Comparison of ultrasonography learning between distance teaching and traditional methodology. An educational systematic review

ABSTRACT BACKGROUND: Use of the web for radiological education is an obvious application. Many computer-based teaching materials have been developed over recent years, and e-learning is becoming increasingly popular in medical schools. OBJECTIVE: To assess whether the effectiveness of distance-learning and/or e-learning, m-learning and web-based methods are equivalent to traditional methods. DESIGN AND SETTING: Systematic review of comparative studies of teaching techniques guided by Best Evidence Medical Education. METHODS: A search was carried out in the MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS online databases in April 2020, for original publications in all languages. The following MeSH terms were used: Ultrasonography; Teleradiology; Telemedicine; Education, Medical; Teaching; and Simulation Training; along with the terms e-learning, m-learning and web-based. All eligible studies were assessed using the Kirkpatrick model and Buckley's quality indicators. RESULTS: The search in the databases and a manual search resulted in 4549 articles, of which 16 had sufficient methodological quality for their inclusion. From analysis of these data, it was observed that teaching of ultrasonography using telemedicine methods is similar to the traditional method, except for venous access procedures, for which the studies did not show agreement. CONCLUSION: We found that learning via telemedicine methodologies presents great acceptance among students, besides demonstrating quality similar to the traditional method. Thus, at least at the moment, this has the capacity to serve as an important adjunct in the teaching of ultrasonography. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/CGUPA at the OPENSCIENCE Framework.

Telementored ultrasonography: a narrative review

ABSTRACT BACKGROUND: Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown. OBJECTIVE: To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission. DESIGN AND SETTING: Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated. RESULTS: We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients. CONCLUSIONS: Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.

Indications for accurate and appropriate use of personal protective equipment for healthcare professionals. A systematic review

ABSTRACT BACKGROUND: The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous pressure on hospitals and other healthcare facilities. This, together with blockages in several countries, has hindered the availability and accessibility of the necessary personal protective equipment (PPE). OBJECTIVE: To identify, systematically evaluate and summarize the available scientific evidence on the efficacy, safety, safe use and reuse of PPE for healthcare professionals, for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN AND SETTING: Systematic review of studies analyzing products for disinfecting and enabling reuse of PPE for coronavirus within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science and LILACS databases, for articles published up to November 30, 2020. RESULTS: Ten studies were selected. These analyzed the use of N95, surgical and cotton masks, face shields, flexible enclosures with plastic covers or polycarbonate intubation boxes and plastic curtains; and also PPE disinfection using several substances. CONCLUSION: Combined use of a face shield with a N95 mask proved to be superior to other associations for protecting healthcare workers. Some products are useful for disinfecting PPE, such as 70% ethanol, 0.1% sodium hypochlorite and a mixture of quaternary ammonium and H2O2, and hydrogen peroxide. Ultraviolet light and dry heat at 70 °C can be used to decontaminate N95 masks. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/4V5FD at the OPENSCIENCE Framework.

Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis

BACKGROUND: Computed tomography (CT) accounts for 13% of all radiological examinations in the United States and 40-70% of the radiation that patients receive. Even with the advent of magnetic resonance imaging (MRI), CT continues to be the gold standard for diagnosing bone fractures. There is uncertainty as to whether CT with a low radiation dose has a fracture detection rate similar to that of standard-dose CT. OBJECTIVE: To determine the detection rate of low-dose radiation CT and standard-dose radiation CT for fractures, in patients with suspected fractures. DESIGN AND SETTING: Systematic review of comparative studies on diagnostic accuracy within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: We searched the electronic databases Cochrane Library, MEDLINE, EMBASE and LILACS up to June 29, 2020, for studies evaluating the detection rates of low-dose CT and standard-dose CT for diagnosing bone fractures. The Research Triangle Institute (RTI) item bank tool was used for methodological quality evaluation. RESULTS: The fracture detection rate according to the number of bones evaluated, using CT with low-dose radiation was 20.3%, while with standard-dose radiation it was 19.2%, and the difference between the methods was not significant. The fracture detection rate according to the number of patients, using CT with low-dose radiation was 56.0%, while with standard-dose radiation it was 58.7%, and this difference between the methods was not significant, either. CONCLUSION: CT with low-dose radiation presented detection rates similar to those of CT with standard-dose radiation, regardless of the bones evaluated. REGISTRATION NUMBER: CRD42019148491 at the PROSPERO database.

Methodological Quality Analysis of Systematic Review for the Treatment of Rotator Cuff Disease / Análise da qualidade metodológica de revisões sistemáticas para tratamento de disfunções do manguito rotador

Abstract Objective To evaluate the methodological quality of systematic reviews for the surgical and nonsurgical treatment of individuals with rotator cuff syndrome; to compare, through the Assessing the methodological quality of systematic reviews (AMSTAR) instrument, the quality of studies found in the Cochrane Library, PubMed (Publisher Medline), EMBASE andQinsightdatabases. Methods This is a descriptive and comparative cross-sectional study, in which two independent authors analyzed, through the AMSTAR instrument, the methodological quality of Cochrane and non-Cochrane systematic reviews on the treatment of individuals diagnosed with rotator cuff syndrome. Results A total of 76 systematic reviews were evaluated by the AMSTAR instrument. The overall mean score was 6.1 (±2.1) and the mean per database was 9.1 (±0.9) for the Cochrane reviews and 5.7 (±1.8) for the non-Cochrane reviews. The lowest-scoring item of AMSTAR was 11, related to the display of the conflict of interests of the publication. In a comparative analysis of the final variable score, there was a statistical difference between the Cochrane and non-Cochrane studies. Conclusion According to the present study, systematic reviews using the Cochrane methodology have a better methodological quality compared to non-Cochrane studies on the treatment of rotator cuff dysfunctions.

