Osteoarthritis (OA) affects about 21 million people in the United States. By age 65, the majority of the population has radiographic evidence of osteoarthritis and 11 percent have symptomatic OA of the knee. This is a systematic review of three treatments for osteoarthritis (OA) of the knee: intraarticular injections of viscosupplements; oral glucosamine, chondroitin or the combination; and, arthroscopic lavage and debridement. The key questions are: (1) effectiveness and harms in primary OA of the knee, (2) in secondary OA of the knee, (3) in subpopulations, and (4) comparison of the three...

A shortage of registered nurses, in combination with increased workload, has the potential to threaten quality of care. Increasing the nurse to patient ratios has been recommended as a means to improve patient safety. However, the cost effectiveness of increasing registered nurse (RN) staffing is controversial. This systematic review analyzes associations between hospital nurse staffing and patient outcomes with consideration of variables that could influence the primary association. The basic research questions were: 1. How is a specific nurse to patient ratio associated with patient...

Multivitamin/mineral supplements are the most commonly used nutritional supplements in the United States. Scientific evidence on the efficacy and safety of supplement use will serve as the basis for us to identify knowledge gaps and inform the general public's practice and future research. This report synthesizes the published literature on the efficacy and the safety of multivitamin/mineral supplements in the prevention of chronic disease for the general population of adults, and on the efficacy and the safety of certain commonly-used single vitamin or mineral supplements in the general...

The Social Security Administration (SSA) operates the world's largest and most stringent disability program, processing more than 3.5 million claims each year, with multiple sclerosis (MS) representing the third most common neurological diagnosis cited as the cause for disability. The purpose of this project is to determine whether current medical knowledge supports the SSA's stated policies regarding MS. The seven major research questions addressed during this review are as follows: Question 1a: What is the reliability of new McDonald criteria (incorporating supplementary information from...

Persistent partial retention of urine or chronic urinary retention (CUR) is a common problem for which we have little understanding in terms of prevalence, natural history, prognosis, or efficacy and comparative effectiveness of treatments. Also unclear are whether and when to suspect, screen, or treat patients for CUR. Standard diagnostic criteria (including the duration and volume of post-void residual PVR] urine necessary for a diagnosis) have not been established for chronic urinary retention. Researchers often define CUR as PVR urine volume greater than 300 ml; however, some studies...

Approximately one in eight U.S. women will develop breast cancer during her lifetime. Because the earliest stages of breast cancer are asymptomatic, the process of breast cancer diagnosis is often initiated by detecting an abnormality through self-examination, physical examination by a clinician, or screening mammography. If the initial assessment suggests that the abnormality could be breast cancer, the woman is likely to be referred for a biopsy-a sampling of cells or tissue from the suspicious lesion. Three techniques for obtaining samples from suspicious breast lesions are available:...

Sudden cardiac death (SCD) is the most common cause of cardiovascular death worldwide, accounting for approximately 300,000 deaths in the U.S. annually, although estimates have ranged from 200,000 to 450,000 deaths. Operationally, SCD is most frequently defined as a cardiac death that occurred within 1 hour of cardiac symptom onset and without another probable cause of death. Studies from epidemiological cohorts from the 1970s through the 1990s suggest that 88 to 91% of deaths that occur within 1 hour of symptom onset are arrhythmic in nature. The temporal definition of SCD strongly...

In spite of significant gains in detection and treatment, breast cancer continues to have a broad impact in the United States, with an estimated 234,580 individuals with new diagnoses in 2013. About 33 percent of individuals with breast cancer diagnosed between 2001 and 2007 had regional metastases, with a 5-year relative survival rate of 84 percent. Approximately 5 percent were diagnosed with distant metastases, most commonly to the bones, lungs, liver, or brain, and had a 5-year relative survival rate of only 23 percent. Several imaging modalities, including magnetic resonance imaging...

Diabetic retinopathy (DR) is a leading cause of vision loss in the United States and occurs as a result of pathologic changes of the retinal vasculature. In 2005-2008, the estimated crude prevalence among Americans over the age of 40 with diabetes was 28.5 percent. Although the prevalence of vision-threatening DR is approximately 4.4 percent, the number of affected Americans 40 years or older is expected to triple from 1.2 million in 2005 to 3.4 million in 2050. The prevalence and severity of DR increases with the duration of diabetes; however, it is inversely correlated to glycemic and blood...

Over 450,000 patients in the U.S. have end stage renal disease (ESRD). There are important morbidity and survival advantages to receiving renal transplantation versus dialysis. Human leukocyte antigens (HLA) are a set of human major histocompatibility complex derived glycoproteins that are expressed on cell surfaces and allow for discrimination of self from non-self. HLA have been classified into two major groups, Class I (HLA-A, HLA-B, and HLA-C) and Class II (HLA-DP, HLA-DQ, and HLA-DR). Recognition of the antigens displayed by the transplanted organ (alloantigen) is the prime event...