Effectiveness of the pelvic floor muscle training on muscular dysfunction and pregnancy specific urinary incontinence in pregnant women with gestational diabetes mellitus: A systematic review protocol.

BACKGROUND: There is ample evidence that gestational diabetes mellitus has a direct influence on urinary incontinence and pelvic floor muscles. There are no standardized pelvic floor muscle exercise programs in the literature for the physiotherapy and differ in the type of exercise, intensity, type and duration of application, and the frequency and duration of treatment sessions. The aim of this systematic review will be to investigate that Pelvic Floor Muscle Training can prevent and/or decrease the pregnancy specific urinary incontinence in women with gestational diabetes mellitus or gestational hyperglycemia. METHODS: We will perform a systematic review according to the Cochrane methodology of Randomized Controlled Trials. An overall search strategy will be developed and adapted for Embase, MEDLINE, LILACS, and CENTRAL databases, with the date of consultation until June 2020. The MeSH terms used will be "Pregnancy", "Hyperglycemia", "Diabetes Mellitus, Type 2", "Diabetes Mellitus, Type 1", "Pregnancy in Diabetics", "Diabetes, Gestational", "Urinary Incontinence", "Pelvic Floor Muscle Strength". Primary outcomes: improvement or cure of pregnancy specific urinary incontinence (which can be assessed by questionnaires, and tools such as tampon test, voiding diary, urodynamic study). Secondary outcomes: improvement of pelvic floor muscle strength (pelvic floor functional assessment, perineometer, electromyography, functional ultrasonography), improved quality of life (questionnaires), presence or absence of postpartum Urinary Incontinence and adverse effects. Quality assessment by Cochrane instrument. Metanalysis if plausible, will be performed by the software Review Manager 5.3. DISCUSSION: The present study will be the first to analyze the effectiveness of pelvic floor exercises in pregnant women with Gestational Diabetes Mellitus or Hyperglycemia, who suffer from pregnancy specific urinary incontinence. Randomized Controlled Trials design will be chosen because they present the highest level of evidence. It is expected to obtain robust and conclusive evidence to support clinical practice, in addition to promoting studies on the theme and contributing to new studies. TRIAL REGISTRATION: Systematic review registration: PROSPERO CRD42017065281.

Oxicodona para analgesia de pacientes com dor aguda no período pós-operatório: revisão sistemática de ensaios clínicos randomizados / Oxycodone for postoperative analgesia in patients with acute pain: systematic review of randomized controlled trials / Oxicodona para la analgesia postoperatoria en pacientes con dolor agudo: revisión sistemática de ensayos controlados aleatorios

Objetivo: avaliar o uso da oxicodona em pacientes com dor aguda no período pós-operatório em comparação aos outros opioides. Método: Trata-se de uma revisão sistemática de ensaios clínicos randomizados (ECR's). Foram consultadas as bases de dados PubMed, EMBASE, Cochrane e LILACS até setembro de 2018. Revisores rastrearam ECR's elegíveis; extraíram os dados e avaliaram o risco de viés. Houve análise de conteúdo descritiva dos achados. Resultados: Em 8 ERC's incluídos a ação da oxicodona comparada morfina foi considerada superior em três estudos e igual em dois estudos. A oxicodona comparada ao fentanil foi considerada melhor em dois estudos. Na comparação com o placebo, a oxicodona também se sobressaiu positivamente. Entretanto não foram encontradas evidências robustas e convergentes que indiquem a superioridade da oxicodona. Conclusão: A oxicodona é um analgésico eficaz na dor pós-operatória aguda, entretanto, mais estudos devem ser realizados bem como a realização de avaliações econômicas.(AU)

Objective: Evaluate the use of oxycodone in patients with acute postoperative pain compared to other opioids. Method: This is a systematic review of randomized controlled trials (RCTs). The PubMed, EMBASE, Cochrane, and LILACS databases were consulted until September 2018. Reviewers screened eligible RCTs; extracted data and assessed the risk of bias. There was descriptive content analysis of the findings. Results: In 8 RCTs included the action of oxycodone compared morphine was considered superior in three studies and equal in two studies. Oxycodone compared to fentanyl was considered better in two studies. Compared to placebo, oxycodone also stood out positively. However, no robust and converging evidence was found to indicate the superiority of oxycodone. Conclusion: Oxycodone is an effective analgesic for acute postoperative pain; however, further studies should be performed as well as economic evaluations.(AU)