Resumo Objetivo Avaliar a qualidade metodológica das revisões sistemáticas para tratamento cirúrgico e não cirúrgico de indivíduos com síndrome do manguito rotador; comparar, através do instrumento Assessingthemethodologicalqualityofsystematic reviews(AMSTAR, na sigla em inglês), a qualidade dos estudos encontrados nas bases de dados Cochrane Library, PubMed (Publisher Medline), EMBASE e Qinsight. Métodos Trata-se de um estudo transversal descritivo e comparativo, em que dois autores independentes analisaram, por meio do instrumento AMSTAR, a qualidade metodológica das revisões sistemáticas Cochrane e nãoCochrane sobre tratamento de indivíduos com diagnóstico de síndrome do manguito rotador. Resultados 76 revisões sistemáticas foram avaliadas pelo instrumento AMSTAR. O escore médio geral foi de 6,1(±2,1) e a média por base de dados foi 9,1(±0,9) para as revisões Cochrane e 5,7(±1,8) para as não Cochrane. O item de menor pontuação do AMSTAR foi 11, relacionada à exibição dos conflitos de interesse da publicação. Em uma análise comparativa do escore da variável final, houve uma diferença estatística entre os estudos Cochrane e nãoCochrane. Conclusão De acordo com o presenteestudo, revisões sistemáticas utilizando a metodologia Cochrane têm uma melhor qualidade metodológica em comparação com estudos nãoCochrane sobre o tratamento de disfunções do manguito rotador.

Evidence for the efficacy of Tai Chi for treating rheumatoid arthritis: an overview of systematic reviews

ABSTRACT BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease with higher prevalence among women aged between 30 and 50 years and general prevalence of 1% worldwide. Interventions promoting improvement of quality of life for individuals with RA are required. Tai Chi appears to be a low-cost alternative, with studies showing positive results from this technique. However, regarding aspects of RA such as pain and sensitivity, studies remain inconclusive. OBJECTIVES: To compare the effectiveness of the Tai Chi method for treating patients diagnosed with rheumatoid arthritis, among systematic reviews. DESIGN AND SETTING: Overview of systematic reviews with Cochrane and non-Cochrane methodology. METHODS: Systematic reviews involving quasi-randomized and randomized clinical trials (RCTs) on use of Tai Chi, with no restrictions regarding the date and language of publication, were included. RESULTS: Three systematic reviews were included. The effects of Tai Chi associated with education and stretching exercises versus education and stretching were evaluated in these reviews. They showed that improvements in the variables of mood, depression and functional index were associated with use of Tai Chi. CONCLUSIONS: The findings suggest that clinical improvement was achieved, although not statistically significant with regard to pain and disease pattern, as assessed using the ACR20 measurement. Improvements relating to disability and quality of life were also seen. There was a low level of evidence and therefore caution in data analysis is recommended. The three studies included showed poor reliability for providing an accurate and complete summary of use of Tai Chi among people diagnosed with rheumatoid arthritis. PROSPERO: CRD42019125501.

Trajetória esportiva e habilidades psicológicas de jogadores de futebol da seleção brasileira / Trayectoria deportiva y habilidades psicológicas de jugadores de fútbol de la selección brasileña / Sports trajectory and psychological skills of brazilian national team soccer players

Resumo O objetivo deste estudo foi compreender a construção da trajetória de jogadores de futebol profissional da seleção brasileira. Foram entrevistados seis jogadores de futebol, do gênero masculino, que faziam parte da equipe principal de clubes que disputam a primeira divisão do Campeonato Brasileiro. Critério de inclusão: mínimo de dois anos como jogador profissional e pelo menos uma convocação pela seleção brasileira de futebol. Os atletas foram entrevistados individualmente. A partir da análise das entrevistas, constatou-se que o futebol se apresenta como tema central em suas vidas e que a família tem um papel importante no contexto do esporte. A importância das habilidades psicológicas é confirmada para aqueles que atingiram a elite do futebol profissional e a seleção brasileira. A compreensão da trajetória esportiva de atletas da elite constitui um tema de grande relevância para o avanço da ciência do esporte.

Resumen El objetivo de este estudio es comprender la construcción de la trayectoria de futbolistas profesionales de la selección brasileña. Entrevistamos a seis futbolistas, de género masculino, que formaban parte del equipo principal de clubes que compiten en la primera división del Campeonato Brasileño. Criterios de inclusión: mínimo de dos años como jugador profesional y al menos una convocatoria para la Selección Brasileña de Fútbol. Los atletas fueron entrevistados individualmente. A partir del análisis de las entrevistas, se constató que el fútbol es un tema central en sus vidas y que la familia juega un papel importante en el contexto del deporte. La importancia de las habilidades psicológicas se confirma para aquellos que alcanzaron la élite del fútbol profesional y la selección brasileña. Comprender la trayectoria deportiva de los deportistas de élite es un tema de gran relevancia para el avance de la ciencia del deporte.

Abstract This study looked into the construction of the professional trajectories of players from Brazil's national soccer team. Interviews were conducted with six male players who were part of the first team of clubs that play in the first division of the Brazilian Championship. Inclusion criteria: minimum of two years as a professional player and at least one call-up to the Brazilian national team. Athletes were interviewed individually. According to the analysis of the interviews, soccer is a central theme in their lives, and their families play important roles in the sports context. The importance of psychological skills for those who reach the elite of professional soccer and the Brazilian team is confirmed. Understanding the trajectories of elite athletes in sports is important for the advancement of sports science.

