Latest Articles
-
Eur J Cardiothorac Surg · Jan 1993
Meta Analysis Comparative StudyOptimal antithrombotic therapy following aortocoronary bypass: a meta-analysis.
To evaluate the role of antithrombotic therapy, on preserving graft patency, we performed a meta-analysis of randomized clinical trials involving aspirin (ASA), dipyridamole (D), anticoagulants (AC) and placebo or nontreatment controls (P). Manual literature searches were performed supplemented by computerized MEDLINE listings complete to July 1991. Saphenous vein graft occlusion was determined by angiography (patients with > or = 1 distal anastomotic occlusion). ⋯ Early postoperative treatment (< or = 6 h) strongly influenced graft occlusion while preoperative administration provided no additional benefit. No mortality advantage was identified for any antithrombotic therapy. Aspirin or anticoagulants enhance saphenous vein graft patency following aortocoronary bypass surgery, and a combination thereof deserves further investigation in a trial large enough to detect the effects of these treatments with respect to clinical events.
-
In spite of 16 randomized trials conducted during the past 15 years, the effect of thoracic radiotherapy on the survival of patients with limited small-cell lung cancer remains controversial. The majority of these trials did not have enough statistical power to detect a difference in survival of 5 to 10 percent at five years. This meta-analysis was designed to evaluate the hypothesis that thoracic radiotherapy contributes to a moderate increase in overall survival in limited small-cell lung cancer. ⋯ Thoracic radiotherapy moderately improves survival in patients with limited small-cell lung cancer who are treated with combination chemotherapy. Identification of the optimal combination of chemotherapy and radiotherapy will require further trials.
-
Meta Analysis Comparative Study
Anesthetic techniques during surgical repair of femoral neck fractures. A meta-analysis.
Fracture of the hip typically occurs in older women. These patients usually have serious accompanying chronic illnesses. There is a difference of opinion as to the choice of regional versus general anesthesia for surgery in these patients. ⋯ By probability difference, mortality was a non-significant 2.7 percentage points less following regional anesthesia. By odds ratio effect measure, death was 1.5 times more likely following general anesthesia, but the lower bound of the 95% confidence interval was close to 1. Meta-analysis does not allow a conclusion that important differences in mortality exist between regional and general anesthesia for traumatic hip fracture surgery.
-
Am. J. Gastroenterol. · Nov 1992
Meta Analysis Comparative StudyOptimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy.
Despite an abundance of nonsurgical hemorrhoid therapies, none has been consistently more efficacious. By combining data from multiple clinical trials in a meta-analysis, the present study compared the efficacy and complications of infrared coagulation, injection sclerotherapy, and rubber band ligation to determine the optimal nonoperative hemorrhoid treatment. All published clinical trials comparing the three methods were identified by computer search and review of appropriate English language journals. ⋯ Although rubber band ligation demonstrated greater long-term efficacy, it was associated with a significantly higher incidence of posttreatment pain. In contrast, infrared coagulation was associated with both fewer and less severe complications. Thus, when all factors are considered, infrared coagulation may in fact be the optimal nonoperative hemorrhoid treatment.
-
The authors review a core of 25 articles (dating from 1982 through 1991) regarding medical school curricula and physicians' knowledge, attitudes, and practices related to nutritional care, with a focus on prevention of coronary heart disease through cholesterol control. They supplement this review by discussing the relation of the core articles' results to those of additional articles, which focus more generally on physicians' health promotion and patient counseling. While there appear to be modest increases in attention to nutrition at various levels of medical training and some improvement in physicians' attitudes about dietary intervention, the authors conclude that both educational opportunities and physicians' practices warrant increased and more effective attention to nutrition. Finally, in light of recent trends and growing efforts to better prepare physicians to play a leading role in preventive care, the authors identify gaps in physicians' training and in research on physicians, preventive care, and applied nutrition.