Abstract:
OBJECTIVES:To determine the strength of evidence for the effectiveness of mental health interventions for patients with three common somatic conditions (chronic fatigue syndrome, irritable bowel syndrome, and chronic back pain). To assess whether results obtained in secondary care can be extrapolated to primary care and suggest how future trials should be designed to provide more rigorous evidence. DESIGN:Systematic review. DATA SOURCES:Five electronic databases, key texts, references in the articles identified, and citations from expert clinicians. STUDY SELECTION:Randomised controlled trials including participants with one of the three conditions for which no physical cause could be found. Two reviewers screened sources and independently extracted data and assessed quality. RESULTS:Sixty one studies were identified; 20 were classified as primary care and 41 as secondary care. For some interventions, such as brief psychodynamic interpersonal therapy, little research was identified. However, results of meta-analyses and of randomised controlled trials suggest that cognitive behaviour therapy and behaviour therapy are effective for chronic back pain and chronic fatigue syndrome and that antidepressants are effective for irritable bowel syndrome. Cognitive behaviour therapy and behaviour therapy were effective in both primary and secondary care in patients with back pain, although the evidence is more consistent and the effect size larger for secondary care. Antidepressants seem effective in irritable bowel syndrome in both settings but ineffective in chronic fatigue syndrome. CONCLUSIONS:Treatment seems to be more effective in patients in secondary care than in primary care. This may be because secondary care patients have more severe disease, they receive a different treatment regimen, or the intervention is more closely supervised. However, conclusions of effectiveness should be considered in the light of the methodological weaknesses of the studies. Large pragmatic trials are needed of interventions delivered in primary care by appropriately trained primary care staff.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Raine R,Haines A,Sensky T,Hutchings A,Larkin K,Black Ndoi
10.1136/bmj.325.7372.1082keywords:
subject
Has Abstractpub_date
2002-11-09 00:00:00pages
1082issue
7372eissn
0959-8138issn
1756-1833journal_volume
325pub_type
杂志文章,评审abstract::Recent changes in the Russian government introduced by Boris Yeltsin include the appointment of Eduard Nechaev as health minister at the beginning of this year. The appointment received little publicity in the West, although his predecessor was sacked after only one year for failing to make any effort to improve healt...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6882.909
更新日期:1993-04-03 00:00:00
abstract:OBJECTIVES:To evaluate the effect of daily zinc supplementation in children on the incidence of acute lower respiratory tract infections and pneumonia. DESIGN:Double masked, randomised placebo controlled trial. SETTING:A slum community in New Delhi, India. PARTICIPANTS:2482 children aged 6 to 30 months. INTERVENTIO...
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.324.7350.1358
更新日期:2002-06-08 00:00:00
abstract:OBJECTIVES:To examine the effects of physical work environment on long term sickness absence and to investigate interaction between physical and psychosocial risk factors. DESIGN AND SETTING:Prospective cohort study of long term sickness absence among employees in Denmark. PARTICIPANTS:5357 employees interviewed in 2...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38731.622975.3A
更新日期:2006-02-25 00:00:00
abstract::The numbers of patients being admitted to hospital with aortic aneurysms have increased recently. A study was carried out to try to find out whether this was a true increase in incidence or whether it could be attributable to more accurate diagnosis and better surgical techniques. From analyses of routine statistics i...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.298.6665.33
更新日期:1989-01-07 00:00:00
abstract:OBJECTIVE:To investigate the relation between total fat intake and body weight in adults and children. DESIGN:Systematic review and meta-analysis of randomised controlled trials and cohort studies. DATA SOURCES:Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials to June 2010. INCLUSION CR...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.e7666
更新日期:2012-12-06 00:00:00
abstract:OBJECTIVE:To assess the incidence and severity of physical and psychosexual symptoms in young women due to ovarian failure caused by total body irradiation for leukaemia and the women's response to hormone treatment. DESIGN:Postal questionnaire and interview. SETTING:Leukaemia unit of oncology hospital. PATIENTS:Con...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6714.1494