Objetivo: Evaluar el uso de oxicodona en pacientes con dolor postoperatorio agudo en comparación con otros opioides. Método: esta es una revisión sistemática de ensayos controlados aleatorios (ECA). Las bases de datos PubMed, EMBASE, Cochrane y LILACS fueron consultadas hasta septiembre de 2018. Los revisores seleccionaron los ECA elegibles; extrajo datos y evaluó el riesgo de sesgo. Hubo un análisis de contenido descriptivo de los hallazgos. Resultados: en 8 ECA incluidos, la acción de la oxicodona en comparación con la morfina se consideró superior en tres estudios e igual en dos estudios. La oxicodona en comparación con el fentanilo se consideró mejor en dos estudios. En comparación con el placebo, la oxicodona también se destacó positivamente. Sin embargo, no se encontró evidencia sólida y convergente que indique la superioridad de la oxicodona. Conclusión: la oxicodona es un analgésico eficaz para el dolor postoperatorio agudo; sin embargo, se deben realizar más estudios, así como evaluaciones económicas.(AU)

Prenatal care satisfaction: perception of caregivers with diabetes mellitus.

OBJECTIVE: to understand the satisfaction of pregnant women with diabetes who took insulin during pregnancy and prenatal care performed through outpatient and inpatient follow-up. METHOD: a qualitative approach with analysis of 30 pregnant women who underwent prenatal care and participated in a clinical trial study carried out by the research group of the Perinatal Diabetes Research Center of the Hospital das Clínicas, of the Faculdade de Medicina de Botucatu. The data were collected through interviews and analyzed from content analysis. RESULTS: from the category Satisfaction, the following subcategories emerged: facilities and difficulties faced in prenatal care performed through outpatient or inpatient follow-up, demonstrating that the pregnant women were satisfied with the prenatal care offered regardless of the type of follow-up. CONCLUSION: there was satisfaction in both care, but in outpatient care some structural, technical and administrative difficulties were identified, requiring reassessment, in order to guarantee service agility.

Quality of life in patients who undergo conventional or robotic-assisted total laparoscopic hysterectomy: Protocol for a systematic review of randomized controlled trials.

BACKGROUND: Hysterectomy for benign gynecologic diseases, especially dysfunctional uterine bleeding, is one of the most common gynecologic interventions. The uterus can be removed using abdominal, vaginal, laparoscopic, or robotic-assisted laparoscopic hysterectomy. In a robotic-assisted procedure, the surgeon directs the robot while seated at a console in the operating room. This differs from laparoscopic hysterectomy because a "robot" performs the operation, while the surgeon watches a monitor. This systematic review will compare quality of life (QOL) in patients who undergo total robotic-assisted laparoscopic hysterectomy for benign indications and those who undergo conventional laparoscopic surgery. METHODS: We will perform a systematic review according to the Cochrane Methodology for randomized controlled trials. The review will include studies reporting use of QOL metrics to assess patients who undergo total hysterectomy for benign indications using robotic-assisted technique or conventional laparoscopic surgery. QOL will be the primary outcome and will be measured using validated instruments. An overall search strategy will be developed and adapted for Embase, MEDLINE, LILACS, and CENTRAL databases. Two reviewers will independently select the eligible studies, assess the risk of bias, and extract the data from included studies. Similar outcomes measured in at least 2 trials will be plotted in the meta-analysis using Review Manager 5.3. The quality of evidence will be determined using the GRADE approach. RESULTS: This systematic review is designed to provide high quality evidence on QOL in patients undergoing total hysterectomy for benign indications using either robotic-assisted or conventional laparoscopic surgery. CONCLUSION: It is expected that high-quality evidence on QOL can be used to guide decision-making by institutions and clinicians to improve health care; the evidence can also be used in future studies. PROSPERO REGISTRATION NUMBER: PROSPERO CRD 42019129913.

Efficacy of vitamin D supplementation in gestational diabetes mellitus: Systematic review and meta-analysis of randomized trials.

