• Title/Summary/Keyword: Methodological Quality

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A Systematic Review of MRI, Scintigraphy, FDG-PET and PET/CT for Diagnosis of Multiple Myeloma Related Bone Disease - Which is Best?

  • Weng, Wan-Wen;Dong, Meng-Jie;Zhang, Jun;Yang, Jun;Xu, Qin;Zhu, Yang-Jun;Liu, Ning-Hu
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.22
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    • pp.9879-9884
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    • 2014
  • Aim: The purpose of the current study was to conduct a systematic review of the published literature to evaluate the diagnostic accuracy of FDG-PET, PTE/CT, MRI and scintigraphy for multiple myeloma related bone disease. Methods: Through a search of PubMed, EMBASE, and the Cochrane Library, two reviewers independently assessed the methodological quality of each study. We estimated pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), and two sample Z-tests were conducted to evaluate for differences in sensitivity, specificity, area under the curve (AUC), and the $Q^*$ index between any two diagnostic modalities. Results: A total of 17 studies were reviewed. The MRI had a pooled sensitivity of 0.88, specificity of 0.68, AUC of 0.897, and $Q^*$ index of 0.828, whereas for MIBI, the corresponding values were 0.98, 0.90, 0.991, and 0.962, respectively, and for bone scan, they were 066, 0.83, 0.805, and 0.740, respectively. The corresponding values of MIBI were 0.98, 0.90, 0.991, and 0.962, respectively. For PET and PET/CT, the values were 0.91, 0.69, 0.927 and 0.861, respectively. Statistically significant differences were not found in the sensitivity, specificity, AUC, and $Q^*$ index between MRI, scintigraphy, FDG-PET and PET/CT. Conclusions: On the condition that X ray is taken as a reference in our study, we suggested that FDG-PET, PTE/CT, MRI and scintigraphy are all associated with high detection rate of bone disease in patients with MM. Thus, in clinical practice, it is recommended that we could choose these tests according to the condition of the patient.

Significant Efficacy of Additional Concurrent Chemotherapy with Radiotherapy for Postoperative Cervical Cancer with Risk Factors: a Systematic Review and Meta-analysis

  • Qin, Ai-Qiu;Liang, Zhong-Guo;Ye, Jia-Xiang;Li, Jing;Wang, Jian-Li;Chen, Chang-Xian;Song, Hong-Lin
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.8
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    • pp.3945-3951
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    • 2016
  • Background: Whether concurrent chemotherapy treatment is superior to radiotherapy alone as an adjuvant regimen for postoperative cervical carcinoma with risk factors remains controversial. Materials and Methods: A literature search strategy examined Pubmed, Embase, the Cochrane Library, the China National Knowledge Internet Web, the Chinese Biomedical Database and the Wanfang Database. Article reference lists and scientific meeting abstracts were also screened. Controlled trials comparing concurrent chemoradiotherapy versus radiotherapy alone in postoperative cervical cancer were included. The methodological quality of non-randomized controlled trials was evaluated using the Newcastle-Ottawa Scale. Randomized controlled studies were evaluated with the Cochrane handbook. A meta-analysis was performed with RevMan 5.3. Results: A total of 1,073 patients from 11 clinical trials were analysed, with 582 patients in the concurrent chemoradiotherapy group and 491 patients in the radiotherapy group. Hazard ratios (HR) of 0.47 (95% CI 0.31-0.72) and 0.50 (95% CI 0.35-0.72) were observed for overall survival and progression-free survival, indicating a benefit from the additional use of concurrent chemotherapy. Subgroup analyses demonstrated that cervical cancer with high risk factors significantly benefitted from concurrent chemotherapy when examining overall survival (HR 0.44, 95% CI 0.28-0.67) and progression-free survival (HR 0.48, 95% CI 0.33-0.70), but patients with intermediate risk factors showed no benefit from concurrent chemotherapy in overall survival (HR 1.72, 95% CI 0.28-10.41) and progression-free survival (HR 1.09, 95% CI 0.19-6.14). No significant differences were observed for grade 3-4 anaemia (risk ratio (RR) 3.87, 95% CI 0.69-21.84), grade 3-4 thrombocytopenia (RR 3.04, 95% CI 0.88-10.58), grade 3-4 vomiting or nausea (RR 1.71, 95% CI 0.27-10.96), or grade 3-4 diarrhoea (RR 1.40, 95% CI 0.69-2.83). Significant differences were observed for grade 3-4 neutropenia in favour of the radiotherapy group (RR 7.23, 95% CI 3.94-13.26). Conclusions: In conclusion, concurrent chemoradiotherapy improves survival in postoperative cervical cancer with high risk factors but not in those with intermediate risk factors.

