Cánula Nasal de Alto Flujo en Adultos con Enfermedades Respiratorias Crónicas durante el Ejercicio Físico: Protocolo de Revisión Sistemática y Metaanálisis / High-Flow Nasal Cannula in Adults with Chronic Respiratory Diseases during Physical Exercise: A Protocol Systematic Review and Meta-analysis

Introducción. El entrenamiento físico puede mejorar la capacidad de ejercicio, la disnea y la calidad de vida (CV) en pacientes con enfermedades respiratorias crónicas (ERC). En este contexto, el uso de oxígeno suplementario a través de una cánula nasal de alto flujo (CNAF) podría ser un dispositivo que permita tolerar mayores niveles de actividad con menos síntomas de esfuerzo físico, optimizando en última instancia la capacidad de ejercicio y la CV. Objetivo. Este protocolo pretende conducir una revisión sistemática para evaluar el efecto terapéutico de la CNAF durante el ejercicio físico en pacientes con ERC. Fuente de búsqueda. Se realizarán búsquedas en el Registro Cochrane Central de Ensayos Controlados (CENTRAL), PUBMED, Embase, Lilacs, Physiotherapy Evidence Database (PEDro), International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov y literatura gris. Criterios de elegibilidad. Examinaremos los ECA de acuerdo con los criterios de elegibilidad para su inclusión en nuestra revisión. Dos revisores examinarán de forma independiente cada estudio para la elegibilidad, la extracción de datos y la evaluación del riesgo de sesgo. Se combinarán los resultados mediante un metanálisis y se aplicará el sistema GRADE para evaluar la certeza de las pruebas para cada resultado. La medida de resultado primaria será la capacidad de ejercicio, y las medidas de resultado secundarias serán la calidad de vida, la disnea, la funcionalidad, la comodidad, las complicaciones y adherencia. Se realizarán metaanálisis para determinar la diferencia de medias (DM) o la DM estandarizada para los datos continuos y la razón de riesgo para los datos dicotómicos. Se realizarán análisis de subgrupos según los tipos y la gravedad de la enfermedad, las condiciones de ejercicio físico y el estado de los dispositivos de oxigenoterapia. Ética y difusión. Como los investigadores no accederán a información que pueda conducir a la identificación de un participante individual, no fue necesario a obtener aprobación ética. Número de registro de PROSPERO: CRD42022336263.

Background. Physical training can improve exercise capacity, dyspnoea, and quality of life (QoL) in patients with chronic respiratory diseases (CRDs). It has been suggested that using supplemental oxygen through a high-flow nasal cannula (HFNC) could lead to higher levels of activity to be tolerated with fewer symptoms of physical exertion, ultimately optimizing exercise capacity and QoL. Objective. To conduct a systematic review to assess the therapeutic effect of HFNC during physical exercise in patients with CRDs. We will search the Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, Embase, Lilacs, Physiotherapy Evidence Database (PEDro), International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, and grey literature. Eligibility criteria. We will examine RCTs according to the eligibility criteria for inclusion in our review. Two reviewers will independently examine each study for eligibility, data extraction, and risk of bias assessment. We will combine the results using meta-analysis and apply the GRADE system to assess the certainty of the evidence for each outcome. The primary outcome will be exercise capacity, and secondary outcomes will be QoL, dyspnoea, functionality, comfort, complications, and adherence. We will perform meta-analyses to determine the mean difference (MD) or standardized MD for continuous data and the risk ratio for dichotomous data. Subgroup analyses will be performed according to types and severity of disease, physical exercise conditions, and condition of oxygen therapy devices. Ethics and Dissemination. As researchers will not access information that could lead to the identification of an individual participant, obtaining ethical approval was waived. Prospero registration number: CRD42022336263.

Are Cannabis, Cannabis-Derived Products, and Synthetic Cannabinoids a Therapeutic Tool for Rheumatoid Arthritis? A Friendly Summary of the Body of Evidence.

BACKGROUND: Symptom management in rheumatoid arthritis (RA) remains a complex challenge. Widespread use of cannabis-based medicines for a myriad of symptoms has fostered rheumatology patients' interest. However, their safety and efficacy in RA remain unclear. OBJECTIVE: The aim of this study was to perform a structured summary of the body of evidence in order to determine whether cannabis, cannabis-derived products, and synthetic cannabinoids are an effective treatment for rheumatoid arthritis. METHODS: An electronic search in Epistemonikos database was performed to identify systematic reviews and their primary studies that addressed our clinical question. The body of evidence was collected in a pivot table in Epistemonikos. Information and data from the primary studies were extracted from the identified reviews. Finally, extracted data were reanalyzed, and a summary of findings table was generated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Twenty-six systematic reviews were identified which included in total only 1 randomized trial assessing our clinical question. CONCLUSIONS: Cannabis, cannabis-derived products and synthetic cannabinoids may slightly reduce disease activity in patients with RA. Its use may result in little to no difference in pain reduction and may slightly increase nervous system adverse events. The evidence is very uncertain about the effect of cannabis, cannabis-derived products, and synthetic cannabinoids on serious adverse events risk.