更新日期:1989-12-16 00:00:00
abstract:OBJECTIVES:To determine the prevalence and associations of symptoms of fatigue. DESIGN:Questionnaire survey. SETTING:London general practice. PARTICIPANTS:611 General practice attenders. MAIN OUTCOME MEASURES:Scores on a fatigue questionnaire and reasons given for fatigue. RESULTS:10.2% Of men (17/167) and 10.6% o...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.301.6762.1199
更新日期:1990-11-24 00:00:00
abstract:OBJECTIVES:To assess and improve the quality of care provided to women undergoing induced abortion. DESIGN:Two rounds of prospective, criterion based case note review audit. SETTING:Ten NHS gynaecology units throughout Scotland. SUBJECTS:2004 patient episodes of abortion care identified consecutively during two roun...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.309.6946.15
更新日期:1994-07-02 00:00:00
abstract:OBJECTIVE:To determine the efficacy of a probiotic drink containing Lactobacillus for the prevention of any diarrhoea associated with antibiotic use and that caused by Clostridium difficile. DESIGN:Randomised double blind placebo controlled study. PARTICIPANTS:135 hospital patients (mean age 74) taking antibiotics. E...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.39231.599815.55
更新日期:2007-07-14 00:00:00
abstract:OBJECTIVE:To systematically review measures of data quality in electronic patient records (EPRs) in primary care. DESIGN:Systematic review of English language publications, 1980-2001. DATA SOURCES:Bibliographic searches of medical databases, specialist medical informatics databases, conference proceedings, and instit...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.326.7398.1070
更新日期:2003-05-17 00:00:00
abstract::For an unprepared sexually active teenager the 1990s present a minefield of potential problems in addition to the most obvious problems of unplanned pregnancy and sexually transmitted disease. Promoting the importance of a healthy sexual and reproductive life to young people requires openness, better sex education, re...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.309.6957.786
更新日期:1994-09-24 00:00:00
abstract:OBJECTIVES:To examine the reporting characteristics and methodological details of randomised trials indexed in PubMed in 2000 and 2006 and assess whether the quality of reporting has improved after publication of the Consolidated Standards of Reporting Trials (CONSORT) Statement in 2001. DESIGN:Comparison of two cross...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.c723
更新日期:2010-03-23 00:00:00
abstract:OBJECTIVES:To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. DESIGN:Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.39049.706493.55
更新日期:2007-01-13 00:00:00
abstract:OBJECTIVE:To evaluate the incidence of serious maternal complications after the use of various tocolytic drugs for the treatment of preterm labour in routine clinical situations. DESIGN:Prospective cohort study. SETTING:28 hospitals in the Netherlands and Belgium. PARTICIPANTS:1920 consecutive women treated with toc...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b744
更新日期:2009-03-05 00:00:00
abstract:OBJECTIVE:To determine whether short-term, oral low dose prednisolone (< or = 15 mg daily) is superior to placebo and non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis. DESIGN:Meta-analysis of randomised trials of oral corticosteroids compared with placebo or a non-steroidal anti-inflammatory...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.316.7134.811
更新日期:1998-03-14 00:00:00
abstract::A random sample of 133 elderly patients who had an unplanned readmission to a district general hospital within 28 days of discharge from hospital was studied and compared with a matched control sample of patients who were not readmitted. The total group was drawn from all specialties in the hospital, and by interviewi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6651.784
更新日期:1988-09-24 00:00:00
abstract::In the existing WHO guidelines, complementary feeding at 4-6 months is advocated. However, many nutrition specialists believe that these guidelines lead to complementary foods being offered from the age of 3 months, or even earlier, subsequently suggesting that the WHO should change its recommendations to about 6 mon...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:
更新日期:2000-09-09 00:00:00
abstract:OBJECTIVE:To investigate socioeconomic variation among young women in the risk of hospital admission for diseases (including neoplasms) of the female genital system and breast and for the common surgical procedures of dilatation and curettage and hysterectomy. DESIGN:Large nationally representative cohort study with i...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7009.840
更新日期:1995-09-30 00:00:00
