative symptoms and lateral meniscectomy show strong statistical association to onset of knee
osteoarthritis. Areas of controversy: We did not find univocal findings defining the risk factors responsible for the
development of post-operative knee osteoarthritis. Growing points: There is a need for standardized clinical and
imaging validated scale to improve definition of post-operative knee osteoarthritis to allow easier and more reliable
comparison of outcomes in different studies. Areas timely for developing research: Appropriately powered High numbers of individuals with Fetal Alcohol Spectrum Disorders (FASD) have been described as having mental
health problems. This article summarizes research about mental health problems in FASD and considers related
developmental and environmental issues. A computer-based literature search was conducted in the databases
Medline, PsycINFO, Google Scholar, Academic Search Complete, and Education Resources Information Centre for
articles addressing the prevalence and types of mental health issues in individuals affected by FASD. High rates of
mental disorders within the FASD and prenatal alcohol exposure (PAE) population were found to be consistently
reported for both internalizing and externalizing disorders. Moreover, problems that emerge in childhood may
reflect a convergence of genetic, environmental, and neurophysiological factors that persist into adulthood. IMPORTANCE: Exposure to a disaster is common, and one-third or more of individuals severely exposed may develop
posttraumatic stress disorder or other disorders. A systematic approach to the delivery of timely and appropriate
disaster mental health services may facilitate their integration into the emergency medical response., OBJECTIVE: To
review and summarize the evidence for how best to identify individuals in need of disaster mental health services
and triage them to appropriate care., EVIDENCE REVIEW: Search of the peer-reviewed English-language literature on
disaster mental health response in PsycINFO, PubMed, Cochrane Database of Systematic Reviews, Academic Search
Complete, and Google Scholar (inception to September 2012) and PILOTS (inception to February 2013), using a
combination of subject headings and text words (Disasters, Natural Disasters, Mental Health, Mental Health
Programs, Public Health Services, Mental Disorders, Mental Health Services, Community Mental Health Services,
Emergency Services Psychiatric, Emotional Trauma, Triage, and Response)., FINDINGS: Unlike physical injuries,
adverse mental health outcomes of disasters may not be apparent, and therefore a systematic approach to case
identification and triage to appropriate interventions is required. Symptomatic individuals in postdisaster settings
may experience new-onset disaster-related psychiatric disorders, exacerbations of preexisting psychopathology,
and/or psychological distress. Descriptive disaster mental health studies have found that many (11%-38%) distressed
ABSTRACT Background: The proportion of older people from black and minority ethnic (BME) groups in the United
Kingdom (UK) is increasing steadily as the population ages. The numbers with dementia, depression, and other
mental health problems are predicted to increase. Government policy documents have highlighted gaps in services
for BME elders and/or the need to develop culturally appropriate services, in order to prevent people from BME
communities from becoming socially excluded and finding services hard to access. This paper reviews published
examples of innovative services and key learning points from them. Method: A search was carried out on Pubmed,
Medline, and Google Scholar for service developments aimed at BME elders in the UK. Sixteen relevant papers and
reports were identified and were analysed to identify learning points and implications for clinical practice and policy.
Results: Commissioning issues included were forward planning for continuing funding and mainstreaming versus
specialist services. Provider management issues included were employing staff from the communities of interest,
partnership, and removing language barriers. Provider service issues included were education for service provider
staff on the needs of BME elders, making available information in relevant languages, building on carers' and users'
experiences, and addressing the needs of both groups. Conclusion: A model for structuring understanding of the
underutilisation of services by BME elders is suggested. The main emphasis in future should be to ensure that
learning is shared, disseminated, and applied to the benefit of all communities across the whole of the UK and
elsewhere. Person-centred care is beneficial to all service users. International Psychogeriatric Association 2012.
PURPOSE: Mentoring is critical for career advancement in academic medicine. However, underrepresented minority
(URM) faculty often receive less mentoring than their nonminority peers. The authors conducted a comprehensive
review of published mentoring programs designed for URM faculty to identify "promising practices." METHOD:
Databases (PubMed, PsycINFO, ERIC, PsychLit, Google Scholar, Dissertations Abstracts International, CINHAL,
Sociological Abstracts) were searched for articles describing URM faculty mentoring programs. The RE-AIM
framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) formed the model for analyzing
programs. RESULTS: The search identified 73 citations. Abstract reviews led to retrieval of 38 full-text articles for
assessment; 18 articles describing 13 programs were selected for review. The reach of these programs ranged from 7
to 128 participants. Most evaluated programs on the basis of the number of grant applications and manuscripts
produced or satisfaction with program content. Programs offered a variety of training experiences, and adoption was
relatively high, with minor changes made for implementing the intended content. Barriers included time-restricted OBJECTIVES: To evaluate, using meta-analysis methodology, mesiodistal tooth dimensions in non-syndromic
unilateral cleft lip and palate (CLP) patients., MATERIALS AND METHODS: A literature search was conducted using
PubMed, Medline, Google Scholar Beta, EMBASE Excerpta Medica, CINAHL, Web of Science, and the Cochrane
Collaboration, identifying English and non-English articles reporting on mesiodistal tooth dimensions on the cleft and
non-cleft side of non-syndromic unilateral CLP patients. Additional studies were identified by searching reference
lists of articles consulted. Only studies with a suitable control group were included. Two examiners independently
performed the literature search and data extraction. Using meta-analysis software, data extracted from each
selected study were statistically combined using the fixed-effects model. Weighted mean differences, 95 %
confidence intervals, and heterogeneity were calculated for each measurement., RESULTS: Four articles fulfilling the
inclusion criteria were located and included in the meta-analysis. Maxillary incisors and first molars were found to be
significantly larger on the non-cleft side while mandibular incisors and premolars were larger on the cleft side, in non-
syndromic unilateral CLP patients. On the cleft side, maxillary premolars and second molars were larger in cleft than
Background: Glucocorticoid is a common drug for treatment of thyroid-associated ophthalmopathy (TAO) with good
effectiveness. But some adverse reactions of glucocorticoid are inevitable. At recent years, 99technetium-methylene
bisphosphonate(99Tc-MDP) is being paid more and more attentions in the treatment of TAO, but its effectiveness
and safety is worthy of comparison to traditional treatment methods. Objective: This study was to evaluate the
efficacy of treatment with intravenous injection of 99Tc-MDP for TAO. Methods: The Cochrane Library, CNKI,
PubMed, Wanfang database, Weipu net were searched in computer and Google Scholar was searched manually. The
randomized controlled trail (RCT) of intravenous injection of 99Tc-MDP for TAO were collected from establishment
of database through April, 2012.The quality of included literature was assessed based on the methodology of the
study. The evaluating indexes included the primary treating outcomes, such as total efficacy, exophthalmic extent
and recurrence rate as well as secondary outcomes such as adverse effect. RevMan 5.1 software was used for Mate
analysis. Results: A total of 11 RCTs were identified with 706 patients. Subgroup analysis was carried out based on
the outcome measures and intervention. No significant difference was found in the overall effective rate between
intravenous injection of 99Tc-MDP and immunosuppressive treatment (RR=0.96, 95% CI:0.76 to 1.22, P=0.740).
However, the effective rate was significant different between intravenous injection of 99Tc-MDP and oral
prednisone (RR=1.25, 95% CI: 1.06-1.46, P=0.007) or between intravenous injection of 99Tc-MDP and the blank
control group (RR=2.53, 95% CI:1.68-3.81, P=0.000). Significant difference also was found in the total effective rate
between intravenous injection of 99Tc-MDP with methyprednisone and methyprednisone alone (RR=1.27, 95%
CI:1.05-1.53, P=0.010). There were significant differences in the effective rate of proptosis between intravenous
injection of 99Tc-MDP and oral prednisone (RR=2.02, 95% CI: 1.44-3.56, P=0.020). The recurrence rate of TAO was
significant different between intravenous injection of 99Tc-MDP and oral prednisone (RR=0.51, 95% CI:0.33-0.78,
P=0.002). Less adverse responses were seen in the intravenous injection of 99Tc-MDP group than the oral
prednisone group and immunosuppressive treatment group. Conclusions: Intravenous injection of 99Tc-MDP for TAO
appears to be of a similar effectiveness to immunosuppressive method. The combination of intravenous injection of
99Tc-MDP with methyprednisone seems to be more effective than methyprednisone alone, with little systemic
adverse effect after application. Copyright 2013 by the Chinese Medical Association.
Background: Central corneal thickness (CCT) is one of important parameters of the anterior eye segment. It plays a
very important part in corneal refractive surgery and diagnosis of glaucoma. Contacted A-scan remains the gold
standard for CCT measurement. Ophthalmologists are trying to look for a more convenient and noncontacted
instrument to take place of contacted A-scan for CCT measurement. Objective: This system analysis was to evaluate
the difference between Pentacam and A-scan in CCT measurement. Methods: A systematic literature retrieval was
conducted from the MEDLINE, EMbase, Google Scholar, CBM disc and CNKI database with the limitation of
publishing time from January 2005 to May 2011. The literature text was limited to the comparison of the CCT values
measured by Pentacam and A-scan. The statistical analysis was performed using RevMan 5.1.0 software. Sensitive
analysis was carried out and the publishing bias was analyzed using inverted funnel plot. Results: A total of 26 studies
met the requirement were included in this Meta-analysis with the 12 pieces of Chinese article and 14 pieces of
English article, with the total eyes 3677. Heterogeneity was found among included studies (P = 0.0003, I2= 56%) and
random effects model was used. The differential value of CCT derived by Pentacam and A-scan was 1.74 mum, and
no significant difference was found between Pentacam and A-scan (WMD = 1.74, 95% CI: -0.69-4.16, P > 0.05). Fixed
effects model was used to exclude the studies with the sample more than 100 eyes as the sensitive analysis. When
fixed effect model was used, CCT by Pentacam was 2.73 mum more than A-scan, showing an insignificantly clinical
difference. When studies with a sample more than 100 eyes were excluded, the CCT value by Pentacam was 2.64
mum more than A-scan, without clinically significant difference between them. No obvious publishing bias was seen
in the included literature. Conclusions: The difference between Pentacam and A-scan in CCT measurement is less and
could be ignored. Copyright 2013 by the Chinese Medical Association.
Background: MR has improved the outcome and progression-free survival (PFS) of patients (pts) with FL and MCL.
However, maintenance schedules have been empirically designed with no consensus on the optimal regimen. While
toxicities are usually predictable, the impact of MR schedule on toxicities has not been previously reported and could
influence selection of maintenance regimens. We analyzed grade 3 and/or 4 adverse events (AE) in FL and MCL pts
enrolled in prospective MR trials in order to compare AEs by MR schedule, histology, and setting (front-line and
relapsed). Methods: A systematic search of the Medline (Pub-Med, Google Scholar, Cochrane Library) electronic
database was performed to identify prospective clinical trials employing MR in FL and MCL. The following search
terms were used: "MR, maintenance immunotherapy, maintenance therapy, low-grade lymphoma, NHL, MCL, and
FL". Abstracts and studies using MR after autologous stem cell transplantation or radioimmunotherapy were
excluded. The number of AE reported was considered as the unit of analysis. Data for overall Grade 3 and/or Grade 4
toxicity (AE reported at any phase of treatment) were further categorized as an AE occurring during the induction
phase or the maintenance phase. The incidence, severity, and type of toxicity were analyzed by type of induction (R
vs. R+chemotherapy), histology (FL, MCL and FL plus other low-grade histologies), setting (front-line vs. relapsed),
and MR schedule (one dose every 2 months vs. one dose every 3 months vs. 4 weekly doses every 6 months; all
given for 2 years) and analysis was performed using t-tests or one-way ANOVA weighted means by either the total
sample or the MR phase sample. Means were calculated using both fixed-effect and random-effect models Results:
Thirteen clinical trials met criteria, including six trials which were randomized controlled in the MR phase. Of the
total 3,100 pts, 1,263 received MR. The mean percentage of Grade 3/4 toxicities during any phase of treatment was
26% (95% CI = 0.12-51.88) but in the MR phase, it was only 12.88% (95% CI = 6.50-19.26). The overall mean number
Background: Schistosomiasis ranks second to malaria in terms of socioeconomic&public health importance, with 200
million people infected in 75 countries. Praziquantel is the current drug of choice and is highly effective against the
adult stages of all human schistosome species. Development of resistance to Praziquantel was noted. Artemether
has been developed as a prophylactic agent for the prevention of schistosome infections. In this light,we aimed to
evaluate the efficacy of artemether in the prevention of schistosomiasis. Methods:Wesearched Pubmed, Google
Scholar for randomized controlled trials. 6 studies fulfilled the inclusion criteria for analysis. However, we were only
able to retrieve the full text of 2 articles examined through meta analysis. Searched trials published from 1995 to
2011. Eligible studies were randomized and blinded, placebo controlled trials of oral artemether at a dose of 6mg/kg
once every 2-4 weeks with participants' ages ranged from 5-60 years old, regardless of sex. Trials that compared
artemether with another drug (praziquantel) and trials that combined artemether with praziquantel were excluded.
Cochrane Collaboration's tool for assessing risk of bias was employed to ensure the validity of the selected studies.
Results were extracted independently by two authors using a paper data collection form and any disagreements
were resolved by consensus of the three authors. Three investigators carried out the initial search and two Combined antiplatelet treatment with aspirin and clopidogrel is pivotal to minimize periprocedural adverse events in
patients who undergo percutaneous coronary intervention. However, there is debate on the best clopidogrel loading
dose. The investigators performed a systematic review and meta-analysis of the optimal clopidogrel loading dose.
Pertinent trials comparing high (>300 mg) and standard (300 mg) clopidogrel loading doses in patients scheduled for
catheterization and/or percutaneous coronary intervention were systematically searched in BioMedCentral,
CENTRAL, Google Scholar, and PubMed (December 2006). The primary end point was the 1-month rate of death or
myocardial infarction. Secondary end points included other ischemic and bleeding adverse effects. Peto odds ratios
were computed. A total of 10 studies (7 randomized, 3 nonrandomized) were included, enrolling 1,567 patients (712
loaded with 300 mg, 11 with 450 mg, 790 with 600 mg, and 54 with 900 mg). Overall, a high loading dose proved
significantly superior to a standard loading dose in preventing cardiac death or nonfatal myocardial infarction (odds Full text: Meta-Analysis Appraising High Clopidogrel Loading in Patients Undergoing Percutaneous Coronary
Intervention++Conflicts of interest: Dr. Angiolillo is a consultant and on the speaker's bureau for Bristol Myers
Squibb, New York, New York, and Sanofi-Aventis, Paris, France. Dr. Biondi-Zoccai has consulted for Boston Scientific,
Natick, Massachusetts, and Cordis, Miami, Florida. Combined antiplatelet treatment with aspirin and clopidogrel is
pivotal to minimize periprocedural adverse events in patients who undergo percutaneous coronary intervention.
However, there is debate on the best clopidogrel loading dose. The investigators performed a systematic review and
meta-analysis of the optimal clopidogrel loading dose. Pertinent trials comparing high (>300 mg) and standard (300
mg) clopidogrel loading doses in patients scheduled for catheterization and/or percutaneous coronary intervention
were systematically searched in BioMedCentral, CENTRAL, Google Scholar, and PubMed (December 2006). The
primary end point was the 1-month rate of death or myocardial infarction. Secondary end points included other
ischemic and bleeding adverse effects. Peto odds ratios were computed. A total of 10 studies (7 randomized, 3
nonrandomized) were included, enrolling 1,567 patients (712 loaded with 300 mg, 11 with 450 mg, 790 with 600 mg,
and 54 with 900 mg). Overall, a high loading dose proved significantly superior to a standard loading dose in
preventing cardiac death or nonfatal myocardial infarction (odds ratio 0.54, 95% confidence interval 0.32 to 0.90, p =
0.02), without any statistically significant increase in major or minor bleedings (p = 0.55 and p = 0.98, respectively).
Sensitivity analysis restricted to randomized trials confirmed the superiority of a high loading dose regimen (p =
0.0031). Meta-regression disclosed a significant interaction between event rate and the benefits of high loading
doses (p = 0.005), suggesting that the greater the underlying risk, the greater the favorable impact of a high loading
dose. In conclusion, a high clopidogrel loading dose (>300 mg) significantly reduces early ischemic events in patients
scheduled for percutaneous coronary intervention. 2007 Elsevier Inc. All rights reserved.
OBJECTIVES: Psoriatic arthritis (PA) is an inflammatory disease affecting joints and connective tissues. The anti-tumor
necrosis factor (TNF) biologics are increasingly being used in patients who have failed traditional diseasemodifying
antirheumatic drugs. Etanercept has shown efficacy in treatment of PA. The objective of this study was to conduct
meta-analysis and present total evidence for etanercept in treatment of PA. METHODS: For this meta-analysis we
included randomized controlled trials (RCTs)evaluating etanercept for the treatment of PS. RCTs studying adult
populations with active and progressive PA with an inadequate response to previous DMARD therapy were eligible.
Trials conducted among PA populations with prior experience with anti-TNF agents, including an inadequate
response, were excluded. A systematic literature search for Etanercept trials was undertaken for the databases
Pubmed, Embase, Biosis, Google Scholar, and Cochrane. Data was collected for the study size, interventions, year,
and the three outcomes HAQ, PASI and PsARC. For metaanalysis, random effects and fixed effects models were used
to obtain cumulative statistics. RESULTS: Two RCTs with a total of 131 patients were identified. The pooled response
rates for Etanercept for PsARC were 75% (95% CI 60%-90%), for HAQ were 59% (95% CI 46%-72%), and for PASI were
24% (95% CI 13%-34%). The pooled response rates for placebo for PsARC were 30% (95% CI 26%-35%), for HAQ were
5% (95% CI 1%-9%), and for PASI were 3% (95% CI 0%-7%). For PsARC the cumulative relative risk with Etanercept
versus placebo was 0.40 (95% CI 33%-48%). For HAQ, the cumulative relative risk with Etanercept versus placebo was
0.08 (95% CI 5%-12%). For PASI, the cumulative relative risk with Etanercept versus placebo was 0.14 (95% CI 8%-
20%). CONCLUSIONS: Metaanalysis shows Etanercept offers patients with psoriatic arthritis an effective therapeutic
option for control of their disease.
OBJECTIVES: Immune (idiopathic) thrombocytopenia (ITP) is an autoimmune condition characterized by increased
platelet destruction and suboptimal platelet production, resulting in low platelet counts (thrombocytopenia).
Romiplostim has shown efficacy in increasing platelet counts. The objective of this study was to conduct meta-
analysis and present total evidence for Romiplostim for treatment of ITP. METHODS: For this meta-analysis we
included randomized controlled trials (RCTs) evaluating Romiplostim for the treatment of ITP. We included RCTs that
compared romiplostim versus placebo for management of ITP, had a treatment duration of at least 24 weeks, were
doubleblind (patients and investigators blinded) and reported data on platelet response. A systematic literature
search for Etanercept trials was undertaken for the databases Pubmed, Embase, Biosis, Google Scholar, and
Cochrane. Data was collected for the study size, interventions, year, and the two outcomes overall and durable
platelet response rate. For meta-analysis, random effects and fixed effects models were used to obtain cumulative
statistics. RESULTS: Two RCTs with a total of 125 patients were identified. The pooled response rates for Romiplostim
for overall platelet response rate were 82% (95% CI 73%-90%); and for durable platelet response rate were 48% (95%
CI 26%-71%). The pooled response rates for placebo for overall platelet response rate were 7% (95% CI 0%-15%), and
for durable platelet response rate were 2% (95% CI 0%-4%). For overall platelet response rate the cumulative relative
risk with Romiplostim versus placebo was 0.09 (95% CI 4%-14%). For durable platelet response rate, the cumulative
relative risk with Romiplostim versus placebo was 0.03 (95% CI 0%-6%). CONCLUSIONS: Meta-analysis shows
Romiplostim offers patients with ITP an effective therapeutic option for increasing platelet counts.
OBJECTIVES: Atrial fibrillation (AF) is an irregular and often rapid heart rate that commonly causes poor blood flow to
the body. Dabigatran and Warfarin have shown safety and efficacy for treatment of AF. The objective of this study
was to conduct meta-analysis and present evidence for safety of Dabigatran versus Warfarin for treatment of AF.
METHODS: For this meta-analysis we included randomized controlled trials (RCTs) evaluating Dabigatran for the
treatment of AF. We included studies that were: 1) a RCT in humans; 2) an investigation of patients with nonvalvular
atrial fibrillation; 3) an evaluation of dabigatran compared with warfarin or each other; and 4) a report of results of
stroke or systemic emboli and major bleeding. A systematic literature search for dabigatran trials was undertaken for
the databases Pubmed, Embase, Biosis, Google Scholar, and Cochrane. Data was collected for the study size,
interventions, year and total bleeding events. For meta-analysis, random effects and fixed effects models were used
to obtain cumulative statistics. RESULTS: Two RCTs with a total of 12,268 patients were identified. The pooled event
rate for Dabigatran for total bleeding events was 31.9% (95% CI 31%-33%). The pooled response rate for Warfarin for
total bleeding events was 35.1% (95% CI 34%-37%). The cumulative relative risk for total bleeding events with
Dabigatran versus Warfarin was 1.1 (95% CI 1.08-1.12). CONCLUSIONS: Meta-analysis shows Dabigatran has a slightly
lower rate of total bleeding events compared to Warfarin.
OBJECTIVES: To compare the safety and efficacy of coronary artery bypass grafting (CABG) with percutaneous
coronary intervention (PCI) using drug-eluting stents (DES) in patients with unprotected left main coronary artery
(ULMCA) disease., METHODS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists
of relevant articles were searched for clinical studies that reported outcomes at the 1-year follow-up after PCI with
DES and CABG for the treatment of ULMCA stenosis. Sixteen studies (three randomized controlled trials and 13
observational studies) were identified and included a total of 5674 patients (2331 for PCI with DES and 3343 for
CABG)., RESULTS: At the 1-year follow-up, there was no significant difference between the CABG and DES groups in
the risk for death (odds ratio [OR] 0.691, P = 0.051) or the composite endpoint of death, myocardial infarction or
stroke (OR 0.832, P = 0.258). The risk for target vessel revascularization (TVR) was significantly higher in the PCI
group compared with the CABG group (OR 3.597, P < 0.001). The risk of major adverse cardiac and cerebrovascular
events (MACCE) was significantly higher in the PCI group compared with the CABG group (OR 1.607, P < 0.001). A
publication bias was observed regarding the outcome of death and also a considerable heterogeneity effect on the
composite endpoint of death, myocardial infarction or stroke and MACCE., CONCLUSIONS: CABG surgery remains the
best option of treatment for patients with ULMCA disease, with less need of TVR and lower MACCE rates.
Fulvestrant is a highly active systemic therapy in patients with metastatic hormone receptor positive breast cancer.
Preclinical work suggested potential synergy of fulvestrant in combination with aromatase inhibitor therapy and
delayed development of endocrine resistance. The purpose of this meta-analysis is to evaluate the effectiveness of
fulvestrant plus anastrozole, compared to anastrozole alone, as first line treatment of postmenopausal stage IV
hormone receptor positive, HER2-negative breast cancer. The literature search was performed using PubMed,
Google Scholar, Embase, ASCO, and ESMO to search for abstracts published during the last 10 years using relevant
keywords. Two prospective randomized clinical trials were found to fulfill the search criteria for combination of
anastrozole plus fulvestrant versus anastrozole alone. Meta-estimates were calculated by combining study estimates
using the DerSimonian and Laird random effects model. The linear mixed-effects model was used to generate 95 %
prediction intervals (PIs) for study-specific hazard and odds ratios. Pooled hazard ratio for progression-free survival is
0.88 (95 % CI 0.72-1.09, 95 % PI 0.65-1.21), overall survival 0.88 (95 % CI 0.72-1.08, 95 % PI 0.68-1.14) and pooled
odds ratio for response rate is 1.13 (95 % CI 0.79-1.63, 95 % PI 0.78-1.65). A non-significant trend was observed with
anastrozole plus fulvestrant being only marginally better than anastrozole alone in the endpoints of: progression-free
survival, overall survival, and response rates. Based on these data, there is not solid evidence that the addition of
fulvestrant at a dose of 250 mg monthly is better than anastrozole alone as first line therapy in women with
postmenopausal hormone receptor positive breast cancer. 2013 Springer Science+Business Media New York.
The aim of this study was to evaluate the association between various cytokine gene polymorphisms and lung cancer
(LC) susceptibility. We searched Pubmed, Elsevier Science Direct, China National Knowledge Infrastructure database,
Chinese Biomedical database, Google scholar. Totally, 20 studies involving 6,467 cases and 8,320 controls were
included in the meta-analysis. The effects of eight polymorphisms, i.e. TNF-alpha 308G/A, IL-6 174G/C, IL-1beta
31T/C, IL-1beta 511C/T, COX-2 8473T/C, IL-10 1082G/A, IL-10 819C/T, and IL-10 592C/A were evaluated. The
combined odds ratio (OR) with 95% confidence interval (95% CI) was calculated to estimate the strength of the
association in a fixed or random effect model. Heterogeneity and publication bias were also assessed. We found a
significant association between IL-10 polymorphism and LC. For IL-10 1082G/A, the overall ORs (95% CI) of the G
versus A, GG versus AA, and GG/ GA versus AA were 2.35 (1.16-4.76), 2.07 (1.16-3.70) and 3.17 (1.31-7.68),
respectively. For IL-10 819C/T, the pooled ORs (95% CI) of the C versus T and CC versus TT were 1.27 (1.01-1.58) and
2.27 (1.32-3.89). For IL-10 592C/A, the comparison of subjects in the CC or CC/CA genotype versus AA homozygotes
showed significant results (OR = 2.00, 95% CI: 1.24-3.23; OR = 1.80, 95% CI: 1.28-2.54). But, other gene
polymorphisms did not reach statistical associations. IL-10 1082G/A, 819C/T and 592C/A polymorphisms might be
risk factors for LC. TNFa 308G/A, IL-6 174G/C, IL-1beta 31T/C, IL-1beta 511C/T, COX-2 8473T/C polymorphisms were
not detected to be related to the risk for LC. Due to the limitation of the number of the studies, we should take the
conclusion with caution. While, further studies are necessary for more precise association. Springer Science+Business
Media B.V. 2011.
The aim of this study was to evaluate the association between various cytokine gene polymorphisms and lung cancer
(LC) susceptibility. We searched Pubmed, Elsevier Science Direct, China National Knowledge Infrastructure database,
Chinese Biomedical database, Google scholar. Totally, 20 studies involving 6,467 cases and 8,320 controls were
included in the meta-analysis. The effects of eight polymorphisms, i.e. TNF- 308G/A, IL-6 174G/C, IL-1 31T/C, IL-1
511C/T, COX-2 8473T/C, IL-10 1082G/A, IL-10 819C/T, and IL-10 592C/A were evaluated. The combined odds ratio
(OR) with 95% confidence interval (95% CI) was calculated to estimate the strength of the association in a fixed or
random effect model. Heterogeneity and publication bias were also assessed. We found a significant association
between IL-10 polymorphism and LC. For IL-10 1082G/A, the overall ORs (95% CI) of the G versus A, GG versus AA,
and GG/GA versus AA were 2.35 (1.16-4.76), 2.07 (1.16-3.70) and 3.17 (1.31-7.68), respectively. For IL-10 819C/T,
the pooled ORs (95% CI) of the C versus T and CC versus TT were 1.27 (1.01-1.58) and 2.27 (1.32-3.89). For IL-10
592C/A, the comparison of subjects in the CC or CC/CA genotype versus AA homozygotes showed significant results
(OR=2.00, 95% CI: 1.24-3.23; OR=1.80, 95% CI: 1.28-2.54). But, other gene polymorphisms did not reach statistical
associations. IL-10 1082G/A, 819C/T and 592C/A polymorphisms might be risk factors for LC. TNF- 308G/A, IL-6
174G/C, IL-1 31T/C, IL-1 511C/T, COX-2 8473T/C polymorphisms were not detected to be related to the risk for LC.
Due to the limitation of the number of the studies, we should take the conclusion with caution. While, further
studies are necessary for more precise association.
Background: Current therapy is still unsatisfactory in patients with high-risk AML (elderly, relapsed, refractory, and
secondary). A CAG regimen has been commonly used in China and Japan for the treatment of this type of patients
(pts). The CAG regimen consists of low-dose cytarabine 10 mg/m2 q12 SQ on d1-14, aclarubicin 7 mg/m2, QD on d1-
8, or 14 mg/m2, QD on d1-4, and G-CSF 200 mug/m2, QD on d1-14. The aim of this study is to summarize the data
and to analyze the efficacy as well as the toxic effects of CAG regimen in acute leukemia (AL) patients. Methods: A
meta-analysis of 15 trials with a total of 580 AL pts was performed to summarize and analyze the efficacy of CAG
regimen as well as the toxic effects. The literature search was conducted in PubMed, Google Scholar, and Medline, as
well as ASH and ASCO meeting abstracts. Results: Among the 580 pts treated with CAG, 456 pts were AML, 100 pts
were MDS/tAML,19 pts were ALL, 5 pts were BAL. 163 pts were newly diagnosed AML, 141/75 pts were
relapsed/refractory (R/R). The CR rates of CAG in newly-diagnosed, relapsed, refractory, elderly AML patients were
63.9% (49%-67.6%), 83% (40%-86%), 30.4 (12.5%-48.4%), and 53.5% (31.5%-67%), respectively. The median OS in
new, relapsed, elderly AML patients were 14.5m (9m-17m), 16m (15m-17m), and 8m (7m-9m), respectively. Data
available from 4 trials which studied the efficacy of CAG in MDS/tAML patients showed that CR rate was 40.5%
(38.5%-46.4%). There were only two small studies of CAG in ALL and in BAL that showed ORR of 100%. The toxicity of
CAG in all reports were mild and the CAG regimen were well tolerated. Conclusion: This low-intensity CAG regimen
appears to be very well tolerated with clear activity in high-risk AL pts. Randomized study may be warranted.
BACKGROUND: Meta-analysis is a statistical tool for combining and integrating the results of independent studies of
a given scientific issue. The present investigation was initiated to investigate case-referent studies of lung cancer risk
from specific environmental and occupational pollutants, using detailed individual exposure data. MATERIALS AND
METHODS: To examine the risk of lung cancer associated with environmental and occupational pollutants, a meta-
analysis of published case-control studies was undertaken using a random effects model. For this study, the papers
were selected for review from electronic search of PubMed, Medline and Google Scholar during 1990-2006. The
principal outcome measure was the odds ratio for the risk of lung cancer. Twelve study reports detailing the
relationship between the lung cancer and the type of exposure were identified. RESULTS: The odds ratio of asbestos,
cooking fuel, cooking fumes, motor and diesel exhaust related to lung cancer were 1.67, 1.99, 2.52 and 1.42 (
P<0.001), respectively. The odds ratio of metal fumes related to lung cancer was 1.28 (0.001<P<0.01). The combined
odds ratio for the environmental and occupational exposure related to lung cancer was 1.67 ( P<0.001).
CONCLUSIONS: The meta-analysis of the present study shows the magnitude association between asbestos, cooking
fumes, cooking fuels, motor and diesel exhaust, with lung cancer risk. Lung cancer risk may be reduced by controlling
exposure levels.
Background: A variety of computerized assessment batteries (CABs) have been utilized to assess cognitive
impairment in schizophrenia; however, there is no consensus regarding CABs sensitivity to medication effects. This
meta-analysis provides a quantitative overview of CABs used in schizophrenia research by examining medication
trials with at least one pre and post cognitive assessment. Methods: A structured search of the CAB literature using
the PsycInfo, MEDLINE, PubMed, and Google Scholar databases yielded 15 suitable publications that met inclusion
criteria for meta-analytic review. Each CAB website was also examined for relevant publications, resulting in a total
of 81 separate pre-post effects. CABs reviewed included CANTAB, ANAM, CogState, CogLab, and MINDSTREAMS.
Specific tests from each CAB were extracted and grouped into cognitive domains reflecting executive function,
working memory, verbal and non-verbal memory, visuospatial reasoning and motor functioning. Effect sizes (ES)
(Cohen's d) were then calculated for each CAB, their component subtests, and for each cognitive domain. Results:
Analysis of medication effects on cognitive functioning, across different medication types, revealed an overall
moderate effect size (d=0.523) for all CABs which was significantly heterogeneous (p<0.001). Of the five CABs,
CogLab yielded the largest effect size (d=0.79) followed by ANAM and then CogState. Effect sizes were largely driven
by battery composition with measures of attention (d=0.809) and visuospatial reasoning (d=0.702) yielding relatively
higher ESs than non-verbal memory (d=0.459) and executive functioning (d=0.403); although these four domains did
not differ significantly from each other. Type of treatment intervention also impacted ES with combination treatment
(Haloperidol plus nicotine) yielding the largest ES (d=1.05) followed by Haloperidol alone, and then various
antipsychotics and nooptropics. Important moderator variables included previous medication type,
inpatient/outpatient status, number of follow-up cognitive assessments, PANSS negative symptomatology score, and
patient age. Discussion: This meta-analysis suggests that it is possible to more confidently select CABs, their
component subtests, and cognitive domains that are more likely to be sensitive in treatment trials; and that this
sensitivity is moderated by medication type and important disease-related and demographic variables.
Fractional anisotropy anomalies occurring in the white matter tracts in the brains of depressed patients may reflect
microstructural changes underlying the pathophysiology of this disorder. We conducted a meta-analysis of fractional
anisotropy abnormalities occurring in major depressive disorder using voxel-based diffusion tensor imaging studies.
Using the Embase, PubMed and Google Scholar databases, 89 relevant data sets were identified, of which 7
(including 188 patients with major depressive disorder and 221 healthy controls) met our inclusion criteria. Authors
were contacted to retrieve any additional data required. Coordinates were extracted from clusters of significant
white matter fractional anisotropy differences between patients and controls. Relevant demographic, clinical and
methodological variables were extracted from each study or obtained directly from authors. The meta-analysis was
carried out using Signed Differential Mapping. Patients with depression showed decreased white matter fractional
anisotropy values in the superior longitudinal fasciculus and increased fractional anisotropy values in the fronto-
occipital fasciculus compared to controls. Using quartile and jackknife sensitivity analysis, we found that reduced
fractional anisotropy in the left superior longitudinal fasciculus was very stable, with increases in the right fronto-
occipital fasciculus driven by just one study. In conclusion, our meta-analysis revealed a significant reduction in
fractional anisotropy values in the left superior longitudinal fasciculus, which may ultimately play an important role in
the pathology of depression.
Context: Functional magnetic resonance imaging studies in attention-deficit/hyperactivity disorder (ADHD) revealed
fronto-striato-parietal dysfunctions during tasks of inhibition and attention. However, it is unclear whether task-
dissociated dysfunctions exist and to what extent they may be influenced by age and by long-term stimulant
medication use. Objective: To conduct a meta-analysis of functional magnetic resonance imaging studies in ADHD
during inhibition and attention tasks, exploring age and long-term stimulant medication use effects. Data Sources:
Pub-Med, Science-Direct, Web of Knowledge, Google Scholar, and Scopus databases were searched up to May 2012
for meta-analyses. Meta-regression methods explored age and long-term stimulant medication use effects. Study
Selection: Twenty-one data sets were included for inhibition (287 patients with ADHD and 320 control subjects), and
13 data sets were included for attention (171 patients with ADHD and 178 control subjects). Data Extraction: Peak
coordinates of clusters of significant group differences, as well as demographic, clinical, and methodological
variables, were extracted for each study or were obtained from the authors. Data Synthesis: Patients with ADHD
relative to controls showed reduced activation for inhibition in the right inferior frontal cortex, supplementary motor
area, and anterior cingulate cortex, as well as striato-thalamic areas, and showed reduced activation for attention in
the right dorsolateral prefrontal cortex, posterior basal ganglia, and thalamic and parietal regions. Furthermore, the
meta-regression analysis for the attention domain showed that long-term stimulant medication use was associated
with more similar right caudate activation relative to controls. Age effects could be analyzed only for the inhibition
meta-analysis, showing that the supplementary motor area and basal ganglia were underactivated solely in children
with ADHD relative to controls, while the inferior frontal cortex and thalamus were underactivated solely in adults
with ADHD relative to controls. Conclusions: Patients with ADHD have consistent functional abnormalities in 2
distinct domain-dissociated right hemispheric fronto-basal ganglia networks, including the inferior frontal cortex,
supplementary motor area, and anterior cingulate cortex for inhibition and dorsolateral prefrontal cortex, parietal,
and cerebellar areas for attention. Furthermore, preliminary evidence suggests that long-term stimulant medication
use may be associated with more normal activation in right caudate during the attention domain. 2013 American
Medical Association. All rights reserved.
The efficacy of hypnosis in the treatment of depressive symptoms was subjected to a meta-analysis. Studies were
identified using Google Scholar and 6 electronic databases: PubMed, Cochrane Library, PsiTri, PsychLit, Embase, and
the Cochrane Depression, Anxiety and Neurosis Review Group (CCDAN). The keywords used were (a) hypnosis, (b)
hypnotherapy, (c) mood disorder, (d) depression, and (e) dysthymia. Six studies qualified and were analyzed using
the Comprehensive Meta-Analysis software package. The combined effect size of hypnosis for depressive symptoms
was 0.57. Hypnosis appeared to significantly improve symptoms of depression (p .001). Hypnosis appears to be a
viable nonpharmacologic intervention for depression. Suggestions for future research are discussed.
The efficacy of hypnosis in the treatment of depressive symptoms was subjected to a meta-analysis. Studies were
identified using Google Scholar and 6 electronic databases: PubMed, Cochrane Library, PsiTri, PsychLit, Embase, and
the Cochrane Depression, Anxiety and Neurosis Review Group (CCDAN). The keywords used were (a) hypnosis, (b)
hypnotherapy, (c) mood disorder, (d) depression, and (e) dysthymia. Six studies qualified and were analyzed using
the Comprehensive Meta-Analysis software package. The combined effect size of hypnosis for depressive symptoms
was 0.57. Hypnosis appeared to significantly improve symptoms of depression (p < .001). Hypnosis appears to be a
viable nonpharmacologic intervention for depression. Suggestions for future research are discussed.
Recent reports indicate that statins are associated with an increased risk for new-onset diabetes mellitus (DM)
compared with placebo and that this relation is dose dependent. The aim of this study was to perform a
comprehensive network meta-analysis of randomized controlled trials (RCTs) investigating the impact of different
types and doses of statins on new-onset DM. RCTs comparing different types and doses of statins with placebo were
searched for using the MEDLINE, Embase, and Cochrane databases. A search of RCTs pertinent to this meta-analysis
covering the period from November 1994 to October 2012 was conducted by 2 independent investigators using the
MEDLINE, Cochrane, Google Scholar, and Embase databases as well as abstracts and presentations from major
cardiovascular meetings. Seventeen RCTs reporting the incidence of new-onset DM during statin treatment and
including a total of 113,394 patients were identified. The RCTs compared either a statin versus placebo or high-dose
versus moderate-dose statin therapy. Among different statins, pravastatin 40 mg/day was associated with the lowest
risk for new-onset DM compared with placebo (odds ratio 1.07, 95% credible interval 0.86 to 1.30). Conversely,
rosuvastatin 20 mg/day was numerically associated with 25% increased risk for DM compared with placebo (odds
ratio 1.25, 95% credible interval 0.82 to 1.90). The impact on DM appeared to be intermediate with atorvastatin 80
mg/day compared with placebo (odds ratio 1.15, 95% credible interval 0.90 to 1.50). These findings were replicated
at moderate doses. In conclusion, different types and doses of statins show different potential to increase the
incidence of DM. 2013 Elsevier Inc. All rights reserved.
Objective: Compare the long-term voice outcome following calcium hydroxylapatite injection laryngoplasty (IL) vs
silicone medialization laryngoplasty (ML) as the long-term treatment modalities for the treatment of unilateral vocal
fold paralysis (UVFP) through a meta-analysis study. Method: A systematic literature review was performed from
MEDLINE, Google Scholar, Web of Science, Scopus, and Cochrane between January 1, 1980, and December 31, 2010.
Studies reporting voice outcome after IL with calcium hydroxylappatite and/or ML with silicone for the treatment for
UVFP were included. The primary outcome measure was change in Voice Handicap Index (VHI). Results: Seven
hundred and forty-two abstracts were screened for relevancy. Seventy-one articles were reviewed in detail. Twelve
studies satisfied the inclusion criteria. The mean VHI score, following IL (n = 209), improved from 68.36 (+/-6.88) to
32.24 (+/-7.33). The mean VHI score, following ML (n = 110), improved from 72.22 (+/-11.06) to 34.02 (+/-6.48). The
improvement in VHI following both techniques was statistically significant. Conclusion: Injection laryngoplasty with
calcium hydroxylapatite and medialization laryngoplasty with silicone offer comparable voice improvement as long-
term treatment modalities for UVFP. The choice of procedure should be based on planned duration of medialization,
patient's preference, and physician's preference.
Background: Hepatocarcinogenesis is a complex process that may be influenced by many factors, including
polymorphism in microsomal epoxide hydrolase (mEH). Previous work suggests an association between the
Tyr113His and His139Arg mEH polymorphisms and susceptibility to hepatocellular carcinoma (HCC), but the results
have been inconsistent. Methods: PubMed, EMBASE, Google Scholar and the Chinese National Knowledge
Infrastructure databases were systematically searched to identify relevant studies. A meta-analysis was performed to
examine the association between Tyr113His and His139Arg mEH polymorphism and susceptibility to HCC. Odds
ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results: Eleven studies were included in the
meta-analysis, involving 1,696 HCC cases and 3,600 controls. The 113His- mEH allele was significantly associated with
increased risk of HCC based on allelic contrast (OR = 1.35, 95% CI = 1.04-1.75, p = 0.02), homozygote comparison (OR
= 1.65, 95% CI = 1.07-2.54, p = 0.02) and a recessive genetic model (OR = 1.54, 95% CI = 1.21-1.96, p<0.001), while
individuals carrying the Arg139Arg mEH genotype had no association with increased or decreased risk of HCC.
Conclusion: The 113His- allele polymorphism in mEH may be a risk factor for hepatocarcinogenesis, while the mEH
139Arg- allele may not be a risk or protective factor. There is substantial evidence that mEH polymorphisms interact
synergistically with other genes and the environment to modulate risk of HCC. Further large and well-designed
studies are needed to confirm these conclusions. 2013 Zhong et al.
BACKGROUND: Hepatocarcinogenesis is a complex process that may be influenced by many factors, including
polymorphism in microsomal epoxide hydrolase (mEH). Previous work suggests an association between the
Tyr113His and His139Arg mEH polymorphisms and susceptibility to hepatocellular carcinoma (HCC), but the results
have been inconsistent., METHODS: PubMed, EMBASE, Google Scholar and the Chinese National Knowledge
Infrastructure databases were systematically searched to identify relevant studies. A meta-analysis was performed to
examine the association between Tyr113His and His139Arg mEH polymorphism and susceptibility to HCC. Odds
ratios (ORs) and 95% confidence intervals (95% CIs) were calculated., RESULTS: Eleven studies were included in the
meta-analysis, involving 1,696 HCC cases and 3,600 controls. The 113His- mEH allele was significantly associated with
increased risk of HCC based on allelic contrast (OR=1.35, 95% CI=1.04-1.75, p=0.02), homozygote comparison
(OR=1.65, 95% CI=1.07-2.54, p=0.02) and a recessive genetic model (OR=1.54, 95% CI=1.21-1.96, p<0.001), while
individuals carrying the Arg139Arg mEH genotype had no association with increased or decreased risk of HCC.,
CONCLUSION: The 113His- allele polymorphism in mEH may be a risk factor for hepatocarcinogenesis, while the mEH
139Arg- allele may not be a risk or protective factor. There is substantial evidence that mEH polymorphisms interact
synergistically with other genes and the environment to modulate risk of HCC. Further large and well-designed
studies are needed to confirm these conclusions.
OBJECTIVE: To compare outcomes between minimally invasive left internal thoracic artery bypass and percutaneous
coronary artery stenting as primary interventions for isolated lesions of the left anterior descending artery. DESIGN:
Meta-analysis of randomised and non-randomised comparative peer reviewed publications. DATA SOURCES:
Embase, Medline, Cochrane, Google Scholar, and Health Technology Assessment databases (1966-2005). REVIEW
METHODS: Studies comparing the two procedures as the primary intervention for isolated left anterior descending
artery stenosis were identified and the following extracted: study design, population characteristics, severity of
coronary artery disease, cardiovascular risk factors, and outcomes of interest. RESULTS: 12 studies (1952 patients)
reporting results from eight groups were included: one was a retrospective design, one prospective non-randomised,
and six prospective randomised. Meta-analysis of randomised trials showed a higher rate of recurrence of angina
(odds ratio 2.62, 95% confidence interval 1.32 to 5.21), incidence of major adverse coronary and cerebral events
(2.86, 1.62 to 5.08), and need for repeat revascularisation (4.63, 2.52 to 8.51) with percutaneous stenting. No
significant difference was found in myocardial infarction, stroke, or mortality at maximum follow-up between
interventions. CONCLUSIONS: Minimally invasive left internal thoracic artery bypass for isolated lesions of the left
anterior descending artery resulted in fewer complications in the mid-term compared with percutaneous
transluminal coronary artery stenting.
Background:The 1306 C>T, 1171 5A>6A, and 1562C>T polymorphisms of matrix metalloproteinase (MMP) 2, MMP3,
and MMP9 genes, respectively, have been found to be functional and may contribute to head and neck
carcinogenesis. However, the results of case-control studies examining associations between MMP polymorphisms
and head and neck cancer (HNC) risk remain inconclusive. Therefore, we performed a meta-analysis to further
evaluate the role of these polymorphisms in HNC development.Methods:We searched PubMed, ISI Web of
Knowledge, MEDLINE, Embase, and Google Scholar to identify all published case-control studies of MMP2-1306 C>T,
MMP3-1171 5A>6A, and MMP9-1562 C>T polymorphisms and HNC risk in the meta-analysis. Odds ratios (ORs) and
95% confidence intervals (CIs) were used to assess the association between these polymorphisms and HNC
risk.Results:Thirteen studies were included in this meta-analysis. For MMP2-1306 C>T polymorphism, significant
associations were observed under three genetic models both in overall comparison and in a hospital-based
subgroup, and in oral cavity cancer and nasopharyngeal cancer under dominant model as well. For MMP3-1171
5A>6A and MMP9-1562 C>T polymorphisms, no association was found in overall comparison; however, in subgroup
analyses based on ethnicity and tumor site, significant associations were detected between the MMP3-1171 5A>6A
polymorphism and HNC risk in a European population and pharyngeal/laryngeal cancer under two genetic
contrasts.Conclusion:This meta-analysis suggests that the MMP2-1306 C>T polymorphism is associated with HNC
risk, as is the MMP3-1171 5A>6A polymorphism specifically in some subgroups. Further studies with larger sample
sizes are warranted. 2013 Zhang et al.
Patients receiving dialysis are at high risk for sudden cardiac death. Although clinical trials have shown that
implantable cardioverter-defibrillators (ICDs) are effective in improving survival in a variety of populations, dialysis
patients have been routinely excluded from these analyses. The purpose of this meta-analysis was to synthesize the
available evidence regarding the effectiveness of ICD therapy in patients receiving dialysis. Medline, EMBASE, Web of
Science, and Google Scholar were searched for pertinent studies published from 1999 to 2008. In addition, hand
searches of the relevant annual scientific sessions and major scientific meetings in North America and Europe from
2000 to 2008 were performed. All clinical reports describing outcomes of ICD therapy in relation to renal function
were eligible. Four investigators independently extracted the data in a standardized manner. Seven studies were
identified, with a total of 2,516 patients and 89 patients receiving dialysis. Despite having ICDs, patients receiving
dialysis had a 2.7-fold higher mortality compared with those not receiving dialysis. The results were similar in fixed-
and random-effects models. Comparing patients receiving dialysis and those with chronic kidney disease but not
receiving dialysis, there was no significant difference in mortality (risk ratio 1.62, 95% confidence interval 0.84 to
3.14). No evidence of publication bias was found. In conclusion, this meta-analysis suggests that even in those with
ICDs, there is still a 2.7-fold increased mortality risk in patients who receive dialysis compared with those who do not.
Beta blockers may be less cardioprotective in patients with ICDs who are on dialysis.
Patients receiving dialysis are at high risk for sudden cardiac death. Although clinical trials have shown that
implantable cardioverter-defibrillators (ICDs) are effective in improving survival in a variety of populations, dialysis
patients have been routinely excluded from these analyses. The purpose of this meta-analysis was to synthesize the
available evidence regarding the effectiveness of ICD therapy in patients receiving dialysis. Medline, EMBASE, Web of
Science, and Google Scholar were searched for pertinent studies published from 1999 to 2008. In addition, hand
searches of the relevant annual scientific sessions and major scientific meetings in North America and Europe from
2000 to 2008 were performed. All clinical reports describing outcomes of ICD therapy in relation to renal function
were eligible. Four investigators independently extracted the data in a standardized manner. Seven studies were
identified, with a total of 2,516 patients and 89 patients receiving dialysis. Despite having ICDs, patients receiving
dialysis had a 2.7-fold higher mortality compared with those not receiving dialysis. The results were similar in fixed-
and random-effects models. Comparing patients receiving dialysis and those with chronic kidney disease but not
receiving dialysis, there was no significant difference in mortality (risk ratio 1.62, 95% confidence interval 0.84 to
3.14). No evidence of publication bias was found. In conclusion, this meta-analysis suggests that even in those with
ICDs, there is still a 2.7-fold increased mortality risk in patients who receive dialysis compared with those who do not.
Beta blockers may be less cardioprotective in patients with ICDs who are on dialysis.
The relationship between protein Z levels and thrombosis is controversial. We performed a systematic review and
meta-analysis of the available studies to assess the association between protein Z and vascular thrombotic diseases.
We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The
Cochrane Library, bibliographies of retrieved articles and abstracts of congresses up to October, 2009. Studies were
included if they analysed protein Z levels in patients with vascular thrombotic diseases. After the review process, 28
case-control studies (33 patient cohorts), including 4,218 patients with thrombotic diseases and 4,778 controls, were
selected for analysis. The overall analysis using a random-effects model showed that low protein Z levels were
associated with an increased risk of thrombosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 2.05-4.12;
p<0.00001). On subgroup analysis, a significant association was found between low protein Z levels and arterial
vascular diseases (OR 2.67, 95%CI 1.60-4.48; p=0.0002), pregnancy complications (OR 4.17, 95%CI 2.31-7.52;
p<0.00001), and venous thromboembolic diseases (OR 2.18, 95%CI 1.19-4.00; p=0.01). The results of this meta-
analysis are consistent with a role for protein Z deficiency in thrombotic diseases, including arterial thrombosis,
pregnancy complications and venous thromboembolism.
The relationship between protein Z levels and thrombosis is controversial. We performed a systematic review and
meta-analysis of the available studies to assess the association between protein Z and vascular thrombotic diseases.
We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The
Cochrane Library, bibliographies of retrieved articles and abstracts of congresses up to October, 2009. Studies were
included if they analysed protein Z levels in patients with vascular thrombotic diseases. After the review process, 28
case-control studies (33 patient cohorts), including 4,218 patients with thrombotic diseases and 4,778 controls, were
selected for analysis. The overall analysis using a random-effects model showed that low protein Z levels were
associated with an increased risk of thrombosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 2.05-4.12;
p<0.00001). On subgroup analysis, a significant association was found between low protein Z levels and arterial
vascular diseases (OR 2.67, 95%CI 1.60-4.48; p=0.0002), pregnancy complications (OR 4.17, 95%CI 2.31-7.52;
p<0.00001), and venous thromboembolic diseases (OR 2.18, 95%CI 1.19-4.00; p=0.01). The results of this
metaanalysis are consistent with a role for protein Z deficiency in thrombotic diseases, including arterial thrombosis,
pregnancy complications and venous thromboembolism. Schattauer 2010.
Toxoplasmic encephalitis (TE) is one of the most common central nervous system (CNS) opportunistic infections in
HIV-infected patients. It can be prevented and treated through drug regimen. However, drugs have serious adverse
effects sometimes. The purpose of this review is to determine the most effective therapy for TE in HIV-infected
patients. Different primary prophylaxis and treatment regimens have been compared with regard to episodes of TE,
clinical response, morbidity, and serious adverse events. In September 2012, we searched PubMed, Google Scholar,
EMBASE, and CENTRAL (the Cochrane Central Register of Controlled Trials) database for randomized and quasi-
randomized controlled trials of any drug regimen for primary prophylaxis and treatment of TE in HIV-infected
patients. We independently extracted data and assessed eligibility and risk of bias using a standardized data
collection form, and resolved any disagreement through discussion. We combined dichotomous outcomes using
odds ratio (OR), presenting with 95% confidence interval (CI). Eleven trials were found to meet the inclusion criteria.
Six trials compared trimethoprim-sulfamethoxazole (TMP-SMX) with dapsone-pyrimethamine (D-P) were analyzed
together for the outcome of episodes of TE, morbidity, and serious adverse events. The two treatment arms did not
differ for episodes of TE (OR=0.98; 95% CI: 0.48-2.00). Compared with D-P, TMP-SMX showed a beneficial trend in
terms of mortality despite a lack of statistical significance (OR=0.75; 95% CI: 0.53-1.06). However, TMP-SMX is still
associated with substantial toxicity and intolerance (OR=1.47; 95% CI: 0.91-2.38). Three trials compared
pyrimethamine-sulfadiazine (P-S) with pyrimethamine-clindamycin (P-C) were analyzed together for the outcome of
clinical response, morbidity, and serious adverse events. Compared with P-C, P-S showed a beneficial trend in terms
of clinical response (OR=1.63; 95% CI: 1.05-2.51); P-S also showed a beneficial trend in terms of mortality despite a
lack of statistical significance (OR=0.66; 95% CI: 0.37-1.17). However, P-S is still associated with substantial toxicity
and intolerance (OR=3.08; 95% CI: 1.82-5.24). Two trials compared P-S with TMP-SMX were analyzed together for
the outcome of clinical response, morbidity, and serious adverse events. The two treatment arms did not differ for
clinical response (OR=0.90; 95% CI: 0.39-2.06). Compared with TMP-SMX, P-S showed a beneficial trend in terms of
mortality despite a lack of statistical significance (OR=0.12; 95% CI: 0.01-1.39). However, P-S is still associated with
substantial toxicity and intolerance (OR=2.91; 95% CI: 0.99-8.55). The available evidence fails to identify any one
superior regimen for the primary prophylaxis and treatment of TE. The choice of therapy will often be directed by
available therapy. Although current evidence does not allow a definitive recommendation, administration of TMP-
SMX for primary prophylaxis and treatment of TE in patients with HIV infection is consistent with the available data.
2013 Elsevier B.V.
Toxoplasmic encephalitis (TE) is one of the most common central nervous system (CNS) opportunistic infections in
HIV-infected patients. It can be prevented and treated through drug regimen. However, drugs have serious adverse
effects sometimes. The purpose of this review is to determine the most effective therapy for TE in HIV-infected
patients. Different primary prophylaxis and treatment regimens have been compared with regard to episodes of TE,
clinical response, morbidity, and serious adverse events. In September 2012, we searched PubMed, Google Scholar,
EMBASE, and CENTRAL (the Cochrane Central Register of Controlled Trials) database for randomized and quasi-
randomized controlled trials of any drug regimen for primary prophylaxis and treatment of TE in HIV-infected
patients. We independently extracted data and assessed eligibility and risk of bias using a standardized data
collection form, and resolved any disagreement through discussion. We combined dichotomous outcomes using
odds ratio (OR), presenting with 95% confidence interval (CI). Eleven trials were found to meet the inclusion criteria.
Six trials compared trimethoprim-sulfamethoxazole (TMP-SMX) with dapsone-pyrimethamine (D-P) were analyzed
together for the outcome of episodes of TE, morbidity, and serious adverse events. The two treatment arms did not
differ for episodes of TE (OR=0.98; 95% CI: 0.48-2.00). Compared with D-P, TMP-SMX showed a beneficial trend in
terms of mortality despite a lack of statistical significance (OR=0.75; 95% CI: 0.53-1.06). However, TMP-SMX is still
associated with substantial toxicity and intolerance (OR=1.47; 95% CI: 0.91-2.38). Three trials compared
pyrimethamine-sulfadiazine (P-S) with pyrimethamine-clindamycin (P-C) were analyzed together for the outcome of
clinical response, morbidity, and serious adverse events. Compared with P-C, P-S showed a beneficial trend in terms
of clinical response (OR=1.63; 95% CI: 1.05-2.51); P-S also showed a beneficial trend in terms of mortality despite a
lack of statistical significance (OR=0.66; 95% CI: 0.37-1.17). However, P-S is still associated with substantial toxicity
and intolerance (OR=3.08; 95% CI: 1.82-5.24). Two trials compared P-S with TMP-SMX were analyzed together for
the outcome of clinical response, morbidity, and serious adverse events. The two treatment arms did not differ for
clinical response (OR=0.90; 95% CI: 0.39-2.06). Compared with TMP-SMX, P-S showed a beneficial trend in terms of
mortality despite a lack of statistical significance (OR=0.12; 95% CI: 0.01-1.39). However, P-S is still associated with
substantial toxicity and intolerance (OR=2.91; 95% CI: 0.99-8.55). The available evidence fails to identify any one
superior regimen for the primary prophylaxis and treatment of TE. The choice of therapy will often be directed by
available therapy. Although current evidence does not allow a definitive recommendation, administration of TMP-
SMX for primary prophylaxis and treatment of TE in patients with HIV infection is consistent with the available data.
Copyright 2013 Elsevier B.V. All rights reserved.
CONTEXT: Antibiotic-associated diarrhea (AAD) is a common complication of most antibiotics and Clostridium difficile
disease (CDD), which also is incited by antibiotics, is a leading cause of nosocomial outbreaks of diarrhea and colitis.
The use of probiotics for these two related diseases remains controversial. OBJECTIVE: To compare the efficacy of
probiotics for the prevention of AAD and the treatment of CDD based on the published randomized, controlled
clinical trials. DATA SOURCES: PubMed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and
Cochrane Central Register of Controlled Trials were searched from 1977 to 2005, unrestricted by language.
Secondary searches of reference lists, authors, reviews, commentaries, associated diseases, books, and meeting
abstracts. STUDY SELECTION: Trials were included in which specific probiotics given to either prevent or treat the
diseases of interest. Trials were required to be randomized, controlled, blinded efficacy trials in humans published in
peer-reviewed journals. Trials that were excluded were pre-clinical, safety, Phase 1 studies in volunteers, reviews,
duplicate reports, trials of unspecified probiotics, trials of prebiotics, not the disease being studied, or inconsistent
outcome measures. Thirty-one of 180 screened studies (totally 3,164 subjects) met the inclusion and exclusion
criteria. DATA EXTRACTION: One reviewer identified studies and abstracted data on sample size, population
characteristics, treatments, and outcomes. DATA SYNTHESIS: From 25 randomized controlled trials (RCTs), probiotics
significantly reduced the relative risk of AAD (RR = 0.43, 95% CI 0.31, 0.58, p < 0.001). From six randomized trials,
probiotics had significant efficacy for CDD (RR = 0.59, 95% CI 0.41, 0.85, p = 0.005). CONCLUSION: A variety of
different types of probiotics show promise as effective therapies for these two diseases. Using meta-analyses, three
types of probiotics (Saccharomyces boulardii, Lactobacillus rhamnosus GG, and probiotic mixtures) significantly
reduced the development of antibiotic-associated diarrhea. Only S. boulardii was effective for CDD. 2006 by Am. Coll.
of Gastroenterology.
Background: Traveler's diarrhea (TD) is a common health complaint among travelers. Rates of TD can range from 5%
to 50%, depending on the destination. The use of probiotics for this disease remains controversial. The objective of
this study was to compare the efficacy of probiotics for the prevention of TD based on published randomized,
controlled clinical trials. Methods: PubMed, Google Scholar, metaRegister, NIH registry of clinical trials and Cochrane
Central Register of Controlled Trials were searched from 1977 to 2005, unrestricted by language. Secondary searches
of reference lists, authors, reviews, commentaries, associated diseases, books and meeting abstracts. Inclusion
criteria included: randomization, controlled, blinded, efficacy trials, in humans, peer-reviewed journals. Exclusion
criteria were: pre-clinical, safety, phase 1 studies in volunteers, reviews, duplicate reports, trials of unspecified
probiotics, trials of prebiotics, and inconsistent outcome measures. Results: Twelve of 940 screened studies met the
inclusion and exclusion criteria. The pooled relative risk indicates that probiotics significantly prevent TD (RR=0.85,
95% CI 0.79,0.91, p < 0.001). Conclusion: Several probiotics (Saccharomyces boulardii and a mixture of Lactobacillus
acidophilus and Bifidobacterium bifidum) had significant efficacy. No serious adverse reactions were reported in the
12 trials. Probiotics may offer a safe and effective method to prevent TD.
Irritable bowel syndrome (IBS) is a chronic condition affecting 3%-25% of the general population. As no curative
treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alteration of the
normal intestinal microflora has been observed in IBS, probiotics (beneficial microbes taken to improve health) may
be useful in reducing symptoms. This paper systematically reviews randomized, controlled, blinded trials of
probiotics for the treatment of IBS and synthesizes data on efficacy across trials of adequate quality. PubMed,
Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and the Cochrane Central Register of Controlled
Trials were searched from 1982-2007. We also conducted secondary searches of reference lists, reviews,
commentaries, relevant articles on associated diseases, books and meeting abstracts. Twenty trials with 23 probiotic
treatment arms and a total of 1404 subjects met inclusion criteria. Probiotic use was associated with improvement in
global IBS symptoms compared to placebo [pooled relative risk (RR pooled) 0.77, 95% confidence interval (95% CI)
0.62-0.94]. Probiotics were also associated with less abdominal pain compared to placebo [RR pooled = 0.78 (0.69-
0.88)]. Too few studies reported data on other IBS symptoms or on specific probiotic strains to allow estimation of a
pooled RR. While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms
compared to placebo, these results should be interpreted with caution, given the methodological limitations of
contributing studies. Probiotics warrant further study as a potential therapy for IBS.
Background: Children born by Caesarean section have modified intestinal bacterial colonization and consequently
may have an increased risk of developing asthma under the hygiene hypothesis. The results of previous studies that
have investigated the association between Caesarean section and asthma have been conflicting. Objective: To review
published literature and perform a meta-analysis summarizing the evidence in support of an association between
children born by Caesarean section and asthma. Methods: MEDLINE, Web Science, Google Scholar and PubMed were
searched to identify relevant studies. Odds ratio (OR) and 95% confidence interval (CI) were calculated for each study
from the reported prevalence of asthma in children born by Caesarean section and in control children. Meta-analysis
was then used to derive a combined OR and test for heterogeneity in the findings between studies. Results: Twenty-
three studies were identified. The overall meta-analysis revealed an increase in the risk of asthma in children
delivered by Caesarean section (OR=1.22, 95% CI 1.14, 1.29). However, in this analysis, there was evidence of
heterogeneity (I 2=46%) that was statistically significant (P<0.001). Restricting the analysis to childhood studies, this
heterogeneity was markedly decreased (I2=32%) and no longer attained statistical significance (P=0.08). In these
studies, there was also evidence of an increase (P<0.001) in the risk of asthma after Caesarean section (OR=1.20,
95% CI 1.14, 12.6). Conclusion: In this meta-analysis, we found a 20% increase in the subsequent risk of asthma in
children who had been delivered by Caesarean section. 2007 The Authors.
Purpose: Oxidative DNA damage caused by reactive oxygen species plays an important role in cancer development.
The association between colorectal cancer and hOGG1 Ser326Cys polymorphisms has been analyzed in several
published studies, but mixed findings have been reported. The main purpose of this study was to integrate previous
results and explore whether the polymorphism of hOGG1 is associated with susceptibility to colorectal cancer.
Methods: PubMed, Embase, Google Scholar, and Cbmdisc were searched for studies on the relationship of hOGG1
SNPs and the incidence of colorectal cancer (CRC). Eligible articles were included for data extraction. The main
outcome was the frequency of hOGG1 Ser326Cys polymorphisms between cases and controls. Comparison of the
distribution of SNP was mainly performed using Review Manager 5.0. Results: A total of 4,174 cases and 6,196
controls from 12 studies were included for this meta-analysis. Overall, stratified by ethnicity or population source, no
significant associations between the hOGG1 Ser326Cys polymorphism and colorectal cancer risk were found for
Cys/Cys allele (OR = 1.146; 95 % CI: 0.978-1.342, P = 0.091), Cys/Cys + Cys/Ser versus Ser/Ser (OR = 1.045; 95 % CI:
0.975-1.121, P = 0.213) Cys/Cys Versus Ser/Ser (OR = 1.243; 95 % CI: 0.979-1.578, P = 0.074) and Cys/Cys versus
Cys/Ser + Ser/Ser (OR = 1.198; 95 % CI: 0.959-1.496, P = 0.111) in a recessive model and (OR = 1.494; 95 % CI: 1.023-
2.181, P = 0.038) in a homozygote contrast. However, if apart from sensitivity analysis, there was some evidence to
indicate that significantly increased risks were found among European plus American subjects, who are mostly
Caucasian (OR = 1.444; 95 % CI: 1.017-2.05 Cys/Cys vs. Ser/Cys + Ser/Ser; P = 0.04). In the subgroup analyses, we also
did not found any association between hOGG1 Ser326Cys polymorphism and certain populations and smokers.
Conclusions: This meta-analysis suggests that there is no robust association between hOGG1 Ser326Cys
polymorphism and colorectal cancer. Because of the limitation of meta-analysis, this finding demands further
investigation. Springer-Verlag 2012.
PURPOSE: Oxidative DNA damage caused by reactive oxygen species plays an important role in cancer development.
The association between colorectal cancer and hOGG1 Ser326Cys polymorphisms has been analyzed in several
published studies, but mixed findings have been reported. The main purpose of this study was to integrate previous
results and explore whether the polymorphism of hOGG1 is associated with susceptibility to colorectal cancer.,
METHODS: PubMed, Embase, Google Scholar, and Cbmdisc were searched for studies on the relationship of hOGG1
SNPs and the incidence of colorectal cancer (CRC). Eligible articles were included for data extraction. The main
outcome was the frequency of hOGG1 Ser326Cys polymorphisms between cases and controls. Comparison of the
distribution of SNP was mainly performed using Review Manager 5.0., RESULTS: A total of 4,174 cases and 6,196
controls from 12 studies were included for this meta-analysis. Overall, stratified by ethnicity or population source, no
significant associations between the hOGG1 Ser326Cys polymorphism and colorectal cancer risk were found for
Cys/Cys allele (OR=1.146; 95% CI: 0.978-1.342, P=0.091), Cys/Cys+Cys/Ser versus Ser/Ser (OR=1.045; 95% CI: 0.975-
1.121, P=0.213) Cys/Cys Versus Ser/Ser (OR=1.243; 95% CI: 0.979-1.578, P=0.074) and Cys/Cys versus
Cys/Ser+Ser/Ser (OR=1.198; 95% CI: 0.959-1.496, P=0.111) in a recessive model and (OR=1.494; 95% CI: 1.023-2.181,
P=0.038) in a homozygote contrast. However, if apart from sensitivity analysis, there was some evidence to indicate
that significantly increased risks were found among European plus American subjects, who are mostly Caucasian
(OR=1.444; 95% CI: 1.017-2.05 Cys/Cys vs. Ser/Cys+Ser/Ser; P=0.04). In the subgroup analyses, we also did not found
any association between hOGG1 Ser326Cys polymorphism and certain populations and smokers., CONCLUSIONS:
This meta-analysis suggests that there is no robust association between hOGG1 Ser326Cys polymorphism and
colorectal cancer. Because of the limitation of meta-analysis, this finding demands further investigation.
Study Design.: A meta-analysis that systematically reviewed the evaluation studies of a scoliosis screening program
reported in the literature. Objective.: To evaluate the best current evidence on the clinical effectiveness of school
screening for adolescent idiopathic scoliosis. Summary of Background Data.: The use of school scoliosis screening is
controversial, and its clinical effectiveness has been diversely reported. Methods.: Data sources included 3
databases, namely, PubMed, Google scholar, CINAHL database, and the references from identified reviews and
studies. Studies were included if: (1) they adopted a retrospective cohort design; (2) were screened using either the
forward bending test (FBT), angle of trunk rotation, or Moire topography; (3) reported results of screening tests and
radiographic assessments; (4) screened adolescents only; (5) reported the incidence of curves with a minimum Cobb
angle of 10degree or greater; and (6) reported the number of referrals for radiography. Reviews, comments, case
studies, and editorials were excluded. Results.: Thirty-six studies, including 34 from the 775 initially identified studies
and 2 from the references, met the selection criteria. The pooled referral rate for radiography was 5.0%, and the
pooled positive predictive values for detecting curves >=10degree, curves >=20degree, and treatment were 28.0%,
5.6%, and 2.6%, respectively. There was substantial heterogeneity across studies. Meta-regression showed that
programs using the FBT alone reported a higher referral rate (odds ratio [OR] = 2.91) and lower positive predictive
values for curves >=10degree (OR = 0.49) and curves >=20degree (OR = 0.34) than programs using other tests. Only
one small study followed students until skeletal maturity and reported the sensitivity of screening; however, the
specificity was not reported. No severe publication bias was noted. Conclusion.: The use of the FBT alone in school
scoliosis screening is insufficient. We need large, retrospective cohort studies with sufficient follow-up to properly
assess the clinical effectiveness of school scoliosis screening. 2010, Lippincott Williams & Wilkins.
To evaluate the safety of simultaneous and staged resection for synchronous liver metastasis from colorectal cancer.
PubMed/Medline, ISI Web of Knowledge, Springer link, ebscohost, Elsevier Wiley Interscience, Google Scholar were
searched for case-control studies concerning simultaneous versus staged resection of synchronous liver metastasis
from colorectal cancer between January 1989 and March 2009. A meta-analysis was performed to analyze the
morbidity and perioperative mortality. Seven case-control studies, with a total of 1390 patients of liver metastasis
from colorectal cancer undergone curative hepatic resection, were reviewed. There were 495 simultaneous and 895
staged resections. Perioperative mortality was 1.1% in the staged resection group and 2.4% in the the simultaneous
group, the difference was statistically significant[Peto OR 3.39, 95% CI 1.29-8.93, P=0.01]. No significant difference
was found in morbidity between two groups[OR(random)0.88, 95% CI 0.51-1.51, P=0.64]. Selective staged resection
is safe for synchronous liver metastasis from colorectal cancer.
OBJECTIVE: To evaluate the safety of simultaneous and staged resection for synchronous liver metastasis from
colorectal cancer., METHODS: PubMed/Medline, ISI Web of Knowledge, Springer link, ebscohost, Elsevier Wiley
Interscience, Google Scholar were searched for case-control studies concerning simultaneous versus staged
resection of synchronous liver metastasis from colorectal cancer between January 1989 and March 2009. A meta-
analysis was performed to analyze the morbidity and perioperative mortality., RESULTS: Seven case-control studies,
with a total of 1390 patients of liver metastasis from colorectal cancer undergone curative hepatic resection, were
reviewed. There were 495 simultaneous and 895 staged resections. Perioperative mortality was 1.1% in the staged
resection group and 2.4% in the the simultaneous group, the difference was statistically significant[Peto OR 3.39,
95% CI 1.29-8.93, P=0.01]. No significant difference was found in morbidity between two groups[OR(random)0.88,
95% CI 0.51-1.51, P=0.64]., CONCLUSION: Selective staged resection is safe for synchronous liver metastasis from
colorectal cancer.
PURPOSE: Tapentadol is an oral analgesic which agonizes muopioid receptors and inhibits norepinephrine synaptic
uptake. Our objective was to systematically identify and synthesize available data on adverse events associated with
use of the new analgesic tapentadol compared with placebo and oxycodone. METHODS: We performed a database
search for "tapentadol" in Medline, Embase, International Pharmaceutical Abstracts, ClinicalTrials.gov, and Google
Scholar. Our search was augmented by citation tracking and package insert information. Randomized, controlled
trials evaluating the safety or tolerability of tapentadol in English were included. Two independent investigators
extracted study data, which was pooled and analyzed using a Mantel-Haenszel random effects model. RESULTS: Ten
studies met inclusion criteria, including 8 randomized, placebo-controlled trials (n=3,800), and 8 papers with an
oxycodone active control (n=5,310). Indications for pain control included post-surgical and chronic pain due to
osteoporosis and diabetic peripheral neuropathy. Studies used total daily doses of tapentadol immediate release (IR)
and extended release (ER) ranging from 25-600 mg and 200-600 mg, respectively, as well as oxycodone IR and CR,
dosed from 20-90 mg and 40-100 mg daily, respectively. Compared to placebo, patients receiving tapentadol were
found to be statistically significantly more likely to experience nausea, dizziness, somnolence, constipation, pruritis,
fatigue, vomiting, hyperhidrosis and dry mouth. The relative risk (RR) for any adverse event was significantly lower
with tapentadol than oxycodone (RR 0.78; 95% confidence interval 0.68-0.87). When compared to oxycodone,
patients receiving tapentadol were more likely to experience dry mouth (RR 1.6; 1.31-2.63), and less likely to report
nausea (RR 0.62; 0.56-0.69), dizziness (RR 0.86; 0.75-0.96), vomiting (RR 0.40; 0.26-0.61), pruritis (RR 0.50; 0.39-
0.64), and constipation (RR 0.47; 0.56-0.69). CONCLUSION: Treatment of moderate to severe pain with tapentadol
was associated with fewer adverse events than oxycodone therapy, with the exception of dry mouth.
Objectives. To compare the voice outcome of calcium hydroxylapatite (CaHA) injection laryngoplasty (IL) vs silicone
medialization thyroplasty (MT) in the treatment of unilateral vocal fold paralysis (UVFP). Data Sources. Systematic
review of English literature from MEDLINE, Google Scholar, Web of Science, Scopus, and the Cochrane library from
January 1, 1980, to December 31, 2010. Review Methods. Included studies reporting voice-related quality of life
(Voice Handicap Inventory [VHI]) following IL with CaHA or MT with silicone. The primary outcome measure was the
improvement in VHI. The secondary outcome was improvement in maximum phonatory time (MPT). Results. Of the
742 abstracts screened for relevancy, 24 studies qualified for analysis. The mean (SD) VHI scores were 72.22 (11.06)
before MT and 34.02 (6.48) after MT. The mean (SD) VHI scores were 68.36 (6.88) before IL and 32.24 (7.33) after IL.
The paired difference mean of VHI improvement was 38.20 (95% confidence interval [CI], 17.05-59.32; P = .007) for
MT and 36.11 (95% CI, 29.65- 42.57; P = .001) for IL. The mean (SD) MPT scores were 7.40 (3.14) before IL and 13.00
(1.75) after IL. The mean (SD) MPT scores were 6.16 (1.90) before MT and 12.40 (2.72) after MT. The paired
difference mean of MPT improvement was 6.23 (95% CI, 4.74-7.73; P>.001) for MT and 5.60 (95% CI, 2.95-8.25; P =
.006) for IL. Conclusion. Injection laryngoplasty with CaHA and MT with silicone appear to achieve comparable voice
improvement within 1 year, but a definitive conclusion is limited by a lack of standardized outcome measures.
American Academy of Otolaryngology-Head and Neck Surgery Foundation 2013.
Background: AECOPD and AECB are commonly treated with antibiotics. However, their benefit has not been
consistently shown. Meta-analyses of 11 and 13 placebo- controlled studies by Ram (2005) and Puhan (2007),
respectively, showed that antibiotics decreased short-term mortality and treatment failure only among AECOPD
patients with increased cough, sputum purulence and dyspnea (Anthonisen I), particularly those hospitalized. In 12
randomized controlled trials (RCTs) comparing various antibiotics, Dimopoulos (2007) found fewer treatment failures
and side-effects with second-line agents. Besides differences in severity of exacerbation, variations in underlying
disease severity and use of less potent drugs may also explain the difficulty in documenting antibiotic efficacy in
AECOPD/AECB. New 'respiratory' FQs, e.g. levofloxacin, widely used for treating AECOPD/ AECB, exhibit high lung
penetration and high activity against respiratory pathogens. This meta-analysis of studies comparing FQs with non-
FQs may provide insights on the clinical impact of antibiotics in AECOPD/AECB. Methods: We searched MEDLINE,
EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and Google scholar for RCTs
published between 1995-2010 comparing FQs with non-FQs for treating AECOPD/AECB. Two investigators
independently selected trials according to preset inclusion criteria. Results: Thirty six RCTs with 16,687 patients met
our criteria. Data were extracted from intention-to-treat analyses of 46 FQ versus non-FQ treatment pairs. Most
studies recruited patients aged >35 years with at least 2 of 3 cardinal signs of COPD exacerbation (Anthonisen I and
II). Twenty-two studies were blinded. Among 45 treatment pairs evaluating post treatment clinical outcomes,
treatment failure (RR, 0.9256; 95% CI, 0.8458-1.0130; p = 0.0929), bacteriology (no resolution) (RR, 0.6245; 95% CI,
0.5066-0.7699; p = 0.0000), diarrhea (RR, 0.4835; 95% CI, 0.2524-0.9264; p = 0.0285) and other side-effects were
significantly less with FQs versus non-FQs. Except for treatment failure, significant difference favouring FQs was
sustained even after excluding non-blinded studies with young subjects and mild COPD exacerbation. Subgroup
analysis of studies involving new 'respiratory' FQs given less than 5 days revealed no significant difference in clinical
outcomes. However, bacterial persistence and diarrhea were still less than non-FQs. Conclusion: This meta-analysis
shows that FQs, including new 'respiratory' FQs, may be clinically and bacteriologically more effective than non-FQs
with less diarrhea in type I and II COPD exacerbation or AECB.
Objective: To study the effectiveness of propranolol in infantile airway haemangiomas and compare the
effectiveness of propranolol vs. different therapies. Methods: A literature search of Ovid, Embase, the Cochrane
database, Google Scholar, and Medline using PubMed as the search engine was performed to identify studies that
analysed the effect of propranolol treatment in children with airway haemangiomas. Random-effect meta-analytical
techniques were conducted for the outcome measures. Results: Thirteen studies, comprising 36 patients were
included in the analysis. Propranolol was found to be an effective intervention for the resolution of infantile airway
haemangiomas (P<0.00001). Meta-analysis of effectiveness of propranolol vs. steroids, CO2 laser, or vincristine
showed that propranolol is the most effective treatment. Conclusions: This meta-analysis demonstrated that
propranolol should be recommended as a first-line treatment in infantile airway haemangiomas. However, because
of the possible side effects of propranolol, current infantile haemangioma treatment centres recommend a full
cardiovascular and respiratory review be performed prior to initiation of therapy. 2011 Elsevier Ireland Ltd.
Background: Helicobacter pylori infection is associated with gastric cancer, but the effect of eradication treatment on
gastric cancer risk is not well defined. Purpose: To determine whether H. pylori eradication treatment can reduce the
risk for gastric cancer. Data Sources: PubMed, EMBASE, Cochrane Library, Google Scholar, and online clinical trial
registers through 31 January 2009, without language restrictions. Study Selection: Randomized trials that compared
eradication treatment with no treatment in H. pylori-positive patients and that assessed gastric cancer or progression
of preneoplastic lesions during follow-up. Data Extraction: Two authors independently reviewed articles and
extracted data. Data Synthesis: Seven studies met inclusion criteria, 1 of which was excluded from pooled analysis
because of clinical and methodological heterogeneity. All studies were performed in areas with high incidence of
gastric cancer, mostly in Asia. Overall, 37 of 3388 (1.1%) treated patients developed gastric cancer compared with 56
of 3307 (1.7%) untreated (control) participants. In a pooled analysis of 6 studies with a total of 6695 participants
followed from 4 to 10 years, the relative risk for gastric cancer was 0.65 (95% CI, 0.43 to 0.98). Limitations: All studies
but 1 were performed in Asia. Only 2 assessed gastric cancer incidence, and only 2 were double-blinded. Conclusion:
Helicobacter pylori eradication treatment seems to reduce gastric cancer risk. 2009 American College of Physicians.
BACKGROUND: Standard proton-pump inhibitor-based therapy for Helicobacter pylori infection fails in up to one
quarter of patients. Sequential therapy may be more efficacious. PURPOSE: To compare sequential therapy with
standard triple therapy for H. pylori infection. DATA SOURCES: MEDLINE, EMBASE (1981 to October 2007), the
Cochrane Central Register of Controlled Trials, and Google Scholar. PubMed and Ovid were the search engines used.
STUDY SELECTION: Randomized, controlled trials (RCTs) comparing sequential and standard triple therapies in
treatment-naive patients with documented H. pylori infection. DATA EXTRACTION: 3 reviewers independently
assessed trial eligibility and quality and extracted data on eradication. DATA SYNTHESIS: The crude rates of H. pylori
eradication in 10 RCTs involving 2747 patients were 93.4% (95% CI, 91.3% to 95.5%) for sequential therapy (n =
1363) and 76.9% (CI, 71.0% to 82.8%) for standard triple therapy (n = 1384) (relative risk reduction, 71% [CI, 64% to
77%]; absolute risk reduction, 16 percentage points [CI, 14 to 19 percentage points]). The median rates of adherence
were 97.4% (range, 90.0% to 98.9%) for sequential therapy and 96.8% (range, 93.0% to 100%) for standard therapy.
Sequential therapy appeared superior in prespecified sensitivity (subgroup) analyses stratified by trial quality;
smoking status; diagnosis (ulcer disease or nonulcer dyspepsia); resistance to clarithromycin, imidazoles, or both;
duration of triple therapy; and method of diagnosis. Both treatments had similar side effect profiles. LIMITATIONS:
Only 1 study was double-blinded. Most patients were from Italy. There was clear evidence of publication bias.
CONCLUSION: Sequential therapy appears superior to standard triple therapy for eradication of H. pylori infection. If
RCTs in other countries confirm these findings, 10-day sequential therapy could become a standard treatment for H.
pylori infection in treatment-naive patients.
Infliximab is highly efficacious in induction as well as maintenance of remission in patients with Crohn's disease (CD).
However, the cost and potential serious side-effects is concerning for continuing the medication on a long-term.
Primary aim of this meta-analysis was to determine the outcome in patients with CD in whom infliximab was
discontinued while in remission. Secondary aim was to assess the results of re-treatment with anti-TNF agents
following a relapse and identify the factors associated with a relapse. Methods- We searched Medline, Scopus,
conference proceedings and Google scholar for Infliximab related trials in Crohn's disease. Studies where the
information on status of remission prior to discontinuation of infliximab was unclear or the clinical outcome following
the discontinuation of infliximab was unavailable were excluded. For studies which provided complete data over at
least 3 years, the median remission rate was calculated using Kaplan-Meier method. For studies which provided
median remission rate, an average of the remission rates was calculated. Results- A total of 398 patients in six
different studies were included in the final analysis. The average relapse rates over 1st, 2nd, 3rd, 4th and 6th year
following the cessation of infliximab were 35%, 48%, 62%, 69% and 76% respectively. The results of Kaplan-Meier
analysis for the 4 studies (219 patients) with detailed data over at least 3 years data are given in Table-1. Following
relapse, retreatment with infliximab results in remission in 91- 100% (89 patients). Medication reaction following
retreatment with infliximab occurred in only one patient. Conclusion- Majority of patients who discontinue infliximab
while in remission will relapse and most relapses will occur in first 3 years following cessation of infliximab.
Retreatment with infliximab is however favorable and risk of re-treatment reaction is not increased. (Table
Presented).
Second-generation antipsychotics (SGA) are being used more often than ever before in children and adolescents with
psychotic and a wide range of non-psychotic disorders. Several SGA have received regulatory approval for some
paediatric indications in various countries, but off-label use is still frequent. The aim of this paper was to perform a
systematic review and critically evaluate the literature on cardiometabolic and endocrine side-effects of SGA in
children and adolescents through a Medline/Pubmed/Google Scholar search of randomized, placebo controlled trials
of antipsychotics in children and adolescents (<18 years old) until February 2010. In total, 31 randomized, controlled
studies including 3595 paediatric patients were identified. A review of these data confirmed that SGA are associated
with relevant cardiometabolic and endocrine side-effects, and those children and adolescents have a high liability to
experience antipsychotic induced hyperprolactinaemia, weight gain and associated metabolic disturbances. Only
weight change data were sufficiently reported to conduct a formal meta-analysis. In 24 trials of 3048 paediatric
patients with varying ages and diagnoses, ziprasidone was associated with the lowest weight gain (-0.04 kg, 95%
confidence interval [CI]: -0.38 to +0.30), followed by aripiprazole (0.79 kg, 95% CI: 0.54 to 1.04], quetiapine (1.43 kg,
95% CI: 1.17 to 1.69) and risperidone (1.76 kg, 95% CI: 1.27 to 2.25) were intermediate, and olanzapine was
associated with weight gain the most (3.45 kg, 95% CI: 2.93 to 3.97). Significant weight gain appeared to be more
prevalent in patients with autistic disorder who were also younger and likely less exposed to antipsychotics
previously. These data clearly suggest that close screening and monitoring of metabolic side effects is warranted and
that the least cardiometabolically problematic agents should be used first whenever possible. A good collaboration
between child- and adolescent psychiatrists, general practitioners and paediatricians is essential to maximize overall
outcomes and to reduce the likelihood of premature cardiovascular morbidity and mortality. 2011 Elsevier Espana,
S.L. All rights reserved.
To review the data with respect to prevalence and risk factors of metabolic syndrome (MetS) in bipolar disorder
patients. Electronic searches were done in PUBMED, Google Scholar and Science direct. From 2004 to June 2011, 34
articles were found which reported on the prevalence of MetS. The sample size of these studies varied from 15 to
822 patients, and the rates of MetS vary widely from 16.7% to 67% across different studies. None of the
sociodemographic variable has emerged as a consistent risk factor for MetS. Among the clinical variables longer
duration of illness, bipolar disorder- I, with greater number of lifetime depressive and manic episodes, and with more
severe and difficult-to-treat index affective episode, with depression at onset and during acute episodes, lower in
severity of mania during the index episode, later age of onset at first manic episode, later age at first treatment for
the first treatment for both phases, less healthy diet as rated by patients themselves, absence of physical activity and
family history of diabetes mellitus have been reported as clinical risk factors of MetS. Data suggests that metabolic
syndrome is fairly prevalent in bipolar disorder patients.
Context: The treatment of colorectal cancer has improved considerably in recent years, but it remains the second
commonest cause of cancer deaths in men and women in the United States. Better therapies have resulted in
prolonged median survival for patients with metastatic disease and a select number of patients can now be cured.
Evidence Acquisition: We conducted a computerized search using PubMed and Google Scholar for reports published
between January 1993 and August 2009 using mesh headings and key words relating to the treatment of colorectal
cancer. If reports identified by these criteria referred to other papers not in the initial search, then these were also
reviewed if relevant to metastatic colorectal cancer (MCRC). Results: Seven new chemotherapy agents have been
licensed for the treatment of advanced colorectal cancer, with associated improved median survival from 5 months
to 2 years. Complete responses are rare with systemic chemotherapy alone, but higher overall response rates to
systemic and intrahepatic chemotherapies have enabled initially unresectable patients to undergo potentially
curative surgical resection of metastases. Improved surgical expertise together with the adjunctive use of
radiofrequency ablation has further expanded the definition of resectability. Advances in the understanding of tumor
biology have resulted in the development of clinically useful biomarkers and the emergence of active biological
therapies. Conclusions: The multidisciplinary management of MCRC incorporating improved systemic and local
therapies continues to improve median survival and enlarge the cohort of patients that can be approached with
curative intent. Recent technological advances have facilitated a better understanding of tumor biology that
promises continued advancements in patient care. 2010 S. Karger AG, Basel.
Background: Polycystic ovarian syndrome (PCOS) leads to a multitude of clinical and biochemical alterations in
patients. Metformin and the thiazolidenediones (TZDs) - which have insulin sensitizing properties - are believed to be
effective in minimizing the changes caused by this syndrome. Objectives: Our goal was to assess the evidence for the
use of TZDs or metformin in the treatment of PCOS patients. In addition, we sought to assess and compare the
effectiveness of metformin vs TZDs in the clinical and biochemical regression of PCOS based on available randomized
controlled trials (RCTs). Search strategy: We searched Medline (January 1966 to January 2007), PubMed (January
1954 to January 2007), Google Scholar search engine (through January 2007), and reference lists of articles. We also
contacted researchers and clinicians in the field. Selection criteria: We reviewed RCTs involving women diagnosed
with PCOS (based on 1990 the National Institutes of Health Criteria) who were treated with either metformin or
TZDs. Trials were limited to those that were testing only the effects of either of these agents as their primary
endpoint. Main results: A total of 115 trials were obtained, of which only 33 trials met the inclusion criteria.
Ultimately, 31 trials involving total 1892 patients were included in the analysis (23 metformin, 2 rosiglitazone, 1
pioglitazone, 5 troglitazone) with 2 unobtainable trials. There was insufficient data to compare metformin to the
TZDs in any parameter because the literature often contained inadequate quantitative data, or there were too few
published trials. As a result, we performed the meta-analysis for metformin only. Among the outcomes examined,
the only statistically significant changes were minimal decreases with metformin in ovulation rates and luteinizing
hormone to follicle stimulating hormone ratio (LH/FSH), and an increase in fasting insulin. There was no clinically
significant change with metformin in ovulation rate, pregnancy rate, body mass index, waist-to-hip ratio, hirsutism (F-
G score), LH/FSH, fasting insulin, fasting blood glucose, total testosterone, free testosterone, androstenedione, and
dehydroepiandrosterone sulfate. Authors' conclusions: There is a paucity of data from RCTs to compare the
effectiveness of metformin vs TZDs as well as the effects of either agent in treating the clinical and biochemical
features of PCOS. Further research involving RCTs with larger sample sizes is needed before any recommendation
can be made on the usefulness of these agents in the treatment of PCOS.
BACKGROUND: Polycystic ovarian syndrome (PCOS) leads to a multitude of clinical and biochemical alterations in
patients. Metformin and the thiazolidenediones (TZDs)--which have insulin-sensitizing properties--are believed to be
effective in minimizing the changes caused by this syndrome., OBJECTIVES: Our goal was to assess the evidence for
the use of TZDs or metformin in the treatment of PCOS patients. In addition, we sought to assess and compare the
effectiveness of metformin vs TZDs in the clinical and biochemical regression of PCOS based on available randomized
controlled trials (RCTs)., SEARCH STRATEGY: We searched Medline (January 1966 to January 2007), PubMed (January
1954 to January 2007), Google Scholar search engine (through January 2007), and reference lists of articles. We also
contacted researchers and clinicians in the field., SELECTION CRITERIA: We reviewed RCTs involving women
diagnosed with PCOS (based on 1990 the National Institutes of Health Criteria) who were treated with either
metformin or TZDs. Trials were limited to those that were testing only the effects of either of these agents as their
primary endpoint., MAIN RESULTS: A total of 115 trials were obtained, of which only 33 trials met the inclusion
criteria. Ultimately, 31 trials involving total 1892 patients were included in the analysis (23 metformin, 2
rosiglitazone, 1 pioglitazone, 5 troglitazone) with 2 unobtainable trials. There was insufficient data to compare
metformin to the TZDs in any parameter because the literature often contained inadequate quantitative data, or
there were too few published trials. As a result, we performed the meta-analysis for metformin only. Among the
outcomes examined, the only statistically significant changes were minimal decreases with metformin in ovulation
rates and luteinizing hormone to follicle stimulating hormone ratio (LH/FSH), and an increase in fasting insulin. There
was no clinically significant change with metformin in ovulation rate, pregnancy rate, body mass index, waist-to-hip
ratio, hirsutism (F-G score), LH/FSH, fasting insulin, fasting blood glucose, total testosterone, free testosterone,
androstenedione, and dehydroepiandrosterone sulfate., AUTHORS' CONCLUSIONS: There is a paucity of data from
RCTs to compare the effectiveness of metformin vs TZDs as well as the effects of either agent in treating the clinical
and biochemical features of PCOS. Further research involving RCTs with larger sample sizes is needed before any
recommendation can be made on the usefulness of these agents in the treatment of PCOS.
Background Common Travel Medicine sources generally do not provide information on the risk of methanol
poisoning among travellers who visit Indonesia. The aim of this analysis was to increase knowledge on this topic
through reports from bibliographic databases and Internet sources. Methods Case reports and studies on methanol
poisoning in Indonesia were retrieved through PubMed, Embase and Google Scholar database searching. The Google
search was used to retrieve the Web Media articles reporting fatal and non-fatal methanol poisoning in Indonesia, in
a timeframe from 01.01.2009 to 03.03.2013. Results Three case reports of methanol poisoning involving four
travellers to Indonesia were found in bibliographic databases. The media sources searching identified 14 articles
published online, reporting 22 cases of methanol poisoning among travellers after consumption of local alcohol
beverages. The total number of death cases was 18. Some sources report also a large number of cases among the
local population. Conclusions Methanol poisoning is likely to be an emerging public health problem in Indonesia, with
an associated morbidity and mortality among travellers and local people. Some strategies can be implemented to
prevent or reduce harm among travellers. 2013 Elsevier Ltd. All rights reserved.
BACKGROUND: Publication records and citation indices often are used to evaluate academic performance. For this
reason, obtaining or computing them accurately is important. This can be difficult, largely due to a lack of complete
knowledge of an individual's publication list and/or lack of time available to manually obtain or construct the
publication-citation record. While online publication search engines have somewhat addressed these problems,
using raw search results can yield inaccurate estimates of publication-citation records and citation indices.
METHODOLOGY: In this paper, we present a new, automated method that produces estimates of an individual's
publication-citation record from an individual's name and a set of domain-specific vocabulary that may occur in the
individual's publication titles. Because this vocabulary can be harvested directly from a research web page or online
(partial) publication list, our method delivers an easy way to obtain estimates of a publication-citation record and the
relevant citation indices. Our method works by applying a series of stringent name and content filters to the raw
publication search results returned by an online publication search engine. In this paper, our method is run using
Google Scholar, but the underlying filters can be easily applied to any existing publication search engine. When
compared against a manually constructed data set of individuals and their publication-citation records, our method
provides significant improvements over raw search results. The estimated publication-citation records returned by
our method have an average sensitivity of 98% and specificity of 72% (in contrast to raw search result specificity of
less than 10%). When citation indices are computed using these records, the estimated indices are within of the true
value 10%, compared to raw search results which have overestimates of, on average, 75%. CONCLUSIONS: These
results confirm that our method provides significantly improved estimates over raw search results, and these can
either be used directly for large-scale (departmental or university) analysis or further refined manually to quickly give
accurate publication-citation records.
Background: Publication records and citation indices often are used to evaluate academic performance. For this
reason, obtaining or computing them accurately is important. This can be difficult, largely due to a lack of complete
knowledge of an individual's publication list and/or lack of time available to manually obtain or construct the
publication-citation record. While online publication search engines have somewhat addressed these problems,
using raw search results can yield inaccurate estimates of publication-citation records and citation indices.
Methodology:In this paper, we present a new, automated method that produces estimates of an individual's
publication-citation record from an individual's name and a set of domain-specific vocabulary that may occur in the
individual's publication titles. Because this vocabulary can be harvested directly from a research web page or online
(partial) publication list, our method delivers an easy way to obtain estimates of a publication-citation record and the
relevant citation indices. Our method works by applying a series of stringent name and content filters to the raw
publication search results returned by an online publication search engine. In this paper, our method is run using
Google Scholar, but the underlying filters can be easily applied to any existing publication search engine. When
compared against a manually constructed data set of individuals and their publication-citation records, our method
provides significant improvements over raw search results. The estimated publication-citation records returned by
our method have an average sensitivity of 98% and specificity of 72% (in contrast to raw search result specificity of
less than 10%). When citation indices are computed using these records, the estimated indices are within 10% of the
true value, compared to raw search results which have overestimates of, on average, 75%. Conclusions:These results
confirm that our method provides significantly improved estimates over raw search results, and these can either be
used directly for large-scale (departmental or university) analysis or further refined manually to quickly give accurate
publication-citation records. 2010 Ruths, Zamal.
The methodological quality of nursing education research has not been rigorously studied. The purpose of this study
was to evaluate the methodological quality and scientific impact of nursing education research reports.The
methodological quality of 133 quantitative nursing education research articles published between July 2006 and
December 2007 was evaluated using the Medical Education Research Study Quality Instrument (MERSQI).The mean
(+/- SD) MERSQI score was 9.8 +/- 2.2. lt correlated (p < .05) with several scientific impact indicators: citation counts
from Scopus (r = .223), Google Scholar (r = .224), and journal impact factor (r = .216); it was not associated with Web
of Science citation count, funding, or h Index.The similarities between this study's MERSQI ratings for nursing
literature and those reported for the medical literature, coupled with the association with citation counts, suggest
that the MERSQI is an appropriate instrument to evaluate the quality of nursing education research.
This study aimed to discuss the role of agents, such as steroids and methotrexate (MTX), in the treatment of patients
with idiopathic granulomatous mastitis (IGM). Using Pubmed and Google Scholar data bases, a retrospective study
was carried out on IGM cases treated with steroids and/or MTX between 1972 and 2010. Four IGM cases treated
with MTX at our clinic were also summarized in this study. A total of 541 IGM cases since 1972, including ours, were
retrospectively analyzed. Steroid treatment 5-85 mg was administered over 5 days-22 months to 112 patients aged
21-48 years. Recurrence occurred in 22 patients, steroid-induced diabetes mellitus in 5 patients, no response to
treatment was observed in 4 patients, in 2 patients, the mass decreased in size, and static disease was observed in
one. The steroid treatment was changed to MTX treatment in 4 patients who had recurrence, 5 with steroid-induced
DM and in 4 who were nonrespondents. Three patients were started on steroid together with MTX as a primary
treatment. Of the patients treated with MTX, a satisfactory result was obtained in 14 cases and in 2, mastectomy was
performed because of recurrence despite the treatment with MTX. IGM is a troublesome condition that presents
management problems due to the side effects of steroids. Our study demonstrates that the use of MTX in IGM cases
has been effective in preventing complications, in resolving the inflammatory process, and in limiting side effects of
corticosteroids. 2011 Wiley Periodicals, Inc.
Methylenetetrahydrofolate reductase (MTHFR) catalyzes the metabolism of folate and nucleotides needed for DNA
synthesis and repair. Variations in MTHFR functions likely play roles in the etiology of lung cancer (LC). So far, several
studies between MTHFR C677T polymorphism and LC provide controversial or inconclusive results. To better assess
the purported relationship, we performed a meta-analysis of 14 publications. Eligible studies were identified by
searching the Pubmed, Embase, Web of Science and Google Scholar databases. Odds ratios (ORs) with 95%
confidence intervals (CIs) were estimated to assess the association. Overall, no significant association was detected
between the MTHFR C677T polymorphism and LC risk, the same as in race subgroup. However, in the stratified
analysis by histological type, significantly increased non-small-cell lung cancer (NSCLC) risk was indicated (T-allele vs.
C-allele: OR=1.11, 95%CI=1.03-1.19; TT vs. CC: OR=1.24, 95%CI=1.09-1.41; TC vs. CC: OR=1.11, 95%CI=1.03-1.20 and
TT+TC vs. CC: OR=1.09, 95%CI=1.03-1.15). At the same time, ever-smokers who carried T-allele (TT+TC) had a 10%
decreased LC risk compared with CC genotype carriers. Our study provided evidence that the MTHFR 677T null
genotype may increase NSCLC risk, however, it may protect ever-smokers against LC risk. Future studies with large
sample sizes are warranted to further evaluate this association in more detail.
OBJECTIVE: Methylenetetrahydrofolate reductase (MTHFR) catalyzes the metabolism of folate and nucleotides
needed for DNA synthesis and repair. Variations in MTHFR functions likely play roles in the etiology of lung cancer
(LC). So far, several studies between MTHFR C677T polymorphism and LC provide controversial or inconclusive
results., METHODS: To better assess the purported relationship, we performed a meta-analysis of 14 publications.
Eligible studies were identified by searching the Pubmed, Embase, Web of Science and Google Scholar databases.
Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated to assess the association., RESULTS: Overall, no
significant association was detected between the MTHFR C677T polymorphism and LC risk, the same as in race
subgroup. However, in the stratified analysis by histological type, significantly increased non-small-cell lung cancer
(NSCLC) risk was indicated (T-allele vs. C-allele: OR=1.11, 95%CI=1.03-1.19; TT vs. CC: OR=1.24, 95%CI=1.09-1.41; TC
vs. CC: OR=1.11, 95%CI=1.03-1.20 and TT+TC vs. CC: OR=1.09, 95%CI=1.03-1.15). At the same time, ever-smokers
who carried T-allele (TT+TC) had a 10% decreased LC risk compared with CC genotype carriers., CONCLUSIONS: Our
study provided evidence that the MTHFR 677T null genotype may increase NSCLC risk, however, it may protect ever-
smokers against LC risk. Future studies with large sample sizes are warranted to further evaluate this association in
more detail.
OBJECTIVES:We examined the effects of the black box warning about the risk of tardive dyskinesia (TD) with chronic
use of metoclopramide on management of gastroparesis within a single clinical practice, and on reporting of adverse
events.METHODS:Medical records of gastroparesis patients were evaluated for physician management choices. The
FDA Adverse Event Reporting System (FAERS) was analyzed for event reports, and for lawyer-initiated reports, with
metoclopramide from 2004 to 2010. Google Scholar was searched for court opinions against metoclopramide
manufacturers.RESULTS:Before the black box warning, 69.8% of patients received metoclopramide for gastroparesis,
compared with 23.7% after the warning. Gastroenterologists prescribed domperidone more often after than before
the warning. Metoclopramide prescriptions decreased after 2008. Adverse event reporting increased after the
warning. Only 3.6% of all FAERS reports but 70% of TD reports were filed by lawyers, suggesting a distortion in signal.
Forty-seven legal opinions were identified, 33 from 2009-2010. CONCLUSIONS:The black box warning for
metoclopramide has decreased its usage and increased its rate of adverse event reporting. Lawyer-initiated reports
of TD hinder pharmacovigilance. 2013 by the American College of Gastroenterology.
Nausea and vomiting occur commonly during and after Caesarean delivery (CD) performed under neuraxial
anaesthesia. Metoclopramide is a prokinetic agent reported to be safe in parturients. This meta-analysis assesses the
efficacy of metoclopramide for prophylaxis against intra- and postoperative nausea and vomiting (IONV and PONV) in
parturients undergoing CD under neuraxial anaesthesia. We performed a literature search of MEDLINE (19662011),
Cochrane Central Register of Controlled Trials, EMBASE (19472011), Google scholar, and CINAHL for randomized
controlled trials which compared metoclopramide with placebo in women having CD under neuraxial anaesthesia.
Eleven studies with 702 patients were included in the analysis. Administration of metoclopramide (10 mg) resulted in
a significant reduction in the incidence of ION and IOV when given before block placement [relative risk (RR) (95
confidence interval, 95 CI)0.27 (0.16, 0.45) and 0.14 (0.03, 0.56), respectively] or after delivery [RR (95 CI)0.38 (0.20,
0.75) and 0.34 (0.18, 0.66), respectively]. The incidence of early (03 or 04 h) PON and POV [RR (95 CI)0.47 (0.26,
0.87) and 0.45 (0.21, 0.93), respectively] and overall (024 or 324 h) PON (RR 0.69; 95 CI 0.52, 0.92) were also reduced
with metoclopramide. Extra-pyramidal side-effects were not reported in any patient. In conclusion, this review
suggests that metoclopramide is effective and safe for IONV and PONV prophylaxis in this patient population. Given
the quality of the studies and the infrequent use of neuraxial opioids, these results should be interpreted with
caution in current practice and further studies are needed to confirm those findings. The Author [2012].
Introduction: Metronidazole, can cause central nervous system (CNS) side effects which are remarkable, but rare and
usually reversible. We present a case of metronidazole induced encephalopathy (MIE) along with a systematic review
of literature using Pubmed and Google Scholar. Methods: A 53 year old man was admitted for Enterobacter species
urinary tract infection. He was also on treatment for Clostridium difficile colitis with metronidazole 1.5 g daily for six
weeks and vancomycin for two weeks which were continued. Three days later patient had slurring of speech with
rhythmic chewing movements suspicious for seizures. Lorazepam stopped the rhythmic movements however patient
was unresponsive and required intubation with intensive care management. Electroencephalogram (EEG) was
suggestive of nonconvulsive status epilepticus warranting treatment with phosphenytoin and levetiracetam.
Encephalopathy evaluation included cerebrospinal fluid examination and a metabolic profile that were unremarkable
except for serum creatinine, 2.0 mg/dl. MRI brain on day 5 showed increased T2 and FLAIR signals within cerebellar
dentate nuclei and splenium of corpus callosum suggesting MIE which prompted metronidazole discontinuation. MRI
brain after one week showed improvement in previously noted changes. When off sedation, patient was alert and
able to follow simple commands. Patient however could not be weaned off the ventilator and later died after family
requested extubation and supportive care keeping in view the patient's wishes. MIE literature from Pubmed and
Google Scholar was reviewed. Results: MIE affects men more than women; there is no relation to age or drug
dosage. Sensorimotor (weakness, paresthesias) symptoms were reported by patients with onset of encephalopathy.
Symptoms usually resolved except for peripheral neuropathy. Typical imaging abnormalities were seen which
improved on discontinuing metronidazole. Conclusions: Based on this review, it appears that the sensorimotor
symptoms may indicate impending MIE. These symptoms and signs should prompt immediate withdrawal of
metronidazole. MIE can be confirmed with typical imaging abnormalities.
Introduction. Every year more than 20 million infants are born with low birth weight worldwide. About 3.6 million
infants die during the neonatal period. More than one third of child deaths are thought to be attributable to
maternal and child under nutrition. Objectives. To systematically review the effect of supplementing various
combinations and types of micronutrients on the course and outcomes of pregnancy. Methods. Electronic search of
Medline, Pub Med, Health Internetwork access to Research Initiative, and Google Scholar databases was conducted.
Outcomes of interest were birth weight, low birth weight, small size for gestational age, prenatal mortality and
neonatal mortality. After exclusion of irrelevant /incomplete ones, 17 out of 115 articles were considered for the
final analysis. Findings. Majority of the articles reviewed favored the supplementation of micronutrients to pregnant
mother. Some studies suggested calcium supplementation is associated with a significant protective benefit in the
prevention of pre-eclampsia. The remaining articles reviewed, showed significant benefit of Multiple Micronutrients
supplementation during pregnancy in reducing low birth weight, small for Gestational Age births as compared to the
usual iron-folate supplements. Conclusions: Supplying micronutrients, mainly multiple micronutrients have beneficial
effect in reducing the risk of low birth weight and other complications. Further studies at various combination and
doses of micronutrient supplements are recommended. 2013 Zerfu and Ayele; licensee BioMed Central Ltd.
Aims: To conduct a review article evaluating midazolam administered by different routes as well as diazepam
administered through intravenous and rectal route for treating status epilepticus in children. Source of Data:
Bibliographic search was conducted on Google Scholar, LILACS, PubMed and SciELO databases, using the key words
status epilepticus, seizure, benzodiazepines, midazolam, diazepam, children. Summary of Findings: Rapid onset
treatment of status epilepticus is associated with better results. Diazepam has been the first-line treatment in the
last 30 years, despite of known difficulties of venipuncture in infants. Midazolam appears to be an important
advance for the quick seizure emergency treatment for its ease administration and rapid action. The ideal drug and
route of administration for seizure control in these situations remain uncertain. Conclusions: If intravenous access is
not available, there is evidence that intramuscular, oral or nasal midazolam can be an alternative to diazepam (rectal
or intravenous) for treatment of seizures in pediatric emergency.
Objectives: South Asians in developed countries such as the UK are at comparatively high risk of coronary heart
disease for reasons which are not fully understood. One unexplored hypothesis is more infections in this ethnic
group. This study assessed whether the prevalence of infections among South Asians differs from that among White
populations of European origin in developed countries. Study design: Systematic review. Methods: Medline, Web of
Science and Google Scholar databases were searched. In addition, reference lists and citations were reviewed.
Results: Twenty-one studies reported prevalence rates and mean antibody levels of infection with 17 different
pathogens or non-specific markers of infection. Among bacterial infections, higher rates of Escherichia coli and
Mycobacterium tuberculosis infection were found in South Asians. No consistent differences were found for
periodontal pathogens, Helicobacter pylori, Staphylococcus aureus, Chlamydia pneumoniae and Mycobacterium
avium. For viral pathogens, higher rates of hepatitis A, hepatitis B and cytomegalovirus; and lower rates of herpes
simplex, hepatitis C, human immunodeficiency virus and varicella zoster virus were found among South Asians. No
difference was seen in the prevalence of hepatitis G virus in South Asians. Levels of non-specific markers of infection
(total immunoglobulin G, endotoxin) were higher in South Asians. Conclusions: The number of studies was small.
Differences in the prevalence of specific infections were found, but the current evidence is insufficient to support or
reject the hypothesis under examination. Further studies are warranted. 2012 The Royal Society for Public Health.
The clinical diagnosis of migraine-associated vertigo may be difficult because it shares features with some other
clinical conditions. This communication presents a systematic review on the epidemiology and theories of
pathophysiology of migraine-associated vertigo and its distinguishing features from peripheral vestibular disorders.
We searched the Cochrane Library, MEDLINE, and Google scholar for all the studies on migraine-associated vertigo
published in English language between 1966 and 2010. Their references were also reviewed for completion. Data
from the studies were independently extracted and assessed by the three authors using standardized data forms.
There was consensus between the authors on the studies in this review that met the criteria. Forty-five studies were
identified and independently assessed based on the objectives of the study by the authors. All the studies discussed
on the epidemiology of the migraine-associated vertigo, six discussed on the pathophysiology, while differential
diagnosis were documented in thirty-two studies. In conclusion, migraine-associated vertigo is a global distinct
disease entity that can be clinically distinguished from peripheral vestibular disorders. Abstinence from trigger
factors remains imperative in the control, whereas some medications have been found useful in the management.
2011 Informa Healthcare USA, Inc.
OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of milnacipran and evaluate relevant
clinical trial data. DATA SOURCES: MEDLINE, International Pharmaceutical Abstracts, and Google Scholar searches
(1966-June 2010) were conducted using the key words fibromyalgia, milnacipran, and serotonin-norepinephrine
reuptake inhibitor. Searches were limited to articles published in English. STUDY SELECTION AND DATA EXTRACTION:
All available English-language articles of human studies were evaluated. One pharmacokinetic study reviewed
included animal data. References cited in identified articles were used for additional evaluation. DATA SYNTHESIS:
Milnacipran is a serotonin-norepinephrine reuptake inhibitor with a 3-fold increased selectivity for norepinephrine
compared to serotonin. It is well absorbed with 85-90% bioavailability. Maximum concentrations are achieved 2-4
hours after administration. Milnacipran does not undergo cytochrome P450 metabolism and has a half-life of 6-8
hours. Fifty-five percent of each dose is excreted unchanged in the urine. Dose adjustment is needed in patients with
an estimated creatinine clearance of <30 mL/min. Clinical trials indicated that twice-daily dosing at 100 mg/day or
200 mg/day was superior to single-daily dosing. Studies further established the effectiveness of both doses in the
treatment of fibromyalgia pain utilizing patient self-reported pain scores, as well as on a visual analog scale, Patient
Global Impression of Change scale, and the Short-Form 36 Physical Component Summary. A 6-month extension trial,
which evaluated patients continued on milnacipran for up to 1 year, demonstrated continued pain relief. The most
common adverse drug reaction associated with milnacipran was nausea, which was reduced with slow-dose titration
and administration with food. CONCLUSIONS: Milnacipran is an effective treatment option for patients with
fibromyalgia. More head-to-head clinical trials are necessary to assess its ultimate place in therapy.
Objective: Mindfulness based Cognitive Therapy (MBCT) is a standardized meditation program which has been
proposed as a therapeutic option for the prevention of relapses in patients suffering from major depression (MD).
The aim of the present review and meta-analysis is to provide an estimate of the efficacy of MBCT for MD patients.
Methods: A literature search was undertaken using MEDLINE, ISI web of knowledge, the Cochrane database, Google
scholar and references of retrieved articles. Controlled studies investigating the efficacy of MBCT for MD were
entered in the Cochrane Collaboration Review Manager Software (RevMan version 5.0). Results: Reviewed data
showed that MBCT in adjunct to usual care was significantly better than usual care alone for reducing MD relpases in
patients with 3 or more past episodes of MD. MBCT plus gradual discontinuation of maintenance antidepressants
was similar to continuation of antidepressants alone with respect to relapse prevention. The augmentation of MBCT
could be useful for patients with current residual symptoms of depression as well. Conclusions: Current studies
showed preliminary evidence about the efficacy of MBCT for patients with 3 or more past episodes of depression
and for currently depressed patients with residual symptoms. However, methodological shortcomings of reviewed
studies including small sample size, frequent lack of replications and the absence of studies comparing MBCT to
control groups designed to distinguish specific from non specific effects of meditation imply the necessity for further
research.
Purpose: To perform a comprehensive quantitative review of the published literature and to assess the methodology
of studies comparing the surgical outcomes in minimally invasive hip arthroplasty (MIHA). Methods: We conducted a
comprehensive literature search using Medline, Embase, Cochrane, CINAHL and Google Scholar. The bibliographies
of papers were also examined. All relevant articles in peer-reviewed journals were retrieved except those not
mentioning outcomes, case reports, review of literature and letters to editors. Two authors independently scored
the quality of the studies using a modified Coleman Methodology Score with 10 criteria which allow critical analysis
of the design and implementation of a particular study. The results are recorded as a final score between 0 and 100.
We collected data for year of publication, type of study, patient numbers, surgical method, follow-up, complications
and patient satisfaction. Results: Thirty-six studies met our inclusion criteria giving details of 6434 HAs, 78.5% (4031)
of which were implanted using MIHA techniques. The only statistically significant outcome was a reduction in length
of hospital stay (P = 0.02). With no significant difference noted between the two groups with respect to operating
time, blood loss, dislocation and revision rates, neurological injury and incidence of peri-operative fracture, patient
selection and surgeons' experience may have had a significant effect on outcome. For instance, studies reporting
outcomes on an average patient age of 48 years had significantly different results to one reporting on patients with a
mean age of over 70 years. Scores were predominantly low for quality of the studies, with patient number, follow-up
time and validated outcome measures being the weakest areas. Conclusion: At present, there is still a lack of quality
evidence to advocate the expansion of MIHA. The better designed studies suggest that it should even be limited
further to recognized expert centres. The complication rates and learning curve may be altered by changes in
training and adapting surgical techniques. We emphasize the need for meticulous design in future studies comparing
the outcomes of these two procedures. The Author 2007. Published by Oxford University Press. All rights reserved.
Study design.: A retrospective review of patients treated at 2 institutions with anterior lumbar interbody fusion using
a minimally invasive lateral retroperitoneal approach, and review of literature. Objective.: To analyze the outcomes
from historical literature and from a retrospectively compiled database of patients having undergone anterior
interbody fusions performed through a lateral approach. Summary of background data.: A paucity of published
literature exists describing outcomes following lateral approach fusion surgery. Methods.: Patients treated with
extreme lateral interbody fusion (XLIF) were identified through retrospective chart review. Treatment variables
included operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), complications, and
fusion rate. A literature review, using the National Center for Biotechnology Information databases
PubMed/MEDLINE and Google Scholar, yielded 14 peer-reviewed articles reporting outcomes scoring, complications,
fusion status, long-term follow-up, and radiographic assessments related to XLIF. Published XLIF results were
summarized and evaluated with current study data. Results.: A total of 84 XLIF patients were included in the current
cohort analysis. OR time, EBL, and length of hospital stay averaged 199 minutes, 155 mL, and 2.6 days, respectively,
and perioperative and postoperative complication rates were 2.4% and 6.1%. Mean follow-up was 15.7 months. Sixty-
eight patients showed evidence of solid arthrodesis and no subsidence on computed tomography and
flexion/extension radiographs. Results were within the ranges of those in the literature. Literature review identified
reports of significant improvements in clinical outcomes scores, radiographic measures, and cost effectiveness.
Conclusion.: Current data corroborates and contributes to the existing body of literature describing XLIF outcomes.
Procedures are generally performed with short OR times, minimal EBL, and few complications. Patients recover
quickly, requiring minimal hospital stay, although transient hip/thigh pain and/or weakness is common. Long-term
outcomes are generally favorable, with maintained improvements in patient-reported pain and function scores as
well as radiographic parameters, including high rates of fusion. 2010, Lippincott Williams & Wilkins.
Purpose: To overview the methods used in the Mini-Sentinel systematic reviews of validation studies of algorithms to
identify health outcomes in administrative and claims data and to describe lessons learned in the development of
search strategies, including their ability to identify articles from previous systematic reviews which used different
search strategies. Methods: Literature searches were conducted using PubMed and the citation database of the Iowa
Drug Information Service. Embase was searched for some outcomes. The searches were based on a strategy
developed by the Observational Medical Outcomes Partnership (OMOP) researchers. All citations were reviewed by
two investigators. Exclusion criteria were applied at abstract and full-text review stages to ultimately identify
algorithm validation studies that used data sources from the USA or Canada, as the results of these studies were
considered most likely to generalize to Mini-Sentinel data. Nonvalidated algorithms were reviewed if fewer than five
algorithm validation studies were identified. Results: The results of this project are described in the separate articles
and reports written on algorithms to identify each outcome of interest. Conclusions: The Mini-Sentinel systematic
reviews of algorithms to identify health outcomes in administrative and claims data are expected to be relatively
complete, despite some limitations. Algorithm validation studies are inconsistently indexed in PubMed, creating
challenges in conducting systematic reviews of these studies. Google Scholar searches, which can perform text word
searches of electronically available articles, are suggested as a strategy to identify studies that are not captured
through searches of standard citation databases. 2012 John Wiley & Sons, Ltd.
Hypothesis / aims of study A number of surgical treatment modalities have been developed over the past decade to
treat women with stress urinary incontinence. The Burch colposuspension was replaced by the retropubic tape as
the gold standard. The complications of bowel, bladder and vascular injury lead to the development of the
transoburator device. This tape has however been associated with a number of complications, notably groin and hip
pain. The mini-sling devices were launched to avoid these complications of the retropubic and transobturator
passage. Despite the widespread use of these products, there is unfortunately limited data available on the efficacy
and complications of these procedures. In this systematic review, we have chosen to review the efficacy and
complications of three mini-slings including TVT SecurR (Gynecare, Ethicon, Somerville, NJ, USA), MiniarcR (American
Medical Systems Inc., Minnetonka, MN) and AjustR (Bard Urological Division, Covington, GA, USA). Study design,
materials and methods This systematic review was implemented in accordance with recommendations from the
Meta-Analysis of Observational Studies in Epidemiology group (MOOSE)(1). The search strategy was both automated
and manual. With the automated search the databases included: PubMed (MEDLINE), MeSH, Google Scholar, Africa
Healthline, CINAHL, Cochrane, LILIACS, and Science Direct. The manual search included journals and abstracts of
international conferences, including oral podium presentations and oral poster presentations. These were from the
IUGA and ICS annual meetings. The following were used as keywords when searching for relevant articles: 'Miniarc',
'TVT Secur', 'Ajust', 'stress urinary incontinence', 'continence surgery' and 'mid urethral sling'. Studies were included
if they showed any relevance to the topic of "mini-slings". Data was extracted by two independent reviewers and
entered into an excel database. This included number of participants in the study, publication type, whether the
surgery performed was primary or secondary, the diagnosis including either stress or mixed urinary incontinence,
type of "mini-sling" performed, follow up time, mean operative time, complications (including de novo urgency, groin
and/or hip pain, vaginal erosion bladder injuries and voiding problems), objective and subjective cure and
improvement rates. Data was then checked by a third reviewer. Overall success and complication rates were
calculated using SPSS version 17.0. We determined pooled objective and subjective success rates for the studies
reporting these outcomes. Separate analyses were carried out to determine success and complication rates for the
different devices and for the small number of papers on the mini-slings published in peer-reviewed journals. W e also
made a crude attempt to obtain pooled efficacy data for all the studies in the review and for this we had to
determine an overall cure rate for each paper. To determine the numerator, the number of women objectively cured
was used if only objective cure rates were given or if both subjective and objective rates were provided. If only
Background: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality especially in the developing
world. Misoprostol, a highly effective drug is highly effective in inducing uterine contractions and has been proposed
as a low-cost, easy-to-use intervention for PPH.Objective: This study assessed evidence of the effectiveness of
misoprostol for the prevention and treatment of PPH.Method: Databases searched included MEDLINE, PUBMED,
CINHAL, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. Reference lists and
conference proceedings were also searched for more studies. Three studies included in the meta-analysis were
limited to randomised controlled trials (RCT). Two reviewers independently screened all articles for methodological
quality using a standardised instrument adapted from the Cochrane Collaboration website. Data were entered in
Review Manager 5.1 software for analysis.Results: Three trials (n = 2346) compared misoprostol to a placebo.
Misoprostol was shown not to be effective in reducing PPH (risk ratios [RR] 0.65; 95% confidence interval [CI] 0.40-
1.06). Only one trial reported on the need for a blood transfusion (RR 0.14; 95% CI 0.02-1.15). Shivering (RR 2.75;
95% CI 2.26-3.34) and pyrexia (RR 5.34; 95% CI 2.86-9.96) were significantly more common with misoprostol than
with a placebo.Conclusion: The use of misoprostol was not associated with any significant reduction in the incidence
of PPH. Therefore, in order to verify the efficacious use of misoprostol in the treatment of PPH, specialised
investigations of its dose and routes of administration for clinically significant effects and acceptable side effects are
warranted.
Many authors report alarming rates of false or questionable claims of scholarly achievement among residency
applicants. The authors sought to further elucidate the authenticity of such inappropriate declarations by
simultaneously conducting an investigation of a selected pool of integrated plastic surgery applicants. The authors'
hypothesis is that the percentage of citations claimed by many authors to be false was erroneously high because of
failure of an adequate search or prolonged time from submission to publication for many journals. Applications
received by the University of Michigan Integrated Plastic Surgery Residency Program for the 2008 National Residency
Match Program match were reviewed 2 years after being submitted by the applicants. Scholarly works listed as
published, accepted, or in-press, including journal articles, abstracts, and book chapters, were investigated. Those
listed as submitted were excluded. An exhaustive search was conducted that included PubMed, Google Scholar, Ovid
UM-MedSearch, hardcopy journals in the authors' medical library, and phone calls to regional societies. The authors'
sample represented 63 percent of all integrated plastic surgery applicants for the 2008 National Residency Match
Program, which included 102 applicants citing 342 scholarly works. Of these, 319 (93 percent) were verified. Of the
remaining 23 citations, 15 (4 percent) by seven applicants (7 percent) were unverifiable, whereas eight (2 percent) by
seven applicants were confirmed as misrepresentations. The majority (93 to 98 percent) of integrated plastic surgery
applicants are truthful regarding scholarly achievement. Applicants should be given the benefit of the doubt and the
opportunity to confirm their claims when we cannot.
Purpose: This study is based on an extensive review of the literature and provides a summary and critical analysis of
population based studies of eye disease published globally since 1990. In particular, it highlights the ages of
participants used to provide epidemiological figures and examines the lack of prevalence data for young adults.
Method: All studies that examined a populationbased sample for the prevalence and causes of visual impairment and
blindness were reviewed. A systemic search on MEDLINE, ISI Web of Science, Scopus and Google Scholar was
conducted using the following (combinations of) key words: blindness, visual impairment, low vision, epidemiology,
prevalence, incidence, population eye study. Results: Worldwide, many well-designed population-based cross-
sectional studies of visual impairment have been performed; however, the majority of these recruited people aged
40 years or older. Generation X and Y have been neglected as epidemiological studies focus on either the older
population in whom the incidence is much higher or childhood causes of visual impairment. A total of 486552 people
have been reviewed in large population-based eye studies worldwide. Of the 81 studies included here, 46(57%)
recruited participants aged 30 years or older. 14 studies examined children. Only 21 studies captured all age groups
and more than half of these were conducted in Africa Conclusion: To date, no prevalence studies have specifically
investigated ophthalmic disease in a young adult population. Although the prevalence of blindness and low vision is
lower in this age group, the economic impact and social cost of visual impairment are high.
To address the impacts of peak oil (PO) on human health and to propose new public health preparedness models and
measures mandated by these impacts. Review of relevant literature. Articles were obtained by searching the
PubMed database (including manual searches using "related citations" tool) plus Google and Google Scholar search
engines using terms such as "peak oil," "energy scarcity," "human health," "public health," and "preparedness." Forty-
six journal articles were reviewed. The projections about PO are concerning, as illustrated by minor PO events in the
recent past. There are many opportunities for devising beneficial solutions within healthcare to mitigate the effects
of PO. It is essential for disaster medicine professionals to become aware of PO and to advocate for change in clinical
practice with patients as well as policy leaders. If we fail to mitigate the effects of PO on healthcare, we will be left
with the less pleasant options of adapting to PO or suffering its effects.
Pretibial lacerations are problematic and best managed by surgical debridement, then skin grafting. Traditional
postoperative care involves bed rest to optimise graft survival. This meta-analysis assesses early mobilisation versus
bed rest for skin graft healing of these wounds. Medline, Embase, Cochrane, Cinahl, and Google Scholar databases
were searched. Analyses were performed on appropriate clinical trials. Four trials met with the inclusion criteria. No
difference was demonstrated in split skin graft healing between patients mobilised early compared to patients
admitted to hospital for postoperative bed rest at either 7 (OR 0.86 CI 0.29-2.56) or 14 days (OR 0.74 CI 0.31-1.79).
There was a statistically significant delay in healing in patients treated with systemic corticosteroids (OR 8.20 CI 0.99-
15.41). There was no difference in postoperative haematoma, bleeding, graft infection, or donor site healing
between the comparison groups. In the available literature, there is no difference between early mobilisation and
bed rest for the healing of skin grafts to pretibial wounds. Corticosteroids exert a negative effect on skin graft healing
unlike early mobilisation, which does not cause increased haematoma, bleeding, infection, or delayed donor site
healing. Modality of anaesthesia does not affect skin graft healing.
In response to population ageing, the numbers of older carers residing in rural areas are increasing. However, rural
older carers are at risk of social isolation due to the decreased social networks associated with ageing and caring
responsibilities, and the geographical isolation associated with rurality. This broad, systematic review of the
literature was undertaken to: (1) identify barriers to social participation for rural older carers; and (2) summarise
features of interventions that were effective in reducing social isolation for rural and/or older carers. Literature was
obtained through systematic searches of selected electronic databases; selected Australian and international
government and research based websites and Google Scholar. Searches were limited to material published from
1999 to 2009, and literature was included which either identified barriers to social participation, or outlined
interventions that were effective in reducing social isolation and increasing social support in rural and/or older
carers. 67 articles, book chapters and reports identified which addressed the review objectives. Findings indicate that
rural older carers experience considerable barriers to socialisation, and six dimensions are identified that are
effective in reducing barriers, decreasing social isolation and increasing social participation. Interventions must
address individual needs; incorporate a dual carer-care recipient focus and/or an educational component; facilitate
informal social interaction; utilise existing networks and experienced personnel; and be both sustainable and long
term. Reducing social isolation in rural older carers is a two-stage process. First, barriers to attendance, both
logistical and perceived, must be addressed, and the focus of the intervention must be relevant to the carer. Second,
opportunities for informal social interaction must be maximised within the intervention. However, a secondary focus
may be necessary to ensure attendance, and the provision of education is also integral to achieving long-term
outcomes. Integration of service providers in an informal capacity is also important in providing long-term support
options. Addressing these issues will assist in developing interventions for rural older carers that are both
appropriate and sustainable.
OBJECTIVE: To review the emerging evidence that therapies targeting key oncogenic and signaling kinases can be
effective in treatment of advanced thyroid carcinomas. METHODS: With use of PubMed and Google Scholar, a
systematic review was performed of publications and scientific presentations summarizing pertinent clinical trials.
RESULTS: Studies of numerous inhibitors of BRAF, vascular endothelial growth factor receptor, and RET kinases
indicate that patients with progressive or metastatic thyroid carcinoma can benefit from therapy with these novel
agents. Severe toxic effects, however, are associated with these treatments, and caution is recommended in their
use. CONCLUSION: Further trials and identification of improved therapeutic targeting should lead to development of
more effective treatments of thyroid carcinomas.
Mood disorders are a major public health problem and are associated with considerable burden of disease, suicides,
physical comorbidities, high economic costs, and poor quality of life. Approximately 30%-40% of patients with major
depression have only a partial response to available pharmacological and psychotherapeutic interventions.
Complementary and alternative medicine (CAM) has been used either alone or in combination with conventional
therapies in patients with mood disorders. This review of the literature examines evidence-based data on the use of
CAM in mood disorders. A search of the PubMed, Medline, Google Scholar, and Quertile databases using keywords
was conducted, and relevant articles published in the English language in the peer-reviewed journals over the past
two decades were retrieved. Evidence-based data suggest that light therapy, St John's wort, Rhodiola rosea, omega-3
fatty acids, yoga, acupuncture, mindfulness therapies, exercise, sleep deprivation, and S-adenosylmethionine are
effective in the treatment of mood disorders. Clinical trials of vitamin B complex, vitamin D, and methylfolate found
that, while these were useful in physical illness, results were equivocal in patients with mood disorders. Studies
support the adjunctive role of omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid in unipolar and
bipolar depression, although manic symptoms are not affected and higher doses are required in patients with
resistant bipolar depression and rapid cycling. Omega-3 fatty acids are useful in pregnant women with major
depression, and have no adverse effects on the fetus. Choline, inositol, 5-hydroxy-L-tryptophan, and N-acetylcysteine
are effective adjuncts in bipolar patients. Dehydroepiandrosterone is effective both in bipolar depression and
depression in the setting of comorbid physical disease, although doses should be titrated to avoid adverse effects.
Ayurvedic and homeopathic therapies have the potential to improve symptoms of depression, although larger
controlled trials are needed. Mind-body-spirit and integrative medicine approaches can be used effectively in mild to
moderate depression and in treatment-resistant depression. Currently, although CAM therapies are not the primary
treatment of mood disorders, level 1 evidence could emerge in the future showing that such treatments are
effective.
Mood disorders are a major public health problem and are associated with considerable burden of disease, suicides,
physical comorbidities, high economic costs, and poor quality of life. Approximately 30%-40% of patients with major
depression have only a partial response to available pharmacological and psychotherapeutic interventions.
Complementary and alternative medicine (CAM) has been used either alone or in combination with conventional
therapies in patients with mood disorders. This review of the literature examines evidencebased data on the use of
CAM in mood disorders. A search of the PubMed, Medline, Google Scholar, and Quertile databases using keywords
was conducted, and relevant articles published in the English language in the peer-reviewed journals over the past
two decades were retrieved. Evidence-based data suggest that light therapy, St John's wort, Rhodiola rosea, omega-3
fatty acids, yoga, acupuncture, mindfulness therapies, exercise, sleep deprivation, and S-adenosylmethionine are
effective in the treatment of mood disorders. Clinical trials of vitamin B complex, vitamin D, and methylfolate found
that, while these were useful in physical illness, results were equivocal in patients with mood disorders. Studies
support the adjunctive role of omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid in unipolar and
bipolar depression, although manic symptoms are not affected and higher doses are required in patients with
resistant bipolar depression and rapid cycling. Omega-3 fatty acids are useful in pregnant women with major
depression, and have no adverse effects on the fetus. Choline, inositol, 5-hydroxy-L-tryptophan, and N-acetylcysteine
are effective adjuncts in bipolar patients. Dehydroepiandrosterone is effective both in bipolar depression and
depression in the setting of comorbid physical disease, although doses should be titrated to avoid adverse effects.
Ayurvedic and homeopathic therapies have the potential to improve symptoms of depression, although larger
controlled trials are needed. Mind-body-spirit and integrative medicine approaches can be used effectively in mild to
moderate depression and in treatment-resistant depression. Currently, although CAM therapies are not the primary
treatment of mood disorders, level 1 evidence could emerge in the future showing that such treatments are
effective. 2013 Qureshi and Al-Bedah, publisher and licensee Dove Medical Press Ltd.
Moral distress has been explored within a number of nursing contexts, including critical care, neuroscience, and end-
of-life decision making. Although the antecedents and consequences of this concept continue to be uncovered, its
unique attributes remain ambiguous. This analysis aims to clarify the concept of moral distress, contribute new
insights about moral distress to nursing as a whole and to the subspecialty of neuroscience nursing in particular, and
enhance advancements in nursing knowledge and practice. Literature published in English between 1987 and 2009
was searched using the Cumulative Index to Nursing and Allied Health Literature and Google Scholar databases.
Eleven journal articles were used in the final analysis. Rodgers' evolutionary model of concept analysis was used in
this study. Four comprehensive attributes were formulated to describe moral distress in neuroscience nursing:
negative feelings, powerlessness, conflicting loyalties, and uncertainty. These attributes are intimately related,
holding true meaning only when viewed within the context of one another and with respect to the historical and
philosophical underpinnings of nursing praxis. This analysis demonstrates the fluidity, complexity, and
multifacetedness of moral distress. Knowledge of the conceptual attributes presented herein will facilitate
recognition and validation of personal experiences within the neuroscience nursing community. 2012 American
Association of Neuroscience Nurses.
Background and aims: Loop ileostomies are used currently in surgical practice to reduce the consequences of distal
anastomotic failure following colorectal resection. It is often assumed that reversal of a loop ileostomy is a simple
and safe procedure. However, many studies have demonstrated high morbidity rates following loop ileostomy
closure. The aims of this systematic review were to examine all the existing evidence in the literature on morbidity
and mortality following closure of loop ileostomy. Method: A literature search of Ovid, Embase, the Cochrane
database, Google Scholar and Medline using Pubmed as the search engine was used to identify studies reporting on
the morbidity of loop ileostomy closure (latest at June 15th 2008), was performed. Outcomes of interest included
demographics, the details regarding the original indication for operation, operative and hospital-related outcomes,
post-operative bowel-related complications, and other surgical and medical complications. Results: Forty-eight
studies from 18 countries satisfied the inclusion criteria. Outcomes of a total of 6,107 patients were analysed. Overall
morbidity following closure of loop ileostomy was found to be 17.3% with a mortality rate of 0.4%. 3.7% of patients
required a laparotomy at the time of ileostomy closure. The most common post-operative complications included
small bowel obstruction (7.2%) and wound sepsis (5.0%). Conclusion: The consequences of anastomotic leakage
following colorectal resection are severe. However, the consequences of stoma reversal are often underestimated.