The impact of a low-calorie, low-glycemic diet on systemic lupus erythematosus: a systematic review

Abstract Background: Diet plays a critical role in Systemic Lupus Erythematosus (SLE) patients, impacting on the microbiota composition and, consequently, on the immune response. The objective was to analyze and verify the diet effect on SLE patients. Methods: This is a systematic review performed at the Evidences-based Health Lab, Escola Superior em Ciências da Saúde, Brasília (DF), Brazil. In March, 2021, five databases, and grey literature, through JSTOR, Open Grey, and Google Scholar were searched. Randomized Clinical Trials in which SLE patients with calorie restricted, low glycemic index or other diet involving the joint adequacy of these aspects, compared with placebo or different types of diet, were included. Results: It was identified in the databases 758 articles; 132 were duplicated; 616 references were screened, and 604 were excluded. After reading the title and abstract, 12 articles were included for full-text reading. After the full-text reading, three studies were included for quantitative analysis. The diet improved the quality of life at 6 (MD 16.30; 5.91;26.69) and 12 weeks (MD 14.60; 0.88;28.32). The GRADE was used to evaluate the quality of evidence. Conclusion: There is low evidence that the diet has a positive impact on the quality of life of SLE patients. Trial registration PROSPERO—CRD4202012208.

Environmental cleaning to prevent COVID-19 infection. A rapid systematic review

ABSTRACT BACKGROUND: Faced with a pandemic, all healthcare actions need to reflect best practices, in order to avoid high transmissibility, complications and even hospitalizations. For hospital environments, the products recommended and authorized by regulatory institutions for environmental cleaning and disinfection need to be highly effective. OBJECTIVE: To identify, systematically evaluate and summarize the best available scientific evidence on environmental cleaning to prevent COVID-19 infection. DESIGN AND SETTING: A systematic review of studies analyzing cleaning products that inactivate coronavirus, conducted within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL and LILACS databases, for articles published up to May 27, 2020, relating to studies evaluating cleaning products that inactivate coronavirus in the environment. RESULTS: Seven studies were selected. These analyzed use of 70% alcohol, detergent, detergent containing iodine, household bleach, sodium hypochlorite, hydrogen peroxide, chlorine dioxide, glutaraldehyde, ultraviolet irradiation and plasma air purifier. The effectiveness of treating sewage with sodium hypochlorite and chlorine dioxide was also evaluated. CONCLUSION: Disinfection of environments, especially those in ordinary use, such as bathrooms, needs to be done constantly. Viral inactivation was achieved using chlorine-based disinfectants, alcohol, detergents, glutaraldehyde, iodine-containing detergents, hydrogen peroxide compounds and household bleaches. Alcohol showed efficient immediate activity. In sewage, sodium hypochlorite had better action than chlorine dioxide. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/YC5P4 in the Open Science Framework.

Ultrasound versus electromyography for the detection of fasciculation in amyotrophic lateral sclerosis: systematic review and meta-analysis / Ultrassonografia versus eletroneuromiografia para o diagnóstico da fasciculação na esclerose lateralamiotrófica: revisão sistemática e meta-análise

Abstract The objective of this study was to determine the diagnostic accuracy of ultrasound and electromyography for the detection of fasciculation in patients with amyotrophic lateral sclerosis and to compare detection rates between the two methods. By searching the Cochrane Library, MEDLINE, Excerpta Medica, and Latin-American and Caribbean Health Sciences Literature databases, we identified studies evaluating the diagnostic accuracy and fasciculation detection rates of ultrasound and electromyography. The Quality Assessment of Diagnostic Accuracy Studies, version 2, and RTI item bank tools were used for the evaluation of methodological quality. Ultrasound, for 10 s or 30 s, had a higher detection rate than did electromyography in all muscles evaluated. The overall detection rate (in patients) did not differ significantly between ultrasound for 10 s and ultrasound for 30 s. The accuracy of ultrasound for 10 s was 70% in muscles and 85% in patients. The accuracy of ultrasound for 30 s was 82% in patients. Ultrasound provided detection rates superior to those achieved with electromyography, independent of the examination time and muscles evaluated.

Resumo O objetivo deste estudo foi determinar a acurácia diagnóstica da ultrassonografia e da eletroneuromiografia para o diagnóstico da fasciculação e comparar suas taxas de detecção. Foram realizadas buscas nas bases de dados eletrônicas Cochrane Library, MEDLINE, Embase e Lilacs, para estudos que avaliam a acurácia diagnóstica e as taxas de detecção da ultrassonografia e eletroneuromiografia. As ferramentas Quality Assessment of Diagnostic Accuracy Studies, versão 2, e RTI item bank foram utilizadas para avaliação da qualidade do método. A ultrassonografia, tanto de 10 s quanto de 30 s, apresentou taxa de detecção superior à eletroneuromiografia em todos os músculos avaliados. A avaliação da taxa de detecção por pacientes não apresentou diferença significativa entre a ultrassonografia de 10 s e 30 s. A acurácia da ultrassonografia de 10 s nos músculos foi de 70%, enquanto nos pacientes foi de 85%. Já na ultrassonografia de 30 s, a acurácia nos pacientes foi de 82%. A ultrassonografia apresentou taxas de detecção superiores à eletroneuromiografia, independentemente do tempo de sua avaliação e dos músculos avaliados.

