Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 16 de 16
Filtrar
Más filtros

Bases de datos
País/Región como asunto
Tipo del documento
Intervalo de año de publicación
1.
Sex Transm Dis ; 49(12): 801-807, 2022 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-36194831

RESUMEN

BACKGROUND: HIV partner services can accelerate the use of antiretroviral-based HIV prevention tools (antiretroviral therapy [ART] and preexposure prophylaxis [PrEP]), but its population impact on long-term HIV incidence reduction is challenging to quantify with traditional partner services metrics of partner identified or HIV screened. Understanding the role of partner services within the portfolio of HIV prevention interventions, including using it to efficiently deliver antiretrovirals, is needed to achieve HIV prevention targets. METHODS: We used a stochastic network model of HIV/sexually transmitted infection transmission for men who have sex with men, calibrated to surveillance-based estimates in the Atlanta area, a jurisdiction with high HIV burden and suboptimal partner services uptake. Model scenarios varied successful delivery of partner services cascade steps (newly diagnosed "index" patient and partner identification, partner HIV screening, and linkage or reengagement of partners in PrEP or ART care) individually and jointly. RESULTS: At current levels observed in Atlanta, removal of HIV partner services had minimal impact on 10-year cumulative HIV incidence, as did improving a single partner services step while holding the others constant. These changes did not sufficiently impact overall PrEP or ART coverage to reduce HIV transmission. If all index patients and partners were identified, maximizing partner HIV screening, partner PrEP provision, partner ART linkage, and partner ART reengagement would avert 6%, 11%, 5%, and 18% of infections, respectively. Realistic improvements in partner identification and service delivery were estimated to avert 2% to 8% of infections, depending on the combination of improvements. CONCLUSIONS: Achieving optimal HIV prevention with partner services depends on pairing improvements in index patient and partner identification with maximal delivery of HIV screening, ART, and PrEP to partners if indicated. Improving the identification steps without improvement to antiretroviral service delivery steps, or vice versa, is projected to result in negligible population HIV prevention benefit.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Masculino , Humanos , Homosexualidad Masculina , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Antirretrovirales/uso terapéutico , Fármacos Anti-VIH/uso terapéutico
2.
Sex Transm Dis ; 49(10): 669-676, 2022 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-35921635

RESUMEN

BACKGROUND: Previous models have estimated the total population attributable fraction of Neisseria gonorrhoeae and Chlamydia trachomatis (NG/CT) on HIV incidence among men who have sex with men (MSM), but this does not represent realistic intervention effects. We estimated the potential impact of screening for NG/CT on downstream incidence of HIV among MSM. METHODS: Using a network model, we estimated the effects of varying coverage levels for sexually transmitted infection screening among different priority populations: all sexually active MSM regardless of HIV serostatus, MSM with multiple recent (past 6 months) sex partners regardless of serostatus, MSM without HIV, and MSM with HIV. Under the assumption that all screening events included a urethral test, we also examined the effect of increasing the proportion of screening events that include rectal screening for NG/CT on HIV incidence. RESULTS: Increasing annual NG/CT screening among sexually active MSM by 60% averted 4.9% of HIV infections over a 10-year period (interquartile range, 2.8%-6.8%). More HIV infections were averted when screening was focused on MSM with multiple recent sex partners: 60% coverage among MSM with multiple recent sex partners averted 9.8% of HIV infections (interquartile range, 8.1%-11.6%). Increased sexually transmitted infection screening among MSM without HIV averted more new HIV infections compared with the transmissions averted because of screening MSM with HIV, but fewer NG/CT tests were needed among MSM with HIV to avert a single new HIV infection. CONCLUSIONS: Screening of NG/CT among MSM is expected to lead to modest but clinically relevant reductions in HIV incidence among MSM.