Surgeons should adopt a selective strategy regarding the use of defunctioning ileostomy, and counsel patients
further prior to the original surgery. In this way, patients at low risk may be spared the morbidity of stoma reversal.
Springer-Verlag 2009.
CONTEXT-Despite the high frequency of liver transplants in infants, few data are available on the characteristics of
posttransplant lymphoproliferative disorders in liver transplant patients (PTLD). OBJECTIVE-To analyze special
features and behavior of PTLD arising after liver transplant in infants. METHODS-A comprehensive search of the
literature was conducted for the available data on PTLD in infant liver transplant recipients through PubMed and
Google scholar. An infant was defined as a liver recipient who was less than 2 years old at the time of transplant.
Overall, 205 cases of PTLD were found in 24 reports, and the 100 infants with PTLD were compared with children and
adults with PTLD. RESULTS-PTLD lesions in infants were more likely to be polymorphic whereas monomorphic lesions
were more prevalent among older patients (P= .05). Remission rates, metastasis frequency, and organ involvement
did not differ significantly between the groups. Survival analysis showed that the infants had a significantly better
outcome than did older patients (P= .05). CONCLUSION-PTLD is more benign and may have a better outcome in
infant liver transplant recipients than in older recipients. A prospective multicenter approach is needed for future
research studies.
Background: Patients on dialysis are at high risk for sudden cardiac death. Although clinical trials have shown that
implantable cardiac defibrillators (ICD) are effective in improving survival in a variety of populations, dialysis patients
have been routinely excluded from these analyses. The purpose of this meta-analysis was to synthesize the available
evidence regarding the effectiveness of ICD therapy in patients receiving dialysis. Methods: We searched MEDLINE,
EMBASE, Web of Science, and Google Scholar for pertinent studies published from 1999 - 2008. In addition, we
performed hand searches of the relevant annual scientific sessions and major scientific meetings in North America
and Europe from 2000 - 2008. All clinical reports describing outcomes of ICD therapy in relation to renal function
were eligible. Four investigators independently extracted the data in a standardized manner. Results: We identified 7
studies with a total of 2516 patients and 89 patients receiving dialysis. Despite having an ICD, there was still a 2.67-
fold increase in mortality in patients undergoing dialysis compared with patients not undergoing dialysis. Results
were similar in both fixed and random effects models. When comparing patients on dialysis and those with chronic
kidney disease but not on dialysis, there was no significant difference in mortality (RR 1.62, 95% CI 0.84-3.14). We
found no evidence of publication bias. Compared with trials with < 75% patients on beta-blockers, trials with > 75%
patients on beta-blockers found a higher mortality among patients on dialysis and a lower mortality rate for patients
not on dialysis. Despite significant heterogeneity in studies included (Q 25.4 (p < 0.001), I2 76.4), other trial-level
variables, such as mean follow-up time and sample size, did not significantly affect the results in a meta-regression.
We found no evidence of publication bias. Conclusions: This meta-analysis suggests that even among those with
ICDs, there is still a 2.67-fold increased mortality risk in patients who receive dialysis compared with those who do
not. Beta-blockers may be less cardioprotective among patients with ICDs who are on dialysis.
Background and aims: Uncertainty existed regarding whether patients with posterior circulation infarction (PCI) have
a high mortality. We conducted a systematically review on its mortality to explore the disparity. Methods: We
searched PUBMED, EMBASE, and SCHOLAR GOOGLE from inception to February 2010 for observational studies that
reported clinical outcomes in patients with PCI and reference lists of eligible studies and reviews also were screened.
We extracted data according to MOOSE guidelines. A pooled mortality rate was calculated. Results: Fifteen studies
involving 2666 patients were included. The pooled estimate of mortality for patients with PCI was 12% (95% CI, 8% to
17%) determined by a random effects model for large heterogeneity among studies. Mortality rates varied among
subgroups stratified by study design, method for PCI diagnosis, inclusion criteria of the subject, and duration of
follow-up. Mortality rate for PCI was 5% (95%CI, 3% to 8%) in 7 studies (1560 patients) in which clinical manifestation
plus neuroimaging diagnosis were employed to determine PCI while patients identified by OCSP classification have a
higher mortality rate(17%, 95%CI, 12% to 22%; I2 = 37%) with low heterogeneity. Of note, three studies (310
patients) focusing on specific lesion locations, mortality rate rise to 20% (95% CI, 3% to 47%). Conclusions: Mortality
rate of patients with PCI varied, but it is not high as before. Due to large heterogeneity among different studies, the
conclusion should be interpreted cautiously.
OBJECTIVE: To summarize and evaluate the literature for Mosquirix (RTS,S) and provide insight into the therapeutic
and economic controversies of this novel malaria vaccine candidate. DATA SOURCES: A systematic literature search
was performed using the terms Mosquirix; RTS,S; malaria; vaccine; and Plasmodium in MEDLINE (1948-November
2011), EMBASE (1980-November 2011), International Pharmaceutical Abstracts (1970-November 2011), Google, and
Google Scholar. STUDY SELECTION AND DATA EXTRACTION: Clinical trials describing vaccine development,
pharmacology, pharmacokinetics, efficacy, and safety were reviewed. For efficacy, clinical trials were reviewed that
reported acquisition of malarial disease. Information regarding study design, population, study period, baseline
characteristics, clinical outcomes, results, and assessors of quality was extracted. DATA SYNTHESIS: Five randomized
controlled trials and 4 follow-up extension studies were identified. In Phase 2 trials, vaccine efficacy rates were 33-
65% in infants and 30-53% in children for preventing the first episode of clinical disease. In Phase 3 trials, vaccine
efficacy was 56% in children aged 5-17 months. RTS,S reduced the number of clinical malaria episodes and prevented
severe malaria in several studies. The follow-up period for vaccine efficacy ranged from 6 to 45 months. RTS,S 25
mug is administered intramuscularly as 3 injections given 1 month apart for infants and children. RTS,S appears to be
generally well tolerated. A few cases of meningitis and seizures (within 7 days of vaccination) have been reported.
CONCLUSIONS: RTS,S has demonstrated efficacy and safety in Phase 1, 2, and 3 trials, and has the potential to
decrease morbidity and mortality from malaria worldwide. Major challenges include determination of the duration of
immunity, assessment of its cost-effectiveness, its use in special populations, and its dissemination in endemic
regions. Pending further studies, RTS,S has the potential to become the benchmark as the first effective vaccine
against malaria.
BACKGROUND: A key constraint to achieving the MDGs is the absence of a properly trained and motivated
workforce. Loss of clinical staff from low and middle-income countries is crippling already fragile health care systems.
Health worker retention is critical for health system performance and a key problem is how best to motivate and
retain health workers. The authors undertook a systematic review to consolidate existing evidence on the impact of
financial and non-financial incentives on motivation and retention. METHODS: Four literature databases were
searched together with Google Scholar and 'Human Resources for Health' on-line journal. Grey literature studies and
informational papers were also captured. The inclusion criteria were: 1) article stated clear reasons for implementing
specific motivations to improve health worker motivation and/or reduce medical migration, 2) the intervention
recommended can be linked to motivation and 3) the study was conducted in a developing country and 4) the study
used primary data. RESULTS: Twenty articles met the inclusion criteria. They consisted of a mixture of qualitative and
quantitative studies. Seven major motivational themes were identified: financial rewards, career development,
continuing education, hospital infrastructure, resource availability, hospital management and
recognition/appreciation. There was some evidence to suggest that the use of initiatives to improve motivation had
been effective in helping retention. There is less clear evidence on the differential response of different cadres.
CONCLUSION: While motivational factors are undoubtedly country specific, financial incentives, career development
and management issues are core factors. Nevertheless, financial incentives alone are not enough to motivate health
workers. It is clear that recognition is highly influential in health worker motivation and that adequate resources and
appropriate infrastructure can improve morale significantly.
Hematopoietic stem cell (HSC) transplantation using bone marrow and peripheral blood stem cells is a lifesaving
treatment for patients with leukemia or other blood disorders. However, donors face the risk of physical and
psychosocial complications. We aimed to synthesize qualitative studies on the experiences and perspectives of HSC
donors. We searched MEDLINE, Embase, PsycINFO, CINAHL, Google Scholar, and reference lists of relevant articles to
November 13, 2012. Thematic synthesis was used to analyze the findings. Thirty studies involving 1552 donors were
included. The decision to donate included themes of saving life, family loyalty, building a positive identity, religious
conviction, fear of invasive procedures, and social pressure and obligation. Five themes about the donation
experience were identified: mental preparedness (pervasive pain, intense disappointment over recipient death,
exceeding expectations, and valuing positive recipient gains), burden of responsibility (striving to be a quality donor,
unresolved guilt, and exacerbated grief), feeling neglected (medical dismissiveness and family inattention),
strengthened relationships (stronger family ties, establishing blood bonds), and personal sense of achievement
(satisfaction and pride, personal development, hero status, and social recognition). Although HSC donation was
appreciated as an opportunity to save life, some donors felt anxious and unduly compelled to donate. HSC donors
became emotionally invested and felt responsible for their recipient's outcomes and were profoundly grieved and
disappointed if the transplantation was unsuccessful. To maximize donor satisfaction and mitigate the psychosocial
risks for HSC donors, strategies to address the emotional challenges of anxiety, sense of coercion, guilt, and grief in
donors are warranted. 2013 American Society for Blood and Marrow Transplantation.
Background: HIV vaccine preparedness studies (VPS) are important precursors to HIV vaccine trials. As well, they
contribute to an understanding of motivators and barriers for participation in hypothetical HIV vaccine trials.
Motivators can take the form of altruism and a desire for social benefits. Perceived personal benefits, including
psychological, personal, and financial well- being, may also motivate participation. Methods: We performed a
systematic review of HIV VPS using the Cochrane Database for Systematic Reviews, Medline/ Pubmed, Embase, and
Google Scholar. Two people independently searched the literature for individual HIV VPS that examined motivators
of participation in a hypothetical HIV vaccine trial. The denominators employed in the literature varied across
studies, and these were standardized to the number of respondents per survey item, regardless of their willingness
to participate (WTP) in an HIV vaccine trial. The Organization for Economic Co-operation and Development (OECD)
countries and the non-OECD countries were compared with respect to these motivators. Results: We retrieved eight
studies on social benefits (i. e. , altruism) and 11 studies on personal benefits conducted in the OECD countries, as
well as 19 studies on social benefits and 20 studies on personal benefits in the non-OECD countries. Various different
forms of altruism were found to be the major motivators for participation in a hypothetical HIV vaccine trial in both
the OECD and the non-OECD countries. In a large number of studies, protection from HIV was cited as a personal
motivator for participation in a hypothetical HIV vaccine trial in the OECD and the non-OECD countries. Conclusion:
This is the first comprehensive review examining motivators of participation for an HIV vaccine trial. Knowledge of
motivators can inform and target recruitment for HIV vaccine trials, though it must be remembered that hypothetical
motivators may not always translate into motivators in an actual vaccine trial.
HIV vaccine preparedness studies (VPS) are important precursors to HIV vaccine trials. As well, they contribute to an
understanding of motivators and barriers for participation in hypothetical HIV vaccine trials. Motivators can take the
form of altruism and a desire for social benefits. Perceived personal benefits, including psychological, personal, and
financial well-being, may also motivate participation. The authors performed a systematic review of HIV VPS using
the Cochrane Database for Systematic Reviews, Medline, PubMed, Embase, and Google Scholar. The authors
independently searched the literature for individual HIV VPS that examined motivators of participation in a
hypothetical HIV vaccine trial, using the same search strategy. As the denominators employed in the literature varied
across studies, the denominators were standardized to the number of respondents per survey item, regardless of
their willingness to participate (WTP) in an HIV vaccine trial. The authors retrieved eight studies on social benefits
(i.e., altruism) and 11 studies on personal benefits conducted in the Organization for Economic Co-operation and
Development (OECD) countries, as well as 19 studies on social benefits and 20 studies on personal benefits in the
non-OECD countries. Various different forms of altruism were found to be the major motivators for participation in
an HIV vaccine trial in both the OECD and the non-OECD countries. In a large number of studies, protection from HIV
was cited as a personal motivator for participation in a hypothetical HIV vaccine trial in the OECD and the non-OECD
countries. Knowledge of motivators can inform and target recruitment for HIV vaccine trials, although it must be
remembered that hypothetical motivators may not always translate into motivators in an actual vaccine trial. 2011
Taylor & Francis.
Periodontal disease is now increasingly believed to play a significant part in various systemic conditions. Likewise
these systemic diseases and their severity have been found to have an impact on the morbidity of periodontal
disease. A number of mechanisms specific to such interlink have been proposed and later established in numerous
studies. The disorders with such bidirectional link with periodontal disease include cardiovascular, respiratory,
neurological, and connective tissue diseases. The periodontal - systemic interlink has a vibrant effect on the
management aspects and is of paramount topical interest to clinicians. We review the pertaining literature (Google
scholar and pubmed).
OBJECTIVE: To conduct a systematic review of social networking tools in Canadian pharmacy practice and to
determine how pharmacists can use web 2.0 technologies to help implement evidence and change their practice.
METHODS: A medical librarian (DG) searched English language MEDLINE, EMBASE and International Pharmaceutical
Abstracts (IPA), PubMed, Google Scholar and Scirus until January 24, 2011. Examples of search terms used include
blog*.mp., wiki*.mp., twitter.mp., facebook.mp., social media. mp., "web 2.0".mp., "pharmacy 2.0" and pharma:.mp.
Search results were imported into the online Mendeley reference management tool (www.mendeley. com,
Mendeley Ltd., London, UK), where duplicates were removed and aggregated for analysis. Imported articles were
analyzed for inclusion using article type, research methodology and other themes. Brief descriptions for each article
were written and new research was identified using the "snowball" technique. Papers were ranked for relevance
from "low" to "high" based on study parameters. RESULTS: Final search results are pending. The initial search
identified over 600 articles related to social media and health. Topics included use by pharmacists and students,
pharmacy education, ethics, concern over liability, marketing and health information. Uncertainty over the role of
social networking by pharmacists was a common theme. DISCUSSION: The social tools and trends of web 2.0 are
changing the way pharmacists share information, communicate with each other and engage collaboratively. As these
technologies evolve, pharmacists and organizations could benefit from the social media revolution by selectively and
cautiously implementing these technologies to support their practice change.
Purpose: Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms have been reported to be associated
with pancreatic cancer, but the published studies have yielded inconsistent results. This study assessed the
relationship between MTHFR gene polymorphisms and the risk for pancreatic cancer using a meta-analysis approach.
Methods:A search of Google scholar, PubMed, Cochrane Library and CNKI databases before April 2012 was
performed, and then associations of the MTHFR polymorphisms with pancreatic cancer risk were summarized. The
association was assessed by odds ratios (ORs) with 95% confidence intervals (CIs). Publication bias was also
calculated. Results: Four relative studies on MTHFR gene polymorphisms (C667T and A1298C) were included in this
meta-analysis. Overall, C667T (TT vs. CC:OR=1.61,95%CI=0.78-3.34; TT vs. CT: OR=1.41,95%CI=0.88-2.25; Dominant
model:OR=0.68,95%CI=0.40-1.17; Recessive model: OR=0.82,95%CI=0.52-1.30) and A1298C (CC vs.
AA:OR=1.01,95%CI=0.47-2.17; CC vs. AC: OR=0.99,95%CI=0.46-2.14; Dominant model:OR=1.01, 95%CI=0.47-2.20;
Recessive model: OR=1.01,95%CI=0.80-1.26) did not increase pancreatic cancer risk. Conclusions: This meta-analysis
indicated that MTHFR polymorphisms (C667T and A1298C) are not associated with pancreatic cancer risk.
PURPOSE: Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms have been reported to be associated
with pancreatic cancer, but the published studies have yielded inconsistent results. This study assessed the
relationship between MTHFR gene polymorphisms and the risk for pancreatic cancer using a meta-analysis
approach., METHODS: A search of Google scholar, PubMed, Cochrane Library and CNKI databases before April 2012
was performed, and then associations of the MTHFR polymorphisms with pancreatic cancer risk were summarized.
The association was assessed by odds ratios (ORs) with 95% confidence intervals (CIs). Publication bias was also
calculated., RESULTS: Four relative studies on MTHFR gene polymorphisms (C667T and A1298C) were included in this
meta-analysis. Overall, C667T (TT vs. CC:OR=1.61,95%CI=0.78-3.34; TT vs. CT: OR=1.41,95%CI=0.88-2.25; Dominant
model:OR=0.68,95%CI=0.40-1.17; Recessive model: OR=0.82,95%CI=0.52-1.30) and A1298C (CC vs.
AA:OR=1.01,95%CI=0.47-2.17; CC vs. AC: OR=0.99,95%CI=0.46-2.14; Dominant model:OR=1.01, 95%CI=0.47-2.20;
Recessive model: OR=1.01,95%CI=0.80-1.26) did not increase pancreatic cancer risk., CONCLUSIONS: This meta-
analysis indicated that MTHFR polymorphisms (C667T and A1298C) are not associated with pancreatic cancer risk.
Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms have been reported to be associated with
pancreatic cancer, but the published studies had yielded inconsistent results.We therefore performed the present
meta-analysis. A search of Google scholar, PubMed, Cochrane Library and CNKI databases before April 2012 was
conducted to summarize associations of MTHFR polymorphisms with pancreatic cancer risk. Assessment was with
odds ratios (ORs) and 95% confidence intervals (CIs). Publication bias were also calculated. Four relative studies on
MTHFR gene polymorphisms (C667T and A1298C) were involved in this meta-analysis. Overall, C667T(TT vs.
CC:OR=1.61, 95%CI=0.78-3.34; TT vs. CT:OR=1.41, 95%CI=0.88-2.25; dominant model: OR=0.68, 95%CI=0.40-1.17;
recessive model: OR=0.82, 95%CI=0.52-1.30) and A1298C(CC vs. AA:OR=1.01, 95%CI=0.47-2.17; CC vs.
AC:OR=0.99,95%CI=0.46-2.14; dominant model: OR=1.01, 95%CI=0.47-2.20; recessive model: OR=1.01, 95%CI=0.80-
1.26) did not increase pancreatic cancer risk. This meta-analysis indicated that MTHFR polymorphisms (C667T and
A1298C) were not associated with pancreatic cancer risk.
OBJECTIVE: Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms have been reported to be
associated with pancreatic cancer, but the published studies had yielded inconsistent results.We therefore
performed the present meta-analysis., METHODS: A search of Google scholar, PubMed, Cochrane Library and CNKI
databases before April 2012 was conducted to summarize associations of MTHFR polymorphisms with pancreatic
cancer risk. Assessment was with odds ratios (ORs) and 95% confidence intervals (CIs). Publication bias were also
calculated., RESULTS: Four relative studies on MTHFR gene polymorphisms (C667T and A1298C) were involved in this
meta-analysis. Overall, C667T(TT vs. CC:OR=1.61, 95%CI=0.78-3.34; TT vs. CT:OR=1.41, 95%CI=0.88-2.25; dominant
model: OR=0.68, 95%CI=0.40-1.17; recessive model: OR=0.82, 95%CI=0.52-1.30) and A1298C(CC vs. AA:OR=1.01,
95%CI=0.47-2.17; CC vs. AC:OR=0.99,95%CI=0.46-2.14; dominant model: OR=1.01, 95%CI=0.47-2.20; recessive
model: OR=1.01, 95%CI=0.80-1.26) did not increase pancreatic cancer risk., CONCLUSION: This meta-analysis
indicated that MTHFR polymorphisms (C667T and A1298C) were not associated with pancreatic cancer risk.
Background: Evaluation of pain localized to the chest in the emergency room is, challenging, time-consuming, costly,
and often inconclusive. Available research, though limited, suggests a role for MDCTA in the evaluation of patients
with acute chest pain of low to intermediate risk, for identifying and excluding ACSs during the initial emergency
department evaluation. Accordingly, our aim was to conduct a meta-analysis to assess the diagnostic accuracy of
MDCTA in this setting. Methods: We included all studies that compared MDCTA with either coronary angiography or
standard of care for early and accurate triage of patients presenting with acute chest pain. Published studies were
identified by searches of the Pubmed, Ovid and Google scholar databases as well as hand searches of selected
references. Data were extracted independently by two reviewers. Included studies were evaluated for
heterogeneity. Meta-analysis was performed at patient level using a random-effects model. Results: 16 studies
totaling 1119 patients were included in the current meta-analysis: one randomized trial, one retrospective analysis
and fourteen prospective cohort studies. Pooled DOR was 190.80 (95%CI, 102.94-353.65). The pooled sensitivity and
specificity were 0.96 (95%CI, 0.93-0.98) and 0.92(95%CI, 0.89-0.94) respectively. The pooled NLR and PLR were 0.09
(95%CI, 0.06-0.14) and 10.12 (95%CI, 6.73-15.22). Conclusion: MDCTA has an excellent diagnostic accuracy in
detection of significant coronary artery stenosis in patients with acute chest pain. This diagnostic accuracy of MDCTA
has a potential for rapid triage of patients in the ED, with acute chest pain of low to intermediate risk of acute
coronary syndrome, to rule out significant epicardial stenosis as the etiology of chest pain. 2008 Elsevier Ireland Ltd.
BACKGROUND: Evaluation of pain localized to the chest in the emergency room is, challenging, time-consuming,
costly, and often inconclusive. Available research, though limited, suggests a role for MDCTA in the evaluation of
patients with acute chest pain of low to intermediate risk, for identifying and excluding ACSs during the initial
emergency department evaluation. Accordingly, our aim was to conduct a meta-analysis to assess the diagnostic
accuracy of MDCTA in this setting., METHODS: We included all studies that compared MDCTA with either coronary
angiography or standard of care for early and accurate triage of patients presenting with acute chest pain. Published
studies were identified by searches of the Pubmed, Ovid and Google scholar databases as well as hand searches of
selected references. Data were extracted independently by two reviewers. Included studies were evaluated for
heterogeneity. Meta-analysis was performed at patient level using a random-effects model., RESULTS: 16 studies
totaling 1119 patients were included in the current meta-analysis: one randomized trial, one retrospective analysis
and fourteen prospective cohort studies. Pooled DOR was 190.80 (95%CI, 102.94-353.65). The pooled sensitivity and
specificity were 0.96 (95%CI, 0.93-0.98) and 0.92(95%CI, 0.89-0.94) respectively. The pooled NLR and PLR were 0.09
(95%CI, 0.06-0.14) and 10.12 (95%CI, 6.73-15.22)., CONCLUSION: MDCTA has an excellent diagnostic accuracy in
detection of significant coronary artery stenosis in patients with acute chest pain. This diagnostic accuracy of MDCTA
has a potential for rapid triage of patients in the ED, with acute chest pain of low to intermediate risk of acute
coronary syndrome, to rule out significant epicardial stenosis as the etiology of chest pain. Copyright 2008 Elsevier
Ireland Ltd. All rights reserved.
Purpose of Study: The purpose of this study is to assess the need and feasibility for, and to consider the possible
design of, a multidisciplinary continuity clinic for patients with esophageal atresia (EA) at BC Children's Hospital
(BCCH). Methods Used: (1) An evidence-based literature review was conducted using the search term "esophageal
atresia, multidisciplinary follow-up care" in the PubMed, OvidSP, EBSCO databases, and Google Scholar search
engine. (2) Data was obtained from a survey of members of the Canadian Association of Paediatric Surgeons (CAPS)
regarding current esophageal atresia continuity clinics in Canada. (3) Charts of EA patients who underwent surgical
repair at BCCH between 2000 and 2011 were retrospectively reviewed for quality and searched for prima facie
evidence related to our purpose. Summary of Results: (1) Thirty-one articles denoting EA follow-up issues were
retrieved from a result of 1,020. Articles were individually assessed and excluded if irrelevant to our study. Only
articles in English were included. Articles were reviewed and the information will be considered for our clinical model
of a multidisciplinary esophageal atresia continuity clinic. (2) Onethird [5] of Canadian pediatric academic health
centres dealing with EA have multidisciplinary follow-up programs. Response to the CAPS survey indicates support
for the development of a multidisciplinary clinic model to ease follow-up and transition issues in pediatric centres. (3)
Our chart review of EA patients indicates that outpatient clinic follow-up at BCCH is often inconsistent and
uncoordinated. Conclusions: Expert opinion supports the use of multidisciplinary continuity clinics in the follow-up of
EA patients due to the associated morbidity issues. Canadian pediatric surgeons have cited transition to adult care as
an issue that can be resolved through the establishment of EA multidisciplinary clinics.
Emergence and spread of Acinetobacter species, resistant to most of the available antimicrobial agents, is an area of
great concern. It is now being frequently associated with healthcare associated infections. Literature was searched at
PUBMED, Google Scholar, and Cochrane Library, using the terms 'Acinetobacter Resistance, multidrug resistant
(MDR), Antimicrobial Therapy, Outbreak, Colistin, Tigecycline, AmpC enzymes, and carbapenemases in various
combinations. The terms such as MDR, Extensively Drug Resistant (XDR), and Pan Drug Resistant (PDR) have been
used in published literature with varied definitions, leading to confusion in the correlation of data from various
studies. In this review various mechanisms of resistance in the Acinetobacter species have been discussed. The
review also probes upon the current therapeutic options, including combination therapies available to treat
infections due to resistant Acinetobacter species in adults as well as children. There is an urgent need to enforce
infection control measures and antimicrobial stewardship programs to prevent the further spread of these resistant
Acinetobacter species and to delay the emergence of increased resistance in the bacteria.
Objectives: Multiple sclerosis (MS) is most common in females of childbearing age. The disease can therefore present
at a time when many have, or are considering, starting a family. We conducted a literature review and Meta analysis
into the effect of MS on the pregnancy outcome. Materials: Using the PICO framework, the authors separately
searched in the following databases: Google scholar,sigle,ovid,sid, EMBASE/Excerpta Medica, Medline, Pubmed,
Scopus, Index Medicus, Biomed Central, Ebsco Fulltext, and the Cochrane Database of Systematic Reviews. Methods:
Selection criteria: only papers presenting original work with analysis of at least one of the outcomes among pregnant
women with MS were included. Two independent authors performed the literature review and summarized data for
analysis. We used comprehensive Meta analysis software version 2 free trial for analyzing data. Results: Eleven
papers reporting on 2827 women with MS and their pregnancies were analyzed. A significant increase in cesarean
rate was observed among these women. Abortion, low birthweight, prematurity, neonatal death and malformations
rate did not seem to be particularly high. Conclusions: Women with multiple sclerosis should be reassured that
pregnancy does not appear to be harmful overall. The outcome of pregnancy for the majority of patients with MS is
not significantly different from that of the general population, though some precautions may be required in patients
with advanced forms of MS. It is necessary to inform women with MS and health care providers on issues regarding
MS and pregnancy.
Introduction. Erectile dysfunction (ED) following radical prostatectomy (RP) is a result of inadvertent damage to the
cavernous nerves that run close to the prostate capsula. The mechanisms behind the development of post-RP ED are
increasingly recognized and include cavernosal fibrosis and cavernosal smooth muscle apoptosis, resulting from
cavernous nerve degeneration due to neuropraxia. In recent years, cell-based therapies have received increasing
attention regarding their potential for recovery of erectile function following cavernous nerve injury (CNI).
Multipotent stromal cells (MSCs) are an attractive cell source for this application based on their regenerative
potential and their clinical applicability. Aim. To review available evidence on the efficacy and mechanisms of action
of MSC application for the treatment of ED, with an emphasis on ED following CNI. Methods. A nonsystematic review
was conducted on the available English literature between 1966 and 2011 on the search engines SciVerse-
sciencedirect, SciVerse-scopus, Google Scholar, and PubMed. Results. MSCs from both bone marrow and adipose
tissue have shown beneficial effects in a variety of animal models for ED. While MSC application in chronic disease
models such as diabetes, aging, and hyperlipidemia may result in cell engraftment and possibly MSC differentiation,
this observation has not been made in the acute CNI rat model. In the latter setting, MSC effects seem to be
established by cell recruitment toward the major pelvic ganglion and local paracrine interaction with the host neural
tissue. Conclusions. While the type of model may influence the mechanisms of action of this MSC-based therapy,
MSCs generally display efficacy in various animal models for ED. Before translation to the clinic is established, various
hurdles need to be overcome. 2011 International Society for Sexual Medicine.
Poor adherence to medications is a significant health care issue, particularly among cardiovascular patients. A variety
of interventions have been tested by researchers in an effort to identify the most effective approach to improving
adherence. Interventions delivered by multiple health care professionals (HCPs) may have an impact on improving
adherence to medications in patients with chronic conditions, although the evidence to support this is still limited.
Objective: To investigate the impact of interventions delivered by HCPs within a multiprofessional team to improve
patients adherence to cardiovascular disease medications in community settings. Search strategy: The search
strategy involved the use of the following data bases: Google scholar, PubMed, Medline, Cinahl, Embase, IPA, and
Cochrane Library, from 1994 to 2010. Search was restricted to articles published in English. Selection criteria: Cluster
randomized trials, controlled randomized clinical trials, prospective randomized trials, and nonrandomized studies
were included. We considered any intervention designed to enhance adherence to medication directed by more
than 1 HCP. Results: We included 17 studies testing 3 different types of interventions directed by more than 1 HCP.
The HCPs received a variety of training via educational lectures or interactive workshops. Informational, behavioral,
and combined interventions were delivered to cardiovascular patients. The majority of studies using only
informational interventions or a combination of behavioral and informational interventions showed improvements in
clinical outcomes (ie, blood pressure and total cholesterol lowering). However, only 2 studies measured
improvements in adherence but the results were not significant. In contrast, all interventions based on the behavior
change strategies improved both clinical outcomes and adherence to medication. Conclusions: Behavioral
interventions delivered by a multiprofessional team appear to offer the best opportunity to improve clinical
outcomes through improvements in adherence. However, whether interventions delivered by a multiprofessional
team are more clinically effective than those delivered by a single HCP remain to be tested. 2013 The Author(s).
Introduction: Adolescents and young adults have been shown to be the age group most at risk of musicinduced
hearing loss (MIHL), which is already evident and increasing among this group. Objective: The purpose of this review
is to provide further insight into the effectiveness of education programmes on attitude and behaviour towards loud
music exposure in adolescents and young adults, and to suggest positive and influential ways of delivering hearing
health education. Methods: Literature searches were conducted using various databases, including PubMed, Google
Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Authors went through the abstracts
of these articles to identify those which were potentially relevant; subsequently the full articles were retrieved.
Results: This review highlights the dangers of significant exposure to music on hearing mechanics in adolescents and
young adults, and shows that this danger continues to increase with modern music culture. Because the
consequences are not immediate, it is difficult for the young to perceive the seriousness of a problem that may not
present itself for many years. Conventional education may go a little way in helping to raise awareness but a raised
awareness of consequences does not, in itself, change behaviour. There is a significant gap in literature regarding
effective methods of education that will inspire attitude change, and have a bearing on actions. Conclusion: This
review has concluded that there is a lack of understanding of how to best influence and educate adolescents and
young adults in a way that will motivate and encourage a change in listening habits. It is of vital importance that
these groups are made aware of the immediate and future dangers, and how changes in listening behaviour do not
necessarily lower their enjoyment. The Author(s) 2011.
Coping with multiple sclerosis symptoms still remains a challenge for each patient suffering from this chronic
inflammatory disease. Therefore, patients often turn to using complementary and alternative medicine (CAM). In this
review, the authors aimed to investigate the current state of literature of music therapy in the treatment of multiple
sclerosis (MS). Medline, PubMed, Embase, AMED, CAMbase and the Music Therapy World Journal Index were
searched for the terms MS and 'music therapy'. In addition, an internet search using Google Scholar was performed.
The authors found seven case-reports/series and seven studies on music therapy for MS-patients. Both the case
reports and studies presented here are pioneer work. Most of the studies are naturally predominated by the use of
qualitative and uncontrolled research designs. Nevertheless, the results of the studies as well as the case reports
demonstrate patients' improvement in the domains of self-acceptance, anxiety and depression. The results of the
studies as well as the case reports define a sufficient basis for further music therapeutical work as they show a
variety of psychosocial and emotional benefits for MS patients. 2006 Future Drugs Ltd.
Background: Clinical trials with N-acetylcysteine (NAC) in perioperative cardiovascular settings have shown
inconsistent effects for renal endpoints. We aimed to systematically review these trials to ascertain its role in
prevention of post-cardiovascular surgery acute renal failure. Methods: We searched MEDLINE, EMBASE, Cochrane
Renal Health Library, and Google Scholar for randomized controlled studies that evaluated NAC in adult patients
undergoing cardiovascular surgery. Acute renal failure, acute renal failure requiring dialysis, and mortality were the
primary outcomes. Additional outcomes studied were length of intensive care unit stay, postoperative serum
creatinine, creatinine clearance, renal biomarkers, and adverse effects of NAC. Results: Twelve studies comprising
1,324 patients were found to be eligible. Meta-analytic estimates showed that NAC was not associated with
reduction in acute renal failure (odds ratio [OR]: 0.89, 95% confidence interval [CI]: 0.68 to 1.15), acute renal failure
requiring dialysis (OR: 1.09, 95% CI: 0.57 to 2.09) or mortality (OR: 0.95, 95% CI: 0.53 to 1.71). N-acetylcysteine was
well tolerated but was not associated with any reduction in the length of intensive care unit stay. It had inconsistent
effects on postoperative serum creatinine, creatinine clearance, and renal biomarkers. Subgroup analysis restricted
to studies using intravenous NAC preparation showed a nonsignificant trend toward reduction in acute renal failure
(OR: 0.81, 95% CI: 0.61 to 1.08) without any significant change in other outcomes. Conclusions: Overall analysis of
the existent literature shows that NAC is not beneficial in the prevention of post-cardiovascular surgery renal
dysfunction. Routine use of NAC for this indication should be avoided. 2009 The Society of Thoracic Surgeons.
Nanotechnology and nanomedicine are new and rapidly developing areas which are concerned with the utilisation of
structures and devices, one billionth of a metre in scale and how their special properties may be utilised in the
diagnosis and treatment of diseases. In otorhinolaryngology, there have been some inroads into utilising these new
treatment modalities and there is future prospect for significant developments. Their impact may be to revolutionise
the current practice of otorhinolaryngology. This review considers current developments and future prospects for
nanotechnology in our specialty and considers the pitfalls that may be encountered. The online medical reference
databases PubMed, Google Scholar, ISI Web of Science and Science Direct were searched with search terms
"Nanotechnology, Nanomedicine" in combination with "Otolaryngology, ENT, Rhinology, Otology, Head and Neck
Surgery, Laryngology" in turn. A number of developments are already showing promise in animal models, particularly
for nanoparticle delivery of drugs, which may avoid some of the inherent systemic side effects seen with
conventional application. Other possibilities include nanoscale reconstruction and regeneration of tissues and even
unexpected spin-off technologies such as haemostatic agents. The future treatment of otorhinolaryngological
diseases could be revolutionised by advances in nanomedicine and nanotechnology and diseases, such as olfactory
disorders may become radically more amenable to medical treatment. Springer-Verlag 2010.
Aims and objectives. To review the empirical literature relating to South Asian patients' experiences of cardiac
rehabilitation. Background. Individuals of South Asian origin (originating from India, Pakistan, Bangladesh, or Sri
Lanka) have increased risk of coronary heart disease-related mortality and morbidity. Low levels of cardiac
rehabilitation participation have been reported among South Asian groups in several English-speaking countries.
Design. Narrative review. Methods. Primary research evidence published in English between 1999-2010 obtained
using pre-defined search criteria in electronic databases MEDLINE, CINAHL, PubMed, EMBASE, Google Scholar and
PsycINFO. Results. Eleven studies met the inclusion criteria for review. Four prominent themes were identified in the
literature related to: (1) exercise; (2) culture and religion; (3) programme access and structure; (4) communication
and language. Conclusions. The emerging themes distilled from the review encompass several factors associated
with South Asian patients' experiences of cardiac rehabilitation that are commensurate with low uptake and poor
adherence. However, few researchers have disaggregated their data by ethnic origin to describe what might best
meet the needs of South Asian patients. Further research is needed to thoughtfully address issues of uptake of and
compliance with cardiac rehabilitation by South Asian patients and to support the development of culturally sensitive
and safe CR programmes. Relevance to clinical practice. The findings from this review can help nurses to develop
guidelines for the design and delivery of culturally competent South Asian cardiac rehabilitation programmes.
Important considerations related to physical exercise, language and communication preferences, religious and
cultural needs and programme access and structure, need to be addressed in a culturally relevant and culturally
sensitive manner to enhance the uptake and efficacy of cardiac rehabilitation for South Asian individuals. 2011
Randomized controlled trials involving natriuretic peptide administration in solid organ transplantation setting have
shown inconsistent effects for renal endpoints. We conducted a systematic review and meta-analysis of these trials
to ascertain the role of natriuretic peptides in the management of solid organ transplantation associated acute
kidney injury (AKI). MEDLINE, EMBASE, and Google scholar were searched independently by two authors for
randomized trials evaluating renal effects of natriuretic peptides in solid organ transplantation settings. Two
reviewers independently assessed the studies for eligibility and extracted the relevant data. The pooled estimate
showed that natriuretic peptide administration is associated with a reduction in AKI requiring dialysis (odds ratio =
0.50 [0.26-0.97]), a statistically nonsignificant trend toward improvement in posttransplant creatinine clearance
(weighted mean difference = 5.5mL/min, [-1.3 to 12.2mL/min]), and reduction in renal replacement requirement
duration (weighted mean difference -44.0 hours, [-60.5 to -27.5 hours]). There were no mortality events and no
adverse events related to natriuretic peptides. In conclusion, administration of natriuretic peptides in solid organ
transplantation may be associated with significant improvements in renal outcomes. These observations need to be
confirmed in an adequately powered, prospective multicenter study.
Ethnopharmacological relevance: Though inflammatory response is beneficial to body damage repair, if it is out of
control, it can produce adverse effects on the body. Although purely western anti-inflammatory drugs, orthodox
medicines, can control inflammation occurrence and development, it is not enough. The clinical efficacy of anti-
inflammation therapies is unsatisfactory, thus the search for new anti-inflammation continues. Chinese Material
Medica (CMM) remains a promising source of new therapeutic agents. CMM and herbal formulae from Traditional
Chinese Medicine (TCM), unorthodox medicines, play an improtant anti-inflammatory role in multi-targets, multi-
levels, and multi-ways in treating inflammation diseases in a long history in China, based on their multi-active
ingredient characteristics. Due to these reasons, recently, CMM has been commercialized as an anti-inflammation
agent which has become increasingly popular in the world health drug markets. Major research contributions in
ethnopharmacology have generated vast amount of data associated with CMM in anti-inflammtion aspect.
Therefore, a systematic introduction of CMM anti-inflammatory research progress is of great importance and
necessity. Aim of the study: This paper strives to describe the progress of CMM in the treatment of inflammatory
diseases from different aspects, and provide the essential theoretical support and scientific evidence for the further
development and utilization of CMM resources as a potential anti-inflammation drug through a variety of databases.
Material and methods: Literature survey was performed via electronic search (SciFinder, Pubmed, Google Scholar
and Web of Science) on papers and patents and by systematic research in ethnopharmacological literature at various
university libraries. Results: This review mainly introduced the current research on the anti-inflammatory active
ingredient, anti-inflammatory effects of CMM, their mechanism, anti-inflammatory drug development of CMM, and
toxicological information. Conclusion: CMM is used clinically to treat inflammation symptoms in TCM, and its effect is
mediated by multiple targets through multiple active ingredients. Although scholars around the world have made
studies on the anti-inflammatory studies of CMM from different pathways and aspects and have made substantial
progress, further studies are warranted to delineate the inflammation actions in more cogency models, establish the
toxicological profiles and quality standards, assess the potentials of CMM in clinical applications, and make more
convenient preparations easy to administrate for patients. Development of the clinically anti-inflammatory drugs are
also warranted. 2012 Elsevier Ireland Ltd. All rights reserved.
Nebulised surfactant has the potential to deliver surfactant to the infant lung with the goal of avoiding endotracheal
intubation and ventilation, ventilator-induced lung injury and bronchopulmonary dysplasia (BPD). To determine the
effect of nebulised surfactant administration either as prophylaxis or treatment compared to placebo, no treatment
or intratracheal surfactant administration on morbidity and mortality in preterm infants with, or at risk of, respiratory
distress syndrome (RDS). Searches were performed of CENTRAL (The Cochrane Library, January 2012), MEDLINE and
PREMEDLINE (1950 to January 2012), EMBASE (1980 to January 2012) and CINAHL (1982 to January 2012), as well as
proceedings of scientific meetings, clinical trial registries, Google Scholar and reference lists of identified studies.
Expert informants and surfactant manufacturers were contacted. Randomised, cluster-randomised or quasi-
randomised controlled trials of nebulised surfactant administration compared to placebo, no treatment, or other
routes of administration (laryngeal, pharyngeal instillation of surfactant before the first breath, thin endotracheal
catheter surfactant administration or intratracheal surfactant instillation) on morbidity and mortality in preterm
infants at risk of RDS. We considered published, unpublished and ongoing trials. Two review authors independently
assessed studies for eligibility and quality, and extracted data. No studies of prophylactic or early nebulised
surfactant administration were found. A single small study of late rescue nebulised surfactant was included. The
study is of moderate risk of bias. The study enrolled 32 preterm infants born < 36 weeks' gestation with RDS on nasal
continuous positive airway pressure (nCPAP). The study reported no significant difference between nebulised
surfactant administration compared to no treatment groups in chronic lung disease (risk ratio (RR) 5.00; 95%
confidence interval (CI) 0.26 to 96.59) or other outcomes (oxygenation 1 to 12 hours after randomisation, need for
mechanical ventilation, days of mechanical ventilation or continuous positive airways pressure (CPAP) or days of
supplemental oxygen). No side effects of the nebulised surfactant therapy or aerosol inhalation were reported. There
are insufficient data to support or refute the use of nebulised surfactant in clinical practice. Adequately powered
trials are required to determine the effect of nebulised surfactant administration for prevention or early treatment of
RDS in preterm infants. Nebulised surfactant administration should be limited to clinical trials.
A high number of HIV positive babies are born each year, whereas by highly effective preventive measures, the risk
of mother-to-child transmission can be decreased significantly. There are different methods (for example mandatory
versus voluntary) for HIV screening in pregnant women, but there are debates on conducting HIV testing by these
methods. One of the most important issues in this field is its ethical considerations. Also its limitations cannot be
ignored. According to these facts several keywords were searched by search engines such as Web of Sciences,
Medline, Google scholar, WHO website. The most relevant and recent articles were chosen. Concerning the
importance of vertical transmission of HIV, the role of preventive measures, ethical considerations, and the
limitations of HIV screening, we recommend HIV testing offer to every pregnant women at the first clinic visit by
providing enough information for patient and considering her autonomy. Also policy makers should provide a
guideline for this test according to the pregnant women's autonomy, confidentiality, and dignity.
The dividing line between non-communicable and communicable disease is quite blurred. This has been explained
through an analogy between neglected tropical diseases (NTDs) and spatial neglect. The electronic databases such as
MEDLINE, Tropical Diseases Research Division at the WHO and Google Scholar were consulted and reference lists of
articles were searched for relevant material. Spatial neglect is a common complication following stroke. Both NTDs
and spatial neglect demonstrate a preference for space and pose challenges in control and management. Although
they may appear to be different entities, at least three NTDs (Chagas disease, neurocysticercosis, and
schistosomiasis) have been implicated as risk factors for stroke (and thence spatial neglect). This makes NTDs an
issue of international concern, unrestricted to the tropics, and too important to be neglected.
Due to the ever increasing number of substances added to infant formula, and the fact that the majority of data
determining the safety of these substances has been derived from adult animals, a search of the available data was
performed to determine if an appropriate neonatal model could be found that could be used for performing
toxicological safety studies. This exercise utilized three different forms of media. The first informational source is
from a publication from the Institute of Medicine (IOM) of the National Academies. The second form of informational
data utilized was from simple YAHOO and Google Scholar searches on the internet. The third source of information
was from the U.S. Food and Drug Administration (FDA), more specifically, the Center for Drug Evaluation and Review
(CDER) preclinical guidance document. Following the examination of the above informational sources, it became
apparent that neonatal rats and pigs have been the most utilized of the neonatal models. Following the evaluation of
the papers, the experimental paradigm which appears to be the most appropriate for testing substances new to
infant formula, and could be used as a pivotal study was the neonatal pig utilizing the automated feeding device
called the Autosow. 2013 Informa Healthcare USA, Inc.
BACKGROUND: Hypothermia is a major factor in neonatal morbidity and mortality in developing countries. High
prevalence of hypothermia has been reported widely even from warmer tropical countries. In spite of the World
Health Organization's recommendation of maintenance of warm chain in newborn care, hypothermia continues to
be a common neonatal condition which has remained under-recognized, under-documented, and poorly-managed.,
OBJECTIVE: This review aims at providing the incidence of and risk factors for neonatal hypothermia as well as
provides a pathophysiological overview and management options for neonates with the condition in sub-Saharan
Africa., MATERIALS AND METHODS: All available published literature on neonatal hypothermia was searched
electronically and manually. The principal electronic reference libraries and sites searched were PubMed, Embase,
Ajol, Cochrane Reference Libraries and Google Scholar. The search terms used included 'neonatal hypothermia,' 'Cold
stress in newborn' 'thermal care of the newborn,' 'neonatal thermogenesis,' 'neonatal cold injury,' among others.
Pertinent books and monographs were accessed. Data in formats inaccessible to the reviewer were excluded.,
RESULT AND CONCLUSION: Neonatal hypothermia is a major condition of public health importance in countries of
sub- Saharan Africa. Awareness of the burden of the disease is still low in some communities. Risk factors for
neonatal hypothermia in the region include poverty, home delivery, low birthweight, early bathing of babies, delayed
initiation of breastfeeding and inadequate knowledge among health workers. Low-tech facilities to prevent heat
losses and provide warmth are available in sub-Saharan Africa and are thus recommended as well as continuous
efforts at sensitizing caregivers on the thermal needs of newborns.
OBJECTIVE: To examine the efficacy of nepafenac in the treatment of pain and inflammation in patients after
cataract surgery using evidence from controlled clinical studies. DATA SOURCES: Citations in Google Scholar,
PubMed, and Web of Science from January 1, 2005, to March 25, 2013, were identified using nepafenac and cataract
as search terms. STUDY SELECTION AND DATA EXTRACTION: The literature search was limited to human studies
published in English. Three trials that compared nepafenac with other nonsteroidal antiinflammatory drugs (NSAIDs)
were included. DATA SYNTHESIS: The pharmacokinetics and pharmacodynamics of nepafenac 0.1% suspension (and
its active metabolite, amfenac) were compared with bromfenac 0.09% solution and ketorolac 0.4% solution with
respect to aqueous humor concentrations and ability to reduce cyclooxygenase 1 and 2 (COX-1 and COX-2) enzymes.
The maximum concentration (Cmax) values of ketorolac and amfenac were statistically similar, while the Cmax of
bromfenac was significantly lower than that of amfenac. Ketorolac most effectively inhibited COX-1 enzymes; COX-2
enzymes were most effectively reduced by amfenac. When nepafenac 0.1% suspension was compared with placebo
and ketorolac 0.5% solution, nepafenac achieved a higher percentage cure rate than placebo at day 14 (p = 0.0241).
Significant differences in cure rates between nepafenac and ketorolac were not observed. Nepafenac 0.1%,
bromfenac 0.09%, and ketorolac 0.45% were compared to determine which most effectively reduced prostaglandin
E2 (PGE2) following surgery. PGE2 concentrations were significantly lowest in the ketorolac group, followed by the
bromfenac and nepafenac groups, respectively. Topical nepafenac 0.1% suspension was approved in 2005. A 0.3%
suspension was approved in October 2012. The 0.3% product may have some advantages over its predecessor: it is
dosed once rather than thrice daily, which may increase patient adherence and improve outcomes. The price and
dosing frequency of the 0.3% product are comparable to those of bromfenac 0.09% solution. CONCLUSIONS: The 2
nepafenac products appear to be equally efficacious, with a slightly increased adverse event rate in patients using
the 0.3% versus 0.1% formulation. Head-to-head clinical trials that compare the 0.3% product with the 0.1% product
or other commercially available NSAIDs are unavailable. 1967-2013 Harvey Whitney Books Co. All rights reserved.
Background: The internet is an expanding source of information and support for cancer patients and their families.
Studies mostly report patient internet use. Little is known about how families/carers use the internet and what they
find useful. Aim: The project reviewed best available evidence for how family/carers use the internet for cancer
related information and support. Method: Findings are based on a review of published studies identified from Ovid
MEDLINE, CINAHL and EMBASE 1996-2009, PsycINFO 2002- 2009, Cochrane data base and Google Scholar. Key
search words used were cancer, patient, information, internet, online, web, support, family, carer, caregiver and
friend. Results: 145 abstracts were read. 52 articles were retrieved in full text. 21 of the 52 articles were critically
appraised. No studies of robust evidence were retrieved. Most compared family/carer and patient internet use with
other cancer information sources or analyzed content of postings to websites. Some reported on patient 'indirect'
internet use through family/carers. Heterogeneity of results related to different study aims, diversity in study tools,
varying sample sizes and differing cancer populations. Broadly, internet use can be divided into information
searching and support group activity. Family/carers access internet information to problem solve, however they
report doctors as their most preferred information source. Email communication with Health Care Professionals is
desirable. Participation in online support groups provide information tailored to individual needs and peer support.
Implications for practice: The internet may be a primary or secondary source of information and access to services.
Considered practice change would be routine assessment of family/carers internet use, prescribing of internet sites
and email communication. The level of evidence is not ideal to influence policy development. Conclusions: No robust
evidence exists for how family/carers use the internet for cancer related information and support. Research is
required to evaluate local practice with results used to effect policy development.
Recent studies have explored the organization of player movements in team sports using a range of statistical tools.
However, the factors that best explain the performance of association football teams remain elusive. Arguably, this is
due to the high-dimensional behavioural outputs that illustrate the complex, evolving configurations typical of team
games. According to dynamical system analysts, movement patterns in team sports exhibit nonlinear self-organizing
features. Nonlinear processing tools (i.e. Artificial Neural Networks; ANNs) are becoming increasingly popular to
investigate the coordination of participants in sports competitions. ANNs are well suited to describing high-
dimensional data sets with nonlinear attributes, however, limited information concerning the processes required to
apply ANNs exists. This review investigates the relative value of various ANN learning approaches used in sports
performance analysis of team sports focusing on potential applications for association football. Sixty-two research
sources were summarized and reviewed from electronic literature search engines such as SPORTDiscus, Google
Scholar, IEEE Xplore, Scirus, ScienceDirect and Elsevier. Typical ANN learning algorithms can be adapted to perform
pattern recognition and pattern classification. Particularly, dimensionality reduction by a Kohonen feature map
(KFM) can compress chaotic high-dimensional datasets into low-dimensional relevant information. Such information
would be useful for developing effective training drills that should enhance self-organizing coordination among
players. We conclude that ANN-based qualitative analysis is a promising approach to understand the dynamical
attributes of association football players.
Introduction: Neural stem cells catalyze strong interests for the development of systems to screen for effective drugs
to treat neurodegenerative conditions and/or improve neurogenesis, fields where the classical approaches have so
far failed in discovering successful drugs. Areas covered: The authors review the known biology of NSCs, their normal
function in development, the adult brain, and in vitro culture systems. The authors also discuss the scientific and
technological progress which will aid wider applications of NSCs for drug screening/development purposes. The
authors base this article on literature searches performed through PubMed and Google Scholar. Expert opinion: NSC
systems present unique opportunities that are starting to be successfully explored for genetic and chemical
screening. These systems provide the possibility of identifying and optimizing molecules/drugs that could lead to the
tighter control in self-renewal and lineage specification of NSCs as well as their functional maturation. This could be
crucial in moving forward NSC-based therapies. It is expected that recent advances in the method of producing NSCs
from patient-specific human induced pluripotent stem (iPS) cells and in the technologies to grow them in vitro, while
preserving their full developmental potential, will allow a full exploitation of NSCs both in drug discovery programs
and in predictive toxicology studies.
Introduction: Traditionally, M&M conference was an academic exercise using a punitive approach to case review.
Audience participation was limited to physicians in a single department, with exclusion of other health-care
providers. Recent evidence suggests that a multidisciplinary approach may be more effective for identifying and
correcting system-based errors. Methods: The neurocritical care team redesigned M&M conference to focus on
multidisciplinary and system-based issues, rather than using the traditional punitive approach. First, a literature
search using Medline and Google Scholar was conducted to evaluate reported M&M structures. Next, a tool was
developed to identify important M&M cases for discussion. Voluntary reporting of potential cases was encouraged.
After case selection, all involved health-care providers were invited to either present or attend the conference. An
experienced physician uninvolved in the case moderated the M&M using a specific process based on the literature.
After each case, an action plan was created, and instituted by the appropriate services. The results of the action plan
were discussed at the subsequent meeting, and further modifications were made as indicated. Results: The new
Neurocritical Care M&M process has been utilized for one year, on a monthly basis. The meeting was wellattended
by neurologists, neurosurgeons, neurointensivists, neurointerventionalists, nurses, pharmacists, and hospital
administrators. Case presentations were multidisciplinary and interactive. To date, 35 patients, with 15 system-based
errors were presented. 13 of those issues have been remediated to date. Issues successfully resolved relate to
interdisciplinary communication, consultation of appropriate services, and errors in drug administration. Solutions
included refinement of ICU protocols, highlighting deficiencies in communication, and educating health-care
personnel on patient-care issues. Conclusions: Transitioning from a traditional punitive-based M&M to a structured
multidisciplinary systems-based approach has resulted in a more open and productive environment for enhancing
patient care.
Background-The goal of this statement was to review the available literature on surveillance, screening, evaluation,
and management strategies and put forward a scientific statement that would comprehensively review the literature
and create recommendations to optimize neurodevelopmental outcome in the pediatric congenital heart disease
(CHD) population. Methods and Results-A writing group appointed by the American Heart Association and American
Academy of Pediatrics reviewed the available literature addressing developmental disorder and disability and
developmental delay in the CHD population, with specific attention given to surveillance, screening, evaluation, and
management strategies. MEDLINE and Google Scholar database searches from 1966 to 2011 were performed for
English-language articles cross-referencing CHD with pertinent search terms. The reference lists of identified articles
were also searched. The American College of Cardiology/American Heart Association classification of
recommendations and levels of evidence for practice guidelines were used. A management algorithm was devised
that stratified children with CHD on the basis of established risk factors. For those deemed to be at high risk for
developmental disorder or disabilities or for developmental delay, formal, periodic developmental and medical
evaluations are recommended. A CHD algorithm for surveillance, screening, evaluation, reevaluation, and BACKGROUND: The goal of this statement was to review the available literature on surveillance, screening,
evaluation, and management strategies and put forward a scientific statement that would comprehensively review
the literature and create recommendations to optimize neurodevelopmental outcome in the pediatric congenital
heart disease (CHD) population., METHODS AND RESULTS: A writing group appointed by the American Heart
Association and American Academy of Pediatrics reviewed the available literature addressing developmental
disorder and disability and developmental delay in the CHD population, with specific attention given to surveillance,
screening, evaluation, and management strategies. MEDLINE and Google Scholar database searches from 1966 to
2011 were performed for English-language articles cross-referencing CHD with pertinent search terms. The reference
lists of identified articles were also searched. The American College of Cardiology/American Heart Association
classification of recommendations and levels of evidence for practice guidelines were used. A management
algorithm was devised that stratified children with CHD on the basis of established risk factors. For those deemed to
be at high risk for developmental disorder or disabilities or for developmental delay, formal, periodic developmental
Aims: During and after surgical procedures there is a complex physiological stress response that involves activation of
inflammatory, neuroendocrine, metabolic, immunological and redox mediators. Minimally invasive surgery induces
less tissue trauma and thus an attenuated stress response is anticipated. This systematic review aimed to review
data on the effect of minimally invasive surgery on neurohormonal stress response. Methods: Pubmed, Scopus,
Google Scholar and MD Consult were searched with the appropriate search terms up to and including January 2010.
Papers comparing open with laparoscopic surgery or different methods of minimally invasive surgery that provided
preoperative and postoperative measurements of at least one stress hormone were included in the study. Results:
Two thousand seven trials were identified and their abstracts were reviewed. Thirty four human trials fulfilled
inclusion criteria and were obtained in full text. Study quality was modest with most studies not providing study
sample calculation data or randomization data. Anesthetic technique was briefly reported in the majority of trials.
The most often measured indices of neuroendocrine stress response were cortisol and ACTH. Outcome data were
confusing with some studies demonstrating attenuated neuroendocrine stress response to laparoscopic surgery, Objective: Neurogenic bladder refers to morphofunctional alterations of the bladder-sphincter complex secondary to
central or peripheral neurological lesions. Discal etiology can be suggested by clinical observation in patients
complaining of classical lower back pain, but not excluded even without musculoskeletal pain. This review provides a
brief overview of associations between neurogenic bladder and disc disease, analyzing neuroanatomy,
pathophysiology, clinical and urodynamic findings. Therapy is reviewed focusing on etiological treatments. Methods:
The literature search was performed on PubMed, Medline and Google scholar using the following keywords:
'neurogenic bladder', 'disc herniation', 'disc prolapse', 'disc protrusion', 'cauda equina syndrome', 'treatment',
'surgery', 'urodynamic', either alone or in combination using 'AND' or 'OR'. The reference lists of articles retrieved
were examined to capture other potentially relevant articles. The search was restricted to articles published between
1970 and 2012. Seventy-nine papers were found, but only 42 were reviewed and summarized. Findings: The
literature reviewed confirmed correlations between neurogenic bladder and disc disease. Approximately 40% of
patients with lumbar disc disease have abnormal urodynamic testing, and an even larger proportion complain of
voiding symptoms. The most common urodynamic finding is detrusor areflexia, but underactive or overactive Objectives: Current research efforts are centered on delineating the novel health benefits of naturally derived
saccharides, including growing interest in their abilities to influence neurologic health. We performed a
comprehensive review of the literature to consolidate all controlled studies assessing various roles of exogenous
saccharide compounds and polysaccharide-rich extracts from plants, fungi, and other natural sources on brain
function, with a significant focus on benefits derived from oral intake. Methods: Studies were identified by
conducting electronic searches on PubMed and Google Scholar. Reference lists of articles were also reviewed for
additional relevant studies. Only articles published in English were included in this review. Results: Six randomized,
double-blind, placebo-controlled clinical studies were identified in which consumption of a blend of plant-derived
polysaccharides showed positive effects on cognitive function and mood in healthy adults. A separate controlled
clinical study observed improvements in well-being with ingestion of a yeast beta-glucan. Numerous animal and in Aim: Sclerotherapy has been shown to be an effective and increasingly popular treatment for varicose veins.
However, recent reports of serious side-effects including cerebro-vascular accidents (CVA), transient ischaemic
attacks (TIA), and speech and visual disturbances have caused serious concern. The aim of the study was to evaluate
the reported incidences of neurological sideeffects associated with the use of sclerotherapy. Method: A systematic
search of the databases Medline, OVID Embase and Google Scholar was undertaken by two independent reviewers.
Articles reporting neurological side-effects in humans following foam and liquid sclerotherapy were included, animal
studies, laboratory studies and review articles were excluded. Additional references were also obtained using the
related articles function. Results: The search yielded 1022 articles of which 40 studies were found to meet the
inclusion criteria. A total of 10,043 treatment episodes of sclerotherapy were reviewed. There were 13 case reports
of CVA, with confirmatory imaging, nine reports of TIA, 86 reports of visual or speech disturbance not associated
Sclerotherapy has been shown to be an effective and increasingly popular therapeutic strategy for the treatment of
varicose veins. However, recent reports of serious side effects, including cerebrovascular accidents (CVA) and
transient ischemic attacks (TIA), as well as speech and visual disturbances, have caused serious concern regarding its
use. This review evaluated the reported incidences of neurological side effects associated with the use of
sclerotherapy. A systematic search of the data bases MEDLINE, OVID Embase, and Google Scholar was undertaken by
two independent reviewers. Articles reporting neurological side effects in humans following foam and liquid
sclerotherapy were included; animal studies, laboratory studies, and review articles were excluded. Additional
references were also obtained using the related articles function. The search yielded 1023 articles, of which 41
studies were found to meet the inclusion criteria. A total of 10,819 patients undergoing sclerotherapy were
reviewed. There were 12 case reports of CVA with confirmatory brain imaging and nine reports of TIA. There were 97
(0.90%) reports of neurological events overall, including TIA, visual and speech disturbances, and 29 cases of
reported migraine (0.27%). Symptoms occurred at times ranging from minutes to several days following
sclerotherapy. Eleven patients with TIA or CVA were found to have a right to left cardiac shunt, usually a patent
foramen ovale. Neurological side effects following sclerotherapy are a rare occurrence; however, CVA associated
with the use of sclerotherapy is clearly documented. The pathologic mechanisms resulting in CVA are likely to be
different to those leading to migraine and visual disturbances; however, care should be exercised in patient
selection, particularly in those with known cardiac defects. 2012 Society for Vascular Surgery.
Background: Patients with treatment-resistant depression (TRD) who showed partial response to pharmacological
and psychotherapeutic interventions need a trial of neuromodulation therapies (NTs). Objective: This paper aims to
review evidence-based data on the use of NTs in TRD. Method: Using keywords and combined-word strategy,
multiple computer searches of PubMed, Google Scholar, Quertle(R), and Medline were conducted for retrieving
relevant articles published in English-language peer-reviewed journals (2000-2012). Those papers that addressed NTs
in TRD were retained for extensive review. Results: Despite methodological challenges, a range of 30%-93% of TRD
patients showed substantial improvement to one of the NTs. One hundred-percent improvement was reported in
two single-case studies on deep brain stimulation. Some studies reported no benefits from transcranial direct current
stimulation. NTs were reported to have good clinical efficacy, better safety margin, and benign side-effect profile.
Data are limited regarding randomized clinical trials, long-term efficacy, and cost-effectiveness of these approaches.
Both modified electroconvulsive therapy and magnetic seizure therapy were associated with reversible but
disturbing neurocognitive adverse effects. Besides clinical utility, NTs including approaches on the horizon may
unlock the biological basis underlying mood disorders including TRD. Conclusion: NTs are promising in patients with
TRD, as the majority of them show good clinical response measured by standardized depression scales. NTs need
further technological refinements and optimization together with continuing well-designed studies that recruit larger
numbers of participants with TRD. Treatment-resistant depression, neuromodulation therapies, modified electro-
convulsive therapy, deep brain stimulation, transcranial direct current stimulation, magnetic seizure
therapyBackground: Patients with treatment-resistant depression (TRD) who showed partial response to
pharmacological and psychotherapeutic interventions need a trial of neuromodulation therapies (NTs). Objective:
This paper aims to review evidence-based data on the use of NTs in TRD. Method: Using keywords and combined-
word strategy, multiple computer searches of PubMed, Google Scholar, Quertle(R), and Medline were conducted for
retrieving relevant articles published in English-language peer-reviewed journals (2000-2012). Those papers that
addressed NTs in TRD were retained for extensive review. Results: Despite methodological challenges, a range of
30%-93% of TRD patients showed substantial improvement to one of the NTs. One hundred-percent improvement
was reported in two single-case studies on deep brain stimulation. Some studies reported no benefits from
transcranial direct current stimulation. NTs were reported to have good clinical efficacy, better safety margin, and
benign side-effect profile. Data are limited regarding randomized clinical trials, long-term efficacy, and cost-
effectiveness of these approaches. Both modified electroconvulsive therapy and magnetic seizure therapy were
Objective To review the updated research on neuroprotection in glaucoma, and summarize the potential agents
investigated so far. Data sources The data in this review were collected from PubMed and Google Scholar databases
published in English up to September 2012, with keywords including glaucoma, neuroprotection, and retinal ganglion
cells, both alone and in combination. Publications from the past ten years were selected, but important older articles
were not excluded. Study selection Articles about neuroprotection in glaucoma were selected and reviewed, and
those that are cited in articles identified by this search strategy and judged relevant to this review were also
included. Results Although lowering the intraocular pressure is the only therapy approved as being effective in the
treatment of glaucoma, increasing numbers of studies have discovered various mechanisms of retinal ganglion cells
death in the glaucoma and relevant neuroprotective strategies. These strategies target neurotrophic factor
deprivation, excitotoxic damage, oxidative stress, mitochondrial dysfunction, inflammation, activation of intrinsic and
extrinsic apoptotic signals, ischemia, and protein misfolding. Exploring the mechanism of axonal transport failure,
synaptic dysfunction, the glial system in glaucoma, and stem cell used in glaucoma constitute promising research
areas of the future. Conclusions Neuroprotective strategies continue to be refined, and future deep investment in
researching the pathogenesis of glaucoma may provide novel and practical neuroprotection tactics. Establishing a
system to assess the effects of neuroprotection treatments may further facilitate this research.
OBJECTIVE: To review the updated research on neuroprotection in glaucoma, and summarize the potential agents
investigated so far., DATA SOURCES: The data in this review were collected from PubMed and Google Scholar
databases published in English up to September 2012, with keywords including glaucoma, neuroprotection, and
retinal ganglion cells, both alone and in combination. Publications from the past ten years were selected, but
important older articles were not excluded., STUDY SELECTION: Articles about neuroprotection in glaucoma were
selected and reviewed, and those that are cited in articles identified by this search strategy and judged relevant to
this review were also included., RESULTS: Although lowering the intraocular pressure is the only therapy approved as
being effective in the treatment of glaucoma, increasing numbers of studies have discovered various mechanisms of
retinal ganglion cells death in the glaucoma and relevant neuroprotective strategies. These strategies target
neurotrophic factor deprivation, excitotoxic damage, oxidative stress, mitochondrial dysfunction, inflammation,
activation of intrinsic and extrinsic apoptotic signals, ischemia, and protein misfolding. Exploring the mechanism of
axonal transport failure, synaptic dysfunction, the glial system in glaucoma, and stem cell used in glaucoma
constitute promising research areas of the future., CONCLUSIONS: Neuroprotective strategies continue to be refined,
and future deep investment in researching the pathogenesis of glaucoma may provide novel and practical
neuroprotection tactics. Establishing a system to assess the effects of neuroprotection treatments may further
facilitate this research.
Objective: To review the neuropsychological and behavioral effects of antiepileptic drugs (AEDs). Methods: Evidence
based on literature review using Medline and Google scholar, together with personal experience. Results: Many AED
studies do not include validated behavioral measures and/or do not take into account confounding factors. Such
factors include reciprocal psychosis, which appears to be precipitated by rapid seizure control, and the 'release
phenomenon', which occurs when someone who has been very disabled by the seizures for a prolonged period
suddenly becomes much less disabled as a result of better seizure control but does not know how to use the
newfound ability in an acceptable manner. These psychiatric and behavioral disturbances may be inappropriately
attributed to a particular drug when they would have occurred with any treatment that resulted in similar seizure
control. Reports of psychiatric disturbance need to be examined critically but there appears to be quite good
evidence for the following associations with the newer AEDs. Vigabatrin: depression and psychosis. Gabapentin:
exacerbation of behavioral problems in some children with pre-existing difficulties. Topiramate: depression,
psychosis and word-finding problems; the psychosis is much less likely with low starting doses and slow dose
escalation. Tiagabine: may precipitate nonconvulsive status epilepticus. Levetiracetam: irritability and behavioral Objectives: To review current trends for treating sensorineural deafness by enhancing spiral ganglion neuron (SGN)
survival using neurotrophins combined with cochlear implants and identify areas for future research and
development. Methods: A literature search was undertaken on PubMed and Google scholar using terms:
neurotrophins, cochlear implants and sensorineural to identify the most recent and significant publications. The
abstracts were read to identify relevant papers; these were accessed in full and analyzed for this review. Results:
Neurotrophins have a known role in cochlear development and the maintenance of spiral ganglion neurons (SGN). So
far experiments using osmotic pumps to deliver neurotrophins have been successful for short term enhanced
survival of SGN's following aminoglycoside ototoxicity in animal models. They have demonstrated the re-sprouting of
radial nerve fibres from SGN's towards the source of delivery. In addition electrical stimulation, gene and cell based
therapy have increased SGN survival to varying degrees. Conclusions: Osmotic pumps carry a high risk of infection
AIMS: The aim of the literature review was to identify new and emerging out of hospital emergency care roles and to
describe their activity and impact., BACKGROUND: Demographic changes, increased demands for health services,
altered working practices, and health system economic pressures have led to the development of a disparate set of
new health care roles., DATA SOURCES: MEDLINE, EMBASE and CINAHL databases, and the two search engines
Google and Google Scholar were searched for contemporary studies in the identified study area., REVIEW METHODS:
All publications identified through the search were assessed for relevance. Those that discussed new roles were
included (n=34) and empirical studies (n=14) analysed in detail., RESULTS: Emergency care and paramedic
practitioner roles (ECP & PP) are having an impact on patient care, including an average 25% reduction in the Aims: The aim of the literature review was to identify new and emerging out of hospital emergency care roles and to
describe their activity and impact. Background: Demographic changes, increased demands for health services,
altered working practices, and health system economic pressures have led to the development of a disparate set of
new health care roles. Data sources: MEDLINE, EMBASE and CINAHL databases, and the two search engines Google
and Google Scholar were searched for contemporary studies in the identified study area. Review methods: All
publications identified through the search were assessed for relevance. Those that discussed new roles were
included (n = 34) and empirical studies (n = 14) analysed in detail. Results: Emergency care and paramedic
practitioner roles (ECP & PP) are having an impact on patient care, including an average 25% reduction in the
conveyance rate to hospital, improved inter-professional working, immediacy of treatment and referral, and high
patient satisfaction. Limited economic data suggests savings of between 31 (USD 55) and 37 (USD 65) per case when
ECPs replace standard ambulance responders. Concerns have been expressed about patient safety, recruitment and
training levels, regulatory and role implementation issues. Conclusion: Further work is required to fully understand
the patient safety, clinical practice, professional role and financial implications of these new roles. 2008 Elsevier Ltd.
Purpose: A metabolic abnormality such as obesity is a major obstacle in the maintenance of the human health
system and causes various chronic diseases including type 2 diabetes, hypertension, cardiovascular diseases, as well
as various cancers. This study was designed to summarize the recent scientific knowledge regarding the anti-obesity
role of curcumin (diferuloylmethane), which is isolated from the herb curcuma longa, known to possess anti-
inflammatory activities. However, little is known about its exact underlying molecular mechanisms in the treatment
of obesity and metabolic diseases. Furthermore, cell cultures, animal models of obesity, and few human clinical and
epidemiological studies have added the promise for future therapeutic interventions of this dietary compound.
Methods: An electronic search was performed using Science finder, Medline, Scopus, Google scholar and collected
English language articles from 2000 to 2010, relating to the role of curcumin in obesity and metabolic diseases.
Results: Obesity has been classified as a growing epidemic and its associated metabolic disorders are considered a
major risk to the health system. Curcumin interacts with specific proteins in adipocytes, pancreatic cells, hepatic
stellate cells, macrophages, and muscle cells, where it suppresses several cellular proteins such as transcription
factor NF-kB, STAT-3, Wnt/beta-catenin and activates PPAR-, Nrf2 cell signaling pathway. In addition, curcumin
This paper reviews how the tobacco industry is promoting its products online and examines possible regulation
models to limit exposure to this form of marketing. Opportunities to use new media to advance tobacco control are
also discussed and future research possibilities are proposed. Published articles and grey literature reports were
identified through searches of the electronic databases, PUBMED and Google Scholar using a combination of the
following search terms: tobacco or smoking and new media, online media, social media, internet media, Web 2.0,
Facebook, YouTube and Twitter. A possible obstacle to fully realising the benefits of regulating tobacco marketing
activities and effectively communicating tobacco control messages is the rapid evolution of the media landscape.
New media also offer the tobacco industry a powerful and efficient channel for rapidly countering the denormalising Objective: To review baboon syndrome (BS). Data Sources: Date sources were obtained from PubMed and Google
Scholar: Photographs of baboon syndrome were obtained from our patient. Study Selections: PubMed and Google
Scholar were searched up to June 30, 2010. The search terms were "baboon syndrome", "SDRIFE" and "thimerosal
allergy". Reverse references from relevant articles and Google Scholar were also used. As BS is a classical disease and
cases of offending agents were relatively old, some references were more than five years old. In order to gather as
many cases of offending agents as possible, more than 50 references were collected. Results and Conclusion: We
divided BS into as 4 groups; classical baboon syndrome, topical druginduced baboon syndrome, systemic Software products available from Copernic and Google that provide tools to search a user's desktop are discussed
and evaluated. In addition, a new Internet search engine, Google Scholar, is described and evaluated. Each of these
can be helpful for pharmacists, although some improvements may be necessary to provide adequate features for Background: It is controversial as to whether nicorandil would have cardioprotective effects in patients with acute
myocardial infarction (AMI) who are undergoing reperfusion therapy. A meta-analysis was performed to study the
impacts of nicorandil on functional outcomes after AMI. Methods and Results: Randomized prospective cohort or
retrospective cohort publications were identified up to October 2007 by means of a computer search of MEDLINE
and Google Scholar databases. Two reviewers checked the quality of the studies and extracted data regarding
patient and disease characteristics, study design, functional parameters such as Thrombolysis In Myocardial
Infarction (TIMI) flow grade after reperfusion, left ventricular ejection fraction (LVEF) and left ventricular end-
diastolic volume index (LVEDVI). Seventeen studies were included for the meta-analysis in this study. Nicorandil
treatment reduced the incidence of TIMI flow grade <=2 in 1,337 patients of 10 studies (risk ratio 0.63; 95% BACKGROUND: It is controversial as to whether nicorandil would have cardioprotective effects in patients with acute
myocardial infarction (AMI) who are undergoing reperfusion therapy. A meta-analysis was performed to study the
impacts of nicorandil on functional outcomes after AMI., METHODS AND RESULTS: Randomized prospective cohort
or retrospective cohort publications were identified up to October 2007 by means of a computer search of MEDLINE
and Google Scholar databases. Two reviewers checked the quality of the studies and extracted data regarding
patient and disease characteristics, study design, functional parameters such as Thrombolysis In Myocardial
Infarction (TIMI) flow grade after reperfusion, left ventricular ejection fraction (LVEF) and left ventricular end-
diastolic volume index (LVEDVI). Seventeen studies were included for the meta-analysis in this study. Nicorandil
treatment reduced the incidence of TIMI flow grade < or =2 in 1,337 patients of 10 studies (risk ratio 0.63; 95% By reducing the amount of nicotine that reaches the brain when a person smokes a cigarette, nicotine vaccines may
help people to stop smoking or to prevent recent quitters from relapsing. The aims of this review are to assess the
efficacy of nicotine vaccines for smoking cessation and for relapse prevention, and to assess the frequency and type
of adverse events associated with the use of nicotine vaccines. We searched the Cochrane Tobacco Addiction Review
Group specialised register for trials, using the term 'vaccine' in the title or abstract, or in a keyword (date of most
recent search April 2012). To identify any other material including reviews and papers potentially relevant to the
background or discussion sections, we also searched MEDLINE, EMBASE, and PsycINFO, combining terms for nicotine
vaccines with terms for smoking and tobacco use, without design limits or limits for human subjects. We searched
the Annual Meeting abstracts of the Society for Research on Nicotine and Tobacco up to 2012, using the search
string 'vaccin'. We searched Google Scholar for 'nicotine vaccine'. We also searched company websites and Google
for information related to specific vaccines. We searched clinicaltrials.gov in March 2012 for 'nicotine vaccine' and
for the trade names of known vaccine candidates. We included randomized controlled trials of nicotine vaccines, at
Phase II and Phase III trial stage and beyond, in adult smokers or recent ex-smokers. We included studies of nicotine
vaccines used as part of smoking cessation or relapse prevention interventions. We extracted data on the type of
participants, the dose and duration of treatment, the outcome measures, the randomization procedure,
concealment of allocation, blinding of participants and personnel, reporting of outcomes, and completeness of
Colonoscopy is the gold standard investigation for large bowel disease. With the increase in demand, pressure is on
clinics to shorten lengths of time per procedure in addition to maintaining high levels of patient safety. Analgesia has
always been the mainstay of adequate pain relief, but it leads to prolonged recovery and lengths of hospital stay, in
addition to increased risk of cardio-respiratory side effects. N2O/O2 mixtures have been used for its effective
analgesic effect and short half life and provides an alternative method of sedation for colonoscopy procedures. The
primary objective was to compare the overall effectiveness of nitrous oxide mixtures to other types of pain relief
used during colonoscopy procedures to provide adequate pain/discomfort relief.The secondary objective was to
compare between nitrous oxide and other types of pain relief with respect to hospitalisation/recovery time, side
effects, patients and endoscopists satisfaction, and colonoscopy completion rates. The following electronic
databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library,
MEDLINE (1966- present), EMBASE (1980 - present), and the Internet (Google Scholar). Randomised controlled trials
which compared nitrous oxide to placebo or active comparators for patients undergoing elective colonoscopic
procedures. Patients with known underlying causes of pain/discomfort were excluded. Seven randomised trials were
included. Each trial compared a nitrous oxide/oxygen mixture to a placebo or sedation +- other analgesic drugs on
patients undergoing elective colonoscopic procedures. The results of these studies were analysed and discussed.
There were a total of 547 patients included.There were 257 patients randomised to receive the N2O/O2 mixture (7
studies), while 225 patients received some form of sedation with or without other analgesia (6 studies), and 65
patients received a placebo (3 studies).Four studies showed that N2O/O2 is as good in controlling pain/discomfort as
conventional methods, while one showed sedation was better and another study showed N2O/O2 was better.Six of
the studies showed that N2O/O2 groups had quicker recovery times and shorter lengths of hospital stays while one
study showed that there was no difference between the two groups.Two studies showed that N2O/O2 was safer
while one reported that sedation was safer. Nitrous oxide is as efficient and safer than various pain relief methods
used during colonoscopy procedures, but further trials are necessary.
BACKGROUND: Colonoscopy is the gold standard investigation for large bowel disease. With the increase in demand,
pressure is on clinics to shorten lengths of time per procedure in addition to maintaining high levels of patient safety.
Analgesia has always been the mainstay of adequate pain relief, but it leads to prolonged recovery and lengths of
hospital stay, in addition to increased risk of cardio-respiratory side effects. N2O/O2 mixtures have been used for its
effective analgesic effect and short half life and provides an alternative method of sedation for colonoscopy
procedures., OBJECTIVES: The primary objective was to compare the overall effectiveness of nitrous oxide mixtures
to other types of pain relief used during colonoscopy procedures to provide adequate pain/discomfort relief.The
secondary objective was to compare between nitrous oxide and other types of pain relief with respect to
hospitalisation/recovery time, side effects, patients and endoscopists satisfaction, and colonoscopy completion
rates., SEARCH STRATEGY: The following electronic databases were searched: Cochrane Central Register of
Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE (1966- present), EMBASE (1980 - present), and the
Internet (Google Scholar)., SELECTION CRITERIA: Randomised controlled trials which compared nitrous oxide to
placebo or active comparators for patients undergoing elective colonoscopic procedures. Patients with known
underlying causes of pain/discomfort were excluded., DATA COLLECTION AND ANALYSIS: Seven randomised trials Background: We examined whether N-methyl d-aspartate (NMDA) receptor antagonists as adjunctive therapy have
therapeutic potential for schizophrenia treatment. Method: Systematic review of PubMed, Cochrane Library,
PsycINFO and Google Scholar up until October 2012 and meta-analysis of randomized placebo-controlled trials were
performed. Risk ratio (RR), 95% confidence intervals (CI), numbers-needed-to-harm (NNH), and standardized mean
difference (SMD) were calculated. Results: Results were across 8 studies and 406 patients (85.5% schizophrenia
related disorder and 14.5% bipolar disorder) were included (amantadine: 5 trials and 220 patients, memantine: 3
trials and 186 patients). NMDA receptor antagonists (NMDAR-ANTs) as adjunctive therapy were not superior to
placebo in overall (SMD=-0.25, CI=-0.72, 0.23, p=0.31, N=6, n=347), positive symptoms (SMD=-0.20, CI=-0.70, 0.31,
p=0.44, N=4, n=205), and negative symptoms (SMD=-0.69, CI=-1.65, 0.27, p=0.16, N=4, n=205), and Clinical Global
Impression Severity scale (SMD=-0.27, CI=-1.20, 0.65, p=0.56, N=3, n=177). There was also no significant difference
in discontinuation rate between NMDAR-ANTs and placebo treatments (all cause: RR=1.23, CI=0.89-1.70, p=0.20,
DATA SOURCES: Medline, Embase, Web of Knowledge, the Cochrane Central Register of Controlled Trials, Current
Contents Connect and the Google Scholar databases were searched. Searches by hand were also made of the Journal
of Clinical Periodontology, Journal of Periodontal Research and the Journal of Periodontology. Bibliographies of
narrative reviews, conference proceedings and relevant texts known to the authors were also searched., STUDY
SELECTION: Screening of studies was carried out independently by three reviewers and assessed for quality. Studies
of Level III, ie, observational studies without control groups (cross sectional studies, before-and-after studies, case
series) or better were included. Studies reported in the English, German, Spanish or Greek language were included.,
DATA EXTRACTION AND SYNTHESIS: Data were extracted from the full-text articles using a purposely designed data
extraction form, and a qualitative summary was carried out., RESULTS: Eighteen studies were included. One abstract
from the meeting EuroPerio 5 reported a randomised-controlled clinical trial (RCT; Level I evidence) in which the
authors concluded that the toothbrushes significantly reduced recessions on buccal tooth surfaces over the course of DATA SOURCES: The Cochrane Library, PubMed, Medline, LILACS (Google Scholar and ISI Web of Science databases
were searched without restriction. The Journal of Dental Research, Community Dentistry and Oral Epidemiology,
American Journal of Orthodontics, American Journal of Orthodontics and Dentofacial Orthopedics, Angle
Orthodontist, and European Journal of Orthodontics were hand searched., STUDY SELECTION: Studies in humans
reporting on the prevalence or severity of dental crowding and dental caries that included a comparator or control
group with no or minimal crowding and assessing the association were included. Non-English articles were excluded
from the review in the study-selection stage., DATA EXTRACTION AND SYNTHESIS: Data extraction and evaluation of
primary studies were performed independently by two reviewers. Study quality was assessed but meta-analysis was
not carried out owing to the wide range of measurement indices used and study heterogeneity. A qualitative
summary is presented., RESULTS: Eight cross-sectional studies were included in the qualitative review. No association
between crowding and caries was reported in four studies, a significant negative correlation was found in two
studies, one study showed a direct and significant relationship and another study showed a positive association in
the mandibular anterior region but an inverse correlation in the maxillary posterior region., CONCLUSIONS: To date
there are no high-quality studies to resolve the possible association between dental crowding and caries; further
high-quality longitudinal studies are needed to clarify this relationship.
Evidence demonstrates the age-related specificity of unfractionated heparin (UFH) response from birth, throughout
childhood and into adulthood. One of the mechanisms contributing to this age-specificity of effect is developmental
haemostasis, whereby the quantity and structure of coagulation and plasma-binding proteins change with age. To
date, the impact of age-related differences in heparin response in neonates has been limited to haematological
effects. This study reports findings of a literature review investigating non-haema-tological effects of UFH in
neonates. A computer-assisted search of the published literature was performed using PubMed and Google Scholar
with key words; heparin AND adverse effects, complications, non-hemorrhagic effects, angiogenesis/ blood vessel,
osteoporosis/bone, HIT, skin necrosis, retinopathy of prematurity/eyes/ocular. The search was limited to
infants/neonates and animal models and the English language. Five papers were identified reporting specific non-
haematological effects of UFH in human or animal-model neonates. UFH was shown to: i) not propitiate retinopathy
of prematurity (kitten model); ii) to accelerate pulmonary vascular maturation (rabbit model); iii). To be associated
with heparin-induced thrombocytopaenia in human neo-nates (1 literature review and one case report); iv) to be
associated with a theoretical relaxation of the ductus arteriosis (human case series). Despite the association between
UFH and osteoporosis and skin necrosis in adult patients, no published evidence of these associations was found
within neonatal populations. Given the burgeoning evidence regarding the age-specific coagulation effect of UFH in
neo-nates compared to older children and adults, further research is required to address this deficit in understanding
regarding the non-haematological effects of UFH in neonates.
Mild cognitive impairment (MCI) can be a stage of pre-dementia. There is no consensus about pharmacological
treatment for this population, so it is important to structure non-pharmacological interventions for increasing their
cognitive reserve. We intended to analyze the effects of non-pharmacological interventions in the cognitive functions
in older people with MC, in form of a systemic review. Data sources were the Web of Science, Biological Abstracts,
Medline, Pub Med, EBSCHost, Scirus and Google Scholar. All studies were longitudinal trials, with MCI sample, aged >
60 years, community-dwelling, and having cognitive functions as dependent variable. Seven studies, from 91
previously selected ones, were identified according to the inclusion criteria. Six studies used cognitive intervention,
improving memory and one study used physical activity as intervention, improving executive functions. The results
show evidence that physical activity and cognitive exercise may improve memory and executive functions in older
people with MCI. But yet, more controlled studies are needed to establish a protocol of recommendations regarding
the systemization of exercise, necessary to produce benefits in the cognitive functioning in older people with MCI.
2011 Elsevier Ireland Ltd.
Objective: There are lots of important non-skeletal systemic consequence of vitamin D deficiency which was often
was underestimated. The purpose of this review is to discus the non-skeletal systemic manifestations of vitamin D
deficiency. Data Sources: We searched Medline, Pub med, Google Scholar & individual searches.
Introduction: Noradrenergic reuptake inhibitors can be effective analgesics, finding application in a wide variety of
clinical pain settings. Due to a shift toward noradrenergic-mediated pain pathways following nerve injury, they are
particularly well suited to the treatment of neuropathic pain. This phenotypic shift makes neuropathic pain difficult
to control with opioids alone; some noradrenergic reuptake inhibitors have demonstrated synergy with opioids.
Agents currently in early clinical trials are discussed and include both novel delivery of old drugs and the
development of new drugs. Areas covered: This review was limited to noradrenergic reuptake inhibitors and
analgesia. Literature search included the terms adrenergic, noradrenergic, reuptake, inhibitors, analgesia, NET,
norepinephrine transporter, and pain using Medline, Google scholar, Web of Knowledge, www.clinicaltrials.gov, and
Pharmaprojects (Informa UK Ltd. 2012). Expert opinion: Topical drug delivery and the use of combinations of agents
both topically and systemically are under active investigation. The intrathecal delivery of noradrenergic reuptake
inhibitors, allowing delivery directly to the central nervous system thus limiting systemic exposure, represents an
exciting avenue of investigation. Gaps in current knowledge have complicated the development of prophylactic
therapies for susceptible individuals or preemptive intervention. Disease-modifying agents and selective inhibitors
would facilitate these treatment strategies. 2012 Informa UK, Ltd.
Because, globally, HIV is transmitted mainly by sexual practices and intravenous drug use and because of a long
asymptomatic period, healthcare-associated HIV transmission receives little attention even though an estimated
5.4% of global HIV infections result from contaminated injections alone. It is an important personal issue for
healthcare workers, especially those who work with unsafe equipment or have insufficient training. They may
acquire HIV occupationally or find themselves before courts, facing severe penalties for causing HIV infections.
Prevention of blood-borne nosocomial infections such as HIV differs from traditional infection control measures such
as hand washing and isolation and requires a multidisciplinary approach. Since there has not been a review of
healthcare-associated HIV contrasting circumstances in poor and rich regions of the world, the aim of this article is to
review and compare the epidemiology of HIV in healthcare facilities in such settings, followed by a consideration of
general approaches to prevention, specific countermeasures, and a synthesis of approaches used in infection control,
injury prevention, and occupational safety. These actions concentrated on identifying research on specific modes of
healthcare-associated HIV transmission and on methods of prevention. Searches included studies in English and
Russian cited in PubMed and citations in Google Scholar in any language. MeSH keywords such as nosocomial
hospital-acquired, iatrogenic, healthcare associated, occupationally acquired infection and HIV were used together
with mode of transmission, such as "HIV and hemodialysis". References of relevant articles were also reviewed. The
evidence indicates that while occasional incidents of healthcare-related HIV infection in high-income countries
Because, globally, HIV is transmitted mainly by sexual practices and intravenous drug use and because of a long
asymptomatic period, healthcare-associated HIV transmission receives little attention even though an estimated
5.4% of global HIV infections result from contaminated injections alone. It is an important personal issue for
healthcare workers, especially those who work with unsafe equipment or have insufficient training. They may
acquire HIV occupationally or find themselves before courts, facing severe penalties for causing HIV infections.
Prevention of blood-borne nosocomial infections such as HIV differs from traditional infection control measures such
as hand washing and isolation and requires a multidisciplinary approach. Since there has not been a review of
healthcare-associated HIV contrasting circumstances in poor and rich regions of the world, the aim of this article is to
review and compare the epidemiology of HIV in healthcare facilities in such settings, followed by a consideration of
general approaches to prevention, specific countermeasures, and a synthesis of approaches used in infection control,
injury prevention, and occupational safety. These actions concentrated on identifying research on specific modes of
healthcare-associated HIV transmission and on methods of prevention. Searches included studies in English and
Russian cited in PubMed and citations in Google Scholar in any language. MeSH keywords such as nosocomial,
hospital-acquired, iatrogenic, healthcare associated, occupationally acquired infection and HIV were used together
with mode of transmission, such as "HIV and hemodialysis". References of relevant articles were also reviewed. The
evidence indicates that while occasional incidents of healthcare-related HIV infection in high-income countries Trichomonas vaginalis may be the most underestimated sexually transmitted infection worldwide. Although
trichomoniasis often spontaneously resolves in male patients, it can lead to significant urogenital morbidity. Despite
the ease with which it may be treated using metronidazole or tinidazole, men are not routinely screened for
trichomoniasis and are left to infect or re-infect their female partners. Moreover, the newer point-of-care testing
methods including latex agglutination and immunochromatographic assays, which could potentially be used as
screening tests, have not been submitted to peer-reviewed randomized clinical trials in men. Further studies will be
necessary to judge their efficacy in the male population. We conducted an exhaustive search of the current literature
using the traditional search engines, Pubmed and OVID, and then supplemented the findings by doing an additional
search using the online engine, Google Scholar. We report our findings on the clinical presentation, diagnosis and
treatment of trichomoniasis in men below.
DATA SOURCES: The Cochrane Library, Medline, TRIP database, MEDPILOT.DE, BIREME, several German-language
journals, Google Scholar, the Web of Science, NTI-tss-associated websites , references of relevant articles and the
MAUDE database of adverse events., STUDY SELECTION: Randomised controlled trials (RCT) were included and their
quality was assessed using the Jadad score., DATA EXTRACTION AND SYNTHESIS: A qualitative synthesis was carried
out., RESULTS: Nine out of 68 relevant publications reported the results of five different RCT. Two RCT concentrated
on electromyographic (EMG) investigations in patients with temporomandibular disorders (TMD) and concomitant
bruxism or with bruxism alone. In both studies, the NTI-tss device showed significant reduction of EMG activity
compared with use of an occlusal stabilisation splint. Two RCT focused exclusively on TMD patients: in one, a
stabilisation appliance led to greater improvement than use of an NTI-tss device, whereas in the other no difference
was found. In a further RCT, participants who suffered from tension-type headaches or migraines responded more
favourably to the NTI-tss splint than to a bleaching tray. NTI-tss-induced complications related predominantly to
single teeth or to the occlusion., CONCLUSIONS: Evidence from RCT suggests that the NTI-tss device may be
successfully used for the management of bruxism and TMD. To avoid potential unwanted effects, it should be chosen
only if the practitioner is certain a patient will be compliant with follow-up appointments. The NTI-tss bite splint may
be justified when a reduction of jaw closer muscle activity (eg, jaw clenching or tooth grinding) is desired, or as an
emergency device when people have acute temporomandibular pain and, possibly, restricted jaw opening.
PURPOSE. This case study was written to demonstrate the usefulness of standardized nursing diagnoses, outcomes,
and interventions in nurse anesthetist care of an adolescent trauma patient. DATA SOURCES. Literature reviews
using Academic Premier, Google Scholar, and CINAHL databases were done to find current, relevant articles
concerning evaluation and support of female African-American adolescents living in socially vulnerable and
economically exploited environments. DATA SYNTHESIS. A case is presented and evidence from current publications
is analyzed to support the diagnosis, outcomes, and interventions. CONCLUSION. The investment in extra time, care,
and effort sometimes required for the full development of a treatment plan for teenagers who live where they are at
high risk for violence and other consequences of stressful environments is a worthwhile one, even if results may
require contact over an extended time period. PRACTICE IMPLICATIONS. Nurses of all specialty backgrounds need to
be concerned with the progress of their patients. Sometimes nurses can best serve their patients by stepping away
from the physiological event and focusing instead on responses in the domain of coping and stress tolerance as the
root of difficulties.
The purpose of this analysis was to explore the concept of nurse competence. Data sources include EBSCOhost, Gale
PowerSearch, ProQuest, PubMed Medline, Google Scholar, and Online Journal of Issues in Nursing. This paper utilizes
Rodgers' evolutionary method to analyze the concept of nurse competence. Antecedents to nurse competence
include personal and external motivations. Attributes include integrating knowledge into practice, experience, critical
thinking, proficient skills, caring, communication, environment, motivation, and professionalism. Consequences
include confidence, safe practice, and holistic care. Implications for nursing responsibility regarding defining nurse
competence and ensuring nurse competence need to be identified. More research is needed to determine the best
evaluation methods for the different facets of nurse competence. 2012, The Author. International Journal of Nursing
Knowledge 2012, NANDA International.
BACKGROUND: Palliative care in Malaysia developed in the 1990s to improve the quality of life of people with
advanced cancer. Like many other countries, Malaysia faces its own challenges in providing palliative care to patients
and their families. In Malaysian culture, families play a significant part in providing care to the dying. Connecting with
families in patient care is therefore important. This paper reports a focused literature review evaluating studies on
the care of the families of terminally ill people in palliative care environments in Malaysia., METHOD: The search
engines CINAHL, Medline, PsycINFO, and Google Scholar were searched for literature published from January 2000 to
April 2010 relating to family care in palliative care environments. Due to a paucity of research on family care in
Malaysia, the search was broadened to include relevant studies on family care internationally., RESULTS: Four Background: Palliative care in Malaysia developed in the 1990s to improve the quality of life of people with advanced
cancer. Like many other countries, Malaysia faces its own challenges in providing palliative care to patients and their
families. In Malaysian culture, families play a signifcant part in providing care to the dying. Connecting with families
in patient care is therefore important. This paper reports a focused literature review evaluating studies on the care of
the families of terminally ill people in palliative care environments in Malaysia. Method: The search engines CINAHL,
Medline, PsycINFO, and Google Scholar were searched for literature published from January 2000 to April 2010
relating to family care in palliative care environments. Due to a paucity of research on family care in Malaysia, the
search was broadened to include relevant studies on family care internationally. Results: Four themes were Background: Institutionalized elderly continue to have the need for sexual expression and intimacy. Nurses often
display negative responses when they are confronted with the sexual behavior of residents. They feel ashamed and
do not know how to react. This generates feelings of discomfort, resulting in the denial of resident's needs and
desires for sexual fulfillment. Objectives: The objective of this review is to thoroughly analyze the literature about the
knowledge, attitudes, and experiences of nursing staff toward sexuality in institutionalized elderly. We shed light
onto the relationship between knowledge and attitudes, and determined whether certain demographic factors relate
to the knowledge and attitudes of nursing home caregivers. Design: We conducted an extensive search of the
electronic databases Medline, Cinahl, Psychinfo, Web of Science, Philosophers Index, Google Scholar, and Invert for
papers published between January 1980 and September 2010. A broad range of search keywords was used. Findings:
The quantitative studies revealed nursing staff to show rather positive attitudes toward later-life sexuality. However,
the extent of the staff's knowledge regarding sexuality in the aged seemed to be very limited. There was no
consensus found about the relationship between knowledge and attitudes. As regards the influence of demographic
variables, the results were very ambiguous. The qualitative studies showed that caregivers hold rather conservative
Background: Obes patients undergoing bariatric surgery have particularly high risk of postoperative deep venous
thrombosis and/or pulmonary embolism. Aim: This review was conducted to determine the risk of deep venous
thrombosis and/or pulmonary embolism following bariatric surgery, and summarize nursing interventions. Methods:
Searching the PubMed database, a computerized search of PubMed, ScienceDirect, Google Scholar, and OVID
(CINAHL) (from 2008 to present) identified literature for this article. Discussion: Preoperative teaching is an
important component in order to relieve patient anxiety, prevent complications, and improve outcomes. The risk of
deep venous thrombosis can be lowered by turning and positioning of the patient in every 1-2 hours and performing
foot and ankle exercises. After taking preoperative patient history and physical findings, health care professionals
should be notified to not to place pressure on the anesthetized patient to avoid circulatory compromise. Extra Title. Nursing home residents in emergency departments: a Foucauldian analysis Aim. This paper is a critical review
of current knowledge about use of emergency departments by nursing home residents. Background. A great deal of
literature focuses on the challenges presented by older adults in acute care environments. Nursing home residents
who transfer to emergency departments have been identified as being particularly problematic because they use
considerable resources and their needs are not always amenable to acute interventions. Method. A literature search
was conducted in May 2006 using the CINAHL, Medline and Cochrane databases and Google Scholar with the
keywords 'nursing home resident', 'long-term care resident', 'hospital transfer', and 'acute illness and emergency
room'. No date restrictions were imposed. Foucault's concept of subjectivity was used to demonstrate how power
derived from medical knowledge is used by emergency department personnel to construct nursing home residents
as problematic. Findings. Knowledge about the use of emergency departments by nursing home residents has been BACKGROUND: The US Centers for Medicare & Medicaid Services has enacted 2 policies that have focused
considerable attention on the optimal use of indwelling catheters in the acute and long-term care settings and the
prevention of complications including catheter-associated urinary tract infection (CAUTI). OBJECTIVES: This is the
second of a 2-part Evidence-Based Report Card reviewing current evidence pertaining to nursing actions for
prevention of CAUTI in patients with short- and long-term indwelling catheters. Part 2 reviews multiple interventions
for CAUTI prevention including staff education, monitoring of catheter use and CAUTI incidence, insertion technique,
urethral meatal care, securement, use of a closed drainage system, bladder irrigation, frequency of catheter change,
and antiseptic solutions in the drainage bag. SEARCH STRATEGY: Nursing actions for prevention of CAUTI were
identified based on search of electronic databases and Web-based search engines for national or international
clinical practice guidelines focusing on this topic. Evidence related to the above nursing interventions was identified
by searching electronic databases MEDLINE, CINAHL, the Cochrane Library, the ancestry of articles identified in these
searches and Google scholar. RESULTS: Limited evidence suggests that the following interventions reduce the
incidence of CAUTI in patients managed by short-term indwelling catheterization: (1) staff education about catheter
management, combined with regular monitoring of CAUTI incidence, (2) a facility-wide program to ensure
catheterization only when indicated and prompt removal of indwelling catheters, (3) daily cleansing of the urethral
meatus using soap and water or perineal cleanser, and (4) maintenance of a closed urinary drainage system. Mixed
evidence suggests that use of a preconnected system reduces inadvertent interruption of a closed urinary drainage
system and may prevent CAUTI. Limited evidence suggests that routine catheter changes every 4 to 6 weeks reduce
CAUTI incidence in patients managed by long-term catheterization. Existed evidence suggests that the following
interventions are not effective for reducing CAUTI incidence: (1) use of sterile technique for catheter insertion, (2)
use of antiseptic solutions or ointments during routine meatal care, (3) use of a 2-chambered urinary drainage bag,
(4) use of antiseptic filters incorporated into a urinary drainage bag, (5) bladder or catheter irrigation, (6) frequent
changes of the urinary drainage bag, and (7) placement of an antiseptic solution in the urinary drainage bag.
IMPLICATIONS FOR PRACTICE: Evidence from parts 1 and 2 of this Evidence-Based Report Card provides a sound
basis for designing an evidence-based program to prevent CAUTI. Essential elements of a CAUTI prevention program
include staff education, ongoing monitoring of CAUTI incidence, monitoring catheter insertion and ensuring prompt
removal, and careful attention to techniques for catheterization and catheter care.
BACKGROUND: The US Centers for Medicare & Medicaid Services has enacted 2 policies that have focused
considerable attention on the optimal use of indwelling catheters in the acute and long-term care settings and the
prevention of complications including catheter-associated urinary tract infection (CAUTI)., OBJECTIVES: This is the
second of a 2-part Evidence-Based Report Card reviewing current evidence pertaining to nursing actions for
prevention of CAUTI in patients with short- and long-term indwelling catheters. Part 2 reviews multiple interventions
for CAUTI prevention including staff education, monitoring of catheter use and CAUTI incidence, insertion technique,
urethral meatal care, securement, use of a closed drainage system, bladder irrigation, frequency of catheter change,
and antiseptic solutions in the drainage bag., SEARCH STRATEGY: Nursing actions for prevention of CAUTI were
identified based on search of electronic databases and Web-based search engines for national or international
clinical practice guidelines focusing on this topic. Evidence related to the above nursing interventions was identified
by searching electronic databases MEDLINE, CINAHL, the Cochrane Library, the ancestry of articles identified in these
searches and Google scholar., RESULTS: Limited evidence suggests that the following interventions reduce the
incidence of CAUTI in patients managed by short-term indwelling catheterization: (1) staff education about catheter
management, combined with regular monitoring of CAUTI incidence, (2) a facility-wide program to ensure
catheterization only when indicated and prompt removal of indwelling catheters, (3) daily cleansing of the urethral
meatus using soap and water or perineal cleanser, and (4) maintenance of a closed urinary drainage system. Mixed
evidence suggests that use of a preconnected system reduces inadvertent interruption of a closed urinary drainage
system and may prevent CAUTI. Limited evidence suggests that routine catheter changes every 4 to 6 weeks reduce
CAUTI incidence in patients managed by long-term catheterization. Existed evidence suggests that the following
interventions are not effective for reducing CAUTI incidence: (1) use of sterile technique for catheter insertion, (2)
use of antiseptic solutions or ointments during routine meatal care, (3) use of a 2-chambered urinary drainage bag,
(4) use of antiseptic filters incorporated into a urinary drainage bag, (5) bladder or catheter irrigation, (6) frequent
changes of the urinary drainage bag, and (7) placement of an antiseptic solution in the urinary drainage bag.,
IMPLICATIONS FOR PRACTICE: Evidence from parts 1 and 2 of this Evidence-Based Report Card provides a sound
basis for designing an evidence-based program to prevent CAUTI. Essential elements of a CAUTI prevention program
include staff education, ongoing monitoring of CAUTI incidence, monitoring catheter insertion and ensuring prompt
removal, and careful attention to techniques for catheterization and catheter care.
Aim: The study aims to provide an overview of the nursing profession in Saudi Arabia, including its history,
educational development, workforce and professional practice. Background: Saudi Arabia is faced with a chronic
shortage of Saudi nurses, accompanied by high rates of turnover. Expatriate nurses form a large proportion of the
nursing workforce in Saudi healthcare facilities, with Saudis comprising only 29.1% of the total nursing workforce.
Despite the fact that the proportion of Saudi nurses is very low in general, this rate is lower in the private health
sector where local nurses comprise only 4.1% of the total. Methods: Data relating to the nursing profession in Saudi
Arabia were extracted from published literature identified through search of a range of publically available databases
such as Medline, CINAHL, Google Scholar, Saudi health databases, Saudi health journals, government reports and
relevant texts. Obtained information was evaluated for relevance and grouped on a thematic basis. Conclusion: The
status of nursing in Saudi Arabia should be enhanced in order to make it a worthwhile career. The media should
engage in helping to promote a positive image of the nursing profession. The education sector should reconsider the
length of nursing training (5 years compared with 3 years in many developed countries) while maintaining competent
and safe practice. Reducing the financial burden on the nursing student through provision of additional financial
support would encourage more students. In particular, nurses should be paid a full salary during the intern year as
currently occurs with medical students. 2011 The Authors. International Nursing Review 2011 International Council
of Nurses.
Introduction: Pregnant women are encouraged to comply with dietary recommendations to meet their own
nutritional needs as well as their child. Deficiency of certain nutrients may lead to morbidity of both the mother and
child. In this review, information on nutrients intake of pregnant women from studies conducted in Indonesia will be
analysed. Methods: A literature search of all possible sources of information was conducted. These included (i)
electronic databases of PubMed, Elsevier, Science Direct, EBSCO, and Google Scholar; (ii) archives and records of the
Ministry of Health; (iii) library collection in institutions such as health polytechnics, local health offices, non-
government organisations and universities in Yogyakarta, Central Java, East Java Province; and (iv) articles on
pregnant women's nutrient intake conducted in Indonesia in 2000 - 2010. The results were analysed descriptively by
comparing them with the Estimated Average Requirements (EAR) value. Results: Two of four studies showed mean
energy intake below EAR. Protein intake was lower than EAR only in two studies, while four are in contrary to the
EAR. No study showed low fat and carbohydrate intake. A large number of studies reported low average intake of
calcium and iron. Conclusion: The reviewed studies suggest that intake of several nutrients by pregnant women in
Indonesia is below the EAR.
India is facing an "epidemic" of diet-related non-communicable diseases (DR-NCDs), along with widely prevalent
undernutrition resulting in substantial socioeconomic burden. The aim of this paper is to review secular trends in
food groups and nutrient intake, and implications for DR-NCDs in India so as to understand optimal choices for
healthy diets for the prevention of DR-NCDs. The literature search was carried out in PubMed (National Library of
Medicine, Bethesda, MD, USA) and Google Scholar search engines up to April 2011. A manual search for all other
references, national and medical databases was also carried out. Nutrition transition over the past 30years (1973-
2004), has resulted in a 7% decrease in energy derived from carbohydrates and a 6% increase in energy derived from
fats. A decreasing intake of coarse cereals, pulses, fruits and vegetables, an increasing intake of meat products and
salt, coupled with declining levels of physical activity due to rapid urbanization have resulted in escalating levels of
obesity, atherogenic dyslipidemia, subclinical inflammation, metabolic syndrome, type2 diabetes mellitus, and The proportion of the population that is >=60 years of age in sub-Saharan Africa (SSA) is increasing rapidly and is
likely to constrain healthcare systems in the future. Nevertheless, the elderly are not a health policy priority for
African countries. This paper reviews the nutritional and health status of older adults in SSA and their determinants.
Literature was abstracted through the Medline, Google Scholar, and Dogpile databases using the following search
terms: sub-Saharan Africa, older adults, nutrition, health. Findings showed that up to half (6-48%) of elderly Africans
in SSA are underweight and almost a quarter (2.5-21%) are overweight, while 56% of older South Africans are obese.
Low-quality diets contribute to poor nutritional status. Poverty, HIV/AIDS, and complex humanitarian emergencies An abundance of research has investigated causes and treatments for attention deficit hyperactivity disorder
(ADHD). The research includes identification of suboptimal levels of nutrients and sensitivities to certain foods and
food additives. This review gives an overview of this research and provides an up-to-date account of clinical trials
that have been conducted with zinc, iron, magnesium, Pycnogenol, omega-3 fatty acids, and food sensitivities. A
literature search was conducted using PubMed, ISI Web of Knowledge, and Google Scholar and included studies
published before April 2008. Although further research is required, the current evidence supports indications of
Our population is ageing, and obesity is increasing in the elderly bringing massive and rapidly changing burdens of ill
health related to increased body weights and fat as well as the main drivers of poor diet and inactivity. Overweight
and obesity, and a static body mass index (BMI) commonly conceal sarcopenia (gain in body fat but loss of muscle
mass and functional capacity) in older people, aggravated by inactivity. A systematic computerized literature search
using an iterative manipulation process of the keywords: obesity, elderly, weight loss. The following databases were
accessed on 20 October 2010: Medline, Cochrane Collaboration, Ovid and Scholar Google. A large number of clinical
consequences of overweight and obesity are particularly problematic for elderly individuals, including type 2
diabetes mellitus, arthritis, urinary incontinence and depression. The observation that the BMI value associated with
the lowest relative mortality is slightly higher in older than in younger adults has often been misinterpreted that
obesity is not as harmful in the elderly. BMI may be a less appropriate index in the elderly. All the medical
consequences of obesity are multi-factorial but all are alleviated by modest, achievable weight loss (510 kg) with an
evidence-based maintenance strategy. Since sarcopenic obesity is common in the elderly, a combination of exercise
and modest calorie restriction appears to be the optimal method of reducing fat mass and preserving muscle mass. To evaluate the impact of non-blinded outcome assessment on estimated treatment effects in randomised clinical
trials with binary outcomes. Systematic review of trials with both blinded and non-blinded assessment of the same
binary outcome. For each trial we calculated the ratio of the odds ratios--the odds ratio from non-blinded
assessments relative to the corresponding odds ratio from blinded assessments. A ratio of odds ratios <1 indicated
that non-blinded assessors generated more optimistic effect estimates than blinded assessors. We pooled the
individual ratios of odds ratios with inverse variance random effects meta-analysis and explored reasons for variation
in ratios of odds ratios with meta-regression. We also analysed rates of agreement between blinded and non-blinded
assessors and calculated the number of patients needed to be reclassified to neutralise any bias. PubMed, Embase,
PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, HighWire Press, and Google Scholar. ELIGIBILITY
CRITERIA FOR SELECTING STUDIES: Randomised clinical trials with blinded and non-blinded assessment of the same
binary outcome. We included 21 trials in the main analysis (with 4391 patients); eight trials provided individual
patient data. Outcomes in most trials were subjective--for example, qualitative assessment of the patient's function.
The ratio of the odds ratios ranged from 0.02 to 14.4. The pooled ratio of odds ratios was 0.64 (95% confidence Objective: To evaluate the impact of non-blinded outcome assessment on estimated treatment effects in
randomised clinical trials with binary outcomes. Design: Systematic review of trials with both blinded and non-
blinded assessment of the same binary outcome. For each trial we calculated the ratio of the odds ratios - the odds
ratio from non-blinded assessments relative to the corresponding odds ratio from blinded assessments. A ratio of
odds ratios <1 indicated that non-blinded assessors generated more optimistic effect estimates than blinded
assessors. We pooled the individual ratios of odds ratios with inverse variance random effects meta-analysis and
explored reasons for variation in ratios of odds ratios with meta-regression. We also analysed rates of agreement
between blinded and non-blinded assessors and calculated the number of patients needed to be reclassified to
neutralise any bias. Data Sources: PubMed, Embase, PsycINFO, CINAHL, Cochrane Central Register of Controlled
Trials, HighWire Press, and Google Scholar. Eligibility criteria for selecting studies: Randomised clinical trials with
blinded and non-blinded assessment of the same binary outcome. Results: We included 21 trials in the main analysis
(with 4391 patients); eight trials provided individual patient data. Outcomes in most trials were subjective - for
example, qualitative assessment of the patient's function. The ratio of the odds ratios ranged from 0.02 to 14.4. The Background: Clinical trials are commonly done without blinded outcome assessors despite the risk of bias. We
wanted to evaluate the effect of nonblinded outcome assessment on estimated effects in randomized clinical trials
with outcomes that involved subjective measurement scales. Methods: We conducted a systematic review of
randomized clinical trials with both blinded and nonblinded assessment of the same measurement scale outcome.
We searched PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, HighWire Press
and Google Scholar for relevant studies. Two investigators agreed on the inclusion of trials and the outcome scale.
For each trial, we calculated the difference in effect size (i.e., standardized mean difference between nonblinded and
blinded assessments). A difference in effect size of less than 0 suggested that nonblinded assessors generated more
optimistic estimates of effect. We pooled the differences in effect size using inverse variance random-effects meta-
analysis and used metaregression to identify potential reasons for variation. Results: We included 24 trials in our
review. The main meta-analysis included 16 trials (involving 2854 patients) with subjective outcomes. The estimated
BACKGROUND: Clinical trials are commonly done without blinded outcome assessors despite the risk of bias. We
wanted to evaluate the effect of nonblinded outcome assessment on estimated effects in randomized clinical trials
with outcomes that involved subjective measurement scales., METHODS: We conducted a systematic review of
randomized clinical trials with both blinded and nonblinded assessment of the same measurement scale outcome.
We searched PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, HighWire Press
and Google Scholar for relevant studies. Two investigators agreed on the inclusion of trials and the outcome scale.
For each trial, we calculated the difference in effect size (i.e., standardized mean difference between nonblinded and
blinded assessments). A difference in effect size of less than 0 suggested that nonblinded assessors generated more
optimistic estimates of effect. We pooled the differences in effect size using inverse variance random-effects meta-
analysis and used metaregression to identify potential reasons for variation., RESULTS: We included 24 trials in our Introdution: The spontaneous reporting system of adverse drug reactions (ADRs) is fundamental to drug safety
surveillance but under-reporting is its major restriction. This bibliographic review sought to assess the influence of
personal and professional characteristics on ADR reporting and to identify the obstacles and solutions associated
with ADR reporting. Materials and methods: A systematic review was conducted using the Pubmed, ISI Web of
Knowledge and Google Scholar databases, including also search of cited papers. We included papers that were
published in English and Portuguese, and covered a study population made up of health professionals (physicians,
pharmacists and nurses). Results: The review covered 25 papers that fulfilled the inclusion criteria. Some of the
obstacles to spontaneous reporting considered were: ADRs diagnosis problem, problems related to time and
resources, lack of information and access, procrastination, the organization of the pharmacovigilance system and INTRODUCTION: Most rural communities are too small and remote to sustain specialist services, and therefore some
rural and remote doctors in Australia practice advanced procedural skills as part of their comprehensive care to
underserved rural communities. The declining number of rural and remote procedural non-specialist doctors poses a
problem in Australia. There is, at present, no comprehensive delineation of the obstacles Australian rural doctors
face in trying to maintain their skills in the procedural areas of obstetrics, anaesthetics and surgery, nor of the
solutions that may overcome the problems. This literature review addresses these two needs. METHODS: We
interrogated the MEDLINE database to find articles about rural and remote medical education, with a specific focus
on procedural skills. Other sources, including Google Scholar, were used to find relevant project and conference
reports. RESULTS: The barriers to the maintenance of advanced procedural skills for rural and remote medical
practitioners include: lack of opportunity; expense associated with remaining skilled in advanced procedural areas;
lack of access to locum relief to attend educational sessions; lack of flexible options for education; lack of access to
advanced procedural training; time constraints; multiple credentialing requirements from state health departments
and joint consultative committees; family obstacles; and perceived medico-legal problems. Retention of rural doctors
and the difficulties faced by them in maintaining advanced procedural skills are related. There is evidence that both BACKGROUND: Obturator hernias (OH) account for a rare presentation to the surgical unit usually associated with
bowel obstruction and strangulation. The treatment of this condition is classical laparotomy with repair of the hernia
and bowel resection, if deemed necessary; recently, the laparoscopic approach has been reported in literature. This
review examines the existing evidence of the safety and effectiveness of the laparoscopic approach for the
management of OH. MATERIALS AND METHODS: We have conducted a systematic review of the cases reported in
the literature between 1991 and 2009, using Medline with PubMed as the search engine, as well as Ovid, Embase,
Cochrane Collaboration and Google Scholar databases to identify articles in English language reporting on
laparoscopic management for the treatment of this condition. RESULTS: A total of 17 articles reporting on 28 cases
Introduction. - Occipital nerve block (ONB) is a promising treatment for headaches. Its indications, selection criteria,
and best techniques are not clear, however. Objective. - To summarize in narrative format what is known about
ONBs and what needs to be learned. Methods. - MD Consult and Google Scholar were searched using the terms
occipital, suboccipital, block, and injection to identify relevant articles that were reviewed. This process was repeated
for all additional pertinent articles identified from these articles, and so on, until no additional articles were
identified. Results. - A total of 21 articles were identified. Conclusions. - Occipital nerve block is an effective
treatment for cervicogenic headache, cluster headache, and occipital neuralgia. While a double blinded randomized
placebo controlled clinical trial is lacking, multiple open label studies reported favorable results for migraine. Two
other possible uses of ONB worthy of further study are use as a rescue treatment and as an adjunctive treatment for
medication overuse headache. ONB may be effective for tension headache, but only under very specific
circumstances. ONB is either ineffective or only effective under as yet unstudied circumstances for hemicrania
continua and chronic paroxysmal hemicrania. Some practitioners use occipital nerve (ON) tenderness to palpation
(TTP) or reproduction of headache pain with ON pressure (RHPONP) as selection criteria for identifying appropriate
patients. While only a clinical trial can produce a definitive answer, current evidence suggests that these selection
criteria are not necessary for cervicogenic headache or cluster headache. Occipital neuralgia by definition involves
TTP of the ONs. Whether RHPONP or ON TTP predicts success in migraine is unclear, and may relate to whether
steroids are used. A single blinded randomized controlled trial evaluating local anesthetic with steroids vs local
anesthetic alone for transformed migraine reported slightly worse results with steroids, but there are several
alternate explanations for this finding other than steroids being counterproductive. The technique of repetitive ONBs
deserves further study. 2009 American Headache Society.
Objectives: Occupational noise-induced hearing loss (ONIHL) describes an acquired hearing deficiency directly
attributable to excessive workplace noise exposure. Data suggest that excessive noise attributes to ~37% of all adult
causes of hearing loss and remains a significant contributor to employment-related morbidity internationally.
Typically insidiously-acquired, often without frank progressive symptomatology, regional medical agencies continue
to struggle with this potentially debilitating condition. The aim of the study was to provide a synopsis of the current
understanding of ONIHL, its impact on individual workers and the wider international community, and to identify
barriers to more uniform adoption of personal hearing protection. Materials and Methods: A review of the
contemporary literature was performed using defined keyword searches and OVID, PubMed, and Google Scholar as
primary electronic search engines. Results: A number of published works were identified, describing aspects of the
relationship between workplace-related noise exposure and subsequent development of employee hearing
impairment, which demonstrate an overwhelming gender imbalance, with up to 97% of affected individuals being
male. Industry-specific associations (e.g., mining, manufacturing and heavy construction) were well documented, as
were links to toxin-specific exposures, in the recognized development of hearing loss. However, evidence of
integration of appraisal of the topically-current area of genetic susceptibility was often lacking. Much discordance
still exists among international agencies in the prescriptive regulation and enforcement of "safe" exposure limits.
Conclusions: Despite a high level of public awareness regarding the importance of hearing preservation and
increasingly stringent international occupational health, safety and welfare requirements mandating provision of
safer work environments, ONIHL continues to be a significant occupational hazard. ONIHL is permanent and may
cause significant disability, for which there currently exists no cure, but is largely overtly-preventable. The impact of
ONIHL on the global transition toward dominant communication-rich white-collar employment roles is difficult to
quantitate, but is likely to be substantive upon the afflicted individual. In the mainstream setting, exposure-
avoidance strategies aimed to reduce the incidence of ONIHL remain the focus of public health and occupational
medicine approaches.
It has been suggested that the perinatal period is a period of increased risk for the development and/or exacerbation
of OCD and that postpartum OCD (ppOCD) presents a distinct clinical picture. This raises the possibility that ppOCD
might be a distinct subtype of OCD. This review examines this contention. A search using Ovid (Medline, PsycINFO
and Embase), EBSCO, Cochrane Library, Web of Science (ISI), Pubmed databases and Google Scholar was carried out
using the key words: "obsessive compulsive disorder" (and derivatives), "perinatal", "pregnancy", "postnatal",
"postpartum", "mothers" (and derivatives), "anxiety disorders" and "subtypes." These articles and their references
were reviewed. The majority of studies reviewed were retrospective, which makes it impossible to infer causality.
Two prospective studies found a higher incidence of OCD in the postpartum period. These were carried out in Turkey
and Brazil and, as such, may be limited in their applicability to other cultural groups. The concept of ppOCD as a
specific subtype has not been robustly demonstrated. The evidence that OCD is more prevalent in the postpartum
period is mixed. The evidence that OCD in the postpartum period presents a distinctive clinical picture with specific
symptomatology and course is more compelling. In view of the impact of culture and religion on the expression of
OCD, collaborative, international, prospective studies that take into account the methodological and definitional
issues raised in this review are necessary to provide clarification. British Association for Behavioural and Cognitive
Psychotherapies 2011
Background: Psoriasis is associated with several extracutaneous manifestations of which ocular complications are
common. Signs and symptoms of ocular psoriasis may be subtle and overlooked. The dermatologic literature has
generally underaddressed these complications; however, a thorough understanding of ophthalmic involvement is
important to the comprehensive care of patients with psoriasis. Objective: We sought to provide a complete and up-
to-date clinical guide on the manifestations and diagnostic considerations of ocular psoriasis. Methods: PubMed and
Google Scholar were used to find primary resources. The MeSH database of PubMed was used to link key ocular
terms with the words "psoriasis," "psoriatic arthritis," and/or various psoriasis medications. Results: Ocular
manifestations of psoriasis are discussed anatomically to allow for easy clinical reference. Complications include
direct cutaneous effects such as eyelid involvement and blepharitis, and immune-mediated conditions such as
uveitis. Limitations: Literature reviewed was primarily focused on English-language journals. In addition, older articles
not included in the above electronic databases were underrepresented. Conclusion: Ophthalmic complications of
psoriasis are numerous and affect almost any part of the eye; however, they may be easily missed. Physicians should
maintain a high index of suspicion that ophthalmic symptoms in patients with psoriasis may be related to their
underlying disease, even though signs and symptoms are often vague. Screening and evaluation guidelines for ocular
disease should be more clearly incorporated into the already large academic framework of psoriasis research and
care. 2010 by the American Academy of Dermatology, Inc.
Background: Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with significant
morbidity and mortality. Controversy exists regarding whether an off-pump technique can reduce post-CABG renal
injury. Study Design: Systematic review and meta-analysis. Setting & Population: Adult patients undergoing CABG.
Selection Criteria for Studies: MEDLINE, EMBASE, Cochrane Renal Library, and Google Scholar were searched in May
2008 for randomized controlled trials (RCTs) and observational studies comparing off-pump CABG (OPCAB) with
conventional CABG (CAB) for renal outcomes. Studies involving patients on long-term renal replacement therapy
(RRT) were excluded. Intervention: OPCAB. Outcomes: Primary outcomes were overall AKI and AKI requiring RRT.
Results: 22 studies (6 RCTs and 16 observational studies) comprising 27,806 patients met the inclusion criteria. The
pooled effect from both study cohorts showed a significant reduction in overall AKI (odds ratio [OR], 0.57; 95%
confidence interval [CI], 0.43 to 0.76; P for effect < 0.001; I2 = 67%; P for heterogeneity < 0.001) and AKI requiring
RRT (OR, 0.55; 95% CI, 0.43 to 0.71; P for effect < 0.001; I2 = 0%; P for heterogeneity = 0.5) in the OPCAB group
compared with the CAB group. In RCTs, overall AKI was significantly reduced in the OPCAB group (OR, 0.27; 95% CI,
0.13 to 0.54); however, no statistically significant difference was noted in AKI requiring RRT (OR, 0.31; 95% CI, 0.06 to Background: Off-pump coronary artery bypass (OPCAB) surgery in patients with left main stem (LMS) disease
remains controversial. This meta-analysis cpmpares early outcomes of OPCAB surgery with on-pump coronary artery
bypass (ON-CAB) surgery in patients with significant LMS disease, focusing on the outcomes stroke and transient
ischemic attack (TIA). Methods: This is a meta-analysis of non-randomized comparative peer-reviewed publications
sourced from a systematic search of Embase, Medline, Cochrane, Google Scholar and CINAHL (1965-2007). A random
effects model was used and heterogeneity was assessed. Results: Nine studies (4411 patients) dating from 2000-
2007, of whom 1036 (23.5%) underwent OPCAB and 3375 (76.5%) ONCAB, were included. The incidence of stroke
BACKGROUND: Most recent published meta-analysis of randomized controlled trials (RCTs) showed that off-pump
coronary artery bypass graft surgery (CABG) reduces incidence of stroke by 30% compared with on-pump CABG, but
showed no difference in other outcomes. New RCTs were published, indicating need of new meta-analysis to
investigate pooled results adding these further studies., METHODS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO,
LILACS, Google Scholar and reference lists of relevant articles were searched for RCTs that compared outcomes (30-
day mortality for all-cause, myocardial infarction or stroke) between off-pump versus on-pump CABG until May
2012. The principal summary measures were relative risk (RR) with 95% Confidence Interval (CI) and P values
(considered statistically significant when <0.05). The RR's were combined across studies using DerSimonian-Laird
random effects weighted model. Meta-analysis and meta-regression were completed using the software
Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, New Jersey, USA)., RESULTS: Forty-seven RCTs
were identified and included 13,524 patients (6,758 for off-pump and 6,766 for on-pump CABG). There was no Background: Anthroposophic medicine offers a variety of treatments, among others the oil-dispersion bath,
developed in the 1930s by Werner Junge. Based on the phenomenon that oil and water do not mix and on
recommendations of Rudolf Steiner, Junge developed a vortex mechanism which churns water and essential oils into
a fine mist. The oil-covered droplets empty into a tub, where the patient immerses for 15-30 minutes. We review the
current literature on oil-dispersion baths. Methods: The following databases were searched: Medline, Pubmed,
Embase, AMED and CAMbase. The search terms were 'oil-dispersion bath' and 'oil bath', and their translations in
German and French. An Internet search was also performed using Google Scholar, adding the search terms 'study'
and 'case report' to the search terms above. Finally, we asked several experts for gray literature not listed in the
above-mentioned databases. We included only articles which met the criterion of a clinical study or case report, and
excluded theoretical contributions. Results: Among several articles found in books, journals and other publications,
we identified 1 prospective clinical study, 3 experimental studies (enrolling healthy individuals), 5 case reports, and 3
field-reports. In almost all cases, the studies described beneficial effects - although the methodological quality of
most studies was weak. Main indications were internal/metabolic diseases and psychiatric/ neurological disorders.
Conclusion: Beyond the obvious beneficial effects of warm bathes on the subjective well-being, it remains to be
clarified what the unique contribution of the distinct essential oils dispersed in the water can be. There is a lack of
clinical studies exploring the efficacy of oil-dispersion baths. Such studies are recommended for the future. 2008
Bussing et al; licensee BioMed Central Ltd.
BACKGROUND: Anthroposophic medicine offers a variety of treatments, among others the oil-dispersion bath,
developed in the 1930s by Werner Junge. Based on the phenomenon that oil and water do not mix and on
recommendations of Rudolf Steiner, Junge developed a vortex mechanism which churns water and essential oils into
a fine mist. The oil-covered droplets empty into a tub, where the patient immerses for 15-30 minutes. We review the
current literature on oil-dispersion baths. METHODS: The following databases were searched: Medline, Pubmed,
Embase, AMED and CAMbase. The search terms were 'oil-dispersion bath' and 'oil bath', and their translations in
German and French. An Internet search was also performed using Google Scholar, adding the search terms 'study'
and 'case report' to the search terms above. Finally, we asked several experts for gray literature not listed in the
above-mentioned databases. We included only articles which met the criterion of a clinical study or case report, and
excluded theoretical contributions. RESULTS: Among several articles found in books, journals and other publications,
Purpose: Several studies have evaluated the effects of sildenafil on the tissue repair and wound healing. In the
present review, the impact of sildenafil on the wound healing in all available clinical and nonclinical (experimental)
studies has been discussed. Methods: A literature search was performed using PubMed, Scopus, Medline, Embase,
Cochrane central register of controlled trials and Cochrane database systematic reviews. Related articles indexed in
Google Scholar were also included. Key words used as search terms were 'phosphodiesterase inhibitor', 'sildenafil',
'skin', 'cutaneous', 'skin lesion', 'skin damage', 'wound', and 'wound healing'. No time limitation was considered in
this review. Results: A total of 15 animal studies, 7 case reports, and 2 small clinical studies have reported the effects PURPOSE: Several studies have evaluated the effects of sildenafil on the tissue repair and wound healing. In the
present review, the impact of sildenafil on the wound healing in all available clinical and non-clinical (experimental)
studies has been discussed., METHODS: A literature search was performed using PubMed, Scopus, Medline, Embase,
Cochrane central register of controlled trials and Cochrane database systematic reviews. Related articles indexed in
Google Scholar were also included. Key words used as search terms were 'phosphodiesterase inhibitor', 'sildenafil',
'skin', 'cutaneous', 'skin lesion', 'skin damage', 'wound', and 'wound healing'. No time limitation was considered in
this review., RESULTS: A total of 15 animal studies, 7 case reports, and 2 small clinical studies have reported the Introduction.- Given the increasing life expectancy, the likelihood increases that health care providers are confronted
with older people having an adult child with a life-limiting illness. This literature review aimed: - to explore the
experiences of older parents in relation with their position and role as a parent of an adult child with a life-limiting
illness; - to detect gaps in the existing literature and to make recommendations for future research. Methods.-
Studies were identified by searching four electronic databases including:Webof Science, MEDLINE, CINAHL and
Google Scholar. In total, 29 published studies were included. Results.- Few studies describe the experiences of older
people having an adult child with cancer, or having an adult child who died from cancer. From the moment the
cancer diagnosis is disclosed, parents are confronted with a reawakening of the parental nurturing which clashes
with the autonomy of the adult child. Even after the adult child is deceased, older parents retain the image of
themselves as parents. The included studies are merely descriptive and give no concrete recommendations for
health care providers in daily practice. No intervention studies were found. Conclusion.- In the current literature little
isknownabout this topic. Limited research exists to provide concrete recommendations for health care providers in
daily practice and helpful family-centered interventions. There is need for more in-depth research to understand the
lived experience of these parents and what health care providers can do to assist these older people.
Background: There is conflicting evidence on the use of omega 3 and omega 6 supplementation for the prevention of
allergic diseases. We conducted a systematic review evaluating the effectiveness of omega 3 and 6 oils for the
primary prevention of sensitization and development of allergic disorders. Methods: We searched The Cochrane
Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS, PsycInfo, AMED, ISI Web of Science and Google
Scholar for double-blind randomized controlled trials. Two authors independently assessed articles for inclusion.
Meta-analyses were undertaken using fixed effects modelling, or random effects modelling in the event of detecting
significant heterogeneity. Results: Of the 3129 articles identified, 10 reports (representing six unique studies)
satisfied the inclusion criteria. Four studies compared omega 3 supplements with placebo and two studies compared
omega 6 supplements with placebo. There was no clear evidence of benefit in relation to reduced risk of allergic
sensitization or a favourable immunological profile. Meta-analyses failed to identify any consistent or clear benefits
associated with use of omega 3 [atopic eczema: RR = 1.10 (95% CI 0.78-1.54); asthma: RR = 0.81 (95% CI 0.53-1.25);
allergic rhinitis: RR = 0.80 (95% CI 0.34-1.89) or food allergy RR = 0.51 (95% CI 0.10-2.55)] or omega 6 oils [atopic
eczema: RR = 0.80 (95% CI 0.56-1.16)] for the prevention of clinical disease. Conclusions: Contrary to the evidence
from basic science and epidemiological studies, our systematic review and meta-analysis suggests that
supplementation with omega 3 and omega 6 oils is probably unlikely to play an important role as a strategy for the
primary prevention of sensitization or allergic disease. 2009 John Wiley & Sons A/S.
The objective of this study was to evaluate and collect current evidence on the effect of probiotics in preventing
pouchitis after restorative ileal pouch anal anastomosis (IPAA). The Pubmed, Medline, EMbase, CINAHL, Web of
Science, and Scopus bibliographic, and Google Scholar databases were searched between 1966 and May 2007, and
relevant controlled clinical trials were extracted, reviewed, and validated according to the study protocol. The
outcome of interest was for pouchitis defined by a pouchitis disease activity index (PDAI) >=7. Five randomized,
placebo-controlled clinical trials were included in the meta-analysis. Pooling of the results from these trials yielded OBJECTIVE: The intent of this manuscript was to review all published studies on slow cortical potentials (SCP)
neurofeedback for the treatment of ADHD, with emphasis on neurophysiological rationale, study design, protocol,
outcomes, and limitations., METHOD: For review, PubMed, MEDLINE, ERIC, and Google Scholar searches identified
six studies and six subsequent publications. In addition to five studies focusing on children with Diagnostic and
Statistical Manual of Mental Disorders (4th ed.; DSM-IV)-diagnosed ADHD, one study reports on adults., RESULTS:
SCP protocols utilize unipolar-electrode placement at Cz, randomized bidirectional signal regulation,
feedback/transfer trials, and discrete feedback/rewards. Results demonstrated learning of SCP self-regulation,
moderate to large within group effect sizes for core ADHD symptom reduction, and enhancement of event-related Introduction: Open tibial fractures have been studied extensively in adults, and detailed treatment strategies have
been developed: wound irrigation and debridement, fracture stabilization and delayed primary wound closure or
early flap coverage are basic principles of management. No clear guidelines regarding the management of open tibial
fractures in children exist.Sources of dataWe searched Medline, Embase, Cochrane, CINAHL and Google Scholar
databases using the keywords: 'open', 'tibia', 'fracture', 'children', 'paediatric', 'pediatric', 'external fixation', 'nailing'.
