Van Tulder Scale Research Articles

Evaluation of pharmaceutical care services in the Middle East Countries: a review of studies of 2013–2020

IntroductionPharmaceutical care services (PCs) have evolved significantly over the last few decades, with a greater focus on patient’s safety and proven effectiveness in a wide range of contexts. Many of the evidence supporting this technique comes from the United States, the evaluation and adoption of (PCs) which differ greatly across the globe.ObjectiveThe goal of this study was to identify and assess the efficacy of pharmaceutical care services in various pharmaceutical aspects throughout seventeen Middle Eastern nations.MethodThe Arkesy and O’Malley technique was used to conduct a scoping review. It was conducted using PubMed/Medline, Scopus, Cochrane Library, Springer Link, Clinical Trials, and Web of Science etc. The Van Tulder Scale was utilized in randomized trials research, whereas the dawn and black checklists were used in non-randomized trials research. A descriptive and numerical analysis of selected research was done. The scope of eligible PCs, pharmaceutical implementers, study outcomes, and quality were all identified by a thematic review of research.ResultsThere were about 431,753 citations found in this study, and 129 publications were found to be eligible for inclusion after analysing more than 271 full-text papers. The study design was varied, with 43 (33.3%) RCTs and 86 (66.7%) n-RCTs. Thirty-three (25.6%) of the studies were published in 2020. Jordan, Saudi Arabia, and Turkey were home to the majority of the studies (25.6%, 16.3%, and 11.6%) respectively. Thirty-seven studies (19.7%) were concerned with resolving drug related problems (DRPs), whereas 27 (14.4%) were concerned with increasing quality of life (QOL) and 23 (12.2%) with improving drug adherence. Additionally, the research revealed that the average ratings of the activities provided to patients improved every year.ConclusionStudies in the Middle East continue to provide evidence supporting the positive impact of pharmaceutical care services on both hard and soft outcomes measured in most studies. Yet there was rare focus on the value of the implemented services. Thus, rigorous evaluation of the economic impact of implemented pharmaceutical care services in the Middle East and assessment of their sustainability is must.

Risk of bias for randomized controlled trials in Journal of Clinical Monitoring and Computing.

Well-designed randomized controlled trials (RCTs) are considered to represent a high level of evidence and influence medical decision-making in evidence-based medicine. When biases occur in study design, processing, and reporting of RCTs, however, it is difficult to interpret results and judge the impact of interventions. Accordingly, we evaluate the quality of RCT reporting published in the Journal of Clinical Monitoring and Computing (JCMC) using three assessment tools. Reporting quality of RCTs published in the JCMC was evaluated through December 31, 2020, using Jadad and van Tulder scales and the Cochrane Collaboration's risk of bias tool (CCRBT). Stepwise regression analysis was performed to identify factors associated with reporting quality. Database searches confirmed 132 RCTs in 1,507 original articles. The numbers of RCTs meeting criteria for high reporting quality were 97 (73.5%) using the Jadad scale, 99 (75.0%) using the van Tulder scale, and 19 (14.4%) with the CCRBT. Jadad scores [median score (interquartile range) = 3.0 (2.0-5.0), coefficients (95% CI) = 0.08 (0.04, 0.11), p < 0.001], van Tulder scores [median score (interquartile range) = 7.0 (5.0-8.75), coefficients (95% CI) = 0.15 (0.11, 0.20), p < 0.001], and CCRBT assessment [coefficients (95% CI) = 0.04 (0.02, 0.06), p < 0.001] increased significantly with publication year. The median score (interquartile range) of the last 5 years were 4.0 (3.0-5.0) in Jadad scores, and 8.0 (6.0-9.0) in van Tulder scores. Only 33.3% and 37.1% of articles described detailed blinding and allocation methods, respectively. Reporting quality increased over time, with consistently high reporting quality in recently published JCMC RCTs.

Quality Assessment and Relevant Clinical Impact of Randomized Controlled Trials of Varicocele: Next Step to Good-Quality Randomized Controlled Trial of Varicocele Treatment.