BACKGROUND: Trials have examined on the benefits of vitamin D supplementation in pregnant women. OBJECTIVE: This review aimed to evaluate whether oral vitamin D supplements, when given to pregnant women with gestational diabetes mellitus (GDM), would improve maternal and neonatal outcomes, compared with no treatment or placebo. METHOD: We performed a systematic review following Cochrane methodology, and randomized trials were included where pregnant women with GDM received vitamin D supplementation versus placebo/no treatment or vitamin D and calcium versus placebo/no treatment. Primary outcomes were preeclampsia, preterm birth, cesarean delivery, gestational hypertension, and adverse events related to vitamin D supplementation. The search strategies were applied to the following databases: MEDLINE, Embase, LILACS, and CENTRAL. Similar outcomes in at least two trials were plotted using Review Manager 5.3 software. The quality of evidence was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: The total of 1224 references were identified, eleven trials were potentially eligible, and six were included in this review (totaling 456 women). The meta-analysis of frequency of cesarean deliveries did not show significant differences between groups, none of the trials evaluated the remaining primary outcomes. For secondary outcomes, our results suggest that vitamin D supplementation in pregnant women with GDM may reduce newborn complications such as hyperbilirubinemia, polyhydramnios (RR: 0.40, 95% CI: 0.23 to 0.68; RR: 0.17, 95% CI: 0.03 to 0.89; respectively), and the need for maternal or infant hospitalization (RR: 0.13; 95% CI: 0.02 to 0.98; RR: 0.40, 95% CI: 0.23 to 0.69). However, the evidence was of low or very low quality. CONCLUSION: We did not find moderate or high quality evidence indicating that vitamin D supplementation, when compared with placebo, improves glucose metabolism, adverse maternal and neonatal outcomes related to GDM in pregnant women.

Análise de custos de nutrição parenteral / Analysis of parenteral nutrition costs

Objetivo: avaliar o custo envolvido no preparo da nutrição parenteral em hospital universitário ao adquirido de uma empresa terceirizada. Método: trata-se de um estudo quantitativo, descritivo, exploratório com análise retrospectiva de dados. Obtiveram-se os dados por meio das prescrições médicas e notas fiscais das NP's. Calcularam-se, para a comparação de custos, os custos médios, em reais, das NP's por prescrição praticados pela empresa terceirizada, o valor estimado da produção no hospital comparado com o valor de ressarcimento pelo SUS, de acordo com a tabela Sistema de Gerenciamento da Tabela de Procedimento (SIGTAP) do SUS. Apresentaram-se os resultados em forma de tabelas. Resultados: analisaram-se 1818 prescrições, sendo 51,05% das prescrições de adultos; 22,71% de Pediatria e 26,24% de Neonatologia. Conclusão: conclui-se que os valores pagos pelo SUS são inferiores aos gastos pelos serviços de saúde, independentemente do tipo de produção da NP. Considera-se este estudo importante para auxiliar os gestores dos serviços hospitalares na tomada de decisões.(AU)

Objective: to evaluate the cost involved in the preparation of parenteral nutrition in a university hospital when acquired from a third party company. Method: this is a quantitative, descriptive, exploratory study with retrospective data analysis. The data was obtained through the medical prescriptions and fiscal notes of the PNs. The average costs, in reais, of the prescription PNs practiced by the outsourced company were calculated for the comparison of costs, the estimated value of the hospital production compared to the UHS compensation amount, according to the Management System table of the UHS Procedure Table (SIGTAP). Results were presented in the form of tables. Results: 1818 prescriptions were analyzed, being 51.05% of adult prescriptions; 22.71% of Pediatrics and 26.24% of Neonatology. Conclusion: it is concluded that the amounts paid by the UHS are lower than those spent by the health services, regardless of the type of PN production. This study is considered important to assist hospital managers in decisionmaking.(AU)

Objetivo: evaluar el costo involucrado en la preparación de la nutrición parenteral en un hospital universitario al adquirido de una empresa tercerizada. Método: se trata de un estudio cuantitativo, descriptivo, exploratorio con análisis retrospectivo de datos. Se obtuvieron los datos por medio de las prescripciones médicas y las notas fiscales de las NP's. Se calcularon, para la comparación de costos, los costos medianos, en reales, de las NP's por prescripción practicados por la empresa tercerizada, el valor estimado de la producción en el hospital comparado con el valor de resarcimiento por el SUS, de acuerdo con la tabla Sistema de Gestión de la Tabla de Procedimiento (SIGTAP) del SUS. Se presentaron los resultados en forma de tablas. Resultados: se analizaron 1818 prescripciones, siendo el 51,05% de las prescripciones de adultos; el 22,71% de Pediatría y el 26,24% de Neonatología. Conclusión: se concluye que los valores pagados por el SUS son inferiores a los gastos por los servicios de salud, independientemente del tipo de producción de la NP. Se considera este estudio importante para auxiliar a los gestores de los servicios hospitalarios en la toma de decisiones.(AU)

