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R Barker Bausell
Evaluation & the Health Professions 03/2010; 33(1):3-6. · 1.23 Impact Factor
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R Barker Bausell
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ABSTRACT: Forty-five complementary and alternative medicine (CAM) efficacy randomized controlled trials (RCTs) from high-impact medical journals (NEJM, JAMA, Annals of Internal Medicine, and Archives of Internal Medicine) were reviewed based on their meeting three validity criteria (the existence of a placebo control, moderate attrition rates, and 50 or more participants per group). Of the 26 efficacy trials meeting all three criteria, only 2 (7.7%) were judged to be positive (i.e., the alternative therapy was significantly superior to its placebo control), while over half (55.5%) of the 19 trials that failed to meet one or more of these criteria reported positive results (p < .001). Of the two positive high-validity trials, one was funded and authored by the herbal company marketing the product tested and one used a placebo-control group of questionable credibility. This analysis is consistent with the hypothesis that CAM therapies are no more effective than placebos when adequate experimental control is present.
Evaluation & the Health Professions 10/2009; 32(4):349-69. · 1.23 Impact Factor
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Evaluation & the Health Professions 10/2008; 31(3):243-4. · 1.23 Impact Factor
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Evaluation & the Health Professions 07/2008; 31(2):107-9. · 1.23 Impact Factor
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ABSTRACT: This is the final installment of the most ambitious project ever undertaken by this journal. As is suggested in the final article in this issue, the work described in this and the past two special issue installments may very well reflect a revolution in health research. Also in this issue are papers discussing (a) the translation (Type I) of genetic, cognitive science, and other basic science findings into preventive practice, (b) transporting prevention interventions used in research into real-world settings, and (c) the perspective of two experienced NIH program officers on "What's Next for Translational Research?" (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Evaluation & the Health Professions 08/2006; · 1.23 Impact Factor
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R Barker Bausell
Evaluation & the Health Professions 04/2006; 29(1):3-6. · 1.23 Impact Factor
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ABSTRACT: This purpose of this article is to contrast the analgesic efficacy of acupuncture following dental surgery with the analgesic effects based on the expectation of benefit in two independently conducted placebo-controlled trials evaluating acupuncture as an adjunctive therapy for dental surgery. Both trials used pain following dental surgery as the outcome variable, and both included a blinding check to ascertain patients' beliefs regarding which treatment they were receiving. Although no statistically significant analgesic effect was observed between the acupuncture and placebo groups, participants in both experiments who believed they received real acupuncture reported significantly less pain than patients who believed that they received a placebo. Patients' beliefs regarding the receipt of acupuncture bore a stronger relationship to pain than any specific action possessed by acupuncture. These results also support the importance of both employing credible controls for the placebo effect in clinical trials and evaluating the credibility of those controls.
Evaluation & the Health Professions 04/2005; 28(1):9-26. · 1.23 Impact Factor
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ABSTRACT: To determine if the quality of complementary and alternative medicine (CAM) placebo controlled randomized controlled trials (RCTs) is related to the effect sizes they produce when the type of interventions and outcome variables are controlled.
A sample of 25 CAM meta-analyses was identified from MEDLINE and hand searches containing published effect sizes for at least three efficacy trials employing placebo control groups. From these 25 reviews, 26 pairs of trials were selected: the one reporting the largest effect size and the matching trial reporting the smallest effect size. Quality and publication characteristics were then abstracted from each trial.
Unlike the preponderance of past evidence examining the relationship between quality and effect size, the present study found that trials possessing the largest effect sizes within a meta-analysis were also associated with higher quality ratings than their counterparts possessing the lowest effect sizes (P=.019).
Possible theoretical reasons for this unexpected positive relationship include (a) sampling error, (b) reduced within group variation, (c) fraudulent reporting, and (d) the restriction of the analyses to placebo controlled trial.
Journal of Clinical Epidemiology 06/2004; 57(5):438-46. · 4.27 Impact Factor
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ABSTRACT: We assessed the efficacy of S-adenosylmethionine (SAMe), a dietary supplement now available in the Unites States, compared with that of placebo or nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis (OA).
This was a meta-analysis of randomized controlled trials.
We identified randomized controlled trials of SAMe versus placebo or NSAIDS for the treatment of OA through computerized database searches and reference lists.
The outcomes considered were pain, functional limitation, and adverse effects.
Eleven studies that met the inclusion criteria were weighted on the basis of precision and were combined for each outcome variable. When compared with placebo, SAMe is more effective in reducing functional limitation in patients with OA (effect size [ES] =.31; 95% confidence interval [CI],.099-.520), but not in reducing pain (ES =.22; 95% CI, -.247 to.693). This result, however, is based on only 2 studies. SAMe seems to be comparable with NSAIDs (pain: ES =.12; 95% CI, -.029 to.273; functional limitation: ES =.025; 95% CI, -.127 to.176). However, those treated with SAMe were less likely to report adverse effects than those receiving NSAIDs.
