Abstract:
OBJECTIVE:To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. DESIGN:Systematic review and meta-analysis of randomised trials, quasirandomised trials, and cohort studies. DATA SOURCES:Medline, Embase, Cochrane register of controlled trials, publishers' databases, and manual search of bibliographies. STUDY SELECTION:Randomised controlled trials, quasirandomised trials, and cohort studies (retrospective and prospective) comparing hemiarthroplasty with total hip arthroplasty for treating displaced femoral neck fractures in patients aged more than 60 years. DATA EXTRACTION:Relative risks, risk differences, and mean differences from each trial, aggregated using random effects models. Analyses were stratified for experimental and non-experimental designs, and two way sensitivity analyses and tests for interaction were done to assess the influence of various criteria of methodological quality on pooled estimates. DATA SYNTHESIS:3821 references were identified. Of the 202 full papers inspected, 15 were included (four randomised controlled trials, three quasirandomised trials, and eight retrospective cohort studies, totalling 1890 patients). Meta-analysis of 14 studies showed a lower risk of reoperation after total hip arthroplasty compared with hemiarthroplasty (relative risk 0.57, 95% confidence interval 0.34 to 0.96, risk difference 4.4%, 95% confidence interval 0.2% to 8.5%), although this effect was mainly driven by investigations without concealed treatment allocation. Total hip arthroplasty consistently showed better ratings in the Harris hip score (three studies, 246 patients, weighted mean difference 5.4, 95% confidence interval 2.7 to 8.2) after follow-up periods of 12 to 48 months. The standardised mean difference of different scores from five studies was 0.42 (95% confidence interval 0.24 to 0.61), indicating a medium functional advantage of total hip arthroplasty over hemiarthroplasty. Total hip arthroplasty was associated with a slightly higher risk of dislocation (relative risk 1.48, 95% confidence interval 0.89 to 2.46) and general complications (1.14, 0.87 to 1.48). CONCLUSION:Single stage total hip arthroplasty may lead to lower reoperation rates and better functional outcomes compared with hemiarthroplasty in older patients with displaced femoral neck fractures. However, heterogeneity across the available trials and distinct subgroup effects preclude definitive statements and require further research in this area.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Hopley C,Stengel D,Ekkernkamp A,Wich Mdoi
10.1136/bmj.c2332subject
Has Abstractpub_date
2010-06-11 00:00:00pages
c2332eissn
0959-8138issn
1756-1833journal_volume
340pub_type
杂志文章,meta分析,评审abstract:OBJECTIVES:To determine the relation between the HIV/AIDS epidemic and support for dependent elderly people in Africa. DESIGN:Retrospective analysis using data from Demographic and Health Surveys. SETTING:22 African countries between 1991 and 2006. PARTICIPANTS:123,176 individuals over the age of 60. MAIN OUTCOME M...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.c2841
更新日期:2010-06-16 00:00:00
abstract:OBJECTIVES:To compare the efficacy and tolerability of butterbur (Petasites hybridus) with cetirizine in patients with seasonal allergic rhinitis (hay fever). DESIGN:Randomised, double blind, parallel group comparison. SETTING:Four outpatient general medicine and allergy clinics in Switzerland and Germany. PARTICIPA...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.324.7330.144
更新日期:2002-01-19 00:00:00
abstract::Currently, clinicians have to make decisions about how to manage pulmonary embolism on the basis of imperfect tests and assessment of odds. Management protocols that inevitably result in large numbers of patients being referred for angiography are unhelpful. Management decisions based on assessment of odds and investi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.314.7078.425
更新日期:1997-02-08 00:00:00
abstract:OBJECTIVE:To assess whether a raised serum troponin T concentration would be an independent predictor of death in patients with an acute ischaemic stroke. DESIGN:Observational study. SETTING:Auckland Hospital, Auckland, New Zealand. SUBJECTS:All 181 patients with an acute ischaemic stroke admitted over nine months i...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.320.7248.1502
更新日期:2000-06-03 00:00:00
abstract:OBJECTIVE:To compare the implications of four widely used cholesterol screening and treatment guidelines by applying them to a population in the United Kingdom. DESIGN:Guidelines were applied to population based data from a cross sectional study of cardiovascular disease and risk factors. SETTING:Newcastle upon Tyne,...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.317.7166.1125
更新日期:1998-10-24 00:00:00
