So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs.

Background: PTSD is a significant mental health problem worldwide. Current evidence-based interventions suffer various limitations. Ketamine is a novel agent that is hoped to be incrementally better than extant interventions.Objective: Several randomized control trials (RCTs) of ketamine interventions for PTSD have now been published. We sought to systematically review and meta-analyse results from these trials to evaluate preliminary evidence for ketamine's incremental benefit above-and-beyond control interventions in PTSD treatment.Results: Omnibus findings from 52 effect sizes extracted across six studies (n = 221) yielded a small advantage for ketamine over control conditions at reducing PTSD symptoms (g = 0.27, 95% CI = 0.03, 0.51). However, bias-correction estimates attenuated this effect (adjusted g = 0.20, 95%, CI = -0.08, 0.48). Bias estimates indicated smaller studies reported larger effect sizes favouring ketamine. The only consistent timepoint assessed across RCTs was 24-hours post-initial infusion. Effects at 24-hours post-initial infusion suggest ketamine has a small relative advantage over controls (g = 0.35, 95% CI = 0.06, 0.64). Post-hoc analyses at 24-hours post-initial infusion indicated that ketamine was significantly better than passive controls (g = 0.44, 95% CI = 0.03, 0.85), but not active controls (g = 0.24, 95% CI = -0.30, 0.78). Comparisons one-week into intervention suggested no meaningful group differences (g = 0.24, 95% CI = 0.00, 0.48). No significant differences were evident for RCTs that examined effects two-weeks post initial infusion (g = 0.17, 95% CI = -0.10, 0.44).Conclusions: Altogether, ketamine-for-PTSD RCTs reveal a nominal initial therapeutic advantage relative to controls. However, bias and heterogeneity appear problematic. While rapid acting effects were observed, all control agents (including saline) also evidenced rapid acting effects. We argue blind penetration to be a serious concern, and that placebo is the likely mechanism behind reported therapeutic effects.

We systematically reviewed and meta-analysed all randomized control trials of ketamine intervention for PTSD.While ketamine was associated with a reduction in symptoms, the effect was generally not stronger than control conditions.By two-weeks post-initial infusion, no meaningful differences are evident between ketamine and controls.

El efecto de la reflexología podal sobre la fatiga en pacientes en hemodiálisis: un estudio de metaanálisis / The effect of foot reflexology on fatigue in hemodialysis patients: a meta-analysis study / O efeito da reflexologia podal sobre a fadiga em pacientes em hemodiálise: um estudo de metanálise

Objetivo: analizar el efecto de la reflexología podal sobre la fatiga en pacientes en hemodiálisis, combinando los resultados de estudios independientes sobre este tema. Método: estudio de metaanálisis. Se realizó una búsqueda bibliográfica en siete bases de datos. La calidad metodológica de los estudios incluidos se evaluó mediante las herramientas propuestas por el Joanna Briggs Institute. Para el metaanálisis se utilizó el programa Comprehensive Meta-Analysis v3. Resultados: en el metaanálisis se incluyeron ocho estudios. El resultado de la diferencia de medias estandarizada del metaanálisis = 1,580 (Intervalo de Confianza de 95% = 1,075 - 2,085 p = 0,000). El resultado del análisis de subgrupos realizado sobre la base de la diferencia de medias estandarizada en el número de sesiones de reflexología podal = 1,478 (Intervalo de Confianza de 95% = 1,210 - 1,747, p = 0,000). Conclusión: se concluyó que la reflexología podal puede utilizarse para reducir la fatiga en pacientes en hemodiálisis. En los estudios investigados no se proporcionó información sobre los posibles efectos secundarios y negativos de la reflexología podal.

Objective: this meta-analysis study analyzed the effect of foot reflexology on fatigue in hemodialysis patients by combining the results of independent studies on this subject. Method: meta-analysis study. A literature search was conducted in seven databases. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Comprehensive Meta-Analysis v3 was used for meta-analysis. Results: eight studies were included in the meta-analysis. The result of the meta-analysis standardized mean difference = 1.580 (95% Confidence Interval = 1.075 - 2.085 p = 0.000). The result of the subgroup analysis performed based on the number of foot reflexology sessions standardized mean difference = 1,478 (95% Confidence Interval = 1,210 - 1,747, p = 0.000). Conclusion: it was concluded that foot reflexology can be used to reduce fatigue in hemodialysis patients. No information was provided in the investigated studies about the possible side effects and negative effects of foot reflexology.

Objetivo: analisar o efeito da reflexologia podal sobre a fadiga em pacientes em hemodiálise, combinando os resultados de estudos independentes sobre este assunto. Método: estudo de metanálise. Foi realizada uma pesquisa bibliográfica em sete bases de dados. A qualidade metodológica dos estudos incluídos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. Para a metanálise, foi utilizado o Comprehensive Meta-Analysis v3. Resultados: oito estudos foram incluídos na metanálise. O resultado da diferença média padronizada da metanálise = 1,580 (Intervalo de Confiança de 95% = 1,075 - 2,085 p = 0,000). O resultado da análise de subgrupo realizada com base na diferença média padronizada do número de sessões de reflexologia podal = 1,478 (Intervalo de Confiança de 95% = 1,210 - 1,747, p = 0,000). Conclusão: a reflexologia podal pode ser utilizada para reduzir a fadiga em pacientes em hemodiálise. Não foram fornecidas informações nos estudos investigados sobre os possíveis efeitos colaterais e negativos da reflexologia podal.

Percutaneous ethanol injection in thyroid nodular pathology and metastatic cervical adenopathies: A systematic review, meta-analysis and economic evaluation.

BACKGROUND: Percutaneous ethanol injection (PEI) has been shown to be a valuable treatment for thyroid nodular pathology and metastatic cervical adenopathies. OBJECTIVE: To evaluate the effectiveness, safety, and cost-effectiveness of PEI in thyroid nodular pathology and metastatic cervical adenopathies. METHODS: A systematic review (SR) using meta-analysis was conducted on the effectiveness and safety of PEI. A SR on cost-effectiveness was also performed. The SRs were conducted according to the methodology developed by the Cochrane Collaboration with reporting in accordance with the PRISMA statement. A cost-minimization analysis was carried out using a decision tree model. Assuming equal effectiveness between two minimally invasive techniques (PEI and radiofrequency ablation (RFA)), the model compared the costs of the alternatives with a horizon of six months and from the perspective of the Spanish National Health System. RESULTS: The search identified three RCTs (n=157) that evaluated PEI versus RFA in patients diagnosed with benign thyroid nodules: ninety-six patients with predominantly cystic nodules and sixty-one patients with solid nodules. No evidence was found on other techniques or thyroid nodular pathology. No statistically significant differences were observed between PEI and RFA in volume reduction (%), symptom score, cosmetic score, therapeutic success and major complications. No economic evaluations were identified. The cost-minimization analysis estimated the cost per patient of the PEI procedure at €326 compared to €4781 for RFA, which means an incremental difference of -€4455. CONCLUSIONS: There are no differences between PEI and RFA regarding their safety and effectiveness, but the economic evaluation determined that the former option is cheaper.

Treatment of dissociative symptoms with opioid antagonists: a systematic review.

