A systematic review of the risk factors for cervical artery dissection

BACKGROUND AND PURPOSE: Cervical artery dissection (CAD) is a recognized cause of ischemic stroke among young and middle-aged individuals. The pathogenesis of dissections is unknown, although numerous constitutional and environmental risk factors have been postulated. To better understand the quality and nature of the research on the pathogenesis of CAD, we performed a systematic review of its risk factors. METHODS: PubMed [MEDLINE (1966 to February 22, 2005)] and Embase (1980 to February 22, 2005) were searched to identify studies fulfilling the inclusion criteria. Two reviewers independently assessed methodological quality of the primary studies. Relevant data were extracted, including the risk factor(s) investigated, characteristics of the study population, and strength of the association(s). RESULTS: Thirty-one case-control studies were included for analysis. Selection bias, lack of control for confounding, and inadequate method of data analysis were the most common identified methodological shortcomings. Strong associations were reported from individual studies for the following risk factors: aortic root diameter >34 mm (odds ratio [OR=14.2; 95% confidence interval [CI], 3.2 to 63.6), migraine (ORadj, 3.6; 95% CI, 1.5 to 8.6), relative diameter change (>11.8%) during the cardiac cycle of the common carotid artery (ORadj, 10.0; 95% CI, 1.8 to 54.2), and trivial trauma (in the form of manipulative therapy of the neck) (ORadj, 3.8; 95% CI, 1.3 to 11). A weak association was found for homocysteine (2 studies: ORcrude, unknown; 95% CI, 1.05 to 1.52; ORcrude, 1.3; 95% CI, 1.0 to 1.7), and recent infection (ORadj, 1.60; 95% CI, 0.67 to 3.80). Two studies had conflicting findings for low levels of alpha1-antitrypsin, with the methodologically stronger study suggesting no association with CAD. CONCLUSIONS: CAD is a multi-factorial disease. Many of the reviewed studies contained 2 or more major sources of bias commonly found in case-control studies. Only one study (of homocysteine) used healthy controls, a robust sample size, and had a low risk of biased results. The relationship between atherosclerosis and CAD has been insufficiently examine

Attenuation-Corrected vs. Nonattenuation-Corrected 2-Deoxy-2-[F-18]fluoro-d-glucose-Positron Emission Tomography in Oncology, A Systematic Review

Purpose: To perform a systematic review and meta-analysis to determine the diagnostic accuracy of attenuation-corrected (AC) vs. nonattenuation-corrected (NAC) 2-deoxy-2-[F-18] fluoro-D-glucose-positron emission tomography (FDG-PET) in oncological patients. Procedures: Following a comprehensive search of the literature, two reviewers independently assessed the methodological quality of eligible studies. The diagnostic value of AC was studied through its sensitivity/specificity compared to histology, and by comparing the relative lesion detection rate reported with NAC-PET vs. AC, for full-ring and dual-head coincidence PET (FRand DH-PET, respectively). Results: Twelve studies were included. For FR-PET, the pooled sensitivity/specificity on a patient basis was 64/97 % for AC and 62/99 % for NAC, respectively. Pooled lesion detection with NAC vs. AC was 98 % [95 % confidence interval (95 % CI): 96Y99%, n=1,012 lesions] for FR-PET, and 88 % (95 % CI:81Y94%, n=288 lesions) for DH-PET. Conclusions: Findings suggest similar sensitivity/specificity and lesion detection for NAC vs. AC FR-PET and significantly higher lesion detection for NAC vs. AC DH-PET

How to develop a program to increase influenza vaccine uptake among workers in health care settings?

Background: Apart from direct protection and reduced productivity loss during epidemics, the main reason to immunize healthcare workers (HCWs) against influenza is to provide indirect protection of frail patients through reduced transmission in healthcare settings. Because the vaccine uptake among HCWs remains far below the health objectives, systematic programs are needed to take full advantage of such vaccination. In an earlier report, we showed a mean 9% increase of vaccine uptake among HCWs in nursing homes that implemented a systematic program compared with control homes, with higher rates in those homes that implemented more program elements. Here, we report in detail the process of the development of the implementation program to enable researchers and practitioners to develop intervention programs tailored to their setting. Methods: We applied the intervention mapping (IM) method to develop a theory-and evidence-based intervention program to change vaccination behaviour among HCWs in nursing homes. Results: After a comprehensive needs assessment, we were able to specify proximal program objectives and selected methods and strategies for inducing behavioural change. By consensus, we decided on planning of three main program components, i.e., an outreach visit to all nursing homes, plenary information meetings, and the appointment of a program coordinator - preferably a physician - in each home. Finally, we planned program adoption, implementation, and evaluation. Conclusion: The IM methodology resulted in a systematic, comprehensive, and transparent procedure of program development. A potentially effective intervention program to change influenza vaccination behaviour among HCWs was developed, and its impact was assessed in a clustered randomised controlled trial