Infecção e óbitos de profissionais da saúde por COVID-19: revisão sistemática / Infección y muerte de profesionales de la salud por COVID-19: revisión sistemática / Infection and death in healthcare workers due to COVID-19: a systematic review

Resumo Objetivo Identificar as evidências quanto à infecção pelo SARS-CoV-2 e óbitos dos profissionais de saúde e fatores de risco relacionados. Métodos Realizou-se uma revisão sistemática buscando-se artigos nas bases de dados Scopus, Portal Regional da BVS, Pubmed e Embase, relacionados à infecção e óbito de profissionais da saúde envolvidos no tratamento de pacientes com a COVID-19. Não houve restrição quanto a data de publicação, idioma ou tipo de estudo. Para a busca foi considerado publicações até 14 de abril de 2020. Resultados Foram incluídos 28 artigos. Os fatores de risco mais citados foram: escassez, uso inadequado ou não uso de equipamentos de proteção individual, sobrecarga de trabalho, contato próximo com pacientes e/ou colegas de trabalho potencialmente contaminados, procedimento com risco de geração de aerossol, diagnóstico tardio e renovação de ar ambiente inadequado. De acordo com cada país, o número de profissionais infectados variou de 1.716 a 17.306. Quanto aos óbitos, existem dados de até 605 profissionais falecidos no mundo inteiro. As evidências encontradas são editoriais, estudos transversais e de coorte. Conclusão As evidências identificadas demonstram um alto número de profissionais infectados e que foram a óbito, sendo a sobrecarga do sistema de saúde um fator significativo.

Resumen Objetivo Identificar evidencias sobre la infección por SARS-CoV-2 y muerte de profesionales de la salud y factores de riesgo relacionados. Métodos Se realizó una revisión sistemática en busca de artículos en las bases de datos Scopus, Portal Regional de la BVS, Pubmed y Embase, relacionados con la infección y muerte de profesionales de la salud involucrados en el tratamiento de pacientes con COVID-19. No hubo restricción respecto a la fecha de publicación, idioma ni tipo de estudio. Para la búsqueda se consideraron publicaciones hasta el 14 de abril de 2020. Resultados Se incluyeron 28 artículos. Los factores de riesgo más mencionados fueron: escasez, uso inadecuado o falta de uso de equipos de protección individual; sobrecarga de trabajo; contacto cercano con pacientes o compañeros de trabajo potencialmente contaminados; procedimientos con riesgo generador de aerosoles; diagnóstico tardío y renovación inadecuada del aire interior. El número de profesionales infectados varió de 1.716 a 17.306, de acuerdo con cada país. Respecto a las muertes, hay datos de 605 profesionales fallecidos en todo el mundo. La evidencia se encontró en editoriales, estudios transversales y de cohorte. Conclusión Las evidencias identificadas demuestran un alto número de profesionales infectados y fallecidos, y la sobrecarga del sistema de salud es un factor significativo.

Abstract Objective To identify evidences regarding infection by SARS-CoV-2 and deaths of healthcare workers and related-risk factors. Methods We conducted a systematic review by searching the following databases SCOPUS, VHL Regional Portal, PubMed and Embase. We included studies on infection and death of healthcare workers who delivery care for COVID-19 patients. There were no restriction on date of publication, idiom, or type of study. The search was conducted until April 14, 2020. Results A total of 28 articles were selected. Most mentioned risk factors were: scarcity, inadequate use or non-usage of personal protective equipment, work overload, close contact with potentially infected patients and/or coworkers, risk for aerosol-generating procedures, late diagnosis and inadequate air renovation. According to each country, the number of infected workers ranged from 1,716 to 17,306. Concerning deaths, there are data of up to 605 healthcare workers who died of COVID-19 all over the world. Evidences found were editorials, cross-sectional, and cohort studies. Conclusion Studies identified showed high number of infection and deaths among healthcare workers. Overload of health system was a significant factor.

Máscaras de tecido na contenção de gotículas respiratórias - revisão sistemática / Mascarillas caseras para contener gotas respiratórias - revisión sistemática / Homemade cloth face masks as a barrier against respiratory droplets - systematic review

Resumo Objetivo Identificar, avaliar sistematicamente e sumarizar as melhores evidências científicas disponíveis sobre a eficácia e a segurança das máscaras de tecido para a comunidade. Métodos Foram consultadas as bases de dados Cochrane, PUBMED, EMBASE, LILACS e a literatura cinzenta por meio do Opengrey . Também foi realizada busca nas referências bibliográficas dos estudos primários e secundários identificados. Não houve restrição de idioma, nem período de tempo. Foram incluídos todos os artigos que tenham como objetivo verificar a eficácia e segurança do uso de máscaras de tecido como proteção contra a transmissão viral, bem como estudos laboratoriais que avaliassem barreiras de contenção de partículas. Foram excluídos os estudos que envolvessem o uso de máscaras por profissionais de saúde. Dois avaliadores independentes selecionaram os estudos e as discrepâncias foram resolvidas por um terceiro avaliador. Resultados Após o processo de seleção, não foram localizados estudos clínicos randomizados envolvendo máscaras de tecidos para a população em geral. Incluímos sete estudos que avaliaram diferentes tecidos no bloqueio de gotículas de nível laboratorial e um estudo de revisão. Conclusão O uso de máscara de tecido possibilita uma barreira às gotículas quando comparada a nenhuma máscara. A máscara é um recurso adicional na prevenção e deve sempre ser associada à etiqueta respiratória, higienização das mãos, distanciamento social e isolamento dos casos.

Resumen Objetivo Identificar, evaluar sistemáticamente y resumir las mejores evidencias científicas disponibles sobre la eficacia y la seguridad de las mascarillas caseras para la comunidad. Métodos Se consultaron las bases de datos Cochrane, PUBMED, EMBASE, LILACS y literatura gris por medio de Opengrey. También se realizó búsqueda en las referencias bibliográficas de los estudios primarios y secundarios identificados. No hubo restricción de idioma ni período de tiempo. Se incluyeron todos los artículos que tuvieran como objetivo verificar la eficacia y seguridad del uso de mascarillas caseras como protección contra la transmisión viral, así como estudios de laboratorio que evaluaran barreras de contención de partículas. Se excluyeron los estudios que abarcaran el uso de mascarillas por profesionales de la salud. Dos evaluadores independientes seleccionaron los estudios y las discrepancias fueron resueltas por un tercer evaluador. Resultados Luego del proceso de selección, no se localizaron estudios clínicos aleatorizados que incluyeran mascarillas caseras para la población en general. Incluimos siete estudios que evaluaron diferentes telas para el bloqueo de gotas de nivel de laboratorio y un estudio de revisión. Conclusión El uso de mascarillas caseras permite una barrera para las gotas al compararlo con ninguna mascarilla. La mascarilla es un recurso adicional en la prevención y siempre debe estar asociada a la etiqueta respiratoria, higienización de manos, distanciamiento social y aislamiento de casos.