BACKGROUND: The clinical guidelines for the treatment of dissociation focus primarily on psychotherapy. However, different psychoactive drugs are used in clinical practice. The use of opioid antagonists has been proposed as a therapeutic option based on the theory that dissociation might be a phenomenon mediated by dysregulation of the endogenous opioid system. OBJECTIVE: To review and meta-analyse the available evidence on the efficacy of the opioid antagonists naltrexone, naloxone, and nalmefene as treatments for dissociative symptoms and disorders. METHOD: The PRISMA guidelines were followed, and this review was registered in Prospero with reference number CRD42021280976. The search was performed in the PubMed, Scopus, Web of Science, EMBASE, PsycINFO, and PubPsych databases. RESULTS: 1,798 citations were obtained. After removing duplicates and applying inclusion and exclusion criteria, we included 5 comparative studies with 9 dissociation measures that had included a total of 154 participants, of whom 134 had been treated with an opioid antagonist. The results of the meta-analysis showed a treatment effect for dissociation when using opioid antagonists [pooled d = 1.46 (95% CI: 0.62-2.31)]. However, the studies we included were very heterogeneous [Q = 66.89 (p < .001)] and there may have been publication bias. CONCLUSIONS: Although more research is needed and the results must be interpreted with caution because of the limited amount of data and heterogeneity in the studies and their methodological qualities, opioid antagonists (particularly naltrexone) are promising candidates for the treatment of dissociative symptoms and showed a moderate - large effect size in reducing these symptoms.

The results of the meta-analysis showed a treatment effect for dissociation when using opioid antagonists [pooled d = 1.46 (95% CI: 0.62­2.31)].The results must be interpreted with caution because of the limited amount of data and heterogeneity in the studies and their methodological qualities.Opioid antagonists (particularly naltrexone) are promising candidates for the treatment of dissociative symptoms and showed a moderate ­ large effect size in reducing these symptoms.

Results beyond 5-years of surgery or percutaneous approach in severe coronary disease. Reconstructed time-to-event meta-analysis of randomized trials.

INTRODUCTION AND OBJECTIVES: There is controversy about the optimal revascularization strategy in severe coronary artery disease (CAD), including left main disease and/or multivessel disease. Several meta-analyses have analyzed the results at 5-year follow-up but there are no results after the fifth year. We conducted a systematic review and meta-analysis of randomized clinical trials, comparing results after the fifth year, between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) using drug-eluting stents in patients with severe CAD. METHODS: We analyzed all clinical trials between January 2010 and January 2023. The primary endpoint was all-cause mortality. The databases of the original articles were reconstructed from Kaplan-Meier curves, simulating an individual-level meta-analysis. Comparisons were made at certain cutoff points (5 and 10 years). The 10-year restricted median survival time difference between CABG and PCI was calculated. The random effects model and the DerSimonian-Laird method were applied. RESULTS: The meta-analysis included 5180 patients. During the 10-year follow-up, PCI showed a higher overall incidence of all-cause mortality (HR, 1.19; 95%CI, 1.04-1.32; P=.008)]. PCI showed an increased risk of all-cause mortality within 5 years (HR, 1.2; 95%CI, 1.06-1.53; P=.008), while no differences in the 5-10-year period were revealed (HR, 1.03; 95%CI, 0.84-1.26; P=.76). Life expectancy of CABG patients was slightly higher than that of PCI patients (2.4 months more). CONCLUSIONS: In patients with severe CAD, including left main disease and/or multivessel disease, there was higher a incidence of all-cause mortality after PCI compared with CABG at 10 years of follow-up. Specifically, PCI has higher mortality during the first 5 years and comparable risk beyond 5 years.

Neurofeedback for post-traumatic stress disorder: systematic review and meta-analysis of clinical and neurophysiological outcomes.

Background: Posttraumatic stress disorder (PTSD) is a debilitating condition affecting millions of people worldwide. Existing treatments often fail to address the complexity of its symptoms and functional impairments resulting from severe and prolonged trauma. Electroencephalographic Neurofeedback (NFB) has emerged as a promising treatment that aims to reduce the symptoms of PTSD by modulating brain activity.Objective: We conducted a systematic review and meta-analysis of ten clinical trials to answer the question: how effective is NFB in addressing PTSD and other associated symptoms across different trauma populations, and are these improvements related to neurophysiological changes?Method: The review followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. We considered all published and unpublished randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving adults with PTSD as a primary diagnosis without exclusion by type of trauma, co-morbid diagnosis, locality, or sex. Ten controlled studies were included; seven RCTs and three NRSIs with a total number of participants n = 293 (128 male). Only RCTs were included in the meta-analysis (215 participants; 88 male).Results: All included studies showed an advantage of NFB over control conditions in reducing symptoms of PTSD, with indications of improvement in symptoms of anxiety and depression and related neurophysiological changes. Meta-analysis of the pooled data shows a significant reduction in PTSD symptoms post-treatment SMD of -1.76 (95% CI -2.69, -0.83), and the mean remission rate was higher in the NFB group (79.3%) compared to the control group (24.4%). However, the studies reviewed were mostly small, with heterogeneous populations and varied quality.Conclusions: The effect of NFB on the symptoms of PTSD was moderate and mechanistic evidence suggested that NFB leads to therapeutic changes in brain functioning. Future research should focus on more rigorous methodological designs, expanded sample size and longer follow-up.

Neurofeedback (NFB) was found to have moderate beneficial effects on PTSD symptoms, and positive effects on secondary outcomes such as depression and anxiety, according to a meta-analysis of seven randomised controlled trials (RCTs).The beneficial effects of NFB were observed across diverse populations, including those with different types of trauma (military and civilians) and from different ethnic backgrounds.Results suggest that modulation of alpha rhythm might be a viable NFB protocol in patients with PTSD, as changes in neurophysiological functioning, such as connectivity in the Default Mode Network (DMN) and Salience Network (SN), were observed post-NFB and were correlated with a decrease in PTSD severity.

Transdiagnostic psychosocial interventions to promote mental health in forcibly displaced persons: a systematic review and meta-analysis.

Background: People forced to leave their homes, such as refugees and internally displaced persons, are exposed to various stressors during their forced displacement, putting them at risk for mental disorders.Objective: To summarize evidence on the efficacy of psychosocial interventions aiming to promote mental health and/or to prevent mental symptoms by fostering transdiagnostic skills in forcibly displaced persons of all ages.Method: Four databases and reference lists were searched for randomized controlled trials on interventions in this population on 11 March 2022. Thirty-six studies were eligible, 32 studies (comprising 5299 participants) were included in random-effects multilevel meta-analyses examining the effects of interventions on mental symptoms and positive mental health (e.g. wellbeing) as well as moderators to account for heterogeneity. OSF Preregistration-ID: 10.17605/OSF.IO/XPMU3Results: Our search resulted in 32 eligible studies, with 10 reporting on children/adolescents and 27 on adult populations. There was no evidence for favourable intervention effects in children/adolescents, with 44.4% of the effect sizes pointing to potentially negative effects yet remaining non-significant. For adult populations, our meta-analyses showed a close-to-significant favourable effect for mental symptoms, M(SMD) = 0.33, 95% CI [-0.03, 0.69], which was significant when analyses were limited to high-quality studies and larger for clinical compared to non-clinical populations. No effects emerged for positive mental health. Heterogeneity was considerable and could not be explained by various moderators (e.g. type of control, duration, setting, theoretical basis). Certainty of evidence was very low across all outcomes limiting the generalizability of our findings.Conclusion: The present review provides at most weak evidence for an effect favouring transdiagnostic psychosocial interventions over control conditions for adult populations but not for children and adolescents. Future research should combine the imperative of humanitarian aid in face of major crises with studying the diverse needs of forcibly displaced persons to improve and tailor future interventions.

