105 research outputs found
Therapeutic ultrasound for osteoarthritis of the knee or hip
No full textBACKGROUND: Osteoarthritis is the most common form of joint disease and the
leading cause of pain and physical disability in the elderly. Therapeutic
ultrasound is one of several physical therapy modalities suggested for the
management of pain and loss of function due to osteoarthritis (OA).
OBJECTIVES: To compare therapeutic ultrasound with sham or no specific
intervention in terms of effects on pain and function safety outcomes in patients
with knee or hip OA.
SEARCH STRATEGY: We updated the search in CENTRAL, CINAHL, EMBASE, MEDLINE and
PEDro up to 23 July 2009, checked conference proceedings, reference lists, and
contacted authors.
SELECTION CRITERIA: Studies were included if they were randomised or
quasi-randomised controlled trials that compared therapeutic ultrasound with a
sham intervention or no intervention in patients with osteoarthritis of the knee
or hip.
DATA COLLECTION AND ANALYSIS: Two independent review authors extracted data using
standardized forms. Investigators were contacted to obtain missing outcome
information. Standardised mean differences (SMDs) were calculated for pain and
function, relative risks for safety outcomes. Trials were combined using
inverse-variance random-effects meta-analysis.
MAIN RESULTS: Compared to the previous version of the review, four additional
trials were identified resulting in the inclusion of five small sized trials in a
total of 341 patients with knee OA. No trial included patients with hip OA. Two
evaluated pulsed ultrasound, two continuous and one evaluated both pulsed and
continuous ultrasound as the active treatment. The methodological quality and the
quality of reporting was poor and a high degree of heterogeneity among the trials
was revealed for function (88%). For pain, there was an effect in favour of
ultrasound therapy, which corresponded to a difference in pain scores between
ultrasound and control of -1.2 cm on a 10-cm VAS (95% CI -1.9 to -0.6 cm). For
function, we found a trend in favour of ultrasound, which corresponded to a
difference in function scores of -1.3 units on a standardised WOMAC disability
scale ranging from 0 to 10 (95% CI -3.0 to 0.3). Safety was evaluated in two
trials including up to 136 patients; no adverse event, serious adverse event or
withdrawals due to adverse events occurred in either trial.
AUTHORS' CONCLUSIONS: In contrast to the previous version of this review, our
results suggest that therapeutic ultrasound may be beneficial for patients with
osteoarthritis of the knee. Because of the low quality of the evidence, we are
uncertain about the magnitude of the effects on pain relief and function,
however. Therapeutic ultrasound is widely used for its potential benefits on both
knee pain and function, which may be clinically relevant. Appropriately designed
trials of adequate power are therefore warranted
La conexión entre la ética de los animales y la migración: Blosch de Beat Sterchi en el contexto de la literatura trascultural de la Suiza de habla alemana
No full textIn den letzten beiden Jahrzehnten des 20. Jahrhunderts hat sich in der deutschsprachigen Schweiz eine Literatur von AutorInnen herausgebildet, die mit fremdkulturellem Hintergrund schreiben und sich des Deutschen nicht selten als einer Fremdsprache bedienen. Diese AutorInnen sind teils Nachkommen von ArbeitsmigrantInnen, die im Zuge von Anwerbeabkommmen der Schweiz mit süd –und südosteuropäischen Ländern seit den 50er Jahren in die Schweiz kamen, teils politische oder aber Wirtschaftsflüchtlinge. Dabei blieb bisher der einzige grössere Migrationstext eines ‘einheimischen Autors’, der Roman Blösch von Beat Sterchi von 1983, etwas ausgeblendet. Dieser Text schildert mit grosser Sprachgewalt das Schikksal eines Arbeitsmigranten aus Galizien, der sich unvermittelt auf einem Berner Bauernhof und später im Schlachthof beschäftigt und hierbei gleichsam in einen ‘third space’ (Homi K. Bhabha) zwischen da und dort versetzt vorfindet. Der Beitrag möchte die vielfältigen Grenz– und Identitätsphänomene, die bei Sterchi verhandelt