Prenatal care satisfaction: perception of caregivers with diabetes mellitus / Satisfacción en el seguimiento prenatal: percepción de gestantes portadoras de diabetes mellitus / Satisfação no acompanhamento pré-natal: percepção de gestantes portadoras de diabetes mellitus

ABSTRACT Objective: to understand the satisfaction of pregnant women with diabetes who took insulin during pregnancy and prenatal care performed through outpatient and inpatient follow-up. Method: a qualitative approach with analysis of 30 pregnant women who underwent prenatal care and participated in a clinical trial study carried out by the research group of the Perinatal Diabetes Research Center of the Hospital das Clínicas, of the Faculdade de Medicina de Botucatu. The data were collected through interviews and analyzed from content analysis. Results: from the category Satisfaction, the following subcategories emerged: facilities and difficulties faced in prenatal care performed through outpatient or inpatient follow-up, demonstrating that the pregnant women were satisfied with the prenatal care offered regardless of the type of follow-up. Conclusion: there was satisfaction in both care, but in outpatient care some structural, technical and administrative difficulties were identified, requiring reassessment, in order to guarantee service agility.

RESUMEN Objetivo: comprender la satisfacción de las gestantes portadoras de diabetes que utilizaron insulina en el período gestacional, durante la asistencia prenatal realizada por acompañamiento ambulatorial y hospitalario. Método: abordaje cualitativo, con análisis de 30 gestantes que realizaban seguimiento prenatal y participar en un estudio de ensayo clínico realizado por el grupo de investigación del Centro de Investigación del Diabete Perinatal del Hospital das Clínicas de la Faculdade de Medicina de Botucatu. Los datos fueron recolectados por medio de entrevistas y analizados a partir del análisis de contenido. Resultados: de la categoría Satisfacción, se constituyen las subcategorías: facilidades y dificultades encontradas con la asistencia prenatal realizada por acompañamiento ambulatorial o hospitalario, demostrando que las gestantes quedaron satisfechas con la asistencia prenatal ofrecida, independientemente del tipo de seguimiento. Conclusión: hubo satisfacción en ambos atendimientos, pero en la atención ambulatoria algunas dificultades de orden estructural, técnico y administrativo fueron identificadas, necesitando de reevaluación, a fin de garantizar agilidad del servicio.

RESUMO Objetivo: compreender a satisfação das gestantes portadoras de diabetes que utilizaram insulina no período gestacional durante a assistência pré-natal realizada por acompanhamento ambulatorial e hospitalar. Método: abordagem qualitativa, com análise de 30 gestantes que faziam acompanhamento pré-natal e participaram de um estudo de ensaio clínico realizado pelo grupo de pesquisa do Centro de Investigação do Diabetes Perinatal do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Os dados foram coletados por meio de entrevista, e analisados a partir da análise de conteúdo. Resultados: da categoria Satisfação, constituiu-se a subcategoria: facilidades e dificuldades encontradas com a assistência pré-natal realizada por acompanhamento ambulatorial ou hospitalar demonstrando que as gestantes ficaram satisfeitas com a assistência pré-natal oferecida, independentemente do tipo de acompanhamento. Conclusão: houve satisfação em ambos os atendimentos, porém, no atendimento ambulatorial, dificuldades de ordem estrutural, técnica e administrativa foram identificadas, necessitando de reavaliação, a fim de garantir agilidade do serviço.

A aceitação da medicina alternativa complementar por gestantes com diabetes / Acceptance of additional alternative medicine by pregnant diabetics

Objetivo: avaliar como as mulheres grávidas com diabetes compreendem e aceitam o uso de práticas integrativas e complementares na saúde, especialmente o Reiki, durante o atendimento pré-natal. Método: trata-se de um estudo qualitativo, descritivo, exploratório, de gestantes diabéticas atendidas num Centro de Investigação do Diabetes Perinatal em um centro terciário, por meio de entrevistas semiestruturadas com 12 gestantes. Audiogravaram-se e transcreveram-se as entrevistas para posterior análise cujos dados foram submetidos à técnica de Análise de Conteúdo. Resultados: demonstrou-se, pela maioria das mulheres gestantes diagnosticadas com diabetes, o conhecimento de algumas práticas integrativas e complementares na saúde. Receber-se-iam, além disso, por um grande número de entrevistadas, tais terapias se essas fossem disponíveis no Sistema Único de Saúde (SUS), porém, a terapia Reiki mostrou ser desconhecida entre as pacientes. Conclusão: serve-se este estudo como ponto de partida para profissionais de saúde introduzirem as terapias integrativas e complementares na saúde pública brasileira. Tornam-se necessários estudos adicionais em outras populações para obter uma visão mais profunda e detalhada do perfil das pacientes em diferentes regiões.(AU)

