Orthopaedic fractures: trends in randomised controlled trials.

AIM: To ascertain and describe the number and epidemiology of randomised controlled trials (RCTs) focused on orthopaedic fractures. METHODS: A sensitive literature search was carried out for the period 1966-May 1999. Labels were applied to each identified RCT to indicate the fracture type, and the main type of intervention. RESULTS: 648 RCTs related to surgery of which 123 focused on adjuvant therapies and 88 related mainly to anaesthesia, analgesia, and radiography. The number of trials have increased exponentially with time so that the present decade has seen more RCTs published than all the other years added together. CONCLUSION: There is clearly an encouraging trend in the number of RCTs published. However there is a need to ensure that trials are on fracture types where there is most need for guidance. This growing evidence base should fuel systematic reviews and clinical guidelines within orthopaedics.

The effects of supporting discharge from hospital to home in older people.

OBJECTIVE: to investigate the effects of supported discharge after an acute admission in older people with undifferentiated clinical problems. DESIGN: a systematic review of randomized controlled trials. METHODS: we searched MEDLINE, CINAHL, the Cochrane Library, PsycLit and the Social Science Citation Index up to the end of 1997. This was augmented by hand-searching, follow-up of bibliographies and.direct enquiry of authors of included studies. Application of inclusion decisions, quality assessment and data abstraction were carried out independently by at least two of the reviewers. We tabulated the results of the included studies and used meta-analysis where appropriate to refine conclusions. RESULTS: we finally included nine studies in the review, assessment of which revealed that bias was present, dictating the need for caution in interpreting results. Despite this, there was relative certainty that the proportion of those at home 6-12 months after admission is greater with supported discharge (odds ratio 1.4, 95% confidence interval 1.1- 2.0). This was associated with a consistent pattern of reduction in admission to long-stay care over the same period, without apparent increases in mortality. There was uncertainty about the effect of supported discharge on hospitalization. There were no rigorous research data on functional status, patient and carer satisfaction, and, in consequence, uncertainty about the overall effectiveness of supported discharge. CONCLUSIONS: we believe that the results of this review provide reassurance that supporting discharge from hospital to home is of value. However, important sources of uncertainty remain, suggesting the need for further research.

Mortality in older people with diabetes mellitus.

It is universally acknowledged that diabetes mellitus is a common cause of morbidity in the elderly population but it is less well established that the mortality of people with diabetes is greater at any given age. This comprehensive literature review aims to examine the evidence in order to clarify the relationship between diabetes and mortality risk in elderly diabetic patients. Information was obtained by carrying out a MEDLINE search for relevant papers published in 1980 and onwards; a key paper on mortality in non-insulin-dependent (Type 2) diabetes mellitus (NIDDM) was used as an index paper; Diabetes, Diabetologia, Diabetic Medicine, Diabete et Metabolisme, and Diabetes Care were hand searched; and, finally, other experts in the field were contacted. Two reviewers independently extracted the data from each of the studies and disagreements were discussed and resolved. The studies in elderly study populations comprised mainly NIDDM. The review demonstrated that diabetes is a significant contributor to mortality and reduced life expectancy in elderly subjects. Demographic trends in our population indicate that diabetes will continue to be a challenging health problem.