Asunto(s)
Infecciones por Chlamydia , Gonorrea , Infecciones por VIH , Minorías Sexuales y de Género , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/prevención & control , Chlamydia trachomatis , Gonorrea/diagnóstico , Gonorrea/epidemiología , Gonorrea/prevención & control , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Humanos , Incidencia , Masculino , Tamizaje Masivo , Neisseria gonorrhoeae , Estados Unidos/epidemiología
3.
J Infect Dis ; 223(6): 1019-1028, 2021 03 29.
Artículo en Inglés | MEDLINE | ID: mdl-33507308

RESUMEN

BACKGROUND: The global COVID-19 pandemic has the potential to indirectly impact transmission dynamics and prevention of HIV and other sexually transmitted infections (STI). It is unknown what combined impact reductions in sexual activity and interruptions in HIV/STI services will have on HIV/STI epidemic trajectories. METHODS: We adapted a model of HIV, gonorrhea, and chlamydia for a population of approximately 103 000 men who have sex with men (MSM) in the Atlanta area. Model scenarios varied the timing, overlap, and relative extent of COVID-19-related sexual distancing and service interruption within 4 service categories (HIV screening, preexposure prophylaxis, antiretroviral therapy, and STI treatment). RESULTS: A 50% relative decrease in sexual partnerships and interruption of all clinical services, both lasting 18 months, would generally offset each other for HIV (total 5-year population impact for Atlanta MSM, -227 cases), but have net protective effect for STIs (-23 800 cases). If distancing lasted only 3 months but service interruption lasted 18 months, the total 5-year population impact would be an additional 890 HIV cases and 57 500 STI cases. CONCLUSIONS: Immediate action to limit the impact of service interruptions is needed to address the indirect effects of the global COVID-19 pandemic on the HIV/STI epidemic.


Asunto(s)
COVID-19/epidemiología , Infecciones por VIH/epidemiología , Conducta Sexual/estadística & datos numéricos , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Georgia/epidemiología , Homosexualidad Masculina , Humanos , Incidencia , Masculino , Modelos Estadísticos , Pandemias , Parejas Sexuales , Minorías Sexuales y de Género
4.
J Infect Dis ; 223(1): 72-82, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-32882043

RESUMEN

BACKGROUND: Long-acting injectable (LAI) human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is reportedly efficacious, although full trial results have not been published. We used a dynamic network model of HIV transmission among men who have sex with men to assess the population impact of LAI-PrEP when available concurrently with daily-oral (DO) PrEP. METHODS: The reference model represents the current HIV epidemiology and DO-PrEP coverage (15% among those with behavioral indications for PrEP) among men who have sex with men in the southeastern United States. Primary analyses investigated varied PrEP uptake and proportion selecting LAI-PrEP. Secondary analyses evaluated uncertainty in pharmacokinetic efficacy and LAI-PrEP persistence relative to DO-PrEP. RESULTS: Compared with the reference scenario, if 50% chose LAI-PrEP, 4.3% (95% simulation interval, -7.3% to 14.5%) of infections would be averted over 10 years. The impact of LAI-PrEP is slightly greater than that of the DO-PrEP-only regimen, based on assumptions of higher adherence and partial protection after discontinuation. If the total PrEP initiation rate doubled, 17.1% (95% simulation interval, 6.7%-26.4%) of infections would be averted. The highest population-level impact occurred when LAI-PrEP uptake and persistence improved. CONCLUSIONS: If LAI-PrEP replaces DO-PrEP, its availability will modestly improve the population impact. LAI-PrEP will make a more substantial impact if its availability drives higher total PrEP coverage, or if persistence is greater for LAI-PrEP.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/prevención & control , Cumplimiento de la Medicación/estadística & datos numéricos , Profilaxis Pre-Exposición/métodos , Minorías Sexuales y de Género/estadística & datos numéricos , Administración Oral , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Incidencia , Inyecciones , Masculino , Cumplimiento de la Medicación/psicología , Modelos Teóricos , Prevalencia
5.
BMC Health Serv Res ; 21(1): 1244, 2021 Nov 17.
Artículo en Inglés | MEDLINE | ID: mdl-34789235