PurposeTo assess the quality of randomized controlled trials (RCTs) on varicocele published from 1979 to 2017.Materials and MethodsWe searched for original RCT on varicocele published between 1979 and 2017. Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool were used to analyze RCT quality over time. Effects on RCT quality including funding source, Institutional Review Board (IRB) approval, and intervention were assessed. Treatment parameters of varicocele were also analyzed.ResultsBlinding and allocation concealment were described in 25.9% and 9.4% of RCT, respectively. Both tended to increase and a sharp dip in allocation concealment was observed in 2010–2017. Jadad scores increased steadily from 1979 to 2017 (1.28±0.59 to 2.19±1.10, p<0.01). Van Tulder scores tended to increase from 1979 to 2017 (4.21±0.94 to 5.58±1.58, p<0.01). RCTs with funding statements had higher Jadad (Yes vs. No, 3.25±0.50 vs. 1.70±0.97; p<0.01) and van Tulder (Yes vs. No, 7.25±1.26 vs. 4.81±1.26; p<0.01) scores than unfunded RCTs. IRB approval and intervention were associated with better quality.ConclusionsThe number of RCTs on varicocele increased from 1979 to 2017. Also, quality improved over time with increasing IRB approval, funding, and multicenter trial. Most RCTs on varicocele reported the use of surgical treatment. RCTs of surgical treatments have limitations to satisfy the condition of RCT to conduct, but their quality has improved over time.

A Systematic Review of Clinical Interventions Facilitating End-of-Life Communication Between Patients and Family Caregivers.

Communication between patients and family caregivers plays a key role in successful end-of-life (EOL) care. In the majority of cases, health-care providers (HCP) are responsible for leading this communication in clinical settings. This systematic review aimed to examine the evidence for the efficacy of HCP-led interventions in enhancing communication between patients and family caregivers. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a search of MEDLINE via PubMed, CINAHL, Scopus, Embase, and PsycINFO as well as a manual search for additional articles on Google Scholar without date restrictions. Of 2955 articles retrieved, 8 meeting the eligibility criteria were included in the review. A quality appraisal of the selected studies was performed using the van Tulder Scale, with 5 of 8 studies rated as high quality. All 8 studies employed psychoeducational interventions involving both patients and surrogate/family caregivers. Common elements of the interventions reviewed included encouraging participant dyads to share their concerns about the patient's medical condition, clarify their goals and values for EOL care, and discuss their EOL care preferences. Of 8 interventions reviewed, 6 measured EOL care preference congruence within dyads as a primary outcome, and all 6 interventions were effective in increasing congruence. Secondary outcomes measured included decisional conflict and relationship quality, with mixed outcomes reported. This review suggests that HCP-led EOL communication interventions show promise for improving EOL care preference congruence. However, further studies with improved methodological rigor are needed to establish the optimal timing, intensity, and duration of interventions.

Reporting Quality Analysis of Randomized Controlled Trials in Journal of Neurosurgical Anesthesiology: A Methodological Assessment.

Randomized controlled trials (RCTs) are considered to provide high levels of evidence to optimize decision-making for patient care, although there can be a risk bias in their design, conduct, and analysis. Quality assessment of RCTs is necessary to assess whether they provide reliable results with little bias. We assessed the reporting quality of RCTs published in the Journal of Neurosurgical Anesthesiology (JNA) between January 1, 2000 and December 31, 2017 using the Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool (CCRBT). We identified 130 RCTs and 570 original articles. Among the 130 RCTs, 92 (70.8%) presented an appropriate blinding method, and 70 (53.8%) described an appropriate allocation method. For the entire period, the percentages of high-quality reporting articles were 71.5%, 73.1%, and 13.8% in the Jadad scale, van Tulder scale, and CCRBT assessments, respectively. There was an improvement in the van Tulder scale over time (coefficients [95% confidence interval {CI}]=0.08 [0.01-0.15]; P=0.02). Appropriate reporting of allocation in the Jadad scale (coefficients [95% CI]=1.68 [1.28-2.07]; P<0.001) and van Tulder scale (coefficients [95% CI]=2.34 [1.97-2.70]; P<0.001), and reporting of blinding in the Jadad (coefficients [95% CI]=1.09 [0.66-1.52]; P<0.001) and van Tulder scores (coefficients [95% CI]=1.85 [1.45-2.25]; P<0.001), were associated with high-quality reporting. The ratio of high-quality reporting RCTs in JNA was consistently high compared with other journals. Thorough consideration of allocation concealment during the peer review process can further improve the reporting quality of RCTs in JNA.