The Research Trends of Papers in The Korean Journal of Occupational Health Nursing (산업간호학회지 논문의 연구동향 분석)

  • Lim, Kyung-Kee;Park, Kyung-Min
    • Korean Journal of Occupational Health Nursing
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    • v.10 no.2
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    • pp.142-152
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    • 2001
  • This study examined all the papers published in the Journal of Occupational Health Nursing from 1991 to May 2000 based on an objective frame of evaluation. The purpose of study is to prospect the trend of occupational nursing research and to provide an optimal direction for future occupational nursing service. The results of total 94 studies were analyzed as follows. 1. The number of papers published in 1991-1992, 1993-1995, 1996-1997 was not significantly increased. However, the number of papers were obviously increased after 1998. 2. In the design of research, survey studies were definitely dominant. But, they are gradually decreasing and experimental studies are increasing. 3. In the fields of research, health problems, health risk factors and health awareness were higher than others. Occupational health nurse's task and job satisfaction were main areas of research until the middle of 1990's. However, after then, not only health problem, risk factor and awareness of health but also health promotion and preventive health behavior are increasing in the research areas. 4. The collaborative researches have gradually increased and the type of author has been varied. The number of researches completed by funds was undertaking only 3 among the total 94. 5. In the research analysis, except for case studies and literature studies, the research subjects have been shifted from the occupational health nurses to the industrial workers, and more diversified. The sample size has been enlarged and the major place of the study is industry. The questionnaire was used in many studies as instrument for data collection and measurement. But, complementary methods of diverse instruments have been increased. The method of data analysis has obviously showed some changes moving from descriptive statistics to inferential and advanced statistics. 6. The ways of nursing intervention have prominently diversified in experimental studies. The contents of case studies were mainly focused on the health management programs and activities in industry. The research concepts and the contents of literature study were also changed progressively in various way. Based on the above findings, conclusions are extended to the following discussion: Since the Korean Academic Society of Occupational Health Nursing was instituted in 1990, the researches of occupational health nursing have shown an acute methodological development in both quantity and quality. However, they were considered still in the lack of research verifying the effects of nursing intervention program. Also, the development of nursing intervention and nursing theory lacked. Therefore, more empirical researches are strongly needed to utilize the field of occupational health nursing in Korea Researchers are also encouraged to exert more efforts to get research funds.

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Effectiveness of Cognitive Behavioral Therapy Techniques for Control of Pain in Lung Cancer Patients: An Integrated Review

  • Phianmongkhol, Yupin;Thongubon, Kannika;Woottiluk, Pakapan
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.14
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    • pp.6033-6038
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    • 2015
  • Background: Experience of lung cancer includes negative impacts on both physical and psychological health. Pain is one of the negative experiences of lung cancer. Cognitive behavioral therapy techniques are often recommended as treatments for lung cancer pain. The objective of this review was to synthesize the evidence on the effectiveness of cognitive behavioral therapy techniques in treating lung cancer pain. This review considered studies that included lung cancer patients who were required to 1) be at least 18 years old; 2) speak and read English or Thai; 3) have a life expectancy of at least two months; 4) experience daily cancer pain requiring an opioid medication; 5) have a positive response to opioid medication; 6) have "average or usual" pain between 4 and 7 on a scale of 0-10 for the day before the clinic visit or for a typical day; and 7) able to participate in a pain evaluation and treatment program. This review considered studies to examine interventions for use in treatment of pain in lung cancer patients, including: biofeedback, cognitive/attentional distraction, imagery, hypnosis, and meditation. Any randomized controlled trials (RCTs) that examined cognitive behavioral therapy techniques for pain specifically in lung cancer patients were included. In the absence of RCTs, quasi-experimental designs were reviewed for possible conclusion in a narrative summary. Outcome measures were pain intensity before and after cognitive behavioural therapy techniques. The search strategy aimed to find both published and unpublished literature. A three-step search was utilised by using identified keywords and text term. An initial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all the identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference list of all identified reports and articles were searched for additional studies. Searches were conducted during January 1991- March 2014 limited to English and Thai languages with no date restriction. Materials and Methods: All studies that met the inclusion criteria were assessed for methodological quality by three reviewers using a standardized critical appraisal tool from the Joanna Briggs Institute (JBI). Three reviewers extracted data independently, using a standardized data extraction tool from the Joanna Briggs Institute (JBI). Ideally for quantitative data meta-analysis was to be conducted where all results were subject to double data entry. Odds ratios (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were to be calculated for analysis and heterogeneity was to be assessed using the standard Chi-square. Where statistical pooling was not possible the finding were be presented in narrative form. Results: There were no studies located that met the inclusion requirements of this review. There were also no text and opinion pieces that were specific to cognitive behavioral therapy techniques pain and lung cancer patients.Conclusions: There is currently no evidence available to determine the effectiveness of cognitive behavioural therapy techniques for pain in lung cancer patients.

