Angela Kaminski

Bach Flower Remedies for psychological problems and pain: a systematic review

BackgroundBach Flower Remedies are thought to help balance emotional state and are commonly recommended by practitioners for psychological problems and pain. We assessed whether Bach Flower Remedies (BFRs) are safe and efficacious for these indications by performing a systematic review of the literature.MethodsWe searched MEDLINE®, Embase, AMED, and the Cochrane Library from inception until June 2008 and performed a hand-search of references from relevant key articles. For efficacy, we included all prospective studies with a control group. For safety, we also included retrospective, observational studies with more than 30 subjects. Two authors abstracted data and determined risk of bias using a recognised rating system of trial quality.ResultsFour randomised controlled trials (RCTs) and two additional retrospective, observational studies were identified and included in the review. Three RCTs of BFRs for students with examination anxiety, and one RCT of BFRs for children with attention-deficit hyperactivity disorder (ADHD) showed no overall benefit in comparison to placebo. Due to the number and quality of the studies the strength of the evidence is low or very low. We did not find any controlled prospective studies regarding the efficacy of BFRs for pain. Only four of the six studies included for safety explicitly reported adverse events.ConclusionMost of the available evidence regarding the efficacy and safety of BFRs has a high risk of bias. We conclude that, based on the reported adverse events in these six trials, BFRs are probably safe. Few controlled prospective trials of BFRs for psychological problems and pain exist. Our analysis of the four controlled trials of BFRs for examination anxiety and ADHD indicates that there is no evidence of benefit compared with a placebo intervention.

Adjunct ultrasonography for breast cancer screening in women at average risk: a systematic review

BACKGROUND Screening with mammography has the ability to detect breast cancer at an early stage but misses some cancers. Supporters of adjunct ultrasonography to the screening regimen argue that it might be a safe and inexpensive approach to reduce the false-negative rates of screening. Critics are concerned that adjunct ultrasonography will also increase the rate of false-positive findings and can lead to unnecessary biopsies and treatments in women at average risk. AIMS The purpose of this review was to systematically assess the comparative benefits and harms of mammography with adjunct breast ultrasonography and mammography only in breast cancer screening. METHODS We searched multiple electronic databases and the Cochrane Breast Cancer Groups Specialised Register (from 1995 to February 2012). To detect ongoing or unpublished studies, we searched trial registries and multiple sources of grey literature. Two researchers independently reviewed all abstracts and full-text articles against pre-defined eligibility criteria. We dually rated the risk of bias of studies and the strength of evidence based on established guidance. RESULTS We did not detect any controlled studies that provide evidence for (or against) the use of adjunct ultrasonography for screening in women at average risk for breast cancer. Extrapolations of results from women at elevated risk for breast cancer indicate that the false-positive rates in women at average risk who were recalled because of positive ultrasonographies will exceed 98%. In women with dense or very dense breast tissue, the evidence regarding the use of adjunct ultrasonography is not conclusive. CONCLUSIONS No methodologically sound evidence is available justifying the routine use of ultrasonography as an adjunct screening tool in women at average risk for breast cancer. IMPLICATIONS FOR PRACTICE Clinicians should not use ultrasonography as a screening tool for breast cancer screening on a routine basis. The use should be limited to women with dense breasts for whom the accuracy of mammography is low, or for diagnostic purposes.

Österreichische Patienteninformationsmaterialien zu PSA-Screening entsprechen nicht internationalen evidenzbasierten Standards

