Showing papers by "Timothy J Wilt published in 2003"

Trazodone for erectile dysfunction: A systematic review and meta-analysis

Abstract: Evidence-based medicine is an important way of allowing the reader to judge clearly whether a treatment has a place in a particular condition, and to see what faults were present in the various trials of its efficacy. It is often rather unsettling to read in a meta-analysis or in a systematic literature review how poorly constructed many trials are. The authors from Minneapolis have carried out such a study into the use of trazodone in male erectile dysfunction. They draw attention to the poor quality of many of the trials and give their reasons for this observation. They suggest that trazodone may be helpful in men with this condition, possibly at higher doses and in men with psychogenic erectile dysfunction.

Prostate cancer: epidemiology and screening.

Abstract: The 13th International Prostate Cancer Update provided an overview of diagnosis, treatment, and management strategies in prostate cancer. This article provides a summary of the reports presented during the epidemiology and screening session. Methods to improve early detection and treatment are being developed. Proposed refinements to prostate-specific antigen (PSA) testing include the use of age-specific PSA levels, PSA velocity, prostate volume-adjusted PSA densities, free-to-total PSA ratios, and complexed PSA. Optimal follow-up screening intervals for persons who elect PSA testing and are found to have initially normal levels have been proposed. Molecular oncology is becoming increasingly important in understanding the development and progression of prostate cancer as well as identifying new therapeutic targets for hormone-refractory disease. Nomograms that include PSA levels, histologic grade, and the extent of the tumor have been developed to optimize management decisions. Despite advances in early detection and treatment, controversy persists because of the lack of evidence demonstrating that they improve length and quality of life. Until results from randomized trials are completed, clinicians should provide patients with balanced information that incorporates the potential risks and benefits of screening and treatment and individual preferences for various outcomes.

Prostate cancer intervention. Involving the patient in early detection and treatment.

Abstract: PREVIEW Prostate cancer is the most common malignancy diagnosed in men. Screening by prostate-specific antigen (PSA) testing is widespread in the United States, and treatment recommendations often urge early therapy. Yet there is ongoing controversy about patient care because of a lack of evidence demonstrating that such an aggressive approach improves the length and quality of a man's life. Drs Wilt and Partin review the epidemiologic factors of prostate cancer and discuss the research findings, recommendations, and pros and cons of screening and therapy. Further, they make a case that rather than routinely ordering a PSA test for all men, physicians should inform patients about the potential but uncertain benefits and the possible harm of screening and treatment and then incorporate patient preferences into decision making.

Total Knee Replacement: Summary

Abstract: Total knee arthroplasty is one of the most common orthopaedic procedures performed. In 2001 171,335 primary knee replacements and 16,895 revisions were performed.1 Throughout this report we use the term total knee arthroplasty (TKA) in lieu of total knee replacement because the abbreviation for the latter may be readily confused with total knee revision. Because these procedures are elective and expensive (Medicare paid approximately $3.2 billion in 2000 for hip and knee joint replacements) and because the prevalence of arthritis is expected to grow substantially as the population ages,2, 3 these procedures are likely to come under increasing scrutiny. Previous reports suggest that TKAs improve functional status, relieve pain, and result in relatively low perioperative morbidity.4 However, based on conclusions from consensus panels or surveys of health care providers, there is considerable disagreement about the indications for the procedure; that is, which patients are most likely to benefit from TKA and, conversely, in which patients is TKA contraindicated or of low value.5-10 This evidence report, which was commissioned for an NIH Consensus Development Conference on Total Knee Replacement, was designed to systematically review, analyze, and discuss empirical data on Total Knee Replacement, to help inform the deliberations of the Consensus Panel. In collaboration with the Office of Medical Applications of Research (OMAR), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and the TKR Planning Committee, the Agency for Healthcare Research and Quality (AHRQ) defined the work to be performed for a comprehensive evidence report on the indications for primary TKR and revisions. The scope of the project specified that it address the following key questions regarding total knee arthroplasty: 1. What are the current indications for, and outcomes from, primary total knee replacement? 2. How do specific characteristics of the patient, material and design of the prosthesis, and surgical factors, affect the short-term and long-term outcomes of primary total knee replacement? 3. Are there important perioperative interventions that influence outcomes? 4. What are the indications, approaches, and outcomes for revision total knee replacement? 5. What factors explain disparities in the utilization of total knee replacement in different populations? 6. What are the directions for future research?

Radical prostatectomy reduced death from prostate cancer but not all cause mortality

Abstract: Main results Analysis was by intention to treat. During follow up, fewer patients in the radical prostatectomy group than the watchful waiting group died from prostate cancer (relative hazard [RH] 0.50, 95% CI 0.27 to 0.91) (table), developed distant metastases (RH 0.63, CI 0.41 to 0.96), or had local progression (RH 0.31, CI 0.22 to 0.44). The difference between groups for all cause mortality was not statistically significant (RH 0.83, CI 0.57 to 1.2) (table). Quality of life outcomes were assessed by mailed questionnaire in 326 men (87% of the men enrolled between January 1989 and February 1996): More radical prostatectomy patients than watchful waiting patients reported erectile dysfunction (80% v 45%, relative risk [RR] 1.8, CI 1.5 to 2.2) and urinary leakage (18% v 2%, RR 9.3, CI 2.9 to 29.9); groups did not differ for bowel function, psychological wellbeing, or subjective quality of life values.