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Journal of Dentistry Oct 2022To assess the clinical evidence for professionally applied fluoride therapy to prevent and arrest caries in older adults. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the clinical evidence for professionally applied fluoride therapy to prevent and arrest caries in older adults.
DATA/SOURCES
Two independent researchers searched the English literature published up to 31st Dec 2021 in five databases (PubMed, Scopus, the Cochrane Library, EMBASE, and Web of Science) for clinical trials with a comparison group on professionally applied fluoride therapy for caries prevention or arrest at older adults aged ≥60 years with any follow-up period. The outcomes were the mean difference in the number of new caries/caries-prevented fraction and caries arrest rate. The Cochrane guidelines were used for the risk of bias assessment.
STUDY SELECTION/RESULTS
Five hundred and twenty-seven studies were identified, and seven studies were finally included. Five studies were rated as having 'low risk'. The root caries-prevented fraction of 38% silver diamine fluoride (SDF) solution, 5% sodium fluoride (NaF) varnish, and 1.23% acidulated phosphate fluoride (APF) gel were 25-71%, 64%, and 32%, respectively. Meta-analysis indicated a decrease in the number of new root caries by 0.55 (95% CI: 0.32-0.78; p < 0.001) and an overall proportion of arrested root caries of 42% (95% CI: 33% to 49%; p < 0.001) after receiving 38% SDF application at the 24-month follow-up.
CONCLUSIONS
According to the findings, 5% NaF varnish and 1.23% APF gel prevented root caries, whereas 38% SDF solution prevented and arrested root caries in older adults. More well-designed clinical trials should be conducted to investigate various methods in caries prevention and arrest in older adults.
CLINICAL SIGNIFICANCE
Preventive measures effective in other age groups may not suit older adults, as caries type and associated risk factors vary. To date, no systematic review has evaluated professionally applied fluoride therapy in older adults. Evidence from clinical trials in older adults could aid clinical practice and public health measures. The International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42022307025.
Topics: Aged; Humans; Acidulated Phosphate Fluoride; Cariostatic Agents; Dental Caries; Fluorides; Fluorides, Topical; Quaternary Ammonium Compounds; Root Caries; Silver Compounds; Sodium Fluoride
PubMed: 36058347
DOI: 10.1016/j.jdent.2022.104273 -
Annals of Internal Medicine Feb 2016In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49 years.
PURPOSE
To review studies of the effectiveness of breast cancer screening in average-risk women.
DATA SOURCES
MEDLINE and Cochrane databases to 4 June 2015.
STUDY SELECTION
English-language randomized, controlled trials and observational studies of screening with mammography, magnetic resonance imaging, and ultrasonography that reported breast cancer mortality, all-cause mortality, or advanced breast cancer outcomes.
DATA EXTRACTION
Investigators extracted and confirmed data and dual rated study quality; discrepancies were resolved through consensus.
DATA SYNTHESIS
Fair-quality evidence from a meta-analysis of mammography trials indicated relative risks (RRs) for breast cancer mortality of 0.92 for women aged 39 to 49 years (95% CI, 0.75 to 1.02) (9 trials; 3 deaths prevented per 10,000 women over 10 years); 0.86 for those aged 50 to 59 years (CI, 0.68 to 0.97) (7 trials; 8 deaths prevented per 10,000 women over 10 years); 0.67 for those aged 60 to 69 years (CI, 0.54 to 0.83) (5 trials; 21 deaths prevented per 10,000 women over 10 years); and 0.80 for those aged 70 to 74 years (CI, 0.51 to 1.28) (3 trials; 13 deaths prevented per 10,000 women over 10 years). Risk reduction was 25% to 31% for women aged 50 to 69 years in observational studies of mammography screening. All-cause mortality was not reduced with screening. Advanced breast cancer was reduced for women aged 50 years or older (RR, 0.62 [CI, 0.46 to 0.83]) (3 trials) but not those aged 39 to 49 years (RR, 0.98 [CI, 0.74 to 1.37]) (4 trials); less evidence supported this outcome.
LIMITATIONS
Most trials used imaging technologies and treatments that are now outdated, and definitions of advanced breast cancer were heterogeneous. Studies of effectiveness based on risk factors, intervals, or other modalities were unavailable or methodologically limited.
