Using discrete choice experiments to inform randomised controlled trials: an application to chronic low back pain management in primary care. Autologous Fat Graft in Postmastectomy Pain Syndrome Following Breast Conservative Surgery and Radiotherapy Effect of levetiracetam on the postmastectomy pain syndrome. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. [Method of pharmacological myocardial preconditioning with halogen-containing anesthetics in cardiosurgical patients]. Efficacy of Radiofrequency Procedures for the Treatment of Spinal Pain: A Systematic Review of Randomized Clinical Trials Fatigue in a simple repetitive motor task: a combined electrophysiological and neuropsychological study Effect of early administration of the N-methyl-d-aspartate receptor antagonist amantadine on the development of postmastectomy pain syndrome: a prospective pilot study. Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review Cytoreduction and HIPEC in The Netherlands: Nationwide Long-term Outcome Following the Dutch Protocol The Effect of a Pain Management Program on Patients With Cancer Pain [Preventive analgesic effect of intraoperative administration of ibuprofen-arginine on postmastectomy pain syndrome]. Diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: a systematic review of evidence. Identification of risk factors by systematic review and development of risk-adjusted models for surgical site infection. Interventions aimed at increasing research use in nursing: a systematic review Pre-operative and post-operative effect of a pain management programme prior to total hip replacement: a randomized controlled trial The development of CHAMP: a checklist for the appraisal of moderators and predictors Abnormal uterine bleeding in pre-menopausal women. Efficacy of meaning-centered group psychotherapy for cancer survivors: a randomized controlled trial. Epidemiology and aetiology of dialysis-treated end-stage kidney disease in Libya Matrix assisted autologous chondrocyte transplantation for cartilage treatment The Bournemouth Questionnaire: a short-form comprehensive outcome measure. I. Psychometric properties in back pain patients. Evaluation of efficacy of the perioperative administration of venlafaxine XR in the prevention of postmastectomy pain syndrome.
Pain Management Programmes ( PMPs ) are a multi-disciplinary approach to the management of chronic low back pain ( CLBP ) . Notwithst and ing evidence of effectiveness , successful take-up of programmes requires acceptability to patients . We used a discrete choice experiment to investigate patient preferences for alternative PMPs for managing CLBP in primary care . Specifically , we estimated the probability of uptake of alternative configurations of PMPs . Potential attributes and associated levels influencing take-up were identified through a systematic literature review , survey of current PMPs , expert consultation , and focus groups . Five attributes were included : content ; provider ; schedule ; group size ; and travel time to clinic . Four hundred and fourteen question naires were mailed to patients attending clinics and 124 question naires were returned suitable for analysis . Method of delivery influenced probability of take-up , with small group sizes and low intensity programmes over a prolonged period increasing the probabilities . Travel time was also important . However , providers and contents of PMPs were not main drivers of preferences , though those with more severe pain did prefer PMPs provided by more specialists . Probability of take-up increases when PMPs better reflect patient preferences . Given preferences , re source constraints , and evidence on clinical outcomes of alternative configurations it is suggested more re source -intensive PMPs be reserved for those with the most severe and disabling pain and less intensive programmes delivered over a longer time period in smaller groups for those with less severe pain . These findings can inform future r and omised trials to evaluate acceptable PMPs in primary care Background Breast cancer is the most common cancer in women worldwide , affecting one in eight women . Breast-conserving surgery ( BCS ) has become a well-established alternative to mastectomy in the treatment of breast cancer , providing a less invasive treatment . Just as life expectancy after breast cancer has improved , so has morbidity increased . One of the most relevant and debilitating consequences of oncological breast surgery is postmastectomy pain syndrome ( PMPS ) . Our results published in 2011 on the treatment of PMPS in patients who had undergone mastectomy and radiotherapy  and our experience in scar treatment with fat grafts were the theoretical bases for this prospect i ve study . Methods From April 2011 to April 2012 a total of 96 patients , who had undergone lumpectomy and radiation therapy , with the diagnosis of PMPS were considered for fat grafts .  We performed autologous fat grafting in  59 patients ( study group ) , whereas  37 patients did not receive any further surgical procedure  ( control group ) . Pain assessment was performed using the visual analog scale ( VAS ) before and after treatment in the treated group and in the control group at the first visit and the control visit , with a mean follow-up of 10 months . Results were analyzed using the Wilcoxon rank sum test . Results Four patients were lost to follow-up ( two patients in the control group and two patients in the treated group ) . A significant VAS pain decrease was detected in patients treated with autologous fat grafting ( 3.1 point reduction , p ≤ 0.005 ) . Conclusion Because of the safety , efficacy , and optimal tolerability of the procedure , we believe that fat grafting can be considered useful in treating PMPS in patients who have undergone BCS and radiotherapy . Level of Evidence IIIFor a full description of these