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1.
Diagn. tratamento ; 24(4): [183-189], out - dez. 2019. tab
Artigo em Português | LILACS | ID: biblio-1049398

RESUMO

Contexto: A Cannabis sativa é uma planta popularmente conhecida como maconha e que há alguns anos é alvo de polêmica, dado seu potencial medicinal e também os efeitos entorpecentes que a qualificam como droga ilícita. Objetivo: O presente estudo teve como objetivo avaliar as revisões sistemáticas desenvolvidas pela Cochrane, no que concerne à eficácia dos princípios ativos da Cannabis para tratamento de doenças. Métodos: Trata-se de overview de revisões sistemáticas Cochrane. Procedeu-se à busca por revisões sistemáticas na Cochrane Library database. Foram utilizados os termos MeSH Cannabis e Cannabidiol. Os critérios de inclusão envolveram pacientes tratados com derivados de Cannabis para qualquer doença. Resultados: A estratégia de busca recuperou sete revisões sistemáticas Cochrane, relacionadas ao tratamento de colite ulcerativa, doença de Crohn, epilepsia, dor crônica neuropática, morbimortalidade associada ao HIV, dor em artrite reumatoide e ataxia em esclerose múltipla, totalizando 2.561 pacientes avaliados. Discussão: há carência de evidências até o momento que permitam afirmar a efetividade de Cannabis no tratamento das condições clínicas avaliadas. Para a dor crônica neuropática, a evidência de melhora é baixa. Os estudos realizados até o momento, com nível baixo de evidência, não demonstraram efeitos adversos graves. Conclusão: Não há evidências de efetividade dos princípios ativos da Cannabis em estudos realizados até o momento e compilados em revisões sistemáticas Cochrane.


Assuntos
Terapêutica , Canabidiol , Cannabis , Prática Clínica Baseada em Evidências
2.
Diagn. tratamento ; 24(3): [102-105], jul - set. 2019. tab
Artigo em Português | LILACS | ID: biblio-1026696

RESUMO

Contexto e objetivo: A vacinação constitui relevante ferramenta na prevenção de doenças, mas a cobertura populacional nem sempre é alcançada, sendo múltiplas as variáveis envolvidas nesse processo. Embora universalmente recomendada, a vacinação é objeto, por vezes, de questionamentos por grupos que a consideram ineficaz, por questões religiosas ou mesmo falta de acesso à informação relativa à sua importância. O presente estudo procurou identificar os riscos, benefícios e argumentos para vacinação contra o sarampo. Métodos: Procedeu-se à busca nas bases eletrônicas de dados PubMed, portais BVS (Biblioteca Virtual em Saúde) e IBECS (Índice Bibliográfico da Espanha em Ciências da Informação). Não houve restrição geográfica e de idioma, sendo utilizados descritores e termos do DeCS (Descritores em Ciências da Saúde). O método de síntese envolveu a combinação de estudos semelhantes em uma revisão narrativa. Resultados: Foi mapeado em total de 1.311 referências. Depois de eliminadas as duplicidades e as referências não relacionadas ao escopo desta análise, foram selecionadas as evidências de melhor qualidade, priorizando-se a pirâmide de nível de evidências. Discussão: A vacinação contra o sarampo reduz significativamente o risco de ocorrência da doença, mas não é impeditiva à ocorrência de surtos, que podem ocorrer diante do fluxo migratório. Há possível redução da mortalidade com a vacinação e clara redução de custos de internações hospitalares para a sociedade. Conclusões: Há evidência de proteção da vacina contra o sarampo. Os riscos à vacinação são baixos e os benefícios relativos à redução no número de casos de doença são evidentes.


Assuntos
Terapêutica , Vacinas , Prevenção de Doenças , Prática Clínica Baseada em Evidências , Sarampo
3.
Sao Paulo Med J ; 137(2): 184-192, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31314879

