1
|
327 To Fuse or Not to Fuse: The Elderly Patient with Lumbar Stenosis and Low-Grade Spondylolisthesis. Systematic Review and Meta-Analysis of Randomised Controlled Trials. Br J Surg 2022. [DOI: 10.1093/bjs/znac268.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
The optimum surgical intervention for elderly patients with lumbar spinal stenosis(LSS) and low-grade degenerative-spondylolisthesis(LGDS) has been extensively debated. We conducted a systematic review and meta-analysis of randomised-controlled-trials(RCTs) comparing the effectiveness of decompression-alone against gold-standard decompression-with-fusion(D+F) in elderly patients with LSS and LGDS.
Method
A systematic literature search was performed on published databases from inception to October-2021. English-language RCTs of elderly patients (mean age over-65) with LSS and LGDS, who had undergone DA or D+F were included. The quality and weight of evidence was assessed, and a meta-analysis performed.
Results
Seven RCTs (n=581; mean age:65.9 years; 59.9% female) were included. There was no difference in visual-analogue-scale(VAS) scores of back-pain(BP) or leg-pain(LP) at mean follow-up of 28.6 months between both DA and D+F groups (BP: mean-difference (MD)-0.22, 95%CI:-0.76–0.32; LP: MD:-0.26, 95%CI:-0.79–0.27). In addition, subgroup analysis of long-term follow-up (>3 years) showed lower VAS scores for BP and LP in patients who underwent DA (BP MD:-1.70, 95%CI:-2.8-(-0.60); LP MD:-1.00, 95%CI:-1.77-(-0.23)). No difference in disability, measured by Oswestry-Disability-Index(ODI) scores, was found between both groups (MD:0.50, 95%CI: -3.31–4.31). However, patients in DA group had less hospital complications and fewer adverse events (total-surgical-complications OR:0.57, 95%CI:0.36–0.90), despite a higher rate of post-operative DS (OR:8.63, 95%CI:3.35–22.26).
Conclusions
DA is not inferior to D+F in elderly patients with LSS and LGDS. DA has better pain outcomes at three-years follow-up and carries lower risk hospital-complications and fewer adverse-events. Surgeons should weigh these findings with increased risk of DS-progression.
Collapse
|
2
|
|
3
|
Implementation of evidence based treatment into clinical practice for older people – A negative trial. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
4
|
IMPLEMENTATION OF VITAMIN D FOR OLDER PEOPLE IN AUSTRALIAN RESIDENTIAL AGED CARE FACILITIES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
5
|
DOES KNOWING ABOUT FRAILTY MAKE A DIFFERENCE IN THE CARE OF HIP FRACTURE PATIENTS? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
6
|
VALIDITY OF A SCALE TO MEASURE COMMITMENT TO HIP PROTECTORS AMONG CARE PROVIDERS IN LONG-TERM CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
7
|
RECRUITING OLDER PEOPLE AT NUTRITIONAL RISK FOR CLINICAL TRIALS: WHAT HAVE WE LEARNED? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
8
|
HAS CONSUMER-DIRECTED CARE IN COMMUNITY AGED CARE IMPROVED QUALITY OF LIFE FOR OLDER AUSTRALIANS? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
9
|
A CITIZENS JURY TO INFORM POLICY ON REHABILITATION FOR PEOPLE IN RESIDENTIAL CARE WITH HIP FRACTURE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
10
|
IS HIP FRACTURE REHABILITATION FOR NURSING HOME RESIDENTS COST-EFFECTIVE? RESULTS FROM AN RCT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
11
|
HIP FRACTURE REHABILITATION FOR PEOPLE LIVING IN NURSING HOMES: RESULTS OF A RCT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
12
|
|
13
|
A MULTIFACTORIAL INTERDISCIPLINARY INTERVENTION IN PRE-FRAIL OLDER PEOPLE: RANDOMISED TRIAL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
14
|
SU-G-IeP1-03: Comparing Arterial Input Function Measurements in DCE-MRI Using MOLLI and Phase. Med Phys 2016. [DOI: 10.1118/1.4956963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
15
|
Cost-effectiveness of individualized nutrition and exercise therapy for rehabilitation following hip fracture. J Rehabil Med 2016; 48:378-85. [DOI: 10.2340/16501977-2070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
16
|