This review is the first to examine the efficacy of transdiagnostic interventions for mental health promotion and prevention of mental disorders in forcibly displaced persons of all ages.Overall, we found no favourable effect of transdiagnostic interventions in both children/adolescents and adults. Excluding studies at high risk of bias, there was weak evidence for a small favourable effect in adults, but not in children and adolescents. Thus, so far, there is weak evidence for transdiagnostic interventions in forcibly displaced persons.Research efforts need to match care needs: While most people live and need care in low-income countries, the majority of research has been conducted in high-income countries.

Effect of home-based cardiac rehabilitation for patients with heart failure: a systematic review and meta-analysis / Rehabilitación para pacientes con insuficiencia cardíaca: una revisión sistemática y metanálisis

SUMMARY: This study is to investigate the effect of home-based cardiac rehabilitation (HBCR) on quality of life, functional capacity, and readmission rates in patients with heart failure. Randomized controlled trials (RCTs) were screened from Cochrane Library, CINAHL, EMBASE, and MEDLINE. The intervention group received a standardized HBCR or a comprehensive rehabilitation strategy that included HBCR. The participants in the control group received CR at a medical center or usual care without CR intervention. The main outcome measurements included quality of life, exercise capacity, mortality and re-hospitalization. This meta-analysis included 20 RCTs, in which 16 studies compared HBCR with usual care, and 4 studies compared HBCR with center-based CR. In comparison with the usual care, HBCR improved the total quality of life score [MD=-5.85, 95 % CI (-9.76, - 1.94), P=0.003, I2=75 %]. Patients with HBCR and usual care were significantly different in VO2max [MD=1.05 mL/kg/min, 95 % CI (0.35, 1.75), P=0.003, I2=46 %]. However, VO2max of patients with HBCR was not significantly different from those with center-based CR [MD=0.08 mL/kg/min, 95 % CI (-1.29, 1.44), P=0.91, I2=0 %]. There was statistically significant difference in the 6-min Walk Distance between usual care and HBCR (for distance [MD=11.84, 95 % CI (7.41, 16.28), P<0.00001, I2=0 %]; and for feet [MD=98.93, 95 % CI (26.79, 171.08), P=0.007, I2=56 %]). However, there was no significant difference in 6-min Walk Distance between patients with HBCR and center-based CR [MD=12.45, 95 % CI (-9.81, 34.72), P=0.27, I2=0 %] , or in anxiety and depression between patients with usual care and HBCR (for anxiety, [MD=-0.25, 95 % CI (-0.56, 0.05), P=0.11, I2=0 %]; for depression, [MD=-0.18, 95 % CI (-0.51, 0.16), P=0.30, I2=0 %] . No significant difference was found in death number [RR=1.04, 95 % CI (0.55, 1.98), P=0.90, I2=0 %] or in the number of re-hospitalization [RR=0.88, 95 % CI (0.66, 1.18), P=0.40, I2=0 %] between usual care and HBCR. For patients with heart failure, compare with usual care and center-based CR, HBCR can improve the total quality of life. Compare with usual care, HBCR can improve VO2max and 6-min Walk Distance, but compare with center- based CR, there are no differences in mortality, re-hospitalization rate or incidence of anxiety and depression. Additionally, center- based CR and HBCR showed similar outcomes and medical costs.

El objetivo de este estudio fue investigar el efecto de la rehabilitación cardíaca domiciliaria (HBCR) sobre la calidad de vida, la capacidad funcional y las tasas de reingreso en pacientes con insuficiencia cardíaca. Se seleccionaron ensayos controlados aleatorios (ECA) de la Biblioteca Cochrane, CINAHL, EMBASE y MEDLINE. El grupo de intervención recibió un HBCR estandarizado o una estrategia de rehabilitación integral que incluía HBCR. Los participantes del grupo de control recibieron RC en un centro médico o atención habitual sin intervención de RC. Las principales medidas de resultado incluyeron la calidad de vida, la capacidad de ejercicio, la mortalidad y la rehospitalización. Este metanálisis incluyó 20 ECA, en los que 16 estudios compararon HBCR con la atención habitual y 4 estudios compararon que mejoró la puntuación total de calidad de vida [DM=-5,85, IC del 95 % (-9,76, -1,94), P=0,003, I2=75 %]. Los pacientes con HBCR y atención habitual fueron significativamente diferentes en el VO2máx [DM = 1,05 ml/kg/ min, IC del 95 % (0,35, 1,75), P = 0,003, I2 = 46 %]. Sin embargo, el VO2max de los pacientes con HBCR no fue significativamente diferente de aquellos con CR basada en el centro [DM = 0,08 ml/kg/min, IC del 95 % (-1,29, 1,44), P = 0,91, I2 = 0 %]. Hubo una diferencia estadísticamente significativa en la distancia de caminata de 6 minutos entre la atención habitual y HBCR (para la distancia [DM=11,84, IC del 95 % (7,41, 16,28), P<0,00001, I2=0 %]; y para los pies [DM= 98,93, IC 95 % (26,79, 171,08), P=0,007, I2=56 %]). Sin embargo, no hubo una diferencia significativa en la distancia de caminata de 6 minutos entre los pacientes con HBCR y CR basada en el cen- tro [DM = 12,45, IC del 95 % (-9,81, 34,72), P = 0,27, I2 = 0 %], o en la ansiedad y depresión entre pacientes con atención habitual y HBCR (para ansiedad, [DM=-0,25, IC del 95 % (-0,56, 0,05), P=0,11, I2=0 %]; para depresión, [DM=-0,18, 95 % IC (- 0,51, 0,16), P=0,30, I2=0 %] No se encontraron diferencias significativas en el número de muertes [RR=1,04, IC del 95 % (0,55, 1,98), P=0,90, I2=0 %] o en el número de reingresos [RR=0,88, IC 95 % (0,66, 1,18), P=0,40, I2=0 %] entre atención habitual y HBCR. Para los pacientes con insuficiencia cardíaca, en comparación con la atención habitual y la CR en un centro, la HBCR puede mejorar la calidad de vida total. En comparación con la atención habitual, la HBCR puede mejorar el VO2máx y la distancia recorrida en 6 minutos, pero en comparación con la CR basada en un centro, no hay diferencias en la mortalidad, la tasa de rehospitalización o la incidencia de ansiedad y depresión. Además, CR y HBCR basados en el centro mostraron resultados y costos médicos similares.