Randomized controlled trials on erectile dysfunction: quality assessment and relevant clinical impact (2007-2018).

The aim of this study was to assess the quality of randomized controlled trials (RCTs) on erectile dysfunction (ED) conducted from 2007 to 2018. We searched for RCT original articles on ED published between 2007 and 2018 using PubMed, Embase, and Cochrane Library databases. RCT quality assessment was performed using Jadad scale, van Tulder scale, and Cochrane Collaboration's Risk of Bias Tool. The effects on RCT quality of including treatment methods, funding sources, institutional review board (IRB) approval statements, and intervention description to the studies were assessed. Blinding and allocation concealment were described in 67.9 and 8.7% of the RCTs, respectively. Blinding tended to decrease, but a sharp rise in blinding was observed in 2011-2012 and allocation in 2017-2018. Funding statement inclusion (60.3% overall) and intervention description (96.4% overall) tended to increase steadily. IRB statement inclusion (78.3% overall) increased (p = 0.05). Jadad scores rose significantly until 2011-2012 but decreased thereafter except 2017-2018 (p = 0.09). RCTs with funding statements had higher Jadad and van Tulder scores than unfunded RCTs (p < 0.01 and 0.02, respectively). Quality improvement has observed from 2007 to 2012 and 2017 to 2018 with Jadad scale because of increased funding, multicenter studies, and intervention description.

Quality analysis of randomized controlled trials in the International Journal of Impotence Research: quality assessment and relevant clinical impact.

The quality of randomized controlled trials (RCTs) reported in the International Journal of Impotence Research (IJIR) was analyzed. The original articles that reported RCTs and were published in the IJIR in 1997-2014 were identified by PubMed. Their methodological quality was assessed using the Jadad scale, van Tulder scale and Cochrane Collaboration Risk of Bias Tool. The review period was divided into three periods: early (1997-2002), mid (2003-2008) and late (2009-2014). The effect of study subject and presence of Institutional Review Board approval, intervention, funding and adequate allocation concealment on RCT quality was assessed. The frequency of RCT publication in the IJIR did not change over the 19-year study period. Numbers of low risk of bias articles were 1 (3.0%), 2 (4.4%) and 4 (12.1%) in the early, mid and late periods in Cochrane Collaboration Risk of Bias Tool (P=0.04). High-quality low risk of bias RCT publication frequency increased over time. Intervention and funding significantly influenced RCT quality. Thus, the number of RCTs published in the IJIR over time has remained constant while their quality has improved. Ongoing efforts to expand the numbers of RCTs and further improve the quality of research published by the IJIR will improve clinical practice.

Analysis of Studies on High-Risk Infants and Quality Assessment of Intervention Studies

Purpose: It is critical that evidence from research is applied to everyday nursing practice to improve the quality of care and health outcomes. Aims of this study were to review high-risk infant related studies published in major nursing and non-nursing journals in Korea and to assess the quality of intervention studies. Methods: Through the Korean literature search engine of RISS.KR the authors identified 132 studies, and two researchers evaluated each of these studies using the analysis criteria. The quality of intervention studies was assessed using the van Tulder Scale. Results: Among the studies, 40.2% were either thesis or dissertation and 86.4% were quantitative studies. Convenience sampling was the most commonly used sampling method. All experimental studies were quasi-experiment except one pre-experiment study. Sensory stimulation and kangaroo care were the most common interventions for high-risk infants. Over half of the intervention studies were assessed to be “low risk of bias” but both randomization and blinding processes were not adequately satisfied in most of the studies. Conclusion: Findings of this study suggest that high-risk infants are more likely to be recruited for experimental studies but types of interventions were very limited. To provide evidence-based care for high-risk infants, rigorously conducted experimental studies should be encouraged.