Evidence -Based Medicine ratings , please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 BACKGROUND AND PURPOSE The aim of this r and omized , double-blind , placebo-controlled , cross-over study was to test whether levetiracetam relieves the postmastectomy pain syndrome ( PMPS ) . METHODS Postmastectomy pain syndrome was defined as pain of neuropathic character located in the area of the surgery and /or the ipsilateral arm . The inclusion criteria were : age more than 18 years , characteristic symptoms corresponding to PMPS more than 6 months after surgery for breast cancer , pain duration more than 3 months , peripheral nerve lesions confirmed by abnormal neurological and quantitative sensory tests , intensity of pain more than 4 on a numeric rating scale from 0 to 10 and pain present at least 4 days a week . RESULTS Forty-nine patients were screened for participation and 27 patients were included in the study . Twenty-five patients completed two treatment phases of 4 weeks duration with levetiracetam ( 3000 mg/day ) and placebo . There was no difference in the rating of pain relief between treatment with levetiracetam ( P = 0.83 ) and placebo nor when adjusted for possible period effect ( P = 0.60 ) . Analysis defining response as pain relief more than 4 on an eleven-point numeric rating scale showed no significant difference between treatment with levetiracetam and placebo ( P = 1.00 ) . CONCLUSIONS Levetiracetam apparently does not relieve peripheral neuropathic pain in PMPS BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions  to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade . In contrast , the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade . Of interest , no agreement between the two tools was evident in their final grade assigned to each study . Although both tools were developed to assess ' quality of the evidence ' , they appear to measure different constructs . CONCLUSIONS Both tools performed quite differently when evaluating the risk of bias or method ological quality of studies in knowledge translation interventions for cancer pain . The newly introduced CCRBT assigned these studies a higher risk of bias . Its psychometric properties need to be more thoroughly vali date d , in a range of research fields , to underst and fully how to interpret results from its application The purpose of the investigation was to study whether isoflurane and sevoflurane might be used for pharmacological myocardial preconditioning ( PMP ) in patients with coronary heart disease during myocardial revascularization on the working ( Part I ) and arrested ( Part II ) heart and to develop a possible procedure for PMP . Part I deals with the study of the effect of PMP with halogen-containing anesthetics during myocardial revascularization on the working heart . The study included 66 patients who were divided into 4 groups ; 1 )  sevoflurane feeding was started just after anesthesia induction and it lasted until some coronary arteries were ligated ; 2 ) sevoflurane was fed for 15 min ; 3 ) isoflurane was used ; 4 ) controls . The markers of myocardial lesion ( troponin T , I ) were measured and the incidence of perioperative myocardial ischemia and needs for inotropic support were also analyzed . Part II was dedicated to the study of the effect of PMP during myocardial revascularization under extracorporeal circulation ( EC ) . The study covered 65 patients who were divided into 4 groups ; 1 ) sevoflurane was administered throughout the anesthesia until the aorta was ligated ; 2 ) it was used for 15 min before aortic ligation ; 3 ) sevoflurane was employed only to induce anesthesia ; 4 ) controls . The variables similar to those in Part I of the investigation were chosen to assess the results of this study . The use of sevoflurane and isoflurane reduces a risk for myocardial ischemic lesion during myocardial revascularization both under EC and on the working heart . Short-term ( 15-min ) use of an agent before myocardial ischemia suffices for PMP to develop its effect . The effect of PMP has its duration that is 76 min , as shown by our findings Background and Objectives The use of radiofrequency ( RF ) procedures in the peripheral nervous system to treat  chronic spinal pain  has been the subject of controversy . Publications concerned only uncontrolled studies , and irreversible nervous tissue damage was believed to be responsible for the effect , if any . In recent years , r and omized , controlled studies have appeared , which have attested to an increasing use of these techniques . This is a systematic review of r and omized controlled trials on RF procedures for spinal pain . Methods We performed a st and ardized literature search for r and omized , controlled trials . Three adjudicators independently registered trial methodology and outcome using vali date d and subject-related instruments . Interadjudicator disagreement was resolved by discussion . It was found necessary to devise additional parameters of study assessment . Results Six trials met the inclusion criteria . This small number , along with clinical and technical heterogeneity precluded statistical analysis . All studies , whether high or low quality , reported positive outcomes . Conclusions We conclude that there is moderate evidence that RF lumbar facet denervation is more effective for chronic low back pain  than placebo . Limited evidence exists for efficacy of RF neurotomy in chronic cervical zygapophyseal joint pain after flexion-extension injury . There is limited evidence that RF heating of the dorsal root ganglion is more effective than placebo in chronic cervicobrachialgia .  