Análisis de la heterogeneidad en revisiones sistemáticas de cardiología publicadas entre 2000-2005 y 2011-2016 / Analysis of heterogeneity in cardiology systematic reviews published be-tween 2000-2005 and 2011-2016 / Análise da heterogeneidade em revisões sistemáticas de cardiologia publicadas entre 2000-2005 e 2011-2016

Introducción: la cardiología es una de las especialidades médicas que cuenta con más revisiones sistemáticas y metanálisis. Estudiar la metodología de las revisiones y anali­zar su heterogeneidad estadística es fundamental para garantizar su validez científica. Objetivo: describir la comparación de medidas de asociación, modelos estadísticos y grado de heterogeneidad en metanálisis de revisiones sistemáticas de intervenciones farmacológicas en cardiología, publicadas entre 2000-2005 y 2011-2016. Metodología: estudio analítico basado en la descripción y comparación de métodos estadísticos de revisiones sistemáticas de intervenciones farmacológicas en cardiología, publicadas en la biblioteca Cochrane. Para las variables cualitativas se estimaron frecuen­cias absolutas y relativas, mientras que para las cuantitativas se determinaron medias y desviaciones estándar, o medianas y rangos intercuartílicos, según su distribución. Para establecer la diferencia de medias se realizó la prueba t de Student y para la diferencia de proporciones el Chi cuadrado. Resultados: se incluyeron 54 revisiones sistemáticas, con un total de 1053 metanálisis, 6 revisiones con 240 metanálisis entre 2000-2005 y 48 revisiones con 813 metanálisis entre 2011-2016. La mayoría de metanálisis utilizaron el tratamiento estándar como grupo de comparación (56.6%), midieron desenlaces cualitativos nominales (86.3%), determinaron riesgos relativos (63.3%) y aplicaron modelos de efectos fijos (57.8%). En 2011-2016 se encontró una media del Índice de Higgins 17.5 menor que en 2000-2005 (p<0.05). Conclusión: se evidenció una disminución de la heterogeneidad estadística y un aumento en la implementación de modelos de efectos aleatorios, lo que da cuenta de una mayor rigurosidad a la hora de demostrar resultados verdaderamente significativos.

Introduction: cardiology is one of the medical specialties with the most systematic reviews and meta-analyses. Studying the methodology of the reviews and analyzing their statistical heterogeneity is essential to guarantee their scientific validity. Objective: to describe the comparison of association measures, statistical models and degree of heterogeneity in meta-analyses of systematic reviews of pharmacological interventions in cardiology, published between 2000-2005 and 2011-2016. Methodology: analytical study based on the description and comparison of statistical methods of systematic reviews of pharmacological interventions in cardiology, published in the Cochrane library. For the qualitative variables, absolute and relative frequencies were estimated, while for the quantitative ones, means and standard deviations, or medians and interquartile ranges, were determined, depending on their distribution. The Student's t test was used to establish the difference in means and the Chi square for the difference in proportions. Results: 54 systematic reviews were included, with a total of 1.053 meta-analyses, 6 reviews with 240 meta-analyses between 2000-2005, and 48 reviews with 813 meta-analyses between 2011-2016. Most meta-analyses used standard treatment as the comparison group (56.6%), measured nominal qualitative outcomes (86.3%), determined relative risks (63.3%), and applied fixed-effect models (57.8%). In the 2011-2016 period, an average of the Higgins Index was found to be 17.5 lower than in the 2000-2005 (p<0.05). Conclusion: there was evidence of a decrease in statistical heterogeneity and an increase in the implementation of random effects models, which accounts for greater rigor when it comes to demonstrating truly significant results.

Introdução: a cardiologia é uma das especialidades médicas com mais revisões sistemáticas e metanálises. Estudar a metodologia das revisões e analisar sua heterogeneidade estatística é essencial para garantir sua validade científica. Objetivo: descrever a comparação de medidas de associação, modelos estatísticos e grau de heterogeneidade em metanálises de revisões sistemáticas de intervenções farmacológicas em cardiologia, publicadas entre 2000-2005 e 2011-2016. Metodologia: estudo analítico baseado na descrição e comparação de métodos estatísticos de revisões sistemáticas de intervenções farmacológicas em cardiologia, publicadas na biblioteca Cochrane. Para as variáveis qualitativas foram estimadas frequências absolutas e relativas, enquanto para as quantitativas foram determinadas médias e desvios padrão, ou medianas e intervalos interquartis, dependendo de sua distribuição. O teste t de Student foi utilizado para estabelecer a diferença de médias e o qui-quadrado para a diferença de proporções. Resultados: foram incluídas 54 revisões sistemáticas, com um total de 1053 meta-análises, 6 revisões com 240 meta-análises entre 2000-2005 e 48 revisões com 813 meta-análises entre 2011-2016. A maioria das metanálises usou tratamento padrão como grupo de comparação (56.6%), mediu resultados qualitativos nominais (86.3%), determinou riscos relativos (63.3%) e aplicou modelos de efeito fixo (57.8%). Em 2011-2016, a média do Índice de Higgins foi 17.5 menor do que em 2000-2005 (p<0.05). Conclusão: evidenciou-se uma diminuição da heterogeneidade estatística e um aumento da implementação de modelos de efeitos aleatórios, o que confere maior rigor na demonstração de resultados verdadeiramente significativos.

Conservative versus liberal oxygen therapy in relation to all-cause mortality among patients in the intensive care unit: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis.

OBJECTIVE: To evaluate the benefits and harmful effects of conservative versus liberal oxygen therapy in patients admitted to the Intensive Care Unit (ICU). DESIGN: A systematic review and meta-analysis was carried out. SETTING: ICU. PARTICIPANTS: Adult patients (aged 18 years or older) were randomized to either a lower oxygenation target strategy (conservative oxygen therapy) or a higher oxygenation target strategy (liberal oxygen therapy) in the ICU. INTERVENTIONS: Patients received different oxygenation target strategies. RESULTS: Ten studies involving 5429 adult patients admitted to the ICU were included in the meta-analysis. The pooled results showed no decreased all-cause mortality at 28 days (RR 0.90; 95%CI 0.75-1.09; p = 0.28), 90 days (RR 1.02; 95%CI 0.92-1.13; p = 0.71) or longest follow-up (RR 0.97; 95%CI 0.88-1.08; p = 0.63) among patients administered conservative oxygen therapy. Secondary outcomes were comparable between the two groups. The results of sensitivity analyses and subgroup analyses were consistent with the main analyses. CONCLUSION: No beneficial or harmful effects of conservative oxygen therapy were found compared to liberal oxygen therapy in relation to all-cause mortality among adult patients in the ICU. Conservative oxygen therapy did not reduce all-cause mortality at 28 days, 90 days or longest follow-up. Other important clinical outcomes were also comparable between the two groups.

Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis.

OBJECTIVE: This study aimed to investigate chlorhexidine's efficacy in preventing ventilator-associated pneumonia (VAP). DESIGN: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. SETTINGS: The data were obtained from Pubmed, Cochrane Library, and EMBASE. PATIENTS OR PARTICIPANTS: Only mechanically ventilated patients for at least 48h were included. INTERVENTIONS: Randomized clinical trials applying any dosage form of chlorhexidine were eligible. MAIN VARIABLES OF INTEREST: The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised. RESULTS: Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]). CONCLUSIONS: CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome.