werden, beleuchten und aufzeigen, dass Texte dieser Art die sich vornehmlich auf klassisch-kanonische Quellen stützenden Diskusssion um die Frage nach einer ‘Schweizer Literatur’ in ein neues Licht zu rücken vermögen.Throughout the last two decades of the 20th Century, there has emerged a kind of literature in German-speaking Switzerland, which is written by authors of foreign cultural background and who seldom use German as a second language. In parts, these writers are descendants of migrant workers who have come to Switzerland from South and South-East European countries in the wake of guest-worker recruitments from the 1950s onwards. In effect they are political or economic refugees. For a long time the only larger migratory text by a ‘local author’, the novel Blösch by Beat Sterchi from 1983, would remain hidden. This text describes with great eloquence the fate of a guest-worker from Galicia, who suddenly starts working on a Bernese farm and later in a slaughterhouse and at the same time finds himself in a ‘third space’ (Homi K. Bhabha) moved between here and there. The article tries to examine and highlight the various border and identity phenomena, which are focussed on by Sterchi, and show that such texts are able to cast a different light on the discussion about a “Swiss literature” which has been primarily based on classical canonical sources.En las dos últimas décadas del siglo XX ha surgido una literatura suiza de habla alemana de autores que escriben con un fondo de cultura extranjera y para los que el alemán a menudo es una lengua extranjera. Estos escritores son en parte descendientes de trabajadores emigrantes que llegaron a Suiza en los años 50 a raíz de acuerdos con países del sur y sureste, en parte son refugiados políticos o económicos. Sin embargo, el único texto de migración importante escrito por una ‘autora local’, la novela Blosch de Beat Sterchi de 1983, ha quedado algo olvidado hasta ahora. Este texto describe con gran elocuencia el destino de un trabajador procedente de Galicia, que enseguida encuentra trabajo en una granja de Berna y más tarde en el matadero y que construye un tipo de “tercer espacio” (Homi K. Bhabha) entre el aquí y el allá. El estudio analizará los diferentes fenómenos fronterizos y de identidad, que se encuentran en Sterchi, y pretende demostrar que textos como éste son capaces de aportar nuevos impulsos a un debate sobre una literatura suiza basado sobre todo en fuentes clásicas y canónicas
The importance of allocation concealment and patient blinding in osteoarthritis trials: a meta-epidemiologic study
No full textOBJECTIVE: To evaluate the association of adequate allocation concealment and
patient blinding with estimates of treatment benefits in osteoarthritis trials.
METHODS: We performed a meta-epidemiologic study of 16 meta-analyses with 175
trials that compared therapeutic interventions with placebo or nonintervention
control in patients with hip or knee osteoarthritis. We calculated effect sizes
from the differences in means of pain intensity between groups at the end of
followup divided by the pooled SD and compared effect sizes between trials with
and trials without adequate methodology.
RESULTS: Effect sizes tended to be less beneficial in 46 trials with adequate
allocation concealment compared with 112 trials with inadequate or unclear
concealment of allocation (difference -0.15; 95% confidence interval [95% CI]
-0.31, 0.02). Selection bias associated with inadequate or unclear concealment of
allocation was most pronounced in meta-analyses with large estimated treatment
benefits (P for interaction < 0.001), meta-analyses with high between-trial
heterogeneity (P = 0.009), and meta-analyses of complementary medicine (P =
0.019). Effect sizes tended to be less beneficial in 64 trials with adequate
blinding of patients compared with 58 trials without (difference -0.15; 95% CI
-0.39, 0.09), but differences were less consistent and disappeared after
accounting for allocation concealment. Detection bias associated with a lack of
adequate patient blinding was most pronounced for nonpharmacologic interventions
(P for interaction < 0.001).