Update of the fdg pet search strategy

The comprehensive search strategy for identification of FDG PET literature in the electronic databases MEDLINE and EMBASE, published in 2000, has been updated for PubMed. The new search strategy presented here is freely available at the VU website and can be easily copied from there and pasted into the PubMed search window. In addition, the strategy can be stored using the ‘Cubby’ feature on the PubMed interface and run whenever needed in a minimum of time. It can therefore be used for quick searches during clinical practice as well as extensive searches for systematic reviews. To increase sensitivity, new search terms and term combinations for ‘PET’ and ‘FDG’ were added. The existing truncations and field qualifications had to be changed for PubMed. The new strategy is even more sensitive than the previous and therefore identifies more articles without affecting precision (proportion of the retrieved articles that are relevant). Since 2000, MeSH indexing of FDG and PET has hardly improved. Our proposal to introduce the MeSH ‘positron emission tomography’ as a narrower term of the current ‘Tomography, emission-computed’ and to replace the current MeSH ‘Fludeoxyglucose F-18’ by ‘18F-Fluorodeoxyglucose’ has been accepted by the National Library of Medicine. The new MeSH terms will be included in the MeSH edition for 2004-2005

Registering patient reported symptoms in patients with lymphoedema – is there a validated questionnaire with good psychometric properties?

Purpose: Patients with lymphoedema report various symptoms. In Norway objective treatment measures have primarily been utilized. Hence we saw a need to study available questionnaires and identify those which register patient reported symptoms. Method: Standard text books were reviewed and searches made in PubMed, Embase, BNI, Ovid Nursing Database and CINAHL. Text books and the identified articles were reviewed to get an overview of registered symptoms, clinical viability of the questionnaires, their psychometric properties and other relevant factors for registering lymphoedema and evaluating treatment. Results: Fourteen articles met the inclusion criteria, and 16 questionnaires were identified. Swelling or a feeling of swelling, heaviness, numbness, tightness and pain were most frequently registered. Four questionnaires did not describe the psychometric properties and the remaining 12 had varying levels of validity and reliability. Several methods of scoring were utilized; categorical yes/no, various Likert scales and VAS. Several time scales were used. Five questionnaires had 50 questions or more. Conclusion: Several validated questionnaires which register subjective symptoms in patients with lymphoedema were identified. Some provide the means to ensure a more accurate assessment. LYMFQOL arm and LYMFQOL leg assess the most frequently reported subjective symptoms on a user-determined time scale. A 4-part Likert scale for grading the severity of the symptoms is used. Both questionnaires are tested for validity and reliability with satisfactory results. LYMFQOL arm and leg register health related quality of life and can help the physiotherapist to select appropriate treatment. A Norwegian version of both questionnaires has been pilot tested

The functional effects of physical exercise training in frail older people : a systematic review

Although trials have shown that exercise has positive effects on bone mineral density (BMD), the majority of exercise trials have been conducted in older women. The aim of this study was to systematically review trials examining the effect of weight-bearing and resistance-based exercise modalities on the BMD of hip and lumbar spine of middle-aged and older men. Eight electronic databases were searched in August 2012. Randomised controlled or controlled trials that assessed the effect of weight-bearing and resistance-based exercise interventions on BMD measured by dual-energy x-ray absorptiometry, and reported effects in middle-aged and older men were included. Eight trials detailed in nine papers were included. The interventions included walking (n = 2), resistance training (n = 3), walking + resistance training (n = 1), resistance training + impact-loading activities (n = 1) and resistance training + Tai Chi (n = 1). Five of the eight trials achieved a score of less than 50% on the modified Delphi quality rating scale. Further, there was heterogeneity in the type, intensity, frequency and duration of the exercise regimens. Effects of exercise varied greatly among studies, with six interventions having a positive effect on BMD and two interventions having no significant effect. It appears that resistance training alone or in combination with impact-loading activities are most osteogenic for this population, whereas the walking trials had limited effect on BMD. Therefore, regular resistance training and impact-loading activities should be considered as a strategy to prevent osteoporosis in middle-aged and older men. High quality randomised controlled trials are needed to establish the optimal exercise prescription