We recommend the systematic application of our additional parameter assessment s for future evaluations of RF studies . These additional parameters should also be used in the preparation of future trial protocol s of RF procedures for the treatment of chronic pain Fatigue is one of the most common psychophysiological symptoms that interact with the control mechanisms regulating task behaviour . The cortical processes involved in preparation and feedback control of voluntary movement are associated with EEG activity time-locked to movement onset : a pre-movement Movement-Related Cortical Potential ( MRCP ) is followed by a post-movement potential ( PMP ) . The aim of this study was to determine whether changes in subjective fatigue which arise in the course of a simple repetitive motor task affect cortical information processing as measured by MRCPs or PMPs . MRCPs/PMPs were recorded in 33 healthy subjects while they made 100 self-paced unilateral button presses with their left or right index finger , and then continued with the other index finger for another 100 movements . Before and after the motor tasks , subjective fatigue was assessed via question naire . ( 1 ) Subjects who reported a higher increase of fatigue when they had finished the motor tasks showed smaller ( more negative ) amplitudes of the PMP . ( 2 ) This increase of negativity was strongest during the initial part of the tasks . ( 3 ) Physical aspects of perceived fatigue had a stronger effect on PMP amplitude than cognitive aspects . Smaller amplitudes of the PMP in more fatigued subjects might be explained by reduced attention to somatosensory feedback . Adaptation of this effect may result from more automatic performance at later stages of the task when all subjects required a lower degree of attentional control . In conjunction with previous studies , effects of fatigue could be separated from habituation UNLABELLED Postmastectomy pain syndrome ( PMPS ) is a neuropathic pain syndrome that might develop after breast surgery . Like many other forms of neuropathic pain , it is relatively resistant to treatment and negatively affects the quality of life . A double-blind , r and omized , placebo-controlled pilot trial was conducted to study the analgesic efficacy of perioperative administration of the N-methyl-D-aspatrate ( NMDA ) receptor antagonist amantadine in preventing PMPS after mastectomy plus axillary lymph node dissection ( ALND ) . In the study group , a regimen of 200 mg/day of amantadine was started 1 day before surgery and continued for 14 days , whereas the control group received a placebo .  Patients were required to indicate the exact location of their pain and to record its level at 1 , 3 , and 6 months after surgery . Neurologic examination and Quantitative Thermal Testing ( QTT ) were performed 1 and 6 months after surgery . On both the neurologic examination and the QTT , all patients , regardless of the perioperative intervention ( amantadine or placebo ) , presented evidence for nerve injury , manifested primarily by painful hypoesthesia ( anesthesia dolorosa ) in the axilla or inner arm . PMPS persisted for the entire duration of the study in 82 % of the patients who were available for follow-up . The average intensity of the pain was moderate in both groups and tended not to decline over time . No differences between the 2 groups in any of the outcome parameters reached statistical significance . According to the results of the present pilot study , the NMDA antagonist amantadine does not prevent the development of PMPS in patients who undergo breast surgery with ALND . PERSPECTIVE Breast surgery that involves ALND seems to uniformly cause nerve injury , which can not be prevented by the perioperative administration of 200 mg of amantadine . It is most commonly presented by painful hypoesthesia or anesthesia dolorosa in the axillary/inner arm area , which is moderate in intensity and likely to persist for at least 6 months Background . This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change . Methods . A systematic review of r and omised controlled trials among people with wrist osteoarthritis was undertaken . Studies reporting reliability , validity , or responsiveness were identified using a systematic reverse citation trail audit procedure . Psychometric properties of the instruments were examined against predefined criteria and summarised . Results . Thirteen clinical trials met inclusion criteria . The most common patient-reported outcome was the disabilities of the arm , shoulder , and h and question naire ( DASH ) . The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness . A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness . Conclusions . The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness . The PEM and PRWE also had favourable empirical evidence reported for these elements . Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted Purpose This nationwide study evaluated results of cytoreductive surgery ( CRS ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) for peritoneal metastasis of colorectal origin in the Netherl and s following a national protocol . Methods In a multi-institutional study prospect i ve data bases of patients with peritoneal carcinomatosis ( PC ) from colorectal cancer and pseudomyxoma peritonei ( PMP ) treated according to the Dutch HIPEC protocol , a uniform approach for the CRS and HIPEC treatment , were review ed . Primary end point was overall survival and secondary end points were surgical outcome and progression-free survival . Results Nine-hundred sixty patients were included ; 660 patients ( 69 % ) were affected by PC of colorectal carcinoma and the remaining suffered from PMP ( 31 % ) . In 767 procedures ( 80 % ) , macroscopic complete cytoreduction was achieved . Three-hundred and thirty one patients had grade III – V complications ( 34 % ) . Thirty-two patients died perioperatively ( 3 % ) . Median length of hospital stay was 16 days ( range 0–166 days ) . Median follow-up period was 41 months ( 95 % confidence interval ( CI ) , 36–46 months ) . Median progression-free survival