Abstract:
CLINICAL QUESTION:Do adults with atraumatic shoulder pain for more than 3 months diagnosed as subacromial pain syndrome (SAPS), also labelled as rotator cuff disease, benefit from subacromial decompression surgery? This guideline builds on to two recent high quality trials of shoulder surgery. CURRENT PRACTICE:SAPS is the common diagnosis for shoulder pain with several first line treatment options, including analgesia, exercises, and injections. Surgeons frequently perform arthroscopic subacromial decompression for prolonged symptoms, with guidelines providing conflicting recommendations. RECOMMENDATION:The guideline panel makes a strong recommendation against surgery. HOW THIS GUIDELINE WAS CREATED:A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines and the GRADE system. The recommendation is based on two linked systematic reviews on (a) the benefits and harms of subacromial decompression surgery and (b) the minimally important differences for patient reported outcome measures. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of surgery in multilayered evidence summaries and decision aids available in MAGIC (www.magicapp.org) to support shared decisions and adaptation. THE EVIDENCE:Surgery did not provide important improvements in pain, function, or quality of life compared with placebo surgery or other options. Frozen shoulder may be more common with surgery. UNDERSTANDING THE RECOMMENDATION:The panel concluded that almost all informed patients would choose to avoid surgery because there is no benefit but there are harms and it is burdensome. Subacromial decompression surgery should not be offered to patients with SAPS. However, there is substantial uncertainty in what alternative treatment is best.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Vandvik PO,Lähdeoja T,Ardern C,Buchbinder R,Moro J,Brox JI,Burgers J,Hao Q,Karjalainen T,van den Bekerom M,Noorduyn J,Lytvyn L,Siemieniuk RAC,Albin A,Shunjie SC,Fisch F,Proulx L,Guyatt G,Agoritsas T,Poolman RWdoi
10.1136/bmj.l294subject
Has Abstractpub_date
2019-02-06 00:00:00pages
l294eissn
0959-8138issn
1756-1833journal_volume
364pub_type
杂志文章abstract:OBJECTIVES:(a) To investigate defensive medical practices among general practitioners; (b) to compare any such practices with general practitioners' understanding of certain aspects of the terms of service and medical negligence and practitioners' concerns about the risk of being sued or having a complaint lodged. DES...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:1995-01-07 00:00:00
abstract:OBJECTIVE:To determine if trimethoprim use for urinary tract infection (UTI) is associated with an increased risk of acute kidney injury, hyperkalaemia, or sudden death in the general population. DESIGN:Cohort study. SETTING:UK electronic primary care records from practices contributing to the Clinical Practice Resea...
journal_title:BMJ (Clinical research ed.)
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更新日期:2018-02-09 00:00:00
abstract:OBJECTIVES:To calculate socioeconomic and health status measures for the primary care groups in London and to examine the association between these measures and hospital admission rates. DESIGN:Cross sectional study. SETTING:66 primary care groups in London, total list size 8.0 million people. MAIN OUTCOME MEASURES:...
journal_title:BMJ (Clinical research ed.)
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更新日期:2000-10-28 00:00:00
abstract:OBJECTIVE:To examine the associations between neuraxial anaesthesia or general anaesthesia and clinical outcomes, length of hospital stay, and readmission in adults undergoing lower limb revascularisation surgery. DESIGN:Comparative effectiveness study using linked, validated, population based databases. SETTING:Onta...
journal_title:BMJ (Clinical research ed.)
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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
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更新日期:1998-11-07 00:00:00
abstract:OBJECTIVE:To test the hypothesis that radiography of the lumbar spine in patients with low back pain is not associated with improved clinical outcomes or satisfaction with care. DESIGN:Randomised unblinded controlled trial. SETTING:73 general practices in Nottingham, north Nottinghamshire, southern Derbyshire, north ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:2001-02-17 00:00:00
abstract:OBJECTIVE:To investigate the association between long term intake of dietary and supplemental calcium and death from all causes and cardiovascular disease. DESIGN:Prospective longitudinal cohort study. SETTING:Swedish mammography cohort, a population based cohort established in 1987-90. PARTICIPANTS:61 433 women (bo...
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更新日期:2013-02-12 00:00:00
abstract:OBJECTIVE:To determine whether being overweight in childhood increases adult obesity and risk of disease. DESIGN:Prospective cohort study. SETTING:City of Newcastle upon Tyne. PARTICIPANTS:932 members of thousand families 1947 birth cohort, of whom 412 attended for clinical examination age 50. MAIN OUTCOME MEASURES...