Abstract Objective To identify, systematically review, and summarize the best scientific evidence available on the efficacy and safety of homemade cloth face masks for the community. Methods The search was conducted using the Cochrane, PUBMED, EMBASE, and LILACS databases, as well as grey literature, using Opengrey . A search was also conducted using references from primary and secondary studies that were found. No language or time period restrictions were applied. All papers that objective was to check efficacy and safety of the use of cloth face masks as protection against viral transmission were included, as well as laboratory studies assessing barriers against particles. We excluded studies approaching the use of face masks by healthcare providers. Two independent reviewers selected the studies, and discrepancies were decided by a third reviewer. Results No randomized clinical trials involving cloth face masks for the general population were found. Seven studies assessing different types of cloth to prevent the penetration of droplets at a laboratory level and a review study were included. Conclusion Using cloth face masks provides a barrier against droplets when compared with not using any face masks. The face mask is an additional preventive mesuare and must be used along with respiratory etiquette, hand hygiene, social distancing, and isolation of cases.

Sensory-motor training versus resistance training among patients with knee osteoarthritis: randomized single-blind controlled trial

ABSTRACT BACKGROUND: Osteoarthritis of the knee is defined as a progressive disease of the synovial joints and is characterized by failure of joint damage repair. The objective here was to compare the effectiveness of sensory-motor training versus resistance training among patients with knee osteoarthritis. DESIGN AND SETTING: Randomized, single-blinded controlled trial conducted at the outpatient service of the University of Santo Amaro. METHODS: A total of 64 patients were randomly assigned to sensory-motor training or resistance training. The evaluations were performed at baseline and 16 weeks after the intervention and included pain evaluation on a visual analogue scale, isometric quadriceps femoris force measurement using a dynamometer, Timed Up and Go test, Tinetti balance scale, Western Ontario and McMaster Universities osteoarthritis index, and the SF-36 quality-of-life questionnaire. Data analysis was performed using analysis of variance with repeated measurements and Cohen's effect size. RESULTS: Sensory-motor training may be a plausible alternative and showed a small effect on pain and a medium effect on maximal voluntary isometric contraction. Resistance training showed a small effect on balance and a medium effect on mobility. CONCLUSION: Resistance training and sensory motor training for the lower limbs among patients with knee osteoarthritis seemed to present similar effects on pain and function. However, because there was a considerable risk of type 2 error, further randomized clinical trials are still needed to provide a sound conclusion.

Oscillation of plantar pressure center in athletes and non-athletes with and without ankle sprains / Oscilação do centro de pressão plantar de atletas e não atletas com e sem entorse de tornozelo

ABSTRACT OBJECTIVE: To assess whether there is any difference in the oscillation of the plantar pressure center in single-leg stance between athletes and non-athletes with and without ankle sprains. METHODS: 54 volunteers performed four static assessments and one dynamic assessment while standing on one foot on a baropodometer, barefoot, for 10 s in each test. The variables of area (cm2), distance (cm), anteroposterior oscillation (cm), mediolateral oscillation (cm) and mean velocity (cm/s) were analyzed. The items "other symptoms" and "sports and recreation" of the subjective Foot and Ankle Outcome Score (FAOS) questionnaire were applied. For the statistical analysis, repeated-measurement ANOVA (ANOVA-MR), multivariate ANOVA (MANOVA), Tukey's post hoc test and partial eta squared were used. RESULTS: ANOVA-MR revealed differences regarding distance, with major effects for eyes (p < 0.001), knees (p < 0.001), group (p < 0.05) and the interaction between eyes and knees (p < 0.05); and regarding mean velocity with major effects for eyes (p < 0.001), knees (p < 0.001) (p < 0.05), group (p < 0.05) and the interaction between eyes and knees (p < 0.05). MANOVA revealed main group effects for distance (p < 0.05), anteroposterior oscillation (p < 0.05) and mean velocity (p < 0.05). In the FAOS questionnaire, there were no differences: "other symptoms", p > 0.05; and "sport and recreation", p > 0.05. CONCLUSION: Athletes present higher mean velocity of oscillation of plantar pressure center and generally do not have differences in oscillation amplitude in the sagittal and coronal planes, in comparison with non-athletes.

