Oral purified bacterial extracts in acute respiratory tract infections in childhood: a systematic quantitative review.

Background: Recurrent acute respiratory tract infections (ARTI) are a common problem in childhood. Some evidence suggests a benefit regarding the prevention of ARTI in children treated with the immunomodulator OM-85 BV (Bronchovaxom).

Methods: We summarised the evidence on the effectiveness of the immunomodulator OM-85 BV in the prevention of ARTI in children.

Patient education in asthma: a survey of physicians' knowledge of the principles and implementation of self management in practice.

Background: Therapeutic patient education, particularly when including written instructions in self-management, improves outcomes in asthma. The education of patients in self-management requires specific knowledge and skills, which are not generally taught in under- or postgraduate training programmes.

Purpose: To investigate physicians' knowledge of the principles and implementation of self-management in asthma care.

More medical journals should inform their contributors about three key principles of graph construction.

Objectives: To identify key principles of graph construction and to review guidance on graph construction provided by medical journals.

Study Design And Setting: Review of a prevailing model of graph comprehension and survey of authors' instructions for all 120 core medical journals as indexed by PubMed.

Results: Graph construction should meet three requirements for optimal graph comprehension: Data symbols should be clearly distinguishable to enable their visual detection.

Are mutans streptococci detected in preschool children a reliable predictive factor for dental caries risk? A systematic review.

Research suggests that mutans streptococci play an important role in cariogenesis in children but the usefulness of bacterial testing in risk assessment is unknown. Our objective was to summarize the literature assessing the association of mutans streptococci and dental caries in preschool children, (Pre)Medline (1966-2003), Embase (1980-2003), the Cochrane Register of Controlled Trials (2003, issue 3), and reference lists of included studies were searched. All abstracts found by the electronic searches (n = 981) were independently scrutinized by 2 reviewers.

Predictors of intra- and postoperative complications in laparoscopic colorectal surgery: results of an expert survey.

Background: The decision which patient should undergo laparoscopic rather than open colorectal surgery depends on weighing its benefits against its complications. We explored which criteria prognosticate complications in a laparoscopic intervention by assembling experienced visceral surgeons' beliefs.

Methods: A two-round postal survey was conducted: 21 experts in laparoscopic surgery were contacted and asked to list (first round) and weigh (second round) indicators (scale 1-10) they believed predicted intra- or postoperative complications in patients undergoing laparoscopic colorectal surgery.

Etiology in a taxonomy of illnesses.

According to what Robert Koch termed the etiological standpoint, illnesses are best understood and controlled by focusing on their causes, including in their definitions and, thus, in the construction of their taxonomies. In some ways flawed, this standpoint has been misunderstood and misapplied. A taxonomy based solely on etiology was an unrealistic dream in the context of 'the bacteriological revolution', and it also is unrealistic in the present context of 'the genetic revolution.

[Check-up: general aspects].

A Check-up is characterized as a medical examination and a counselling of asymptomatic persons. The aim of such a Check-up is the identification of modifiable risk factors for different illnesses and/or the detection of a treatable, latent disease. The value and the cost-effectiveness of regular Check-up examinations can be assessed in scientific enquiries.

Posterior epistaxis: systematic review on the effectiveness of surgical therapies.

Objective: The optimal surgical treatment for patients with posterior epistaxis and failed conservative therapy is unknown. Therefore we planned a systematic review studying all available publications assessing the effect on bleeding recurrence and postoperative complications of ligation of the internal maxillary artery or the sphenopalatine artery.

Methods: We searched the electronic databases Medline, Medline In Process, and Cochrane Library.

Does the Angiotensin-converting enzyme (ACE) gene insertion/deletion polymorphism modify the response to ACE inhibitor therapy?--A systematic review.

Background: Pharmacogenetic testing to individualize ACE inhibitor therapy remains controversial. We conducted a systematic review to assess the effect modification of the insertion/deletion (I/D) polymorphism of the ACE gene on any outcome in patients treated with ACE inhibitors for cardiovascular and/or renal disease.

Methods: Our systematic review involved searching six electronic databases, then contacting the investigators (and pharmaceutical industry representatives) responsible for the creation of these databases.

A randomized trial of ways to describe test accuracy: the effect on physicians' post-test probability estimates.

Background: Some people believe that likelihood ratios provide diagnostic information that is more useful than sensitivity and specificity estimates.

Objective: To assess how physicians' estimates about probability of illness are affected by the presentation of a diagnostic test's value as an estimate of sensitivity and specificity versus a likelihood ratio or an inexact numerical graphic.

Design: Random assignment of vignettes with different presentation formats of diagnostic test accuracy.

Education and a standardized management protocol improve the assessment and management of asthma in the emergency department.