Metanálises em psicologia: uma introdução conceitual e prática / Meta-analyses in psychology: a conceptual and hands-on introduction / Metanálisis en psicología: una introducción conceptual y práctica

Metanálise consiste em um conjunto de técnicas estatísticas que visa integrar os resultados de dois ou mais estudos primários. Ela permite produzir estimativas pontuais e intervalares de algum parâmetro populacional, geralmente uma medida de tamanho de efeito. Este artigo tem como objetivo apresentar conceitos fundamentais sobre metanálise e suas aplicações para psicólogos e estudantes de psicologia. O artigo: (1) introduz a lógica da metanálise, seus potenciais e as críticas a ela endereçadas; (2) apresenta dois modelos de metanálise comumente usados por pesquisadores; e (3) aborda dois tópicos importantes para a interpretação correta dos resultados: heterogeneidade e análise de subgrupos. Um exemplo fictício ilustra os conceitos ao longo do artigo. Os Materiais Suplementares contêm equações dos modelos apresentados no texto, resultados comentados de uma síntese metanalítica, código na linguagem R para reproduzir resultados e figuras desse artigo e uma breve lista comentada de fontes adicionais sobre metanálise. (AU)

Meta-analysis consists of a set of statistical techniques that aims to combine the results of two or more primary studies. It enables the calculation of point and interval estimates of some population parameter, usually a measure of effect size. The aim of this article is to introduce fundamental concepts of meta-analysis and its applications for psychologists and psychology students. The article: (1) introduces the logic of meta-analysis, its uses and common criticisms levied against it; (2) presents two computational models of meta-analysis commonly used by researchers; and (3) addresses two issues associated with the correct interpretation of results from meta-analyses: heterogeneity and subgroup analysis. A worked example illustrates the concepts throughout the article. The Supplementary Materials contain a worked example of the models presented in the text, a script in R language that allows the reader to reproduce the results, and a commented list of additional sources. (AU)

El metanálisis consiste en un conjunto de técnicas estadísticas que tiene como objetivo integrar los resultados de dos o más estudios primarios. Permite producir estimaciones puntuales y de intervalo de algún parámetro de población, generalmente una medida del tamaño del efecto. Este artículo presenta conceptos fundamentales sobre el metanálisis y sus aplicaciones para psicólogos y estudiantes de psicología. El artículo: (1) introduce la lógica del metanálisis, sus potencialidades y las críticas que se le dirigen; (2) presenta dos modelos de metanálisis comúnmente utilizados por los investigadores; y (3) aborda dos temas importantes para la correcta interpretación de los resultados: heterogeneidad y análisis de subgrupos. Un ejemplo ficticio ilustra los conceptos a lo largo del artículo. Los Materiales Suplementarios contienen ecuaciones de los modelos presentados en el texto, resultados comentados de una síntesis metanalítica, código en el lenguaje R para reproducir los resultados y las figuras de este artículo, y una breve lista comentada de fuentes adicionales. (AU)

Moral injury and mental health among health-care workers during the COVID-19 pandemic: meta-analysis.

Background: During the COVID-19 pandemic, health-care workers (HCWs) may have been confronted with situations that may culminate in moral injury (MI). MI is the psychological distress that may result from perpetrating or witnessing actions that violate one's moral codes. Literature suggests that MI can be associated with mental health problems.Objective: We aimed to meta-analytically review the literature to investigate whether MI is associated with symptoms of posttraumatic stress disorder (PTSD), anxiety, depression, burnout, and suicidal ideation among active HCWs during the COVID-19 pandemic.Method: We searched eight databases for studies conducted after the onset of the COVID-19 pandemic up to 18 July 2023, and performed random-effects meta-analyses to examine the relationship between MI and various mental health outcomes.Results: We retrieved 33 studies from 13 countries, representing 31,849 individuals, and pooled 79 effect sizes. We found a positive association between MI and all investigated mental health problems (rs = .30-.41, all ps < .0001). Between-studies heterogeneity was significant. A higher percentage of nurses in the samples was associated with a stronger relationship between MI and depressive and anxiety symptoms. Samples with a higher percentage of HCWs providing direct care to patients with COVID-19 exhibited a smaller effect between MI and depressive and anxiety symptoms. We observed a stronger effect between MI and PTSD symptoms in US samples compared to non-US samples.Conclusion: We found that higher MI is moderately associated with symptoms of PTSD, anxiety, depression, burnout, and suicidal ideation among HCWs during the COVID-19 pandemic. Our findings carry limitations due to the array of MI scales employed, several of which were not specifically designed for HCWs, but underscore the need to mitigate the effect of potentially morally injurious events on the mental health of HCWs.

We conducted the first meta-analysis of moral injury and mental health among healthcare workers.Moral injury is moderately associated with symptoms of PTSD, depression, anxiety, burnout, and suicidal ideation.There was a stronger association between MI and anxiety and depressive symptoms for samples with more nurses.

Esquecidos após a exclusão escolar: uma meta-análise do estudo da deriva educacional / Forgotten after school exclusion: an educational drift study meta-analysis / Olvidados tras la exclusión escolar: un metanálisis del estudio de la deriva educativa

Este artigo tem como objetivo analisar os desafios e possibilidades encontradas no estudo da deriva educacional, condição em que os sujeitos já estiveram na escola, mas foram dela excluídos antes de concluir a educação básica, sendo responsabilizados pelo retorno aos estudos. Trata-se de um ensaio teórico-metodológico que foca no pensamento categorial, sobretudo a categoria da dimensão subjetiva como recurso para apreensão da concreticidade do fenômeno social estudado. A deriva educacional é um fenômeno social pouco estudado no campo da Psicologia da Educação e a possibilidade de explicá-lo é desafiadora, tendo em vista as armadilhas presentes nos discursos carregados da intenção de ocultar o modo como se trata de uma condição social e historicamente determinada no modo de produção capitalista. Diante dessa dificuldade, ter como base teórico-etodológica o Materialismo Histórico-dialético (MHD) e a Psicologia Sócio-histórica (PSH) foi fundamental. O pensamento categorial possibilitou, partindo das significações dos participantes da pesquisa, superar as múltiplas camadas de aparência para compreender a deriva educacional em sua complexidade. A categoria da dimensão subjetiva e o processo de análise por meio dos núcleos de significação possibilitaram chegar a uma síntese das múltiplas determinações da deriva educacional que permitiu explicá-la de forma contra-hegemônica, apontando para os movimentos já existentes ou ainda necessários para a transformação, sem recorrer à justificativas individualizantes, psicologizantes ou sociologizantes. (AU)

This article aims to analyze the challenges and possibilities experienced in the educational drift study, condition in which the subjects had already been to school, but were excluded from it before completing basic education, being held responsible for returning to their studies. This is a theoretical-methodological essay that focuses on categorical thinking, especially the subjective dimension category as a resource for apprehending the social phenomenon concreteness. Educational drift is a social phenomenon on which there are few studies in the field of Educational Psychology. The possibility of explaining this issue is a challenge, since the pitfalls present in the discourses intended to hide the way in which it is a social and historically determined condition in the capitalist mode of production. Faced with this difficulty, it was fundamental to have Historical-Dialectical Materialism (MHD) and Socio-Historical Psychology (PSH) as a theoreticalmethodological basis. The categorical thinking enabled us, starting from the research participants significations, to overcome the appearance of multiple layers and to understand the educational drift in its complexity. The subjective dimension category and the analysis processes through the signification nuclei made it possible to reach an educational drift multiple determinations synthesis that allowed us to explain the issue in a counter-hegemonic way, pointing to the already existing or still necessary movements to transformation, without resorting to individualizing, psychologizing or sociologizing justifications. (AU)

