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1.
Open Heart ; 7(2)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33168640

RESUMEN

The COVID-19, due to SARS-CoV-2, has uncovered many real-world issues when it comes to healthcare management and has led to a widespread mortality. Observations thus far from the reports of COVID-19 have indicated that certain risk groups for example, those with pre-existing cardiovascular (CV) disease, hypertension, diabetes, chronic kidney disease and tobacco use are prone to disease development and specifically development of severe disease and possible fatality. It is increasingly evident that many CV conditions occur frequently. These include myopericarditis, acute coronary syndromes, thrombosis, arrhythmias, hypertension and heart failure. Many professional organisations and societies related to cardiology have produced guidelines or recommendations on most of the above-mentioned aspects. Given these rapid developments, the aims of this review manuscript were to summarise and integrate recent publications with newly developed guidelines and with the first-hand experience of frontline physicians and to yield a pragmatic insight and approach to CV complications of COVID-19. We emphasise on a strategic tier-based approach for initial assessment and management of COVID-19, and then delve into focused areas within CV domains, and additionally highlighting the role of point-of-care ultrasound especially lung ultrasound, echocardiography and electrocardiography, in the management of these patients. We hope this paper will serve as a useful tool in the CV management of COVID-19 for clinicians practicing in both developing and developed countries.


Asunto(s)
Enfermedades Cardiovasculares/terapia , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Medicina Basada en la Evidencia , Humanos , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Pronóstico , Medición de Riesgo , Factores de Riesgo
2.
J Thromb Haemost ; 18(11): 3099-3105, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33174388

RESUMEN

BACKGROUND: Observational studies indicate that children hospitalized with COVID-19-related illness, like adults, are at increased risk for venous thromboembolism (VTE). A multicenter phase 2 clinical trial of anticoagulant thromboprophylaxis in children hospitalized with COVID-19-related illness has recently been initiated in the United States. To date, there remains a paucity of high-quality evidence to inform clinical practice world-wide. Therefore, the objective of this scientific statement is to provide consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses, and to identify priorities for future research. METHODS: We surveyed 20 pediatric hematologists and pediatric critical care physicians from several continents who were identified by Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee leadership as having experience and expertise in the use of anticoagulant thromboprophylaxis and/or the management of COVID-19-related illness in children. A comprehensive review of the literature on COVID-19 in children was also performed. RESULTS: Response rate was 90%. Based on consensus of expert opinions, we suggest the administration of low-dose low molecular weight heparin subcutaneously twice-daily as anticoagulant thromboprophylaxis (in the absence of contraindications, and in combination with mechanical thromboprophylaxis with sequential compression devices, where feasible) in children hospitalized for COVID-19-related illness (including the multisystem inflammatory syndrome in children [MIS-C]) who have markedly elevated D-dimer levels or superimposed clinical risk factors for hospitalassociated VTE. For children who are clinically unstable or have severe renal impairment, we suggest the use of unfractionated heparin by continuous intravenous infusion as anticoagulant thromboprophylaxis. In addition, continued efforts to characterize VTE risk and risk factors in children with COVID-19, as well as to evaluate the safety and efficacy of anticoagulant thromboprophylaxis strategies in children hospitalized with COVID-19-related illness (including MIS-C) via cooperative multicenter trials, were identified among several key priorities for future research. CONCLUSION: These consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses and priorities for future research will be updated as high-quality evidence emerges.