Tuberculosis patients learning about second-hand smoke (TBLASS): results of a pilot randomised controlled trial. Int J Tuberc Lung Dis 2015; 19:237-43. [PMID: 25574925 DOI: 10.5588/ijtld.14.0615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Passive smoking is associated with tuberculosis (TB). Measures are required to protect non-smoking TB patients from second-hand smoke (SHS). SETTING We developed a behavioural intervention to encourage TB patients to implement smoking restrictions at home in Pakistan. OBJECTIVES To assess the likelihood of such an intervention being successful and to inform a definitive trial in future. DESIGN This was a pilot randomised controlled trial in which non-smoking TB patients were randomised to receive either individual-based support or individual-based support combined with family reminders. We recruited patients living with at least one smoker in their homes. Our primary outcome was urinary cotinine level as a measure of SHS exposure 2 months post-randomisation. RESULTS Of 273 patients assessed for eligibility, 150 (56%) patients were recruited and all but one were retained throughout the trial. A statistically significant absolute reduction was observed in non-smoking participants' exposure to SHS based on urinary cotinine levels in both Arm 1 (71%, 95%CI 61-79) and Arm 2 (76%, 95%CI 67-83) between baseline and follow-up at 2 months. CONCLUSIONS The recruitment and retention rates for trial participants make it feasible to conduct a definitive trial in future. The observed effect size makes it worthwhile to conduct such a trial.
Collapse
|
17
|
Successful isolation and culture of equine placental cells from failed early pregnancies. J Equine Vet Sci 2014. [DOI: 10.1016/j.jevs.2013.10.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
18
|
The association of compensation and long-term health status for people with severe traumatic injuries. J Rehabil Med 2013; 45:446-51. [DOI: 10.2340/16501977-1135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
19
|
What are frail older people prepared to endure to achieve improved mobility following hip fracture? A Discrete Choice Experiment. J Rehabil Med 2013; 45:81-6. [DOI: 10.2340/16501977-1054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
20
|
Lionel Maurice Kremer. West J Med 2012. [DOI: 10.1136/bmj.d8089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
21
|
The World Health Organization Disability Assessment Scale, WHODAS II: Reliability and validity in the measurement of activity and participation in a spinal cord injury population. J Rehabil Med 2012; 44:747-55. [DOI: 10.2340/16501977-1016] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
22
|
Effects of development on low-level feature processing during natural viewing of dynamic scenes. J Vis 2011. [DOI: 10.1167/11.11.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
23
|
Physical exercise after hip fracture: an evidence overview. Eur J Phys Rehabil Med 2011; 47:297-307. [PMID: 21555983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Improving strategies for hip fracture rehabilitation among older people is an urgent public health challenge due to the increasing proportion of older people in the global population and therefore the increasing numbers of falls and fractures. Most older people who suffer a hip fracture experience a permanent decrease in physical functioning. It is now clear in the general older population that muscle strength and balance can be improved and falls can be prevented by well-designed exercise programs. Physical exercise has the potential to improve physical outcomes after hip fracture in older people. Increasingly, clinicians are being urged to seek guidance from clinical trials in order to make clinical decisions. This article presents: 1) an overview of clinical practice guidelines and systematic reviews about rehabilitation after hip fracture and 2) an overview of randomised trials of exercise for people after hip fracture indexed on the Physiotherapy Evidence Database (PEDro). The lack of well-designed large-scale trials of exercise after hip fracture means that current guidelines do not include detailed recommendations about exercise after hip fracture. The Cochrane reviews covering this field also do not draw firm conclusions. However, several individual trials have had promising findings and indicate some benefits of exercise after hip fracture.
Collapse
|
24
|
Stimulation of Substrate Oxidation in Rat Hepatic Mitochondria Following Pretreatment with Appetite Modifying Drugs. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1985.tb14217.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
The Effect of L-Cysteine on the Cadmium-Induced Inhibition of Monoamine Oxidase Activity in Rat Liver. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1986.tb14339.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
26
|
The Effect of Cyproheptadine on Oxidative Phosphorylation in Rat Liver Mitochondria. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1986.tb14340.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
Abstract
Pancreatic trauma is an uncommon occurrence and so a consensus about optimal management is not readily available. Isolated pancreatic injury occurs only occasionally, as in the majority of cases there is concurrent visceral or vascular injury. Morbidity and mortality are related to delay in diagnosis, concurrent organ injury or the presence and extent of pancreatic duct injury.