Este artículo tiene como objetivo analizar los desafíos y las posibilidades encontradas en el estudio de la deriva educativa, condición en la que los sujetos ya habían ido a la escuela, pero fueron excluidos de ella antes de completar la educación básica, siendo responsables de regresar a sus estudios. Este es un ensayo teórico-metodológico que se centra en el pensamiento categorial, en especial la categoría de la dimensión subjetiva como recurso para aprehender la concreción del fenómeno social estudiado. Este es un fenómeno social poco estudiado en el campo de la Psicología Educativa, y la posibilidad de explicarlo es desafiante, dadas las trampas presentes en los discursos cargados con la intención de ocultar la forma en que es una condición social e históricamente determinada en la forma de producción capitalista. Ante esta dificultad, tener como base teórico-metodológica el Materialismo Histórico-Dialéctico (MHD) y la Psicología Socio-Histórica (PSH) fue fundamental. El pensamiento categórico nos permitió, a partir de los significados de los participantes de la investigación, superar las múltiples capas de apariencia para comprender la deriva educativa en su complejidad. La categoría de la dimensión subjetiva y los procesos de análisis a través de los núcleos de significación permitieron llegar a una síntesis de múltiples determinaciones de la deriva educativa que permitieron explicarla de manera contrahegemónico, apuntando a los movimientos ya existentes o aún necesarios a la transformación, sin recurrir a justificaciones individualizantes, psicologizantes o sociologizantes.(AU)

The benefits of peritoneal dialysis (PD) solution with low-glucose degradation product in residual renal function and dialysis adequacy in PD patients: A meta-analysis / Beneficios de la solución de diálisis peritoneal (DP), con producto de degradación bajo en glucosa, en la función renal residual y la adecuación de la diálisis en pacientes en DP: un metanálisis

Abstract The peritoneal effects of low-glucose degradation product (GDP)-containing peritoneal dialysis (PD) solutions have been extensively described. To systematically evaluate the efficacy and safety of low GDP solution for PD patients, specifically the effect on residual renal function (RRF) and dialysis adequacy, we conducted a meta-analysis of the published randomized controlled trials (RCTs). Different databases were searched for RCTs that compared low GDP-PD solutions with conventional PD solutions in the treatment of PD patients with continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). The outcomes of RCTs should include RRF and may include small solute clearance, peritoneal transport status, nutritional status, and all-cause mortality. Seven studies (632 patients) were included. Compared with the conventional solution, low-GDP solution preserved RRF in PD patients over time (MD 0.66 mL/min, 95% CI 0.34 to 0.99; p<0.0001), particularly in one year of treatment (p<0.01), and improved weekly Kt/V (MD 0.11, 95% CI 0.05 to 0.17; p=0.0007) without an increased 4-hour D/Pcr (MD 0.00, 95% CI -0.02 to 0.02; p=1.00). Notably, the MD of RRF and urine volume between the two groups tended to decrease as time on PD progressed up to 24 months. Patients using low GDP PD solutions did not have an increased risk of all-cause mortality (MD 0.97, 95% CI 0.50 to 1.88; p=0.93). Our meta-analysis confirms that the low GDP PD solution preserves RRF, improves the dialysis adequacy without increasing the peritoneal solute transport rate and all-cause mortality. Further trials are needed to determine whether this beneficial effect can affect long-term clinical outcomes.

Resumen Los efectos peritoneales de las soluciones de diálisis peritoneal (DP) que contienen productos de degradación bajos en glucosa (PIB) se han descrito ampliamente. Para evaluar sistemáticamente la eficacia y la seguridad de la solución de PIB bajo para pacientes en DP, específicamente el efecto sobre la función renal residual (RRF) y la adecuación de la diálisis, realizamos un metanálisis de los ensayos controlados aleatorios (ECA) publicados. Se realizaron búsquedas en diferentes bases de datos de ECA que compararan la solución de DP de bajo PIB con la solución de DP convencional en el tratamiento de pacientes con EP con CAPD y APD. Los resultados de los ECA deben incluir la RRF y pueden incluir la depuración de solutos pequeños, el estado nutricional, el estado del transporte peritoneal y la mortalidad por todas las causas. Se incluyeron siete estudios (632 pacientes). En comparación con la solución convencional, la solución de bajo PIB preservó la FRR en pacientes con EP a lo largo del tiempo (DM 0,66 mL/min, IC del 95%: 0,34 a 0,99; p<0,0001), particularmente en un año de tratamiento (p<0,01), y mejoró el Kt/V semanal (DM 0,11, IC del 95%: 0,05 a 0,17; p = 0,0007), sin un aumento de D/Pcr a las 4 horas (DM 0,00, IC del 95%: -0,02 a 0,02; p = 1,00). Los pacientes que usaron una solución para DP con bajo contenido de GDP no tuvieron un mayor riesgo de mortalidad por todas las causas (DM 0,97; IC del 95%: 0,50 a 1,88; p = 0,93). Nuestro metanálisis confirma que la solución de DP de bajo PIB preserva la FRR, mejora la adecuación de la diálisis sin aumentar la tasa de transporte peritoneal de solutos y la mortalidad por todas las causas. Se necesitan más ensayos para determinar si este efecto beneficioso puede afectar los resultados clínicos a largo plazo.

Tecido Adiposo Epicárdico nos Fenótipos de Insuficiência Cardíaca - Uma Metanálise / Epicardial Adipose Tissue in Heart Failure Phenotypes - A Meta-Analysis

Resumo Fundamento O tecido adiposo epicárdico (TAE) é aumentado em comorbidades comuns na insuficiência cardíaca (IC). Dessa forma, o TAE teria o potencial de mediar efeitos que levam à deterioração da função cardíaca. Objetivos Esta metanálise tem o objetivo de investigar se a quantidade de TAE em todos os tipos de IC e cada tipo de IC são significativamente diferentes dos pacientes de controle. Métodos Esta metanálise seguiu as diretrizes da Meta-analysis of Observational Studies in Epidemiology (Metanálise de estudos observacionais em epidemiologia). A pesquisa foi realizada nos bancos de dados MEDLINE, Embase e Lilacs até novembro de 2020. Dois autores realizaram a triagem, a extração de dados e a avaliação de qualidade. Um p-valor <0,05 foi definido como estatisticamente significativo. Resultados Foram incluídos oito estudos observacionais, compreendendo 1248 pacientes no total, dos quais 574 eram de controle, 415 tinham IC com fração de ejeção reduzida (ICFER) e 259 tinham IC com fração de ejeção de faixa média ou preservada (ICFEfm ou ICFEP). A quantidade de TAE não era diferente entre todos os tipos de IC e o grupo de controle (DMP = -0,66, IC 95%: -1,54 a 0,23, p =0,14) . Analisando cada fenótipo de IC separadamente, pacientes com ICFER tinham TAE reduzido em comparação aos pacientes de controle (DMP = 1,27, IC 95%: - 1,87 a -0,67, p <0,0001), enquanto os pacientes com ICFEfm ou ICFEP tiveram TAE aumentado em comparação aos pacientes de controle (DMP = 1,24, IC 95%: 0,99 a 1,50, p <0,0001). Conclusão A quantidade de TAE não era significativamente diferente entre todos os tipos de IC e o grupo de controle. Em pacientes com ICFER o volume de TAE era reduzido, enquanto em pacientes com ICFEP e ICFEfm, a quantidade de TAE era significativamente aumentada. Número de registro PROSPERO: CRD42019134441.