Effectiveness and Safety of Pemetrexed Versus Docetaxel as a Treatment for Advanced Non-small Cell Lung Cancer: a Systematic Review and Meta-analysis

  • Di, Bao-Shan;Wei, Kong-Ping;Tian, Jin-Hui;Xiao, Xiao-Juan;Li, Yan;Zhang, Xu-Hui;Yu, Qin;Yang, Ke-Hu;Ge, Long;Huang, Wen-Hui;Zhang, Fang-Wa
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.8
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    • pp.3419-3424
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    • 2014
  • Background: Our aim was to conduct a meta-analysis to compare the efficacy and safety of pemetrexed and docetaxel for non-small cell lung cancer (NSCLC). Materials and Methods: We systematically searched the Cochrane Library, PubMed, Embase, China Biology Medicine Database for randomized controlled trials (RCTs) comparing the efficacy and toxicities of pemetrexed versus docetaxel as a treatment for advanced NSCLC. We limited the languages to English and Chinese. Two reviewers independently screened articles to identify eligible trials according to the inclusion and exclusion criteria and assessed the methodological quality of included trials, and then extracted data. The meta-analysis was performed using STATA12.0. Results: Six RCTs involving 1,414 patients were identified. We found that there was no statistically significant differences in overall response rate, survival time, progression-free survival, disease control rate, and 1-2yr survival rate (p>0.050) but it is worthy of mention that patients in the pemetrexed arms had significantly higher 3-yr survival rate (P=0.002). With regard to the grade 3 or 4 hematological toxicity, compared with docetaxel, pemetrexed led to lower rate of grade 3-4 febrile neutropenia, neutropenia, and leukocyts toxicity (p<0.001). There was no significant difference in anemia between the two arms (p=0.08). In addition, pemetrexed led to higher rate of grade 3-4 thrombocytopenia toxicity (p=0.03). As for the non-hematological toxicities, compared with docetaxel, pemetrexed group had lower rate of grade 3-4 diarrhea and alopecia. Conclusions: Pemetrexed was almost as effective as docetaxel in patients with advanced NSCLC. At the same time, pemetrexed might increase the 3-yr survival rate. As for safety, pemetrexed led to lower rate of grade 3-4 febrile neutropenia, neutropenia, leukocytes, diarrhea and alopecia toxicity. However, it was associated with a higher rate of grade 3-4 thrombocytopenia.

Platelet Rich Plasma Injection: Evidence Based Analysis (혈소판 풍부 혈장 주사 요법: 근거 중심의 분석)

  • Oh, Joo Han;Chung, Seok Won
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.4 no.2
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    • pp.111-122
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    • 2011
  • Platelet rich plasma (PRP) has been widely used nowadays for several common orthopaedic-related sports medicine conditions with the theoretical basis that PRP supplies numerous autologous growth factors from concentrated platelets needed to promote the healing process of injured tissue. Even though there are many basic sciences, animal studies and some clinical studies regarding PRP injections for musculoskeletal injuries which suggested good results, it is difficult to compare these various studies due to marked methodological differences such as PRP preparation method, the timing, volume and number of injection, and the outcome measurement tool. In addition, many studies have no control groups or a limited sample size, and there are few prospective randomized controlled trials assessing the efficacy of PRP injections. Therefore, well designed high-quality randomized studies are required to confirm the preliminary results until now and provide scientific evidence to support its use, and the paucity of scientific clinical evidence suggest that the administration of PRP on humans for musculoskeletal injuries should be performed with caution.