SummaryBACKGROUND: Currently, the available evidence regarding the net benefits of prostate cancer screening with PSA (prostate-specific antigen) tests is unclear. Therefore, international guidelines do not recommend PSA-screening on a regular basis for men. Because of the unclear evidence, guidelines emphasize the importance of shared decision-making. Shared decision-making, however, requires that balanced and evidence-based information is available for those who take PSA-screening into consideration. The aim of this paper was to evaluate all in Austria available patient information materials on PSA-screening with regard to their evidence-based content and their potential to facilitate informed decision-making. METHODS: To get information materials, we contacted a wide variety of public, industry, and academic institutions, professional organisations, patient advocacy groups, and other organisations that are concerned with prostate cancer screening in Austria. Two persons independently evaluated the quality of each information product based on adapted criteria of the UK (United Kingdom) General Medical Council. RESULTS: We evaluated a total of 17 information leaflets. Not a single brochure fulfilled all of the criteria necessary for informed decision-making. More than half fulfilled less than 50% of the recommended criteria. All of the analysed leaflets provided information about the benefits of screening, while only 35% mentioned the possibility of harms caused by screening. CONCLUSIONS: To date, Austrian patient information materials on PSA-screening do not meet international standards. Therefore, they cannot serve as a balanced and objective information base for informed decision-making.ZusammenfassungGRUNDLAGEN: Aufgrund der wissenschaftlich unklaren Studienlage wird PSA(Prostata-spezifisches Antigen)-Screening von den meisten internationalen Leitlinien nicht als Routineuntersuchung zur Früherkennung von Prostatakarzinomen empfohlen. PSA-Screening sollte erst nach genauer Diskussion der Vor- und Nachteile mit Männern, die diese Art der Krebsfrüherkennung in Erwägung ziehen, durchgeführt werden. Um eine solche informierte Entscheidung erreichen zu können, ist es daher wichtig, dass ausgewogene und evidenzbasierte Information über Vor- und Nachteile von PSA-Screening zur Verfügung steht. Ziel unserer Studie war es, alle in Österreich zur Verfügung stehenden Patienten-Informationssmaterialien über PSA-Screening auf ihren evidenzbasierten Inhalt, sowie ihre Eignung, eine Grundlage für informierte Entscheidungen zu bieten, zu prüfen. METHODIK: Um möglichst alle in Österreich verfügbaren Patienten-Informationsmaterialien zu PSA-Screening zu erhalten, kontaktierten wir universitäre Institutionen, öffentliche Einrichtungen, Selbsthilfeorganisationen, Standesvertretungen und industrielle Unternehmen, die sich in Österreich mit PSA-Screening beschäftigen oder dieses anbieten. Zusätzlich führten wir gezielte Suchen in Google durch. Zwei Personen evaluierten unabhängig voneinander die Qualität der erhaltenen Materialien nach adaptierten Kriterien des UK (United Kingdom) General Medical Councils. ERGEBNISSE: Insgesamt wurden 17 Informationsmaterialien evaluiert. Keines der untersuchten Materialien erfüllte alle für eine informierte Entscheidungsfindung notwendigen Kriterien. Die inhaltlich beste Informationsbroschüre entsprach nur 57 % der untersuchten Qualitätskriterien. Mehr als die Hälfte der untersuchten Informationsbroschüren erfüllten weniger als 50 % der Qualitätskriterien. Alle untersuchten Broschüren betonten den potentiellen Nutzen von PSA-Screening, nur 35 % berichteten jedoch auch über den möglichen Schaden. SCHLUSSFOLGERUNGEN: Die derzeit in Österreich vorhandenen Informationsmaterialien zu PSA-Screening sind einseitig und entsprechen nicht internationalen Standards. Sie können daher keine ausreichende Basis für eine informierte Entscheidungsfindung über PSA-Screening bieten.BACKGROUND Currently, the available evidence regarding the net benefits of prostate cancer screening with PSA (prostate-specific antigen) tests is unclear. Therefore, international guidelines do not recommend PSA-screening on a regular basis for men. Because of the unclear evidence, guidelines emphasize the importance of shared decision-making. Shared decision-making, however, requires that balanced and evidence-based information is available for those who take PSA-screening into consideration. The aim of this paper was to evaluate all in Austria available patient information materials on PSA-screening with regard to their evidence-based content and their potential to facilitate informed decision-making. METHODS To get information materials, we contacted a wide variety of public, industry, and academic institutions, professional organisations, patient advocacy groups, and other organisations that are concerned with prostate cancer screening in Austria. Two persons independently evaluated the quality of each information product based on adapted criteria of the UK (United Kingdom) General Medical Council. RESULTS We evaluated a total of 17 information leaflets. Not a single brochure fulfilled all of the criteria necessary for informed decision-making. More than half fulfilled less than 50% of the recommended criteria. All of the analysed leaflets provided information about the benefits of screening, while only 35% mentioned the possibility of harms caused by screening. CONCLUSIONS To date, Austrian patient information materials on PSA-screening do not meet international standards. Therefore, they cannot serve as a balanced and objective information base for informed decision-making.

Austrian patient information materials on PSA-screening do not meet international evidence-based standards:

