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Malvern East, Australia

Watson D.I.,Flinders University | Thompson S.K.,University of Adelaide | Devitt P.G.,University of Adelaide | Smith L.,Flinders University | And 6 more authors.
Annals of Surgery

Objective: Determine whether absorbable or nonabsorbable mesh in repair of large hiatus hernias reduces the risk of recurrence, compared with suture repair. Background: Repair of large hiatus hernia is associated with radiological recurrence rates of up to 30%, and to improve outcomes mesh repair has been recommended. Previous trials have shown less short-term recurrence with mesh, but adverse outcomes limit mesh use. Methods: Multicentre prospective double blind randomized controlled trial of 3 methods of repair: sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome"hernia recurrence assessed by barium meal radiology and endoscopy at 6 months. Secondary outcomes"clinical symptom scores at 1, 3, 6, and 12 months. Results: A total of 126 patients enrolled: 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Among them, 96.0% were followed up to 12 months, with objective follow-up data in 92.9%. A recurrent hernia (any size) was identified in 23.1% after suture repair, 30.8% after absorbable mesh, and 12.8% after nonabsorbable mesh (P = 0.161). Clinical outcomes were similar, except less heartburn at 3 and 6 months and less bloating at 12 months with nonabsorbable mesh; more heartburn at 3 months, odynophagia at 1 month, nausea at 3 and 12 months, wheezing at 6 months; and inability to belch at 12 months after absorbable mesh. The magnitudes of the clinical differences were small. Conclusions: No significant differences were seen for recurrent hiatus hernia, and the clinical differences were unlikely to be clinically significant. Overall outcomes after sutured repair were similar to mesh repair. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved. Source

McCrory P.,University of Melbourne | McCrory P.,Monash University | Davis G.,Cabrini Hospital | Makdissi M.,University of Melbourne
Current Sports Medicine Reports

Second impact syndrome is believed to be the catastrophic consequence of repeated head injury in sport. The scientific evidence to support this concept is nonexistent, and belief in the syndrome is based upon the interpretation of anecdotal cases more often than not, lacking sufficient clinical detail to make definitive statements. The fear of this condition has driven many of the current return-to-play guidelines following concussion. Diffuse cerebral swelling (DCS) following a head injury is a wellrecognized condition, more common in children than in adults, and usually has a poor outcome. © 2012 Paul McCrory, The University of Melbourne. Source

Buchbinder R.,Cabrini Hospital | Kallmes D.F.,Mayo Medical School
Spine Journal

COMMENTARY ON: Bono C, Heggeness M, Mick C, et al. North American Spine Society: Newly released vertebroplasty randomized controlled trials: a tale of two trials. Spine J 2010;10:238-240 (in this issue). © 2010 Elsevier Inc. All rights reserved. Source

Krogh T.P.,Diagnostic Center | Bartels E.M.,Copenhagen University | Ellingsen T.,Diagnostic Center | Stengaard-Pedersen K.,Aarhus University Hospital | And 7 more authors.
American Journal of Sports Medicine

Background: Injection therapy with glucocorticoids has been used since the 1950s as a treatment strategy for lateral epicondylitis (tennis elbow). Lately, several novel injection therapies have become available. Purpose: To assess the comparative effectiveness and safety of injection therapies in patients with lateral epicondylitis. Study Design: Systematic review and meta-analysis. Methods: Randomized controlled trials comparing different injection therapies for lateral epicondylitis were included provided they contained data for change in pain intensity (primary outcome). Trials were assessed using the Cochrane risk of bias tool. Network (random effects) meta-analysis was applied to combine direct and indirect evidence within and across trial data using the final end point reported in the trials, and results for the arm-based network analyses are reported as standardized mean differences (SMDs). Results: Seventeen trials (1381 participants; 3 [18%] at low risk of bias) assessing injection with 8 different treatments-glucocorticoid (10 trials), botulinum toxin (4 trials), autologous blood (3 trials), platelet-rich plasma (2 trials), and polidocanol, glycosaminoglycan, prolotherapy, and hyaluronic acid (1 trial each)-were included. Pooled results (SMD [95% confidence interval]) showed that beyond 8 weeks, glucocorticoid injection was no more effective than placebo (20.04 [-0.45 to 0.35]), but only 1 trial (which did not include a placebo arm) was at low risk of bias. Although botulinum toxin showed marginal benefit (-0.50 [-0.91 to 20.08]), it caused temporary paresis of finger extension, and all trials were at high risk of bias. Both autologous blood (-1.43 [-2.15 to 20.71]) and platelet-rich plasma (-1.13 [-1.77 to 20.49]) were also statistically superior to placebo, but only 1 trial was at low risk of bias. Prolotherapy (-2.71 [-4.60 to 20.82]) and hyaluronic acid (-5.58 [-6.35 to 24.82]) were both more efficacious than placebo, whereas polidocanol (0.39 [-0.42 to 1.20]) and glycosaminoglycan (-0.32 [-1.02 to 0.38]) showed no effect compared with placebo. The criteria for low risk of bias were only met by the prolotherapy and polidocanol trials. Conclusion: This systematic review and network meta-analysis of randomized controlled trials found a paucity of evidence from unbiased trials on which to base treatment recommendations regarding injection therapies for lateral epicondylitis. © 2013 The Author(s). Source

Busija L.,University of Melbourne | Busija L.,Deakin University | Osborne R.H.,Deakin University | Roberts C.,University of Melbourne | And 2 more authors.
Journal of Clinical Epidemiology

Objective: The objective of this study was to describe the content of questionnaires used in the assessment of the individual burden of osteoarthritis. Study Design and Setting: A systematic search of computerized databases was conducted to identify self-report measures of osteoarthritis burden. The content of identified measures was assessed against the eight-domain Personal Burden of Osteoarthritis (PBO) model, which covers physical distress, fatigue, physical limitations, psychosocial distress, physical deconditioning, financial hardship, sleep disturbances, and lost productivity. The PBO was derived from extensive consultations with osteoarthritis patients and clinicians. Results: A review of 5,703 publications identified 158 multi-item self-report measures of the individual burden of osteoarthritis. Content analysis showed that the dimensions of physical limitations, physical distress, and psychosocial distress were well represented by the identified questionnaires. The physical deconditioning and financial hardship dimensions were the least represented in the identified measures. The World Health Organization Quality of Life Scale gave the best coverage of PBO elements, with items matching seven of the eight PBO domains. Conclusion: Despite the large number of questionnaires identified, many aspects of the individual burden of osteoarthritis are not well represented by currently available measures. This may result in systematic gaps in how experiences of people with osteoarthritis are represented in research studies. © 2013 Elsevier Inc. All rights reserved. Source

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