Fourteen clinical studies were included. Quality of the studies was assessed using the Coleman Methodology
Score.Areas of agreementAge above 10 years and grade III (severe) open fractures are associated with complications
and outcomes similar to those in adults.Areas of controversyIt is unclear whether open fractures of the tibia in
children should be managed according to the principles followed in adults. Many authors support primary skin
Introduction: Methadone is the most prescribed opioid maintenance treatment (OMT) in Europe, but buprenorphine
chlorhydrate is now available in quite all European countries. Since 2005, it is included on the List of essential
medicines for OMT by the World Health Organization. France was the pioneer of large-scale buprenorphine
treatment programmes (100 900 patients treated in 2009). The aim of this study was to inventory scientific data on
and regulations of buprenorphine in France. Method: Literature review available on the French experience: official
reports, regulatory decisions, guidelines, scientific publications indexed in Medline or Google Scholar. Results:
Buprenorphine was launched in 1996, registered on List I of prescription medicines. It can be prescribed by any
practitioners on the special prescription form mandatory for narcotics. This allowed a rapid increase of the number
of patients treated. A reinforced control of prescribing and dispensing was applied in 1999 (66 000 patients treated):
dispensing for only 1 week if not otherwise specified (dispensing for 4 weeks if specified on the prescription form).
Clinical guidelines were published in 2003 and 2004, reimbursement was submitted to a national control by the
social security system since 2004. Due to trafficking and diverted use, classification on the list of narcotic drugs was Objective. Experts disagree about the optimal classification of upper extremity disorders. To explore whether
differential response to treatments offers a basis for choosing between case definitions, we analyzed previously
published research. Methods. We screened 183 randomized controlled trials (RCTs) of treatments for upper
extremity disorders identified from the bibliographies of 10 Cochrane reviews and 4 other systematic reviews, and a
search in Medline, Embase, and Google Scholar to June 2010. From these, we selected RCTs that allowed estimates
of benefit (expressed as relative risks [RRs]) for >1 case definition to be compared when other variables (treatment,
comparison group, followup time, outcome measure) were effectively held constant. Comparisons of RRs for paired
case definitions were summarized by their ratios, with the RR for the simpler and broader definition as the
denominator. Results. Two RCT reports allowed within-trial comparison of RRs and 13 others allowed between-trial
comparisons. Together these provided 17 ratios of RRs (5 for shoulder treatments, 12 for elbow treatments, and Background: The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary
syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different
risk profiles of the studied populations. Purpose: To do the most comprehensive meta-analysis of current evidence
on early versus delayed invasive treatment in NSTE-ACS. Data Sources: MEDLINE, PubMed Central, and Google
Scholar databases; conference proceedings; ClinicalTrials.gov registry; and Current Controlled Trials registry through
May 2012. Study Selection: Available randomized, controlled trials (RCTs) and observational studies comparing early
versus delayed intervention in the NSTE-ACS population. Data Extraction: Data were extracted for populations,
interventions, outcomes, and risk of bias. All-cause mortality was the prespecified primary end point. The longest
follow-up available in each study was chosen. The odds ratio with 95% CI was the effect measure. Data Synthesis:
Seven RCTs (5370 patients) and 4 observational studies (77 499 patients) were included. Early intervention was less
than 20 hours after hospitalization or randomization for RCTs and 24 hours or less for observational studies. Meta-
analysis of the RCTs was inconclusive for a survival benefit associated with the early invasive strategy (odds ratio, BACKGROUND: The optimal timing of coronary intervention in patients with non-ST-segment elevation acute
coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to
different risk profiles of the studied populations., PURPOSE: To do the most comprehensive meta-analysis of current
evidence on early versus delayed invasive treatment in NSTE-ACS., DATA SOURCES: MEDLINE, PubMed Central, and
Google Scholar databases; conference proceedings; ClinicalTrials.gov registry; and Current Controlled Trials registry
through May 2012., STUDY SELECTION: Available randomized, controlled trials (RCTs) and observational studies
comparing early versus delayed intervention in the NSTE-ACS population., DATA EXTRACTION: Data were extracted
for populations, interventions, outcomes, and risk of bias. All-cause mortality was the prespecified primary end point.
The longest follow-up available in each study was chosen. The odds ratio with 95% CI was the effect measure., DATA
SYNTHESIS: Seven RCTs (5370 patients) and 4 observational studies (77 499 patients) were included. Early
intervention was less than 20 hours after hospitalization or randomization for RCTs and 24 hours or less for Background and Purpose: Laparoscopic urologic surgery (LUS) is one of the fastest growing subspecialties in the
surgical world. The procedures require technical expertise and finesse; unlike their open counterparts, there is
significant limitation in the margin for error. Various ethical, medicolegal, and health economy demands have made
training in laparoscopic urologic surgery challenging. Whereas several groups have sought solutions through models,
there remains a lack of consensus on the optimal training program. We review the current LUS programs with a
conscious effort to decipher the basic tenets of an optimal training program and propose training models based on
published evidence, in conjunction with current trends in LUS. Methods: A literature search of MEDLINE, Pubmed,
CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Google Scholar was performed, seeking
publications from January 1970 to July 2006 on laparoscopic surgical training pertaining to urology. Additionally, we
looked at pertinent abstracts of the annual meetings of the American Urological Association, the European
What is known and Objective: Thrombolysis using intravenous tissue plasminogen activator (tPA) is the only available
evidence-based treatment for acute ischaemic stroke; however, its current utilization is very low. Therefore, the aim
of this article is to review the literature regarding the use of intravenous tPA for the treatment of acute ischaemic
stroke. The review will also compare utilization rates of thrombolysis in different centres across the world and
identify key reasons for the underutilization of thrombolysis in stroke. Methods: MEDLINE, EMBASE, International
Pharmaceutical Abstracts (IPA) and Google Scholar were searched for relevant original articles, review papers and
other publications over the publication period 1995-2012. Results and Discussion: The National Institute of
Neurological Disorders and Stroke (NINDS) (1995, N = 624 patients) and ECASS III (2008, N = 821 patients) are two
pivotal randomized controlled trials providing evidence for the use of intravenous tPA within 3 h or 3-45 h from
stroke onset, respectively. Both trials have shown that tPA administration decreases disability at 90 days from stroke.
Furthermore, a recent pooled analysis of randomized controlled trials (2010, N = 3670 patients) supports these
results, highlighting that early stroke treatment is associated with better outcomes, especially when treatment is Background: Oral poliovirus vaccine (OPV) remains the vaccine-of-choice for routine immunization and supplemental
immunization activities (SIAs) to eradicate poliomyelitis globally. Recent data from India suggested lower than
expected immunogenicity of an OPV birth dose, prompting a review of the immunogenicity of OPV or inactivated
poliovirus vaccine (IPV) when administered at birth. Methods: We evaluated the seroconversion and reported
adverse events among infants given a single birth dose (given <=7 days of life) of OPV or IPV through a systematic
review of published articles and conference abstracts from 1959 to 2011 in any language found on PubMed, Google
Scholar, or reference lists of selected articles. Results: 25 articles from 13 countries published between 1959 and
2011 documented seroconversion rates in newborns following an OPV dose given within the first seven days of life.
There were 10 studies that measured seroconversion rates between 4 and 8 weeks of a single birth dose of TOPV,
using an umbilical cord blood draw at the time of birth to establish baseline antibody levels. The percentage of
newborns who seroconverted at 8 weeks range from 6-42% for poliovirus type 1, 2-63% for type 2, and 1-35% for
type 3. For mOPV type 1, seroconversion ranged from 10 to 76%; mOPV type 3, the range was 12-58%; and for the Purpose: To review the epidemiological and clinical evidence for the association between oral contraceptives (OCs)
and uterine leiomyoma (UL). Methods: Several databases (Pubmed, Cochrane Central, OVID, SpringerLink, Clinical
Evidence, and Google scholar) and reference lists were searched through March 2012 with no restrictions. Inclusion
criteria: cohort or case-control studies; the exposure of interest was OCs; the outcome of interest was UL; relative
risk (RR) or odds ratio (OR) (or data to calculate them) were reported. Two independent reviewers assessed eligibility
criteria and extracted data. Results: Eleven literatures involving 8,990 UL patients and 1,31,055 participants were
included from 3,017 studies initially found. The influence of OCs on UL risk was assessed by comparing "ever",
"current" or "former" users and "never" users. Meta-analysis indicated that OCs use did not increase UL morbidity
("ever" vs "never": risk ratio [RR] 0.88; 95 % confidence interval [95 % CI] 0.75-1.04. "current" vs "never": RR 0.43; 95 DATA SOURCES: The Cochrane Central Register of Controlled Trials, Medline and Embase databases were searched. A
hand search was made of the American Journal of Orthodontics and Dentofacial Orthopaedics, (British) Journal of
Orthodontics, European Journal of Orthodontics and Angle Orthodontist, Google Scholar and the reference lists of
relevant articles., STUDY SELECTION: Only randomised controlled trials (RCT) and quasi-randomised controlled
clinical trials (CCT), which specifically stated that they assessed reductions in dental plaque levels and/ or gingival
bleeding when comparing oral health promotion (OHP) interventions, were included. Trials that involved plaque
removal by a professional (except at baseline) or the use of proprietary antiplaque agents were excluded., DATA
EXTRACTION AND SYNTHESIS: Data extraction was carried out independently by two reviewers. Study quality was
assessed for their method of allocation, concealment of allocation, masking of assessment and reporting of
withdrawals. Direct comparison between the trials was difficult because of the heterogeneity in the outcome
measures between the included studies., RESULTS: Six RCT and quasi-randomised CCT met the inclusion criteria. Background: This article aims to analyze the situation of oral health surveillance in Africa, as certain trends in political
and regional strategies and to initiate a reflection on future orientations of African health information systems.
Methods: A literature review from 1997 to 2008 was performed using PubMed/Medline, The Cochrane Library and
Pascal. A search with the same terms and expressions was performed on Internet using the website Google Scholar
and WHO. Keywords and headings corresponding to a list of terms and expressions related to the oral health
surveillance were "health information systems", "oral health surveillance", "politics", "strategies" and "indicators for
Africa". Results: Fifty-eight articles were analyzed and results concerned insufficiencies and stakes of oral health
surveillance systems for the African region. Many political recommendations and strategies contribute to better
comprehension of problematic and new orientations for oral health surveillance systems, as new public health issues
BACKGROUND: This article aims to analyze the situation of oral health surveillance in Africa, as certain trends in
political and regional strategies and to initiate a reflection on future orientations of African health information
systems., METHODS: A literature review from 1997 to 2008 was performed using PubMed/Medline, The Cochrane
Library and Pascal. A search with the same terms and expressions was performed on Internet using the website
Google Scholar and WHO. Keywords and headings corresponding to a list of terms and expressions related to the oral
health surveillance were "health information systems", "oral health surveillance", "politics", "strategies" and
"indicators for Africa"., RESULTS: Fifty-eight articles were analyzed and results concerned insufficiencies and stakes
of oral health surveillance systems for the African region. Many political recommendations and strategies contribute Background: Many online resources for the life sciences have been developed and introduced in peer-reviewed
papers recently, ranging from databases and web applications to data-analysis software. Some have been introduced
in special journal issues or websites with a search function, but others remain scattered throughout the Internet and
in the published literature. The searchable resources on these sites are collected and maintained manually and are
therefore of higher quality than automatically updated sites, but also require more time and effort. Description: We
developed an online resource search system called OReFiL to address these issues. We developed a crawler to gather
all of the web pages whose URLs appear in MEDLINE abstracts and full-text papers on the BioMed Central open-
access journals. The URLs were extracted using regular expressions and rules based on our heuristic knowledge. We
then indexed the online resources to facilitate their retrieval and comparison by researchers. Because every online
resource has at least one PubMed ID, we can easily acquire its summary with Medical Subject Headings (MeSH)
terms and confirm its credibility through reference to the corresponding PubMed entry. In addition, because OReFiL BACKGROUND: Clinical audit is a systematic and critical analysis of "quality of care" to improve clinical care. This
study was aimed to find organizational and managerial facilitators and barriers of effective clinical audit
implementation in hospitals. METHODS:A systematic literature review was performed using the PubMed, Google
Scholar and Cochrane databases with key words of " clinical audit" , " effective audit" , " evaluation of audits" and "
medical audit" supplemented by hand-search. Content analysis was used to identify external and organizational
factors that influence implementation of clinical audit. RESULTS: Of the 53 scientific articles about clinical audit, 4
core themes with 11 main themes and 50 subthemes related to negative factors affecting clinical audit and 5 core
themeswith 15 main themes and 92 subthemes about organizational facilitator factors were found. Resource
limitation, poor information management system, lack of audit support centers, excessive workload and time
constraint, lack of organizational support for building audit team, unavailability of evidence-based guidelines and Studies have reported that the oral health status is jeopardized in patients with eating disorders. The aim was to
review the oro-facial manifestations in patients with eating disorders. The address the focused question was " What
is the oro-dental health status in patients with eating disorders?" MEDLINE/PubMed and Google Scholar databases
were searched from 1948 to March 2012 using the following terms in various combinations: " Anorexia nervosa" , "
bulimia nervosa" , " eating disorders" , " dental" , " oral health status" Letters to the editor, unpublished data and
articles published in languages other than English were excluded. Dry lips, burning tongue and parotid gland swelling
are common manifestations in patients with eating disorders as compared to medically healthy controls. The
association of dental caries and periodontal disease in patients with eating disorders remains debatable. Osteomyelitis is an inflammatory bone disorder caused by infection, leading to necrosis and destruction of bone. It
can affect all ages, involve any bone, become a chronic disease and cause persistent morbidity. Treatment of
osteomyelitis is challenging particularly when complex multiresistant bacterial biofilm has already been established.
Bacteria in biofilm persist in a low metabolic phase, causing persistent infection due to increased resistance to
antibiotics. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative organism
responsible for more than 50% of osteomyelitis cases. Osteomyelitis treatment implies the administration of high
doses of antibiotics (AB) by means of endovenous and oral routes and should take a period of at least 6 weeks. Local
drug delivery systems, using non-biodegradable (polymethylmethacrylate) or biodegradable and osteoactive
materials such as calcium orthophosphates bone cements, have been shown to be promising alternatives for the Purpose: The purpose of this systematic review was to determine patient outcomes after arthroscopic debridement
and microfracture for osteochondral lesions (OCLs) of the talar dome. Methods: Infotrieve-PubMed/MEDLINE and
Google Scholar were systematically searched for the following terms: microfracture AND ankle OR talus. In addition,
we hand-searched common American and European orthopaedic and podiatric surgical journals for relevant
manuscripts. Articles considered for inclusion were published in peer-reviewed journals, used the American
Orthopaedic Foot & Ankle Society hindfoot scoring system for outcome measurement, and involved arthroscopic
debridement and microfracture for OCL of the talar dome. Results: We identified 29 potentially relevant publications,
of which 7 met our inclusion criteria. A total of 295 patients (299 ankles) were included in this study. The weighted
mean postoperative American Orthopaedic Foot & Ankle Society hindfoot score was 86.8 points, translating to good
Introduction: Hip pathology is a recognised cause of pain and reduced function in adults. Hip arthroscopy is rapidly
increasing in occurrence and aims to improve pain and function in people with intra-articular hip pathology. The
purpose of this study was to conduct a systematic review to investigate pain and physical function outcomes
following hip arthroscopy with and without femoral osteotomy, for various and co-existing intra-articular hip
pathologies. Methods: A comprehensive search strategy was utilized to identify studies that investigated hip
arthroscopy for intraarticular hip pathology. Only studies which followed patients for at least three months and used
patient-reported outcomes for pain and/or function were included. Scopus, MEDLINE, CINAHL, PEDro, PubMed,
Sportdiscus, Ausport, Google Scholar, PsychINFO databases and the full Cochrane Library were searched. The Downs
and Black scale was used to rate methodological quality. Effect sizes were calculated where sufficient data was
present. Results: Of 40 suitable studies, 29 of moderate methodological quality were included. Fifteen studies
investigated hip arthroscopy alone (i.e., no osteotomy performed). Of these, effect sizes could be calculated for two
studies, with large effects (3.12-5.46) noted at one to two year follow-up. For the remaining studies (13/15), post-
operative improvements in pain and function were consistently reported (median improvements of 47%) over longer
follow-up periods (up to 10 years). Fifteen studies investigated hip arthroscopy with osteotomy. Effect sizes Background: While there are internationally validated outcome measures for speech and facial growth in cleft lip and
palate patients, there is no such internationally accepted system for assessing outcomes in facial aesthetics. Method:
A systematic critical review of the scientific literature from the last 30 years using PUBMED, Medline and Google
Scholar was conducted in-line with the PRISMA statement recommendations. This encompassed the most relevant
manuscripts on aesthetic outcomes in cleft surgery in the English language. Results: Fifty-three articles were
reviewed. Four main means of determining outcome measures were found: direct clinical assessment, clinical
photograph evaluation, clinical videographic assessment and three-dimensional evaluation. Cropped photographs
were more representative than full face. Most techniques were based on a 5-point scale, evolving from the Asher-
McDade system. Multiple panel-based assessments compared scores from lay or professional raters, the results of
which were not statistically significant. Various reports based on cohorts were poorly matched for gender, age,
clinical condition and ethnicity, making their results difficult to reproduce. Conclusions: The large number of Background: There is long standing interest in identifying patient outcomes that are sensitive to nursing care and an
increasing number of systems that include outcomes in order to demonstrate or monitor the quality of nursing care.
Objective: We undertook scoping reviews of the literature in order to identify patient outcomes sensitive to the
quality of nursing services in ambulatory cancer chemotherapy settings to guide the development of an outcomes-
based quality measurement system. Methods: A 2-stage scoping review to identify potential outcome areas which
were subsequently assessed for their sensitivity to nursing was carried out. Data sources included the Cochrane
Library, Medline, Embase, the British Nursing Index, Google and Google scholar. Results: We identified a broad range
of outcomes potentially sensitive to nursing. Individual trials support many nursing interventions but we found
relatively little clear evidence of effect on outcomes derived from systematic reviews and no evidence associating This review analyzes the development of head and neck oncology as outlined in medical history articles. A systematic
literature survey was conducted with the search engines "Google Scholar" and "PubMed" and the retrieved
publications were cross-referenced. In addition, books and, when possible, original sources were consulted. While
most of the material was obtained from publications from the modern era reviewing historical data, some of the
information was derived from original source material. The obtained articles on the history of cancer were then
analyzed for details on head and neck oncology. The cradle of oncology was located in ancient Egypt and Greece. The
search showed that the first tumors treated in the head and neck were either cutaneous malignancies or cancers on
the mucosal surfaces of the oral cavity. The origin, diagnosis and treatment of more deeply situated tumors of the
larynx and hypopharynx remained obscure for many centuries. The medieval age brought little progress to medicine
in general, and in head and neck oncology in particular, due to religious concerns. Renaissance medicine was Dokuz Eylul University Graduate School of Health Sciences was established in 1982 to coordinate MSc and PhD
education programmes in various fields related to medical and health sciences, according to the regulations of
Turkish Higher Council of Education. The MSc and PhD programs aim to educate research scienstists with a high level
of quality and a strong sense of integrity. The students are also strongly encouranged to write journal publications
from their theses. We investigated the total number of journal publications (published in SCI, SCI Expanded, SSCI and
national peer-reviewed journals) from the theses of MSc and PhD students who graduated between the years 2005-
2010. Our study group was consisted of 267 MSc and 75 PhD theses. We divided the group into three divisions: Basic
Sciences, Physiotherapy and Rehabilitation and Nursing. The data were collected from the archives of Graduated
School of Health Sciences and Dokuz Eylul University, Web Of Science, PubMed and Google Scholar. The publications
were grouped according to journals listed in Science Citation Index (SCI), Science Citation Index-Expanded (SCI-EXP),
Social Science Citation Index (SSCI) and National Peer-Reviewed Indexes. Total number of MSc students and PhD
Introduction: Normoglycaemia in people with diabetes results in improved outcome. Continuous glucose monitoring
provides detailed diagnostic information used to optimise therapy with the goal of achieving normoglycaemia. The
objective of this study was to review the published literature evaluating the single device available for blinded,
professional clinical use of continuous glucose monitoring; in particular all randomised controlled trials (RCTs) and
relevant observational studies. Methods: Published studies (to 31 March 2009) using the Medtronic MiniMed
Continuous Glucose Monitoring System (CGMS System Gold, Medtronic MiniMed, Inc., Northridge, CA) were
identified using appropriate search terms in a series of clinical databases including: Medline, Pubmed, Google Scholar
and Scientific Web of Knowledge. Other measures were also taken such as reviewing the reference lists. Findings: In
addition to an extensive range of non-randomised studies using the device, seven randomised controlled trials were
identified, of which five were in children. Although HbA1c was explicitly stated as the primary endpoint in four
studies, the studies were only adequately powered to detect large, between-group minimum differences (range 0.5
to 1.0% HbA1c). Only two studies included subjects with type 2 diabetes. Other endpoints included the frequency of This paper reviews the methods used in cross-cultural studies of menopausal symptoms with the goal of formulating
recommendations to facilitate comparisons of menopausal symptoms across cultures. It provides an overview of
existing approaches and serves to introduce four separate reviews of vasomotor, psychological, somatic, and sexual
symptoms at midlife. Building on an earlier review of cross-cultural studies of menopause covering time periods until
2004, these reviews are based on searches of Medline, PsycINFO, CINAHL and Google Scholar for English-language
articles published from 2004 to 2010 using the terms "cross cultural comparison" and "menopause." Two major
criteria were used: a study had to include more than one culture, country, or ethnic group and to have asked about
actual menopausal symptom experience. We found considerable variation across studies in age ranges, symptom
lists, reference period for symptom recall, variables included in multivariate analyses, and the measurement of Viral hepatitis is one of the major health problems worldwide, particularly in South East Asian countries including
Pakistan where hepatitis C virus (HCV) and hepatitis B virus (HBV) infections are highly endemic. Hepatitis delta virus
(HDV) is also not uncommon world-wide. HCV, HBV, and HDV share parallel routes of transmission due to which dual
or triple viral infection can occur in a proportion of patients at the same time. HBV and HCV are important factors in
the development of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). In addition to LC and HCC, chronic HDV
infection also plays an important role in liver damage with oncogenic potential.The current article reviews the
available literature about the epidemiology, pathogenesis, transmission, symptoms, diagnosis, replication, disease
outcome, treatment and preventive measures of triple hepatitis infection by using key words; epidemiology of triple The objective of this study is to obtain reliable data from recent surveys carried out in Italy on the prevalence of
overweight (OW) and obesity (OB) in children. We searched in MEDLINE/PubMed, Google and Google Scholar and
we included the surveys that fulfilled the following criteria: English or Italian language, time period January 2000-
April 2008, target of 6-11 years; BMI evaluated according to IOFT cut-offpoints. Search terms included overweight,
obesity, children, Italy, associated with AND/OR. 41 studies have been selected; the percentage of OW varied
between 14.7% and 31.3% and OB between 4.3% and 27.3%. In girls, OW values ranged from 11.5% to 34.7% and in
boys from 12.6% to 30.1%; in girls, the percentage of OB varied between 4.7% and 29.2%, in boys between 4.4% and
25.8%. There were some variations in the prevalence of OW and OB among diferent regions. The highest values were The prevalence of obesity is rising globally and in India. Overweight, obesity and related diseases need to be
delineated in Asian Indian women. A literature search was done using key words like 'obesity', 'Asian Indian women',
'body fat distribution', 'type 2 diabetes', 'fertility', 'polycystic ovarian disease', metabolic syndrome', 'cardiovascular
disease', 'non-alcoholic fatty liver disease', 'gender', 'sex' and 'prevalence' up to September 2012 in Pubmed and
Google Scholar search engines. This review highlights the Asian Indian body composition with regards to obesity and
provides a collated perspective of gender-specific prevalence of the co-morbidities. Recent data show that women
(range of prevalence of overweight and obesity from different studies 15-61%) have higher prevalence of overweight
and obesity as compared with men (range of prevalence of overweight and obesity from different studies 12-54%) in
India and that obesity is increasing in the youth. The prevalence of overweight and obesity in both men and women
steeply rose in a Punjabi community from Jaipur. Importantly, prevalence of abdominal obesity has been consistently Overweight, obesity, and metabolic syndrome are increasing in South Korea dramatically. This review of the
literature summarizes published studies on the prevalence of overweight, obesity, and metabolic syndrome in South
Korean adults and children; summarizes studies related to obesity management and prevention in South Korean
adults and children; and identifies gaps in the literature for further research. A PubMed, CINAHL, and Google Scholar
search identified articles published between January 1, 2000, and June 30, 2010, using the following key search
terms: overweight, obesity, adult, children, adolescent, metabolic syndrome, prevention, and South Korea. Inclusion
criteria included articles published in English or Korean, and primary or secondary research that measured the
prevalence and characteristics of overweight and obesity or described a management or prevention program. Twelve
articles met the inclusion criteria and were categorized into either adult or child studies. In adults, the prevalence of
Context and objective Pain following craniotomy has been demonstrated to be frequent and moderate-to-severe in
nature. In recent years, the focus on the challenges in treatment of postoperative pain following craniotomy has
increased. Fear of using opioids because of their wide array of side-effects has led to the search for alternative
analgesic options. The objective of this systematic review was to evaluate current evidence about analgesic therapy
following craniotomy. Data sources PubMed database, Embase, Cochrane library, Google scholar and the Cumulative
Index to Nursing and Allied Health Literature. Eligibility criteria Randomised double-blinded placebo-controlled trials
(RCTs) with pain or supplemental postoperative analgesic consumption as an endpoint were included in the analysis.
Results A total of 34 RCTs were identified, and nine RCTs were included in the final analysis, with a total of 519
patients (251 control vs. 268 active treatment). Four treatment modalities - scalp infiltration (five RCTs), nerve scalp
block (two RCTs), parecoxib (one RCT) and patient-controlled analgesia with morphine (one RCT) - were evaluated.
Scalp infiltration with local anaesthetic may provide adequate analgesia in the first few postoperative hours, and Purpose: Worldwide, particularly in developing countries, many women present with advanced stage cervical cancer
for which palliative radiotherapy is the treatment of choice or may be the only available treatment. The purpose of
this study was to determine from the literature the optimal palliative radiation scheme for the treatment of
advanced cervical cancer. Design: A systematic literature review up to January 2010 was performed in Medline,
Embase, the Cochrane database, CinHL and Google Scholar using a combination of synonyms for: cervical cancer,
palliative treatment and radiation therapy. No limitations were applied for language or study types. For included
papers data were extracted and described. Results: Only eight papers were identified and none compared the results
of different fractionation schemes. Most used observational retrospective study design with considerable sources of
bias. No studies used validated endpoints for symptom relief nor did they include measures of the quality of life.
Several papers described the experience with single or multiple monthly 10 Gy doses or with a higher total dose
delivered in 2-4 fractions within 48 h to 1 week. Studies report varying amounts of relief from bleeding. The effect on Objectives: Malignant bowel obstruction (MBO) from peritoneal metastasis has a grim prognosis regardless of the
primary cancer. Patients presenting with MBO have a life expectancy of weeks to months. When conservative
treatments such as medications and gastric drainage are inadequate, palliative surgery may provide symptomatic
relief. Morbidity and mortality after surgery for MBO is high, and effects of palliative surgery on patients' quality of
life are not well characterized. We performed a systematic review to better characterize palliative surgery outcomes
for patients with MBO to guide decision making about the value of surgery and associated postoperative
interventions in the setting of incurable cancer. Materials and Methods: We searched PubMed, EMBASE, CINAHL
Plus, Cochrane Library, Web of Knowledge, and Google Scholar from inception through August 2012 for all available
literature in all languages. We included studies reporting outcomes after open or laparoscopic surgery for bowel
obstruction from peritoneal metastases from any primary malignancy. Outcomes of interest included survival,
postoperative mortality, postoperative complications, ability to tolerate a diet or resolution of obstructive symptoms
(successful treatment), rates of re-obstruction, hospital length of stay, and quality of life. We excluded case studies
with fewer than 5 patients, studies of operations with curative rather than palliative intent, studies of percutaneous
procedures, and studies where outcomes of benign obstruction could not be separated from malignant. Results: We
screened 2347 titles and selected 109 articles for review. Fifteen studies fit our inclusion and exclusion criteria. Context The discovery and subsequent ultrastructural characterization of the interstitial Cajal like cells (now called
telocytes) in virtually every anatomic sites of the human body, by Laurentiu M Popescu and co-workers, have
dramatically improved the understanding the function of these cells and pathogenesis of extragastrointestinal
stromal tumors (EGIST). Pancreatic extragastrointestinal stromal tumors (pEGIST), phenotypically similar to
pancreatic interstitial Cajal like cells, are extremely rare with an unpredictable biological behavior. Objective To
review the clinicopathological, radiological, immunohistochemical, and therapeutic outcome data of all reported
cases of pEGIST, and highlight the developments in the field of pancreatic interstitial Cajal like cells/telocytes.
Methods A systematic review of English literature (January 2000 to July 2012) was done by using the search engine
of PubMed, PubMed Central, Google Scholar, and the Directory of Open Access Journals. Results There have been 19
reported cases of pEGIST during the last decade, over an age range of 31 to 84 years (mean: 56 years) with equal
gender predilection ((male:female ratio: 9:10). Preoperative radiological characteristics have been mostly
nondiagnostic though these were used, in some, for tissue diagnosis. Majority of pEGIST were localized to pancreatic
head (8/19, 42.1%), and 15 of 19 patients (78.9%) were symptomatic at first presentation. The mean size ranged
from 2.5 to 35cm (mean: 14 cm). Histomorphological features were that of predominantly spindle cell tumor which
Background: Even after the description of papuloerythroderma of Ofuji (PEO) in 1984, little is known about this
clinical entity. Objective:To report on 2 new cases of PEO and review of the worldwide literature on this topic.
Methods: Article citations were searched on several biomedical search engines (PubMed, EMBASE, SCOPUS, Google
Scholar). Papers were retrieved either online or in print. Results: A grand total of 170 PEO cases were identified.
Most patients were older than 55 years and of Asian or white descent, with an overall male/female ratio of 4.0. Itch
and the deck-chair sign were observed in all patients. Peripheral eosinophilia, lymphocytopenia and increased serum
IgE were common findings. Histopathology mostly showed aspecific inflammation, while 17 showed histological
features of cutaneous T-cell lymphoma (CTCL). Atopy, malignancies, infections and drugs were rarely linked to PEO. Introduction: Although mention of Priapism is made in man's earliest writings, current management regimes have
evolved remarkably recently. Methods: A literature search for articles and textbooks on Priapism was performed
using the Wellcome Trus's and RSM's databases, and Medline and Google scholar websites. Results: The Ebers papyri
describe drugs that the Egyptians prescribed for the condition. In the 19th century "conservative" management was
adopted in preference to surgical intervention following the "successful" use of leaching. At the beginning of the
20th century, however, larger series were published and incision was popularised. The perceived association with
lasciviousness and drinking persisted, and as recently as 1964 truth serum was employed to reveal associated
psychological abnormalities. In the 1970's shunting procedures were described, but it was only in 1990 that the The aim of this review was to highlight the current situation of nutrition-related diseases in the Arab countries, and
factors associated with prevalence of these diseases. PubMed and Google Scholar were searched for data relating to
such nutrition-related diseases published between January 1990 and May 2011. The picture of nutritional status in
the Arab countries has changed drastically over the past 30 years as a result of changes in the social and economic
situation. Two contrasting nutrition-related diseases exist, those associated with inadequate intake of nutrients and
unhealthy dietary habits such as growth retardation among young children and micronutrient deficiencies; and those
associated with changes in lifestyle such as cardiovascular disease, cancer, osteoporosis, diabetes and obesity (diet-
related non-communicable diseases). Factors contributing to nutritional problems vary from country to country,
depending on socio-economic status. In general, unsound dietary habits, poor sanitation, poverty, ignorance and lack Objective: To highlight and discuss the considerations for the future development of equipment standards for Winter
Paralympic sports. Data Sources: Literature searches were performed (in English) during May 2011 using the key
words "technology, winter sport, Olympic, and Paralympic" in the computerized databases PubMed, PsycINFO,
Science Direct, and Google Scholar. In addition, personal scientific observations were made at several Winter
Paralympic Games. The retrieved articles were screened and assessed for relevance to the biological, biomechanical,
and sport medicine aspects of equipment. Main Results: There are 3 key areas in which technology has influenced
sports performance in Paralympic winter sports, namely, specialized prostheses, crutch skis or outriggers (in lieu of
poles), and sport-specific wheelchairs (such as the sit-ski). From a sport medicine perspective, a crucial factor not
considered in the standard laboratory test of mechanical efficiency is the influence of the human-equipment
connection, such as the stump-to-prosthesis interface or the required human-to-wheelchair control. This OBJECTIVE: To highlight and discuss the considerations for the future development of equipment standards for
Winter Paralympic sports., DATA SOURCES: Literature searches were performed (in English) during May 2011 using
the key words "technology, winter sport, Olympic, and Paralympic" in the computerized databases PubMed,
PsycINFO, Science Direct, and Google Scholar. In addition, personal scientific observations were made at several
Winter Paralympic Games. The retrieved articles were screened and assessed for relevance to the biological,
biomechanical, and sport medicine aspects of equipment., MAIN RESULTS: There are 3 key areas in which technology
has influenced sports performance in Paralympic winter sports, namely, specialized prostheses, crutch skis or
outriggers (in lieu of poles), and sport-specific wheelchairs (such as the sit-ski). From a sport medicine perspective, a
crucial factor not considered in the standard laboratory test of mechanical efficiency is the influence of the human-
equipment connection, such as the stump-to-prosthesis interface or the required human-to-wheelchair control. This BACKGROUND: The ability to perform drug calculations accurately is imperative to patient safety. Research into
paramedics' drug calculation abilities was first published in 2000 and for nurses' abilities the research dates back to
the late 1930s. Yet, there have been no studies investigating an undergraduate paramedic student's ability to
perform drug or basic mathematical calculations. The objective of this study was to review the literature and
determine the ability of undergraduate and qualified paramedics to perform drug calculations., METHODS: A search
of the prehospital-related electronic databases was undertaken using the Ovid and EMBASE systems available
through the Monash University Library. Databases searched included the Cochrane Central Register of Controlled
Trials (CENTRAL), MEDLINE, CINAHL, JSTOR, EMBASE and Google Scholar, from their beginning until the end of
August 2009. We reviewed references from articles retrieved., RESULTS: The electronic database search located
Background: This article provides a review of the literature on beliefs that parents of children with autism hold, with
a focus on their beliefs on the cause and course of the disorder. Research on the outcomes of their beliefs also was
reviewed. Methods: Medline, PsychInfo, Nursing@Ovid and PubMed were searched from 1995 through 2009 using
the keywords autism, autistic disorder, beliefs, culture, parents, attitudes, and perceptions. Additional articles were
identified through Google Scholar and from references in related articles. Thirteen articles were retrieved and
reviewed. Results: It was found in the review that parents hold a wide variety of beliefs about the cause of their
child's autism, including genetic factors, events surrounding the child's birth, and environmental influences in the
early childhood period. Some parents continue to attribute their child's autism to immunizations, although more
recent studies suggest the frequency may be decreasing. Some parents are pessimistic about their child's future
while others are hopeful that new strategies will be developed. Some trust that society will become more accepting Background: Tension type headache (TTH) is highly prevalent in the US population. NSAIDs are considered first-line
therapy. For patients with persistent TTH despite appropriate oral therapy, it is unclear which parenteral agent
should be used. (Table Presented) Objectives: To perform a systematic review of the literature to determine whether
parenteral therapies other than NSAIDS are efficacious for acute TTH Methods: We systematically reviewed PubMed,
Embase, Google scholar, and Cochrane Central Registry of Controlled Trials from inception through 2012 using the
terms "tension type headache" and "parenteral or subcutaneous or intramuscular or intravenous". We identified
randomized trials in which one parenteral treatment was compared to an active comparator or to placebo for the
acute relief of TTH. We only included studies that distinguished TTH from other migraine. The primary outcome for
this review was measures of efficacy 1 hour after medication administration. One reviewer extracted data, and a
second reviewer verified the data for accuracy. Discrepancies were resolved by a third. We assessed the internal
validity of trials using the Cochrane risk of bias tool. Because of the small number of trials identified, and the
substantial heterogeneity among study design and medications, we decided not to combine data or report summary
statistics. The results of individual studies are presented using number needed to treat (NNT) with 95%CI when BACKGROUND: The feasibility and acceptability of partner notification (PN) for sexually transmitted infections (STIs)
in developing countries was assessed through a comprehensive literature review, to help identify future intervention
needs. METHODS: The Medline, Embase, and Google Scholar databases were searched to identify studies published
between January 1995 and December 2007 on STI PN in developing countries. A systematic review of the research
extracted information on: (1) willingness of index patients to notify partners; (2) the proportion of partners notified
or referred; (3) client-reported barriers in notifying partners; (4) infrastructure barriers in notifying partners; and (5)
PN approaches that were evaluated in developing countries. RESULTS: Out of 609 screened articles, 39 met our
criteria. PN outcome varied widely and was implemented more often for spousal partners than for casual or
commercial partners. Reported barriers included sociocultural factors such as stigma, fear of abuse for having an STI, Passive smoking may be implicated in the development of cardiovascular disease (CVD) in children because of their
partially developed physiological systems. The aim of the present systematic paper is to investigate whether passive
smoking is associated with factors that influence the development of CVD in children. Data sources included
Medline, Cochrane Library, Cumulative Index to Nursing & Allied Health (CINAHL) research database, Google Scholar,
Excerpta Medica database (EMBASE), the 2006 Office of the Surgeon General's report, and the 2005 report from the
California Environmental Protection Agency. We identified a total of 42 relevant articles (i.e., 30 reviews and 12 Passive smoking may be implicated in the development of cardiovascular disease (CVD) in children because of their
partially developed physiological systems. The aim of the present systematic paper is to investigate whether passive
smoking is associated with factors that influence the development of CVD in children. Data sources included
Medline, Cochrane Library, Cumulative Index to Nursing & Allied Health (CINAHL) research database, Google Scholar,
Excerpta Medica database (EMBASE), the 2006 Office of the Surgeon General's report, and the 2005 report from the
California Environmental Protection Agency. We identified a total of 42 relevant articles (i.e., 30 reviews and 12 STUDY DESIGN: Review of the literature on the pathogenesis of adolescent idiopathic scoliosis (AIS). OBJECTIVE: To
discuss the different theories that have appeared on this subject. SUMMARY OF BACKGROUND DATA: The
pathogenesis of AIS, a condition exclusive to humans, has been the subject of many studies. Over the years,
practically every structure of the body has been mentioned in the pathogenesis of AIS; however, the cause of this
spinal deformity remains little understood. The pathogenesis of this condition is termed multifactorial. METHODS:
PubMed and Google Scholar electronic databases were searched focused on parameters concerning the
pathogenesis of adolescent idiopathic scoliosis. The search was limited to the English language. RESULTS: No single
causative factor for the development of idiopathic scoliosis has been identified, it is thus termed multifactorial. AIS is
STUDY DESIGN: Review of the literature on the pathogenesis of adolescent idiopathic scoliosis (AIS)., OBJECTIVE: To
discuss the different theories that have appeared on this subject., SUMMARY OF BACKGROUND DATA: The
pathogenesis of AIS, a condition exclusive to humans, has been the subject of many studies. Over the years,
practically every structure of the body has been mentioned in the pathogenesis of AIS; however, the cause of this
spinal deformity remains little understood. The pathogenesis of this condition is termed multifactorial., METHODS:
PubMed and Google Scholar electronic databases were searched focused on parameters concerning the
pathogenesis of adolescent idiopathic scoliosis. The search was limited to the English language., RESULTS: No single
causative factor for the development of idiopathic scoliosis has been identified, it is thus termed multifactorial. AIS is OBJECTIVE: To explain a pathopharmacologic mechanism that initiates an increase in hemorrhage following medical
abortions with mifepristone. DATA SOURCES: MEDLINE, PubMed, and Google Scholar databases were searched
(1990-July 2007). Key search terms were mifepristone, RU486, medical abortion hemorrhage, bleeding,
inflammation, innate immune system, phagocytes, macrocytes, cytokines, interleukins, and nitric oxide. STUDY
SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated and all information
deemed relevant was included for the information related to the development of the understanding of the
pathopharmacology of mifepristone as the initiating cause of increased hemorrhage in medical abortions.
Mifepristone's blockade of glucocorticoid receptors, prolonged generation of nitric oxide (NO), and postabortion
vasodilatation of uterine vasculature by NO that favors excessive hemorrhage were the criteria used to determine
whether information was relevant for inclusion. DATA SYNTHESIS: Inescapable bacterial contamination of the OBJECTIVE: To explain the role of mifepristone in medical abortions that results in fulminant and lethal septic shock
due to Clostridium sordellii. DATA SOURCES: MEDLINE, PubMed, and Google Scholar databases were searched (1984-
March 2005). Key search terms were mifepristone, RU38486, RU486, Mifeprex, medical abortion, septic shock,
innate immune system, cytokines, and Clostridium sordellii. STUDY SELECTION AND DATA EXTRACTION: All articles
identified from the data sources were evaluated and all information deemed relevant was included for the
information related to the development of the understanding of the pathophysiology of mifepristone-induced septic
shock due to C. sordellii. DATA SYNTHESIS: The mechanisms of action of mifepristone were incorporated into the
pathophysiology of septic shock due to C. sordellii. Mifepristone, by blocking both progesterone and glucocorticoid
receptors, interferes with the controlled release and functioning of cortisol and cytokines. Failure of physiologically
controlled cortisol and cytokine responses results in an impaired innate immune system that results in disintegration Objective: To review the epidemiologic studies that describe the relationships among diabetes, obesity, and cancer;
animal studies that have helped to decipher the mechanisms of cancer development; and some of the therapeutic
targets undergoing investigation. Methods: An electronic search was performed of Medline, Scopus, Google Scholar,
and ClinicalTrials.gov to identify English-language articles and studies published from 1995 through 2010 relating to
obesity, insulin, insulinlike growth factors, diabetes mellitus, and cancer. Results: Epidemiologic studies have
reported that diabetes and obesity are linked to an increased risk of certain cancers in association with higher levels
of insulin, C-peptide, and insulinlike growth factor 1. Animal models have demonstrated that increased insulin,
insulinlike growth factor 1, and insulinlike growth factor 2 signaling can enhance tumor growth, while inhibiting this
signaling can reduce tumorigenesis. Therapies that target insulin and insulinlike growth factor 1 signaling pathways OBJECTIVES: Patient reported outcomes (PRO) are becoming useful tools for collecting and generating evidence for
new medical products to show improvements in health-related quality of life (HRQoL). Chronic myeloid leukemia
(CML) is now a chronic disease in which HRQoL is becoming important. The objective of this study was to review,
analyze, and understand trends in the PRO instruments used in patients with CML. METHODS: A systematic literature
search for CML randomized controlled trials (RCTs) with PROs endpoints was undertaken for the databases Pubmed,
Embase, Biosis, Google Scholar, and Cochrane. Data was collected for the study size, interventions, year, PRO
instrument, and results for PROs. Analysis was conducted to identify trends in commonly used PRO instruments and
results were categorized as positive, neutral, or negative. RESULTS: Eight RCTs with a total of 3342 patients were
identified. In these studies, there were eight different PROs instruments identified: FACT-Leu, SF-36, FSI, PSQI, MSAS-
SF, FACT-BRM, EQ-5D, and MDASICML. The most commonly used instruments were FACT-Leu (used in 1336 patients)
OBJECTIVES: Patient reported outcomes (PRO) are becoming useful tools for collecting and generating evidence for
new medical products to show improvements in health-related quality of life (HRQoL). Glaucoma is a chronic disease
with high importance for patient HRQoL. The objective of this study was to review, analyze, and understand trends in
the PRO instruments used in patients with Glaucoma. METHODS: A systematic literature search for Glaucoma trials
with PROs endpoints was undertaken for the databases Pubmed, Embase, Biosis, Google Scholar and Cochrane. Data
was collected for the study size, interventions, year, PRO instrument and results for PROs. Analysis for conducted to
identify trends in commonly used PRO instruments and categorize results as positive, neutral or negative. RESULTS:
Thirty-one studies with a total of 9819 patients were identified. In these studies there were eleven different PROs
instruments were identified that were Glaucoma health perception index, Glaucoma quality of life questionnaire
(Glau-QoL), Glaucoma utility index, Impact of vision impairment, Low vision quality of life questionnaire, National eye
institute visual function index-19 items, National eye institute visual function index-51 items, Nursing home vision OBJECTIVES: Patient reported outcomes (PRO) are becoming useful tools for collecting and generating evidence for
new medical products to show improvements in health-related quality of life (HRQoL). Castration-Resistant Prostate
Cancer (CRPC) is a chronic disease with high importance for patient HRQoL. The objective of this study was to review,
analyze, and understand trends in the PRO instruments used in patients with CRPC. METHODS: A systematic
literature search for CRPC randomized controlled trials (RCTs) with PROs endpoints was undertaken for the
databases Pubmed, Embase, Biosis, Google Scholar, and Cochrane. Data was collected for the study size,
interventions, year, PRO instrument, and results for PROs. Analysis was conducted to identify trends in commonly
used PRO instruments and categorize results as positive, neutral or negative. RESULTS: Ten RCTs with a total of 5797
patients were identified. In these studies there were 13 different PROs instruments were identified that were FACT-
P, FACT-G, BPI-SF, EQC30, EQPR25, FLIC, SDS, SUF, PDA, IPDA, PROSQOLI, SF-36, and QOLM-P14. The most A significant development for conducting research on patient rights has been made in Iran over the past decade. This
study is conducted in order to review and analyze the previous studies that have been made, so far, concerning
patient rights in Iran. This is a comprehensive review study conducted by searching the Iranian databases, Scientific
Information Database, Iranian Research Institute for Information Science and Technology, Iran Medex and Google
using the Persian equivalent of keywords for 'awareness', 'attitude', and 'patient rights'. For pertinent Iranian papers
published in English, scientific databases PubMed, and Google Scholar were searched using the keyword 'patient
rights' and 'Iran'. A total of 41 Persian and five English articles were found for these keywords, only 26 of which OBJECTIVE: We performed a literature review of patient safety topics pertinent to dermatology and related to
outpatient settings for situations in which data from dermatology are lacking. METHODS: Searches in MEDLINE via
PubMed interface, OVID and Google Scholar were carried out from October, 2008 through May, 2009 for English-
language articles published between 1948 and 2009. Each search combined 2 or 3 of the following terms: patient
safety, medical error, human error, preventable adverse event, dermatology, outpatient, ambulatory care,
medication error, diagnostic error, laboratory error, pathology error, office-based surgery, wrong-site procedure,
infections, falls, laser safety, scope of practice. Personal communications, websites, books, dermatology newsletters
and major textbooks were also scrutinized. Potentially relevant articles and communications were critically evaluated Patient safety is the key element of quality in healthcare. Improving patient safety involves identifying the incidents,
analyzing the trend of events and developing corrective solutions for promoting the system. Health care
organizations can not judge the safety of the care without data and information related to patient safety. Therefore,
patient safety information system (PSIS) is used in identifying and recording patient safety incidents, determining and
analyzing their causes, hypothesizing corrective solutions, and finally, implicating and monitoring the improvements.
According to the importance of this system, this study was conducted to explain the different components of the
PSIS. In this review study, we reviewed the materials searched via Web of Science, Pubmed (Medline), Ovid, Science
Direct and Google Scholar. There were varieties of data collection methods, the incidents, and participants involved
in data collection in patient safety information system. Moreover, some specific methods such as patient safety To provide a patient-centered medical home (PCMH) primer for pharmacists, including basic background
information, key terminology, and examples of success stories. PCMH literature and resources obtained through
search strategies by authors including but not limited to PubMed and Google Scholar. PCMHs are a potential means
of achieving cost reduction in health care and providing collaborative and comprehensive care, and they represent a
promising option for achieving health care reform. Medication therapy management and collaborative drug therapy
management are possible means for pharmacists to fulfill the goals of PCMHs. Pharmacists must become
Patient-controlled analgesia (PCA) with intravenous morphine is commonly used to control moderate-to-severe
postoperative pain. The US FDA recently approved a transdermal system for patient-controlled iontophoretic
delivery of fentanyl as an alternative treatment. Aside from the route of administration, other differences between
these systems may result in differing adverse-effect profiles. This review compares the clinical utility of these two
modalities. MEDLINE, Cinahl and Google Scholar searches for clinical trials (1982 through to July 2007) were
performed. Search terms included transdermal analgesia, iontophoresis, patient-controlled analgesia, IONSYS and E-
TRANS. All trials comparing intravenous morphine PCA with the transdermal iontophoretic fentanyl system (fentanyl
ITS) were included. CONSORT diagrams and adverse-event sequencies were available in all cases. Results
demonstrated that fentanyl ITS and intravenous PCA morphine are equally effective analgesics for the management Aim Celiac disease (CeD) is an inherited autoimmune disease triggered by ingesting wheat gluten. In the absence of a
pharmacotherapy alternative to current management (gluten-free diet, GFD), most major healthcare systems have
given minimal thought to the burden of illness in patients with CeD. Consequently, little is known about patient-
reported outcomes in patients with CeD and their families. We conducted a systematic literature review to
investigate current status and propose future research needs for quality of life (QOL) measures in CeD. Methods
PubMed and Advanced Google Scholar were searched for papers published from 1993 to 2008. Keywords used were
[(coeliac OR celiac) AND (quality of life OR EQ-5D OR SF-36)]. Papers reporting the application of a validated QOL
instrument (either disease-specific or generic) were included in the review. Results Thirty-three papers were
identified. The number of QOL studies reported by country varied widely (lowest in France and US; highest in Italy,
Sweden, and Finland). Generic QOL instruments, mainly SF-36 (13/33 papers), were most frequently used and
tended to be US-developed tools. The variety of QOL instruments used makes it difficult to provide a quantitative
overview of the impact of CeD on QOL. The German Celiac Disease Questionnaire is the only currently available QOL
measure specifically for use in adults with CeD. Current QOL studies focus on incremental gains associated with
compliance/adherence to GFD. These studies showed that GFD-adherent patients with CeD who are free of major GI Objectives: The acceptance and use of long-acting depot antipsychotics has been shown to be influenced by the
attitudes of patients and clinicians. Depot treatment rates are low across countries and especially patients with first-
episode psychosis are rarely treated with depot medication. The aim of this article was to review the literature on
patients' and clinicians' attitudes towards long-acting depot antipsychotics in subjects with first-episode psychosis.
Methods: A systematic search of Medline, Embase, PsycINF and Google Scholar was conducted. Studies were
included if they reported original data describing patients' and clinicians' attitudes towards long-acting depot
antipsychotic in subjects with first-episode psychosis. Results: Six studies out of a total of 503 articles met the
inclusion criteria. Four studies conveyed a negative and two a positive opinion of clinicians toward depot medication. OBJECTIVE: To systematically review fully randomised patient preference trials and to explore the impact of
preferences on attrition and outcome by meta-analysis of patient level data. DATA SOURCES: Citation search using
Science Citation Index and Google Scholar and search of the main electronic databases (Medline, CINAHL, Embase,
and AMED) with a combination of key words. STUDY SELECTION: Fully randomised patient preference trials that
compared treatments for any clinical condition were included. Other types of preference trials and crossover trials
were excluded. Other inclusion criteria: participants aged 16 years and over; primary, self-reported outcomes
measured on a continuous numerical scale. From 167 studies identified and screened, 17 were identified as fully
randomised patient preference trials. DATA SYNTHESIS: Of the 17 trials identified, 11 authors provided raw data for
the meta-analysis. Data collected were baseline and follow-up data for the main outcome, randomised allocation
data, preference data, and demographic data. Baseline and first post-intervention follow-up data for the main
outcome were standardised. To improve homogeneity, data for only the eight musculoskeletal trials (n=1594) were
combined. To estimate the effects of preferences on outcomes and attrition, three groups were compared: patients
who had a preference and were randomly allocated to their preferred treatment; patients who had a preference and
were randomly allocated to the treatment they did not prefer; and patients who had no preference. RESULTS:
Objective: To systematically review fully randomised patient preference trials and to explore the impact of
preferences on attrition and outcome by meta-analysis of patient level data. Data sources: Citation search using
and AMED) with a combination of key words. Study selection: Fully randomised patient preference trials that
randomised patient preference trials. Data synthesis: Of the 17 trials identified, 11 authors provided raw data for the
meta-analysis. Data collected were baseline and follow-up data for the main outcome, randomised allocation data,
preference data, and demographic data. Baseline and first post-intervention follow-up data for the main outcome
were standardised. To improve homogeneity, data for only the eight musculoskeletal trials (n=1594) were combined.
To estimate the effects of preferences on outcomes and attrition, three groups were compared: patients who had a
preference and were randomly allocated to their preferred treatment; patients who had a preference and were
randomly allocated to the treatment they did not prefer; and patients who had no preference. Results: Patients who OBJECTIVE: To systematically review fully randomised patient preference trials and to explore the impact of
preferences on attrition and outcome by meta-analysis of patient level data., DATA SOURCES: Citation search using
and AMED) with a combination of key words., STUDY SELECTION: Fully randomised patient preference trials that
randomised patient preference trials., DATA SYNTHESIS: Of the 17 trials identified, 11 authors provided raw data for
the meta-analysis. Data collected were baseline and follow-up data for the main outcome, randomised allocation
data, preference data, and demographic data. Baseline and first post-intervention follow-up data for the main
outcome were standardised. To improve homogeneity, data for only the eight musculoskeletal trials (n=1594) were
combined. To estimate the effects of preferences on outcomes and attrition, three groups were compared: patients
who had a preference and were randomly allocated to their preferred treatment; patients who had a preference and
were randomly allocated to the treatment they did not prefer; and patients who had no preference., RESULTS: Background: Recent papers present pectoralis major muscle rupture as a rare injury with about 200 reported cases in
the literature. In the last years, we were able to find many references to pectoralis major muscle rupture in the
literature. Objectives: To determine the real number and occurence of published cases. Methods: A review of the
recent literature published between January 2000 and December 2010 was performed. We used the PubMed and
Google Scholar search and applied the keywords: pectoralis major muscle rupture. The search strategy was also
complemented by looking at the reference lists of the papers retrieved. Results: A review of the recent literature
succeeded in identifying 283 published cases on pectoralis major muscle rupture since the year 2000. Previous
reviews and our search identified about 163 cases prior to the year 2000 for a total, including our case, of 447 cases
of pectoralis major rupture reported in the world literature since its initial description by Patissier in 1822. Objectives: After driving, walking is older adults' second most preferred mode of transport and preferred
recreational activity. This leads to greater exposure to traffic, increasing their risk of pedestrian-vehicle crashes, with
older adults being more likely to die as a pedestrian compared to when using other modes of transport. However,
less focus has been placed on this particularly vulnerable group. This review summarizes issues associated with older
adult pedestrian and motorized mobility scooters (MMS) safety and interventions that have been conducted.
Methods: A literature search was undertaken from PubMed, MUARC publications, the Curtin University Library
Catalogue, and Google Scholar. Keywords included older pedestrians, older adult road injury, mobility scooter injury,
and injury prevention. Publications from 2000 and later were used, unless an earlier publication had significant
relevance and worth. Conclusion: Maintaining older adults' mobility and independence during a time of decreasing
physical and mental capacity is a priority. Walking provides a key mode of transport that needs to be given higher
PURPOSE: Primary spontaneous pneumothorax from subplueral bleb disease is an uncommon occurrence in
pediatric patients. To our knowledge, this is the first reported case with monozygotic twins presenting at alternating
intervals with a single sided spontaneous pneumothorax, only to have it surgically corrected, and to present later
with a subsequent contralateral pneumothorax. A case presentation as well as a literature review follows. METHODS:
A literature search was performed using PubMed and Google Scholar. All articles pertaining to familial spontaneous
pneumothorax occurring in children were investigated. These articles were queried for congenital or genetic
syndromes associated with spontaneous pneumothoraces. The following data points were queried: age, clinical
presentation, congenital or genetic syndromes associated with spontaneous pneumothoraces, family occurrences
and follow-up evaluation. RESULTS: These criteria were met by 38 articles, with 5 articles discussing monozygotic
twins. Only 2 of the 5 monozygotic twin case reports were in pediatric patients. When considering all of the data
queried, several conclusions regarding familial spontaneous pneumothoraces in the pediatric population can be
drawn. The vast majority of pneumothoraces in children, like adults, are not spontaneous and not familial linked.
When familial spontaneous pneumothoraces occur, rarely is there a congenital syndrome or identified genetic
abnormality. Both autosomal recessive and autosomal dominant hereditary patterns have been identified. Genetic Intra-regional, extra-regional and international health mobility are important phenomena for regional and national
healthcare planning. Pediatric data on this topic are scarce. We therefore conducted a systematic literature search
on the PubMed database. Because of the insufficiency of published data we also resorted to conference proceedings
and publications retrieved by Google Scholar and Google search engines. Thirty-one articles were identified. Main
components of patients mobility were looking for better quality and timely treatment, advanced technology, Topic: Pediatric obsessive-compulsive disorder (OCD). Purpose: OCD is a neuropsychiatric disorder characterized by
the presence of obsessions and/or compulsions. Given that most children with OCD will initially be seen by nursing
professionals in environments such as pediatrician offices, hospitals, and schools, increasing awareness of this
disorder among nurses will likely facilitate early detection, accurate diagnosis, and appropriate treatment. Sources:
Psyc-INFO, PubMed, Google Scholar. Conclusion: This article provides an overview of pediatric OCD, including Objectives:Mortality following hospital discharge is an important and under-recognized contributor to overall child
mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting
post-discharge mortality in children, estimate likelihood of death, and determine the most important risk factors for
death.Search Strategy:MEDLINE and EMBASE were systematically searched using MeSH terms and keywords from
the inception date to October, 2012. Key word searches using Google Scholar and hand searching of references of
retrieved articles was also performed. Studies from developing countries reporting mortality following hospital
discharge among a pediatric population were considered for inclusion.Results:Thirteen studies that reported
mortality rates following discharge were identified. Studies varied significantly according to design, underlying
characteristics of study population and duration of follow-up. Mortality rates following discharge varied significantly
between studies (1%-18%). When reported, post-discharge mortality rates often exceeded in-hospital mortality
rates. The most important baseline variables associated with post-discharge mortality were young age, malnutrition,
multiple previous hospitalizations, HIV infection and pneumonia. Most post-discharge deaths occurred early during Objective: To review and critique the research literature on training pediatric residents to address tobacco. Methods:
A Medline search was conducted to identify studies that specifically addressed pediatric residency training on
tobacco, and Google Scholar was used to identity articles in which the referenced study was cited. Results: Eight
studies that specifically addressed training pediatric residents to intervene on tobacco were identified. Most used
active as well as passive approaches to training. Baseline data underscored the importance of training future
pediatricians to address tobacco. Although the studies differed in size, scope and rigor, they showed that training INTRODUCTION AND OBJECTIVES: Currently, the most common metric utilized to evaluate the impact of peer-
reviewed journals in urology is the impact factor (IF), defined as the ratio of citations in 1 calendar year to the
number of citable items published during the preceding 2 years. While considered a standard metric for the
evaluation of quality, there are numerous criticisms of the IF, including its ability to be manipulated by editorial
policies and reporting of citable sources. Over the past 5 years, other bibliometric indices have been introduced,
claiming to provide a more objective measure of impact. We aim to evaluate the impact of widely-circulated English-
language urology journals using these alternative metrics. METHODS: Bibliometric indices for all English-language
peerreviewed urology publications were queried for calendar year 2007 using Publish or Perish v. 2.7 (Harzing.com),
a freeware bibliometric utility which queries the Google Scholar database. In addition to number of citations per
article, newer bibliometric indices, including Hirsch's h-index, Egghe's g-index, and Zhang's e-index were also
OBJECTIVE: To evaluate efficacy and safety of pegloticase, approved by the Food and Drug Administration in
September 2010 for treatment of patients with chronic treatment-refractory gout. DATA SOURCES: Literature
searches were conducted using PubMed (1948- January 2012), TOXLINE, International Pharmaceutical Abstracts
(1970-January 2012), and Google Scholar using the terms pegloticase, puricase, PEG-uricase, gout, uricase, and
Krystexxa. Results were limited to English-language publications. References from selected articles were reviewed to
identify additional citations. STUDY SELECTION AND DATA EXTRACTION: Studies evaluating the pharmacology,
pharmacokinetics, safety, and efficacy of pegloticase for the treatment of chronic treatment-refractory gout were
included. DATA SYNTHESIS: Pegloticase represents a novel intravenous treatment option for patients who have
chronic gout refractory to other available treatments. Pegloticase is a recombinant uricase and achieves therapeutic
effects by catalyzing oxidation of uric acid to allantoin, resulting in decreased uric acid concentrations. Results of
published trials demonstrate the ability of pegloticase to maintain uric acid concentrations below 7 mg/dL in patients
with chronic gout. Data supporting reduction of gout flares are limited. Pegloticase is well tolerated but associated Social determinants of health (SDH) are an important public health policy discourse and the concept and scope of
SDH is debated within and outside of the public health field. This article concerns itself with the visibility of people
with disabilities in existing SDH discourses. It employed a frequency analysis of Google and Google Scholar search hits
obtained with the phrase "social determinants of health" in combination with various social groups and looked at the
visibility of people with disabilities within key SDH documents, the Millennium Development Goals and some Hypothesis/aims of study Urinary incontinence (UI) is common and affects women in multiple racial and ethnic
groups. Although perceptions regarding UI are likely to vary, to our knowledge this variation has not been
systematically reviewed. We evaluate differences and similarities in perception regarding female UI in various racial
and ethnic populations. Study design, materials and methods We systematically reviewed published qualitative
literature in any language. Using keywords for urinary incontinence, helpseeking, attitudes, perceptions, race, and
ethnicity, we searched the following databases from 1/1980 - 6/2011: Medline; EMBASE; Scirus; Google Scholar;
Open J-Gate; AgeLine; and Global Health (CABI). Qualitative studies were included if they described knowledge,
perception, or personal views about UI in women. Studies were excluded if they were performed exclusively in men,
did not specify the race or ethnicity of the study population or if they reported on other urinary symptoms without
mention of UI. Three independent reviewers screened all abstracts and full-text articles. The Relevance,
Appropriateness, Transparency, and Soundness (RATS) scale for qualitative research was used to assess study
quality[1]. Discrepancies were resolved by consensus amongst three reviewers. Dominant themes, sub-themes, and
representative quotes were abstracted from included studies using a pre-defined data abstraction form. Results We
identified 3,676 unique citations with our original literature search. Of these, 77 were selected for full-text review,
and 23 met criteria for inclusion in the systematic review. Four of the 23 studies were of very low quality based on
the RATS scale. Ten studies were performed in well-characterized mixed Western populations (white, black, Hispanic,
Asian), 6 in Asian women, 5 in white women, and 2 in Arab women. Dominant themes fell into two major categories:
1) UI management and 2) UI experience. UI management encompassed self-management strategies, treatment
seeking, and communication with health care providers. UI experience generally included fear, restriction of
activities, stigmatization, secrecy, and normalization or rationalization of symptoms (i.e. with aging and childbirth).
Women across multiple racial and ethnic groups felt that their urinary symptoms were not taken seriously by health STUDY DESIGN: A comprehensive systematic review of the literature., OBJECTIVES: To assess the modern literature
on the use of polyethylene mesh-contained morcelized allograft (PMCMA) bone for spinal fusion and vertebral
compression fracture management., SUMMARY OF BACKGROUND DATA: There are presently no systematic reviews
of PMCMA., METHODS: A systematic literature review was performed within three databases (OVID, PubMed, and
Google Scholar) using the following keyword search terms: vertebroplasty, kyphoplasty, vertebral compression
fracture, percutaneous, polyethylene mesh, and osteoporosis., RESULTS: The initial search identified 764 items, from
which two pertinent technique-based articles were identified. There were no published scientific peer-reviewed or
case series reporting the clinical results of this technique. The use of PMCMA in the management of vertebral
compression fractures (VCFs) is similar to vertebroplasty and kyphoplasty. This novel, percutaneous system uses the
Background: Urinary liver-type fatty acid-binding protein (L-FABP) is a proximal tubular injury candidate biomarker
for early detection of acute kidney injury (AKI), with variable performance characteristics depending on clinical
settings. Study Design: Meta-analysis of diagnostic test studies assessing the performance of urinary L-FABP in AKI.
Setting & Population: Literature search in MEDLINE, EMBASE, Scopus, Google Scholar, Cochrane Central Register of
Controlled Trials, and ClinicalTrials.gov using search terms "liver-type fatty acid-binding protein" and "L-FABP."
Selection Criteria for Studies: Studies of humans investigating the performance characteristics of urinary L-FABP for
the early diagnosis of AKI and AKI-related outcomes, including dialysis requirement and mortality. Predictor: Urinary
L-FABP. Outcomes: Diagnosis of AKI, dialysis requirement, and in-hospital death. Results: 15 prospective cohort and 2
case-control studies were identified. Only 7 cohort studies could be meta-analyzed. The estimated sensitivity of
urinary L-FABP level for the diagnosis of AKI was 74.5% (95% CI, 60.4%-84.8%), and specificity was 77.6% (95% CI, Background: The aim of this article is to review various studies aimed at finding the association between
Periodontitis and Chronic Kidney Disease. Methods: A search was conducted for all the articles in the past that have
studied the association between Periodontitis and Chronic Kidney Disease. Data sources primarily included Pub Med
with MeSH terms and free text, Scopus and Cochrane library, Google Scholar and Copernicus. In addition, a hand
search of selected periodontal journals and review articles was conducted. Result: Almost all the work in this
direction has developed in the last decade. Majority of the articles suggest a strong positive association between the Introduction: Elective ambulatory laparoscopic cholecystectomies are increasingly common. Postoperative pain can
be problematic, and may delay discharge or result in unplanned hospital admissions. Opioids analgesics have
conventionally been used, despite evidence of its manifold side effects. Dexamethasone is a high potency, long-
acting, anti-inflammatory glucocorticoid with antinocioceptive action. We postulate that perioperative
dexamethasone may be used as an adjunct to ameliorate pain, decrease opioid consumption, and hasten the process
of postoperative recovery in laparoscopic cholecystectomy patients. Methods: A systematic literature search from
Pubmed, Medline, and google scholar was done with the key words "laparoscopic cholecystectomy", "gallbladder",
"pain", "analgesia", "dexamethasone", and "corticosteroid" by 2 of the co-authors. Additional studies were identified
by manually searching reference from review articles and original articles. Only randomized clinical trial in the English
language, limited to human studies were included after mutual agreement. Eleven original articles pertained to the
systematic review question were analyzed. Results: Five papers included pain as a primary outcome and 6 as
secondary outcomes (Table). Eight papers reported pain scores comparing intravenous dexamethasone with placebo - Introduction: Over the years, different strategies have been proposed to improve postoperative pain control(1).
Among those, perioperative intravenous lidocaine infusion (IVLI) has recently gained interest. However, because the
clinical benefit of IVLI remains unclear, its use is not broadly accepted. The goal of this study was to evaluate the
analgesic efficiency of IVLI during general anesthesia by performing a meta-analysis of randomized controlled trials
(RCT). Methods: A systematic search was performed using MEDLINE, EMBASE, The Cochrane Library and SCOPUS
databases, while gray literature was searched using OpenSIGLE, Intute, Trip Database and Google Scholar (Nov
2008). All RCT comparing IVLI during general anesthesia, with a placebo or any other comparator, regardless of the
type of surgery, were included. Primary outcomes were pain control and opioid requirements during the
postoperative period. Secondary outcomes were: incidence of nausea/vomiting, time to bowel function recovery,
hospital length of stay and mortality. Two reviewers (LV, DC) independently screened all citations retrieved and
extracted data using a standardized form. The methodological quality of included studies was assessed using the
Jadad scale(2) and the GRADE system(3). Random effect models(4) were used for analyses, except for
nausea/vomiting and mortality (Peto fixed effect models)(5). Heterogeneity was assessed using the I2 index(6).
Sensitivity analyses were performed to evaluate the robustness of the findings. Results: From 4442 citations
retrieved, 17 (n = 903) were included. 12 RCT presented good methodological quality (Jadad >=3) and 7 had a low
risk of bias according to GRADE. IVLI did not significantly reduce pain at rest or during cough up to 48 hours after
surgery. However, IVLI significantly reduced opioid requirements (morphine equivalent: -8.2 mg, 95%CI -12.4, -4.0, I2
Introduction: Peripartum cardiomyopathy (PPCM) is a rare and life-threatening disease of unknown aetiology. The
primary objective of this review was to analysed aetiopathogeneses, clinical presentation and diagnosis, as well as
pharmacological, perioperative and intensive care management and prognosis of this pathology. Methods: We
undertook a systematic review of the literature using Medline, Google Scholar and PubMed searches. Results: Unlike
other parts of the world in which cardiomyopathy are rare, dilated cardiomyopathy is a major cause of heart failure
throughout Africa. Its aetiopathogenesis is still poorly understood, but recent evidence supports inflammation, viral
infection and autoimmunity as the leading causative hypotheses. This diagnosis should be limited to previously
healthy women who present with congestive heart failure (CHF) and decreased left ventricular systolic function in
the last month of pregnancy or within 5 months after delivery. Recently, introduction of echocardiography has made
diagnosis of PPCM easier and more accurate. Conventional treatment consists of diuretics, vasodilators, and
sometimes digoxin and anticoagulants, usually in combination. Patients who fail to recover may require inotropic
therapy. In resistant cases, newer therapeutic modalities such as immunomodulation, immunoglobulin and IntroductionPeripheral arterial disease (PAD) is a common vascular condition that affects both quality of life and life
expectancy with an increased risk of cardiovascular events.Sources of dataA literature search was carried out of Pub-
Med, MEDLINE, the Cochrane Library and Google Scholar from the establishment of these databases up to February
2012. The search was performed by using the keywords 'peripheral arterial disease' and one of the following words:
'management', 'investigations', 'risk factors', 'epidemiology', 'revascularization', 'cryoplasty', 'atherectomy' and 'gene
therapy'. Studies were limited to those published in English language.Areas of agreementAggressive risk factors
modification is needed to reduce cardiovascular-related mortality in PAD patients.Areas of controversyChoice of
endovascular or surgical intervention remains controversial in an ever-evolving field.Growing pointsThere is a rapid Background Signs of nervous system dysfunction such as headache or convulsions often occur in severe systemic
hypertension. Less recognized is the association between severe hypertension and peripheral facial nerve palsy. The
aim of this study was to systematically review the literature on the association of peripheral facial palsy with severe
hypertension. Methods Systematic review of Medline, Embase, Web of Science, and Google Scholar from 1960
through December 2011 and report of two cases. Results The literature review revealed 24 cases to which we add
two cases with severe hypertension and peripheral facial palsy. Twenty-three patients were children. Palsy was
unilateral in 25 cases, bilateral in one case, and recurred in nine. The time between the first facial symptoms and
diagnosis of hypertension was a median of 45 days (range, 0 days-2 years). In five case series addressing the Backround. Ischemic mitral regurgitation (IMR) is a consequence of coronary artery disease and the main underlying
mechanism is augmented leaflet tethering due to outward displacement of the papillary muscles. Although mitral
annuloplasty combined with coronary revascularization is usually effective in the treatment of IMR, occasionally the
regurgitation can persist or recur and this can affect patient prognosis. & Methods. We searched Medline and
Google scholar database for articles published since 1996 to June 2009. Search terms included ischemic mitral
regurgitation, recurrent mitral regurgitation, persistent mitral regurgitation and annuloplasty failure. & Conclusion. Aims. Personalised support services assist patients with severe and persistent mental illness (SPMI) to live with
functional deficits by providing living skills, emotional support, community access and advocacy. This paper aims to
systematically review the evidence for personalised support. Methods. Systematic searches of Medline, PsycINFO
and Google Scholar (inception to March 2011) identified studies investigating patient outcomes for personalised
support services. The quality of the selected studies was assessed. The strength of evidence for the three categories
of patient outcomes (illness acuity, personal functioning and patient satisfaction) was graded. Results. Fifteen studies
met inclusion criteria with most rated as having moderate or weak study designs. The selected studies evaluated
programs for outpatients with SPMI. There was moderate strength of evidence for reducing illness acuity and Within the last few years the field personalized medicine entered the stage. Accompanied with great hopes and
expectations it is believed that this field may have the potential to revolutionize medical and clinical care by utilizing
genomics information about the individual patients themselves. In this paper, we reconstruct the early footprints of
personalized medicine as reflected by information retrieved from PubMed and Google Scholar. That means we are Chronic diseases are invariably associated with decreased functioning ability of the individual in one form or the
other depending upon the system/organ involved. Disability consequent to the disease is the major factor affecting
the patient's physical and psychosocial well-being; in other words, the 'Quality of Life (QOL)'. Besides the disease
itself, the treatment and its consequences are also major determinants of QOL of the patients. Globally, glaucoma,
which is emerging as one of the leading causes of blindness, is one such chronic ophthalmic disease characterized by
a progressive loss of visual function and a potential to cause irreversible blindness, if not treated at an early stage.
Patients of glaucoma need to take lifelong medications in order to keep their intraocular pressure within limits. It's
impact on the daily life of patients cannot be overexpressed and compounded by the fact that it remains
asymptomatic for a considerable time after the disease has set in; has led to new imperatives in diagnosis, treatment
Phantom organ pain syndrome occurs presumably due to injury to the visceral sensory nerves innervating the
missing organ. The pain has been attributed to deafferentation due to surgical trauma to the incision site, to deep
somatic nerves, to mononeuropathy, or to the possibility of phantom organ pain syndrome. We present a case of a
man with chronic left flank pain and pyelonephritis despite ongoing therapy with antibiotics and hydrocodone.
Ultimately, a left-sided nephrectomy was performed which resolved his chronic infection but did not minimize his
chronic flank pain. Postsurgical imaging included a negative MRI, CT, and ultrasound of his abdomen and pelvis. To
determine an optimal treatment plan for our case patient, a literature search for "phantom organ," "phantom pain,"
and "phantom limb" was undertaken. The following medical databases were used: PubMed, Cochrane Library, MD
Consult, Ovid, Google and Google Scholar, Medscape, and UpToDate. Over 100 articles written in English were
reviewed, and a total of 36 articles were determined to be clinically relevant to our patient. Only 3 of the 36
aforementioned articles discussed phantom organ pain directly, but no specific treatment for phantom organ pain
was described. Multiple treatment options for phantom pain in general were discussed in the reviewed articles. Extensive studies have been carried out in the last decade to assess the pharmaceutical potential and screen the
phytochemical constituents of Cinnamomum burmannii. Databases such as PubMed (MEDLINE), Science Direct
(Embase, Biobase, biosis), Scopus, Scifinder, Google Scholar, Google Patent, Cochrane database, and web of science
were searched using a defined search strategy. This plant is a member of the genus Cinnamomum and is traditionally
used as a spice. Cinnamomum burmannii have been demonstrated to exhibit analgesic, antibacterial, anti-diabetic,
anti-fungal, antioxidant, antirheumatic, anti-thrombotic, and anti-tumor activities. The chemical constituents are The goal of the current study is to review the published articles for pharmacoeconomic analyses of the highly active
antiretroviral therapy (HAART) in patients with HIV/AIDS. Systematic literature databases search was performed in
Scopus, PubMed, Google Scholar with key words HAART + pharmacoeconomics, HAART +cost of therapy. On total 77
studies were selected and analyzed. Pharmaceoconomic evaluations are necessary and important, because they are
part of the therapeutic, and managerial decision rules. An important part of such evaluations is the budget impact
analysis of the new therapies. Studies show that the burden of HIV infection is heavy for the society and individuals, OBJECTIVE: To summarize and evaluate the pharmacogenetic literature pertaining to the effects of CYP2D6
polymorphism on clinical outcomes of risperidone therapy. DATA SOURCES: A systematic literature search was
performed using the search terms risperidone, pharmacogenetics, cytochrome P-450 enzyme system, cytochrome P-
450 CYP2D6, and polymorphism (genetic) in MEDLINE (1946-October 2012), EMBASE (1980-October 2012), PubMed
(1947-October 2012), International Pharmaceutical Abstracts (1970-October 2012), and Google Scholar. STUDY
SELECTION AND DATA EXTRACTION: Identified articles were included if they measured the association between
CYP2D6 genetic polymorphisms and clinical outcomes in at least 2 patients taking risperidone. The data elements
extracted from these articles consisted of study design, number of subjects, indication for risperidone therapy,
CYP2D6 phenotype status, mean daily dose of risperidone, and effects on clinical outcomes. DATA SYNTHESIS: The
identified citations consisted of 10 prospective nonrandomized, uncontrolled cohort studies, 1 retrospective cohort
study, 1 prospective casecontrol study, and 1 retrospective case series. Studies were of variable quality and none
provided high-quality evidence; they included heterogeneous patient populations with varying clinical diagnoses and Context: Asthma is a complex disease with multiple genetic and environmental factors contributing to it. A
component of this complexity is a highly variable response to pharmacological therapy. Pharmacogenomics is the
study of the role of genetic determinants in the variable response to therapy. A number of examples of possible
pharmacogenomic approaches that may prove of value in the management of asthma are discussed below. Evidence
Acquisition: A search of PubMed, Google scholar, E-Medicine, BMJ and Mbase was done using the key words
"pharmacogenomics of asthma", "pharmacogenomics of-agonist, glucocorticoids, leukotriene modifiers,
theophylline, muscarinic antagonists in asthma". Results: Presently, there are limited examples of gene
polymorphism that can influence response to asthma therapy. Polymorphisms that alter response to asthma therapy
include Arg16Gly, Gln27Glu, Thr164Ile for-agonist receptor, polymorphism of glucocorticoid receptor gene, CRHR1 Introduction: Azilsartan medoxomil is a newly approved angiotensin-receptor blocker for the management of
hypertension. It is a prodrug that is quickly hydrolyzed to the active moiety azilsartan, a potent and highly selective
angiotensin-receptor blocker with estimated bioavailability of ~ 60%. This new agent induces a potent and long-
lasting antihypertensive effect. The effective therapeutic antihypertensive dosages of azilsartan medoxomil in
humans vary from 40 to 80 mg/day. Areas covered: The authors review the results of clinical trials published in
journals indexed in Medline, Scopus and Google Scholar. Primarily the authors discuss articles that analyze the safety
and efficacy of azilsartan in lowering blood pressure. Expert opinion: Clinical trials have demonstrated that azilsartan
is superior to other angiotensin-receptor blockers in lowering blood pressure. However, the clinical blood pressure
Malaria is one of the most common parasitic infections worldwide. Plasmodium falciparum is the most prevalent
strain in Africa and also the most fatal. The disease especially affects children, with those under age 5 years
accounting for approximately 86 % of malaria deaths in 2010. The objectives of this review are to summarize and
evaluate published literature reporting the pharmacokinetic parameters of artemisinin-based combinations used to
treat P. falciparum in paediatric populations and to identify and discuss controversies regarding pharmacokinetics of
these agents in children. A search of MEDLINE (1948-September 2012), EMBASE (1980-September 2012),
International Pharmaceutical Abstracts (1970-September 2012), Google and Google Scholar was conducted for
articles describing pharmacokinetics of antimalarials in children. Our search produced 30 articles, of which 23 were
included in the review: artemisinin compounds, 12 articles; lumefantrine, four articles; amodiaquine, five articles;
sulfadoxine, six articles; pyrimethamine, one article; mefloquine, three articles; and piperaquine, two articles. Studies
were summarized based on comparison groups and major findings. Many controversies were identified, including
pharmacokinetic equivalence of novel dosage forms, altered pharmacokinetic parameters in children versus adults, Malaria is a serious parasitic infection, which affects millions of people worldwide. As pregnancy has been shown to
alter the pharmacokinetics of many medications, the efficacy and safety of antimalarial drug regimens may be
compromised in pregnant women. The objective of this review is to systematically review published literature on the
pharmacokinetics of antimalarial agents in pregnant women. A search of MEDLINE (1948May 2011), EMBASE
(1980May 2011), International Pharmaceutical Abstracts (1970May 2011), Google and Google Scholar was
conducted for articles describing the pharmacokinetics of antimalarials in pregnancy (and supplemented by a
bibliographic review of all relevant articles); all identified studies were summarized and evaluated according to the
level of evidence, based on the classification system developed by the US Preventive Services Task Force. Identified
articles were included in the review if the study had at least one group that reported at least one pharmacokinetic
parameter of interest in pregnant women. Articles were excluded from the review if no pharmacokinetic information
was reported or if both pregnant and non-pregnant women were analysed within the same group. For quinine and
its metabolites, there were three articles (one level II-1 and two level III); for artemisinin compounds, two articles
(both level III); for lumefantrine, two articles (both level III); for atovaquone, two articles (both level III); for proguanil,
three articles (one level II-1 and two level III); for sulfadoxine, three articles (all level II-1); for pyrimethamine, three
articles (all level II-1); for chloroquine and its metabolite, four articles (three level II-1 and one level II-3); for Rosa damascena mill L., known as Gole Mohammadi in Iran is one of the most important species of Rosaceae family
flowers. R. damascena is an ornamental plant and beside perfuming effect, several pharmacological properties
including anti-HIV, antibacterial, antioxidant, antitussive, hypnotic, antidiabetic, and relaxant effect on tracheal
chains have been reported for this plant. This article is a comprehensive review on pharmacological effects of R.
damascena. Online literature searches were performed using Medline, Pubmed, Iran medex, Scopus, and Google Objectives- To evaluate the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) in managing pain arising
from orthodontic interventions, such as archwire or separators placement. Data Sources- Medline and Cochrane
databases searched in February 2010 and updated in July 2010 using orthodontics and pain as the search terms.
Additional studies located from Google Scholar, Clinical Trials and the reference lists of retrieved articles. Study
Selection- Randomized controlled trials comparing NSAID to placebo using visual analogue scale (VAS) scores. Data
Synthesis- Of the 1127 studies identified through database searches, seven were included for meta-analysis.
Treatment effects (Hedges' g using random effects model) and 95% confidence intervals (CI) of the pain VAS scores
were evaluated at 2, 6 and 24h after intervention, during chewing and biting activities. Pain level at 2h differed
between the ibuprofen and placebo groups during biting (95% CI: -0.178 to -0.046), but not during chewing (95% CI: - The usage of plants, plant extracts or plant-derived pure chemicals for disease management, become a therapeutic
modality, which has stood the test of time. In the present review, we focus on pharmacological profile (in tabular
form) of Tribulus terrestris L., apart from Phytochemistry, Taxonomy and Traditional uses. Data were located,
selected and extracted from SCI database, Medline, Pubmed, Highwire and Google Scholar. Fruits and seeds of
Tribulus terrestris L., (Zygophyllaceae) are of immense importance in oriental medicine because they are used as an
aphrodisiac, diuretic and anthelmintic, as well as to treat coughs and kidney failure. Tribulus terrestris L. has reported
to have antimicrobial, antihypertension, diuretic, antiacetylcholine, haemolytic activity, spermatogenesis and libido
enhancer, antitumor activity and effects on cardiovascular system. Furostanol and spirostanol saponins, flavonoid
A range of surgical, endovenous, physical and medical treatments are available for patients with chronic venous
disease. The aim of this review was to evaluate the evidence for pharmacological agents used for the treatment of
chronic venous disease. A literature search was performed using Pubmed, Embase, Cochrane and Google Scholar
databases. The initial search terms 'varicose vein', 'venous ulcer', 'venous disease' and 'lipodermatosclerosis' were
used to identify relevant clinical studies of pharmacotherapy in patients with chronic venous disease (C4-C6). A huge
range of naturally occurring and synthetic drugs have been studied in patients with chronic venous disease. For
patients with C4 venous disease, micronized purified flavonoid fraction (MPFF), oxerutin, rutosides and calcium
dobesilate may reduce venous symptoms and oedema. MPFF and pentoxifylline have been shown to improve venous Intrapartum pharyngeal instillation of surfactant before the first breath may result in surfactant administration to the
infant lung, with the potential benefit of avoiding endotracheal intubation and ventilation, ventilator induced lung
injury and bronchopulmonary dysplasia. To determine the effect of pharyngeal instillation of surfactant before the
first breath compared to placebo, no treatment or intratracheal surfactant administration followed by intermittent
positive pressure ventilation (IPPV) on morbidity and mortality in preterm infants at risk of respiratory distress
syndrome (RDS). Searches were made of CENTRAL (The Cochrane Library, to September 2010), MEDLINE and
PREMEDLINE (1950 to September 2010), EMBASE (1980 to 2010) and CINAHL (1982 to 2010). This strategy was
supplemented by searches of proceedings of scientific meetings, Google Scholar and reference lists of identified
studies, as well as contact with expert informants and surfactant manufacturers. Published, unpublished and ongoing
randomised controlled or quasi-randomised trials (using individual or cluster allocation) of pharyngeal instillation of Objective Phenazepam (fenazepam; 7-bromo-5-(2-chlorophenyl)-1,3-dihydro-2H- 1,4-benzodiazepin-2-one; PNZ,
'Bonsai') is a benzodiazepine developed in the former Soviet Union during the 1970s to treat neurological disorders,
epilepsy, and alcohol withdrawal syndrome. Its recreational use appears to have increased over recent years.
Because of the lack of accessible data on this substance, it is important that information is made available to health
professionals. Methods A literature search was conducted in relevant databases (Medline, Toxbase, PsychInfo, etc.),
grey literature (using Google Scholar) and Internet sites to identify key data on phenazepam, including epidemiology
such as availability, price, supply sources, confiscations, and health-related problems. Results Information from these
sources indicates the potential for serious adverse health consequences for this drug when taken recreationally and
that its use is spreading in the USA and Europe. Although first use was reported in the UK in October 2009, major
concerns in the UK arose in summer 2010 when individuals across Britain were admitted to hospital following Objective. To state the role of physical activity on women aging and menopause. Materials and methods. We
searched in the following sources: the Cochrane database, Medline, EBESCO, and Google Scholar. Hand-searching of
recent conference proceedings was also undertaken. After that three reviewers independently extracted data from
included studies onto a standard form and assessed studies methodological quality. The data abstracted were
relevant to predetermined outcome measures (physical activity and its effects on menopause, and post-menopausal
disabilities). Where appropriate, a summary statistic was calculated: a odds ratio for dichotomous data and a
weighted mean difference for continuous data. Results. Aging involves many changes in female body partly due to
changes in endocrine system, especially due to a progressive reduction of anabolic hormones activity. In addition, Objective. The relationship between physical activity and cognitive function is intriguing but controversial. We
performed a systematic meta-analysis of all the available prospective studies that investigated the association
between physical activity and risk of cognitive decline in nondemented subjects. Methods. We conducted an
electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The Cochrane Library and
bibliographies of retrieved articles up to January 2010. Studies were included if they analysed prospectively the
association between physical activity and cognitive decline in nondemented subjects. Results. After the review
process, 15 prospective studies (12 cohorts) were included in the final analysis. These studies included 33816
nondemented subjects followed for 1-12years. A total of 3210 patients showed cognitive decline during the follow-
up. The cumulative analysis for all the studies under a random-effects model showed that subjects who performed a
high level of physical activity were significantly protected (-38%) against cognitive decline during the follow-up Objective: The relationship between physical activity and cognitive function is intriguing but controversial. We
performed a systematic review with meta-analysis of all the available prospective studies that investigated the
association between physical activity and risk of cognitive decline in nondemented subjects. Methods: We conducted
an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The Cochrane Library, and
bibliographies of retrieved articles up to January, 2010. Studies were included if they analysed prospectively the
association between physical activity and cognitive decline in nondemented subjects. Results: After the review
process 15 prospective studies (12 cohort of patients) were included in the final analysis. These studies included
33,816 nondemented subjects followed for a time ranging from 1 to 12 years. A total of 3,210 patients manifested a
cognitive decline during the follow-up. The cumulative analysis for all the studies under a random-effects model
To systematically evaluate the effects of physical activity in adult patients after completion of main treatment related
to cancer. Meta-analysis of randomised controlled trials with data extraction and quality assessment performed
independently by two researchers. Pubmed, CINAHL, and Google Scholar from the earliest possible year to
September 2011. References from meta-analyses and reviews. Randomised controlled trials that assessed the effects
of physical activity in adults who had completed their main cancer treatment, except hormonal treatment. There
were 34 randomised controlled trials, of which 22 (65%) focused on patients with breast cancer, and 48 outcomes in
our meta-analysis. Twenty two studies assessed aerobic exercise, and four also included resistance or strength
training. The median duration of physical activity was 13 weeks (range 3-60 weeks). Most control groups were
considered sedentary or were assigned no exercise. Based on studies on patients with breast cancer, physical activity
was associated with improvements in insulin-like growth factor-I, bench press, leg press, fatigue, depression, and
quality of life. When we combined studies on different types of cancer, we found significant improvements in body OBJECTIVE: To systematically evaluate the effects of physical activity in adult patients after completion of main
treatment related to cancer., DESIGN: Meta-analysis of randomised controlled trials with data extraction and quality
assessment performed independently by two researchers., DATA SOURCES: Pubmed, CINAHL, and Google Scholar
from the earliest possible year to September 2011. References from meta-analyses and reviews., STUDY SELECTION:
Randomised controlled trials that assessed the effects of physical activity in adults who had completed their main
cancer treatment, except hormonal treatment., RESULTS: There were 34 randomised controlled trials, of which 22
(65%) focused on patients with breast cancer, and 48 outcomes in our meta-analysis. Twenty two studies assessed
aerobic exercise, and four also included resistance or strength training. The median duration of physical activity was
13 weeks (range 3-60 weeks). Most control groups were considered sedentary or were assigned no exercise. Based
on studies on patients with breast cancer, physical activity was associated with improvements in insulin-like growth
factor-I, bench press, leg press, fatigue, depression, and quality of life. When we combined studies on different types OBJECTIVE: To systematically evaluate the effects of physical activity in adult patients after completion of main
treatment related to cancer. DESIGN: Meta-analysis of randomised controlled trials with data extraction and quality
assessment performed independently by two researchers. DATA SOURCES PUBMED:, CINAHL, and Google Scholar
from the earliest possible year to September 2011. References from meta-analyses and reviews. STUDY: selection
Randomised controlled trials that assessed the effects of physical activity in adults who had completed their main
cancer treatment, except hormonal treatment. RESULTS: There were 34 randomised controlled trials, of which 22
(65%) focused on patients with breast cancer, and 48 outcomes in our meta-analysis. Twenty two studies assessed
aerobic exercise, and four also included resistance or strength training. The median duration of physical activity was
13 weeks (range 3-60 weeks). Most control groups were considered sedentary or were assigned no exercise. Based
on studies on patients with breast cancer, physical activity was associated with improvements in insulin-like growth
factor-I, bench press, leg press, fatigue, depression, and quality of life. When we combined studies on different types The purpose of this study, based on a systematic literature review, was to describe the prevalence of physical activity
(or inactivity) in the Brazilian population. The databases consulted were: LILACS, SciELO, MEDLINE, Web of Science,
and the Google Scholar portal. The terms "physical activity", "physical exercise", "physical inactivity", "sedentary"
"Brazil", and "Brazilian" were used in the search. Overall, 47 studies (all cross-sectional) with random samples were
found, and in 26 studies physical activity was the main variable. Only two studies were published before the year
2000, as compared to 12 in 2008 alone. The studies were heavily concentrated in the South and Southeast of Brazil,
and there were few studies on physical activity in children and adolescents. In all the studies, physical activity was
Background: Lifestyle has been shown to significantly effect breast cancer incidence evident in the increased risk
associated with obesity, diabetes, cigarettes and alcohol. The aim of this meta-analysis was to investigate the effect
of two traditionally "beneficial" lifestyle choices: physical activity and weight loss. Specifically, we aimed to
investigate the effect of the timing, intensity and duration of exercise on breast cancer incidence in women classified
as either normal risk or increased risk. Finally, we aimed to investigate the effect of weight loss on breast cancer
incidence. Method: Studies were obtained from a database search of MEDLINE, EMBASE, PubMed, Current Contents
Connect and Google Scholar. Databases were searched using subject headings, keyword searches and text word
searches wherever possible using the search terms "Exercise" OR "weight loss" AND "breast cancer" OR "breast
carcinoma" OR "breast neoplasm". Inclusion criteria required a confirmed diagnosis of breast cancer, reporting of an
odds ratio or data to calculate an odds ratio (and 95% confidence interval) and the use of an internal control group as
the comparator. Exercise was catagorised as "high intensity" if it was vigorous exercise likely to cause sweating (ie.
Running, competitive sport) while lower impact activities such as walking and golf were categorized as "low
intensity". The effect of the timing on breast cancer incidence was quantified across three time periods: adolescence,
adulthood and post menopause. Collated data was assessed for heterogeneity and a pooled odds ratio calculated.
Results: 111 studies were identified in the literature search of which 76 were included in the meta-analysis. Overall,
both exercise and weight loss were associated with a significantly reduced risk of breast cancer in women (OR 0.77,
95% CI 0.72-0.81 and OR 0.74, 95% CI 0.60-0.93 respectively). Heterogeneity was high (I2=77.12) and publication Socially valorised, sport like other forms of behaviour, can take on an addictive aspect. A review of the English and
French literatures from 1979 to 2012 was conducted, using PubMed, Google Scholar, EMBASE, and PsycInfo, using
the following key words alone or combined: sport, dependence, exercise, addiction. Exercise dependence is defined
as a craving for physical activity that leads to extreme exercise intensity and generates physiological and
psychological symptoms. Measurement scales have been proposed to make the diagnosis. No epidemiological
studies have examined the prevalence of exercise dependence in the general population, although some studies
suggest a frequency ranging from 10 to 80%. Disorders begin with a search for pleasure in physical effort, which then There is an expanding body of research on exercise intervention for multidisciplinary rehabilitation of people with
multiple sclerosis (PwMS). Most of this research focuses on people with mild/moderate MS who are ambulatory. As
the costs of care increases with increasing disability, it is important to evaluate the evidence for interventions in
nonambulatory PwMS. The aim of this study was to evaluate the evidence regarding physical rehabilitation
interventions in nonambulatory PwMS. The databases AMED, CINAHL, MEDLINE, EMBASE and PSYCHARTICLES were
searched up to 31 May 2011. Reference lists, Google Scholar and PEDro were also searched. Trials of physical
rehabilitation interventions in nonambulatory PwMS that analysed nonambulatory results separately were included.
Pharmacological, surgical, medical and assistive device interventions were excluded. Risk of bias was assessed and
the GRADE approach was used to classify the quality of evidence. Sixteen low-grade studies, only three of which
were randomized controlled trials (RCTs), were found. There are trends of improvement following some Objective: To analyze the health policies related to physician assistants (PAs) and to understand the factors
influencing this medical work force movement. Quality of evidence: This work combines a review of the literature
and qualitative information, and it serves as a historical bookmark. The approach was selected when attempts to
obtain reports or literature using customary electronic bibliography (PubMed, CINAHL, Google Scholar, EBSCO, and
MEDLINE) searches in English and French, from 1970 through 2010, identified only 14 documents (including gray
literature) of relevance. Reports, provincial documents, and information from developers of the PA movement
supplemented the literature base. Main message: The historical development of the role of PAs in Canada spans 2
decades. There are now more than 250 PAs, most working in family medicine and emergency medicine. Enabling
legislation for PAs has been formalized in Manitoba, and 3 provinces have recognized PAs in various policy
statements or initiatives. Three universities and 1 military training centre have enrolled more than 120 students in PA
L-ornithine-L-aspartate (LOLA) is a stable salt of two natural nonessential L-amino acids: ornithine and aspartic acid. It
is formulated and marketed in low and high doses. Low doses are used as a food supplement and high doses (above
5 g) as a medicinal product to lower blood ammonia concentration and to eliminate symptoms of hepatic
encephalopathy associated with liver cirrhosis. The aim of this review is to present physiological roles of L-ornithine
and L-aspartate in the human body, to assess conditions under which these amino acids could be deficient, to
analyze consequences of these deficiencies, and to review the current state of knowledge on the effects of LOLA
administration. The data used in this publication result from searches of different electronic databases such as
Cochrane Trials Register, MEDLINE, PubMed, Medscape, or Google Scholar, with a cut-off date of November 29,
2009, using terms: L-omithine-L-aspartate, ornithine aspartate, ornithine, Hepa-Merz, ornithine deficiency,
hyperammonemia, hepatic encephalopathy, and liver cirrhosis. Both amino acids play key roles in ammonia
detoxification and in proline and polyamine biosyntheses. Polyamines are considered critical for DNA synthesis and
cell replication and have been shown to stimulate hepatic regeneration. Supplementation with ornithine in animal
models demonstrated enhanced wound breaking strength and collagen deposition. It has been shown in vitro, in vivo
and in perfused organs that urea synthesis from ammonia is limited by endogenous ornithine and that ornithine can Background: Warfarin is a mainstay atrial fibrillation (AF) treatment, yet it has a narrow therapeutic window. Novel
agents have been successfully tested against warfarin, yet no direct comparison among them is available. We thus
performed a pair-wise and warfarin-adjusted network metaanalyses of novel oral anticoagulants for AF. Methods:
CENTRAL, Google Scholar, MEDLINE/PubMed and Scopus were searched for randomized warfarin-controlled trials of
novel anticoagulants for non-valvular AF (updated September 2011). The primary end-point was stroke/systemic
embolism at the longest available follow-up. Odds ratios (OR) with 95% intervals were computed with RevMan and
WinBUGS using intention-to-treat data. Results: From 7114 citations, 7 trials (52701 patients) were included,
focusing on apixaban, dabigatran, edoxaban and rivaroxaban. Studies were largely similar, despite a higher baseline
risk of patients in the rivaroxaban trial. Pair-wise meta-analysis showed that after a weighted average of 23 months
these novel drugs lead to significant reductions in the risk of stroke/systemic embolism (OR=0.81 [0.71-0.92]) and all
cause death (OR=0.88 [0.82-0.95]) in comparison to warfarin. Head-to-head comparisons showed that apixaban and
dabigatran proved similarly superior to warfarin in preventing stroke/systemic embolism (OR=0.78 [0.62-0.96] for PURPOSE/OBJECTIVES: To summarize the current scientific literature pertaining to the role of the patient navigator in
oncology using the concept analysis framework developed by Walker and Avant. DATA SOURCES: Published research
articles, clinical articles, and Internet sources on patient navigator roles and programs. Literature was obtained from
CINAHL, PubMed, PsycINFO, the Cochrane Library, and Google Scholar, incorporating reports in English from 1990-
2008. DATA SYNTHESIS: Patient navigation has received a plethora of attention as healthcare programs strive to
streamline care and address current gaps in service delivery. The literature revealed that the role of the patient
navigator remains context-specific and has been filled by a variety of individuals, including nurses, social workers,
peer supporters, and lay individuals. CONCLUSIONS: The role of a patient navigator includes removing barriers to Aim of the study: This review assesses the botany, traditional medicinal uses, phytochemistry, pharmacology and
toxicology of P. umbellatum. Materials and methods: Information on P. umbellatum was gathered via the internet
(using Scirus, Google Scholar, CAB-Abstracts, MedlinePlus, Embase, Scielo, and Web of Science) and libraries.
Additionally, previously unpublished work on the traditional uses of P. umbellatum from our National Study of the
Medicinal Plants of the Dominican Republic has been included. Results: Piper umbellatum is a Neotropical plant
species widely distributed in Mexico, Central America, South America and the West Indian Islands. It has also been
introduced to Africa and South-East Asia. Traditional uses for this plant are recorded in 24 countries in three
continents, America, Africa and Asia for a wide range of ailments such as kidney, women diseases, diarrhea, skin
affections, burns, rheumatism, malaria, intestinal parasites, inflammation and fever. We have analyzed the cross-
cultural agreement among traditional uses in different countries and found a high degree of consensus for the
indications kidney/diuretic, stomachache and wounds. Phytochemical studies of P. umbellatum have demonstrated One of the main indicators of the suspension system efficiency in lower limb prostheses is vertical displacement or
pistoning within the socket. Decreasing pistoning and introducing an effective system for evaluating pistoning could
contribute to the amputees' rehabilitation process. The main objective of this study was to review existing research
studies that examine the occurrence of pistoning in lower limb prosthesis with different techniques in static
(standing) and dynamic (walking and jumping) positions. Literature review. Keywords related to slippage, suspension,
pistoning and vertical movement in lower limb prosthetics were used to search the literature available in PubMed,
ScienceDirect, Web of Science and Google Scholar databases. Sixteen articles were selected for further analysis
according to the selection criteria. The following methods have been used to measure the occurrence of pistoning in
Background: One of the main indicators of the suspension system efficiency in lower limb prostheses is vertical
displacement or pistoning within the socket. Decreasing pistoning and introducing an effective system for evaluating
pistoning could contribute to the amputees' rehabilitation process.Objectives: The main objective of this study was
to review existing research studies that examine the occurrence of pistoning in lower limb prosthesis with different
techniques in static (standing) and dynamic (walking and jumping) positions.Study Design: Literature
review.Methods: Keywords related to slippage, suspension, pistoning and vertical movement in lower limb
prosthetics were used to search the literature available in PubMed, ScienceDirect, Web of Science and Google
Scholar databases. Sixteen articles were selected for further analysis according to the selection criteria.Results: The
following methods have been used to measure the occurrence of pistoning in prosthetic limbs: radiological methods,
photographic technique, motion analysis system, sensor and spiral computerized tomography (CT). Pistoning was
measured both in standing and walking.Conclusions: The results of this review reveal that further research is needed Introduction: Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disease with an obscure pathophysiology.
Current treatments for IBS have modest efficacy at best and the need for a robust therapy for IBS remains unmet. As
small intestinal bacterial overgrowth has been proposed to be involved in pathogenesis of IBS, antibacterial agents
might be efficacious in treatment of this condition. Material and methods: PubMed, Embase, Scopus, Google Scholar,
Web of Science, and Cochrane Central Register of Controlled Trials were searched for studies comparing the efficacy
of antibiotics in the management of IBS and/or IBS type symptoms. Data were collected from 1966 to April 2009.
Clinical response was considered as our key outcome of interest. Results: Of five trials that evaluated the effect of
antibiotics in IBS, two randomized placebo-controlled trials met the inclusion criteria for the metaanalysis. This meta-
analysis included 234 patients with IBS-type symptoms of whom 181 met the Rome criteria for IBS. The pooled Context: Cabergoline is widely considered to be poorly effective in acromegaly. Objective: The aim of this study was
to obtain a more accurate picture of the efficacy of cabergoline in acromegaly, both alone and in combination with
somatostatin analogs. Design: We systematically reviewed all trials of cabergoline therapy for acromegaly published
up to 2009 in four databases (PubMed, Pascal, Embase, and Google Scholar). We identified 15 studies (11
prospective) with a total of 237 patients; none were randomized or placebo-controlled. A meta-analysis was
conducted on individual data (n = 227). Results: Cabergoline was used alone in nine studies. Fifty-one (34%) of the
149 patients achieved normal IGF-I levels. In multivariate analysis, the decline in IGF-I was related to the baseline IGF-
I concentration (beta=1.16; P<0.001), treatment duration (beta=0.28; P<0.001), and baseline prolactin concentration
(beta= -0.18; P=0.01), and with a trend toward a relation with the cabergoline dose (beta= 0.38; P =0.07). In five
studies, cabergoline was added to ongoing somatostatin analog treatment that had failed to normalize IGF-I. Forty Context:Transsphenoidal neurosurgery is the accepted first-line treatment of acromegaly in the majority of patients.
Previous studies addressing preoperative somatostatin analog (SSA) treatment and subsequent surgical cure rates
are conflicting, reporting either benefits or no significant differences.Objective:The aim of this study, based on a
meta-analysis of all published reports, was to investigate whether treatment with SSA before surgery improves the
surgical outcome of acromegaly.Data Sources:All studies of preoperative treatment of acromegaly with SSA were
systematically reviewed up to December 2011. We searched the Medline, Embase, Cochrane and Google Scholar
electronic databases. Study Selection: The primary endpoint was the biochemical postoperative cure rate. We
identified 286 studies, out of which 10 studies (3.49%) fulfilling the eligibility criteria were selected for analysis; five
retrospective studies with a control group, two prospective non-randomized trials, and three prospective controlled
trials. The meta-analysis was conducted using the random-effects model.Data Extraction:Data were extracted from Objective: Placenta accreta is an increasingly prevalent and potentially dangerous complication of pregnancy.
Although most studies on the subject have addressed the risk factors for the development of this condition, evidence
on maternal and neonatal outcomes for these pregnancies is scarce. The objective of the present study is to compile
current evidence with regard to risk factors as well as adverse outcomes associated with placenta accreta. Methods:
We conducted a complete literature review using PubMed, MEDLINE, Cochrane Database Reviews, UptoDate,
DocGuide, as well as Google scholar and textbook literature for all articles on placenta accreta, and any one of the
following keywords: "risk factors", "maternal outcomes", "neonatal outcomes", "morbidity", and "mortality".
Individual case reports were excluded. Results: We reviewed 34 studies conducted between 1977 and 2012. A total
number of 508,617 deliveries were studied, with 865 cases of confirmed placenta accreta (average pooled
incidence=1/588). The development of placenta accreta appears to be most strongly predicted by a history of
cesarean section, low-lying placenta/previa, in vitro fertilization pregnancy, as well as elevated second-trimester
levels of alpha-fetoprotein and beta-human chorionic gonadotropin. The most significant maternal outcomes include
Overview: As obesity has reached epidemic proportions, the management of this global disease is of clinical
importance. The availability and popularity of natural dietary supplements for the treatment of obesity has risen
dramatically in recent years. Aims: The aim of this paper was to assess the current evidence of commonly available
natural supplements used to suppress appetite for obesity control and management in humans using a systematic
search of clinical trials meeting an acceptable standard of evidence. Methods: The electronic databases PubMed,
Web of Science, Google Scholar, ScienceDirect, and MEDLINE with full text (via EBSCOHost) were accessed during
late 2012 for randomized controlled clinical trials (RCTs) using natural plant extracts as interventions to treat obesity
through appetite regulation. A quality analysis using a purpose-designed scale and an estimation of effect size, where
data were available, was also calculated. The inclusion criteria included the following: sample participants classified
as overweight or obese adults (aged 18-65 years), randomized, double blind, controlled design, suitable
placebo/control intervention, sample size >20, duration of intervention >2 weeks, have measurable outcomes on Context: Psoriasis vulgaris is a hyper proliferative, autoimmune skin disorder affecting 1-3% of the world's
population. The prescribed synthetic drugs for the treatment of psoriasis are associated with severe side effects,
thus, researchers around the globe are searching for new, effective, and safer drugs from natural resources.
Objective: The present review has been prepared with an objective to compile exhaustive literature on
pharmacological reports on antipsoriatic plants, plant products, and formulations. An attempt has been made to
incorporate chemical constituents (with structures) isolated from different plants responsible for antipsoriatic
activity and their possible mechanism of actions in this review. Materials and methods: The review has been
compiled using references from major databases like Chemical Abstracts, Medicinal and Aromatic Plants Abstracts,
PubMed, Scirus, Google scholar, Open J Gate, Scopus, Science Direct and Online Journals, and includes 127
references. Results: A survey of literature revealed that extracts/fractions/isolates from 18 plants, 23 chemical CONTEXT: Psoriasis vulgaris is a hyper proliferative, autoimmune skin disorder affecting 1-3% of the world's
population. The prescribed synthetic drugs for the treatment of psoriasis are associated with severe side effects,
thus, researchers around the globe are searching for new, effective, and safer drugs from natural resources.,
OBJECTIVE: The present review has been prepared with an objective to compile exhaustive literature on
pharmacological reports on antipsoriatic plants, plant products, and formulations. An attempt has been made to
incorporate chemical constituents (with structures) isolated from different plants responsible for antipsoriatic
activity and their possible mechanism of actions in this review., MATERIALS AND METHODS: The review has been
compiled using references from major databases like Chemical Abstracts, Medicinal and Aromatic Plants Abstracts,
PubMed, Scirus, Google scholar, Open J Gate, Scopus, Science Direct and Online Journals, and includes 127
references., RESULTS: A survey of literature revealed that extracts/fractions/isolates from 18 plants, 23 chemical Context: Epidemiological studies have shown that despite mortality due to communicable diseases, poverty and
human conflicts, the incidence of dementia increases in the developing world in tandem with the ageing population.
Although some FDA approved drugs are available for the treatment of dementia, the outcomes are often
unsatisfactory. In traditional practices of medicine, numerous plants have been used to treat cognitive disorders,
including neurodegenerative diseases such as Alzheimer's disease (AD) and other memory-related disorders. In
western medicine most of the drugs used for the treatment of neurodegenerative disorders are derived from plant
sources. Objective: This article reviews plants and their active constituents that have been used for their reputed
cognitive-enhancing and antidementia effects. Methods: A literature survey in Science Direct, Pubmed, and Google
Scholar was performed to gather information regarding drug discovery from plants sources for the treatment of
congnitive disorders and dementia. Results: More than forty herbal remedies were identified with cholinesterase Background: Regarding the treatment of humeral shaft fractures, the choice of plating or intramedullary nailing
remains controversial. Previous randomized controlled trials and meta-analyses failed to draw a unanimous
conclusion. To guide clinical decision making, we conducted an updated meta-analysis on the optimal treatment of
humeral shaft fractures. Methods: We identified eligible studies published from 1969 to July 2011 using the
Cochrane Library; Cochrane Bone, Joint and Muscle Trauma Group; MEDLINE; Embase; OVID; and Google Scholar and
manually searched the references of relevant studies. Randomized controlled trials that compared nailing and plating
in the treatment of humeral shaft fractures were included. After the methodologic assessment, available data were
extracted and statistically reviewed. The primary outcomes were nonunion, delayed union, postoperative infection,
reoperation, and radial nerve palsy. The secondary outcomes were restriction of shoulder motion, shoulder
impingement, iatrogenic fracture comminution, and implant failure. Results: We included 10 studies comparing
plating and nailing in patients with humeral shaft fractures, comprising 439 participants. Plating reduced the risk of
Context: Platelets have significant roles in initiating and mediating reduced alveolar blood flow, microvascular leak,
and ventilation/perfusion mismatch caused by metabolic changes and altered signal transduction caused by ischemia-
reperfusion. Objective: This review focuses on platelet mechanisms of vascular dysfunction in the lung and presents
a hypothesis for interplay between platelet activation, endothelial damage and fibrinogen. The purpose is to discuss
current knowledge regarding mechanisms of platelet-mediated endothelial injury and implications for new strategies
to treat vascular dysfunction associated with acute lung injury (ALI). Methods: Literature from a number of fields was
searched using Medline and Google Scholar. Results: Activated platelets contribute to redox imbalance through Platelet-rich plasma (PRP) may represent a new thera peutic option for chronic tendinopathies. Platelets release
various cytokines and growth factors which promote angiogenesis, tissue remodeling, and wound healing. We made
an extended literature review of the use of PRP in chronic tendinopathies: epi-condylitis, rotator cuff, patellar and
calcaneal tendi-nopathies, and plantar fasciitis. Medline, Embase and Google Scholar were used (until July 31, 2012).
Clinical studies on PRP and tendi-nopathies published in English and French language peer-reviewed journals were
included. Articles with a high level of evidence were given special consideration. Despite the proven efficacy of PRP
on tissue regeneration in experimental studies, there is currently scanty tangible clinical evidence with respect to its Platelet-rich plasma (PRP) may represent a new therapeutic option for chronic tendinopathies. Platelets release
various cytokines and growth factors which promote angiogenesis, tissue remodeling, and wound healing. We made
an extended literature review of the use of PRP in chronic tendinopathies: epicondylitis, rotator cuff, patellar and
calcaneal tendinopathies, and plantar fasciitis. Medline, Embase and Google Scholar were used (until July 31, 2012).
Clinical studies on PRP and tendinopathies published in English and French language peer-reviewed journals were
included. Articles with a high level of evidence were given special consideration. Despite the proven efficacy of PRP
on tissue regeneration in experimental studies, there is currently scanty tangible clinical evidence with respect to its Background: Bedside ultrasound is increasingly commonly used by surgeons in their everyday practice. Little is
known on the practical implications of bedside ultrasound, its efficacy and safety. Objectives: To carry out a review of
the literature on bedside ultrasound as performed by surgeons. Methods: Searching was carried out through Ovid
Medline 1950 to current; the Ovid EMBASE 1980 to current; Cochrane Database of Systematic Reviews, PubMed and
Google Scholar. Studies were eligible if they were any type of study relating to ultrasound scanning performed by
surgeons or non-radiologists, using portable equipment and assessed as relevant by two reviewers. A narrative
synthesis of the eligible studies was presented. Results: There was moderately good evidence for the routine use of
ultrasound by surgeons at the bedside for Gallbladder, Thyroid, Parathyroid, DVT scanning and trauma scanning. Objective: To provide pharmacy technicians with a review of selected home blood glucose meters, enabling them to
be more effective in aiding patients at the point-of-sale. Data Source: Primary literature and review articles were
identified by searching MEDLINE (1950-September 2010) and Google Scholar, using the key terms glucometers,
glucose meters, home glucose meters, blood glucose meters, blood glucose monitoring, and self-monitoring of blood
glucose. Additional articles were identified from the bibliographies of obtained literature. User manuals were
obtained from the manufacturers' Web sites to determine specific characteristics for each blood glucose meter.
Study Selection and Data Extraction: Reviewed literature was restricted to English-language articles. Blood glucose
meter reviews have mostly compared standard meter functions. Eleven meters were selected for review and
identified as currently marketed by their manufacturers and commonly sold in community pharmacies. Data Introduction New Zealand has a number of plants, both native and introduced, contact with which can lead to
poisoning. The New Zealand National Poisons Centre (NZNPC) frequently receives enquiries regarding exposures to
poisonous plants. Poisonous plants can cause harm following inadvertent ingestion, via skin contact, eye exposures
or inhalation of sawdust or smoked plant matter. Aim The purpose of this article is to determine the 15 most
common poisonous plant enquiries to the NZNPC and provide a review of current literature, discussing the
symptoms that might arise upon exposure to these poisonous plants and the recommended medical management of
such poisonings. Methods Call data from the NZNPC telephone collection databases regarding human plant
exposures between 2003 and 2010 were analysed retrospectively. The most common plants causing human
poisoning were selected as the basis for this review. An extensive literature review was also performed by
systematically searching OVID MEDLINE, ISI Web of Science, Scopus and Google Scholar. Further information was
obtained from book chapters, relevant news reports and web material. Results For the years 2003-2010 inclusive, a
total of 256,969 enquiries were received by the NZNPC. Of these enquiries, 11,049 involved exposures to plants and
fungi. The most common poisonous plant enquiries, in decreasing order of frequency, were: black nightshade
(Solanum nigrum), arum lily (Zantedeschia aethiopica), kowhai (Sophora spp.), euphorbia (Euphorbia spp.), peace lily
Increasing evidence suggests that variants of common and low-penetrance genes are involved in pancreatic cancer
(PC) carcinogenesis. We undertook a meta-analysis of published studies to assess evidence regarding the risk
associated with these genes. Medline, Web of Science, ProQuest, Google Scholar, and international conference
proceedings were searched and citations in relevant primary and review articles were collected. The studies that we
considered eligible included all reports that investigated an association between genetic polymorphisms and PC. We
identified 23 studies that evaluated the risk effects on PC of common alleles for 13 gene polymorphisms. A significant
association was recognized between ALDH 2*1*2 polymorphisms and PC [odds ratio (OR)=1.37, 95% confidence
interval (CI)=1.07-1.75, P=0.01] based on only two studies. Although the overall results for MTHFR T677T are
negative, sensitivity analysis stratified by ethnic background showed a significant association between Caucasian and
MTHFR T677T polymorphisms and PC (OR=1.66, 95% CI=1.10-2.52, P=0.02). The risk for PC was higher in individuals Background: Historical accounts of Polynesian populations by the early European explorers suggested that these
populations enjoyed exceptionally good health. Anthropologists described individuals in these communities as some
of the finest specimens in the human race. The aim of this review is to explore the hypothesis that Polynesians enjoy
better perinatal outcomes even though they are economically disadvantaged. Methods: Literature search for
observational studies on perinatal outcomes among Polynesian populations. Medline, EMBASE and Google Scholar
were searched electronically, using the keywords 'Polynesian', 'Maori', 'Pacific Islanders', 'Perinatal outcome',
'perinatal mortality' as keywords. All observational studies were included. Results: Only six studies of acceptable
quality were retrieved. Pacific women living in New Zealand had significantly lower preterm delivery rates and SGA
when compared to Caucasians. Maori women in New Zealand had significantly lower rates of cesarean sections than
non- Maoris. In one Australian study, Pacific women had a 30% greater risk of perinatal mortality than Australians in Ethnopharmacological relevance: Punica granatum L. (Punicaceae) has been used for centuries in many cultures for
the prevention and treatment of a wide number of health disorders such as inflammation, diabetes, diarrhea,
dysentery, dental plaque and to combat intestinal infections and malarial parasites. Aim of the review: This review
aims at providing an up-to-date overview of the chemical constituents, traditional uses, phytochemistry,
pharmacology and toxicology of Punica granatum L. Moreover, the focus of this review is the possible exploitation of
this species to treat different diseases and to suggest future investigations. Materials and methods: An extensive and
systematic review of the extant literature was carried out, and the data under various sections were identified by
using a computerized bibliographic search via PubMed, Web of Science and Google Scholar. All abstracts and full-text
articles were examined. The most relevant articles were selected for screening and inclusion in this review. Key
findings: A variety of pomegranate ethnomedical uses have been recorded. Additionally, over the last decade, there
has been a dramatic increase of interest in pomegranate as a medicinal and nutritional product due to its n1ewly PURPOSE: Although the data are promising from limited studies with technetium-99m ubiquicidin (Tc-UBI)
scintigraphy in detection of infection in humans, these studies have had a limited sample size. This study was
conducted to provide a systematic review and meta-analysis of the reported diagnostic accuracy of Tc-UBI
scintigraphy in detection of an infectious process. MATERIALS AND METHODS: The PubMed/MEDLINE, Web of
Science, EMBASE, and Google Scholar literature databases were systematically searched to find the relevant human
studies on Tc-UBI scintigraphy. For each eligible study, the true-positive, false-positive, true-negative, and false-
negative findings at Tc-UBI scintigraphy were recorded, and the overall statistical parameters were acquired. RESULT:
Ten studies carried out from 2004 to 2010 were included in the analysis. The pooled data sensitivity was 94.5 % and PURPOSE: Although the data are promising from limited studies with technetium-99m ubiquicidin (Tc-UBI)
scintigraphy in detection of infection in humans, these studies have had a limited sample size. This study was
conducted to provide a systematic review and meta-analysis of the reported diagnostic accuracy of Tc-UBI
scintigraphy in detection of an infectious process., MATERIALS AND METHODS: The PubMed/MEDLINE, Web of
Science, EMBASE, and Google Scholar literature databases were systematically searched to find the relevant human
studies on Tc-UBI scintigraphy. For each eligible study, the true-positive, false-positive, true-negative, and false-
negative findings at Tc-UBI scintigraphy were recorded, and the overall statistical parameters were acquired.,
RESULT: Ten studies carried out from 2004 to 2010 were included in the analysis. The pooled data sensitivity was DATA SOURCES: The Medline, Cochrane CENTRAL, Biomed Central, Database of Open Access Journals (DOAJ), OpenJ-
Gate, Bibliografia Brasileira de Odontologia (BBO), LILACS, IndMed, Sabinet, Scielo, Scirus (Medicine), OpenSIGLE and
Google Scholar databases were searched. Hand searching was performed for journals not indexed in the databases.
References of included trials were checked., STUDY SELECTION: Prospective clinical trials with test and control
groups with a follow up of at least one year were included., DATA EXTRACTION AND SYNTHESIS: Data abstraction
was conducted independently and clinical and methodologically homogeneous data were pooled using a fixed-
effects model., RESULTS: Eighteen trials were included. From these 32 individual dichotomous datasets were
extracted and analysed. The majority of the results show no differences between both types of intervention. A high
risk of selection-, performance-, detection- and attrition bias was identified. Existing research gaps are mainly due to
To provide nurses with an evidence-based Position Statement on the standards patients and visitors should expect
when visiting an adult critical care unit in the 21st century in the UK. The British Association of Critical Care Nurses
(BACCN) is a leading organization for critical care nursing in the UK and regularly receives enquiries about best
practice regarding visiting policies. Therefore, in keeping with the BACCN's commitment to provide evidence-based
guidance for nurses, a Position Statement on visiting practices in adult critical care units was commissioned. This
brought together experts from the field of critical care nursing and representatives from patient and relatives' groups
to review visiting practices and the literature and produce a Position Statement. An extensive search of the literature
was undertaken using the following databases: Blackwell Synergy, CINAHL, Medline, Swetswise, Cochrane Data Base
of Systematic Reviews, National Electronic Library for Health, Institute for Healthcare Improvement and Google
Scholar. After obtaining selected articles, the references from these articles were then evaluated for their relevance
to this Position Statement and were retrieved. The evidence suggests a disparity between what nurses believe is best
practice and what patients and visitors actually want. Historically, visitors have been perceived as being responsible
for increasing noise, taking up space, taking up nursing time, hindering nursing care and spreading infection. The Objective: The objective of the study was to evaluate the current state of clinical assays for total and free
testosterone. Participants: The five participants were appointed by the Council of The Endocrine Society and charged
with attaining the objective using published data and expert opinion. Evidence: Data were gleaned from published
sources via online databases (principally PubMed, Ovid MEDLINE, Google Scholar), the College of American
Pathologists, and the clinical and laboratory experiences of the participants. Consensus Process: The statement was
an effort of the committee and was reviewed in detail by each member. The Council of The Endocrine Society
reviewed a late draft and made specific recommendations. Conclusions: Laboratory proficiency testing should be Objective: Previous studies indicate that positive trials are more likely to be published in a timely manner. We sought
to investigate whether this trend is ongoing and to evaluate other variables in the publication of positive and
negative clinical trials. Research design and methods: A list of phase III pharma-sponsored trials with >=500 patients
in the cardiovascular therapy area, completed between July 2008 and June 2009, was obtained from
www.ClinicalTrials.gov. PubMed and Google Scholar were used to determine if results were published. Abstracts and
Trialtrove were interrogated to determine if primary endpoints were met. Results: A total of 44 clinical trials were
evaluated. The primary endpoint was met in 65.9% (29/44), and 72.4% (21/29) were published. In all, 53.3% (8/15) of
trials that did not meet their primary endpoint were published. No significant association between publication status
and positive/negative results was found (Fisher's exact test, p=0.32). While 6/8 published negative trials appeared in Introduction: The value of pleural lavage cytology (PLC) in assessing the prognosis of early stage lung cancer is still
controversial. No systematic review has investigated the relationship between PLC and lung cancer recurrence. Our
primary goal was to investigate the association between positive pre-resection PLC and pleural, distant and overall
tumour recurrence in patients undergoing surgical resection. Methods: Medline, EMBASE and Google Scholar
databases were searched up to 2011. All studies reporting relevant outcomes in both patient groups were included.
Data were extracted for the following outcomes of interest: overall, local and distant recurrence; and freedom from
death (survival - overall and patients with stage I disease only). Random effects meta-analysis was used to aggregate
the data. Sensitivity and heterogeneity analysis were performed. Results: A meta-analysis of eight studies at
maximum follow-up demonstrated a significant association between positive pre-resection PLC and increased risk of
post-resection overall recurrence (OR 4.82, 95% CI 2.45 to 9.51), pleural recurrence (OR 9.89, 95% CI 5.95 to 16.44) Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiological syndrome characterized by seizures,
altered level of consciousness and visual disturbance. PRES is associated with hyperintense lesions on magnetic
resonance imaging (MRI) most commonly seen in the posterior regions. In most cases symptoms and radiological
lesions are reversible. The aims of this article are: (i) to review the literature for all cases involving oxaliplatin,
fluoropyrimidine and bevacizumab and (ii) highlight the increasing number of cases attributed to anti-neoplastic
agents. An in-depth literature review was conducted by utilizing Pubmed's MEDLINE and Google Scholar databases.
We found that there have been nine cases of PRES associated with oxaliplatin or fluoropyrimidine therapy; five cases
also involved therapy with bevacizumab. Eight of the nine patients made a full recovery with a complete resolution The developing world is disproportionately burdened with high rates of maternal mortality. Despite widespread
reduction in maternal deaths due to improved antepartum, intrapartum, and postpartum care in developed nations,
mortality rates are persistently high in many countries unable to provide advanced medical care. Postpartum
haemorrhage accounts for a substantial proportion of maternal deaths in developing countries. This review
addresses the clinical management strategies aimed at the prevention and treatment of postpartum haemorrhage
that are effective in lowresource settings. The review was conducted by searching the English-language medical
literature using MEDlINE (1950 - Feb 2009) and the online search engine Google Scholar. Four relevant strategies
Introduction and Aims: Although several studies have investigated different aspects of post transplantation
lymphoproliferative disorders (PTLD) in renal recipients, most of these data have been derived from studies on adult
patients, and data in the paediatric setting is extremely limited. In this study, we aimed to evaluate different aspects
of PTLD arising in the paediatric renal transplant recipients, and to compare them with those in their adult
counterparts. Methods: A comprehensive search of the current literature was performed through Pubmed and
Google Scholar for reports or series including individual cases of paediatric and adult recipients of renal allograft
recipients developing PTLD. Overall 100 (Case group) cases of PTLD in paediatric renal recipients were found whose
data were compared to 504 (Control group) adult renal transplant patients with PTLD. Available data for each
variable were collected and compared between the two groups. Results: PTLD in paediatric renal recipients was
more likely to be of B cell type (93% vs. 79%; p = 0.05), early onset ( < 1 yr post transplant; 49% vs. 29%; p < 0.001),
and metastatic disease ( > 1 organs involved; 60% vs. 37%; p = 0.002). Moreover, PTLD in children more frequently
complicated respiratory tract (19% vs. 8%; p = 0.03), spleen (16% vs. 4%; p = 0.004), and kidney allograft (39% vs.
18%; p = 0.001), while it was less likely to involve skin (4% vs. 21%; p = 0.001) and CNS (8% vs. 18%; p = 0.032). Post-transplantation lymphoproliferative disorders (PTLD) localized to the central nervous system (CNS) is a rare but
potentially fatal side-effect of immunosuppression for organ transplantation. Till now, to the best of our knowledge,
the total number of such cases reported worldwide is less than 100. In this survey, we collected the data of PTLD
localized to the CNS (CNS-PTLD) and compared this data with other PTLD patients with localizations to other areas
serving as the control group. A comprehensive search was performed for studies reporting CNS-PTLD data in the
Pubmed and Google scholar search engines. Finally, international data from 21 different studies were included in the
analysis. Overall, 367 patients were entered into analysis. Organ recipients with CNS-PTLD had comparable gender
make up, lymphoma cell types, Epstein-Barr virus infection rate, remission and mortality rates, with PTLD patients
having other localizations. Multiorgan involvement as well as disseminated lymphoma were significantly more
prevalent in the control group (P <0.05). At the last follow-up, 192 (60%) patients were dead (47 missing data). The epidemiology and other aspects of post-transplantation lymphoproliferative disorders (PTLD) are different in
different transplant populations. In this study, we sought to determine the clinical, histopathological and various
other features of PTLD in recipients of pancreas-renal allografts and to compare their data with renal-only transplant
patients, based on the current available literature. We conducted a comprehensive search for the available data
using the Pubmed and Google scholar search engines for reports of lymphoproliferative disorders after renal and
simultaneous pancreas-renal (SPR) transplantations. A total of 229 recipients of renal and pancreas-renal allografts
were included in the analysis. Localizations for SPR recipients were significantly higher than renal recipients in the
pancreas (P <0.0001), skin (P = 0.035), liver (P = 0.043) and bone marrow (P = 0.022). Involvement of lymph nodes
was more prevalent in renal recipients (P = 0.046). The occurrence of metastasis was more common among SPR Background: The adenotonsillar region is an important localization for post transplantation lymphoproliferative
disorders (PTLD) due to its anatomical relevance. In this study, we sought to aggregate data of PTLD series reported
by different international authors on tonsillar and adenoidal localization of PTLD and to compare their data with
other PTLD patients. Material/Methods: We conducted a comprehensive search for the available data by Pubmed
and Google Scholar search engines for reports of lymphoproliferative disorders occurring within tonsils and adenoids
among organ transplant patients. Data from 22 previously published studies from various countries were included
into analysis. Results: Overall, 352 patients with lymphoproliferative disorders after organ transplantation were
entered into analysis. Patients with adenotonsillar PTLD were significantly younger (13+/-15 vs. 26+/-23 yr/o;
p<0.0001), more frequently females (56% vs. 35%; p=0.013), less likely to develop metastasis (4.5% vs. 12.5%;
p=0.07), and were more frequently from polyclonal (80% vs. 53%; p=0.002) and polymorphic (68% vs. 27%; p=0.001) Introduction: Schizophrenia is a relatively common chronic psychotic mental illness, which usually continues
throughout life. Current diagnosis is based on a set of psychiatrist-applied diagnostic criteria. There can be
considerable differences between diagnostic classification based upon either the set of criteria used, or the
individual who applies the criteria. For this reason, the development of an objective test to inform the diagnosis
could be highly beneficial. Objectives: To assess the use of Support Vector Machine (SVM) as a potential diagnostic
tool for schizophrenia, with a particular focus on the application of SVM to Magnetic Resonance Imaging (MRI) data.
Aims: To show the use of SVM on MRI data to be a potentially viable diagnostic test. Method: A systematic literature
search was carried out using the PubMed database, Web of Knowledge as well as Google Scholar. This search was
conducted using the terms 'Schizophrenia', 'SVM'/ 'Support Vector Machine' and 'MRI/fMRI'. This was followed by
Background: Heparan sulphates play key roles in conception and early pregnancy events. The role of heparin, a
structural analogue, and its application to assisted conception, is largely unknown. Methods: Relevant studies were
identified by searching PubMed 1966-November 2007 and Google Scholar without limitations. Sensitive search
strategies were combined with relevant medical subject headings and text words. Results: The similarities of heparin
and heparan, the haemostatic changes induced by ovarian stimulation and the risk of thrombosis, the contribution of
thrombophilia to pregnancy and infertility outcomes, early embryo-maternal dialogue and how these various aspects
of assisted conception may be modified by heparin are reviewed. Conclusions: Heparin can alter the haemostatic
response to controlled ovarian stimulation and modify the risk of thrombosis. It can also modulate many of the OBJECTIVE: To review the evidence base supporting the use of salicylates for glucose level control in patients with
type 2 diabetes and provide a comprehensive review of available information describing the potential role of
salicylates and, in particular, salsalate, for glucose control in type 2 diabetes prevention and treatment. DATA
SOURCES: A literature search using MEDLINE (1966-March 2010), PubMed, and Google Scholar was conducted using
the search terms salicylates, salicylic acid, aspirin, salsalate, acetylsalicylic acid, insulin, glucose, glycemic control,
diabetes, hyperglycemia, and nuclear factor. The bibliographies of identified articles were reviewed for additional
citations. STUDY SELECTION AND DATA EXTRACTION: All relevant English-language information on the
pharmacology, efficacy, and safety of salicylates for glucose control related to insulin resistance or diabetes
prevention were reviewed. Preclinical data, clinical trials, and case reports were identified, evaluated, and included in
this systematic review. DATA SYNTHESIS: Treatment of inflammation may be a potential novel strategy in prevention
and treatment of type 2 diabetes, in which the body is resistant to the effects of insulin. Previous and recent studies
reveal a possible relationship between inflammation and obesity. The chronic activation of the immune system due
to low-grade inflammation was found in several studies to be associated with obesity, and this, in turn, can promote
development of insulin resistance and impaired glucose tolerance. Administration of salicylates was shown over a
century ago to lower glucose levels in patients with diabetes. Many in vitro and in vivo pharmacologic studies have Background: In the management of sensorineural hearing loss, effective therapy for degenerated hair cells, third
order neurons, ganglions, dendrites and synaptic areas of the vestibulo-cochleo-cerebral pathway remains an
enigma. Transplantation of stem and progenitor cells appears to be an emerging potential solution, and is the focus
of this review.Aim: To review recent developments in the management of sensorineural hearing loss in the field of
stem cell research.Materials and method: A systematic review of the English language literature included all
experimental and non-experimental studies with a Jadad score of three or more, published between 2000 and 2010
and included in the following databases: Cochrane Library Ear, Nose and Throat Disorders; Medline; Google Scholar;
Hinari; and the Online Library of Toronto University.Results: Of the 455 and 29 600 articles identified from Medline Spinal tuberculosis (TB) or Pott's spine is the commonest extrapulmonary manifestation of TB.It spreads through
hematogenous route. Clinically, it presents with constitutional symptoms, back pain, tenderness, paraplegia or
paraparesis, and kyphotic or scoliotic deformities. Pott's spine accounts for 2% of all cases of TB, 15% of
extrapulmonary, and 50% of skeletal TB. The paradiscal, central, anterior subligamentous, and neural arch are the
common vertebral lesions. Thoracic vertebrae are commonly affected followed by lumbar and cervical vertebrae.
Plain radiographs are usually the initial investigation in spinal TB. For a radiolucent lesion to be apparent on a plain
radiograph there should be 30% of bone mineral loss. Computed tomographic scanning provides much better bony
detail of irregular lytic lesions, sclerosis, disc collapse, and disruption of bone circumference than plain radiograph.
Magnetic resonance imaging (MRI) is the best diagnostic modality for Pott's spine and is more sensitive than other
modalities. MRI frequently demonstrates disc collapse/destruction, cold abscess, vertebral wedging/collapse,
OBJECTIVE: There are challenges in delivering maternal and infant health (MIH) care to remote Northern Territory
(NT) communities. These include fragmented care with birthing in regional hospitals resulting in cultural and
geographical dislocation for Aboriginal women. Many NT initiatives are aimed at improving care. Indicators for
evaluating these for remote Aboriginal mothers and infants need to be clearer. We reviewed existing indicators to
inform a set of pragmatic indicators for reporting improvement in remote MIH care. METHODS: Scientific databases
and grey literature (organisational websites and Google Scholar) were searched using the terms
'Aboriginal/maternal/infant/remote health/monitoring performance'. Key stakeholders identified omitted indicators
sets. Relevant sets were reviewed and organised by indicator type, stage of patient journey, topic and theme.