RESUMEN

BACKGROUND: Hospitals in the public and private sectors tend to join larger organizations to form hospital groups. This increasingly frequent mode of functioning raises the question of how countries should organize their health system, according to the interactions already present between their hospitals. The objective of this study was to identify distinctive profiles of French hospitals according to their characteristics and their role in the French hospital network. METHODS: Data were extracted from the national hospital database for year 2016. The database was restricted to public hospitals that practiced medicine, surgery or obstetrics. Hospitals profiles were determined using the k-means method. The variables entered in the clustering algorithm were: the number of stays, the effective diversity of hospital activity, and a network-based mobility indicator (proportion of stays followed by another stay in a different hospital of the same Regional Hospital Group within 90 days). RESULTS: Three hospital groups were identified by the clustering algorithm. The first group was constituted of 34 large hospitals (median 82,100 annual stays, interquartile range 69,004 - 117,774) with a very diverse activity. The second group contained medium-sized hospitals (with a median of 258 beds, interquartile range 164 - 377). The third group featured less diversity regarding the type of stay (with a mean of 8 effective activity domains, standard deviation 2.73), a smaller size and a higher proportion of patients that subsequently visited other hospitals (11%). The most frequent type of patient mobility occurred from the hospitals in group 2 to the hospitals in group 1 (29%). The reverse direction was less frequent (19%). CONCLUSIONS: The French hospital network is organized around three categories of public hospitals, with an unbalanced and disassortative patient flow. This type of organization has implications for hospital planning and infectious diseases control.


Asunto(s)
Hospitales Públicos , Aprendizaje Automático no Supervisado , Análisis por Conglomerados , Servicios de Salud , Humanos , Grupos de Población
6.
Clin Infect Dis ; 71(2): 293-300, 2020 07 11.
Artículo en Inglés | MEDLINE | ID: mdl-31612225

RESUMEN

BACKGROUND: In late 2013, France was one of the first countries to recommend initiation of combination antiretroviral therapy (cART) irrespective of CD4 cell count. METHODS: To assess the impact of achieving the second and third Joint United Nations Programme on HIV/AIDS 90-90-90 targets (ie, 90% of diagnosed people on sustained cART, and, of those, 90% virologically controlled) on human immunodeficiency virus (HIV) incidence, we conducted a longitudinal study to describe the epidemiology of primary HIV infection (PHI) and/or recent HIV infection (patients with CD4 cell count ≥500/mm3 at HIV diagnosis; (PRHI) between 2007 and 2017 in a large French multicenter cohort. To identify changes in trends in PHI and PRHI, we used single breakpoint linear segmented regression analysis. RESULTS: During the study period, 61 822 patients were followed in the Dat'AIDS cohort; 2027 (10.0%) had PHI and 7314 (36.1%) had PRHI. The second and third targets were reached in 2014 and 2013, respectively. The median delay between HIV diagnosis and cART initiation decreased from 9.07 (interquartile range [IQR], 1.39-33.47) months in 2007 to 0.77 (IQR, 0.37-1.60) months in 2017. A decrease in PHI (-35.1%) and PRHI (-25.4%) was observed starting in 2013. The breakpoints for PHI and PRHI were 2012.6 (95% confidence interval [CI], 2010.8-2014.4) and 2013.1 (95% CI, 2011.3-2014.8), respectively. CONCLUSIONS: Our findings show that the achievements of 2 public health targets in France and the early initiation of cART were accompanied by a reduction of about one-third in PHI and PRHI between 2013 and 2017. CLINICAL TRIALS REGISTRATION: NCT02898987.


Asunto(s)
Infecciones por VIH , Recuento de Linfocito CD4 , Francia/epidemiología , VIH , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Estudios Longitudinales , Naciones Unidas
8.
Sex Transm Dis ; 50(2): 83-85, 2023 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-36630415

RESUMEN

Using a network model, we simulated transmission of HIV, gonorrhea, and chlamydia among men who have sex with men to estimate the number of HIV infections that can be attributed to gonorrhea and chlamydia, per gonococcal and chlamydial infection. This metric can inform future modeling and health economic studies.