Asunto(s)
Anticoagulantes/administración & dosificación , Infecciones por Coronavirus/tratamiento farmacológico , Medicina Basada en la Evidencia/normas , Hospitalización , Neumonía Viral/tratamiento farmacológico , Investigación/normas , Tromboembolia Venosa/prevención & control , Adolescente , Factores de Edad , Anticoagulantes/efectos adversos , Niño , Preescolar , Toma de Decisiones Clínicas , Consenso , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Encuestas de Atención de la Salud , Humanos , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Tromboembolia Venosa/sangre , Tromboembolia Venosa/etiología , Adulto Joven
3.
Eur Respir Rev ; 29(158)2020 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-33153991

RESUMEN

The 2019 coronavirus disease (COVID-19) pandemic is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Clinical outcomes, including mortality, are worse in males, older individuals and patients with comorbidities. COPD patients are included in shielding strategies due to their susceptibility to virus-induced exacerbations, compromised pulmonary function and high prevalence of associated comorbidities. Using evidence from basic science and cohort studies, this review addresses key questions concerning COVID-19 and COPD. First, are there mechanisms by which COPD patients are more susceptible to SARS-CoV-2 infection? Secondly, do inhaled corticosteroids offer protection against COVID-19? And, thirdly, what is the evidence regarding clinical outcomes from COVID-19 in COPD patients? This up-to-date review tackles some of the key issues which have significant impact on the long-term outlook for COPD patients in the context of COVID-19.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Progresión de la Enfermedad , Susceptibilidad a Enfermedades , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Adulto , Factores de Edad , Anciano , Comorbilidad , Infecciones por Coronavirus/terapia , Medicina Basada en la Evidencia , Humanos , Incidencia , Persona de Mediana Edad , Pandemias/estadística & datos numéricos , Neumonía Viral/terapia , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Pruebas de Función Respiratoria , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/epidemiología , Índice de Severidad de la Enfermedad , Factores Sexuales
7.
Syst Rev ; 9(1): 256, 2020 11 04.
Artículo en Inglés | MEDLINE | ID: mdl-33148320

RESUMEN

BACKGROUND: The COVID-19 pandemic has created a sense of urgency in the research community in their bid to contribute to the evidence required for healthcare policy decisions. With such urgency, researchers experience methodological challenges to maintain the rigour and transparency of their work. With this in mind, we offer reflections on our recent experience of undertaking a rapid Cochrane qualitative evidence synthesis (QES). METHODS: This process paper, using a reflexive approach, describes a rapid QES prepared during, and in response to, the COVID-19 pandemic. FINDINGS: This paper reports the methodological decisions we made and the process we undertook. We place our decisions in the context of guidance offered in relation to rapid reviews and previously conducted QESs. We highlight some of the challenges we encountered in finding the balance between the time needed for thoughtfulness and comprehensiveness whilst providing a rapid response to an urgent request for evidence. CONCLUSION: The need for more guidance on rapid QES remains, but such guidance needs to be based on actual worked examples and case studies. This paper and the reflections offered may provide a useful framework for others to use and further develop.


Asunto(s)
Infecciones por Coronavirus , Toma de Decisiones , Medicina Basada en la Evidencia , Pandemias , Neumonía Viral , Edición , Proyectos de Investigación , Literatura de Revisión como Asunto , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Exactitud de los Datos , Humanos , Neumonía Viral/epidemiología , Neumonía Viral/virología , Investigación Cualitativa
8.
Rev Med Suisse ; 16(713): 2092-2098, 2020 Nov 04.
Artículo en Francés | MEDLINE | ID: mdl-33146957

RESUMEN

Consistent with the principles of evidence-based medicine, communicating clinical risks to patients and their families is an essential part of informed consent and decision-making. Communication of clinical risks can take place during and after consultations, orally or in writing, based on the latest available scientific data, when available. Numerous studies show that there are different degrees of innumeracy in the general population, meaning more or less significant difficulties mastering numbers in everyday situations. It is therefore imperative to communicate risks in a way that is adapted to the patients' variable numeracy and health literacy levels. This article presents a synthesis of international research on risk communication, as well as recommendations for clinical practice.