Collapse
|
28
|
|
29
|
Can a community-based 'smoke-free homes' intervention persuade families to apply smoking restrictions at homes? J Public Health (Oxf) 2010; 33:48-54. [DOI: 10.1093/pubmed/fdq073] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
30
|
Smoke-free homes: an intervention to reduce second-hand smoke exposure in households. Int J Tuberc Lung Dis 2010; 14:1336-1341. [PMID: 20843427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Second-hand tobacco smoke is a serious health hazard. We tested the fidelity and feasibility of the Smoke-Free Homes (SFH) intervention and looked for preliminary evidence of its effectiveness in imposing smoking restrictions in homes in Pakistan. METHODS SFH was piloted and adapted for Pakistan. The adapted SFH intervention was then delivered to primary schoolchildren, community leaders and health professionals in a semi-rural Union Council. We carried out a survey before and after the intervention to assess adult smoking behaviour and restrictions at homes. We also carried out focus group discussions with stakeholders to determine the appropriateness and acceptability of the intervention. RESULTS We found the adapted SFH intervention feasible and appropriate in a typical semi-rural setting in Pakistan. The proportion of smoke-free homes increased from 43% (95%CI 37.4-48.2) to 85% (95%CI 80.9-89.2) after the intervention. The number of households with at least one smoker decreased from 57.5% (95%CI 52.1-62.9) to 38.4% (95%CI 32.7-44.1). There was a reduction in self-reported adult smoking prevalence from 44% (95%CI 39-48) to 28% (95%CI 24-33) in males. CONCLUSION SFH has the potential to influence adult smoking behaviour in households. This approach needs to be further evaluated to establish its effectiveness and cost-effectiveness and to ascertain its long-term sustainability.
Collapse
|
31
|
|
32
|
Poster - Thur Eve - 29: Determination of Contrast Agent Concentration in Tortuous Blood Vessels Using Measured MRI Phase Changes and Fourier-Based Field Inhomogeneity Equations. Med Phys 2010. [DOI: 10.1118/1.3476134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
33
|
Screening attentional-related diseases based on correlation between salience and gaze. J Vis 2010. [DOI: 10.1167/9.8.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
34
|
The impact of maturation and aging on mechanisms of attentional selection. J Vis 2010. [DOI: 10.1167/7.9.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
35
|
Post-traumatic amnesia and its relationship to the functional outcome of people with severe traumatic brain injury. Brain Inj 2010; 24:479-85. [DOI: 10.3109/02699051003610417] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
36
|
Sci-Fri AM(1): Imaging-07: Biexponential Characterization of Diffusion in Brain Tumor. Med Phys 2009. [DOI: 10.1118/1.3244190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
37
|
Sci-Fri AM(1): Imaging-08: Improved Diffusion Weighted MR Imaging of Liver in Normal Subjects. Med Phys 2009. [DOI: 10.1118/1.3244191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
38
|
Effects of Current Alcohol Use on Working Memory in Young Adults using fMRI. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
39
|
David Hunsley. West J Med 2009. [DOI: 10.1136/bmj.b2278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
40
|
SU-FF-I-123: Clinical Value of Diffusion-Weighted MRI in White Matter in Vivo. Med Phys 2009. [DOI: 10.1118/1.3181244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
41
|
|
42
|
Towards an accurate and robust method based on fuzzy logic principles for the reconstruction and quantification of large volumes from MR and CT images. Br J Radiol 2008; 82:228-34. [PMID: 19001469 DOI: 10.1259/bjr/33222418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The authors have previously evaluated a new method of volume reconstruction and quantification from MR images, based on fuzzy logic (FL) principles. The technique is evaluated here for larger and more complex structures by investigating its accuracy and robustness using MR and CT images. Four large (50-71 cm(3)) and complex (e.g. mimicking a prostate) structures were created and imaged on MR and CT scanners, both with increasing slice thickness. Contours were delineated to generate 112 volumes. MR and CT images were processed using the FL method and a "classical" method of reconstruction on research software. In addition, the CT images were also processed on commercial virtual simulation software. Calculated volumes were compared with actual volumes. The mean +/- standard deviation of the relative variations in calculated target volume using the FL method was found to be 4.4%+/-2.8%, whereas with the "classical" method it was 23.7%+/-6% from axial MR images and 23.3%+/-9.8% from CT images. With the "classical" method, the relative variations in calculated volumes rise with increasing slice thickness, and the displayed volumes show deformations in the longitudinal direction. With the FL method, the volume calculation is not sensitive to the slice thickness and so the deformations are minimal. When used with MR images, our FL method of volume reconstruction is accurate and robust with respect to changes in slice thickness. For CT images, the results are encouraging but some work is still needed to improve the accuracy of the FL method.