SAMe appears to be as effective as NSAIDs in reducing pain and improving functional limitation in patients with OA without the adverse effects often associated with NSAID therapies.
The Journal of family practice 06/2002; 51(5):425-30. · 0.61 Impact Factor
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ABSTRACT: This study was designed to determine rheumatologists' self-reported knowledge, perceptions of legitimacy, referral patterns, and use in practice of 22 complementary and alternative medicine (CAM) therapies.
A survey was mailed to a random sample of 2000 physician members of the American College of Rheumatology asking respondents which (if any) CAM therapies they (1) knew enough about to discuss with patients, (2) considered part of "legitimate medical practice," and (3) "personally administered" to patients, or "referred patients to someone else" to administer. The response rate was 47%.
On average, the respondents reported knowing enough to discuss 10 of the therapies with patients, considered 9 to be part of legitimate medical practice, and had referred patients to someone else for 8 of the 22 therapies. Correlates of use and/or referral included sex, age, belief in the legitimacy of the therapies, and self-reported knowledge.
These results provide potentially important preliminary data regarding rheumatologists' responses to dramatic increases in the use of CAM therapies among their patients.
Archives of Internal Medicine 05/2002; 162(7):766-70. · 11.46 Impact Factor
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ABSTRACT: Although considerable data exist linking individual lifestyle variables to health outcomes, little is known about how the elderly differ from younger adults with respect to both their health seeking behavior and their beliefs about health. A national survey contrasted 155 persons aged 65 years of age or older with 1100 younger adults in order to identify behavioral and affective differences in health associated with age. In general the elderly were more likely to report poorer health and to be less optimistic about the degree of control possessed over their future health status, although they were significantly more likely to comply with salutary dietary practices than were their young counterparts. They also reported considering these practices as more important and rated their self-efficacy with respect to effecting them considerably higher. While more compliant with a number of preventive behaviors, the elderly were significantly deficient in certain specific areas such as exercise, having their cholesterol blood levels monitored regularly, participating in medical treatment decisions, and in their knowledge with respect to cancer prevention. It was concluded that these data have the potential to provide a relatively comprehensive picture of the elderly's health seeking experiences and beliefs and to serve as a mechanism by which both strengths and deficits therein are identifiable. (Author/NB)
01/1986;
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ABSTRACT: In the era of evidence-based practice (EBP), Randomized Controlled Trials (RCTs) may provide the best evidence of the efficacy of nursing interventions and yet the quality of RCT reporting in nursing literature has not been evaluated. The purposes of this study were to apply the Consolidated Standards of Reporting Trials (CONSORT) statement to published reports of nursing science, examine how adequately the published reports adhere to the statement, and examine the effect of the adoption of CONSORT on the quality of the RCT published reports. One hundred RCTs from 2002-2005 were identified from 4 nursing journals. Articles were randomly assigned to 4 reviewers and the quality of the published reports was evaluated using a modified CONSORT checklist. There was no difference between the 4 journals in the quality of the published reports of RCTs based on the modified CONSORT checklist employed (F = 1.27, P =.29). The quality of reporting of RCTs improved significantly in the only journal, Nursing Research, to adopt the CONSORT statement during the study period (t =-2.70, P =.01). Adoption of CONSORT is recommended as it may lead to an overall improvement in quality of reporting of RCTs in nursing journals. The profession may also wish to explore the use or development of standards similar to CONSORT but ones more appropriate for the types of research typical of that published by nurse scientists.
Nursing Outlook 56(1):31-37. · 1.52 Impact Factor
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ABSTRACT: The possibility is presented that the current collaborative versus conventional medical debate may be a consumer-driven continuation of the biomedical versus biopsychosocial controversy first proposed by George Engel 25 years ago. If true, we may all be actors in a genuine Kuhnian paradigmatic shift destined to occur whether we appreciate our roles therein or approve of the ultimate outcome. At the very least, however, it is important to recognize the evidence that at least some patients suffering from chronic conditions may be choosing collaborative therapies for different reasons than for those for which they seek conventional medical care. For these patients, at least, it is important that the quality of the collaborative care they receive be judged on outcomes capable of reflecting these alternative objectives. Finally, whether we are in the midst of a paradigmatic shift in medicine or not, it is essential that we all, as providers of clinical care or as investigators of clinical efficacy, adopt a collaborative role to ensure the provision of both good medicine and good science.
American Journal of Medical Quality 17(1):28-32. · 1.64 Impact Factor