was 15 months ( 95 % CI 13–17 months ) for CRC patients and 53 months ( 95 % CI 40–66 months ) for PMP patients . Overall median survival was 33 ( 95 % CI 28–38 months ) months for CRC patients and 130 months ( 95 % CI 98–162 months ) for PMP patients . Three- and five-year survival rates were 46 and 31 % respectively in case of CRC patients and 77 and 65 % respectively in case of PMP patients . Conclusions The results underline the safety and efficacy of cytoreduction and HIPEC for PC from CRC and PMP . It is assumed the uniform Dutch HIPEC protocol was beneficial Background : Pain is 1 of the most common symptoms that a cancer patient would experience . A significant barrier to positive pain management is patients ’ misconceptions regarding analgesics and inadequate use of nonpharmacological strategies as pain relief . Objective : The purpose of this study was to investigate the effectiveness of a pain management program ( PMP ) on pain intensity , use of PRN drugs  and  nonpharmacological strategies  as pain relief , and barriers to managing pain in cancer patients . Methods : The study was conducted in the palliative care and hospice ward of a public hospital in Hong Kong . Patients were r and omized to either an experimental group ( receiving the PMP ) or a control group ( routine care ) . There were 38 hospitalized patients , with 20 ( 13 males and 7 females ) in the experimental group and 18 ( 11 males and 7 females ) in the control group ; mean age was 61.95 years ( experimental group ) to 63.94 years ( control group ) . Results : Upon the completion of PMP , pain scores were significantly reduced in both groups , yet patients in the experimental group showed a significant increase in the use of PRN analgesics and nonpharmacological strategies to relieve pain ( P < .05 ) and significantly reduce barriers to managing their cancer pain ( P < .05 ) compared with the control group . Conclusion : Cancer patients should be empowered with pain management education to gain knowledge and correct misconceptions in managing their cancer pain . Implication s for Practice : Integration of the PMP into routine clinical work may help to improve the st and ard of care for cancer patients . It is recommended to provide pain management education to all cancer patients The efficacy of preemptive analgesia on postoperative pain is discussed . From experimental neurophysiological data , the present policy of preventive analgesia aims at precluding modifications of the nervous system secondary to a nervous lesion and the appearance of chronic pain , particularly of the neurogenic kind . The post-mastectomy pain syndrome ( PMPS ) falls within the realm of neurogenic pain and is still poorly understood and underestimated . This study evaluated the preemptive effect of a perioperative administration of an oral non steroid anti-inflammatory , the ibuprofen-arginine , on PMPS . Thirty patients scheduled for partial or total mastectomy with axillary dissection were prospect ively and r and omly assigned to 2 groups . The ibuprofen-arginine group ( group I ) ( n = 15 ) , received an oral administration of 400 mg of ibuprofen-arginine , 90 min before surgery , 2 h after surgery and then every 8 h in the first 32 postoperative hours . The control group ( group C ) received in doubled blind a placebo at the same time . At 6 months , we looked after pain or dysesthesia . We confirmed the diagnosis of PMPS in presence of association of diagnosis criteria s. Fourteen patients in each group have been included . Eighty-six percent of the patients ( 13 patients in group I and 11 patients in group C ) presented at 6 months dysesthesia of the upper member ipsilateral to the mastectomy and /or the operated breast , appearing either immediately or after a laps of time . Nine patients ( group I ) and 6 patients ( group C ) had PMPS . Postoperative radiotherapy and lymphoedema were statistically associated with PMPS ( p = 0.019 and p = 0.011 ) . The perioperative preventive administration of a non-steroid anti-inflammatory drug reduces neither the incidence of pain in the first post-operative months , nor the appearance of PMPS at 6 months . These results suggest that others factors than the nervous lesion may play a role in the occurrence of PMPS , as radiotherapy , lymphoedema , but also psychosocials factors BACKGROUND Chronic refractory spinal pain poses a peculiar diagnostic challenge because of multiple putative pain sources , overlapping clinical features , and nonspecific radiologic findings . Diagnostic injection techniques are employed to isolate the source ( s ) of pain . Facet or zygapophysial joint pain is an example of spinal pain diagnosed by local anesthetic injections of the facet joint or its nerve supply . Diagnostic facet joint injections are expected to meet the cardinal features of a diagnostic test ( i.e. , accuracy , safety and reproducibility ) . Accuracy must be compared with a " gold " or criterion st and ard that can confirm presence or absence of a disease . There is , however , no available gold st and ard , such as biopsy , to measure presence or absence of pain . Hence , there is a degree of uncertainty concerning the accuracy of diagnostic facet joint injections . OBJECTIVES To evaluate accuracy , safety and reproducibility of facet or zygapophysial joint injections in diagnosing chronic spinal pain of facet joint origin . STUDY DESIGN A systematic review of the literature for clinical studies on efficacy and utility of facet joint/nerve injections in diagnosing spinal pain from facet joints . METHODS Relevant literature on diagnostic facet injections was identified through data base search es . Excluded were abstract s , review s , book chapters , case reports and studies based on single blocks or blocks without radiologic control . Prospect i ve studies with placebo control , or controlled comparative local