RESULTS: Forty-two indicators sets were found. Seven focused on Aboriginal health, 23 on reproductive/maternal
health, eight on child/infant health and four on other aspects, e.g. remote health. We identified more than 1,000
Acute urinary tract infections (UTI) are one of the most common bacterial infections among women presenting to
primary care. However, there is a lack of consensus regarding the optimal reference standard threshold for
diagnosing UTI. The objective of this systematic review is to determine the diagnostic accuracy of symptoms and
signs in women presenting with suspected UTI, across three different reference standards (10(2) or 10(3) or 10(5)
CFU/ml). We also examine the diagnostic value of individual symptoms and signs combined with dipstick test results
in terms of clinical decision making. Searches were performed through PubMed (1966 to April 2010), EMBASE (1973
to April 2010), Cochrane library (1973 to April 2010), Google scholar and reference checking.Studies that assessed
the diagnostic accuracy of symptoms and signs of an uncomplicated UTI using a urine culture from a clean-catch or
catherised urine specimen as the reference standard, with a reference standard of at least >= 10(2) CFU/ml were
included. Synthesised data from a high quality systematic review were used regarding dipstick results. Studies were
combined using a bivariate random effects model. Sixteen studies incorporating 3,711 patients are included. The
weighted prior probability of UTI varies across diagnostic threshold, 65.1% at >= 10(2) CFU/ml; 55.4% at >= 10(3)
CFU/ml and 44.8% at >= 10(2) CFU/ml >= 10(5) CFU/ml. Six symptoms are identified as useful diagnostic symptoms BACKGROUND: Acute urinary tract infections (UTI) are one of the most common bacterial infections among women
presenting to primary care. However, there is a lack of consensus regarding the optimal reference standard threshold
for diagnosing UTI. The objective of this systematic review is to determine the diagnostic accuracy of symptoms and
signs in women presenting with suspected UTI, across three different reference standards (10(2) or 10(3) or 10(5)
CFU/ml). We also examine the diagnostic value of individual symptoms and signs combined with dipstick test results
in terms of clinical decision making., METHODS: Searches were performed through PubMed (1966 to April 2010),
EMBASE (1973 to April 2010), Cochrane library (1973 to April 2010), Google scholar and reference checking.Studies
that assessed the diagnostic accuracy of symptoms and signs of an uncomplicated UTI using a urine culture from a
clean-catch or catherised urine specimen as the reference standard, with a reference standard of at least >= 10(2)
CFU/ml were included. Synthesised data from a high quality systematic review were used regarding dipstick results.
Studies were combined using a bivariate random effects model., RESULTS: Sixteen studies incorporating 3,711
patients are included. The weighted prior probability of UTI varies across diagnostic threshold, 65.1% at >= 10(2)
CFU/ml; 55.4% at >= 10(3) CFU/ml and 44.8% at >= 10(2) CFU/ml >= 10(5) CFU/ml. Six symptoms are identified as
useful diagnostic symptoms when a threshold of >= 10(2) CFU/ml is the reference standard. Presence of dysuria (+LR Background: A complete pathological response to neo-adjuvant chemo-radiation for oesophageal cancer is
associated with favourable survival. However, such a benefit is seen in the minority. If one could identify, at
diagnosis, those patients who were unlikely to respond unnecessary toxicity could be avoided and alternative
treatment can be considered. The aim of this review was to highlight predictive markers currently assessed and
evaluate their clinical utility. Methods: A systematic search of Pubmed and Google Scholar was performed using the
following keywords; "neo-adjuvant", "oesophageal", "trimodality", "chemotherapy", "radiotherapy",
"chemoradiation" and "predict". The original manuscripts were sourced for further articles of relevance. Results:
Conventional indices including tumour stage and grade seem unable to predict histological response. Immuno-
histochemical markers have been extensively studied, but none has made its way into routine clinical practice. Global Objective: Antidepressants (ADs) are the mainstay of treatment for major depressive disorder (MDD). Despite their
widespread usage, a consensus does not exist as to the timing of clinically significant symptomatic improvement
during an AD trial. The objective of this review is to provide practitioners with empirically based recommendations
pertaining to the optimal duration of index (initial) AD therapy before a clinical intervention is warranted. Methods:
We conducted a nonsystematic review, using a combination of a MeSH key word search, Google Scholar, and the
Scopus database. Our search strategy focused on research papers reporting on the early symptomatic response to
AD therapy. Results: Available evidence suggests that there are several subpopulations that exist within whole-group
data assigned to an AD treatment. Among the responder subgroups, an early responder group (that is, less than 3
weeks) and later responder group (that is, 3 weeks or more) are identified. People who exhibit early partial
symptomatic improvement are more likely to respond to therapy thereafter. However, the interpretability of extant Background: Postresection liver failure (PLF) is the major cause of death following liver resection. However, there is
no unified definition, the pathophysiology is understood poorly and there are few controlled trials to optimize its
management. The aim of this review article is to present strategies to predict, prevent and manage PLF. Methods:
The Web of Science, MEDLINE, PubMed, Google Scholar and Cochrane Library databases were searched for studies
using the terms 'liver resection', 'partial hepatectomy', 'liver dysfunction' and 'liver failure' for relevant studies from
the 15 years preceding May 2011. Key papers published more than 15 years ago were included if more recent data
were not available. Papers published in languages other than English were excluded. Results: The incidence of PLF
ranges from 0 to 13 per cent. The absence of a unified definition prevents direct comparison between studies. The
major risk factors are the extent of resection and the presence of underlying parenchymal disease. Small-for-size
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a condition that is detrimental to the quality of life of
men. Evidence suggests that it may have a neuropathic origin and therefore medications such as pregabalin might
have a role in the controlling of symptoms. The primary objective was to compare pregabalin to other modalities of
pain relief to alleviate men's symptoms of CP/CPPS.The secondary objective was to assess the safety and
effectiveness of pregabalin to improve various individual symptoms consistent with CP/CPPS. We searched the
Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to May 2012), EMBASE (1980 to May
2012), CINAHL, clinicaltrials.gov, Google Scholar, and reference lists of articles and abstracts from conference
proceedings, without language restriction for pregabalin treatment of Class III prostatitis and CP/CPPS. Randomized
controlled trials (RCTs) comparing pregabalin to placebo or other types of analgesics for the management of patients
with CP/CPPS were included. Patients with known causes of pain/discomfort were excluded. Only one RCT was
included. The trial compared pregabalin to placebo for patients who had CP/CPPS. For men who responded clinically
(>= 6-point improvement), there was no difference between the pregabalin (103/218; 47.2%) and placebo (38/106;
35.8%) arms (risk ratio (RR) 1.32; 95% CI 0.99 to 1.76). There was less pain with a higher point improvement in the
pregabalin group compared to the placebo group (4.2 points versus 1.7 points, respectively; mean difference (MD) - Objective: There are multiple causes for elevated serum beta-hCG (beta-human chorionic gonadotrophin), most
commonly, pregnancy. Gestational trophoblastic disease, ectopic secretion from tumours, pituitary derived hCG and
false positive beta-hCG are causes that occasionally fall into this category. Rarely there are a group of women where
no cause is apparent for their persistently elevated levels. These women may present to an early pregnancy unit
potentially posing management dilemmas such as complicated prolonged 'pregnancy of unknown location' (PUL). We
will discuss our literature review and management of a woman who presented with amenorrhoea and elevated
serum hCG that persisted for months with no identifiable pregnancy or ectopic source of beta-hCG secretion.
Methods: PubMed, Google scholar and Ovid literature searches were performed for persistently elevated and false
positive beta-hCG. This paper looks at the performance of hCG curves in women with ectopic pregnancies and the
other recognized causes of raised beta-hCG. We will also discuss the case of a patient who presented with elevated
serum hCG and had no identifiable pregnancy or ectopic source of beta-hCG secretion despite numerous
investigations. Results: The literature review revealed little on this subject. The largest case series came from one of
the UK's regional trophoblastic disease centres identifying only 14 patients over a 24 year period. Three of these
cases developed gestational choriocarcinoma after 9-29 months, the remaining 11 had no cause found. Our patient
was initially managed expectantly as a PUL with a serum beta-hCG of 318 IU/L, then medically when the levels OBJECTIVE: The aim of this review is to give comprehensive summary on alloimmunisation of non-RhD erythrocyte
antibodies. DESIGN: Review. SETTING: Department of Obstetrics and Gynecology, University Hospital Ostrava,
Department of Obstetrics and Gynecology, University Hospital Olomouc. SUBJECT AND METHOD: Based on literature
analysis using database search engines PubMed, Google Scholar, Ovid and Proquest in field of non-RhD erytrocyte
antibodies, there has been summarized up-to-date knowledge on irregular antibodies. CONCLUSION: Pregnant
women alloimmunisation of non-RhD erythrocyte antigens gather importance in conjunction with relative increase of Context: It is well established that maternal prenatal and postpartum depression is prevalent and has negative
personal, family, and child developmental outcomes. Paternal depression during this period may have similar
characteristics, but data are based on an emerging and currently inconsistent literature. Objective: To describe point
estimates and variability in rates of paternal prenatal and postpartum depression over time and its association with
maternal depression. Data Sources: Studies that documented depression in fathers between the first trimester and
the first postpartum year were identified through MEDLINE, PsycINFO, EMBASE, Google Scholar, dissertation
abstracts, and reference lists for the period between January 1980 and October 2009. Study Selection: Studies that
reported identified cases within the selected time frame were included, yielding a total of 43 studies involving 28 004
participants after duplicate reports and data were excluded. Data Extraction: Information on rates of paternal and
maternal depression, as well as reported paternal-maternal depressive correlations, was extracted independently by
2 raters. Effect sizes were calculated using logits, which were back-transformed and reported as proportions.
Random-effects models of event rates were used because of significant heterogeneity. Moderator analyses included
timing, measurement method, and study location. Study quality ratings were calculated and used for sensitivity
Objectives: Age at menarche (AAM) is one of the most significant indicators of female sexual maturation. Early AAM
may be associated with cancers of the reproductive organs, obesity, diabetes type 2, cardiovascular diseases,
infertility and psychological disorders in later life. There are data that some prenatal conditions may contribute to
AAM, however, no consensus view on this problem exists. We have systematically reviewed the available literature
in order to identify these factors and their relative significance for AAM. Method: Using various combinations of
keywords, we searched MEDLINE and Google Scholar databases for the data published from 1980 till December
2012. In total 134 articles were retrieved, and 65 of them contained information relevant to our study. Results: The
following prenatal factors have been reported as associated with AAM: mother's AAM, weight gain during
pregnancy, preeclampsia, birth size, prematurity, environmental hazards exposure during pregnancy. Birth weight
and exposure to estrogen-like endocrine disruptors seem to have the most significant effect on AAM. Low birth
weight, especially due to intrauterine growth restriction, can lower AAM by 0.5 to 0.8 year through development of Background: Morgagni hernias are a very rare form of diaphragmatic hernias. No robust studies have been
performed to show the true natural history of this disease process. This study aimed to summarize clinically relevant
data with respect to Morgagni hernias in adults. These data should help surgeons workup, diagnose, and treat
Morgagni hernias in adult patients. Methods: A literature search was performed using PubMed, Google scholar, and
the following key words: Morgagni, Larrey, retrosternal, retrocostoxiphal, retrochondrosternal, parasternal,
substernal, anterior diaphragmatic, and subcostosternal. All case reports and series after 1951 that pertained to
adults were included in the review. The following data points were queried: age, sex, presentation, studies used
during workup, laterality, surgical approach, hernia sac management, specific laparoscopic techniques, and follow-up
evaluation. Results: These criteria were met by 135 articles representing 298 patients. Based on the data provided,
several conclusions regarding this disease process can be drawn. Most patients (72%) present with symptoms related Background: To assess the quality of research presentations made in conferences, its success or failure to be
published in a peer-reviewed journal is a well-accepted marker. However, there is no data regarding the publication
of research presentations made in Indian conferences of anesthesiology. Objective: The primary objective was to
determine publication rate of research presented at the largest and best attended national conference in
anesthesiology, the Indian Society of Anaesthesiologists' Conference (ISACON), and also compare it with the rate
from an international conference American Society of Anesthesiologists (ASA annual meeting) held in the same year.
Materials and Methods: All 363 abstracts presented as poster or podium presentations at the ISACON, and an equal
number of randomly selected abstracts presented at ASA annual meeting were searched on Pubmed and Google
Scholar for their full-text publications in peer-reviewed journals using a standardized search strategy. As secondary
observations, abstracts were assessed for completeness by noting certain components central to research Resection of the chordopapillary apparatus during mitral valve replacement has been associated with a negative
impact on survival. Mitral valve replacement with the preservation of the mitral valve apparatus has been associated
with better outcomes, but surgeons remain refractory to its use. To determine if there is any real difference in
preservation vs non-preservation of mitral valve apparatus during mitral valve replacement in terms of outcomes, we
performed a systematic review and meta-analysis using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google
Scholar and reference lists of relevant articles to search for clinical studies that compared outcomes (30-day
mortality, postoperative low cardiac output syndrome or 5-year mortality) between preservation vs non-preservation
during mitral valve replacement from 1966 to 2011. The principal summary measures were odds ratios (ORs) with
95% confidence interval and P-values (that will be considered statistically significant when <0.05). The ORs were
combined across studies using a weighted DerSimonian-Laird random-effects model. The meta-analysis was
completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, NJ, USA). Twenty Resection of the chordopapillary apparatus during mitral valve replacement has been associated with a negative
impact on survival. Mitral valve replacement with the preservation of the mitral valve apparatus has been associated
with better outcomes, but surgeons remain refractory to its use. To determine if there is any real difference in
preservation vs non-preservation of mitral valve apparatus during mitral valve replacement in terms of outcomes, we
performed a systematic review and meta-analysis using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google
Scholar and reference lists of relevant articles to search for clinical studies that compared outcomes (30-day
mortality, postoperative low cardiac output syndrome or 5-year mortality) between preservation vs non-preservation
during mitral valve replacement from 1966 to 2011. The principal summary measures were odds ratios (ORs) with
95% confidence interval and P-values (that will be considered statistically significant when <0.05). The ORs were
combined across studies using a weighted DerSimonian-Laird random-effects model. The meta-analysis was
completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, NJ, USA). Twenty
The objective of this study is to review ethical and clinical guidelines and position papers concerning the
presymptomatic and predictive genetic testing of minors. The databases Medline, Philosopher's Index, Biological
Abstracts, Web of Science and Google Scholar were searched using keywords relating to the presymptomatic and
predictive testing of children. We also searched the websites of the national bioethics committees indexed on the
websites of World Health Organization (WHO) and the German Reference Centre for Ethics in the Life Sciences, the
websites of the Human Genetics Societies of various nations indexed on the website of the International Federation
of Human Genetics Societies and related links and the national medical associations indexed on the website of the
World Medical Association. We retrieved 27 different papers dealing with guidelines or position papers that fulfilled
our search criteria. They encompassed the period 1991-2005 and originated from 31 different organizations. The
main justification for presymptomatic and predictive genetic testing was the direct benefit to the minor through Preterm delivery is still the primary cause of mortality and morbidity in infants, which shows a problematic condition
in the care of pregnant women all over the world. This review study describes prevalence and psycho - socio-
demographic as well as obstetrical risk factors related to live preterm delivery (PTD) in the recent decade in Iran. A
narrative review was performed in Persian and international databases including PubMed, SID, Google Scholar, Iran
Medex, Magiran and Irandoc from 2001 to 2010 with following keywords: preterm delivery and pregnancy outcomes
with (prevalence, socioeconomic condition, structural determinant, Intermediary determinants, Psychosocial factor,
Behavioral factor and Maternal circumstance, Health system). All of article was reviewed then categorized based on
WHO model. Totally 52 article were reviewed and 35 articles were selected, of which 26 were cross-sectional or
longitudinal, 9 were analytical (cohort or case-control). The prevalence rates of preterm delivery in different cities of
Iran were reported between 5.6% in Quom to 39.4% in Kerman. The most common social factors in structural Objective: To assess the prevalence and correlates of antipsychotic polypharmacy (APP) across decades and regions.
Methods: Electronic PubMed/Google Scholar search for studies reporting on APP, published from 1970 to 05/2009.
Median rates and interquartile ranges (IQR) were calculated and compared using non-parametric tests. Demographic
and clinical variables were tested as correlates of APP in bivariate and meta-regression analyses. Results: Across 147
studies (1,418,163 participants, 82.9% diagnosed with schizophrenia [IQR=42-100%]), the median APP rate was
19.6% (IQR=12.9-35.0%). Most common combinations included first-generation antipsychotics (FGAs)+second-
generation antipsychotics (SGAs) (42.4%, IQR=0.0-71.4%) followed by FGAs+FGAs (19.6%, IQR=0.0-100%) and
SGAs+SGAs (1.8%, IQR=0.0-28%). APP rates were not different between decades (1970-1979:28.8%, IQR=7.5-44%;
1980-1989:17.6%, IQR=10.8-38.2; 1990-1999:22.0%, IQR=11-40; 2000-2009:19.2% IQR=14.4-29.9, p=0.78), but
between regions, being higher in Asia and Europe than North America, and in Asia than Oceania (p<0.001). APP
increased numerically by 34% in North America from the 1980s 12.7%) to 2000s (17.0%) (p=0.94) and decreased OBJECTIVE: To assess the prevalence and correlates of antipsychotic polypharmacy (APP) across decades and
regions., METHODS: Electronic PubMed/Google Scholar search for studies reporting on APP, published from 1970 to
05/2009. Median rates and interquartile ranges (IQR) were calculated and compared using non-parametric tests.
Demographic and clinical variables were tested as correlates of APP in bivariate and meta-regression analyses.,
RESULTS: Across 147 studies (1,418,163 participants, 82.9% diagnosed with schizophrenia [IQR=42-100%]), the
median APP rate was 19.6% (IQR=12.9-35.0%). Most common combinations included first-generation antipsychotics
(FGAs)+second-generation antipsychotics (SGAs) (42.4%, IQR=0.0-71.4%) followed by FGAs+FGAs (19.6%, IQR=0.0-
100%) and SGAs+SGAs (1.8%, IQR=0.0-28%). APP rates were not different between decades (1970-1979:28.8%,
IQR=7.5-44%; 1980-1989:17.6%, IQR=10.8-38.2; 1990-1999:22.0%, IQR=11-40; 2000-2009:19.2% IQR=14.4-29.9,
p=0.78), but between regions, being higher in Asia and Europe than North America, and in Asia than Oceania
(p<0.001). APP increased numerically by 34% in North America from the 1980s 12.7%) to 2000s (17.0%) (p=0.94) and This paper reviews the current situation concerning nutrition-related noncommunicable diseases (N-NCDs) and the
risk factors associated with these diseases in the Eastern Mediterranean region (EMR). A systematic literature review
of studies and reports published between January 1, 1990 and September 15, 2011 was conducted using the
PubMed and Google Scholar databases. Cardiovascular disease, type 2 diabetes, metabolic syndrome, obesity,
cancer, and osteoporosis have become the main causes of morbidity and mortality, especially with progressive aging
of the population. The estimated mortality rate due to cardiovascular disease and diabetes ranged from 179.8 to
765.2 per 100,000 population, with the highest rates in poor countries. The prevalence of metabolic syndrome was
very high, ranging from 19% to 45%. The prevalence of overweight and obesity (body mass index >=25 kg/m2) has
reached an alarming level in most countries of the region, ranging from 25% to 82%, with a higher prevalence among
women. The estimated mortality rate for cancer ranged from 61.9 to 151 per 100,000 population. Osteoporosis has
OBJECTIVE: To analyze alcohol and tobacco use among Brazilian adolescents and identify higher-risk subgroups.,
METHODS: A systematic review of the literature was conducted. Searches were performed using four databases
(LILACS, MEDLINE /PubMed, Web of Science, and Google Scholar), specialized websites and the references cited in
retrieved articles. The search was done in English and Portuguese and there was no limit on the year of publication
(up to June 2011). From the search, 59 studies met all the inclusion criteria: to involve Brazilian adolescents aged 10-
19 years; to assess the prevalence of alcohol and/or tobacco use; to use questionnaires or structured interviews to
measure the variables of interest; and to be a school or population-based study that used methodological
procedures to ensure representativeness of the target population (i.e. random sampling)., RESULTS: The prevalence
of current alcohol use (at the time of the investigation or in the previous month) ranged from 23.0% to 67.7%. The
mean prevalence was 34.9% (reflecting the central trend of the estimates found in the studies). The prevalence of
current tobacco use ranged from 2.4% to 22.0%, and the mean prevalence was 9.3%. A large proportion of the
studies estimated prevalences of frequent alcohol use (66.7%) and heavy alcohol use (36.8%) of more than 10%. Objective: To analyze alcohol and tobacco use among Brazilian adolescents and identify higher-risk subgroups.
Methods: A systematic review of the literature was conducted. Searches were performed using four databases
(LILACS, MEDLINE /PubMed, Web of Science, and Google Scholar), specialized websites and the references cited in
retrieved articles. The search was done in English and Portuguese and there was no limit on the year of publication
(up to June 2011). From the search, 59 studies met all the inclusion criteria: to involve Brazilian adolescents aged 10-
19 years; to assess the prevalence of alcohol and/or tobacco use; to use questionnaires or structured interviews to
measure the variables of interest; and to be a school or population-based study that used methodological
procedures to ensure representativeness of the target population (i.e. random sampling). Results: The prevalence of
current alcohol use (at the time of the investigation or in the previous month) ranged from 23.0% to 67.7%. The
mean prevalence was 34.9% (refl ecting the central trend of the estimates found in the studies). The prevalence of
current tobacco use ranged from 2.4% to 22.0%, and the mean prevalence was 9.3%. A large proportion of the
studies estimated prevalences of frequent alcohol use (66.7%) and heavy alcohol use (36.8%) of more than 10%. Objective: To integrate the empirical estimates of bisexual behaviour among the bridge population of men who have
sex with men (MSM) in China and their HIV and syphilis prevalences stratified by sexual behaviour. Methods: The
Pubmed, Chinese Biomedical, Chinese National Knowledge Infrastructure, VIP, Wanfang and Google Scholar
databases were searched to January 2011 to identify relevant articles. Data of eligible citations were extracted by
two reviewers. All analyses were performed using Stata 10.0. Results: Forty-nine articles (including 28 739 MSM
subjects) met the selection criteria. Aggregated findings indicated that the estimated prevalence of bisexual
behaviour among MSM in China is 31.2% (95% CI 28.1% to 34.5%). HIV and syphilis prevalences were 5.4% and
11.4%, respectively, among MSM engaging in bisexual behaviour and 3.8% and 9.3% among MSM only having sex
with men. HIV prevalence among MSM engaging in sex with both men and women was significantly higher than in Background: Diabetes may worsen breast cancer prognosis and complicate treatment. No published study to-date
has reviewed the prevalence of diabetes among breast cancer patients. Objectives: We conducted a systematic
review of the literature to examine the prevalence of diabetes diagnosed before or within 3-months of breast cancer
diagnosis. Methods: Searches of Medline, Embase, and Google Scholar and manual searches of bibliographies were
performed up until December 31, 2008. Key words included breast, cancer, and diabetes. We did not restrict to
English-language manuscripts. Studies were selected if women were recently diagnosed with breast cancer (>=1990),
diabetes was reported before or within 3 months of breast cancer diagnosis, and prevalence of diabetes was
reported. Descriptive analyses were performed using SAS version 9. Results: Among 2393 papers, 12 studies met our
selection criteria, representing 63,936 breast cancer patients. Prevalence of diabetes ranged from 1.55% to 16.6%
among breast cancer patients. The average after weighting prevalence values by sample size was 9.72%. The largest
and most robust investigation, a SEER-Medicare analysis of 26,377 breast cancer patients, reported a similar diabetes BACKGROUND: Although diabetic retinopathy (DR) is considered to be a major cause of blindness, this is the first
meta-analysis to investigate the pooled prevalence of DR in mainland China., METHODOLOGY/PRINCIPAL FINDINGS:
We conducted a search of all English reports on population-based studies for the prevalence of DR using Medline,
EMbase, Web of Science, Google (scholar), and all Chinese reports were identified manually and on-line using
CBMDisc, Chongqing VIP database, and CNKI database. A meta-analysis was carried out. The fixed effects model or
random effects model was used as a statistical test for homogeneity. Nineteen studies were included. The
prevalence of DR, non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) in the
pooled general population was 1.3% (95%CI: 0.5%-3.2%), 1.1% (95%CI: 0.6%-2.1%), and 0.1% (95%CI: 0.1%-0.3%),
respectively, but was 23% (95%CI: 17.8%-29.2%), 19.1% (95%CI: 13.6%-26.3%), and 2.8% (95%CI: 1.9%-4.2%) in the
Background: Although diabetic retinopathy (DR) is considered to be a major cause of blindness, this is the first meta-
analysis to investigate the pooled prevalence of DR in mainland China. Methodology/Principal Findings: We
conducted a search of all English reports on population-based studies for the prevalence of DR using Medline,
EMbase, Web of Science, Google (scholar), and all Chinese reports were identified manually and on-line using
CBMDisc, Chongqing VIP database, and CNKI database. A meta-analysis was carried out. The fixed effects model or
random effects model was used as a statistical test for homogeneity. Nineteen studies were included. The
prevalence of DR, non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) in the
pooled general population was 1.3% (95%CI: 0.5%-3.2%), 1.1% (95%CI: 0.6%-2.1%), and 0.1% (95%CI: 0.1%-0.3%),
respectively, but was 23% (95%CI: 17.8%-29.2%), 19.1% (95%CI: 13.6%-26.3%), and 2.8% (95%CI: 1.9%-4.2%) in the BACKGROUND: Hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodefciency virus (HIV) share similar
routes of transmission by sexual intercourse or drug use by parenteral injection, so coinfection is common. This study
aimed to determine the prevalence of coinfection with either HCV or HBV in patients infected with HIV DATA
SOURCES: A meta-analysis was performed to quantify HBV coinfection with HCV in HIV patients. Published studies in
the English and Chinese language medical literature involving cohorts of HIV patients concomitantly infected with
HBV and/or HCV were collected from the PubMed database, ISI Web of Science, the Cochrane library clinical trials
registry, CNKI (China National Knowledge Infrastructure) and Google Scholar, for relevant articles before November
2009. The search was conducted with the following key words: hepatitis C, HCV, hepatitis B, HBV, human
immunodefciency virus, HIV, and coinfection. Data were extracted from relevant studies by two investigators.
RevMan 5.0 software was used to perform the meta-analysis. RESULTS: We identifed 22 studies involving 17 664
patients. Substantial differences in the HCV rate compared to the HBV rate in HIV patients were found in the overall BACKGROUND: Hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share similar
routes of transmission by sexual intercourse or drug use by parenteral injection, so coinfection is common. This study
aimed to determine the prevalence of coinfection with either HCV or HBV in patients infected with HIV., DATA
SOURCES: A meta-analysis was performed to quantify HBV coinfection with HCV in HIV patients. Published studies in
the English and Chinese language medical literature involving cohorts of HIV patients concomitantly infected with
HBV and/or HCV were collected from the PubMed database, ISI Web of Science, the Cochrane library clinical trials
registry, CNKI (China National Knowledge Infrastructure) and Google Scholar, for relevant articles before November
2009. The search was conducted with the following key words: hepatitis C, HCV, hepatitis B, HBV, human
immunodeficiency virus, HIV, and coinfection. Data were extracted from relevant studies by two investigators.
RevMan 5.0 software was used to perform the meta-analysis., RESULTS: We identified 22 studies involving 17 664 Background: Hepatitis D Virus (HDV) causes the most threatening form of chronic viral hepatitis. To date, there is no
overall estimation of HDV prevalence in the Eastern Mediterranean Region Office of WHO (EMRO) countries.
Objectives: To provide a clear estimation of HDV prevalence in the aforementioned region. Patients and Methods: In
the current systematic review, databases such as PubMed, Embase, Web of sciences and Google scholar were
searched Until December 2010. The summary estimate of HDV prevalence in the EMRO region was calculated as an
average of the pooled infection prevalence of each country weighted by the ratio of the country's HBV population to
the study's sample size in the survey data analysis. Results: We included 62 eligible studies. The weighted mean of
HDV prevalence in the EMRO region was 14.74% (95% CI: 14.73 - 14.77), 27.8% (95% CI: 27.78 - 27.82), 36.57% (95%
CI: 36.55 - 36.59) and 16.44%. (95% CI: 16.42 - 16.46) in asymptomatic HBsAg positive carriers, chronic hepatitis BACKGROUND: Hepatitis D Virus (HDV) causes the most threatening form of chronic viral hepatitis. To date, there is
no overall estimation of HDV prevalence in the Eastern Mediterranean Region Office of WHO (EMRO) countries.,
OBJECTIVES: To provide a clear estimation of HDV prevalence in the aforementioned region., PATIENTS AND
METHODS: In the current systematic review, databases such as PubMed, Embase, Web of sciences and Google
scholar were searched Until December 2010. The summary estimate of HDV prevalence in the EMRO region was
calculated as an average of the pooled infection prevalence of each country weighted by the ratio of the country's
HBV population to the study's sample size in the survey data analysis., RESULTS: We included 62 eligible studies. The
weighted mean of HDV prevalence in the EMRO region was 14.74% (95% CI: 14.73 - 14.77), 27.8% (95% CI: 27.78 -
27.82), 36.57% (95% CI: 36.55 - 36.59) and 16.44%. (95% CI: 16.42 - 16.46) in asymptomatic HBsAg positive carriers,
Objectives:The aim of this study is to systematically review the published studies and summarize the estimates of
HIV and syphilis prevalences among high school and college student MSM in China in order to provide information
for conducting targeted interventions.Methods:Pubmed, Chinese National Knowledge Infrastructure, Wanfang and
Google Scholar databases were searched in January 2013 to identify relevant articles. Data of eligible citations were
extracted by two reviewers. All analyses were performed using Comprehensive Meta-Analysis V2.0 and SPSS
V17.0.Results:Twenty-four eligible studies (6 in English and 18 in Chinese), published between 2006 and 2012, with a
total of 3083 student MSM participants, were included. The meta-analyses showed that the prevalences of HIV and
syphilis among studied student MSM were 4.4% (95% CI: 3.0%, 6.4%) and 5.7% (95% CI: 4.8%, 6.7%), respectively.
HIV prevalence increased over the study period (3.0% in 2003-2006; 4.5% in 2007-2008, and 6.8% in 2009-2010, Introduction: Italian Ministry of Health recommends vaccination for seasonal influenza to all healthcare workers
(HCW), particularly to nurses who have an important interaction with patients. The aim of this study is to conduct a
systematic review in order to estimate the pooled prevalence of influenza vaccinations among nurses and ancillary
workers in Italy and analyze the enhancing and hindering factors. Results: The review was performed using 15
articles, 6 containing the prevalence of vaccination for nurses and ancillary workers, while the others qualitative
analysis. In all the selected articles the score calculation has been performed by using a protocol for observational
studies. The nurses and ancillary workers pooled proportion of influenza vaccination was respectively 13.47% (95%
CI: 9.58-17.90%) and 12.52% (95% CI: 9.97-15.31%). Discussion: The Italian mean of influenza vaccination prevalence
appear low if compared with other European countries, ranging from 15% to 29% in Countries such as UK, Germany, Background: Obstructive sleep apnea (OSA) is a common disease, affecting approximately 2% of women and 4% of
men residing in Western communities. No systematically reviewed data are available about the prevalence of this
disease in Asia, the most heavily populated continent.Methods: PubMed/Medline, Scopus and Google Scholar were
searched for articles published from 1993 to May 2012 that reported the prevalence of OSA diagnosed via sleep
monitoring and the prevalence of patients at risk for OSA as assessed by symptomatology and/or sleep
questionnaires. We have also searched abstract database of major pulmonary and sleep scientific societies for
relevant abstracts presented from 2010 to 2012. The following inclusion criteria were used: articles published in
English, age >= 18 years, >= 100 participants in studies using sleep monitoring for the diagnosis of OSA, >= 300
participants in studies using questionnaires to detect patients at high risk for OSA. Exclusion criteria: duplicate
publications, studies reporting the prevalence of central sleep apnea only, hospital based studies as well as studies
assessing OSA prevalence among patients with resistant arterial hypertension, chronic kidney disease, heart failure
and in patients with concomitant neurological disease.Results: Twenty four articles were found to meet the inclusion Aims: To review existing literature to estimate the prevalence of Tourette syndrome in schoolchildren. Methods: An
electronic literature search was used to identify existing studies on the prevalence of Tourette syndrome in school
age children. Databases used were Medline 1950 to the present, Embase 1974 to the present, Pubmed 2000,
PsychInfo, Proquest and Google Scholar. Key words used were "Tourette syndrome","Prevalence", "Epidemiology",
"Incidence", "School Child" and "Gilles-de-la-Tourette Syndrome". Results: Tourette prevalence studies use a wide
variation of diagnostic criteria to diagnose Tourette syndrome. These included DSM III and DSM IV criteria. DSM IV
added the criteria that the disturbance caused marked distress and that there had been no "tic" free period of more
than 3 consecutive months. Studies using the DSM IV estimated a lower prevalence rate as they may only have
identified the more severe forms of Tourette syndrome. One large study used the Yale Schedule for ourette s
syndrome and other behavioural studies as iagnostic criteria, while another used the classification and diagnostic Offspring of women with anti-SSA/Ro-SSB/La antibodies are believed to be at risk for congenital heart block (CHB).
Whether this risk can be reduced, and what constitutes standard of care treatment is, however, unclear. The
objective of this review therefore was to determine whether currently proposed standard of care treatments to
avoid CHB in offspring of mothers at risk are evidence-based. To do so, we conducted a review of the literature
under appropriate keywords and phrases in Medline/PubMed and Google Scholar for the years 2000-2013.
Reference lists were further reviewed, and relevant manuscripts were pulled. We also reviewed
www.clinicaltrials.gov for registered studies. In the absence of randomized prospective clinical trials, a meta-analysis
was not feasible. We, therefore, reviewed lower evidence level studies individually. Risk of CHB actually appears
more closely associated with general autoimmunity than, specifically, with SSA/Ro-SSB/La antibodies. This and other
observations raise questions whether CHB is caused by passively transferred maternal autoimmunity, as is currently
widely believed. Observational studies suggest the possible effectiveness of intravenous gamma globulin (IV-Ig) and
Background: Acute kidney injury (AKI) is common in patients undergoing cardiac surgery and is associated with a high
rate of death, long-term sequelae and healthcare costs. We conducted a systematic review of randomized controlled
trials for strategies to prevent or treat AKI in cardiac surgery. Methods: We screened Medline, Scopus, Cochrane
Renal Library, and Google Scholar for randomized controlled trails in cardiac surgery for prevention or treatment of
AKI in adults. Results: We identified 70 studies that contained a total of 5,554 participants published until November
2008. Most studies were small in sample size, were single-center, focused on preventive strategies, and displayed
wide variation in AKI definitions. Only 26% were assessed to be of high quality according to the Jadad criteria. The
types of strategies with possible protective efficacy were dopaminergic agents, vasodilators, anti-inflammatory Objectives. Review of burden of congenital transmission of malaria, challenges of preventive measures, and
implications for health system strengthening in sub-Saharan Africa. Methods. Literature from Pubmed (MEDLINE),
Biomed central, Google Scholar, and Cochrane Database were reviewed. Results. The prevalence of congenital
malaria in sub-Saharan Africa ranges from 0 to 23. Diagnosis and existing preventive measures are constantly
hindered by weak health systems and sociocultural issues. WHO strategic framework for prevention: intermittent
preventive therapy (IPT), insecticide-treated nets (ITNs), and case management of malaria illness and anaemia
remain highly promising; though, specific interventions are required to strengthen the health systems in order to Many perimenopausal women and their medical service providers have turned away from estrogens to treat their
complaints. This mini-review investigated whether women could be prescribed androgens to promote cognitive
function and to prevent dementia. Using PubMed and Google Scholar we identified several treatment studies but the
majority had included insufficient controls. Tentatively some studies suggested that adding a testosterone to
estrogen treatment promoted complex information processing over that of estrogens alone, but methodology of
studies limited firm conclusions. While a larger study showed no effects in naturally menopausal women over that of
placebo, some studies including only oophorectomized women showed positive effects of testosterone but these Despite the proven effectiveness of the prevention of mother to child transmission (PMTCT) of human
immunodeficiency virus (HIV) program, Nigeria currently has the highest burden of vertical transmission of HIV in the
world due to poor coverage of the PMTCT program partly as a result of poor knowledge of PMTCT interventions
amongst healthcare providers in the country. This paper aims at making information on PMTCT interventions more
readily available to healthcare providers in developing countries. The internet was searched using Google and Google
scholar. In addition, relevant electronic journals from the Universities library including PubMed and Scirus, Medline,
Cochrane library, and World Health Organization (WHO)'s Hinari were used. There was paucity of published work on Objective To evaluate the efficacy and safety of antenatal ambroxol as a preventive therapeutic of respiratory
distress syndrome (RDS) in preterm infants. Methods Randomized controlled trials of antenatal ambroxol treatment
for RDS in preterm infants published up to March 2012 were downloaded from the Cochrane Library, PubMed,
EMBASE, Science Citation Index, and Google Scholar databases. Data were evaluated for homogeneity and analyzed
by the Cochrane Collaboration's RevMan software. Result Twelve trials involving a total of 1335 premature infants
were selected for meta-analysis. Neonatal RDS was lower in the ambroxol-treated group than in the groups treated
with placebo (risk ratio [RR] = 0.38, 95% confidence interval [CI]: 0.24 to 0.59) or corticosteroids (RR = 0.49, 95% CI:
0.31 to 0.78). The ambroxol-treated group had lower risk of neonatal infection than the corticosteroid-treated group Objective To evaluate the efficacy and safety of antenatal ambroxol as a preventive therapeutic of respiratory
distress syndrome (RDS) in preterm infants.Methods Randomized controlled trials of antenatal ambroxol treatment
for RDS in preterm infants published up to March 2012 were downloaded from the Cochrane Library, PubMed,
EMBASE, Science Citation Index, and Google Scholar databases. Data were evaluated for homogeneity and analyzed
by the Cochrane Collaboration's RevMan software.Result Twelve trials involving a total of 1335 premature infants
were selected for meta-analysis. Neonatal RDS was lower in the ambroxol-treated group than in the groups treated
with placebo (risk ratio [RR] = 0.38, 95% confidence interval [CI]: 0.24 to 0.59) or corticosteroids (RR = 0.49, 95% CI:
0.31 to 0.78). The ambroxol-treated group had lower risk of neonatal infection than the corticosteroid-treated group Background: Low molecular-weight heparins (LMWHs) are recommended for thromboprophylaxis in major
orthopaedic surgery at high risk of venous thromboembolism events (VTE). The use of LMWHs remains questionable
in traumatologic surgery probably because few randomized clinical trials are available. In addition, none of them,
even meta-analyses, have taken into account the level of surgical risk to assess the benefit risk ratio of LMWH in this
setting. Methods: We performed a comprehensive meta-analysis of all randomised trials comparing LMWH to
placebo or no prophylaxis in patients undergoing traumatologic surgery of lower limb, to assess the efficacy of
LMWHs in reducing clinically relevant outcomes. Studies were retrieved by searching MEDLINE, Google Scholar and
Cochrane Library databases and proceedings of major conferences. The primary endpoint was VTE according to the
EMEA definition (proximal deep-vein-thrombosis or pulmonary embolism or VTE related deaths) on treatment. Major
bleedings were also recorded. Distal traumatology (plastered or not) and ligamentoplasty were considered as
moderate risk surgeries, the others as low risk. Results: A total of 13 studies (4017 patients) were included. The risk
We conducted a review of effectiveness of preventive treatments of iron deficiency anaemia in pregnancy in
developing countries and highlighted their constraints as well as interventions required to strengthen the health
services. Methods. Literature from Pubmed (MEDLINE), AJOL, Google Scholar, and Cochrane database was reviewed.
Evidence-based preventive treatment options for iron deficiency anaemia in pregnancy include prophylaxis iron
supplements and food fortification with iron. Evidence abounds on their effectiveness in reducing the prevalence of
iron deficiency anaemia in pregnancy. However, these prospects are threatened by side effects of iron supplements,
low utilization of maternal health service in developing countries, partial implementation of preventive treatments, Aim of this review is to assess the role and indications for primary sigmoidectomy with direct anastomosis for
diverticulitis comparing it with the Hartmann's procedures. A literature search was performed using MEDLINE
(PubMed), Google Scholar and The Cochrane Library and the articles from January 1990 until June 2011 were
analyzed. All patients were divided into three groups: primary anastomosis (PA), primary anastomosis and stoma
protection (SP) and Hartmann's procedure (HP). Number of patients, overall mortality and morbidity, the rate of
fistulization, the rate of reversal after SP (RSP) and after HP (RHP) and the Hinchey classification have been
considered. The mortality was of 38/1010 patients (3.8%) for PA, 11/153 patients (7.2%) for SP and 139/800 patients
(17.4%) for HP. The morbidity was reported in 103/325 patients (31.7%) in PA, in 23/97 patients (23.7%) in SP and in
290/586 patients (49.5%) in HP. Fistula formation was recorded in 35/625 patients (5.6%) for PA, in 10/149 patients Objective: To evaluate the role of primary antifungal prophylaxis for prevention of cryptococcal meningitis or all-
cause mortality in HIV-infected patients. Design: Systematic review and meta-analysis of randomized trials and
observational studies. Methods: PubMed, Google Scholar, Embase and Cochrane data bases were searched for
studies evaluating if primary antifungal prophylaxis prevents cryptococcal meningitis or all-cause mortality. Quality
assessed using different criteria depending on study type.Publication bias was assessed. Sub-group and sensitivity
analyses were done. Due to homogeneity, results of meta-analysis for prevention of infection gave the fixed-effects
model.The random effects model was used for results of all-cause mortality, due to heterogeneity. Findings: 13
studies assessed for prevention of infection,the summary risk ratio (RR) was 0.2(Fixed effects 95% CI: 0.13-0.30) p <
0.0001. 8 studies assessed for impact on all-cause mortality,the summary RR was 0.95(Random effects 95% CI: 0.76,
1.38) p = 0.613. On subgroup analysis for all-cause mortality, studies in resource limited settings gave a summary RR This paper gives an overview of the literature between 2000 and 2010 on primary retroperitoneal hydatid cyst. We
reported 2 cases of primary retroperitoneal hydatid cyst, and studies published in English literature on hydatid cyst
developing in the retroperitoneal space were accessed via Pubmed and Google Scholar databases. Forty-one
published primary retroperitoneal hydatid cyst cases were evaluated, and 2 patients (1 man, 78 years old; 1 woman,
75 years old) who presented with abdominal mass caused by retroperitoneal hydatid cyst were reported. Twenty-
five of the patients were men (including our patient), and 18 were women; patients ranged in age from 3 to 80 years,
and the median +/- standard deviation age was 41.37 +/- 20.4 years. On presentation, 72% of the patients
complained of back or abdominal pain; 13.9% had urinary tract symptoms, and 65.1% were determined as having a
palpable mass. Ultrasonography was performed on 93% of the patients, computed tomography was performed on
81.4%, magnetic resonance imaging was performed on 18.6%, and intravenous pyelography test was performed on There are two very different ways of executing linear regression analysis. One is Model I, when the x-values are fixed
by the experimenter. The other is Model II, in which the x-values are free to vary and are subject to error. I have
received numerous complaints from biomedical scientists that they have great difficulty in executing Model II linear
regression analysis. This may explain the results of a Google Scholar search, which showed that the authors of
articles in journals of physiology, pharmacology and biochemistry rarely use Model II regression analysis. I repeat my
previous arguments in favour of using least products linear regression analysis for Model II regressions. I review
three methods for executing ordinary least products (OLP) and weighted least products (WLP) regression analysis: (i)
scientific calculator and/or computer spreadsheet; (ii) specific purpose computer programs; and (iii) general purpose
computer programs. Using a scientific calculator and/or computer spreadsheet, it is easy to obtain correct values for Objective: To briefly review the characteristics of prions, the risk of transmission and implications for infection
control in dentistry. Methods: The literature on prion disease in the context of dentistry up to March 2005 was
reviewed using the PubMed, MEDLINE, Cumulative Index to Nursing & Allied Health Literature, Google Scholar
databases and the Web sites of the departments of health of countries affected by the disease. Results: The sporadic
form of Creutzfeldt-Jakob disease (CID) is the most common human prion disease; the mean age of those affected to
date is 68 years, the mortality rate is 85% within 1 year, and the average death rate is 1 per million persons. Variant
CJD (vCJD) affects people (mean age 26 years) with a history of previous extended periods of residence in certain
countries, mainly in the United Kingdom. Currently, there is no evidence of human-to-human transmission of CJD or
vCJD following casual or intimate contact or blood transfusion, nor is there evidence of iatrogenic transmission of
OBJECTIVE: To briefly review the characteristics of prions, the risk of transmission and implications for infection
control in dentistry., METHODS: The literature on prion disease in the context of dentistry up to March 2005 was
reviewed using the PubMed, MEDLINE, Cumulative Index to Nursing & Allied Health Literature, Google Scholar
databases and the Web sites of the departments of health of countries affected by the disease., RESULTS: The
sporadic form of Creutzfeldt-Jakob disease (CJD) is the most common human prion disease; the mean age of those
affected to date is 68 years, the mortality rate is 85% within 1 year, and the average death rate is 1 per million
persons. Variant CJD (vCJD) affects people (mean age 26 years) with a history of previous extended periods of
residence in certain countries, mainly in the United Kingdom. Currently, there is no evidence of human-to-human
transmission of CJD or vCJD following casual or intimate contact or blood transfusion, nor is there evidence of Aim: The study aims to provide an overview of the practice of private duty nurses in Greek hospitals. Background: For
several decades, it has been a necessity for some hospital patients to hire private duty nurses (PDNs) to
counterbalance the inadequacies of hospital infrastructures. In the current economic crisis in Greece, the majority of
patients will not be able to afford to pay for private nursing care. Methods: Databases such as PubMed, CINAHL,
ScienceDirect, Wiley Online Library, Google Scholar and national sources were searched for relevant literature
through a range of keywords. Information gathered was evaluated for relevance and grouped on a thematic basis.
Findings: Five articles met the inclusion criteria. Nearly 90% of PDNs have secondary levels of education or below.
Approximately 15% of patients use PDNs at night due to nurse shortages and inability of their families to stay with
them. Fifty percent of the relatives reported being very unsatisfied with PDN services, while the cost for the use of a Background: Ulcerative colitis (UC) is an acute and inflammatory disease of the large bowel of unknown aetiology.
The use of probiotics for this disease remains controversial. The objective of this systematic review was to identify
studies based on randomised controlled trials comparing the effect of probiotics to the effect of anti-inflammatory
drugs or placebo in the remission of UC. Methods: We conducted a systematic review of clinical trials comparing the
effect of probiotics to the effect of anti-inflammatory treatment or placebo in the remission of UC. PubMed,
ScienceDirect, Cochrane, Google Scholar, metaRegister of Controlled Trials and National Institutes of Health were
searched. Results: Nine studies met the inclusion criteria. These studies present a significant heterogeneity
concerning their methodology and their results. The improvement in UC remission and the frequency of adverse The characteristics of the cognitive processing of food, body and emotional information in patients with anorexia
nervosa (AN) are debatable. We reviewed functional magnetic resonance imaging studies to assess whether there
were consistent neural basis and networks in the studies to date. Searching PubMed, Ovid, Web of Science, The
Cochrane Library and Google Scholar between January 1980 and May 2012, we identified 17 relevant studies.
Activation likelihood estimation was used to perform a quantitative meta-analysis of functional magnetic resonance
imaging studies. For both food stimuli and body stimuli, AN patients showed increased hemodynamic response in the
emotion-related regions (frontal, caudate, uncus, insula and temporal) and decreased activation in the parietal Purpose: Proctalgia fugax (PF) is a benign anorectal condition which has been described in the literature since the
nineteenth century commonly presenting to general surgeons. There is little high level evidence on the subject and
its therapeutic modalities. We aimed through this systematic literature review to outline the definition and
diagnostic criteria of this condition, the aetiology and differential diagnoses and describe the different treatment
modalities that have been attempted and their success. Method: A literature search of Google Scholar and Medline
using Pubmed as the search engine was used to identify all studies directly related to the definition, aetiology and
treatment options for this condition (latest at 12 August 2008) was performed. Results: The search produced 61
references with three others obtained from the references of these papers. The prevalence of PF in the general
population ranges from 4% to 18%. The diagnosis is based on the presence of characteristic symptoms as defined by
Rome III guidelines and physical examination. The mainstay of treatment is reassurance and careful counselling with Context: To better target services to those who may benefit, many guidelines recommend incorporating life
expectancy into clinical decisions. Objective: To assess the quality and limitations of prognostic indices for mortality
in older adults through systematic review. Data Sources: We searched MEDLINE, EMBASE, Cochrane, and Google
Scholar from their inception through November 2011. Study Selection: We included indices if they were validated
and predicted absolute risk of mortality in patients whose average age was 60 years or older. We excluded indices
that estimated intensive care unit, disease-specific, or in-hospital mortality. Data Extraction: For each prognostic
index, we extracted data on clinical setting, potential for bias, generalizability, and accuracy. Results: We reviewed 21
593 titles to identify 16 indices that predict risk of mortality from 6 months to 5 years for older adults in a variety of
clinical settings: the community (6 indices), nursing home (2 indices), and hospital (8 indices). At least 1 measure of
transportability (the index is accurate in more than 1 population) was tested for all but 3 indices. By our measures,
Purpose: Although recognized as a predictor of poor prognosis in several other cancers, the role of lymphovascular
invasion (LVI) as a prognostic factor for biochemical recurrence in prostate cancer remains controversial. We
performed a comprehensive systematic literature review of studies examining the association between
lymphovascular invasion in prostatectomy specimens and prostate cancer recurrence. Ovid MEDLlNE, Embase, Web
of Knowledge, Cochrane Database of Systematic Reviews, Database of Abstracts of Review of Effects (DARE) and
Google Scholar were searched from January 2000 to February 2009. The primary outcome of interest was
biochemical recurrence measured by serum prostate specific antigen (PSA). Materials and Methods: 1248 unique
papers met our search criteria. Of these, 26 articles reported results of multivariate analysis to evaluate LVI as an
independent prognostic factor of biochemical recurrence. Twelve (46%) of these studies concluded that LVI was an
independent prognostic factor and 14 (54%) studies concluded that LVI was not. Significant heterogeneity in the Study Type - Prognosis (systematic review) Level of Evidence 1a What's known on the subject? and What does the
study add? Prognostic factors such as serum PSA, tumor T stage, and Gleason grading are commonly used to predict
disease progression and mortality in prostate cancer and to guide treatment decision-making. These markers are
combined to define risk strata that are commonly accepted in practice. Despite the assignment of patients to a
specific risk stratum (e.g. intermediate-risk disease), however, within-stratum survival duration varies considerably,
suggesting that many other factors, including lymphovascular invasion (LVI) may influence prognosis. LVI is currently
a recognized prognostic factor in the management of some cancers (e.g. in early-stage breast cancer) and prostate
cancer is known to spread via lymphatic channels. Furthermore, the reporting of microscopic lymphovascular
invasion is now considered part of the standard pathologic report of prostatectomy specimens. Nevertheless,
scientific studies in this area have produced conflicting conclusions regarding the utility of LVI as a prognostic
indicator in prostate cancer. This paper provides a comprehensive review and synthesis of the recent literature.
Although a number of studies examining the role of LVI as an independent prognostic factor for biochemical
recurrence in prostate cancer have been reported, the characteristics, quality and results of these studies vary
considerably. The value of using LVI as a prognostic factor in prostate cancer remains unclear. This study provides a
systematically-performed synthesis of the results of recent research including lymphovascular invasion (LVI) in the
multivariate analyses of potential prostate cancer prognostic factors. Not only do we report on the results of these
studies, we assess the heterogeneity of the study populations, disease characteristics, and quality of the studies.
Ultimately, we determined that meta-analysis of the existing data is not possible, and thus, there is no 'best
estimate' of the strength of association between LVI status and disease recurrence after prostatectomy. Most
studies, but not all, reveal a weak or statistically insignificant association between LVI status and recurrence. We
therefore conclude with a recommendation to clinicians that they should not overweight the importance of LVI
status on clinical prognostication. The use of LVI status as a strong predictor of clinical outcomes is not
recommended. OBJECTIVES To synthesize the results of studies including lymphovascular invasion (LVI) in the Background: Data regarding the use of corticosteroids for the prevention of post-endoscopic retrograde
cholangiopancreatography (ERCP) pancreatitis are conflicting. The aim of this meta-analysis was to compare
corticosteroids with placebo for prevention of post-ERCP pancreatitis. Methods: Multiple databases including
MEDLINE, EMBASE, Cochrane controlled trials register, the Cochrane Library, Science Citation Index, Google Scholar
and Google updated to June 2007 were searched to retrieve the relevant randomized controlled trials. Primary
outcome measure was post-ERCP pancreatitis. Results: Six randomized controlled trials involving 2,448 patients were OBJECTIVES: The aim of this study was to assess the efficacy of a prophylactic intra-aortic balloon pump (IABP) in
high-risk patients undergoing coronary artery bypass graft surgery. METHODS: MEDLINE, EMBASE, CENTRAL/CCTR,
SciELO, LILACS, Google Scholar, and reference lists of relevant articles were searched. We included only randomized
controlled trials. Assessments for eligibility, relevance, and study validity and data extraction were performed in
duplicate using prespecified criteria. Meta-analysis was carried out using fixed-effect and random-effect models.
RESULTS: Seven publications fulfilled our eligibility criteria. There was no important statistical heterogeneity or
publication bias among included studies. In total, 177 patients received prophylactic IABP and 168 did not. Overall
relative risk (RR) for hospital mortality in patients treated with prophylactic IABP was 0.255 [95% confidence interval
(CI), 0.122-0.533; P<0.001; same results for both effect models]. Pooled RR for postoperative low cardiac output
syndrome was 0.206 (95% CI, 0.109-0.389; P<0.001) for the fixed-effect model and 0.219 (95% CI, 0.095-0.504;
Background: Human papillomavirus (HPV) is now known to be a necessary cause of cervical cancer, and prophylactic
HPV vaccines aimed at preventing genital warts, precancerous cervical lesions and cervical cancer are now available.
To gauge the potential impact on disease burden, we performed a systematic review of the evidence from
randomized controlled trials. Methods: We conducted a systematic search of the literature to identify all randomized
controlled trials of prophylactic HPV vaccination. Reports in 5 electronic databases covering 1950 to June 2007
(MEDLINE, MEDLINE in process, EMBASE, the Cochrane Central Registry of Controlled Trials and the Cochrane
Library), bibliographies of all included studies and of narrative reviews (2006-2007), clinical trial registries, Google
Scholar, public health announcements, selected conference proceedings (2004-2007) and manufacturers'
information on unpublished data or ongoing trials were screened against predefined eligibility criteria by 2
independent reviewers. Vaccines had to contain coverage against at least 1 oncogenic HPV strain. The primary
outcome of interest was the frequency of high-grade cervical lesions (high-grade squamous intraepithelial lesion, or
grade 2 or 3 cervical intraepithelial neoplasia). The secondary outcomes were persistent HPV infection, low-grade
cervical lesions (low-grade squamous intraepithelial lesion or grade 1 cervical intraepithelial neoplasia), external
genital lesions, adverse events and death. Meta-analysis of the data was done in all cases where adequate clinical
and methodological homogeneity existed. Results: Of 456 screened reports, 9 were included in the review (6 were Prostate cancer is the most prevalent cancer and the second leading cause of cancer death in men. There are various
modalities for treatment of prostate cancer. Immunotherapy with several vaccines and antibodies has also been
successfully used with positive clinical outcome in prostate cancer patients. The majority of these vaccines are
palliative and have been employed when a person is already diagnosed with prostate cancer. The aim of this article is
to review various vaccines that have been examined for immunoprophylactic prevention of
initiation/development/metastasis of prostate cancer. The Pubmed database and Google Scholar search identified 26
articles on various vaccines that have been investigated for prophylactic prevention of cancer development. These OBJECTIVE: To understand the forces propelling countries to legislate universal health insurance. DATA
SOURCE/STUDY DESIGN: Descriptive review and exploratory synthesis of historic data on economic, geographic,
socio-demographic, and political factors., DATA EXTRACTION METHODS: We searched under "insurance, health" on
MEDLINE and Google Scholar, and we reviewed relevant books and articles via a snowball approach., PRINCIPAL
FINDINGS: Ten countries with universal health insurance were studied. For the five countries that passed final
universal insurance laws prior to 1958, we found that two forces of "historical context" (i.e., social solidarity and
historic patterns), one "ongoing dynamic force" (political pressures), and "one uniqueness of the moment" force
(legislative permissiveness) played a major role. For the five countries that passed final legislation between 1967 and
2010, the predominant factors were two "ongoing dynamic forces" (economic pressures and political pressures) and Objective. To understand the forces propelling countries to legislate universal health insurance. Data Source/Study
Design. Descriptive review and exploratory synthesis of historic data on economic, geographic, socio-demographic,
and political factors. Data Extraction .We searched under "insurance, health" on MEDLINE and Google Scholar, and
we reviewed relevant books and articles via a snowball approach. Principal Findings. Ten countries with universal
health insurance were studied. For the five countries that passed final universal insurance laws prior to 1958, we
found that two forces of "historical context" (i.e., social solidarity and historic patterns), one "ongoing dynamic
force" (political pressures), and "one uniqueness of the moment" force (legislative permissiveness) played a major
role. For the five countries that passed final legislation between 1967 and 2010, the predominant factors were two PURPOSE: To develop a model of the optimal mentoring environment for medical residents. The authors propose
that such an environment is a function of a relationship that rests upon a set of interactional foundations that allow a
protege to capitalize on the strengths of the mentor, and it facilitates behaviors that will enable the protege to
develop and internalize the requisite knowledge, skills, and attitudes (KSAs) as fully as possible. METHOD: The
authors searched the literature using Web of Science and Google Scholar in 2007-2008 to identify articles addressing
the mentoring process and the context in which it occurs (mentoring environment), and the effect both have on KSA
development. The authors distilled the attributes of a good mentor that were consistent across the 20 papers that
met inclusion criteria and described good mentoring of residents or curricula for training mentors or residents.
RESULTS: The authors identified six interactional foundations that underlie the optimal mentoring relationship:
emotional safety, support, protege-centeredness, informality, responsiveness, and respect. These foundations
BACKGROUND: Infantile hemangiomas are benign vascular neoplasms that can cause numerous functional or
cosmetic problems. The authors reviewed the pathogenesis of hemangioma and compared the efficacy and
complications related to therapy with propranolol versus corticosteroids., METHODS: A comprehensive review of the
literature was conducted from 1965 to March of 2012 using MEDLINE, PubMed, Ovid, Cochrane Review database,
and Google Scholar. All articles were reviewed for reports of clinical cases, reported side effects, doses, duration of
treatment, number of patients, and response rate to treatment., RESULTS: A total of 1162 studies were identified. Of
those, only 56 articles met inclusion criteria after review by two independent reviewers (A.I. and J.K.). For the meta-
analysis, 16 studies comprising 2629 patients and 25 studies comprising 795 patients were included. Less than 90
percent of patients treated with corticosteroids responded to therapy, compared with 99 percent of patients treated
with propranolol after 12 months of follow-up. Meta-analysis demonstrated the corticosteroid studies to have a Infantile hemangiomas are benign vascular neoplasms that can cause numerous functional or cosmetic problems.
The authors reviewed the pathogenesis of hemangioma and compared the efficacy and complications related to
therapy with propranolol versus corticosteroids. A comprehensive review of the literature was conducted from 1965
to March of 2012 using MEDLINE, PubMed, Ovid, Cochrane Review database, and Google Scholar. All articles were
reviewed for reports of clinical cases, reported side effects, doses, duration of treatment, number of patients, and
response rate to treatment. A total of 1162 studies were identified. Of those, only 56 articles met inclusion criteria
after review by two independent reviewers (A.I. and J.K.). For the meta-analysis, 16 studies comprising 2629 patients
and 25 studies comprising 795 patients were included. Less than 90 percent of patients treated with corticosteroids
responded to therapy, compared with 99 percent of patients treated with propranolol after 12 months of follow-up.
Meta-analysis demonstrated the corticosteroid studies to have a pooled response rate of 69 percent versus the Background: Considering the pivotal role of negative emotional experiences in the development and persistence of
mental disorders, interfering with the consolidation/reconsolidation of such experiences would open the door to a
novel treatment approach in psychiatry. We conducted a meta-analysis on the experimental evidence regarding the
capacity of the beta-blocker propranolol to block the consolidation/ reconsolidation of emotional memories in
healthy adults. Methods: Selected studies consisted of randomized, double-blind experiments assessing long-term
memory for emotional material in healthy adults and involved at least 1 propranolol and 1 placebo condition. We
searched PsycInfo, PubMed, Web of Science, Cochrane Central, PILOTS, Google Scholar and clinicaltrials.org for
eligible studies from the period 1995-2012. Ten consolidation (n = 259) and 8 reconsolidation (n = 308) experiments
met the inclusion criteria. We calculated effect sizes (Hedges g) using a random effects model. Results: Compared
with placebo, propranolol given before memory consolidation reduced subsequent recall for negatively valenced
stories, pictures and word lists (Hedges g = 0.44, 95% confidence interval [CI] 0.14-0.74). Propranolol before
reconsolidation also reduced subsequent recall for negatively valenced emotional words and the expression of cue- Background: Ghrelin is an endogenous ligand of the growth hormone secretagogue receptor (GHS-R) that functions
as a short-term meal initiator and a long-term energy balance regulator. Antagonizing GHS-R could be a method to
treat obesity. Objective: To review the published in vivo characterization of GHS-R antagonists between 2005 and
2008 and evaluate the validity of antagonizing GHS-R as a therapeutic strategy for obesity. Methods: Primary
literature was searched using SciFinder and Google Scholar. Patents were searched using the European Patent Office
and SciFinder. Results/conclusion: Several classes of small molecule GHS-R antagonists have been reported to be The aim of this article is to systematically review the literature on prosthodontic maintenance requirements of
maxillary implant overdentures with different prosthodontic designs. A standard approach of searching MEDLINE,
PubMed, and Google Scholar databases as well as early online journal articles was followed. Hand-searching
identified other relevant articles from the reference lists of the articles found. Selection criteria were details of
prosthodontic maintenance related to different prosthodontic designs of maxillary implant overdentures, regardless
of the dentition of the opposing arch or prosthesis. From a total of 58 relevant studies identified, only 18 met the
criteria. Several categories were used to document the prosthodontic maintenance of maxillary implant
overdentures, usually with four or more splinted or unsplinted implants using different attachment systems. Aspects
of patrix and matrix maintenance were primarily reported, although soft tissue complications were described
frequently. Subjective information on relines and the rationale for minimizing overdenture fractures was found.
PURPOSE: The aim of this article is to systematically review the literature on prosthodontic maintenance
requirements of maxillary implant overdentures with different prosthodontic designs., MATERIALS AND METHODS: A
standard approach of searching MEDLINE, PubMed, and Google Scholar databases as well as early online journal
articles was followed. Hand-searching identified other relevant articles from the reference lists of the articles found.
Selection criteria were details of prosthodontic maintenance related to different prosthodontic designs of maxillary
implant overdentures, regardless of the dentition of the opposing arch or prosthesis., RESULTS: From a total of 58
relevant studies identified, only 18 met the criteria. Several categories were used to document the prosthodontic
maintenance of maxillary implant overdentures, usually with four or more splinted or unsplinted implants using
different attachment systems. Aspects of patrix and matrix maintenance were primarily reported, although soft
tissue complications were described frequently. Subjective information on relines and the rationale for minimizing Objective: The relationship between protein Z levels and thrombosis is controversial. We performed a systematic
review and meta-analysis of all the available studies to assess the association between protein Z and vascular
thrombotic diseases. Methods: We conducted an electronic literature search through MedLine, Embase, Google
Scholar, Web of Science, The Cochrane Library, bibliographies of retrieved articles and abstracts of congresses up to
May, 2009. Studies were included if they analysed protein Z levels in patients with vascular thrombotic diseases.
Results: After the review process 28 case-control studies (33 cohort of patients) were included in the final analysis.
These studies included 4,218 patients with thrombotic diseases as compared to 4,778 controls. The cumulative
analysis for all the studies under a fixed-effects model showed that patients with low protein Z levels are at increased
risk of occurring a thrombotic event (OR 1.87, 95%CI 1.62-2.15; p<0.00001). By subgrouping studies according to the The rate of preterm birth is a public health concern worldwide because it is increasing and efforts to prevent it have
failed. We report a Clinically Relevant Complex Systematic Review (CSCSR) designed to identify and evaluate the best
available evidence in support of the association between periodontal status in women and pregnancy outcome of
preterm low birth weight. We hypothesize that the traditional limits of research synthesis must be expanded to
incorporate a translational component. As a proof-of-concept model, we propose that this CSCSR can yield greater
validity of efficacy and effectiveness through supplementing its recommendations with data of the proteomic
signature of periodontal disease in pregnancy, which can contribute to addressing specifically the predictive validity
for adverse outcomes. For this CRCSR, systematic reviews were identified through The National Library of
MedicinePubmed, The Cochrane library, CINAHL, Google Scholar, Web of Science, and the American Dental
Association web library. Independent reviewers quantified the relevance and quality of this literature with R- Warfarin-related intracranial hemorrhage carries a high mortality and poor neurological outcome. Rapid reversal of
coagulopathy is a cornerstone of medical therapy to halt bleeding progression; however the optimal approach
remains undefined. Prothrombin complex concentrates have promising features that may rapidly reverse
coagulopathy, but remain relatively unstudied. We aim to review the literature regarding the use of prothrombin
complex concentrates in patients with warfarin-related intracranial hemorrhage. A comprehensive review of the
literature was conducted using PUBMED and Google Scholar databases to identify the use of PCC in patients with
warfarin-related intracranial hemorrhage. The characteristics abstracted included the type of PCC, dosing, study
design, type of intracranial hemorrhage, changes in the INR, and adverse effects. Prothrombin complex concentrates Background/Aims: Both proton pump inhibitor (PPI) and histamine-2-receptor antagonist (H2RA) are considered to
be effective for the treatment of iatrogenic gastric ulcer after endoscopic mucosal resection (EMR) or endoscopic
submucosal dissection (ESD). We aimed to systematically evaluate the evidence comparing PPI and H2RA for
iatrogenic ulcer. Methods: Data from PubMed, Cochrane Library and Google Scholar were searched to identify
eligible randomized trials. Outcome measures were delayed bleeding, epigastric pain and ulcer healing. Results: Six
full-text studies were identified including a total of 522 patients. Pooled data suggested a significantly lower bleeding
rate in the PPI group than in the H2RA group (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.25-0.95). Subgroup
analysis showed PPI was more effective in the prevention of bleeding than H2RA for ESD-induced ulcer (OR 0.41,
Study Design. Systematic review. Objective. To review the literature on proximal junctional kyphosis (PJK) as a
specific form for proximal adjacent segment pathology and report on the incidence, timing, risk factors, and effect on
health-related quality of life (HRQOL) outcomes reported for PJK. Summary of Background Data. PJK is a complication
of spinal deformity surgery that can compromise outcomes and necessitate revision surgery. Multiple risk factors
have been associated with PJK, making the etiology multifactorial. Knowledge of the risk factors is important for
minimizing the occurrence of PJK and to allow surgeons to take measures for its prevention when possible. Methods.
A systematic search of PubMed, CINAHL, EMBASE, the Cochrane Library, and Google Scholar through February 15,
2012, was performed. The focus was on studies designed to evaluate PJK in patients who had surgery for scoliosis
and/or kyphosis. Adjusted effect sizes and significance based on adjusting for confounders were reported if available,
otherwise, crude risk ratios and 95% confidence intervals were calculated. Results. The search yielded 85 citations
and 8 met the criteria for inclusion. The incidence of PJK ranged from 17% to 39% and the majority seemed to occur
within 2 years of surgery. The most common patient demographic associated with a higher PJK risk was increased
age. Surgery-related risk factors were fusions to the sacrum, combined anterior/posterior surgery, thoracoplasty, and
upper instrumented vertebra at T1-T3. Postoperative hypokyphosis or hyperkyphosis was associated with an Background: Pseudoaneurysms after carotid endarterectomy (CEA) or stenting (CAS) are uncommon with an
incidence of less than 1% and are associated with stroke, thrombosis, bleeding, infection and focal cranial nerve
compression. Methods: We describe a case of CEA who presented with restenosis and carotid pseudoaneurysm
formation after 10 years. He was successfully treated via endovascular deployment of a carotid Wallstent. A search
of the English-language literature using the databases Ovid-MEDLINE, PubMed, and Google Scholar was conducted.
We collected clinical information including the etiology of the pseudoaneurysm, presenting features, timing of
development, type of treatment and final outcome. Result: We identified 66 reports describing 171 cases of post-
CEA pseudoaneurysm and 2 cases of post-CAS pseudoaneurysm. Eighty were male, 28 were female, and 65 were non-
specified. The mean age was 69 + 5 years. In 75% of CEA patients, arteriotomy closure was performed using synthetic
patch. Primary closure and closure using a vein patch were performed in 17% and 8%, respectively. Timing of
presentation of the carotid pseudoaneurysm varied from 2 days to 22 years after revascularization. The most
common presenting symptom was an enlarging neck mass. Thirty percent of cases had infection. Eleven percent of Background: Pseudomonas aeruginosa is a gram negative facultative anaerobe and well-documented scourge of
immunocompromised patient populations. Objective: To study the prevalence and predisposing conditions for
Pseudomonas aeruginosa infections of cartilaginous structures. Method and results: We conducted an exhaustive
search of the current literature using PubMed, Ovid, and Google Scholar. The various clinical entities of pseudomonal Context: Solid-cystic pseudopapillary tumor of the pancreas is a rare tumor, but has favorable prognosis even in the
presence of distant metastases. It is often associated with diagnostic and therapeutic challenges. Case reports:
Described are two cases of solidcystic pseudopapillary tumor of the pancreas managed in our hospital between
January 2000 and January 2010. One female and one male with mean age of 42 years (range: 33 to 51 years). Data
collected were: presenting symptoms, signs, imaging and management. Literature review was obtained from
computer generated MEDLINE and Google Scholar search for solid-cystic pseudopapillary tumor of the pancreas
between 1980 and 2010. Articles relevant to the scope of this paper were selected. The incidence of solidcystic
pseudopapillary tumors of the pancreas in our institution is 2 cases in 10 years; i.e., 0.2 cases/year. Clinical
presentation include; palpable abdominal mass, vague abdominal discomfort, increasing abdominal girth, significant
weight loss, nausea and vomiting in both patients. The mean diameter of the tumors was 7.0 cm (range: 5.9 to 8.0 Objectives: The burden experienced by caregivers of patients with bipolar disorder has been associated with
increased caregiver depression, anxiety and mental health service use. As caregiver burden is also associated with
poor patient outcome, these findings may indicate a source of distress not only for caregivers, but also for patients.
This review presents what is currently known about psychiatric symptoms in this population and suggests directions
for future research. Methods: Computerized databases Medline, Pubmed, PsychINFO and Google Scholar were
searched using the keywords 'bipolar disorder', 'manic-depressive disorder', 'caregiver', 'caregiver burden', 'family',
'couple', 'spouse' and 'partner.' Of these, publications both measuring and reporting psychiatric symptoms or mental
health service use in adult caregivers were included. Results: Twenty four (24) papers were analyzed. Thirteen (13) of
these papers measured general psychiatric distress, 2 measured anxiety symptoms, 9 reported mood symptoms and
8 reported increased mental health service use. 21 total papers reported clinical significance of least one category of
psychiatric distress. Significant findings include up to 46% of caregivers reporting depression and up to 32.4%
reporting mental health service use. Data suggest that caregiver psychiatric symptoms depend on the nature of the
BACKGROUND: No consensus exists on the optimal treatment for irritable bowel syndrome (IBS). Psychological
treatments are increasingly advocated but their effectiveness is unclear. OBJECTIVES: To evaluate the efficacy of
psychological interventions for the treatment of irritable bowel syndrome. SEARCH STRATEGY: A computer assisted
search of MEDLINE, EMBASE, PsychInfo, CINAHL, Web of Science, The Cochrane Library and Google Scholar was
performed for the years 1966-2008. Local databases were searched in Europe. SELECTION CRITERIA: Randomised
trials comparing single psychological interventions with either usual care or mock interventions in patients over 16
years of age. No language criterion was applied. DATA COLLECTION AND ANALYSIS: The search identified 25 studies
that fulfilled the inclusion criteria. The relative risk (RR), risk difference (RD), number needed to treat (NNT) and
standardized mean difference (SMD) along with 95% confidence intervals were calculated using a random effects
model for each outcome. MAIN RESULTS: Psychological interventions as a group The SMD for symptom score
improvement at 2 and 3 months was 0.97 (95% CI 0.29 to 1.65) and 0.62 (95% CI 0.45 to 0.79) respectively compared
to usual care. Against placebo, the SMDs were 0.71 (95% CI 0.08 to 1.33) and -0.17 (95% CI -0.45 to 0.11)
respectively. For improvement of abdominal pain, the SMDs at 2 and 3 months were 0.54 (95%CI 0.10 to 0.98) and
0.26 (95% CI 0.07 to 0.45) compared to usual care. The SMD from placebo at 3 months was 0.31 (95% CI -0.16 to
0.79). For improvement in quality of life, the SMD from usual care at 2 and 3 months was 0.47 (95%CI 0.11 to 0.84)
and 0.31 (95%CI -0.16 to 0.77) respectively. Cognitive behavioural therapy The SMD for symptom score improvement
at 2 and 3 months was 0.75 (95% CI -0.20 to 1.70) and 0.58 (95% CI 0.36 to 0.79) respectively compared to usual
care. Against placebo, the SMDs were 0.68 (95% CI -0.01 to 1.36) and -0.17 (95% CI -0.45 to 0.11) respectively. For
improvement of abdominal pain, the SMDs at 2 and 3 months were 0.45 (95% CI 0.00 to 0.91) and 0.22 (95% CI -0.04 Background: Early diagnosis and intervention for people with dementia is increasingly considered a priority, but
practitioners are concerned with the effects of earlier diagnosis and interventions on patients and caregivers. This
systematic review evaluates the qualitative evidence about how people accommodate and adapt to the diagnosis of
dementia and its immediate consequences, to guide practice. Methods and Findings: We systematically reviewed
qualitative studies exploring experiences of community-dwelling individuals with dementia, and their carers, around
diagnosis and the transition to becoming a person with dementia. We searched PubMed, PsychINFO, Embase,
CINAHL, and the British Nursing Index (all searched in May 2010 with no date restrictions; PubMed search updated in
February 2012), checked reference lists, and undertook citation searches in PubMed and Google Scholar (ongoing to
September 2011). We used thematic synthesis to identify key themes, commonalities, barriers to earlier diagnosis,
and support identified as helpful. We identified 126 papers reporting 102 studies including a total of 3,095
participants. Three overarching themes emerged from our analysis: (1) pathways through diagnosis, including its
impact on identity, roles, and relationships; (2) resolving conflicts to accommodate a diagnosis, including the Background: Many previous studies argue that the Adjustment Disorder is the most prevalent mental syndrome in
patients with cancer. However the research about the psychological treatment for this disorder is scarce. The aim of
this study was to evaluate the efficacy of psychological treatments in Adjustment Disorder for oncological patients.
We systematically reviewed the randomized controlled trials of psychological interventions for this specific
population. Previous related reviews include less specific studies in terms of patients and interventions selected.
Methods: Electronic searches were carried out. To identify randomized studies that were published up to 2012, we
have searched in the following databases: PubMed, PsycINFO and the Cochrane Central Register of Controlled Trials.
The search strategy included the following terms: cancer, adjustment disorder, oncology, psychotherapy,
psychosocial interventions and stress. Additionally, we have searched in Scholar Google to find gray literature. The
study designs, participants, treatments and outcome characteristics of the studies were coded and evaluated by two Background: Psychosis and HIV/AIDS are comorbid in some subjects. Their association might be simply coexisting or
complex - psychosis enhances the risk to contract or protract HIV infection, and HIV/AIDS increases the risk to
develop psychosis in terms direct effect of HIV on CNS or prescribed medications. Objective: This review focused on
the association of psychosis and HIV/AIDS with conceptual issues in their coexistence and management. Method: A
literature review was conducted using PubMed and Google Scholar databases from 1970 to January 2012 to identify
studies focused on HIV, AIDS, psychosis, psychiatric disturbances and side effects of antiretroviral therapy and
antipsychotics. Results: We review the limited research available on association of HIV and psychosis. Up to one-
fourth of the subjects (3%-23%) with psychotic disorders were HIV positive. In contrast, the prevalence of new-onset
psychosis among patients with HIV infection ranges 0.23-15.2%. Psychosis is also found to be associated with medical
As smoke-free car policy is a frontier domain for tobacco control, attitudes to smoke-free private car laws are briefly
reviewed. Medline and Google Scholar searches for the period up to mid-November 2008, from English language
sources, were undertaken. Studies were included that contained data from national and subna- tional populations
(eg, in states and provinces), but not for smaller administrative units, eg, cities or councils. Jurisdiction, sample size
and survey questions were assessed. One reviewer conducted the data extraction and both authors conducted
assessments. A total of 15 relevant studies (from 1988) were identified, set in North America, the UK and Australasia.
The available data indicates that, for the jurisdictions with data, there is majority public support for laws requiring
cars that contain children to be smoke free. There appears to be an increase over time in this support. In five surveys BACKGROUND: Ethics is a discipline, which primarily deals with what is moral and immoral behavior. Public Health
Ethics is translation of ethical theories and concepts into practice to address complex multidimensional public health
problems. The primary purpose of this paper was to conduct a narrative literature review-addressing role of ethics in
developing curriculum in programs and schools of public health, ethics-related instruction in schools and programs of
public health and the role of ethics in developing a competent public health workforce., METHODS: An open search
of various health databases including Google scholar and Ebscohost yielded 15 articles related to use of ethics in
public health practice or public health training and the salient features were reported., RESULTS: Results indicated a
variable amount of ethics' related training in schools and programs of public health along with public health
practitioner training across the nation. Bioethics, medical ethics and public health ethics were found to be
subspecialties' needing separate ethical frameworks to guide decision making., CONCLUSIONS: Ethics based Review of public health perspectives of preeclampsia in developing countries and implications for health system
strengthening. Literature from Pubmed (MEDLINE), AJOL, Google Scholar, and Cochrane database were reviewed.
The prevalence of preeclampsia in developing countries ranges from 1.8% to 16.7%. Many challenges exist in the
prediction, prevention, and management of preeclampsia. Promising prophylactic measures like low-dose aspirin and
calcium supplementation need further evidence before recommendation for use in developing countries. Treatment
remains prenatal care, timely diagnosis, proper management, and timely delivery. Prevailing household, community, OBJECTIVE: To assess the risk of mass casualties and necessary public health and provider preparation relating to
maritime terrorist attacks on the US ports. DESIGN: Articles were obtained by searching PubMed database, Google,
and Google Scholar search engines using terms such as "maritime security," "maritime terrorism,""port security,"
"terrorist attacks on the U.S. ports," "terrorist nuclear attacks," "terrorist attacks on liquefied natural gas tankers,"
and "terrorist attack on high occupancy ships." SETTING: U.S. ports and coastal waters. RESULTS: Seventy-six journal To assess the changes in weather and weather-associated disturbances related to global warming; the impact on
human health of these changes; and the public health preparedness mandated by this impact. Qualitative review of
the literature. Articles will be obtained by searching PubMed database, Google, and Google Scholar search engines
using terms such as "global warming," "climate change," "human health," "public health," and "preparedness." Sixty-
seven journal articles were reviewed. The projections and signs of global environmental changes are worrisome, and
there are reasons to believe that related information may have been conservatively interpreted and presented in the
recent past. Although the challenges are great, there are many opportunities for devising beneficial solutions at
individual, community, and global levels. It is essential for public health professionals to become involved in This is a systematic review of studies about the public image of or attitudes toward mental health professionals,
particularly psychologists, psychiatrists, and psychotherapists (including psychoanalysts) on the basis of
computerized medical and psychological databases (PsycLIT, Pub Med, Google Scholar) and their cross-references
with 43 new articles. It is an update of an older meta-content analysis of the same topic (N= 60 primary studies)
which analyzed studies, published between 1948 and 1995. Data about their perceived social status, field of activity
and clinical expertise, their sex/gender and physical appearance, personality and social interaction (especially those
between therapists and clients), their work setting and about differential effects are presented. It becomes obvious
that there exists a "shrink"-stereotype, which refers equally to psychologists, psychotherapists and psychiatrists, and Background: Public reporting of patient health outcomes offers the potential to incentivize quality improvement by
fostering increased accountability among providers. Voluntary reporting of risk-adjusted outcomes in cardiac
surgery, for example, is viewed as a "watershed event" in healthcare accountability. However, public reporting of
outcomes, cost, and quality information in orthopaedic surgery remains limited by comparison, attributable in part to
the lack of standard assessment methods and metrics, provider fear of inadequate adjustment of health outcomes
for patient characteristics (risk adjustment), and historically weak market demand for this type of information.
Questions/purposes: We review the origins of public reporting of outcomes in surgical care, identify existing
initiatives specific to orthopaedics, outline the challenges and opportunities, and propose recommendations for
public reporting of orthopaedic outcomes. Methods: We performed a comprehensive review of the literature
through a bibliographic search of MEDLINE and Google Scholar databases from January 1990 to December 2010 to
identify articles related to public reporting of surgical outcomes. Results: Orthopaedic-specific quality reporting
efforts include the early FDA adverse event reporting MedWatch program and the involvement of surgeons in the
Background: Full publication of RCTs presented as abstracts in scientific meetings may reduce publication bias,
facilitate systematic reviews, and expedite implementation of therapeutic interventions in guidelines and clinical
practice. We sought to compare the publication rates of positive and negative RCTs presented at recent ASCO Annual
Meetings. Methods: We used the ASCO Website to identify all phase III RCTs in colorectal cancer accepted for ASCO
Annual Meetings 1999-2006. We searched for full publications using PubMed (1999-current) and Google Scholar.
Exclusion criteria were systematic reviews, combined/post-hoc analysis and interim/preliminary results. For each
trial, data were summarized for presentation status, sample size, endpoints, type of analysis, participating
organizations, pharmaceutical sponsorship, time to publication, journal impact factor (JCR 2008) of published trials
and citations by Google Scholar. A positive trial was defined when the primary endpoint rejected the null hypothesis.
Results: Wefound 199 phase III abstracts during the 8-year period, 102 of which met the eligibility criteria. By Kaplan-
Meier, the 5-year cumulative publication rates were 73,1% and 59,3% for positive and negative trials (p = 0.009). The
median time to publication for pharmaceutical industry-sponsored and government-funded trials were 21 and 40 Objective To assess the extent of research publication misrepresentation among otolaryngology residency applicants
and to determine applicant attributes associated with misrepresentation. Study Design Prospective study. Setting A
single otolaryngology residency program. Subjects and Methods Electronic Residency Application Service (ERAS)
applications to the incoming 2010 class of an otolaryngology residency program were reviewed for peer-reviewed
journal publications reported as "provisionally accepted," "accepted," or "in print." Publications were verified by
searching PubMed, Google Scholar, and electronic journals. Applicants with remaining unverified publications were e-
mailed before announcing interviews. Erroneously reported or unverifiable publications were considered
misrepresented. Results There were 432 publications reported by 173 of 325 applicants (53.2%). Twenty-two
publications (5.1%) were misrepresented by 17 applicants (9.8%). Contacting applicants verified 26 publications and
identified 10 errors. Seven publications were inappropriately reported as provisionally accepted, three articles were
not peer-reviewed, and applicants were erroneously listed as first author on two publications. Ten publications
remained unverifiable. Multivariate logistic regression models showed that being an international medical graduate OBJECTIVE: To assess the extent of research publication misrepresentation among otolaryngology residency
applicants and to determine applicant attributes associated with misrepresentation., STUDY DESIGN: Prospective
study., SETTING: A single otolaryngology residency program., SUBJECTS AND METHODS: Electronic Residency
Application Service (ERAS) applications to the incoming 2010 class of an otolaryngology residency program were
reviewed for peer-reviewed journal publications reported as "provisionally accepted," "accepted," or "in print."
Publications were verified by searching PubMed, Google Scholar, and electronic journals. Applicants with remaining
unverified publications were e-mailed before announcing interviews. Erroneously reported or unverifiable
publications were considered misrepresented., RESULTS: There were 432 publications reported by 173 of 325
applicants (53.2%). Twenty-two publications (5.1%) were misrepresented by 17 applicants (9.8%). Contacting
applicants verified 26 publications and identified 10 errors. Seven publications were inappropriately reported as
provisionally accepted, three articles were not peer-reviewed, and applicants were erroneously listed as first author
on two publications. Ten publications remained unverifiable. Multivariate logistic regression models showed that Objectives. To determine the publication rate of abstracts submitted at the national scientific meetings of medical
students in Peru between 2002 and 2009, and associated factors. Materials and methods. A retrospective cohort was
performed; the characteristics of overall abstract submitted were assessed. In addition, whether they were published
in scientific journals was determined by way of a search strategy validated using Google Scholar. Crude and adjusted
relative risks (RR) were calculated using Poisson regression with robust variance to assess association with the
analyzed factors. Results. 532 abstracts were analyzed, 52 (9.8%) of which were published in scientific journals after
their presentation at a scientific meeting. All of them were published in Peruvian journals written in Spanish. The
most important journal in which they were published was Ciencia e Investigacion Medica Estudiantil Latinoamericana
(CIMEL) (13/52). The median of publication time was 13 months (range: 0-75). The fact that a student from the OBJECTIVES: To determine the publication rate of abstracts submitted at the national scientific meetings of medical
students in Peru between 2002 and 2009, and associated factors., MATERIALS AND METHODS: A retrospective
cohort was performed; the characteristics of overall abstract submitted were assessed. In addition, whether they
were published in scientific journals was determined by way of a search strategy validated using Google Scholar.
Crude and adjusted relative risks (RR) were calculated using Poisson regression with robust variance to assess
association with the analyzed factors., RESULTS: 532 abstracts were analyzed, 52 (9.8%) of which were published in
scientific journals after their presentation at a scientific meeting. All of them were published in Peruvian journals
written in Spanish. The most important journal in which they were published was Ciencia e Investigacion Medica
Estudiantil Latinoamericana (CIMEL) (13/52). The median of publication time was 13 months (range: 0-75). The fact
We analysed 580 articles (original articles only) published in Medical Journal of Malaysia between 2004 and 2008,
the resources referenced by the articles and the citations and impact received. Our aim was to examine article and
author productivity, the age of references used and impact of the journal. Publication data was obtained from MyAIS
database and Google Scholar provided the citation data. From the 580 articles analyzed, contributors mainly come
from the hospitals, universities and clinics. Contributions from foreign authors are low. The useful lives of references Many research abstracts presented at orthopaedic conferences do not undergo a formal editorial, or peer-review
process; however, abstracts are frequently referenced in textbooks and influence clinical practice. The purpose of
this study was to determine the publication rate of abstracts formally presented at the Society of Military
Orthopaedic Surgeons (SOMOS) annual meetings from 1998 to 2006 that went to full-text publication. Using Google
Scholar and PubMed, a literature search was performed for each abstract presented at the annual SOMOS meeting
in the years 1998-2006, to calculate the overall full-text publication rate, the average duration from presentation to
publication, and the distribution of publications in the various journals. A total of 770 abstracts were presented at
the annual SOMOS meetings. The overall full-text publication rate at a minimum of 3 years was 45.7% (352 Presentation at national and international meetings is a useful way to disseminate new information. Publication in a
peer-reviewed journal remains the gold standard. We analyzed the publication rates of oral presentations from the
British and European Hip Society, British Orthopaedic Association, and European Federation of Orthopaedics and
Traumatology between 2003 and 2006. Multiple databases were used to identify publication of work presented as an
abstract at these meetings. The publishing journal, time until publication, impact factor of publishing journal, and
rate of publication identified by each database were analyzed. The overall mean publication rate across the 4
meetings was 23.4%; there were no significant differences between the meetings. Google Scholar (P<.01) and
Medline (P<.05) identified significantly more publications than EMBASE. There were no significant differences BACKGROUND: Earlier studies have indicated that across medical specialties, the overall publication rate of
submitted manuscripts ranges from 36% to 66%. However, there have not been any recent studies conducted
concerning the publication rates specifically for the Pediatric Orthopaedic Society of North America (POSNA).
Consequently, the purpose of our study was to determine the overall publication rates of abstracts presented during
the POSNA annual meetings, and whether there were differences in publication rates and time to publication
according to type of presentation (podium vs. poster), journal, and orthopaedic subspecialty. METHODS: A
comprehensive literature search using PubMed and Google Scholar for all abstracts (including podiums, posters, and
e-posters) presented at the 2002 to 2006 POSNA annual meetings was performed. Abstracts were classified
according to presentation type: podium, poster, or e-posters, and were subsequently categorized into a specific
orthopaedic subspecialty: basic science, hip, lower extremities, spine, trauma, and upper extremity. RESULTS: A total
of 762 abstracts were presented at POSNA meetings between the years of 2002 and 2006. Of these 762 abstracts,
386 (50.7%) were published in peer-reviewed literature. There was no significant variation in the yearly publication
percentage rate between 2002 and 2006 (P=0.63). However, overall time between presentation at POSNA and
publication in a peer-reviewed journal varied significantly by year (P=0.002), with the average time to publication
being 29 months in 2002, compared with 18.8 months in 2006. Time to publication also varied significantly by journal Traditionally, the most commonly used source of bibliometric data is the Thomson ISI Web of Knowledge, in
particular the (Social) Science Citation Index and the Journal Citation Reports, which provide the yearly Journal
Impact Factors. This database used for the evaluation of researchers is not advantageous in the humanities, mainly
because books, conference papers, and non-English journals, which are an important part of scientific activity, are
not (well) covered. This paper presents the use of an alternative source of data, Google Scholar, and its benefits in
calculating citation metrics in the humanities. Because of its broader range of data sources, the use of Google Scholar
generally results in more comprehensive citation coverage in the humanities. This presentation compares and INTRODUCTION: The aim of this survey was to illustrate statistical information about endodontic research published
in pubmed index journals from the different universities of Iran., MATERIALS AND METHODS: A PubMed search was
performed to retrieve the endodontic publications of authors affiliated to different universities of Iran. Abstracts
were reviewed and unrelated articles were omitted. Citation of each article was obtained from Scopus and Google
scholar databases. Data were extracted and transferred to Microsoft Excel to determine the related scintometric
indicators., RESULTS: A total of 307 papers were found according to the defined criteria which shows considerable
increase from 2 papers in 1992 to 54 in 2011. The majority of the papers (48%) were related to in vitro studies; this
number was 33% for in vivo surveys. Meta-analysis, systematic review and clinical trial constituted 10% of all
Background: There has been considerable controversy and several changes in guidelines for the basic life support
(BLS) management of choking since the introduction of the Heimlich procedure in 1974. Objectives: The objective of
this project was to conduct a structured literature review to answer the question, "For adults, either conscious or
unconscious, with obstructed airway, does any specific resuscitation techniques compared to currently
recommended techniques, lead to different outcomes?" Methods: We searched MEDLINE using a complex search
criterion. We performed further searches on the basis of articles cited in references and by using the 'Cited by'
function in Google Scholar. We included articles if they addressed a therapy for choking in adults. We excluded
articles if they addressed only pediatric patients, if there was no comparison group, or if the skills involved were
beyond BLS. We collected data using a standardized study selection and data extraction form. This included specific
criteria to grade the level of evidence (LOE) and quality of each paper. Results: We identified 475 records after
duplicates were removed; we screened all of these and excluded 454. This left 22 full-text articles which we assessed
for eligibility; we excluded 19 of these, leaving 3 studies that we included in qualitative synthesis. Of these, data from Summary: MEDLINE is one of the most important bibliographical information sources for biologists and medical
workers. Its PubMed interface supports Boolean queries, which are potentially expressive and exact. However,
PubMed is also designed to support simplicity of use at the expense of query expressiveness and exactness. Many
PubMed users have never tried explicit Boolean queries. We developed a Java program, PubMed Assistant, to make
literature access easier in several ways. PubMed Assistant provides an interface that efficiently displays information The four most popular search engines PubMed/MEDLINE, ScienceDirect, Scopus and Google Scholar are investigated
to assess which search engine is most effective for literature research in laser medicine. Their search features are
described and the results of a performance test are compared according to the criteria (1) recall, (2) precision, and
(3) importance. As expected, the search features provided by PubMed/MEDLINE with a comprehensive investigation
of medical documents are found to be exceptional compared to the other search engines. However the most To evaluate the clinical effectiveness of pulsed electromagnetic field therapy in the treatment of knee osteoarthritis.
Based on the principles and methods of Cochrane systematic reviews, the authors searched the Cochrane Library
(2012, 2 issue), PubMed (1966 to February, 2012), EMBASE (1974 to February, 2012), Chinese Biomedicine Database
(1978 to February, 2012), China Journal Full-text Database (1979 to February, 2012), VIP database (1989 to February,
2012), as well as search engine Google Scholar. Randomized controlled trials (RCTs) of pulsed electromagnetic field
therapy to treat knee osteoarthritis were included. The authors assessed the quality of the included trials according
to the Cochrane Handbook for Systematic Reviews of Interventions Version. The Cochrane Collaboration's software
RevMan 5.1 was used for meta-analysis. Five RCTs totaling 331 patients were included. The results showed that
compared with placebo control treatment, pulsed electromagnetic field therapy had little clinical benefit in relieving OBJECTIVE: To evaluate the clinical effectiveness of pulsed electromagnetic field therapy in the treatment of knee
osteoarthritis., METHODS: Based on the principles and methods of Cochrane systematic reviews, the authors
searched the Cochrane Library (2012, 2 issue), PubMed (1966 to February, 2012), EMBASE (1974 to February, 2012),
Chinese Biomedicine Database (1978 to February, 2012), China Journal Full-text Database (1979 to February, 2012),
VIP database (1989 to February, 2012), as well as search engine Google Scholar. Randomized controlled trials (RCTs)
of pulsed electromagnetic field therapy to treat knee osteoarthritis were included. The authors assessed the quality
of the included trials according to the Cochrane Handbook for Systematic Reviews of Interventions Version. The
Cochrane Collaboration's software RevMan 5.1 was used for meta-analysis., RESULTS: Five RCTs totaling 331 patients
were included. The results showed that compared with placebo control treatment, pulsed electromagnetic field Incidence of surgical site infection (SSI) following loop ileostomy reversal can reach 41%. Variations on primary linear
closure (PLC) include delayed primary closure, antibiotic implants and purse-string approximation (PSA). The optimal
approach remains to be determined. This meta-analysis compares outcomes with primary closure versus purse-string
approximation for loop ileostomy reversal. A literature search of Embase, the Cochrane database, Google Scholar
and Medline was performed to identify studies comparing PLC with PSA published between 1966 and 2011. Reviews
of each study were conducted, and data were extracted. Random effects methods were used to combine data and
between-study heterogeneity was assessed. Data is presented as odds ratio (OR) with 95% confidence interval (CI).
Six out of 40 identified studies met the inclusion criteria (n = 369 patients); one randomized controlled trial and five
case controlled series. For the primary outcome of SSI rate, 217 patients in the PLC and 152 patients in the PSA
Aim. This paper is a report of a methodological review of language appropriate practice in qualitative research, when
language groups were not determined prior to participant recruitment. Background. When older people from
multiple language groups participate in research using in-depth interviews, additional challenges are posed for the
trustworthiness of findings. This raises the question of how such challenges are addressed. Data sources. The
Cumulative Index to Nursing and Allied Health Literature, Scopus, Embase, Web of Science, Ageline, PsycINFO,
Sociological abstracts, Google Scholar and Allied and Complementary Medicine databases were systematically
searched for the period 1840 to September 2009. The combined search terms of 'ethnic', 'cultural', 'aged', 'health'
and 'qualitative' were used. Review methods. In this methodological review, studies were independently appraised
by two authors using a quality appraisal tool developed for the review, based on a protocol from the McMaster
University Occupational Therapy Evidence-Based Practice Research Group. Results. Nine studies were included. BACKGROUND: Numerous projects, initiatives, and programs are dedicated to the development of Electronic Health
Records (EHR) worldwide. Increasingly more of these plans have recently been brought from a scientific environment
to real life applications. In this context, quality is a crucial factor with regard to the acceptance and utility of
Electronic Health Records. However, the dissemination of the existing quality approaches is often rather limited.,
OBJECTIVES: The present paper aims at the description and comparison of the current major quality certification
approaches to EHRs., METHODS: A literature analysis was carried out in order to identify the relevant publications
with regard to EHR quality certification. PubMed, ACM Digital Library, IEEExplore, CiteSeer, and Google (Scholar)
were used to collect relevant sources. The documents that were obtained were analyzed using techniques of
qualitative content analysis., RESULTS: The analysis discusses and compares the quality approaches of CCHIT, Aims: Gastroenterology practice guideline steering committees have incorporated data from phase III clinical trials
presented in abstract form in guideline development. If valid, a notable benefit of abstract incorporation into
guidelines is that they may reduce publication bias and provide early treatment alterations that may have significant
impact on patient morbidity and mortality. Our objectives were to: 1) evaluate publication rates of complete articles
after abstract presentation, 2) evaluate consistency in the results between abstracts and successive journal
publication, and 3) examine factors that predict publication success. Methods: All abstracts accepted at the Digestive
Diseases Week between 1998-2003 describing phase III randomized controlled trials (RCTs) in Inflammatory Bowel
Disease therapeutics were identified. Medline, Pubmed (1997-current), and Google Scholar were searched for all
subsequent publications in English. Numerous abstract and publication attributes were extracted and analysed.
These included characteristics of the abstracts and papers (e.g. authors, number of centers, significance of results,
funding, time to publication, etc.), study design issues (e.g. objective and/or hypothesis, sample size, statistical
methodology, primary outcome), and characteristics crucial to gauge the quality of RCTs (e.g. method of
randomization, concealment, blinding, ITT, etc.). Results: Our search of over 19,000 abstracts yielded 82 eligible
abstracts and 64 subsequent publications (78% publication success rate). Currently, an interim analysis has been Background: The incorporation of abstracts from scientific meetings into systematic reviews and practice guidelines
may reduce publication bias and delays in implementing therapeutic interventions. Methods: All abstracts of Phase III
randomized controlled trials in inflammatory bowel disease accepted at Digestive Disease Week (1998-2003) were
identified. MedLine, PubMed (1997-current), EMBASE, and Google Scholar were searched for subsequent full
publications. Characteristics of methodology and outcomes of the abstracts and articles were analyzed. Results: The
5-year cumulative publication rate of the 82 eligible abstracts was 78%. Abstracts that presented negative results
were less likely to be published than those with positive findings, particularly after the first 2 years (hazard ratio 6.45;
95% confidence interval [CI]: 2.22-18.7) with 5-year cumulative publication rates of (50% versus 91%, respectively, P
< 0.001). The median time to publication was longer for negative than positive abstracts (58 versus 26 months, P <
0.001). Abstracts selected for oral presentation were more likely to be published than poster presentations (89% Purpose: This article aims to provide a literature review on the use of quality function deployment (QFD) in
healthcare and a case study in order to provide contextual knowledge as a means of improving applications of QFD in
healthcare. Design/methodology/approach: The literature search was done via Google Scholar, PubMed/MEDLINE,
and Web of Science using the keywords "quality function deployment" and "healthcare"; focusing on journal
publications and their related citations. The case study was done within a design for Six Sigma project (DFSS) in a
Swedish hospital. Empirical data were collected through face-to-face interviews and project documentation.
Findings: Four potentials (better understanding of customers' needs and wants, identification of opportunities for
process improvement, effective system thinking approach, and better communication and more transparent
process) and three antecedents (understanding the customer, understanding the customer's needs, and finding ways
to prioritize and translate those needs) of QFD application in healthcare were identified from the literature review.
From the case study, the application of QFD leads to an increased awareness of a complex multiple-customer
concept, traceability of the improvement strategies in a more structured way, and the formation of a new process
Background: Colorectal cancer (CRC) is the second most common and forth most common cancer death worldwide.
Screening has been shown to reduce CRC incidence and its mortality. The role of nurse endoscopists (NE) in CRC
screening is increasing but quality outcomes have not been systematically reported. We aimed to evaluate the
performance of nurse endoscopists in colorectal cancer screening. Aim and Methods: We performed a systematic
search of English language articles in British Nursing Index, CINAHL, EMBASE, All EBM Reviews, Ovid MEDLINE and
Google Scholar from 1946 to August 2012. We included studies that have reported adenoma detection rate (ADR),
and had compared performance between medical endoscopists (ME) and nurse endoscopists. The primary outcome
was ADR and secondary outcomes were cecal intubation rates (in colonoscopy studies) and complication rates.
Results: The search identified 1583 articles. Two randomized controlled trials (RCT) and four observational studies
enrolling a total of 5347 patients were included. There were two studies on colonoscopy and four on flexible
sigmoidoscopy. The median ADR of NE was 17.2%, ranged from 6% to 42% and ME was 16.5%, ranged from 8% to Objectives: To evaluate quality of life at least 12 months after discharge from the intensive care unit of adult critically
ill patients, to evaluate the methodology used to assess long-term quality of life, and to give an overview of factors
influencing quality of life. Data sources: EMBASE-PubMed, MEDLINE (OVID), SCI/Web of Science, the Cochrane
Library, Google Scholar, and personal files. Data extraction: Data extraction was performed independently and cross-
checked by two reviewers using a predefined data extraction form. Eligible studies were published between 1999
and 2009 and assessed quality of life >=12 months after intensive care unit discharge by means of the Medical
Outcomes Study 36-Item Short Form Health Survey, the RAND 36-Item Health Survey, EuroQol-5D, and/or the
Nottingham Health Profile in adult intensive care unit patients. DATA SYNTHESIS:: Fifty-three articles (10
multicenters) were included, with the majority of studies performed in Europe (68%). The Medical Outcomes Study
36-Item Short Form Health Survey was used in 55%, and the EuroQol-5D, the Nottingham Health Profile, the RAND
36-Item Health Survey, or a combination was used in 21%, 9%, 8%, or 8%, respectively. A response rate of >=80%
was attained in 26 studies (49%). Critically ill patients had a lower quality of life than an age- and gender-matched
population, but quality of life tended to improve over years. The worst reductions in quality of life were seen in cases Online pharmacies are companies that sell pharmaceutical preparations, including prescription-only drugs, on the
Internet. Very little is known about this phenomenon because many online pharmacies operate from remote
countries, where legal bases and business practices are largely inaccessible to international research. The aim of the
study was to perform an up-to-date and comprehensive review of the scientific literature focusing on the broader
picture of online pharmacies by scanning several scientific and institutional databases, with no publication time
limits. We searched 4 electronic databases up to January 2011 and the gray literature on the Internet using the
Google search engine and its tool Google Scholar. We also investigated the official websites of institutional agencies
(World Health Organization, and US and European centers for disease control and drug regulation authorities). We
focused specifically on online pharmacies offering prescription-only drugs. We decided to analyze and report only
articles with original data, in order to review all the available data regarding online pharmacies and their usage. We
selected 193 relevant articles: 76 articles with original data, and 117 articles without original data (editorials,
regulation articles, or the like) including 5 reviews. The articles with original data cover samples of online pharmacies
in 47 cases, online drug purchases in 13, consumer characteristics in 15, and case reports on adverse effects of online
drugs in 12. The studies show that random samples with no specific limits to prescription requirements found that at
least some websites sold drugs without a prescription and that an online questionnaire was a frequent tool to Purpose: To evaluate the methodological quality of randomized controlled trials (RCTs) published in Intensive Care
Medicine from 2001 to 2010, and to compare it with a previous review of RCTs published from 1975 to 2000.
Methods: We assessed the quality of reporting of randomization, blinding and participant flow, both individually and
combined within the Jadad scale, and compared them with findings from our previous review. For RCTs published
from 2001 to 2010, we also evaluated the frequency of distorted finding presentation (spin) and inflated predicted
treatment effect (delta inflation). Results: In the 221 RCTs from 2001 to 2010, the sample size was significantly larger
than in the older series, and there was a higher proportion of studies with negative findings. Reporting of the
rationale for sample size estimation and allocation concealment increased significantly, but reporting of other
important individual methodological components did not change substantially compared with the previous period
and remained low. Among RCTs from 2001 to 2010, a spin strategy was used in 69 of 111 RCTs with statistically
Background: Every year since 2000, the journal Academic Emergency Medicine (AEM) has presented a one-day
consensus conference devoted to generating a research agenda for advancement of a scientific topic of interest to
the readership of AEM. One of the 12 annual issues of AEM is reserved for the proceedings of the conferences.
Quantitatively, downstream gains in terms of funding and scholarly output from these conferences are unknown.
Objectives: We evaluated the academic productivity of the consensus conferences, as quantified by 1) subsequent
federal research funding received by authors of conference-related manuscripts, and 2) citation counts of consensus
conference papers. Methods: We conducted a cross-sectional study during August and September 2012. NIH
RePORTER was searched to identify subsequent federal funding obtained by contributing authors to the articles in
the consensus conference issues from 2000 to 2010. Funded projects were coded by two investigators as related or
unrelated to the consensus conference topic. Citation counts for all conference manuscripts were quantified using
Scopus and Google Scholar. Simple descriptive statistics were reported. Results: There were 852 individual authors
contributing to 280 papers published in the 11 consensus conference issues. Of these, 137 authors (16%) obtained
funding for 318 individual projects, totaling $329,392,017. There was a median of 22 topic-related projects per Background: The practice of evidence-based medicine depends upon the publication of high quality clinical studies.
However, publication bias may act to exclude some trials from contributing to the knowledge base. The influence of
such biases upon the evidence base is often unknown as clinicians have no way of knowing the results of unreported
studies. ClinicalTrials.gov was commissioned in 2000. In 2005 the ICMJE announced that publication of trials would
be limited to trials registered with a public registry prior to commencing. Aim: We aimed to quantify reporting biases
present within the CF literature. Method: We interrogated ClinicalTrials.gov using 'cystic fibrosis' as the keyword,
limited to interventional studies that had been closed. We searched PubMed, the Cochrane Central Register of
Controlled Trials and Google Scholar for publications using ClinicalTrials.gov ID, study title and Chief Investigator Background: Carbamazepine has been used as AEDs since 1965, and is most effective against partial seizures. Two
basic mechanisms of action have been proposed: 1) enhancement of sodium channel inactivation by reducing high-
frequency repetitive firing of action potentials, 2) and action on synaptic transmission. The aim of this study was to
provide a review of carbamazepine pharmacokinetics and its management guidelines in Iranian epileptic population.
Materials and Methods: Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO),
Web of Science were searched; 1600, 722 and 167 research and review articles relevant to the topics;
carbamazepine pharmacokinetics, carbamazepine pharmacokinetics in epilepsy and review on carbamazepine
pharmacokinetics in epilepsy were found, respectively. Results: Carbamazepine is highly bound to plasma proteins. In
patients the protein-bound fraction ranged from 75-80% of the total plasma concentration. Bioavailability ranges
from 75-85%. The rate or extent of absorption was not be affected by food. It is completely metabolized and the
main metabolite is carbamazepine-epoxide (CBZ-E). Carbamazepine induces its own metabolism, leading to BACKGROUND: Quit and Win contests were developed in the 1980s by the Minnesota Heart Health Program, and
have been widely used since then as a population-based smoking cessation intervention at local, national and
international level. Since 1994 an international contest has been held every two years in as many as 80 countries
(2002). OBJECTIVES: To determine whether quit and win contests can deliver higher long-term quit rates than
baseline community quit rates.To assess the impact of such programmes, we considered both the quit rates achieved
by participants, and the population impact, which takes into account the proportion of the target population
entering the contest. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group Specialized Register,
with additional searches of MEDLINE, EMBASE, CINAHL, PsycINFO and Google Scholar. Search terms included
competition*, quit and win, quit to win, contest*, prize*. Most recent search date was November 2007. SELECTION
CRITERIA: We considered randomized controlled trials, allocating individuals or communities to experimental or
control conditions. We also considered controlled studies with baseline and post-intervention measures. DATA
COLLECTION AND ANALYSIS: Data were extracted by one author and checked by the second. We contacted study
authors for additional data where necessary. The main outcome measure was abstinence from smoking for at least
six months from the start of the intervention. We used the most rigorous definition of abstinence in each trial, and
biochemically validated rates where available. We decided against performing a meta-analysis, because of the Using combinations of the key words urolithiasis, kidney stones, race, ethnicity, population group in Google Scholar
and Pubmed, a literature search identified 40 articles. Of these, 33 satisfied the principal inclusion criterion of studies
involving comparison of at least two groups in which there is a perceived difference in stone occurrence. Studies
were classified as "weak" (no attempt to account for inter-racial or inter-ethnic group differences in stone
occurrence), "soft" (speculative explanations reached by default) or "hard" (explanations based on empirically
measured lithogenic risk factors). Only 12 studies (36 %) fell into the latter category. Among these, a wide diversity of
The internal thoracic artery is the most effective conduit for coronary artery bypass surgery; however, most patients
have multivessel disease and require additional saphenous vein or radial artery grafts. In this systematic review of
the literature and meta-analysis, we aim to compare reported patency rates for these conduits and explore if
differences are homogeneous across follow-up intervals. A literature search was performed using Embase, Medline,
Cochrane Library, Google Scholar and randomised controlled trial databases to identify studies published between
1965 and October 2009. All studies reporting angiographic comparison of saphenous vein and radial artery conduit
patency were included, irrespective of language. The end point was angiographic graft patency stratified over
different follow-up intervals. Meta-analysis was performed according to recommendations from the Cochrane
Collaboration and Meta-analysis Of Observational Studies in Epidemiology guidelines. We used a random-effect
model and the odds ratio as the summary statistic. A total of 35 studies were identified. They reported early patency
(<=1 year, 6795 grafts), medium-term patency (1-5 years, 3232 grafts) and long-term patency (>5 years, 1157 grafts). The internal thoracic artery is the most effective conduit for coronary artery bypass surgery; however, most patients
have multivessel disease and require additional saphenous vein or radial artery grafts. In this systematic review of
the literature and meta-analysis, we aim to compare reported patency rates for these conduits and explore if
differences are homogeneous across follow-up intervals. A literature search was performed using Embase, Medline,
Cochrane Library, Google Scholar and randomised controlled trial databases to identify studies published between
1965 and October 2009. All studies reporting angiographic comparison of saphenous vein and radial artery conduit
patency were included, irrespective of language. The end point was angiographic graft patency stratified over
different follow-up intervals. Meta-analysis was performed according to recommendations from the Cochrane
Collaboration and Meta-analysis Of Observational Studies in Epidemiology guidelines. We used a random-effect
model and the odds ratio as the summary statistic. A total of 35 studies were identified. They reported early patency
(<= 1 year, 6795 grafts), medium-term patency (1-5 years, 3232 grafts) and long-term patency (>5 years, 1157
grafts). Significant variation of comparative patency existed across different follow-up intervals. Early saphenous vein To discover the status and structure of radiology in Latin America with respect to the health care systems it is part of,
the effects of socioeconomics, the equipment and technology used, technologists and their training, accreditation,
and professional organizations. Health-related databases and Google Scholar were searched for articles concerning
radiology practice in Latin America. Articles were selected based on relevance to the research scope. Many regions in
Latin America offer little to no access to radiology. Where there is access, the equipment often is old or not
functioning, with limited and costly service and maintenance. Most trained technologists live in urban areas. There
are no standardized accreditation practices in Latin America. However, forming professional organizations would
help promote the practice of radiology and accreditation standards. International cooperative organizations enhance BACKGROUND: During Ramadan, the 9th month in the Hijri lunar calendar, healthy adult Muslims are obliged to fast
from sunrise to sunset. The fast of Ramadan has significant health effects and is the most commonly researched
religious fasting. In this study, we will investigate available findings on the effects of Ramadan fasting on
gastrointestinal (GI) signs, symptoms, and diseases. METHODS: We searched PubMed, Google Scholar, Iran Medex,
and Scientific Information Database (SID) for related articles in English or Farsi. Editorial articles and case reports
were excluded. RESULTS: Of 2312 articles found, 23 articles fulfilled our inclusion criteria and were included.
Ramadan fasting seems to increase peptic ulcer complications (peptic ulcer perforation and bleeding) and have a
deteriorating effect on patients with chronic peptic ulcer diseases on drug therapy, but not on duodenal ulcer
patients under treatment. Healthy individuals might experience minor GI symptoms but no serious complications Objective: To review the pharmacology, pharmacokinetics, clinical efficacy, and safety of ranirestat, an oral aldose
reductase inhibitor with a unique chemical structure, as treatment of diabetic sensorimotor polyneuropathy in
patients with diabetes mellitus. Data Sources: Primary literature and review articles were identified by searching
MEDLINE (1950-June 2008), EMBASE (1991-June 2008), International Pharmaceutical Abstracts (1970-June 2008),
and Google Scholar using the key terms ranirestat, AS-3201, SX-3030, aldose reductase inhibitors, diabetes mellitus,
and peripheral neuropathy. Additional articles were identified from the bibliographies of the obtained literature.
Study Selection and Data Extraction: Reviewed literature was restricted to available English-language articles.
Preclinical and clinical trials were reviewed. One Phase 2 clinical trial and its extension study were identified. No data
have yet been reported from Phase 3 trials that were conducted between 2004 and 2006. Data Synthesis: Ranirestat
is a selective and reversible inhibitor of aldose reductase. Nerve damage is reduced by inhibiting this key enzyme in
Numerous studies have evaluated the association between regulated upon activation, normal T cells expressed and
secreted (RANTES) gene polymorphisms (-403G/A and -28C/G) and risk of pediatric asthma. However, the results
have been inconsistent. A meta-analysis of the association between RANTES gene polymorphisms and pediatric
asthma risk was performed in the current study. A search for published literature was conducted in the Google
Scholar, PubMed and the CNKI databases (January 2000 to April 2012) and seven studies were retrieved. The
associations between RANTES gene polymorphisms and pediatric asthma risk were estimated by pooled odds ratio
(OR) and 95% confidence interval (CI) using a fixed-or random-effects model. Meta-analysis results revealed no
significant association between the -403G/A polymorphism and risk of pediatric asthma. In the subgroup analysis by
ethnicity, no association was identified between the -403G/A polymorphism and pediatric asthma risk in Caucasian
and Asian populations. In the -28C/G group, the meta-analysis indicated a significant association between the -28C/G Purpose: Prof Otto Wichterle was one of the most important pioneers of modern soft contact lens industry; his work
has made a significant impact on the ophthalmic world. Fifty years ago, in 1961, Wichterle produced the first soft
contact lenses. Due to his work, nowadays millions of people around the world enjoy comfortable vision correction
with soft contact lenses. This poster honours Wichterle's scientific achievements. Methods: Our poster is based on
an intensive literature research of current and historic literature via PubMed, Google Scholar and Google in order to
document the life and to evaluate the scientific impact of Wichterle's work. Results: Our poster gives an overview of
life and the impact on ophthalmology by the Czechoslovakian chemist Prof Otto Wichterle born in 1913. The most
important steps in the development of soft contact lenses will be shown and the impact on the visual correction of
millions of people with refractive errors will be discussed. Today contact lenses gain more and more importance Background: Medical advances, improved health status, and increased longevity have led to increased elderly in the
society; therefore, the role of rehabilitation centers in the service industry has grown considerably in the two past
decades. Methods: The studies compared types of rehabilitation centers for the treatment of patients with motor or
perception disability and other methods commonly used in rehabilitation, in terms of functional outcomes, Barthel
index, and cost-effectiveness, were evaluated. The Cochrane, CRD (Centre for Reviews and Dissemination), Scopus,
and Google scholar databases were searched until June 2012. Results were analyzed using qualitative method.
Findings: According to 15 included articles, the Barthel index scores in patients with an inpatient rehabilitation (42 +/-
29 points) were more than outpatient rehabilitation (26 +/- 23 points) (P < 0.050). For inpatient centers, early
rehabilitation led to the rapid acquisition of functional abilities than outpatient centers (1.55 vs. 0.50). Regarding to Background: Securing the airway is a core competence in emergency medicine. Nevertheless, airway management
presents a major challenge not only for non- anaesthesiologists but also for anaesthesia experienced emergency
physicians. While patients in elective surgeryare fasted, the emergencypatient is always considered not to be soberly
and requires a corresponding rapid sequence induction (RSI). In addition to a relevant experience in the
implementation of RSI, an optimal preparation of the patient (pre-oxygenation, drug selection, cricoid pressure and
correct head and neck position) minimizes complications. Due to the controversy regarding the best position and
whether the head-up, head-down, or supine position is the safest during induction of anesthesia in full-stomach
patients, we conducted a systematic review and meta-analysis. Methods: We searched the main medical databases
(PubMed, Medline), Google Scholar and Google using combinations of applicable terms ("head", "neck", "position",
"rapid sequence induction", "RSI") for articles published between 01.01.1950 and 30.06.2010. Additionally,
references and related articles were also screened. Literature was analyzed bytwo independent anesthesiologists for Background: The increasing availability of antiretroviral therapy (ART) has improved survival and quality of life for
many infected with HIV, but can also engender drug resistance. This review summarizes the available information on
drug resistance in adults in resource-limited settings. Methods: The online databases PubMed and Google Scholar,
pertinent conference abstracts and references from relevant articles were searched for publications available before
November 2011. Data collected after ART rollout were reviewed. Results: A total of 7 studies fulilled the criteria for
the analysis of acquired drug resistance and 22 fulilled the criteria for the analysis of transmitted drug resistance
(TDR). Acquired resistance was detected in 7.2% of patients on ART for 6-11 months, 11.1% at 12-23 months, 15.0%
at 24-35 months, and 20.7% at >=36 months. Multi-class drug resistance increased steadily with time on ART. The
overall rate of TDR in all resource-limited countries studied was 6.6% (469/7,063). Patients in countries in which ART
Purpose: The average American adult reads at a fifth to eighth-grade level, with wide variability, presenting
challenges for the assessment of self-reported health related quality of life. We identified the health related quality
of life instruments used in patients with urological diseases and evaluated their readability. Materials and Methods:
We focused on the most burdensome urological diseases, based on total expenditures in the United States. We then
identified disease specific instruments by systematically searching PubMed, the Cochrane Database of Systematic
Reviews, Google, Google Scholar, the Patient Reported Outcome and Quality of Life Instruments Database (Mapi
Research Institute, Lyon, France) and Yahoo! for health related quality of life studies in patients with these urological
conditions. Where disease specific instruments were lacking, we noted the general health related quality of life
measures most commonly used. For each instrument, we calculated the median Flesch-Kincaid grade level, the
proportion of questionnaire items below an eighth-grade reading level, the mean Flesch Reading Ease, and the mean
number of words per sentence and characters per word, all of which are validated measures of readability. Results: OBJECTIVES: Regulators and payers view randomized controlled trials (RCT) as the gold standard for establishing the
benefit/risk of new drugs. However, they are increasingly interested in real-world data (RWD) due to their external
validity. This survey explored stakeholders' perceptions and emerging trends in the area of RWD. METHODS: We
identified relevant literature since 2006 via Google Scholar and manual search, and reviewed it based on several
topics: types of RWD, pros and cons of different approaches, and impact of new statistical techniques and
technology on availability and quality of RWD. We then conducted 45-60 min in-depth, semistruc- tured discussions
with 17 experts from Academia, HTA bodies, health insurance, research organizations, and pharmaceutical industry-
from the UK, France, Germany, the The Netherlands, and the United States. Their views about value and future
directions of RWD approaches were elicited. RESULTS: Experts unanimously thought that RCTs would remain a
mandatory approach for the foreseeable future due to the limitations of RWD, mainly potential for confounding.
New study designs (e.g., randomized database studies) and statistical techniques (e.g., high-dimensional propensity Background: The 'reamer-irrigator-aspirator' (RIA) is an innovation developed to reduce fat embolism (FE) and
thermal necrosis (TN) that can occur during reaming/nailing of long-bone fractures. Since its inception its indications
have expanded to include the treatment of long-bone osteomyelitis and as a harvester of bone graft/mesenchymal
stem cells (MSCs). Methods: This study involved a systematic review, via Pubmed and Google Scholar, of English
language sources (nine non-clinical studies, seven clinical studies and seven case reports) using the keywords:
'reamer', 'irrigator', 'aspirator' (1st May 2010). Sources were reviewed with reference to the RIAs efficacy in (1)
preventing FE/TN, (2) treating long-bone osteomyelitis, (3) harvesting bone graft/MSCs, and (4) operating safely.
Experimental data supports the use of the RIA in preventing FE and TN, however, there is a paucity of clinical data. Purpose: Acetaminophen has been for decades recommended as a first line analgesic for osteoarthritis (OA) by
consensus guidelines. However, a recent update of the evidence led OARSI investigators to infer that evidence for its
efficacy has diminished in strength. Furthermore, concerns have also emerged in respect of its safety. We aimed to
reassess the role of acetaminophen, including the extended release formulation, in OA by systematic review and
latest evidence synthesis of studies reporting data on its efficacy and safety. Methods: We searched Medline,
EMBASE, CINAHL, BIOSIS, Google Scholar, ISI Web of Science and Cochrane database from inception to April 2010.
We also hand searched review articles, manuscripts and supplements from medical journals and contacted authors
for unpublished data. We included all human randomized clinical trials comparing acetaminophen with placebo for
OA. Two reviewers (RB, UD) independently performed data extraction and assessed the quality of each trial. We
computed effect sizes for pain, function and stiffness (change from baseline) for each study using Hedges' g statistic
corrected for small sample sizes. Effect sizes were pooled using DerSimonian and Laird random effects model.
Heterogeneity was estimated with the help of I2 statistic. Sub group analyses were undertaken for pain to determine
whether the quality of trials influences the results. Relative risk was calculated for any adverse event, GI events and
withdrawals due to adverse events. Results: The 10 eligible trials included 3004 participants (acetaminophen - 1515;
placebo - 1489) with an age range of 56 to 70 years. They were published between 1983 and 2007. Eight trials used
immediate release acetaminophen and two trials used extended release acetaminophen as an active agent. The
sample sizes varied between 25 and 779 with a mean of 300; 3 trials had a sample size less than 100. Trial duration
Background: Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs) has been perplexing most
clinicians and users of NSAIDs. Rebamipide is increasingly advocated as a candidate option for the prevention of
NSAIDs induced gastrointestinal mucosal injury. Aims: To assess the efficacy and the safety of rebamipide for the
prevention and treatment of NSAID-induced gastroenteropathy. Methods: PubMed, Embase, Web of Science, Google
Scholar, the Cochrane Library, Japan Science and Technology Information Aggregator, and China Biology Medicine
Disc were searched up to December 2011. Randomized controlled trials (RCTs) recruiting subjects with co-
prescriptions of NSAIDs and rebamipide were eligible. Efficacy and safety of rebamipide were reevaluated, and
dichotomous data were pooled to obtain relative risk (RR) with a 95 % confidence interval. Heterogeneity and
publication bias were assessed by the inconsistency index statistic and funnel plot analysis, respectively. Results: The
search identified 338 citations, and 15 RCTs including 965 individuals were eligible. In general, rebamipide acted
better than placebo against short-term NSAID-induced gastroduodenal injury. Separate studies showed rebamipide Anxiety disorders are common and debilitating mental illnesses. Current pharmacological treatments are beset by
problems of poor efficacy and side effect profiles. Increasing understanding of novel neurotransmitter systems and
the interplay between these systems is broadening the scope of anxiolytic drug treatment. This article aims to
describe the areas of current interest and possible future development of anxiolytic drugs by outlining recent patents
in this field. A patent database was searched for 17 neurotransmitters and their synonyms as well as 23 compounds
of recent known interest from May 2003 to May 2005. The internet resources Pubmed and Google Scholar were Anxiety disorders are common and debilitating mental illnesses. Current pharmacological treatments are beset by
problems of poor efficacy and side effect profiles. Increasing understanding of novel neurotransmitter systems and
the interplay between these systems is broadening the scope of anxiolytic drug treatment. This article aims to
describe the areas of current interest and possible future development of anxiolytic drugs by outlining recent patents
in this field. A patent database was searched for 55 neurotransmitters, synonyms as well as compounds of recent
known interest from May 2003 to July 2009. The internet resources Pubmed and Google Scholar were searched for The importance of insulin in the management of diabetes mellitus cannot be over emphasized. Newer formulations
and delivery devices have improved the efficacy, safety and tolerability of insulin. All available insulins and insulin
analogues, however, are administered by subcutaneous insulin. The subcutaneous route of administration is
associated with a certain level of discomfort, which is not acceptable to some patients. This has led researchers to
explore other methods of insulin delivery. Inhaled insulin, nasal insulin and oral insulin are some of the novel insulins
which have been studied. This review highlights recent advances and patents related to oral insulin. It covers the
limitations of subcutaneous insulin, the physiological rationale of administering oral insulin, and the barriers to these
formulations. The review is based on a literature search, done by all authors, using the key words "oral insulin", from Objective: The majority of studies comparing recombinant FSH versus urinary FSH have been done in IVF, and a
number of meta-analysis are available. However, as far as we know, there are no meta-analysis on recombinant FSH
vs urinary FSH in intrauterine insemination. Material and methods: Electronic search in Medline and the Cochrane
Library with a variety of keywords used, including "recombinant FSH", "urinary FSH", "insemination intrauterine" for
the period from 1966 to December 2007. 515 articles were obtained, wich were manually reviewed to select those
comparing the use of urinary FSH or recombinant FSH for ovarian stimulation in IUI cycles. We also reviewed
manually the abstract books of the annual meeting of the ESHRE and the American Society for Reproductive
Medicine from 1998 to 2006. Cross citations were investigated, mainly with Google scholar. Some authors were
contacted to clarify aspects of their work. Meta-analysis was performed following Der- Simonian method. Six
prospective randomized trials were identified. In three of them the same dose was used in rec FSH and urinary FSH Aim: This paper presents a discussion of the role of altruism in development of the discipline of nursing and an
exploration of how nursing altruism compares with current thinking in biological evolutionary theory. There is an
assumption that the role of the nurse has its foundations in altruistic behaviours; however, the source of this
altruism is never analysed or debated. Data sources: A search of the biological altruism, altruism and health-related
literature encompassing the years 1975-2007 was performed using Google Scholar. Discussion: The first element of
the study is a brief overview of nursing altruism as a way of establishing the conceptual boundaries. Additionally, the
major tenets of biological evolution are explored to clarify the theoretical underpinnings of the hypotheses
presented. A key premise of this study is that nursing altruism is not solely a manifestation of disinterested sacrifice
for the benefit of others, but is more concerned with ensuring the survival of a clearly defined social group.
Background: Despite the number of older adults who are being hospitalized with mental health problems, including
dementia, only a very limited number of undergraduate student nurses express the desire to pursue a career in
gerontological mental health nursing once they graduate. The purpose of this pilot study was to explore what the
salient facilitating and constraining factors were for this choice based on the perspectives of undergraduate students
from one Bachelor of Nursing program in an urban Canadian setting. Methods: A major review of refereed journal
articles pertaining to attitudes of student nurses perspectives about caring for older adults was done using CINHAL,
Pub Med, Nursing Consult and Google Scholar. Based on our analysis of key themes of that literature, we developed
a preliminary survey tool to administer to a self -selected (convenience) sample of 120 undergraduate nursing
students in one Canadian University. Results: The major facilitating factors affecting their choice of working with
older adults once they graduated was a history of having a close relationship with a relative who was older,
particularly one's grandparents, and a positive work environment. Salaries were not ranked as an important
incentive. The major constraining factors affecting their choice not to work with older adults were primarily their fear AIM: To examine the association between statin use and the development of esophageal cancer, METHODS: We
performed a systematic review and meta-analysis. Multiple databases (Pubmed, EMBASE, Cochrane Library, Web of
Science, Wiley Interscience and Google Scholar) were systematically searched for studies reporting the association of
statin use and the development of esophageal cancer. Literature searching and data abstraction were performed
independently by two separate researchers. The quality of studies reviewed was evaluated using the Newcastle-
Ottawa Quality assessment scale. Meta-analysis on the relationship between statin use and cancer incidence was
performed. The effect of the combination of statin plus a cyclo-oxygenase inhibitor was also examined., RESULTS:
Eleven studies met eligibility criteria, 9 high and 2 medium quality. All were observational studies. Studies examining
adenocarcinoma development in Barrett's esophagus included 317 cancers and 1999 controls, population-based
studies examining all esophageal cancers included 371203 cancers and 6083150 controls. In the Barrett's population
the use of statins (OR = 0.57; 95%CI: 0.43-0.75) and cyclo-oxygenase inhibitors (OR = 0.59; 95%CI: 0.45-0.77) were Increasing noise in hospital environments, especially in intensive care units (ICUs) and operating rooms (ORs), has
created a formidable challenge for both patients and hospital staff. A major contributing factor for the increasing
noise levels in these environments is the number of false alarms generated by medical devices. This study focuses on
discovering best practices for reducing the number of false clinical alarms in order to increase patient safety and
provide a quiet environment for both work and healing. The researchers reviewed Pub Med, Web of Knowledge and
Google Scholar sources to obtain original journal research and review articles published through January 2012. This
review includes 27 critically important journal articles that address different aspects of medical device alarms
management, including the audibility, identification, urgency mapping, and response time of nursing staff and The clinical effectiveness of intensive lifestyle interventions in preventing or delaying diabetes in people at high risk
has been established from randomised trials of structured, intensive interventions conducted in several countries
over the past two decades. The challenge is to translate them into routine clinical settings. The objective of this
review is to determine whether lifestyle interventions delivered to high-risk adult patients in routine clinical care
settings are feasible and effective in achieving reductions in risk factors for diabetes. Data sources: MEDLINE
(PubMed), EMBASE, CINAHL, The Cochrane Library, Google Scholar, and grey literature were searched for English-
language articles published from January 1990 to August 2009. The reference lists of all articles collected were
checked to ensure that no relevant suitable studies were missed. Study selection: We included RCTs, before/after
evaluations, cohort studies with or without a control group and interrupted time series analyses of lifestyle
interventions with the stated aim of diabetes risk reduction or diabetes prevention, conducted in routine clinical
settings and delivered by healthcare providers such as family physicians, practice nurses, allied health personnel, or
other healthcare staff associated with a health service. Outcomes of interest were weight loss, reduction in waist
circumference, improvement of impaired fasting glucose or oral glucose tolerance test (OGTT) results, improvements
in fat and fibre intakes, increased level of engagement in physical activity and reduction in diabetes incidence. Strengthening exercise for the infraspinatus (IS) muscle is commonly prescribed for rotator cuff, shoulder pathology.