Asunto(s)
Infecciones por Chlamydia , Chlamydia , Gonorrea , Infecciones por VIH , Minorías Sexuales y de Género , Masculino , Humanos , Estados Unidos/epidemiología , Gonorrea/epidemiología , Homosexualidad Masculina , Infecciones por VIH/epidemiología , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis
9.
Soins Gerontol ; 23(134): 32-35, 2018.
Artículo en Francés | MEDLINE | ID: mdl-30449368

RESUMEN

Non-pharmacological therapies are now used in many nursing homes often with residents presenting a risk of behavioural disorders. They include music therapy, animal-assisted therapy, physical activity as well as other approaches such as light therapy or aromatherapy. It requires rigorous assessment, the permanent involvement and engagement of residents as well as the staff as part of a compassionate and participative approach.


Asunto(s)
Trastornos Mentales/terapia , Casas de Salud , Anciano , Terapia Asistida por Animales , Aromaterapia , Humanos , Musicoterapia
10.
Soins Gerontol ; 22(126): 16-20, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28687128

RESUMEN

A study analysed, on the one hand, the efficacy of the use of music therapy with residents and, on the other, the feasibility of the implementation of such a technique in nursing homes and in follow-up and rehabilitation units. In this context, music therapy seems to be an effective alternative to traditional approaches.


Asunto(s)
Hogares para Ancianos , Musicoterapia , Casas de Salud , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Francia , Humanos , Masculino , Resultado del Tratamiento
11.
Joint Bone Spine ; 89(6): 105433, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-35779790

RESUMEN

INTRODUCTION: We aimed to evaluate the efficacy and tolerance of A1 pulley release using the needle technique, under ultrasound guidance, in patients with symptomatic trigger finger. METHODS: All patients with symptomatic trigger finger underwent A1 pulley release using an intramuscular 21 gauge (G) needle. Quinnell grade (I-IV), Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score (0-100) and pain score on a visual analog scale (VAS: 0-10mm) were recorded at inclusion. The primary endpoint was complete resolution of the trigger finger at 6 months. RESULTS: Eighty-four patients totaling 105 treated digits were included. Mean age was 63.3±10.7 years. Prior to treatment, mean VAS pain score was 5.8±2.6mm, and mean QuickDASH score was 44.3±19.1. At 6 months, disappearance of symptoms was achieved in 85 of 91 digits with follow-up (93.4%), and in 85.7% at 12 months. The absolute reduction in VAS pain and QuickDASH scores at 6 months was respectively 4.1±3.1 (P<0.001) and 36.1±20.7 (P<0.001), and 90% of patients reported being satisfied or very satisfied at 6 months. Long duration of symptoms was significantly associated with persistent trigger finger at 6 months after intervention. Complications were rare and minor. Tenosynovitis occurred in 5.7% of cases, for which a corticosteroid injection into the tendon sheath rapidly led to favorable resolution. CONCLUSION: Treatment of trigger finger by release of the A1 pulley under ultrasound guidance using the needle technique is a mildly invasive technique that yields rapid and effective symptom resolution with good tolerance up to 12 months.


