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Showing papers by "Cochrane Collaboration published in 1997"


Journal ArticleDOI
28 Jun 1997-BMJ
TL;DR: This systematic review of randomised controlled trials of corticosteroids in acute traumatic brain injury shows that there remains considerable uncertainty over their effects and the widely practicable nature of the drugs and the importance of the health problem suggest that large simple trials are feasible and worth while.
Abstract: OBJECTIVE: To quantify the effectiveness and safety of corticosteroids in the treatment of acute traumatic brain injury. DESIGN: Systematic review of randomised controlled trials of corticosteroids in acute traumatic brain injury. Summary odds ratios were estimated as an inverse variance weighted average of the odds ratios for each study. SETTING: Randomised trials available by March 1996. SUBJECTS: The included trials with outcome data comprised 2073 randomised participants. RESULTS: The effect of corticosteroids on the risk of death was reported in 13 included trials. The pooled odds ratio for the 13 trials was 0.91 (95% confidence interval 0.74 to 1.12). Pooled absolute risk reduction was 1.8% (-2.5% to 5.7%). For the 10 trials that reported death or disability the pooled odds ratio was 0.90 (0.72 to 1.11). For infections of any type the pooled odds ratio was 0.92 (0.69 to 1.23) and for the seven trials reporting gastrointestinal bleeding it was 1.05 (0.44 to 2.52). With only those trials with the best quality of concealment of allocation, the pooled odds ratio estimates for death and death or disability became closer to unity. CONCLUSIONS: This systematic review of randomised controlled trials of corticosteroids in acute traumatic brain injury shows that there remains considerable uncertainty over their effects. Neither moderate benefits nor moderate harmful effects can be excluded. The widely practicable nature of the drugs and the importance of the health problem suggest that large simple trials are feasible and worth while to establish whether there are any benefits from use of corticosteroids in this setting.

169 citations


Journal ArticleDOI
29 Nov 1997-BMJ
TL;DR: Reliable evidence is available to show some specific strategies improve adherence to tuberculosis treatment, and these should be adopted in health systems, depending on their appropriateness to practice circumstances.
Abstract: Objective: To determine the effectiveness of strategies to promote adherence to treatment for tuberculosis. Identification: Searches in Medline (1966 to August 1996), the Cochrane trials register (up to October 1996), and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud) (1982 to September 1996); screening of references in articles on compliance and adherence; contact with experts in research on tuberculosis and adherence. Inclusion criteria: Randomised or pseudorandomised controlled trials of interventions to promote adherence with curative or preventive treatment for tuberculosis, with at least one measure of adherence. Main outcome measure: Relative risks and 95% confidence intervals for estimates of effect for categorical outcomes. Results: Five trials met the inclusion criteria. The relative risk for tested reminder cards sent to patients who defaulted on treatment was 1.2 (95% confidence interval 1.1 to 1.4), for help given to patients by lay health workers 1.4 (1.1 to 1.8), for monetary incentives offered to patients 1.6 (1.3 to 2.0), for health education 1.2 (1.1 to 1.4), for a combination of a patient incentive and health education 2.4 (1.5 to 3.7) or 1.1 (1.0 to 1.2), and for intensive supervision of staff in tuberculosis clinics 1.2 (1.1 to 1.3). There were no completed trials of directly observed treatment. All of the interventions tested improved adherence. On current evidence it is unclear whether health education by itself leads to better adherence to treatment. Conclusions: Reliable evidence is available to show some specific strategies improve adherence to tuberculosis treatment, and these should be adopted in health systems, depending on their appropriateness to practice circumstances. Further innovations require testing to help find specific approaches that will be useful in low income countries. Randomised controlled trials evaluating the independent effects of directly observed treatment are awaited. Key messages Despite adequate delivery systems, some patients with tuberculosis do not complete treatment Six specific interventions have been tested in randomised trials to improve adherence, ranging from intensive staff supervision to monetary incentives for patients This systematic review of randomised trials found that all of the strategies tested seemed to improve adherence Independent effects of health education could not be assessed, and there are no trials yet available that test the effectiveness of directly observed treatment Health providers should draw on what is known to be effective when designing strategies appropriate to local needs and circumstances Further innovations, especially those that are feasible in developing countries, should be evaluated in randomised controlled trials before being introduced into routine practice.