Our present knowledge of IS muscle fiber bundle architecture and innervation suggests three distinct regions. Given
the potential for regionally specific activation of IS, rehabilitation of this muscle may be most effective when
functional distinct regions are targeted by physical therapy. The purpose of this study was to systematically review
the current literature of IS strengthening and exercise prescription and determine if health care practitioners
purposefully target functionally distinct regions of IS. A thorough review of the literature was performed to compile
available data pertaining to IS strengthening and rehabilitation. Medline, PubMed, CINAHL, Embase, Scholar's Portal
and Google Scholar databases were searched to January 2012. A broad range of rehabilitation practices were
described that target the IS muscle. The battery of exercises identified in the literature primarily treated the IS
Background: One supposed benefit of prospective registration of clinical trials is that it should discourage selective or
delayed reporting of trials. We aimed to determine the proportion of registered clinical trials involving participants
with cystic fibrosis that are published and how soon after study completion publication occurs. Methods: In Jan 2011,
we searched the register ClinicalTrials.gov for clinical trials involving participants with cystic fibrosis that were
registered in January 2000 or later and that were completed by December 2008. For each trial identified, we
searched Google Scholar using the names of the investigators and key terms for the study population and
intervention to determine whether the trial had been published by the end of 2010. Results: 240 trials involving
participants with cystic fibrosis had been registered since 1999. Of these, 100 trials were reported on the register as
having been completed by December 2008. Of the 100 completed trials, 64 had been published by December 2010. CONTEXT: High ankle sprains are common in athletes who play contact sports. Most high ankle sprains are treated
nonsurgically with a rehabilitation program., EVIDENCE ACQUISITION: All years of PUBMED, Cochrane Database of
Systematic Reviews, CINAHL PLUS, SPORTDiscuss, Google Scholar, and Web of Science were searched to August
2010, cross-referencing existing publications. Keywords included syndesmosis ankle sprain or high ankle sprain and
the following terms: rehabilitation, treatment, cryotherapy, braces, orthosis, therapeutic modalities, joint
mobilization, massage, pain, pain medications, TENS (ie, transcutaneous electric nerve stimulation), acupuncture,
aquatic therapy, strength, neuromuscular training, perturbation training, and outcomes., RESULTS: Level of evidence,
5. A 3-phase rehabilitation program is described. The acute phase is directed at protecting the joint while minimizing
pain, inflammation, muscle weakness, and loss of motion. Most patients are treated with some form of
immobilization and have weightbearing restrictions. A range of therapeutic modalities are used to minimize pain and This brief review addresses the existing systems and challenges and provides future recommendations on computer-
and biosensor-assisted rehabilitation systems for physically disabled patients. We further list the types of sensors,
technical issues, and different software and hardware technologies that are currently used in rehabilitation systems
to make the whole process dynamic and real-time. The review focused on 36 consolidated studies that were found
using the following keywords: rehabilitation system, sensor, and computer. The electronic databases PubMed,
Scopus, and Google Scholar were searched for relevant articles that were published from 2007 through 2012. These
published articles included discussion of several biosensors, automated rehabilitation systems, and the application of
these systems in the affected body parts of the individuals. We found that 54 types of biosensors have been used for DATA SOURCES: PubMed, Ovid (including OLDMedline), Google Scholar Beta, the Cochrane Library and references of
identified articles were used to identify data sources., STUDY SELECTION: Studies were included if they involved
more than 10 adults, a followup of greater than 6 months, and mandibular advancement by bilateral sagittal split
osteotomy (BSSO) with rigid internal fixation. Studies that included another surgical intervention (eg, Le Fort I
osteotomy), syndromic or medically compromised patients, case reports, case series, descriptive studies, review and
opinion articles or abstracts were excluded., DATA EXTRACTION AND SYNTHESIS: The following data items were
extracted: year of publication, study design, followup, number and mean age of patients, ethnic background of
patients, number of surgeons operating, type of rigid internal fixation, use of MMF (maxillomandibular fixation), use
of genioplasty, mean advancement, mean relapse, correlations between relapse and different variables, proportion
of patients with more than 2 mm of sagittal relapse, and authors' conclusions. A quality assessment of the included
studies was undertaken following selection. Studies were categorised as medium or low quality based on study
design, sample size, selection descriptions, withdrawals, valid methods, confounding factors, method error analysis,
blinding in measurements and adequate statistics. None of the included studies met the criteria of the high-quality The epidemiological evidence for the protective effect of naturally acquired anti-merozoite antibodies against P.
falciparum malaria is conflicting. Some studies report that antigen specific antibodies are associated with protection,
whereas others do not, and study quality and design varies substantially. We performed a systematic review, with
meta-analyses, to evaluate the evidence that supports a role for antibodies to specific merozoite antigens in
protection from P. falciparum malaria in naturally exposed populations. PubMed, Web of Science, Scopus and Google
Scholar were searched for population-based prospective studies examining the association of anti-merozoite
antibodies with incidence risk of P. falciparum malaria. Studies had to attain a minimum inclusion and quality criteria
to be accepted for review, including a rigorous definition of symptomatic malaria. The appraisal of each study for
inclusion and abstraction of data was carried out independently by two review authors. The literature search
identified 70 possible studies according to the title of the paper and information in the abstract. On detailed
examination, only 32 fulfilled the initial inclusion and quality criteria. We also obtained data from a further 2 studies
OBJECTIVES: To investigate the association between proximal colonic neoplasia and distal lesions as a function of the
lesion type. The extent to which health, demographic, and study characteristics moderate this association was also
examined. DATA SOURCES: Google Scholar, Web of Science, Scopus, and PubMed. STUDY ELIGIBILITY CRITERIA:
Studies allowing the calculation of OR of proximal neoplasia(PN) and proximal dvanced neoplasia (PAN) for distal
hyperplastic polyps (HP), nonadvanced adenomas (NAA), adenomas (AD), and advanced neoplasia (AN); also, studies
for which the proportions of subjects with isolated (i.e., not accompanied by distal lesions) PN (IPN) and PAN (IPAN)
over the total number of subjects with PN or PAN could be calculated. STUDY APPRAISAL AND SYNTHESIS METHODS:
Thirty-two studies were included for calculating OR between proximal neoplasia and distal lesions and 40 studies for
proportions of IPN and IPAN. Subgroup analyses were conducted for presence of symptoms, prevalence of PN and
PAN, age, proportion of males, geographic region, study design, and demarcation point. RESULTS: The association
between distal lesions and proximal neoplasia increased with the severity of the distal lesions. Odds of PN were
higher in subjects with HP compared to subjects with a normal distal colon. Odds of PN and PAN were higher in
subjects with NAA, AD, and AN than in subjects with a normal distal colon. PAN were more strongly associated with The objective of this paper is to examine the relationship between the development of executive function (EF) and
obesity in children and adolescents. We reviewed 1,065 unique abstracts: 31 from PubMed, 87 from Google Scholar,
16 from Science Direct, and 931 from PsycINFO. Of those abstracts, 28 met inclusion criteria and were reviewed.
From the articles reviewed, an additional 3 articles were added from article references (N = 31). Twenty-three
studies pertained to EF (2 also studied the prefrontal and orbitofrontal cortices (OFCs); 6 also studied cognitive
function), five studied the relationship between obesity and prefrontal and orbitofrontal cortices, and three
evaluated cognitive function and obesity. Inhibitory control was most often studied in both childhood (76.9%) and
adolescent (72.7%) studies, and obese children performed significantly worse (P < 0.05) than healthy weight controls The objective of this paper is to examine the relationship between the development of executive function (EF) and
obesity in children and adolescents. We reviewed 1,065 unique abstracts: 31 from PubMed, 87 from Google Scholar,
16 from Science Direct, and 931 from PsycINFO. Of those abstracts, 28 met inclusion criteria and were reviewed.
From the articles reviewed, an additional 3 articles were added from article references (N = 31). Twenty-three
studies pertained to EF (2 also studied the prefrontal and orbitofrontal cortices (OFCs); 6 also studied cognitive
function), five studied the relationship between obesity and prefrontal and orbitofrontal cortices, and three
evaluated cognitive function and obesity. Inhibitory control was most often studied in both childhood (76.9%) and
adolescent (72.7%) studies, and obese children performed significantly worse (P < 0.05) than healthy weight controls Objective: Authoring teams may emphasize measures such as impact factor (IF) when selecting target journals.
Subsequent 'success' may be measured as the number of citations in the peer-reviewed literature. The utility of a
journal's IF to predict citations for submitted articles is uncharacterized. Research design and methods: All drug-
related journal submissions (n=362) for a pharmaceutical company for 1 year were assessed. The number of citations
since publication was determined on a single date (July 26, 2012) using Google Scholar. Days elapsed from
publication date to citation count date were calculated and used to normalize for days post-publication. Linear
regression analyses were used to characterize the relationship between a journal's IF and subsequent number of
peer-reviewed literature citations for individual articles. Results: For 258 evaluable and published articles, the
average journal IF at time of submission was 4.9 (range: 0.23-47.05). The average days elapsed since publication was Objectives: We sought to compare the nephrotoxicity of the iso-osmolar contrast medium, iodixanol, to low-osmolar
contrast media (LOCM). Background: Contrast-induced acute kidney injury (CI-AKI) is a common cause of in-hospital
renal failure. A prior meta-analysis suggested that iodixanol (Visipaque, GE Healthcare, Princeton, New Jersey) was
associated with less CI-AKI than LOCM, but this study was limited by ascertainment bias and did not include the most
recent randomized controlled trials. Methods: We searched Medline, Embase, ISI Web of Knowledge, Google
Scholar, Current Contents, and International Pharmaceutical Abstracts databases, and the Cochrane Central Register
of Controlled Trials from 1980 to November 30, 2008, for randomized controlled trials that compared the incidence
of CI-AKI with either iodixanol or LOCM. Random-effects models were used to calculate summary risk ratios (RR) for
CI-AKI, need for hemodialysis, and death. Results: A total of 16 trials including 2,763 subjects were pooled. There was
no significant difference in the incidence of CI-AKI in the iodixanol group than in the LOCM group overall (summary
RR: 0.79, 95% confidence interval [CI]: 0.56 to 1.12, p = 0.19). There was no significant difference in the rates of post-
Fatalism has been identified as a dominant belief among Latinos and is believed to act as a barrier to cancer
prevention. However, controversy exists over the utility of the construct in explaining health disparities experienced
by disadvantaged populations above the influence of structural barriers such as low socioeconomic status (SES) and
limited access to health care. This paper reviews the empirical research on fatalism and Latinas' participation in
cancer screening in an attempt to determine whether fatalism predicts participation in cancer screening after
accounting for structural barriers. Google Scholar, ERIC, CINAHL, Medline, PsychINFO, ProQuest, PubMed, and
PsychARTICLES were searched for empirical studies published prior to February 25, 2010. A total of 43 articles were
obtained and 11 met the inclusion criteria. The majority of studies (64%) reported a statistically significant
association between fatalism and utilization of cancer screening services after accounting for structural barriers. Objective:: Summarize the validity and reliability of child/adolescent food frequency questionnaires (FFQs) that
assess food and/or food groups. Methods: We performed a systematic review of child/adolescent (6-18 years) FFQ
studies published between January 2001 and December 2010 using MEDLINE, Cochrane Library, PsycINFO, and
Google Scholar. Main inclusion criteria were peer reviewed, written in English, and reported reliability or validity of
questionnaires that assessed intake of food/food groups. Studies were excluded that focused on diseased people or
used a combined dietary assessment method. Two authors independently selected the articles and extracted
questionnaire characteristics such as number of items, portion size information, time span, category intake
frequencies, and method of administration. Validity and reliability coefficients were extracted and reported for food
categories and averaged across food categories for each study. Results: Twenty-one studies were selected from 873,
18 included validity data, and 14 included test-retest reliability data. Publications were from the United States, Children and adolescents with cognitive disorder are a heterogeneous group of children with different aetiology of
disability and also with a higher risk of pain. These children and adolescents are not often able to verbalize the
presence of pain nor they are able to score the intensity of pain using the self-assessing scales. Detection of pain in
children can be improved by providing methods of pain assessment, which correspond to their development and
cognitive abilities, and can assist in the understanding of adults and subsequent care. This paper presents the results
of a systematic analysis of literary sources. The aim was to review the reliability of the recommended measurement
tools for assessing pain intensity in children with cognitive impairment at the age of 3-19 years, appropriate for the
pain assessment by a paediatric nurse. Search selected studies confirming the reliability of measurement
instruments have been made by methods practice based on evidence. For searching of valid sources were used
licensed professional database and freely accessible databases - Medline, ProQuest, Google, Google Scholar, Web of
Science, Springer, Wiley, Science Direct, Cochrane Library. For a systematic analysis the period of 1990-2010 was
selected. Criteria for inclusion: included were randomized controlled studies and nonrandomized studies. Only 16
studies have met the selected criteria focus of the study and underwent assessment quality as per adopted
methodological filter. None of the studies have demonstrated a level of evidence 1 or 2. Analysis of the results did
not demonstrate unambiguously the reliability of a single measurement instrument. Review study, of which the level
of quality was defined as level 3 and focused on measuring instruments recommended by the Royal College of
Nursing and Royal College of Paediatrics and Child Health to measure pain in children with cognitive disabilities, Objectives/Hypothesis The aim of this study was to compare available guidelines for the diagnosis and treatment of
patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) regarding their content, conclusions on the
available evidence, and recommendations. Study Design: Literature review/systematic review. Methods We
retrieved guidelines from Embase, PubMed, Web of Science, and Web sites of several health care improvement
centers and with a Google Scholar search. We appraised the quality of selected guidelines according to the Appraisal
of Guidelines for Research and Evaluation instrument. For similar clinical questions we compared the conclusions,
the attached levels of evidence, and the references used. If differences were found, we checked search strategies,
appraisal criteria, and publication date as possible sources for these differences. Results We selected the guidelines
on diagnosis and treatment of OSAHS of the Scottish Scottish Intercollegiate Guidelines Network, the Dutch Institute
for Healthcare Improvement, and the Institute for Clinical Systems Improvement in the United States for this
comparison. For similar clinical questions these three guidelines showed conflicting conclusions (11%-18%),
Background: Relapsed or chemotherapy refractory extramedullary AML (granulocyte sarcoma) carries a very poor
prognosis. This is particularly true when it develops following allogeneic BMT. We report complete remission
induction using GCSF priming with decitabine sustained for 7 months for a decitabineresistant multiply relapsed
granulocytic sarcoma occuring 2 years after allogeneic BMT. Objectives: To describe a unique case of sustained
remission induction using a novel strategy of GCSF priming with decitabine in a patient with decitabine-refractory
multiply relapsed extramedullary AML. Design/Method: We conducted a literature search for GCSF priming with
decitabine in AML with PubMed and Google Scholar. We report a 20-year-old male with past history of aplastic
anemia, liver failure, AML, and allogeneic SCT now with extramedullary AML presenting as a large abdominal mass
and mediastinal mass. After an initial response to radiation and steroids, decitabine was tried following Singh et tal
(BMT 47:1008,July 2012). Unfortunately, the disease progressed in the lungs and abdomen. The patient was felt to
be incurable. We decided to try GCSF priming with decitabine, similar to the strategy used by Lowenberg et al with Rathore FA, New PW, Iftikhar A. A report on disability and rehabilitation medicine in Pakistan: past, present, and
future directions. Disability is a stigma in Pakistan, and cultural norms are a hindrance to the integration of the
disabled into the community. Additional barriers to addressing the needs of the disabled include the lack of reliable
disability epidemiologic data, inadequate funding and poor health care infrastructure, and workforce shortages. The
aim of this report is to present an overview of Physical Medicine and Rehabilitation (PM&R) in Pakistan, covering its
origins, current status, and future directions. An electronic literature search (19502009) was conducted using the
Medline, ScienceDirect, Springer Link, CINAHL, and Google Scholar databases. The key words used were "disability,"
"persons with disability" (PWDs), "rehabilitation," "Pakistan," "developing countries," "stroke," "spinal cord injury,"
"causes," "attitudes," "physiotherapy," "occupational therapy," and "speech therapy." Only publications in English
involving physical disability were selected. Statistical data were obtained from the Federal Bureau of Statistics.
Interviews with pioneers of rehabilitation medicine in Pakistan, PWDs, and their families were conducted. The origins Background: The use of checklists is a promising strategy for improving patient safety in all types of surgical
processes inside and outside the operating room. This article aims to provide requirements and implementation of
checklists for surgical processes. Methods: The literature on checklist use in the operating room was reviewed based
on research using Medline, Pubmed, and Google Scholar. Although all the studies showed positive effects and
important benefits such as improved team cohesion, improved awareness of safety issues, and reduction of errors,
their number still is limited. The motivation of team members is considered essential for compliance. Currently, no
general guidelines exist for checklist design in the surgical field. Based on the authors' experiences and on guidelines
used in the aviation industry, requirements for the checklist design are proposed. The design depends on the
checklist purpose, philosophy, and method chosen. The methods consist of the "call-do- response" approach," the
"do-verify" approach, or a combination of both. The advantages and disadvantages of paper versus electronic Background: Studies have shown the eye movement during visual fixation not only includes the noise signal from the
nervous system, but also contains the information of cognitive processing. Fixation components and their functions
attracted attention increasingly. Objective: To review the research progress and its present situation of visual fixation
component separation. Methods: We retrieved the articles in PebMed database and Google Scholar with the
computer using the key words of "visual fixation, fixational eye movement, tremor, drifts, micro saccades". And we
also made a reference to some corresponding monograph. The articles with repeated, unconcerned or obsolete
contents were eliminated, and 64 articles were included in the final analysis. Results and Conclusion: Visual fixation is
a phenomenon of human visual perception in which the individual is maintaining gaze in a stationary object. There
are three types of eye movement during fixation: tremor, drifts and micro saccades, and they are vital for Objective: There is a lack of consensus on how to evaluate the risk of research studies conducted with persons who
have psychiatric disorders. The authors reviewed research on vulnerability, risk, and procedures to mitigate risk in
studies with this population to help inform evaluation of such research. Methods: Searches of MEDLINE (1966-2006),
PsycINFO (1967-2006), and Google Scholar used combinations of the terms mental illness, vulnerable, psychiatric,
schizophrenia, and depression combined with terms such as research risk, vulnerability, research harm, capacity, risk,
and mitigation of risk. Articles were identified from reference lists, and additional searches used terms from
identified articles. Results: Evidence for two types of vulnerability - capacity based and power based - is presented,
which supports the notion of vulnerability as a state, rather than a trait, among persons with psychiatric disorders.
Three categories of risk are described - minimal risk, minor increment over minimal risk, and greater than minor
The past 23 years of post-socialist restructuring of health system funding and management patterns has brought
many changes to small Balkan markets, putting them under increasing pressure to keep pace with advancing
globalization. Socioeconomic inequalities in healthcare access are still growing across the region. This uneven
development is marked by the substantial difficulties encountered by local governments in delivering medical
services to broad sectors of the population. This paper presents the results of a systematic review of the following
evidence: published reports on health system reforms in the region commissioned by WHO, IMF, World Bank, OECD,
European Commission; all available published evidence on health economics, funding, reimbursement in world/local
languages since 1989 indexed at Medline, Excerpta Medica and Google Scholar; in depth analysis of official website
data on medical care financing related legislation among key public institutions such as national Ministries of health,
Health Insurance Funds, Professional Associations were applicable, in local languages; correspondence with key Introduction: The optimal management of partial thickness tears of the rotator cuff (PTRCT) is still controversial.
Source of data: A literature search, on PubMed, Cochrane and Google Scholar databases, identified 273 relevant
abstracts of articles published in peer-reviewed journals. Twenty-three clinical studies reporting the outcomes of
surgically treated patients affected by PTRCTs were selected. Areas of agreement: The different repair approaches
results in variable functional outcomes. The Coleman Methodology Score (CMS) used to asses the quality of the
studies showed great heterogeneity in study design, the sample, pre- and post-operative diagnostic assessments and
the score used to evaluate outcomes. The mean CMS value was 67.95 (ranging from 30 to 82). Areas of controversy:
The heterogeneity of the treatment options and of the outcome assessment methods makes it difficult to compare
the results of the different studies. Growing points: There is a need to use standardized pre- and post-operative Introduction: Umbilical cord infection causes to increase neonatal mortality and morbidity risk in developing
countries. There is an increasing emphasis on quality care of the umbilical cord for newborn but still need to guide
appropriately recommendations for optimal umbilical cord-care practices for newborns. Purpose: The study is
planned to determine the methods was used for umbilical cord care and the evaluate researches was designed to
effectiveness of these methods. Material-Methods: The data were selected from articles published in Turkish and
English, to be placed in MEDLINE (PubMed), Turkish Medline and Scholar Google between January 2001 and April
2010 years. The keywords such as 'cord', 'umbilical cord care', and 'newborn umbilical cord care' used in literature
screening. Evaluated the answer of these three questions: (i) which methods are used for umbilical cord care?; (ii)
what are the effects of umbilical cord care methods?; (iii) which is the most effective method for umbilical cord care? Purpose: We examined the incidence of resume fraud among urology residency applicants by determining the rate of
misrepresented publications listed in applications to a urology residency program. Materials and Methods:
Applications from all 147 urology residency applicants to a program from the 2007 application cycle were analyzed.
Verification of listed publications was attempted by querying PubMed, Google Scholar and MEDLINE. Univariate
analysis was conducted to assess associations between unverifiable publications and applicant demographics.
Results: Of the applicants who submitted publications 19% (14 of 71) had at least 1 unverifiable publication, which
represented 9% (14 of 147) of the entire applicant pool. There were no statistically significant associations between Objective: To evaluate whether the inclusion of any specific resuscitation training educational strategy in developing
countries improves outcomes. Methods: As part of the International Liaison Committee on Resuscitation evidence
evaluation process, a systematic review of the literature was conducted. The Cochrane database of systematic
reviews; Medline; Google Scholar and EmBASE were searched using multiple search strategies. Results: Forty-four
papers were relevant to review, including 38 studies that provided support for the use of resuscitation training
programs in developing countries. All studies that examined self-efficacy (15 studies) and student satisfaction (8
studies) reported improvement. There was no consistent testing method for educational outcomes across studies
and few studies examined both educational outcomes and patient outcome (1 of 15 self-efficacy, 0 of 18 cognitive
knowledge, 0 of 8 psychomotor skills, 0 of 5 simulated operational performance). Fourteen of 15 studies that
examined patient survival were either newborn or trauma resuscitation, 1 adult resuscitation, and none were in Introduction Retained sponges and instruments (RSI) due to surgery are a recognised medical 'never event' and have
catastrophic implications for patients, healthcare professionals and medical care providers. The aim of this review
was to elucidate the extent of the problem of RSI and to identify preventative strategies. Methods A comprehensive
literature search was performed on MEDLINE, Embase, the Science Citation Index and Google Scholar for articles
published in English between January 2000 and June 2012. Studies outlining the incidence, risk, management and
attempts to prevent RSI following surgical intervention were retrieved. Results The overall incidence of RSI is low
although its incidence is substantially higher in operations performed on open cavities. Sponges are the most
commonly retained item when compared with needles and instruments. Clinical presentation is varied, leading to
avoidable morbidity, and the error is indefensible medicolegally. Risk factors include emergency operations,
operations involving unexpected change in procedure, raised body mass index, and a failure to perform accurate
BACKGROUND: Physicians frequently search PubMed for information to guide patient care. More recently, Google
Scholar has gained popularity as another freely accessible bibliographic database., OBJECTIVE: To compare the
performance of searches in PubMed and Google Scholar., METHODS: We surveyed nephrologists (kidney specialists)
and provided each with a unique clinical question derived from 100 renal therapy systematic reviews. Each physician
provided the search terms they would type into a bibliographic database to locate evidence to answer the clinical
question. We executed each of these searches in PubMed and Google Scholar and compared results for the first 40
records retrieved (equivalent to 2 default search pages in PubMed). We evaluated the recall (proportion of relevant
articles found) and precision (ratio of relevant to nonrelevant articles) of the searches performed in PubMed and
Google Scholar. Primary studies included in the systematic reviews served as the reference standard for relevant Introduction: There is paucity of literature on retroperitoneal haemorrhage/haematomas. (RH) as these cases are
extremely rare in obstetrics. Experience is available mostly from case reports and therefore the incidence of RH in
obstetrics is unknown. Methods: Literature search in Medline/Pubmed and Google scholar using MeSH; aneurysm,
haematoma, haemorrhage, obstetrics and retroperitoneal. Aetiology and pathogenesis: This article discusses
aetiology, pathogenesis, diagnostic difficulties and dilemmas, as well as misleading symptoms that often mimic
common clinical conditions. Diagnosis and Management: Management of RH is complex and continues to improve Background: High school football players are the single largest cohort of athletes playing tackle football, and account
for the majority of sport-related concussions. Return to play guidelines (RTPs) have emerged as the preferred
approach for addressing the problem of sport-related concussion in youth athletes. Methods: This article reviews
evidence of the risks and effects of football-related concussion and subconcussive brain trauma, as well as the
effectiveness of RTPs as a preventative measure. Literature review utilized PubMed and Google Scholar, using
combinations of the search terms "football,""sports,""concussion,""Chronic Traumatic
Encephalopathy,""athlete,""youth," and "pediatric." Literature review emphasized medical journals and primary
neuroscientific research on sport-related concussion and concussion recovery, particularly in youth athletes.
RESULTS: Sport-related concussion is a significant problem among student athletes. Student athletes are more
vulnerable to concussion, and at risk of neurocognitive deficits lasting a year or more, with serious effects on IntroductionThis review aims to provide information on the time athletes will take to resume sports activity following
ankle fractures.Sources of dataWe systematically searched Medline (PubMED), EMBASE, CINHAL, Cochrane, Sports
Discus and Google scholar databases using the combined keywords 'ankle fractures', 'ankle injuries', 'athletes',
'sports', 'return to sport', 'recovery', 'operative fixation', 'pinning', 'return to activity' to identify articles published in
English, Spanish, French, Portuguese and Italian.Areas of agreementSeven retrospective studies fulfilled our inclusion
criteria. Of the 793 patients, 469 (59%) were males and 324 (41%) were females, and of the 356 ankle fractures we
obtained information on, 338 were acute and 18 stress fractures. The general principles were to undertake open
reduction and internal fixation of acute fractures, and manage stress fractures conservatively unless a thin fracture
line was visible on radiographs.Areas of controversyThe best timing to return to sports after an acute ankle fracture OBJECTIVES: The primary objective is a review, classification and critical appraisalof contingent valuation method
(CVM) healthcare studies conducted in Sub-SaharaAfrica based on criteria by O'Brien and Gafni (1996). The
secondary objective is todetermine the impact of the Bamako Initiative adopted in the early 1990s on CVMstudies in
the same setting. METHODS: CVM African healthcare studies (willingnessto pay (WTP) and willingness to accept
(WTA)), were identified using a comprehensiveliterature search in EconoLit, Google Scholar, Medline, PubMed
andWeb of Science between 1981 to 2010. CVM studies evaluated included WTP andWTA studies reporting primary
data were included for evaluation. Primary assessmentof the studies was based on the conceptual framework for
evaluation ofcontingent valuation of healthcare programs (5 Items)(O'Brien and Gafni 1996).Secondary assessment
was based on the time horizon of publication: pre-, during-(1990s), or post- BI, and area of intervention. RESULTS:
Twenty-four CVM studieswere evaluated: all used WTP and compensating variation. Elicitation techniqueswere
dominated by bidding game (42%), followed by dichotomous choice (33%), andthen payment card and the open Pouchitis is the most frequent long-term complication of Ileal Pouch-Anal Anastomosies (IPAA) surgery for Ulcerative
Colitis (UC) which is a nonspecific inflammation of the ileal reservoir. Its clinical frequency varies depending on the
definition and the follow up but is approximately 50% after a decade. Antibiotics and probiotics are currently the
most widely accepted treatment in pouchitis patients. Objective of this study was to meta-analyze efficacy of
probiotics and antibiotics in the management of pouchitis. All databases specially Pubmed, Web of Science, Scopus,
Cochrane and Google Scholar were searched between 1965 and December 2009 and relevant controlled clinical
trials were extracted, reviewed and validated according to the study protocol. The outcome of interest was defined
by a Pouchitis Disease Activity Index (PDAI)<7. Thirteen clinical trials were included in the meta-analysis. Pooling of
the results from eight trials yielded a Relative Risk (RR) of 5.33 with a 95% CI of 2.12-13.35 and a significant RR (p =
0.0004) in all kind of probiotics treatment group in comparison with the placebo group. Summary RR for clinical
improvement in six trials was 14.17 with a 95% CI of 1.19-168.93 (p = 0.036) in efficacy of VSL#3 (all doses)
Electronic databases of MEDLINE, EMBASE, CINAHL, and the Cochrane Library as well as the Google Scholar search
engine were used. Studies written in the English language highlighting the use of magnetic resonance imaging (MRI)
and computed tomography in diagnosing occult proximal femoral fractures despite negative or equivocal plain
radiographs were included. Two reviewers independently extracted data from each article. Raw frequencies for each
of the details investigated were calculated. 15 prospective and 7 retrospective studies from 1989 to 2009 were
included in this systematic review. A total of 996 patients (mean age, 75 years; standard deviation, 5 years) with
suspected occult proximal femur fractures underwent MRI for further assessment. 350 (35%) of the patients tested Background Recent research has led to an interest in the role of the gut and liver in type 2 diabetes mellitus (T2DM).
Aim To review the role of the gastrointestinal system in glucose homoeostasis, with particular focus on the effects of
incretin hormones, hepatic steatosis and bile acids. Methods PubMed and Google Scholar were searched using terms
such as incretin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide-1 (GLP-1), dipeptidyl
peptidase-4 (DPP-4), hepatic steatosis, bile acid and gastric bypass. Additional relevant references were identified by
reviewing the reference lists of articles. Results Perturbations of incretin hormones and bile acid secretion contribute
to the pathogenesis of T2DM, leading to their potential as therapeutic targets. The incretin hormones (GIP and GLP-
1) are deactivated by DPP-4. GLP-1 agonists and DPP-4 inhibitors improve glycaemic control in patients with T2DM.
Hepatic steatosis, along with insulin resistance, may precede the development of T2DM, and may benefit from anti-
diabetes medications. Bile acids play an important role in glucose homoeostasis, with effects mediated via the Magnetic resonance (MR) imaging is often used to characterize and quantify multiple sclerosis (MS) lesions in the
brain and spinal cord. The number and volume of lesions have been used to evaluate MS disease burden, to track the
progression of the disease and to evaluate the effect of new pharmaceuticals in clinical trials. Accurate identification
of MS lesions in MR images is extremely difficult due to variability in lesion location, size and shape in addition to
anatomical variability between subjects. Since manual segmentation requires expert knowledge, is time consuming
and is subject to intra- and inter-expert variability, many methods have been proposed to automatically segment
lesions.The objective of this study was to carry out a systematic review of the literature to evaluate the state of the
art in automated multiple sclerosis lesion segmentation. From 1240. hits found initially with PubMed and Google
scholar, our selection criteria identified 80 papers that described an automatic lesion segmentation procedure
applied to MS. Only 47 of these included quantitative validation with at least one realistic image. In this paper, we
describe the complexity of lesion segmentation, classify the automatic MS lesion segmentation methods found, and Objective: To summarize and evaluate the published literature pertaining to boceprevir and telaprevir, and to
provide clinicians with suggestions for use in patients with chronic hepatitis C infection. methods: A standardized
search strategy was performed using the MEDLINE, EMBASE, Google Scholar and International Pharmaceuticals
Abstracts databases using the search terms "boceprevir", "telaprevir", "boceprevir and hepatitis C" and "telaprevir
and hepatitis C". A manual search of references was performed to identify articles missed by the electronic search.
Studies were included in the review if they assessed either boceprevir or telaprevir in comparison with standard of
care in chronic hepatitis C patients. Results: The studies identified assessed boceprevir and telaprevir in genotype-1
hepatitis C patients. In both treatment-naive and treatment-experienced patients, sustained virological response
rates were achieved more often with boceprevir or telaprevir in combination with pegylated interferon and ribavirin
compared with pegylated interferon and ribavirin alone. Both medications were well tolerated, with anemia OBJECTIVE: To summarize and evaluate the published literature pertaining to boceprevir and telaprevir, and to
provide clinicians with suggestions for use in patients with chronic hepatitis C infection., METHODS: A standardized
search strategy was performed using the MEDLINE, EMBASE, Google Scholar and International Pharmaceuticals
Abstracts databases using the search terms "boceprevir", "telaprevir", "boceprevir and hepatitis C", and "telaprevir
and hepatitis C". A manual search of references was performed to identify articles missed by the electronic search.
Studies were included in the review if they assessed either boceprevir or telaprevir in comparison with standard of
care in chronic hepatitis C patients., RESULTS: The studies identified assessed boceprevir and telaprevir in genotype-
1 hepatitis C patients. In both treatment-naive and treatment-experienced patients, sustained virological response
rates were achieved more often with boceprevir or telaprevir in combination with pegylated interferon and ribavirin
compared with pegylated interferon and ribavirin alone. Both medications were well tolerated, with anemia
This review aimed to address studies of cancer control in Indigenous populations, with a focus on: (1) the nature and
extent of community engagement; and (2) the extent to which community engagement has facilitated successful
outcomes. Articles addressing Indigenous cancer control using some degree of community engagement were
identified by a search of the following electronic databases: MEDLINE (via Ovid and Pubmed), psycINFO, CINAHL and
Google Scholar. Relevant studies were scored and analysed according to Green etal.'s guidelines for participatory
research. Studies often engaged the community only minimally. Where studies resulted in successful outcomes, they
tended to have included Indigenous community members in genuine research roles, from planning, to
implementation, to presentation of results at conferences. Studies with positive health outcomes were often
initiated by a combination of academic researchers and community members or organisations. This narrative review BACKGROUND: An increasing burden of cardiovascular disease (CVD) is occurring in low- and middle-income
countries (LMICs) as a result of urbanisation and globalisation. Low rates of awareness and treatment of risk factors
worsen the prognosis in these settings. Prevention of CVD is proven to be cost effective and should be the main
intervention. Insight into prevention programmes in LMIC is important in addressing the rising levels of these
diseases., OBJECTIVE: To evaluate the effectiveness of the community-based interventions for CVD prevention
programmes in LMIC., DESIGN: A literature review with searches in the databases of PubMed, EMBASE, CINAHL,
LILACS, African Index Medicus and Google Scholar between 1990 and May 2012., RESULTS: Twenty-six studies
involving population-based and high-risk interventions have been included in this review. The content of the
population intervention was mainly health promotion through media and health education, and the high-risk
approach focused often on education of patients, training of health care providers and implementing treatment OBJECTIVE: To evaluate the efficacy and safety of administering vancomycin as a continuous infusion., DATA
SOURCES: Literature was accessed through MEDLINE (1977-September 2012), Embase (1977-September 2012), and
Google Scholar, using the terms vancomycin, continuous, discontinuous, infusion, pharmacokinetics,
pharmacodynamics, and nephrotoxicity. In addition, reference citations from publications identified were reviewed.,
STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data sources were
evaluated. Studies including more than 30 adults were included in the safety and efficacy review., DATA SYNTHESIS:
Infections due to methicillin-resistant Staphylococcus aureus (MRSA) carry a significant risk of morbidity and
mortality. Vancomycin is commonly prescribed for invasive MRSA infections and has been traditionally administered
as an intermittent infusion. Administering vancomycin as a continuous infusion is a novel approach to improving its
efficacy and safety profile. Fourteen clinical trials were reviewed (2 prospective, 1 meta-analysis, 11 retrospective).
The pharmacodynamic profiles between continuous-infusion vancomycin and intermittent-infusion vancomycin were
comparable. Continuous-infusion therapy did not significantly improve the efficacy of vancomycin in the treatment
of invasive MRSA infections. Conflicting results exist regarding the safety profile of continuous-infusion compared OBJECTIVE: To evaluate the efficacy and safety of administering vancomycin as a continuous infusion. DATA
SOURCES: Literature was accessed through MEDLINE (1977-September 2012), Embase (1977-September 2012), and
Google Scholar, using the terms vancomycin, continuous, discontinuous, infusion, pharmacokinetics,
pharmacodynamics, and nephrotoxicity. In addition, reference citations from publications identified were reviewed.
STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data sources were
evaluated. Studies including more than 30 adults were included in the safety and efficacy review. DATA SYNTHESIS:
Infections due to methicillin-resistant Staphylococcus aureus (MRSA) carry a significant risk of morbidity and
mortality. Vancomycin is commonly prescribed for invasive MRSA infections and has been traditionally administered
as an intermittent infusion. Administering vancomycin as a continuous infusion is a novel approach to improving its
efficacy and safety profile. Fourteen clinical trials were reviewed (2 prospective, 1 meta-analysis, 11 retrospective).
The pharmacodynamic profiles between continuous-infusion vancomycin and intermittentinfusion vancomycin were
comparable. Continuous-infusion therapy did not significantly improve the efficacy of vancomycin in the treatment
of invasive MRSA infections. Conflicting results exist regarding the safety profile of continuousinfusion compared Background. The brain metastasis (BM) represents one of the most common and refractory malignancies worldwide
with a rising incidence in all countries. It is generally believed that once a BM has developed, this disease cannot be
cured and has a poor prognosis. The challenges of managing this tumor include diagnosis and selective treatment
options. In addition, patients with BM frequently have greater expectations of the current therapy outcomes, which
hope to get long-term survival and good quality of life. Methods. This is a review of current clinical practice based on
an exhaustive literature search of PubMed, Embase, and Google Scholar. A series of case studies is presented to
provide outcomes of the effective management in BMs that have required treatment for the terminal stage of
patients with cancer, and makes recommendations for future practice. Results. Current technical advances have
been made in the diagnosis and treatment of BM. After surgery, radiotherapy, or stereotactic radiosurgery, and for
some cases additional systemic chemotherapy for the primary cancer, most patients experience meaningful
BACKGROUND: The brain metastasis (BM) represents one of the most common and refractory malignancies
worldwide with a rising incidence in all countries. It is generally believed that once a BM has developed, this disease
cannot be cured and has a poor prognosis. The challenges of managing this tumor include diagnosis and selective
treatment options. In addition, patients with BM frequently have greater expectations of the current therapy
outcomes, which hope to get long-term survival and good quality of life., METHODS: This is a review of current
clinical practice based on an exhaustive literature search of PubMed, Embase, and Google Scholar. A series of case
studies is presented to provide outcomes of the effective management in BMs that have required treatment for the
terminal stage of patients with cancer, and makes recommendations for future practice., RESULTS: Current technical
advances have been made in the diagnosis and treatment of BM. After surgery, radiotherapy, or stereotactic
radiosurgery, and for some cases additional systemic chemotherapy for the primary cancer, most patients BACKGROUND AND PURPOSE: Autologous Iliac Crest Bone Grafting (ICBG) is considered the gold-standard graft
choice for spinal arthrodesis; however, it is associated with donor site morbidity and a limited graft supply. Bone
graft alternatives to replace autograft and augment arthrodesis are a topic of ongoing research. This article will
review properties of Demineralized Bone Matrix (DBM) and review the evidence for its use, including animal models
and human clinical trials., METHODS: A systematic and critical review of the English-language literature was
conducted on Pubmed, Cochrane, CINAHL, and Google Scholar using search key terms such as 'Demineralized Bone
Matrix', 'Spine' and 'Fusion'. Papers that were included were original research articles in peer-reviewed journals that
investigated fusion outcomes. Scientific validity of articles was appraised using the PRISMA methodology. Articles
were critically examined and compared according to study design, DBM type, outcomes, and results. Primary
outcome of interest was fusion rate. Secondary outcomes included Oswestry Disability Index; Short Form-36 survey;
Odom's criteria; Visual Analog Scale neurologic pain score; Japanese Orthopedic Association myelopathy score; Neck
Disability and Ishihara Curvature Indices; and pseudarthrosis and surgical failure rates., RESULTS: Demineralized Bone
Matrix has been evaluated in animal models and human clinical trials of spine fusion. Results of animal studies The purpose of this study was to: (1) describe caries prevalence and experience among Aboriginal children; and (2)
investigate the disparity in dental caries between Aboriginal and non-Aboriginal Australian children. As background,
dental caries is a widespread disease within Aboriginal communities and it has a particularly severe impact on
children. In recognition of the extent and severity of this disease, its impact on childhood nutrition, socialisation and
schooling, the control of dental caries has been identified as a key indicator in the reduction of disadvantage among
Aboriginal communities. Medline was the primary database used in the literature search. Other databases included:
PubMed, Web of Science and Google Scholar. Australian National and State departments of health websites were
also searched for relevant documents. Articles were included in the review if they reported information on either
caries prevalence rates or experience scores or both, for Aboriginal children in Australia. Articles were excluded if the
study sample was special needs children, and/or caries statistics were reported only for children over 12 years. Caries
prevalence among 6-year-olds in rural non-fluoridated Western Australia in 1963 was 27%, and in 2004 was 85%
among 6-year-olds in rural non-fluoridated Queensland. There was a corresponding increase in caries experience
scores in this period from 2.07 in 1963 to 6.37 in 2004. National estimates for 2000-2003 reported a caries
prevalence of 72% and caries experience (dmft: decayed, missing and filled primary teeth) of 3.68 for 6-year-old
Aboriginal Australian children. For 12-year-olds the national estimates were a caries prevalence of 45% and
experience (DMFT, Decayed, Missing and Filled Permanent Teeth) of 1.25 (SE=0.07). The magnitude of disparity Purpose. Chronic hepatitis C virus (HCV) is a major problem affecting up to 170 million people worldwide. Two
protease inhibitors have recently been approved that will revolutionize treatment. Our objective was to summarize
and evaluate the literature pertaining to the pharmacokinetics of boceprevir and telaprevir, in order to provide
clinicians with insight into the management of actual and potential drug interactions. Summary. A standardized
search using MEDLINE (1948-November 2011), EMBASE (1980-November 2011), IPA (1970-November 2011), Google,
and Google Scholar that combined the search terms boceprevir, telaprevir, pharmacokinetics, drug interaction, and
drug metabolism was performed. Manual reference searches of chosen articles were completed. Monographs and
articles, conference proceedings, and abstracts were evaluated. Boceprevir and telaprevir are both substrates and
inhibitors of cytochrome P450 3A4 and telaprevir is a substrate of p-glycoprotein. Levels of boceprevir are decreased
in patients taking efavirenz but effects with other antiretrovirals are minimal or unknown. Coadministration with
PURPOSE: Chronic hepatitis C virus (HCV) is a major problem affecting up to 170 million people worldwide. Two
protease inhibitors have recently been approved that will revolutionize treatment. Our objective was to summarize
and evaluate the literature pertaining to the pharmacokinetics of boceprevir and telaprevir, in order to provide
clinicians with insight into the management of actual and potential drug interactions. SUMMARY: A standardized
search using MEDLINE (1948-November 2011), EMBASE (1980-November 2011), IPA (1970-November 2011), Google,
and Google Scholar that combined the search terms boceprevir, telaprevir, pharmacokinetics, drug interaction, and
drug metabolism was performed. Manual reference searches of chosen articles were completed. Monographs and
articles, conference proceedings, and abstracts were evaluated. Boceprevir and telaprevir are both substrates and
inhibitors of cytochrome P450 3A4 and telaprevir is a substrate of p-glycoprotein. Levels of boceprevir are decreased
in patients taking efavirenz but effects with other antiretrovirals are minimal or unknown. Coadministration with The ability for nurse educators to improve the empathy skill set of nurses has been the subject of several studies
with varied outcomes. The aim of this paper is to review the evidence for empathy education programmes in nursing
and make recommendations for future nurse education. A review of CINAHL, Medline, Psych Info and Google Scholar
was undertaken using the keywords empathy, person centredness, patient centredness, client centredness,
education and nursing. The studies included were required to have measured the effectiveness of empathy training
in postgraduate and or undergraduate nurses. The included studies incorporated both qualitative and quantitative
methods and were published in peer-reviewed journals. Studies were ranked for level of evidence according to The
Joanna Briggs Institute criteria. Seventeen studies from the literature review were found that met the inclusion Objectives: We report the common surgical approaches, incidence of sinus tracts, and recurrence rates of floor of
mouth dysontogenic (epidermoid, dermoid, and teratoid) cysts in the pediatric population. Methods: Data were
derived from PubMed, Medline, Embase, Google Scholar, and manual searches. Three cases from the senior author's
(J.P.M.) practice were included. All English-language studies consisting of floor of mouth dysontogenic cysts were
included. Case reports of tongue dysontogenic cysts, mandibular dysontogenic cysts, maxillary dysontogenic cysts,
and dysontogenic cysts in the neck below the hyoid bone were excluded. Results: There are 198 case reports,
including those presented here, of floor of mouth dysontogenic cysts. They are more common in male patients
(55.1%), and the most common location is in the sublingual space (104 or 52.5%). Most floor of mouth dysontogenic
cysts can be excised by an intraoral approach. There are 5 reported cases in the literature of recurrent dysontogenic Objective: To identify human papillomavirus (HPV) infection and HPV vaccine-related attitudes among college-aged
women and the relationship between HPV vaccine uptake and subsequent sexual behaviors. Methods: PubMed,
MEDLINE, CINAHL, and Google Scholar searches were performed from 2006, the date after the first HPV vaccine
became available, to present. Results: Of the 13 studies identified, most were cross-sectional. College-aged women
saw HPV infection as serious and had positive attitudes toward the HPV vaccine. Barriers (ie, cost, lack of insurance
coverage) existed that prevented women from obtaining the vaccine and many women did not see themselves at risk
for HPV. The vaccine uptake rate, although increasing, has been slow. Conclusion: College-aged women in the United Some of the needs that people with dementia and their informal carers currently perceive as insufficiently met by
regular care and support services might be alleviated, or even be met, using modern Information and
Communication Technology (ICT). The study described in this paper was designed to provide an insight into the state
of the art in ICT solutions that could contribute to meet the most frequently mentioned unmet needs by people with
dementia and their informal carers. These needs can be summarized as (1) the need for general and personalized
information; (2) the need for support with regard to symptoms of dementia; (3) the need for social contact and
company; and (4) the need for health monitoring and perceived safety. Databases that were searched include:
PubMed, Cinahl, Psychinfo, Google (Scholar), INSPEC and IEEE. In total 22 websites and 46 publications were included
that satisfied the following criteria: the article reports on people with dementia and/or their informal carers and
discusses an ICT-device that has been tested within the target group and has proven to be helpful. Within the first
need area 18 relevant websites and three studies were included; within the second need area 4 websites and 20
publications were included. Within the third and fourth need area 11 and 12 publications were included respectively.
Most articles reported on uncontrolled studies. It is concluded that the informational websites offer helpful
information for carers but seem less attuned to the person with dementia and do not offer personalized information.
Delay in seeking treatment for acute coronary syndrome (ACS) symptoms is a well recognised problem. While the
factors that influence pre-hospital delay have been well researched, to date this information alone has been
insufficient in altering delay behaviour. This paper reports the results of a critical appraisal of previously tested
interventions designed to reduce pre-hospital delay in seeking treatment for ACS symptoms. The search was
confined to interventions published between 1986 and the present that were written in English and aimed at
reducing pre-hospital delay time. The following databases were searched using keywords: Cumulative Index to
Nursing and Allied Health Literature (CINAHL), Pubmed, Academic Search Premier, Ovid, Cochrane, British Nursing
Index, and Google Scholar. A total of eight intervention studies were identified as relevant. This review was
developed following a systematic comparative analysis of those eight studies. Seven of the eight interventions were Background: Rising health and financial costs associated with iatrogenic errors have drawn increasing attention to
the dexterity of surgeons. With the advent of new technologies, such as robotic surgical systems and medical
simulators, researchers now have the tools to analyze surgical motion with the goal of differentiating the level of
technical skill in surgeons. Methods: The review for this paper is obtained from a Google Scholar and PubMed search
of the key words "objective surgical skill evaluation." Only studies that included motion analysis were used. Results:
In this paper, we provide a clinical motivation for the importance of surgical skill evaluation. We review the current
methods of tracking surgical motion and the available data-collection systems. We also survey current methods of Inter-observer variability in anatomical contouring is the biggest contributor to uncertainty in radiation treatment
planning. Contouring studies are frequently performed to investigate the differences between multiple contours on
common datasets. There is, however, no widely accepted method for contour comparisons. The purpose of this
study is to review the literature on contouring studies in the context of radiation oncology, with particular
consideration of the contouring comparison methods they employ. A literature search, not limited by date, was
conducted using Medline and Google Scholar with key words: contour, variation, delineation, inter/intra observer,
uncertainty and trial dummy-run. This review includes a description of the contouring processes and contour
comparison metrics used. The use of different processes and metrics according to tumour site and other factors
were also investigated with limitations described. A total of 69 relevant studies were identified. The most common
tumour sites were prostate (26), lung (10), head and neck cancers (8) and breast (7).The most common metric of Psychosocial issues and health-related quality of life (HRQOL) are important components of care in patients
diagnosed with chronic hepatitis B (CHBV). In this review, we searched Medline, ISI Web of Knowledge, Google
Scholar and the American Association for the Study of Liver Diseases (AASLD) website (until January 2012) using
relevant terms and we categorized the retrieved content into three areas: HRQOL, mental health, and psychosocial
issues such as stigma and coping. Increasing severity of CHBV leads to a decline in HRQOL. Cirrhosis worsens HRQOL,
whereas treatment and psycho-education improves it. Frequency of mood disorders seems to be increased in
patients with CHBV, although not all studies have shown this trend. Some factors such as alcohol consumption and
low social support negatively impact patients' mental health. Those with CHBV generally have better HRQOL and
mental health than their hepatitis C (HCV) counterparts. Patients with psychiatric disorders, particularly those with Psychosocial issues and health-related quality of life (HRQOL) are important components of care in patients
diagnosed with chronic hepatitis B (CHBV). In this review, we searched Medline, ISI Web of Knowledge, Google
Scholar and the American Association for the Study of Liver Diseases (AASLD) website (until January 2012) using
relevant terms and we categorized the retrieved content into three areas: HRQOL, mental health, and psychosocial
issues such as stigma and coping. Increasing severity of CHBV leads to a decline in HRQOL. Cirrhosis worsens HRQOL,
whereas treatment and psycho-education improves it. Frequency of mood disorders seems to be increased in
patients with CHBV, although not all studies have shown this trend. Some factors such as alcohol consumption and
low social support negatively impact patients' mental health. Those with CHBV generally have better HRQOL and
mental health than their hepatitis C (HCV) counterparts. Patients with psychiatric disorders, particularly those with OBJECTIVES: Normoglycaemia in people with diabetes results in improved outcome. Continuous glucose monitoring
provides detailed diagnostic information used to optimise therapy. The objective of this study was to review
randomised controlled trials (RCTs) of the only device available for blinded, professional use. METHODS: Published
studies using the MiniMed Continuous Glucose Monitoring System (CGMS, Medtronic Inc., Northridge, CA) were
identifi ed using appropriate search terms in a series of clinical databases including: Medline, Pubmed, Google
Scholar and Scientifi c Web of Knowledge. Other measures were also taken such as searching the reference lists and
review by recognised experts. RESULTS: Seven randomised controlled trials were identifi ed, fi ve in children. Double-
blinding was not possible. Although HbA1c was explicitly stated as the primary endpoint in four studies the studies
were only adequately powered to detect large, between-group minimum differences (range 0.5 to 1.0% HbA1c).
Only two studies included subjects with type-2 diabetes. Other endpoints included the frequency of hypoglycaemia
and hyperglycaemia events. Within-group HbA1c decreases were observed in all but one study. The crude, weighted
INTRODUCTION: Alcohol is the most commonly used drug within Australia. Recently, there have been indications
that there is a greater incidence of high-risk drinking within rural populations as compared with their urban
counterparts. High-risk drinking is associated with numerous conditions, such as diabetes, heart attack and cancer, as
well as acute harms such as assault, suicide and road accidents. The objective of this article is to review the current
research and relevant data pertaining to alcohol use and alcohol-related harms within rural Australia. METHODS: This
paper is a systematic review of 16 databases, including PubMed, PsycINFO and Google Scholar. RESULTS: Overall, 18
studies describing alcohol consumption or alcohol-related harms were found. Approximately half of these studies
were large-scale national population surveys, which were therefore limited in their representativeness of specific
regional and rural towns. Most studies examining alcohol consumption used self-report data collection, meaning that
interpretation of results needs to be tentative. There is a consistent pattern of higher rates of alcohol consumption BACKGROUND: Male doctors in China have a high rate of smoking (41%). Smoke-free policies and help in quitting
smoking in health care facilities would improve the health of staff and patients, and reduce smoking among doctors.
METHODS: A review of smoke-free activity in the health care sector was undertaken by conducting a search of
PubMed, Google Scholar, Google and Globalink on smoke-free health care in China and by scanning the print media.
Relevant published and unpublished documents were also reviewed. RESULTS: It is not mandatory for health care
facilities to be smoke free. However, a Ministerial Decision issued in May 2009 requires all medical and health
institutions to be smoke free by the end of 2011, and in Beijing, Shanghai and Guangzhou, legislation requires
hospital buildings to be smoke free. A range of initiatives have been implemented to ensure the goal of smoke-free
health care is met by the end of 2011. DISCUSSION: A limitation of this review is that it may understate the amount HIV is a RNA retrovirus that causes progressive weakening of the host's immune system increasing susceptibility to
opportunistic infections. Antiretroviral drugs are currently used to manage the infection. This paper reviews the
benefits and the toxicity associated with ARTs currently used in Ghana. Google search, PUBMED and Google scholar
were used to gather information from different books, websites and peerreviewed journal articles. ARTs significantly
improved the quality of life of people living with HIV/AIDS by increasing the CD4 count and reducing the viral load.
ARTs have short and long term side effects which may be life threatening. Toxicity may vary from drug to drug and OBJECTIVES: Oropharyngeal cancer (OPC) is the sixth most common cancer worldwide. Focus on risk factors,
improved diagnostic methods and effective management strategies have made it possible to successfully treat OPC.
However, the 5-year survival rate has not improved for several years due to multiple treatment complications, tissue
morbidity, loss of function, and diminished quality of life. Survivors are faced with complications like oral mucositis,
hyposalivation, osteoradionecrosis, tissue fibrosis, morbidity from jaw resection, disfigurement, and loss of function
that further diminish quality of life. The aim of this review is to highlight major complications associated with
treatment of OPC via a literature search and review of available options for identification and management of these
complications., DATA SOURCES: Relevant publications on oral complications of OPC therapy were thoroughly
reviewed from the literature published between the years 1988 and 2012. We evaluated reported incidence,
prevalence, and risk factors for oral complications of chemotherapy and radiotherapy for OPC. The authors
conducted an electronic search using English language databases, namely PubMed Plus, Medline (Pre-Medline and
Medline), Cochrane Database of Systematic Reviews (evidence-based medicine), Dentistry & Oral Sciences Source, A Objective: This article presents a systematic review of published scientific studies on the potential ecological effects
of radiofrequency electromagnetic fields (RF-EMF) in the range of 10. MHz to 3.6. GHz (from amplitude modulation,
AM, to lower band microwave, MW, EMF). Methods: Publications in English were searched in ISI Web of Knowledge
and Scholar Google with no restriction on publication date. Five species groups were identified: birds, insects, other
vertebrates, other organisms, and plants. Not only clear ecological articles, such as field studies, were taken into
consideration, but also biological articles on laboratory studies investigating the effects of RF-EMF with biological
endpoints such as fertility, reproduction, behaviour and development, which have a clear ecological significance,
were also included. Results: Information was collected from 113 studies from original peer-reviewed publications or
from relevant existing reviews. A limited amount of ecological field studies was identified. The majority of the studies
were conducted in a laboratory setting on birds (embryos or eggs), small rodents and plants. In 65% of the studies,
ecological effects of RF-EMF (50% of the animal studies and about 75% of the plant studies) were found both at high Introduction. The purpose of this article is to present the results of a systematic review on the costs and the
efficiency of Deep Brain Stimulation (DBS) on patients suffering advanced Parkinson's disease. Material and Method.
A systematic review is performed using databases such as Medline, NHS EED and HTA del Centre for Reviews and
Dissemination and Google Scholar from January 2001-2008. Results. Ten articles meet the criteria; one cost
description, four cost analyses and five economic evaluations. The scientific evidence shows a reduction in the
pharmaceutical costs of those patients treated with DBS. Regarding the direct medical costs, the same statement
cannot be made. While some studies estimate the equivalent annual cost of DBS is 54,7% higher than that of
traditional therapy, other studies, which include indirect costs such as productivity losses or informal care, claim DBS
The objective of this review is to summarize and evaluate the literature pertaining to antimicrobial utilization with
respect to implementation of immunization programs or within clinical studies assessing vaccine effectiveness. A
literature search was performed using the search terms vaccine; immunization; antimicrobial; antibiotic; influenza;
pneumococcal; haemophilus; meningococcal in MEDLINE (1948-May 2012), EMBASE (1980-May 2012), International
Pharmaceutical Abstracts (1970-May 2012), Google, and Google Scholar. Identified clinical or epidemiological studies
were included if antimicrobial utilization was listed as a reported outcome. Seven articles (three randomized
controlled trials and four epidemiological studies) were identified and included in the review. These studies reported
outcomes associated with pneumococcal and influenza immunization programs. All studies reported decreased
antibiotic use associated with initiation of immunization programs or increased uptake of available vaccines. Large- Objectives: Aesthetic improvement and psychological enhancement have been cited as justifications for orthodontic
treatment. This paper reviews the evidence that relates malocclusion to psychological health and quality of life and
explores whether this evidence supports the most commonly used aesthetic Orthodontic Treatment Need Indices
(OTNI). Materials and methods: The relevant cited material from the MEDLINE, Web of Science, Scopus, Cochrane
databases, and scientific textbooks were used. The citation rate was confirmed by using the Google Scholar. Results:
The subjective nature of aesthetic indices and the variable perception of attractiveness between clinicians and
patients, and among various cultures or countries are a few limitations of aesthetic OTNI. The available evidence of
mainly cross-sectional studies on the link between malocclusion and either psychosocial well-being or quality of life is
not conclusive, and sometimes contradictory, to suggest these characteristics are affected by malocclusions. Further,
the long-term longitudinal studies did not suggest that people with malocclusion are disadvantaged psychologically,
or their quality of life would be worse off, which challenges using aesthetic OTNI to assess the social and
psychological implications of malocclusion. Conclusion: The subjective nature of aesthetic OTNI and the minor Context: Piper sarmentosum Roxb. (Piperaceae) is a traditional medicinal as well as a culinary plant in South East
Asian countries, whereby aerial parts of the plant are consumed as a vegetable in various forms and the whole plant
or parts are used as folk remedies, alone or in combination with other herbs, to treat various ailments. The plant has
extensively been investigated in a broad range of studies to provide scientific evidence for folklore claims or to find
new therapeutic uses; however, heretofore, a summary of the data are not available. Objective: In order to describe
nutritional and therapeutic potential of P. sarmentosum and summarize scientific evidence that supports traditional
claims, a literature review and latest advances in research of the plant are given herein. Materials and methods: The
literature has been retrieved from a number of databases such as Google Scholar, PubMed, Medline, Science Direct
and SciFinder. The articles related to synthetic work, ecology and agriculture have been excluded. Results and Ethnopharmacological relevance: The Vernonia genus has about one thousand species and members of the genus
are widely used as food and medicine. The aim of this review is to analyze published data on the ethnomedicinal,
ethnoveterinary and zoopharmacognostic uses of plants of the Vernonia genus. This will help to identify the state of
ethnopharmacological knowledge in regard to this genus and to propose future research priorities. Materials and
methods: The major scientific databases including SciFinder, Sciencedirect, Medline and Google Scholar were
queried for information on Vernonia genus using various keyword combinations. The International Plant Name Index
was also used to verify the names of species and authors. Results: A total of 109 Vernonia species were reported in
the literature to have medicinal properties. One hundred and five (105) plants were linked to the treatment or
management of 44 human diseases or health conditions. Plants of the genus also feature in ethnoveterinary and
zoopharmacognostic practices. A total of 12 vernonia species were identified to be used in ethnoveterinary medicine
while 2 species are used in self medication practices by chimpanzees and gorillas. In vitro and in vivo research studies
reporting the validation of the medicinal properties of some species were also reviewed. One hundred and three
bioactive compounds isolated from various Vernonia species were also identified. Vernonia amygdalina was Objective: Anti-infectives are constantly discharged at trace levels in natural waters near urban centers and
agricultural areas. They represent a cause for concern because of their potential contribution to the spread of anti-
infective resistance in bacteria and other effects on aquatic biota. We compiled data on the occurrence of anti-
infectives published in the last 24 years in environmental water matrices. The collected information was then
compared with the available ecotoxicologic values to evaluate potential environmental concerns. Data sources: We
used Web of Science and Google Scholar to search for articles published in peer-reviewed journals written in the
English language since 1984. Data extraction: Information on compound concentrations in wastewaters and natural
and drinking waters, the source of contamination, country of provenance of the samples, year of publication, limits
of quantification, and method of analysis was extracted. Data synthesis: From the 126 different substances analyzed
Background: The challenges of managing breast cancer in women with augmented breasts include screening,
diagnosis, oncologic and revisional surgery, and surveillance. In addition, women with augmented breasts frequently
have greater expectations of cosmetic outcomes. More breast clinicians will be affected by these challenges as
augmentation grows in popularity and women with implants reach the age range in which they are at higher risk of
developing breast cancer. In the United States, more than 2 million women have undergone augmentation, making
this the second most commonly performed cosmetic procedure.1 With a lifetime risk of developing breast cancer of
1 in 8, it is projected that more than 50,000 women who undergo augmentation each year in the United States will
develop breast cancer at some point in their lives.2 Methods: This is a review of current practice based on an
exhaustive literature search of PubMed, Google Scholar, and conference proceedings. A series of case studies is
presented to illustrate mammographic changes and cosmetic outcomes in augmented breasts that have required Background and objectives: To date, there is no evidence-based method of quantification for malocclusion.
Consequently, how deviant occlusal traits should be scored and weighted relative to one another is a matter of
serious debate. Orthodontic Treatment Need Indices (OTNI) use the subjective opinion of the experts, as their
foundation, to define the pathological boundaries (cut-offs) of occlusal traits. This paper reviews the evidence
relating malocclusions or deviated occlusal traits to oral health problems, and investigates if this evidence supports
the cut-off points and the rationale used for OTNI. Materials and methods: The relevant cited studies and reviews
from the MEDLINE, Web of Science, Scopus, Cochrane databases, and scientific textbooks were used. The citation
rate was confirmed by using the Google Scholar. Results: So far, the evidence for harmful effects of deviated occlusal
traits on oral health is either lacking or exists as cross-sectional (mostly) and longitudinal (a few and primarily short-
term) studies. When an association was reported between a deviated occlusal trait and an oral health problem,
either the strength of that association was weak, or due to methodological issues, findings were not conclusive. Introduction: Alcohol (AUD) and other substance use disorders (SUD) are common among adolescents. The CRAFFT
(Car, Relax, Alone, Forget, Friends, Trouble, 1999) was developed as brief screening instrument for adolescents to
measure AUD and SUD. This systematic review examines the psychometric properties of the CRAFFT. Methods: We
performed a systematic review using Cochrane Database for Systematic Reviews, Pubmed/Medline, Embase (1980 to
present), PsycInfo, and Google Scholar using the keywords "CRAFFT", "CRAFFT questionnaire", "alcohol misuse",
"alcohol abuse", "alcohol dependence" "alcohol", "substance misuse", and "substance abuse" and "substance
dependence". Results: We report 11 studies on validity and six studies on reliability. Populations examined were
clinic patients including hospital-based clinic patients, primary care patients, emergency room patients, Native-
Americans, sexually transmitted diseases clinic patients, substance users, a general population group, and enlisting
military concripts. In general, the CRAFFT was found to be a good screening instrument for gradations of alcohol and Rationale: Diagnostic imaging is being driven by technological developments particularly so in the field of Magnetic
Resonance Imaging (MRI). Electromagnetic fields used to produce images are becoming much stronger and switched
more rapidly and it is essential that safety advice remains appropriate and current. Using a systematic methodology,
this review aims to identify the clinical safety implications in performing MRI at field strengths of 3 Tesla (T) and
above and determine whether the current clinical safety guidelines are appropriate. Method: References were
sourced from The Cochrane Library, Centre for Reviews and Dissemination Science Direct, PubMed and Google
Scholar. Related websites searched included The British Institute of Radiology, Society of Radiographers, Royal
College of Radiologists, The Institution of Engineering and Technology, IMRSER (Institute for Magnetic Resonance Objective: To review the current status of physical activity research for individuals with traumatic brain injury (TBI) by
using the behavioral epidemiologic framework to categorize the research into 5 unique phases. Data Sources: All
articles were published from 2000 to 2012 and retrieved through the electronic databases EBSCOHOST, PubMed,
and Google Scholar using keywords "exercise," "physical activity," "health promotion," and "traumatic brain injury."
Study Selection: Studies selected for review were peer reviewed and included physical activity research for
individuals with TBI. Of the initial 79 articles retrieved, 63 met the criteria for this study. Data Extraction: To
determine the appropriate phase for each study, researchers determined the main themes of the study and then
categorized them into 1 of the 5 phases. Reliability between coders was established at 94%. Data Synthesis: Of 63
articles, 44% were categorized as phase 1 (establishing connections between behavior and health), 23% as phase 2
Purpose of Study: Antiretroviral therapy (ART) has become more widely available in resource-limited countries.
Expansion of treatment, however, has engendered drug-resistance, which needs to be characterized as it is a
measure of treatment efficacy and will influence future treatment strategies. Methods Used: The online databases
PubMed and Google Scholar were searched for articles using the terms "drug resistance" or "drug resistant" and
"HIV" or "AIDS" and "resource limited" or "Africa" or "Asia." Abstracts from recent conferences were also searched.
All patients were naBve to ART before initiation of treatment. Analysis was restricted to data that were collected
either in 2007 and later or in 2005 or 2006 if the country had implemented a national scale up of ART at least one
year before data collection. 17 studies met these criteria. Summary of Results: The overall prevalence of transmitted
HIVDR in Africa was found to be 5.6% (217/3863). 2.4% of patients were resistant to reverse transcriptase inhibitors
(NRTIs), 3.2% to non-nucleoside reverse transcriptase inhibitors (NNRTIs), 1.2% to protease inhibitors (PIs), and 1.1%
to multiple drug classes. Prevalence varied among subregions: 7.1% (26/368) in Middle Africa, 6.7% (157/2337) in
East Africa, 3.0% (21/708) in Southern Africa, and 2.9% (13/450) in West Africa. NRTI, NNRTI, PI, and multi-class Purpose: Current re-introduction of "improved" preimplantation genetic screening (PGS#2) raises the question
whether PGS#2 is ready for routine clinical application. Methods: We assessed available evidence via review of
published data for years 2005-2012, and review of currently ongoing registered clinical trials, based on searches
under appropriate key words in PubMed, MEDLINE, Cochrane Database System Review and Google Scholar and
http://www.ClinicalTrials.gov. In absence of prospective clinical trials, and due to limited available data, individual
publications/ongoing studies are assessed. Results: PGS#2 offers significant improvements in accuracy of aneuploidy
diagnosis over PGS#1. By moving embryo biopsy from day-3 after fertilization (6-8 cell stage) to trophectoderm
biopsy at blastocyst stage (day 5-6), PGS#2, however, adds additional co-variables to the analysis of efficacy of the
procedure, which have special relevance for women with diminished ovarian reserve (DOR), who usually produce
small egg and embryo numbers. Limited published data, claiming efficacy of PGS#2, as well as ongoing clinical trials, Bark extract of Pinus pinaster has a long history of ethnomedicinal use and is available commercially as herbal dietary
supplement with proprietary name pycnogenol. It is used as a food supplement to overcome many degenerative
disorders. Rohdewald (2002) wrote the first comprehensive review of extract highlighting its antioxidative nature
and its role in different diseases. Later, Watson (2003) and Gulati (2005) in their reviews about cardiovascular health,
described the extract as a best neutraceutical agent in this regard. The objective of this paper is to review the current
research on this extract in terms of extraction methods, its pharmacological, toxicological and nutraceutical effects
and clinical studies. Web sites of Google Scholar, Pubmed and Medline were searched for articles written in English Elderly, due to immuno suppression caused by predisposing factors such as age, drugs, underlying diseases or
malnutrition, is a risk factor for pulmonary tuberculosis (PTB).Aged patients with PTB because of difficulty in
diagnosis remain undiagnosed and acts as a source of infection in occupational space of health service units. General
physicians (GP) as health care workers (HCW) are concerned about PTB in elderly both as an important public health
problem and as an occupational hazard. A systematic review of the literature on the epidemiology, diagnosis,
treatment and prevention of tuberculosis in elderly from 1991 to 2012 using computerized bibliographic databases
which includes PubMed, Scopus, EMBASE, Google scholar and Iran Medex was carried out to increase understanding
of tuberculosis in aged patients attending the health care units. Information obtained from previous studies on PTB Autosomal recessive, autosomal dominant and the sporadic forms of hyperimmunoglobulin E syndrome (HIES) are
multi-system disorders. Although HIES patients may present with cold abscesses, the vascular features of HIES are
not well recognized. The objective of this review is to characterize the nature and spectrum of vascular abnormalities
in HIES patients. Vascular abnormalities in HIES patients were reviewed with Medline and Google Scholar-based
searches. In brief, the searches combined terms related to HIES with the terms related to vasculature. Furthermore,
reference lists from the original studies and review papers identified were screened. There were vascular
abnormalities in 25 patients with HIES. These abnormalities were identified as aneurysms (coronary, aortic, carotid
and cerebral), pseudoaneurysms, congenital patent ductus venosus, superior vena cava syndrome, vasculitides,
vascular ectasia, thrombosis and others. They may be congenital or acquired, in the veins and arteries, affecting both
sexes. These abnormalities can be seen in all subtypes of HIES. They could be also fatal in children and adults. Limited Keratoconus is an ectatic corneal disorder for which exciting therapeutic and diagnostic technologies are emerging.
However, its pathogenesis is still heterogeneous and elusive. We researched overlooked Asian keratoconus data by
literature review of databases (PubMed, MEDLINE, Ovid, Google Scholar, Cornea, and Cochrane) using key words
"keratoconus, Asia, epidemiology, treatment, risk factors, genes" and names of Asian countries. Articles and their
references were analyzed. Studies showed that keratoconus may be more prevalent, have earlier onset, and have
greater disease progression in certain Asian and non-Asian ethnicities, particularly Indians, Pakistanis, Middle
Easterners, and Polynesians, compared with white populations. Epidemiological risk factors include ethnicity, age
(younger than 30 years), gender (male), positive family history, and eye rubbing. Genetic and disease risk factors
include atopy, vernal keratoconjunctivitis, Down syndrome, pellucid marginal corneal degeneration, VSX1 (visual
Keratoconus is an ectatic corneal disorder for which exciting therapeutic and diagnostic technologies are emerging.
However, its pathogenesis is still heterogeneous and elusive. We researched overlooked Asian keratoconus data by
literature review of databases (PubMed, MEDLINE, Ovid, Google Scholar, Cornea, and Cochrane) using key words
"keratoconus, Asia, epidemiology, treatment, risk factors, genes" and names of Asian countries. Articles and their
references were analyzed. Studies showed that keratoconus may be more prevalent, have earlier onset, and have
greater disease progression in certain Asian and non-Asian ethnicities, particularly Indians, Pakistanis, Middle
Easterners, and Polynesians, compared with white populations. Epidemiological risk factors include ethnicity, age
(younger than 30 years), gender (male), positive family history, and eye rubbing. Genetic and disease risk factors
include atopy, vernal keratoconjunctivitis, Down syndrome, pellucid marginal corneal degeneration, VSX1 (visual Ethnopharmacological relevance: Rheum australe D. Don (Polygonaceae) has been commonly used in traditional
medicine for a wide range of ailments related to the circulatory, digestive, endocrine, respiratory and skeletal
systems as well as to infectious diseases. Aim of the review: To provide the up-to-date information that is available
on the botany, traditional uses, phytochemistry, pharmacology and toxicology of Rheum australe. Additionally, to
highlight the possible uses of this species to treat different diseases and to provide a basis for future research.
Materials and methods: The present review covers the literature available from 1980 to 2011. The information was
collected from scientific journals, books, theses and reports via a library and electronic search (Google Scholar, Web
of Science and ScienceDirect). Results: Ethnomedical uses of Rheum australe have been recorded from China, India,
Nepal and Pakistan for 57 different types of ailments. The phytochemical studies have shown the presence of many
secondary metabolites belonging to anthraquinones, stilbenes, anthrones, oxantrone ethers and esters, chromones,
flavonoids, carbohydrate, lignans, phenols and sterols. Crude extracts and isolated compounds from Rheum australe This systematic review investigates the effectiveness of exercise interventions in improving disease-related
characteristics in patients with rheumatoid arthritis (RA). It also provides suggestions for exercise programmes
suitable for improving the cardiovascular profile of RA patients and proposes areas for future research in the field. Six
databases (Medline, Cochrane Library, CINAHL, Google Scholar, EMBASE and PEDro) were searched to identify
publications from 1974 to December 2006 regarding RA and exercise interventions. The quality of the studies
included was determined by using the Jadad scale. Initial searches identified 1342 articles from which 40 met the
inclusion criteria. No studies were found investigating exercise interventions in relation to cardiovascular disease in This systematic review investigates the effectiveness of exercise interventions in improving disease-related
characteristics in patients with rheumatoid arthritis (RA). It also provides suggestions for exercise programmes
suitable for improving the cardiovascular profile of RA patients and proposes areas for future research in the field. Six
databases (Medline, Cochrane Library, CINAHL, Google Scholar, EMBASE and PEDro) were searched to identify
publications from 1974 to December 2006 regarding RA and exercise interventions. The quality of the studies
included was determined by using the Jadad scale. Initial searches identified 1342 articles from which 40 met the
inclusion criteria. No studies were found investigating exercise interventions in relation to cardiovascular disease in Photodynamic therapy has been used in treating immune-mediated dermatological conditions such as psoriasis and
a topic dermatitis. There are emerging reports on the efficacy of intranasal phototherapy in allergic rhinitis. The aim
of this review was to assess intranasal phototherapy in the treatment of allergic rhinitis, with particular emphasis on
clinical efficacy, scientific basis and safety. A structured search of the U.S. National Library of Medicine (PubMed), the
Cochrane Collaboration library, Google Scholar and ISI Web of Knowledge database was undertaken using MeSH
terms 'phototherapy' and 'rhinitis.' Fourteen full-text articles were available for review. Three different phototherapy
medical devices were assessed: (1) Bionase, (2) Allergy Reliever SN206 and (3) Rhinolight. Light wavelength used in
these devices ranged from red light to ultraviolet. Clinical use of intranasal phototherapy appears to be safe and well OBJECTIVE: To review the existing data on use of the rifamycin class of antibiotics as therapy for Clostridium difficile-
associated diarrhea (CDAD). DATA SOURCES: A literature search was performed using PubMed (1996-January 2008),
abstracts from the International Conference on Antimicrobial Agents and Chemotherapy (September 2007), the
Infectious Diseases Society of America (October 2007), Salix Pharmaceuticals Web site (January 2008), ActivBiotics
Web site (January 2008), Google Scholar, and searches of selected bibliographies using the terms rifamycin,
ansamycins, rifampin, rifabutin, rifampicin, rifaximin, rifalazil, Clostridium difficile, C. difficile, and CDAD. STUDY
SELECTION AND DATA EXTRACTION: In vivo and in vitro studies investigating the use of rifamycins for CDAD were
selected, along with all clinical trials using rifamycins in patients with CDAD. DATA SYNTHESIS: Nine studies totaling
890 isolates were identified that investigated the in vitro susceptibility of rifampin (6 studies), rifaximin (3 studies),
BACKGROUND: Radial artery access is a mainstay in the diagnosis and treatment of coronary artery disease.
However, there is uncertainty on the comparison of right versus left radial access for coronary procedures. We thus
undertook a systematic review and meta-analysis comparing right versus left radial access for coronary diagnostic
and interventional procedures., METHODS: Pertinent studies were searched in CENTRAL, Google Scholar,
MEDLINE/PubMed, and Scopus, together with international conference proceedings. Randomized trials comparing
right versus left radial (or ulnar) access for coronary diagnostic or interventional procedures were included. Risk
ratios (RR) and weighted mean differences (WMD) were computed to generate point estimates (95% confidence
intervals)., RESULTS: A total of 5 trials (3210 patients) were included. No overall significant differences were found
comparing right versus left radial access in terms of procedural time (WMD=0.99 [-0.53; 2.51]min, p=0.20), contrast
use (WMD=1.71 [-1.32; 4.74]mL, p=0.27), fluoroscopy time (WMD=-35.79 [-3.54; 75.12]s, p=0.07) or any major BACKGROUND: Instruments for assessing the risk of violent behaviour have proved their worth in the field of forensic
psychiatry. However, it is not certain whether such instruments provide an accurate assessment of recidivism when
used with psychiatric patients who have an intellectual disability. AIM: To find out whether these instruments - or
which of these instruments - can provide a reliable assessment of the risk of violent sexual recidivism if used with
forensic psychiatric patients who have an intellectual disability. METHOD: We searched PubMed, PSYCINFO and
Google Scholar for studies in English or Dutch, published between 1980 and 2010, concerning the reliability of
instruments for assessing the risk of recidivism in forensic psychiatric patients with an intellectual disability. RESULTS:
The studies show that several of the risk assessment instruments currently in use provide reliable predictions Several risk factors are reportedly associated with dengue shock syndrome (DSS), but the results from these reports
are highly inconclusive. In order to estimate overall association of risk factors and DSS over dengue hemorrhagic
fever (DHF), we systematically reviewed and performed a meta-analysis of relevant studies in both DSS and DHF
patients. PubMed, EMBASE, Scopus, Google Scholar, Dengue Bulletin, Cochrane Library, Virtual Health Library,
Cochrane Library, and manual search of reference lists of articles published before September 2010 were used to
retrieve relevant studies. Two reviewers independently selected articles and extracted data on study characteristics
and data regarding the association between factors and DSS over DHF in the form of 2x2 tables. A meta-analysis
using fxed-effects or random-effects models to pooled odds ratios (OR) or difference in mean with corresponding
95% confdence intervals were calculated only if more than one study had investigated particular factor. We found OBJECTIVE: To identify medications and other potential risk factors, in addition to renal dysfunction, for developing
gadolinium-induced nephrogenic systemic fibrosis (NSF). DATA SOURCES: Information was obtained from PubMed.
International Pharmaceutical Abstracts, Iowa Drug Information Service, and Google Scholar, using the unlimited
search terms nephrogenic systemic fibrosis. NSF, nephrogenic fibrosing dermopathy, NFD. gadolinium, gadodiamide.
gadoversetamide. gadopentetate. gadobenate. and gadoteridol. Information was also obtained from the Food and
Drug Administration, as well as the manufacturers of the above-mentioned products. Data were collected during
April and May 2007. STUDY SELECTION AND DATA EXTRACTION: All identified articles and information were
evaluated. Articles and other information that included data regarding concurrent medications, disease states, and
other risk factors for developing gadolinium-induced NSF were included in this review, as were clinical practice
guidelines. DATA SYNTHESIS: NSF is a mysterious and severe disorder that occurs in individuals with severe renal
impairment. Virtually all cases of NSF have been associated with the administration of gadolinium-containing
contrast media. However, not all renally impaired patients who receive gadolinium develop NSF. Thus, additional risk Educational objectives: At the conclusion of this presentation, participants should be able to identify key factors that
may increase the risk of domestic violence among women in developing countries and recognize factors that may be
protective. Purpose: The main objectives of this review were to identify and summarize the individual, household,
and neighborhood risk factors for the victimization and perpetration of intimate partner violence (IPV) in low- and
middlie-income countries (LMIC) and to highlight knowledge gaps, contextual considerations and methodological
limitations. Methods: A literature search was performed from January 2000 to December 2010 using Medline,
Embase, CINAHL, PsychINFO and Google Scholar. Citations were included if they were (1) a primary article from a
LMIC; (2) reported on adult women and men in the community and (3) reported any estimates on predictors,
determinants, risk or protective factors for IPV. Results: There were 58 primary studies examining risk factors for IPV
conducted in LMIC. There were a total of 35 factors associated with IPV. There were 17 of these that were identified
at the individual level, 9 at the family/relationship level, 6 at the community level and 3 at the societal level. The
Case reports for uterine rupture subsequent to laparoscopic myomectomy were reviewed to determine whether
common causal factors could be identified. Published cases were identified via electronic searches of PubMed,
Google Scholar, and hand searches of references, and unpublished cases were obtained via E-mail queries to the
AAGL membership and AAGL Listserve participants. Nineteen cases of uterine rupture after laparoscopic
myomectomy were identified. The removed myomas ranged in size from 1 through 11 cm (mean, 4.5 cm). Only 3
cases involved multilayered closure of uterine defects. Electrosurgery was used for hemostasis in all but 2 cases. No
plausible contributing factor could be found in one case [corrected]. It seems reasonable for surgeons to adhere to Case reports for uterine rupture subsequent to laparoscopic myomectomy were reviewed to determine whether
common causal factors could be identified. Published cases were identified via electronic searches of PubMed,
Google Scholar, and hand searches of references, and unpublished cases were obtained via E-mail queries to the
AAGL membership and AAGL Listserve participants. Nineteen cases of uterine rupture after laparoscopic
myomectomy were identified. The removed myomas ranged in size from 1 through 11 cm (mean, 4.5 cm). Only 3
cases involved multilayered closure of uterine defects. Electrosurgery was used for hemostasis in all but 2 cases. No Study Objective: We reviewed cases of uterine rupture subsequent to laparoscopic myomectomy to determine if
common causal factors could be identified. Design: Previously published cases, identified through electronic searches
using PubMed and Google Scholar, hand searches of references, and email queries to the AAGL membership and
AAGL Listserve participants were used to obtain case data. Setting: Previously published cases, e-mail queries to the
AAGL membership and AAGL Listserve participants. Patients: 19 women with uterine rupture during pregnancy
following laparoscopic myomectomies. Intervention: Laparoscopic myomectomy. Measurements and Main Results:
Nineteen cases of uterine rupture following laparoscopic myomectomy were identified. (Table presented) Sizes of
the removed myomas ranged from 1-11 cm with a mean of 4.5 cm. Only 3 cases had multi-layered closures of the Background: Previous reviews on risk and protective factors for violence in psychosis have produced contrasting
findings. There is therefore a need to clarify the direction and strength of association of risk and protective factors
for violent outcomes in individuals with psychosis. Method: We conducted a systematic review and meta-analysis
using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar.
Studies were identified that reported factors associated with violence in adults diagnosed, using DSM or ICD criteria,
with schizophrenia and other psychoses. We considered non-English language studies and dissertations. Risk and
protective factors were meta-analysed if reported in three or more primary studies. Meta-regression examined
sources of heterogeneity. A novel meta-epidemiological approach was used to group similar risk factors into one of
10 domains. Sub-group analyses were then used to investigate whether risk domains differed for studies reporting
severe violence (rather than aggression or hostility) and studies based in inpatient (rather than outpatient) settings.
Findings: There were 110 eligible studies reporting on 45,533 individuals, 8,439 (18.5%) of whom were violent. A
total of 39,995 (87.8%) were diagnosed with schizophrenia, 209 (0.4%) were diagnosed with bipolar disorder, and OBJECTIVE: To characterize patient and programmatic factors associated with retention in care during the pre-
antiretroviral therapy (ART) period and linkage to ART care. DESIGN: Systematic literature review. METHODS: An
electronic search was conducted on MEDLINE, Global Health, Google Scholar and conference databases to identify
studies reporting on predictors, barriers and facilitators of retention in care in the pre-ART period, and linkage to
care at three steps: ART-eligibility assessment, pre-ART care and ART initiation. Factors associated with attrition were
then divided into areas for intervention. RESULTS: Seven hundred and sixty-eight citations were identified. Forty-two
studies from 12 countries were included for review, with the majority from South Africa (16). The most commonly
cited category of factors was transport costs and distance. Stigma and fear of disclosure comprised the second most
commonly cited category of factors followed by staff shortages, long waiting times, fear of drug side effects, male
sex, younger age and the need to take time off work. CONCLUSION: This review highlights the importance of
Introduction: Ultra-endurance events are getting more popular, both in the categories of mass-participation and solo
(often fund-raising for a nominated charity). However, part of the popularity and potential for charity fund-raising is
connected to perceived and real risk of the event(s). The consequences of catastrophic outcome for a competitor are
not well-defined in terms of insurance or legal liability, with these risk management considerations having the
potential to cancel out the benefits of events. Ironically, often the publicity an event receives (positive benefit for
fund-raising) is in direct proportion to the risk (negative) of catastrophic outcome (e.g. solo unassisted endurance
attempts receive greater publicity than the same attempts made with a support team nearby). Methods: Pubmed
and Google scholar searches were performed for the terms "ultra-endurance risks", "triathlete risks" and "ultra-
endurance liability". An emphasis on the literature and internet review was placed on risk management publications
and descriptions of actual catastrophic outcomes to illustrate potential consequences that must be foreseen in a risk
management appraisal of events. An attempt to summarise recommendations as medical, legal and ethical risks was
made. Results: No summary paper was found which gave a comprehensive overview of the factors needing to be
considered by organisers, sponsors or participants. Multiple disasters were documented, particularly on internet
resources. These included the Tony Bullimore rescue, Andrew McAuley's attempt to kayak from Australia to New To evaluate current risk models and scores for type 2 diabetes and inform selection and implementation of these in
practice. Systematic review using standard (quantitative) and realist (mainly qualitative) methodology. Inclusion
criteria Papers in any language describing the development or external validation, or both, of models and scores to
predict the risk of an adult developing type 2 diabetes. Medline, PreMedline, Embase, and Cochrane databases were
searched. Included studies were citation tracked in Google Scholar to identify follow-on studies of usability or impact.
Data were extracted on statistical properties of models, details of internal or external validation, and use of risk
scores beyond the studies that developed them. Quantitative data were tabulated to compare model components
and statistical properties. Qualitative data were analysed thematically to identify mechanisms by which use of the
risk model or score might improve patient outcomes. 8864 titles were scanned, 115 full text papers considered, and
43 papers included in the final sample. These described the prospective development or validation, or both, of 145
risk prediction models and scores, 94 of which were studied in detail here. They had been tested on 6.88 million
participants followed for up to 28 years. Heterogeneity of primary studies precluded meta-analysis. Some but not all
risk models or scores had robust statistical properties (for example, good discrimination and calibration) and had
been externally validated on a different population. Genetic markers added nothing to models over clinical and Objective: Deterioration in neurological status in adults with cerebral palsy is an area of significant concern, as a
person's already reduced autonomy becomes further compromised. One potential cause of this deterioration can be
the development of cervical mylopathy secondary to a spinal cord compression. The significant stressors inflicted on
the cervical spine by the altered postures and loads on the joints can lead to aberrations in the cervical spine joints
leading to an acceleration of the degenerative process. The purpose of this study was to identify who is most at risk
of developing a cervical mylopathy and to determine what postures and movements contribute to the progression of
this condition. Design: Systematic review of the literature using the framework of a critically appraised topic.
Method: Key terms were used for population (cerebral palsy, adults, >18y old), intervention (symptoms, clinical
presentation, radiological findings) and outcomes (spinal cord compression, cervical mylopathy, spondylotic cervical
mylopathy). These were entered into five electronic data bases (Medline, CINAHL, Cochrane, Google Scholar,
Pubmed). Additional articles were then identified by citation tracking. These articles were then critically appraised,
looking at quality (using the Oxford Centre for evidence based medicine 2011 levels of evidence) and the relevance
of the articles (as per the PICO terms of reference). Eleven articles were selected for inclusion in the study, published
since 1991. Results: There have been a number of key findings that have implications for this population group.
These include that there are a higher incidence of cervical spine malpostures (kyphosis, scoliosis - 58%) and
instabilities (angular and listhetic -27%, eight times the frequency of that seen in the general population) within the
cerebral palsy population, particularly those with athetosis and dystonia. These malpostures and instabilities are Introduction: The colon and rectum are common sites of food-related cancer in developed countries. Recent studies
strongly suggest that red meat intake is associated with colon cancer, whereas for rectal cancer such an association
still needs to be proved. The aim of the study was to assess the role of total amount and frequency of red meat
intake in colorectal carcinogenesis based on published data using meta-analysis methods. Material and methods:The
literature published until 2009 was selected from: MEDLINE, PubMed, Scopus, Embase, CancerLit, Google Scholar
and Cochrane Library databases. The used search terms were: colorectal cancer, colon cancer, rectal cancer, meat
intake, red meat intake, red meat consumption, meat consumption, colorectal cancer risk, colon cancer risk, rectal
cancer risk and lifestyle. Articles investigating red meat intake of more often than once a day or 50 g per day were
reviewed and selected for further analysis. Results: Twenty-two studies fulfilled the established criteria. A meta-
Bariatric surgery is one of the most effective treatments for morbid obesity, and a large body of research indicates
significant long-term weight loss. While overall mortality decreases in patients who received bariatric surgery, a
number of studies have shown that suicide rates are higher in bariatric patients than in control groups. The objective
of this study was to present a systematic review of suicide mortality after bariatric surgery and calculate an estimate
for the suicide rate. Literature researches of the databases PubMed, Web of Knowledge, PsychInfo, ScienceDirect
and Google Scholar were conducted. Thirty studies concerning bariatric surgery and completed suicides met the
inclusion criteria. We included 28 studies in the estimation of a suicide rate for the bariatric population. Only one
study (Tindle etal.) put a main focus on suicide after bariatric surgery; this was therefore chosen as an adequate
reference figure for comparison. The other 27 chosen studies were compared with World Health Organization data
and the suicide rate reported by Tindle etal. Twenty-three thousand eight hundred eighty-five people were included OBJECTIVE: To review the potential risks of administering intravenous iron to patients with infection. DATA SOURCES:
Literature was accessed through MEDLINE (1977-June 2007) and Google Scholar, using the terms intravenous iron,
iron sucrose, ferric gluconate, iron dextran, and infection. In addition, reference citations from publications identified
were reviewed. STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data
sources were evaluated. Studies that provided data relevant to the objective were used, including in vitro and animal
studies. DATA SYNTHESIS: The role of iron in bacterial growth and the pathophysiology of cellular immunity create
legitimate, yet theoretical, concerns that active infection may be exacerbated by the administration of intravenous
iron. Human data relating to this issue are limited. A few small, human studies in a population with chronic kidney
disease suggest a possible increased risk of developing an infection associated with intravenous iron; however,
prospective human data directly linking intravenous iron to exacerbation of existing infection or infection-related OBJECTIVE: Literature review and meta-analysis to review the evidence of relationship between the presence of right-
to-left shunts (RLSs) and the occurrence of neurological decompression sickness (DCS) in divers. DATA SOURCES:
MEDLINE, Google Scholar, and Health Technology Assessment databases. STUDY SELECTION: Five case-control
studies in which the prevalence of a RLS in a group of divers with neurological DCS was compared with that of a
group of divers with no history of DCS, 3 cross-transversal studies in which the prevalence of RLS was measured in
divers with neurological DCS, and 4 cross-transversal studies in which the prevalence of RLS was measured in divers
with no history of DCS were reviewed. DATA EXTRACTION: Only case-control studies were retained for meta-analysis.
DATA SYNTHESIS: This meta-analysis gathers 5 studies and 654 divers. The combined odds ratio of neurological DCS
in divers with RLS was 4.23 (3.05-5.87). The meta-analysis including only large RLS found a combined odds ratio of Objective: Although pregnant and postpartum women are presumed to be at greater risk of obsessive-compulsive
disorder (OCD) than the general population, the evidence has been inconclusive. This meta-analysis provides an
estimate of OCD prevalence in pregnant and postpartum women and synthesizes the evidence that pregnant and
postpartum women are at greater risk of OCD compared to the general population. Data Sources: An electronic
search of Google Scholar, PsycINFO, PsychARTICLES, and PubMed was performed by using the search terms OCD,
obsessive-compulsive disorder, pregnancy, postpartum, prevalence, and epidemiology. We SUPPLemented our
search with articles referenced in the obtained sources. The search was conducted until August 2012 without date
restrictions. Study Selection: We included English-language studies reporting OCD prevalence (diagnosed according
to DSM-III-R, DSM-IV, or ICD-10 criteria) in pregnant (12 studies) or postpartum (up to 12 months; 7 studies) women
using structured diagnostic interviews. We also included a sample of regionally matched control studies (10 studies)
estimating 12-month prevalence in the general female population for comparison. The control studies were limited
to those conducted during the same time frame as the pregnant and postpartum studies. Data Extraction: We Background: Antipsychotic drugs are widely prescribed for the treatment of various psychiatric disorders such as
schizophrenia, mania, dementia, major psychotic depression... An unexpected frequency of thromboembolic
complications is observed with the use of antipsychotic drugs, a priori unrelated to psychiatric disease. Several
observational studies have tried to quantify the association between antipsychotic drug use and the risk of
thromboembolic events, but no synthesis is available. Methods: We performed an exhaustive meta-analysis of
analytic observational studies assessing the existence of a link between antipsychotic drug use and risk of
thromboembolic events. The computer-assisted research was conducted via MEDLINE, Cochrane Library and Google
Scholar. Congress proceedings have also been consulted. The outcome of interest was the presence of a venous
thromboembolic event (deep vein thrombosis and/or pulmonary embolism) objectively confirmed. The exposition
was defined as current antipsychotic drugs use or use in the last 3 months before the inclusion. Odds Ratio (OR) and
95% confidence intervals (95%CI) of each study was combined weighting by the inverse of the variance using log(OR)
method. Results: Seven studies were included (five case-controls and two cohorts) including 370 516 patients. When
pooling adjusted OR estimated in each study, an increase of 82% of the risk of thromboembolic events was observed
Background: There is increasing concern that emerging infectious diseases (EIDs) may be effectively transmitted by
blood transfusion in addition to their common routes of infection. In most countries a range of safety measures are
in place to minimize the transfusion transmission (TT) risk of well known infectious diseases, yet these might be
insufficient against EIDs. Aim: In order to evaluate the potential threat of EIDs in EU countries a risk prioritization (RP)
tool was developed to identify EIDs that are considered to be a high priority for blood safety. Methods: Published
literature was searched using Pubmed and Google Scholar with keywords: emerging infections, Europe, transmission
by transfusion, blood safety, screening, tests, and risk model. In addition, information presented by experts on
conferences and fact sheets published on public health and transfusion related websites were reviewed. Information
on seventy EIDs was collected and assessed. We defined eight dimensions that characterize the risk of TT namely the
likelihood of TT, the associated mortality rate, the severity and curability of the disease in recipients, the existence of
specific screening questions, the availability of a test, the presence and duration of the agent in the blood, and the Background: Early risk stratification of patients with acute heart failure syndrome (AHFS) can guide the decision to
admit the patient to hospital and the choice of therapy. Methods: Standard review methodology using Medline and
Google scholar from the years 2006present. Papers before 2006 were reviewed when necessary. Results: Biomarkers
used in AHFS are broadly classified based on their mechanism of action: inflammation, renal stress, extracellular
matrix remodeling, oxidative stress, cardiac myocyte stress, and neurohormonal regulation. Conclusion: This paper BACKGROUND AND OBJECTIVES: The treatment of membranous nephropathy (MN) remains controversial.
Rituximab, which selectively targets B cells, has emerged as a possible alternative treatment option with limited
toxicity. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The available data on rituximab therapy for MN were
reviewed using the MEDLINE database (inception to August 1, 2008), Google Scholar, and selected reference lists.
English-language studies investigating the use of rituximab in idiopathic and secondary MN, in native and
transplanted kidneys, were included. Study design, subject number, clinical characteristics (diagnosis, previous and
concomitant treatment courses, baseline proteinuria, baseline renal function), rituximab protocol, follow-up period,
achievement of complete or partial remission, changes in proteinuria and renal function, and adverse effects of
therapy were extracted. RESULTS: Twenty-one articles were included for review; all were either case reports or case
series without controls. More than half of the published cases (50 of 85) came from one center where rituximab was PURPOSE OF REVIEW: To provide an overview of the history, development, and potential applications of robotic
technology, with a focus on ophthalmic surgery. An extensive literature review and authors' own perspectives were
taken into account in selecting the most relevant articles from MEDLINE and Google scholar. RECENT FINDINGS:
Most surgical specialties have introduced robots in current use. Although the application of robots in ophthalmic
surgery is in its infancy today, its advantages and great potential is quite apparent. As robotics transcends utility and
attain wider consensus among the surgical profession, ophthalmologists must acquaint themselves with this novel PURPOSE OF REVIEW: To provide an overview of the history, development, and potential applications of robotic
taken into account in selecting the most relevant articles from MEDLINE and Google scholar., RECENT FINDINGS:
Most surgical specialties have introduced robots in current use. Although the application of robots in ophthalmic
surgery is in its infancy today, its advantages and great potential is quite apparent. As robotics transcends utility and
attain wider consensus among the surgical profession, ophthalmologists must acquaint themselves with this novel Purpose of review To provide an overview of the history, development, and potential applications of robotic
taken into account in selecting the most relevant articles from MEDLINE and Google scholar. Recent findings Most
surgical specialties have introduced robots in current use. Although the application of robots in ophthalmic surgery is
in its infancy today, its advantages and great potential is quite apparent. As robotics transcends utility and attain
wider consensus among the surgical profession, ophthalmologists must acquaint themselves with this novel OBJECTIVE: To recommend strategies for enhancing patients' sense of self-worth and self-efficacy in order to give
them sufficient faith in themselves to make healthier choices about their weight. SOURCES OF INFORMATION:
PubMed, PsycINFO, Google Scholar, and APA Journals Online were searched for original research articles on
treatment models and outcome review articles from 1960 to the present. Key search terms were weight loss, weight-
loss treatments, diets and weight loss, psychology and obesity, physiology and obesity, and exercise and weight loss.
Most evidence was level I and level II. MAIN MESSAGE: In spite of extensive research, there is widespread belief that
the medical system has failed to stem the tide of weight gain in North America. The focus has been on physiologic,
behavioural, and cultural explanations for what is seen as a relatively recent phenomenon, while the self-perception
of overweight individuals has been largely overlooked. Professional treatments have consisted mainly of cognitive-
Introduction: The aim of this systematic review is to assess whether antibacterial agents are more effective than
either placebo or no intervention at all in the treatment of acute bacterial sinusitis. Patients and methods: We
reviewed the databases and search engines: PubMed, EMBASE, Cochrane Central Register of Controlled Trials and
Google Scholar to identify randomized clinical trials (RCTs) in children comparing antibiotics versus placebo. Sinusitis
was considered as the persistence of clinically compatible symptoms for at least 10 days. The methodological quality
was assessed using the Jadad scale. Four RCTs were selected. We studied the following variables: cure, clinical
improvement (on days 10 to 14), relapse-recurrence (from day 14 to day 60) and presence of adverse effects. The
results were combined using meta-analysis. We used the fixed effects model or random model depending on
whether or not there was heterogeneity. We estimated the combined relative risk (RR) and 95% confidence interval.
Results: Only two RCTs had a Jadad scale score >=3. Variable cure-improvement (4 RCTs): RR 1.11 (95% CI: 0.9 to INTRODUCTION: The aim of this systematic review is to assess whether antibacterial agents are more effective than
either placebo or no intervention at all in the treatment of acute bacterial sinusitis., PATIENTS AND METHODS: We
reviewed the databases and search engines: PubMed, EMBASE, Cochrane Central Register of Controlled Trials and
Google Scholar to identify randomized clinical trials (RCTs) in children comparing antibiotics versus placebo. Sinusitis
was considered as the persistence of clinically compatible symptoms for at least 10 days. The methodological quality
was assessed using the Jadad scale. Four RCTs were selected. We studied the following variables: cure, clinical
improvement (on days 10 to 14), relapse-recurrence (from day 14 to day 60) and presence of adverse effects. The
results were combined using meta-analysis. We used the fixed effects model or random model depending on
whether or not there was heterogeneity. We estimated the combined relative risk (RR) and 95% confidence interval.,
RESULTS: Only two RCTs had a Jadad scale score >=3. Variable cure-improvement (4 RCTs): RR 1.11 (95% CI: 0.9 to Objective: Efficacy of artemisinin derivatives alone or in combination compared to praziquantel alone for the
treatment of urinary schistosomiasis in schoolchildren. Methods: Randomized clinical trials comparing praziquantel
with artemisinin derivatives in the treatment of urinary schistosomiasis in schoolchildren were included. Medline,
EMBASE, LILACS, CENTRAL, African Index Medicus, and Scielo were searched. We also analyzed the abstracts of the
main conferences on infectious diseases and tropical medicine during the years 2009-2011. Google Scholar and Open
SIGLE were also searched. The last search was performed in July 2012. The primary endpoint was the cure rate. The
main outcome data were retrieved using a standardized form; three independent researchers (WP, HC, and SS)
performed the search, retrieved data, and evaluated the risk of bias. Disagreements were resolved by discussion.
Risk ratios were used and heterogeneity was evaluated. A fixed or random-effects model was used according to the
results of heterogeneity testing. An intention-to-treat analysis was done. Data were analyzed using Revman 5.0.24
(Copenhagen: The Nordic Cochrane Centre). Results: Seven studies were selected for full text review and only five Introduction: Traditionally, patients have been fasted from midnight on the night before elective surgery. With the
advent of the enhanced recovery programme for elective colorectal surgery, there has been a major change in
established practice with patients able to continue with clear fluids up to two hours prior to surgery and solids up to
six hours prior to surgery. It has been suggested that nutritional supplements in the immediate pre-operative period
enhance post-operative recovery. The aim of this review was therefore critically to appraise the evidence available
regarding the use of pre-operative carbohydrate (CHO) supplements for elective colorectal surgery. Methods: A
literature search was performed using: PubMed, MEDLINE, Athens and Google Scholar. The following keywords were
used: 'pre-operative', 'carbohydrate supplements', 'enhanced recovery' and 'colorectal surgery', singly or in
combination. To ensure an up-to-date literature search, the search was restricted to the last ten years. To maximise Objective: A systematic review of the literature was conducted, in order to investigate the role of continuity of care
(COC) in the treatment of comorbid mental health and substance use disorders (SUDs). Methods: Reviewed
databases included: Academic One File, Academic Search Premier, CINAHL, Cochrane, Embase, Eric, Informit,
PsychArticles, PsychInfo, Scopus, Web of Science and Google Scholar. Abstracts and titles meeting the following
inclusion criteria were included: studies published in English, peer reviewed, published after 1980, DSM-IV or ICD-10
criteria of mental health and SUD and a psychometric measurement of COC. Based on rigorous screening, a total of
45 relevant articles remained for analysis. Results: Majority of relevant articles referred to alcohol use disorder,
depression and anxiety disorder comorbidity. Reviewed studies discussed COC in the context of sustained contact,
COC through discharge and transfers and as a measure of program quality. In all domains, COC was observed to be
lower among patients with mental health and SUD comorbidity, as opposed to patients with a single SUD diagnosis.
There are numerous issues surrounding adherence in children taking recombinant human growth hormone (rh-GH).
New technologies capable of accurately recording/monitoring may highlight some of these issues, and have value in
optimizing adherence levels through education and counseling. The intention of this review is to guide healthcare
professionals (HCPs). PubMed, Google Scholar and citations in published papers were used to substantiate the views
expressed by the authors. Both perceptional and practical factors influence the adherence levels of children taking rh-
GH. Understanding such factors may help to identify the characteristics of ideal rh-GH devices and their potential
impact on adherence. New technologies, such as electronic monitors, may facilitate patient-provider discussions on OBJECTIVE: To evaluate the efficacy of gabapentin for the treatment of uremic pruritus (UP). DATA SOURCES:
Literature retrieval was accessed through MEDLINE (1950-March week 3, 2008; In-Process & Other Non-Indexed
Citations, April 1, 2008) and International Pharmaceutical Abstracts (1970-March 2008) using the terms gabapentin,
pruritus, itch, urem$ (truncated), dialysis, and kidney disease. The Google Scholar search engine was used to identify
articles that MEDLINE did not capture with the described search terms. Additionally, reference citations from
publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: All articles in English and studies
conducted in humans were identified and evaluated. DATA SYNTHESIS: UP is an unpleasant itching sensation that
affects approximately 30% of patients on hemodialysis (HD). The current mainstays of therapy include antihistamines
and topical therapies, although many patients remain symptomatic despite these treatments. Alternative
therapeutic approaches, including topical, oral, and intravenous drugs; dialysis modifications; homeopathic
therapies; and physical treatments have been used, but few evidence-based studies exist to support their utility.
Gabapentin has been evaluated for the treatment of UP in 2 small, randomized, placebo-controlled studies, 1 pilot objective: To review the role of huperzine A in the treatment of Alzheimer's disease (AD). data sources: A literature
search was conducted through MEDUNE (1950- September week 2, 2008), EMBASE (all years), Google Scholar,
International Pharmaceutical Abstracts, and a bibliographic review of relevant articles. Key words included
huperzine, huperin, Huperzia serrata, and Alzheimer's disease. study selection and data extraction: All clinical trials
published in the English language that evaluated huperzine A in patients with AD were included in this review.
Articles published in Chinese were included when English abstracts or electronic translation technology were
available. data synthesis: AD is a progressive neurodegenerative brain disorder for which there is no cure; available
therapies only decrease cognitive decline. Huperzine A. an alkaloid derived from Chinese club moss (H. serrata), acts Introduction: Post-operative pain following laparoscopic cholecystectomy can delay discharge. Shoulder tip pain may
be a result of diaphragmatic stretching due to the creation of the pneumoperitoneum. The use of local anaesthetic
intraperitoneally may therefore reduce this reaction, and the overall post-operative pain. This review aimed to
evaluate the role of intraperitoneal local anaesthetic infiltration in the management of post-operative pain following
laparoscopic cholecystectomy. Methods: A literature search was carried out using the following databases - Pubmed,
Athens, Medline and Google scholar search engine. The following key words were used - laparoscopic
cholecystectomy, post-operative pain management, intraperitoneal, and local anaesthetic, singly or in combination.
To ensure an up-to-date literature search, the search initially restricted to the last six years. To maximize this search,
backward chaining of reference lists from retrieved papers was also undertaken. The search was limited to the
English language. A total of 15 papers were originally identified, 6 were excluded due to date or content, leaving a
total of 9 papers. Results: Five randomised control trials supported the use of intraperitoneal local anaesthetic to
control post-operative pain following laparoscopic cholecystectomy. Evidence supported the combined use of pre- Background: Mast cells (MCs) are the classical mediators of allergy, however, their importance in the development of
innate and adaptive immune responses is increasingly being recognized. Herein, the present MC literature is
summarized, with particular focus on studies of MCs in the endometrium and myometrium, and their involvement in
fertility, implantation, pregnancy and labour. Methods: Recent developments in MC biology were identified by
systematic searches of PubMed, Medline and Google Scholar from 2000 to November 2009. To specifically examine
the role of MCs in fertility and pregnancy, we then performed a systematic review of English literature cited in the
PubMed, Medline and Google Scholar databases, but extended the search period, from 1980 to January 2010.
Results: MCs can respond to immunoglobulin E-independent innate immune stimuli and are present within the
endometrium, with activation and release of mediators occurring prior to menstruation and in association with
endometriosis. With respect to pregnancy, MCs are redundant during blastocyst implantation and although their Melatonin is a neurohormone secreted by the pineal gland. It is widely present in both plant and animal sources. In
several countries, it is sold over the counter as tablets and as food supplement or additive. Currently, it is most often
used to prevent jet lag and to induce sleep. It has been and is being used in several clinical trials with different
therapeutic approaches. It has sedative, analgesic, anti-inflammatory, anti-oxidative and chronobiotic effects. In the
present review, the potential therapeutic benefits of melatonin in anaesthesia and critical care are presented. This
article aims to review the physiological properties of melatonin and how these could prove useful for several clinical
Objective: The progressive aging of the population has highlighted the importance of discovering therapeutic
alternatives for diseases of high incidence and disability, such as stroke. The only approved therapy for stroke is tPA,
strongly limited by the short therapeutic window and hemorrhagic complications, therefore excluding most patients
from its benefits. Materials and Methods: In this review article, electronic searches were undertaken in PubMed,
Scholar google and up to date, since 2009. Results: Menstrual blood is a source of stem cells with potential relevance
for the treatment of stroke that is recurring and readily accessible. Immunocytochemi- cal assays of cultured
menstrual blood reveal that they express embryonic-like stem cell phenotypic markers (Oct4, SSEA, Nanog), and
when grown in appropriate conditioned media, express neuronal phenotypic markers (Nestin, MAP2). Migration to
the infarct site, modulation of the inflammatory reaction, secretion of neurotrophic factors, and possible
differentiation warrant these cells as therapeutic tools. Transplantation of menstrual blood-derived stem cells, either Background and objectives: This review focuses on three areas, basic acid-base physiology especially concerning
hydrogen ion balance, development of acidosis in chronic kidney disease (CKD), and the consequences of acidosis.
We highlight what is well established, what is less certain, and what is unknown. Method and results: The literature
on acidosis in CKD were searched from 2004 to 2010 utilizing PubMed, Google Scholar, and Ovid to augment the
classic work on acid base physiology over the past three decades. The original research in endogenous acid
production and net acid excretion were reviewed. Touching upon the development of metabolic acidosis in CKD, we
focused on the consequences of chronic metabolic acidosis on growth and other important variables. Finally, we Background: Colorectal metastatic disease of the liver carries a significant mortality. Surgical resection improves
prognosis in suitable patients. Microwave ablation is a recent innovative technique for the management of hepatic
cancer. The aim of this study was to review the relevant literature regarding its safety and efficacy. Methods: A
literature search was performed using Pubmed, Athens, Medline and Google Scholar search engine. The following
key words were used - thermal ablation, microwave ablation, liver, colorectal cancer, colorectal liver metastases -
singly or in combination. To ensure an up-to-date literature search, the search has been restricted to the last ten
years from 2000 to date inclusively, and the search was restricted to English language articles. To maximize this Objective: Randomized controlled trials involving natriuretic peptide administration in the perioperative
cardiovascular setting have shown inconsistent effects for renal and other clinical endpoints. The authors aimed to
systematically review these trials to ascertain the role of natriuretic peptide administration in the management of
cardiovascular surgery-associated renal dysfunction. Design: A systematic review and meta-analysis. Setting: A
hospital. Participants: A total of 934 adult patients from 13 randomized controlled trials. Interventions: Natriuretic
peptides. Measurements and Main Results: MEDLINE, EMBASE, Cochrane Renal Health Library, and Google scholar
were searched independently by 2 reviewers for randomized controlled studies comparing natriuretic peptides with
placebo in patients undergoing cardiovascular surgeries. Studies reporting data on renal outcomes were included.
Two reviewers independently assessed the studies for eligibility and extracted the relevant data. The pooled
estimate showed that natriuretic peptide administration was associated with a reduction in acute renal failure
requiring dialysis (odds ratio = 0.32 [0.15-0.66]) and a statistically nonsignificant trend toward a reduction in 30-day OBJECTIVE: To evaluate the efficacy of ondansetron for the treatment of schizophrenia. DATA SOURCES: Searches of
MEDLINE (1950-March 2010) and Google Scholar were performed. Key search terms included ondansetron, Zofran,
serotonin antagonists, 5-HT3 serotonin receptor, and schizophrenia. STUDY SELECTION AND DATA EXTRACTION: All
articles published in English identified from the data sources were evaluated. All studies and case reports evaluating
ondansetron for the treatment of schizophrenia were reviewed. DATA SYNTHESIS: Six clinical trials, including 3
double-blind, randomized trials, and 2 case reports pertinent to ondansetron use in schizophrenia, were identified.
Ondansetron daily doses ranged from 4 to 16 mg, with doses administered once or twice daily. Ondansetron was
used as monotherapy in 3 trials and as an adjunct to therapy with clozapine, haloperidol, or risperidone, respectively,
in 3 trials. Studies were of varying durations, ranging from a single-dose study with a 3-hour follow-up to three 12-
week studies. Most studies evaluated ondansetron's efficacy in treating schizophrenia as measured with changes in
Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale, and Clinical Global Impression scale
Background. Transient hypocalcemia is a frequent complication after total thyroidectomy. Routine postoperative
administration of vitamin D and calcium can reduce the incidence of symptomatic postoperative
hypocalcemia.Weperformed a systematic review to assess the effectiveness of this intervention. The primary aim
was to evaluate the efficacy of routine postoperative oral calcium and vitamin D supplementation in preventing
symptomatic post-thyroidectomy hypocalcemia. The second aim was to draw clear guidelines regarding prophylactic
calcium and/or vitaminDtherapy for patients after thyroidectomy. Methods.Weidentified randomized controlled
trials comparing the administration of vitamin D or its metabolites to calcium or no treatment in adult patients after
thyroidectomy. The search was performed in PubMed, Cochrane Library, Cumulative Index to Nursing and Allied
Health Literature, Google Scholar,andWebofKnowledgedatabases. Patients withahistory of previous neck surgery,
calcium supplementation, or renal impairment were excluded. Results. Nine studies with 2,285 patients were
included: 22 in the vitamin D group, 580 in the calcium group, 792 in the vitamin D and calcium group, and 891 in the Introduction: Liver resection can be associated with major blood loss and a high morbidity and mortality. Pringle's
manoeuvre involves total clamping of the hepatic pedicle to reduce hepatic haemorrhage, but can alter
cardiovascular dynamics and increase post-operative complications and mortality. This has led to variations in
practice with the use of either intermittent or continuous clamping. The study aim was to review total inflow
occlusion as a method of vascular control in liver resection. Methods: A literature search was carried out using the
following databases - PubMed, Athens, Medline and Google scholar search engine. The following key words were
used - liver resection, total inflow occlusion, Pringle's manoeuvre, continuous, intermittent, singly or in combination.
To ensure an up-to-date literature search, the search was been restricted to the last five years from 2006 to date
inclusively. To maximize this search backward chaining of reference lists from retrieved papers was also undertaken,
a total of 11 papers were retrieved. Results: Evidence regarding Pringle's manoeuvre is inconclusive. One study
compared 3 methods of vascular inflow occlusion found Pringle's manoeuvre was associated with a shorter operating
time but a higher rate of complications. One study found continuous and intermittent clamping were equally Objective: To assess the safety and efficacy for drug delivery in chlorofluorocarbon (CFC)-versus hydrofluoroaklane
(HFA)-propelled asthma therapies, determine the superiority of HFA-propelled therapy over CFC-propelled
formulations, and assess patient acceptance. Methods: Literature searches were completed using Google Scholar,
OVID, IDIS, and PubMed. Key terms used in the search included combinations of chlorofluorocarbon and
hydrofluoroalkane along with terms referring to safety, efficacy, superiority trials, and patient acceptance. The
articles were used to compare and contrast the two propellants with respect to drug therapy. Results: Studies
performed in children using HFA inhalers established both the safety and efficacy of HFA propellant, with no effects
on growth and development. HFA was considered a superior propellant due to smaller, more uniform particle sizes
of drug, with increased lung deposition, as well as offering the same asthma maintenance at half the dose of CFC
formulations. CFCs have proven safety, stability, and efficacy data for drug delivery; however, they have been linked
to destruction of the planet's ozone layer. HFA formulations are void of chlorine, and instead contain hydrogen, Background: Radioactive iodine (RAI) usage is increasingly becoming a standard therapeutic and diagnostic measure
in the management of thyroid disorders. Despite these advances, there are varying opinions on the appropriate
usage of this treatment option of thyroid disorders. In sub-saharan Africa, reports on RAI in the management of
thyroid disorders are scanty and RAI usage is shrouded in mystery. Objectives: This review article sought to evaluate
the role of RAI in the diagnosis and treatment of thyroid disorders with emphasis on its usage inAfrica. It also
addresses specific areas of concern amongst others such as RAI use in children, in large compressive goiters,
reproductive function and the issue of associated iatrogenic hypothyroidism. Methods: A systematic review of
literature- local and otherwise- on radioactive iodine usage from indexed and online journals using Pubmed, Google
and Google Scholar in the period between 1942 till 2007. Results: The most common complication of RAI therapy is
hypothyroidism which appears to be almost inevitable. There is controversy as to whether RAI therapy is a risk factor
Background: The complicated natural history of venous ulcers requires the continued development and
improvement of treatments to ensure the most effective management. Compression therapy or surgical correction
of superficial venous incompetence (SVI) are currently the main methods employed for the treatment for venous
ulceration (VU). This review compares and summates the healing and recurrence rates for each treatment modality
used over the last thirty years. Methods: Sixty-one articles investigating compression and superficial venous surgical
treatments were obtained from a systematic search of electronic databases (Medline, Embase, The Cochrane Library,
and Google Scholar) and then an expanded reference list review. Patient demographics, CEAP classification, patterns
of venous insufficiency, type of intervention, length of follow up, healing and recurrence rates for venous ulceration
was assessed. Inadequate data in seven reports led to their exclusion. Recent randomised controlled trials (RCTs)
specifically comparing superficial surgery to compression therapy were reviewed and data from non-randomised
and/or 'small' clinical studies prior to 2000 underwent summation analysis. Results: Five RCTs since 2000
demonstrate a similar healing rate of VU with surgery and conservative compression treatments, but a reduction in
ulcer recurrence rate with surgery. The effect of deep venous incompetence (DVI) on the ulcer healing is unclear, but
sub-group analysis of long-term data from the ESCHAR trial suggests that although surgery results in a less
impressive reduction in ulcer recurrence in patients with DVI, these patients appear to still benefit from surgery due Background The Internet is an expanding source of information and support for cancer patients and their families.
Studies mostly report patient Internet use. Little is known about how carers (families/informal caregivers/friends)
use the Internet and what they find useful. Aim The aim of this paper was to review the literature on the role of the
Internet in supporting and informing carers of people with cancer. Materials and methods: Findings are based on a
review of published studies identified from 1996-2009 Ovid MED-LINE, CINAHL, EMBASE and 2002-2009 PsycINFO,
Cochrane database and Google Scholar. Key search words used were cancer, patient, information, Internet, online,
web, support, family, carer, caregiver and friend. Results: One hundred forty-five abstracts were reviewed. Fifty-two
articles were retrieved in full text. Twenty of the 52 articles were critically appraised using the appropriate Critical
Appraisal Skills Programme tool. All studies retrieved were level IV evidence. Most compared carer and patient
Internet use with other cancer information sources or analysed content of postings to web sites. Some reported on
patient 'indirect' Internet use through carers. Heterogeneity of results related to different study aims, diversity in
study tools, varying sample sizes and differing cancer populations. Broadly, Internet use can be divided into
information searching and support group activity. Carers access Internet information to problem solve; however, Background: Immune thrombocytopenic purpura (ITP) is characterized by platelet deficiency due to platelet
destruction and/or inadequate production. Initial therapy consists of corticosteroids or intravenous immunoglobulin
(IVIg). Patients with chronic refractory disease might undergo splenectomy. Although there is no treatment of choice
in those who do not respond to splenectomy, immunosuppressive agents are typically prescribed. Romiplostim is the
first available drug in a recently developed class of agents that work through stimulation of the thrombopoietin (TPO)
receptor (c-Mpl) to increase platelet production. Objective: The aim of this report was to review the mechanism of
action, pharmacology, clinical activity, and adverse events associated with the use of romiplostim for the treatment
of thrombocytopenia in patients with chronic ITP. Methods: MEDLINE, Google Scholar, International Pharmaceutical
Abstracts, and Web of Science were searched for English-only clinical trials and reviews (publication dates: 2000-June
1, 2009; key terms: romiplostim, Nplate, ITP, and idiopathic and immune thrombocytopenic purpura). Abstracts from
the 2000-2008 meetings of the American Society of Hematology and references from relevant articles were
reviewed. Results: A total of 6 studies were included. Romiplostim is the first marketed agent developed to directly
stimulate the bone marrow to produce platelets. Produced in Escherichia coli using recombinant DNA technology, it
is an Fc-peptide fusion protein. It works intracellularly in a manner similar to that of the naturally occurring TPO to
activate the transcriptional pathways, leading to increased platelet production via stimulation of the c-Mpl receptor.
Romiplostim was approved by the US Food and Drug Administration for the treatment of chronic ITP primarily based
on the findings from 2 multicenter, randomized, placebocontrolled, parallel-group studies in 125 adult patients with
chronic ITP and an insufficient response to corticosteroids, IVIg, and/or splenectomy. The most common prior
Objective To assess the efficacy and safety of rosiglitazone in treating type 2 diabetes mellitus (T2DM) with essential
hypertension (HBP). Methods Such databases as The Cochrane Library (Issue 4, 2009), PubMed (1970 to May 2010),
CBM (1978 to May 2010), CNKI (1996 to May 2010), WanFang Database (1999 to May 2010), VIP (1996 to May
2010), and Google Scholar were searched on computer, and the relevant journals such as Chinese Journal of
Diabetes Mellitus were also hand researched to investigate references and collect randomized controlled trials
(RCTs) about rosiglitazone (experimental group) compared with non-rosiglitazone (control group) in treating T2DM
with HBP. The data were extracted according to the inclusion and exclusion criteria by two reviewers independently,
the quality of the included studies was assessed according to the Cochrane Handbook for Systematic Reviews of
Interventions Version 5.0, and meta-analysis was conducted by using RevMan 5.0 software. Results Among 10 RCTs
involving 738 patients, one was in English from Greece, while nine were in Chinese. The average score quality of the
included studies was in C level. The results of meta-analyses showed that the experimental group was more effective
than the control group in lowering blood pressure levels (SBP: WMD= -17.83 mmHg, 95%CI -27.63 to -8.02; DBP:
WMD=-7.81 mmHg, 95%CI -10.18 to -5.44), blood glucose levels (FBG: WMD= -1.66 mmol/L, 95%CI -3.08 to -0.23;
PBG: WMD= -2.38 mmol/L, 95%CI - 4.12 to -0.64), triglyceride (TG) levels (WMD= -0.29 mmol/L, 95%CI -0.43 to -
0.14), low-density lipoprotein cholesterol (LDL-C) levels (WMD= -0.76 mmol/L, 95%CI -1.02 to -0.50), insulin levels
(FINS: WMD= -7.06 mU/L, 95%CI -9.47 to -4.65; PINS: WMD= -98.86 mU/L, 95%CI -116.38 to -81.34), glycosylated
hemoglobin (HbA1c) levels (WMD=-0.75%, 95%CI -1.07 to -0.42), and insulin resistance index (HOMA-IR) (WMD= - Introduction: Lennox-Gastaut syndrome (LGS) is a severe treatment-resistant childhood-onset epilepsy. This review
examines the role of the new drug rufinamide for the treatment of LGS. Areas covered: MEDLINE and Google Scholar
searches were undertaken. The pharmaceutical company was contacted for the latest information. LGS is
characterized by the triad of diffuse slow spike-wave discharges in the electroencephalogram (EEG), learning
disability (mental retardation) and frequent generalized seizures of multiple types, usually including tonic, atonic and
atypical absence seizures. Felbamate, lamotrigine and topiramate have resulted in significant reductions in some
seizure types, but no treatment has achieved acceptable seizure control in most patients. In a pivotal randomized,
double-blind, placebo-controlled trial, the new drug rufinamide achieved significant improvements in seizure control
in previously resistant subjects when added to up to three concomitant antiepileptic drugs. Open studies including
patients with LGS have also demonstrated efficacy. These trials and a large open trial in adults and adolescents with Aims: Drug-eluting stents (DES) are a major advance in interventional cardiology; however concerns have been raised
regarding their long-term safety due to the permanent nature of the polymer. New generation stents with
biodegradable polymers (BDS) have recently been developed. The aim of this study was to perform a meta-analysis
of randomised controlled trials (RCTs) comparing the safety and efficacy profile of BDS vs. durable polymer DES.
Methods and results: The MEDLINE/CENTRAL and Google Scholar databases were searched for RCTs comparing
safety and efficacy of BDS vs. DES. Safety endpoints were mortality, myocardial infarction (MI), and stent thrombosis
(ST). Efficacy endpoints were target vessel revascularisation (TVR), target lesion revascularisation (TLR) and six-month
in-stent late loss (ISLL). The meta-analysis included eight RCTs (n=7,481). At a median follow-up of nine months, as
compared to DES, BDS use did not increase mortality (OR [95% CI] = 0.91 [0.69-1.22], p=0.53) or MI (OR [95% CI] = BACKGROUND: Septic shock is common and results in significant morbidity and mortality. Adjunctive treatment with
corticosteroids is common, but definitive data are lacking. We aimed to determine the efficacy and safety of
corticosteroid therapy among patients with septic shock., METHODS: Medline, Embase, Cochrane Library, Web of
Science, and Google Scholar were searched for randomized trials and observational studies published from January
1993 through December 2008. Studies were selected if they included adults with septic shock, discussed treatment
with intravenous corticosteroids, and reported at least 1 outcome of interest (e.g., mortality, shock reversal, or
incidence of superinfection). Two reviewers independently agreed on eligibility, assessed methodologic quality, and
abstracted data., RESULTS: Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated for 28-day
all-cause mortality, shock reversal at 7 days, and incidence of superinfection with use of random-effects models.
Analyses, stratified by adrenal responsiveness, were prespecified. Eight studies (6 randomized trials) involving a total
of 1876 patients were selected. Overall, corticosteroid therapy did not result in a statistically significant difference in
mortality (42.2% [369 of 875 patients] vs. 38.4% [384 of 1001]; RR, 1.00; 95% CI, 0.84-1.18). A statistically significant
Background. Septic shock is common and results in significant morbidity and mortality. Adjunctive treatment with
corticosteroids is common, but definitive data are lacking. We aimed to determine the efficacy and safety of
corticosteroid therapy among patients with septic shock. Methods. Medline, Embase, Cochrane Library, Web of
Science, and Google Scholar were searched for randomized trials and observational studies published from January
1993 through December 2008. Studies were selected if they included adults with septic shock, discussed treatment
with intravenous corticosteroids, and reported at least 1 outcome of interest (e.g., mortality, shock reversal, or
incidence of superinfection). Two reviewers independently agreed on eligibility, assessed methodologic quality, and
abstracted data. Results. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated for 28-day all-
cause mortality, shock reversal at 7 days, and incidence of superinfection with use of random-effects models.
Analyses, stratified by adrenal responsiveness, were prespecified. Eight studies (6 randomized trials) involving a total
of 1876 patients were selected. Overall, corticosteroid therapy did not result in a statistically significant difference in
mortality (42.2% [369 of 875 patients] vs. 38.4% [384 of 1001]; RR, 1.00; 95% CI, 0.84-1.18). A statistically significant Intrathecal Ziconotide (ITZ) is a non-opioid analgesic used to control chronic pain in patients intolerant or refractory
to oral and other intrathecal analgesics. A review of the literature was conducted to assess the safety and efficacy of
this intrathecal agent in chronic pain patients. A search from 2006-2011 was conducted using PubMed, OVID, and
Google Scholar. Four papers identified met inclusion (an implanted infusion system in chronic pain patients whose
next step in therapy was intrathecal treatment) and exclusion criteria (no exposure to an investigational drug in thirty
days). In a randomized double blind placebo controlled study (n=248), 112 patients were treated with ITZ and 108
randomized to placebo. Results showed significant reduction (>30%) in pain after one and three weeks of therapy,
but greater frequency (p=0.023) of mild to moderate adverse effects (AE's) with ITZ versus placebo. Review of a
retrospective cohort study yielded that despite reports of one mild to moderate AE by 63% of ITZ treated patients
(n=104), statistically significant pain reduction (p<0.01) was still achieved after only one month of treatment. Analysis
of multicenter open-label, long-term studies reveal that despite higher discontinuation rates over an extended time Background/Purpose: The objectives of this systematic review were to study and update the safety of anti-TNF
agents. We examined whether etanercept (ETN), compared to the anti-TNF antibody therapies, infliximab (INF) and
adalimumab (ADA), had an inverse impact on adult patients with rheumatoid arthritis (RA) in terms of malignancy,
serious adverse events (SAEs), serious infection, and discontinuation due to adverse events (AEs). Methods: We
conducted a systematic-literature review of randomized controlled trials (RCTs) that studied one of the three
biologics used for rheumatoid arthritis and reported on our pre-specified adverse outcomes of malignancy, SAEs,
serious infections, and discontinuation due to AEs. We searched various databases including MEDLINE via OVID and
PubMed, the Cochrane Library, Google Scholar, and ClinicalTrials.gov, and further mined the reference lists from
systematic reviews and original publications to identify all English-language studies published from January 1, 1990
until September 30, 2011. In addition, we searched the US Food and Drug Administration (FDA) database to review
drug approval reports that could provide eligible trials. The search strategy and data extraction processes were
duplicated by independent reviewers. For the meta-analysis, we performed random effect inverse variance,
maximum-likelihood estimation (MLE), arcsine transformed, and Bayesian models. We abstracted the studies with 0
events in both arms and used software default correction coefficients for 0 events or missing data. Furthermore, we
compared the results from randomized trials with published large nationally representative cohort studies and Background: Because of recent concerns about the safety of aprotinin, we updated our 2007 Cochrane review that
compared the relative benefits and risks of aprotinin and the lysine analogues tranexamic acid and epsilon
aminocaproic acid. Methods: We searched electronic databases, including CENTRAL, MEDLINE, EMBASE, Google and
Google Scholar for trials of antifibrinolytic drugs used in adults scheduled for cardiac surgery. Searches were updated
to January 2008. By comparing aprotinin and the 2 lysine analogues to control, we derived indirect head-to-head
comparisons of aprotinin to the other drugs. We derived direct estimates of risks and benefits by pooling estimates
from head-to-head trials of aprotinin and tranexamic acid or epsilon aminocaproic acid. Results: For indirect
estimates, we identified 49 trials involving 182 deaths among 7439 participants. The summary relative risk (RR) for
death with aprotinin versus placebo was 0.93 (95% confidence interval [CI] 0.69-1.25). In the 19 trials that included
tranexamic acid, there were 24 deaths among 1802 participants. The summary RR was 0.55 (95% CI 0.24-1.25). From
the risk estimates derived for individual drugs, we calculated an indirect summary RR of death with use of aprotinin
versus tranexamic acid of 1.69 (95% CI 0.70-4.10). To calculate direct estimates of death for aprotinin versus
tranexamic acid, we identified 13 trials with 107 deaths among 3537 participants. The summary RR was 1.43 (95% CI
0.98-2.08). Among the 1840 participants, the calculated estimates of death for aprotinin compared directly to
Objective: This study assessed the safety of direct trocar insertion (DTI) versus Veress needle followed by primary
trocar insertion (VN). Methods: Ovid MEDLINE, Cochrane Library, Google Scholar, Scopus, and the reference lists of
published articles were searched up to September 2011 to identify randomized clinical trials comparing DTI with VN.
This meta-analysis was restricted to randomized studies comparing the safety of these two laparoscopic entry
techniques. Results: Seven randomized studies consisting of 2940 women (VN, n=1525; DTI, n=1415) were identified.
The data on the safety of two entry techniques were abstracted, integrated, and analyzed with the meta-analysis
method and are presented as pooled relative risk (RR) with 95% confidence intervals (CI). There were 4 cases of a
major complication in the VN group in contrast to none in the DTI group. Pooled results failed to show a statistically
significant difference in the risk of major complications between the two groups. A significantly higher risk of minor
complications was detected in the VN group (RR [95% CI]=10.78 [6.27-18.51]). Among minor complications, Background: In patients with suspected lower extremity deep vein thrombosis (DVT), compression ultrasonography
(CUS) is typically used as the initial test to confirm or exclude DVT. Patients with a negative CUS and either a
moderate-to-high probability and/or a positive D-dimer usually require repeat CUS testing after 5-7 days to exclude
proximal propagation of distal DVT, reducing diagnostic efficiency. Whole-leg compression ultrasound may safely
exclude proximal and distal DVT in a single evaluation. Purpose: To assess the safety of withholding anticoagulation
in patients presenting with suspected lower extremity DVT following a single negative whole-leg CUS. Methods:
MEDLINE, EMBASE, CINAHL, LILACS, Cochrane, Health Technology Assessments databases were searched from
January 1970 to April 2009 without language restrictions. This search was supplemented by reviewing Google,
Google Scholar, clinicaltrials.gov, meeting abstracts, conference proceedings, reference lists, and by contacting
content experts. Study Selection and Data Extraction: Randomized controlled trials and prospective cohort studies of
patients with suspected DVT with a negative whole-leg CUS, not treated with anticoagulation, and followed at least
90 days for occurrence of venous thromboembolism (VTE). Studies required objective confirmation of VTE events Background: After Roux-en-Y gastric bypass (RYGB), a substantial number of patients do not achieve successful long-
term weight loss. In cases of loss of restriction, the application of an adjustable gastric band ("salvage banding") over
the gastric pouch, or gastrojejunostomy, could prevent weight regain or increase weight loss. The objective of this
literature review is to provide an overview of the studies that report the effect of salvage banding after failed RYGB.
Methods: A systemic literature search was conducted in PubMed, Google Scholar, Medline, the Cochrane Library,
and the online websites of specific bariatric surgery journals to identify all relevant studies describing salvage
banding after failed RYGB. Results: Seven studies, with a total of 94 patients, were included for a systemic literature
review. Inclusion criteria for salvage banding varied from unsuccessful weight loss to technical pouch failure. After
salvage banding, all studies reported further weight loss, varying from 55.9%-94.2% excess body mass index loss
(EBMIL) after 12-42 months of follow-up. In the included study group, 18% (17/94) of the patients developed long- Background: Right to health indicators have been subject to debate. Indeed, inadequate monitoring or reporting by
states, missing or contradicting data as well as a lack of consensus on what is an appropriate right to health indicator
call for new approaches and new ideas in this field.One right to health indicator might be patient satisfaction, a
widely collected indicator, yet not always beyond bias nor adequately monitored, neither well used. Methods: We
compared, applying the concept analysis of Rodgers, key-items of patient satisfaction surveys/reviews to key
concepts of right to health as developed in the General Comment 14/2000 of the ICESCR. Inclusion criteria of the
selected patient satisfaction papers were: number of citations in Scholar Google, various care settings, various
cultural contexts, methodological reviews and time frame. Results: High correspondence between recommended or
Background: Some conventional therapies for type 2 diabetes mellitus (T2DM) fail to address the progressive nature
of the disease, and as a result, they may become ineffective in maintaining normoglycemia. Antihyperglycemic
agents have been developed to target incretin hormones, specifically glucagon-like peptide (GLP)-1. Incretin
analogues and agents that delay GLP-1 degradation, the dipeptidyl peptidase (DPP)-4 inhibitors, offer mechanisms of
action that may improve T2DM management. Saxagliptin was approved by the US Food and Drug Administration in
July 2009 and by the European Medicines Evaluation Agency in October 2009 for use as monotherapy or in
combination regimens for the treatment of T2DM. Objective: The aim of this article was to review the mechanism of
action, pharmacology, clinical efficacy, and tolerability associated with the use of saxagliptin in patients with T2DM.
Methods: MEDLINE, BIOSIS, International Pharmaceutical Abstracts, and Google Scholar were searched for English-
only clinical trials and therapeutic reviews published between 1966 and June 15, 2011 (search term: saxagliptin).