Pulmonary rehabilitation for COVID-19: A living systematic review protocol. / Rehabilitación pulmonar en COVID-19: protocolo de una revisión sistemática viva.

OBJECTIVE: This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of pulmonary rehabilitation in the treatment of patients with COVID-19. DESIGN: This is the protocol of a living systematic review. DATA SOURCES: We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. ELIGIBILITY CRITERIA FOR SELECTING STUDIES AND METHODS: We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the effect of pulmonary rehabilitation as monotherapy or in combination with other interventions-versus sham or no treatment in patients with COVID-19. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. ETHICS AND DISSEMINATION: No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.

OBJETIVO: Proporcionar un resumen oportuno, riguroso y continuamente actualizado de la evidencia disponible sobre el papel de la rehabilitación pulmonar en el tratamiento de los pacientes con COVID-19. DISEÑO: Es el protocolo de una revisión sistemática viva. FUENTE DE DATOS: Realizaremos búsquedas en la plataforma L·OVE (Living OVerview of Evidence) para COVID-19, un sistema que mapea los componentes de las preguntas de investigación (PICO) en un repositorio mantenido a través de búsquedas regulares en bases de datos electrónicas, servidores de pre-impresión, registros de ensayos y otros recursos relevantes para COVID-19. No se aplicarán restricciones de fecha ni de idioma. CRITERIOS DE ELEGIBILIDAD PARA LA SELECCIÓN DE ESTUDIOS Y MÉTODOS: Se adaptó un protocolo común ya publicado para revisiones sistemáticas paralelas múltiples a las especificidades de la pregunta. Se incluirán ensayos aleatorios que evalúen el efecto de la rehabilitación pulmonar como monoterapia o en combinación con otras intervenciones frente a un tratamiento simulado o ningún tratamiento en pacientes con COVID-19. Dos revisores examinarán de forma independiente cada estudio para determinar su elegibilidad, extraerán los datos y evaluarán el riesgo de sesgo. Se agruparán los resultados mediante un metaanálisis y se aplicará el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE) para evaluar la certeza de las pruebas para cada resultado. ÉTICA Y DIFUSIÓN: No se considera necesaria la aprobación ética. Los resultados de esta revisión se difundirán ampliamente a través de publicaciones revisadas por pares, redes sociales y medios de comunicación tradicionales.

Pulmonary rehabilitation for COVID-19: a living systematic review protocol

Objective This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of pulmonary rehabilitation in the treatment of patients with COVID-19. Design This is the protocol of a living systematic review. Data sources We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the effect of pulmonary rehabilitation as monotherapy or in combination with other interventions-versus sham or no treatment in patients with COVID-19. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. Ethics and dissemination No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.

Epistemonikos: a comprehensive database of systematic reviews for health decision-making.

BACKGROUND: Systematic reviews allow health decisions to be informed by the best available research evidence. However, their number is proliferating quickly, and many skills are required to identify all the relevant reviews for a specific question. METHODS AND FINDINGS: We screen 10 bibliographic databases on a daily or weekly basis, to identify systematic reviews relevant for health decision-making. Using a machine-based approach developed for this project we select reviews, which are then validated by a network of more than 1000 collaborators. After screening over 1,400,000 records we have identified more than 300,000 systematic reviews, which are now stored in a single place and accessible through an easy-to-use search engine. This makes Epistemonikos the largest database of its kind. CONCLUSIONS: Using a systematic approach, recruiting a broad network of collaborators and implementing automated methods, we developed a one-stop shop for systematic reviews relevant for health decision making.

Evidencia viva como respuesta a las controversias en el uso de antimaláricos en COVID-19 / Living evidence in response to controversies about the use of antimalarials in COVID-19

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Evidence synthesis relevant to COVID-19: a protocol for multiple systematic reviews and overviews of systematic reviews. / Síntesis de evidencia relevante para COVID-19: protocolo común para múltiples revisiones sistemáticas y revisiones panorámicas.

Introduction: The evidence on COVID-19 is being produced at high speed, so it is challenging for decision-makers to keep up. It seems appropriate, then, to put into practice a novel approach able to provide the scientific community and other interested parties with quality evidence that is actionable, and rapidly and efficiently produced. Methods and analysis: We designed a protocol for multiple parallel systematic reviews and overviews of systematic reviews in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). We will search for primary studies and systematic reviews that answer different questions related to COVID-19 using both a centralized repository (Epistemonikos database) and a manual search in MEDLINE/PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. We will also search for literature in several other sources. At least two researchers will independently undertake the selection of studies, data extraction, and assessment of the quality of the included studies. We will synthesize data for each question using meta-analysis, when possible, and we will prepare Summary of Findings tables according to the GRADE approach. All the evidence will be organized in an open platform (L·OVE - Living OVerview of Evidence) that will be continuously updated using artificial intelligence and a broad network of experts. Ethics and dissemination: No ethics approval is considered necessary. The results of these articles will be widely disseminated via peer-reviewed publications, social networks, and traditional media, and will be sent to relevant international organizations discussing this topic.