129 citations


Journal ArticleDOI
26 Apr 1997-BMJ
TL;DR: There seems to be no survival benefit of antifungal agents given prophylactically or empirically to patients with cancer complicated by neutropenia and these agents should be restricted to Patients with proved infection and those in randomised trials.
Abstract: OBJECTIVE: To determine whether antifungal agents given prophylactically or empirically decrease morbidity and mortality in patients with cancer complicated by neutropenia. DESIGN: Meta-analysis of randomised trials of amphotericin B, various lipid soluble formulations of amphotericin B (for example, AmBisome), fluconazole, ketoconazole, miconazole, or itraconazole compared with placebo or no treatment. SETTING: Trials conducted anywhere in the world. SUBJECTS: Patients with cancer complicated by neutropenia. MAIN OUTCOME MEASURES: Mortality, invasive fungal infection (defined as positive blood culture, oesophageal candidiasis, or lung or deep tissue infection), and colonisation. RESULTS: 24 trials with 2758 randomised patients were reviewed; the total number of deaths was 434. Prophylactic or empirical treatment with antifungals as a group bad no effect on mortality (odds ratio 0.92; 95% confidence interval 0.74 to 1.14). Amphotericin B decreased mortality significantly (0.58; 0.37 to 0.93) but the studies were small and the difference in number of deaths was only 15. Antifungal treatment decreased the incidence of invasive fungal infection (0.47; 0.35 to 0.64) and fungal colonisation (0.45; 0.30 to 0.69). For every 73 patients treated (95% confidence interval to 48 to 158) one case of fungal invasion was prevented in surviving patients. CONCLUSIONS: There seems to be no survival benefit of antifungal agents given prophylactically or empirically to patients with cancer complicated by neutropenia. These agents should be restricted to patients with proved infection and those in randomised trials. A large, definitive placebo controlled trial of amphotericin B is needed.

97 citations


Journal ArticleDOI
TL;DR: Ask what was Bradford Hill's most important specific contribution to knowledge and the answer must surely be his research with Richard Doll on the relation between tobacco and lung cancer but medical numerophobes such as myself honour him also for the clarity of his writing for nonstatisticians.
Abstract: Ask what was Bradford Hill's most important specific contribution to knowledge and the answer must surely be his research with Richard Doll on the relation between tobacco and lung cancer. But medical numerophobes such as myself honour him also for the clarity of his writing for nonstatisticians. This is nowhere better exemplified than in his two articles entitled 'The Clinical Trial', published at the beginning of the 1950sl,2. In these papers, he notes the circumstances in which carefully controlled trials are unnecessary; he discusses the ethics of doing and of not doing trials; and he covers virtually all the methodological aspects of the subject matter that are judged important today. He even remarks, for those who perceive some inherent antithesis between controlled trials and the collection of qualitative data, that as long as the studies have been appropriately designed to control biases, subjective impressions can be given full weight in analyses of controlled trials. And he also has important things to say about the relevance of the results of controlled trials in practice:

77 citations


Journal ArticleDOI
TL;DR: This strategy was elaborated based on the optimal search strategy for MEDLINE recommended by Cochrane Collaboration for the identification of clinical trials in electronic databases, and was elaborated combining headings with text word in three languages, adapting the interface of the LILACS.
Abstract: OBJECTIVE: To define and disseminate the optimal search strategy for clinical trials in the Latin American and Caribbean Health Science Literature (LILACS). This strategy was elaborated based on the optimal search strategy for MEDLINE recommended by Cochrane Collaboration for the identification of clinical trials in electronic databases. DESIGN: Technical information. SETTING: Clinical Trials and Meta-Analysis Unit, Federal University of Sao Paulo, in conjunction with the Brazilian Cochrane Center, Sao Paulo, Brazil. (http://www.epm.br/cochrane). DATA: LILACS/CD-ROM (Latin American and Caribbean Health Science Information Database), 27th edition, January 1997, edited by BIREME (Latin American and Caribbean Health Science Information Center). LILACS Indexes 670 journals in the region, with abstracts in English, Portuguese or Spanish; only 41 overlap in the MEDLINE-EMBASE. Of the 168.902 citations since 1982, 104,016 are in human trials, and 38,261 citations are potentiality clinical trials. Search strategy was elaborated combining headings with text word in three languages, adapting the interface of the LILACS. We will be working by locating clinical trials in LILACS for Cochrane Controlled Trials Database. This effort is being coordinated by the Brazilian Cochrane Center.

45 citations


Journal ArticleDOI
TL;DR: Igualmente, se mencionan distintas actividades e iniciativas, algunas ya bien establecidas y otras aun en fase of desarrollo, de ayuda a una practica clinica basada en evidencias.
Abstract: En este articulo se presentan los origenes y los conceptos sobre los que se sustenta el paradigmade esta nueva corriente del razonamiento medico denominada: «medicina basada en la evidencia». En el, se describen sus caracteristicas (los componentesde este metodo de razonamiento), como son: la formulacion de preguntas clinicas basadas en problemas; la consulta de la literatura y la extraccionde la evidencia relevante; la evaluacion critica de dicha evidencia identificada, y la aplicacionde los hallazgos a la practica clinica. Igualmente, se mencionan distintas actividades e iniciativas, algunas ya bien establecidas y otras aun en fase de desarrollo, de ayuda a una practica clinica basada en evidencias. Se presta especial atencion a la Colaboracion Cochrane, una iniciativa internacional encaminada a preparar, mantener y divulgar revisiones sistematicas sobre los efectos de la atencion sanitaria.