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更新日期:2001-12-01 00:00:00
abstract:OBJECTIVES:To investigate the consequences of longstanding obesity on left ventricular mass and structure and to examine the effects of weight loss on these variables. DESIGN:Cross sectional survey and controlled intervention study. SETTING:City of Gothenburg and surrounding areas. Sweden. SUBJECTS:41 obese patients...
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更新日期:1997-10-11 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...
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pub_type: 临床试验,杂志文章
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更新日期:1989-04-22 00:00:00
abstract:OBJECTIVE:To examine differences in morbidity and mortality due to non-insulin dependent diabetes in African Caribbeans and Europeans. DESIGN:Cohort study of patients with non-insulin dependent diabetes drawn from diabetes clinics in London. Baseline investigations were performed in 1975-7; follow up continued until 1...
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更新日期:1996-10-05 00:00:00
abstract:OBJECTIVE:To observe the effects of stimulation of the sacral anterior roots on anorectal and low colonic pressures and to programme implanted stimulators to produce defecation. DESIGN:Prospective study of 12 consecutive patients. SETTING:Spinal injuries unit and university gastrointestinal physiology department. PA...
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pub_type: 杂志文章
doi:10.1136/bmj.300.6738.1494
更新日期:1990-06-09 00:00:00
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 ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.f6153
更新日期:2013-11-04 00:00:00
abstract:OBJECTIVES:To investigate the cost effectiveness of cyclo-oxygenase-2 (COX 2) selective inhibitors and traditional non-steroidal anti-inflammatory drugs (NSAIDs), and the addition of proton pump inhibitors to these treatments, for people with osteoarthritis. DESIGN:An economic evaluation using a Markov model and data ...
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更新日期:2009-07-14 00:00:00
abstract::The author is one of the medical advisers to the judge who led a government inquiry into allegations that an experimental research program at the National Women's Hospital in Auckland, New Zealand, to study the natural course of cervical carcinoma in situ had withheld conventional treatment from some patients. She ar...
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pub_type: 杂志文章
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更新日期:1988-08-20 00:00:00
abstract:OBJECTIVE:To show the influence of variations in case mix on clinical outcome indicators for patients admitted to hospital with acute stroke. DESIGN:"Before and after" cohort study, with prospective, consecutive identification of patients and prospective follow up; multiple logistic regression analyses to correct for ...
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pub_type: 杂志文章
doi:10.1136/bmj.312.7045.1503
更新日期:1996-06-15 00:00:00
abstract:OBJECTIVE:To assess the risk of epileptic seizures in people with and without epilepsy after vaccination with a monovalent AS03 adjuvanted pandemic A/H1N1 influenza vaccine (Pandemrix; Glaxo SmithKline, Sweden). DESIGN:Register based self controlled case series. SETTING:Three Swedish counties (source population 750,0...
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doi:10.1136/bmj.e7594
更新日期:2012-12-18 00:00:00
abstract:STUDY OBJECTIVE:To assess effect of intravenous recombinant tissue type plasminogen activator on size of infarct, left ventricular function, and survival in acute myocardial infarction. DESIGN:Double blind, randomised, placebo controlled prospective trial of patients with acute myocardial infarction within five hours ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1988-11-26 00:00:00
abstract:OBJECTIVES:To evaluate the effectiveness of a self help approach to smoking cessation in pregnancy. DESIGN:Pragmatic cluster randomised controlled trial with community midwife as the unit of randomisation. SETTING:Three NHS hospital trusts in England. PARTICIPANTS:1527 women who smoked at the start of pregnancy. IN...
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:2002-12-14 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2005-03-19 00:00:00
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更新日期:1990-02-03 00:00:00
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更新日期:2001-03-10 00:00:00
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更新日期:2018-09-26 00:00:00
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更新日期:1999-10-02 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2002-11-09 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2009-12-03 00:00:00
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更新日期:2013-07-18 00:00:00
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pub_type: 杂志文章,收录出版
doi:10.1136/bmj.298.6682.1215
更新日期:1989-05-06 00:00:00
abstract::Cancers of unknown primary (CUPs) are histologically confirmed, metastatic malignancies with a primary tumor site that is unidentifiable on the basis of standard evaluation and imaging studies. CUP comprises 2-5% of all diagnosed cancers worldwide and is characterized by early and aggressive metastasis. Current standa...
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pub_type: 杂志文章,评审
doi:10.1136/bmj.m4050
更新日期:2020-12-07 00:00:00