Collapse
|
43
|
Poster - Thurs Eve-28: New brain diffusion analysis method: White matter grey matter dissasociation. Med Phys 2008; 35:3406. [PMID: 28512828 DOI: 10.1118/1.2965947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Diffusion MR studies are often used to investigate the physical properties of brain tissues (1, 2). It is known that a full characterisation of the diffusion decay for brain could give valuable information about the structural organisation of cerebral tissue. The significance of the present diffusion decay study lies in the combination of three novel procedures to provide a better characterization of the diffusion decay: i) the acquisition of a large number of b-values (96 b-values up to 10,000 s/mm2 ), ii) the application of a noise correction technique (3) to the acquired data, and iii) the use of a Non Negative Least Squares (NNLS) fitting algorithm to evaluate the diffusion coefficients. The presence of noise in magnitude MR images can affect the calculation of the diffusion parameters (4) and therefore a noise correction technique (3) is applied. The NNLS algorithm is used to fit the corrected data instead of the more commonly used Levenberg-Marquardt algorithm since the NNLS algorithm does not require the number of components to be specified, nor does it need initial estimates of the fitting parameters as input; thus giving it more versatility as a fitting tool for the diffusion decay. The results indicate that the diffusion decays in grey and white matter have one and two components, respectively. Consequently, the short diffusion component in white matter (Fig. 1.c) can be used as a tool in the disassociation of white and grey matter tissues.
Collapse
|
44
|
SU-GG-I-128: Biophysical Studies of Tendon to Elucidate Magic Angle MRI. Med Phys 2008. [DOI: 10.1118/1.2961526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
45
|
Abstract
BACKGROUND Excessively heavy menstrual bleeding (HMB) or menorrhagia is an important cause of ill health in women. Eighty per cent of women treated for HMB have no anatomical pathology, which makes medical therapy, with the avoidance of possibly unnecessary surgery, an attractive alternative. Of the wide variety of medications used to reduce heavy menstrual bleeding, oral progestogens are the most commonly prescribed. This review assesses the effectiveness of two different regimens of oral progestogens in reducing ovulatory HMB. OBJECTIVES The primary objective of this review was to investigate the effectiveness of oral progestogen therapy taken either during the luteal phase or for a longer course of 21 days in achieving a reduction in menstrual blood loss in women of reproductive years with heavy menstrual bleeding (HMB). SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched April 2007), MEDLINE (1966 to April 2007) and EMBASE (1985 to April 2007). Attempts were also made to identify trials from citation lists of review articles. In most cases, the first author of each included trial was contacted. SELECTION CRITERIA The inclusion criteria were randomised comparisons of oral progestogen therapy versus placebo or other medical treatments in women of reproductive years with regular heavy periods measured either objectively or subjectively and with no pathological or iatrogenic causes for their heavy menstrual blood loss. DATA COLLECTION AND ANALYSIS Seven randomised controlled trials (RCTs) were identified that fulfilled the inclusion criteria. The review authors extracted the data independently. Odds ratios for dichotomous outcomes and weighted mean differences for continuous outcomes were estimated from the data. MAIN RESULTS No RCTs comparing progestogen treatment with placebo were identified. Comparisons between oral progestogens and other medical therapies were assessed separately according to dosage regimen.Progestogen therapy during the luteal phase was significantly less effective at reducing menstrual blood loss when compared with tranexamic acid, danazol and the progesterone-releasing intrauterine system (IUS). Duration of menstruation was significantly longer with the progesterone IUS when compared with oral progestogen therapy but significantly shorter with danazol treatment. Adverse events were significantly more likely with danazol when compared with progestogen