CONCLUSION
Breast cancer mortality is generally reduced with mammography screening, although estimates are not statistically significant at all ages and the magnitudes of effect are small. Advanced cancer is reduced with screening for women aged 50 years or older.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Age Factors; Aged; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Middle Aged; Risk Factors; Time Factors
PubMed: 26756588
DOI: 10.7326/M15-0969 -
The Cochrane Database of Systematic... Mar 2016Post-dural puncture headache (PDPH) is a common complication of lumbar punctures. Several theories have identified the leakage of cerebrospinal fluid (CSF) through the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Post-dural puncture headache (PDPH) is a common complication of lumbar punctures. Several theories have identified the leakage of cerebrospinal fluid (CSF) through the hole in the dura as a cause of this side effect. It is therefore necessary to take preventive measures to avoid this complication. Prolonged bed rest has been used to treat PDPH once it has started, but it is unknown whether prolonged bed rest can also be used to prevent it. Similarly, the value of administering fluids additional to those of normal dietary intake to restore the loss of CSF produced by the puncture is unknown. This review is an update of a previously published review in the Cochrane Database of Systematic Reviews (Issue 7, 2013) on "Posture and fluids for preventing post-dural puncture headache".
OBJECTIVES
To assess whether prolonged bed rest combined with different body and head positions, as well as administration of supplementary fluids after lumbar puncture, prevent the onset of PDPH in people undergoing lumbar puncture for diagnostic or therapeutic purposes.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and LILACS, as well as trial registries up to February 2015.
SELECTION CRITERIA
We identified randomized controlled trials that compared the effects of bed rest versus immediate mobilization, head-down tilt versus horizontal position, prone versus supine positions during bed rest, and administration of supplementary fluids versus no/less supplementation, as prevention measures for PDPH in people who have undergone lumbar puncture.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the studies for eligibility through the web-based software EROS (Early Review Organizing Software). Two different review authors independently assessed risk of bias using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We resolved any disagreements by consensus. We extracted data on cases of PDPH, severe PDPH, and any headache after lumbar puncture and performed intention-to-treat analyses and sensitivity analyses by risk of bias. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created a 'Summary of findings' table.
MAIN RESULTS
We included 24 trials with 2996 participants in this updated review. The number of participants in each trial varied from 39 to 382. Most of the included studies compared bed rest versus immediate mobilization, and only two assessed the effects of supplementary fluids versus no supplementation. We judged the overall risk of bias of the included studies as low to unclear. The overall quality of evidence was low to moderate, downgraded because of the risk of bias assessment in most cases. The primary outcome in our review was the presence of PDPH.There was low quality evidence for an absence of benefits associated with bed rest compared with immediate mobilization on the incidence of severe PDPH (risk ratio (RR) 0.98; 95% confidence interval (CI) 0.68 to 1.41; participants = 1568; studies = 9) and moderate quality evidence on the incidence of any headache after lumbar puncture (RR 1.16; 95% CI 1.02 to 1.32; participants = 2477; studies = 18). Furthermore, bed rest probably increased PDPH (RR 1.24; 95% CI 1.04 to 1.48; participants = 1519; studies = 12) compared with immediate mobilization. An analysis restricted to the most methodologically rigorous trials (i.e. those with low risk of bias in allocation method, missing data and blinding of outcome assessment) gave similar results. There was low quality evidence for an absence of benefits associated with fluid supplementation on the incidence of severe PDPH (RR 0.67; 95% CI 0.26 to 1.73; participants = 100; studies = 1) and PDPH (RR 1; 95% CI 0.59 to 1.69; participants = 100; studies = 1), and moderate quality evidence on the incidence of any headache after lumbar puncture (RR 0.94; 95% CI 0.66 to 1.34; participants = 200; studies = 2). We did not expect other adverse events and did not assess them in this review.
AUTHORS' CONCLUSIONS
Since the previous version of this review, we found one new study for inclusion, but the conclusion remains unchanged. We considered the quality of the evidence for most of the outcomes assessed in this review to be low to moderate. As identified studies had shortcomings on aspects related to randomization and blinding of outcome assessment, we therefore downgraded the quality of the evidence. In general, there was no evidence suggesting that routine bed rest after dural puncture is beneficial for the prevention of PDPH onset. The role of fluid supplementation in the prevention of PDPH remains unclear.
Topics: Bed Rest; Early Ambulation; Fluid Therapy; Head; Humans; Patient Positioning; Post-Dural Puncture Headache; Posture; Spinal Puncture
PubMed: 26950232
DOI: 10.1002/14651858.CD009199.pub3 -
BMC Medicine Jul 2012Lower limb injuries in sport are increasingly prevalent and responsible for large economic as well as personal burdens. In this review we seek to determine which easily... (Review)
Review
The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review.
BACKGROUND
Lower limb injuries in sport are increasingly prevalent and responsible for large economic as well as personal burdens. In this review we seek to determine which easily implemented functional neuromuscular warm-up strategies are effective in preventing lower limb injuries during sports participation and in which sporting groups they are effective.
METHODS
Seven electronic databases were searched from inception to January 2012 for studies investigating neuromuscular warm-up strategies and injury prevention. The quality of each included study was evaluated using a modified version of the van Tulder scale. Data were extracted from each study and used to calculate the risk of injury following application of each evaluated strategy.
RESULTS
Nine studies were identified including six randomized controlled trials (RCT) and three controlled clinical trials (CCT). Heterogeneity in study design and warm-up strategies prevented pooling of results. Two studies investigated male and female participants, while the remaining seven investigated women only. Risk Ratio (RR) statistics indicated 'The 11+' prevention strategy significantly reduces overall (RR 0.67, confidence interval (CI) 0.54 to 0.84) and overuse (RR 0.45, CI 0.28 to 0.71) lower limb injuries as well as knee (RR 0.48, CI 0.32 to 0.72) injuries among young amateur female footballers. The 'Knee Injury Prevention Program' (KIPP) significantly reduced the risk of noncontact lower limb (RR 0.5, CI 0.33 to 0.76) and overuse (RR 0.44, CI 0.22 to 0.86) injuries in young amateur female football and basketball players. The 'Prevent Injury and Enhance Performance' (PEP) strategy reduces the incidence of anterior cruciate ligament (ACL) injuries (RR 0.18, CI 0.08 to 0.42). The 'HarmoKnee' programme reduces the risk of knee injuries (RR 0.22, CI 0.06 to 0.76) in teenage female footballers. The 'Anterior Knee Pain Prevention Training Programme' (AKP PTP) significantly reduces the incidence of anterior knee pain (RR 0.27, CI 0.14 to 0.54) in military recruits.
CONCLUSIONS
Effective implementation of practical neuromuscular warm-up strategies can reduce lower extremity injury incidence in young, amateur, female athletes and male and female military recruits. This is typically a warm-up strategy that includes stretching, strengthening, balance exercises, sports-specific agility drills and landing techniques applied consistently for longer than three consecutive months. In order to optimize these strategies, the mechanisms for their effectiveness require further evaluation.
Topics: Athletes; Athletic Injuries; Equipment and Supplies; Exercise; Female; Humans; Incidence; Lower Extremity; Male; Military Personnel; Randomized Controlled Trials as Topic; Young Adult
PubMed: 22812375
DOI: 10.1186/1741-7015-10-75 -
Quality & Safety in Health Care Jun 2008Adverse events in hospitals constitute a serious problem with grave consequences. Many studies have been conducted to gain an insight into this problem, but a general... (Review)
Review
INTRODUCTION
Adverse events in hospitals constitute a serious problem with grave consequences. Many studies have been conducted to gain an insight into this problem, but a general overview of the data is lacking. We performed a systematic review of the literature on in-hospital adverse events.
METHODS
A formal search of Embase, Cochrane and Medline was performed. Studies were reviewed independently for methodology, inclusion and exclusion criteria and endpoints. Primary endpoints were incidence of in-hospital adverse events and percentage of preventability. Secondary endpoints were adverse event outcome and subdivision by provider of care, location and type of event.
RESULTS
Eight studies including a total of 74 485 patient records were selected. The median overall incidence of in-hospital adverse events was 9.2%, with a median percentage of preventability of 43.5%. More than half (56.3%) of patients experienced no or minor disability, whereas 7.4% of events were lethal. Operation- (39.6%) and medication-related (15.1%) events constituted the majority. We present a summary of evidence-based interventions aimed at these categories of events.
CONCLUSIONS
Adverse events during hospital admission affect nearly one out of 10 patients. A substantial part of these events are preventable. Since a large proportion of the in-hospital events are operation- or drug-related, interventions aimed at preventing these events have the potential to make a substantial difference.
Topics: Data Interpretation, Statistical; Health Services Research; Hospitals; Humans; Medical Errors; Risk Management
PubMed: 18519629
DOI: 10.1136/qshc.2007.023622 -
BMJ Quality & Safety Apr 2014Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use.
METHODS
To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation.
RESULTS
30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was -1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD -0.37; p<0.001) but not in reminder studies (SMD, -1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs.
CONCLUSIONS
UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits.
Topics: Catheter-Related Infections; Humans; Practice Guidelines as Topic; Quality Improvement; Reminder Systems; Unnecessary Procedures; Urinary Catheterization
PubMed: 24077850
DOI: 10.1136/bmjqs-2012-001774 -
Journal of Rehabilitation Medicine May 2008This article reviewed the literature to clarify the physiological effects and benefits of, and misconceptions about, stretches used to reduce musculoskeletal disorders. (Review)
Review
OBJECTIVE
This article reviewed the literature to clarify the physiological effects and benefits of, and misconceptions about, stretches used to reduce musculoskeletal disorders.
METHODS
Nine databases were reviewed to identify studies exploring the effectiveness of stretching to prevent work-related musculoskeletal disorders. Included studies were reviewed and their methodological quality was assessed using the PEDro scale.
RESULTS
The physiological effects of stretches may contribute to reducing discomfort and pain. However, if other measures are not in place to remediate their causes, stretches may suppress awareness of risks, resulting in more debilitating injuries. If inadequately performed, stretches may also cause or aggravate injuries. Careful analysis and stretching program design are required before implementing stretches. Seven studies evaluating the effectiveness of stretching to prevent musculoskeletal disorders in different occupations were identified and reviewed.
CONCLUSION
The studies provided mixed findings, but demonstrated some beneficial effect of stretching in preventing work-related musculoskeletal disorders. However, due to the relatively low methodological quality of the studies available in the literature, future studies are necessary for a definite response. Future studies should minimize threats to internal and external validity, have control groups, use appropriate follow-up periods, and present a more detailed description of the interventions and worker population.
Topics: Cumulative Trauma Disorders; Follow-Up Studies; Humans; Muscle Contraction; Muscle Stretching Exercises; Musculoskeletal Diseases; Occupational Diseases; Pain; Pain Management; Range of Motion, Articular; Reminder Systems; Software; Treatment Outcome
PubMed: 18461255
DOI: 10.2340/16501977-0204 -
The Cochrane Database of Systematic... 2003Fluoride toothpastes have been widely used for over three decades and remain a benchmark intervention for the prevention of dental caries. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fluoride toothpastes have been widely used for over three decades and remain a benchmark intervention for the prevention of dental caries.
OBJECTIVES
To determine the effectiveness and safety of fluoride toothpastes in the prevention of caries in children and to examine factors potentially modifying their effect.
SEARCH STRATEGY
We searched the Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers.
SELECTION CRITERIA
Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride toothpaste with placebo in children up to 16 years during at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS).
DATA COLLECTION AND ANALYSIS
Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in caries increments between the treatment and control groups expressed as a percentage of the increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects meta-regression analyses.
MAIN RESULTS
Seventy-four studies were included. For the 70 that contributed data for meta-analysis (involving 42,300 children) the D(M)FS pooled PF was 24% (95% confidence interval (CI), 21 to 28%; p<0.0001). This means that 1.6 children need to brush with a fluoride toothpaste (rather than a non-fluoride toothpaste) over three years to prevent one D(M)FS in populations with caries increment of 2.6 D(M)FS per year. In populations with caries increment of 1.1 D(M)FS per year, 3.7 children will need to use a fluoride toothpaste for three years to avoid one D(M)FS. There was clear heterogeneity, confirmed statistically (p<0.0001). The effect of fluoride toothpaste increased with higher baseline levels of D(M)FS, higher fluoride concentration, higher frequency of use, and supervised brushing, but was not influenced by exposure to water fluoridation. There is little information concerning the deciduous dentition or adverse effects (fluorosis).
REVIEWER'S CONCLUSIONS
Supported by more than half a century of research, the benefits of fluoride toothpastes are firmly established. Taken together, the trials are of relatively high quality, and provide clear evidence that fluoride toothpastes are efficacious in preventing caries.
Topics: Adolescent; Child; Dental Caries; Fluorides; Humans; Randomized Controlled Trials as Topic; Toothpastes
PubMed: 12535435
DOI: 10.1002/14651858.CD002278 -
The Cochrane Database of Systematic... Dec 2015It has been reported that neural tube defects (NTD) can be prevented with periconceptional folic acid supplementation. The effects of different doses, forms and schemes... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It has been reported that neural tube defects (NTD) can be prevented with periconceptional folic acid supplementation. The effects of different doses, forms and schemes of folate supplementation for the prevention of other birth defects and maternal and infant outcomes are unclear.
OBJECTIVES
This review aims to examine whether periconceptional folate supplementation reduces the risk of neural tube and other congenital anomalies (including cleft palate) without causing adverse outcomes in mothers or babies. This is an update of a previously published Cochrane review on this topic.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2015). Additionally, we searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (31 August 2015) and contacted relevant organisations to identify ongoing and unpublished studies.
SELECTION CRITERIA
We included all randomised or quasi-randomised trials evaluating the effect of periconceptional folate supplementation alone, or in combination with other vitamins and minerals, in women independent of age and parity.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the eligibility of studies against the inclusion criteria, extracted data from included studies, checked data entry for accuracy and assessed the risk of bias of the included studies. We assessed the quality of the body of evidence using the GRADE approach.
MAIN RESULTS
Five trials involving 7391 women (2033 with a history of a pregnancy affected by a NTD and 5358 with no history of NTDs) were included. Four comparisons were made: 1) supplementation with any folate versus no intervention, placebo or other micronutrients without folate (five trials); 2) supplementation with folic acid alone versus no treatment or placebo (one trial); 3) supplementation with folate plus other micronutrients versus other micronutrients without folate (four trials); and 4) supplementation with folate plus other micronutrients versus the same other micronutrients without folate (two trials). The risk of bias of the trials was variable. Only one trial was considered to be at low risk of bias. The remaining studies lacked clarity regarding the randomisation method or whether the allocation to the intervention was concealed. All the participants were blinded to the intervention, though blinding was unclear for outcome assessors in the five trials.The results of the first comparison involving 6708 births with information on NTDs and other infant outcomes, show a protective effect of daily folic acid supplementation (alone or in combination with other vitamins and minerals) in preventing NTDs compared with no interventions/placebo or vitamins and minerals without folic acid (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.17 to 0.58); five studies; 6708 births; high quality evidence). Only one study assessed the incidence of NTDs and showed no evidence of an effect (RR 0.07, 95% CI 0.00 to 1.32; 4862 births) although no events were found in the group that received folic acid. Folic acid had a significant protective effect for reoccurrence (RR 0.34, 95% CI 0.18 to 0.64); four studies; 1846 births). Subgroup analyses suggest that the positive effect of folic acid on NTD incidence and recurrence is not affected by the explored daily folic acid dosage (400 µg (0.4 mg) or higher) or whether folic acid is given alone or with other vitamins and minerals. These results are consistent across all four review comparisons.There is no evidence of any preventive or negative effects on cleft palate (RR 0.73, 95% CI 0.05 to 10.89; three studies; 5612 births; low quality evidence), cleft lip ((RR 0.79, 95% CI 0.14 to 4.36; three studies; 5612 births; low quality evidence), congenital cardiovascular defects (RR 0.57, 95% CI 0.24 to 1.33; three studies; 5612 births; low quality evidence), miscarriages (RR 1.10, 95% CI 0.94 to 1.28; five studies; 7391 pregnancies; moderate quality evidence) or any other birth defects (RR 0.94, 95% CI 0.53 to 1.66; three studies; 5612 births; low quality evidence). There were no included trials assessing the effects of this intervention on neonatal death, maternal blood folate or anaemia at term.
AUTHORS' CONCLUSIONS
Folic acid, alone or in combination with vitamins and minerals, prevents NTDs, but does not have a clear effect on other birth defects.
Topics: Dietary Supplements; Female; Folic Acid; Humans; Infant; Neural Tube Defects; Preconception Care; Pregnancy; Randomized Controlled Trials as Topic; Vitamin B Complex
PubMed: 26662928
DOI: 10.1002/14651858.CD007950.pub3 -
BMJ (Clinical Research Ed.) Dec 2003To determine whether parachutes are effective in preventing major trauma related to gravitational challenge. (Review)
Review
OBJECTIVES
To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.
DESIGN
Systematic review of randomised controlled trials.
DATA SOURCES
Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.
STUDY SELECTION
Studies showing the effects of using a parachute during free fall.
MAIN OUTCOME MEASURE
Death or major trauma, defined as an injury severity score > 15.
RESULTS
We were unable to identify any randomised controlled trials of parachute intervention.
CONCLUSIONS
As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
Topics: Accidents, Aviation; Death, Sudden; Humans; Odds Ratio; Protective Devices; Publication Bias; Randomized Controlled Trials as Topic; Wit and Humor as Topic; Wounds and Injuries
PubMed: 14684649
DOI: 10.1136/bmj.327.7429.1459