anesthetic blocks , were given priority over retrospective studies . Each study was grade d using AHRQ and QUADAS criteria . The level of evidence was classified as conclusive , strong , moderate , limited , or inconclusive . RESULTS Available literature pointed to strong evidence for controlled comparative local anesthetic facet joint medial branch blocks in the diagnosis of neck and low back pain . There was moderate evidence in the diagnosis of pain arising from thoracic facet joints . CONCLUSION The evidence obtained from literature review suggests that controlled comparative local anesthetic blocks of facet joint nerves ( medial branch or dorsal ramus ) are reproducible , reasonably accurate , and safe . The sensitivity , specificity , false-positive rates , and predictive values of these diagnostic tests for neck and low back pain have been vali date d and reproduced in multiple studies BACKGROUND  Surgical site infections ( SSIs ) are complications of surgery that cause significant postoperative morbidity . SSI has been proposed as a potential indicator of the quality of care in the context of clinical governance and monitoring of the performance of NHS organisations against targets . OBJECTIVES We aim ed to address a number of objectives . Firstly , identify risk factors for SSI , criteria for stratifying surgical procedures and evidence about the importance of postdischarge surveillance ( PDS ) . Secondly , test the importance of risk factors for SSI in surveillance data bases and investigate interactions between risk factors . Thirdly , investigate and vali date different definitions of SSI . Lastly , develop models for making risk-adjusted comparisons between hospitals . DATA SOURCES A single hospital surveillance data base was used to address objectives 2 and 3 and the UK Surgical Site Infection Surveillance Service data base to address objective 4 . STUDY DESIGN There were four elements to the research : ( 1 ) systematic review s of risk factors for SSI ( two review ers assessed titles and abstract s of studies identified by the search strategy and the quality of studies was assessed using the Newcastle Ottawa Scale ) ; ( 2 ) assessment of agreement between four SSI definitions ; ( 3 ) validation of definitions of SSI , quantifying their ability to predict clinical outcomes ; and ( 4 ) development of operation-specific risk models for SSI , with hospitals fitted as r and om effects . RESULTS Review s of SSI risk factors other than established SSI risk indices identified other risk ; some were operation specific , but others applied to multiple operations . The factor most commonly identified was duration of preoperative hospital stay . The review of PDS for SSI confirmed the need for PDS if SSIs are to be compared meaningfully over time within an institution . There was wide variation in SSI rate ( SSI% ) using different definitions . Over twice as many wounds were classified as infected by one definition only as were classified as infected by both . Different SSI definitions also classified different wounds as being infected . The two most established SSI definitions had broadly similar ability to predict the chosen clinical outcomes . This finding is paradoxical given the poor agreement between definitions . Elements of each definition not common to both may be important in predicting clinical outcomes or outcomes may depend on only a subset of elements which are common to both . Risk factors fitted in multivariable models and their effects , including age and gender , varied by surgical procedure . Operative duration was an important risk factor for all operations , except for hip replacement . Wound class was included least often because some wound classes were not applicable to all operations or were combined because of small numbers . The American Association of Anesthesiologists class was a consistent risk factor for most operations . CONCLUSIONS The research literature does not allow surgery-specific or generic risk factors to be defined . SSI definitions varied between surveillance programmes and potentially between hospitals . Different definitions do not have good agreement , but the definitions have similar ability to predict outcomes influenced by SSI . Associations between components of the National Nosocomial Infections Surveillance risk index and odds of SSI varied for different surgical procedures . There was no evidence for effect modification by hospital . Estimates of SSI% should be disseminated within institutions to inform infection control . Estimates of SSI% across institutions or countries should be interpreted cautiously and should not be assumed to reflect quality of medical care . Future research should focus on developing an SSI definition that has satisfactory psychometric properties , that can be applied in everyday clinical setting s , includes PDS and is formulated to detect SSIs that are important to patients or health services . FUNDING The National Institute for Health Research Technology Assessment programme Background There has been considerable interest recently in developing and evaluating interventions to increase research use by clinicians . However , most work has focused on medical practice s ; and nursing is not well represented in existing systematic review s. The purpose of this article is to report findings from a systematic review of interventions aim ed at increasing research use in nursing . Objective To assess the evidence on interventions aim ed at increasing research use in nursing . Methods A systematic review of research use in nursing was conducted using data bases ( Medline , CINAHL , Healthstar , ERIC , Cochrane Central Register of Controlled Trials , and Psychinfo ) , grey literature , ancestry search ing ( Cochrane Data base of Systematic Review s ) , key informants , and manual search ing of journals . R and omized controlled trials