Abstract Background Epicardial adipose tissue (EAT) is increased in comorbidities common in heart failure (HF). In this sense, EAT could potentially mediate effects that lead to an impaired cardiac function. Objectives This meta-analysis aims to investigate if the amount of EAT in all-types of HF and each HF phenotype is significantly different from control patients. Methods This meta-analysis followed the Meta-analysis Of Observational Studies in Epidemiology guidelines. The search was performed in the MEDLINE, Embase, and Lilacs databases until November 2020. Two authors performed screening, data extraction, and quality assessment. A p-value <0.05 was defined as statistically significant. Results Eight observational studies were included, comprehending 1,248 patients in total, from which 574 were controls, 415 had HF with reduced ejection fraction (HFrEF) and 259 had HF with mid-range or preserved ejection fraction (HFmrEF or HFpEF). The amount of EAT was not different between all types of HF and the control group (SMD = -0.66, 95% CI: -1.54 to 0.23, p =0.14). Analyzing each HF phenotype separately, patients with HFrEF had a reduced EAT when compared to the controls (SMD= -1.27, 95% CI: - 1.87 to -0.67, p <0.0001), while patients with HFmrEF or HFpEF showed an increased EAT when compared to controls (SMD= 1.24, 95% CI: 0.99 to 1.50, p <0.0001). Conclusion The amount of EAT was not significantly different between all types of HF and the control group. In patients with HFrEF, the EAT volume was reduced, whereas in HFpEF and HFmrEF, the amount of EAT was significantly increased. PROSPERO registration number: CRD42019134441.

Impact of lipid-lowering therapies on cardiovascular outcomes according to coronary artery calcium score. A systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVES: Coronary artery calcium (CAC) score improves the accuracy of risk stratification for atherosclerotic cardiovascular disease (ASCVD) events compared with traditional cardiovascular risk factors. We evaluated the interaction of coronary atherosclerotic burden as determined by the CAC score with the prognostic benefit of lipid-lowering therapies in the primary prevention setting. METHODS: We reviewed the MEDLINE, EMBASE, and Cochrane databases for studies including individuals without a previous ASCVD event who underwent CAC score assessment and for whom lipid-lowering therapy status stratified by CAC values was available. The primary outcome was ASCVD. The pooled effect of lipid-lowering therapy on outcomes stratified by CAC groups (0, 1-100,> 100) was evaluated using a random effects model. RESULTS: Five studies (1 randomized, 2 prospective cohort, 2 retrospective) were included encompassing 35 640 individuals (female 38.1%) with a median age of 62.2 [range, 49.6-68.9] years, low-density lipoprotein cholesterol level of 128 (114-146) mg/dL, and follow-up of 4.3 (2.3-11.1) years. ASCVD occurrence increased steadily across growing CAC strata, both in patients with and without lipid-lowering therapy. Comparing patients with (34.9%) and without (65.1%) treatment exposure, lipid-lowering therapy was associated with reduced occurrence of ASCVD in patients with CAC> 100 (OR, 0.70; 95%CI, 0.53-0.92), but not in patients with CAC 1-100 or CAC 0. Results were consistent when only adjusted data were pooled. CONCLUSIONS: Among individuals without a previous ASCVD, a CAC score> 100 identifies individuals most likely to benefit from lipid-lowering therapy, while undetectable CAC suggests no treatment benefit.

Frailty and delirium in hospitalized older adults: A systematic review with meta-analysis / Fragilidade e delirium em idosos hospitalizados: revisão sistemática com metanálise / Fragilidad y delirium en adultos mayores hospitalizados: revisión sistemática con metanálisis

Abstract Objective: to estimate the prevalence and synthesize diverse evidence about the relationship between frailty and delirium in hospitalized older adults. Method: a systematic review with meta-analysis in which observational studies conducted with older adults about frailty, delirium and hospitalization, were selected without time of language restrictions. The search was conducted in the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and CENTRAL databases during August 2021. The precepts set forth by the Joanna Briggs Institute (JBI) - Evidence Synthesis Groups were followed. The meta-analysis model estimated the relative risk corresponding to the prevalence of frailty and delirium. The inverse variance method for proportions was used to estimate the prevalence values and relative risks for binary outcomes. Results: initially, 1,244 articles were identified, of which 26 were included in the meta-analysis (n=13,502 participants), with 34% prevalence of frailty (95% CI:0.26-0.42; I 2=99%; t 2=0.7618, p=0) and 21% for delirium (95% CI:0.17-0,25; I 2=95%; t 2=0.3454, p<0.01). The risk for hospitalized older adults to develop delirium was 66% (RR: 1.66; 95% CI:1.23-2.22; I2=92%; t2=0.4154; p<0.01). Conclusion: 34% prevalence of frailty and 21% of delirium in hospitalized older adults, with frailty being an independent risk factor for developing delirium, with an increased chance of 66% when compared to non-frail individuals.

Resumo Objetivo: estimar a prevalência e sintetizar evidências sobre a relação entre fragilidade e delirium em idosos hospitalizados. Método: revisão sistemática com metanálise na qual foram selecionados estudos observacionais realizados com idosos sobre fragilidade, delirium e hospitalização, sem recortes temporais e de idioma. A busca foi realizada nas bases de dados MEDLINE, EMBASE, CINAHL, Scopus, Web of Science e CENTRAL durante o mês de agosto de 2021. Foram seguidos os preceitos estabelecidos pelo Joanna Briggs Institute (JBI) - Grupos de Síntese de Evidências.. O modelo de metanálise estimou risco relativo da prevalência de fragilidade e delirium. Utilizou-se método da variância inversa para proporções para estimar as prevalências e risco relativo para desfechos binários. Resultados: identificaram-se, inicialmente, 1.244 artigos, 26 incluídos na metanálise (n=13.502 participantes), sendo a prevalência de fragilidade 34% (IC 95% 0,26 a 0,42; I 2=99%; t 2= 0,7618, p=0) e delirium 21% (IC 95% 0,17 a 0,25; I 2=95%; t 2= 0,3454, p<0,01). O risco do idoso frágil hospitalizado desenvolver delirium foi de 66% (RR 1,66; IC 95% 1,23 a 2,22; I2=92%; t2=0,4154; p<0,01). Conclusão: prevalência de 34% de fragilidade e 21% de delirium em idosos hospitalizados, sendo a fragilidade um fator de risco independente para desenvolvimento de delirium, com um aumento de chance de 66% comparado aos não frágeis.