RESUMO OBJETIVO: Avaliar se há diferença quanto à oscilação do centro de pressão plantar em apoio unipodal entre atletas e não atletas com e sem entorse de tornozelo. MÉTODO: Fizeram quatro avaliações estáticas e uma dinâmica em apoio unipodal descalço sobre o baropodômetro 54 voluntarios, com duração de 10 segundos cada teste. Foram analisadas as variáveis área (cm2), distância (cm), oscilação anteroposterior (cm), oscilação mediolateral (cm) e velocidade média (cm/s). Foram aplicados os itens "Outros sintomas" e "Esporte e recreação" do questionário subjetivo Foot and Ankle Outcome Score (FAOS). Para a análise estatística foram usadas a ANOVA de médias repetidas (ANOVA-MR), a ANOVA multivariada (MANOVA), o post hoc de Tukey e o partial eta square. RESULTADOS: A ANOVA-MR revelou diferenças para distância, com efeitos principais para olhos (p < 0,001), joelho (p < 0,001), grupo (p < 0,05) e interação olhos e joelho (p < 0,05) e para a velocidade média com efeitos principais para olhos (p < 0,001), joelho (p < 0,001), grupo (p < 0,05) e interação olhos e joelho (p < 0,05). A MANOVA revelou efeitos principais de grupo para distância (p < 0,05), oscilação anteroposterior (p < 0,05) e velocidade média (p < 0,05). No questionário FAOS não houve diferenças ("Outros sintomas" [p > 0,05], "Esporte e eecreação" [p > 0,05]). CONCLUSÃO: Atletas apresentam maior velocidade média de oscilação do centro de pressão plantar e não apresentam, de modo geral, diferenças quanto à amplitude de oscilação nos planos sagital e coronal quando comparados com não atletas.

Spine school for patients with low back pain: interdisciplinary approach / Escola de coluna para pacientes com lombalgia: abordagem interdisciplinar / Escuela de columna para pacientes com dolor lumbar: enfoque interdisciplinario

To analyze and evaluate an interdisciplinary educational treatment - Spine School.

Analisar e avaliar um tratamento educativo interdisciplinar - Escola da Coluna.

Analizar y evaluar un tratamiento educativo interdisciplinario - Escuela de la Columna.

Avaliação da simetria e descarga de peso entre os membros inferiores de atletas de futebol da categoria de base / Evaluation of symmetry and weight-bearing in lower limbs of youth soccer players / Evaluación de la simetría y de la descarga de peso en los miembros inferiores de atletas de fútbol de la categoría de base

INTRODUÇÃO: A avaliação instrumentada dos saltos verticais informa sobre as capacidades funcionais e variáveis neuromusculares, auxiliando no atendimento dos atletas. Essencial dar atenção maior para as categorias de base, pois contém fases importantes do desenvolvimento dos atletas que serão o futuro do esporte. Objetivo: Avaliar as características funcionais e neuromusculares de atletas de futebol da categoria de base, no desempenho em saltos verticais. METODOLOGIA: Foram avaliados atletas de futebol com idade entre 15 e 17 anos. Foram realizados em duas plataformas de força os seguintes saltos verticais: salto em agachamento, salto em contramovimento, salto pliométrico de 40 cm de altura. Para análise das variáveis das forças concêntrica, excêntrica, impacto e altura dos saltos utilizou-se a prova estatística de Shapiro-Wilk, descrição das variáveis em média e desvio padrão, considerando quando p < 0,05. RESULTADOS: Dos 30 atletas avaliados, obtivemos: três goleiros (10%), cinco zagueiros (16,7%), um lateral (3,3%), três volantes (10%), 12 meio-campistas (40%) e seis atacantes (20%). A categoria sub-17 apresentou maiores resultados comparada a categoria sub-15. Maior altura de salto do contramovimento em relação ao salto em agachamento (p < 0,05) e ao pliométrico (p > 0,05). Sem diferença na força concêntrica entre as categorias e os tipos de saltos. Maior força de impacto no contramovimento. Maior força em membro inferior direito em todos os saltos e variáveis de força. CONCLUSÕES: Encontramos assimetria entre os membros inferiores, podendo correlacionar com um déficit de potência muscular, má desaceleração do movimento e erros biomecânicos. Fatores predisponentes a lesões musculoesqueléticas, os quais podem ser prevenidos. A avaliação instrumentada da força através desses testes pode subsidiar os profissionais do clube como uma ferramenta de trabalho, capaz de aprimorar o treinamento, preparação e reabilitação. Entretanto, são necessárias mais pesquisas, de forma que momentos distintos da idade e da temporada do atleta sejam avaliados.

INTRODUCTION: The instrumented jump tests evaluation inform us about the functional capabilities and neuromuscular variables assisting in the care of athletes. It is essential to give a greater attention to the basic categories because it contains important stages of development of the athletes who are the future of the sport. Objective: To evaluate the functional and neuromuscular youth soccer athletes' category based on performance in jump tests. METHODS: Soccer players aged between 15 and 17 years were evaluated. The following jump tests were performed on two force platforms: squat Jump; countermovement test; drop jump of 40 cm. To analyze the variables concentric and eccentric forces, impact and height of jumps, the Shapiro-Wilk test, mean and standard deviation of variables with p < 0.05 were used. RESULTS: Of the 30 athletes evaluated, we found: three goalkeepers (10%), five quarterbacks (16.7%), one winger (3.3%), three defensive midfielders (10%), 12 midfielders (40%) and six strikers (20%). The under 17 category had higher results compared to the under 15;it was achieved maximum height of the countermovement jump over the squat jump (p < 0.05) and drop jump (p > 0.05); no difference was found in concentric force between the categories and types of jumps; greater impact force was obtained on countermovement jump and an increased strength in the right lower limb was found in all jump tests and variables. CONCLUSIONS: We found an asymmetry between the lower limbs, which may correlate with a muscle power deficit, poor eccentric movement and biomechanical errors. These predisposing factors for musculoskeletal injuries can be prevented. The instrumented evaluation of muscle force through these tests can assist club professionals as a working tool, able to enhance training programs, preparation and rehabilitation. However, more research is needed in order to evaluate different moments of the athlete's age and season.