and controlled before- and after- studies were included if they included nurses , if the intervention was explicitly aim ed at increasing research use or evidence -based practice , and if there was an explicit outcome to research use . Method ological quality was assessed using pre-existing tools . Data on interventions and outcomes were extracted and categorized using a pre-established taxonomy . Results Over 8,000 titles were screened . Three r and omized controlled trials and one controlled before- and after- study met the inclusion criteria . The method ological quality of included studies was generally low . Three investigators evaluated single interventions . The most common intervention was education . Investigators measured research use using a combination of surveys ( three studies ) and compliance with guidelines ( one study ) . Research er-led educational meetings were ineffective in two studies . Educational meetings led by a local opinion leader ( one study ) and the formation of multidisciplinary committees ( one study ) were both effective at increasing research use . Conclusion Little is known about how to increase research use in nursing , and the evidence to support or refute specific interventions is inconclusive . To advance the field , we recommend that investigators : ( 1 ) use theoretically informed interventions to increase research use , ( 2 ) measure research use longitudinally using theoretically informed and psychometrically sound measures of research use , as well as , measuring patient outcomes relevant to the intervention , and ( 3 ) use more robust and method ologically sound study design s to evaluate interventions . If investigators aim to establish a link between using research and improved patient outcomes they must first identify those interventions that are effective at increasing research use & NA ; Patients may wait some time for total hip replacement with conservative management of pain and disability , but no attempts to rehabilitate them . This study r and omised 40 patients accepted for and awaiting total hip replacement to a brief rehabilitative psychologically based pain management programme ( PMP ) or to a control group with no intervention . Patients were assessed before r and omisation , 3 months after the PMP or equivalent waiting time , and again one year later after total hip replacement . Assessment s included pain , impact of pain ( Arthritis Impact Scale : AIMS ) , mobility ( timed walk ) , sleep and analgesic consumption . The patients who had learned pain management reported lower pain intensity and pain distress and less sleep disturbance than waiting list controls , but no improvement in function or analgesic consumption . Six patients opted to delay , but this did not differ between groups . Post‐hip replacement both groups improved in pain and some aspects of activity ( AIMS ) with greater improvement in the PMP group for physical activity and total AIMS scores , suggesting that some techniques had continued to be of use post‐surgically . Rehabilitative pain management may be useful to patients pre‐operatively in managing everyday pain , but not to the extent that they opt to delay surgery ; it may also improve their function after hip replacement Background Personalized healthcare relies on the identification of factors explaining why individuals respond differently to the same intervention . Analyses identifying such factors , so called predictors and moderators , have their own set of assumptions and limitations which , when violated , can result in misleading cl aims , and incorrect actions . The aim of this study was to develop a checklist for critically appraising the results of predictor and moderator analyses by combining recommendations from published guidelines and experts in the field . Methods C and i date criteria for the checklist were retrieved through systematic search es of the literature . These criteria were evaluated for appropriateness using a Delphi procedure . Two Delphi rounds yielded a pilot checklist , which was tested on a set of papers included in a systematic review on reinforced home-based palliative care . The results of the pilot informed a third Delphi round , which served to finalize the checklist . Results Forty-nine appraisal criteria were identified in the literature . Feedback was obtained from fourteen experts from (bio)statistics , epidemiology and other associated fields elicited via three Delphi rounds . Additional feedback from other research ers was collected in a pilot test . The final version of our checklist included seventeen criteria , covering the design ( e.g. a priori plausibility ) , analysis ( e.g. use of interaction tests ) and results ( e.g. complete reporting ) of moderator and predictor analysis , together with the transferability of the results ( e.g. clinical importance ) . There are criteria both for individual papers and for bodies of evidence . Conclusions The proposed checklist can be used for critical appraisal of reported moderator and predictor effects , as assessed in r and omized or non-r and omized studies using individual participant or aggregate data . This checklist is accompanied by a user ’s guide to facilitate implementation . Its future use across a wide variety of research domains and study types will provide insights about its usability and feasibility BACKGROUND Abnormal uterine bleeding is the direct cause of a significant health care burden for women , their families , and society as a whole . Up to 30 % of women will seek medical assistance for this problem during their reproductive years . This guideline replaces previous clinical guidelines on the topic and is aim ed to enable health care providers with the tools to provide the latest evidence -based care in the diagnosis and the medical and surgical management of this common problem . OBJECTIVE To provide current