Additional trials and reviews were identified from the reference lists of published articles. Results: Findings on
efficacy and tolerability were obtained from 11 completed Phase III clinical trials. In trials in saxagliptin-naive
patients, changes from baseline in glycosylated hemoglobin (HbA1c) ranged from -0.72% to -0.90% in the saxagliptin
treatment arms compared with -0.27% with placebo (all, P < 0.007). When saxagliptin was used in combination with
metformin for 24 weeks, the adjusted mean reductions from baseline in HbA1c and the proportions of patients
achieving target HbA1c (<7.0%) were significantly greater with saxagliptin + metformin compared with monotherapy
with either drug (all, P <= 0.0001). When saxagliptin was used in combination with a sulfonylurea or a Maternal nutrition interventions are efficacious in improving birth outcomes. It is important to demonstrate that if
delivered in field conditions they produce improvements in health and nutrition. Analyses of scaling-up of five
program implemented in several countries. These include micronutrient supplementation, food fortification, food
supplements, nutrition education and counseling, and conditional cash transfers (as a platform for delivering
interventions). Evidence on impact and cost-effectiveness is assessed, especially on achieving high, equitable, and
sustained coverage, and reasons for success or failure Systematic review of articles on large-scale programs in
several databases. Two separate reviewers carried out independent searches. A separate review of the gray
literature was carried out including websites of the most important organizations leading with these programs. With
Google Scholar a detailed review of the 100 most frequently cited references on each of the five above topics was
conducted. Food fortification programs: iron and folic acid fortification were less successful than salt iodization
initiatives, as the latter attracted more advocacy. Micronutrient supplementation programs: Nicaragua and Nepal BACKGROUND: 'Scared Straight' and other similar programs involve organized visits to prison by juvenile delinquents
or children at risk for criminal behavior. Programs are designed to deter participants from future offending through
first hand observation of prison life and interaction with adult inmates. These programs remain in use despite
research questioning their effectiveness. This is an update of a 2002 review., OBJECTIVES: To assess the effects of
programs comprising organized visits to prisons by juvenile delinquents (officially adjudicated, that is, convicted by a
juvenile court) or pre-delinquents (children in trouble but not officially adjudicated as delinquents), aimed at
deterring them from delinquency., SEARCH METHODS: To update this review, we searched 22 electronic databases,
including CENTRAL, MEDLINE, PsycINFO, and Criminal Justice Abstracts, in December 2011. In addition, we searched
clinical trials registries, consulted experts, conducted Google Scholar searches,and followed up on all relevant
citations., SELECTION CRITERIA: We included studies that tested programs involving the organized visits of
delinquents or children at risk for delinquency to penal institutions such as prisons or re formatives. Studies that had
overlapping samples of juvenile and young adults (for example, ages 14 to 20 years) were included. We only
considered studies that assigned participants to conditions randomly or quasi-randomly (that is,by odd/even
assignment to conditions). Each study had to have a no-treatment control condition and at least one outcome
measure of 'post-visit' criminal behavior., DATA COLLECTION AND ANALYSIS: The search methods for the original
review generated 487 citations, most of which had abstracts. The lead review author screened these citations,
determining that 30 were evaluation reports. Two review authors independently examined these citations and
agreed that 11 were potential randomized trials. All reports were obtained. Upon inspection of the full-text reports,
two review authors independently agreed to exclude two studies, resulting in nine randomized trials. The lead review
author extracted data from each of the nine study reports using a specially designed instrument. In cases in which
outcome information was missing from the original reports, we made attempts via correspondence to retrieve the
data for the analysis from the original investigators. Outcome data were independently checked by a second review
author (CTP).In this review, we report the results of each of the nine trials narratively.We conducted two meta-
Objective: Schizophrenia is a devastating and common psychiatric disorder which is associated with a high degree of
medical morbidity and reduced life span in addition to psychosis. In this article, these problems will be discussed in
the context of schizophrenia and aging. Method: The recent literature was reviewed using Pubmed, Medline, and
Google scholar with the search terms "schizophrenia, aging, medical problems." Results: Schizophrenia is associated
with significant medical morbidity and mortality. Diabetes and cardiovascular disease, along with smoking and
obesity, are over-represented and contribute to reduced quality of life and life span. Schizophrenics often receive
poor medical care. Conclusions: The impacts of schizophrenia on physical health and successful aging have been The World Health Organization estimates that 13 million children aged 5-15 years worldwide are visually impaired
from uncorrected refractive error. School vision screening programs can identify and treat or refer children with
refractive error. We concentrate on the findings of various screening studies and attempt to identify key factors in
the success and sustainability of such programs in the developing world. We reviewed original and review articles
describing children's vision and refractive error screening programs published in English and listed in PubMed,
Medline OVID, Google Scholar, and Oxford University Electronic Resources databases. Data were abstracted on study
objective, design, setting, participants, and outcomes, including accuracy of screening, quality of refractive services,
barriers to uptake, impact on quality of life, and cost-effectiveness of programs. Inadequately corrected refractive
error is an important global cause of visual impairment in childhood. School-based vision screening carried out by
teachers and other ancillary personnel may be an effective means of detecting affected children and improving their
Obesity is associated with an increased risk for early death, heart disease and stroke, disability and several other
comorbidities. Although there is concern about the potential burden on health-care services with the aging
demographic and the increasing trend of obesity prevalence in older adults, evidence on which to base management
strategies is conflicting for various reasons. The analytic framework for this review is based on a scoping review
methodology, and was conducted to examine what is known about the diagnosis, treatment and management of
obesity in older adults. A total of 492 relevant research articles were identified using PubMed, Scirus, EBSCO,
Clinicaltrials.gov, Cochrane Reviews and Google Scholar. The findings of this review indicate that the current WHO
(World Health Organization)-recommended body mass index, waist circumference and waist-to-hip ratio obesity
thresholds for the general adult population may not be appropriate for older adults. Alternatively, weight change or
physical fitness may be more useful measures of mortality and health risk in obese older adults. Furthermore,
although obesity in older adults is associated with several disorders that increase functional disability, Idiopathic scoliosis affects 2-3% of adolescents. Large, progressing deformities, mostly present in girls, may lead to
pulmonary complications, pain symptoms, the feeling of social isolation, and even mental disorders. The correlation
of screening programs with surgery rate reduction and the clinical effectiveness of bracing remain a matter of
debate. Critics indicate overdetection, qualification for therapy of insignificant curves, unjustified treatment, and
risks of psychological side effects, whereas supporters underline the need for screening, and suggest improvements.
It remains unclear whether such opposite opinions are based on sound evidence. To identify relevant studies,
guidelines, and recommendations, MEDLINE, Google Scholar, and Cochrane Library databases were searched. The
levels of evidence presented in selected studies and grading of recommendations reported in available guidelines
and recommendation statements were assessed using the SIGN scoring system. Screening programs are legislated,
recommended, or not recommended in different American states. British and Canadian screening recommendations Background: Two large-scale campaigns in the USA have demonstrated successful screening of migrants for viral
hepatitis. Although the increased risk among migrants is well known, comparable campaigns in the European Union
(EU) have not been performed. To summarise available data on screening and to highlight critical factors for success
we performed a. a literature review; b. an in depth analysis of five recent and successful campaigns. Methods: a.
EMBASE, MEDLINE and Google Scholar databases were searched for migrant screening campaigns conducted after
2000. The identified studies were further selected in a three-step-process based on title, abstract and full text. b.
Hand searching was used to identify five campaigns in countries of the HEPscreen Project (Germany, Hungary, Italy,
Netherlands, Spain, United Kingdom). Results: a. After the selection process 11 articles of 323 originally identified
were included. b. The campaigns were conducted in the Netherlands and UK in populations ranging from 170 to
4833. Targeted ethnicities were Bengali, Chinese, Indian, Pakistani and Turkish. Testing locations varied widely and
included outreach locations. Awareness was raised using different media. Most campaigns used serology; only one
Aim: To identify and describe screening instruments for detecting illicit drug use/abuse that are appropriate for use
in general hospital wards and review evidence for reliability, validity, feasibility and acceptability. Methods:
Instruments were identified from a number of screening instrument databases/libraries and Google Scholar. They
were independently assessed for eligibility by two reviewers. MEDLINE, EMBASE, PSYCINFO, and Cochrane Library
were searched for articles published up to February 2010. Two reviewers independently assessed the identified
articles for eligibility and extracted data from the eligible studies. Results: 13 instruments, ASSIST, CAGE-AID, DAST,
DHQ/PDHQ, DUDIT, DUS, NMASSIST, SIP-AD, SDS, SMAST-AID, SSI-SA, TICS and UNCOPE were included in the review.
They had 2 to 28 items and took less than 10. min to administer and score. Evidence on validity, reliability,
acceptability and feasibility of instruments in adult patients not known to have a substance abuse problem was
scarce. Of the 21 studies included in the review, only one included participants from general hospital wards. OBJECTIVE: Screening for inherited thrombophilias with laboratory tests is impractical before starting women on
combined oral contraceptives. As an alternative, some recommend eliciting a family history of venous
thromboembolism. The validity of this approach, however, remains unclear. DATA SOURCES: We sought all published
reports that correlated a family history of venous thromboembolism with any thrombophilia confirmed by laboratory
test. We used sequential, overlapping computer searches including MeSH terms used for articles in PubMed, a
narrative search phrase in Google Scholar, and then all "related" articles in PubMed for each article included without
time or language limitations. This was supplemented by a search of www.clinicaltrials. gov. METHODS OF STUDY
SELECTION: The search yielded 10 reports. Information was sought without success from corresponding authors of
four other reports that may have had relevant data. Most reports studied atypical, high-prevalence referral
populations. TABULATION, INTEGRATION, AND RESULTS: Results were presented according to the MOOSE (Meta-
analysis of observational studies in epidemiology) guidelines for systematic reviews of observational studies. The
patient populations varied widely, definitions of family history included first- or first- and second-degree relatives,
and the thrombophilias studied differed among these reports. Hence, aggregation of results was not possible. OBJECTIVES: To assess cost-benefi t and cost-effectiveness studies examining seasonal infl uenza vaccination in the
healthy, working-age population of the United States (US). METHODS: A systematic review of economic evaluations
investigating the costbenefi t or cost-effectiveness of vaccinating healthy adults was conducted on articles published
between January 1990 and January 2010. Studies considered for inclusion in this review were identifi ed using
Medline, Embase, Econlit, and Google Scholar (n = 11). The source and appropriateness of parameters
(epidemiological data, probabilities, and costs), the designs employed, and the suffi ciency of sensitivity analysis were
considered during the review. RESULTS: Seven studies were identifi ed as appropriate for this review. Key inputs of
the selected studies included infl uenza or ILI attack rates, outpatient visits averted, total vaccination costs, and lost
workdays. All studies were conducted in the US and from the societal perspective; three were randomized, clinical
trials and the remaining four constructed economic simulation models to compare vaccination to antivirals or no
intervention. Results ranged from net savings of $69.19 to net costs of $85.89 per vaccination (4 studies) and from BACKGROUND: Weight gain in schizophrenia, particularly secondary to second-generation antipsychotic (SGA) use, is
a common adverse effect and often is associated with significant physical and psychological morbidity. METHODS:
We performed a critical literature review of all controlled clinical trials for pharmacologic and/or behavioral
management of SGA-induced weight gain in schizophrenia patients by searching PubMed and Google Scholar. A
meta-analysis was performed to estimate and compare weight changes for various medications and behavioral
interventions. RESULTS: Sample sizes generally were small. Clinical trials were 6 weeks to 1 year, and weight loss was
modest with any treatment. Although several adjunctive pharmacologic treatments showed no weight loss,
sibutramine, metformin, and topiramate showed some benefit. Amantadine and orlistat were somewhat less
effective and had lower rates of tolerability. Among the behavioral therapies, nutritional counseling combined with Background: Some countries have recently extended smoke-free policies to particular outdoor settings; however,
there is controversy regarding whether this is scientifically and ethically justifiable. Objectives: The objective of the
present study was to review research on secondhand smoke (SHS) exposure in outdoor settings. Data sources: We
conducted different searches in PubMed for the period prior to September 2012. We checked the references of the
identified papers, and conducted a similar search in Google Scholar. Study selection: Our search terms included
combinations of "secondhand smoke," "environmental tobacco smoke," "passive smoking" OR "tobacco smoke
pollution" AND "outdoors" AND "PM" (particulate matter), "PM2.5" (PM with diameter <= 2.5 mum), "respirable
suspended particles," "particulate matter," "nicotine," "CO" (carbon monoxide), "cotinine," "marker," "biomarker"
OR "airborne marker." In total, 18 articles and reports met the inclusion criteria. Results: Almost all studies used
PM2.5 concentration as an SHS marker. Mean PM2.5 concentrations reported for outdoor smoking areas when
smokers were present ranged from 8.32 to 124 mug/m3 at hospitality venues, and 4.60 to 17.80 mug/m3 at other
Context: Secular trend in birth sizes is a well-known indicator of living conditions of a society. Objective: This study
conducted meta-analyses estimating the mean birth weight (BW) and birth length (BL) of Iranian neonates born
between 1971 and 2010. Methods: Data were collected from published studies through literature searches using
Pubmed, Google scholar, Irandoc, Iranmedex, SID, magiran and unpublished studies including theses and projects
conducted at the three main Iranian medical universities between 1971-2010. Mean and SD of BW or BL with other
relevant data were extracted from eligible studies. Results: Of 266 studies identified, 61 were found to be eligible.
The combined BW was 3222 (95% CI = 3093-3351), 3233 (95% CI = 3203-3264) and 3152 grams (95% CI = 3114-3189)
in the 1970s, 1990s and 2000s, respectively. The mean decrease of 81 grams in BW during the 2000s was significant Objectives: To summarize randomized controlled trials on the effects of sedative agents on neurologic outcome,
mortality, intracranial pressure, cerebral perfusion pressure, and adverse drug events in critically ill adults with
severe traumatic brain injury. Data Sources: PubMed, MEDLINE, EMBASE, the Cochrane Database, Google Scholar,
two clinical trials registries, personal files, and reference lists of included articles. Study Selection: Randomized
controlled trials of propofol, ketamine, etomidate, and agents from the opioid, benzodiazepine, alpha-2 agonist, and
antipsychotic drug classes for management of adult intensive care unit patients with severe traumatic brain injury.
DATA EXTRACTION:: In duplicate and independently, two investigators extracted data and evaluated methodologic
quality and results. DATA SYNTHESIS:: Among 1,892 citations, 13 randomized controlled trials enrolling 380 patients
met inclusion criteria. Long-term sedation (24 hrs) was addressed in six studies, whereas a bolus dose, short infusion,
or doubling of plasma drug concentration was investigated in remaining trials. Most trials did not describe baseline
traumatic brain injury prognostic factors or important cointerventions. Eight trials possibly or definitely concealed
allocation and six were blinded. Insufficient data exist regarding the effects of sedative agents on neurologic
outcome or mortality. Although their effects are likely transient, bolus doses of opioids may increase intracranial The monitoring and assessment of the degree of conscious sedation experienced by patients is important for both
clinical practice and in research. Whereas clinical monitoring remains the gold standard for safety in patient care,
numerous measures are available to supplement this and to provide quantitative data on level of sedation. This
manuscript provides an overview of existing measures of the degree of sedation. Scales that have been used in
published research were identified from a search of Medline and Google Scholar, and for each scale we identified the OBJECTIVE: To review available information in the literature about akathisia (inner restlessness) caused by the
selective serotonin reuptake inhibitors (SSRIs). DATA SOURCES: Databases searched included Medline, PsychInfo, the
International Pharmaceutical Abstracts, and Google Scholar. Search terms included drug-induced akathisia,
psychomotor agitation, drug-induced side effect, movement disorders, and extrapyramidal symptoms. These search
terms were cross-referenced with selective serotonin reuptake inhibitors and each of the currently marketed SSRIs:
fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram, and escitalopram. STUDY SELECTION: Relevant articles
were chosen if they specifically mentioned the word akathisia. Case reports were chosen based on a clear view that
an SSRI was a contributing or causative agent of akathisia. DATA SYNTHESIS: Recognizing akathisia is important
because it can be very bothersome and may cause suicidal ideations. Akathisia can be recognized by examining
symptoms, looking at predisposing factors, and using the Barnes Akathisia Rating Scale (BARS). Predisposing factors Objective: The consumer's feedback is critical for decision making during recommendation of prosthetic provision
and predicting the outcome of the treatment. A systematic literature review was conducted to assess and analyze
various functional outcome measure instruments used in field of prosthetics. The instruments considered were
specifically self-reported outcome measure tools to be completed by individuals with lower limb amputations.
Design: A systematic literature review was conducted to compare various self-reported functional Outcome Measure
Instrument (OMI) with reference to their psychometric properties and the life domains in published articles from the
following databases: MEDLINE and University of Pittsburgh Health Sciences Library System, CINAHL- EBSCO, GOOGLE
SCHOLAR, SCOPUS, OVID, and PUBMED (1990 to 2010). Articles were included and excluded according to criterion
determined by the author. Setting, Participants and Interventions: Not Applicable. Results: Twenty articles which met
the inclusion criterion were analyzed on their psychometric properties, and clinical recommendations were made
based on this analysis. The strengths and weaknesses of psychometric properties of various outcome measurement Chronic illness may be a risk factor for low self-esteem; however, previous meta-analyses are inconclusive whether
children with a chronic illness have lower self-esteem than their healthy peers. The goal of the present study was to
summarize available research in order to compare the self-esteem of children and adolescents with a chronic illness
with that of healthy children. Random-effects meta-analysis was used to integrate the results of 621 empirical
studies that compare levels of self-esteem of children with a chronic physical illness with healthy peers or general
test norms. Studies were identified via the electronic databases Adolesc, Embase, Google Scholar, MEDLINE,
PSNYDEX, PSYCINFO, and cross-referencing. Children with chronic illnesses have lower self-esteem than healthy
peers or test norms (g = -0.18 standard deviation units). The lowest levels of self-esteem were observed in children
with chronic fatigue syndrome and chronic headaches. Lower levels of self-esteem in children with a chronic illness
Objective: To review the literature relating to self-medication practice with nonprescription medication among
university students. Methods: A narrative review of studies on self-medication practice with nonprescription
medication among university student was performed. An extensive literature search was undertaken using indexing
services available at Universiti Sains Malaysia (USM) library. The following keywords were used for the search: self-
care, self-medication, over-thecounter medicine, nonprescription medicine, minor illnesses, minor ailment,
university population and community pharmacy. Electronic databases searched were Science Direct, Medline, ISI
Web of Knowledge, Inside Web, JSTOR, Springer Link, Proquest, Ebsco Host and Google Scholar. These electronic The concept of semantic tagging and its potential for semantic enhancements to taxonomic papers is outlined and
illustrated by four exemplar papers published in the present issue of ZooKeys. The four papers were created in
different ways: (i) written in Microsoft Word and submitted as non-tagged manuscript (doi:
10.3897/zookeys.50.504); (ii) generated from Scratchpads and submitted as XML-tagged manuscripts (doi:
10.3897/zookeys.50.505 and doi: 10.3897/zookeys.50.506); (iii) generated from an author's database (doi:
10.3897/zookeys.50.485) and submitted as XML-tagged manuscript. XML tagging and semantic enhancements were
implemented during the editorial process of ZooKeys using the Pensoft Mark Up Tool (PMT), specially designed for
this purpose. The XML schema used was TaxPub, an extension to the Document Type Definitions (DTD) of the US
National Library of Medicine Journal Archiving and Interchange Tag Suite (NLM). The following innovative methods of
tagging, layout, publishing and disseminating the content were tested and implemented within the ZooKeys editorial
workflow: (1) highly automated, fine-grained XML tagging based on TaxPub; (2) final XML output of the paper
validated against the NLM DTD for archiving in PubMedCentral; (3) bibliographic metadata embedded in the PDF
through XMP (Extensible Metadata Platform); (4) PDF uploaded after publication to the Biodiversity Heritage Library
(BHL); (5) taxon treatments supplied through XML to Plazi; (6) semantically enhanced HTML version of the paper
encompassing numerous internal and external links and linkouts, such as: (i) vizualisation of main tag elements
within the text (e.g., taxon names, taxon treatments, localities, etc.); (ii) internal cross-linking between paper ETHNOPHARMACOLOGICAL RELEVANCE: The aerial parts of Senecio scandens Buch.-Ham. (family Asteraceae) have a
long history in traditional Chinese medicine as a treatment for various ailments, such as bacterial diarrhea, enteritis,
conjunctivitis, and respiratory tract infections., MATERIALS AND METHODS: A bibliographic investigation of Senecio
scandens was accomplished by analyzing secondary sources, including the Chinese Medicinal plantal Classics, the
Internet (Google Scholar and Baidu Scholar), and scientific databases accepted worldwide (Pubmed, Scopus, Web of
Science, SciFinder, and CNKI). These sources were scrutinized for available information about the uses of Senecio
scandens in traditional Chinese medicine, phytochemistry, pharmacology, and toxicology., RESULTS: Senecio
scandens is a medicinal plant with a climbing woody stem. Phytochemical studies have shown the presence of
numerous valuable compounds, such as flavonoids, alkaloids, phenolic acids, terpenes, volatile oils, carotenoids, and
trace elements. Among them, PAs are the characteristic constituents, adonifoline is one of the index ingredients of
Senecio scandens. Studies in modern pharmacology have demonstrated that extracts and compounds isolated from
Senecio scandens show a wide spectrum of pharmacological activities, including anti-inflammatory, antimicrobial,
anti-leptospirosis, hepatoprotective, anti-infusorial, antioxidant, antiviral, antitumoral, analgesic, mutagenic, and
toxicological activities., CONCLUSIONS: Phytochemical and pharmacological studies have demonstrated that the One of the most common psychiatric disorders in children is attention deficit hyperactivity disorder (ADHD). Its
course and outcome are heterogeneous. Sensory processing problems impact the nature of response to daily events.
ADHD and sensory problems may occur together and interact. No published review article about sensory processing
problems in children with ADHD were found. A systematic search, conducted on Pub-Med (up to January 2010), and
Google Scholar, yielded 255 abstracts on sensory processing problems in children including 11 studies about sensory
problems in children with ADHD. Sensory processing problems in children with ADHD is not a well studied area.
Sensory processing problems in children with ADHD are more common than in typically developing children. Findings Introduction: Sentinel lymph node biopsy is a fairly new approach for staging of gynecological malignancies. In the
current study, we comprehensively reviewed the available reports on sentinel node biopsy of endometrial cancer.
Methods: We searched Medline, SCOPUS, ISI web of knowledge, Science Direct, Springer, OVID SP, and Google
scholar with the following search terms: "(endometrium OR endometrial OR uterine OR uterus) AND sentinel". The
outcomes of interest were detection rate and sensitivity. Results: Overall 30 studies had enough information for false
negative rate evaluation and 46 studies (including the sub-groups of the above-mentioned studies) for detection rate
evaluation. Pooled detection rate was 75.7% [95% CI: 71-79.8%] and pooled sensitivity was 89% [95% CI: 82-93%].
Aim: Sentinel node (SN) biopsy is becoming a standard procedure in the management of several malignancies.
Several groups have evaluated the feasibility and value of this procedure in prostate cancer patients. In the current
meta-analysis, we comprehensively and quantitatively summarized the results of these studies. Methods: Several
databases including Medline, SCOPUS, Google Scholar, Ovid, Springer, and Science direct were systematically
searched for the relevant studies regarding SL biopsy in the prostate cancer ("prostate" AND "sentinel" as search
keywords). The outcomes of interest were sensitivity and detection rate of the procedure. Results: For detection rate
and sensitivity 21 and 16 studies met the criteria of inclusion respectively. Pooled detection rate was 93.8% (95% CI Background: Several alternative treatment regimens for Helicobacter pylori eradication have been proposed since
the efficacy of standard triple therapy has declined over time, and sequential therapy is one of them. The purpose of
this systematic review is to analyze and compare the efficacy, adverse effects and cost of sequential therapy with
that of standard triple therapy for H. pylori infection. Methods: MEDLINE, EMBASE, Google Scholar and Cochrane
databases were used to retrieve all relevant articles published in the English language over the last 5 years (January
2008-October 2012). Eligibility criteria were randomized controlled trials (RCTs) comparing sequential and standard
triple therapies in patients with documented H. pylori infection. Eligibility and quality of the trials were assessed
independently by two reviewers, and the data regarding eradication rate, adverse effects and the cost of therapy
were extracted. Results: Of the 17 RCTs included in the analysis (Asia 13, Europe 3, Latin America, 1), 12 reported
better eradication rates with the sequential therapy, four did not find a significant difference between the two
treatment regimens, and one reported a better eradication rate with standard triple therapy. All except one RCT
reported no significant difference in the incidence of adverse effects between standard triple therapy and sequential Benign prostatic hyperplasia (BPH) is a nonmalignant enlargement of the prostate, which can lead to obstructive and
irritative lower urinary tract symptoms (LUTS). The pharmacologic use of plants and herbs (phytotherapy) for the
treatment of LUTS associated with BPH is common. The extract of the berry of the American saw palmetto, or dwarf
palm plant, Serenoa repens (SR), which is also known by its botanical name of Sabal serrulatum, is one of several
phytotherapeutic agents available for the treatment of BPH. This systematic review aimed to assess the effects and
harms of Serenoa repens in the treatment of men with LUTS consistent with BPH. We searched for trials in general
and in specialized databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE,
EMBASE, CINAHL, Web of Science, SCOPUS, BIOSIS Previews, LILACS, ClinicalTrials.gov, Controlled-Trials.com, World
Health Organization (WHO), and Google Scholar. We also handsearched systematic reviews, references, and clinical
practice guidelines. There were no language restrictions. Trials were eligible if they randomized men with
symptomatic BPH to receive preparations of SR (alone or in combination) for at least four weeks in comparison with
placebo or other interventions, and included clinical outcomes, such as urologic symptom scales, symptoms, and
urodynamic measurements. Eligibility was assessed by at least two independent observers (JT, RM). One review
author (JT) extracted Information on patients, interventions, and outcomes which was then checked by another
review author (RM). The main outcome measure for comparing the effectiveness of SR with active or inert controls
was change in urologic symptom-scale scores, with validated scores taking precedence over non validated ones.
Secondary outcomes included changes in nocturia and urodynamic measures. The main outcome measure for harms
was the number of men reporting side effects. In a meta-analysis of two high quality long-term trials (n = 582),
Serenoa repens therapy was not superior to placebo in reducing LUTS based on the AUA (mean difference (MD) 0.25
points, 95% confidence interval (CI) -0.58 to 1.07). A 72 week trial with high quality evidence, using the American Background: Although several cross-sectional studies have investigated serum vitamin D levels in relation to body
mass index (BMI), findings are inconsistent. Objective: This systematic review and meta-analysis of published cross-
sectional data was conducted to summarize the evidence on the link between serum vitamin D levels and BMI in
adults. Methods: PubMed, ISI Web of Science, Scopus and Google scholar database were searched to May 2012 for
all relevant published papers. We found 34 articles that reported the correlation coefficients between serum 25-
hydroxy vitamin D (25(OH)D) levels and BMI in apparently healthy adults (>18 years). The primary analysis was done
on these 34 papers that reported 37 correlation coefficients. To find the source of between-study heterogeneity, our
secondary analysis was confined to eight studies that had used random sampling method and reported the
correlations for the whole population. Results: Our meta-analysis on 34 relevant papers revealed an overall
significant inverse, but weak, association between serum 25(OH)D levels and BMI (Fisher's Z=-0.15, 95% CI: -0.19, -
0.11) with a significant heterogeneity between studies. In the subgroup analysis based on gender and study location
(East vs. West), the inverse associations were significant in both genders (male: Fisher's Z=-0.11, 95% CI: -0.14, -0.08
and female: -0.14, 95% CI: -0.21, -0.08) and both study locations (East: -0.09, 95% CI: -0.14, -0.04 and West: -0.23,
BACKGROUND: There is a growing emphasis on the need to tackle inadequate human resources for health (HRH) as
an essential part of strengthening health systems; but the focus is mostly on macro-level issues, such as training,
recruitment, skill mix and distribution. Few attempts have been made to understand the capability of health workers,
their motivation and other structural and organizational aspects of systems that influence workforce performance.
We have examined literature on the roles of mid-level managers to help us understand how they might influence
service delivery quality in Kenyan hospitals. In the Kenyan hospital settings, these are roles that head of departments
who are also clinical or nursing service providers might play., METHODS: A computerized search strategy was run in
Pub Med, Cochrane Library, Directory of Open Access Journals Social Science Research Network, Eldis, Google
Scholar and Human Resources for Health web site databases using both free-text and MeSH terms from 1980 to
2011. In addition, citation searching from excluded and included articles was used and relevant unpublished
literature systematically identified., RESULTS AND DISCUSSION: A total of 23 articles were finally included in the
review from over 7000 titles and abstracts initially identified. The most widely documented roles of mid-level Objective: The use of the sepsis bundles in patients with severe sepsis and septic shock has been controversial in the
last decade. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to
assess the clinical evidence and to evaluate survival effects. Data source: Database searches (2004-current) of
Medline, CINAHL, Pubmed, Cochrane, Scopus and Google scholar databases which covered full publications,
abstracts from conferences and digital thesis were performed using the search terms sepsis, septic shock and/or
bundles, processes of care, guidelines, early goal directed therapy, resuscitation. Results: From 253 identified
studies, 21 sepsis bundle original studies were selected and included 23,438 patients. The Resuscitation 6 hour
Bundle pooled analysis (1819 patients) achieved the greatest survival benefit (odds ratio (OR) 2.124, 95% CI 1.701-
2.651, p< 0.000) with the Management 24 hour Bundle pooled analysis the lowest survival benefit (16,521 patients)
(OR 1.646, 95% CI 1.036-2.614, p< 0.035). Both bundles together (Complete Bundle) achieved a combined survival Background: A sexual dimorphism in human life expectancy has existed in almost every country for as long as records
have been kept. Although human life expectancy has increased each year, females still live longer, on average, than
males. Undoubtedly, the reasons for the sex gap in life expectancy are multifaceted, and it has been discussed from
both sociological and biological perspectives. However, even if biological factors make up only a small percentage of
the determinants of the sex difference in this phenomenon, parity in average life expectancy should not be
anticipated. Objective: The aim of this review is to highlight biological mechanisms that may underlie the sexual
dimorphism in life expectancy. Methods: Using PubMed, ISI Web of Knowledge, and Google Scholar, as well as cited
and citing reference histories of articles through August 2012, English-language articles were identified, read, and
synthesized into categories that could account for biological sex differences in human life expectancy. Results: The
examination of biological mechanisms accounting for the female-based advantage in human life expectancy has
been an active area of inquiry; however, it is still difficult to prove the relative importance of any 1 factor.
Nonetheless, biological differences between the sexes do exist and include differences in genetic and physiological
factors such as progressive skewing of X chromosome inactivation, telomere attrition, mitochondrial inheritance, Introduction. Vulvectomy is an intrusive treatment option for women with vulvar malignancy that theoretically may
affect sexual function. Aim. This study aims to provide a comprehensive review of the literature on the impact of
surgical treatment for vulvar malignancy on sexual functioning, overall quality of life, and partner relationship.
Methods. Systematic search of the medical literature on PubMed, PsycINFO, Cochrane database, Google Scholar and
Embase using a number of related terms including vulvar malignancy, vulvar cancer, vulva cancer, vulval cancer,
vulvectomy, sexual function, partner relation, quality of life, and psychological functioning. Main Outcome Measure.
Measures and indicators of sexual function, overall quality of life, and partner relationship following vulvectomy for
vulvar malignancy. Results. There is evidence that women who undergo surgical treatment for vulvar cancer or vulvar
intraepithelial neoplasia are at high risk for sexual dysfunctions, dissatisfaction with partner relationship, and
psychological difficulties. Factors associated with posttreatment sexual dysfunction include patient's increased age,
Objective: To evaluate the relative short term safety and intermediate term efficacy of carotid endarterectomy
versus carotid artery stenting. Design: Systematic review and meta-analysis. Data sources: BIOSIS, Embase, Medline,
the Cochrane central register of controlled trials, International Pharmaceutical Abstracts database, ISI Web of
Science, and Google scholar and bibliographies, from 1 January 1990 to 25 July 2009. Study selection: Randomised
controlled trials comparing carotid endarterectomy with carotid artery stenting in patients with carotid artery
stenosis with or without symptoms. Data extraction: Primary end point was a composite of mortality or stroke.
Secondary end points were death, stroke, myocardial infarction, or facial neuropathy (as individual end points), and
mortality or disabling stroke (as a composite end point). Data synthesis: 11 trials were included (4796 patients); 10
reported on short term outcomes (n=4709) and nine on intermediate term outcomes (1-4 years). The periprocedural
risk of mortality or stroke was lower for carotid endarterectomy (odds ratio 0.67, 95% confidence interval 0.47 to
0.95; P=0.025) than for carotid stenting, mainly because of a decreased risk of stroke (0.65, 0.43 to 1.00; P=0.049),
whereas the risk of death (1.14, 0.56 to 2.31; P=0.727) and the composite end point mortality or disabling stroke Clinicians must frequently decide whether or not to treat patients with loss of posterior teeth, a condition called the
shortened dental arch (SDA). Although many studies have been reported, there are no clear recommendations for
the management of SDA cases. In this work, therefore, an innovative system, the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) approach, was used to grade the evidence and strength of
recommendations for clinical intervention. An extensive literature search for longitudinal studies was conducted on
17 November 2010 in the PubMed and LILACS electronic databases using the term shortened dental arch. A
'snowballing' strategy, for example, manual searching of the reference lists of included papers, was also conducted.
Unpublished and published studies were sought in ClinicalTrials.gov and in the search engine 'Google' (Scholar) in
English, French, German, Italian, Portuguese and Spanish. Finally, grey literature was searched in OpenSIGLE (System
for Information on Grey Literature in Europe). Titles and abstracts of 133 articles were initially assessed. Nine studies The outcomes of total and bicaval heart transplantation techniques are better than those of the biatrial technique;
however, the latter is still considered the gold-standard. The objective of this study was to determine whether the
total and bicaval heart transplantation techniques are, in fact, better than the biatrial technique. A systematic review
with meta-analysis was carried out. Studies were retrieved from Pubmed, Lilacs, Web of Science, Scirus, Scopus,
Google Scholar, and Scielo databases, identified by sensitive strategy. Randomized, prospective, and retrospective
controlled studies were selected for inclusion. Intra and postoperative parameters were assessed. A total of 11,602
studies were identified and 36 were included in our review. The number of atrial arrhythmias, tricuspid valve
regurgitation, deaths, and embolic events, as well as bleeding volume; temporary and permanent pacemaker Furosemide is the most widely prescribed loop diuretic in the setting of systolic heart failure (HF), yet torsemide has
been shown to have less inter- and intra-individual variation in bioavailability and a longer duration of action
compared with furosemide. Thus, a systematic review and meta-analysis of randomized controlled trials comparing
torsemide versus furosemide in patients with systolic HF using OVID MEDLINE, Excerpta Medica (Embase), Web of
Science, PubMed and Google Scholar was performed. Extracted data included study design, sample characteristics,
intervention, outcomes and control for potential confounding factors. A DerSimonian and Laird random-effects
model was used to compute summary risk ratios for HF and cardiovascular (CV) readmission outcomes. Two
randomized trials comparing furosemide with torsemide in 471 patients with systolic HF were identified. Compared
to furosemide, torsemide significantly reduced total HF readmissions (relative risk [RR]: 0.41, 95% CI: 0.28-0.61, p < Purpose: To determine which resources residents use at the point-of-care (POC) for decision making, the drivers for
selection of these resources, and how residents use Google/Google Scholar to answer clinical questions at the POC.
Method: In January 2012, 299 residents from three internal medicine residencies were sent an electronic survey
regarding resources used for POC decision making. Resource use frequency and factors influencing choice were
determined using descriptive statistics. Binary logistic regression analysis was performed to determine relationships
between the independent variables. Results: A total of 167 residents (56%) responded; similar numbers responded at
each level of training. Residents most frequently reported using UpToDate and Google at the POC at least daily (85%
and 63%, respectively), with speed and trust in the quality of information being the primary drivers of selection.
Google, used by 68% of residents, was used primarily to locate Web sites and general information about diseases,
'P' stands for the probability, ranging in value from 0 to 1, that results from a test of significance. It can also be
regarded as the strength of evidence against the statistical null hypothesis (H0). When H0 is evaluated by statistical
tests based on distributions such as t, normal or Chi-squared, P can be derived from one tail of the distribution (one-
sided or one-tailed P), or it can be derived from both tails (two-sided or two-tailed P). Distinguished statisticians, the
authors of statistical texts, the authors of guidelines for human and animal experimentation and the editors of
biomedical journals give confusing advice, or none at all, about the choice between one- and two-sided P values.
Such a choice is available only when there are no more than two groups to be compared. I argue that the choice
between one- and two-sided P values depends on the alternative hypothesis (H1), which corresponds to the
scientific hypothesis. If H1 is non-specific and merely states that the means or proportions in the two groups are The main aim of this systematic review is to synthesize and critically evaluate literature on the incidence and clinical
presentation of shoulder pain in water polo. A secondary aim is to examine the contributing factors to shoulder pain
in water polo. Medline, Cinahl, Embase, Ausport, Ovid, Sports Discus, Pubmed and Google Scholar data bases were
electronically searched. Data were extracted regarding research design, injuries, pain, incidence, interventions and
therapy outcomes. Of an initial yield of 23 papers, 11 fulfilled the inclusion criteria and were categorized into studies
on incidence, shoulder pain, shoulder mobility, strength and throwing injuries. Methodological limitations included
sampling and measurement biases, inadequate internal validity of measurement tools, poor specification of testing Objective: HSPB1 functions to prevent stress-induced cellular damage and has is elevated in multiple cancer types.
The significance of HSPB1 in HNSCC remains controversial. We sought to perform a meta-analysis of HSPB1
expression to clarify previous findings. Study Design: Meta-analysis of all published studies of HSPB1 in HNSCC
patients using IHC techniques. Methods: A literature review was performed on PubMed and Google Scholar search
engines using terms HSP27, HSPB1, Heat Shock Proteins, Cancer, Head and Neck Squamous Cell Carcinoma.
Additional studies were added by review of manuscript bibliographies. Means and standard deviations for
continuous data were obtained for overall HSPB1 expression (in cancer, normal and dysplasia), nodal status and TNM
stage. Chi-square and Cochrans Q test were used to test statistical significance. Results: There were 77 studies
identified in the context of HSPB1 and cancer in general. Of these, 7 studies (total patients n=347) met inclusion Background: Epstein-Barr virus (EBV) encodes 2 small nonpolyadenylated noncoding RNAs termed EBERs. EBERs are
the most common viral transcripts found in EBV-infected cells. In the present study we aimed to examine various
aspects of EBER positivity in PTLD patients. Material/Methods: We conducted a comprehensive search for the
available data by Pubmed and Google Scholar search engines for reports indicating results of EBERs in PTLD patients.
Data from 27 previously published studies were included into analysis. Finally, 243 recipients of allograft were
included into analysis. Results: One and 5 years survival rates for PTLD patients with EBER-positive results were 61%
and 50%, respectively, compared to 55% and 49%, respectively, for EBER-negative PTLD patients. When death
specifically due to PTLD was used as the final outcome, EBER-positive PTLD patients had relatively superior outcome;
although p-value did not reach the significance level (p=0.09). EBER-positive patients were significantly more likely to
develop PTLD lesions of B cell types (vs. T cell type; p=0.018); and early onset PTLD (p<0.001). EBER-positive PTLD
patients were significantly more likely to be polymorphic versus monomorphic (p=0.05). EBER-negative PTLD patients Recently, many studies have been published to evaluate the correlation between the cytochrome P450 1A1
(CYP1A1) T3801C polymorphism and cervical neoplasia risk. However, the results remain inconclusive. To clarify this
possible association, we conducted a systematic review and meta-analysis of published studies. Data were collected
from the following electronic databases: PubMed, Embase, Ovid, ISI Web of Knowledge, Google Scholar, and Chinese
Biomedical Database databases. The pooled odds ratio (OR) and its 95 % confidence interval (95 % CI) were used to
assess the strength of this association. The pooled ORs were performed for the allele model (C vs. T), the
homozygote model (CC vs. TT), the dominant model (CC/CT vs. TT), and the recessive model (CC vs. TT/CT),
respectively. Finally, a total of 12 independent studies including a total of 3,724 subjects (1,912 cases/1,812 controls)
were eligible for meta-analysis. Overall, there was a significant association between the CYP1A1 T3801C
polymorphism and cervical neoplasia susceptibility (C vs. T, OR 1.32, 95 % CI 1.04-1.68, P = 0.02; CC vs. TT, OR 1.99, Aim: To critically examine the evidence for simulation based learning in midwifery education. Background: Simulated
Learning Programs (SLPs) using low to high fidelity techniques are common in obstetric professionals' education and
focus on the development of team work, labour and obstetric emergencies. Review methods: A systematic review
incorporating critical appraisal approaches, setting clear objectives and a defined search and analysis strategy.
Evidence from obstetrics, neonatology, technical and non-technical skills (teamwork) was included where it informed
the development of midwifery curricula. Studies in English from 2000 to 2010 were included searching CINAHL Plus,
OVID Medline, Cochrane, SCOPUS and ProQuest and Google Scholar. Results: Twenty-four papers were identified
that met the inclusion criteria. All were quantitative reports; outcomes and levels of evidence varied with two
notable papers indicating that simulation had an impact on clinical practice. Benefits of SLP over didactic formats
were apparent, as were the development of non-technical skills confidence and competence. The study outcomes
BACKGROUND: Computer-based surgical simulators create a no-risk virtual environment where surgeons can
develop and refine skills through harmless repetition. These applications may be of particular benefit to
neurosurgeons, as the vulnerability of nervous tissue limits the margin for error. The rapid progression of computer-
processing capabilities in recent years has led to the development of more sophisticated and realistic neurosurgery
simulators. OBJECTIVE: To catalogue the most salient of these advances and characterize our current effort to create
a spine surgery simulator. METHODS: An extensive search of the databases Ovid-MEDLINE, PubMed, and Google
Scholar was conducted. Search terms included, but were not limited to: neurosurgery combined with simulation,
virtual reality, haptics, and 3-dimensional imaging. RESULTS: A survey of the literature reveals that surgical simulators
are evolving from platforms used for preoperative planning and anatomic education into programs that aim to
simulate essential components of key neurosurgical procedures. This evolution is predicated upon the advancement
of 3 main components of simulation: graphics/volume rendering, model behavior/tissue deformation, and haptic BACKGROUND: Computer-based surgical simulators create a no-risk virtual environment where surgeons can
develop and refine skills through harmless repetition. These applications may be of particular benefit to
neurosurgeons, as the vulnerability of nervous tissue limits the margin for error. The rapid progression of computer-
processing capabilities in recent years has led to the development of more sophisticated and realistic neurosurgery
simulators., OBJECTIVE: To catalogue the most salient of these advances and characterize our current effort to create
a spine surgery simulator., METHODS: An extensive search of the databases Ovid-MEDLINE, PubMed, and Google
Scholar was conducted. Search terms included, but were not limited to: neurosurgery combined with simulation,
virtual reality, haptics, and 3-dimensional imaging., RESULTS: A survey of the literature reveals that surgical
simulators are evolving from platforms used for preoperative planning and anatomic education into programs that
aim to simulate essential components of key neurosurgical procedures. This evolution is predicated upon the
advancement of 3 main components of simulation: graphics/volume rendering, model behavior/tissue deformation, Introduction: We analyzed different morbidity parameters between single-incision laparoscopic cholecystectomy
(SILC) and conventional laparoscopic cholecystectomy (CLC). Methods: Pubmed, Ovid, Embase, SCI database,
Cochrane, and Google Scholar were searched. The primary endpoints analyzed were cosmetic result and the
postoperative pain (at 6 and 24 h) and the secondary endpoints were operating time, hospital stay, incidence of
overall postoperative complications, wound-related complications, and port-site hernia. Results: Six hundred fifty-
nine patients (SILC-349, CLC-310) were analyzed from nine randomized controlled trials. The objective postoperative
pain scores at 6 and 24 h and the hospital stay were similar in both groups. The total postoperative complications,
wound-related problems, and port-site hernia formation, though higher in SILC, were also comparable in both
groups. SILC had significantly favorable cosmetic scoring compared to CLC [weighted mean difference = 1.0, p = OBJECTIVE: Although the efficacy of meditation interventions has been examined among adult samples, meditation
treatment effects among youth are relatively unknown. We systematically reviewed empirical studies for the health-
related effects of sitting-meditative practices implemented among youth aged 6 to 18 years in school, clinic, and
community settings. METHODS: A systematic review of electronic databases (PubMed, Ovid, Web of Science,
Cochrane Reviews Database, Google Scholar) was conducted from 1982 to 2008, obtaining a sample of 16 empirical
studies related to sitting-meditation interventions among youth. RESULTS: Meditation modalities included
mindfulness meditation, transcendental meditation, mindfulness-based stress reduction, and mindfulness-based
cognitive therapy. Study samples primarily consisted of youth with preexisting conditions such as high-normal blood
pressure, attention-deficit/hyperactivity disorder, and learning disabilities. Studies that examined physiologic
outcomes were composed almost entirely of African American/black participants. Median effect sizes were slightly Introduction: Survivors of cancer may experience lingering adverse skeletal effects such as osteoporosis and
osteomalacia. Skeletal disorders are often associated with advancing age, but these effects can be exacerbated by
exposure to cancer and its treatment. This review will explore the cancer and cancer treatment-related causes of
skeletal disorders. Methods: We performed a comprehensive search, using various Internet-based medical search
engines such as PubMed, Medline Plus, Scopus, and Google Scholar, for published articles on the skeletal effects of
cancer and cancer therapies. Results: One-hundred-forty-two publications, including journal articles, books, and
book chapters, met the inclusion criteria. They included case reports, literature reviews, systematic analyses, and
cohort reports. Skeletal effects resulting from cancer and cancer therapies, including hypogonadism, androgen
deprivation therapy, estrogen suppression, glucocorticoids/corticosteroids, methotrexate, megestrol acetate,
platinum compounds, cyclophosphamide, doxorubicin, interferon-alpha, valproic acid, cyclosporine, vitamin A,
NSAIDS, estramustine, ifosfamide, radiotherapy, and combined chemotherapeutic regimens, were identified and
It is suggested that the internal thoracic artery (ITA) harvesting technique influences the incidence of sternal wound
infection (SWI) after coronary artery bypass graft (CABG). To determine if there is any real difference between
skeletonized vs pedicled ITA, we performed a meta-analysis to determine if there is any real difference between
these two established techniques in terms of SWI. We performed a systematic review using MEDLINE, EMBASE,
CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for studies that
compared the incidence of SWI after CABG between skeletonized vs pedicled ITA until June 2012. The principal
summary measures were odds ratio (OR) with 95% confidence interval (CI) and P values (statistically significant when
<0.05). The ORs were combined across studies using the weighted DerSimonian-Laird random effects model and
weighted Mantel-Haenszel fixed effects. Meta-analysis, sensitivity analysis and meta-regression were completed
using the software Comprehensive Meta-Analysis version 2 (Biostat, Inc., Englewood, NJ, USA). Twenty-two studies
involving 4817 patients (2424 skeletonized; 2393 pedicled) met the eligibility criteria. There was no evidence for
important heterogeneity of effects among the studies. The overall OR (95% CI) of SWI showed a statistically
significant difference in favour of skeletonized ITA (fixed effect model: OR 0.443, 95% CI 0.323-0.608, P < 0.001;
random effect model: OR 0.443, 95% CI 0.323-0.608, P < 0.001). In the sensitivity analysis, the difference in favour of It is suggested that the internal thoracic artery (ITA) harvesting technique influences the incidence of sternal wound
infection (SWI) after coronary artery bypass graft (CABG). To determine if there is any real difference between
skeletonized vs pedicled ITA, we performed a meta-analysis to determine if there is any real difference between
these two established techniques in terms of SWI. We performed a systematic review using MEDLINE, EMBASE,
CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for studies that
compared the incidence of SWI after CABG between skeletonized vs pedicled ITA until June 2012. The principal
summary measures were odds ratio (OR) with 95% confidence interval (CI) and P values (statistically significant when
<0.05). The ORs were combined across studies using the weighted DerSimonian-Laird random effects model and
weighted Mantel-Haenszel fixed effects. Meta-analysis, sensitivity analysis and meta-regression were completed
using the software Comprehensive Meta-Analysis version 2 (Biostat, Inc., Englewood, NJ, USA). Twenty-two studies
involving 4817 patients (2424 skeletonized; 2393 pedicled) met the eligibility criteria. There was no evidence for
important heterogeneity of effects among the studies. The overall OR (95% CI) of SWI showed a statistically
significant difference in favour of skeletonized ITA (fixed effect model: OR 0.443, 95% CI 0.323-0.608, P < 0.001; The relationship between sleep disorders and Internet addiction has been poorly studied. Given the importance of
these disorders in our clinical practice, we felt it appropriate to make a synthesis of available data and to establish
causality or accountability between Internet addiction and the onset of sleep disorders. A literature review was then
performed. We selected scientific articles in English and French, published between 1974 and 2010 by consulting the
databases Medline, Embase, PsycINFO and Google Scholar. The words used alone or in combination are as follows:
addiction, dependence, Internet, behavioral adddiction, sleep. A high prevalence of sleep disorders is found, with In this study, data on post-renal transplant lymphoproliferative disorders (PTLD) collected from the existing literature
were pooled and analyzed to compare the characteristics, predictors and prognosis of small intestinal PTLDs. We
performed a comprehensive search for the available data by Pubmed and Google scholar search engines for reports
on this subject. Data from 18 previously published studies, comprising 120 renal allograft recipients, were included in
the analysis. Renal transplant recipients with intestinal PTLD were significantly less likely to have Hogkin's and
Hogkin's-like lesions (P = 0.044) and to be younger at the time of transplantation (P = 0.07). Except for Hodgkin's-like
lesions, histopathological evaluations elsewhere were comparable between the group with PTLD in the small
intestine and age- and sex-matched renal transplant recipients with PTLD in other sites. The overall mortality was
relatively higher in the control group (P = 0.09). When death only due to PTLD was used as the outcome, a trend
toward better outcome was seen for the intestinal PTLD group compared with the other localizations (P = 0.1). The 1- OBJECTIVES: The article provides an overview of current trends in personal sensor, signal and imaging informatics,
that are based on emerging mobile computing and communications technologies enclosed in a smartphone and
enabling the provision of personal, pervasive health informatics services., METHODS: The article reviews examples of
these trends from the PubMed and Google scholar literature search engines, which, by no means claim to be
complete, as the field is evolving and some recent advances may not be documented yet., RESULTS: There exist
critical technological advances in the surveyed smartphone technologies, employed in provision and improvement of
diagnosis, acute and chronic treatment and rehabilitation health services, as well as in education and training of
healthcare practitioners. However, the most emerging trend relates to a routine application of these technologies in
a prevention/wellness sector, helping its users in self-care to stay healthy., CONCLUSIONS: Smartphone-based
personal health informatics services exist, but still have a long way to go to become an everyday, personalized
Introduction: Smokeless tobacco (ST) use represents an important target for intervention in the U.S. military
population because it impairs "military readiness" and harms the health of the military. This paper aims to provide a
systematic review of ST studies conducted in the U.S. military population in order to assess the content of existing ST
research in this population, provide estimates of prevalence and clinically relevant use patterns, and discuss how
these findings might be used to guide future ST research among this population. Methods: We reviewed articles
published through December 2010 using PubMed and PsycINFO databases, Google Scholar, and any relevant articles'
reference lists. Inclusion criteria included focus on a U.S. military sample, English language, measured tobacco use,
and ST prevalence was reported or could be calculated. To the extent possible, each article was coded for
demographics, socioeconomic status, prevalence, amount, frequency, and length of use, and quit
intentions/attempts. Results: Thirty-nine articles met criteria for inclusion. Less than half focused primarily on ST use Objectives To evaluate tobacco smoking cessation interventions and cessation rates in the oncology population
through a systematic review and meta-analysis. Data Sources The literature was searched using PubMed, Google
Scholar, Medline, EMBASE, and the Cochrane Library (inception to October 2012) by 3 independent review authors.
Review Methods Studies were included if they were randomized controlled trials (RCTs) or prospective cohort (PCs)
studies evaluating tobacco smoking cessation interventions with patients assigned to a usual care or an intervention
group. The primary outcome measure was smoking cessation rates. Two authors extracted data independently for
each study. When applicable, disagreements were resolved by consensus. Results The systematic review identified
10 RCTs and 3 PCs. Statistical analysis was conducted using StatsDirect software (Cheshire, UK). Pooled odds ratios
(ORs) for smoking cessation interventions were calculated in 2 groups based on follow-up duration. The therapeutic
interventions included counseling, nicotine replacement therapy, buproprion, and varenicline. Smoking cessation This systematic review evaluated the extent of HIV/AIDS research conducted in Jordan related to behavioural and/or
social outcomes. MEDLINE, CINAHL, PsycINFO and OVID (1980-2009) were searched as well as the International AIDS
Society abstract archives (2000-2009). Existing reviews and primary studies were cross-referenced for further
citations, and unpublished literature and ongoing trials were searched by contacting experts and active researchers
in the field. Google Scholar was used to search in peer-reviewed local or regional journals not included in the above-
mentioned databases. Searches were also conducted of Arabic literature. Only 8 relevant studies were identified; all OBJECTIVE: The objective of this study was to perform a critical and systematic literature review of studies on
societal costs due to hearing disorders., DESIGN: We used predefined search terms and inclusion/exclusion criteria.
Systematic searches were conducted in Medline, Cochrane Library, Google Scholar, and other relevant websites. The
review included studies written in English or Swedish between 1995 and the end of January 2012., STUDY SAMPLE:
We identified four published studies and four reports that met the pre-defined inclusion criteria., RESULTS: Swedish
cost studies primarily focused on costs of hearing aids. International studies with a societal perspective used
different costing approaches and were limited to specific patient populations. Hearing disorders impact the social Objective: The objective of this study was to perform a critical and systematic literature review of studies on societal
costs due to hearing disorders. Design: We used predefined search terms and inclusion/exclusion criteria. Systematic
searches were conducted in Medline, Cochrane Library, Google Scholar, and other relevant websites. The review
included studies written in English or Swedish between 1995 and the end of January 2012. Study sample: We
identified four published studies and four reports that met the pre-defined inclusion criteria. Results: Swedish cost
studies primarily focused on costs of hearing aids. International studies with a societal perspective used different
costing approaches and were limited to specific patient populations. Hearing disorders impact the social welfare Background. A legacy of colonial rule coupled with a devastating 16-year civil war through 1992 left Mozambique
economically impoverished just as the human immunodeficiency virus (HIV) epidemic swept over southern Africa in
the late 1980s. The crumbling Mozambican health care system was wholly inadequate to support the need for new
chronic disease services for people with the acquired immunodeficiency syndrome (AIDS). Methods. To review the
unique challenges faced by Mozambique as they have attempted to stem the HIV epidemic, we undertook a
systematic literature review through multiple search engines (PubMed, Google Scholar, SSRN, AnthropologyPlus,
AnthroSource) using Mozambique as a required keyword. We searched for any articles that included the required
keyword as well as the terms 'HIV' and/or 'AIDS', 'prevalence', 'behaviors', 'knowledge', 'attitudes', 'perceptions',
'prevention', 'gender', drugs, alcohol, and/or 'health care infrastructure'. Results. UNAIDS 2008 prevalence estimates
ranked Mozambique as the 8th most HIV-afflicted nation globally. In 2007, measured HIV prevalence in 36 antenatal
clinic sites ranged from 3% to 35%; the national estimate of was 16%. Evidence suggests that the Mozambican HIV
Purpose: The purpose of the present systematic review was to evaluate the soft tissue/hard tissue ratio in bilateral
sagittal split advancement osteotomy (BSSO) with rigid internal fixation (RIF) or wire fixation (WF). Materials and
Methods: The databases PubMed, Medline, CINAHL, Web of Science, Cochrane Library, and Google Scholar Beta
were searched. From the original 711 articles identified, 12 were finally included. Only 3 studies were prospective
and 9 were retrospective. The postoperative follow-up ranged from 3 months to 12.7 years for RIF and 6 months to 5
years for WF. Results: The short- and long-term ratios for the lower lip to lower incisor for BSSO with RIF or WF were
50%. No difference between the short- and long-term ratios for the mentolabial-fold to point B and soft tissue
pogonion to pogonion could be observed. It was a 1:1 ratio. One exception was seen for the long-term results of the
soft tissue pogonion to pogonion in BSSO with RII they tended to be greater than a 1:1 ratio. The upper lip mainly Purpose: To evaluate the ratio of soft tissue to hard tissue in bilateral sagittal split setback osteotomy with rigid
internal fixation or wire fixation. Materials and Methods: A literature search was performed using PubMed, Medline,
CINAHL, Web of Science, the Cochrane Library, and Google Scholar Beta. From the original 766 articles identified, 8
articles were included. Two articles were prospective and 6 retrospective. The follow-up period ranged from 1 year
to 12.7 years for rigid internal fixation. Two articles on wire fixation were found to be appropriate for inclusion.
Results: The differences between short- and long-term ratios of the lower lip to lower incisors for bilateral sagittal
split setback osteotomy with rigid internal fixation or wire fixation were quite small. The ratio was 1:1 in the long
term and by trend slightly lower in the short term. No distinction was seen between the short- and long-term ratios
for mentolabial fold. The ratio was found to be 1:1 for the mentolabial fold to point B. In the short term, the ratio of PURPOSE: To evaluate the ratio of soft tissue to hard tissue in bilateral sagittal split setback osteotomy with rigid
internal fixation or wire fixation., MATERIALS AND METHODS: A literature search was performed using PubMed,
Medline, CINAHL, Web of Science, the Cochrane Library, and Google Scholar Beta. From the original 766 articles
identified, 8 articles were included. Two articles were prospective and 6 retrospective. The follow-up period ranged
from 1 year to 12.7 years for rigid internal fixation. Two articles on wire fixation were found to be appropriate for
inclusion., RESULTS: The differences between short- and long-term ratios of the lower lip to lower incisors for
bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation were quite small. The ratio was
1:1 in the long term and by trend slightly lower in the short term. No distinction was seen between the short- and
long-term ratios for mentolabial fold. The ratio was found to be 1:1 for the mentolabial fold to point B. In the short
term, the ratio of the soft tissue pogonion to the pogonion showed a 1:1 ratio, with a trend to be lower in the long Background: With a tradition of 200 years of patient care, homeopathy is one of the oldest integrative medical
systems in the field of traditional European medicine. An essential part of homeopathic case-taking is comprehensive
anamnesis, followed by individualised identification of a remedy that fits the conditions the patient describes. This is
called repertorisation and today it is done with the help of computer programs using modern database technology.
Aim: This systematic review provides an overview of the application of software technology for repertorisation in
homeopathy. Methods: The databases PubMed, Embase, AMED, Thieme Erfahrungsschatz, CAMbase, Science Direct
and Google Scholar were searched for the combination of 'software' AND 'homeopathy' in all 'text fields'. The
references of obtained articles were also searched to identify further literature not listed in the databases. All
publications with software applications for homeopathic repertorisation were evaluated with respect to year, origin,
software technology applied, repertory, availability and system requirements. Results: A total of 31 publications
were included in this review. They consisted of both technological reports and software descriptions, and were
published in a wide range of scientific journals and in scientific monographs. From the aspect of information
technology, a wide range of topics, from expert systems to the application of neural networks and fuzzy systems, Soil-transmitted helminth (STH) infections (i.e., Ascaris lumbricoides, hookworm, and Trichuris trichiura) affect more
than a billion people. Preventive chemotherapy (i.e., repeated administration of anthelmintic drugs to at-risk
populations), is the mainstay of control. This strategy, however, does not prevent reinfection. We performed a
systematic review and meta-analysis to assess patterns and dynamics of STH reinfection after drug treatment. We
systematically searched PubMed, ISI Web of Science, EMBASE, Cochrane Database of Systematic Reviews, China
National Knowledge Infrastructure, WanFang Database, Chinese Scientific Journal Database, and Google Scholar.
Information on study year, country, sample size, age of participants, diagnostic method, drug administration
strategy, prevalence and intensity of infection pre- and posttreatment, cure and egg reduction rate, evaluation
period posttreatment, and adherence was extracted. Pooled risk ratios from random-effects models were used to
assess the risk of STH reinfection after treatment. Our protocol is available on PROSPERO, registration number:
CRD42011001678. From 154 studies identified, 51 were included and 24 provided STH infection rates pre- and
posttreatment, whereas 42 reported determinants of predisposition to reinfection. At 3, 6, and 12 months
BACKGROUND: Soil-transmitted helminth (STH) infections (i.e., Ascaris lumbricoides, hookworm, and Trichuris
trichiura) affect more than a billion people. Preventive chemotherapy (i.e., repeated administration of anthelmintic
drugs to at-risk populations), is the mainstay of control. This strategy, however, does not prevent reinfection. We
performed a systematic review and meta-analysis to assess patterns and dynamics of STH reinfection after drug
treatment., METHODOLOGY: We systematically searched PubMed, ISI Web of Science, EMBASE, Cochrane Database
of Systematic Reviews, China National Knowledge Infrastructure, WanFang Database, Chinese Scientific Journal
Database, and Google Scholar. Information on study year, country, sample size, age of participants, diagnostic
method, drug administration strategy, prevalence and intensity of infection pre- and posttreatment, cure and egg
reduction rate, evaluation period posttreatment, and adherence was extracted. Pooled risk ratios from random-
effects models were used to assess the risk of STH reinfection after treatment. Our protocol is available on
PROSPERO, registration number: CRD42011001678., PRINCIPAL FINDINGS: From 154 studies identified, 51 were
included and 24 provided STH infection rates pre- and posttreatment, whereas 42 reported determinants of Squamous cell carcinoma (SCC) of the lower lip is a deadly nonmelanoma skin cancer. Its precursor, a distinctive
cutaneous neoplasia analogous to cervical dysplasia, is known by the confusing term actinic cheilitis. Solar cheilosis
(SC) is a more appropriate designation. It represents incipient SCC in situ. SC is widely recognized as an ultraviolet
light-induced precancer of the lower lip that is typically seen in light-skinned individuals and others with poorly
pigmented lower lips. Lip SCC is one of the most common malignancies of the oral cavity. SCC is much more likely to
metastasize from the lip than cutaneous surfaces, with a 5-year overall survival rate of less than 75%. SC results from
long-term exposure to ultraviolet radiation. The occurrence of SC is dose-dependent and is influenced by the
patient's solar exposure, age, genetic predisposition, geographic latitude of residence, occupation, leisure activities,
and use of lip protective agents. Molecular abnormalities of SC are similar to those of actinic keratosis and facilitate PURPOSE: This article will analyze the concept of trauma, and illustrate distinctions between accepted definitions
and actual meaning. For populations at high risk for exposure to traumatic situations, such as Special Operations
Forces (SOF) and deployed military personnel, delineating the beliefs and environment-specific comprehension of
trauma and its consequences is imperative. BACKGROUND: Trauma is a common term in health sciences literature
and in the social vernacular, but is often misunderstood and lacks specificity. Differences in perception of what
trauma is and is not may exist even between civilian and military populations. Therefore, the concept of trauma Background: Several well conducted reviews of different forms of electrical stimulation and motor recovery in stroke
rehabilitation exist. However, few include somatosensory stimulation with repeated peripheral nerve sensory
stimulation, a recently proposed adjunct to physical rehabilitation. A systematic review was conducted prior to a
Phase II study to address the question: Does repeated peripheral stimulation of upper limb nerves improve
functional motor outcomes compared to standard rehabilitation interventions in adults at any stage after stroke?
Method: We searched Pubmed, EMBASE, Google Scholar, PEDro, Zetoc, CINAHL and Cochrane CENTRAL databases
(including key words: stroke; therapy; rehabilitation; somatosensory stimulation; upper limb; randomised) from 1980-
2010 and citations in relevant papers. We included only randomised study designs. Two research physiotherapists
independently reviewed published titles and abstracts for papers fitting our inclusion criteria. Studies were tabulated
and assessed for quality (PEDro scale). Results: Six studies were identified. Two were truly randomised trials (subjects
n=40), with 4 being pseudo -randomised or crossover study designs (n= 40). Mean PEDro scale 7/10. Participants Background: This review details the examination, diagnosis, treatment and management of injuries encountered by
competitive swimmers. Primarily, these involve the shoulder, however, the spine, knee and hip can be involved.
Using the Coleman methodology score, we show that the methods used in obtaining and reporting clinical findings
and intervention results could be improved. Where possible, we suggest improvements. Sources of data: A literature
review was conducted in English, Italian, French and German using PubMed, Google Scholar and Ovid search engines
with strict inclusion/exclusion criteria. Areas of agreement: Poor technique, and high training intensity and distance
are the most common cause of missed swim practice and competition through injury. Areas of controversy: Few OBJECTIVES: Post-approval product research in the form of observational study is increasingly prominent.
Observational studies inform real-world safety and effectiveness. Lack of specific regulatory requirements or
guidances for source data verification (SDV) in these studies, however, leaves sponsors and partner CROs to
determine the level of SDV necessary to ensure quality. A literature review was performed to determine the level of
SDV in practice in published observational studies. METHODS: Google Scholar and Pubmed searches were used to
retrieve relevant publications. The term 'source data verification' was used in combination with the terms
'observational study' and 'non-interventional study'. Articles readily available in full text were included for analysis.
The methods sections were screened to determine the level of SDV applied. If multiple publications referred to a
single study or registry, only one representative publication was selected for inclusion. RESULTS: Of the observational
studies included, 37 studies mentioned SDV in their methods section. Of these, 16 (43%) did not further specify the
level of SDV. In the remaining 21 studies, SDV ranged from 0 to 100%, with a median of 10%. Subject numbers in
The specialized scientific search engines are one of the most interesting electronic resources for obtaining scientific
literature. In 2004 the Scopus database started and from its scientific search engine Scirus has extended search
capabilities beyond the databases of Thomson Reuters. Scopus has a broad thematic coverage (4,100 journals from
the field of life sciences, 6,700 journals in the field of health) and with Scirus with 450 millions of entries they
become in obligatory reference sources due to their completeness. The development and implementation of Google
Scholar, adds itself to the appearance of this type of specialized search tools and is a very interesting contribution Aims: To assess the impact of alcohol advertising and media exposure on future adolescent alcohol use. Methods:
We searched MEDLINE, the Cochrane Library, Sociological Abstracts, and PsycLIT, from 1990 to September 2008,
supplemented with searches of Google scholar, hand searches of key journals and reference lists of identified papers
and key publications for more recent publications. We selected longitudinal studies that assessed individuals'
exposure to commercial communications and media and alcohol drinking behaviour at baseline, and assessed alcohol
drinking behaviour at follow-up. Participants were adolescents aged 18 years or younger or below the legal drinking
age of the country of origin of the study, whichever was the higher. Results: Thirteen longitudinal studies that
followed up a total of over 38,000 young people met inclusion criteria. The studies measured exposure to advertising
and promotion in a variety of ways, including estimates of the volume of media and advertising exposure, ownership
of branded merchandise, recall and receptivity, and one study on expenditure on advertisements. Follow-up ranged
from 8 to 96 months. One study reported outcomes at multiple time-points, 3, 5, and 8 years. Seven studies provided
data on initiation of alcohol use amongst non-drinkers, three studies on maintenance and frequency of drinking
amongst baseline drinkers, and seven studies on alcohol use of the total sample of non-drinkers and drinkers at
baseline. Twelve of the thirteen studies concluded an impact of exposure on subsequent alcohol use, including
initiation of drinking and heavier drinking amongst existing drinkers, with a dose response relationship in all studies Background: Werner syndrome (WS) is an autosomal recessive genetic instability and progeroid ('premature aging')
syndrome which is associated with an elevated risk of cancer. Objectives: Our study objectives were to characterize
the spectrum of neoplasia in WS using a well-documented study population, and to estimate the type-specific risk of
neoplasia in WS relative to the general population. Methods: We obtained case reports of neoplasms in WS patients
through examining previous case series and reviews of WS, as well as through database searching in PubMed, Google
Scholar, and J-EAST, a search engine for articles from Japan. We defined the spectrum (types and sites) of neoplasia
in WS using all case reports, and were able to determine neoplasm type-specific risk in Japan WS patients by
calculating standardized incidence and proportionate incidence ratios (SIR and SPIR, respectively) relative to Osaka
Japan prefecture incidence rates. Results: We used a newly assembled study population of 189 WS patients with 248
neoplasms to define the spectrum of neoplasia in WS. The most frequent neoplasms in WS patients, representing
2/3 of all reports, were thyroid neoplasms, malignant melanoma, meningioma, soft tissue sarcomas, leukemia and BACKGROUND: Werner syndrome (WS) is an autosomal recessive genetic instability and progeroid ('premature
aging') syndrome which is associated with an elevated risk of cancer., OBJECTIVES: Our study objectives were to
characterize the spectrum of neoplasia in WS using a well-documented study population, and to estimate the type-
specific risk of neoplasia in WS relative to the general population., METHODS: We obtained case reports of
neoplasms in WS patients through examining previous case series and reviews of WS, as well as through database
searching in PubMed, Google Scholar, and J-EAST, a search engine for articles from Japan. We defined the spectrum
(types and sites) of neoplasia in WS using all case reports, and were able to determine neoplasm type-specific risk in
Japan WS patients by calculating standardized incidence and proportionate incidence ratios (SIR and SPIR,
respectively) relative to Osaka Japan prefecture incidence rates., RESULTS: We used a newly assembled study
population of 189 WS patients with 248 neoplasms to define the spectrum of neoplasia in WS. The most frequent
neoplasms in WS patients, representing 2/3 of all reports, were thyroid neoplasms, malignant melanoma,
UNLABELLED:, BACKGROUND: Lithium is an integral drug used in the management of acute mania, unipolar and
bipolar depression and prophylaxis of bipolar disorders. Thyroid abnormalities associated with treatment with
lithium have been widely reported in medical literature to date. These include goitre, hypothyroidism,
hyperthyroidism and autoimmune thyroiditis. This current review explores the varied thyroid abnormalities
frequently encountered among patients on lithium therapy and their management, since lithium is still a
fundamental and widely drug used in psychiatry and Internal Medicine., METHODS: PubMed database and Google
scholar were used to search for relevant English language articles relating to lithium therapy and thyroid
abnormalities up to December 2012. The search terms used were lithium treatment, thyroid abnormalities, thyroid
dysfunction, goitre, hypothyroidism, hyperthyroidism, thyrotoxicosis, autoimmune thyroiditis, lithium toxicity,
treatment of affective disorders and depression and side effects of antipsychotic drugs. Reference lists of the
identified articles were further used to identify other studies., RESULTS: Lithium affects normal thyroid functioning
through multiple mechanisms. At the cellular level, it decreases thyroid hormone synthesis and release. It also
decreases peripheral deiodination of tetraiodothyronine (T4) or thyroxine by decreasing the activity of type I 5' de-
iodinase enzyme. Hypothyroidism and goitre (clinically and/ultrasonographically detected) are the most prevalent Context: Pyruvate dehydrogenase complex (PDC) deficiency is a genetic mitochondrial disorder commonly associated
with lactic acidosis, progressive neurological and neuromuscular degeneration and, usually, death during childhood.
There has been no recent comprehensive analysis of the natural history and clinical course of this disease. Objective:
We reviewed 371 cases of PDC deficiency, published between 1970 and 2010, that involved defects in subunits
E1alpha and E1beta and components E1, E2, E3 and the E3 binding protein of the complex. Data sources and
extraction: English language peer-reviewed publications were identified, primarily by using PubMed and Google
Scholar search engines. Results: Neurodevelopmental delay and hypotonia were the commonest clinical signs of PDC
deficiency. Structural brain abnormalities frequently included ventriculomegaly, dysgenesis of the corpus callosum
and neuroimaging findings typical of Leigh syndrome. Neither gender nor any clinical or neuroimaging feature
differentiated the various biochemical etiologies of the disease. Patients who died were younger, presented clinically PURPOSE: This review summarizes research on disorders of speech production in Down syndrome (DS) for the
purposes of informing clinical services and guiding future research., METHOD: Review of the literature was based on
searches using MEDLINE, Google Scholar, PsycINFO, and HighWire Press, as well as consideration of reference lists in
retrieved documents (including online sources). Search terms emphasized functions related to voice, articulation,
phonology, prosody, fluency, and intelligibility., CONCLUSIONS: The following conclusions pertain to four major areas
of review: voice, speech sounds, fluency and prosody, and intelligibility. The first major area is voice. Although a
number of studies have reported on vocal abnormalities in DS, major questions remain about the nature and
frequency of the phonatory disorder. Results of perceptual and acoustic studies have been mixed, making it difficult
to draw firm conclusions or even to identify sensitive measures for future study. The second major area is speech
sounds. Articulatory and phonological studies show that speech patterns in DS are a combination of delayed Objective: A broad variation in speech perception results has been observed in patients who have received electrical
stimulation of the cochlear nucleus complex from auditory brainstem implants (ABIs). This study aims to investigate
the factors following implantation that influence speech perception outcomes in both tumour (T) and non-tumour
(NT) patient groups by reviewing the current literature and also help explain the reasons behind the broad variation
in speech perception outcomes reported. Study design: A search strategy was devised and applied to databases
including PubMed, Medline, Google Scholar, CINAHL, and the Cochrane review library to identify relevant cohort
studies available. Relevant citations from current publications were also followed up. Papers investigating speech
perception outcomes post ABI implantation were sought. Results: Six longitudinal studies were identified that
assessed speech perception outcomes in ABI recipients. Meta-analysis was not possible due to variations in BACKGROUND: Glial scar (GS) is the most important inhibitor factor to neuroregeneration after spinal cord injury
(SCI) and behaves as a tertiary lesion. The present review of the literature searched for representative studies
concerning GS and therapeutic strategies to neuroregeneration., METHODS: The author used the PubMed database
and Google scholar to search articles published in the last 20 years. Key words used were SCI, spinal cord (SC)
inflammation, GS, and SCI treatment., RESULTS: Both inflammation and GS are considered important events after
SCI. Despite the fact that firstly they seem to cause benefit, in the end they cause more harm than good to
neuroregeneration. Each stage has its own aspects under the influence of the immune system causing inflammation,
from the primary to secondary lesion and from those to GS (tertiary lesion)., CONCLUSION: Future studies should
OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical trials, and safety profile of spinosad 0.9% topical
lotion, a recently approved pediculicide for treatment of head lice infestation. DATA SOURCES: English-language
articles indexed in MEDLINE (1948-May 2011), Toxline, Google Scholar, International Pharmaceutical Abstracts(1970-
May 2011), and Cumulative Index to Nursing and Allied Health Literature (1981-May 2011) were identified, using the
search terms spinosad, head lice, and pediculosis capitis. STUDY SELECTION AND DATA EXTRACTION: Available
English-language articles were reviewed. DATA SYNTHESIS: In the studies that were reviewed, the percentage of
patients who were lice free 14 days after the last treatment was significantly higher in the spinosad groups compared
to the permethrin groups (84.6% vs 44.9% and 86.7% vs 42.9%, respectively; p < 0.001 for both studies). Additionally,
the proportion of all primary and nonprimary participants determined to be lice free following only 1 treatment with
the study medication was higher among patients in the spinosad groups compared with those in the permethrin
groups. Application-site erythema was observed in patients in both treatment groups; however, it was more OBJECTIVES: To introduce pharmacy practitioners to spirometry testing and provide strategies for integrating this
"value-added" tool with other direct patient care pharmacy services., DATA SOURCES: Spirometry literature and
resources obtained through search strategies including Ovid, PubMed, and Google Scholar., SUMMARY: Pharmacists
are distinctive members of the multidisciplinary patient care team and can contribute by performing spirometry
services for pulmonary patients. Pharmacists have been largely absent from performing this much needed service,
perhaps as a result of lack of training or because this testing may be perceived as irrelevant to the pharmacist scope
of practice. However, pharmacists are actively integrated with many aspects of pulmonary patient care, including
recommending and adjusting inhaled pharmacological agents, monitoring for potential drug-drug and drug-disease
interactions, recommending smoking cessation, assessing patient prescription insurance coverage, and educating
patients, caregivers, and health care providers on use of prescribed respiratory delivery devices. Adding quality Background: Spinal infections are an important clinical problem that often require aggressive medical therapy, and
sometimes even surgery. Known risk factors are advanced age, diabetes mellitus, rheumatoid arthritis,
immunosuppression, alcoholism, long-term steroid use, concomitant infections, poly-trauma, malignant tumor, and
previous surgery or invasive procedures (discography, chemonucleolysis, and surgical procedures involving or
adjacent to the intervertebral disc space). The most common level of involvement is at the lumbar spine, followed by
the thoracic, cervical and sacral levels: lesions at the thoracic spine tend to lead more frequently to neurological
symptoms. Objective: The aim of the current paper is to describe current evidence-based standards of therapy in the
management of SD by emphasizing pharmacological therapy and principles and indications for bracing and surgery.
Methods: A PubMed and Google Scholar search using various forms and combinations of the key words:
spondylodiscitis, spine, infection, therapy, surgery, radiology, treatment. Reference citations from publications
identified in the literature search were reviewed. Publications highlighted in this article were extracted based on Background: Spontaneous perforation of the colon is a rare complication in neonates with anorectal malformations
(ARMs). There are no detailed studies concerning this complication. Materials and Methods: A retrospective review
of hospital records between 1994 and 2010 revealed 8 cases of bowel perforation among 136 cases of ARM.
Eighteen additional cases were culled from the literature by searching Pubmed, Indmed, Embase, and Google
Scholar. Results: Perforations occurred more commonly in males with ARM (85%). Low and high anomalies were
equally affected. The median age at diagnosis was 48 hours. Pneumoscrotum and abdominal wall erythema were
occasionally suggestive of perforation. In addition to the Rigler sign and collapsed bowel on plain radiographs, a
newly described "rectal-tail sign" was useful in recognizing pneumoperitoneum in the lateral view invertogram. A
lower midline incision offered optimal surgical access. Two distinct patterns of perforation were identified: type 1
(88%) occurred before surgical decompression of the obstructed colon, whereas type 2 (12%) occurred
postoperatively. Type 1 cases were subdivided into cecal (type 1a, 16%), transverse colon (type 1b, 8%), rectosigmoid
(type 1c, 60%), and miscellaneous (type 1d, 4%) perforations. Type 1a is best treated with cecostomy and distal Introduction: Active sports participation can be important in some patients with degenerative joint disease in the
lower limb. We investigated whether this is possible after an osteotomy for osteoarthritis of the hip, knee and ankle
joints.Sources of dataWe performed a literature search using Medline, Cochrane, CINAHL and Google Scholar with no
restriction to time period or language using the keywords: 'osteotomy and sports'. Eleven studies (all level IV
evidence) satisfied our inclusion and exclusion criteria. Nine reported on high tibial osteotomies, one on
periacetabular osteotomies and one on distal tibial osteotomies. The Coleman Methodology Score to assess the
quality of studies showed much heterogeneity in terms of study design, patient characteristics, management
methods and outcome assessment.Areas of agreementParticipation in recreational sports is possible in most patients
who were active in sports before lower limb osteotomy. In no study were patients able to participate in competitive
sports.Areas of controversyIntensive participation in sports after osteotomy may adversely affect outcome and lead
INTRODUCTION: Returning an athlete to play following a spinal or concussive injury remains a challenge for the
health practitioner making the decision. Among the possible mechanisms responsible for such injuries in amateur
football, the concept of "spearing" has attracted a great deal of attention in sport medicine., OBJECTIVE: The purpose
of this paper is to present a review of the diagnosis and treatment of the potentially catastrophic neck and head
injuries caused by spearing in Canadian amateur football and to suggest the role the chiropractic profession can have
in their prevention. It proposes to follow the recommendations advocated by the National Capital Amateur Football
Association (NCAFA) athletic trainers group, led by a chiropractor., METHODS: Information regarding the concepts
and prevention of "spearing", concussion and spinal injuries at the amateur football level in both the United States
and Canada was obtained using the following computerized search methods: PubMed - MeSH (via the National
Center for Biotechnology Information (NCBI); The Index to Chiropractic Literature (ICL); Google Scholar Beta. Recent
(2005) information on sports related spinal injuries and concussion were obtained by attendance at the 2005 Sports
Related Concussion and Spine Injury Conference. Foxborough, Massachusetts. From a total of 698 references, 63
were retained., CONCLUSION: Literature search yields very little information regarding Canadian statistics for Although dental implants have seen tremendous clinical success over the past few decades, there are some worrying
reports in literature describing squamous cell carcinoma (SCC) in close association with dental implants. This article
also provides a critical assessment of the published literature relating to the presence of carcinoma in association
with dental implants, analyzing the previously published and hypothesized carcinogenic responses to an implant, to
try and come to a conclusion regarding the plausibility and clinical risk for cancer formation in association with dental
implants. An unusual case of an SCC noted in close proximity to a dental implant is also presented. A systematic
search was conducted using Medline (PubMed), Cochrane Database, and Google Scholar with the search terms
"cancer," "squamous cell carcinoma," "dental implant," "SCC," "peri-implantitis," "oral cancer," and "implantology"
and using multiple combinations using Boolean operators "or" and "and." The search was not limited to dental
literature; orthopedic and biomedical literature was also included. The results were then hand screened to pick out
the relevant articles. In total, 14 previous published reports were found, where 24 dental implants were reported to Purpose: The purpose of this systematic review was to evaluate horizontal relapse and its causes in bilateral sagittal
split advancement osteotomy (BSSO) with rigid internal fixation of different types. Materials and Methods: A search
of the literature was performed in the databases PubMed, Ovid, Cochrane Library, and Google Scholar Beta. From
488 articles identified, 24 articles were finally included. Six studies were prospective, and 18 were retrospective. The
range of postoperative study records was 6 months to 12.7 years. Results: The short-term relapse for bicortical
screws was between 1.5% and 32.7%, for miniplates between 1.5% and 18.0%, and for bioresorbable bicortical
screws between 10.4% and 17.4%, at point B. The long-term relapse for bicortical screws was between 2.0% and
50.3%, and for miniplates between 1.5% and 8.9%, at point B. Conclusions: BSSO for mandibular advancement is a
good treatment option for skeletal Class II, but seems less stable than BSSO setback in the short and long terms.
Bicortical screws of titanium, stainless steel, or bioresorbable material show little difference regarding skeletal
stability compared with miniplates in the short term. A greater number of studies with larger skeletal long-term
relapse rates were evident in patients treated with bicortical screws instead of miniplates. The etiology of relapse is Purpose: The purpose of this systematic review was to evaluate relapse and its causes in bilateral sagittal split
setback osteotomy with rigid internal fixation. Materials and Methods: Literature research was done in databases
such as PubMed, Ovid, the Cochrane Library, and Google Scholar Beta. From the original 488 articles identified, 14
articles were finally included. Only 5 studies were prospective and 9 retrospective. The range of postoperative study
records was from 6 weeks to 12.7 years. Results: The horizontal short-term relapse was between 9.9% and 62.1% at
point B and between 15.7% and 91.3% at pogonion. Long-term relapse was between 14.9% and 28.0% at point B and
between 11.5% and 25.4% at pogonion. Conclusions: Neither large increase nor decrease of relapse was seen when
short-term values were compared with long-term. Bilateral sagittal split osteotomy for mandibular setback in
combination with orthodontics is an effective treatment of skeletal Class III and a stable procedure in the short- and
Statement of problem. Implant therapies have increased the range of prosthodontic options for the treatment of
edentulism. Considering both dentist- and patient-mediated outcomes, a universal treatment intervention for the
treatment of the edentulous mandible has not been demonstrated. Purpose. The purpose of this study was to test
the null hypothesis that there is no single standard of care for the edentulous mandible as defined by a specific
treatment modality. Material and methods. A review of the literature was undertaken seeking evidence of a superior
intervention for the treatment of the edentulous mandible. A search of the English language peer-reviewed
literature was completed using Medline and Google Scholar for the period from 1995 to 2005, focusing on evidence-
based research. This was supplemented with a hand search of selected dental journals and textbooks. Longitudinal
retrospective studies, longitudinal prospective studies, longitudinal experimental clinical studies, nonrandomized
controlled studies, and randomized controlled clinical trials were included for review using a general linear
hierarchical classification of studies. Articles that did not focus exclusively on treatment interventions for mandibular
edentulism or on the effects of such therapies on the patient were excluded from further evaluation. The search
period included articles that were published before the criteria for evidence-based literature were established, but
this was not necessarily used to exclude an article. The last search was conducted on September 25, 2005. Results. Background: Sepsis is still one of the leading causes of death worldwide despite advances in diagnosis and therapy.
Recently, statins have been shown to demonstrate a protective effect in patients with sepsis and/or other infections
based on several cohort studies by virtue of the pathophysiological similarities between sepsis and atherosclerosis.
However, this finding has not been corroborated until recently by several randomized controlled trials (RCTs).
Considering the possible beneficial effects and lower cost of statins, the demonstration of amortality benefit would
have significant cost-benefit implications, which is what this meta-analysis seeks to investigate. Methods: An
electronic search of PubMed, Cochrane, Clinicaltrials. gov, International Standard RCT Numbers, and Google Scholar
using the terms sepsis and statins was conducted and supplemented with a hand search. The studies were assessed
for inclusion based on pre-specified criteria and independently evaluated by two authors. Data was analyzed in
RevMan from pooled risk ratios (RRs) using a random effects model. Heterogeneity was assessed using Cochran's Q
statistic and I2. Results: A total of 3 RCTs were included with a total of 333 participants. The effect of statins in Introduction: Studies have established a relationship between inflammation and venous thromboembolism (VTE).
Though statins modulate inflammation, it is uncertain if they prevent VTE in heterogeneous populations. A recent
randomized trial demonstrated that statins prevent VTE in healthy older adults, yet this has not been well
established in other groups, including younger individuals and individuals with comorbidities. The objective of this
meta-analysis was to estimate the effect of statins on VTE in a heterogeneous group of adults. Methods: We
systematically reviewed the effect of statins in preventing VTE in adult inpatients and outpatients. We systematically
searched MEDLINE (1966-Jan 2010), EMBASE (1980-Jan 2010), Google Scholar, Cochrane Library, PapersFirst,
ProceedingsFirst, and ISI Web of Science, manually reviewed references, and contacted experts. Observational
studies that compared any dose of statin to no statin or placebo, examined inpatients or outpatients, and assessed
VTE, pulmonary embolism, and/or deep vein thrombosis were included. Study selection, data abstraction and study Introduction: Breast cancer is one of the most common types of cancer diagnosed in women, and metastasis is the
leading cause of death by this cancer. The existing antineoplastic drugs are highly toxic to patients, so, currently,
there are attempts to develop other drugs to overcome this obstacle. Recently, statins, hypocholesterolemic drugs
and inhibitors of 3-hydroxy-3-methylglutaryl-Coenzyme A reductase (HMGCR), shown to produce anticancer effects,
but the mechanisms by which these occur are not yet elucidated. There have been several studies in order to clarify
this matter, based on the consideration that the inhibition of the mevalonate pathway by statins is responsible for
their pleiotropic effects. Thus, this study is focused on some of the newly discovered targeted therapies of statins,
specifically identified in the case of breast cancer, describing also the mevalonate pathway, some limitations of the
use of statins and some of their synergistic associations with other drugs identified for anticancer purposes. Material
and methods: It was conducted a search in PubMed, ScienceDirect, HighWire and Google Scholar to obtain articles,
preferably original, published between 2005 and 2010, using keywords such as statins, cancer, rho, angiogenesis and
apoptosis, selecting articles by title and abstract. Thereafter, the resulting articles were read in full, being made a
second selection of the articles of interest to this study. Results: By blocking the mevalonate pathway, statins
prevent the production of non-steroid isoprenoids, such as farnesyl diphosphate (FPP) and geranylgeranyl
diphosphate (GGPP), which are important for the modification and function of small GTPases in cell growth,
angiogenesis, cell migration and cell invasion. Following this reasoning, there were recently identified some of the
Objectives: This study was designed to document the state of open access (OA) in the biomedical field in 2005.
Methods: PubMed was used to collect bibliographic data on target articles published in 2005. PubMed, Google
Scholar, Google, and OAIster were then used to establish the availability of free full text online for these publications.
Articles were analyzed by type of OA, country, type of article, impact factor, publisher, and publishing model to
provide insight into the current state of OA. Results: Twenty-seven percent of all the articles were accessible as OA
articles. More than 70% of the OA articles were provided through journal websites. Mid-rank commercial publishers
often provided OA articles in OA journals, while society publishers tended to provide OA articles in the context of a
traditional subscription model. The rate of OA articles available from the websites of individual authors or in OBJECTIVES: Health care research in present scenario is a platform wherein a range of interventions play their role to
alleviate suffering and mitigate the course of diseases. Gaming console have so far demonstrated promising and
considerable potential as rehabilitation and lifestyle treatments. The objective of this review was to study the advent
and role of new generation gaming consoles (e.g. Nintendo Wii, Xbox, and PS3) in healthcare research in a systematic
manner. METHODS: A consolidated search strategy was developed and run in EMBASE, MEDLINE, Cochrane,
POPLINE, SCOPUS, and Clinicaltrials.gov databases to identify the trials utilising gaming consoles as principal
intervention or supportive treatment in various disease areas. Grey literature was also identified though Google
Scholar. Data extraction was performed and results were summarized. RESULTS: The data revealed that motion
sensor and interactive gaming consoles have found their role in multiple health care fields ranging from
rehabilitation, weight loss, stroke recovery, improvement in locomotor activity, Parkinson's disease, Alzheimer's Objectives: The use of stem cell therapy for the repair of cartilage defects has shown promising results in in vitro and
animal studies. However, only a small number of studies have been performed to evaluate the benefits in human
subjects. The aim of this study is to systematically review studies that focus on the clinical application of stem cell
therapy to treat cartilage defects in human subjects. Design: A literature search was performed, adhering to the
PRISMA guidelines, to review any studies using such techniques in humans. Our initial search retrieved 105 articles
listed on MEDLINE, EMBASE, Google Scholar, CINHal and SPortDiscus. From these studies, 11 studies meeting the
eligibility criteria were selected and formed the basis of our systematic review. Results: There is limited evidence
showing the benefit in humans. The study designs, follow-up methods and criteria reporting and evaluation vary Stoma formation is a commonly performed procedure in colorectal surgery as a part of operations performed for
malignant- and inflammatory bowel disease. Stoma formation is a simple, but not trivial, undertaking. When
performed badly, it can leave the patients with a legacy of complications such as leakage, prolapse, parastomal
hernia and retraction. Various studies have reported a complication rate of 21-70%. We performed a literature
search using the Medline, Ovid and Google scholar database for all the articles published between January 1980 and
December 2008. The search terms used were colostomy, ileostomy, stoma, parastomal hernia, stenosis, prolapse, Introduction: The ideal measures to prevent postoperative delirium remain unestablished. We conducted this
systematic review and meta-analysis to clarify the significance of potential interventions.Methods: The PRISMA
statement guidelines were followed. Two researchers searched MEDLINE, EMBASE, CINAHL and the Cochrane Library
for articles published in English before August 2012. Additional sources included reference lists from reviews and
related articles from 'Google Scholar'. Randomized clinical trials (RCTs) on interventions seeking to prevent
postoperative delirium in adult patients were included. Data extraction and methodological quality assessment were
performed using predefined data fields and scoring system. Meta-analysis was accomplished for studies that used
similar strategies. The primary outcome measure was the incidence of postoperative delirium. We further tested
whether interventions effective in preventing postoperative delirium shortened the length of hospital stay.Results:
We identified 38 RCTs with interventions ranging from perioperative managements to pharmacological,
psychological or multicomponent interventions. Meta-analysis showed dexmedetomidine sedation was associated
with less delirium compared to sedation produced by other drugs (two RCTs with 415 patients, pooled risk ratio (RR)
= 0.39; 95% confidence interval (CI) = 0.16 to 0.95). Both typical (three RCTs with 965 patients, RR = 0.71; 95% CI =
0.54 to 0.93) and atypical antipsychotics (three RCTs with 627 patients, RR = 0.36; 95% CI = 0.26 to 0.50) decreased
Purpose: Regenerative medicine will likely facilitate improved stress urinary incontinence treatment via the
restoration of its neurogenic, myogenic and structural etiologies. Understanding these pathophysiologies and how
each can optimally benefit from cellular, molecular and minimally invasive therapies will become necessary. While
stem cells in sphincteric deficiency dominate the regenerative urology literature, little has been published on
pudendal nerve regeneration or other regenerative targets. We discuss regenerative therapies for pudendal nerve
injury in stress urinary incontinence. Materials and Methods: A PubMed search for pudendal nerve combined
individually with regeneration, injury, electrophysiology, measurement and activity produced a combined but
nonindependent 621 results. English language articles were reviewed by title for relevance, which identified a
combined but nonindependent 68 articles. A subsequent Google Scholar search and a review of the references of the
articles obtained aided in broadening the discussion. Results: Electrophysiological studies have associated pudendal
nerve dysfunction with stress urinary incontinence clinically and assessed pudendal nerve regeneration functionally, ObjectiveS:: To describe different paradigms that define the stress response, and to postulate how stress is
implicated in the pathophysiology of critical illness. DESIGN:: Articles were identified through a search of PubMed
and Google Scholar. Results:: The stress response represents a bundle of adaptive behavioral, physiological, and
cellular responses. Although generally beneficial, an important adverse consequence of excessive stress is organ
dysfunction. Many interventions currently applied to the critically ill patient are additive and may contribute to organ
dysfunction, renewed deterioration, and impaired or delayed recovery. Resilience () summarizes the interaction
among predisposition factors, injury (or stressors), and the body's allostatic responses. Resilience changes over the
course of critical illness but is potentially measurable and may be used to identify at-risk patients and to tailor
therapy. CONCLUSION:: Critical illness may represent a stress-related decompensation syndrome mediated by Background: Methylenetetrahydrofolate reductase (MTHFR) is an important enzyme of folate and methionine
metabolism, making it crucial for DNA synthesis and methylation. The objective of this study was to analyze MTHFR
gene 677C>T polymorphism in infertile male individuals from North India, followed by a meta-analysis on our data
and published studies. Methodology/Principal Findings: We undertook genotyping on a total of 837 individuals
including well characterized infertile (N = 522) and confirmed fertile (N = 315) individuals. The SNP was typed by
direct DNA sequencing. Chi square test was done for statistical analysis. Published studies were searched using
appropriate keywords. Source of data collection for meta-analysis included 'Pubmed', 'Ovid' and 'Google Scholar'.
Those studies analyzing 677C>T polymorphism in male infertility and presenting all relevant data were included in
meta-analysis. The genotype data for infertile subjects and fertile controls was extracted from each study. Chi square
test was done to obtain odds ratio (OR) and p-value. Meta-analysis was performed using Comprehensive Meta- Methylenetetrahydrofolate reductase (MTHFR) is an important enzyme of folate and methionine metabolism,
making it crucial for DNA synthesis and methylation. The objective of this study was to analyze MTHFR gene 677C>T
polymorphism in infertile male individuals from North India, followed by a meta-analysis on our data and published
studies. We undertook genotyping on a total of 837 individuals including well characterized infertile (N = 522) and
confirmed fertile (N = 315) individuals. The SNP was typed by direct DNA sequencing. Chi square test was done for
statistical analysis. Published studies were searched using appropriate keywords. Source of data collection for meta-
analysis included 'Pubmed', 'Ovid' and 'Google Scholar'. Those studies analyzing 677C>T polymorphism in male
infertility and presenting all relevant data were included in meta-analysis. The genotype data for infertile subjects
and fertile controls was extracted from each study. Chi square test was done to obtain odds ratio (OR) and p-value.
Meta-analysis was performed using Comprehensive Meta-analysis software (Version 2). The frequency of mutant (T) Context: This systematic review provides a synthesis of the growing field of public health systems research related to
the structure and organization of state and local governmental public health agencies. It includes an overview of
research examining the influence of organizational characteristics on public health performance and health status
and a summary of the strengths and gaps of the literature to date. Evidence acquisition: Data were retrieved through
an iterative process, beginning with key word searches in three publication databases (PubMed, JSTOR, Web of
Science). Gray literature was searched through the use of Google Scholar. Targeted searches on websites and key
authors were also performed. Documents underwent an initial and secondary screening; they were retained if they
contained information about local or state public health structure, organization, governance, and financing. Evidence
synthesis: 77 articles met the study criteria. Public health services are delivered by a mix of local, state, and tribal
governmental and nongovernmental agencies and delivered through centralized (28%); decentralized (37%); or
combined authority (35%). The majority of studies focused on organizational characteristics that are associated with
public health performance based on the 10 Essential Public Health Services framework. Population size of jurisdiction
served (>50,000); structure of authority (decentralized and mixed); per capita spending at the local level; some
partnerships (academic, health services); and leadership of agency directors have been found to be related to public
INTRODUCTION: Nepal lacks sufficient data on injury and violence. Studies have been done in different regions but
there is not a nationwide study on this topic. So, we have designed this systematic review to get a cumulative picture
of injury and violence status in Nepal. METHODS: We searched Medline database, Google scholar database and also
all the national medical journals for relevant studies on injuries and violence. Our eligibility criteria included studies
done in Nepal, evaluating the incidence of different forms of injuries, and their causes and effects. We excluded case
reports, editorials and reviews. All together, we had 23 studies. We made cumulative analysis wherever possible.
RESULTS: All the studies were descriptive. In overall, the incidence of injuries was twice as common in male as in
female with the ratio of 2.1:1. The economically active population between 20-50 years of age was mostly involved A literature review was performed to analyse the evidence supporting submental intubation and to aid in the
development of a new airway algorithm in craniofacial surgery patients. A systematic search of Pub Med, OVID, the
Cochrane Database and Google Scholar between January 1984 and April 2011 was performed. Measured variables
included the outcome, complications, publishing specialty journal and method of intubation including technique
modifications, indications for the procedure, devices utilized and the total procedure time to complete the
submental intubation. Of the 842 patient cases from 41 articles represented in the review, the success rate was
100%. Minor complications were reported in 60 patients and included superficial skin infections (N = 23), damage to
the tube apparatus (N = 10), fistula formation (N = 10), right mainstem bronchus tube dislodgement/obstruction (N =
5), hypertrophic scarring (N = 3), accidental extubation in paediatric patients (N = 2), excessive bronchial flexion (N = Individuals with disabilities are a growing population that confronts multiple disadvantages from social and
environmental determinants of health. In particular, the 7-8 million people in the U.S. with an intellectual disability
(ID) suffer disproportionately from substance use problems, largely because of a lack of empirical evidence to inform
prevention and treatment efforts for them. Although available research could inform future research efforts, studies
are scattered across disciplines with the last review synthesizing findings written more than five years ago. To
consider more recent findings with earlier works, PubMed, PsychINFO, and Google Scholar were searched and
produced 37 peer-reviewed texts across multiple disciplines, 15 from 2006 or later. While the prevalence of alcohol
and illicit drug use in this population are low, the risk of having a substance-related problem among ID substance
users is comparatively high. Gaps in the research and population subgroups that warrant special attention are Individuals with disabilities are a growing population that confronts multiple disadvantages from social and
environmental determinants of health. In particular, the 7-8 million people in the U.S. with an intellectual disability
(ID) suffer disproportionately from substance use problems, largely because of a lack of empirical evidence to inform
prevention and treatment efforts for them. Although available research could inform future research efforts, studies
are scattered across disciplines with the last review synthesizing findings written more than five years ago. To
consider more recent findings with earlier works, PubMed, PsychINFO, and Google Scholar were searched and
produced 37 peer-reviewed texts across multiple disciplines, 15 from 2006 or later. While the prevalence of alcohol
and illicit drug use in this population are low, the risk of having a substance-related problem among ID substance
users is comparatively high. Gaps in the research and population subgroups that warrant special attention are BACKGROUND: Providing efficient and effective aged care services is one of the greatest public policy concerns
currently facing governments. Increasing the integration of care services has the potential to provide many benefits
including increased access, promoting greater efficiency, and improving care outcomes. There is little research,
however, investigating how integrated aged care can be successfully achieved. The PRISMA (Program of Research to
Integrate Services for the Maintenance of Autonomy) project, from Quebec, Canada, is one of the most systematic
and sustained bodies of research investigating the translation and outcomes of an integrated care policy into
practice. The PRISMA research program has run since 1988, yet there has been no independent systematic review of
this work to draw out the lessons learnt., METHODS: Narrative review of all literature emanating from the PRISMA
project between 1988 and 2012. Researchers accessed an online list of all published papers from the program
website. The reference lists of papers were hand searched to identify additional literature. Finally, Medline, Pubmed,
EMBASE and Google Scholar indexing databases were searched using key terms and author names. Results were
extracted into specially designed spread sheets for analysis., RESULTS: Forty-five journal articles and two books
authored or co-authored by the PRISMA team were identified. Research was primarily concerned with: the design,
development and validation of screening and assessment tools; and results generated from their application. Both
quasi-experimental and cross sectional analytic designs were used extensively. Contextually appropriate expert
opinion was obtained using variations on the Delphi Method. Literature analysis revealed the structures, processes
and outcomes which underpinned the implementation. PRISMA provides evidence that integrating care for older
persons is beneficial to individuals through reducing incidence of functional decline and handicap levels, and
improving feelings of empowerment and satisfaction with care provided. The research also demonstrated benefits to
the health system, including a more appropriate use of emergency rooms, and decreased consultations with medical
Breathing techniques are regularly recommended for relaxation, stress management, control of psychophysiological
states, and to improve organ function. Yogic breathing, defined as a manipulation of breath movement, has been
shown to positively affect immune function, autonomic nervous system imbalances, and psychological or stress-
related disorders. The aim of this study was to assess and provide a comprehensive review of the physiological
mechanisms, the mind-body connection, and the benefits of Sudarshan Kriya Yoga (SKY) in a wide range of clinical
conditions. Various online databases searched were Medline, Psychinfo, EMBASE, and Google Scholar. All the results
were carefully screened and articles on SKY were selected. The references from these articles were checked to find Sugar-sweetened soft drinks (SSD) are a special target of many obesity-prevention strategies, yet critical reviews
tend to be more cautious regarding the aetiological role of SSD in promoting excess body weight. Since ongoing
evaluation of this issue is important, the present systematic review re-examined the evidence from epidemiological
studies and interventions, up to July 2008. Database searches of Medline, Cochrane reviews, Google scholar and a
hand search of cross-references identified forty-four original studies (twenty-three cross-sectional, seventeen
prospective and four intervention) in adults and children, as well as six reviews. These were critically examined for
methodology, results and interpretation. Approximately half the cross-sectional and prospective studies found a
statistically significant association between SSD consumption and BMI, weight, adiposity or weight gain in at least
one subgroup. The totality of evidence is dominated by American studies where SSD consumption tends to be higher
and formulations different. Most studies suggest that the effect of SSD is small except in susceptible individuals or at
high levels of intake. Methodological weaknesses mean that many studies cannot detect whether soft drinks or other Epidemiological research has demonstrated that suicidal ideation is a relatively frequent complication of pregnancy
in both developed and developing countries. Hence, the aims of this study are: to assess whether or not pregnancy
may be considered a period highly susceptible to suicidal acts; to recognize potential contributing factors to suicidal
behaviors; to describe the repercussions of suicide attempts on maternal, fetal, and neonatal outcome; to identify a
typical profile of women at high risk of suicide during pregnancy. Medical literature information published in any
language since 1950 was identified using MEDLINE/PubMed, Scopus, and Google Scholar databases. Search terms
were: "pregnancy", (antenatal) "depression", "suicide". Searches were last updated on 28 September 2010. Forty-six
articles assessing the suicidal risk during pregnancy and obstetrical outcome of pregnancies complicated by suicide
attempts were analyzed, without methodological limitations. Worldwide, frequency of suicidal attempts and the rate
of death by suicidal acts are low. Although this clinical event is rare, the consequences of a suicidal attempt are
medically and psychologically devastating for the mother-infant pair. We also found that common behaviors exist in
women at high risk for suicide during pregnancy. Review data indeed suggest that a characteristic profile can Background: Studies have found that deaf individuals have higher rates of psychiatric disorder than those who are
hearing, while at the same time encountering difficulties in accessing mental health services. These factors might
increase the risk of suicide. However, the burden of suicidal behaviour in deaf people is currently unknown. The aim
of the present review was to provide a summary of literature on suicidal behaviour with specific reference to deaf
individuals. The objectives of the review were to establish the incidence and prevalence of suicidal behaviour in deaf
populations; describe risk factors for suicidal behaviour in deaf populations; describe approaches to intervention and
suicide prevention that have been used in deaf populations. Methods: A number of electronic databases (e.g.
Medline, PsycINFO, CINAHL, EMBASE, Dissertation Abstracts International, Web of Science, ComDisDome, ASSIA,
Education Sage Full Text, Google Scholar, and the grey literature databases FADE and SIGLE) were explored using a
combination of key words and medical subject headings as search terms. Reference lists of papers were also
searched. The Science and Social Sciences Citation Index electronic databases were used to identify studies that had
cited key papers. We also contacted experts and organisations with an interest in the field. Results: Very few studies
focussed specifically on suicide in deaf populations. Those studies that were included (n = 13) generally involved
small and unrepresentative samples. There were limited data on the rate of suicidal behaviour in deaf people. One
study reported evidence of hearing impairment in 0.2% of all suicide deaths. Another found that individuals with
tinnitus seen in specialist clinics had an elevated rate of suicide compared to the general population. The rates of
Background: A number of studies have reported on the effectiveness of sulbactam-based therapies for Acinetobacter
baumannii infection; however, there is little evidence that sulbactam-based therapies are more or less effective than
alternative therapies. Unfortunately, there is a distinct lack of high quality data (i.e., from randomized controlled
trials) available on this issue. Therefore, we conducted a systematic review and meta-analysis comparing the efficacy
of sulbactam-based and non-sulbactam-based regimens in the treatment of A. baumannii infection. Methods: We
searched PubMed, MEDLINE, Biomedical Central, Google Scholar, the China National Knowledge Infrastructure, the
Cochrane library, and the Directory of Open Access using the terms "sulbactam and baumannii" or "maxtam and
baumannii". Randomized controlled trials, controlled clinical studies, and cohort studies were considered for
inclusion. The primary outcome was the clinical response rate for sulbactam-based therapy vs comparator therapies.
Results: Four studies (1 prospective, 3 retrospective) were included in the meta-analysis. Sulbactam was given in
combination with ampicillin, carbapenem, or cefoperazone (n= 112 participants). Comparator drugs included colistin, The benefit of exercise in the management of intermittent claudication has been explored through extensive
research in the preceding decades. Within the clinical setting, there is often little differentiation between home-
based and supervised exercise regimens. We examined the history and qualification of supervised exercise as a
distinct treatment modality from nonsupervised exercise in intermittent claudication. A Medline, Embase, Ovid,
Cochrane Database, and Google Scholar search was performed on all studies published until December 31, 2007,
investigating the use of supervised exercise in peripheral arterial disease. Supervised exercise is well grounded in Long chain polyunsaturated fatty acids (LCPUFA), especially docosahexaenoic acid (DHA), are the most abundant
fatty acids in the brain and are necessary for growth and maturation of the brain and retina. LCPUFA are named
"essential" because they cannot be synthesised efficiently by the human body and come from maternal diet. It
remains controversial whether LCPUFA supplementation to breastfeeding mothers is beneficial for the development
of their infants. To assess the effectiveness and safety of supplementation with LCPUFA in breastfeeding mothers in
the cognitive and physical development of their infants as well as safety for the mother and infant. We searched the
Cochrane Pregnancy and Childbirth Group's Trials Register (November 2009), CENTRAL (2009, Issue 2), PubMed
(1966 to July 2009), EMBASE (1974 to June 2009), CINAHL (1984 to June 2009), LILACS (1982 to June 2009), Google
Scholar (June 2009) and reference lists of published narrative and systematic reviews. Randomised controlled trials
or cluster-randomised controlled trials evaluating the effects of LCPUFA supplementation on breastfeeding mothers
and their infants. Two review authors independently assessed eligibility and trial quality and performed data
extraction. We included six randomised controlled trials involving 1280 women. We found no significant difference in
children's neurodevelopment: language development (standardised mean difference (SMD) -0.14, 95% confidence
interval (CI) -0.49 to 0.20; two trials, 349 participants); intelligence or problem-solving ability (two trials, 817
participants; SMD -0.22, 95% CI -0.23 to 0.66); psychomotor development (SMD 0.34, 95% CI -0.11 to 0.78; two Objective: Suprapubic catheterization is commonly used for postoperative bladder drainage after gynecologic
procedures. However, recent studies have suggested an increased rate of complications compared with urethral
catheterization. We undertook a systematic review and meta-analysis of randomized controlled trials comparing
suprapubic catheterization and urethral catheterization in gynecologic populations. Data Sources: PubMed, EMBASE,
CINAHL, Google Scholar, and trial registries were searched from 1966 to March 2012 for eligible randomized
controlled trials comparing postoperative suprapubic catheterization and urethral catheterization in gynecologic
patients. We used these search terms: "catheter," "supra(-)pubic catheter," "urinary catheter," "gyn(a)ecological,"
"catheterization techniques gyn(a)ecological surgery," "transurethral catheter," and "bladder drainage." No language
restrictions were applied. Methods And Study Selection: The primary outcome was urinary tract infection. Secondary
outcomes were the need for recatheterization, duration of catheterization, catheter-related complications, and
duration of hospital stay. Pooled effect size estimates were calculated using the random effects model from
DerSimonian and Laird. TABULATION, INTEGRATION, AND Results: In total, 12 eligible randomized controlled trials
were included in the analysis (N=1,300 patients). Suprapubic catheterization was associated with a significant
reduction in postoperative urinary tract infections (20% compared with 31%, pooled odds ratio [OR] 0.31, 95% PURPOSE: This work intended to investigate, by means of a literature revision, the techniques and materials used for
the rehabilitation of hemimandibular defect patients, prosthetic and occlusal aspects of these patients, and chewing
and swallowing. MATERIALS AND METHODS: For the confection of this revision, we consulted the database indexers
Google Scholar, PubMed, and SciELO and found studies published between the periods 1972 and 2008. The terms
used for the search had been "to hemimandibular defects," "to temporomandibular joint protheses," and
"vascularized cap grafts," which had been searched separately and combined. CONCLUSIONS: Diverse techniques
and materials used for the reconstruction of hemimandibular defects exist; however, great bone resorption is still
PURPOSE: This work intended to investigate, by means of a literature revision, the techniques and materials used for
the rehabilitation of hemimandibular defect patients, prosthetic and occlusal aspects of these patients, and chewing
and swallowing., MATERIALS AND METHODS: For the confection of this revision, we consulted the database indexers
Google Scholar, PubMed, and SciELO and found studies published between the periods 1972 and 2008. The terms
used for the search had been "to hemimandibular defects," "to temporomandibular joint protheses," and
"vascularized cap grafts," which had been searched separately and combined., CONCLUSIONS: Diverse techniques
and materials used for the reconstruction of hemimandibular defects exist; however, great bone resorption is still Background: Unilateral lambdoid synostosis is considered to be the rarest form of craniosynostosis. Since the
introduction of the Sudden Infant Death Syndrome 'back-to-sleep' campaign the incidence of unilateral lambdoid
synostosis was reportedly increasing. This was proven to be false and a consequence of non-specific diagnostic
criteria in excluding suture fusion fromdeformational changes. This in turn led to ambiguity in the literature in terms
of features and surgical correction in the 1980-90s. Objective of review: We aim to navigate the literature for true
studies of unilateral lambdoid synostosis and examine the results of their surgical corrections. Type of review: A
systematic review with a defined search strategy Search strategy: A search on MEDLINE and Google Scholar using
strategy: (Unilateral AND ((lambdoid*AND Synostosis) OR (lambdoid*AND Craniosynostosis) OR (Posterior AND
Plagiocephaly)) AND (Surgery). Evaluation method: Articles were reviewed and data compiled into tables for analysis.
Results: 17 studies were included in this review. 188 cases of unilateral lambdoid synostosis were identified. No
patients suffered major complications (venous sinus tear, neurological injury or cerebrospinal fluid leakage). Facial
asymmetry was widely noted and only limited improvement was achieved postoperatively. Auricular displacement Conflicting reports and surgeon opinions have contributed to a long-standing debate regarding the merits of the
intact canal wall versus canal wall down approach to cholesteatoma. The objective of this analysis was to identify and
synthesize available data concerning rates of recidivism after the two primary types of cholesteatoma surgery.
PubMed, Cochrane Collaboration, and Google Scholar searches were performed and articles filtered based on
predetermined exclusion criteria. Individually reported rates of recurrent and residual disease were extracted and
recorded. Meta-analysis demonstrated a relative risk of 2.87 with a confidence interval of 2.45-3.37, confirming a
significantly increased incidence of postoperative cholesteatoma when using an intact canal wall approach rather
than a canal wall down approach. Next, rates of recidivism following the typical two-stage intact canal wall operation Purpose Controversy still surrounds the optimal treatment for patients with displaced intra-articular calcaneal
fractures (DIACF). An up-to-date meta-analysis was performed to evaluate clinical effectiveness of surgical treatment
for DIACF compared with nonsurgical treatment. Methods We systematically searched four electronic databases
(Medline, BIOSIS, Cochrane library and Google Scholar) to identify randomised controlled trials (RCTs) and clinical
controlled trials (CCTs) in which surgical treatment was compared with nonsurgical treatment of DIACF from 1980 to
2011. Trial quality was assessed using the modified Jadad scale and effective data were pooled for meta-analysis.
Results Ten studies (six RCTs and four CCTs) with a total of 891 participants were screened. Results showed that
surgical treatment was superior to nonsurgical treatment in better recovery of the Bohler angle (P<0.0001), more
stable calcaneal height (P=0.0009) and width (P<0.00001). Moreover, fewer surgically treated patients needed PURPOSE: Controversy still surrounds the optimal treatment for patients with displaced intra-articular calcaneal
fractures (DIACF). An up-to-date meta-analysis was performed to evaluate clinical effectiveness of surgical treatment
for DIACF compared with nonsurgical treatment., METHODS: We systematically searched four electronic databases
(Medline, BIOSIS, Cochrane library and Google Scholar) to identify randomised controlled trials (RCTs) and clinical
controlled trials (CCTs) in which surgical treatment was compared with nonsurgical treatment of DIACF from 1980 to
2011. Trial quality was assessed using the modified Jadad scale and effective data were pooled for meta-analysis.,
RESULTS: Ten studies (six RCTs and four CCTs) with a total of 891 participants were screened. Results showed that
surgical treatment was superior to nonsurgical treatment in better recovery of the Bohler angle (P<0.0001), more
stable calcaneal height (P=0.0009) and width (P<0.00001). Moreover, fewer surgically treated patients needed This article reviews the use of journal literature databases including CINAHL, EMBASE, and Web of Science;
summarizing databases including Cochrane Database of Systematic Reviews, online textbooks, and clinical decision-
support tools; and the Internet search engines Google and Google Scholar. The series closes with a practical example Object. The h index is a recently developed bibliometric that assesses an investigator's scientific impact with a single
number. It has rapidly gained popularity in the physical and, more recently, medical sciences. Methods. The h index
for all 1120 academic neurosurgeons working at all Electronic Residency Application Service-listed training programs
was determined by reference to Google Scholar. A random subset of 100 individuals was investigated in PubMed to
determine the total number of publications produced. Results. The median h index was 9 (range 0-68), with the 75th,
90th, and 95th percentiles being 17, 26, and 36, respectively. The h indices increased significantly with increasing
academic rank, with the median for instructors, assistant professors, associate professors, and professors being 2, 5,
10, and 19, respectively (p < 0.0001, Kruskal-Wallis; all groups significantly different from each other except the
difference between instructor and assistant professor [Conover]). Departmental chairs had a median h index of 22
BACKGROUND: Social Anxiety Disorder (SAD) is one of the most prevalent anxiety disorders in Europe and comprises
the fear of public speaking as its typical sub-type. Cognitive-Behavioural Therapy (CBT) is the intervention of choice
for SAD, and it includes exposure to anxiety-provoking stimuli to induce systematic desensitization and reduce
anxiety. Similarly, exposure therapy per se has been used and found effective, although it is not as specific as CBT for
the treatment of SAD. Interestingly, exposure to anxiety-provoking situations can be achieved in Virtual
Environments (VEs) through the simulation of social situations allowing individuals with public speaking anxiety to
live and develop real exposure-like reactions. The Virtual Reality Exposure Therapy (VRET) is the treatment of anxiety
disorders based on such VEs., AIM: This article aims to provide an overview of the scientific literature related to the
applications of Virtual Reality to the treatment of fear of public speaking., MATERIALS AND METHODS: We
conducted the literature review on PubMed and Google Scholar for studies including the fear-of-public-speaking Objective: We sought to develop an overview of neurology educational opportunities in Africa. Methods: The survey
was constructed for general physicians or non-physician healthcare workers involved in neurologic care. Email
addresses were identified through the World Federation of Neurology. The survey was distributed electronically but
recipients were offered the option of feedback by post, fax, or return call. For non-responding countries, inactive
email addresses, or where no respondent was identified, we conducted a Pub Med and Google Scholar search with
criteria using country names. Results: 26 respondents from 15 countries provided information for 28% of African
countries. Respondents were neurologists (34.6%) and non-neurologist physicians (65.4%). All reported that non-
physician healthcare workers provide neurologic care in their country. There were no neurologists or neurosurgeons This article reviews the literature addressing exercise programs for dialysis patients to identify elements necessary
for sustaining exercise programs in this population. Literature searches for publications (January 1980-February
2009) in Medline (OVID), PubMed, CINAHL (EBSCO), EBSCOhost EJS, ProQuest Central, Web of Science, Cochrane
Library, Google Scholar, ScienceDirect, SpringerLink (Kluwer), and Wiley Interscience (Blackwell) were performed.
Reference lists from relevant articles were hand-searched for further publications. Criteria for inclusion included full-
text primary research and review articles focused on exercise for adult hemodialysis patients. One hundred and
seventy one publications were found with a primary focus on exercise in hemodialysis. Of these, 28 primary research
and 14 review articles addressed one or more aspects of sustainability of hemodialysis exercise programs. Factors OBJECTIVE: To determine the type and prevalence of measurement methods used to analyze symptom outcomes
after endoscopic sinus surgery (ESS). DATA SOURCES: Data were derived from PubMed, MEDLINE, EMBASE, Web of
Science, Cochrane databases, Google Scholar, and manual searches. STUDY SELECTION: All English-language studies
consisting of more than 10 adult patients from January 1980 to December 2006 reporting ESS symptom outcome
results were reviewed. Studies of radical surgery and studies involving patients with significant comorbidities were
excluded. RESULTS: The ESS symptom outcome results of 29,333 patients were reported in 204 studies. Symptom
outcome was determined by survey instruments in 47 (23.0%) studies and individual symptom scoring in 63 (31%)
studies. Of 18 validated instruments used, almost two thirds of studies that reported results by survey measures
used the following three instruments: Chronic Sinusitis Survey (12 studies), Sinonasal Outcome Test-20 (11 studies),
and Medical Outcomes study 36-Item Short-Form Health Survey (10 studies). The percentages of studies that
reported specific results of the 1997 American Academy of Otolaryngology-Head Neck Surgery Rhinosinusitis Task Aim Celiac disease (CeD) is an inherited autoimmune disease with a global prevalence of 0.71% to 1.25%. The
standard of care is strict adherence to a gluten free diet (GFD); there are currently no pharmacotherapeutic options.
CeD has the potential, in part through its reimbursement status, to incur substantial costs for the patient, the family,
and the community. This study evaluated costs of CeD treatment and reimbursement status of GFD in various
countries. Methods A literature search of PubMed and Advanced Google Scholar was conducted with the keywords
[(celiac OR coeliac) AND (cost OR cost-effectiveness)] for the period May 1993 to May 2008. Papers reporting direct
costs of CeD or cost-effectiveness of interventions for CeD were included in the review. A review of reimbursement
agencies' web sites and published guidelines was also conducted to evaluate country-specific reimbursement of a
GFD. Results The search identified only 11 papers that met inclusion criteria. The majority of studies focused on the
costs and cost-effectiveness (in the US) of screening and diagnostic options for CeD, with a particular focus on high
risk populations. Surprisingly few studies reported the costs associated with treatment of CeD. Apart from one paper
that considered the costs of GFD compliance, there were no studies that comprehensively addressed the direct costs
of treating CeD (and associated comorbidities) from a patient, family, or health system perspective. Treatment with
GFD presents several compliance challenges. Policies to offset the dietary and compliance costs of CeD vary widely.
Introduction: Research shows anxiety clustering within families: a greater proportion of children with anxious parents
develop symptoms of anxiety than children with non-anxious parents. Anxious children often describe their parents
as over-controlling and intrusive, lacking in affection and warmth, with reports of decreased parental support.
Objectives: (1) to identify if parenting behaviors differ between anxious and non-anxious parents, (2) to discuss if
these differences in behaviors can contribute to transgenerational transmission of anxiety. Aims: Identifying whether
behaviour modification could reduce familial transmission rates of anxiety. Method: A search of OvidSP Medline,
Google Scholar, and PubMed was performed, covering 1999 to 2010. Search terms used were: parenting, parents,
maternal, paternal, or parental; and anxiety, PTSD, OCD, panic disorder, or phobia. 14 Papers were identified.
Results: While most papers identified differences in parenting between anxious and control parents, the conclusions
were variable. Two observed increased amounts of controlling behaviour, 5 a decrease in sensitivity, 1 witnessed Despite more than a decade of use, there are currently no comprehensive reviews summarising clinical results with
the Profix Total Knee System in primary total knee arthroplasty. Searching the PubMed and Google Scholar databases
revealed 17 potentially relevant Profix manuscripts. After author review and exclusion of studies not meeting
predetermined variables, 8 manuscripts were selected. Knee Society data were provided in all 8 and implant survival
data in 4. Data for 987 patients (1152 knees) were available. The overall estimated implant survival was 98.6% at 5
years and 94.2% at 10 years with revision for any reason as an endpoint, and 100% at both time points with Death from trauma is a significant and international problem. Outcome for patients suffering out-of-hospital cardiac
arrests is significantly improved by early cardiopulmonary resuscitation. The usefulness of first aid given by laypeople
in trauma is less well established. The aim of this study was to review the existing literature on first aid provided by
laypeople to trauma victims and to establish how often first aid is provided, if it is performed correctly, and its impact
on outcome. A systematic review was carried out, according to preferred reporting items for systematic reviews and
meta-analysis (PRISMA) guidelines, of all studies involving first aid provided by laypeople to trauma victims.
Cochrane, Embase, Medline, Pubmed, and Google Scholar databases were systematically searched. Ten eligible
articles were identified involving a total of 5836 victims. Eight studies were related to patient outcome, while two
studies were simulation based. The proportion of patients who received first aid ranged from 10.7% to 65%.
Incorrect first aid was given in up to 83.7% of cases. Airway handling and haemorrhage control were particular areas This study focuses on effects of aerial portions of Urtica dioica (Nettle) on some cardiovascular risk factors in
diabetes mellitus. Databases including Pubmed, Science direct, Scopus, Google scholar and IranMedex, were
searched for terms: lipid profile, glucose, Insulin Resistance, Oxidative stress, Inflammation, Cardiovascular disease,
Blood Pressure, Diabetes and Nettle from 2000 till December 2011. Studies on Nettle root, mixed herbs, unpublished
and review articles were excluded. Three human, 18 animal and 7 in vitro or in vitro studies were reviewed. More
studies showed positive effects of nettle on decreasing cardiovascular risk factors in diabetes or non-diabetes.
Available evidences suggest that Urtica dioica can prevent patients with diabetes from cardiovascular disease with It is unclear how polyethylene glycol (PEG) laxatives compare with other classes of laxative in terms of efficacy. To
assess efficacy of PEG vs. placebo and active comparators in adults with non-organic constipation. Text Word
searches were carried out on MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Clinical Trials and Google
Scholar databases covering the period January 1970 to October 2009. Search terms were (constipation) AND
(randomised OR randomized) AND (PEG OR polyethylene OR macrogol OR movicol OR idrolax OR miralax OR
transipeg OR forlax OR colyte OR golytely OR isocolan OR nulytely) NOT colonoscopy. Only published randomised
controlled trials, with a parallel-group or cross-over design, comparing oral PEG with placebo or a comparator
laxative in adults with a history of non-organic constipation, were included. The frequency of defaecation in each
arm, on completion of the protocol-defined treatment duration was extracted. All pooled analyses were based on
random effect models. Of the 20 qualifying studies, 10 were vs. placebo, seven were vs. lactulose, and four were vs. Aim: Maladaptive cognitions about food, weight and shape bias attention, memory and judgment and may be linked
to disordered eating behaviour. This paper reviews information processing of food stimuli (words, pictures) in people
with eating disorders (ED). Method: PubMed, Ovid, ScienceDirect, PsychInfo, Web of Science, Cochrane Library and
Google Scholar were searched to December 2009. 63 studies measured attention, memory and judgment bias
towards food stimuli in women with ED. Results: Stroop tasks had sufficient sample size for a meta-analyses and
effects ranged from small to medium. Other studies of attention bias had variable effects (e.g. the Dot-Probe task,
distracter tasks and Startle Eyeblink Modulation). A meta-analysis of memory bias studies in ED and RE yielded
Background and Objectives: In recent years, a potential relationship between, migraine, stroke and patent foramen
ovale (PFO) has emerged. We aimed to investigate the role of transcatheter closure of interatrial septal
abnormalities on the occurrence of migraine. Methods: BioMedCentral, Google Scholar and PubMed from January
2000 to December 2008 were systematically searched for pertinent clinical studies. Secondary sources were also
used. Secondary prevention studies of transcatheter closure for patent foramen ovale were required to include at
least more than 10 patients followed for more than 6 months. The primary end-point was the rate of cured or
significantly improved migraine after percutaneous PFO closure. Results: After excluding 634 citations, we finally
included a total of 14 studies for a total of 1,434 patients. Forty-two percent of the subjects included suffered from
migraine, while most had a previous history of transient ischemic attack/stroke and were investigated Objectives: To investigate the role of transcatheter closure of patent foramen ovale on the occurrence of migraine.
Background: In recent years, a potential relationship between, migraine, stroke, and patent foramen ovale (PFO) has
emerged. Methods: BioMedCentral, Google Scholar, and PubMed from January 2000 to December 2008 were
systematically searched for pertinent clinical studies. Secondary sources were also used. Secondary prevention
studies of transcatheter closure for patent foramen ovale were required to include at least more than 10 patients
followed for more than 6 months. The primary end-point was the rate of cured or significantly improved migraine
after percutaneous PFO closure. Results: After excluding 637 citations, we finally included a total of 11 studies for a
total of 1,306 patients. Forty percent of the subjects included suffered from migraine, while most had a previous
history of transient ischemic attack/stroke and were investigated retrospectively. Quantitative synthesis showed that Aims: There is evidence that reducing blood glucose levels, inducing weight loss and improving lipid profile reduces
cardiovascular risk in people with Type 2 diabetes. We therefore assessed the effect of various diets on glycaemic
control, lipids and weight loss. Methods: We conducted searches of PubMed, Embase and Google Scholar to August
2011. We included randomised controlled trials (RCTs) with interventions lasting six or more months that compared
low carbohydrate, vegetarian, vegan, low glycaemic index (GI), high fibre, Mediterranean and high protein diets with
control diets including low fat, high GI, American Diabetes Association (ADA) diet, European Association for the Study
of Diabetes (EASD) diet and low protein diet. Results: A total of 20 RCTs were included (3,073 included in final
analyses, across 3,460 randomised individuals). The low carbohydrate, low GI and Mediterranean and high protein
diets all led to a greater improvement in glycaemic control (HbA1c reductions of - 0.12%, p = 0.04; -0.14%, p = 0.008; - Background: There is evidence that reducing blood glucose concentrations, inducing weight loss, and improving the
lipid profile reduces cardiovascular risk in people with type 2 diabetes. Objective: We assessed the effect of various
diets on glycemic control, lipids, and weight loss. Design: We conducted searches of PubMed, Embase, and Google
Scholar to August 2011. We included randomized controlled trials (RCTs) with interventions that lasted 6 mo that
compared lowcarbohydrate, vegetarian, vegan, low-glycemic index (GI), highfiber, Mediterranean, and high-protein
diets with control diets including low-fat, high-GI, American Diabetes Association, European Association for the Study
of Diabetes, and low-protein diets. Results: A total of 20 RCTs were included (n = 3073 included in final analyses
across 3460 randomly assigned individuals). The lowcarbohydrate, low-GI, Mediterranean, and high-protein diets all
led to a greater improvement in glycemic control [glycated hemoglobin reductions of 20.12% (P = 0.04), 20.14% (P = Introduction: Serological tests are becoming an important aspect of the diagnosis of inflammatory bowel diseases
(IBD). Pancreatic autoantibody (PAB) has been described as an immunological marker of IBD. The purpose of the
present study is to synthesize available data from the literature on the diagnostic accuracy of PAB against standard
diagnosis of IBD (with clinical, radiological and histological criteria). Methods:We searched articles and abstracts
indexed in Medline/PubMed, Scopus, EMBASE and Google Scholar using the following search terms: pancreatic
autoantibody and inflammatory bowel disease. There was no language or time limit in our literature search. Papers
included had to mention diagnostic accuracy measures (e.g. sensitivity, specificity) of PAB against standard diagnosis
of IBD. The Standards for Reporting of Diagnostic Accuracy Initiative and the Review of Methodological Standards
were used to assess study quality.Pooled sensitivities and specificities were calculated for PAB with use of the
DerSimonian-Laird random effects model; an assessment of heterogeneity was performed with use of Cochran's Q
statistic. A pooled diagnostic OR was calculated for each of the diagnostic tests evaluated. All statistical analyses
were performed with use of MetaDisc software. Results: Seventeen studies were included in the meta-analysis. The
Introduction: Recurrence of Hepatocellular Carcinoma (HCC) following Liver Transplantation (LT) is common and is
usually associated with poor prognosis. Several reports have suggested a lower risk of post-transplant tumour
recurrence with the use of Sirolimus (SRL), but the selection of an ideal immunosuppression protocol is still a matter
for debate. This study aims to conduct a systematic review and metaanalysis on the usage of SRL as an
immunosuppressive agent following LT for HCC. Methods: A literature search was performed using Medline, Embase,
Cochrane Library, CINAHL and Google scholar databases to identify studies where SRL has been used as an
immunosuppressive agent following LT for HCC. 8 studies met the inclusion criteria and included a total of 523
patients. All were observational studies and two of them were prospective. Four studies compared SRL treated (n =
224) with CNI treated patients (n = 235). Primary outcome of interest were tumour recurrence rate and recurrence-
free survival (RFS) rate. Secondary outcomes were recurrence-related mortality and overall survival (OS).
Metaanalysis was performed to compare the outcomes from those studies which reported outcomes from both the
SRL and CNI treated patients. Results: The reported recurrence was 4.9 to 25.9% in the SRL group and was much
higher in the CNI group 17.3 to 38.7%. The 1, 3 and 5 year RFS was 70-96%, 82-86% and 79-80% for SRL, which was Selection of candidates for liver transplantation depends on identification and assessment of risk factors that may
affect posttransplant survival. Diabetes has been identified as a risk factor and examined by several investigators. We
performed a systematic review and meta-analysis of the literature to examine the effect of Diabetes Mellitus on long-
term survival post-liver transplant. Methods: PubMed, Embase and Google Scholar were searched with the terms:
Diabetes Liver Transplant (Outcome or Mortality or Survival). Papers that appeared suitable were screened further.
We also examined references cited in relevant papers. Papers were included if they reported the effect of pre-
transplant diabetes on 5-year survival after transplantation. Suitable papers were included in a meta-analysis using
RevMan v.5 software, using random effect analysis to generate risk ratios (RR). Results: Initial searches yielded 368
titles. Of these, 18 appeared relevant and 9 were included. Meta-analysis of these papers showed that diabetes Introduction: Sentinel lymph node biopsy is the standard method of axillary staging in early stage breast cancer
patients. An important issue is the eligibility of patients undergone prior surgical biopsy of the primary breast lesion.
In this meta-analysis we comprehensively searched the literature regarding this issue and summarized the results
accordingly. Materials and methods: We systematically searched Medline, SCOPUS, and Google Scholar for studies
with head to head comparison of sentinel lymph node biopsy method in patients with and without prior surgical
biopsy. No language or date restriction was imposed. Studies with enough information to calculate detection rate as
well as false negative rate for both groups were included. For pooling of the results random effects model was used
(Der-Simonian and Laird method). Q statistics and I2 index were used for heterogeneity evaluation. Results: 68
studies for detection rate and 16 for false negative rate were located with the required information. Pooled
detection rates for patients with and without history of prior surgical biopsy were 91.33% [89.1-93%] and 92.7%
[90.9-94.1%] respectively. OR of unsuccessful mapping was 1.14 [0.955-1.362] and risk difference was 0.00018 [- Background: The aim was to investigate whether a relationship existed between case volume and outcome for lower
limb vascular surgical procedures. Mathoda: PubMcd, Embase, the Cochrane Library and Google Scholar were
searched for all articles on population-based studies on the volume-outcome relationship for lower limb vascular
surgery at hospital level. Outcomes were mortality and subsequent amputation after lower limb vascular surgery.