39 citations


Journal ArticleDOI
J.Z. Zhu1
TL;DR: It is found that some of the widely used error estimators are in fact related, although they were originally derived from different methodologies.

38 citations


Journal ArticleDOI
TL;DR: No association was found between the CYP2D6 oxidation polymorphism and lung cancer risk when sample size bias was taken into account.
Abstract: To examine the association between the sparteine/debrisoquine (CYP2D6) oxidation polymorphism and the risk of lung cancer. Meta-analysis of case-control studies using a random effects model. The “Main outcome measure” was the odds ratio for the risk of lung cancer, using extensive metabolisers as the reference group. Thirteen studies were identified. The studies were too heterogeneous to be pooled the size of the odds ratio increased with the sample size. When the analysis was restricted to the largest studies, there was no difference in risk between poor and extensive metabolisers (odds ratio 0.95, 95% confidence interval 0.68–1.33). No association was found between the CYP2D6 oxidation polymorphism and lung cancer risk when sample size bias was taken into account.

37 citations


Journal ArticleDOI
TL;DR: In the authors' opinion a nonsurgical approach has positive implications for both health services and women, and it is therefore “acceptable to allow patient preference to determine the management”.

36 citations


Journal ArticleDOI
TL;DR: Quality of reviews would improve if author, editors and readers systematically applied any of the sets of criteria now available in the literature, according to published criteria.

33 citations


Journal ArticleDOI
TL;DR: The results reported do not support Olsen and Clausen’s claim that their study was the first to compare ultrasound term and term based on the LMP, and the method to predict labour should ‘on average be correct’, but this is a misunderstanding.

Journal ArticleDOI
TL;DR: The subject of accurate and robust a posteriori error estimation is presented and the problem of 3-D automatic mesh generation is discussed in some detail.

Journal ArticleDOI
Abstract: SUMMARY South Africa's offshore living marine resources are commercially the most valuable of its renewable marine resources They are herein defined as the demersal, pelagic and squid fisheries Reviews are given of the fisheries and the focus research has taken since Gilchrist's days, with accent on the present situation and understanding Progress has not always been smooth, but many of the developments in research on offshore living resources have placed South Africa at the forefront of fisheries management Looking to the future, options are explored and likely scenarios generated Certain is the fact that management of the offshore living marine resources has been and will continue to be exciting and, to some extent, even controversial

Journal ArticleDOI
TL;DR: There is insufficient evidence at this point, without further research, to recommend acupuncture as an effective form of therapy, and the odds of quitting were higher in comparisons betweenupuncture and no acupuncture than between acupuncture and sham acupuncture.
Abstract: The role of acupuncture in facilitating smoking cessation is controversial. A systematic review was undertaken, incorporating meta-analytic techniques, of all the available randomized controlled trials examining the effectiveness of acupuncture in smoking cessation. Based on the data from nine trials involving 2707 patients, the odds ratio of abstinence at 6-12 months' follow-up is 1.48 (95% confidence interval 1.13-1.94) with acupuncture compared to no acupuncture or sham acupuncture. The odds of quitting were higher in comparisons between acupuncture and no acupuncture (OR 2.41, CI: 1.52 to 3.83) than between acupuncture and sham acupuncture (OR 1.16, CI: 0.90 to 1.49). Many of the included trials were small and had methodological shortcomings. Therefore, while acupuncture appears promising, there is insufficient evidence at this point, without further research, to recommend it as an effective form of therapy.