Asunto(s)
Comunicación , Alfabetización en Salud , Toma de Decisiones , Medicina Basada en la Evidencia , Humanos , Consentimiento Informado , Riesgo
9.
Artículo en Inglés | PAHO-IRIS | ID: phr-52970

RESUMEN

[ABSTRACT]. Objectives. To identify scientific evidence on the use and results of information and communication technologies for the improvement of neonatal health in general or specific health problems or interventions, and to describe the type of intervention and its results. Methods. A systematic review of the available evidence was performed. The search was carried out in peerreviewed journals between January 1, 2008 and April 30, 2018, in English and Spanish. The searched key terms were (health informatics OR telemedicine OR mHealth) AND (newborn OR newborn care OR neonatal care). Results. From a total of 305 articles initially identified, 10 articles fulfilled the inclusion criteria. The main domains of eHealth identified as applied to neonatal health were telemedicine (3 studies), eLearning (1 study) and mHealth (7 studies). Target population were health care providers or parents. The studies aimed at diagnosis, provision of health care and training, promoting adherence to interventions in parents or improving quality of care. Conclusions. The use of eHealth in general and specifically focused on neonatal health shows important possibilities for development and expansion, given the advances and present needs, and should be considered a key tool for the reduction of inequalities.


[RESUMEN]. Objetivos. Identificar la evidencia científica sobre el uso y los resultados de las tecnologías de la información y la comunicación para mejorar la salud neonatal en general o problemas de salud o intervenciones específicos, y describir el tipo de intervención y sus resultados. Métodos. Se realizó una revisión sistemática de la evidencia disponible. La búsqueda se llevó a cabo en revistas revisadas por pares entre el 1 de enero de 2008 y el 30 de abril de 2018, en español e inglés. Los términos clave de la búsqueda fueron (health informatics OR telemedicine OR mHealth) AND (newborn OR newborn care OR neonatal care). Resultados. De un total de 305 artículos identificados inicialmente, 10 artículos cumplieron los criterios de inclusión. Los principales dominios de la eSalud aplicados a la salud neonatal fueron la telemedicina (3 estudios), el aprendizaje electrónico (1 estudio) y la salud móvil (7 estudios). La población destinataria consistió en los proveedores de atención de la salud o los padres. Los estudios tenían por objeto el diagnóstico, la prestación de atención sanitaria y la capacitación, la promoción del cumplimiento de las intervenciones en los padres o la mejora de la calidad de la atención. Conclusiones. El uso de la eSalud en general, y específicamente en la salud neonatal, muestra importantes posibilidades de desarrollo y expansión, dados los avances y las necesidades actuales, y debería considerarse un instrumento clave para la reducción de las desigualdades.


Asunto(s)
Tecnología de la Información , Salud del Lactante , Medicina Basada en la Evidencia , Atención Perinatal , Estrategias de eSalud , Telemedicina , Tecnología de la Información , Salud del Lactante , Medicina Basada en la Evidencia , Atención Perinatal , Estrategias de eSalud , Telemedicina , Infecciones por Coronavirus , Coronavirus , Pandemias , Pandemias
10.
Rev. bioét. derecho ; (50): 255-270, nov. 2020.
Artículo en Español | IBECS | ID: ibc-191357

RESUMEN

Este artículo evalúa el papel de los científicos en el análisis y la gestión de los asuntos mundiales, en particular durante las crisis sanitarias como la actual pandemia de COVID-19. Las autoridades y la población requieren su asesoramiento basado en el conocimiento adquirido a través del proceso científico para comprender los problemas locales y globales, y facilitar la búsqueda de soluciones. La intervención de los expertos debe estar inscrita en principios éticos y deontológicos del conocimiento científico, y tener en cuenta una serie de aspectos sociales y económicos, para proporcionar respuestas que favorezcan el avance del conocimiento, el bienestar social y la mejora de la salud de las poblaciones


This article evaluates the role of scientists in the analysis and management of global affairs, in particular during health crises such as the current COVID-19 pandemic. Their advice based in the knowledge acquired through the scientific process is required by the authorities and the population to understand local and global issues and to facilitate the search for solutions. Experts' intervention must be inscribed on ethical and deontological principles of scientific knowledge, and take into account a series of social and economic aspects, to provide answers in favor of the advancement of knowledge, social well-being and the improvement of the health of populations