Asunto(s)
Procedimientos Ortopédicos , Trastorno del Dedo en Gatillo , Humanos , Persona de Mediana Edad , Anciano , Trastorno del Dedo en Gatillo/diagnóstico por imagen , Trastorno del Dedo en Gatillo/tratamiento farmacológico , Ultrasonografía , Procedimientos Ortopédicos/métodos , Ultrasonografía Intervencional , Dolor
12.
AIDS ; 36(14): 2015-2023, 2022 11 15.
Artículo en Inglés | MEDLINE | ID: mdl-35876641

RESUMEN

OBJECTIVE: To evaluate if community-level HIV PrEP coverage is correlated with individual sexual behaviors. DESIGN: We used demographic, behavioral, and sexual network data from ARTnet, a 2017-2019 study of United States MSM. METHODS: Multivariable regression models with a Bayesian modeling framework were used to estimate associations between area-level PrEP coverage and seven sexual behavior outcomes [number of total, main, and casual male partners (network degree); count of one-time partnerships; consistent condom use in one-time partnerships; and frequency of casual partnership anal sex (total and condomless)], controlling for individual PrEP use. RESULTS: PrEP coverage ranged from 10.3% (Philadelphia) to 38.9% (San Francisco). Total degree was highest in Miami (1.35) and lowest in Denver (0.78), while the count of one-time partners was highest in San Francisco (11.7/year) and lowest in Detroit (1.5/year). Adjusting for individual PrEP use and demographics, community PrEP coverage correlated with total degree [adjusted incidence rate ratio (aIRR) = 1.73; 95% credible interval (CrI), 0.92-3.44], casual degree (aIRR = 2.05; 95% CrI, 0.90-5.07), and count of one-time partnerships (aIRR = 1.90; 95% CrI, 0.46-8.54). Without adjustment for individual PrEP use, these associations strengthened. There were weaker or no associations with consistent condom use in one-time partnerships (aIRR = 1.68; 95% CrI, 0.86-3.35), main degree (aIRR = 1.21; 95% CrI, 0.48-3.20), and frequency of casual partnership condomless anal sex (aIRR = 0.23; 95% CrI, 0.01-3.60). CONCLUSION: Most correlations between community PrEP coverage and sexual behavior were explained by individual PrEP use. However, some residual associations remained after controlling for individual PrEP use, suggesting that PrEP coverage may partially drive community-level differences in sexual behaviors.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Masculino , Humanos , Estados Unidos , Homosexualidad Masculina , Teorema de Bayes , Parejas Sexuales , Infecciones por VIH/tratamiento farmacológico , Conducta Sexual , Fármacos Anti-VIH/uso terapéutico
13.
Public Health Pract (Oxf) ; 2: 100174, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36101612

RESUMEN

Objectives: This study aimed to evaluate the impact of centralizing hospital support functions such as administration, quality monitoring, procurement, and insurance on patient outcomes in a French regional hospital group. Study design: A before-after study was conducted within a medium-sized hospital in a rural region of France including 87,373 hospital stays between 2013 and 2017. Methods: The intervention tested was the centralization of support functions: administration, quality monitoring, procurement, and insurance. The outcomes analyzed were patient mortality, 30 day readmissions and average length of stay. Results: The odds ratio (OR) for patient mortality after centralization was 0.99 (95%CI, 0.92 to 1.06), and 0.94 (95%CI, 0.90 to 0.96) for readmissions. The multiplicative factor for average length of stay was 0.93 (95%CI 0.92-0.94). Conclusions: There was an increase in measured quality of care after the intervention. This study highlights the complexity of assessing the impact of hospital-level centralization on quality-of-care indicators.

14.
Sci Rep ; 11(1): 5900, 2021 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-33723312

RESUMEN

University administrators face decisions about how to safely return and maintain students, staff and faculty on campus throughout the 2020-21 school year. We developed a susceptible-exposed-infectious-recovered (SEIR) deterministic compartmental transmission model of SARS-CoV-2 among university students, staff, and faculty. Our goals were to inform planning at our own university, Emory University, a medium-sized university with around 15,000 students and 15,000 faculty and staff, and to provide a flexible modeling framework to inform the planning efforts at similar academic institutions. Control strategies of isolation and quarantine are initiated by screening (regardless of symptoms) or testing (of symptomatic individuals). We explored a range of screening and testing frequencies and performed a probabilistic sensitivity analysis. We found that among students, monthly and weekly screening can reduce cumulative incidence by 59% and 87%, respectively, while testing with a 2-, 4- and 7-day delay between onset of infectiousness and testing results in an 84%, 74% and 55% reduction in cumulative incidence. Smaller reductions were observed among staff and faculty. Community-introduction of SARS-CoV-2 onto campus may be controlled with testing, isolation, contract tracing and quarantine. Screening would need to be performed at least weekly to have substantial reductions beyond disease surveillance. This model can also inform resource requirements of diagnostic capacity and isolation/quarantine facilities associated with different strategies.