The data were subjected to meta-analysis by outcome. Results: Some 452 093 patients from ten studies were
included in the systematic review and five studies were included in meta-analyses. Seven of these articles found a
significant positive hospital-volume outcome relationship. The pooled effect estimate for mortality was odds ratio
(OR) 0-81 (95 per cent confidence interval 0-71 to 0-91) and that for amputation was OR 0-88 (0-79 to 0-98), with Background: Toxoplasmosis is a disease caused by Toxoplasma gondii and at least one-third of the world's population
has detectable T. gondii antibodies. The seroprevalence of T.gondii ranges from 15% to 50% among the Mexican
general population. The aim of this work was to determine the mean prevalence and weighted mean prevalence of
T. gondii infection, and to evaluate the epidemiological transition of infection in Mexico. Methods. Pub Med, Lilacs,
Medline, Latindex, Google Scholar data bases were searched to retrieve reports from 1951 up to 2012 regarding
prevalence data, diagnostic tests and risk factors of infection among the adult population. Data collection and criteria
eligibility was established in order to determine the crude prevalence (proportion of positive cases) of each study,
together with weighted population prevalence according to individual research group categories to limit the bias that
may impose the heterogeneous nature of the reports. A Forest Plot chart and linear regression analysis were
performed by plotting the prevalence of infection reported from each study over a period of sixty years. Results: A
total of 132 studies were collected from 41 publications that included 70,123 individuals. The average mean
prevalence was 27.97%, and weighted mean prevalence was 19.27%. Comparisons among different risk groups
Objective: Although all intracompartmental pressure (ICP) measurement, magnetic resonance imaging, and near-
infrared spectroscopy seem to be useful in confirming the diagnosis of chronic exertional compartment syndrome
(CECS), no standard diagnostic procedure is currently universally accepted. We reviewed systematically the relevant
published evidence on diagnostic criteria commonly in use for CECS to address 3 main questions: (1) Is there a
standard diagnostic method available? (2) What ICP threshold criteria should be used for diagnosing CECS? (3) What
are the criteria and options for surgical management? Finally, we made statements on the strength of each
diagnostic criterion of ICP based on a rigorous standardized process. DATA SOURCES:: We searched for studies that
investigated ICP measurements in diagnosing CECS in the leg of human subjects, using PubMed, Score, PEDRO,
Cochrane, Scopus, SportDiscus, Web of Knowledge, and Google Scholar. Initial searches were performed using the
phrase, "chronic exertional compartment syndrome." The phrase "compartment syndrome" was then combined,
using Boolean connectors ("OR" and "AND") with the words "diagnosis," "parameters," "levels," "localisation," or
"measurement." Data extracted from each study included study design, number of subjects, number of controls, ICP
instrument used, compartments measured, limb position during measurements, catheter position, exercise protocol,
timing of measurements, mean resting compartment pressures, mean maximal compartment pressures, mean
postexercise compartment pressures, diagnostic criteria used, and whether a reference diagnostic standard was
used. The quality of studies was assessed based on the approach used by the American Academy of Orthopaedic
Surgeons in judging the quality of diagnostic studies, and recommendations were made regarding each ICP
diagnostic criteria in the literature by taking into account the quality and quantity of the available studies proposing
each criterion. MAIN Results: In the review, 32 studies were included. The studies varied in the ICP measurement
techniques used; the most commonly measured compartment was the anterior muscle compartment, and the
exercise protocol varied between running, walking, and ankle plantarflexion and dorsiflexion exercises. Preexercise, Purpose: The purpose of this research was to evaluate the temporal association between exposure to proton pump
inhibitors (PPIs) and the likelihood of hip fracture. Prior studies examining PPIs and various fractures have been
widely discrepant in terms of study focus and duration of exposure. Studies looking at short duration of exposure
have oft en shown minimal or no effect. We hypothesized that cumulative exposure would result in increased
likelihood of hip fracture. We made the assumption that the association of hip fracture is related to alteration in
bone structure. With this assumption and with consideration of the slow rate of bone turnover, we anticipated no
effect in an early exposure window of unclear duration, followed by a graded increase in risk. Methods: A highly
sensitive search was performed for Medline, Embase, Google Scholar, CINHL and LILAC through 5/26/2010. Multiple
search terms including osteoporosis, fracture, hip fracture, proton pump inhibitor were used. Clinical studies related
to PPI use and hip fracture were identified. Bibliographies of identified articles were reviewed for relevant articles. 8 OBJECTIVES: Adherence to medications (AM) has been a major research priority for recent decades. Numerous
factors including poor access to medicines have been identified to affect AM particularly in middle income countries
(MIC). However, access to medicines seems to be addressed well in Iran as a MIC but little is known about the rate
and the determinants of AM for Iranian patients. In the present study, we systematically reviewed the AM literature
related to Iranian patients with diabetes (DM) and cardiovascular diseases (CVD). METHODS: We searched
biomedical databases including Scopus, Web of Science, PubMed, CINAHL, and Google Scholar, Scientific Information
Database, and IranMedex from inception to July 2012. Two independent researchers screened all abstracts. Studies
were included if they reported rate of adherence to CVD or DM medications in Iran. We also included studies which
had focused on AM determinants or AM improving interventions. Two teams of researchers reviewed full-texts of
the relevant articles for quality appraisal and data extraction. We preferred qualitative synthesis of literature as the
AM definitions and measurement tools were highly diverse among studies. RESULTS: Among 1003 citation, fourteen Obesity is the most prevalent health problem affecting all age groups, and leads to many complications in the form
of chronic heart disease, diabetes mellitus Type 2 and stroke. A systematic review about safety and efficacy of herbal
medicines in the management of obesity in human was carried out by searching bibliographic data bases such as,
PubMed, Scopus, Google Scholar, Web of Science, and IranMedex, for studies reported between 30th December
2008 to 23rd April 2012 on human or animals, investigating the beneficial and harmful effects of herbal medicine to
treat obesity. Actually we limited our search to such a narrow window of time in order to update our article
published before December of 2008. In this update, the search terms were "obesity" and ("herbal medicine" or
"plant", "plant medicinal" or "medicine traditional") without narrowing or limiting search items. Publications with
available abstracts were reviewed only. Total publications found in the initial search were 651. Total number of
publications for review study was 33 by excluding publications related to animals study.Studies with Nigella Sativa,
Camellia Sinensis, Crocus Sativus L, Seaweed laminaria Digitata, Xantigen, virgin olive oil, Catechin enriched green
tea, Monoselect Camellia, Oolong tea, Yacon syrup, Irvingia Gabonensi, Weighlevel, RCM-104 compound of Camellia
BACKGROUND: Asthma is one of the most common inflammatory lung diseases and its prevalence and incidence
have increased in many developed and developing countries. Asthma places a heavy burden on healthcare
expenditures and productivity, which in turn diminishes the quality of life of the individuals involved as well as their
families. The goal of improving a patient's knowledge about asthma management should include the enhancement
of the individual's skills with the hopeful outcome of improving how the individual manages the condition. However,
when health professionals prepare a training program, they are faced with the challenging cosmopolitan reality of
individuals with different ethnic backgrounds. METHODS: In order to find links between asthma and health literacy in
a cultural/ethnicity perspective, we performed a systematic review of all publications on the topic of asthma, health,
and literacy among cultural groups from 1980 to 2006 using the Internet and journals: Medline (Ovid), ERIC,
EMBASE, PsycINFO, Google, Google Scholar, Sociological Abstracts, and Anthropology Plus. Key words included the
following: "asthma," "culture," "ethnicity," "literacy," "health," "health literacy," "health beliefs," "adults," "disease
management," "chronic condition," "ethnocultural groups," "minority groups," and "newcomers/immigrants."
RESULTS: More than 650 articles were initially identified in our review; 65 met our inclusion criteria. From these, we
examined the factors related to asthma and literacy/health literacy with a cultural lens. All of these are categorized
and summarized below. We chose what we considered to be the most relevant and important articles/documents in
the research literature to date. Because many of the studies were qualitative, a formal meta-analytic review was not Introduction. In stroke rehabilitation, bilateral upper limb training is gaining ground. As a result, a growing number of
mechanical and robotic bilateral upper limb training devices have been proposed. Objective. To provide an overview
and qualitative evaluation of the clinical applicability of bilateral upper limb training devices. Methods. Potentially
relevant literature was searched in the PubMed, Web of Science, and Google Scholar databases from 1990 onwards.
Devices were categorized as mechanical or robotic (according to the PubMed MeSH term of robotics). Results. In
total, 6 mechanical and 14 robotic bilateral upper limb training devices were evaluated in terms of mechanical and
electromechanical characteristics, supported movement patterns, targeted part and active involvement of the upper
limb, training protocols, outcomes of clinical trials, and commercial availability. Conclusion. Initial clinical results are Introduction. In stroke rehabilitation, bilateral upper limb training is gaining ground. As a result, a growing number of
mechanical and robotic bilateral upper limb training devices have been proposed. Objective. To provide an overview
and qualitative evaluation of the clinical applicability of bilateral upper limb training devices. Methods. Potentially
relevant literature was searched in the PubMed, Web of Science, and Google Scholar databases from 1990 onwards.
Devices were categorized as mechanical or robotic (according to the PubMed MeSH term of robotics). Results. In
total, 6 mechanical and 14 robotic bilateral upper limb training devices were evaluated in terms of mechanical and
electromechanical characteristics, supported movement patterns, targeted part and active involvement of the upper
limb, training protocols, outcomes of clinical trials, and commercial availability. Conclusion. Initial clinical results are Hypothesis/aims of study Our aim was to look at urinary tract infections and retention following vaginal repair/
vaginal hysterectomy by performing a systematic review and meta-analysis. Most Gynaecologists leave an indwelling
catheter following the pelvic organ prolapse repair. A questionnaire survey of bladder drainage practices showed the
initial catheterisation varied from 1-7 days postoperatively [1]. We have limited evidence available regarding the
optimal duration of catheterisation. Study design, materials and methods We searched randomised controlled
studies to compare the duration of indwelling catheters following vaginal prolapse surgery with or without vaginal
hysterectomy. We conducted a literature search of English articles in MEDLINE, Embase, Pub med, CINAHL and
Google scholar from December 2002 till December 2012. We also hand searched references, Conference
proceedings and abstracts of IUGA/ICS for the last 10 years. We looked into the rates of postoperative retention and
urinary tract infection. Results Interpretation of results The results showed a lower risk of urinary infection in Objectives: There is limited evidence in several rare types of retinopathies, in which there are no published trials but
only case reports and case series. The purpose of this study was to develop a methodology of systematic review of
case reports, in order to increase knowledge about some types of rare retinopathies, until now scarcely known.
Materials: case series and case reports selected systematically according to strict and previously defined inclusion
criteria. Purtscher retinopathy was chosen as an example of a rare retinopathy. Methods: Systematic review of
several databases (1980- 2010 May): MEDLINE, EMBASE, ISI, EBSCO, Science Direct y Google Scholar. Inclusion
criteria: case reports, case series and prospective studies with specific diagnostic criteria of Purtscher retinopathy
and with ophthalmologic assessment at presentation and at 1 and 6 months of follow-up. Results: Of 670 papers, 40
Hepatic veno-occlusive disease (HVOD) is a serious life-threatening complication of hematopoietic stem cell
transplantation (HSCT). Currently, there is no optimal therapeutic strategy and preventive measures are ill-defined.
Ursodeoxycholic acid (UA) is well-tolerated oral medication that has been associated with possible benefit as a
prophylactic agent. We sought to summarize and quantify the clinical effects of prophylactic UA in the context of
HSCT. We undertook a systematic review of studies addressing the use of UA as monotherapy or in combination with
other agents in patients undergoing HSCT. The Search Strategy included MEDLINE (1966 to fourth week of March
2006), EMBASE (1980 to fourth week of March 2006), all EBM Reviews (fourth quarter of 2005), Ovid Healthstar
(1966 to fourth week of March 2006), and Google Scholar on March 20, 2006. Six studies, 4 randomized clinical trials
and 2 historically controlled studies, representing 824 patients were included in the review. Three randomized
clinical trials comparing prophylactic UA with no treatment demonstrated reduced proportion of HVOD (relative risk Children's lack of knowledge about disability can adversely impact their attitudes toward people with disabilities. The
purpose of this study is to review the common elements of effective disability awareness interventions. A systematic
review of disability awareness interventions for children and youth was conducted to assess the effective
components of these interventions. Electronic searches were conducted using OVID, CENTRAL, PsychInfo, ERIC,
Social Science Citation Index, GreyNET Scopus and Google Scholar. The inclusion criteria included (i) an intervention
raising awareness about disability, (ii) school-age children with the average age between 5-19 years old, (iii) at least
one measurable outcome focusing on knowledge about disability or attitudes towards and/or acceptance of people
with a disability and (iv) published article or grey literature. Of the 1031 articles that were identified in the search, 42
met the criteria to be included in the review. We classified the disability awareness interventions into 5 broad types
including (i) social contact, (ii) simulation, (iii) curriculum, (iv) multi-media curriculum and (v) multiple components. OBJECTIVES: To systematically review published literature assessing the economic evidence of biologic treatments
indicated for Crohn's disease (CD). METHODS: Published articles between January 1995 and June 2011 were
searched in PubMed, EMBASE, ABI/INFORM, Tuft's Cost-Effectiveness Analysis Registry Database, Cochrane National
Health Service Economic Evaluation Database, International Pharmaceutical Abstracts, Web of Science, and Google
Scholar. Studies of interest included: 1) cost studies; 2) economic evaluations; or 3) narrative or systematic reviews
related to economic evaluations of biological treatments used for moderate- to-severe CD. Exclusion criteria included
the following characteristics: 1) CDrelated cost studies that were narrative or systematic reviews; 2) CD-related cost
studies that did not include costs of biologic treatments; 3) studies published only as abstracts; or 4) non-English
studies. The primary outcomes of interest included costs associated with biological treatments and cost-
effectiveness measures including incremental cost-effectiveness ratios. A threshold value of $50,000/QALY or
$30,000/QALY was used to judge treatment cost-effectiveness. RESULTS: Twenty- nine studies were identified,
including 12 economic evaluations and 17 cost studies or reviews of economic evaluations. Economic evaluation This review focuses on the efficacy and safety of Urtica dioica which has been utilized in traditional medicine for
management of diabetes. All relevant databases including Pubmed, Google Scholar, Web of Science, Scopus,
Iranmedex and MD Consult were searched for the terms diabetes mellitus and Urtica dioica without limitation up to
15th September 2010. All the animal studies with the outcome of change in blood glucose or other relevant
complications of diabetes and all available abstracts were included. Review articles and letters to the editor were
excluded. Search of databases resulted in 724 articles which 87 were potentially relevant studies on Urtica dioica and
diabetes. On the basis of inclusion/exclusion criteria, 21 studies were finally included. One human and 20 animal
studies were reviewed for the efficacy of Urtica dioica. Most of these studies showed significant decrease in blood Background: Various treatments of osteoarthritis (OA) have been described, including use of nutraceuticals.
Objectives: To review systematically the literature about the effects of nutraceuticals on clinical signs of pain or
abnormal locomotion in horses, dogs, and cats, and to discuss methodological aspects of trials and systematic
reviews. Methods: A systematic search of controlled trials evaluating the impact of nutraceuticals on OA in horses,
dogs, and cats was performed, using Medline, CAB Abstracts, and Google Scholar. Scientific evidence was evaluated
by means of criteria proposed by the Food and Drug Administration (FDA), and a scoring system adapted from both
the CONsolidated Standards of Reporting Trials (CONSORT) statement and recommendations for assessing trials by
the Center of Evidence Based Medicine of Oxford. Results: Twenty-two papers were selected and reviewed, with 5
studies performed in horses, 16 in dogs, and 1 in cats. The strength of evidence was low for all nutraceuticals except
Aim: The aim of this study was to perform a systematic review on the maternal and fetal/neonatal outcome of grand
multiparity (defined as a woman giving birth for the fifth to ninth time) and on the outcome of great grand
multiparity (women delivering for the tenth or following time). Methods: A Medline (1966-2004) and Google Scholar
search was performed. Studies reporting on grand multiparity or great-grand multiparity and comparing these
women with a control group were retained. Results: On the subject of grand multiparity 19 comparative studies
could be identified, of these 9 used para 5 to 9 as the definition of grand multiparity. Grand multiparous women
show more obesity, gestational diabetes and chronic hypertension but less pre-eclampsia). Grand multiparous
women more frequently have a suboptimal prenatal care. Concerning labour and delivery grand multiparous women
have less malpresentation, induction, oxytocin use, caesarean section and instrumental delivery although they more
often give birth to a macrosomic child. Grand multiparous women demonstrate more placenta previa and
postpartum haemorrhage. Considering fetal and neonatal complications the risk of a low Apgar-score after 5 min. is
higher, perinatal death is less frequent. No significant differences were found for maternal anaemia, breech position, Objectives: To assess the effect of non-invasive head cooling after traumatic brain injury (TBI) and stroke on
temperature, functional outcome and mortality; determine adverse effects and evaluate costeffectiveness. Search
strategy: Studies of any type, using any form of non-invasive head cooling in adults (>=18 years) after TBI or stroke
were relevant. Studies in cardiac arrest and neonatal hypoxic-ischaemic encephalopathy were included for
information on temperature change and adverse effects. Major international databases (including Medline, Embase,
CINAHL, WoS, Zetoc), Cochrane Library, trial registers, country specific databases (including China, Japan), Google
scholar and reference lists were searched with no publication, date or language restrictions. Results: Twelve studies
had useable data on intracranial and core body temperature. These included 99 patients who were cooled after TBI
or stroke and 198 patients cooled after cardiac arrest. The data were too heterogeneous for a single summary
measure of effect but showed that the most effective techniques for which there were adequate data, i.e. nasal
coolant and liquid cooling helmets, could reduce intracranial temperature by >=1degreeC in an hour. The main
device related adverse effects were localised skin problems, which were generally mild and self-limiting. There were Brain injuries resulting from trauma and stroke are common and costly. Cooling therapy may reduce damage and
potentially improve outcome. Head cooling targets the site of injury and may have fewer side effects than systemic
cooling, but there has been no systematic review and the evidence base is unclear. To assess the effect of non-
invasive head cooling after traumatic brain injury (TBI) and stroke on intracranial and/or core body temperature,
functional outcome and mortality, determine adverse effects and evaluate cost-effectiveness. Search strategy Major
international databases [including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web
of Science, the British Library's Electronic Table of Contents (Zetoc)], The Cochrane Library, trial registers, country-
specific databases (including China, Japan), Google Scholar, hypothermia conference reports and reference lists of
papers were searched with no publication or language restrictions. The searches were conducted from March 2010
to April 2011, with no back date restriction. Selection criteria For formal analysis of effect of head cooling on
functional outcome and mortality: randomised controlled trials (RCTs) of non-invasive head cooling in TBI or stroke in
adults (aged >= 18 years). RCT prespecified in protocol to include adequate randomisation and blinded outcome
assessment. For assessment of effect on temperature and adverse effects of cooling methods/devices: studies of any
type in TBI, stroke, cardiac arrest and neonatal hypoxic-ischaemic encephalopathy (adverse effects only). Data
collection and analysis A study assessment and data collection form was developed and piloted. Data on functional
outcome, mortality, temperature change and adverse effects of devices were sought and extracted. Two authors
independently assessed RCTs for quality using the Cochrane Renal Group checklist. Out of 46 head-cooling studies in
TBI and stroke, there were no RCTs of suitable quality for formal outcome analysis. Twelve studies had useable data
on intracranial and core body temperature. These included 99 patients who were cooled after TBI or stroke and 198
patients cooled after cardiac arrest. The data were too heterogeneous for a single summary measure of effect (many
studies had no measure of spread) and are therefore presented descriptively. The most effective techniques for
Background: Brain injuries resulting from trauma and stroke are common and costly. Cooling therapy may reduce
damage and potentially improve outcome. Head cooling targets the site of injury and may have fewer side effects
than systemic cooling, but there has been no systematic review and the evidence base is unclear. Objective: To
assess the effect of non-invasive head cooling after traumatic brain injury (TBI) and stroke on intracranial and/or core
body temperature, functional outcome and mortality, determine adverse effects and evaluate cost-effectiveness.
Review methods: Search strategy Major international databases [including MEDLINE, EMBASE, Cumulative Index to
Nursing and Allied Health Literature, Web of Science, the British Library's Electronic Table of Contents (Zetoc)], The
Cochrane Library, trial registers, country-specific databases (including China, Japan), Google Scholar, hypothermia
conference reports and reference lists of papers were searched with no publication or language restrictions. The
searches were conducted from March 2010 to April 2011, with no back date restriction. Selection criteria For formal
analysis of effect of head cooling on functional outcome and mortality: randomised controlled trials (RCTs) of non-
invasive head cooling in TBI or stroke in adults (aged >= 18 years). RCT prespecified in protocol to include adequate
randomisation and blinded outcome assessment. For assessment of effect on temperature and adverse effects of
cooling methods/devices: studies of any type in TBI, stroke, cardiac arrest and neonatal hypoxic-ischaemic
encephalopathy (adverse effects only). Data collection and analysis A study assessment and data collection form was
developed and piloted. Data on functional outcome, mortality, temperature change and adverse effects of devices
were sought and extracted. Two authors independently assessed RCTs for quality using the Cochrane Renal Group
checklist. Results: Out of 46 head-cooling studies in TBI and stroke, there were no RCTs of suitable quality for formal
outcome analysis. Twelve studies had useable data on intracranial and core body temperature. These included 99
patients who were cooled after TBI or stroke and 198 patients cooled after cardiac arrest. The data were too
heterogeneous for a single summary measure of effect (many studies had no measure of spread) and are therefore BACKGROUND: Black men who have sex with men (MSM) are disproportionately burdened by HIV/AIDS. Despite this
burden there has been a shortage of research on HIV interventions for black MSM. This article provides a
comprehensive review of the literature on interventions for black MSM to identify effective HIV prevention
intervention strategies for black MSM., METHODS: We searched 3 databases: Pubmed, Scopus, and Google Scholar
to identify peer-reviewed articles and used the following search terms: African American or black; MSM or men who
have sex with men and women (MSMW); HIV; program or intervention; and evaluation or intervention science or
implementation research. We included research articles that assessed interventions for black men who have sex with
men. We included studies that used an experimental, quasi-experimental, or pre-post test design as well as
formative research studies. We also searched the CDC and NIH websites to identify planned and on-going
intervention studies. We identified a total of 23 studies to include in the review., RESULTS: We identified 12 Objective: Headache is one of the most common physical symptoms after traumatic brain injury (TBI). The specific
goals of this review include (1) determination of effective interventions for post-traumatic headache (PTHA), (2)
development of treatment recommendations, (3) identification of gaps in the current medical literature regarding
PTHA treatment, and (4) suggestions for future directions in research to improve outcome for persons with PTHA.
Data Sources: Peer-reviewed studies in PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar:
(1) including adult and child samples with mild, moderate, or severe TBI, whiplash, and postconcussion syndrome; (2)
with clearly described interventions; (3) with headache treatment as a primary or secondary outcome; (4) published
since 1985; and (5) written in English. Study Selection: Abstracts from 812 articles from the above searches were
reviewed. All research types that studied the treatment of headache after TBI were included, and 64 of the 812
articles appeared to meet the inclusion criteria. Data Extraction: The 64 articles were reviewed in full and data were
extracted; 36 met all criteria for inclusion. The final 36 articles were rated according to the American Academy of
To evaluate the effectiveness of interventions used in primary care to improve health literacy for change in smoking,
nutrition, alcohol, physical activity and weight (SNAPW). A systematic review of intervention studies that included
outcomes for health literacy and SNAPW behavioral risk behaviors implemented in primary care settings.We
searched the Cochrane Library, Johanna Briggs Institute, Medline, Embase, CINAHL, Psychinfo, Web of Science,
Scopus, APAIS, Australasian Medical Index, Google Scholar, Community of Science and four targeted journals (Patient
Education and Counseling, Health Education and Behaviour, American Journal of Preventive Medicine and Preventive
Medicine).Study inclusion criteria: Adults over 18 years; undertaken in a primary care setting within an Organisation
for Economic Co-operation and Development (OECD) country; interventions with at least one measure of health
literacy and promoting positive change in smoking, nutrition, alcohol, physical activity and/or weight; measure at
least one outcome associated with health literacy and report a SNAPW outcome; and experimental and quasi-
experimental studies, cohort, observational and controlled and non-controlled before and after studies.Papers were
assessed and screened by two researchers (JT, AW) and uncertain or excluded studies were reviewed by a third
researcher (MH). Data were extracted from the included studies by two researchers (JT, AW). Effectiveness studies
were quality assessed. A typology of interventions was thematically derived from the studies by grouping the SNAPW
interventions into six broad categories: individual motivational interviewing and counseling; group education;
multiple interventions (combination of interventions); written materials; telephone coaching or counseling; and Introduction: This review focuses on the efficacy and safety of Iranian medicinal plants found effective in the
management of diabetes in humans and animals. Material and methods: EMBASE, Scopus, PubMed, Web of Science,
Google Scholar, and IranMedex databases were searched up to 8 October 2007. The search terms were "diabetes"
and "plant", "herb", "traditional", and "natural" or "herbal medicine", limited to Iran. All of the human studies were
included. Animal studies with the outcome of blood glucose or serum lipids, antioxidant effect, changes in hepatic
enzymes, anti-inflammatory effect, or vascular activity in diabetes were included. Studies performed on cell lines,
reviews and letters to editors were excluded. Blood glucose and serum lipids were the key outcomes. Results: Twelve
human studies were reviewed for efficacy of plants. These studies showed significant decrease in blood glucose after
treatment with Citrullus colocynthus L., Silybum marianum, Psyllium, Teucrium polium, and Pomegranate. Thirty-one
animal studies were included showing Walnut leaf, Coriander, Pomegranate, Garlic, Satureja khuzestanica, Phlomis
anisodonta, Trigonella foenum graecum, Olive (Olea europaea L.), Capsicum frutescens, Achillea santolina, Aloe vera, Objective. To identify and appraise the evidence for an association between laryngomalacia (LM) and acid reflux
through a systematic review of the existing literature. Data Sources. MEDLINE, EMBASE, the Cochrane Library,
Google Scholar, and collected additional publications cited in bibliographies. Review Methods. Literature search by
both authors with structured criteria to select studies evaluated for systematic review. The Oxford Centre for
Evidence-Based Medicine (CEBM) guidelines were applied to assess study quality of evidence. Results. Twenty-seven
studies, representing 1295 neonates with LM, were included. Levels of evidence varied from CEBM level 2a (n = 1) to
4 (n = 23). Although reflux definitions were diverse, overall reflux prevalence in this group was 59% (pooled odds
ratio [OR] of 4 controlled studies = 1.15, P = .67). Further evidence supporting an association between reflux and LM
included the ubiquity of acid reflux using dual-probe pH monitoring in children with LM (2 studies; n = 84), the There are contradictory reports about the association of magnesium and attention- deficit hyperactivity disorder
(ADHD). Moreover, some studies reported that magnesium is effective for treating ADHD. This is the first systematic
review evaluating the effectiveness of magnesium to treat patients with ADHD. The two databases of MEDLINE/
PubMedline and Google Scholar were electronically searched using the search items and considering inclusion and
exclusion criteria. Out of the 37 titles, only six studies were experimental interventional studies. However, three of
these studies were without any control group. The other three studies were controlled clinical trials. Nevertheless,
none of the studies was a randomized double- blind controlled clinical trial. These studies supported that magnesium There are contradictory reports about the association of magnesium and attention- deficit hyperactivity disorder
(ADHD). Moreover, some studies reported that magnesium is effective for treating ADHD. This is the first systematic
review evaluating the effectiveness of magnesium to treat patients with ADHD. The two databases of MEDLINE/
PubMedline and Google Scholar were electronically searched using the search items and considering inclusion and
exclusion criteria. Out of the 37 titles, only six studies were experimental interventional studies. However, three of
these studies were without any control group. The other three studies were controlled clinical trials. Nevertheless,
none of the studies was a randomized double- blind controlled clinical trial. These studies supported that magnesium
BACKGROUND: Lesbian, gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual
people. METHOD: We conducted a systematic review and meta-analysis of the prevalence of mental disorder,
substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people. We searched Medline, Embase,
PsycInfo, Cinahl, the Cochrane Library Database, the Web of Knowledge, the Applied Social Sciences Index and
Abstracts, the International Bibliography of the Social Sciences, Sociological Abstracts, the Campbell Collaboration
and grey literature databases for articles published January 1966 to April 2005. We also used Google and Google
Scholar and contacted authors where necessary. We searched all terms related to homosexual, lesbian and bisexual
people and all terms related to mental disorders, suicide, and deliberate self harm. We included papers on
population based studies which contained concurrent heterosexual comparison groups and valid definition of sexual
orientation and mental health outcomes. RESULTS: Of 13706 papers identified, 476 were initially selected and 28 (25
studies) met inclusion criteria. Only one study met all our four quality criteria and seven met three of these criteria.
Data was extracted on 214,344 heterosexual and 11,971 non heterosexual people. Meta-analyses revealed a two
fold excess in suicide attempts in lesbian, gay and bisexual people [pooled risk ratio for lifetime risk 2.47 (CI 1.87, Context: Despite improvements in mental health services in recent decades, it is unclear whether the risk of
mortality in schizophrenia has changed over time. Objective: To explore the distribution of standardized mortality
ratios (SMRs) for people with schizophrenia. Data Sources: Broad search terms were used in MEDLINE, PsychINFO,
Web of Science, and Google Scholar to identify all studies that investigated mortality in schizophrenia, published
between January 1, 1980, and January 31, 2006. References were also identified from review articles, reference lists,
and communication with authors. Study Selection: Population-based studies that reported primary data on deaths in
people with schizophrenia. Data Extraction: Operationalized criteria were used to extract key study features and
mortality data. Data Synthesis: We examined the distribution of SMRs and pooled selected estimates using random-
effects meta-analysis. We identified 37 articles drawn from 25 different nations. The median SMR for all persons for
all-cause mortality was 2.58 (10%-90% quantile, 1.18-5.76), with a corresponding random-effects pooled SMR of
2.50 (95% confidence interval, 2.18-2.43). No sex difference was detected. Suicide was associated with the highest PURPOSE: Guidelines for hospice, diabetes treatment, and cancer screening recommend incorporating life
expectancy into clinical decisions. Yet prognostic indices are not widely used in clinical practice. To help clinicians
prognosticate, we conducted a systematic review of prognostic indices for older adults, and describe their strengths
and weaknesses. METHODS: We electronically searched MEDLINE, EMBASE, Cochrane, and Google Scholar citation
tracking; screened references of included indices; and emailed authors. Indices were included if they contained a
validated prognostic index predicting absolute risk of all-cause mortality in patients average age >= 60. We excluded
indices that estimated only relative risk, ICU or in-hospital mortality rate, or that were disease-specific. For each
prognostic index, we described: how, where, and in whom it was developed, as well as its accuracy and
generalizability. RESULTS: We reviewed 18,761 titles to identify 16 indices (8 Pubmed, 5 EMBASE, 2 Google Scholar, 1
reference list). Common final predictors of mortality included functional status and comorbidities (each only absent
in 1 index). Indices varied in terms of their time frame for predicted mortality and clinical setting: 6-12 month
mortality rate (1 community, 6 hospital, 3 nursing home), 2-3 year mortality rate (3 community, 1 hospital), and 4-5 Background and aims: There is an increased prevalence of depression after traumatic brain injury (TBI); Dikmen and
colleagues (2004) reported moderate to severe depressive symptomatology ranging from 31% at one month to 17%
at three to five years post-injury. Despite the prevalence of this problem there is a paucity of research outcomes
concerning the efficacy of non-pharmacological treatments. Existing treatments have usually been created for
cognitively intact individuals and may not be suitable for people with cognitive impairments. Method: This paper
presents results from a systematic literature review of treatments for depression following TBI and describes the
treatments applied. Four databases were searched (PubMED, PsycINFO, PsycBITE and Google Scholar). Results: 15
studies were identified that met selection criteria. Although no study focused specifically on a sample of people with
TBI and a diagnosed mood disorder, several studies used depression scales as outcomes measures. There was a
variety of treatments that were applied either individually or in combination. Four studies evaluated cognitive
Superficial siderosis is a progressive disease of the central nervous system associated with chronic subarachnoid
hemorrhage. Sensorineural hearing loss occurs early in the disease typically progressing to a profound hearing loss
during several years and ultimately affecting 95% of patients. There are published reports of variable outcomes
regarding auditory performance for cochlear implantation in cases of superficial siderosis: the objective of this article
was to systematically review this evidence. A systematic search of NHS Evidence electronic journal databases AMED
(1985 to present), BNI (1985 to present), CINAHL (1981 to present), EMBASE (1980 to present), HEALTH BUSINESS
ELITE, HMIC, MEDLINE (1950 to present), and PsycINFO (1806 to present) was performed. Further research using
personal communication, Google Scholar, hand searching Otology & Neurotology (2008-2011), and assessment of
reference lists identified in other relevant articles yielded additional articles. A total of 24 articles were short-listed
based on relevance; no studies were excluded on a basis of quality. Of these 24 articles, 11 were excluded. The 13
articles included in this review report 15 cases of cochlear implantation in superficial siderosis. Of these 15 individual
cases, 7 (47%) showed clear sustained benefit from cochlear implantation, 6 showed limited/no benefit from the BACKGROUND: Superficial siderosis is a progressive disease of the central nervous system associated with chronic
subarachnoid hemorrhage. Sensorineural hearing loss occurs early in the disease typically progressing to a profound
hearing loss during several years and ultimately affecting 95% of patients., OBJECTIVE: There are published reports of
variable outcomes regarding auditory performance for cochlear implantation in cases of superficial siderosis: the
objective of this article was to systematically review this evidence., DATA SOURCES: A systematic search of NHS
Evidence electronic journal databases AMED (1985 to present), BNI (1985 to present), CINAHL (1981 to present),
EMBASE (1980 to present), HEALTH BUSINESS ELITE, HMIC, MEDLINE (1950 to present), and PsycINFO (1806 to
present) was performed. Further research using personal communication, Google Scholar, hand searching Otology &
Neurotology (2008-2011), and assessment of reference lists identified in other relevant articles yielded additional
articles., STUDY SELECTION: A total of 24 articles were short-listed based on relevance; no studies were excluded on
a basis of quality. Of these 24 articles, 11 were excluded., DATA EXTRACTION AND SYNTHESIS: The 13 articles
included in this review report 15 cases of cochlear implantation in superficial siderosis. Of these 15 individual cases, 7
(47%) showed clear sustained benefit from cochlear implantation, 6 showed limited/no benefit from the onset, and Aims and objectives. This paper reviews and summarises the literature on assessment, diagnosis and management of
personality disorder in people with intellectual disability. It will proceed to argue the implications of a mental health
nurse practitioner in clinical practice. Background. Personality disorder is a potentially severe and disabling condition
causing significant distress as well as presenting considerable challenges for service providers. Diagnosis in people
with intellectual disability is controversial. However, it is considered that this population is at greater risk of these
disorders. There is, however, little research on which to base clinical interventions or service planning. Design.
Systematic review. Methods. A literature search of electronic data was undertaken in April 2007 using CINAHL,
AMED, Medline, PsycINFO, EMBASE and Cochrane Library. Other sources included Google Scholar, hand searching of
reference lists and texts and search of relevant websites. Results. The literature on personality disorder in intellectual
disability is notable for its paucity. The limited evidence available suggests that this population is at greater risk of
personality disorder and that assessment and diagnosis is complex and often overshadowed by the intellectual
disability. Few papers address treatment, there are no trial-based studies and it has not been established whether Purpose (1) To describe the clinical characteristics of Purtscher and Purtscher-like retinopathies, including etiologies,
fundoscopic signs, Results of complementary investigation, treatments, and outcomes. (2) To compare visual acuity
(VA) of patients receiving corticosteroids for PuR compared with observation. Methods Systematic review of several
databases (1980-2010): Medline, EMBASE, ISI, EBSCO, Science Direct and Google Scholar. Study selection criteria
included: (A) Studies of PuR with ophthalmology assessments; (B) >=3 of 5 diagnostic criteria of PuR; (C) Quantified
VA at presentation. For quantitative assessment (Purpose 2), we selected only studies that reported whether
corticosteroids were administered, and with vision assessments after at least 1 month. Results (1) From 670 studies
initially found, 40 were included (68 cases, 110 eyes): 1 prospective, 5 case series, and 34 case reports. Mean VA at
presentation was 1.3 logMAR (logarithm of the minimum angle of resolution) (<20/200; range: 20/20-light
perception). Purtscher flecken were underreported. Trauma and acute pancreatitis were the most frequent
Background and Purpose: Carotid endarterectomy (CEA) with patch angioplasty produces greater results than with
primary closure; however, there remains uncertainty on the optimal patch material in CEA. A systematic review of
randomized controlled trials (RCTs) was performed to evaluate the effect of angioplasty using venous patch versus
synthetic patch material, and Dacron patch versus polytetrafluoroethelene (PTFE) patch material during CEA.
Methods: A multiple electronic health database screening was performed including the Cochrane library, Pubmed,
Ovid, EMBASE and Google Scholar on all randomized controlled trials (RCTs) published before November 2012 that
compared the outcomes of patients undergoing CEA with venous patch versus synthetic patch. RCTs were included if
they compared carotid patch angioplasty with autologus venous patch versus synthetic patch material, or compared
one type of synthetic patch with another. Results: Thirteen RCTs were identified. Ten trials, involving 1946 CEAs,
compared venous patch with synthetic patch materials. Two trials, involving 400 CEAs in 380 patients, compared
Dacron patch with PTFE patch. The hemostasis time in CEA with PTFE patch was significantly longer than with venous
patch (P<0.0001), and longer than with Dacron patch (P<0.0001). There was no significant difference of mortality Objective: To provide descriptions of existing remuneration models for pharmacist clinical care services and to
summarize the existing evaluations of economic, clinical, and humanistic outcome studies of the remuneration
models. Methods: We searched MEDLINE, EMBASE, International Pharmaceutical Abstracts, EconLit, Scopus, Web of
Science, Google Scholar, and PubMed from date of inception to June 2006. We also searched the World Wide Web,
hand-searched pertinent journals and reference lists, and contacted experts in pharmacy practice research. One
reviewer assessed titles and, with a second independent reviewer, assessed abstracts and full-text articles for
inclusion and abstracted data. Disagreements were resolved by discussion or by a third independent reviewer. We
included English language articles that described or evaluated current remuneration systems for pharmacist clinical
care services and that involved a substantial number of pharmacists and that were paid by a third party other than
the patient. Due to heterogeneity between systems, data were compiled qualitatively. Then, based on these results,
an expert panel developed recommendations for implementing a remuneration model into current pharmacy To assess the effectiveness of telephone-based interventions for mental illness, a systematic search of the literature
was conducted using the databases PsycINFO and PubMed, and the search engine Google Scholar. The search
identified 14 studies evaluating telephone-based interventions in the areas of depression (n = 6), anxiety (n = 3),
eating disorders (n = 3), substance use (n = 1) and schizophrenia (n = 1). Although these studies provide evidence
that telephone interventions can be effective, the few studies conducted, small sample sizes and lack of randomized
controlled trial methodology prevent firm conclusions from being drawn. The articles reviewed suggest that an Unhealthy lifestyle behaviors are major public health problems. Promoting positive behavior change is an ongoing
challenge that warrants innovative solutions. Mobile phone use is becoming widespread across populations and
merits further exploration as a strategy to promote wellness and reduce health disparities. The purpose of this paper
is to review the evidence using text messaging as a tool to deliver healthy lifestyle behavior intervention programs in
pediatric and adolescent populations. The following question was used to guide the systematic review, "In pediatric
and adolescent populations, how does the use of text-message-based interventions versus control or comparison
interventions affect healthy lifestyle behaviors?" A systematic search for relevant literature was conducted in the
following databases: MEDLINE, PubMed, Google Scholar, Cochrane Library, and PsycINFO, and by hand-searching
bibliographies. Evidence was compiled from experimental studies in peer-reviewed journals published from 2004 to
May 15, 2011. Data were extracted using guidelines set forth by the Centre for Reviews and Dissemination. Thirty-
seven articles were identified from the comprehensive search. Eight articles representing seven studies (two articles
were published describing different aspects of the outcomes from one study) met inclusion for this review. Mean age Background: The purpose of this review was to investigate evidence for a possible etiological association between
oral health and pneumonia or other respiratory diseases. Methods: The following data sources were used: Ovid
MEDLINE (In-Process & Other Non-indexed Citations, Daily Update, and OLD-MEDLINE); Cumulative Index to Nursing
& Allied Health Literature; Evidence Based Medicine of Cochrane Central Register of Controlled Trials; Cochrane
Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; EMBASE; Health and Psychosocial
Instruments; HealthSTAR; International Pharmaceutical Abstracts; PubMed; and Google Scholar from the earliest
record until July 2005. Studies were selected from randomized controlled clinical trials and longitudinal, cohort, case-
control, and epidemiological studies. Searches were limited to English language and human studies. Results: A total
of 728 articles were searched for relevancy, determined by article title, abstract, and full copy, resulting in a yield of
19 studies that met our inclusion criteria. These articles were read and scored independently by the reviewers to
obtain the evidence for this review: 1) the potential risk factors for pneumonia were identified as the presence of
cariogenic and periodontal pathogens, dental decay, and poor oral hygiene in five studies; 2) a weak association
between periodontal disease and chronic obstructive pulmonary disease (COPD) was identified in four poor to fair
Rural nurses and doctors typically have little opportunity to further their education and training. Studies have shown
high participant satisfaction with the use of educational technology, such as videoconferencing, for education. A
review of effectiveness of videoconference-based tele-education for medical and nursing education was conducted.
The aims of this study were to: (1) systematically review the literature and critique the research methods on studies
addressing the review question: "How effective is videoconference-based education for the education of doctors and
nurses?" (2) summarize the existing evidence on the effectiveness of videoconference education for medical and
nursing staff; and (3) apply the findings to South Africa and other countries across the globe. Research citations from
1990 to 2011 from cumulative index of nursing and allied health literature, Medline, Pubmed, PsycInfo, EBSCOhost,
SABINET, Cochrane Database of Systematic Reviews, the Cochrane Controlled Trial Registry, Database of Abstracts of
Reviews of Effectiveness, unpublished abstracts through NEXUS and Internet search engines (Google/Google scholar)
were searched. Review methods included searching, sifting, abstraction, and quality assessment of relevant studies
by two reviewers. Studies were evaluated for sample, design, intervention, threats to validity, and outcomes. No This review article systematically and critically summarizes the current evidence regarding desipramine for treating
children and adolescents with attention deficit hyperactivity disorder (ADHD). PRISMA guideline was used for
gathering the data. The databases of PubMed/Medline and Google scholar were electronically searched. This review
included controlled clinical trials investigating the efficacy of desipramine for treating children and adolescents with
ADHD. The primary outcome measure was clinical improvement measured by valid and reliable objective
instruments in order to assess the severity of ADHD clinical symptoms. Adverse effects were evaluated as well. Out
of 267 titles under the study, thirty three articles mentioned desipramine for treating ADHD. Two trials met the This review focuses on the efficacy and safety of effective herbal medicines in the management of obesity in humans
and animals. PubMed, Scopus, Google Scholar, Web of Science, and IranMedex databases were searched up to
December 30, 2008. The search terms were "obesity" and ("herbal medicine" or "plant", "plant medicinal" or
"medicine traditional") without narrowing or limiting search elements. All of the human and animal studies on the
effects of herbs with the key outcome of change in anthropometric measures such as body weight and waist-hip
circumference, body fat, amount of food intake, and appetite were included. In vitro studies, reviews, and letters to
editors were excluded. Of the publications identified in the initial database, 915 results were identified and
reviewed, and a total of 77 studies were included (19 human and 58 animal studies). Studies with Cissus
quadrangularis (CQ), Sambucus nigra, Asparagus officinalis, Garcinia atroviridis, ephedra and caffeine, Slimax (extract This review focuses on the efficacy and safety of Teucrium species that are effective in the management of different
conditions in human and animal. Embase, Scopus, Pubmed, Google Scholar and IranMedex databases were searched
up to 11th May 2009. The search terms were Teucrium or germander or Calpoureh. All of the human and animal
studies considered the effects of Teucrium with the key outcome of change in blood glucose, serum lipids, anti-
oxidant parameters, hepatic enzymes, anti-inflammation, analgesic effects, anti-ulcer effects anti-microbial effect
and toxic effects were included. Studies performed on cell lines, in vitro studies, reviews and letters to editors were
excluded. Of initial search, 7325 record were reviewed for inclusion or exclusion in study. Finally, 68 studies were
included. Some animal and one human study showed hypoglycemic effects of Teucrium. In one animal study,
Teucrium decreased serum cholesterol and triglyceride in hyper-lipidemic rats. Some studies indicated anti-oxidant, Objective: To carry out a systematic review of the evidence for longterm feeding via percutaneous endoscopic
gastrostomy, (PEG) tube or nasogastric tube, (NGT) in patients with dysphagia due to idiopathic Parkinson's disease,
(IPD). Background: Dysphagia is common in IPD. Reported prevalence varies from 18.2% to 100%. The NICE
guidelines state that "Enteral feeding options may need to be considered". In clinical practice both NGT and PEG
tubes are used to provide nutrition to patients thought to be at risk of aspiration even though the evidence for these
interventions remains unclear. Methods: We searched the major databases including MEDLINE, AARP Ageline, British
Nursing Index, Embase, PsychInfo, CINAHL, Cochrane Library, JBI connect, NHS eLibrary, Google Scholar, TRIP, NICE,
SIGN, NHS evidence, Clinical trials.gov, WHO Register of Clinical Trials, Parkinson's Disease Society using keywords
gastrostomy, PEG tube, PEG or enteral feed, swallow, enteral nutrition, nasogastric, parkinsonian disorders,
Parkinson's disease, dopamine, dysphagia, deglutition disorders, multiple system atrophy, progressive supranuclear
palsy, Steele-Richardson-Olszewski syndrome. All titles, abstracts and full text articles were independently reviewed
by JL and BA. References of suitable articles were handsearched independently by JL and BA. Results: No relevant
randomised controlled trials were identified. One randomised trial comparing PEG feeding with NGT feeding in
Background: Alcohol use disorders (AUDs) are highly prevalent and associated with non-adherence to antiretroviral
therapy, decreased health care utilization and poor HIV treatment outcomes among HIV-infected individuals.
Objectives: To systematically review studies assessing the impact of AUDs on: (1) medication adherence, (2) health
care utilization and (3) biological treatment outcomes among people living with HIV/AIDS (PLWHA). Data sources: Six
electronic databases and Google Scholar were queried for articles published in English, French and Spanish from
1988 to 2010. Selected references from primary articles were also examined. Review methods: Selection criteria
included: (1) AUD and adherence (N=20); (2) AUD and health services utilization (N=11); or (3) AUD with CD4 count
or HIV-1 RNA treatment outcomes (N=10). Reviews, animal studies, non-peer reviewed documents and ongoing To summarise the relevant published evidence on the health and behavioural impact of brief interventions in
individuals with recognised co-morbidity. A pre-specified search strategy was applied to Medline and Embase from
1999 to 2009 inclusive. We also scanned the reference lists of key reviews in the field and carried out text-word
searches of Google and Google-Scholar. Two authors independently abstracted data, assessed trial quality and
recorded study outcomes. Analysis took the form of a qualitative evidence synthesis due to the heterogeneity of
studies in this field. We identified 14 trials meeting our inclusion criteria. The majority of this research focused on
substance use and mental health problems (n=8) whilst the remaining trials focused on substance use and physical
health problems (n=3) and dual substance use (n=3). The evidence-base was very heterogeneous and it was not
possible to quantitatively pool the trial outcome data. There were generally positive outcomes of brief intervention Simulation-based learning is an educational intervention which creates an environment that is conducive to
experiential learning. Despite the prevalence of research on the influence of simulation on nursing education, there
is a dearth of literature on the effectiveness of simulation-based learning. This systematic review examines literature
on simulation outcomes in nursing education from the years 2000-2010. The electronic databases reviewed for the
systematic review of the literature included: CINAHL Plus, Medline, Health Source: Nursing/Academic Education,
Google Scholar, and Digital Dissertations and Theses through ProQuest. The MeSH search terms included "simulation
outcomes measurement" and "nursing education". Seventeen studies were included in the review of the literature.
The literature was categorized into three themes; internal outcomes, external outcomes, and clinical evaluation. The BACKGROUND: Athletes competing in sports that require running, changes in direction, repetitive kicking and
physical contact are at a relatively higher risk of experiencing episodes of athletic groin pain. To date, there has been
no systematic review that aims to inform clinicians about the best available evidence on features of exercise
interventions for groin pain in athletes. The primary aim of this systematic review was to evaluate the available
evidence on the effectiveness of exercise therapy for groin pain in athletes. The secondary aim of this review was to
identify the key features of exercise interventions used in the management of groin pain in an athletic population.,
METHODS: MEDLINE, CINAHL, PubMed, SPORTSDiscus, Embase, AMED, Ovid, PEDro, Cochrane Controlled Trials
Register and Google Scholar databases were electronically searched. Data relating to research design, sample
population, type of sport and exercise intervention was extracted. The methodological evaluation of included studies
was conducted by using a modified quantitative critical appraisal tool., RESULTS: The search strategy identified 468
studies, 12 of which were potentially relevant. Ultimately five studies were included in this review. Overall the
quality of primary research literature was moderate, with only one randomised controlled trial identified. All
included studies provided evidence that an exercise intervention may lead to favourable outcomes in terms of return
to sport. Four of the five studies reviewed included a strengthening component and most utilised functional, Objective: This review focuses on the medicinal plants growing and having history of folk medicine in Iran and found
effective as anti free radical damage in animal or human. Design: Embase, Scopus, Pubmed, Web of Science, Google
Scholar, IranMedex, and SID databases were searched up to 2 February 2008. The search terms were antioxidant or
"lipid peroxidation" and "plant, medicinal plant, herb, traditional, natural or herbal medicine" limited to Iran. Studies
that assessed effects on cell lines or isolated organs, fetal toxicity, and reviews or letters were excluded.
Antioxidative effect and lipid peroxidation inhibition were the key outcomes. Results: Forty-six animal studies on the
efficacy of medicinal plants were reviewed. Lipid peroxidation was reduced in different clinical circumstances by
Ferula szovitsiana, Nigella sativa, Rosa damascene petal, Phlomis anisodonta, Rosemary, Zataria multiflora Boiss,
Saffron, Amirkabiria odorastissima mozaffarian, Ficus carica Linn., Ziziphora clinopoides, Carica papaya, Chichorium
Background: Since the use of the questionnaire to evaluate adherence to HIV therapy (acronym CEAT-VIH) has
increased in the last decade and translation into new language versions has been requested, summarizing
information regarding the psychometric properties of the instrument may be useful for researchers and
practitioners. Objective: The purpose of this work was to review the psychometric properties of the questionnaire
CEAT-VIH, available from published studies and research reports. Data sources: Medline, PsycINFO, Google Scholar
and Google; the searched period was from 2001 to 2012. Study selection: Forty-eight research materials referring to
the questionnaire CEAT-VIH were initially gathered from academic databases and direct contact with researchers,
before being analyzed. From the initial pool of material compiled (i.e., abstracts, technical reports or database files,
dissertations or complete articles), only 20 comprised original data. Study appraisal and synthesis methods: The
selected research material described a variety of information in terms of the psychometric properties of the
questionnaire. The results from the primary studies were then summarized in tables for evaluation, description and
comparison. Results: Thirteen out of 16 studies reported a Cronbach's alpha value of above 0.70, supporting the
internal consistency reliability of the CEAT-VIH questionnaire. No floor or ceiling effects were observed.
Hypothesized relationships between the CEAT-VIH score and adherence-related variables (e.g., viral load, CD4+,
compliance evaluated by physician or pharmacist, complexity of treatment and pill numbers) were observed,
indicating validity evidence. Thus, variables expected to act as psychological risk factors for low adherence (e.g.,
stress, depression and anxiety) or protector factor (e.g., social support) to good adherence were observed. The Introduction: Reiki is an ancient form of Japanese healing. While this healing method is widely used for a variety of
psychologic and physical symptoms, evidence of its effectiveness is scarce and conflicting. The purpose of this
systematic review was to try to evaluate whether Reiki produces a significant treatment effect. Methods: Studies
were identified using an electronic search of Medline, EMBASE, Cochrane Library, and Google Scholar. Quality of
reporting was evaluated using a modified CONSORT Criteria for Herbal Interventions, while methodological quality
was assessed using the Jadad Quality score. Data extraction: Two (2) researchers selected articles based on the
following features: placebo or other adequate control, clinical investigation on humans, intervention using a Reiki
practitioner, and published in English. They independently extracted data on study design, inclusion criteria, type of
control, sample size, result, and nature of outcome measures. Results: The modified CONSORT Criteria indicated that An economic evaluation of interventions for older people requires accurate assessment of costing and consideration
of both acute and long-term services. Accurate information on the unit cost of allied health and community services
is not readily available in Australia however. This systematic review therefore aims to synthesise information
available in the literature on the unit costs of allied health and community services that may be utilised by an older
person living in Australia. A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was
undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department
websites were inspected. The search identified the cost of specified allied health services including: physiotherapy,
occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included:
personal care, meals on wheels, transport costs and domestic services. Where the information was not available, Objective: To summarize evidence on the use of upper extremity casting designed to achieve reductions in
contracture, tone, pain, function, oedema or spasticity in the elbow, wrist or hand of adults and children with
neurological conditions. Data sources: A search was conducted of the Cochrane Database of Systematic Reviews; the
electronic databases MEDLINE, EMBASE, CINAHL, PEDro, OT-Seeker; Google Scholar; reference lists of retrieved trial
reports and review articles. Review methods: Two independent reviewers determined whether retrieved study
abstracts met inclusion criteria: human subjects; >50% of participants children or adults described as having brain
injury, cerebral palsy or stroke. Methodological quality of randomized controlled trials was rated using the PEDro
scale (1-10 highest). Results: Thirty-one papers were retrieved and 23 studies appraised: three were randomized
controlled trials and four were systematic reviews. Over three-quarters of the studies, excluding systematic reviews,
were lower level evidence (n= 4 level V; n=4 level IV; n=1 level III). Methodological quality of randomized controlled
Background: Upper limb hypertonicity, contracture and other abnormalities of tone and hand position are common
clinical features of cerebral palsy. One common upper limb intervention to reduce contractures and the unwanted
effects of hypertonicity is casting. Objective: To summarize evidence on the use of upper extremity casting designed
to achieve reductions in contracture, tone, pain, function, oedema or spasticity in the elbow, wrist or hand of
children with cerebral palsy. Design: Systematic Review. Data sources: A search was conducted of the Cochrane
Database of Systematic Reviews; the electronic databases MEDLINE, EMBASE, CINAHL, PEDro, OT-Seeker; Google
Scholar; reference lists of retrieved trial reports and review articles. Methods: Two independent reviewers
determined whether retrieved study abstracts met inclusion criteria: human subjects; >50% of participants children
described as having cerebral palsy. Methodological quality of randomized controlled trials was rated using the PEDro
scale (1-10 highest). Results: Thirty-one papers were retrieved and 15 studies appraised: only two were randomized
controlled trials and three were systematic reviews. Methodological quality of randomized controlled trials was high Purpose: This paper aimed to systematically review algorithms to identify transfusion-related ABO incompatibility
reactions in administrative data, with a focus on studies that have examined the validity of the algorithms. Methods:
A literature search was conducted using PubMed, Iowa Drug Information Service database, and Embase. A Google
Scholar search was also conducted because of the difficulty identifying relevant studies. Reviews were conducted by
two investigators to identify studies using data sources from the USA or Canada because these data sources were
most likely to reflect the coding practices of Mini-Sentinel data sources. Results: One study was found that validated
International Classification of Diseases (ICD-9-CM) codes representing transfusion reactions. None of these cases
were ABO incompatibility reactions. Several studies consistently used ICD-9-CM code 999.6, which represents ABO
incompatibility reactions, and a technical report identified the ICD-10 code for these reactions. One study included
the E-code E8760 for mismatched blood in transfusion in the algorithm. Another study reported finding no ABO Purpose: To systematically review algorithms to identify transfusion-related sepsis or septicemia in administrative
data, with a focus on studies that have examined the validity of the algorithms. Methods: A literature search was
conducted using PubMed, the database of the Iowa Drug Information Service (IDIS/Web), and Embase. A Google
Scholar search was conducted because of difficulty identifying relevant studies. Reviews were conducted by two
investigators to identify studies using data sources from the USA or Canada, because these data sources were most
likely to reflect the coding practices of Mini-Sentinel data sources. Results: No studies that were identified that used
administrative data to identify sepsis or septicemia related to transfusion of blood products. Thus, four studies that
studied the validity of algorithms to identify sepsis and two that studied algorithms to identify allogeneic blood
transfusion are described in this review. Two studies found acceptable positive predictive values of 80% and 89% for
algorithms to identify sepsis in hospitalized patients. One study reported a negative predictive value of 80% in OBJECTIVE: Common methods for matching tooth shade can be classified into two categories: visual and
instrumental measurements. This systematic review evaluated these two methods in terms of precision and accuracy
using the agreement percentage rate., METHOD AND MATERIALS: The following databases were searched for studies
comparing different shade-matching methods: MEDLINE (PubMed), Embase, and Google Scholar. Reference lists of
relevant articles were also searched. Screening, data abstraction, and quality assessment were conducted
independently and in duplicate., RESULTS: Twenty-six studies were included. Seventeen studies provided data on the
precision of the evaluated shade-matching methods, eight provided data on accuracy, and one provided data on The purpose of this study was to provide a systematic review on the animal or human evidences linking aluminium
(Al) toxicity to oxidant/antioxidant imbalance. Embase, Scopus, Pubmed, Web of Science, Google Scholar and SID
databases were searched up to 1 st October 2010. Over 50 studies including animal and human linking oxidative
stress to Al were reviewed. Most of animal and human studies show a significant increase in lipid peroxidation (LPO)
by Al. The maximum LPO was reported in the brain. Data about changes of enzymatic antioxidants such as
Superoxide Dismutase (SOD), Catalase (CAT), Glutathione Peroxidase (GPx) post exposure to Al are controversial.
Animal studies showed that vitamin E, C, melatonin and pinoline reduce LPO in Al-exposed subjects. Al can affect
body oxidant/antioxidant balance in favor of oxidative toxic stress. Among parameters tested in various studies, LPO Objective: To identify the antifungal plants of Iran, this systematic review of the published literature on the efficacy
of Iranian medicinal plant for antifungal property conduced. The progress of this expanding scientific field will be
documented by the most important results published in the last decade. Methods: We performed an electronic
literature search of Embase, Scopus, Pub med, Google Scholar, IranMedex, SID and Cochrane up to February 2012.
Data were extracted in a standardized manner by two independent reviewers and are reviewed narrative. Primary
search terms used were medicinal plant, herb, natural or herbal medicine, antifungal, mycosis, yeast and mold
limited to Iran. The names of individual plants with antifungal effects as documented in vitro. Antifungal property
was the key outcome. We did not apply a language restriction. The classical methods include agar diffusion and the
dilution method that commonly used for the evaluation of antifungal activities. Factors influencing the in vitro
Purpose: Several prospective trials for the post-operative prophylaxis of Crohn's disease (CD) have yielded conflicting
data. We aimed to perform a systematic review comparing the efficacy of corticosteroids (CS), 5 aminosalicylates (5-
ASA), immuno-modulators (IM) and biological agents for postoperative prophylaxis to prevent recurrence of CD.
Methods: A PubMed/Medline, CENTRAL, Google Scholar search was conducted on articles from 1946 to December
31, 2011 with appropriate medical subject headings to obtain prospective trials comparing the efficacy of CS, 5ASA,
IM or biologicals for the post-operative prophylaxis of CD. Quality assessment of trials was based on the Cochrane
risk assessment score. Heterogeneity was calculated with the I square (I) statistic. All dichotomous data was analyzed
on an intention to treat basis. Forest plots were constructed when adequate studies with a follow up period
anywhere between 6 months and 36 months could be pooled for outcomes like clinical and endoscopic recurrence.
Results: When compared to placebo, budesonide (B), mesalamine (M), azathioprine/6MP (A) and infliximab (In)
demonstrated a risk ratio (RR) for clinical recurrence of 0.94 (0.67-1.32, p=0.72, I=0%), 0.83 (0.69-1.01, p=0.06,
I=22%), 0.59 (0.40-0.88, p=0.009, I=0%), 0.11 (0.01-1.73, p=0.12, I=not estimable) respectively. Pooled analysis of
each intervention to the others showed a clinical recurrence with RR of 0.97 (0.83-1.17, p=0.72, I=42%), 0.77 (0.62- OBJECTIVES: To evaluate the extent and quality of published pharmacoeconomics studies based in China. METHODS:
A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar to identify
pharmacoeconomics studies conducted in China. The keywords included different combinations of the following:
health economics, pharmacoeconomics, cost-effectiveness, and China. The inclusion criteria for the studies were as
follows: 1) original research articles; 2) written in English; 3) compared a pharmaceutical to another pharmaceutical,
treatment modality, or no treatment; and 4) conducted in China. The articles were reviewed by two independent
reviewers using the 100- point Quality of Health Economic Studies (QHES) scale for pharmacoeconomic studies and a
subjective 10-point scale for cost studies. Disagreements were settled by a third researcher. General and economic
analysis information of the articles was collected. RESULTS: A total of 19 studies were included. The studies were
published in 11 different journals between 2006 and 2012 with an average of five authors (SD=2.5). The mean QHES
scores for the 17 pharmacoeconomic studies was 80.4 (SD=9.9) and the mean quality score for the two cost studies PURPOSE: The purpose of this study was to perform a systematic review that evaluated changes in the quality of life
(QoL) of children and adolescents younger than 14 years old after oral health interventions., METHODS: The search
strategy was based on OVID, PubMed, VHL, Cochrane, and Google Scholar databases and was completed by a
manual cross-reference search. The keywords used for the search were "child" and "oral health" and "quality of life";
for Google Scholar, "before and after treatment" were also used. Articles that met the inclusion criteria were
classified considering methodological quality and risk of bias., RESULTS: A total of 1,044 articles were initially
retrieved; after excluding duplicate abstracts, 13 articles remained from the electronic search, and the manual
search of their references detected 14 new articles. The exclusion criteria eliminated 16 of these 27 articles, leaving Background: Liver transplantation (LT) offers a possible cure for carefully selected patients with hepatocellular
carcinoma (HCC). Studies report that preoperative alpha-fetoprotein (AFP) is a prognostic indicator that can predict
survival and recurrence in these patients. Aim: To undertake a systematic review of available literature on
preoperative AFP as a predictor of survival and recurrence following LT for HCC. Methods: A literature search was
performed using Medline, Embase, Cochrane Library, CINAHL and Google scholar databases to identify studies
reporting AFP as a prognostic marker in LT for HCC. Primary outcomes of interest were overall survival and
recurrence. Secondary outcomes were correlation of pre-LT AFP with vascular invasion and grade of tumour
differentiation. Results: A total of 13 studies met the inclusion criteria (12 159 patients). The majority were male
(9603, 78.9%). All were observational studies and only one prospective. Methodological quality was rated as poor for
all studies, with selection and observer bias apparent for most cohorts. Reported survival rates and recurrence rates Objective: Systematic reviews are increasing in popularity owing to the transparent, unbiased and reproducible
means by which they review published data. By virtue of the rigorous search techniques they employ, systematic
reviews can be more timeconsuming to produce than other publications. Here we used bibliometrics to evaluate
whether the added investment is reflected by a high impact on the literature. Research design and methods: All
systematic reviews, narrative reviews and primary manuscripts across three client accounts published in peer-
reviewed journals between 2003 and 2011 were included. Each paper was authored by, received professional
medical writing support from, or was coordinated by writers at Oxford PharmaGenesis. An analysis of all citations of
each paper was carried out using Google Scholar (April 2012). The time since publication and number of citable years
were calculated for each paper. Current impact factors of the publishing journals were captured using Journal
Background: Radiation therapy (RT) staffing models have traditionally been based on the number of linear
accelerators available at cancer centers (i.e., task-focused). RT treatments are becoming increasingly complex and a
novel staffing model should be established that incorporates a total quality culture (TQC) to promote process-
focused performance by using a patient-centered approach throughout the entire organization. Objectives: The
objective of this article was to conduct a systematic scoping literature review of publications that study TQC within
hospitals. The second objective was to specifically identify the publications that report on the relationship between
TQC and their current RT staffing model. Methods and Results: A systematic scoping literature review was conducted
in July 2010 using the Web of Science, Pub Med, and Google Scholar databases. Nine studies were identified that
discussed TQC in hospitals. Five of the nine studies found that a TQC is positively correlated with patient satisfaction This study aimed to systematically review the data related to the treatment of tic disorders through aripiprazole
administration, an atypical antipsychotic. The databases of MEDLINE/PubMed and Google Scholar were searched
using the key words: "aripiprazole," "tic," and "Tourette," and the relevant titles retrieved. Thirty-five articles met
the inclusion criteria and were further scrutinized. Most of the articles were case reports, and only 2 published trials
included control groups. The number of randomized double-blind controlled clinical trials was zero, therefore, no
strong evidence, provided by one, or more well-designed randomized controlled clinical trials, was found. Current Background: Common belief holds that as topical glucocorticoids are used over time the less effective they become,
a phenomenon called tolerance or tachyphylaxis. Objective: To determine what evidence supports the concept of
tachyphylaxis to glucocorticoids. Methods: We searched Medline and Google Scholar for articles on tachyphylaxis to
glucocorticoids published through October 2012. Results: Rapid tolerance, tachyphylaxis, to non-clinical effects of
glucocorticoids has been reported in literature. However, clinically significant tolerance to topical glucocorticoids has
not been identified in clinical trials. We did not identify any evidence that clinical efficacy of glucocorticoids in
inflammatory skin diseases significantly diminishes during long term continuous use. Limitations: Tachyphylaxis or OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical trial data, efficacy data, and adverse effect
incidence of tafluprost. DATA SOURCES: A literature search was completed using PubMed, Web of Science, and
Google Scholar. Tafluprost was the primary search term. Articles published between January 2008 and April 2012
were included in this review. Additional limits placed on the searches were "human" and "English." Citations in which
tafluprost appeared in the title were 36, 29, and more than 300 in PubMed, Web of Science, and Google Scholar,
respectively. STUDY SELECTION AND DATA EXTRACTION: Three clinical trials were included in this review. One trial
enrolled more than 500 subjects in a randomized fashion. Another also enrolled more than 500 subjects, although
the study design was not randomized. The third trial evaluated the effects of tafluprost on subjects who had recently
discontinued use of latanoprost, another prostaglandin that is approved to treat glaucoma and ocular hypertension.
The duration of all 3 trials was 12 weeks. DATA SYNTHESIS: Tafluprost 0.0015% is the first topical prostaglandin
approved by the Food and Drug Administration for treatment of open-angle glaucoma and ocular hypertension that
does not contain the widely used preservative, benzalkonium chloride (BAK). Although some controversy surrounds
the longterm safety of exposure to BAK, clinical trial data are inconclusive. Tafluprost, like other prostaglandin
analogues, exerts its effects on prostaglandin F receptors to reduce intraocular pressure (IOP). Results from 1 trial Background: Takotsubo Cardiomyopathy (TTC) is commonly triggered by acute illness, physical or emotional stress
and has been associated with elevated catecholamine levels. TTC has also been associated with pheochromocytoma
(TTC-pheo). Methods: We performed a computer assisted search of the electronic databases Medline, Scopus and
Google Scholar from 1965 to January 2011. All case reports with reported TTC-pheo were selected and compared to
a recent review by Gianni et al. which examined primary TTC (TTC-primary). Statistics: Data analysis was performed
using SPSS version 18. Chi-square test of Fisher's exact test was used as appropriate to compare categorical data.
Results: 38 cases of TTC-pheo were retrieved from literature and compared to 254 cases of TTC-p. Chest pain was
the most common presentation in both groups. The TTC-pheo patients were on average 18 years younger than
patients with TTC-p (p < 0.01). Only a minority of TTC-pheo patients presented with classical features of
pheochromocytoma including hypertension (52.6%), headache (28.9%), palpitations (31.6 %), and diaphoresis
(26.3%). In TTC-pheo complications rates were higher compared to TTC-p, including cardiogenic shock (34.2% vs. Poisoning morbidity and mortality is high in the developing world. Systems for care of poisoned patients differ
markedly between countries. In this paper a comparison of two very different systems for the care of poisoned
patients, is presented. Specifically, the role of poison centers and poison treatment centers in the US and Iran are
contrasted. A systematic literature search was undertaken utilizing the PubMed, Scopus, and Google Scholar and the
keywords "poison centers", "treatment" "Iran" "United States of America" and 100 publications were identified.
From these, relevant data were found in 23 publications. The information was double-checked and data were
summarized herein.We find that the system of the care of poisoned patients relies heavily on certified poison centers
in the US and that only a few hospitals have well developed medical toxicology services. In contrast, in Iran, the
Objective: This is a systematic review of the existing literature to examine the burden and profile of stroke in the
WHO African region and proffer coordinated and responsive means of tackling the epidemic. Background Africa is
currently experiencing epidemiological transition with growing burden of stroke and other non-communicable
diseases, initially adding to the infectious and poverty-related disease burden and later becoming the dominant
causes of death and disability. There is inadequate pooled data describing the total burden of stroke in Africa.
Design/Methods: A systematic review of the literature was conducted according to the Centre for Reviews and
Dissemination Guidelines using Pubmed, African Journals On-Line and Google Scholar databases. Over 1300 articles
were obtained. All abstracts were screened, and every article that might have contained relevant information was
read in full. Their heterogeneity made meta-analysis impossible. So a critical assessment of the data with a narrative
review was conducted. Results: Stroke has an annual incidence rate of up to 316 per 100 000, a prevalence rate of up
to 315 per 100 000 and a 3-year fatality of up to 84% in Africa. In 2002, model-based estimated age-adjusted stroke Globally, stroke is the second leading cause of death. This is a systematic review of the existing literature to examine
the burden and profile of stroke in the World Health Organization (WHO) African region and proffer coordinated and
responsive means to tackle the epidemic. A systematic review of the literature was conducted according to the
Centre for Reviews and Dissemination Guidelines using Pubmed, African Journals On-Line and Google Scholar
databases. Over 1300 articles were obtained. All abstracts were screened, and every article that might have
contained relevant information was read in full. Their heterogeneity made meta-analysis impossible. So a critical
assessment of the data with a narrative review was conducted. Stroke has an annual incidence rate of up to 316 per
100 000, a prevalence rate of up to 315 per 100 000 and a three-year fatality of up to 84% in Africa. In 2002, model-
based estimated age-adjusted stroke mortality rates ranged between 168 and 179 per 100 000 population for
countries in the African region. There is severe scarcity of facilities and human resources for prevention, INTRODUCTION: Chronic pain reduces quality of life, utilizes healthcare resources, and increases healthcare costs. It
is widespread, but generally inadequately treated or managed, partly due to several obstacles, including a limited
number of mechanistic options for long-term pharmacologic agents. Opioids are generally the primary class of
analgesic prescribed, but because of associated side effects during long-term treatment, many patients become
noncompliant or discontinue treatment. A long-term use analgesic with a good benefit/risk ratio is advantageous.,
METHODS: A literature search for randomized trials using tapentadol extended release (ER) for noncancer chronic
pain patients was conducted. Databases searched included PubMed, MEDLINE, EMBASE, and Google Scholar, using
key terms "tapentadol," "prolonged release," "extended release," and "chronic pain" individually or in combination.
The results were synthesized and evaluated., RESULTS: A total of six randomized, controlled studies were identified.
Chronic pain conditions analyzed included low back, osteoarthritis, and diabetic peripheral neuropathy. Treatment
arms consisted most often of placebo, tapentadol ER (100-250 mg twice daily [b.i.d.]), and/or oxycodone CR
(controlled release) (20-50 mg b.i.d.). Subjects treated with tapentadol ER had significant reduction in pain intensity Objective: To review the role of tapentadol in the treatment of moderate-to-severe acute pain. Data Sources:
Primary literature was retrieved by searching MEDLINE (1950-August Week 3, 2010), EMBASE (1980-Week 34, 2010),
International Pharmaceutical Abstracts (1970-August 2010), and Google Scholar, A bibliographic review of published
articles was also performed. Search terms included tapentadol, Nucynta, and acute pain. Study Selection and Data
Extraction: Randomized controlled trials available in the English language that evaluated the efficacy and/or safety of
tapentadol were included in this review. Data Synthesis: Tapentadol is a centrally acting analgesic that
simultaneously activates mu-opioid receptors and inhibits the reuptake of norepinephrine in the central nervous
system without affecting serotonin reuptake. We identified 6 randomized controlled trials that evaluated the use of
tapentadol in over 3,000 adult patients in various acute pain models. Tapentadol was found to be superior to placebo Depression is a complex progressive disorder accompanied by activation of inflammatory and Th-1 driven pathways,
oxidative and nitrosative stress (O&NS), lowered antioxidant levels, mitochondrial dysfunctions, neuroprogression
and increased bacterial translocation. In depression, activation of immuno-inflammatory pathways is associated with
an increased risk for cardio-vascular disorder (CVD). Because of the inflammatory component, the use of
cyclooxygenase 2 (COX-2) inhibitors, such as celecoxib, has been advocated to treat depression. Electronic
databases, i.e. PUBMED, Scopus and Google Scholar were used as sources for this selective review on the effects of
COX-2 inhibitors aggravating the abovementioned pathways. COX-2 inhibitors may induce neuroinflammation,
exacerbate Th1 driven responses, increase lipid peroxidation, decrease the levels of key antioxidants, damage
mitochondria and aggravate neuroprogression. COX-2 inhibitors may aggravate bacterial translocation and CVD
Introduction: Depression is associated with inflammation, Th1 and Th17 responses, oxidative and nitrosative stress
(O&NS), autoimmune responses against neoantigenic determinants, and neuroprogression (i.e., neurodegeneration,
impaired plasticity and reduced neurogenesis). These pathways involve increased monocytic activation and
interleukin-1 (IL-1) levels. Areas covered: This review will highlight the putative role of IL-1 in depression and the
potential use of IL-1 signaling blockade as a treatment of depression. Electronic databases, i.e., Scopus, PUBMED and
Google Scholar were employed using keywords: depression, depressive-like, interleukin-1, and interleukin-1 receptor
antagonist (IL-1RA). Expert opinion: Ample studies show that depression is accompanied by increased levels of IL-1
and IL-1RA, which attenuates the pro-inflammatory activities of IL-1. In some, but not all studies, antidepressant Objective: To review the available methods of evaluating the small airways disease in asthma and the therapeutic
strategies to achieve better control using emerging extrafine particle inhaler technologies. Data Sources: The
PubMed, MEDLINE (Ebsco), Scirus, Scopus, and Google Scholar databases were all scanned with Cross-search using
the following keywords: asthma, small airways, hydrofluoroalkane 134a, extrafine particle, inhaled corticosteroid,
long-acting beta-agonist, spirometry, impulse oscillometry, nitrogen washout, exhaled nitric oxide, airway
hyperresponsiveness, and adrenal suppression. Study Selection: Key clinical studies considered to being relevant to
the topic under review were evaluated. Results: There is an unmet need in current asthma guidelines for those
individuals who exhibit the small airways asthma phenotype with a preserved forced expiratory volume in 1 second
but abnormal forced midexpiratory flow and peripheral airway resistance, which tends to be associated with poorer Background and objective: The accuracy of cause-of-death statistics substantially depends on the quality of cause-of-
death information in death certificates, primarily completed by medical doctors. Deficiencies in cause-of-death
certification have been observed across the world, and over time. Despite educational interventions targeted at
improving the quality of death certification, their intended impacts are rarely evaluated. This review aims to provide
empirical evidence that could guide the modification of existing educational programmes, or the development of
new interventions, which are necessary to improve the capacity of certifiers as well as the quality of cause-of-death
certification, and thereby, the quality of mortality statistics. Design: A literature review using keywords: death;
certification; education/training. Data sources: The primary search through PubMed. Reference lists in individual
articles from the primary search and also manual searching of other databases such as Google Scholar and
OpenDOAR. Eligibility criteria for selecting studies: Evaluation studies which assessed educational interventions for
medical students and doctors on correct completion of death certificates. Results: All educational interventions Systematic reviews were performed to assess methods of teaching the evidence-based medicine (EBM) process and
determine which format or what components of journal club appear to be most effective in teaching critical appraisal
skills to surgical residents and have the highest user satisfaction. MEDLINE, Embase, Web of Science, AMED,
PsychINFO, PubMed, Cochrane Library, and Google scholar were searched to identify relevant articles. To be
included, studies had to provide details about the format of their EBM curriculum or journal club and report on the
effectiveness or participant satisfaction. Potentially relevant articles were independently reviewed by 2 authors and
data were extracted on separate data forms. Seven studies met the inclusion criteria for assessment of teaching EBM
and 8 studies (including 3 in the EBM systematic review) met criteria for assessment of journal club format. Overall,
study quality was poor. Only 2 studies were randomized controlled trials. Five were before-after studies, which
showed significant improvement in critical appraisal skills or statistical knowledge following an EBM course or journal
club. The 2 randomized controlled trials (RCTs) compared teaching EBM or critical appraisal skills in lecture format or OBJECTIVE: Systematic reviews were performed to assess methods of teaching the evidence-based medicine (EBM)
process and determine which format or what components of journal club appear to be most effective in teaching
critical appraisal skills to surgical residents and have the highest user satisfaction., DESIGN: MEDLINE, Embase, Web
of Science, AMED, PsychINFO, PubMed, Cochrane Library, and Google scholar were searched to identify relevant
articles. To be included, studies had to provide details about the format of their EBM curriculum or journal club and
report on the effectiveness or participant satisfaction. Potentially relevant articles were independently reviewed by 2
authors and data were extracted on separate data forms., RESULTS: Seven studies met the inclusion criteria for
assessment of teaching EBM and 8 studies (including 3 in the EBM systematic review) met criteria for assessment of
journal club format. Overall, study quality was poor. Only 2 studies were randomized controlled trials. Five were
before-after studies, which showed significant improvement in critical appraisal skills or statistical knowledge
following an EBM course or journal club. The 2 randomized controlled trials (RCTs) compared teaching EBM or critical
Background and Goal of Study: The dynamic, complex and variable nature of hospital work presents significant
coordination challenges. Clinicians spend much time gathering and sharing information in order to coordinate their
work, and their means are often ad hoc and interruptive. We hypothesized that technology may have advanced to
such a degree that there would be literature reports of successful implementations wherein new technologies had
been used to achieve more effective coordination and mitigate the workload it imposes on hospital staff. Materials
and Methods: We did a literature search for novel technologies used for coordination in hospitals in the following
electronic databases: PubMed, International Journal of Medical Informatics, ACM Digital library, IEEE Xplore,
CiteSeer, and Google Scholar. Results and Discussion: We identified 13 primary studies and two secondary studies.
The degree to which the technologies were realized varied from concept proposals to fully deployed systems. Six of
the systems were tested in actual hospital settings. We identified four main strategies used to increase clinicians'
situational awareness and support coordination: 1) Location tracking of staff and equipment; 2) visulization of
ongoing activities and processes; 3) communication support; and 4) access to and integration with existing hospital
information systems. Most of the proposed systems utilized two or more of these modalities. While some of the Background: Telavancin, a lipoglycopeptide antibiotic, is a semisynthetic derivative of vancomycin. It was approved
by the US Food and Drug Administration (FDA) in 2009 for the treatment of complicated skin and skin structure
infections (cSSSIs) caused by grampositive bacteria, including methicillin-resistant Staphylococcus aureus.Objective:
This article summarizes the pharmacology, in vitro and in vivo activity, pharmacokinetic properties, and clinical
efficacy and tolerability of telavancin.Methods: Relevant information was identified through a search of MEDLINE
(1966-August 2010), Iowa Drug Information Service (1966-August 2010), International Pharmaceutical Abstracts
(1970-August 2010), and Google Scholar using the terms telavancin, lipoglycopeptide, and TD-6424. Abstracts and
posters from scientific meetings, as well as documents submitted by the manufacturer of telavancin to the FDA as
part of the approval process, were consulted. In vivo and in vitro experimental and clinical studies and review articles
that provided information on the activity, mechanism of action, pharmacologic and pharmacokinetic properties,
clinical efficacy, and tolerability of telavancin were reviewed.Results: In vitro, telavancin has potent activity against S
aureus, including methicillin-resistant strains; Streptococcus pneumoniae; and vancomycin-susceptible enterococci
with MICs generally <1 mug/mL. Telavancin appears to have a dual mechanism of action, inhibiting cell wall
formation and disrupting the cell membrane. In Phase III studies (ATLAS 1 and ATLAS 2), telavancin was found to be Veterinary surgeons have a long tradition of consulting one another about problem cases and many have unwittingly
practised telemedicine when discussing cases by telephone or by sending laboratory reports by telefax. Specific
veterinary telemedicine applications have been in use since the early 1980s, but little research has been undertaken
in this field. The Pubmed and CAB International databases were searched for the following Boolean logic-linked
keywords; veterinary AND telemedicine, veterinary AND telecare, animal AND telemedicine, animal AND telecare
and veterinary AND e-mail and an additional search was made of the worldwide web, using Google Scholar. This
returned 25 papers which were reviewed. Of these only 2 report research. Sixteen papers had no references and 1
author was associated with 13 papers. Several themes emerge in the papers reviewed. These include remarks about
the use of telemedicine, the benefits that can and are derived from the use of telemedicine, areas of practice in A literature review was conducted to identify research into multiple-contact (i.e. extended) telemedicine
interventions for substance-use disorder. The goals were: (1) to describe the methodology used to evaluate
telemedicine interventions; (2) to identify the range of interventions which have been formally evaluated; and (3) to
summarize the findings. Fourteen databases and Google Scholar were searched, as well as bibliographies of relevant
papers and online conference abstracts. There were 50 studies which met the inclusion criteria, of which 50% were
randomized controlled trials. The studies most frequently reported the effect on substance use and 61% of those
findings fully supported telemedicine interventions. Although the studies reported persistent challenges in sustaining
This is one of three Cochrane reviews that examine the role of the telephone in HIV/AIDS services. Both in developed
and developing countries there is a large proportion of people who do not know they are infected with HIV.
Knowledge of one's own HIV serostatus is necessary to access HIV support, care and treatment and to prevent
acquisition or further transmission of HIV. Using telephones instead of face-to-face or other means of HIV test results
delivery could lead to more people receiving their HIV test results. To assess the effectiveness of telephone use for
delivery of HIV test results and post-test counselling.To evaluate the effectiveness of delivering HIV test results by
telephone, we were interested in whether they can increase the proportion of people who receive their HIV test
results and the number of people knowing their HIV status. We searched The Cochrane Central Register of Controlled
Trials (CENTRAL), MEDLINE, PubMed Central, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied
Health (CINAHL), WHOs The Global Health Library and Current Controlled Trials from 1980 to June 2011. We also
searched grey literature sources such as Dissertation Abstracts International,CAB Direct Global Health, OpenSIGLE,
The Healthcare Management Information Consortium, Google Scholar, Conference on Retroviruses and
Opportunistic Infections, International AIDS Society and AEGIS Education Global Information System, and reference
lists of relevant studies for this review. Randomised controlled trials (RCTs), quasi-randomised controlled trials
(qRCTs), controlled before and after studies (CBAs), and interrupted time series (ITS) studies comparing the
effectiveness of telephone HIV test results notification and post-test counselling to face-to-face or other ways of HIV
test result delivery in people regardless of their demographic characteristics and in all settings. Two reviewers
independently searched, screened, assessed study quality and extracted data. A third reviewer resolved any
disagreement. Out of 14 717 citations, only one study met the inclusion criteria; an RCT conducted on homeless and
high-risk youth between September 1998 and October 1999 in Portland, United States. Participants (n=351) were
offered counselling and oral HIV testing and were randomised into face-to-face (n=187 participants) and telephone BACKGROUND: This is one of three Cochrane reviews that examine the role of the telephone in HIV/AIDS services.
Both in developed and developing countries there is a large proportion of people who do not know they are infected
with HIV. Knowledge of one's own HIV serostatus is necessary to access HIV support, care and treatment and to
prevent acquisition or further transmission of HIV. Using telephones instead of face-to-face or other means of HIV
test results delivery could lead to more people receiving their HIV test results., OBJECTIVES: To assess the
effectiveness of telephone use for delivery of HIV test results and post-test counselling.To evaluate the effectiveness
of delivering HIV test results by telephone, we were interested in whether they can increase the proportion of
people who receive their HIV test results and the number of people knowing their HIV status., SEARCH METHODS:
We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed Central, PsycINFO, ISI
Web of Science, Cumulative Index to Nursing & Allied Health (CINAHL), WHOs The Global Health Library and Current
Controlled Trials from 1980 to June 2011. We also searched grey literature sources such as Dissertation Abstracts
International,CAB Direct Global Health, OpenSIGLE, The Healthcare Management Information Consortium, Google
Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society and AEGIS Education
Global Information System, and reference lists of relevant studies for this review., SELECTION CRITERIA: Randomised
controlled trials (RCTs), quasi-randomised controlled trials (qRCTs), controlled before and after studies (CBAs), and
interrupted time series (ITS) studies comparing the effectiveness of telephone HIV test results notification and post-
test counselling to face-to-face or other ways of HIV test result delivery in people regardless of their demographic
characteristics and in all settings., DATA COLLECTION AND ANALYSIS: Two reviewers independently searched,
screened, assessed study quality and extracted data. A third reviewer resolved any disagreement., MAIN RESULTS:
Out of 14 717 citations, only one study met the inclusion criteria; an RCT conducted on homeless and high-risk youth
between September 1998 and October 1999 in Portland, United States. Participants (n=351) were offered
BACKGROUND: This is one of the three Cochrane reviews that examine the role of the telephone in HIV/AIDS
services. Although HIV infection can be prevented, still a large number of new infections occur. More effective HIV
prevention interventions are needed to reduce the number of people newly infected with HIV. Phone calls can be
used to potentially more effectively deliver HIV prevention interventions. They have the potential to save time,
reduce costs and facilitate easier access., OBJECTIVES: To assess the effectiveness of voice landline and mobile
telephone delivered HIV prevention interventions in HIV-negative persons., SEARCH METHODS: We searched the
Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, Web of Science,
Cumulative Index to Nursing & Allied Health, the World Health Organization's Global Health Library and Current
Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts
International and the CentreforAgriculturalBioscienceInternational Direct Global Health database, the System for
Information on Grey Literature Europe, The Healthcare Management Information Consortium, Google Scholar,
Conference on Retroviruses and Opportunistic Infections database, International AIDS Society conference database,
AIDS Education Global Information System and reference lists of articles., SELECTION CRITERIA: Randomised
controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time
series studies comparing the effectiveness of delivering HIV prevention by phone calls to usual care in HIV-negative
people regardless of their demographic characteristics and in all settings., DATA COLLECTION AND ANALYSIS: Two
reviewers independently searched databases, screened citations, assessed study quality and extracted data. A third
reviewer resolved any disagreement. Primary outcomes were knowledge about the causes and consequences of
HIV/AIDS, change in behaviour, healthcare uptake and clinical outcomes. Secondary outcomes were users' and
providers' views on the intervention, economic outcomes and adverse outcomes., MAIN RESULTS: Out of 14,717
citations, only one study met the inclusion criteria. The included RCT recruited women and girl children who received
post-exposure prophylaxis (PEP) after rape from sexual assault services in South Africa between August 2007 and BACKGROUND: This is one of three Cochrane reviews examining the role of the telephone in HIV/AIDS services.
Telephone interventions, delivered either by landline or mobile phone, may be useful in the management of people
living with HIV (PLHIV) in many situations. Telephone delivered interventions have the potential to reduce costs, save
time and facilitate more support for PLHIV., OBJECTIVES: To assess the effectiveness of voice landline and mobile
telephone delivered interventions for reducing morbidity and mortality in people with HIV infection., SEARCH
METHODS: We searched The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE,
PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health, World Health Organisation's The Global
Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature
sources: Dissertation Abstracts International, Centre for Agriculture Bioscience International Direct Global Health
database, The System for Information on Grey Literature Europe, The Healthcare Management Information
Consortium database, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS
Society, AIDS Educational Global Information System and reference lists of articles., SELECTION CRITERIA:
Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and
interrupted time series studies comparing the effectiveness of telephone delivered interventions for reducing
morbidity and mortality in persons with HIV infection versus in-person interventions or usual care, regardless of
demographic characteristics and in all settings.Both mobile and landline telephone interventions were included, but
mobile phone messaging interventions were excluded., DATA COLLECTION AND ANALYSIS: Two reviewers
independently searched, screened, assessed study quality and extracted data. Primary outcomes were change in
behaviour, healthcare uptake or clinical outcomes. Secondary outcomes were appropriateness of the mode of
Background Several recent studies have provided evidence that polymorphisms in the telomerase reverse
transcriptase (TERT) gene sequence are associated with cancer development, but a comprehensive synopsis is not
available. We conducted a systematic review and meta-analysis of the available molecular epidemiology data
regarding the association between TERT locus polymorphisms and predisposition to cancer.MethodsA systematic
review of the English literature was conducted by searching PubMed, Embase, Cancerlit, Google Scholar, and ISI Web
of Knowledge databases for studies on associations between TERT locus polymorphisms and cancer risk. Random-
effects meta-analysis was performed to pool per-allele odds ratios for TERT locus polymorphisms and risk of cancer,
and between-study heterogeneity and potential bias sources (eg, publication and chasing bias) were assessed.
Because the TERT locus includes the cleft lip and palate transmembrane 1-like (CLPTM1L) gene, which is in linkage
disequilibrium with TERT, CLPTM1L polymorphisms were also analyzed. Cumulative evidence for polymorphisms with
statistically significant associations was graded as "strong," "moderate," and "weak" according to the Venice criteria.
The joint population attributable risk was calculated for polymorphisms with strong evidence of
association.ResultsEighty-five studies enrolling 490901 subjects and reporting on 494 allelic contrasts were retrieved. Background: Internal hernias occur frequently after laparoscopic gastric bypass. We have found no data in Pubmed
or Google Scholar on the relative strength of the various techniques available for closing these defects. The present
study was performed to obtain such data in order to form a theoretical basis for clinical studies. Material and
methods: Six piglets were operated laparoscopically and four loops of small bowel created. These mesenteric gaps
were closed over a distance of 40 mm using I/ running 2-0 Ethibond suture, II/ Endohernia stapler III/ fibrin glue
(Tisseel) and IV/ controls where the mesenteric surfaces were rubbed with a sponge and approximated without
further intervention. After 6 weeks the different segments of the mesentery were excised. The tensile strength was
measured using continuously increased traction until the closure ruptured. Ordinary mesentery served as control.
The breaking tension and total amount of energy transferred to tissue were registered. Results: Control areas with OBJECTIVE: To review the pharmacology, pharmacokinetics, safety, and efficacy of teplizumab and evaluate relevant
clinical trial data. DATA SOURCES: Searches of MEDLINE, International Pharmaceutical Abstracts, ClinicalTrials.gov,
American Diabetes Association scientific posters, and Google Scholar (1966-May 2012) were conducted using the key
words teplizumab, anti-CD3 monoclonal antibody, MGA031, and hOKT31 (Ala-Ala). Searches were limited to articles
published in English. STUDY SELECTION AND DATA EXTRACTION: Clinical trials evaluating teplizumab for type 1
diabetes mellitus (T1DM) published in English were selected from the data sources. All published relevant abstracts
were included. References cited in identified articles were used for additional citations. DATA SYNTHESIS: T1DM
accounts for up to 10% of all cases of diabetes mellitus. T1DM is characterized as a chronic and progressive
autoimmune disease leading to the destruction of insulin-producing beta-cells of the pancreas. Teplizumab is a
humanized Fc-mutated anti-CD3 monoclonal antibody that alters the function of the T-lymphocytes that mediate the
destruction of the insulin-producing beta-cells. While clinical data are limited, both Phase 2 and Phase 3 studies have Background: Combined pharmacologic (vasoactive agents) and endoscopic therapy remains the mainstay of
treatment in acute variceal esophageal bleeding among cirrhotics. Terlipressin, a synthetic vasopressin analog,
reduces portal pressure and has been shown to improve variceal bleeding and improve survival compared to
placebo. Octreotide, a synthetic somatostatin analogue, shows a similar mechanism and appears to be equivalent to
terlipressin in controlling variceal bleeding. Thus, this study aims to compare the efficacy of terlipressin and
octreotide in controlling acute bleeding from esophageal varices among cirrhotic patients. Methods: Cochrane
Library, Pubmed, EMBASE, Google Scholar, LILAC databases were searched for randomized controlled trials (RCTs)
published until May 2011 comparing the efficacy of terlipressin and octreotide in controlling bleeding from acute
esophageal varices. Cross-reference was also done. Using Jadad scale, two independent reviewers evaluated the
methodologic criteria of each study while a third reviewer settled any disputes. Analysis was done using odds ratio as OBJECTIVE: To investigate the efficacy of terpene compound drug(Pinene, Camphene, Borneol, Anethole, Fenchone
and Cineol in Olive oil) in facilitating spontaneous passage of ureteral calculi through meta-analysis of randomized
controlled trials(RCT). METHODS: Systematic literature search on MEDLINE, EMBASE, OVID, Science Direct, Proquest,
Google scholar, Cochrane Library databases and reference list of related literatures was done without language
restriction. RCTs on ureterolithiasis medical expulsive therapy(MET) that compare terpene compound drug versus
placebo/control group or alpha-blockers were identified. Articles retrieved were critically appraised by two
independent reviewers according to Cochrane Collaboration recommendations. Data from included studies were
extracted for calculation of risk ratio(RR) and 95% confidence interval(CI). Effect estimates were pooled using Mantel-
Haenszel method with random effect model. Inter-study heterogeneity and publication bias were assessed. The
PRISMA guidelines for metaanalysis reporting were followed. RESULTS: Five RCTs (total of 344 subjects) of adequate
methodological quality were included. Pooled effect estimates from homogenous studies showed that compared to
The aim of this study is to investigate the efficacy of terpene compound drug (pinene, camphene, borneol, anethole,
fenchone and cineol in olive oil) in facilitating spontaneous passage of ureteral calculi through meta-analysis of
randomized controlled trials (RCT). Systematic literature search on MEDLINE, EMBASE, OVID, Science Direct,
Proquest, Google scholar, Cochrane Library databases and reference list of related literatures were done without
language restriction. RCTs on ureterolithiasis medical expulsive therapy (MET) that compare terpene compound drug
versus placebo/control group or alpha-blockers were identified. Articles retrieved were critically appraised by two
extracted for calculation of risk ratio (RR) and 95 % confidence interval (CI). Effect estimates were pooled using
Mantel-Haenszel method with random effect model. Inter-study heterogeneity and publication bias were assessed.
The PRISMA guidelines for meta-analysis reporting were followed. Five RCTs (total of 344 subjects) of adequate
methodological quality were included. Pooled effect estimates from homogenous studies showed that compared to The aim of this study is to investigate the efficacy of terpene compound drug (pinene, camphene, borneol, anethole,
fenchone and cineol in olive oil) in facilitating spontaneous passage of ureteral calculi through meta-analysis of
randomized controlled trials (RCT). Systematic literature search on MEDLINE, EMBASE, OVID, Science Direct,
Proquest, Google scholar, Cochrane Library databases and reference list of related literatures were done without
language restriction. RCTs on ureterolithiasis medical expulsive therapy (MET) that compare terpene compound drug
versus placebo/control group or alpha-blockers were identified. Articles retrieved were critically appraised by two
extracted for calculation of risk ratio (RR) and 95 % confidence interval (CI). Effect estimates were pooled using
Mantel-Haenszel method with random effect model. Inter-study heterogeneity and publication bias were assessed.
The PRISMA guidelines for meta-analysis reporting were followed. Five RCTs (total of 344 subjects) of adequate
methodological quality were included. Pooled effect estimates from homogenous studies showed that compared to Objective: To evaluate the therapeutic trajectory of intra-articular hyaluronic acid (IAHA) vs placebo for knee
osteoarthritis (OA). Design: Our data sources include Medline, EMBASE, CINAHL, BIOSIS, Web of Science, Google
Scholar, Cochrane database; hand searched reviews, manuscripts, and, supplements; author contacts for
unpublished data. Randomized trials that reported effects of IAHA vs placebo on knee OA were selected based on
inclusion criteria. We computed effect sizes for change from baseline at 4, 8, 12, 16, 20 and 24 weeks, using Bayesian
random effects model. We performed multivariate analyses adjusting for correlation between time points. Meta-
regressions were performed adjusting for potential confounders. Results: The 54 eligible trials included 7545
participants. The conduct and quality of these trials varied in number of aspects. The effect size (ES) favored IAHA by
week 4 (0.31; 95% CI 0.17, 0.45), reaching peak at week 8 (0.46; 0.28, 0.65), and then trending downwards, with a
residual detectable effect at week 24 (0.21; 0.10, 0.31). This therapeutic trajectory was consistent among the subset
of high quality trials and on multivariate analysis adjusting for correlation between time points. Conclusions: Our Purpose: Hyaluronic acid (HA) injections are safe but costly interventions that are widely used for knee osteoarthritis
(OA) despite views that evidence for their efficacy is weak. Indeed, systematic reviews have generated conflicting
results, hampered by low quality of trials available for metaanalysis and possible conflicts of interest. However, these
meta-analyses did not evaluate the post-injection trajectory of its therapeutic effect, an aspect that would provide
meaningful insight into its effectiveness, nor did they benefit from the extent of data now available. Therefore, we
performed a meta-analysis using fully current data to evaluate the magnitude of effect of hyaluronic acid at specified
intervals post-treatment with adjustment for trial quality indicators. Methods: We searched Medline, EMBASE,
CINAHL, BIOSIS, Cochrane database, Web of Science and Google Scholar from inception to March 2010 for human
randomized clinical trials comparing hyaluronic acid vs. placebo for knee OA. We hand searched review articles,
manuscripts and medical journal supplements, and contacted authors for unpublished data. Two reviewers
independently assessed the quality of each trial and extracted means and variances for pain, function and stiffness.
We computed effect sizes for mean change from baseline to weeks 4, 8, 12, 16, 20 and 24 using Hedges' g statistic.
Effect sizes were pooled using random effects model. We defined "high quality trials" as those with N>100 also
reporting intent-to-treat analysis, blinding, and allocation concealment. We performed sensitivity analyses by pooling
high quality trials and multivariate analyses adjusting for correlation between time points. Results: The 54 eligible
trials published during 1983-2009 included 7545 participants with age range 45-72 yrs. The proportion of women
ranged 28% - 100%. There were 16 high quality trials (n = 3176) and 8 were unpublished (n = 963). Industry affiliation
OBJECTIVE: To evaluate the therapeutic trajectory of intra-articular hyaluronic acid (IAHA) vs placebo for knee
osteoarthritis (OA)., DESIGN: Our data sources include Medline, EMBASE, CINAHL, BIOSIS, Web of Science, Google
Scholar, Cochrane database; hand searched reviews, manuscripts, and, supplements; author contacts for
unpublished data. Randomized trials that reported effects of IAHA vs placebo on knee OA were selected based on
inclusion criteria. We computed effect sizes for change from baseline at 4, 8, 12, 16, 20 and 24 weeks, using Bayesian
random effects model. We performed multivariate analyses adjusting for correlation between time points. Meta-
regressions were performed adjusting for potential confounders., RESULTS: The 54 eligible trials included 7545
participants. The conduct and quality of these trials varied in number of aspects. The effect size (ES) favored IAHA by
week 4 (0.31; 95% CI 0.17, 0.45), reaching peak at week 8 (0.46; 0.28, 0.65), and then trending downwards, with a
residual detectable effect at week 24 (0.21; 0.10, 0.31). This therapeutic trajectory was consistent among the subset
of high quality trials and on multivariate analysis adjusting for correlation between time points., CONCLUSIONS: Our OBJECTIVE: To evaluate the outcomes of thoracolaparoscopic esophagectomy venus open esophagectomy for
esophageal cancer., METHODS: Literature search was performed using PubMed, Embase, Cochrane Library, and
Google Scholar databases, CBM, and CNKI from inception to July 2011 for comparative studies assessing
thoracolaparoscopic esophagectomy and open esophagectomy. Data were extracted and evaluated by two reviewers
independently according to the Cochrane Handbook for Systematic Reviews. Meta-analyses were conducted using
RevMan 5.1., RESULTS: A total of 10 studies involving 1017 patients were included for the analysis. Four hundred and
fifty-five patients underwent thoracolaparoscopic esophagectomy and 562 patients underwent open
esophagectomy. There were no significant differences between the two groups in anastomotic leak, 30-day Background: Minimally invasive esophageal surgery has arisen in an attempt to reduce the significant complications
associated with esophagectomy. Despite proposed technical and physiological advantages, the prone position
technique has not been widely adopted. This article reviews the current status of prone thoracoscopic
esophagectomy. Methods: A systematic literature search was performed to identify all published clinical studies
related to prone esophagectomy. Medline, EMBASE and Google Scholar were searched using the keywords "prone",
"thoracoscopic", and " esophagectomy" to identify articles published between January 1994 and September 2010. A
critical review of these studies is given, and where appropriate the technique is compared to the more traditional
minimally invasive technique utilising the left lateral decubitus position. Results: Twelve articles reporting the
outcomes following prone thoracoscopic oesophagectomy were tabulated. These studies were all non-randomised
single-centre prospective or retrospective studies of which four compared the technique to traditional minimally Background:The vast majority of medical interventions introduced into clinical development prove unsafe or
ineffective. One prominent explanation for the dismal success rate is flawed preclinical research. We conducted a
systematic review of preclinical research guidelines and organized recommendations according to the type of validity
threat (internal, construct, or external) or programmatic research activity they primarily address.Methods and
Findings:We searched MEDLINE, Google Scholar, Google, and the EQUATOR Network website for all preclinical
guideline documents published up to April 9, 2013 that addressed the design and conduct of in vivo animal
experiments aimed at supporting clinical translation. To be eligible, documents had to provide guidance on the
design or execution of preclinical animal experiments and represent the aggregated consensus of four or more
investigators. Data from included guidelines were independently extracted by two individuals for discrete
recommendations on the design and implementation of preclinical efficacy studies. These recommendations were
then organized according to the type of validity threat they addressed. A total of 2,029 citations were identified Background: Researchers turn to citation tracking to find the most influential articles for a particular topic and to see
how often their own published papers are cited. For years researchers looking for this type of information had only
one resource to consult: the Web of Science from Thomson Scientific. In 2004 two competitors emerged - Scopus
from Elsevier and Google Scholar from Google. The research reported here uses citation analysis in an observational
study examining these three databases; comparing citation counts for articles from two disciplines (oncology and
condensed matter physics) and two years (1993 and 2003) to test the hypothesis that the different scholarly
publication coverage provided by the three search tools will lead to different citation counts from each. Methods:
Eleven journal titles with varying impact factors were selected from each discipline (oncology and condensed matter
physics) using the Journal Citation Reports (JCR). All articles published in the selected titles were retrieved for the
years 1993 and 2003, and a stratified random sample of articles was chosen, resulting in four sets of articles. During
the week of November 7-12, 2005, the citation counts for each research article were extracted from the three
sources. The actual citing references for a subset of the articles published in 2003 were also gathered from each of
the three sources. Results: For oncology 1993 Web of Science returned the highest average number of citations,
45.3. Scopus returned the highest average number of citations (8.9) for oncology 2003. Web of Science returned the
Background: Thrombocytopenia following percutaneous coronary intervention (PCI) is an underappreciated
condition that is often clinically challenging. There are no guidelines on the management of patients with this
condition. Objective: To review recent data in etiologies, risk factors, prevention, management, and prognostic
implications of thrombocytopenia following PCI. Evidence Acquisition: Search of MEDLINE, EMBASE, the Cochrane
Database, and Google Scholar using the term thrombocytopenia + PCI and other relevant keywords to identify
systematic reviews, clinical trials, cohort studies, case series, and case reports. The review was limited to English-
language articles published between January 1980 and June 2009. Articles on patients with baseline
thrombocytopenia prior to PCI were excluded. Evidence Synthesis: Thrombocytopenia is not infrequent following
PCI. The typical patient with post-PCI thrombocytopenia is on multiple therapies that can potentially cause a
decrease in the platelet count. Identification of the cause is critical because management of the condition varies OBJECTIVE: To describe a successful case involving the use of tenecteplase during cardiac arrest for presumed
pulmonary embolism (PE) and to systematically review the evidence from controlled trials supporting the efficacy
and safety of thrombolysis during cardiac arrest. CASE SUMMARY: A 48-year-old male presented to the emergency
department with an acute onset of shortness of breath that began approximately 2 hours prior to presentation. Prior
to undergoing a computed tomography (CT) scan to rule out PE, the patient went into cardiac arrest, with an initial
rhythm of pulseless electrical activity at a rate of 140 beats/min. Cardiopulmonary resuscitation (CPR) was initiated
and, due to suspected PE, a bolus dose of tenecteplase 50 mg was administered immediately following a single 1-mg
dose of epinephrine. CPR was continued and 4 additional 1-mg doses of epinephrine and three 1-mg doses of
atropine were given. After 13 minutes of CPR, return of spontaneous circulation (ROSC) was achieved, with a blood
pressure of 144/50 mm Hg. After the patient was stabilized, a CT scan demonstrated extensive bilateral pulmonary
emboli in most segmental arteries. He was admitted to the intensive care unit where he was sedated, paralyzed, and
treated with induced hypothermia for 24 hours. He was discharged from the hospital 2 weeks later on warfarin, with
no noted neurologic deficits. DISCUSSION: A systematic search of MEDLINE (1950-August 2010), Embase (1980- It was the aim of the review to determine the risks and benefits of primary thromboprophylaxis with anticoagulants
in cancer patients with central venous devices. Medline, Central and Google Scholar databases were searched for
randomized controlled trials (RCTs) in June 2006. Two reviewers extracted data and appraised the quality of RCTs.
Results were expressed as relative risk (RR) with 95% confidence intervals (CI) using random effects model for the
outcomes of catheter-related thrombosis, bleeding and thrombocytopenia. Eight RCTs (1,428 patients) were
included.There was no statistically significant difference in the risk of catheter-related thrombosis for the use of
warfarin versus placebo (3 trials, 425 patients, RR 0.75, 95% CI 0.24-2.35, p=0.63), heparin versus placebo (4
trials,886 patients, RR 0.46 95% CI 0.18-1.20, p=0.06) or warfarin, unfractionated heparin or low-molecular-weight
heparin versus placebo (7 trials, 1,311 patients, RR 0.59, 95% CI 0.31-1.13, p=0.11). Substantial statistical Objectives: Occasionally, when a patient (pt) is being evaluated for a thyroid nodule and has elevated blood thyroid
hormone levels and/or suppressed thyroid stimulating hormone levels, a thyroid scan is performed to evaluate the
functional status of that thyroid nodule. If the nodule is functional, then the treating physician often assumes that
thyroid cancer is not present within that specific nodule. Despite the lack of any sizable study evaluating the
frequency of thyroid cancer within or adjacent to functioning thyroid nodules, a significant number of case reports
have been published. The objective of this study was to analyze those case reports regarding the occurrence of
thyroid cancer in or adjacent to functioning thyroid nodules. Methods: A comprehensive review of the English
literature was performed using a myriad of search engines, including PubMed, Ovid, Medline, and Google Scholar.
The terms 'thyroid cancer', 'functioning nodules', 'toxic nodules,' and 'toxic multi-nodular goiter' were used as search
keywords. Twenty four articles were identified, and 22 were subsequently reviewed for the following data: age,
gender, radioisotope used, histology, size of primary thyroid cancer tumor, number of primary tumors, multifocal
versus unifocal, multinodular versus solitary nodule, location (within or adjacent to functioning nodule), lymph node
involvement, and any related mutations. Results: Of the 22 articles reviewed, 22 pts were reported to have had a
total of 28 foci of thyroid cancer (TC) identified in or adjacent to the functioning nodule. The mean (range) age was
40 (11-77) y.o. of which 18, 3, and 1 were female, male, and not specified, respectively. The radioisotopes used were
Background: The controversial relationship between benign thyroid diseases and breast cancer has been investigated
for over 50 years. Despite extensive population studies, the results as a whole have been inconsistent. The purpose
of this study was to collate and analyse available data, calculating a pooled odds ratio of the risk of breast cancer in
patients diagnosed with benign thyroid diseases. Materials and Methods: Studies were obtained from a database
search of MEDLINE, EMBASE, PubMed, Current Contents and Google Scholar with additional cross checking of
reference lists. Inclusion criteria required a confirmed diagnosis of a benign thyroid disease, reporting of an odds
ratio or data to calculate an odds ratio (and 95% confidence interval) and the use of an internal control group as the
comparator. Collated data was assessed for heterogeneity and a pooled odds ratio calculated. From 276 citations
identified in this search, a total of 28 studies were identified meeting our inclusion criteria. No language restrictions
were used in the search or study selection. All data were analysed using a random effects model. Results: There was
significant evidence of an increased risk of breast cancer in patients with auto-immune thyroiditis, evident in a
pooled odds ratio (OR) of 2.92 (95% CI: 2.13-4.01). No heterogeneity was present (I2=0, p=0.62) and there was no
publication bias (p=0.15). In addition, the results supported an increased risk associated with the presence of anti-
thyroid antibodies (OR 2.02, 95% CI: 1.63-2.50) and goitre (OR 2.19, 95% CI: 1.44-3.33). Moderate but non-significant
heterogeneity was present in the analysis of goitre (I2=49.2, p=0.08), while the risk of publication bias was not Although no consensus has been reached regarding the management of PCL deficiency, in vitro and in vivo studies
have investigated whether the tibial inlay technique restores the anatomical site of insertion of the PCL, prevents
elongation, stretching, graft failure, and improves long-term PCL stability. A systematic search using PubMed, Ovid,
the Cochrane Reviews, and Google Scholar databases using 'posterior cruciate ligament tear', 'Tibial inlay technique'
and 'posterior cruciate ligament reconstruction' as keywords identified 71 publications, of which 10 were relevant to
the topic, and included a total of 255 patients. The tibial inlay technique restores the anatomic insertion site of the
PCL, eliminates the killer turn effect, and places the graft at lower potential risk for abrasion and subsequent rupture.
It has the disadvantages of increased operating time and risk to the posterior neurovascular structures. There was no
evidence of an association between outcome results and Coleman methodology score, but the Coleman Mammalian preimplantation embryo development is a complex process in which the exact timing and sequence of
events are as essential as the accurate execution of the events themselves. Time-lapse microscopy (TLM) is an ideal
tool to study this process since the ability to capture images over time provides a combination of morphological,
dynamic and quantitative information about developmental events. Here, we systematically review the application
of TLM in basic and clinical embryo research. We identified all relevant preimplantation embryo TLM studies
published in English up to May 2012 using PubMed and Google Scholar. We then analysed the technical challenges
involved in embryo TLM studies and how these challenges may be overcome with technological innovations. Finally,
we reviewed the different types of TLM embryo studies, with a special focus on how TLM can benefit clinical assisted
reproduction. Although new parameters predictive of embryo development potential may be discovered and used
clinically to potentially increase the success rate of IVF, adopting TLM to routine clinical practice will require
innovations in both optics and image analysis. Combined with such innovations, TLM may provide embryologists and Objectives: To determine whether the timing of DNase inhalation affects clinical outcomes in people with CF,
specifically examining before vs after airway clearance techniques; morning vs evening; and long vs short dwell time.
Method: Relevant randomised and quasi-randomised controlled trials were identified from the Physiotherapy
Evidence Database (PEDro), Google Scholar and international CF conference proceedings. Relevant data were
extracted and, where possible, meta-analysed. Results: The searches identified 87 trials, of which 6 trials (involving
140 participants) met our inclusion criteria. All 6 studies used a cross-over design. Intervention periods ranged from 2
to 8 weeks. Inhalation after instead of before airway clearance did not change FEV1 (SMD -0.22, 95%CI -1.36 to
0.93). Similarly, FVC and quality of life were unaffected. Some secondary outcomes were statistically significant in
individual studies (eg MEF25 was significantly higher with inhalation before airway clearance), but these have not The last decade has witnessed a dramatic change in management of metastatic spine disease, with an increased role
for surgery and emerging use of stereotactic radiotherapy, often in combination. Patients may be treated with
radiotherapy followed by surgery, or have surgery and then adjuvant radiotherapy. In both cases, the surgeon and
oncologist need to select the optimal timing for surgery and radiotherapy to minimize wound complications while
obtaining maximum oncolytic effects. The purpose of this review was to determine the optimal timing of surgery and
radiotherapy in patients surgically treated for spinal metastases. A systematic review utilizing Medline, Embase,
Paper First, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews was performed.
References were screened to further identify relevant studies and basic science literature reviewed. A total of 46
reports discussing the timing of surgery after radiotherapy, describing experience in 5836 patients, were identified.
Only one retrospective study addressed the research question and suggested that surgery within seven days of
This review examined existing evidence to investigate the link between tobacco and poverty in Vietnam, to assess
the impact of tobacco control policies on employment related to tobacco consumption and to identify information
gaps that require further research for the purposes of advocating stronger tobacco control policies. A Medline,
PubMed and Google Scholar search identified studies addressing the tobacco and poverty association in Vietnam
using extensive criteria. In all, 22 articles related either to tobacco and health or economics, or to the potential
impact of tobacco control policies, were identified from titles, abstracts or the full text. 28 additional publications
were identified by other means. PHA, LTT and LTTH reviewed the publications and prepared the initial literature This review examined existing evidence to investigate the link between tobacco and poverty in Vietnam, to assess
the impact of tobacco control policies on employment related to tobacco consumption and to identify information
gaps that require further research for the purposes of advocating stronger tobacco control policies. A Medline,
PubMed and Google Scholar search identified studies addressing the tobacco and poverty association in Vietnam
using extensive criteria. In all, 22 articles related either to tobacco and health or economics, or to the potential
impact of tobacco control policies, were identified from titles, abstracts or the full text. 28 additional publications
were identified by other means. PHA, LTT and LTTH reviewed the publications and prepared the initial literature OBJECTIVES: To assess the strength of evidence in published articles for an association between smoking and passive
exposure to tobacco smoke and various manifestations and outcomes of tuberculosis (TB). Clinicians and public
health workers working to fight TB may not see a role for themselves in tobacco control because the association
between tobacco and TB has not been widely accepted. A qualitative review and meta-analysis was therefore
undertaken. METHODS: Reference lists, PubMed, the database of the International Union Against Tuberculosis and
Lung Disease and Google Scholar were searched for a final inclusion of 42 articles in English containing 53 outcomes
for data extraction. A quality score was attributed to each study to classify the strength of evidence according to
each TB outcome. A meta-analysis was then performed on results from included studies. RESULTS: Despite the
limitations in the data available, the evidence was rated as strong for an association between smoking and TB
disease, moderate for the association between second-hand smoke exposure and TB disease and between smoking Tobacco use is a commonplace phenomenon in our society. Its use is responsible for more death and disease than
any other noninfectious cause. More deaths are caused each year by tobacco use than by all deaths from HIV, illegal
drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. Tobacco remains responsible for
greater morbidity than alcohol and all other drugs combined. Tobacco dependence is highly prevalent among drug-
dependent patients. Substance abuse patients smoke more and are more vulnerable to the effects of smoking than
general populations. Traditional substance abuse therapeutic programs too frequently focus only on treatment of
alcohol or other drugs rather than including treatment for tobacco dependence. Currently, there are no official
medical recommendations for the treatment of tobacco addiction in illicit polysubstance users. Methods: A
comprehensive literature search from a range of electronic databases (PubMed, Embase, PsycInfo, Google Scholar)
was conducted for the period from 1988 to September 2012, using the following keywords alone or in combination: Hyperbaric oxygen therapy (HBO2T) is a specialty with wide clinical applications and study fields. An evaluation of the
major research direction of HBO2T studies would be helpful for researchers in this field. In this study, we identified
the most frequently cited HBO2T articles to analyze the study focus of HBO2T research in the past 10 years.
"Hyperbaric oxygen" was used as the keyword to search articles in PubMed between January 2000 and November
2010. The cited times of an article were tracked in Google Scholar. The top 100 most-cited articles were identified
and their publication year, author nationalities, journal, study field and style were recorded and analyzed. In total,
2,362 HBO2T-related articles were retrieved. The number of HBO2T articles published per year has been increasing
during the past 10 years. More than half of the top-cited articles (52/100) were from studies in the United States. OBJECTIVE: Hyperbaric oxygen therapy (HBO2T) is a specialty with wide clinical applications and study fields. An
evaluation of the major research direction of HBO2T studies would be helpful for researchers in this field. In this
study, we identified the most frequently cited HBO2T articles to analyze the study focus of HBO2T research in the
past 10 years., METHODS: "Hyperbaric oxygen" was used as the keyword to search articles in PubMed between
January 2000 and November 2010. The cited times of an article were tracked in Google Scholar. The top 100 most-
cited articles were identified and their publication year, author nationalities, journal, study field and style were
recorded and analyzed., RESULTS: In total, 2,362 HBO2T-related articles were retrieved. The number of HBO2T
articles published per year has been increasing during the past 10 years. More than half of the top-cited articles
Cervical cancer screening is the key to reducing the incidence and mortality of cervical cancer in developing
countries. In the absence of a national screening program, healthcare givers in Nigeria are encouraged to routinely
inform and screen eligible women. This review aims at equipping health workers for this task by re-educating them
on the basics of the disease and its screening by cytology. Relevant texts and online databases including Pubmed,
African Journal Online, and Google Scholar, were searched for relevant literature on the subject area. Persistent
infection by a high-risk human papilloma virus, especially types 16 and 18, is necessary for the development of
cervical cancer. The exfoliation of cells from the metaplastic squamous cells of transformation zone of the cervix is
the basis of cervical cytology. Organized Pap screening reduces the incidence and mortality of cervical cancer, but
screening protocols vary. Nevertheless, annual screening is not recommended except for high-risk women such as To summarize the literature describing computer-based interventions aimed at improving bidirectional
communication between clinical and public health. A systematic review of English articles using MEDLINE and Google
Scholar. Search terms included public health, epidemiology, electronic health records, decision support, expert
systems, and decision-making. Only articles that described the communication of information regarding emerging
health threats from public health agencies to clinicians or provider organizations were included. Each article was
independently reviewed by two authors. Ten peer-reviewed articles highlight a nascent but promising area of
research and practice related to alerting clinicians about emerging threats. Current literature suggests that additional
research and development in bidirectional communication infrastructure should focus on defining a coherent
architecture, improving interoperability, establishing clear governance, and creating usable systems that will Background - There is growing interest in the role of microbial agents in the causation of psychiatric disorders. The
neurotropic protozoan parasite Toxoplasma gondii is one of the main candidates and has been associated with
various psychiatric conditions, including schizophrenia. Methods - A narrative review of the literature from the main
medical databases (Medline, PubMed, PsycINFO), Google Scholar and Google using combinations of applicable
terms. Results - T. gondii affects the brain in both the acute and the latent stages of infection causing apparent brain
pathologies in infected rodents and both immuno-compromised and immuno-competent humans. In immuno-
competent individuals, behavioural disorders are primarily related to the latent stages of the illness.
Behavioural/mental disorders that include schizophrenia, mood disorders, personality changes and cognitive
impairments may be related to infection with T. gondii. Evidence for a behavioural effect of T. gondii comes from
observational reports in animal models and controlled behavioural analysis in humans. Indirect clues of infection also BACKGROUND: There is growing interest in the role of microbial agents in the causation of psychiatric disorders. The
neurotropic protozoan parasite Toxoplasma gondii is one of the main candidates and has been associated with
various psychiatric conditions, including schizophrenia., METHODS: A narrative review of the literature from the main
medical databases (Medline, PubMed, PsycINFO), Google Scholar and Google using combinations of applicable
terms., RESULTS: T. gondii affects the brain in both the acute and the latent stages of infection causing apparent
brain pathologies in infected rodents and both immuno-compromised and immuno-competent humans. In immuno-
competent individuals, behavioural disorders are primarily related to the latent stages of the illness.
Behavioural/mental disorders that include schizophrenia, mood disorders, personality changes and cognitive
impairments may be related to infection with T. gondii. Evidence for a behavioural effect of T. gondii comes from
observational reports in animal models and controlled behavioural analysis in humans. Indirect clues of infection also Colorectal cancer constitutes a significant proportion of the global burden of cancer morbidity and mortality. A
number of studies have been conducted to explore whether TP53 codon 72 polymorphism is associated with
colorectal cancer susceptibility. However, controversial results were obtained. In order to derive a more precise
estimation of the relationship, we systematically searched Medline, Google scholar, and Ovid database for studies
reported before May 2010. A total of 3603 colorectal cancer cases and 5524 controls were included. TP53 codon 72
polymorphism was not associated with colorectal cancer risk in all genetic models (for dominant model: OR = 0.99,
95% CI: 0.86-1.15; for recessive model: OR = 1.00, 95% CI: 0.81-1.23; for Arg/Pro vs. Arg/Arg: OR = 1.00, 95% CI: 0.87- Colorectal cancer constitutes a significant proportion of the global burden of cancer morbidity and mortality. A
number of studies have been conducted to explore whether TP53 codon 72 polymorphism is associated with
colorectal cancer susceptibility. However, controversial results were obtained. In order to derive a more precise
estimation of the relationship, we systematically searched Medline, Google scholar, and Ovid database for studies
reported before May 2010. A total of 3603 colorectal cancer cases and 5524 controls were included. TP53 codon 72
polymorphism was not associated with colorectal cancer risk in all genetic models (for dominant model: OR = 0.99,
95% CI: 0.86-1.15; for recessive model: OR = 1.00, 95% CI: 0.81-1.23; for Arg/Pro vs. Arg/Arg: OR = 1.00, 95% CI: 0.87-
Obesity in childhood carries a wide range of physical, psychological and social disbenefits and also increases the risk
of adult obesity with its well-recognised, enhanced risk of several common complex diseases as well as adverse
socioeconomic and psychosocial sequelae. Understanding the tracking of the two key modifiable behaviours, food
consumption and physical activity, between childhood and adulthood may illuminate the childhood determinants of
adult obesity and contribute to the development of effective interventions. We performed a systematic review of the
available literature on tracking of both physical activity and of dietary intake between childhood and adulthood by
searching MEDLINE, EMBASE, CINAHL, PSYCInfo, Google and Google Scholar. For inclusion, studies had to report
baseline measurements when the children were less than, or equal to, 18 years and to report follow-up for at least 5
years to any age over 18 years. After removal of duplicates, 9625 search hits were screened by title and/or abstract
and 79 potentially relevant papers were identified and full papers obtained. In total 39 papers were included in this
analysis. Of these, 11 papers (from 5 studies) reported data on tracking of diet from childhood to adulthood and 28 Ethnopharmacological relevance: Ficus religiosa L. (Moraceae) has been extensively used in traditional medicine for a
wide range of ailments of the central nervous system, endocrine system, gastrointestinal tract, reproductive system,
respiratory system and infectious disorders. Aim of the review: To comprehend the fragmented information available
on the botany, traditional uses, phytochemistry, pharmacology and toxicology of F. religiosa to explore its
therapeutic potential and future research opportunities. Materials and methods: All the available information on F.
religiosa was collected via electronic search (using Pubmed, SciFinder, Scirus, Google Scholar, Agricola and Web of
Science) and a library search. Results: Ethnomedical uses of F. religiosa are recorded throughout South Asia, where it
has been used for about 50 types of disorders. Phytochemical research had led to the isolation of phytosterols,
amino acids, furanocoumarins, phenolic components, hydrocarbons, aliphatic alcohols, volatile components and few
other classes of secondary metabolites from F. religiosa. Fresh plant materials, crude extracts and isolated
components of F. religiosa showed a wide spectrum of in vitro and in vivo pharmacological activities like,
antidiabetic, cognitive enhancer, wound healing, anticonvulsant, anti-inflammatory, analgesic, antimicrobial,
antiviral, hypolipidemic, antioxidant, immunomodulatory, antiasthmatic, parasympathetic modulatory, esterogenic,
antitumor, antiulcer, antianxiety, antihelmintic, endotheilin receptor antagonistic, apoptosis inducer and ETHNOPHARMACOLOGICAL RELEVANCE: Polyporus umbellatus (Pers.) Fries (Polyporaceae, Zhuling ) has been
commonly used in medicine for a wide range of ailments related to the edema, scanty urine, vaginal discharge,
urinary dysfunction, as well as jaundice and diarrhea., AIM OF THE REVIEW: The present paper reviewed the
traditional uses, propagation, phytochemistry, pharmacology, pharmacokinetics and quality control of Polyporus
umbellatus., MATERIALS AND METHODS: All the available information on Polyporus umbellatus was collected via a
library and electronic search (using Web of Science, Pubmed, ScienceDirect, Splinker, Google Scholar, etc.).,
RESULTS: Phytochemical studies showed the presence of many valuable secondary metabolites such as steroids,
polysaccharides, anthraquinones and nucleosides. Crude extracts and isolated compounds showed a wide spectrum
of pharmacological activities including diuretic, nephroprotective, anti-cancer, immuno-enhancing, hepatoprotective,
anti-inflammatory and antioxidative activities. The pharmacokinetic studies demonstrated that the ergosterol and
ergone had a high distribution and absorption in the plasma and the two main components of Polyporus umbellatus
were mainly excreted by faeces. The determination of multiple chemical components was successfully applied to the
quality control of Polyporus umbellatus., CONCLUSIONS: Modern phytochemical, pharmacological and metabonomic
investigations showed that the crude extracts and isolated compounds from Polyporus umbellatus possess many
kinds of biological functions, especially in the diuretic activities and the treatment of kidney diseases as well as anti- Objective: To establish a new training program for hypertension training in Uganda. Design and Methods: A search
was carried out on pubmed and google scholar to find national hypertension guidelines and surveys of hypertension
in Uganda. The WHO database was also searched for statistical data on Uganda. Results: Uganda has a total
population of 29,899,000. There are a total of 2,209 Physicians at a density of one per 10,000 people.Hypertension is
an emerging problem especially in urban areas. A non-random survey (including patients admitted in hospital) by
Lasky et al of 440 subjects above the age of 35 found that 40 % of non-diabetic males and 43 % of non-diabetic males
were found to have hypertension. One of the the commonest causes of suboptimal hypertension control in resistant
hypertension patients is an inadequate medical regime which is something a robust guideline should be able to help
with. One of the major issues identified in hypertension studies is that physicians do not increase anti-hypertensive
regimes when the systolic blood pressure is only modestly elevated. Better levels of control in hypertension may be
achieved by better adherence of physicians to guidlelines and by creating specialist hypertension clinics. Uganda also
Introduction. Oral sex is usually considered a lower-risk sexual activity when compared with sex, but it is frequently
the cause of sexually transmitted infections (STI). In particular, STI transferred through oral sex might have no visible
symptoms, depending on the type of infection. Aims. The aim of this study is to review the literature about the role
of oral sex in the transmission of nonviral STI. Main Outcome Measures. State-of-the-art information in the area of
STI in relation to sexual function and self-care, this last important for development of STI prevention products such
as vaginal microbicides. Sexual behaviors assessed focusing on receiving oral sex and giving oral sex. Methods. A
search of the main electronic databases including registers of clinical controlled trials was performed in addition to a
hand search of the most relevant Journals. The following electronic databases were searched: PubMed, Embase,
Google Scholar, literature review of research articles, and public health department Internet Web sites, for the
period of 1945-2011. In addition to searching the Clinical Trials Registry at the US National Institutes of Health, we Background: Various types of suburethral tapes inserted via the transobturator route (tension-free vaginal tape
obturator route [TVTO] and transobturator tape [TOT]) have been widely adopted for treatment of stress urinary
incontinence (SUI) before proper evaluation of their effectiveness and complications. Objectives: To assess the
effectiveness and complications of TOTs as treatment of SUI by means of a systematic review. Search strategy:
MEDLINE, EMBASE, CINAHL, LILIACS (up to September 2006), CENTRAL (The Cochrane Library, Issue 3, 2006),
MetaRegister of Controlled Trials, The National Library for Health, the National Research Register and Google Scholar
were searched using various relevant search terms. The citation lists of review articles and included trials were
searched, and contact with the corresponding author of each included trials was attempted. Selection criteria:
Randomised controlled trials (RCTs) that compared the effectiveness of TVTO or TOT with synthetic tension-free
vaginal tape (TVT) by retropubic route (Gynecare; Ethicon Inc., NJ, USA) for the treatment of SUI in all languages
were included. Data collection and analysis: Two reviewers extracted data on participants' characteristics, study
quality, population, intervention, cure and adverse effects independently. The data were analysed in the Review PURPOSE: The therapeutic management of catheter-related thromboembolic events in children is still a challenge
due to the large number of potentially effective pharmacological alternatives and the insufficient scientific evidence
available. A bibliographic review was performed in order to identify the available pharmacological alternatives for
the prophylaxis and therapeutic management of catheter-related thrombosis in children., METHODS: A literature
search was carried out on MEDLINE using the medical subject heading (MeSH) central venous catheter thrombosis
and on Google Scholar. The search was limited to review papers, meta-analyses, clinical practice guidelines, and
randomized controlled trials performed on pediatric populations until November 2011., RESULTS: The different
options for anticoagulation include unfractionated heparin, low molecular weight heparin and vitamin K antagonists.
Thrombus resolution is stimulated more rapidly with thrombolytic agents than with anticoagulants, but the risk-
benefit ratio must be considered. Streptokinase is not considered an optimal alternative due to the risk of Purpose. The therapeutic management of catheter-related thromboembolic events in children is still a challenge due
to the large number of potentially effective pharmacological alternatives and the insufficient scientific evidence
available. A bibliographic review was performed in order to identify the available pharmacological alternatives for
the prophylaxis and therapeutic management of catheter-related thrombosis in children. Methods. A literature
search was carried out on MEDLINE using the medical subject heading (MeSH) central venous catheter thrombosis
and on Google Scholar. The search was limited to review papers, meta-analyses, clinical practice guidelines, and
randomized controlled trials performed on pediatric populations until November 2011. Results. The different options
for anticoagulation include unfractionated heparin, low molecular weight heparin and vitamin K antagonists.
Thrombus resolution is stimulated more rapidly with thrombolytic agents than with anticoagulants, but the risk-
benefit ratio must be considered. Streptokinase is not considered an optimal alternative due to the risk of The aim of this systematic review was to critically evaluate the evidence on interventions for depression following
traumatic brain injury (TBI) and provide recommendations for clinical practice and future research. We reviewed
pharmacological, other biological, psychotherapeutic, and rehabilitation interventions for depression following TBI
from the following data sources: PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar. We
included studies written in English published since 1980 investigating depression and depressive symptomatology in
adults with TBI; 658 articles were identified. After reviewing the abstracts, 57 articles met the inclusion criteria. In
addition to studies describing interventions designed to treat depression, we included intervention studies in which
depressive symptoms were reported as a secondary outcome. At the end of a full review in which two independent
reviewers extracted data, 26 articles met the final criteria that included reporting data on participants with TBI, and
using validated depression diagnostic or severity measures pre- and post-treatment. Three external reviewers also
Objectives: Hemothorax is a very unusual complication of hepatocellular carcinoma (HCC), accompanied by a high
mortality because the negative pressure inside the pleural cavity makes spontaneous hemostasis difficult. The
objectives of this study were to present an extremely rare case in which we experienced presenting with ruptured
HCC complicated by hemothorax and to also review the pertinent literature so as to assess the efficacy of
transcatheter arterial embolization (TAE) in the treatment of hemothorax secondary to HCC rupture. Methods: The
PubMed, Google Scholar and Japan Medical Abstracts Society databases were searched for articles in English and
Japanese languages reporting on ruptured HCC complicated by hemothorax. The articles were then systematically
reviewed. Results: Case: The case pertains to a 56-year-old female who was transported to our hospital due to
hemorrhagic shock. She was diagnosed with ruptured HCC in the caudate lobe accompanied by concomitant
hemothorax and hemoperitoneum. Successful hemostasis was obtained by TAE (Figure), and surgery was conducted
one month after TAE. In this case, no lesions as possible sources of bleeding were observed in the thorax and blood
from the liver seemed to have traversed the intact diaphragm to enter the pleural cavity soon after the HCC rupture.
This unusual phenomenon was considered to be strongly associated with the location of the tumor and the
formation of a hematoma inside the omental bursa. It is said that TAE is not always effective for ruptured HCC in the
caudate lobe because of the multiple tumor-feeding arteries. Successful TAE in the present case was very beneficial
for performing subsequent surgery. Review: As far as our research tells us, 16 cases of ruptured HCC complicated by
hemothorax have so far been reported in the literature, and the details of a total of 17 cases, including our case,
were analyzed. These cases consisted of 13 males (76%) and 4 females (24%) between the ages of 31 and 79. Of AIM: This was to review the literature concerning the treatment of permanent teeth with molar-incisor
hypomineralised enamel (MIH), comment about possible shortcomings and propose areas of future research.
METHODS: A search of MedLine, Scopus, ResearchGate, Isis and Google Scholar databases was conducted using all
terms relevant to the subject. Relevant papers published in English were identified after a review of their titles,
abstracts or full reading of the papers. RESULTS: Of 189 references initially found, 66 papers were included; 34
directly relevant to the subject. From the latter, only 14 concerned laboratory or clinical studies dealing with
treatment for MIH. Since 2000 11 reviews evaluated, to a certain extent, treatment options for affected teeth. Background: Lateral ankle sprains are common musculoskeletal injuries. Objectives: The objective of this study was
to perform a systematic literature review of the last 10 years regarding evidence for the treatment and prevention of
lateral ankle sprains. Data source: Pubmed central, Google scholar. Study eligibility criteria: Meta-analysis,
prospective randomized trials, English language articles. Interventions: Surgical and non-surgical treatment,
immobilization versus functional treatment, different external supports, balance training for rehabilitation, balance
training for prevention, braces for prevention. Methods: A systematic search for articles about the treatment of
lateral ankle sprains that were published between January 2002 and December 2012. Results: Three meta-analysis
and 19 articles reporting 16 prospective randomized trials could be identified. The main advantage of surgical ankle
ligament repair is that objective instability and recurrence rate is less common when compared with non-operative
treatment. Balancing the advantages and disadvantages of surgical and non-surgical treatment, we conclude that the
majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery. For non-surgical
treatment, long-term immobilization should be avoided. For grade III injuries, however, a short period of
immobilization (max. 10 days) in a below knee cast was shown to be advantageous. After this phase, the ankle is
most effectively protected against inversion by a semi-rigid ankle brace. Even grades I and II injuries are most Adolescence is a vulnerable period for the development of obesity, and adolescent weight tracks strongly into
adulthood. Previous reviews of treatment strategies have failed to discriminate between adolescents and children,
thereby, disregarding the uniqueness of this population. Hence, this review aims to summarise the evidence for
treatment approaches for adolescent obesity. Pubmed, OVID, EBSCOhost and Google Scholar were searched for
randomised controlled trials, meta-analyses and systematic reviews testing treatments for overweight/obese
adolescents (aged 12-19 years), published from 1982-2006 in English. Eligible studies had to assess either weight,
percentage overweight, body mass index (BMI) or body fat. Thirty-four randomised controlled trials were eligible.
The results of this review indicate that the safety and efficacy of surgical and pharmacotherapy treatments for
adolescent obesity is uncertain. Diet and physical activity approaches may improve obese status in the short term.