Reporting of randomized controlled trials in andrology journals: a quality assessment.

Quality assessment of randomized controlled trials (RCTs) is important to prevent the adoption of findings of low-quality trials into clinical practice. The aim of this study was to analyze the quality of studies reporting RCTs in andrology journals (The Journal of Sexual Medicine [JSM], the Asian Journal of Andrology [AJA], the Journal of Andrology [JOA], the International Journal of Andrology [IJA]). A quality assessment was conducted on all studies identified as RCTs published in andrology journals (JSM, AJA, JOA, IJA) until 2011. The review period was divided into three terms: early, mid, and late each journal. The Jadad scale, van Tulder scale, and the Cochrane Collaboration Risk of Bias Tool (CCRBT) were employed. The RCTs were also categorized by country of origin, the inclusion of institutional review board (IRB) approval, funding, and blindness. There were1,954 original articles published in the JSM, 893 articles in the AJA, 2,527 articles in the JOA, and 2,086 articles in the IJA for the review period. There were 172 studies reporting on RCTs in the JSM, 33 RCTs in the AJA, 63 RCTs in the JOA, and 29 RCTs in the IJA. No significant increase in Jadad or van Tulder scale scores were found over time, nor were there any significant changes in the number of high-quality articles as assessed by CCRBT. However, significant differences in quality analysis were found according to blinding, funding, and IRB approval. The number of original articles and RCTs in andrology increased over time. However, the ratio of RCTs to original articles as well as RCT quality was statistically insignificant. It would be required for the researchers to focus efforts in performing high-quality studies to ensure appropriate randomization, reviews by IRB, financial support, and inclusion of allocation concealment during study performance.

Randomized Controlled Trials in the Journal of Sexual Medicine: A Quality Assessment and Relevant Clinical Impact

Quality assessment of randomized clinical trials (RCTs) is important to prevent the adoption of findings of low-quality trials into clinical practice. The aim if this study was to analyze the quality of studies reporting RCTs in the Journal of Sexual Medicine (JSM) and to find relevant clinical impact. A quality assessment was conducted in all studies identified as RCTs published in the JSM from 2004 to 2012. The review period was divided into three periods: early (2004-2006), mid (2007-2009), and late (2010-2012). The Jadad scale, van Tulder scale, and the Cochrane Collaboration Risk of Bias Tool (CCRBT) quality scoring instruments were used. The RCTs were also categorized by country of origin, topic, the inclusion of institutional review board (IRB) approval, funding, citation rate, and impact factor. A total of 2,418 original articles were published in the JSM during the review period, and 188 were reports of RCTs. There were 39 (14.89%), 70 (7.77%), and 76 (6.29%) RCTs published during the early, mid, and late terms, respectively (P < 0.001). No significant increases in Jadad or van Tulder scale scores were found over time nor were there any significant changes in the number of low-risk articles as assessed by the CCRBT. However, significant differences in quality analysis were found in funding and IRB approval. Citation rates and impact factor were not correlated with RCT quality using any of the tools. The number of original articles and RCTs published in the JSM increased over time. However, the ratio of RCTs to original articles did not increase significantly. Adequate randomization and blinding methods, IRB review, and financial support are required for the conduct of high-quality RCTs.

