Abstract:
OBJECTIVES:To assess the effects of treatments for non-metastatic invasive squamous cell carcinoma (SCC) of the skin using evidence from observational studies, given the paucity of evidence from randomised controlled trials. DESIGN:Systematic review of observational studies. DATA SOURCES:Medline, Embase, to December 2012. REVIEW METHODS:Observational studies of interventions for primary, non-metastatic, invasive, SCC of the skin that reported recurrence during follow-up, quality of life, initial response to treatment, adverse events, cosmetic appearance, or death from disease. Studies were excluded if data for primary cutaneous SCC was not separable from other data. Data were extracted independently by two reviewers. Meta-analysis was performed where appropriate using a random effects model to estimate the pooled proportion of an event with 95% confidence intervals. RESULTS:118 publications were included, covering seven treatment modalities. Pooled estimates of recurrence of SCCs were lowest after cryotherapy (0.8% (95% confidence interval 0.1% to 2%)) and curettage and electrodesiccation (1.7% (0.5% to 3.4%)), but most treated SCCs were small, low risk lesions. After Mohs micrographic surgery, the pooled estimate of local recurrence during variable follow-up periods from 10 studies was 3.0% (2.2% to 3.9%), which was non-significantly lower than the pooled average local recurrence of 5.4% (2.5% to 9.1%) after standard surgical excision (12 studies), and 6.4% (3.0% to 11.0%) after external radiotherapy (7 studies). After an apparently successful initial response of SCCs to photodynamic therapy, pooled average recurrence of 26.4% (12.3% to 43.7%; 8 studies) was significantly higher than other treatments. Evidence was limited for laser treatment (1 study) and for topical and systemic treatments (mostly single case reports or small non-comparative series with limited follow-up). CONCLUSIONS:Many observational studies have looked at different treatment modalities for SCC, but the evidence base for the effectiveness of these interventions is poor. Comparison of outcomes after different treatments should be interpreted cautiously owing to biases inherent in the types of study included, and lack of direct comparisons to enable the estimation of relative treatment effect. Further evidence is needed to develop a prognostic model and stratify individuals at high risk of developing SCC, to improve the evidence base for this common cancer and to optimise clinical management. PROTOCOL REGISTRATION:International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42011001450.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Lansbury L,Bath-Hextall F,Perkins W,Stanton W,Leonardi-Bee Jdoi
10.1136/bmj.f6153subject
Has Abstractpub_date
2013-11-04 00:00:00pages
f6153eissn
0959-8138issn
1756-1833journal_volume
347pub_type
杂志文章,meta分析,评审abstract:OBJECTIVE:To determine whether use of intermediate acting neuromuscular blocking agents during general anesthesia increases the incidence of postoperative respiratory complications. DESIGN:Prospective, propensity score matched cohort study. SETTING:General teaching hospital in Boston, Massachusetts, United States, 20...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e6329
更新日期:2012-10-15 00:00:00
abstract:OBJECTIVES:To determine whether informed consent introduces selection bias in prospective observational studies using data from medical records, and consent rates for such studies. DESIGN:Systematic review. DATA SOURCES:Embase, Medline, and the Cochrane Library up to March 2008, reference lists from pertinent article...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.b866
更新日期:2009-03-12 00:00:00
abstract:OBJECTIVE:To see whether the issue of AIDS has influenced the observed decline in blood donation in Scotland. DESIGN:Two methods: a quantitative survey using personal interviews based on a questionnaire and a qualitative survey based on group discussions. SETTING:Interviews based on the questionnaire were conducted i...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.298.6679.1012
更新日期:1989-04-15 00:00:00
abstract:OBJECTIVE:To investigate the contribution of neuroleptic drugs to cognitive decline in dementia. DESIGN:Two year prospective, longitudinal study consisting of interviews every four months, with necropsy follow up. SETTING:Community settings in Oxfordshire. SUBJECTS:71 subjects with dementia, initially living at home...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7076.266
更新日期:1997-01-25 00:00:00
abstract:OBJECTIVE:To determine medical students' self awareness and ability to discriminate right from left; to identify characteristics associated with this ability; and to identify any techniques used to aid discrimination. DESIGN:Questionnaire and psychometric study. SETTING:Undergraduate medical school, Northern Ireland....
