OBJECTIVE:To develop a meta-analysis to determine the effectiveness of rehabilitation in patients with chronic obstructive pulmonary disease (COPD).DATA SOURCES: MEDLINE, CINHAL, and Cochrane Library searches for trials of rehabilitation for COPD patients. Abstracts presented at national meetings and the reference lists of pertinent articles were reviewed.STUDY SELECTION: Studies were included if: trials were randomized; patients were symptomatic with forced expiratory volume in one second (FEV1) <70% or FEV1 divided by forced vital capacity (FEV1/FVC) <70% predicted; rehabilitation group received at least 4 weeks of rehabilitation; control group received no rehabilitation; and outcome measures included exercise capacity or shortness of breath. We identified 69 trials, of which 20 trials were included in the final analysis.DATA EXTRACTION: Effect of rehabilitation was calculated as the standardized effect size (ES) using random effects estimation techniques. RESULTS:The rehabilitation groups of 20 trials (979 patients) did significantly better than control groups on walking test (ES = 0.71; 95% confidence interval [95% CI], 0.43 to 0.99). The rehabilitation groups of 12 trials (723 patients) that used the Chronic Respiratory Disease Questionnaire had less shortness of breath than did the control groups (ES = 0.62; 95% CI, 0.35 to 0.89). Trials that used respiratory muscle training only showed no significant difference between rehabilitation and control groups, whereas trials that used at least lowerextremity training showed that rehabilitation groups did significantly better than control groups on walking test and shortness of breath. Trials that included severe COPD patients showed that rehabilitation groups did significantly better than control groups only when the rehabilitation programs were 6 months or longer. Trials that included mild/moderate COPD patients showed that rehabilitation groups did significantly better than control groups with both short-and long-term rehabilitation programs.CONCLUSION: COPD patients who receive rehabilitation have a better exercise capacity and they experience less shortness of breath than patients who do not receive rehabilitation. COPD patients may benefit from rehabilitation programs that include at least lower-extremity training. Patients with mild/ moderate COPD benefit from short-and long-term rehabilitation, whereas patients with severe COPD may benefit from rehabilitation programs of at least 6 months.KEY WORDS: rehabilitation; obstructive lung disease; shortness of breath; exercise; review. J GEN INTERN MED 2003;18:213±221.
AIM: Continuous quality improvement has been shown to work in urban and suburban clinics. The objective of this project is to test whether continuous quality improvement would improve the quality of care for patients with diabetes mellitus and/or hypertension in a rural health clinic.SETTING: Rural health clinic with 3 providers and two and half fulltime registered nurses. Patients were mostly older adults with Medicare health insurance.PROGRAM DESCRIPTION: Health care providers and nursing staff agreed on the quality improvement project. The intervention included providing quarterly feedback to health care providers, empowering the nurses to remind patients of diabetes care, and flagging the charts to remind providers. PROGRAM EVALUATION:The proportions of diabetic patients who had ophthalmologic exam, pneumococcal vaccine and lipid screening significantly improved over 12-month period. The proportions of patients with hypertension who had blood pressure less than 140/90 and patients who were taking aspirin also significantly improved over 12-month period.CONCLUSION: The quality of care for patients with diabetes and patients with hypertension could be improved in rural health clinics using repetitive cycles of measurements, implementation of interventions and evaluation of outcomes. This process could be used as the backbone for translation of evidence into practice and improving quality of care.