abstract:OBJECTIVE:To describe the progression of HIV disease in a haemophilic cohort and to show the influence of treatment. DESIGN:11 year longitudinal clinical and laboratory study. SETTING:A haemophilia centre. PATIENTS:111 patients infected with HIV during October 1979 to July 1985. MAIN OUTCOME MEASURES:Symptoms of HI...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.303.6810.1093
更新日期:1991-11-02 00:00:00
abstract:OBJECTIVES:To examine the individual and combined associations of unhealthy behaviours (low/intermediate physical activity, consuming fruit and vegetables less than once a day, current smoking/short term ex-smoking, never/former/heavy alcohol drinking), assessed at start of follow-up, with hazard of disability among ol...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f4240
更新日期:2013-07-23 00:00:00
abstract:OBJECTIVES:To develop a systematic method for both summative and formative audit of practice audits, and to use the method to review Oxfordshire practice audits and to plan improvement. DESIGN:Development of a coding system for the audit cycle subsequently used prospectively to assess audits reported to medical audit ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.303.6812.1247
更新日期:1991-11-16 00:00:00
abstract:OBJECTIVE:To assess the risk of cerebral thromboembolism in women using low dose oral contraceptives. DESIGN:A retrospective case-control study. SETTING:All Danish medical, neurological, neurosurgical, and gynaecological departments. SUBJECTS:All 794 women in Denmark aged 15-44 who had suffered a cerebral thromboemb...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6883.956
更新日期:1993-04-10 00:00:00
abstract:OBJECTIVES: To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself. DEIGN: Observational cohort study. SETTING: US Health and Retirement Study. PARTICIPANTS: 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage w...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.i2375
更新日期:2016-05-17 00:00:00
abstract:OBJECTIVE:To determine the clinical and cost effectiveness of booklet based vestibular rehabilitation with and without telephone support for chronic dizziness, compared with routine care. DESIGN:Single blind, parallel group, pragmatic, randomised controlled trial. SETTING:35 general practices across southern England ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.e2237
更新日期:2012-06-06 00:00:00
abstract:OBJECTIVE:To assess long term survival (> 5 years) and quality of life in severely ill patients referred for urgent cardiac transplantation. SETTING:Tertiary referral centres: before transplantation at the National Heart Hospital (late 1984 to end 1986); after transplantation at Harefield Hospital. SUBJECTS:Eighteen ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6870.98
更新日期:1993-01-09 00:00:00
abstract:OBJECTIVE:To investigate the risk of glioma in adults in relation to mobile phone use. DESIGN:Population based case-control study with collection of personal interview data. SETTING:Five areas of the United Kingdom. PARTICIPANTS:966 people aged 18 to 69 years diagnosed with a glioma from 1 December 2000 to 29 Februa...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.38720.687975.55
更新日期:2006-04-15 00:00:00
abstract:OBJECTIVE:To assess the effectiveness of two mechanical methods of blood conservation in reducing the need for allogeneic red blood cells or coagulation products during cardiac surgery. DESIGN:Randomised controlled trial. SETTING:Regional cardiac centre in a teaching hospital in Southampton. PARTICIPANTS:263 adults ...
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.324.7349.1299
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:To explore genetic and environmental contributions to the influence of parental social class and region of upbringing on adult human fatness. DESIGN:Survey of sample of adults who had been adopted in childhood to relate their body mass index to sociodemographic variables in a series of multiple linear regres...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6740.1615
更新日期:1990-06-23 00:00:00
abstract:OBJECTIVE:To assess effects on condom use and other sexual behaviour of an HIV prevention programme at school that promotes the use of condoms with and without emergency contraception. DESIGN:Cluster randomised controlled trial. SETTING:40 public high schools in the state of Morelos, Mexico. PARTICIPANTS:10 954 firs...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38796.457407.80
更新日期:2006-05-20 00:00:00
abstract:OBJECTIVE:To determine cancer morbidity in members of the armed forces who took part in tests of chemical warfare agents from 1941 to 1989. DESIGN:Historical cohort study, with cohort members followed up to December 2004. DATA SOURCE:Archive of UK government research facility at Porton Down, UK military personnel rec...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.b655
更新日期:2009-03-24 00:00:00