INTRODUCCIÓN: La evaluación por instrumentos de los saltos verticales suministra informaciones sobre las capacidades funcionales y las variables neuromusculares, ayudando para los cuidados de los atletas. Es esencial dar más atención a las categorías de base, pues contienen fases importantes del desarrollo de los atletas, quienes serán el futuro del deporte. OBJETIVO: Evaluar las características funcionales y neuromusculares de atletas de fútbol de la categoría de base, en el desempeño cuanto a saltos verticales. METODOLOGÍA: Se evaluaron atletas de fútbol de edades entre 15 y 17 años. Se realizaron, en dos plataformas de fuerza, los siguientes saltos verticales: salto en agachamento, salto en contramovimiento, salto pliométrico de 40 cm de altura. Para el análisis de las variables referentes a las fuerzas concéntrica, excéntrica, impacto y altura de los saltos, se utilizó la prueba estadística de Shapiro-Wilk, descripción de las variables en promedio y desvío estándar, considerando cuando p < 0,05. RESULTADOS: De los 30 atletas evaluados, identificamos: tres arqueros (10%), cinco zagueros (16,7%), un lateral (3,3%), tres volantes (10%), 12 mediocampistas (40%) y seis delanteros (20%). La categoría sub-17 presentó resultados mejores en comparación con la categoría sub-15; más altura de salto del contramovimiento en relación con el salto en agachamento (p < 0,05) y al pliométrico (p > 0,05); sin diferencia en la fuerza concéntrica entre las categorías y los tipos de saltos. Más fuerza de impacto en el contramovimiento; más fuerza en el miembro inferior derecho en todos los saltos y variables de fuerza. CONCLUSIONES: Encontramos asimetría entre los miembros inferiores, pudiéndose correlacionar con un déficit de potencia muscular, mala desaceleración del movimiento y errores biomecánicos. Se hallaron factores que predisponen a lesiones musculoesqueléticas, los cuales pueden ser prevenidos. La evaluación, por instrumentos, de la fuerza, mediante estas pruebas, puede ayudar a los profesionales del club como una herramienta de trabajo que puede perfeccionar el entrenamiento, la preparación y la rehabilitación. No obstante, se necesitan más investigaciones, de modo que sean evaluados momentos diferentes de la edad y la temporada del respectivo atleta.

Efeitos do exercício na redução do risco de quedas em mulheres idosas com osteoporose / Effects of exercise in reducing the risk of falls in elderly women with osteoporosis

OBJETIVO: Avaliar o efeito de um programa de treinamento de força muscular progressiva e sensório-motor, no equilíbrio e na redução do risco de quedas em mulheres com osteoporose. MÉTODO: Foram selecionadas 82 mulheres sedentárias com idade entre 60 e 75 anos com osteoporose, randomizadas em dois grupos: grupo intervenção, composto por 41 pacientes submetidas a 18 semanas de treinamento de força muscular progressiva do quadríceps (a 50%, 60%, 70% até 80% de 1-RM - uma repetição máxima), e de propriocepção, associado ao tratamento clínico medicamentoso para osteoporose; e grupo controle, também composto por 41 pacientes que receberam apenas o tratamento clínico medicamentoso. O equilíbrio e o risco de quedas foram avaliados por meio da Escala de Equilíbrio de Berg (BBS) e do cálculo do Índice de Quedas (IQ). O número de quedas foi avaliado seis meses antes do início da pesquisa e nos seis meses seguintes. RESULTADOS: 69 pacientes concluíram a pesquisa. O programa promoveu melhora no equilíbrio funcional (p<0,001) demonstrado pela BBS, redução do risco de quedas calculado pelo escore geral do IQ (p<0,004) e ainda uma redução do número total de quedas, que no grupo experimental foram significativamente menores que no grupo controle (p<0,001). CONCLUSÃO: A associação do treinamento de força progressiva para quadríceps e propriocepção é eficaz na prevenção de quedas e redução de seus fatores de risco, e o modelo para previsão quantitativa do risco de quedas pode ser útil na identificação do risco de quedas em pessoas idosas. Registro ensaio clínico: 082213- ANZCTR.

OBJECTIVE: This study aims to evaluate the effect of progressive muscular strength and proprioception training program on the balance and decrease in the risk of falls in women with osteoporosis. METHOD: 82 sedentary women aged 60-75 years with osteoporosis were selected and randomized in two groups: the intervention group comprised 41 patients submitted to an 18-week progressive muscular strength and proprioception training of quadriceps associated to drug therapy for osteoporosis; and control group, formed by 41 patients submitted to drug therapy only. The balance and fall risk were evaluated using the Balance Berg Scale (BBS) and calculating the Fall Index (FI). The number of fall was assessed six months before the research and the following six months. RESULTS: 69 patients completed the research. The program improved the functional balance (p<0.001) shown by BBS, decreased the risk of falls evidenced by the general score of FI (p<0.004) and also a decrease in the total number of falls. The experimental group showed significant lower number of falls when compared to the control group (p<0.001). CONCLUSION: The association of progressive strength of quadriceps and proprioceptive training is effective to prevent falls and reduce risk factors. The quantitative model to predict risk of falls might be useful to identify the risk of falls in the elderly. Trial registration: 082213-ANZCTR.