Analysis of randomized controlled trials in Rheumatology International from 1981 to 2012: methodological assessment

The aim of the study is to assess the methodological quality of randomized controlled trials (RCTs) published in Rheumatology International (RI) by using three types of analytical tools. MEDLINE was used to extract RCTs from original articles published in the RI from 1981 (vol. 1) to 2012 (vol. 32). The relationship between the number of articles and RCTs with time and that between various factors and the quality of RCTs were analyzed. To analyze the methodological quality of the RCTs, the time period was divided into several sections and three tools were applied (e.g., the Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool). The number of RCTs published gradually increased with time significantly (p < 0.001). The differences in RCT quality scores by each method in the publication years evaluated were not statistically significant, but RCTs that included descriptions of allocation concealment methods had received institutional review board (IRB) approval, and that conducted in the multicenter had significantly higher-quality scores than other studies. In conclusion, although the number of RCTs published in RI since its publishing in 1981 has increased with time, but no qualitative improvement of RCT was observed over time. It is necessary to improve the reporting of concealment of allocation, generation of randomization sequences, design of blinded studies, and obtaining IRB approval, all of which are criteria of high-quality RCTs.

The effectiveness of working wrist splints in adults with rheumatoid arthritis: A mixed methods systematic review

To evaluate the effectiveness of working wrist splints in people with rheumatoid arthritis. This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Ten databases were searched from inception until September 2012 for quantitative and qualitative studies on the effectiveness of working wrist splints in rheumatoid arthritis. Data was extracted on participants, interventions, outcome measures and results. Experimental studies were evaluated using the van Tulder scale and the Cochrane Risk of Bias tool. Data was extracted by a single reviewer and all studies were reviewed by two blind reviewers. Twenty-three studies were included in the review (n = 1,492), 13 experimental studies including 9 randomized controlled trials (RCTs) and 2 qualitative studies. Data was summarized using best evidence synthesis and a meta-ethnographical approach guided qualitative evidence synthesis. There is strong quantitative evidence (including 9 RCTs), supported by conclusions from qualitative literature, that working wrist splints reduce pain (d = 0.7-0.8), moderate evidence that grip strength is improved (d = 0.3-0.4) and dexterity impaired and insufficient evidence of their effect on function. Working wrist splints reduce pain and improve grip in rheumatoid arthritis. The effect of splints on function is not yet clear.

A Systematic Review of Randomized Controlled Trials in the Field of Dysphagia Rehabilitation

We carried out a systematic review of randomized controlled trials (RCT) of oropharyngeal swallowing interventions conducted between years 2010 and 2013. A systematic literature search of RCTs was conducted using databases MEDLINE (PubMed), PsychInfo, Google Scholar, EBSCO, PROQUEST, Web of Science, and grey literature. Data were abstracted from all eligible studies by the first author and independently assessed by two raters using the Van Tulder scale. A total of 15 RCTs of behavioral swallowing therapy were included for evaluation. Significant heterogeneity between experimental studies was noted. Only 33 % (5) of studies included met the quality criterion identified by the van Tulder scale for high study rigor. Data supporting swallowing rehabilitation methods with adult dysphagic patients is advancing. Although studies intervention approaches remain diverse, the use of RCT designs is increasing with noted improvements in control methods. More research is needed to ascertain the most optimal intervention methodology for dysphagia rehabilitation.

Randomized Controlled Trials In Endourology: A Quality Assessment

To analyze the quality of studies reporting randomized clinical trials (RCTs) in the field of endourology. RCTs published in the Journal of Endourology from 1993 until 2011 were identified. The Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool (CCRBT) were used to assess the quality of the studies. The review period was divided into early (1993-1999), mid (2000-2005), and late (2006-2011) terms. Studies were categorized by country of origin, subject matter, single- vs multicenter setting, Institutional Review Board (IRB) approval and funding support, and blinding vs nonblinding. In total, 3339 articles had been published during the defined review period, of which 165 articles were reporting a RCT. There was a significant increase in the number of RCTs published over time, with 18 (2.81%), 43 (4.88%), and 104 (5.72%) studies identified in the early, mid, and late term, respectively (P=0.009). Nevertheless, there was no difference in terms of quality of reporting, as assessed with the Jadad scale, van Tulder scale, or CCRBT, between the three study terms. On the other hand, significant differences were found in both the number of high qualitative RCTs that used blinding methodology and those that had IRB review, when comparing the early, mid, and late terms. There has been a growing number of Journal of Endourology publications reporting on RTC over the last two decades. The quality of reporting for these studies remains suboptimal, however. Researchers should focus on a more appropriate description of key features of any given RCT, such as randomization and allocation methods, as well as disclosure of IRB review and financial support.