SummaryBACKGROUND: Currently, the available evidence regarding the net benefits of prostate cancer screening with PSA (prostate-specific antigen) tests is unclear. Therefore, international guidelines do not recommend PSA-screening on a regular basis for men. Because of the unclear evidence, guidelines emphasize the importance of shared decision-making. Shared decision-making, however, requires that balanced and evidence-based information is available for those who take PSA-screening into consideration. The aim of this paper was to evaluate all in Austria available patient information materials on PSA-screening with regard to their evidence-based content and their potential to facilitate informed decision-making. METHODS: To get information materials, we contacted a wide variety of public, industry, and academic institutions, professional organisations, patient advocacy groups, and other organisations that are concerned with prostate cancer screening in Austria. Two persons independently evaluated the quality of each information product based on adapted criteria of the UK (United Kingdom) General Medical Council. RESULTS: We evaluated a total of 17 information leaflets. Not a single brochure fulfilled all of the criteria necessary for informed decision-making. More than half fulfilled less than 50% of the recommended criteria. All of the analysed leaflets provided information about the benefits of screening, while only 35% mentioned the possibility of harms caused by screening. CONCLUSIONS: To date, Austrian patient information materials on PSA-screening do not meet international standards. Therefore, they cannot serve as a balanced and objective information base for informed decision-making.ZusammenfassungGRUNDLAGEN: Aufgrund der wissenschaftlich unklaren Studienlage wird PSA(Prostata-spezifisches Antigen)-Screening von den meisten internationalen Leitlinien nicht als Routineuntersuchung zur Früherkennung von Prostatakarzinomen empfohlen. PSA-Screening sollte erst nach genauer Diskussion der Vor- und Nachteile mit Männern, die diese Art der Krebsfrüherkennung in Erwägung ziehen, durchgeführt werden. Um eine solche informierte Entscheidung erreichen zu können, ist es daher wichtig, dass ausgewogene und evidenzbasierte Information über Vor- und Nachteile von PSA-Screening zur Verfügung steht. Ziel unserer Studie war es, alle in Österreich zur Verfügung stehenden Patienten-Informationssmaterialien über PSA-Screening auf ihren evidenzbasierten Inhalt, sowie ihre Eignung, eine Grundlage für informierte Entscheidungen zu bieten, zu prüfen. METHODIK: Um möglichst alle in Österreich verfügbaren Patienten-Informationsmaterialien zu PSA-Screening zu erhalten, kontaktierten wir universitäre Institutionen, öffentliche Einrichtungen, Selbsthilfeorganisationen, Standesvertretungen und industrielle Unternehmen, die sich in Österreich mit PSA-Screening beschäftigen oder dieses anbieten. Zusätzlich führten wir gezielte Suchen in Google durch. Zwei Personen evaluierten unabhängig voneinander die Qualität der erhaltenen Materialien nach adaptierten Kriterien des UK (United Kingdom) General Medical Councils. ERGEBNISSE: Insgesamt wurden 17 Informationsmaterialien evaluiert. Keines der untersuchten Materialien erfüllte alle für eine informierte Entscheidungsfindung notwendigen Kriterien. Die inhaltlich beste Informationsbroschüre entsprach nur 57 % der untersuchten Qualitätskriterien. Mehr als die Hälfte der untersuchten Informationsbroschüren erfüllten weniger als 50 % der Qualitätskriterien. Alle untersuchten Broschüren betonten den potentiellen Nutzen von PSA-Screening, nur 35 % berichteten jedoch auch über den möglichen Schaden. SCHLUSSFOLGERUNGEN: Die derzeit in Österreich vorhandenen Informationsmaterialien zu PSA-Screening sind einseitig und entsprechen nicht internationalen Standards. Sie können daher keine ausreichende Basis für eine informierte Entscheidungsfindung über PSA-Screening bieten.BACKGROUND Currently, the available evidence regarding the net benefits of prostate cancer screening with PSA (prostate-specific antigen) tests is unclear. Therefore, international guidelines do not recommend PSA-screening on a regular basis for men. Because of the unclear evidence, guidelines emphasize the importance of shared decision-making. Shared decision-making, however, requires that balanced and evidence-based information is available for those who take PSA-screening into consideration. The aim of this paper was to evaluate all in Austria available patient information materials on PSA-screening with regard to their evidence-based content and their potential to facilitate informed decision-making. METHODS To get information materials, we contacted a wide variety of public, industry, and academic institutions, professional organisations, patient advocacy groups, and other organisations that are concerned with prostate cancer screening in Austria. Two persons independently evaluated the quality of each information product based on adapted criteria of the UK (United Kingdom) General Medical Council. RESULTS We evaluated a total of 17 information leaflets. Not a single brochure fulfilled all of the criteria necessary for informed decision-making. More than half fulfilled less than 50% of the recommended criteria. All of the analysed leaflets provided information about the benefits of screening, while only 35% mentioned the possibility of harms caused by screening. CONCLUSIONS To date, Austrian patient information materials on PSA-screening do not meet international standards. Therefore, they cannot serve as a balanced and objective information base for informed decision-making.

