OBJECTIVE: The optimal treatment of children with empyema remains controversial. The purpose of this review was to compare reported results of nonoperative and primary operative therapy for the treatment of pediatric empyema. METHODS: A systematic comprehensive review of the scientific literature was conducted with the PubMed (National Library of Medicine) ...

(1) Evidence that the Cox-2 inhibitors have severe cardiovascular adverse effects continues to accumulate, including an increase in overall mortality in several trials of rofecoxib. (2) Yet regulatory agencies on both sides of the Atlantic have so far only taken half-measures, issuing new contraindications and warnings that complicate matters for ...

Thrombocytosis is a common clinical problem and it represents either a primary myeloid disorder (a clonal process) or a reactive phenomenon. While reactive thrombocytosis is often inconsequential, clonal thrombocytosis may require cytoreductive therapy to prevent thrombohemorrhagic complications. In this regard, a controlled clinical trial has previously demonstrated the efficacy of ...

BACKGROUND: Arsenic trioxide delivers high rates of complete clinical remission in patients with relapsed/refractory acute promyelocytic leukaemia (APL), and is associated with high rates of molecular remission as indicated by PCR negativity for the PML-RARalpha gene. OBJECTIVE: Mitochondria are considered to be the primary intracellular target of arsenic trioxide, and ...

BACKGROUND: Sensitivity to Salsola kali is a frequent cause of allergic respiratory disease in various regions of Spain. However, there are very few articles in which this allergen has been studied. METHODS AND RESULTS: In order to evaluate the tolerance of this extract, a prospective study has been performed. This ...

The superiority of innovative over standard treatments is not known. To describe accurately the outcomes of innovations that are tested in randomized controlled trials (RCTs) 3 factors have to be considered: publication rate, quality of trials, and the choice of the adequate comparator intervention. To determine the success rate of ...

BACKGROUND AND PURPOSE: Insomnia is a common problem that increases with age and can last months to years. While substantial data establish the efficacy and safety of short-acting hypnotic therapy for the management of short-term insomnia using benzodiazepines receptor agonists (BzRAs), there are few studies on the continued efficacy and ...

BACKGROUND: COPD is a common condition, mainly related to smoking. The burden of the disease is increasing and it is projected to rank fifth in 2020 for the world-wide burden of disease. Acute exacerbations of COPD, usually related to superimposed infection occur commonly and systemic corticosteroids are widely used in ...

BACKGROUND: Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent renal damage. Published guidelines recommend treatment of acute pyelonephritis initially with intravenous (IV) therapy followed by ...

BACKGROUND: Substance dependence is a major social and public health problem; therefore it is a priority to develop effective treatments. The treatment of opioid dependence is complex. Previous Cochrane reviews have explored the efficacy of pharmacotherapy for opiate dependence. This current review focuses on the role of psychosocial interventions alone ...

BACKGROUND: Presently, problems exist with the rationale of oral therapy and the nature and indication of topical and accompanying treatment of perioral dermatitis. OBJECTIVE: Providing the basis to overcome these problems by a quality evaluation of treatment reports and assessment of the consistency of treatment experience. METHODS: Sources were Medline ...

BACKGROUND: Acute bacterial meningitis remains a disease with high mortality and morbidity rates. However, with prompt and adequate antimicrobial and supportive treatment, the chances for survival have improved, especially in infants and children. Careful management of fluid and electrolyte balance is an important supportive therapy. Both over and under hydration ...

BACKGROUND: Antithyroid drugs are widely used in the therapy of hyperthyroidism. There are wide variations in the dose, regimen or duration of treatment used by health professionals. OBJECTIVES: To assess the effects of dose, regimen and duration of antithyroid drug therapy for Graves' hyperthyroidism. SEARCH STRATEGY: We searched the Cochrane ...

DATA SOURCES: Medline Ovid Library, the Cochrane Library, PubMed, Embase, Science Citation Index (SCI) and System for Information on Grey Literature in Europe (SIGLE). STUDY SELECTION: Reviews, full reports, or research abstracts of prospective, retrospective, comparative, and/or radiographic studies were included, while case reports and letters were excluded. DATA EXTRACTION ...

BACKGROUND: Whooping cough is a highly contagious disease. Infants are the population at highest risk of severe disease and death. Erythromycin for 14 days is recommended for treatment and contact prophylaxis but this regime is considered inconvenient and prolonged. The value of contact prophylaxis is uncertain. OBJECTIVES: To study the ...

BACKGROUND: Anthracyclines are among the most effective chemotherapeutic agents in the treatment of numerous malignancies. Unfortunately, their use is limited by a dose-dependent cardiotoxicity. In an effort to prevent this cardiotoxicity, different cardioprotective agents have been studied. OBJECTIVES: The objective of this review was to assess the efficacy of different ...