evidence -based guidelines for the diagnosis and management of  abnormal uterine bleeding ( AUB ) among women of reproductive age . OUTCOMES Outcomes evaluated include the impact of AUB on quality of life and the results of interventions including medical and surgical management of AUB . METHODS Members of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of location in Canada , type of practice , subspecialty expertise , and general gynaecology background . The committee review ed relevant evidence in the English medical literature including published guidelines . Recommendations were established as consensus statements . The final document was review ed and approved by the Executive and Council of the SOGC . RESULTS This document provides a summary of up-to- date evidence regarding diagnosis , investigations , and medical and surgical management of AUB . The result ing recommendations may be adapted by individual health care workers when serving women with this condition . CONCLUSIONS Abnormal uterine bleeding is a common and sometimes debilitating condition in women of reproductive age . St and ardization of related terminology , a systematic approach to diagnosis and investigation , and a step-wise approach to intervention is necessary . Treatment commencing with medical therapeutic modalities followed by the least invasive surgical modalities achieving results satisfactory to the patient is the ultimate goal of all therapeutic interventions . EVIDENCE Published literature was retrieved through search es of MEDLINE and the Cochrane Library in March 2011 using appropriate controlled vocabulary ( e.g. uterine hemorrhage , menorrhagia ) and key words ( e.g. menorrhagia , heavy menstrual bleeding , abnormal uterine bleeding ) . Results were restricted to systematic review s , r and omized control trials/controlled clinical trials , and observational studies written in English and published from January 1999 to March 2011 . Search es were up date d on a regular basis and incorporated in the guideline to February 2013 . Grey ( unpublished ) literature was identified through search ing the websites of health technology assessment and health technology-related agencies , clinical practice guideline collection s , clinical trial registries , and national and international medical specialty societies . VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care ( Table ) . BENEFITS , HARMS , AND COSTS Implementation of the guideline recommendations will improve the health and well-being of women with abnormal uterine bleeding , their families , and society . The economic cost of implementing these guidelines in the Canadian health care system was not considered BACKGROUND The aim of this study was to assess the efficacy of meaning-centered group psychotherapy for cancer survivors ( MCGP-CS ) to improve personal meaning , compared with supportive group psychotherapy ( SGP ) and care as usual ( CAU ) . METHOD A total of 170 cancer survivors were r and omly assigned to one of the three study arms : MCGP-CS ( n = 57 ) ; SGP ( n = 56 ) ; CAU ( n = 57 ) . The primary outcome measure was the Personal Meaning Profile ( PMP ; total score ) . Secondary outcome measures were subscales of the PMP , psychological well-being ( Scales of Psychological Well-being ; SPWB ) , post-traumatic growth ( Posttraumatic Growth Inventory ) , Mental Adjustment to Cancer ( MAC ) , optimism ( Life Orientation Test-Revised ) , hopelessness ( Beck 's Hopelessness Scale ) , psychological distress ( anxiety and depression , Hospital Anxiety and Depression Scale ; HADS ) and quality of life ( European Organization for Research and Treatment of Cancer Quality of Life Question naire ; EORTC QLQ-C30 ) . Outcome measures were assessed before r and omization , post-intervention , and after 3 and 6 months of follow-up ( FU ) . RESULTS Linear mixed model analyses ( intention-to-treat ) showed significant differences between MCGP-CS , SGP and CAU on the total PMP score , and on (sub)scales of the PMP , SPWB , MAC and HADS . Post-hoc analyses showed significantly stronger treatment effects of MCGP-CS compared with CAU on personal meaning ( d = 0.81 ) , goal -orientedness ( d = 1.07 ) , positive relations ( d = 0.59 ) , purpose in life ( d = 0.69 ) ; fighting spirit ( d = 0.61 ) ( post-intervention ) and helpless/hopeless ( d = -0.87 ) ( 3 months FU ) ; and distress ( d = -0.6 ) and depression ( d = -0.38 ) ( 6 months FU ) . Significantly stronger effects of MCGP-CS compared with SGP were found on personal growth ( d = 0.57 ) ( 3 months FU ) and environmental mastery ( d = 0.66 ) ( 6 months FU ) . CONCLUSIONS MCGP-CS is an effective intervention for cancer survivors to improve personal meaning , psychological well-being and mental adjustment to cancer in the short term , and to reduce psychological distress in the long run Background The extent and the distribution of end stage kidney disease ( ESKD ) in Libya have not been reported despite provision of dialysis over 4 decades . This study aim ed to develop the first comprehensive description of the epidemiology of  dialysis-treated  ESKD in Libya . Methods Structured demographic and clinical data were obtained regarding all adult patients treated at all maintenance dialysis facilities ( n=39 ) in Libya from May to September 2009 . Subsequently data were collected prospect ively on all new patients who started dialysis from September 2009 to August 2010 . Population estimates were obtained from the Libyan national statistics department . The age and gender breakdown of the population in each region was obtained from mid-2009 population estimates based on 2006 census data . Results The prevalence of dialysis-treated ESKD was 624 per million population ( pmp ) . 