Reference EntryDOI
TL;DR: Plasma-derived vaccines appear to be efficacious and safe for use in high risk health-care workers, such as staff of renal dialysis and transplant units, and there is some uncertainty concerning the effectiveness of the vaccine in lower risk health care workers, although the trend is towards benefit.
Abstract: Background Hepatitis B causes acute and chronic liver disease and may be prevented by vaccination. Objectives To assess the effectiveness and safety of plasma-derived vaccines against acute and chronic hepatitis B in health-care workers in protecting them from hepatitis B infection and its consequences. Search strategy MEDLINE and Excerpta Medica Database (EMBASE) search using standard Cochrane strategy, Cochrane Library, full text searching of the journal "Vaccine", bibliography of retrieved studies and correspondence with authors, researchers and manufacturers. Selection criteria All original prospective randomised comparisons of yeast-derived vaccines and plasma-derived vaccines against no intervention, placebo, or vaccines against other disease (control vaccines). Assessment of trial quality was made according to: 1. generation of allocation schedule 2. measure(s) taken to conceal treatment allocation 3. drop-out of allocated health-care worker participants from the analysis of trial results 4. measures taken to implement double blinding Trial reports were blinded by removal of authors and their affiliation, journal reference, introduction, results, and discussion. Data collection and analysis To assess efficacy the incidence rates of acute hepatitis B were observed in the surveillance of the vaccinated and control groups of the trials included in the review. Safety was assessed from side-effect rates, classified as systemic (malaise, nausea, fever, arthralgias, rash, headache) or local (induration and soreness at the site of the inoculation). Main results Four trials fulfilling the criteria were identified and the data synthesised. All trials compared plasma-derived vaccines versus placebo. Differences in the settings (and level of incidence) between three of the trial settings and Dienstag's led us to stratify our comparison grouping the three trials performed in dialysis units together. After our stratification, the Desmyter, Smuzness and Crosnier group appears to be homogeneous (Chi-square = 0.11, degrees of freedom = 2). Our estimates of effectiveness and safety in the high risk group favour treatment, the OR for cases of HB being 0.34; 95% CI (0.21, 0.55). The analysis also revealed a non-significant trend towards benefit in the lower risk health-care workers (Dienstag trial, OR 0.26 (0.05, 1.30). Overall the evidence strongly favours vaccination (OR=0.33; 95% CI (0.21, 0.53)). There was no difference in the incidence and severity of side-effects between the two arms of the trials. We calculated that it was necessary to vaccinate between 145 (assuming a baseline rate of 10 cases/1000/year) and 7 (for a baseline rate of 200/1000/year) health-care workers with plasma-derived vaccines to avoid one case of hepatitis B. Completeness of trial reporting was not good with all four trials failing to report titre results on antibodies against hepatitis B surface antigen and hepatitis B core antigen in the placebo arms (correspondence with two of the four authors failed to shed light on the reasons for such an omission). All four trials achieved low scores in the four quality dimensions assessed (generation of allocation schedule, measure(s) taken to conceal treatment allocation, exclusion of allocated participants from the analysis of the trial and measures taken to implement and protect double blinding). Mean length of follow-up was 14.5 months. Reviewer's conclusions Plasma-derived vaccines appear to be efficacious and safe for use in high risk health-care workers, such as staff of renal dialysis and transplant units. There is some uncertainty concerning the effectiveness of the vaccine in lower risk health-care workers, although the trend is towards benefit. We found no evidence of a long-term protective effect due to the short follow-up time of the four trials included in this review. We found relatively poor standard of trial reporting, possibly related to the age of the trials.

Patent
20 Oct 1997
TL;DR: In this article, the authors disclosed a press-on bottle cap which is convertible to a screw reclosure lid, where the cap is formed with a circular disc having an integral, downwardly dependent circumferential skirt.
Abstract: There is disclosed a press-on bottle cap which is convertible to a screw reclosure lid. The cap is formed with a circular disc having an integral, downwardly dependent circumferential skirt. The skirt has a raised helical bead on its inside wall which extends an angular increment from 270 to about 400 degrees and a raised circumferential bead located beneath the helical bead and at least one tear line defined by a circumferential band of weakened strength located between the circumferential and helical beads. A tear tab extends from the outer wall of the skirt adjacent the tear line which can be pulled by the user to sever a reclosure lid having the helical bead which can be threaded onto the neck of the bottle to seal its contents. For this purpose, the undersurface of the disc of the cap has a compressible sealing gasket which is engaged by an annular lip of the upper end of the bottle neck.

Journal ArticleDOI


Journal ArticleDOI
TL;DR: The results of this survey invite a reappraisal of many policy initiatives involving GPs aimed at reducing AAS-related harm, and some GPs had favourable attitudes towards prescription of AASs for non-medical purposes.
Abstract: The aim of this study was to assess GPs' attitudes, clinical behaviour, information needs and contact with anabolic-androgenic steroid (AAS) users in an area reported to have a high prevalence of AAS use. It was a cross-sectional study of GPs using a self-administered questionnaire. The sample comprised of 202 GPs practising in the Central Business District and inner city area of Sydney took part. Of 164 eligible GPs, 143 responded (87% response rate). Fifty-three per cent of respondents reported that they had seen at least one patient in the last year who told them they had used AASs for non-medical purposes; 6% indicated that they had seen more than 20 patients who mentioned AAS use. Two per cent of respondents reported prescribing AASs for body-building purposes and 6% indicated a willingness to do so in a hypothetical situation. Forty per cent of respondents reported that they would be willing to provide harm minimization advice to AAS users; 77% of respondents were interested in obtaining more information about AAS use, most frequently requested in the form of a fact sheet or pamphlet. Most GPs in the area surveyed had some contact with AAS users in their practice. Some GPs had favourable attitudes towards prescription of AASs for non-medical purposes. These attitudes require further exploration. The results of this survey invite a reappraisal of many policy initiatives involving GPs aimed at reducing AAS-related harm.