BACKGROUND: Renal colic is a common cause of acute severe pain. Both opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for treatment, but the relative efficacy of these drugs is uncertain. OBJECTIVES: To examine the benefits and disadvantages of NSAIDs and opioids for the management of pain in acute renal ...

Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract there is an urgent need for cataract surgery to be made available as ...

BACKGROUND: Various types of traction are used in the treatment of low-back pain (LBP), often in conjunction with other treatments. OBJECTIVES: To determine the effectiveness of traction in the management of LBP. SEARCH STRATEGY: We searched The Cochrane Library 2004, Issue 4, MEDLINE, EMBASE, and CINAHL to November 2004, references ...

We describe a randomized controlled trial of an investigational spinal implant. The investigational device has an obvious benefit in comparison with control in that it precludes the need for harvesting bone graft and the pain and morbidity associated with it. Therefore, the principal comparison is one of noninferiority. The primary ...

DATA SOURCES: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, OLDMedline, Embase, Zetoc (Zetoc provides access to the British Library's electronic table of contents of approx. 20,000 current journals and 16,000 conference proceedings published per year. The database covers 1993 to date and is ...

Background: Transitioning patients between cholinesterase inhibitors was thought to require a washout period to avoid cholinergic toxicity; however, evidence suggests that abrupt discontinuation of donepezil may lead to cognitive decline. We evaluated the safety and tolerability of an immediate switch from donepezil to rivastigmine.Method: This is an analysis of the ...

DATA SOURCES: PubMed and the Cochrane Controlled Clinical Trials Register were searched. Reference lists from retrieved articles were also searched by hand for additional studies. STUDY SELECTION: For inclusion, an article had to satisfy the following criteria: cases in primary and early mixed dentition with unilateral posterior crossbite; be a ...

BACKGROUND: When constructing complete dentures for edentulous patients, ultimately patient satisfaction is key. Complete dentures can be produced with different types of occlusal schemes (chewing surfaces) and it is widely accepted that the occlusal scheme for complete dentures has a direct influence upon their success. OBJECTIVES: To assess the relative ...

BACKGROUND: Observational studies have suggested that lung volume reduction surgery (LVRS) is superior to optimal medical therapy for selected subsets of patients with advanced emphysema. Randomized clinical trials (RCTs) with the exception of the National Emphysema Treatment Trial (NETT), failed to enroll a sufficient number of patients to provide clinicians ...

In recent years, the use of adaptive methods in clinical development based on accrued data has become very popular due to its flexibility in modifying trial procedures and/or statistical procedures of on-going clinical trials. However, it is a concern that the actual patient population after the modifications could deviate from ...

OBJECTIVES: To systematically review the published experience on intratympanic gentamicin treatment for intractable Menière's disease. STUDY DESIGN: Meta-analysis using a random effect model. METHODS: A comprehensive literature search was performed for articles using intratympanic gentamicin as a sole treatment modality with reporting of results according to the American Academy of ...

HYPOTHESIS: There is little scientific evidence to support the routine practice of mechanical bowel preparation (MBP) before elective colorectal surgery in order to minimize the risk of postoperative septic complications. DATA SOURCES: Trials were retrieved using a MEDLINE search followed by a manual search of the bibliographic information in select ...

OBJECTIVE: Results of randomised clinical trials (RCTs) appear to differ from results of observational studies. This paper explores differences in methodology, interpretation and presentation of results that elucidate these differences. METHOD: We identified patients who completed a survey questionnaire during the period January 1998 through December 1998 and also completed ...

To determine the optimum duration of follow-up for the assessment of drug efficacy against Plasmodium falciparum malaria, 96 trial arms from randomized controlled trials (RCTs) with follow-up of 28 days or longer that were conducted between 1990 and 2003 were analyzed. These trials enrolled 13,772 patients, and participating patients comprised ...

OBJECTIVE: To determine the effect of albumin administration on morbidity in acutely ill hospitalized patients. DATA SOURCE: Computer searches of MEDLINE, EMBASE, and the Cochrane Library; hand searches of journals and Index Medicus; inquiries with investigators and fluid product suppliers; and examination of reference lists. No language or time period ...

To assess the effects of treatments for basal cell carcinoma. Systematic review of randomised controlled trials. Recurrence of basal cell carcinoma at three years or beyond, assessed clinically. Randomised controlled trials of interventions for histologically confirmed basal cell carcinoma (published and unpublished material; no language restrictions). 25 studies were identified, ...

The anuran genus Eleutherodactylus occurs in Central and South America, as well as the West Indies, and comprises nearly 700 recognized species. The diversity of Eleutherodactylus makes it difficult to study the genus as a whole; as a consequence, several authors have divided the genus in phenetic species groups. This ...

