“…Other difficulties include a lack of standardization in how the primary outcome is measured, with some studies relying on clinical assessment of relatively crude measures, i.e. failure, slight improvement, cure (Adriaenssen, 1998;Gilmore et al, 1988;Hanna, 1991;Kuriyama et al, 2005), and others a combination of both patient responses and clinical examination with welldefined but subjective criteria (Fazakerley et al, 1993;Fouad et al, 1996;Mangundjaja & Hardjawinata, 1990;Paterson & Curzon, 1993;Schuen et al, 1974;von Konow et al, 1992).…”