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.a2826
更新日期:2008-12-16 00:00:00
abstract:OBJECTIVES:To clarify the type of fetal growth impairment associated with increased blood pressure in adult life, and to establish whether this association is influenced by obesity and is mediated through impairment of insulin action. DESIGN:Cross sectional survey with retrospective ascertainment of size at birth from...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7028.401
更新日期:1996-02-17 00:00:00
abstract:OBJECTIVE:To determine whether genetic factors associated with established rheumatoid arthritis could, in combination with rheumatoid factor, predict the development of radiological erosions in patients with early symmetrical (rheumatoid-like) arthritis. DESIGN:Prospective study. SETTING:Teaching hospital, early arth...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6866.1387
更新日期:1992-12-05 00:00:00
abstract:OBJECTIVES:To investigate the association between environmental tobacco smoke, plasma cotinine concentration, and respiratory cancer or death. DESIGN:Nested case-control study within the European prospective investigation into cancer and nutrition (EPIC). PARTICIPANTS:303,020 people from the EPIC cohort (total 500,00...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.38327.648472.82
更新日期:2005-02-05 00:00:00
abstract::Managed care has entered the lexicon of healthcare reform, but confusion and ignorance surround its meaning and purpose. It seeks to cut the costs of health care while maintaining its quality, but the evidence that it is able to achieve these aims is mixed. As well as raising awareness and understanding of the issues ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.314.7097.1823
更新日期:1997-06-21 00:00:00
abstract:PROBLEM:Despite widespread acceptance of the Ottawa ankle rules for assessment of acute ankle injuries, their application varies considerably. DESIGN:Before and after study. BACKGROUND AND SETTING:Emergency departments of a tertiary teaching hospital and a community hospital in Australia. KEY MEASURES FOR IMPROVEMEN...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b3056
更新日期:2009-08-12 00:00:00
abstract:OBJECTIVES:To assess the associations between both uric acid levels and hyperuricaemia, with ischaemic heart disease and blood pressure, and to explore the potentially confounding role of body mass index. DESIGN:Mendelian randomisation analysis, using variation at specific genes (SLC2A9 (rs7442295) as an instrument fo...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f4262
更新日期:2013-07-18 00:00:00
abstract:OBJECTIVE:To assess general practitioners' decisions to request lumbar spine radiographs according to the guidelines of the Royal College of Radiologists. DESIGN:Prospective questionnaire survey of outpatients attending for lumbar spine radiography. SETTING:London community hospital. SUBJECTS:100 consecutive adult o...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6806.813
更新日期:1991-10-05 00:00:00
abstract:OBJECTIVES:To compare patterns of admission to hospital and prognosis in white and South Asian patients newly admitted with heart failure, and to evaluate the effect of personal characteristics and comorbidity on outcome. DESIGN:Historical cohort study. SETTING:UK district health authority (population 960,000). PART...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.327.7414.526
更新日期:2003-09-06 00:00:00
abstract::Preparing a review entails many judgments. The focus of the review must be decided. Studies that are relevant to the focus of the review must be identified, selected for inclusion and critically appraised. Information must be collected and synthesised from the relevant studies, and conclusions must be drawn. Checklist...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.309.6955.648
更新日期:1994-09-10 00:00:00
abstract:OBJECTIVES:To measure the impact of socioeconomic deprivation on rates of teenage pregnancy and the extent of local variation in pregnancy rates in Scotland, and to examine how both have changed over time. DESIGN:Population study using routine data from hospital records, aggregated for small areas. SUBJECTS:Female te...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.323.7306.199
更新日期:2001-07-28 00:00:00
abstract:OBJECTIVE:To identify historical and clinical findings at emergency department presentation associated with severe H1N1 outcome in children presenting with influenza-like illness. DESIGN:Multicentre retrospective case-control study. SETTING:79 emergency departments of hospitals associated with the Pediatric Emergency...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.f4836
更新日期:2013-08-12 00:00:00
abstract::One hundred and two patients returned structured questionnaires sent to clinics for sickle cell disease in the United Kingdom in order to gain greater insight into the patients' perception of painful crises. Most patients who suffer pain crises experience a prodromal stage that should be investigated further to find o...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6646.452
更新日期:1988-08-13 00:00:00
abstract:OBJECTIVE:To determine if the Food Standards Agency nutrient profiling system (FSAm-NPS), which grades the nutritional quality of food products and is used to derive the Nutri-Score front-of-packet label to guide consumers towards healthier food choices, is associated with mortality. DESIGN:Population based cohort stu...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m3173
更新日期:2020-09-16 00:00:00
abstract:OBJECTIVE:To describe and quantify patterns of injury from antipersonnel mines in terms of distribution of injury, drain on surgical resources, and residual disability. DESIGN:Retrospective analysis. SETTING:Two hospitals for patients injured in war. SUBJECTS:757 patients with injuries from antipersonnel mines. MAI...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6816.1509
更新日期:1991-12-14 00:00:00
abstract:OBJECTIVES:To investigate whether sending patients a copy of their referral letter can reduce non-attendance at outpatient departments. DESIGN:Blinded randomised controlled trial. SETTING:13 general practices in Exeter, Devon. SUBJECTS:2078 new consultant referrals from 26 doctors. MAIN OUTCOME MEASURES:Non-attenda...