CONCLUSION: Results of osteoarthritis trials may be affected by selection and
detection bias. Adequate concealment of allocation and attempts to blind patients
will minimize these biases
Transcutaneous electrostimulation for osteoarthritis of the knee
No full textBACKGROUND: Osteoarthritis is the most common form of joint disease and the
leading cause of pain and physical disability in the elderly. Transcutaneous
electrical nerve stimulation (TENS), interferential current stimulation and
pulsed electrostimulation are used widely to control both acute and chronic pain
arising from several conditions, but some policy makers regard efficacy evidence
as insufficient.
OBJECTIVES: To compare transcutaneous electrostimulation with sham or no specific
intervention in terms of effects on pain and withdrawals due to adverse events in
patients with knee osteoarthritis.
SEARCH STRATEGY: We updated the search in CENTRAL, MEDLINE, EMBASE, CINAHL and
PEDro up to 5 August 2008, checked conference proceedings and reference lists,
and contacted authors.
SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that
compared transcutaneously applied electrostimulation with a sham intervention or
no intervention in patients with osteoarthritis of the knee.
DATA COLLECTION AND ANALYSIS: We extracted data using standardised forms and
contacted investigators to obtain missing outcome information. Main outcomes were
pain and withdrawals or dropouts due to adverse events. We calculated
standardised mean differences (SMDs) for pain and relative risks for safety
outcomes and used inverse-variance random-effects meta-analysis. The analysis of
pain was based on predicted estimates from meta-regression using the standard
error as explanatory variable.
MAIN RESULTS: In this update we identified 14 additional trials resulting in the
inclusion of 18 small trials in 813 patients. Eleven trials used TENS, four
interferential current stimulation, one both TENS and interferential current
stimulation, and two pulsed electrostimulation. The methodological quality and
the quality of reporting was poor and a high degree of heterogeneity among the
trials (I(2) = 80%) was revealed. The funnel plot for pain was asymmetrical (P <
0.001). The predicted SMD of pain intensity in trials as large as the largest
trial was -0.07 (95% CI -0.46 to 0.32), corresponding to a difference in pain
scores between electrostimulation and control of 0.2 cm on a 10 cm visual
analogue scale. There was little evidence that SMDs differed on the type of
electrostimulation (P = 0.94). The relative risk of being withdrawn or dropping
out due to adverse events was 0.97 (95% CI 0.2 to 6.0).
AUTHORS' CONCLUSIONS: In this update, we could not confirm that transcutaneous
electrostimulation is effective for pain relief. The current systematic review is
inconclusive, hampered by the inclusion of only small trials of questionable
quality. Appropriately designed trials of adequate power are warranted
Compartmentalised expression of meprin in small intestinal mucosa: enhanced expression in lamina propria in coeliac disease
No full textEpithelial cells in the human small intestine express meprin, an astacin-like metalloprotease, which accumulates normally at the brush border membrane and in the gut lumen. Therefore, meprin is targeted towards luminal components. In coeliac disease patients, peptides from ingested cereals trigger mucosal inflammation in the small intestine, disrupting epithelial cell differentiation and function. Using in situ hybridisation on duodenal tissue sections, we observed a marked shift of meprin mRNA expression from epithelial cells, the predominant expression site in normal mucosa, to lamina propria leukocytes in coeliac disease. Meprin thereby gains access to the substrate repertoire present beneath the epithelium
Automatisierung des kostenorientierten Medikamenten-Pricings der Swiss Caps AG - Implementierung einer R-Applikation inklusive automatisierten Quarto-Reportings und dynamischen Shiny-Dashboards
No full textBis zum heutigen Tag ist dieser Prozess weder automatisiert noch kontinuierlich überwacht. Im Rahmen von Neuverhandlungen stellen Accountmanagerinnen und -manager Anfragen an das Controlling zur Nachkalkulation einzelner Medikamente für auserwählte Kundinnen und Kunden, woraufhin das Controlling eine manuelle Produktpreiskalkulation durchführt und über eine allfällige Preisveränderung informiert. Dies führt dazu, dass nicht das gesamte Weiterverrechnungspotential identifiziert und genutzt wird, woraus sich ein möglicher Umsatzverlust und Gewinneinbruch ableiten lässt
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