Trans-radial cerebral angiography-safety, efficacy and patient comfort: review of literature

A diagnostic cerebral angiography is a vital tool in the planning and management of various cerebrovascular conditions. Newer angiographic modalities, such as digital subtraction angiography offers dynamic imaging of the cerebral blood flow and is the preferred diagnostic modality of choice when a subsequent intervention is contemplated. Traditionally, the transfemoral route at the groin was used as the site for vascular access. However, landmark randomised controlled trials in the field of interventional cardiology have demonstrated the safety, efficacy and patient comfort attained by employing a trans-radial access for angiography and interventions. This has spawned numerous studies which were directed explicitly towards cerebral angiography and neuro-intervention. We present this review of literature to consolidate the current practices and to encourage the neuro-interventionalists to shift to a radial first approach.

Reporting of Randomised Clinical Trials in Skull Base Surgery: A Fourteen-Year Review.

Skull base surgery has experienced dramatic advances in the last decade. Recently, various surgical disciplines have conducted reviews of quality of randomised controlled trials (RCTs). This is the first review to our knowledge regarding RCT quality within skull base surgery. Systematic review of skull base surgery RCTs published between 2000 and 2014 were conducted. Literature search provided 96 papers. Duplicates and trials which did not meet our inclusion criteria were excluded. This left 28 papers for analysis. A total of 1785 patients participated across trials. Consolidated Standards of Reporting Trials statement (CONSORT) and Jadad scale were used assess to the quality of reporting. These were our main outcome measures. The mean CONSORT score prior to 2011 was 16.9 (n = 17, range; 13 – 22), and post 2011 was 17.5 (n = 11, range; 12 – 22). The mean Jadad score was 3.1 (n = 28, range 2 – 5). CONSORT were found to increase significantly with both increasing sample size (rho=0.467, p=0.012) and Jadad scores (rho=0.540, p=0.003). Linear regression showed CONSORT increase by 0.36 (95% CI: 0.02 – 0.70, p=0.041) for each additional 10 patients included, and by 1.50 (95% CI: 0.58 – 0.24, p=0.002) for each increase of one in the JADAD score. There are common omissions related to randomization, sample size calculations and availability of protocols. RCTs in skull base surgery are comparable to other surgical disciplines. We recommend utilisation of the CONSORT statement during protocol formation of RCTs to improve reporting of trials.

The effectiveness of corticosteroid injection in the treatment of plantar fasciitis

Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient's daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4-12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks.

Quality of abstracts for randomised controlled trials published in Journal of Clinical Anesthesiology based on CONSORT for Abstracts / 临床麻醉学杂志

Objective To assess the quality of randomized controlled trials(RCT)abstracts published in Journal of Clinical Anesthesiology by CONSORT for Abstracts.Methods Articles invol-ving human RCTs published from 2012 to 2013 were reviewed and searched through WanFang Med Online.Trials involving animal experiments,in vitro,RCTs without abstract,and meta-analyses were excluded.According to the CONSORT checklists for abstracts,the quality of abstracts for RCT were assessed.Results In total,392 RCT abstracts were analysed.The median word counts of ab-stracts was 364 (IQR 306-444),sample size was 60 (IQR 40-80).Almost all abstracts provided an appropriate description of conclusions (100%), numbers randomized (99.0%) and objective (99.0%).The majority of abstracts described interventions (94.6%)and participants (82.4%).Re-quirements present in less than 50% of the abstracts were details regarding trial design (46.2%)and harms (48.7%).The descriptions of randomization (13.3%),blinding (1.8%),methods-outcome (3.6%)and results-outcome (9.7%)were very low.Moreover,title,recruitment and numbers ana-lysed were not reported.Conclusion The quality of RCT abstracts and adherence to the CONSORT checklist for abstracts remains poor,and the CONSORT for Abstracts should be endorsed to improve the quality of RCT abstracts as early as possible.

The Effectiveness Of Auricular Acupuncture For Drug Addiction: A Review Of Research Evidence From Clinical Trials

Objectives: This review aims to compile and evaluate all available randomised controlled trials (RCTs) of auricular acupuncture (AA) treatment in drug addiction population with emphasis on the length of treatment course, needle-points, outcome measures, reported side-effects and overall outcomes. Methods: Science Direct, Medline and EBSCOhost databases were searched. From the year 1990 until 2010, only full-length English articles incorporating RCTs related to AA studies (needlebased only) in drug addiction such as heroin, morphine, methamphetamine and cocaine were included. Studies involving the usage of various methods of electroacupuncture and investigations relating to cigarette-smoking or alcohol addiction were excluded. Results: Eight RCTs met all inclusion criteria comprising of 1,594 respondents (age = 19 - 46 years; male = 57% - 76%). Most were involved in cocaine addiction. Overall, trials were designed with brief periods of treatment course and utilised three to five standard National Acupuncture Detoxification Association (NADA) points (Sympathetic, Lung, Liver, Kidney and Shenmen), but inconsistent sham points. All trials included urine toxicology test as the main outcome measure while data on side-effects incidence was insufficient. Conclusions: Overall, four of the RCTs reported positive outcomes although at this point, AA’s effectiveness and safety could not be substantially confirmed. For the future, high-quality RCTs of AA are urgently required to provide a clearer understanding on the usefulness of this complementary therapy in drug addiction treatment.

Comment on Literatures of Clinical Randomized Controlled Trials of Traditional Chinese Medicine for Acute Myocardial Infarction / 广州中医药大学学报

[ Objective ] To assess the quality of clinical randomised controlled trials (RCT) of traditional Chinese medicine (TCM) for acute myocardial infarction (AMI). [Methods] Eighty - three journals of TCM from the first issues of 1977 to the latest issues of 2002 were manually searched and reviewed under the following inclusion criteria: clinical trials of TCM for AMI with 'randomized controlled or randomised being mentioned. And a questionnaire was designed according to the criteria of RCT with the items of diagnostic standard, consistent of baseline, method of randomization, concealment in allocation, blind method, intention - to - treat analysis, statistic methods and conclusion. Percentages of each item were figured out to assess the quality. [Results] Two thousand five hundred and one trials were associated with heart diseases, among which 102 were associated with AMI and 42 accorded with the inclusion criteria. Calculation method of sample size, concealment in allocation and intention - to - treat analysis after drop - out were mentioned in none of the 42 articles, single - blind method adopted in 4 (9.52%) , diagnostic standard described in 40 (95.24%), baseline consistent illuminated in 27 (64.29%), method of randomization presented in 8 (19.05%) , statistic methods used mistakenly in 6 (14.28%) and statistic methods not described in 18 (42.86%). [Conclusion] There still exist some problems in the design of RCT of TCM for AMI: (1) mistaken use of randomization method; (2) less adoption of calculation method of sample size, concealment in allocation and intention - to - treat analysis after drop - out; (3) improper application of statistic methods; (4) lower rate of utilization for blind study.