Study Objective: To evaluate the effect of a standardized management protocol on acute asthma care in the emergency department (ED).

Method: We conducted a before-after study regarding acute asthma management. Deficiencies in acute asthma care over a time period of 19 month (January 1997- October 1998) were identified.

Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality -- a systematic review.

Background: Acute exacerbations of chronic obstructive pulmonary disease (COPD) represent a major burden for patients and health care systems. Respiratory rehabilitation may improve prognosis in these patients by addressing relevant risk factors for exacerbations such as low exercise capacity. To study whether respiratory rehabilitation after acute exacerbation improves prognosis and health status compared to usual care, we quantified its effects using meta-analyses.

Ultrasonography in screening for developmental dysplasia of the hip in newborns: systematic review.

Objective: To assess the accuracy and effectiveness of the screening of all newborn infants for developmental dysplasia of the hip (DDH) using ultrasound imaging, as is standard practice in some European countries but not in the United Kingdom, the United States, or Scandinavia.

Design: Systematic review.

Data Sources: Twenty three medical, economic, and grey literature databases (to March 2004), with no limitations of design or language; some references were provided by experts.

Oral purified bacterial extracts in chronic bronchitis and COPD: systematic review.

Background: Oral lyophilized extracts of bacteria species have been used since the early 1970s to improve symptoms and to prevent exacerbations in COPD patients. The value of these treatments, which are thought to be immunomodulating, is poorly understood. Our aim was to quantify the efficacy of oral bacteria extracts in patients with chronic bronchitis and COPD.

[Medical decision making: some aspects].

Three main aspects of medical decision making will be shortly described in this article. Comprehensible information is required to make decisions. The question is, how much information is needed to make decisions, and a third aspect in this article concerns the decision maker.

What is the impact of the ACE gene insertion/deletion (I/D) polymorphism on the clinical effectiveness and adverse events of ACE inhibitors?--Protocol of a systematic review.

Background: The Angiotensin Converting Enzyme (ACE) insertion/deletion (I/D) polymorphism has received much attention in pharmacogenetic research because observed variations in response to ACE inhibitors might be associated with this polymorphism. Pharmacogenetic testing raises the hope to individualise ACE inhibitor therapy in order to optimise its effectiveness and to reduce adverse effects for genetically different subgroups. However, the extent of its effect modification in patients treated with ACE inhibitors remains inconclusive.

[Where are the boundaries of science in medicine?].

Medicine in general can be described as science and praxis. A central aspect of every science is the formation of theories and the testing of these theories and hypotheses with methods accepted by the scientific community as the adequate way to do it. Modern medicine defined as science is based on knowledge from natural sciences as well as the humanities.

Comprehensive Geriatric Assessment (CGA) in general practice: results from a pilot study in Vorarlberg, Austria.

Background: Most comprehensive geriatric assessment (CGA) programs refer to hospital-based settings. However the body of geriatric healthcare is provided by general practitioners in their office. Structured geriatric problem detection by means of assessment instruments is crucial for efficient geriatric care giving in the community.

[Pharmacogenetics. Tailored therapy in medicine -- opportunities and challenges].

This article provides a general introduction into the field of pharmacogenetics and discusses its opportunities and limits. Pharmacogenetic research explores genetic variability between patients to explain observed differences in effectiveness of a drug therapy or adverse event profiles. Sometimes drug therapy is unfavourable: Patients may respond only partially to a drug therapy, do not respond at all, or suffer from serious adverse events.

[Preserving vision in the elderly: a survey to start a quality development program in general practice].

The study examined the rate of patients, who do not follow recommendations for routine screening, do not visit physicians for eye-symptoms and when suffering from diabetes or glaucoma do not adhere to follow-up. To what extent can primary care physicians impact on these deficits of ophthalmologic care? 4918 consecutive, > or = 40 old patients of 107 primary care physicians of 9 networks participated. Of these patients 15% had never, 43% not within the last 3 years, consulted an ophthalmologist.

The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review.

Background: The Ottawa knee rule is a clinical decision aid that helps rule out fractures and avoid unnecessary radiography.

Purpose: To summarize evidence about the accuracy of the Ottawa knee rule.

Data Sources: Relevant English- and non-English-language articles were identified from PreMEDLINE and MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL (1982-2003), BIOSIS (1990-2003), the Cochrane Library (2002, Issue 3), the Science Citation Index database, reference lists of included studies, and experts.

Observational studies on ultrasound screening for developmental dysplasia of the hip in newborns - a systematic review.

Aim: To assess whether observational studies provide evidence to support general ultrasound screening for developmental dysplasia of the hip (DDH).

Method: Systematic Review. Following a predefined study protocol, observational studies on ultrasound screening in unselected newborns were identified by search through 23 electronic databases and by hand search.