OBJECTIVE: It is now generally accepted that the use of second-generation, or atypical, antipsychotics for schizophrenia represents an advance over conventional antipsychotic agents. However, adherence continues to be a problem, as with other medications for chronic disorders. Long-acting formulations of conventional antipsychotics partly address adherence problems, but their use is ...

Distant water fishing nations (DWFN) began longlining for tuna in the Western Indian Ocean (WIO) in the early 1950s, initiated by the Japanese soon followed by the Taiwanese (1954) and Koreans (1960). Large scale industrial purse seining began in 1983 when the French and Spanish fleets moved into the Western ...

To assess the effects of corticosteroids on mortality in patients with severe sepsis and septic shock. Randomised and quasi-randomised trials of corticosteroids versus placebo (or supportive treatment alone) retrieved from the Cochrane infectious diseases group's trials register, the Cochrane central register of controlled trials, Medline, Embase, and LILACS. Two pairs ...

In some HIV clinical trials, the proportion of patients who achieve treatment success at a clinically meaningful time point (e.g., 16 or 24 weeks) and the subsequent durability of the treatment success after that time point are collected from two exclusive followup intervals. Two treatments are usually compared in terms ...

AIMS: Gastric cancer in Western countries is often diagnosed in an advanced stage and prognosis is poor. We performed a randomised trial with pre-operative FAMTX vs. surgery alone in order to evaluate the effect of pre-operative chemotherapy on resectability and survival. METHODS: Patients with proven adenocarcinoma of the stomach were ...

The authors describe the status of bluetongue (BT) since 13 October 2000, when the first outbreak was reported in Sicily. The results of the epidemiological surveillance programme, based on sentinel animals distributed over the entire region, are also given. In Sicily, the incidence of the disease is relatively low compared ...

After a treatment is found to be effective in a clinical study, attention often focuses on the effect of treatment duration on outcome. Such an analysis facilitates recommendations on the most beneficial treatment duration. In many studies, the treatment duration, within certain limits, is left to the discretion of the ...

As the patient is the primary recipient of treatment, there is a need to recognize and value the patient's perception of change in response to treatment in clinical trials. A new outcomes classification, patient-reported outcomes (PROs), has been proposed by regulators. The PROs are used as an umbrella term and ...

CONTEXT: Selective reporting of outcomes within published studies based on the nature or direction of their results has been widely suspected, but direct evidence of such bias is currently limited to case reports. OBJECTIVE: To study empirically the extent and nature of outcome reporting bias in a cohort of randomized ...

BACKGROUND: While each of the available femoral arterial sealing devices claims equivalent safety to manual compression following invasive cardiac procedures, these claims are based on small, underpowered studies. Our aim was to increase the ability to detect a clinically meaningful difference by performing a meta-analysis. METHODS: We identified studies via ...

PURPOSE: To describe a bias that can occur in the analysis of data from certain randomized trials. METHODS AND RESULTS: Although randomized trials are effective at preventing confounding, a potentially strong confounding can arise in certain therapeutic drug trials in which follow-up is extended in an open-label phase that allows ...

BACKGROUND: Craniospinal irradiation (CSI) is commonly used for medulloblastoma patients and some others; for example, those with ependymoma. It is a complex technique where accuracy of field placement and choice of irradiation source and energy can play a major role in determining success or failure. PROCEDURE: A literature review of ...

The purpose of this systematic review was to determine the effectiveness of conservative treatments for lateral epicondylitis and to provide recommendations based on this evidence. Five reviewers searched computerized bibliographic databases for articles on the conservative treatment of lateral epicondylitis from the years 1983 to 2003. A total of 209 ...

The discontinuation design has been proposed as an alternative to the classic randomized design for evaluating the effect of an experimental agent on time-to-disease progression and survival duration. With this design, all enrolled patients are treated with an experimental agent for a fixed course of therapy. Those patients with progressive ...

To compare beta lactam monotherapy with beta lactam-aminoglycoside combination therapy for severe infections. Medline, Embase, Lilacs, Cochrane Library, and conference proceedings, to 2003; references of included studies; contact with all authors. No restrictions, such as language, year of publication, or publication status. All randomised trials of beta lactam monotherapy compared ...

REFERENCE: Phillips AM, Smart C, Groom AFG. Acromioclavicular dislocation: conservative or surgical therapy. Clin Orthop. 1998;353:10-17. CLINICAL QUESTION: Among patients with acromioclavicular (AC) dislocation, does surgical intervention produce better outcomes than conservative therapy? DATA SOURCES: Studies were identified by a MEDLINE search (1966-1997) and a manual search of the reference ...

Chronic graft-versus-host disease (GvHD) remains a significant cause of late morbidity and mortality following allogeneic stem cell transplantation. However, patients with chronic GvHD are very heterogeneous, making evaluation and treatment difficult. Corticosteroids remain the most effective primary treatment of this condition. Randomized trials have not confirmed the beneficial effect of ...