Resumen Objetivo: estimar la prevalencia y sintetizar evidencias sobre la relación entre fragilidad y delirium en adultos mayores hospitalizados. Método: revisión sistemática con metanálisis en el que se seleccionaron estudios observacionales realizados con adultos mayores sobre fragilidad, delirium y hospitalización, sin recorte temporal ni de idioma. La búsqueda se realizó en las bases de datos MEDLINE, EMBASE, CINAHL, Scopus, Web of Science y CENTRAL en agosto de 2021. Se siguieron los preceptos del Instituto Joanna Briggs (Joanna Briggs Institute, JBI) - Evidence Synthesis Groups. El modelo de metanálisis estimó el riesgo relativo de la prevalencia de fragilidad y delirium. Se utilizó el método de la varianza inversa para proporciones para estimar la prevalencia y el riesgo relativo de los desenlaces binarios. Resultados: inicialmente se identificaron 1.244 artículos, se incluyen en el metanálisis 26 (n=13.502 participantes), la prevalencia de fragilidad fue del 34% (IC 95% 0,26 a 0,42; I 2=99%; t 2= 0,7618, p=0) y de delirium del 21% (IC 95% 0,17 a 0,25; I 2=95%; t 2= 0,3454, p<0,01). El riesgo de que el adulto mayor frágil hospitalizado desarrolle delirium fue del 66% (RR 1,66; IC 95% 1,23 a 2,22; I2=92%; t2=0,4154; p<0,01). Conclusión: los adultos mayores hospitalizados tienen una prevalencia de fragilidad del 34% y de delirium del 21%, la fragilidad es un factor de riesgo independiente para el desarrollo de delirium, cuando se compara a los frágiles con los no frágiles, la probabilidad de delirium de los primeros es de un 66% más.

Predictive power of early-warning scores used in hospital emergency departments: a systematic review and meta-analysis. / Capacidad predictiva de las escalas de alerta temprana en los servicios de urgencias hospitalarios: revisión sistemática y metanálisis.

OBJECTIVES: To assess the predictive power of scores used in hospital emergency departments (EDs) to give early warning of risk for mortality and hospital ward or intensive care unit (ICU) admission. MATERIAL AND METHODS: Systematic review and meta-analysis. We searched MEDLINE, Embase, the Web of Science, and the Cochrane Library. Observational studies and clinical trials published between January 1, 1950, and June 12, 2020 that used early-warning scores in hospital EDs were included. The main outcomes were mortality (at 24, 48, and more than 72 hours), hospital admission, and ICU admission. RESULTS: Nine studies entered into the systematic review; 4 of them, with 165 580 patients, were included in the meta-analysis. The studies were heterogeneous with respect to the scores used. The one used most often was the National Early Warning Score (NEWS). The meta-analysis of studies using the NEWS scale showed that it had good predictive power for mortality: the area under the curve (AUC) of the receiver operating characteristic was 0.88 (95%, CI, 0.87-0.89; P .001, I2 = 0%) at 24 hours and 0.86 (0.84-0.88; P .001; I2 = 49.3%) at 48 hours. The AUC for inhospital mortality was 0.77 (95% CI, 0.74-0.80; P .001; I2 = 96.2%). The NEWS score had adequate power for predicting risk of hospital ward and ICU admission. CONCLUSION: Early warning scores used in hospital EDs are able to predict risk of early and in-hospital mortality.

OBJETIVO: Evaluar, en términos de ingreso hospitalario o en unidad de cuidados intensivos (UCI) y muerte, la capacidad predictiva de las escalas de alerta temprana en los servicios de urgencias hospitalarios (SUH). METODO: Revisión sistemática y metanálisis. Se consultaron las bases de datos Medline, Embase, Web of Science y Cochrane Library. Se incluyeron estudios observacionales y ensayos clínicos publicados entre e 1 de enero de 1950 y 12 de junio de 2020 en los que se empleara una escala de alerta temprana en los SUH. Las variables de resultados principales fueron mortalidad (24 horas, 48 horas y más de 72 horas) e ingreso hospitalario y en UCI. RESULTADOS: Se seleccionaron 9 estudios en la revisión sistemática, 4 se incluyeron en el metanálisis (165.580 pacientes). Hubo heterogeneidad en las escalas empleadas, siendo la escala NEWS la más utilizada. El uso de la escala NEWS mostró una buena capacidad predictiva para la mortalidad a las 24 horas [AUROC 0,88 (IC 95% 0,87-0,89); p 0,001; I2 = 0%], a las 48 horas [AUROC 0,86 (IC 95% 0,84-0,88); p 0,001; I2 = 49,3%] e intrahospitalaria [AUROC: 0,77 (IC 95% 0,74-0,80); p 0,001; I2 = 96,2%]. Para el ingreso hospitalario y en UCI, NEWS mostró una capacidad predictiva adecuada. CONCLUSIONES: El uso de las escalas de alerta temprana en los SUH muestra una capacidad predictiva buena en términos de mortalidad temprana e intrahospitalaria.

Resveratrol as an anti-asthmatic agent: could this stilbenoid help against COVID-19 in any way? a meta-analysis / Resveratrol como agente antiasmático: ¿podría este estilbenoide ayudar contra el COVID-19 de alguna manera? un metaanálisis

Resveratrol is a phenolic phytoconstituent found in many plants. This molecule has always caught the attention of scientists because of biological potentials such as inhibition of inflammation, oxidative stress and platelet aggregation as well as to prevent/protect against cardiovascular and neurodegenerative disease/disorders. Literature search have been conducted over resveratrol in covid-19 and asthma studies published in Pubmed and Google Scholars until 30 September 2020. The criteria used in the literature review were determined and were reviewed works on resveratrol including 368 articles and 47 articles on covid-19 and asthma, respectively. As a result of meta-analysis, TNF-α values of the studies showed a significant difference (heterogeneity) of I2=68.39% from each other in total (Cohran Q:6.33, p<0.0423). This study shows that resveratrol would have a potential to reduce ARDS symptoms, by suppressing the cytokine storm and severe inflammation caused by SARS-CoV-2, and by showing strong activity against various types of DNA/RNA viruses.

El resveratrol es un fitoconstituyente fenólico que se encuentra en muchas plantas. Esta molécula siempre ha llamado la atención de los científicos debido a sus potenciales biológicos como la inhibición de la inflamación, el estrés oxidativo y la agregación plaquetaria, así como para prevenir/proteger contra enfermedades/trastornos cardiovasculares y neurodegenerativos. Se han realizado búsquedas bibliográficas sobre resveratrol en covid-19 y estudios sobre asma publicados en Pubmed y Google Scholars hasta el 30 de septiembre de 2020. Se determinaron los criterios utilizados en la revisión bibliográfica y se revisaron trabajos sobre resveratrol que incluyen 368 artículos y 47 artículos sobre covid-19 y asma, respectivamente. Como resultado del metanálisis, los valores de TNF-α de los estudios mostraron una diferencia significativa (heterogeneidad) de I2=68,39% entre sí en total (Cohran Q: 6,33, p<0,0423). Este estudio muestra que el resveratrol podría reducir los síntomas del ARDS al suprimir la tormenta de citocinas y la inflamación severa causada por el SARS-CoV-2, y al mostrar una fuerte actividad contra varios tipos de virus de ADN/ARN.