The Online journal of current clinical trials
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Online J Curr Clin Trials · Jul 1996
Meta AnalysisConservative management of mechanical neck disorders. A systematic overview and meta-analysis.
This overview reports the efficacy of conservative treatments (drug therapy, manual therapy, patient education, physical medicine modalities) in reducing pain in adults with mechanical neck disorders. ⋯ Within the limits of methodologic quality, the best available evidence supports the use of manual therapies in combination with other treatments for short-term relief of neck pain. There is some support for the use of electromagnetic therapy and against the use of laser therapy. In general, other interventions have not been studied in enough detail adequately to assess efficacy or effectiveness. This overview provides the foundation for an evidence-based approach to practice. More robust design and methodology should be used in future research, in particular, the use of valid and reliable outcomes measures.
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Online J Curr Clin Trials · May 1993
Meta AnalysisMetaanalysis of the effects of intensive glycemic control on late complications of type I diabetes mellitus.
To estimate the effects of intensive glycemic control on the progression of diabetic retinopathy and nephropathy, and to assess the risks of severe hypoglycemia and diabetic ketoacidosis. ⋯ Long-term intensive glycemic control significantly reduced the risks of diabetic retinopathy and nephropathy progression among type I diabetes patients when compared with randomly assigned controls. However, long-term continuous subcutaneous insulin infusion was associated with an increased incidence of diabetic ketoacidosis, and intensive therapy might cause more severe hypoglycemic reactions in some patients.
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To investigate the association between trial characteristics, findings, and publication. The major factor hypothesized to be associated with publication was "significant" results, which included both statistically significant results and results assessed by the investigators to be qualitatively significant, when statistical testing was not done. Other factors hypothesized to have a possible association with publication were funding institute, funding mechanism (grant versus contract versus intramural), multicenter status, use of comparison groups, large sample size, type of control (parallel versus nonparallel), use of randomization and masking, type of analysis (by treatment received versus by treatment assigned), and investigator sex and rank. ⋯ Even when the overall publication rate is high, such as for trials funded by the NIH, publication bias remains a significant problem. Given the importance of trials and their utility in evaluating medical treatments, especially within the context of metaanalysis, it is clear that we need more reliable systems for maintaining information about initiated studies. Trial registers represent such a system but must receive increased financial support to succeed.