However, obesity interventions appear more effective when strategies are combined, rather than when used in
isolation. Psychological interventions, such as behavioural and cognitive behavioural therapy, show promise in
Background: the treatment of human brucellosis is controversial. the purpose of this study was to search published
clinical trial papers to provide a simple and effective treatment in brucellosis.methods: many studies on brucellosis
treatment in a twenty- year span from 1993 to 2012 were searched in pubmed, web of science (isi), scopus, google
scholar, magiran, iranmedex and sid. the studies that were searched and classified in groups according to
combination therapy and monotherapy and their results in treatment outcome were compared. regimens with lower
treatment failure or relapse were considered as more suitable for brucellosis treatment.results: the comparison of
combined doxycycline and rifampicin (dr) with a doxycycline plus streptomycin (ds) favors the latter regimen. the
combined doxycycline/cotrimoxazole (dctm) showed similar effect with dr. the treatment with the combined
regimen including quinolones was similar to dr but with higher relapse rates. higher relapse rate was searched in
monotherapy (13% vs. 4.8%) and in short-term (less than 4 weeks) treatment regimen (22% vs. 4.8%), respectively. Study Design. Systematic review. Objective. To critically review and summarize evidence on the treatment of cervical
adjacent segment pathology (ASP). Summary of Background Data. Clinical ASP (CASP) refers to clinically significant
symptoms and signs (radiculopathy, myelopathy, mechanical pain) that correlate with imaging evidence of
degeneration at motion segments adjacent to a previous intervention. Despite growing awareness of the long-term
risks of ASP, fusion is the most commonly performed type of cervical spine surgery. There are little data regarding
the optimal treatment for cervical CASP. Methods. A systematic search of PubMed, the Cochrane Library, and Google
Scholar for literature published through March 2, 2012, was conducted to answer 2 key questions: (1) What is the
comparative effectiveness and safety of operative versus nonoperative treatments for cervical CASP?; and (2)
Describe the outcomes of surgical treatment of cervical CASP. Results. A total of 5 studies were selected for
inclusion. No comparative studies were found to answer question 1. We found 1 comparative study and 4 case series
of more than 10 patients that addressed question 2: 2 studies described fusion (1 comparing discectomy with
corpectomy), 2 evaluated laminoplasty, and 1 reported on use of artificial discs. No studies on use of laminectomy,
foraminotomy, or posterior decompression and fusion were found. Two poor-quality (level of evidence III)
retrospective cohort studies compared anterior cervical discectomy and fusion with corpectomy for the treatment of
CASP, but 1 study was too small to draw meaningful comparisons and was considered a case series. The other
reported a 37.5% risk difference favoring corpectomy; however, most patients in both treatment groups had
excellent or good clinical results, and the study had significant methodological limitations that limit comparison of
anterior cervical discectomy and fusion with corpectomy (nonrandomized allocation to treatment groups, limited Introduction: Pharmacologic treatments for nightmares are limited. Increased adrenergic hyperresponsiveness has
been postulated as a mechanism in the pathophysiology of Post-Traumatic Stress Disorder (PTSD). Prazosin, a central
alpha-1 adrenergic receptor antagonist, has been studied for PTSD-related nightmares. Objectives: To review
evidence for prazosin to treat PTSD and non-PTSD nightmares. Methods: A systematic review using
MEDLINE/PubMed, EMBASE, EBM Review, Google Scholar, and Web of Science. Two authors reviewed abstracts and
selected clinical reports of prazosin treatment. Results: Of 115 abstracts, 19 studies met criteria: 3 randomized,
double-blind, placebo controlled trials; 3 open label case series; 5 retrospective chart reviews; and 8 case reports.
183 evaluable patients (135 veterans and 48 civilians; 163 males) were described. Only one study did not confirm a
PTSD diagnosis, but commented that their patients had symptoms consistent with PTSD. Common outcome
measures were the Clinician Administered PTSD Scale (CAPS) items B2 ("recurrent distressing dreams") and D1 Objective: To date, there are no reliable data regarding the actual treatment received by women with refractory
obstetric antiphospholipid syndrome (OAPS). The aim of this study was to assess current clinical evidence and new
trends in the treatment of refractory OAPS. Methods: A non-systematic but comprehensive literature search using
relevant keywords was made to identify relevant articles published in English from different computerized
databases: PubMed (Medline), Google Scholar electronic database search and The Cochrane Library, from January
2000 to March 2012. Studies on the treatment of poor obstetric outcomes in women with OAPS were included.
Prospective randomized clinical trials, cohort studies, reviews, systematic reviews and meta-analysis were retrieved.
Results: A total of 130 articles were finally selected for this review, including 17 randomized clinical trials and four
meta-analyses. The majority of articles were non-randomized original papers and basic and clinical reviews.
Background: Skin and soft tissue infections (SSTIs) have become the second most common type of infection among
persons residing in long-term care facilities. Objective: The purpose of this article was to review the latest
information on SSTIs among the elderly, including age-related changes, challenges, and treatment strategies in the
era of emerging bacterial resistance. Methods: Relevant information was identified through a search of MEDLINE
(1970April 2010), International Pharmaceutical Abstracts (1970April 2010), and Google Scholar using the terms skin
and soft tissue infection, skin and skin structure infection, cellulitis, treatment guidelines, and elderly. Additional
publications were found by searching the reference lists of the identified articles. Trials published since 1970 were
selected for this review if they prospectively evaluated mostly adults (<18 years of age), included >50 patients, and
reported diagnostic criteria as well as clinical outcomes in patients treated for simple or complicated SSTIs. Results:
Fifty-eight of 664 identified studies were selected and included in this review. A search of the literature did not
identify any prospective clinical trials that were conducted exclusively in the elderly. Information on the treatment of
SSTIs in the elderly was based solely on clinical studies that were conducted in adults in general. As recommended by
the Infectious Diseases Society of America (IDSA) 2008 update, SSTIs should be suspected in elderly patients who
have skin lesions and present with a decline in functional status, with or without fever. Patients who present with
symptoms of systemic toxicity should be hospitalized for further evaluation. Current challenges in the management
of SSTIs include the rapid emergence of community-acquired, methicillin-resistant Staphylococcus aureus (CAMRSA),
the emergence of macrolide-resistant streptococci within the past decade, and the lack of a reliable algorithm to
differentiate potentially life-threatening SSTIs that require aggressive interventions and prompt hospitalization from Introduction: The objective of this systematic review is to determine if the treatment of streptococcal pharyngitis
with a daily dose of amoxicillin is similar in effectiveness to other dosing schedules (every 6, 8 or 12 hours) of the
same antibiotic or penicillin V. Material and methods: Randomised clinical trials (RCT) comparing amoxicillin (one
dose per day) compared to other dosages of amoxicillin (every 8-12 hours) or penicillin V (every 6, 8 or 12 hours).
Search databases consulted: Medline, Central, EMBASE and Google Scholar. The results were combined using the risk
difference (RD). We measured the effectiveness of each treatment with a negative throat culture on the 14-21th day,
being previously positive to group A Streptococcus (under a non-inferiority hypothesis, where the upper limit of the
95% confidence interval [95% CI] of the DR does not exceed 10%) and clinical failure on days 10-21. The results were
combined according to a fixed effects model or random depending on whether or not there was heterogeneity.
Results: Four RCT met the selection criteria with 1,314 participants (657 received amoxicillin once per day, and 657 INTRODUCTION: The objective of this systematic review is to determine if the treatment of streptococcal pharyngitis
with a daily dose of amoxicillin is similar in effectiveness to other dosing schedules (every 6, 8 or 12 hours) of the
same antibiotic or penicillin V., MATERIAL AND METHODS: Randomised clinical trials (RCT) comparing amoxicillin
(one dose per day) compared to other dosages of amoxicillin (every 8-12 hours) or penicillin V (every 6, 8 or 12
hours). Search databases consulted: Medline, Central, EMBASE and Google Scholar. The results were combined using
the risk difference (RD). We measured the effectiveness of each treatment with a negative throat culture on the 14-
21th day, being previously positive to group A Streptococcus (under a non-inferiority hypothesis, where the upper
limit of the 95% confidence interval [95% CI] of the DR does not exceed 10%) and clinical failure on days 10-21. The
results were combined according to a fixed effects model or random depending on whether or not there was
heterogeneity., RESULTS: Four RCT met the selection criteria with 1,314 participants (657 received amoxicillin once OBJECTIVES: The construct of treatment satisfaction with medication (TS-M) provides an avenue for incorporating
the patients' voice in treatment evaluation. In recent years, due to the growing influence of the consumer in health
care decisions, there have been a substantial number of both generic and disease-specific TS-M instruments
developed. This study provides a review of the available TS-M measures and examples of its applications. METHODS:
A literature review was conducted using MEDLINE, ISPOR Research Digest and Google Scholar to identify generic and
disease-specific TS-M instruments as well as any applications of these instruments. The review included evaluation of
research articles, abstracts, review articles, news articles and editorials discussing instruments that measure TS-M.
RESULTS: A total of 39 instruments that measure TS-M were identified. Out of the 39 instruments, four instruments
were generic in nature that could be used across therapy areas and included the three versions of the Treatment
Satisfaction Questionnaire for Medication (TSQM) (TSQM v1.4, TSQM vII, TSQM-9) and the SATMED-Q. The rest of
the 35 measures were disease-specific TS-M instruments covering many diseases including migraine, pain, HIV,
diabetes, Crohn's disease, oncology, osteoarthritis, men's health and multiple sclerosis. The instruments varied
BACKGROUND: Patients with major depression respond to antidepressant treatment, but 10%-30% of them do not
improve or show a partial response coupled with functional impairment, poor quality of life, suicide ideation and
attempts, self-injurious behavior, and a high relapse rate. The aim of this paper is to review the therapeutic options
for treating resistant major depressive disorder, as well as evaluating further therapeutic options., METHODS: In
addition to Google Scholar and Quertle searches, a PubMed search using key words was conducted, and relevant
articles published in English peer-reviewed journals (1990-2011) were retrieved. Only those papers that directly
addressed treatment options for treatment-resistant depression were retained for extensive review., RESULTS:
Treatment-resistant depression, a complex clinical problem caused by multiple risk factors, is targeted by integrated
therapeutic strategies, which include optimization of medications, a combination of antidepressants, switching of
antidepressants, and augmentation with non-antidepressants, psychosocial and cultural therapies, and somatic
therapies including electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure Background: Playing video games in childhood may help achieve advanced laparoscopic skills later in life. The virtual
operating room will soon become a reality, as "doctor games 2.0" will doubtlessly begin to incorporate virtual
laparoscopic techniques. Objectives: To teach surgical skills to schoolchildren in order to attract them to urology as a
professional choice later in life. Materials and Methods: As part of EAU Urology Week 2010, 108 school children aged
15-19 attended a seminar with lectures and simulators (laparoscopy, TUR, cystoscopy, and suture sets) at the 62nd
Congress of the German Society of Urology in Dusseldorf. A Pub-Med and Google Scholar search was also performed
in order to review the beneficial effects of early virtual surgical training. MeSh terms used were "video games,"
"children," and "surgical skills." Searches were performed without restriction for a certain period of time. Results: In Medicinal plants are used by traditional practitioners to treat several ailments. Ethnomedicinal studies on Trema
orientalis Linn. Blume (Ulmaceae) have shown that it is used in the treatment of diabetes mellitus, respiratory
diseases, oliguria, and malaria. This article is aimed at providing comprehensive information on the medicinal uses,
biology, phytochemical constituents, and pharmacological data available on T. orientalis. This has been done to
explore its therapeutic potential for future research opportunities. This review was compiled with information
obtained from databases such as Medline, Elsevier, Springer, Science Direct, Pubmed, Google Scholar, and a library
search for articles published in peer-reviewed journals. Compounds present in the plant include tannins, saponins,
flavanoids, triterpenes, phytosterols, and several constituents of xanthones. Some pharmacological research done on Medicinal plants are used by traditional practitioners to treat several ailments. Ethnomedicinal studies on Trema
orientalis Linn. Blume (Ulmaceae) have shown that it is used in the treatment of diabetes mellitus, respiratory
diseases, oliguria, and malaria. This article is aimed at providing comprehensive information on the medicinal uses,
biology, phytochemical constituents, and pharmacological data available on T. orientalis. This has been done to
explore its therapeutic potential for future research opportunities. This review was compiled with information
obtained from databases such as Medline, Elsevier, Springer, Science Direct, Pubmed, Google Scholar, and a library
search for articles published in peer-reviewed journals. Compounds present in the plant include tannins, saponins,
flavanoids, triterpenes, phytosterols, and several constituents of xanthones. Some pharmacological research done on OBJECTIVE: The aim of this study was to determine which journals publish medical disaster-related work, their
individual focus, and publication volume pre- and post-9/11. METHODS: PubMed and Google Scholar were searched
using key words to identify peer-review journals (print or electronic) publishing medical and public health disaster-
related manuscripts. All medical journals with an average volume of at least five disaster-related publications per
year over the 11-year study period (1996-2006) were selected. Identified journals were categorized as either general
or specialty medical, or disaster health dedicated. All disaster-related articles in each journal were identified and
classified according to 11 subtopics. RESULTS: Of 16 journals meeting entry criteria, 10 were disaster dedicated. Of
these, only six existed pre-9/ 11. Only six general journals (JAMA, American Journal of Public Health, The Lancet, New
England Journal of Medicine, Annals of Emergency Medicine, Academic Emergency Medicine) had sufficient
publications for analysis. Of the 2899 disaster articles identified, 1769 (61 percent) were from the dedicated journals.
Publications increased by 320 percent in the general/subspecialty journals and 145 percent for disaster-specific
journals in the 5-year period post-9/11 (2002-2006) versus the previous 5-year period (1996-2000). Among the
dedicated journals, Journal of Prehospital and Disaster Medicine published the most (21 percent), followed by
Disaster Prevention and Management: An International Journal (18 percent). Among the general/subspecialty
Background: The benefits of antiretroviral therapy (ART) cannot be experienced if they are not taken as prescribed.
Yet, not all causes of non-adherence are dependent on the patient. Having to pay for medication reduces adherence
rates. Non- adherence has severe public health implications which must be addressed locally and globally. This paper
seeks to describe the trends in adherence rates reported in Cameroon and to investigate the determinants of
adherence to ART in the Cameroon Mobile Phone SMS (CAMPS) trial.Methods: We conducted a systematic review of
electronic databases (PubMed, Google Scholar, Web of Science, CINAHL, EMBASE and PSYCINFO) for publications on
adherence to ART in Cameroon (from January 1999 to May 2012) and described the trend in reported adherence
rates and the factors associated with adherence. Data were extracted in duplicate. We used multivariable analyses
on the baseline data for 200 participants in the CAMPS trial to determine the factors associated with adherence in
four models using different measures of adherence (more than 90% or 95% on the visual analogue scale, no missed
doses and a composite measure: 100% on the visual analogue scale, no missed doses and all pills taken on
time).Results: We identified nine studies meeting our inclusion criteria. Adherence to ART in Cameroon has risen Background: Autologous flap reconstruction can improve aesthetic results after failed implant reconstruction and be
considered following previous failed autologous flap reconstruction. This study presents a review of the indications,
motivation and outcomes of tertiary breast reconstruction. Methods: A comprehensive literature review was
conducted using Pubmed, Embase, Web of Science and Google Scholar. Articles were identified using key search
terms and through citations. A single centre, retrospective, review of all patients who underwent autologous flap
reconstruction following previous breast reconstruction between 2004 and 2010. Details on patient demographics,
surgical outcomes and patient satisfaction were collected. Results: Out of 580 autologous flap breast
reconstructions, 31 patients had 36 tertiary breast reconstructions with an autologous free or pedicled flap.
Indications for surgery included: capsule contracture with discomfort (n = 24), asymmetry (n = 8), extrusion of
implant (n = 4), exposed implant (n = 1). and previous failed autologous flap reconstruction (n = 7). The mean age our
cohort was 50.1 years, BMI of 26.1, 52.3% had radiotherapy (n = 19) and 51.6% had chemotherapy. We performed
free DIEP(n = 22), LD with or without an implant (n = 11) and free TRAM flap (n = 3). 5 were bilateral procedures. Flap
complications included total flap loss (n = 2), partial skin necrosis (n = 1) and fat necrosis (n = 1). Mean follow up time
was 20 months. Overall satisfaction, excluding the two flap failures was good. Literature review: Only small case OBJECTIVES: The recent reforms and policy changes have increased the cost pressures on all health care
stakeholders, including clinical experts. In the past, clinical guidelines were developed independent of cost or
economic considerations. However, increasingly, more clinical guidelines are mentioning cost concerns and referring
to economic data in new recommendations. The objective of this study was to analyze trends in the use of health
economic information for developing clinical guidelines. METHODS: To understand trends in use of health economic
information we conducted targeted search for clinical guidelines, expert recommendations, and consensus
statements with specific mention of "cost" or "economic" or related terms. A systematic literature search was
undertaken for the databases Pubmed, Google Scholar and Cochrane. The guidelines published between 2003-2012
were included. For guidelines which met the search criteria, data was collected for the name of the authors,
indication, year of publication, country/region, and context of use of cost/economic evidence. RESULTS: Sixteen
clinical guidelines published between 2003-2012 met the inclusion criteria for specific mention of cost/economic
evidence. More than 50% of these guidelines were published between 2006-2012. For indication 3 out of 16 This article analyzes the literature describing factors affecting nurses' triage of emergency department (ED) patients
with potential acute coronary syndrome (ACS), with particular attention paid to gender-based differences. Acute
coronary syndrome is one of the most time-critical conditions requiring ED nurse triage. This literature review will
provide examination of how triage nurses prioritize patients with possible ACS, reflecting on challenges specifically
associated with evaluating women for ACS in the ED. The article presents a description of the research findings that
may help improve the timely revascularization of ACS in women. An electronic search of EBSCOhost CINAHL, Health
Source Nursing Academic Edition, MEDLINE, Psychology and Behavioral Sciences Collection databases, online theses,
the Cochrane Library, the Joanna Briggs Institute, and National Guideline Clearinghouse resources were used to
identify all relevant scientific articles published between 1990 and 2010. Google and Google Scholar search engines
were used to undertake a broader search of the World Wide Web to improve completeness of the search. This
search technique was augmented by hand searching these articles' reference lists for publications missed during the
primary search. : Review of the literature suggests factors such as patient age, sex, and symptoms at ED presentation
affect the accuracy of nurses' triage of ACS, particularly for women. However, research examining delays due to ED
triage is scant and has predominantly been undertaken by one researcher. Little research has examined triage of ACS
Emergence of resistance to widely used trimethoprim/sulfamethoxazole (TMP/SMX) as well as common adverse
events in human immunodeficiency virus (HIV)-infected patients casts interest on combinations of TMP with other
sulfonamides. Sulfametrole (SMT) combined with TMP could provide a choice for difficult-to-treat infections,
particularly when administered intravenously. The objective of this review was to evaluate the available clinical and
pharmacokinetic/pharmacodynamic (PK/PD) evidence regarding TMP/SMT, particularly in comparison with
TMP/SMX. We reviewed the available evidence retrieved from searches in PubMed/Scopus/Google Scholar and by
bibliography hand-searching. In total, 46 eligible studies (most published before 1997) were identified, 7 regarding
intravenous (i.v.) TMP/SMT, 24 regarding oral TMP/SMT and 15 providing comparative data for TMP/SMT versus
TMP/SMX. The antimicrobial activity of TMP/SMT was similar to TMP/SMX for Gram-positive isolates. A greater
percentage of Escherichia coli and Proteus spp. isolates were susceptible to TMP/SMT compared with TMP/SMX.
PK/PD data suggest a dosage adjustment of i.v. TMP/SMT in patients with seriously impaired renal function. Four
randomised controlled trials and 16 non-comparative studies reported good effectiveness/safety outcomes for oral Background: Tropomyosin-related kinases (Trks) are a family of receptor tyrosine kinases activated by neurotrophins.
Trks play important roles in pain sensation as well as tumour cell growth and survival signaling. Thus, inhibitors of Trk
receptor kinases might provide targeted treatments for pain and cancer. Objective: This paper reviews those patent
applications since 2002 claiming small-molecule inhibitors of Trk receptor kinases. Methods: Primary literature and
patents were searched with SciFinder and Google Scholar. Patents were selected based on their relevance to Trks
and were evaluated and representative compounds were listed as examples. Results/conclusion: Several series of Trk The burden of tuberculosis in Nigeria is the highest in Africa. Therefore, improved knowledge of health workers on
the current issues concerning the disease, including the National guideline, is important for effective disease control.
An in-depth search of relevant literature on the subject area. This includes texts and operational documents of the
Nigerian national tuberculosis programme, as well as online searches using Pubmed, Africanjournal online (Ajol), and
Google scholar. About one third of the world population is infected with tuberculous bacilli with up to 10% lifetime
risk of developing the disease. Pulmonary tuberculosis (PTB) especially the reactivated latent infection is the major
source of the infection in communities. In an effort to increase case detection, a single acid fast bacillus in at least
one of two sputum smears is currently adequate to diagnose PTB. Furthermore, there is a global effort to eliminate Tuberculosis (TB) is one of the most ancient diseases of mankind, with molecular evidence going back to over 17,000
years. In spite of newer modalities for diagnosis and treatment of TB, unfortunately, people are still suffering, and
worldwide it is among the top 10 killer infectious diseases, second only to HIV. According to World Health
Organization (WHO), TB is a worldwide pandemic. It is a leading cause of death among HIV-infected people. In India,
historically speaking, fight against TB can be broadly classified into three periods: early period, before the discoveries
of x-ray and chemotherapy; post-independence period, during which nationwide TB control programs were initiated
and implemented; and the current period, during which the ongoing WHO-assisted TB control program is in place.
Today, India's DOTS (directly observed treatment-short course) program is the fastest-expanding and the largest
program in the world in terms of patients initiated on treatment; and the second largest, in terms of population
coverage. Major challenges to control TB in India include poor primary health-care infrastructure in rural areas of Tuberculosis (TB) is one of the most ancient diseases of mankind, with molecular evidence going back to over 17,000
years. In spite of newer modalities for diagnosis and treatment of TB, unfortunately, people are still suffering, and
worldwide it is among the top 10 killer infectious diseases, second only to HIV. According to World Health
Organization (WHO), TB is a worldwide pandemic. It is a leading cause of death among HIV-infected people. In India,
historically speaking, fight against TB can be broadly classified into three periods: early period, before the discoveries
of x-ray and chemotherapy; post-independence period, during which nationwide TB control programs were initiated
and implemented; and the current period, during which the ongoing WHO-assisted TB control program is in place.
Today, India's DOTS (directly observed treatment-short course) program is the fastest-expanding and the largest
program in the world in terms of patients initiated on treatment; and the second largest, in terms of population
coverage. Major challenges to control TB in India include poor primary health-care infrastructure in rural areas of INTRODUCTION: Early detection of breast cancer (BC) recurrence is a fundamental issue during follow-up. Although
the utilization of new therapeutic protocols aimed at reducing the recurrence risk is defined, the diagnostic approach
for early detection remains to be clarified. We aim to provide a critical overview of recently published reports and
perform a meta-analysis on the use of tumor markers in BC patients as a guide for fluorodeoxyglucose positron
emission tomography (PET) imaging. METHODS: Medline and Google Scholar were used for searching English and
non-English articles that evaluate the role of PET in BC recurrence when an increase in tumor markers is found. All
complete studies were reviewed; thus, quantitative and qualitative analyses were performed. RESULTS: From 2001
to May 2011, we found 19 complete articles that critically evaluated the role of PET in BC recurrence detection in the
presence of elevated tumor markers. The meta-analysis of the 13 studies provided the following results: pooled
Microenvironmental elements can directly contribute to the induction and the maintenance of tumor. Oxygen is the
main element in the cell microenvironment and hypoxia can affect the process of tumorigenesis. In response to
hypoxia, cells change their pattern and characteristics. These changes suggest that it is not just adaptation, but some
sort of cell defense against hypoxia. If hypoxia is corrected, then cell defense mechanisms are interrupted. An
examination of the process of tumorigenesis helps to design better therapeutic strategies. A systematic review of the
English literature was conducted by searching PubMed, Google Scholar, and ISI Web databases for studies on
changes that defend and help cells to live in a hypoxic microenvironment. Cells respond to hypoxia by de-
differentiation and an increase in heat shock proteins. Angiogenesis and deviation of inflammatory response in favor
of hypoxic cell survival also defend and save the oxygen-starved cells from death. Finally, anti-angiogenic therapies
and more hypoxia enhance metastasis, as tumors with low oxygen concentration are more malignant than tumors INTRODUCTION: Mineral trioxide aggregate (MTA) has been suggested for root-end filling, vital pulp therapy, apical
plug, perforations repair, and root canal filling. Since the introduction of MTA in 1993, many studies about this
material have been published. The aim of this survey was to illustrate statistical information about published articles
in PubMed-index journals vis-a-vis the various aspects of this biomaterial., MATERIAL AND METHODS: A PubMed
search was performed to retrieve the relative articles from 1993 to August 2012. The data of each article including
publication year, journal name, number of authors, first author name, affiliations and study design were recorded.
Citation of each article till 2009 was obtained from Scopus and Google scholar databases. Data were analyzed to
determine the related scientometric indicators., RESULTS: In total, 1027 articles were found in PubMed-indexed
journals which show considerable increase from 2 papers in 1993 to 139 in 2011. While ~62% of articles had no level
of evidence, only ~5% could be classified as having the highest level of evidence (LOE1); however, the majority of Study Type - Therapy (meta-analysis) Level of Evidence1a OBJECTIVES To assess the effectiveness and complications
of transobturator tape (inside-out and outside-in, TOT) by means of a systematic review of direct and indirect
randomized controlled trials (RCTs). METHOD MEDLINE, EMBASE, CINAHL, LILIACS (up to December 2008), CENTRAL
(The Cochrane Library, Issue 1, 2009), MetaRegister of Controlled Trials, The National Library for Health, the National
Research Register and Google Scholar were searched using various relevant search terms. The citation lists of review
articles and included trials were searched and contact with the Correspondence of each included trials was
attempted. RCTs which compared the effectiveness of synthetic transobturator (inside-out tape TVTO, or outside-in
TOT) with TVT by the retropubic route (Gynecare, Ethicon, Inc., or similar tape by a different company) or with each
other for the treatment of stress urinary incontinence (SUI), and in all languages, were included. Two reviewers
extracted data on participants' characteristics, study quality, intervention, cure and adverse effects independently.
The data were analysed using Review Manager 5 software. RESULTS There were 12 RCTs that compared TOT with
TVT, and 15 that compared TVTO vs TVT for treating SUI. There were four direct comparison RCTs of TVTO vs TOT.
When compared at 1-44 months, the subjective (odds ratio 1.16; 95% confidence interval 0.83-1.6) and objective
(0.94; 0.66-1.32) cure of TOT was similar to TVT. For TVTO, the subjective (1.06, 0.85-1.33) and objective cure (1.03,
0.77-1.39) was also similar to TVT. Adverse events such as bladder injuries (TOT, odds ratio 0.11, 0.05-0.25; TVTO,
0.15, 0.06-0.35) and haematomas (0.06, 0.01-0.30) were less in the TOT than TVT. Voiding difficulties (TOT, odds We performed a systematic review and meta-analysis to explore whether type 2 diabetes mellitus (T2DM) increases
the risk of Alzheimer's disease (AD). We also reviewed interactions with smoking, hypertension, and apolipoprotein E
4. Using a series of databases (MEDLINE, EMBASE, PubMed, Current Contents Connect, and Google Scholar), we
identified a total of 15 epidemiologic studies. Fourteen studies reported positive associations, of which 9 were
statistically significant. Risk estimates ranged from 0.83 to 2.45. The pooled adjusted risk ratio was 1.57 (95%
confidence interval: 1.41, 1.75), with a population-attributable risk of 8%. Smoking and hypertension, when
comorbid with T2DM, had odds of 14 and 3, respectively. Of the 5 studies that investigated the interaction between
T2DM and apolipoprotein E 4, 4 showed positive associations, of which 3 were significant, with odds ranging from
2.4 to 4.99. The pooled adjusted risk ratio was 2.91 (95% confidence interval: 1.51, 5.61). Risk estimates were
presented in the context of a key confounder - cerebral infarcts - which are more common in those with T2DM and
might contribute to the manifestation of clinical AD. We provide evidence from clinico-neuropathologic studies that
Objective. The aim of this work was to review the technical aspects and clinical applications of contrast media
(microbubbles and nanomolecular agents) in obstetric and gynecologic ultrasonographic imaging. Methods. With the
use of a computerized database (MEDLINE) and several Web-based search engines (Google Scholar and Copernic),
relevant articles on ultrasonographic contrast media were reviewed. References cited in these articles and not
obtained via the search engines were also reviewed. Results. Ultrasonographic contrast media constitute a new and
expanding technology. They are frequently used, for example, in adult cardiology. Extensive research in laboratory
setups, animals, and human subjects has shown their safety and huge potential as an adjunctive tool in clinical
practice. They increase signals returning from insonated tissues and are particularly effective as intravascular agents,
enhancing color and Doppler signals, for instance. Preliminary results in tumor imaging are encouraging. The
ultrasonographic contrast media permit pharmacokinetic perfusion studies, which may be of enormous clinical Background: Despite the growing interest in the use of ultrasound (US) imaging to guide performance of regional
anaesthetic procedures such as peripheral nerve blocks, controversy still exists as to whether US is superior to
previously developed nerve localization techniques such as the use of a peripheral nerve stimulator (PNS). We sought
to clarify this issue by performing a systematic review and meta-analysis of all randomized controlled trials that have
compared these two methods of nerve localization. Methods: We searched Ovid MEDLINE, the Cochrane Central
Register of Controlled Trials, and Google Scholar databases and also the reference lists of relevant publications for
eligible studies. A total of 13 studies met our criteria and were included for analysis. Studies were rated for
methodological quality by two reviewers. Data from these studies were abstracted and synthesized using a meta-
analysis. Results: Blocks performed using US guidance were more likely to be successful [risk ratio (RR) for block
failure 0.41, 95% confidence interval (CI) 0.26-0.66, P<0.001], took less time to perform (mean 1 min less to perform This review highlights the need in the Pakistani medical education system for teachers and students to be able to:
define constructive feedback; provide constructive feedback; identify standards for constructive feedback; identify a
suitable model for the provision of constructive feedback and evaluate the use of constructive feedback. For the
purpose of literature review we had defined the key word glossary as: feedback, constructive feedback, teaching
constructive feedback, models for feedback, models for constructive feedback and giving and receiving feedback.
The data bases for the search include: Medline (EBSCO), Web of Knowledge, SCOPUS, TRIP, ScienceDirect, Pubmed,
UK Pubmed Central, ZETOC, University of Dundee Library catalogue, SCIRUS (Elsevier) and Google Scholar. This article Purpose: To perform a systematic review of the research literature on postdivorce coparenting relationships and
improve practice through increasing providers' understanding of this dynamic relationship. Data sources: Health
science and social science literatures were reviewed using the following databases: Cumulative Index of Nursing and
Allied Health Literature (CINAHL), MEDLINE, PsycINFO, Google Scholar, PubMed, and Sociology Abstracts.
Conclusions: Over 290 articles were found, although only 19 peer-reviewed articles met the inclusion criteria of
research conducted with both postdivorce coparents. Researchers' priorities centered on quality and conflict in the Background: Disability is not a category of disease but rather relates to the physical, sensory, cognitive, and/or
mental disorders that substantially limit one or more major life activities. These functional limitations have been
found to be predictive of suicide, with psychiatric comorbidities increasing the risk for suicide. Enormous gaps exist in
the understanding of the relationship between disability and suicide. Objective: We reviewed the current literature
addressing the prevalence of and risk factors for suicide among persons with three major disabling conditions and
identify priorities for future research. Methodology: We performed a literature review investigating the relationship
between three major disabilities (intellectual disability, spinal cord injury, multiple sclerosis) and suicide. To ensure
thorough evaluation of the available literature, we searched PubMed, the Cochrane Library, and Google Scholar with
terms including "suicide," "disability," "intellectual disability," "spinal cord injury," "multiple sclerosis," and
permutations thereof. By this method we evaluated 110 articles and included 21 in the review. Results: Suicide rates
are significantly higher among persons with multiple sclerosis and spinal cord injury than in the general population. A
more nuanced picture of suicide rates and risk factors exists for the intellectual disability population, in which it Aim: To indicate about the need for involving general dentists in the process of screening and early detection of
malignant and premalignant lesions. To make brief literature review, which lesions are included under the term "oral
premalignant lesions", and which lesions should be excluded from this nomenclature, according to the contemporary
views and conceptions. To gather in one place the latest information about new diagnostic procedures used
worldwide for screening and early diagnosis of premalignant and malignant lesions of oral mucosa. Material and
Method: Searching was conducted by electronic selection of published papers over the largest database of published
papers, PubMed (http://www.ncbi.nlm.nih.gov/pubmed/), and its subsequent ramifications PubMed Central
(http://www. ncbi.nlm.nih.gov / pmc /), as well as through the database of Google Scholar
PURPOSE/OBJECTIVES: To provide a comprehensive overview of weight loss in patients with colorectal cancer (CRC)
within the context of the Human Response to Illness (HRTI) model. DATA SOURCES: Research from 1990-2008 and
classic research from the 1980s were included. PubMed, CINAHL(R), and Google Scholar were searched for the terms
cancer, CRC, weight loss, and cancer cachexia. DATA SYNTHESIS: Progressive, unintentional weight loss is a common
issue in patients with CRC that has a devastating effect on patients' self-image, quality of life, and survival.
Physiologic abnormalities, responses to the tumor, and treatments contribute to weight loss in these patients. In
addition, cancer cachexia is an end-stage wasting syndrome and a major cause of morbidity and mortality in this
population. CONCLUSIONS: The HRTI model provides an appropriate framework to gain a comprehensive PURPOSE/OBJECTIVES: To provide a comprehensive overview of weight loss in patients with colorectal cancer (CRC)
within the context of the Human Response to Illness (HRTI) model., DATA SOURCES: Research from 1990-2008 and
classic research from the 1980s were included. PubMed, CINAHL(R), and Google Scholar were searched for the terms
cancer, CRC, weight loss, and cancer cachexia., DATA SYNTHESIS: Progressive, unintentional weight loss is a common
issue in patients with CRC that has a devastating effect on patients' self-image, quality of life, and survival.
Physiologic abnormalities, responses to the tumor, and treatments contribute to weight loss in these patients. In
addition, cancer cachexia is an end-stage wasting syndrome and a major cause of morbidity and mortality in this
population., CONCLUSIONS: The HRTI model provides an appropriate framework to gain a comprehensive OBJECTIVE: To review the characteristics of unintentional injuries and their impact on children and adolescents.
SOURCES OF DATA: Articles published between 2000 and 2005 in the MEDLINE, EBSCO, Proquest, SciELO, BVS and
Google Scholar databases were selected. The authors used the keywords unintentional injuries, injuries, safe home,
burns, falls, drowning, scorpions, snakes, poisoning, child, adolescent, mortality, injury control, and hospitalization.
Some articles were evaluated based on the selected publications. SUMMARY OF THE FINDINGS: Unintentional
injuries in the world and in Brazil are analyzed, and so are the behaviors currently adopted for injury prevention and
control. The impact on mortality, on physical damage, and the economic burden of injuries are evaluated. Special
emphasis is placed on home environment, approaching the effects of child development, social disparities and Objective: To review the characteristics of unintentional injuries and their impact on children and adolescents.
Sources of data: Articles published between 2000 and 2005 in the MEDLINE, EBSCO, Proquest, SciELO, BVS and
Google Scholar databases were selected. The authors used the keywords unintentional injuries, injuries, safe home,
burns, falls, drowning, scorpions, snakes, poisoning, child, adolescent, mortality, injury control, and hospitalization.
Some articles were evaluated based on the selected publications. Summary of the findings: Unintentional injuries in
the world and in Brazil are analyzed, and so are the behaviors currently adopted for injury prevention and control.
The impact on mortality, on physical damage, and the economic burden of injuries are evaluated. Special emphasis is
placed on home environment, approaching the effects of child development, social disparities and contextualization Aim: Radiation induced bowel toxicity results from patient and treatment (dosimetric) factors. Design of new studies
to find patient factors such as genetic loci for normal tissue radiosensitivity requires the removal of dose and volume
as confounders. This study aims to review what is known about dosimetric predictors of bowel toxicity in prostate
radiotherapy. Methods: Online database searching (PubMed) and citation/reference linking (Web of Science, Google
Scholar) were performed to identify recent publications (since 1998) that correlated dose and volume of rectal
radiation to late rectal toxicity. This review was limited to prostate cancer external beam radiotherapy and data from
clinical studies only. Each study was reviewed to determine: prescribed dose/fractionation; rectal volume definition;
toxicity endpoints reported; and conclusions drawn. Results: The review found 24 original articles and 2 systematic
reviews. Five studies reported findings from the same clinical cohort as another study, meaning 19 patient cohorts
were reviewed. There was great heterogeneity of reported dose-volume constraints and predictors. This is due partly
to intrinsic variation of patient radiosensitivity, but also to heterogeneity in treatment and reporting. There were ten BACKGROUND: Intussusception is defined as the telescoping of a segment of the gastrointestinal tract into an
adjacent one. A demonstrable etiology is found in 70% to 90% of cases in adult patients, and about 40% of them are
caused by a primary or secondary malignant tumor. The aims of this study were to give an overview of the literature
on intussusception due to gastrointestinal lymphoma. MATERIALS AND METHODS: We present a case of ileocecal
intussusception secondary to non-Hodgkin's lymphoma (NHL), as well as a literature review of studies published in
the English language on intussusception secondary to lymphoma, accessed through PubMed and Google Scholar
databases. RESULTS: Thirty-six published cases of intussusception causedby lymphoma were evaluated, and a
caseofileocecal lymphomaina 62 year-old woman is herein presented. Inthe reviewed literature, 33 reports meeting
the aforementioned criteria were included in this review. The patients were aged from 16 to 86 years (mean, 48.2 +/-
BACKGROUND: The aim of this study was to provide an overview of the literature on Tailgut cysts (TGCs) arising in
the presacral space., MATERIALS AND METHODS: We present a new case of presacral TGC and a literature review of
English-language studies of presacral TGCs, accessed through the PubMed and Google Scholar databases. Keywords
used were presacral or retrorectal tailgut cyst, presacral mucus-secreting cyst, retrorectal cystic hamartoma,
retrorectal tumor, vestigial retrorectal or presacral cyst, and presacral cystic tumor., RESULTS: A 29-year-old woman
presented to our Clinic with defecation disturbance caused by a presacral TGC. Our literature review resulted in the
inclusion of 94/111 articles and 155/332 described cases (129 women, 26 men; age, 0-80 years) of presacral TGC in
this study. Although most patients presented with complaints such as rectal bleeding, rectal fullness, perianal pain,
constipation, and pain reflected to the back, some asymptomatic cases were identified incidentally and others were
detected during the investigation of atypical complaints such as pilonidal abscess, sinus, vaginal obstruction, and AIM: To document unusual findings in appendectomy specimens. METHODS: The clinicopathological data of 5262
patients who underwent appendectomies for presumed acute appendicitis from January 2006 to October 2010 were
reviewed retrospectively. Appendectomies performed as incidental procedures during some other operation were
excluded. We focused on 54 patients who had unusual findings in their appendectomy specimens. We conducted a
literature review via the PubMed and Google Scholar databases of English language studies published between 2000
and 2010 on unusual findings in appendectomy specimens. RESULTS: Unusual findings were determined in 54 (1%)
cases by histopathology. Thirty were male and 24 were female with ages ranging from 15 to 84 years (median, 32.2
+/- 15.1 years). Final pathology revealed 37 cases of enterobiasis, five cases of carcinoids, four mucinous
cystadenomas, two eosinophilic infiltrations, two mucoceles, two tuberculosis, one goblet-cell carcinoid, and one
neurogenic hyperplasia. While 52 patients underwent a standard appendectomy, two patients who were diagnosed Hydatid disease is caused by Echinococcus granulosus and is endemic in many parts of the world, including Iran. This
parasitic tapeworm can produce cysts in almost every organ of the body, with the liver and lung being the most
frequently targeted organs. However, the cyst tends to appear in different and sometimes unusual body sites in
various geographical areas of the world. This review provides information on the reported cases of the unusual body
sites of the hydatid cyst from Iran in the last 20 years. A literature search was performed through PubMed, Scopus,
Google Scholar, IranMedex, Society Information Display (SID), Magiran, and Irandoc using the keywords of "hydatid
cyst and Iran" and "Echinococcus granulosus and Iran", and 463 published cases of the hydatid cyst in unusual body This is a descriptive case report of a 30-year-old man with massive epistaxis, echymosis on arms, abnormal CBC and
increased plasma urea and creatinine level (i.e. above normal range). Probably, these are as side effects of interferon
beta-1a injection. This is the first report according to our literature search (Pub Med, Google scholar, ISI web of
knowledge, ProQuest, MD consult, Science Direct, and SCOPUS) about interferon beta-1a related abnormal kidney
function tests hereafter. Abnormal kidney function tests (i.e. increased plasma urea and creatinie level) is not a To determine the prevalence of unverifiable ("ghost") publications in applications to an otolaryngology residency
program through the Electronic Residency Application Service (ERAS), correlate with applicant characteristics, and
determine if incidence changed after the addition of PubMed (PMID) numbers in 2008. Cross-sectional study of
residency applications before and after inclusion of PMID numbers at an academic otolaryngology program.
Applications for 2007 and 2008 were reviewed. Publications were verified against Medline, Google Scholar, PubMed,
ISI Web of Science, and Google. Ghost publications were defined as journals, books, abstracts, or posters that could
not be verified as presented, published, or including the applicant author. In total, 489 applications were reviewed:
243 before PMID numbers were requested and 246 after. Of 2300 listed publications, 125 (5%) were not actual
publications and 460 (20%) were in pending status. Forty-five percent (775/1715) could not be verified: 660 of 953
(69%) abstracts/posters, 18 of 47 (38%) chapters, and 97 of 715 (14%) journal articles. Abstracts/posters and book Objective. To determine the prevalence of unverifiable ("ghost") publications in applications to an otolaryngology
residency program through the Electronic Residency Application Service (ERAS), correlate with applicant
characteristics, and determine if incidence changed after the addition of PubMed (PMID) numbers in 2008. Study
Design and Setting. Cross-sectional study of residency applications before and after inclusion of PMID numbers at an
academic otolaryngology program. Subjects and Methods. Applications for 2007 and 2008 were reviewed.
Publications were verified against Medline, Google Scholar, PubMed, ISI Web of Science, and Google. Ghost
publications were defined as journals, books, abstracts, or posters that could not be verified as presented, published,
or including the applicant author. Results. In total, 489 applications were reviewed: 243 before PMID numbers were
requested and 246 after. Of 2300 listed publications, 125 (5%) were not actual publications and 460 (20%) were in
pending status. Forty-five percent (775/1715) could not be verified: 660 of 953 (69%) abstracts/posters, 18 of 47
(38%) chapters, and 97 of 715 (14%) journal articles. Abstracts/posters and book chapters were hardest to verify. The
Though much has been studied and written about food allergy, the majority of the available literature focuses on
food allergies in the pediatric population. Unfortunately, it is likely that in regard to food allergies, adults are not just
big children, and extrapolating findings from pediatric to adult patient populations might lead to erroneous
assumptions. Thus, it is important to validate the correlation between pediatric and adult data, gather data regarding
adult food allergy and understand the specific nuances of subsets of adults to better treat their food allergy. This
review was conducted by identifying potentially relevant studies regarding food allergies in adults through electronic
databases, including PubMed, Medline, and Google Scholar. The search terms included "allergy", "food" and Background: HIV-1 strains have diversified extensively through mutation and recombination since their initial
transmission to human beings many decades ago in Central Africa in the first part of the 20th Century (between 1915
and 1941). The upward trend in global HIV-1 diversity has continued unabated, with newer groups, subtypes, and
unique and circulating recombinants increasingly being reported, especially in Africa. Objective: In this review, we
focus on the extensive diversity of HIV-1 over a decade (2000-2011), in 51 countries of the three African geographic
regions (eastern and southern, western and central, and northern Africa) as per the WHO/UNAIDS 2010
classification. Methodology: References for this review were identified through searches of PubMed, conference
abstracts, Google Scholar, and Springer Online Archives Collection. We retrieved 273 citations, of which 200 reported
HIV-1 diversity from Africa from January, 2000 to August, 2011. Articles resulting from these searches and relevant
references cited in those articles were reviewed. Articles published in English and French were included. Findings:
There has been a high diversity of HIV-1 in its epicenter, west-central Africa. A few subtypes, namely, A (A1, A2, A3,
A4, A5), C, CRF02-AG, and D accounted for about 85% of new infections. Subtype A and D have been stable in East BACKGROUND: HIV-1 strains have diversified extensively through mutation and recombination since their initial
transmission to human beings many decades ago in Central Africa in the first part of the 20th Century (between 1915
and 1941). The upward trend in global HIV-1 diversity has continued unabated, with newer groups, subtypes, and
unique and circulating recombinants increasingly being reported, especially in Africa., OBJECTIVE: In this review, we
focus on the extensive diversity of HIV-1 over a decade (2000-2011), in 51 countries of the three African geographic
regions (eastern and southern, western and central, and northern Africa) as per the WHO/UNAIDS 2010
classification., METHODOLOGY: References for this review were identified through searches of PubMed, conference
abstracts, Google Scholar, and Springer Online Archives Collection. We retrieved 273 citations, of which 200 reported
HIV-1 diversity from Africa from January, 2000 to August, 2011. Articles resulting from these searches and relevant
references cited in those articles were reviewed. Articles published in English and French were included., FINDINGS:
There has been a high diversity of HIV-1 in its epicenter, west-central Africa. A few subtypes, namely, A (A1, A2, A3,
A4, A5), C, CRF02_AG, and D accounted for about 85% of new infections. Subtype A and D have been stable in East Since ancient, the genus Satureja L. is well recognized for its therapeutic values. Only recently, scientists have been
aware of its new medicinal aspects. In our last review, we evaluated existing scientific data about this genus.
Regarding ongoing reports and new multi-functional properties of this plant we were interested to update
pharmacology of Satureja. Data were gathered using of scientific books, journals, articles and websites including
Pubmed, Scopus and Google Scholar up to 25th April 2010. Of initial search, 1540 records were reviewed for
inclusion or exclusion in study, of which 71 publications were included. Different species of Satureja are famous for
their analgesic, antiseptic, antimicrobial, antiviral, antioxidant, antiproliferative, antiprotozoal, antifungal,
antidiarrheal, anti-inflammatoiy, anti-nociceptive, anticholinesterase and vasodilatory activities. The valuable
therapeutic aspects of this genus are mostly correlated to the existence of essential oils, flavonoids and Introduction: Hypericum perforatum (HP), more commonly known as St. John's wort, is a popular medicinal herb
used for the treatment of depression. HP affects the pharmacokinetics of many drugs by inducing cytochrome P450
(CYP) isozymes, such as CYP3A4, CYP2C19, CYP2C9, and the P-glycoprotein (P-gp) transporter. Areas covered: This
review focuses on drugs that are metabolized by CYP3A4, CYP2C19, CYP2C9 and P-gp as their plasma concentrations
show the effects of concomitant use of HP. For the purpose of this review, all electronic databases such as PubMed,
Scopus, Google Scholar and Cochrane library were searched to identify in vitro, in vivo or human studies about the
effects of HP on the metabolism of drugs. Data collected were published between 1966 and January 2012. Expert
opinion: There are a number of drugs whose metabolism is reduced by HP. The authors point out that metabolic
interactions between HP and drugs are not always unfavorable and sometimes have benefits (e.g., reduction of
irinotecan toxicity and increase in clopidogrel responsiveness). HP does not have a significant influence on the
IntroductionPowerful immunosuppressive regimens have reduced rejection risk, leading to an expanding cohort of
long-term kidney transplant recipients who are likely to encounter practitioners in other specialties.Sources of
dataKey review papers and primary literature identified through searches of PubMed, Google Scholar and
Medline.Areas of agreementDeath from cardiovascular disease and malignancy remain the chief causes of transplant
loss. Risk factors and phenotypes for these differ from the general population.Areas of controversyMany guidelines
for renal transplant recipients are based on extrapolation from studies on non-transplant cohorts and may not be
appropriate. Emerging studies demonstrate that established interventions in the general population are less Spondyloarthritis (SpA) is a group of interrelated but phenotypically distinct chronic inflammatory arthritis. To
describe the management of SpA in Asian countries, we performed systematic literature searches through MEDLINE
/ PubMed, EMBASE and Google Scholar using the following keywords: spondyloarthritis, management, treatment,
classification criteria, physical exercise, non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic
drugs, thalidomide, glucocorticoids, tumor necrosis factor blockers, bisphosphonates. Studies conducted in Asian
countries in the past 3 years were included. Low quality evidences, which had too small sample size or lacked
controlled group, were excluded. Through the analysis of the included literature, it was concluded that management
of SpA in Asia has changed in recent years. More frequent uses of magnetic resonance imaging (MRI) in diagnosing
SpA and successful uses of tumor necrosis factor (TNF) blockers in active, refractory diseases have significantly Objective: Recently we have demonstrated that a greater adherence to Mediterranean diet is able to confer a
significant protection versus mortality, occurrence of cardiovascular diseases and major chronic degenerative
diseases. Aim of this study was to update the evidences reported in our previous meta-analysis with recent studies
published in the literature, in order to investigate whether the protective role of Mediterranean diet remained to be
statistically significant as the number of studies and subjects increased. Methods: We conducted an electronic
literature search through MedLine, Embase, Google Scholar, Web of Science, The Cochrane Library, and
bibliographies of retrieved articles up to January, 2010. Studies were included if they analysed prospectively the
association between adherence to Mediterranean diet and chronic degenerative diseases. Results: The updated
review process evidenced 7 new prospective studies published in the last 2 years (1 for overall mortality, 3 for
cardiovascular incidence and/or mortality, 1 for cancer incidence and/or mortality, and 2 for neurodegenerative
diseases) for a total of 640,575 subjects. The cumulative analysis for all the studies under a random-effects model,
conducted after the inclusion of these recent studies, showed that a 2-point increase of adherence to Mediterranean Objective: To update a meta-analysis and determine the effectiveness of psychological interventions on glycaemic
control measured by HbA1c and psychological status in type 2 diabetes and to compare effects when interventions
are delivered by generalist clinicians compared to psychological specialists. Methods: We used the original review
protocol and searched the Cochrane central register of controlled trials, Medline, Embase, PsychLIT, and Google
Scholar from February 2003 (end of previous review) to March 2007. We extracted data on the participants,
interventions, delivery methods, comparison groups and outcome measures. Results: 35 trials were reviewed and
meta-analysis of 19 trials (n = 1431), reporting HbA1c found a reduction in HbA1c by 0.54% (-0.32; 95% CI: -0.47 to -
0.16). In nine trials (n = 832) interventions were delivered by diabetes or general clinicians reducing HbA1c by 0.51%
(-0.27; 95% CI: -0.50 to 0.04). In nine trials, interventions (n = 561) were delivered by psychological specialists Background: Occupational Therapists often provide custom and pre fabricated Orthoses for support and bracing of
weak and ineffective joints or muscles of the upper extremity in the management of ALS/MND. The purpose of the
orthosis is to decrease the effects of muscle imbalance to provide greater ease in performance of activities of daily
living (ADLs), prevent joint contracture, and to relieve pain. Objectives: The objective of this study is to perform a
systematic review of the literature as well as to draw on experiences in the ALS clinic to determine which upper
extremity orthotic devices are useful for pts with ALS/MND. Methods: A systematic review of the literature available
on Medline, EMBASE, Google Scholar, PubMed, and Cinahl was performed; 32 articles were appraised by one author
according to a standard format. Observational, qualitative, and quantitative studies were included. In addition, the
author drew on her own experience over the past 25 years with ALS/ MND patients. Results: No randomized
controlled trials or controlled clinical trials were identified. A summary of descriptive and qualitative studies that
relate to upper extremity orthoses as well as results in the author's experience will be discussed. Discussion and
Aim: The world is experiencing a phenomenal rise in cardiovascular disease morbidity and mortality. These are higher
in developed than developing countries as well as urban more than rural areas. The place of the urban environment
in this picture is seen more as an association than a cause. With the epidemiological transition coming on, the need
to draw attention to the role of a "toxic" environment becomes necessary if preventive measures are to be put in
place. This review article sought to evaluate the role of the urban environment in the development of cardiovascular
disease. This would therefore highlight the areas where preventive measures can be instituted to stem the tide of
rising cardiovascular disease morbidity and mortality Method: A systematic review of literature on environmental
and cardiovascular diseases from indexed and on-line journals using Pubmed, Google and Google scholar were
performed. Relevant local materials on housing and urban environment were also consulted. Results: The various Objectives: To evaluate the current status of ureteroscopic lithotripsy (UL) for treating renal calculi of >2 cm, as
advances in flexible ureteroscope design, accessory instrumentation and lithotrites have revolutionised the
treatment of urinary calculi. While previously reserved for ureteric and small renal calculi, UL has gained an
increasing role in the selective management of larger renal stone burdens. Methods: We searched the available
databases, including PubMed, Google Scholar, and Scopus, for relevant reports in English, and the article
bibliographies to identify additional relevant articles. Keywords included ureteroscopy, lithotripsy, renal calculi, and
calculi >2 cm. Retrieved articles were reviewed to consider the number of patients, mean stone size, success rates,
indications and complications. Results: In all, nine studies (417 patients) were eligible for inclusion. After one, two or
three procedures the mean (range) success rates were 68.2 (23-84)%, 87.1 (79-91)% and 94.4 (90.1-96.7)%,
respectively. Overall, the success rate was >90% with a mean of 1.2-2.3 procedures per patient. The overall Hypothesis / aims of study Although urodynamic tests are widely used in the investigation of stress urinary
incontinence (SUI), their place in the diagnostic work-up and selection of surgical treatment remains controversial.
The measurement of changes in patient-reported symptoms and changes in quality of life are now the norm for
measuring success of the incontinence treatments. A recent survey of urologists and urogynaecologists concluded
that 89% currently arrange UDS for the majority of women with SUI or stress predominant mixed urinary
incontinence (MUI). We aimed to collate the evidence on the outcome of stress urinary incontinence (SUI) surgery
based on urodynamic diagnosis versus history and examination alone, in women with SUI or stress predominant
mixed urinary incontinence and no voiding dysfunction. Study design, materials and methods We searched Cochrane,
MEDLINE, EMBASE, CINAHL, LILACS, meta Register of Controlled trials (m RCT) and Google Scholar databases from
inception until 03/2013. We included randomised controlled trials (RCT) comparing clinical outcomes in women who
were investigated by UDS versus women who underwent SUI surgery based on office evaluation alone. Two
independent reviewers assessed trial quality and extracted the data. All the information was analysed using Rev Man
5.2 software. Results Out of the 388 articles identified in the search, 4 RCTs met our inclusion criteria; out of which 2
were published as full manuscripts, one as an abstract and the results from the 4th study are as yet unpublished. The
women were randomised to either baseline office evaluation (n=382) or preoperative urodynamics (n=345). There
was no statistical difference in the subjective surgical outcome in the two groups in both the studies [odds ratio
0.81(95%Confidence Interval (CI) 0.49-1.34)] Objective cure rate in the form of negative stress test at 12-49 months
follow up was also found to be similar in both groups [OR 0.89(95% CI of 0.50-1.60)]. During the one year follow up, Background: One approach postulated to improve the provision of health care is effective utilization of team-based
care including pharmacists. Objective: The objective of this study was to conduct a comprehensive systematic review
with focused meta-analyses to examine the effects of pharmacist-provided direct patient care on therapeutic, safety,
and humanistic outcomes. Methods: The following databases were searched from inception to January 2009: NLM
PubMed; Ovid/MEDLINE; ABI/INFORM; Health Business Fulltext Elite; Academic Search Complete; International
Pharmaceutical Abstracts; PsycINFO; Cochrane Database of Systematic Reviews; National Guideline Clearinghouse;
Database of Abstracts of Reviews of Effects; ClinicalTrials.gov; LexisNexis Academic Universe; and Google Scholar.
Studies selected included those reporting pharmacist-provided care, comparison groups, and patient-related
outcomes. Of these, 56,573 citations were considered. Data were extracted by multidisciplinary study review teams.
Variables examined included study characteristics, pharmacists' interventions/services, patient characteristics, and
study outcomes. Data for meta-analyses were extracted from randomized controlled trials meeting meta-analysis
criteria. Results: A total of 298 studies were included. Favorable results were found in therapeutic and safety
Background: The adjective <> has a double meaning and it is used for naming two disciplines with separate activities:
Cognitive neuroscience and cognitive psychotherapy. This has an unrecognised impact on the health terminology and
the classification systems. Method: The current use of this term is reviewed in a series of key dictionaries, scientific
books, databases (OldMedline and PsycINFO) and specific web searchers (Google Scholar). The history of this term
and its etymology is also reviewed and compared to other alternatives (i.e. noetic) as well as its use in international
classifications (e.g. the International Classification of Functioning ICF). Results: The modern use of the term <> in
Neurosciences can be traced back to Hebb in a 1955 one year before that recorded at official version. The different
meaning of this term in psychology can be traced back to the same decade. Departing from the ICF framework of
mental functions, <> can be regarded as a generic term that encompasses both neurocognitive and meta-cognitive Recurrent pleural effusion (RPE) can be encountered in various benign conditions such as inflammatory, infectious,
or other systemic diseases (e.g., congestive heart failure (CHF), hepatic hydrothorax, post lung transplants, post
coronary artery bypass graft (CABG) surgery, and chronic exudative pleurisy). Each condition is treated based on its
unique pathophysiologic characteristics, and medical management is successful in the majority of patients. In rare
circumstances, pleural effusions are rapidly recurring despite optimal medical therapy and patients have frequent
hospitalisations that require repeated thoracenteses. Other than medical therapy and repeat thoracentesis,
treatment options are limited to chest tube placement and chemical pleurodesis or, rarely, surgical pleurodesis. We
conducted a literature review using PubMed and Google Scholar, finding 33 articles that were relevant to our topic Aims: In adult cardiac arrest, antiarrhythmic drugs are frequently utilized in acute management and legions of
medical providers have memorized the dosage and timing of administration. However, data supporting their use is
limited and is the focus of this comprehensive review. Methods: Databases including PubMed, Cochrane Library
(including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials), Embase,
and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-
references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion
criteria for this review included human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review.
Excluded were review articles, case series and case reports. Results: Of 185 articles found, only 25 studies met the
inclusion criteria for further review. Of these, 9 were randomised controlled trials. Nearly all trials solely evaluated Purpose: Delivery of home parenteral nutrition (HPN), traditionally via tunneled central venous catheters (CVCs) is
associated with several complications, the commonest being catheter related bloodstream infections. We have
reviewed the literature to investigate the use of arteriovenous fistulae (AVF) as a viable alternative to traditional
routes for long-term parenteral nutrition (PN). Methods: A literature search was performed using the Medline
database, PubMed and a Google scholar search. search terms (keywords) used were: parenteral AND nutrition AND
arteriovenous AND fistula for title and Abstract. Our search yielded 12 articles (1972-2012). two were excluded
because of foreign language and difficult retrieval. the final yield was 10 papers. Results: there were four case
reports, six original papers (one swedish, one French - both excluded), one abstract and one letter to the editor.
there were 19 native AVF, 11 bovine grafts (BG), four synthetic grafts (sG) and 10 autologous venous grafts (AVG). Background: Intraoperative blood loss has been shown to be an important factor correlating with increased
morbidity and mortality in oncological surgery. Despite technological advances in parenchymal transection devices,
bleeding remains the single most important complication. To address this, we designed and developed a bipolar
radiofrequency (RF) device, the Habib 4X (Angiodynamics, Inc., Queensbury, N.Y., USA), which was initially used
specifically for liver resections. Methods: A search using Medline, Embase and Google Scholar was performed for the
period January 2001 to August 2011. The following Mesh terms were used: 'bipolar radiofrequency', 'Habib 4X',
'laparoscopic', 'liver resection', 'partial nephrectomy' and 'distal pancreatectomy'. The references of the studies
included were also reviewed. Series from our centre were excluded. Results: There wereseven series published,
reporting a total of 188 liver resections [113 minor (<3 segments) and 75 major (>=3 segments)] assisted by the
bipolar RF (Habib 4X) device over this period. The median blood loss reported ranged from 15 to 427 ml with a Hormonal agents (estrogen and progesterone) are being studied for their use in bleeding. This observance was
initially explored in a patient with hereditary hemorrhagic telangiectasia (HHT) with epistaxis had variation in
bleeding depending on her menstrual cycles.1 Thus, hormonal therapy was initially used in patients with HHT to
control episodes of epistaxis.2 The literature on hormonal therapy in patients with life-threatening bleeding from
gastrointestinal (GI) lesions is very limited. There are a few clinical trials in patients with chronic bleeds. However, no
definite guidelines exist on their use in life-threatening GI bleeding in patients with uremia. Here, we describe a case Hormonal agents (estrogen and progesterone) are being studied for their use in bleeding. This observance was
initially explored in a patient with hereditary hemorrhagic telangiectasia (HHT) with epistaxis had variation in
bleeding depending on her menstrual cycles.(1) Thus, hormonal therapy was initially used in patients with HHT to
control episodes of epistaxis.(2) The literature on hormonal therapy in patients with life-threatening bleeding from
gastrointestinal (GI) lesions is very limited. There are a few clinical trials in patients with chronic bleeds. However, no
definite guidelines exist on their use in life-threatening GI bleeding in patients with uremia. Here, we describe a case
Purpose The purposes of this paper are to review the best evidence supporting the use of hyperbaric oxygen therapy
(HBOT) in delayed radiation injuries in gynecologic malignancies and report the incidence of radiation injuries at two
large medical centers in southeastern Wisconsin. Methods A literature search was performed on Google Scholar,
PubMed, and Ovid for studies evaluating the use of HBOT radiation cystitis, proctitis, and necrosis. The studies were
then reviewed for the highest quality evidence using American Academy of Neurology guidelines. To evaluate
radiation injuries, cancer databases at Froedtert Memorial Lutheran Hospital (FMLH) and Aurora St. Luke's Hospital
(ASLH) were accessed. Results Several studies support the use of HBOT in treating radiation cystitis, proctitis, and
necrosis, with proctitis having the strongest evidence in its favor. The average annual incidence of radiation injury at Objective. To compare multimedia and standard consent, in respect to patient comprehension, anxiety, and
satisfaction, for various surgical/interventional procedures. Data sources. Electronic searches of PubMed, MEDLINE,
Ovid, Embase, and Google Scholar were performed. Relevant articles were assessed by 2 independent reviewers.
Study selection. Comparative (randomized and nonrandomized control trials) studies of multimedia and standard
consent for a variety of surgical/interventional procedures were included. Studies had to report on at least one of the
outcome measures. Data extraction. Studies were reviewed by 2 independent investigators. The first investigator
extracted all relevant data, and consensus of each extraction was performed by a second investigator to verify the OBJECTIVE: To summarise the extent to which narrative text fields in administrative health data are used to gather
information about the event resulting in presentation to a health care provider for treatment of an injury, and to
highlight best practise approaches to conducting narrative text interrogation for injury surveillance purposes.
DESIGN: Systematic review. DATA SOURCES: Electronic databases searched included CINAHL, Google Scholar,
Medline, Proquest, PubMed and PubMed Central. Snowballing strategies were employed by searching the
bibliographies of retrieved references to identify relevant associated articles. SELECTION CRITERIA: Papers were
selected if the study used a health-related database and if the study objectives were to a) use text field to identify
injury cases or use text fields to extract additional information on injury circumstances not available from coded data
or b) use text fields to assess accuracy of coded data fields for injury-related cases or c) describe
methods/approaches for extracting injury information from text fields. METHODS: The papers identified through the
search were independently screened by two authors for inclusion, resulting in 41 papers selected for review. Due to
heterogeneity between studies meta-analysis was not performed. RESULTS: The majority of papers reviewed focused
on describing injury epidemiology trends using coded data and text fields to supplement coded data (28 papers),
with these studies demonstrating the value of text data for providing more specific information beyond what had
been coded to enable case selection or provide circumstantial information. Caveats were expressed in terms of the
consistency and completeness of recording of text information resulting in underestimates when using these data.
Four coding validation papers were reviewed with these studies showing the utility of text data for validating and
checking the accuracy of coded data. Seven studies (9 papers) described methods for interrogating injury text fields Breast cancer is the most common cancer diagnosed in women. Nipple-sparing mastectomy (NSM) offers the
opportunity to preserve the breast envelope and the nipple-areolar complex by removing only breast tissue and
avoiding multiple surgical procedures for reconstruction. The objective of this article is to review the oncologic and
surgical concerns with NSM, along with the appropriate selection of patients and potential postoperative
complications. A review of the literature was conducted through MEDLINE, PubMed, and Google Scholar, focusing on
recent research. The findings revealed that although the oncologic safety of NSM continues to be debated,
indications are strong that cancer recurrence rates are low and the aesthetic motivation is high for carefully screened Introduction: Acute pancreatitis is a common complication after ERCP with an incidence reported as high as 10%.
Nitrate derivatives have been reported to decrease the tone of the sphincter of Oddi, thereby decreasing pancreatic
complications, especially in patients with sphincter dysfunction. We assessed the clinical outcome of patients
undergoing ERCP treated with prophylactic nitrates compared to that of patients given placebo. Methods: We
performed a systematic search of Medline, EMBASE, and Cochrane Central Register of Controlled Trials using
Pubmed, Ovid and Google Scholar as search engines without language restriction. We also hand searched the
references of original/review articles and evaluated symposia proceedings, poster presentations, and abstracts from
major gastrointestinal and surgical meetings. Relative risks were calculated for individual trials and data pooled using
a fixed effects model. Relative risk reduction (RRR) and absolute risk reduction (ARR) were calculated and are
reported with 95% confidence intervals when the relative risk was significant. Results were subjected to sensitivity
analysis in order to determine heterogeneity among studies. Results: Four studies from which we pooled 856
patients met eligibility criteria. Four hundred and twenty-one patients were randomized to receive prophylactic
transdermal glyceryl nitrate or intravenous nitroglycerin (154 men, 267 women), while 435 were randomized to the
OBJECTIVE: Recognizing the need for a consensus tool to measure social class in health sciences, in 1995 the Spanish
Society of Epidemiology (Sociedad Espanola de Epidemiologia [SEE]) made a proposal for such a measure. The aim of
this article was to explore the bibliometric impact of the SEE's proposal., METHODS: Articles citing the SEE's report
and those citing articles published as a result of the report were identified using Google Scholar and Scopus. The
information extracted from these articles consisted of year, nationality and impact factor of the journal, self-citation,
information source, subject area, city of the first author, type of publication, study design, use of social class as a
variable, number of social class categories, and the use of education or occupation to determine social class.,
RESULTS: The number of citations progressively increased. Citations also showed heterogeneity in the subject. Object. Published case series of endoscopic third ventriculostomy (ETV) for childhood hydrocephalus have reported
widely varying success rates. The authors recently developed and internally validated the ETV Success Score (ETVSS);
this is a simplified means of predicting the 6-month success rate of ETV for a child with hydrocephalus, based on age,
etiology of hydrocephalus, and presence of a previous shunt. The authors hypothesized that the ETVSS would be able
to predict with reasonable accuracy the actual ETV success rate reported among published case series. Methods. A
literature search was performed to identify published pediatric ETV papers that contained enough information with
which to calculate an aggregate, mean predicted ETVSS for the cohort. This was then compared with the actual ETV
success rate in the cohort. Data were extracted independently in triplicate, including by 2 individuals who were not
involved with the development of the ETVSS. Results. Fifteen papers reporting on 322 patients were included.
Interrater reliability was very high in determining the predicted ETVSS (intraclass correlation coefficient 0.99). The Object. Assessing academic productivity through simple quantification may overlook key information, and the use of
statistical enumeration of academic output is growing. The h index, which incorporates both the total number of
publications and the citations of those publications, has been recently proposed as an objective measure of academic
productivity. The authors used several tools to calculate the h index for academic neurosurgeons to provide a basis
for evaluating publishing by physicians. Methods. The h index of randomly selected academic neurosurgeons from a
sample of one-third of the academic programs in the US was calculated using data from Google Scholar and from the
Scopus database. The mean h index for each academic rank was determined. The h indices were also correlated with
various other factors (such as time spent practicing neurosurgery, authorship position) to identify how these factors
influenced the h index. The h indices were then compared with other citation statistics to evaluate the robustness of
this metric. Finally, h indices were also calculated for a sampling of physicians in other medical specialties for
comparison. Results. As expected, the h index increased with academic rank and there was a statistically significant
difference between each rank. A weighting based on position of authorship did not affect h indices. The h index was To evaluate the literature on the stress, coping, and quality of life of organ transplant candidates and recipients, and
to place previous research within a theoretical context. CINAHL database, Proquest database, Google Scholar;
references from articles were also reviewed to identify additional data. Qualitative and quantitative research studies
and meta-analyses pertinent to the stress, coping, and quality of life of transplant candidates and recipients were
selected. Stressors associated with the transplantation process, coping strategies of transplant patients, and quality
of life or transplant patients have been well researched for many years. Patients typically use problem-focused
coping strategies in response to various stressors. Transplant recipients typically report a higher quality of life than Objective: There has been an uptick in the field of emergency department (ED) operations research and data
gathering, both published and unpublished. This new information has implications for ED design. The specialty
suffers from an inability to have these innovations reach frontline practitioners, let alone design professionals and
architects. This paper is an attempt to synthesize for design professionals the growing data regarding ED operations.
Methods: The following sources were used to capture and summarize the research and data collections available
regarding ED operations: the Emergency Department Benchmarking Alliance database; a literature search using both
PubMed and Google Scholar search engines; and data presented at conferences and proceedings. Results: Critical
information that affects ED design strategies is summarized, organized, and presented. Data suggest an optimal size
for ED functional units. The now-recognized arrival and census curves for the ED suggest a department that expands Evidence-based management (EBMa) is the application of the evidence-based medicine process to making
management decisions. EBMa has been described in a number of publications, which note the advantages of utilizing
EBMa and offer generic guidance on the nature of EBMa evidence. This paper provides a specific EBMa pathway for
physician practice and health system mangers to use to conduct EBMa database searches. It provides an example of
conducting an EBMa search for a practice-based management problem. It describes how to do database searches
using Advance Google Scholar, PubMed, and other data sources. It discusses challenges to conducting quality This article provides information about conducting a literature search on the Google Scholar website. The article
briefly describes how to narrow or expand a search and how to find non-journal literature. Although Google Scholar
is not without limitations, it offers a practical starting point for a literature search.
To review the current research of hidden populations of illicit drugs users using web-based methods and discuss
major advantages and disadvantages. Systematic review of 16 databases, including PubMed, PsycINFO (EBSCOhost),
CSA Sociological Abstracts, Expanded Academic ASAP and Google Scholar. Substances researched were most
commonly 'party/club drugs' (such as ecstasy) and cannabis. All of the studies reviewed concluded that the internet
is a useful tool for reaching hidden populations, but is likely to impose some bias in samples. Advantages include:
access to previously under-researched target groups; speed; international applications; increased ease of data entry;
and improved confidentiality for respondents. The major disadvantage is a lack of representativeness of samples. Context: Uterine leiomyomas (fibroids or myomas) are benign tumors of the uterus and are clinically apparent in up
to 25% of reproductive-age women. Heavy or abnormal uterine bleeding, pelvic pain or pressure, infertility, and
recurrent pregnancy loss are generally associated with leiomyoma. Although surgical and radiological therapies are
frequently used for the management of this tumor, medical therapies are considered the first-line treatment of
leiomyoma. Evidence Acquisition and Synthesis: A review was conducted of electronic and print data comprising
both original and review articles on pathophysiology and medical treatments of uterine leiomyoma retrieved from
the PubMed or Google Scholar database up to June 2012. These resources were integrated with the authors'
knowledge of the field. Conclusion: To date, several pathogenetic factors such as genetic factors, epigenetic factors,
estrogens, progesterone, growth factors, cytokines, chemokines, and extracellular matrix components have been
implicated in leiomyoma development and growth. On the basis of current hypotheses, several medical therapies
have been investigated. GnRH agonist has been approved by US Food and Drug Administration for reducing fibroid Purpose - The aim of this paper is to present the literature which identifies the characteristics of small enterprises
and outlines the opportunities to utilise them in working with small businesses to prevent and reduce exposures to
hazardous substances. Design/methodology/approach - A search of a variety of data sources, including Medline,
PubMed, Web of Science, Google Scholar, was conducted which combined the keyword search terms "small
business", "small enterprise", "management", "health and safety management", "hazardous substances", "hazardous
chemicals", "management of hazardous substances". High quality studies were selected and combined with studies
known to the authors. Findings - A strong body of evidence exists which shows that the management of OSH in small
enterprises has been extensively reviewed and the most recurring theme is the identification of problems and
challenges. A growing body of literature also confirms that models for chemical risk management and social Objective: The objectives of this article are to explore the extent to which the International Statistical Classification of
Diseases and Related Health Problems (ICD) has been used in child abuse research, to describe how the ICD system
has been applied, and to assess factors affecting the reliability of ICD coded data in child abuse research. Methods:
PubMed, CINAHL, PsychInfo and Google Scholar were searched for peer reviewed articles written since 1989 that
used ICD as the classification system to identify cases and research child abuse using health databases. Snowballing
strategies were also employed by searching the bibliographies of retrieved references to identify relevant associated
articles. The papers identified through the search were independently screened by two authors for inclusion,
resulting in 47 studies selected for the review. Due to heterogeneity of studies meta-analysis was not performed.
Results: This paper highlights both utility and limitations of ICD coded data. ICD codes have been widely used to
conduct research into child maltreatment in health data systems. The codes appear to be used primarily to Purpose: Weblogs (blogs) offer a free, easily accessible service which can be used by fellows in training and residents
to create and maintain a web site on their own. We explored the use of a weblog to stay up-to-date with the new
developments in allergy and immunology at a fellowship training program. Methods: The weblog was created by 3
fellows in training at 2 allergy and immunology training programs and hosted free of charge by Blogger.com, a
service owned by Google, Inc. The content included clinically-relevant questions and answers, links to core clinical
cases, procedures photos and videos, journal article abstracts and comments. Results After a period of 8 months, the
fellows-in-training have posted 492 updates on the website. The service was used to document the process of
answering clinical questions using evidencebased data, for example, "how prevalent is sesame allergy?", including
location of relevant information in online databases such as Pubmed and Google Scholar, and listing of relevant
references. Under the guidance, and with the direct input of a faculty member, the fellows-in-training appraised and
assimilated the evidence information from scientific studies. The summaries were posted online to be shared with
other fellows and residents and to create a permanent record for later reference. A customized search engine was
Context: Determination of tumour involvement of regional lymph nodes in patients with prostate cancer (PCa) is of
key importance for the proper planning of treatment. Objectives: To provide a critical overview of published reports
and to perform a meta-analysis about the diagnostic performance of 18F-choline and 11C-choline positron emission
tomography (PET) or PET/computed tomography (CT) in the lymph node staging of PCa. Evidence acquisition: A
Medline, Web of Knowledge, and Google Scholar search was carried out to select English-language articles published
before January 2012 that discussed the diagnostic performance of choline PET to individualise lymph node disease at
initial staging in PCa patients. Articles were included only if absolute numbers of true-positive, true-negative, false-
positive, and false-negative test results were available or derivable from the text and focused on lymph node
metastases. Reviews, clinical reports, and editorial articles were excluded. All complete studies were reviewed; thus
qualitative and quantitative analyses were performed. Evidence synthesis: From the year 2000 to January 2012, we
found 18 complete articles that critically evaluated the role of choline PET and PCa at initial staging. The meta- CONTEXT: Determination of tumour involvement of regional lymph nodes in patients with prostate cancer (PCa) is of
key importance for the proper planning of treatment., OBJECTIVES: To provide a critical overview of published
reports and to perform a meta-analysis about the diagnostic performance of 18F-choline and 11C-choline positron
emission tomography (PET) or PET/computed tomography (CT) in the lymph node staging of PCa., EVIDENCE
ACQUISITION: A Medline, Web of Knowledge, and Google Scholar search was carried out to select English-language
articles published before January 2012 that discussed the diagnostic performance of choline PET to individualise
lymph node disease at initial staging in PCa patients. Articles were included only if absolute numbers of true-positive,
true-negative, false-positive, and false-negative test results were available or derivable from the text and focused on
lymph node metastases. Reviews, clinical reports, and editorial articles were excluded. All complete studies were
reviewed; thus qualitative and quantitative analyses were performed., EVIDENCE SYNTHESIS: From the year 2000 to
January 2012, we found 18 complete articles that critically evaluated the role of choline PET and PCa at initial
staging. The meta-analysis was carried out and consisted of 10 selected studies with a total of 441 patients. The meta- Introduction: With rising global antibiotic resistance, stewardship programs aimed at controlling multi-drug resistant
(MDR) pathogens have begun to gain acceptance. These programs stress appropriate antibiotic selection, dosage and
duration. A growing literature suggests serum procalcitonin (PCT) levels may be useful in guiding antibiotic duration
and de-escalation. This report sought to evaluate data available in prospective randomized controlled trials (RCT) on
the role of PCT in guiding reductions in antibiotic duration in the adult sepsis patient. Methods: A comprehensive
search of all published prospective RCT(s) on the use of PCT as a tool for guiding antibiotic therapy in adult sepsis
patients was conducted using PubMed and Google Scholar. Keywords searched included, "procalcitonin", "sepsis
biomarker", "antibiotic duration" and "antimicrobial stewardship". Results: Four RCT(s) involving 826 adult sepsis
patients have evaluated the role of serum PCT levels. Each study used unique criteria for cessation of antibiotic
therapy based on PCT levels and kinetics. Bouadma et al. (N = 621) stopped antibiotics when the PCT concentration
became < 80% of the peak PCT value, or the absolute PCT concentration was < 0.5 mug/L. The PCT arm showed a 2.7-
day reduction in antibiotics. Schroeder et al. (N = 27) discontinued antibiotics if clinical signs of infection improved
and the PCT value decreased to < 1 ng/mL or to < 35% of the initial value within three days. The PCT arm had a 1.7-
day reduction in antibiotics. Hochreiter et al. (N = 110) ceased antibiotics when the PCT decreased to < 1 ng/mL, or to OBJECTIVES: Injury surveillance in the pediatric emergency department (PED) has the potential to be an important
part of program planning and clinical management. However, a lack of data has been identified as one of the critical
limitations in the field of pediatric emergency services research. The aims of this article were to investigate how
injury surveillance has been attempted in the PED and to develop an understanding of why E-coding has not met its
full potential as an injury surveillance tool in this setting. METHODS: We conducted a literature review for E-coding in
the PED as well as for injury surveillance more generally in the PED. PubMed, PubMed Central, Google Scholar,
CINAHL, EMBASE, and Academic Search Elite were used. Inclusion criteria were applied for each search. RESULTS:
Two reports on E-coding in the PED met the criteria and were reviewed. Five articles on PED injury surveillance were
reviewed. The most common mechanism of surveillance was a review of emergency department logs (n = 4). The
DATA SOURCES: Pubmed, Cochrane and Lilac databases, Google, Google Scholar, hand searching of websites of
major dental journals. The reference list of five recently published systematic reviews on peri-implantitis treatment
were also screened for potential studies., STUDY SELECTION: Randomised controlled trials and non-randomised
studies in English, German, French, Spanish and Italian on peri-implantitis treatment in humans were included. Case
series, case reports and cross sectional or non-therapy studies were excluded from the assessment of endpoints. No
minimum follow up time was set for studies that were included., DATA EXTRACTION AND SYNTHESIS: Data were
extracted in duplicate by two reviewers and disagreements were resolved by consensus. True endpoints for peri-
implantitis treatment were considered only if they provided evidence of tangible benefit to the patient. The outcome
variables regarded as true endpoints were implant failure, aesthetic assessment and variables related to quality of
life, but these were only considered if they were clearly identified as an objective of the research, not as an outcome Objective. The current recommended endometrial cancer surgical treatment is abdominal extrafascial total
hysterectomy with bilateral salpingo-oophorectomy followed by pelvic lymphadenectomy if >50% myometrial
invasion is estimated by intraoperative gross examination (IGE). This meta-analysis aims to quantify evidence
regarding the validity/predictive value of IGE staging compared with final histology. Design. Meta-analysis of studies
published until October 2011. Setting. Systematic search, according to PRISMA guidelines, of the six major medical
literature databases - Medline, Scopus, EMBASE, Google Scholar, Ovid, Cochrane. Population. Sixteen eligible studies
including 2567 endometrial cancer patients. Methods. Pooled sensitivity/specificity, accuracy, negative/positive
predictive value (NPV/PPV) and diagnostic odds ratio (DOR) of IGE were calculated and the summary receiver
operator characteristic (sROC) curve was constructed. A metaregression analysis was used to explore the role of
potential modifiers of sensitivity and specificity. Main outcome measures. Pooled diagnostic measures of IGE indices.
Results. Sixteen studies (15 retrospective, one prospective) meeting the inclusion criteria were qualitatively analyzed. Introduction: Previous impact tool-kits for UK health libraries required updating to reflect recent evidence and
changes in library services. The National Knowledge Service funded development of updated guidance. Methods:
Survey tools were developed based on previous impact studies and a systematic review. The resulting draft
questionnaire survey was tested at four sites, and the interview schedule was investigated in a fifth area. A literature
search in assia, Google Scholar, intute, lisa, lista, scirus, Social Sciences Citation Index (Web of Knowledge), and the
major UK University and National Libraries Catalogue (copac), identified ways to improve response rates. Other
expert advice contributed to the guidance. Results: The resulting guidance contains evidence-based advice and a
planning pathway for conducting an impact survey as a service audit. The survey tools (critical incident questionnaire INTRODUCTION: Previous impact tool-kits for UK health libraries required updating to reflect recent evidence and
changes in library services. The National Knowledge Service funded development of updated guidance., METHODS:
Survey tools were developed based on previous impact studies and a systematic review. The resulting draft
questionnaire survey was tested at four sites, and the interview schedule was investigated in a fifth area. A literature
search in ASSIA, Google Scholar, INTUTE, LISA, LISTA, SCIRUS, Social Sciences Citation Index (Web of Knowledge), and
the major UK University and National Libraries Catalogue (COPAC), identified ways to improve response rates. Other
expert advice contributed to the guidance., RESULTS: The resulting guidance contains evidence-based advice and a
planning pathway for conducting an impact survey as a service audit. The survey tools (critical incident questionnaire Recent focus on cost-benefit/socio-economic assessment of government " life-saving" programmes within public
health, pharmaceutics, transport, and civil contingencies has spurred a wave of empirical research on the value of a
statistical life (VSL) in Sweden. This paper provides an overview of the received evidence from a range of studies in
one country and over a relatively short time period. A literature search was conducted in Econlit, Pubmed, Google
Scholar and in bibliographies of published papers. Twelve studies on VSL with a total of 48 VSL estimates, published
with data from Sweden from 1996 onwards, were identified. Among all estimates VSL varies from 9 to 1121 million
SEK (0.9-121 million). Based on a set of additional quality inclusion criteria, as used also in a recent global review of
VSL studies, the sample is restricted to 9 studies with a total of 29 VSL estimates with VSL varying from 9 to 98
million SEK (0.9-10.6 million). The raw mean among these estimates is 34.6 million SEK (3.7 million) and the median Objective: To compare the accuracy of autofluorescence bronchoscopy (AFB) combined with white light
bronchoscopy (WLB) versus WLB alone in the diagnosis of lung cancer. Methods: The Ovid, PubMed, and Google
Scholar databases from January 1990 to October 2010 were searched. Two reviewers independently assessed the
quality of the trials and extracted data. The relative risk for sensitivity and specificity on a per-lesion basis of AFB +
WLB versus WLB alone to detect intraepithelial neoplasia and invasive cancer were pooled by Review Manager.
Results: Twenty-one studies involving 3266 patients were ultimately analyzed. The pool relative sensitivity on a per-
lesion basis of AFB + WLB versus WLB alone to detect intraepithelial neoplasia and invasive cancer was 2.04 (95%
confidence interval [CI] 1.72-2.42) and 1.15 (95% CI 1.05-1.26), respectively. The pool relative specificity on a per-
One of the most important diagnostic tools used to detect prostate cancer is prostate-specific antigen (PSA), yet
increased PSA alone does not reflect the presence of prostate cancer. Other pathological prostatic conditions such as
prostatitis and benign prostatic hyperplasia (BPH) may also increase the level of PSA. However, unlike in other
prostate diseases, PSA has a key role in the diagnosis and management of prostate cancer. The incidence of prostate
cancer varies from country to country, with the highest incidence being found in the Western world and the lowest
in Asian countries. Owing to the low incidence of prostate cancer, there could be different views regarding the use of
PSA in Asian countries, especially for the early detection/screening of prostate cancer. The purpose of this article is
to review the use and value of PSA in the diagnosis of prostate diseases (especially prostate cancer) in Asian
countries/populations. A literature search was performed in 'MEDLINE' (PubMed) and Google Scholar using main
keywords such as 'PSA', 'PSA usage', 'PSA sensitivity and specificity', 'Asia', and various countries in Asia. Articles that One of the most important diagnostic tools used to detect prostate cancer is prostate-specific antigen (PSA), yet
increased PSA alone does not reflect the presence of prostate cancer. Other pathological prostatic conditions such as
prostatitis and benign prostatic hyperplasia (BPH) may also increase the level of PSA. However, unlike in other
prostate diseases, PSA has a key role in the diagnosis and management of prostate cancer. The incidence of prostate
cancer varies from country to country, with the highest incidence being found in the Western world and the lowest
in Asian countries. Owing to the low incidence of prostate cancer, there could be different views regarding the use of
PSA in Asian countries, especially for the early detection/screening of prostate cancer. The purpose of this article is
to review the use and value of PSA in the diagnosis of prostate diseases (especially prostate cancer) in Asian
countries/populations. A literature search was performed in 'MEDLINE' (PubMed) and Google Scholar using main
keywords such as 'PSA', 'PSA usage', 'PSA sensitivity and specificity', 'Asia', and various countries in Asia. Articles that At the 10th anniversary of the first report of vanA vancomycin-resistant Staphylococcus aureus (VRSA), we aimed to
determine the total number of vanA-VRSA reported in the literature. Relevant key words were used to search
through PubMed, Sciverse, and Google Scholar, as well as the abstract book of recent related meetings, university
theses, and the CDC website. All studies reporting vanA-positive S aureus confirmed by the polymerase chain
reaction were included. Final analysis revealed that 33 VRSA isolates have been reported worldwide, of which one
isolate was from Pakistan, 3 isolates were from Iran, 13 isolates were from the United States, and 16 isolates were BACKGROUND AND OBJECTIVES: Alcohol and nicotine dependence are serious public health problems worldwide.
They are associated with substantial morbidity and mortality, as well as adverse social effects and increased
healthcare costs. Although efficacious treatments are available for these disorders, additional therapeutic options
are required to ensure greater treatment utilization. In this paper, we describe the empirical basis on which
varenicline, a nicotinic partial agonist approved for smoking cessation, may also have utility in the treatment of
alcohol addiction., METHODS: We sought to identify papers examining nicotine dependence, alcohol dependence,
smoking, alcohol, and varenicline for possible inclusion in the present review. We identified over 600 papers through
Pubmed/Medline, PsychINFO, and Google Scholar. We found 12 papers taking into consideration the following
criteria: original language English, varenicline effect on alcohol consumption., RESULTS: Animal studies have shown
that varenicline reduces alcohol consumption. Two recent studies showed that varenicline also reduces alcohol
consumption in humans. Both nicotine and alcohol interact with alpha4beta2 and alpha3beta4 nicotinic Background: Smoking is the leading preventable risk to human health. Various agents have been used to promote
smoking cessation, but none has had long-term efficacy. Varenicline, a new nicotinic ligand based on the structure of
cytosine, was approved by the US Food amd Drug Administration for use as a smoking cessation aid. Objectives: The
aims of this review were to provide an overview on the mechanism of action and preclinical and clinical data of the
new drug, varenicline, and to discuss the current and future impact of varenicline as a treatment for smoking
cessation. Methods: MEDLINE, BIOSIS, and Google scholar databases were searched (March 1, 2007-July 1, 2008)
using the terms varenicline, smoking cessation, and nicotinic receptors. Full-text articles in English were selected for
reference, and articles presenting the mechanism of action, pharmacokinetics, and data from preclinical and clinical
trials were included. Results: The initial literature search yielded 70 papers. A total of 20 articles fulfilled the inclusion
criteria. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, inhibits dopaminergic activation
produced by smoking and decreases the craving and withdrawal syndrome that accompanies cessation attempts. In
Introduction: Recently, literature has generated controversy regarding the global burden of chronic kidney disease
(CKD). It has been suggested that the existing CKD classification and screening methodologies have contributed to an
overestimate of true population-based prevalence of CKD. In this review, population-based CKD screening programs
were critically appraised with strengths, pitfalls and relevance of the various studies evaluated. Methods: A
systematic review with critical appraisal of major published population-based studies of CKD was undertaken. The
literature review was built upon a broad and intensive search of the published literature on population-based studies
of CKD on PubMed, Google scholar, Cinahl, Embase and Cochrane databases from January 1, 1990 to October 31,
2008. In order to ensure that the review was systematic and objective, the Cochrane collaboration appraisal
method/checklists was adopted to take account of the strengths and weaknesses of the various studies examined.
Only studies that examined CKD (GFR <= 60 ml/min/1.73 m2) and/or albuminuria in a community setting and
published in English were retrieved. Studies were included if they met the following criteria: 1. Having a measure of
prevalence for CKD and/or albuminuria in a general population. 2. Recruited subjects from a community-based
population sample. 3. Presenting sufficient detailed methodology and results, and also ethically approved by the
relevant authorities. 4. In situations where multiple studies have been published based on the same population base,
the first original publication and/or the most recent one is selected for review. Results: The studies presented are
commonly general population screening but occasionally targeted screening of high risk individuals. Some studies
focus on children, adults or a combination of both, or on the elderly. Most of the studies relied on urine analysis,
dipstick testing for albuminuria estimation and/or measurement of serum creatinine (SCr) and Cockroft and Gault (C-
G) and/or the MDRD 4-variable formulae to estimate GFR. The prevalence of MA in the studies varies between 3-
16%, CKD Stages 3 and 4 varies between 2.5 and 4% and a very low prevalence of ESRD or CKD Stage 5, where the Background and Aims: Previous studies indicated that the arachidonate 5-lipoxygenase-activating protein (ALOX5AP)
gene polymorphisms are associated with risk of coronary heart disease (CHD). However, other studies have yielded
contradictory results. This meta-analysis investigated the relationship between variants of arachidonate 5-
lipoxygenase-activating protein (ALOX5AP) gene and CHD. Methods: We identified all studies published before
January 2010 through computer-based searches of PubMed, EMBASE, Google Scholar databases, and CNKI (Chinese
National Knowledge Infrastructure). Data were extracted by two authors and pooled odds ratio (OR) and 95%
confidence interval (CI) were calculated. Results: In this meta-analysis, HapA haplotype (rs17222814G-rs10507391T-
rs4769874G-rs9551963A) was associated with myocardial infarction (MI) (OR = 1.37, 95% CI: 1.02-1.82). Regarding
the HapB haplotype (rs17216473A-rs10507391A- rs9315050A- rs17222842G), there was a significant association Introduction: The arachidonate 5-lipoxygenase-activating protein (ALOX5AP) gene polymorphisms have benn
implicated in association with coronary heart disease (CHD). However, existing researches have yielded contradictory
results. The aim of this study was to investigate the relationship between variants of arachidonate 5-lipoxygenase-
activating protein (ALOX5AP) gene and coronary heart disease (CHD). Methods: We identified all studies published
before May 2009 through computer-based searches of the PubMed, EMBASE, Google Scholar databases, and CNKI
(Chinese National Knowledge Infrastructure). And we reviewed all references that were cited in these studies to look
for additional published article. Analyses were carried out with the Review manager software version 4.2 and the
Stata software version 10.0. Results: Eleven articles were involved in meta-analysis. The HapA haplotype was not
associated with CHD (OR=1.12, 95%CI: 0.92-1.35). The HapB haplotype showed a marginal association with CHD OBJECTIVES: To determine to what extent actual practice as reported in the literature is consistent with clinical
guidelines for dementia care., DESIGN: A systematic review of empirical studies of clinical services provided by
physicians to older adults with a diagnosis of dementia., SETTING: All settings involving primary care physicians in
which a diagnosis of dementia is provided., PARTICIPANTS: Physicians providing care to individuals aged 60 and older
with a primary or secondary diagnosis of dementia., INTERVENTION: Seven dementia care processes recommended
by guidelines: formal memory testing, imaging, laboratory testing, interventions, counseling, community service, and
specialist referrals., MEASUREMENTS: Web of Knowledge, PubMed, Science Direct, MedLine, PsychINFO, EMBASE,
and Google Scholar databases were searched for articles in English published before March 1, 2012., RESULTS:
Twelve studies met the final inclusion criteria, all of which were self-reported cross-sectional surveys. There was
broad variation in the proportion of physicians who reported conducting each dementia care process, with the
widest variation in formal memory testing (4-96%). Recently published studies reflected a shift in scope of care,
Familial Mediterranean fever (FMF) is a common hereditary autoinflammatory disorder characterized by recurrent
febrile attacks and polyserositis. The MEditerranean FeVer (MEFV) gene missense mutations altering the structure
and function of pyrin protein play a significant role in the pathophysiology of the disease. Mutated pyrin is associated
with the loss of delicate control of the inflammatory pathways, which results in a prolonged or augmented
inflammation that predisposes these patients and carriers of the MEFV mutation to a pro-inflammatory state. This
increased inflammation might lead to susceptibility to vascular comorbidities in FMF patients and even in carriers. In
this review, we aim to discuss the vascular comorbidities seen in FMF patients. For this purpose, a thorough search
was done in Web sites such as Pubmed, Web of Science, Scopus and Google Scholar, and the most relevant articles There were conflicting results about whether promoter polymorphisms (-2578C/A,. 1154G/A) of vascular endothelial
growth factor (VEGF) gene is a risk factor of Alzheimer's disease (AD). To determine the relationship between them, a
meta-analysis is needed urgently. We searched all the reports about VEGF promoter polymorphisms (-2578C/A,.
1154G/A) and AD risk from PubMed, Web of Science, Cochrane Collaboration and Google Scholar database for the
period up to 1 August, 2012. A total of 7 studies were included in this meta-analysis. The pooled odds ratios (ORs)
and 95% confidence intervals (CIs) were calculated applying fixed or random effects models. There was no significant
association between VEGF. 2578C/A polymorphisms and AD risk in all gene models (OR = 1.08, 95% CI = 0.94-1.23 for
A vs. C; OR = 1.19, 95% CI = 0.89-1.59 for AA vs. CC; OR = 1.15, 95% CI = 0.91-1.45 for AA vs. CC + CA; OR = 1.11, 95% Venous thromboembolism (VTE) is an important cause of in-hospital mortality. A local understanding of disease
burden, occurrence, etiology and successful preventive and therapeutic interventions is of vital import. We aimed to
review the current literature of VTE originating from Pakistan to determine gaps in knowledge in order to prioritize
future research. An electronic search was performed using Pakmedinet, Pubmed and Google Scholar to retrieve
research articles on thrombosis, deep vein thrombosis and pulmonary thromboembolism in Pakistan. The search
included all years and no limits were applied. All original research articles presenting primary data from Pakistan
were selected. Full texts were reviewed and information synthesized and summarized in our review. Eighty-one
studies were found, out of which we were able to retrieve and review 77 (95 %) full texts. A total of 6,501 patients
are included in this review. Among the studies, we found 25 case reports/series, 1 case-control, 3 cohort, 20 cross-
sectional, 1 quasi-experimental, 2 randomized controlled trials, 4 retrospective file reviews and 21 review articles.
Most of these were small studies with only eight having a patient population above 100. Six studies presented Background And Objectives: Knowledge of the significance of post-transplant lymphoproliferative disord-ders (PTLD)
that occur "very late" or more 10 years after renal transplantation is limited. Thus, we analysed and compared
characteristics and prognosis of the disease in renal transplant patients with very late onset PTLD vs. early- and late-
onset PTLD. Design And Setting: Retrospective study of data obtained from comprehensive search of medical
literature Patients And Methods: We searched for available data using the Pubmed and Google scholar search
engines for reports of lymphoproliferative disorders occurring in renal transplant patients by disease presentation
time. Results: We analyzed data from 27 studies that included 303 patients with lymphoproliferative disorders after
renal transplantation. Renal graft recipients with very late onset PTLD were significantly less likely to be under
mycophenolate mofetil (MMF)- and/or tacrolimus (FK-506) (vs. azathioprine) -based immunosuppress-sion (P=.035) Vesicovaginal fistula is a preventable calamity, which has been an age-long menace in developing countries. To
review the causes, complications, and outcome of Vesicovaginal fistula in Nigeria. Studies on Vesicovaginal fistula
were searched on the internet. Information was obtained on PubMed(medline), WHO website, Bioline International,
African Journal of Line, Google scholar, Yahoo, Medscape and e Medicine. Many Nigerian women are living with
Vesicovaginal fistula. The annual obstetric fistula incidence is estimated at 2.11 per 1000 births. It is more prevalent
in northern Nigeria that southern Nigeria. Obstetric fistula accounts for 84.1%-100% of the Vesicovaginal fistula and
prolonged obstructed labour is consistently the most common cause (65.9%-96.5%) in all the series. Other common
causes include caesarean section, advanced cervical cancer, uterine rupture, and Gishiri cut. The identified
predisposing factors were early marriage and pregnancy, which were rampant in northern Nigeria, while unskilled
birth attendance and late presentation to the health facilities was common nationwide. Among the significant BACKGROUND: Vesicovaginal fistula is a preventable calamity, which has been an age-long menace in developing
countries. OBJECTIVE: To review the causes, complications, and outcome of vesicovaginal fistula in Nigeria.
METHODS: Studies on vesicovaginal fistula were searched on the internet. Information was obtained on Pubmed
(medline), WHO website, Bioline Innternational, African Journal on Line, Google scholar, Yahoo, Medscape and e
Medicine. RESULTS: Many Nigerian women are living with vesicovaginal fistula. The annual obstetric fistula incidence
is estimated at 2.11 per 1000 births. It is more prevalent in northern Nigeria than southern Nigeria. Obstetric fistula
accounts for 84.1%-100% of the vesicovaginal fistula and prolonged obstructed labour is consistently the most
common cause (65.9%-96.5%) in all the series. Other common causes include caesarean section, advanced cervical
cancer, uterine rupture, and Gishiri cut. The identified predisposing factors were early marriage and pregnancy,
which were rampant in northern Nigeria, while unskilled birth attendance and late presentation to the health
Recruitment of underserved participants begins to close the disparity gap evident within disadvantaged
communities, and innovative approaches to recruitment support this effort. Literacy, communication, and credibility
barriers distance potential research participants. The literature search from 1975 to 2005 included the Cochrane
Review, MEDLINE, EBSCO, PsycINFO, Google Scholar, and CINAHL for the terms video recruitment, videotaped,
minority recruitment, and research subject recruitment with no documented use of videotape recruitment of non-
English-speaking (NES) participants. Based on this review, an innovative recruitment video was developed and
targeted to monolingual Hispanic mothers to explain a study using home safety visits. Community assistants OBJECTIVE: To evaluate the clinical literature on and potential clinical role of vilazodone for the treatment of major
depressive disorder. DATA SOURCES: Searches were conducted on MEDLINE (1948-February 2011), Iowa Drug
Information Service (1988-February 2011), EBSCO Academic Search Premier (1975-February 2011), Google Scholar
(1992-February 2011), PsycINFO (1980-February 2011), and PsycARTICLES (1985-February 2011), and on general
Internet search engines including Google and Bing (no lower limit-February 2011). Search terms were vilazodone,
EMD 68843, depression, and major depressive disorder. Potential prior marketers of vilazodone, including Merck
KGaA in Germany and Genaissance Pharmaceuticals, were contacted for any available unpublished Phase 1, Phase 2,
Phase 3 studies, or preclinical information. STUDY SELECTION AND DATA EXTRACTION: All applicable full-text
Englishlanguage articles, abstracts, and professional poster presentations found were evaluated and included in the
review, as well as marketing and Securities and Exchange Commission filings available from the patent holders. DATA
SYNTHESIS: Vilazodone is an antidepressant recently approved by the Food and Drug Administration (FDA) that is
first in a new class regarding mechanism of action. It has demonstrated efficacy in the primary outcome of the BACKGROUND: Vasoactive and neuroprotective drugs such as vinpocetine are used to treat stroke in some countries.
OBJECTIVES: To assess the effect of vinpocetine in acute ischaemic stroke. SEARCH STRATEGY: We searched the
Cochrane Stroke Group Trials Register (last searched February 2007), MEDLINE (1966 to February 2007) and Scopus
(1960 to February 2007). We also searched the Internet Stroke Center Stroke Trials Registry, Google Scholar, the
science-specific search engine Scirus and Wanfang Data, the leading information provider in China. We contacted
researchers in the field and four pharmaceutical companies that manufacture vinpocetine. Searches were complete
to February 2007. SELECTION CRITERIA: Unconfounded randomised trials of vinpocetine compared with placebo, or
any other reference treatment, in people with acute ischaemic stroke. We included trials if treatment started no
later than 14 days after stroke onset. DATA COLLECTION AND ANALYSIS: Two review authors independently applied
the inclusion criteria. One review author extracted the data, which was then checked by the second review author. Objectives: To compare modes and sources of infection and clinical and biosafety aspects of accidental viral
infections in hospital workers and research laboratory staff reported in scientific articles. Methods: PubMed, Google
Scholar, ISI Web of Knowledge, Scirus, and Scielo were searched (to December 2008) for reports of accidental viral
infections, written in English, Portuguese, Spanish, or German; the authors' personal file of scientific articles and
references from the articles retrieved in the initial search were also used. Systematic review was carried out with
inclusion criteria of presence of accidental viral infection's cases information, and exclusion criteria of absence of
information about the viral etiology, and at least probable mode of infection. Results: One hundred and forty-one
scientific articles were obtained, 66 of which were included in the analysis. For arboviruses, 84% of the laboratory
infections had aerosol as the source; for alphaviruses alone, aerosol exposure accounted for 94% of accidental
infections. Of laboratory arboviral infections, 15.7% were acquired percutaneously, whereas 41.6% of hospital
infections were percutaneous. For airborne viruses, 81% of the infections occurred in laboratories, with hantavirus
the leading causative agent. Aerosol inhalation was implicated in 96% of lymphocytic choriomeningitis virus
infections, 99% of hantavirus infections, and 50% of coxsackievirus infections, but infective droplet inhalation was
the leading mode of infection for severe acute respiratory syndrome coronavirus and the mucocutaneous mode of
infection was involved in the case of infection with influenza B. For blood-borne viruses, 92% of infections occurred
in hospitals and 93% of these had percutaneous mode of infection, while among laboratory infections 77% were due
to infective aerosol inhalation. Among blood-borne virus infections there were six cases of particular note: three
cases of acute hepatitis following hepatitis C virus infection with a short period of incubation, one laboratory case of
human immunodeficiency virus infection through aerosol inhalation, one case of hepatitis following hepatitis G virus
infection, and one case of fulminant hepatitis with hepatitis B virus infection following exposure of the worker's
The objective of the study was to review the literature reporting visual disturbance (VD) following sclerotherapy for
varicose veins. Underlying mechanisms will be discussed. A literature search of the databases Medline and Google
Scholar was performed. Original articles including randomized trials, case series and case reports reporting VD in
humans following sclerotherapy for varicose veins were included. Additional references were also obtained if they
had been referenced in related publications. The search yielded 4948 results of which 25 reports were found to meet
the inclusion criteria. In larger series with at least 500 included patients the prevalence of VD following sclerotherapy
ranges from 0.09% to 2%. In most reports foam sclerotherapy was associated with VD (19); exclusive use of liquid
sclerosant was reported in two cases, some reports included foam and liquid sclerosant (4). There were no persistent
visual disorders reported. VD occurred with polidocanol and sodium tetradecyl sulphate in different concentrations Background: Vitamins have long been thought to modulate the various stages of wound healing through a variety of
proposed mechanisms. Our goal was to investigate relevant studies examining the role of different vitamins in
wound healing. Methods: MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched
for basic science and clinical studies examining the role of vitamins as adjuncts in wound healing. Results:
Mechanisms of action for each of the vitamins are reviewed. It was suggested by many of the studies that the major
vitamins A, C, E, D, K, and B have demonstrated utility as adjuncts in wound care in basic science and clinical trials. Objective: To summarize the basic technological advances of vitreous cryopreservation and the experimental
research of the vitreous cryopreservation of various engineered tissues, and explore the main factors, evaluated
indexes influencing the vitreous cryopreservation, so as to guide the experiment of vitreous cryopreservation. Data
Sources: A computer-based online search of Medline, EBSCO, ScienceDirect Onsite and google scholar based search
was undertaken to identify the articles on cells and tissues cryopreservation published in English from February 1980
to May 2006 with the key words of "tissue engineering, engineered tissue, cryopreservation, vitrification, ice-free
cryopreservation, vitreous cryopreservation". Meanwhile, we searched Wanfang database for the related articles
published in Chinese from February 1980 to May 2006 with the key words of "tissue engineering, engineered tissue,
cryopreservation, vitreous cryopreservation" in Chinese. Study Election: The articles were primarily screened to
select those closely related with the research. Inclusive criteria: the subjects should be animals or human; the study
should be basic and/or clinical research on vitrification technology and experiments of some engineered tissue
preservation. Exclusive criteria: articles about the vitreous cryopreservation of gamete, embryo, plants and food.
Data Extraction: Totally 122 articles about cells and tissue cryopreservation were found in these databases, among
which 17 were closely associated with the study and 42 were indirectly related. Finally, 31 articles were selected for
analysis. Data Synthesis: The commercialization of tissue engineering needs long-term and stable preservation of The current status of sigmoid volvulus (SV) was reviewed to assess trends in management and to assess the
literature. The literature on SV was retrieved using PubMed, Embase, Scopus, Pakmedinet, African Journals online
(AJOL), Indmed and Google scholar. These databases were searched for text words including 'sigmoid', 'colon' and
'volvulus'. Relevant nonindexed surgical journals published from endemic countries were also manually searched.
We focused on original articles published within the last 10 years; but classical references prior to this period were
also included. Seminal papers published in non-English languages were also included. Sigmoid volvulus is a leading
cause of acute colonic obstruction in South America, Africa, Eastern Europe and Asia. It is rare in developed countries
such as USA, UK, Japan and Australia. Characteristic geographic variations in the incidence, clinical features,
prognosis and comorbidity of SV justify recognition of endemic and sporadic subtypes. Controversy on aetiologic
agents can be minimized by classifying them into 'predisposing' and 'precipitating' factors. Modern imaging systems,
although more effective than plain radiographs, are yet to gain popularity. Emergency endoscopic reduction is the
treatment of choice in uncomplicated patients. But it is only a temporizing procedure, and it should be followed in
Introduction: State of the art guidance exists for management of vulvodynia, but the scientific basis for interventions
has not been well described. Although there are many interventional therapies, and their use is increasing, there is
also uncertainty or controversy about their efficacy. Objective: To systematically assess benefits and harms of
interventional therapies for vulvodynia and vestibulodynia. Methods: The following databases were searched, using
MeSH terms for studies related to the treatment of vulvodynia or vulva
pain/pruritus/dysesthesia/hyperesthesia/hypersensitivity: MEDLINE, PsycINFO, Scopus, Cochrane Library, EBSCO
Academic, and Google Scholar. Using Medical Subject Reference sections of relevant original articles, reviews, and
evidence-based guidelines were screened manually. Manual searching for indirect evidence supporting interventions
was done whenever no direct evidence was found for a treatment described within a review or guideline. Each
modality is assessed with a grading system similar to the Grades of Recommendation, Assessment, Development,
and Evaluation system. The grading system assesses study quality, effect size, benefits, risks, burdens, and costs.
Results: For improvement of pain and/or function in women with vestibulodynia (provoked localized vulvodynia),
there was fair evidence that vestibulectomy was of benefit, but the size of the effect cannot be determined with
confidence. There was good evidence of a placebo effect from multiple studies of nonsurgical interventions. There
was fair evidence of lack of efficacy for several nonsurgical interventions. There were several interventions for which
there were insufficient evidence to reliably evaluate. There was insufficient evidence to judge harms or to judge long-
term benefits.For clinically meaningful improvement of pain in women with generalized unprovoked vulvodynia,
there was insufficient evidence for benefit of any intervention. There was fair evidence of a placebo effect in people INTRODUCTION: State of the art guidance exists for management of vulvodynia, but the scientific basis for
interventions has not been well described. Although there are many interventional therapies, and their use is
increasing, there is also uncertainty or controversy about their efficacy., OBJECTIVE: To systematically assess benefits
and harms of interventional therapies for vulvodynia and vestibulodynia., METHODS: The following databases were
searched, using MeSH terms for studies related to the treatment of vulvodynia or vulva
pain/pruritus/dysesthesia/hyperesthesia/hypersensitivity: MEDLINE, PsycINFO, Scopus, Cochrane Library, EBSCO
Academic, and Google Scholar. Using Medical Subject Reference sections of relevant original articles, reviews, and
evidence-based guidelines were screened manually. Manual searching for indirect evidence supporting interventions
was done whenever no direct evidence was found for a treatment described within a review or guideline. Each
modality is assessed with a grading system similar to the Grades of Recommendation, Assessment, Development,
and Evaluation system. The grading system assesses study quality, effect size, benefits, risks, burdens, and costs.,
RESULTS: For improvement of pain and/or function in women with vestibulodynia (provoked localized vulvodynia),
there was fair evidence that vestibulectomy was of benefit, but the size of the effect cannot be determined with
confidence. There was good evidence of a placebo effect from multiple studies of nonsurgical interventions. There
was fair evidence of lack of efficacy for several nonsurgical interventions. There were several interventions for which
there were insufficient evidence to reliably evaluate. There was insufficient evidence to judge harms or to judge long-
term benefits. For clinically meaningful improvement of pain in women with generalized unprovoked vulvodynia,
there was insufficient evidence for benefit of any intervention. There was fair evidence of a placebo effect in people Purpose: Understanding disease and treatment is beneficial for parents who have children with cancer. News of
research progress in pediatric oncology is sought after by motivated parents of children with cancer world-wide.
Information on clinical trials, cancer biology, and treatment advances presented at scientific meetings and published
in journals is in demand, particularly in Europe. This project sought to address this unmet need for parents of
children with neuroblastoma (NB). Method: A collaboration of 6 non-profit foundations from Australia, North
America, and Europe supported the NB Globe Neuroblastoma News website project, and provided travel funds for
reporting on 6 oncology meetings from June 2010 to April 2011. News curation was accomplished using feeds from
clinicaltrials.gov, PubMed, and Google Scholar using the search term ''neuroblastoma.'' Reports on journal
publications, meeting abstracts, trial openings, industry news, and related developments were posted an average of
once weekly. Website traffic analysis was performed using Google Analytics. Results: Forty-one articles on NB-related
research were published on nbglobe.com and from August 2010 to March 2011 the site had 1290 unique visits per The purpose of this literature review was to examine the utilization of church-based interventions designed for
African-Americans in the community for the management of overweight and obesity and prevention of type 2
diabetes and cardiovascular disease. PubMed, CINAHL, and Google scholar were searched using the following key
search terms: type 2 diabetes, cardiovascular disease, prevention, management, African-Americans, Blacks, weight
loss, weight management, church-based interventions, community interventions, faith-based interventions, and
prayer. Sixteen primary studies were located and six met inclusion criteria. The studies were separated into two
categories: faith-placed interventions or collaborative interventions. The overall results demonstrated significant
Background: Although cultural competency is not a new concept in healthcare, it has only recently been formally
embraced as important in the field of surgery. All physicians, including and especially surgeons, must acknowledge
the potential influence of culture in order to provide effective and equitable care for patients of all backgrounds. The
Accreditation Council for Graduate Medical Education (ACGME) recognizes cultural competency as a component of
patient care, professionalism, and interpersonal and communication skills. Methods: A systematic literature search
was conducted using the MEDLINE, EBSCOhost, Web of Science, and Google Scholar databases. All publications
focusing on surgical residents and the assessment of patient care, professionalism, interpersonal and communication
skills, or specifically cultural competency and/or were considered. This initial search resulted in 12 articles. To further
refine the review, publications discussing curricula in residencies other than surgery, the assessment of technical, or
clinical skills and/or without any explicit focus on cultural competency were excluded. Results: Based on the specified OBJECTIVE: To characterize the clinical features, risk factors, radiographic findings, and prognosis of Wernicke
encephalopathy after bariatric surgery. METHODS: We performed a systematic review of MEDLINE, Embase, Ovid, ISI
(Science Citation Index), and Google Scholar for case reports, case series, or cohort studies of Wernicke
encephalopathy after bariatric surgery. RESULTS: We found 32 cases (27 of whom were women) reported, from 2
weeks to 18 months after the procedure. Most patients had vomiting as a risk factor (n = 25) and presented with the
triad of Wernicke encephalopathy (confusion, ataxia, and nystagmus; n = 21). Optic neuropathy, papilledema,
deafness, seizures, asterixis, weakness, and sensory and motor neuropathy were also reported. Characteristic
radiographic findings were hyperintense signals in the periaqueductal gray area and dorsal medial nucleus of the
thalamus; radiographs were normal in 15 patients. One series from Brazil reported 4 patients (among 50 patients)
with Wernicke encephalopathy; all presented with vomiting and concomitant peripheral neuropathy at a median of Background: From the historical literature it is apparent that birthing in an upright position was once common
practice while today it appears that the majority of women within Western cultures give birth in a semi-recumbent
position. Aim: To undertake a review of the literature reporting the impact of birth positions on maternal and
perinatal wellbeing, and the factors that facilitate or inhibit women adopting various birth positions throughout the
first and second stages of labour. Methods: A search strategy was designed to identify the relevant literature, and
the following databases were searched: CINAHL, CIAP, the Cochrane Database of Systematic Reviews, Medline,
Biomed Central, OVID and Google Scholar. The search was limited to the last 15 years as current literature was
sought. Over 40 papers were identified as relevant and included in this literature review. Results: The literature
reports both the physical and psychological benefits for women when they are able to adopt physiological positions
in labour, and birth in an upright position of their choice. Women who utilise upright positions during labour, have a
shorter duration of the first and second stage of labour, experience less intervention, and report less severe pain and
increased satisfaction with their childbirth experience than women in a semi recumbent or supine/lithotomy Background: Internet technologies and usage are expanding worldwide. Debate over <> as a distinct clinical
syndrome persists, while public perceptions of internet-related pathology and demand for treatment are rising.
Literature review of internet addiction to assess the current evidence base and to characterize phenotypes of
pathological internet use is presented. Methods: PubMed, PsychlNFO, and Google Scholar databases were searched
(1990 to present; English) using the terms, <> < > and <> among other related terms. Results: This search yielded 416
articles. Pathological internet use is generally defined by excessive time spent using internet technology to the
detriment of other normal or role-appropriate behaviors; however, consensus is lacking for defining criteria. Diverse
phenotypes may be characterized functionally as informational (eg, news updates, Wikipedia), social (eg, Facebook,
texting), occupational (eg, blogging), or compulsive behavioral (eg, gambling, shopping, pornography, gaming, etc.).
Studies of diagnostic criteria, screening instruments, and treatment response rely solely on patient self-reports of Purpose: To summarise the causes of decreased fecundity with age and review chronological vs biological ovarian
ageing. To explore the clinician's means of assessing a woman's ovarian reserve. To review the recent literature on
the effectiveness of different assisted reproductive technology (ART) techniques for women aged 40 and over and
offer a single best treatment option. Methods: Pubmed and google scholar were searched for relevant articles using
key words. Data were extracted based on authors, year, aims, sample and results. Results: Success rates for women
aged 40 or over with clomiphene, IUI, IUI with FSH are all extremely low, at less than 1 % live birth per cycle. This study aimed to examine English-language publications on 'cloacogenic carcinoma which has developed outside
the anorectal zone. Studies published in English literature on cloacogenic carcinoma developing in the colorectal area
were accessed via Pubmed and Google scholar databases. Within these articles, studies in which there were
developments in the other segments of the colon outside the anorectal zone were examined. We retrieved seven
studies matching our selection criteria from the research. The studies were published between 1977 and 2009. Four
of the patients were female and three were male; patient age ranged from 23 to 69 years. The anatomic tumors
Objective: To investigate relevant long-term studies which assess the use of 1Hz repetitive transcranial magnetic
stimulation (rTMS) in participants with chronic tinnitus and so determine its benefits as a possible treatment option.
Study design: A systematic review was developed to conclude the research question. The inclusion involved double-
blind randomized sham-controlled clinical trials conducted over six months using 1Hz rTMS. The search strategy
included the use of databases such as Pubmed, Cochrane Library, OVID Medline, CINAHL, Google Scholar, University
of Bristol MetaLib and the University of Bristol library catalogue. Results: Three suitable studies were obtained and
fulfilled the inclusion criteria. The results indicated that rTMS appears to have a beneficial psychological and
physiological long-term effect spanning six months, although a correlation between a particular participant trait and Children with allergic asthma living in urban areas are exposed to heavy loads of allergens that adversely affect their
health. The purpose of this inquiry was to determine if environmental remediation programs for urban exposures are
effective. Research articles relevant to this topic were obtained by conducting a literature search of the Cumulative
Index of Nursing and Allied Health Literature, PubMed Plus, and Google Scholar databases. Search terms included
combinations of asthma, environmental remediation, environmental triggers, environmental interventions, urban,
and allergies. Out of 27 articles retrieved, 14 meeting inclusion and exclusion criteria were retained. When
considered together, it appears that multiple-trigger environmental remediation programs are more effective than OBJECTIVES: Comparative effectiveness (US) and value-based pricing (VBP) (UK) are anticipated to bring changes
from a'free-pricing' system for drugs to one where prices are influenced by governmental authorities. A product's
value will take into account additional factors, such as wider societal benefits and therapeutic innovation. The aim of
this research is to determine the impact of comparative effectiveness and VBP on the price and market access of
new drugs in depression. METHODS: Aliterature review was conducted usingelectronic databases (Medline, Embase,
Google Scholar). The search was performed for the years 2009-2011 and key terms included comparative
effectiveness USA, value based pricing UK, drug value and societal benefits. In addition, an analysis of a UK
Department of Health consultation paper and the US Agency for Healthcare Research and Quality policy documents
was performed in order to determine how comparative effectiveness and VBP may affect the market access and
commercial viability of products in disease area of depression (SSRIs, SNRIs and atypical antidepressants). A
spreadsheet was used to capture data and a comparison was undertaken to compare and contrast the two markets Informal health care providers (IPs) comprise a significant component of health systems in developing nations. Yet
little is known about the most basic characteristics of performance, cost, quality, utilization, and size of this sector.
To address this gap we conducted a comprehensive literature review on the informal health care sector in
developing countries. We searched for studies published since 2000 through electronic databases PubMed, Google
Scholar, and relevant grey literature from The New York Academy of Medicine, The World Bank, The Center for
Global Development, USAID, SHOPS (formerly PSP-One), The World Health Organization, DFID, Human Resources for
Health Global Resource Center. In total, 334 articles were retrieved, and 122 met inclusion criteria and chosen for
data abstraction. Results indicate that IPs make up a significant portion of the healthcare sector globally, with almost
half of studies (48%) from Sub-Saharan Africa. Utilization estimates from 24 studies in the literature of IP for
healthcare services ranged from 9% to 90% of all healthcare interactions, depending on the country, the disease in
question, and methods of measurement. IPs operate in a variety of health areas, although baseline information on Purpose: To compare and evaluate the mostly used methods of urinary stone analysis. Materials and Methods: We
searched PubMed and Google Scholar for "urolithiasis, nephrolithiasis, renal stone, and kidney stone" combined with
"stone analysis, spectroscopy, X-ray diffraction, chemical analysis, mass spectrometry, and laser-induced breakdown
spectroscopy, review article, and quality control assessment." Results: We identified 24 articles about reviews of the
principles of stone analy-sis techniques and their quality control trials. Seven articles were not in English language;
hence, were omitted from this review. The remaining 17 articles and their related references were studied
thoroughly. There are various chemical and physical techniques available for urinary stone analysis. The correct stone
analysis has to identify not only all stone components, but also the molecular structure and crystalline forms of them
Objective: To establish the empirical evidence base for the information that participants want to know about medical
research and to assess how this relates to current guidance from the National Research Ethics Service (NRES). Data
sources: Medline, Web of Science, Applied Social Sciences Index and Abstracts, Sociological abstracts, Health
Management Information Consortium, Cochrane Library, thesis index's, grey literature databases, reference and
cited article lists, key journals, Google Scholar and correspondence with expert authors. Study selection: Original
research studies published between 1950 and October 2010 that asked potential participants to indicate how much
or what types of information they wanted to be told about a research study or asked them to rate the importance of
a specific piece of information were included. Study appraisal and synthesis methods: Studies were appraised based
on the generalisability of results to the UK potential research participant population. A metadata analysis using basic
thematic analysis was used to split results from papers into themes based on the sections of information that NRES
recommends should be included in a participant information sheet. Results: 14 studies were included. Of the 20
pieces of information that NRES recommend should be included in patient information sheets for research pooled
proportions could be calculated for seven themes. Results showed that potential participants wanted to be offered Objective: The aim of this study is to review available treatment options and to review current opinions in the
management of patients with chronic gastroesophageal reflux disease (GERD). Materials and methods: This is a
review article. Articles for the literature review were collected by using Google Search Scholar Engine. Literature
search included relevant original and review articles addressing issues like medical treatment for GERD, surgical
treatment for GERD, studies comparing surgical and medical treatment for GERD. GERD is a common and chronic
syndrome. Patients affected with syndrome experience symptoms which affect their quality of life. The goals of
treatment in this condition is to control symptoms, heal injured esophageal mucosa and to prevent complications.
Both proton pump inhibitor (PPI) therapy and antireflux surgery are equally effective in controlling symptoms and in
healing esophageal mucosal injury. In the recent years, laparoscopic surgery is increasingly been offered to patients
with GERD. However, there is still controversy over best approach to management of GERD. This study attempted to The sense of smell is still mysterious in many ways, despite the advances of the past few years. This review gives a
broad overview of the state of the field by examining each step of the process of signal transduction from odorant to
brain. Each subject section was searched individually in Pubmed, ISI Web of Science and Google Scholar as well as
materials known to the author. The results are sequentially presented in order of anatomical progression of the Background: Evaluations of massive envenomation events have not commonly shown an increased risk for adrenal
insufficiency. Methods: A 77 year old woman and her 80 year old husband live part of the year in Bolovia where they
have kept hives of Africanized honey bees for many years. Neither of them had shown evidence of bee sting
hypersensitivity in the past. While tending their hives in a remote area, both were exposed to a massive number of
stings (he . 600, she . 200) and barely survived. They are both wondering if they have become sensitized as a result of
this event. After discharge from the hospital in Bolivia, she began to experience lethargy and was hospitalized again
in Seattle with nausea, vomitting and eosinophilia. Abdominal CT scans showed bilateral adrenal enlargement/
masses. Medline, PubMed and Google Scholar searches were performed looking for reports of adrenal insufficiency
and bee sting anaphylaxis/ exposure. Results: Evaluation showed evidence of adrenal insufficiency and she has
responded to replacement therapy. Subsequent abdominal CT scans have shown shrinkage and involution of both Purposes: To analyze potential journals considered for publication of papers on neurointervention including the
official journal of WFITN, Interv Neuroradiol and to compare the other medical fields such as cardiology or neurology,
and to overview how much the e-journal environment has changed. Materials and Methods: We searched and
reviewed categories of journals to which interventional neuroradiology specialists can submit the papers. Journal
citation indexes, citation trend per years of Cardiology (Circulation, J Am Coll cardiol, Eur heart J, et al) and Clinical
Neurology (Lancet Neurol, Brain, Ann Neurol, Neurol, Stroke, et al) journals will be compared based on the data
supplied by Scopus (Elsevier BV, Nethelands) and Journal Citation Reports (Thomson Reuters, USA), Web of Science
(Thomson Reuters, USA) and Google Scholar, et al. We also analyzed and authors, Impact Factor (IF) and their recent
trends of Interv Neuroradiol since 1995, the year when the journal started and compared the citation index with
similar. Results: Impact factors of Cardiology and Clinical Neurology journals are relatively higher than those
People with low health literacy may not have the capacity to self-manage their health and prevent the development
of chronic disease through lifestyle risk factor modification. The aim of this narrative synthesis is to determine the
effectiveness of primary healthcare providers in developing health literacy of patients to make SNAPW (smoking,
nutrition, alcohol, physical activity and weight) lifestyle changes. Studies were identified by searching Medline,
Embase, Cochrane Library, CINAHL, Joanna Briggs Institute, Psychinfo, Web of Science, Scopus, APAIS, Australian
Medical Index, Community of Science and Google Scholar from 1 January 1985 to 30 April 2009. Health literacy and
related concepts are poorly indexed in the databases so a list of text words were developed and tested for use. Hand
searches were also conducted of four key journals. Studies published in English and included males and females aged
18 years and over with at least one SNAPW risk factor for the development of a chronic disease. The interventions
had to be implemented within primary health care, with an aim to influence the health literacy of patients to make
SNAPW lifestyle changes. The studies had to report an outcome measure associated with health literacy (knowledge,
skills, attitudes, self efficacy, stages of change, motivation and patient activation) and SNAPW risk factor.The Background. The glaucomas are generally asymptomatic diseases until they are very advanced. They affect 2% of the
population over 40 years of age and therefore represent a significant public health issue. There have been a number
of attempts to develop quality of life scales for the disease. This review discusses the pros and cons of these scales
and suggests the best of the current ones for use in a clinical setting. Methods. Medline, Embase and Google Scholar
were searched for relevant articles. No time period was defined and all types of article were included. Results. 11
Quality of Life scores were identified that have been used with glaucoma patients. Conclusion. There is no generally The Visceral Leishmaniasis (VL) control program in Nepal launched in 1993 includes provision of free diagnostic test,
treatment along with vector control by indoor residual spraying. However, even after 14 years the disease is far from
being controlled. Elimination of VL by 2015 has recently been identified as a regional priority with high level of
political commitment. We analyzed the VL control effort in Nepal over the period 1994-2006 and tried to formulate
recommendations for the VL elimination initiative. To document performance of the VL control program in Nepal we
used literature review and a case study. First, we reviewed articles on VL in Nepal published in medical journals
through Pubmed, ISI Web of Science, Google scholar and by hand searching. Secondly, the grey literature, mainly the
reports on VL drafted by the Ministry of Health was reviewed for the period 1994-2006. Thirdly, a case study is
presented to analyze the performance of the VL elimination program in a "pilot district", where the program was OBJECTIVE: Symptoms, including tinnitus, ear pain and vertigo, have been reported following exposure to wind
turbine noise. This review addresses the effects of infrasound and low frequency noise and questions the existence
of 'wind turbine syndrome'., DESIGN: This review is based on a search for articles published within the last 10 years,
conducted using the PubMed database and Google Scholar search engine, which included in their title or abstract the
terms 'wind turbine', 'infrasound' or 'low frequency noise'., RESULTS: There is evidence that infrasound has a
physiological effect on the ear. Until this effect is fully understood, it is impossible to conclude that wind turbine Background: In 1995, atrial fibrillation (AF) was estimated to affect 2.2 million people in the United States. After the
age of 75 years (the median age for onset of AF), ~60% of people with AF are women. Women have a significantly
higher risk of AF-related stroke than do men and are more likely to live with stroke-related disability and a
significantly lower quality of life. Objective: This article provides an overview of the contributing factors and clinical
presentation of AF in women and offers a rational, safe, effective, and gender-specific approach to therapy for
women with AF. Methods: Search engines, including PubMed and Google Scholar, were used to review the English-
language literature addressing AF gender differences for the years 1989-2009. The search term atrial fibrillation was
combined with multiple other terms, as well as with female, gender, sex, or women. Full-length manuscripts were
reviewed. Original studies obtained were searched for additional relevant manuscripts using the cited references.
Results: Studies have shown that women are more likely than men to experience symptomatic attacks, a higher
frequency of recurrences, and significantly higher heart rates during AF. Hormonal fluctuations during the menstrual
cycle that affect QT intervals are an important consideration when selecting antiarrhythmic drugs for premenopausal Although the term workaholism is widely used, there is very little consensus about its meaning. Since the seventies,
workaholism has been described as a work addiction such as drug or alcohol addiction. Similarities with other
addictions include craving, withdrawal, tolerance, progressive involvement, and denial. Although considerable
attention has been devoted to the concept of workaholism in recent years, little empirical research has been
undertaken to further the understanding of this phenomenon. The existence of different types of workaholism has
been described. Questionnaires were developed to assess this concept. This heterogeneous disease has negative
health, personal, family relationships and professional consequences. Many therapeutic interventions are possible
Introduction: Previous reviews have demonstrated that patient outcomes following orthopaedic surgery are strongly
influenced by the presence of Workers' Compensation. However, the variability in the reviews' methodology may
have inflated the estimated strength of this association. The main objective of this meta-analysis is to evaluate the
influence of Workers' Compensation on the outcomes of orthopaedic surgical procedures. Methods: We conducted a
systematic search of the literature published in this area from 1992-2012, with no language restrictions. The
following databases were used MEDLINE (Ovid), Embase (Ovid), CINAHL, Google Scholar, LILACS and Pubmed. We
also hand-searched the reference sections of all selected papers. We included all prospective studies evaluating the
effect of compensation status on outcomes in adult patients who had undergone surgery due to orthopaedic
conditions or diseases. Outcomes of interest included disease specific, region specific and/or overall quality of life
scales/questionnaires and surgeons' personal judgment of the results. We used an assessment tool to appraise the
quality of all included studies. We used Review Manager to create forest plots to summarize study data and funnel
plots for the assessment of publication bias. Results: Twenty studies met our eligibility criteria. The overall risk ratio Background: Much work has been done relating to mothers ante-and postnatal mental heath. There has been less
consideration, to date, of fathers' role. Aim: To explore fathers' roles in ante-and postnatal mental health. Objectives:
To present an overview of the available evidence relating to fathers' roles in ante-and postnatal mental health.
Methods: A extensive search of databases was carried out. Databases searched include MIDIRS, Cochrane, Medline,
ScienceDirect, PubMed, Embase, IBSS, British Nursing Index, PsycInfo, ASSIA, NCT and Google Scholar. Terms
searched were 'father + depression' 'father + postnatal depression' 'father + postpartum depression' 'father +
prenatal depression' 'partner + postnatal depression'. An overview was written. Results: A range of research
evidence was found, key findings included - A new mother's mental health is strongly associated with the quality of
her relationship with her baby's father, and his support and participation in infant care. Severe depression in new
fathers is estimated at 10.4% - double the whole population rate for same-age men, but with no evidence of increase
in other severe mental disorders. New fathers' severe depression impacts even on very young children. Fathers who Aim of this study is to analyze data reported in literature concerning the efficacy of using wound low-vacuum suction
drainages in orthopedic surgery after total hip arthroplasty. We analyzed studies concerning the use of drainages in
prosthetic hip replacement surgery, performing our research through Pubmed, Cochrane database and Google
Scholar, and selecting the ones evaluating the following parameters: bleeding, the need for blood transfusions,
number or reinforcement of post-operative medications, length of hospitalization, functional results, periprosthetic
and surgical wound infection, post-operative hematoma. Our review did not show any demonstrated advantage from
the use of wound drainages in total hip arthroplasty. Moreover, some studies enlighted a possible complication Background In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of
wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar
spine surgery. Methods Medline, the Cochrane Library and Google Scholar were searched for appropriate trials.
Qualitative analysis of post-operative effectiveness was evaluated by assessment of significant difference (P < 0.05)
between study groups regarding pain relief using pain scores, supplemental analgesic consumption and time to first
analgesic request as outcome measures. Data on adverse effects were extracted and evaluated. Results Nine trials
including 12 comparisons and 529 patients met the inclusion criteria. Ten comparisons presented data on pain
scores. In only three of these 10 comparisons (30%), a reduction in pain score using local anesthetic infiltration was
observed averaging between 8 and 40 mm on a 100 mm visual analog scale. In six out of 12 comparisons, the local
anesthetic infiltration significantly reduced the supplemental opioid consumption after surgery. Observed reductions Purpose: Numerous studies have evaluated the association between XRCC1 Arg399Gln gene polymorphism and
hepatocellular carcinoma risk in the Chinese Han population. However, the results have been inconsistent. We
therefore here examined whether the XRCC1 Arg399Gln gene polymorphism confers hepatocellular carcinoma risk
by conducting a meta-analysis. Methods: PubMed, Google scholar and China National Knowledge Infrastructure
databases were searched for eligible articles in English and Chinese that were published before April 2012. Results: 6
studies involving 1,246 patients with hepatocellular carcinoma and 1,953 controls were included. The association
between XRCC1 Arg399Gln gene polymorphism and hepatocellular carcinoma in the Chinese Han population was PURPOSE: Numerous studies have evaluated the association between XRCC1 Arg399Gln gene polymorphism and
hepatocellular carcinoma risk in the Chinese Han population. However, the results have been inconsistent. We
therefore here examined whether the XRCC1 Arg399Gln gene polymorphism confers hepatocellular carcinoma risk
by conducting a meta-analysis., METHODS: PubMed, Google scholar and China National Knowledge Infrastructure
databases were searched for eligible articles in English and Chinese that were published before April 2012., RESULTS:
6 studies involving 1,246 patients with hepatocellular carcinoma and 1,953 controls were included. The association
between XRCC1 Arg399Gln gene polymorphism and hepatocellular carcinoma in the Chinese Han population was
Schizophrenia is one of the most severe mental disorders. Despite significant advances in pharmacotherapy,
treatment remains sub-optimal, with many patients having persisting deficits, especially in cognitive and social
functioning. Yoga as a therapy has proven to be effective as a sole or additional intervention in psychiatric disorders
such as depression and anxiety. Recently, there has been significant interest in the application of yoga therapy in
psychosis and schizophrenia. To review a) the evidence for the use of yoga therapy in patients with schizophrenia b)
studies which have been done in this area, c) the barriers for reaching yoga to patients, and d) future directions, an
English language literature search of PubMed/MEDLINE, Google Scholar, and EBSCO as well as grey literature was This study systematically reviews the randomized clinical trials examining the effect of zinc on attention-deficit
hyperactivity disorder (ADHD), searching the PubMed/Medline and Scholar Google databases. All randomized
controlled trials that examined zinc as the intervention, and ADHD as the primary outcome were included. Only three
randomized controlled trials, one which included a community sample and two that included clinical samples, met
inclusion criteria. The only trial that was well controlled and randomized according to the baseline zinc level showed
that using zinc, either alone or in combination with stimulants, did not improve ADHD. Considering the lack of clear
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