Österreichische Patienteninformationsmaterialien zu PSA-Screening entsprechen nicht internationalen evidenzbasierten Standards@@@Austrian patient information materials on PSA-screening do not meet international evidence-based standards

SummaryBACKGROUND: Currently, the available evidence regarding the net benefits of prostate cancer screening with PSA (prostate-specific antigen) tests is unclear. Therefore, international guidelines do not recommend PSA-screening on a regular basis for men. Because of the unclear evidence, guidelines emphasize the importance of shared decision-making. Shared decision-making, however, requires that balanced and evidence-based information is available for those who take PSA-screening into consideration. The aim of this paper was to evaluate all in Austria available patient information materials on PSA-screening with regard to their evidence-based content and their potential to facilitate informed decision-making. METHODS: To get information materials, we contacted a wide variety of public, industry, and academic institutions, professional organisations, patient advocacy groups, and other organisations that are concerned with prostate cancer screening in Austria. Two persons independently evaluated the quality of each information product based on adapted criteria of the UK (United Kingdom) General Medical Council. RESULTS: We evaluated a total of 17 information leaflets. Not a single brochure fulfilled all of the criteria necessary for informed decision-making. More than half fulfilled less than 50% of the recommended criteria. All of the analysed leaflets provided information about the benefits of screening, while only 35% mentioned the possibility of harms caused by screening. CONCLUSIONS: To date, Austrian patient information materials on PSA-screening do not meet international standards. Therefore, they cannot serve as a balanced and objective information base for informed decision-making.ZusammenfassungGRUNDLAGEN: Aufgrund der wissenschaftlich unklaren Studienlage wird PSA(Prostata-spezifisches Antigen)-Screening von den meisten internationalen Leitlinien nicht als Routineuntersuchung zur Früherkennung von Prostatakarzinomen empfohlen. PSA-Screening sollte erst nach genauer Diskussion der Vor- und Nachteile mit Männern, die diese Art der Krebsfrüherkennung in Erwägung ziehen, durchgeführt werden. Um eine solche informierte Entscheidung erreichen zu können, ist es daher wichtig, dass ausgewogene und evidenzbasierte Information über Vor- und Nachteile von PSA-Screening zur Verfügung steht. Ziel unserer Studie war es, alle in Österreich zur Verfügung stehenden Patienten-Informationssmaterialien über PSA-Screening auf ihren evidenzbasierten Inhalt, sowie ihre Eignung, eine Grundlage für informierte Entscheidungen zu bieten, zu prüfen. METHODIK: Um möglichst alle in Österreich verfügbaren Patienten-Informationsmaterialien zu PSA-Screening zu erhalten, kontaktierten wir universitäre Institutionen, öffentliche Einrichtungen, Selbsthilfeorganisationen, Standesvertretungen und industrielle Unternehmen, die sich in Österreich mit PSA-Screening beschäftigen oder dieses anbieten. Zusätzlich führten wir gezielte Suchen in Google durch. Zwei Personen evaluierten unabhängig voneinander die Qualität der erhaltenen Materialien nach adaptierten Kriterien des UK (United Kingdom) General Medical Councils. ERGEBNISSE: Insgesamt wurden 17 Informationsmaterialien evaluiert. Keines der untersuchten Materialien erfüllte alle für eine informierte Entscheidungsfindung notwendigen Kriterien. Die inhaltlich beste Informationsbroschüre entsprach nur 57 % der untersuchten Qualitätskriterien. Mehr als die Hälfte der untersuchten Informationsbroschüren erfüllten weniger als 50 % der Qualitätskriterien. Alle untersuchten Broschüren betonten den potentiellen Nutzen von PSA-Screening, nur 35 % berichteten jedoch auch über den möglichen Schaden. SCHLUSSFOLGERUNGEN: Die derzeit in Österreich vorhandenen Informationsmaterialien zu PSA-Screening sind einseitig und entsprechen nicht internationalen Standards. Sie können daher keine ausreichende Basis für eine informierte Entscheidungsfindung über PSA-Screening bieten.BACKGROUND Currently, the available evidence regarding the net benefits of prostate cancer screening with PSA (prostate-specific antigen) tests is unclear. Therefore, international guidelines do not recommend PSA-screening on a regular basis for men. Because of the unclear evidence, guidelines emphasize the importance of shared decision-making. Shared decision-making, however, requires that balanced and evidence-based information is available for those who take PSA-screening into consideration. The aim of this paper was to evaluate all in Austria available patient information materials on PSA-screening with regard to their evidence-based content and their potential to facilitate informed decision-making. METHODS To get information materials, we contacted a wide variety of public, industry, and academic institutions, professional organisations, patient advocacy groups, and other organisations that are concerned with prostate cancer screening in Austria. Two persons independently evaluated the quality of each information product based on adapted criteria of the UK (United Kingdom) General Medical Council. RESULTS We evaluated a total of 17 information leaflets. Not a single brochure fulfilled all of the criteria necessary for informed decision-making. More than half fulfilled less than 50% of the recommended criteria. All of the analysed leaflets provided information about the benefits of screening, while only 35% mentioned the possibility of harms caused by screening. CONCLUSIONS To date, Austrian patient information materials on PSA-screening do not meet international standards. Therefore, they cannot serve as a balanced and objective information base for informed decision-making.