Objective: to evaluate how pregnant women with diabetes understand and accept the use of integrative and complementary health practices, especially Reiki, during prenatal care. Method: this is a qualitative, descriptive, exploratory study of diabetic pregnant women seen at a Perinatal Diabetes Research Center in a tertiary center, through semi-structured interviews with 12 pregnant women. The interviews were audio recorded and transcribed for later analysis whose data were submitted to the Content Analysis technique. Results: it was demonstrated, by most pregnant women diagnosed with diabetes, the knowledge of some integrative and complementary practices in health. In addition, a large number of respondents would receive such therapies if they were available in the Unified Health System (UHS), but Reiki therapy was unknown to patients. Conclusion: this study serves as a starting point for health professionals to introduce integrative and complementary therapies in Brazilian public health. Further studies in other populations are needed to gain a deeper and more detailed view of patients' profiles in different regions.(AU)

Objetivo: evaluar cómo las mujeres embarazadas con diabetes entienden y aceptan el uso de prácticas de salud integradoras y complementarias en salud, especialmente el Reiki, durante la atención prenatal. Método: este es un estudio cualitativo, descriptivo, exploratorio de mujeres embarazadas diabéticas atendidas en un Centro de Investigación de Diabetes Perinatal en un centro terciario, a través de entrevistas semiestructuradas con 12 mujeres embarazadas. Las entrevistas se grabaron en audio y se transcribieron para un análisis posterior cuyos datos fueron sometidos a la técnica de Análisis de Contenido. Resultados: la mayoría de las mujeres embarazadas diagnosticadas con diabetes demostraron el conocimiento de algunas prácticas integradoras y complementarias en salud. Además, un gran número de encuestados recibiría tales terapias si estuvieran disponibles en el Sistema Único de Salud (SUS), pero la terapia de Reiki era desconocida para los pacientes. Conclusión: este estudio sirve como punto de partida para que los profesionales de la salud introduzcan terapias integradoras y complementarias en la salud pública brasileña. Se necesitan más estudios en otras poblaciones para obtener una visión más profunda y detallada de los perfiles de los pacientes en diferentes regiones.(AU)

Is the risk of low birth weight or preterm labor greater when maternal stress is experienced during pregnancy? A systematic review and meta-analysis of cohort studies.

Antenatal stress is linked to fetal risks that increase the chances of neonatal complications and reduction of child cognitive ability. Therefore, we aimed to evaluate if maternal stress affects fetal, neonatal or child development. The following databases were searched: MEDLINE (1966 to May 2016), Embase (1980 to May 2016), LILACS (1982 to May 2016) and CENTRAL (1972 to May 2016). Observational studies published in English and Portuguese were included whether there was any relationship between fetal and neonatal outcome, such as birth weight, preterm labor, child development with pregnant women that were subjected to any stress type during at least one month of follow-up. Two independent reviewers screened eligible articles, extracted data and assessed the risk of bias. Thus, 8 cohort studies with about 8,271 pregnant women and 1,081,151 children proved eligible. Results suggested a significant association between antenatal stress exposure and increasing rates of low birth weight (Odds ratio (OR) 1.68 [95% Confidential Interval (CI) 1.19, 2.38]). However, there was no statistically significance difference between non-exposed and exposed groups related to preterm labor (OR 1.98 [95% CI 0.91 to 4.31]; I2 = 68%, p = 0.04). Although, results were inconsistent with primary analysis suggesting a significant association between antenatal stress exposure and the occurrence of higher rates of preterm birth (OR 1.42 [95% CI 1.05 to 1.91]; I2 = 68%, p = 0.04) in the sensitivity analysis. Furthermore, the current review has suggested that stress perceived during antenatal negatively influences fetal life and child development. Yet, further studies are necessary with adequate sample size and longer follow-up time to confirm our findings.