Intervenção fisioterapêutica pré-operatória para pacientes submetidos à ressecção pulmonar por câncer: revisão sistemática / Preoperative physiotherapeutic intervention for patients undergo resection for lung cancer: systematic review

INTRODUÇÃO: A Fisioterapia tem sido defendida como um componente importante na prevenção e no tratamento de complicações pulmonares pós-operatórias, sendo utilizada nas fases pré e pós-operatória de ressecções pulmonares. A efetividade e a segurança da fisioterapia pré-operatória em pacientes que serão submetidos a cirurgias de ressecção pulmonar por câncer precisam ser avaliadas. MATERIAIS E MÉTODOS: Revisão sistemática de ensaios clínicos randomizados com metodologia Cochrane. A busca eletrônica foi realizada nas bases de dados Cochrane Central Register of Controlled Trials (CENTRAL); PEDro; MEDLINE; EMBASE; CINAHL; e LILACS. Realizamos também uma busca por estudos em andamento e/ou não publicados, através da Current Controlled Trials Database. Além disso, realizamos uma busca adicional na lista de referências de todos os estudos incluídos e contato com os autores, quando necessário. RESULTADOS: Vinte e oito estudos foram considerados potencialmente relevantes; destes, 26 foram excluídos. Dois ensaios clínicos randomizados preencheram os critérios de inclusão desta revisão. Um estudo comparou a ventilação mecânica não invasiva (BILEVEL) associada ao tratamento padrão versus tratamento padrão sendo atribuído de forma única; e o outro estudo comparou o treinamento muscular inspiratório e a espirometria de incentivo a nenhum tratamento. Um único desfecho foi comum entre os estudos, mas não foi possível realizar uma metanálise devida à insuficiência de informações. CONCLUSÕES: Não há evidência suficiente na literatura para se afirmar que a intervenção fisioterapêutica pré-operatória seja efetiva e segura para pacientes que serão submetidos à ressecção pulmonar por câncer.

INTRODUCTION: The physiotherapy has been advocated as an important component in the treatment and prevention of postoperative pulmonary complications, being used in both pre and postoperative periods of lung resection surgery. The objective of this study was to assess the efficacy and safety of preoperative physiotherapy for patients who will undergo resection surgery for lung cancer. MATERIALS AND METHODS: Systematic review of randomized clinical trials carried out in accordance with the Cochrane metodology. The electronic search was performed in Cochrane Library, PEDro, MEDLINE, EMBASE, CINAHL, LILACS. We also searched for both non-published and on-going studies in the Current Controlled Trials database. In addition, a manual search in the references of all relevant studies was performed, and the authors were contacted for additional non-published data. RESULTS: Twenty-eight papers were considered potentially relevant; among them, 26 were excluded. Two randomized controlled trials met the inclusion criteria. One study compared non invasive ventilation (BILEVEL) associated to standard treatment with standard treatment alone; and other study compared inspiratory muscle training and incentive spirometry with no training. There was just one common outcome between the studies, but was not possible to perform the meta-analysis due to missing data. CONCLUSION: There is no sufficient evidence to state that the preoperative physiotherapeutic intervention has efficacy and safety for patients who will undergo resection surgery for lung cancer.

Is neuromuscular electrical stimulation effective for improving pain, function and activities of daily living of knee osteoarthritis patients? A randomized clinical trial / A estimulação elétrica neuromuscular é efetiva na melhora da dor, função e atividades de vida diária de pacientes com osteoartrite do joelho? Ensaio clínico randomizado

CONTEXT AND OBJECTIVE Neuromuscular electrical stimulation (NMES) has been used in rehabilitation protocols for patients suffering from muscle weakness resulting from knee osteoarthritis. The purpose of the present study was to assess the effectiveness of an eight-week treatment program of NMES combined with exercises, for improving pain and function among patients with knee osteoarthritis. DESIGN AND SETTING Randomized clinical trial at Interlagos Specialty Ambulatory Clinic, Sao Paulo, Brazil. METHODS One hundred were randomized into two groups: NMES group and control group. The following evaluation measurements were used: numerical pain scale from 0 to 10, timed up and go (TUG) test, Lequesne index and activities of daily living (ADL) scale. RESULTS Eighty-two patients completed the study. From intention-to-treat (ITT) analysis comparing the groups, the NMES group showed a statistically significant improvement in relation to the control group, regarding pain intensity (difference between means: 1.67 [0.31 to 3.02]; P = 0.01), Lequesne index (difference between means: 1.98 [0.15 to 3.79]; P = 0.03) and ADL scale (difference between means: -11.23 [-19.88 to -2.57]; P = 0.01). CONCLUSION NMES, within a rehabilitation protocol for patients with knee osteoarthritis, is effective for improving pain, function and activities of daily living, in comparison with a group that received an orientation program. CLINICAL TRIAL REGISTRATION ACTRN012607000357459. .

CONTEXTO E OBJETIVO A estimulação elétrica neuromuscular (EENM) tem sido incluída em protocolos de reabilitação de pacientes com fraqueza muscular decorrente da osteoartrite do joelho. O objetivo do presente estudo foi determinar a efetividade de um tratamento de oito semanas de EENM combinado com exercícios na melhora da dor e função em pacientes com osteoartrite do joelho. TIPO DE ESTUDO E LOCAL Ensaio clínico randomizado realizado no Ambulatório de Especialidades de Interlagos, São Paulo, Brasil. MÉTODOS Cem pacientes foram randomizados em dois grupos: Grupo EENM (GEENM) e grupo controle (GC). As medidas de avaliação utilizadas foram: escala numérica de dor (END) 0 a 10, teste timed up and go (TUG), índice de Lequesne e escala de atividades de vida diária (EAVD). RESULTADOS Oitenta e dois pacientes completaram a pesquisa. Por meio da análise por intenção de tratar, na comparação entre grupos, o GEENM apresentou melhora estatisticamente significante em comparação ao GC na redução da dor (diferença entre as médias: 1,67 [0,31; 3,02], P = 0,01), no índice de Lequesne (diferença entre as médias: 1,98 [0,15; 3,79] e na EAVD (diferença entre as médias: -11,23 [-19,88; -2,57], P = 0,01). CONCLUSÃO A EENM, quando inserida em um protocolo de reabilitação para pacientes com osteoartrite do joelho, é efetiva na redução da dor, melhora da função e das atividades de vida diária quando comparada a um grupo submetido a programa de orientação. REGISTRO DE ENSAIO CLÍNICO ACTRN012607000357459. .