treatment. Progestogen therapy from day 5 to day 26 of the menstrual cycle was significantly less effective at reducing menstrual blood loss than the IUS. A significantly higher proportion of norethisterone (NET) patients taking progestogens found their treatment unacceptable compared to IUS patients. However, the adverse effects of breast tenderness and intermenstrual bleeding were more likely in women with the IUS. AUTHORS' CONCLUSIONS Progestogens administered from day 15 or 19 to day 26 of the cycle offer no advantage over other medical therapies such as danazol, tranexamic acid, non-steroidal anti-inflammatory drugs (NSAIDs) and the IUS in the treatment of menorrhagia in women with ovulatory cycles. Progestogen therapy for 21 days of the cycle results in a significant reduction in menstrual blood loss, although women found the treatment less acceptable than intrauterine levonorgestrel. This regimen of progestogen may have a role in the short-term treatment of menorrhagia.
Collapse
|
46
|
Controlled Release Morphine for Chronic Non-Cancer Pain—Multiple N of 1 Trials. PAIN MEDICINE 2007. [DOI: 10.1111/j.1526-4637.2007.00385_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
47
|
Grace in extremis. CMAJ 2007. [DOI: 10.1503/cmaj.045218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
48
|
|
49
|
Sergey Tolstoy and The Doukhobors: The Halifax Quarantine. CMAJ 2006. [DOI: 10.1503/cmaj.050362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
50
|
Five additional mobility and locomotor items to improve responsiveness of the FIM in wheelchair-dependent individuals with spinal cord injury. Spinal Cord 2005; 44:495-504. [PMID: 16331309 DOI: 10.1038/sj.sc.3101872] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Repeated-measures design. OBJECTIVES To assess the validity and responsiveness of five additional mobility and locomotor (5-AML) items when used in conjunction with the Functional Independence Measure (FIM) for assessing the mobility and locomotor function of individuals with spinal cord injury (SCI). SETTING Specialised acute spinal and rehabilitation units in Sydney, Australia. METHODS A previously published scale comprising five key mobility and locomotor skills was further refined. The five items included a bed mobility and vertical (floor-to-chair) transfer item and three wheelchair propulsion items (pushing 200 m over flat ground, pushing up a ramp and negotiating a kerb). A total of 43 eligible patients with SCI (ASIA A-C impairment) admitted consecutively to two acute SCI units in Sydney between 1999 and 2002 were recruited, with four being lost to follow-up. Locomotor and mobility outcomes were measured at regular intervals for up to 6 months with the FIM and the 5-AML. Construct validity of the 5-AML was assessed by testing ability of items to discriminate between different impairment groups (tetraplegia and paraplegia). Item responsiveness was assessed by analysing ability to detect changes in mobility and locomotor function over time. Factor analysis techniques were used to test the hypothesis that the 5-AML, when used in conjunction with the FIM, provides a more sensitive measure of mobility and locomotor function than the FIM alone. RESULTS The 5-AML items were shown to be valid and responsive, measuring aspects of 'real world' mobility and locomotor function not reflected by the FIM. The bed mobility item was highly responsive to change over time for the tetraplegic group, but quickly reached a ceiling in the paraplegic group. The vertical (floor-to-chair) transfer item showed greater responsiveness over time and less ceiling effect for the paraplegic group than any of the FIM locomotor or mobility items. The three wheelchair propulsion items better discriminated between people with tetraplegia and paraplegia, and were more sensitive to changes in locomotor ability over the 6-month period than FIM locomotor items. Results of a preliminary factor analysis indicated that the 5-AML items measure different aspects of mobility and locomotor function than the FIM. CONCLUSION The 5-AML items, when used in conjunction with the FIM, provides better delineation of function between people with tetraplegia and paraplegia and provides a more responsive measure of change in function over time than the FIM alone.
Collapse
|