abstract:OBJECTIVE:To provide a comprehensive survey of the content and quality of intervention studies relevant to the treatment of schizophrenia. DESIGN:Data were extracted from 2000 trials on the Cochrane Schizophrenia Group's register. MAIN OUTCOME MEASURES:Type and date of publication, country of origin, language, size o...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.317.7167.1181
更新日期:1998-10-31 00:00:00
abstract:OBJECTIVES:To elucidate current trends and geographical patterns in the sex ratio at birth and in the population aged under 20 in China and to determine the roles played by sex selective abortion and the one child policy. DESIGN:Analysis of household based cross sectional population survey done in November 2005. SETT...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b1211
更新日期:2009-04-09 00:00:00
abstract::When oxygen concentrators became available on form FP10 in 1985 the Department of Health and Social Security issued clear guidelines for their prescription for long term treatment. Reassessment of those patients prescribed a concentrator in one district showed that 29 out of 61 patients did not fulfil these criteria. ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6655.1030
更新日期:1988-10-22 00:00:00
abstract:OBJECTIVE:To examine the protective efficacy of measles vaccination in infants in a low income country before 9 months of age. DESIGN:Randomised clinical trial. PARTICIPANTS:1333 infants aged 4.5 months: 441 in treatment group and 892 in control group. SETTING:Urban area in Guinea-Bissau. INTERVENTION:Measles vacci...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.a661
更新日期:2008-07-24 00:00:00
abstract:OBJECTIVE:To prepare and assess the sensitivity and specificity of a latex agglutination test specific for the serotype of antigen in diagnosing pneumococcal pneumonia in Gambian children. DESIGN:Comparison of agglutination test specific for serotype with culture of blood and lung aspirates, countercurrent immunoelect...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.298.6680.1061
更新日期:1989-04-22 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of corticosteroid injections with physiotherapy for the treatment of painful stiff shoulder. DESIGN:Randomised trial. SETTING:40 general practices. SUBJECTS:109 patients consulting general practitioners for shoulder pain were enrolled in the trial. INTERVENTIONS:Patients were ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.317.7168.1292
更新日期:1998-11-07 00:00:00
abstract::Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st birth weight standard.Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestatio...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j3677
更新日期:2017-08-17 00:00:00
abstract:OBJECTIVE:To investigate whether an important football match increases stress to such an extent that it triggers acute myocardial infarction and stroke. DESIGN:Longitudinal study of mortality around 22 June 1996 (the day the Dutch football team was eliminated from the European football championship). Mortality on 22 J...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.321.7276.1552
更新日期:2000-12-23 00:00:00
abstract:OBJECTIVES:To evaluate the use of a maternity unit run by general practitioners and midwives, describing the outcome of labour in an unselected group of women and quantifying the contribution made by general practitioners. DESIGN:Retrospective population based review of obstetric patients who had access to an isolated...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7025.223
更新日期:1996-01-27 00:00:00
abstract:OBJECTIVE:To assess the efficacy of a newly developed system for applying continuous or intermittent negative (subatmospheric) extrathoracic pressure in respiratory failure. DESIGN:Uncontrolled clinical trials in infants deteriorating or failing to improve despite standard medical treatment. SETTING:Paediatric and ne...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.299.6710.1253
更新日期:1989-11-18 00:00:00
abstract:OBJECTIVE:To test the hypothesis that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) may decrease the risk of community acquired pneumonia. DESIGN:Population based case-control study. SETTING:Group Health, a large integrated healthcare delivery system. Population Immunocompetent, community dwelling ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.b2137
更新日期:2009-06-16 00:00:00
abstract:OBJECTIVE:To investigate the differences between skeletal and chronological age and to assess the role of maturity status, anthropometric data, and football related variables in explaining injury statistics in elite schoolboy footballers. DESIGN:Prospective study of injuries in schoolboy footballers according to skele...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.b490
更新日期:2009-02-26 00:00:00
abstract:OBJECTIVE:To establish whether there is evidence of the efficacy of homoeopathy from controlled trials in humans. DESIGN:Criteria based meta-analysis. Assessment of the methodological quality of 107 controlled trials in 96 published reports found after an extensive search. Trials were scored using a list of predefined...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.302.6772.316