Assessing the quality of randomized controlled trials published in neurourology and urodynamics from 1993 to 2012

To assess the quality of randomized controlled trials (RCTs) published in Neurourology and Urodynamics (NAU) by using three types of analytical tools. MEDLINE was used to extract RCTs from original articles published in the NAU from 1993 to 2012. The relationship between the number of articles and RCTs with time and that between various factors and the quality of RCTs were analyzed. To analyze the quality of the RCTs, the time period was divided into four sections and three tools were applied (e.g., the Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool [CCRBT]). Among the 1,957 original articles, 93 (4.75%) were RCTs. The ratio between the number of NAU and RCTs over time increased. The Jadad score for years 1993-1997 was 3.25 ± 1.71, 1998-2002 was 2.10 ± 0.74, 2003-2007 was 2.09 ± 1.12, and 2008-2012 was 2.80 ± 1.09 (P = 0.014). The van Tulder scales were 6.25 ± 3.10, 4.40 ± 1.65, 4.97 ± 1.99, and 5.93 ± 1.98, respectively (P = 0.055). The CCRBT identified a low risk of bias in 1 (25%), 0 (0%), 1 (2.86%), and 5 (11.36%) articles, respectively. Trials with allocation concealment, Institutional review board (IRB) approval, and blinded studies had significantly higher quality than others. The quantitative increase of RCT presented in NAU over time was observed but there was no definite qualitative improvement. Effort is required to improve the quality of RCTs published in NAU from the design step.

Assessments of the quality of randomized controlled trials published in International Journal of Urology from 1994 to 2011

Randomized controlled trials are one of the most reliable resources for assessing the effectiveness and safety of medical treatments. Low quality randomized controlled trials carry a large bias that can ultimately impair the reliability of their conclusions. The present study aimed to evaluate the quality of randomized controlled trials published in International Journal of Urology by using multiple quality assessment tools. Randomized controlled trials articles published in International Journal of Urology were found using the PubMed MEDLINE database, and qualitative analysis was carried out with three distinct assessment tools: the Jadad scale, the van Tulder scale and the Cochrane Collaboration Risk of Bias Tool. The quality of randomized controlled trials was analyzed by publication year, type of subjects, intervention, presence of funding and whether an institutional review board reviewed the study. A total of 68 randomized controlled trial articles were published among a total of 1399 original articles in International Journal of Urology. Among these randomized controlled trials, 10 (2.70%) were from 1994 to 1999, 23 (4.10%) were from 2000 to 2005 and 35 (4.00%) were from 2006 to 2011 (P = 0.494). On the assessment with the Jadad and van Tulder scale, the numbers and percentage of high quality randomized controlled trials increased over time. The studies that had institutional review board reviews, funding resources or that were carried out in multiple institutions had an increased percentage of high quality articles. The numbers and percentage of high-quality randomized controlled trials published in International Journal of Urology have increased over time. Furthermore, randomized controlled trials with funding resources, institutional review board reviews or carried out in multiple institutions have been found to be of higher quality compared with others not presenting these features.