Aquest article avalua el paper dels científics en l'anàlisi I la gestió dels assumptes mundials, en particular durant les crisis sanitàries com l'actual pandèmia de COVID-19. Les autoritats I la població requereixen el seu assessorament basat en el coneixement adquirit a través del procés científic per comprendre els problemes locals I globals, I facilitar la recerca de solucions. La intervenció dels experts ha d'estar inscrita en principis ètics I deontològics del coneixement científic, I tenir en compte un seguit d'aspectes socials I econòmics per proporcionar respostes que afavoreixin l'avanç del coneixement, el benestar social I la millora de la salut de les poblacions


Asunto(s)
Humanos , Diplomacia en la Salud , Pandemias , Cooperación Técnica , Medicina Basada en la Evidencia , Acuerdos de Cooperación Científica y Tecnológica , Uso de la Información Científica en la Toma de Decisiones en Salud , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Estrategias Mundiales
11.
Recurso Educacional Abierto en Portugués | CVSP - Regional | ID: oer-3918

RESUMEN

Sistema Fi-Admin Campos descritivos dos recursos educacionais


Asunto(s)
Gestión de la Información en Salud , Medicina Basada en la Evidencia/métodos
13.
Zhonghua Wai Ke Za Zhi ; 58(11): 831-834, 2020 Nov 01.
Artículo en Chino | MEDLINE | ID: mdl-33120444

RESUMEN

The rational clinical examination is important. The authors raised the concept of "medical imaging clinical appropriateness (MICA) " to meet the medical need in clinic (for diagnosis or assessment of a kind of disease or syndrome), which means radiologists and clinicians work together to carefully evaluate the necessity and rationality of an examination according to evidence of evidence-based medicine, expertise, experience, and patient's willing.The necessity is prerequisite, the rationality is the core, the evaluation of evidence is the basis, the application of evidence-based medicine is the important method. This work will provide us a series of criteria in the format of guidelines, providing evidence of rational examination for clinicians. Based on hard working and cooperation between radiologists and clinicians, we will establish the system of MICA in China, standardizing medical process, promoting rationalization, optimizing medical resources allocation and usage.


Asunto(s)
Diagnóstico por Imagen/normas , Medicina Basada en la Evidencia , China , Toma de Decisiones Clínicas , Necesidades y Demandas de Servicios de Salud , Humanos , Estados Unidos
14.
PLoS One ; 15(10): e0230037, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33104733

RESUMEN

BACKGROUND: Bacteremia is a leading cause of mortality in developing countries, however, etiologic evaluation is infrequent and empiric antibiotic use not evidence-based. Here, we evaluated the patterns of ESBL resistance in children enrolled into a surveillance study for community acquired bacteremic syndromes across health facilities in Central and Northwestern Nigeria. METHOD: Blood culture was performed for children aged less than 5 years suspected of having sepsis from Sept 2008-Dec 2016. Blood was incubated using the BACTEC00AE system and Enterobacteriacea identified to the species level using Analytical Profile Index (API20E®). Antibiotic susceptibility profile was determined by the disc diffusion method. Real time PCR was used to characterize genes responsible for ESBL production. RESULT: Of 21,000 children screened from Sept 2008-Dec 2016, 2,625(12.5%) were culture-positive. A total of 413 Enterobacteriaceae available for analysis were screened for ESBL. ESBL production was detected in 160 Enterobacteriaceae, high resistance rates were observed among ESBL-positive isolates for Ceftriaxone (92.3%), Aztreonam (96.8%), Cefpodoxime (96.3%), Cefotaxime (98.8%) and Trimethoprim/sulfamethoxazole (90%), while 87.5%, 90.7%, and 91.9% of the isolates were susceptible to Imipenem, Amikacin and Meropenem respectively. Frequently detected resistance genes were blaTEM-83.8% (134/160), and, blaCTX-M 83.1% (133/160) followed by blaSHVgenes 66.3% (106/160). Co-existence of blaCTX-M, blaTEM and blaSHV was seen in 94/160 (58.8%), blaCTX-M and blaTEM in 118/160 (73.8%), blaTEM and blaSHV in 97/160 (60.6%) and blaCTX-M and blaSHV in 100/160 (62.5%) of isolates tested. CONCLUSION: Our results indicate a high prevalence of bacteremia from ESBL Enterobacteriaceae in this population of children. These are resistant to commonly used antibiotics and careful choice of antibiotic treatment options is critical. Further studies to evaluate transmission dynamics of resistance genes could help in the reduction of ESBL resistance in these settings.