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Evaluation of the Validity of Risk-Adjustment Model of Acute Stroke Mortality for Comparing Hospital Performance (병원 성과 비교를 위한 급성기 뇌졸중 사망률 위험보정모형의 타당도 평가)

  • Choi, Eun Young;Kim, Seon-Ha;Ock, Minsu;Lee, Hyeon-Jeong;Son, Woo-Seung;Jo, Min-Woo;Lee, Sang-il
    • Health Policy and Management
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    • v.26 no.4
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    • pp.359-372
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    • 2016
  • Background: The purpose of this study was to develop risk-adjustment models for acute stroke mortality that were based on data from Health Insurance Review and Assessment Service (HIRA) dataset and to evaluate the validity of these models for comparing hospital performance. Methods: We identified prognostic factors of acute stroke mortality through literature review. On the basis of the avaliable data, the following factors was included in risk adjustment models: age, sex, stroke subtype, stroke severity, and comorbid conditions. Survey data in 2014 was used for development and 2012 dataset was analysed for validation. Prediction models of acute stroke mortality by stroke type were developed using logistic regression. Model performance was evaluated using C-statistics, $R^2$ values, and Hosmer-Lemeshow goodness-of-fit statistics. Results: We excluded some of the clinical factors such as mental status, vital sign, and lab finding from risk adjustment model because there is no avaliable data. The ischemic stroke model with age, sex, and stroke severity (categorical) showed good performance (C-statistic=0.881, Hosmer-Lemeshow test p=0.371). The hemorrhagic stroke model with age, sex, stroke subtype, and stroke severity (categorical) also showed good performance (C-statistic=0.867, Hosmer-Lemeshow test p=0.850). Conclusion: Among risk adjustment models we recommend the model including age, sex, stroke severity, and stroke subtype for HIRA assessment. However, this model may be inappropriate for comparing hospital performance due to several methodological weaknesses such as lack of clinical information, variations across hospitals in the coding of comorbidities, inability to discriminate between comorbidity and complication, missing of stroke severity, and small case number of hospitals. Therefore, further studies are needed to enhance the validity of the risk adjustment model of acute stroke mortality.

Effect of Acupuncture on Sciatica in Rat Models: Systematic Review and Meta-analysis (좌골신경통 백서모델에서 침치료의 효과: 체계적 문헌고찰 및 메타분석)

  • Yoon, Ye-Ji;Kim, Soojeon;Cho, Jae-Heung;Kim, Koh-Woon;Song, Mi-Yeon
    • Journal of Korean Medicine Rehabilitation
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    • v.30 no.1
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    • pp.79-93
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    • 2020
  • Objectives While sciatic neuropathy is one of the common symptoms which have the lifetime incidence of 13~40%, still there is no consensus about the standardized and the most effective conservative treatment. In addition, the importance of systematic review and meta-analysis of preclinical are growing as they could suggest possible effective treatment strategy for future studies. Therefore, we conducted systematic review and meta-analysis to estimate analgesic effect of acupuncture on sciatica in rat models. Methods Systematic search was conducted for all controlled comparative preclinical trials which assessed analgesic effect of acupuncture in sciatica rat models. Database of PubMed, EMBASE, Web of Science, CNKI and 6 Korean databases were used. The primary outcome was pain, which is evaluated by stimulus behavior tests in rat models. We assessed the methodological quality with Systematic Review Centre for Laboratory Animal Experimentation's risk of bias tool. RevMan 5.3 was used for meta-analysis and subgroup analysis was conducted according to treatment site, acupuncture point, treatment period and frequency used in electroacupuncture. Results 14 studies were finally included following our inclusion criteria. The data from meta-analysis indicated that the acupuncture significantly improved the result values of behavior tests for pain evaluation, compared to no-treatment control group in animal models (standardized mean difference=4.43, 95% confidence interval 3.16 to 5.69, Z=6.84, p<0.00001; χ2=68.02, p<0.00001; I2=82%). The results of subgroup analysis indicate that acupuncture treatment of unilateral site, distal acupoints, longer treatment period and applying 2/100 Hz frequency in electroacupuncture could be more effective. Conclusions Systematic review and meta-analysis of animal studies are getting important for the future clinical studies and the improvement of heatlh care. Therefore the results of the study would provide evidence and better design for the forthcoming studies.