A Quality Analysis of Randomized Controlled Trials about Erectile Dysfunction

PurposeA low quality clinical trial could produce errors, and these errors could, in turn, distort the results of the clinical trial. To avoid applying distorted results of trials clinically, a quality analysis of clinical trials is needed.Materials and MethodsWe selected randomized controlled trials (RCTs) about erectile dysfunction (ED) conducted in Korea using Medline and KoreaMed. Quality assessment of selected RCTs was performed using three assessment tools (Jadad scales, van Tulder scale, Cochrane Collaboration Risk of Bias Tool [CCRBT]).ResultsThe first RCT about ED conducted in Korea was published in 2002. Since 2002, a total of 20 RCTs have been published in medical journals. Among the 20 articles, only 1 article was found to have a low risk of bias according to the CCRBT. On the Jadad scale, there were 17 high quality articles, while 19 articles were assessed as high quality by the VTS. Only 2 RCTs described the randomization method adequately. Only 1 RCT presented allocation concealment.ConclusionsA low quality clinical trial could produce errors, and these errors could, in turn, distort the results of the clinical trial. To avoid applying distorted results of trials clinically, a quality analysis of clinical trials is needed. The quality of RCTs was found to be high because almost all of the selected RCTs were double blinded studies. However, the quality of RCTs was inadequate with regard to the lack of randomization and absence of allocation concealment. Therefore, performing adequate randomization and adding a description of the appropriate concealment of allocation may improve the quality of RCTs.

Assessing the Quality of Randomized Controlled Urological Trials Conducted by Korean Medical Institutions

PurposeTo assess the quality of randomized controlled urological trials conducted by Korean medical institutions.Materials and MethodsQuality assessment was conducted by using the Jadad scale; in addition, the van Tulder scale and the Cochrane Collaboration risk of bias tool were used as individual indices. All assessments were performed by two reviewers. If the outcomes differed, the two reviewers and a third reviewer adjusted the discrepancy in the results through discussion. Starting from 1986, a quality analysis of randomized controlled trials (RCTs) was conducted in 1-year and 5-year units. The quality assessment was conducted by subject, type of intervention, presence of double blinding, presence of funding, and review by an Institutional Review Board (IRB).ResultsWhereas the number of RCTs published has gradually increased, there was no significant difference in the quality of the RCTs according to publication year. Drug studies, double-blind studies, studies with funding, and studies reviewed by IRBs had higher quality scores and a higher percentage of high-quality RCTs than did other studies. Thirty-six RCTs were published in journals included in the Science Citation Index and 20 RCTs were published in journals included in the Science Citation Index Expanded. The largest number of RCTs (32.32%) were published by the Korean Journal of Urology.ConclusionsA quantitative increase was observed in RCTs over time, but no qualitative improvement in the RCTs was observed. It seems necessary to put effort into the quality improvement of RCTs at the design stage.

Transurethral Procedures for Lower Urinary Tract Symptoms Resulting From Benign Prostatic Enlargement: A Quality and Meta-Analysis

PurposeThanks to advancements in surgical techniques and instruments, many surgical modalities have been developed to replace transurethral resection of the prostate (TURP). However, TURP remains the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH). We conducted a meta-analysis on the efficacy and safety of minimally invasive surgical therapies for BPH compared with TURP.MethodsThis meta-analysis used a Medline search assessing the period from 1997 to 2011. A total of 784 randomized controlled trials were identified in an electronic search. Among the 784 articles, 36 randomized controlled trials that provided the highest level of evidence (level 1b) were included in the meta-analysis. We also conducted a quality analysis of selected articles.ResultsOnly 2 articles (5.56%) were assessed as having a low risk of bias by use of the Cochrane collaboration risk of bias tool. On the other hand, by use of the Jadad scale, there were 26 high-quality articles (72.22%). Furthermore, 28 articles (77.78%) were assessed as high-quality articles by use of the van Tulder scale. Holmium laser enucleation of the prostate (HoLEP) showed the highest reduction of the International Prostate Symptom Score compared with TURP (P<0.0001). Bipolar TURP, bipolar transurethral vaporization of the prostate, HoLEP, and open prostatectomy showed superior outcome in postvoid residual urine volume and maximum flow rate. The intraoperative complications of the minimally invasive surgeries had no statistically significant inferior outcomes compared with TURP. Also, there were no statistically significant differences in any of the modalities compared with TURP.ConclusionsThe selection of an appropriate surgical modality for BPH should be assessed by fully understanding each patient's clinical conditions.

The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review

BackgroundLower 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.MethodsSeven 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.ResultsNine 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.ConclusionsEffective 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.