Asunto(s)
Antibacterianos/farmacología , Bacteriemia/epidemiología , Infecciones por Enterobacteriaceae/epidemiología , Enterobacteriaceae/clasificación , Resistencia betalactámica , Bacteriemia/microbiología , Preescolar , Pruebas Antimicrobianas de Difusión por Disco , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/aislamiento & purificación , Infecciones por Enterobacteriaceae/microbiología , Medicina Basada en la Evidencia , Femenino , Humanos , Lactante , Especies Introducidas , Masculino , Nigeria/epidemiología , Vigilancia de la Población , Prevalencia
15.
JAMA ; 324(15): 1543-1556, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-33079159

RESUMEN

Importance: Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients. Objective: To develop an evidence-based clinical practice guideline for adults with Down syndrome. Evidence Review: The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE, EMBASE, PubMed, PsychINFO, Cochrane Library, and the TRIP Database, searched from January 1, 2000, to February 26, 2018, with an updated search through August 6, 2020. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework, in January 2019, the 13-member Workgroup and 16 additional clinical and scientific experts, nurses, patient representatives, and a methodologist developed clinical recommendations. A statement of good practice was made when there was a high level of certainty that the recommendation would do more good than harm, but there was little direct evidence. Findings: From 11 295 literature citations associated with 10 PICO questions, 20 relevant studies were identified. An updated search identified 2 additional studies, for a total of 22 included studies (3 systematic reviews, 19 primary studies), which were reviewed and synthesized. Based on this analysis, 14 recommendations and 4 statements of good practice were developed. Overall, the evidence base was limited. Only 1 strong recommendation was formulated: screening for Alzheimer-type dementia starting at age 40 years. Four recommendations (managing risk factors for cardiovascular disease and stroke prevention, screening for obesity, and evaluation for secondary causes of osteoporosis) agreed with existing guidance for individuals without Down syndrome. Two recommendations for diabetes screening recommend earlier initiation of screening and at shorter intervals given the high prevalence and earlier onset in adults with Down syndrome. Conclusions and Relevance: These evidence-based clinical guidelines provide recommendations to support primary care of adults with Down syndrome. The lack of high-quality evidence limits the strength of the recommendations and highlights the need for additional research.


Asunto(s)
Síndrome de Down/terapia , Adulto , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/epidemiología , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/prevención & control , Comorbilidad , Complicaciones de la Diabetes/epidemiología , Síndrome de Down/complicaciones , Medicina Basada en la Evidencia , Humanos , Tamizaje Masivo , Obesidad/complicaciones
16.
Curr Opin Anaesthesiol ; 33(6): 711-717, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33002957