Asunto(s)
COVID-19/epidemiología , Tamizaje Masivo , Modelos Teóricos , Cuarentena , SARS-CoV-2 , Universidades , COVID-19/diagnóstico , COVID-19/transmisión , COVID-19/virología , Trazado de Contacto , Humanos , Incidencia , Prevalencia , Vigilancia en Salud Pública
15.
J Acquir Immune Defic Syndr ; 88(4): 340-347, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34354011

RESUMEN

BACKGROUND: Key components of Ending the HIV Epidemic (EHE) plan include increasing HIV antiretroviral therapy (ART) and HIV pre-exposure prophylaxis (PrEP) coverage. One complication to addressing this service delivery challenge is the wide heterogeneity of HIV burden and health care access across the United States. It is unclear how the effectiveness and efficiency of expanded PrEP will depend on different baseline ART coverage. METHODS: We used a network-based model of HIV transmission for men who have sex with men (MSM) in San Francisco. Model scenarios increased varying levels of PrEP coverage relative under current empirical levels of baseline ART coverage and 2 counterfactual levels. We assessed the effectiveness of PrEP with the cumulative percentage of infections averted (PIA) over the next decade and efficiency with the number of additional person-years needed to treat (NNT) by PrEP required to avert one HIV infection. RESULTS: In our projections, only the highest levels of combined PrEP and ART coverage achieved the EHE goals. Increasing PrEP coverage up to 75% showed that PrEP effectiveness was higher at higher baseline ART coverage. Indeed, the PIA was 61% in the lowest baseline ART coverage population and 75% in the highest. The efficiency declined with increasing ART (NNT range from 41 to 113). CONCLUSIONS: Improving both PrEP and ART coverage would have a synergistic impact on HIV prevention even in a high baseline coverage city such as San Francisco. Efforts should focus on narrowing the implementation gaps to achieve higher levels of PrEP retention and ART sustained viral suppression.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/prevención & control , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Profilaxis Pre-Exposición , Adolescente , Adulto , Anciano , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , San Francisco/epidemiología , Estados Unidos , Adulto Joven
16.
Front Med (Lausanne) ; 8: 708380, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34552944

RESUMEN

Introduction: Systematic reviews are routinely used to synthesize current science and evaluate the evidential strength and quality of resulting recommendations. For specific events, such as rare acute poisonings or preliminary reports of new drugs, we posit that case reports/studies and case series (human subjects research with no control group) may provide important evidence for systematic reviews. Our aim, therefore, is to present a protocol that uses rigorous selection criteria, to distinguish high quality case reports/studies and case series for inclusion in systematic reviews. Methods: This protocol will adapt the existing Navigation Guide methodology for specific inclusion of case studies. The usual procedure for systematic reviews will be followed. Case reports/studies and case series will be specified in the search strategy and included in separate sections. Data from these sources will be extracted and where possible, quantitatively synthesized. Criteria for integrating cases reports/studies and case series into the overall body of evidence are that these studies will need to be well-documented, scientifically rigorous, and follow ethical practices. The instructions and standards for evaluating risk of bias will be based on the Navigation Guide. The risk of bias, quality of evidence and the strength of recommendations will be assessed by two independent review teams that are blinded to each other. Conclusion: This is a protocol specified for systematic reviews that use case reports/studies and case series to evaluate the quality of evidence and strength of recommendations in disciplines like clinical toxicology, where case reports/studies are the norm.

SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA