Search

The article describes the efforts of the James Lind Alliance Priority Setting Partnership on Urinary Continence in helping patients and clinicians identify and prioritize gaps in evidence on commonly used interventions. Ten research priorities agreed upon by clinicians and patients are listed.

Objective--To determine the value of recommending breast shells or Hoffman's exercises, or both, to pregnant women with inverted or non-protractile nipples who intend to breast feed. Design--Randomised controlled trial with a two treatment by two level factorial design. Setting--Antenatal clinics in a district general hospital and the community. Subjects--96 nulliparous women recruited between 25 and 35 completed weeks in a singleton pregnancy with at least one inverted or non-protractile nipple. Main outcome measures--Anatomical change of nipples, judged blindly before first breast feeding, and success of breast feeding reported by postal questionnaire six weeks postnatally. Results--Sustained improvement in nipple anatomy was more common in the untreated groups but the differences were not significant (52% (25/48) shells [unkeyable]60% (29/48) no shells; differences; --8% (95% confidence interval -28% to 11%) and 54% (26/48) exercises [unkeyable]58% (28/48) no exercises; -4% (-24% to 16%)). 24(50%) women not recommended shells and 14(29%) recommended shells (21%;40% to 2%) were breast feeding six weeks after delivery (p=0.05), reflecting more women recommended shells both deciding to bottle feed before delivery and discontinuing breast feeding. The same number of women in exercise and no exercise groups were successfully breast feeding (0%; -20% to 20%). 13% of women approached about the trial (and planning to breast feed) did not attempt breast feeding. Conclusions--Recommending nipple preparation with breast shells may reduce the chances of successful breast feeding. While there is no clear evidence that the treatments offered are effective antenatal nipple examination should be abandoned.

Abstract Objectives To assess the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training compared with standard management among women with persistent incontinence three [...]

Background: A key aim when conducting systematic reviews of randomized controlled trials (RCTs) is to include all of the evidence, if possible. Serious bias may result if trials are missed through inadequate search strategies. Objective: The objective was to evaluate the search plan for identifying RCTs in nutrition as part of a systematic review, in The Cochrane Library, of nutritional supplementation trials in patients after hip fracture. Design: We identified potential studies by searching the electronic databases BIOSIS, CABNAR, CINAHL, EMBASE, HEALTHSTAR, and MEDLINE; reference lists in trial reports; and other relevant articles. We also contacted investigators and other experts for information and searched 4 nutrition journals by hand. Results: We identified 15 RCTs that met the predefined inclusion criteria. The search plan identified 8 trials each in EMBASE, HEALTHSTAR, and MEDLINE and 7 in BIOSIS and CABNAR. BIOSIS was the only electronic database source of 2 trials. Eleven trials were identified by searching electronic databases and 2 unpublished trials were identified via experts in the field. We found one trial, published only as a conference abstract, by searching nutrition journals by hand. After publication of the protocol for the review in The Cochrane Library, we were informed of another unpublished trial. Conclusions: We found that a limited search plan based on only MEDLINE or one of the other commonly available databases would have failed to locate nearly one-half of the studies. To protect against bias, the search plan for a systematic review of nutritional interventions should be comprehensive. Am J Clin Nutr 2001;73:505-10. KEY WORDS Systematic reviews, meta-analysis, search strategy, randomized controlled trials, nutrition, databases, bibliography, bias, MEDLINE