RESUMEN

PURPOSE OF REVIEW: Implementation of enhanced recovery pathways have allowed migration of complex surgical procedures from inpatient setting to the outpatient setting. These programs improve patient safety and patient-reported outcomes. The present article discusses the principles of enhanced recovery pathways in adults undergoing ambulatory surgery with an aim of improving patient safety and postoperative outcomes. RECENT FINDINGS: Procedure and patient selection is one of the key elements that influences perioperative outcomes after ambulatory surgery. Other elements include optimization of comorbid conditions, patient and family education, minimal preoperative fasting and adequate hydration during the fasting period, use of fast-track anesthesia technique, lung-protective mechanical ventilation, maintenance of fluid balance, and multimodal pain, nausea, and vomiting prophylaxis. SUMMARY: Implementation of enhanced recovery pathways requires a multidisciplinary approach in which the anesthesiologist should take a lead in collaborating with surgeons and perioperative nurses. Measuring compliance with enhanced recovery pathways through an audit program is essential to evaluate success and need for protocol modification. The metrics to assess the impact of enhanced recovery pathways include complication rates, patient reported outcomes, duration of postoperative stay in the surgical facility, unplanned hospital admission rate, and 7-day and 30-day readmission rates.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/métodos , Anestesia , Vías Clínicas , Recuperación Mejorada Después de la Cirugía , Complicaciones Posoperatorias/prevención & control , Adulto , Anestesia/efectos adversos , Vías Clínicas/normas , Medicina Basada en la Evidencia , Humanos , Tiempo de Internación , Selección de Paciente , Cuidados Posoperatorios , Complicaciones Posoperatorias/epidemiología , Recuperación de la Función
18.
J Trauma Stress ; 33(5): 634-642, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33007149

RESUMEN

In response to COVID-19, continued workforce training is essential to ensure that evidence-based treatments are available on the frontline to meet communities' ongoing and emerging mental health needs. However, training during a pandemic imposes many new challenges. This paper describes a multisite training and implementation pilot program, facets of which allowed for continued training despite the onset of the COVID-19 pandemic and subsequent social distancing guidelines. This virtual facilitated learning collaborative in Written Exposure Therapy, an evidence-based treatment for posttraumatic stress disorder, included virtual workshop training, phone-based clinical consultation, implementation-focused video calls for program leadership, and program evaluation. Data are presented about program enrollees and patient impact following the onset of COVID-19-related social distancing restrictions. Challenges, successes, and practical guidance are discussed to inform the field regarding training strategies likely to be durable in an uncertain, dynamic healthcare landscape.


Asunto(s)
Infecciones por Coronavirus/psicología , Educación a Distancia/organización & administración , Terapia Implosiva/educación , Neumonía Viral/psicología , Trastornos por Estrés Postraumático/terapia , Betacoronavirus , Medicina Basada en la Evidencia/métodos , Humanos , Pandemias , Desarrollo de Programa/métodos , Trastornos por Estrés Postraumático/psicología , Escritura
19.
Cochrane Database Syst Rev ; 10: CD012575, 2020 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-33058172

RESUMEN

BACKGROUND: Rehabilitation based upon research evidence gives stroke survivors the best chance of recovery. There is substantial research to guide practice in stroke rehabilitation, yet uptake of evidence by healthcare professionals is typically slow and patients often do not receive evidence-based care. Implementation interventions are an important means to translate knowledge from research to practice and thus optimise the care and outcomes for stroke survivors. A synthesis of research evidence is required to guide the selection and use of implementation interventions in stroke rehabilitation. OBJECTIVES: To assess the effects of implementation interventions to promote the uptake of evidence-based practices (including clinical assessments and treatments recommended in evidence-based guidelines) in stroke rehabilitation and to assess the effects of implementation interventions tailored to address identified barriers to change compared to non-tailored interventions in stroke rehabilitation. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and eight other databases to 17 October 2019. We searched OpenGrey, performed citation tracking and reference checking for included studies and contacted authors of included studies to obtain further information and identify potentially relevant studies. SELECTION CRITERIA: We included individual and cluster randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies comparing an implementation intervention to no intervention or to another implementation approach in stroke rehabilitation. Participants were qualified healthcare professionals working in stroke rehabilitation and the patients they cared for. Studies were considered for inclusion regardless of date, language or publication status. Main outcomes were healthcare professional adherence to recommended treatment, patient adherence to recommended treatment, patient health status and well-being, healthcare professional intention and satisfaction, resource use outcomes and adverse effects. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. The primary comparison was any implementation intervention compared to no intervention. MAIN RESULTS: Nine cluster randomised trials (12,428 patient participants) and three ongoing trials met our selection criteria. Five trials (8865 participants) compared an implementation intervention to no intervention, three trials (3150 participants) compared one implementation intervention to another implementation intervention, and one three-arm trial (413 participants) compared two different implementation interventions to no intervention. Eight trials investigated multifaceted interventions; educational meetings and educational materials were the most common components. Six trials described tailoring the intervention content to identified barriers to change. Two trials focused on evidence-based stroke rehabilitation in the acute setting, four focused on the subacute inpatient setting and three trials focused on stroke rehabilitation in the community setting. We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence was very low (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.53 to 2.64; 2 trials, 39 clusters, 1455 patient participants; I2 = 0%). Low-certainty evidence indicates implementation interventions in stroke rehabilitation may lead to little or no difference in patient adherence to recommended treatment (number of recommended performed outdoor journeys adjusted mean difference (MD) 0.5, 95% CI -1.8 to 2.8; 1 trial, 21 clusters, 100 participants) and patient psychological well-being (standardised mean difference (SMD) -0.02, 95% CI -0.54 to 0.50; 2 trials, 65 clusters, 1273 participants; I2 = 0%) compared with no intervention. Moderate-certainty evidence indicates implementation interventions in stroke rehabilitation probably lead to little or no difference in patient health-related quality of life (MD 0.01, 95% CI -0.02 to 0.05; 2 trials, 65 clusters, 1242 participants; I2 = 0%) and activities of daily living (MD 0.29, 95% CI -0.16 to 0.73; 2 trials, 65 clusters, 1272 participants; I2 = 0%) compared with no intervention. No studies reported the effects of implementation interventions in stroke rehabilitation on healthcare professional intention to change behaviour or satisfaction. Five studies reported economic outcomes, with one study reporting cost-effectiveness of the implementation intervention. However, this was assessed at high risk of bias. The other four studies did not demonstrate the cost-effectiveness of interventions. Tailoring interventions to identified barriers did not alter results. We are uncertain of the effect of one implementation intervention versus another given the limited very low-certainty evidence. AUTHORS' CONCLUSIONS: We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence is very low.


Asunto(s)
Medicina Basada en la Evidencia/métodos , Personal de Salud/estadística & datos numéricos , Rehabilitación de Accidente Cerebrovascular/métodos , Medicina Basada en la Evidencia/educación , Medicina Basada en la Evidencia/estadística & datos numéricos , Personal de Salud/educación , Estado de Salud , Humanos , Cooperación del Paciente/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Rehabilitación de Accidente Cerebrovascular/psicología
20.
Rev Col Bras Cir ; 47: e20202705, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33053066

RESUMEN

One of the struggles faced by physicians in clinical decisions during the COVID-19 pandemic is how to deal with already available or lacking scientific evidence. The COVID-19 pandemic has a large impact in the routine of the many health services, including surgery, which demanded changes in assist protocols. Questions began to arise about well-established surgery conducts due to situations related to SARS-COV-2 infection, and, according to public health measures that are necessary to fight the pandemic. In situations of scarce available evidence, it is natural for us to have to deal with systematically more fragile, provisory and bias-susceptible information. Considering the principles that guide Evidence Based Medicine and Bioethical, the authors analyze the complexity of the medical decision-making during this time. Medical conducts must be adapted to the context of fighting the pandemic and consider patients and healthcare providers exposure and well-being and, lastly, the conservation of resources. The authors conclude that acceptance and tolerance to divergence is commendable, being a path to achieving unity in the diversity of medicine in times of little safe knowledge.


Asunto(s)
Infecciones por Coronavirus , Medicina Basada en la Evidencia , Pandemias , Médicos , Neumonía Viral , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología
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