更新日期:1991-02-09 00:00:00
abstract:OBJECTIVE:To compare ultrasonography with intravenous urography in the investigation of adults with haematuria. DESIGN:Prospective study entailing the examination of all patients with both investigations concurrently. The investigations were performed independently on routine lists by different duty radiologists. Each...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.301.6760.1074
更新日期:1990-11-10 00:00:00
abstract:OBJECTIVE:To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change. DESIGN:Interviews using the critical incident technique. SETTING:Primary and secondary care. SUBJECTS:Random sample of 50 general practit...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7084.870
更新日期:1997-03-22 00:00:00
abstract::In the absence of any systematic evaluation of the changes it has made to the NHS, the government cites three "indicators of success." These are record numbers of patients treated, shorter waiting times for hospital treatment, and more children being immunised against the main childhood diseases. Closer inspection of ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:
更新日期:1995-04-22 00:00:00
abstract:OBJECTIVE:To assess treatment related changes in quality of life up to 15 years after diagnosis of localised prostate cancer. DESIGN:Population based, prospective cohort study with follow-up over 15 years. SETTING:New South Wales, Australia. PARTICIPANTS:1642 men with localised prostate cancer, aged less than 70, an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m3503
更新日期:2020-10-07 00:00:00
abstract:OBJECTIVE:To determine the risk factors for neonatal encephalopathy among term infants in a developing country. DESIGN:Unmatched case-control study. SETTING:Principal maternity hospital of Kathmandu, Nepal. SUBJECTS:All 131 infants with neonatal encephalopathy from a population of 21 609 infants born over an 18 mont...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.320.7244.1229
更新日期:2000-05-06 00:00:00
abstract::Chronic insomnia is a common condition that affects people worldwide and has negative effects on patients' health and wellbeing. The treatment of insomnia can be complex and time consuming for patients and providers. Although behavioral interventions are the first line therapy, there are barriers to access for these t...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.i2123
更新日期:2016-07-06 00:00:00
abstract:PROBLEM:Prophylactic treatment and follow-up after exposure to HIV, hepatitis B, and hepatitis C outside hospital needs to be improved. BACKGROUND AND SETTING:Until January 2000, people in Amsterdam could report exposure outside hospital to either a hospital or the municipal health service. If they reported to the mun...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.330.7495.825
更新日期:2005-04-09 00:00:00
abstract:OBJECTIVES:To investigate use of commodes and attitudes of users and carers to them. DESIGN:Interview with semi-structured questionnaire of subjects supplied with commodes from Leeds community appliance centre. SUBJECTS:140 users of a commode and 105 of their carers. RESULTS:Main reasons for being supplied with a co...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6914.1258
更新日期:1993-11-13 00:00:00
abstract:OBJECTIVE:To examine changes in immunisation performance in Grampian region after the introduction of the 1990 contract for general practitioners. DESIGN:Retrospective descriptive study using data held on the Grampian immunisation record system's computer. SETTING:All 95 general practices in Grampian region (313 gene...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6830.816
更新日期:1992-03-28 00:00:00
abstract::Objective To analyse stage specific incidence of breast cancer in the Netherlands where women have been invited to biennial mammography screening since 1989 (ages 50-69) and 1997 (ages 70-75), and to assess changes in breast cancer mortality and quantified overdiagnosis.Design Population based study.Setting Mammograph...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j5224
更新日期:2017-12-05 00:00:00
abstract::An increase in the incidence of cardiovascular disease has generally been observed in postmenopausal women, but there have been few studies of the association between menopausal state and atherosclerosis. In this study 294 premenopausal and 319 postmenopausal women aged 45 to 55 were examined radiographically for calc...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.298.6674.642
更新日期:1989-03-11 00:00:00
abstract:OBJECTIVE:To determine the effectiveness of oral rehydration in children with moderate dehydration caused by gastroenteritis, and to compare the complications of oral and intravenous treatment. DESIGN:Randomised controlled trial. SETTING:Emergency department and infectious diseases ward in a large urban teaching hosp...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.303.6799.393
更新日期:1991-08-17 00:00:00