85 % of prevalent patients were aged < 65 years and 58 % were male . The prevalence of ESKD varied considerably with age with a peak at 55–64 years ( 2475 pmp for males ; 2197 pmp for females ) . The annual incidence rate was 282 pmp with some regional variation and a substantially higher rate in the South ( 617 pmp ) . The most common cause of ESKD among prevalent and incident patients was diabetes . Other important causes were glomerulonephritis , hypertensive nephropathy and congenital or hereditary diseases . Conclusions Libya has a relatively high prevalence and incidence of dialysis-treated ESKD . As the country prepares to redevelop its healthcare system it is hoped that these data will guide strategies for the prevention of CKD and planning for the provision of renal replacement therapy Objectives Matrix-assisted autologous chondrocyte transplantation ( MACT ) has been developed and applied in the clinical practice in the last decade to overcome most of the disadvantages of the first generation procedures . The purpose of this systematic review is to document and analyse the available literature on the results of MACT in the treatment of chondral and osteochondral lesions of the knee . Methods All studies published in English addressing MACT procedures were identified , including those that fulfilled the following criteria : 1 ) level I-IV evidence , 2 ) measures of functional or clinical outcome , 3 ) outcome related to cartilage lesions of the knee cartilage . Results The literature analysis showed a progressively increasing number of articles per year . A total of 51 articles were selected : three r and omised studies , ten comparative studies , 33 case series and five case reports . Several scaffolds have been developed and studied , with good results reported at short to medium follow-up . Conclusions MACT procedures are a therapeutic option for the treatment of chondral lesions that can offer a positive outcome over time for specific patient categories , but high-level studies are lacking . Systematic long-term evaluation of these techniques and r and omised controlled trials are necessary to confirm the potential of this treatment approach , especially when comparing against less ambitious traditional treatments OBJECTIVE Develop and test a short-form comprehensive outcome measure for back pain . DESIGN Prospect i ve longitudinal study of 3 consecutive cohorts of back pain patients . SETTING Anglo-European College of Chiropractic outpatient clinic and several field chiropractic practice s. METHOD Domains judged important in the back pain model and responsive to clinical change were identified from the literature . Items were scored on an 11-point numerical rating scale . The instrument was psychometrically tested by use of those tests relevant to an evaluative measure . RESULTS Seven dimensions of the back pain model were included in the question naire . Having established face validity , the instrument was shown to demonstrate high internal consistency ( Cronbach 's alpha = 0.9 ) and good test-retest reliability ( ICC = 0.95 ) . All items were retained on the basis that they contributed to the overall score ( item-corrected total score correlations ) and to the instrument 's responsiveness to clinical change ( item change-corrected total change score correlations ) . The instrument demonstrated acceptable construct and longitudinal construct validity with established external measures . The effect size of the instrument was high ( 1.29 ) and comparable with established measures . CONCLUSION A reliable , valid , and responsive instrument has been developed for use in back pain patients . It is practical for use in investigations of both the efficacy and effectiveness of back pain treatments Postmastectomy pain syndrome ( PMPS ) is a neuropathic pain syndrome that may develop following breast surgery .  Venlafaxine has been shown to be efficacious in the management of PMPS . The preemptive administration of venlafaxine has been shown to be efficacious in reducing the incidence of neuropathic pain in the rat model . We examined the efficacy of administering either venlafaxine or placebo for two weeks starting the night before surgery to 100 patients scheduled for either partial or radical mastectomy with axillary dissection . Patients were administered PCA morphine for the first 24 hours following surgery and then acetaminophen/oxycodone tablets .  Pain scores were recorded at rest and movement on day 1 , at 1 month , and at 6 months after surgery . At 6 months postoperatively , the presence of pain in the chest , arm , and axilla ; edema ; decreased sensation in the operative area ; and phantom breast pain were recorded . There was no difference in postoperative opioid use . Pain scores with movement were lower in the venlafaxine group at 6 months . Pain scores at all other time intervals were similar . There was a significant decrease in the incidence of chest wall pain ( 55 % vs. 19 % , P = 0.0002 ) , arm pain ( 45 % vs. 17 % , P = 0.003 ) , and axilla pain ( 51 % vs. 19 % , P = 0.0009 ) between the control group and the venlafaxine group , respectively . No significant differences were noted between the two groups with regard to edema , phantom pain , or sensory changes . We conclude that the perioperative administration of venlafaxine beginning the night prior to surgery significantly reduces the incidence of PMPS following breast cancer surgery
The level of evidence for PMPs varied across different test procedures in different types of PJP .
H and -held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability , agreement , and responsiveness , simultaneously , when it was investigated in patients with chronic knee osteoarthritis .
BACKGROUND Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties ( PMPs ) to be used in clinical practice .
The aim of this systematic review was to evaluate the literature to assess the level of evidence for PMPs of test procedures investigated in individuals with peripheral joint pain ( PJP ) .