Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain

OBJECTIVE: To determine the efficacy and safety of extracorporeal shock wave therapy (ESWT) for lateral elbow pain. METHODS: Systematic review of randomized controlled trials using Cochrane Collaboration methodology. RESULTS: Nine placebo-controlled trials (1006 participants) and one trial of ESWT versus steroid injection (93 participants) were included. The 9 placebo-controlled trials reported conflicting results, although 11 of 13 pooled analyses found no significant benefit of ESWT over placebo, e.g., weighted mean difference for improvement in pain (on a 100-point scale) from baseline to 4-6 weeks (pooled analysis of 3 trials, 446 participants) was -9.42 (95% CI -20.70 to 1.86). Two pooled results favored ESWT, e.g., relative risk of treatment success (at least 50% improvement in pain with resisted wrist extension at 12 weeks) for ESWT in comparison to placebo (pooled analysis of 2 trials, 192 participants) was 2.2 (95% CI 1.55 to 3.12). However, this finding was not supported by the results of 4 other trials that were unable to be pooled. Steroid injection was more effective than ESWT at 3 months after the end of treatment assessed by a reduction of pain of 50% from baseline [21/25 (84%) vs 29/48 (60%); p < 0.05]. Minimal adverse effects of ESWT were reported. CONCLUSION: Based upon systematic review of 9 placebo-controlled trials, there is "platinum" level evidence that ESWT provides little or no benefit in terms of pain and function in lateral elbow pain. There is "silver" level evidence based upon one trial that steroid injection may be more effective than ESWT.     

Laparoscopic radical prostatectomy in men older than 70 years of age with localized prostate cancer: comparison of morbidity, reconvalescence, and short-term clinical outcomes between younger and older men

OBJECTIVES: To analyze the safety and efficacy of extraperitoneal laparoscopic radical prostatectomy (eL-RPE) in elderly versus younger men with localized prostate cancer. METHODS: Patients undergoing eL-RPE were retrospectively subdivided into group eL-RPE1 (72 men aged 71 yr and older) and group eL-RPE2 (132 men aged 59 yr and younger). Group eL-RPE1 was compared with a group of 70 contemporary, comparable patients aged 71 yr and older undergoing open retropubic radical prostatectomy (group OPEN-RPE). RESULTS: Compared with group eL-RPE2, patients of group eL-RPE1 had a higher pathologic stage (45% vs. 32% stage pT3 or greater, p<0.001) and higher Gleason score (median 7 vs. 6, p<0.001). Prostate-specific antigen recurrence was significantly worse compared with age-matched controls for younger patients with high-stage or high-grade lesions (p<0.001). Importantly operative time, analgesic requirements, hospital stay, convalescence, and complication rates were comparable. Urinary continence rate was significantly better in group eL-RPE2 at 6 mo (67% vs. 91%, respectively, p<0.001). Group eL-RPE1 and group OPEN-RPE patients had statistically similar pathologic stage and Gleason score (each p>0.05), similar operative time (p=0.12), but less blood loss (p<0.001), shorter hospital stay (p<0.001), and more rapid convalescence (p<0.001) occurred in eL-RPE1. CONCLUSIONS: eL-RPE is feasible and efficacious even in elderly patients with unfavorable, large-volume disease. eL-RPE offers the advantages of decreased blood loss, shorter hospital stay, and more rapid recovery over OPEN-RPE. However, the elderly patient must be informed preoperatively about the observed higher incontinence rate.     

Evaluating CAM treatment at the end of life: a review of clinical trials for massage and meditation

BACKGROUND: There is a pressing need for improved end-of-life care. Use of complementary and alternative medicine (CAM) may improve the quality of care but few controlled trials have evaluated CAM at the end of life. OBJECTIVES: To determine the strength of evidence for the benefits of touch and mind-body therapies in seriously ill patients. METHODS: Systematic review of randomized controlled trials of massage and mind-body therapies. A PubMed search of English language articles was used to identify the relevant studies. RESULTS: Of 27 clinical trials testing massage or mind-body interventions, 26 showed significant improvements in symptoms such as anxiety, emotional distress, comfort, nausea and pain. However, results were often inconsistent across studies and there were variations in methodology, so it was difficult to judge the clinical significance of the results. CONCLUSIONS: Use of CAM at the end of life is warranted on a case-by-case basis. Limitations in study design and sample size of the trials analyzed mean that routine use of CAM cannot be supported. There are several challenges to be addressed in future research into the use of CAM in end-of-life patients.     

Critical appraisal and review of the Rankin scale and its derivatives

BACKGROUND AND PURPOSE: Efforts to reduce stroke burden require accurate assessment of outcomes in order to compare treatments. The Rankin Scale and its derivatives, the Modified Rankin Scale and the Oxford Handicap Scale, taken together, are among the most common outcome measures that have been used in stroke research. The aim of this study was to perform a critical appraisal of the clinimetric properties of these scales. It was also planned to review the use of these scales in a selection of articles to illustrate concerns raised by the critical appraisal. SUMMARY OF REVIEW: A literature search was performed using electronic databases to locate relevant articles about the reviewed scales. The scales were appraised using a structured format regarding the following properties: purpose, development, presentation, language, method of administration, content validity, face validity, feasibility, construct validity, reliability, responsiveness, and generalizability. There are concerns in each of the appraised areas regarding the clinimetric properties of these scales. CONCLUSION: Further work is needed to improve the clinimetric properties of the reviewed scales to ensure that they are more useful tools in determining the outcome of stroke. Alternatively, a newer global outcome scale with improved clinimetric properties may be a better option for future stroke research.     

The Mediating Role of Children’s Causal Attributions in the Parent Distress-Child Depressive Symptom Association in Juvenile Rheumatic Diseases

To test whether children’s pessimistic causal attributions mediate the parent distress–child depressive symptom relation in youth diagnosed with juvenile rheumatic diseases (JRDs) and their parents. Fifty-two youth completed the Children’s Attributional Style Questionnaire and the Children’s Depression Inventory; parents completed the Brief Symptom Inventory. Parent distress was significantly related to children’s depressive symptoms. More importantly, children’s pessimistic attributions were shown to fully mediate the observed association between parent distress and children’s depressive symptoms. Results support a parent distress→ child attribution→ child depressive symptom interpretation, suggesting that parent distress engenders children’s depressogenic attributions, which eventuate in an increased vulnerability for depressive symptoms. The implications of our findings for clinical intervention and future research are discussed.