A study of the Characteristics of Community Design for Modern Industrial Heritage's Reproduction (근대산업유산 재생을 위한 커뮤니티디자인 특성 연구)

  • Jeong, Min-Joo;Lee, Chan
    • Korean Institute of Interior Design Journal
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    • v.23 no.4
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    • pp.157-168
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    • 2014
  • In buildings on the street, indiscriminate redevelopment are being made by overlooking the relationship with surrounding landscape to create their own unique meaning, due to industrialization progressed rapidly with human needs of longing for something constantly. Selection and methods of two plans, conservation and utilization should be required, considering heritage values on industrial buildings which are being lost and aged in this redevelopment higher. The attempt for the use of modern industrial heritage becomes a hot topic, and several experimental challenges are being made. However, there are rather many cases of causing industrial buildings' depreciation and one-size-fits-all reproduction performance as it applies other examples as standards by recognizing the reproduction of modern industrial heritage as one trend, not focusing on the trend of the times or paradigm, what the times want. To minimize these problems, we focus on how to utilize industrial buildings beyond the importance of industrial buildings' reproduction, considering the quality of local residents' life as well as the expected effect obtainable due to security of local identity and reproduction of buildings, focusing on the concept of community design that offers and forms a way of community life as the design of shares based on unspecified individuals' common life. Community design's core can be called to have diversity rather than undifferentiated unity by pursuing whole unification, since local residents become those who plan design and all people participate in it. In addition, community design achieves integration with other fields as an enlarged design area without limiting in an environmental area, by making indigenously natural characteristics combined with cultural factors in one context so that people may understand the flow of the place. The importance of effects acquired from modern industrial heritage's reproduction has well-known, and the attempt for utilizing aged heritage as a new value and a function has constantly been made. Now, it's time to focus on how long it lasts through this method, rather than modern industrial heritage's reproduction itself. There can be a significance in this study in proposing methodological solutions on modern industrial heritage's reproduction, not to cause depreciation of industrial buildings by recognizing contemporary trends and uniform regeneration performance, multifaceted research is needed for creative, effective development on modern industrial heritage which will occur constantly.

Radiation Safety Management Guidelines for PET-CT: Focus on Behavior and Environment (PET-CT의 방사선안전관리 가이드라인 개발: 행위와 환경을 중심으로)

  • Jung, Jin-Wook;Han, Eun-Ok
    • Journal of Radiation Protection and Research
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    • v.36 no.3
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    • pp.140-147
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    • 2011
  • Our purpose is to specify behavior and environmental factors aimed at reducing the exposed dosage caused by PET-CT and to develop radiation safety management guidelines adequate for domestic circumstances. We have used a multistep-multimethod as the methodological approach to design and to carry out the research both in quality and quantity, including an analysis on previous studies, professional consultations and a survey. The survey includes responses from 139 practitioners in charged of 109 PET-CTs installed throughout Korea(reported by the Korean Society of Nuclear Medicine, 2010). The research use 156 questions using Cronbach's ${\alpha}$ (alpha) coefficients which were: 0.818 for "the necessity of setting and installing the radiation protective environment"; 0.916 for "the necessity of radiation protection", "setting and installing the radiation protective environment"; and 0.885 for "radiation protection". The check list, derived from the radiation safety management guidelines focused on behavior and environment, was composed of 20 items for the radiation protective environment: including 5 items for the patient; 4 items for the guardian; 3 items for the radiologist; and 8 items applied to everyone involved; for a total of 26 items for the radiation protective behavior including: 12 items for the patient; 1 item for the guardian, 7 items for the radiologist; and 6 items applied to everyone involved. The specific check list is shown in(Table 5-6). Since our country has no safety management guidelines of its own to reduce the exposed dosage caused by PET-CTs, we believe the guidelines developed through this study means great deal to the field as it is not only appropriate for domestic circumstances, but also contains specific check lists for each target who may be exposed to radiation in regards to behavior and environment.