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.318.7195.1392
更新日期:1999-05-22 00:00:00
abstract:OBJECTIVE:To assess the effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy. DESIGN:Parallel group, cluster randomised, controlled trial of an educational package on cognitive behaviour therapy. SETTING:General practices in north London. PARTICIPANTS:84 general practitioner pr...
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.324.7343.947
更新日期:2002-04-20 00:00:00
abstract:OBJECTIVES:To compare the costs of admission to a hospital at home scheme with those of acute hospital admission. DESIGN:Cost minimisation analysis within a pragmatic randomised controlled trial. SETTING:Hospital at home scheme in Leicester and the city's three acute hospitals. PARTICIPANTS:199 consecutive patients ...
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.319.7224.1547
更新日期:1999-12-11 00:00:00
abstract:OBJECTIVE:To characterise the functional morphology of the nasal microcirculation in humans in comparison with reindeer as a means of testing the hypothesis that the luminous red nose of Rudolph, one of the most well known reindeer pulling Santa Claus's sleigh, is due to the presence of a highly dense and rich nasal mi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e8311
更新日期:2012-12-14 00:00:00
abstract:OBJECTIVE:To determine if any excess of childhood leukaemia was associated with the large and increasing numbers of national military servicemen in 1949 and 1950, particularly in rural districts. This would be a further test of the hypothesis that childhood leukaemia can originate in an infection, the transmission of w...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6814.1357
更新日期:1991-11-30 00:00:00
abstract:OBJECTIVE:To estimate the usefulness of serum concentrations of the complex of trypsin 2 and alpha 1 antitrypsin in diagnosing and assessing the severity of acute pancreatitis in comparison with serum C reactive protein, amylase, and trypsinogen 2 concentrations (reference markers). DESIGN:Markers were measured in con...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7053.333
更新日期:1996-08-10 00:00:00
abstract:OBJECTIVE:To investigate the effectiveness of supplementing information and advice on analgesia and exercise from a general practitioner with transcutaneous electrical nerve stimulation (TENS) as a non-drug form of analgesia to reduce pain intensity in patients with tennis elbow. DESIGN:Pragmatic randomised controlled...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.f5160
更新日期:2013-09-02 00:00:00
abstract:OBJECTIVES:To estimate survival after a diagnosis of dementia in primary care, compared with people without dementia, and to determine incidence of dementia. DESIGN:Cohort study using data from The Health Improvement Network (THIN), a primary care database. SETTING:353 general practices in the United Kingdom providin...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.c3584
更新日期:2010-08-05 00:00:00
abstract:OBJECTIVE:To determine the effect of home blood pressure monitoring on blood pressure levels and proportion of people with essential hypertension achieving targets. DESIGN:Meta-analysis of 18 randomised controlled trials. PARTICIPANTS:1359 people with essential hypertension allocated to home blood pressure monitoring...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.38121.684410.AE
更新日期:2004-07-17 00:00:00
abstract:OBJECTIVE:To document the relative importance of endogenous sex steroids in modulating the frequency of orgasms, the dominant aspect of sexual behaviour in healthy eugonadal men. DESIGN:Measurement of adrenal and testicular sex steroids in a sample of army recruits and study of their relation to frequency of orgasms a...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6990.1289
更新日期:1995-05-20 00:00:00
abstract:OBJECTIVES:To measure the potential for cadaver organ retrieval in New South Wales and to determine the reasons for potential donors failing to become actual donors. DESIGN:Prospective audit of all patients dying in five hospitals in New South Wales between 1 December 1989 and 30 November 1990; quality assurance of th...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6838.1339
更新日期:1992-05-23 00:00:00