Short oral presentation abstractsfetus, the type of pregnancy (single or twin), diseases of the mother, elevated leukocyte count during pregnancy, abnormal amniotic fluid volume, condition of the bowel (echogenic bowel, massive inflammatory peel) and the use of intrauterine therapy (replacement of amniotic fluid). Multivariate logistic regression showed that the main independent risk factor having influence on the mortality was the vaginal mode of delivery (p = 0.01). Conclusions: In the present study, perinatal mortality due to gastroschisis seemed to depend mainly on vaginal mode of delivery and presence of associated congenital anomalies. OP33: SYSTEMATIC REVIEWS IN GYNECOLOGY OP33.01The impact of endometriosis and its staging on assisted reproduction outcomes: a systematic review and meta-analysis Objectives: Evaluate whether the presence or severity of endometriosis affect the outcomes of assisted reproductive techniques (ART). Methods: In this systematic review all studies comparing the ART outcomes of women with and without endometriosis or at different stages of the disease were considered eligible. Our primary outcome was live birth; the secondary outcome was clinical pregnancy. Miscarriage and the number of oocytes retrieved were examined as additional outcomes. Results: We included 90 studies in the review and 76 in the meta-analysis: 20,167 women with endometriosis were compared with 121,931 women without endometriosis; and 1,703 women with endometriosis III/IV were compared with 2,227 women with endometriosis I/II. The results are summarized in the table. Conclusions: Women with endometriosis undergoing ART have practically the same chance of achieving clinical pregnancy and live birth than women with other causes of infertility. No relevant difference was observed in the chance of achieving clinical pregnancy and live birth following ART when comparing endometriosis III/IV with endometriosis I/II. The quality of the evidence for the additional examined outcomes was very low, not allowing meaningful conclusions. OP33.02How good are the sonographic markers in detecting endometrial polyps? A systematic review and meta-analysis G. Salman EGA Institute for Women's Health, UCL and UCLH NHS Foundation Trust, UK, London, United KingdomObjectives: The precise diagnosis of endometrial polyp can remain a challenge for ultrasound operators when detecting an endometrial polypoid mass on ultrasound examination. The aim of the review was to assess the accuracy of different sonographic features (echogenic lesion, cystic spaces, bright edge line and feeder vessel) described in the literature when diagnosing endometrial polyps to answer the question, which of the sonographic markers is most likely to diagnose endometrial polyp. Methods: Comparative studies (1960 to March 2013) were selected if they were compliant with the eligibility criteria and contained data from the diagnostic test (ultrasound) and from reference test (histology. The analysis of the outcomes was performed using the logit scale (logit = log (p/(1...
Objectives: To assess the reproducibility of tumor volume evaluation at three dimensional (3D) transvaginal ultrasound (TVUS) with virtual organ computer-aided analysis (VOCAL) software in patients with endometrial cancer. Methods: Consecutive patients with confirmed histological diagnosis of endometrial cancer underwent TVUS performed by an experienced examiner (Observer A at the National Cancer Institute and B at the University of Milan Bicocca) with 3D volumes storage. Each tumor volume was independently calculated offline using VOCAL software and volume contrast imaging (VCI) enhancement by the two examiners. Finally, a beginner examiner (Observer C) independently recalculated the tumor volumes. A consensus was defined for the analysis: box A was considered as reference image, the angle of rotation was 15 • , VCI slice thickness was 2 mm. Reproducibility study was performed. Results: 54 patients were enrolled and underwent TVUS within one week prior to surgery. Mean (SD) volume evaluated by Observer A, B and C were 20.52 (± 36.06), 20.38 (± 35.46) and 20.45 (± 35.7), respectively. No between-group difference in tumor volume was observed (p = 0.94, Kruskal-Wallis Test). No differences in tumor volumes was observed comparing results of the two skilled examiners (p = 0.73, Mann Whitney test). Interestingly, the beginner examiner detected similar tumor volumes than the experienced ones (p = 0.97). Similarly, no differences were observed comparing the beginner examiner with Observer A (p = 0.94) and Observer B (p = 0.84). Conclusions: Our study suggests the reliability and reproducibility of tumor volume assessment during preoperative TVUS examination. Both beginner and skilled examiners experienced similar results, thus suggesting the feasibility of this technique. The relationship between tumor volume and intraoperative and histologic findings that might determine surgical and adjuvant treatments has to be investigated.
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