RESUMO

BACKGROUND: Telemedicine has emerged as a tool for overcoming the challenges of healthcare systems and is likely to become increasingly viable, since information and communication technologies have become more sophisticated and user-friendly. OBJECTIVE: We aimed to identify all Cochrane systematic reviews (CSRs) on telemedicine within healthcare and to summarize the current evidence regarding its use. DESIGN AND SETTING: Review of CSRs, developed at the Discipline of Emergency and Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: We searched for studies that compared use of telemedicine with conventional treatment or management of diseases within healthcare. Diagnostic telemedicine studies or studies using automatic text, voice-text or even self-managed care were excluded. The main characteristics and the certainty of evidence were synthetized and critically discussed by all authors. RESULTS: We included 10 CSRs that investigated a broad range of diseases. There is still insufficient evidence to determine what types of telemedicine interventions are effective, for which patients and in which settings, and whether such interventions can be used as a replacement for the standard treatment. Harm relating to telemedicine technologies needs to be better investigated and addressed. CONCLUSION: Telemedicine might be an excellent way to facilitate access to treatment, monitoring and dissemination of important clinical knowledge. However, given the recognition of systematic reviews as the best evidence resource available for decision-making, further randomized controlled trials with stricter methods are necessary to reduce the uncertainties in evidence-based use of telemedicine.


Assuntos
Medicina Baseada em Evidências , Revisões Sistemáticas como Assunto , Telemedicina , Humanos
4.
Health Info Libr J ; 36(3): 223-243, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31271504

RESUMO

BACKGROUND: There are few publications on search strategies to identify diagnostic test accuracy (DTA) studies in lilacs. OBJECTIVE: To translate and customise medline search strategies for use in lilacs and assess their retrieval of studies in Cochrane DTA systematic reviews. METHOD: We developed a six-step process to translate and customise medline search strategies for use in lilacs (iAHx interface). We identified medline search strategies of published Cochrane DTA reviews, translated/customised them for use in lilacs, ran searches in lilacs and compared the retrieval results of our translated search strategy versus the one used in the published reviews. RESULTS: Our lilacs search strategies translated/customised from the medline strategies retrieved studies in 70 Cochrane DTA reviews. Only 29 of these reviews stated that they had searched the lilacs database and 21 published their lilacs search strategies. Few had used the lilacs database search tools, none exploded the subject headings, and 86% used only English terms. CONCLUSION: Translating and tailoring a medline search strategy for the lilacs database resulted in the retrieval of DTA studies that would have been missed otherwise.

6.
Säo Paulo med. j ; 137(2): 184-192, Mar.-Apr. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1014639

RESUMO

ABSTRACT BACKGROUND: Telemedicine has emerged as a tool for overcoming the challenges of healthcare systems and is likely to become increasingly viable, since information and communication technologies have become more sophisticated and user-friendly. OBJECTIVE: We aimed to identify all Cochrane systematic reviews (CSRs) on telemedicine within healthcare and to summarize the current evidence regarding its use. DESIGN AND SETTING: Review of CSRs, developed at the Discipline of Emergency and Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: We searched for studies that compared use of telemedicine with conventional treatment or management of diseases within healthcare. Diagnostic telemedicine studies or studies using automatic text, voice-text or even self-managed care were excluded. The main characteristics and the certainty of evidence were synthetized and critically discussed by all authors. RESULTS: We included 10 CSRs that investigated a broad range of diseases. There is still insufficient evidence to determine what types of telemedicine interventions are effective, for which patients and in which settings, and whether such interventions can be used as a replacement for the standard treatment. Harm relating to telemedicine technologies needs to be better investigated and addressed. CONCLUSION: Telemedicine might be an excellent way to facilitate access to treatment, monitoring and dissemination of important clinical knowledge. However, given the recognition of systematic reviews as the best evidence resource available for decision-making, further randomized controlled trials with stricter methods are necessary to reduce the uncertainties in evidence-based use of telemedicine.

9.
Sao Paulo Med J ; 136(3): 251-261, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29947699

RESUMO

BACKGROUND: This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten integrative practices that were recently added to the Brazilian public healthcare system (SUS). DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). METHODS: Review of Cochrane SRs on the following interventions were identified, summarized and critically assessed: apitherapy, aromatherapy, bioenergetics, family constellation, flower therapy, chromotherapy, geotherapy, hypnotherapy, hand imposition or ozone therapy. RESULTS: We included a total of 16 SRs: 4 on apitherapy, 4 on aromatherapy, 6 on hypnotherapy and 2 on ozone therapy. No Cochrane SR was found regarding bioenergetics, family constellation, chromotherapy, clay therapy, flower therapy or hand imposition. The only high-quality evidence was in relation to the potential benefit of apitherapy, specifically regarding some benefits from honey dressings for partial healing of burn wounds, for reduction of coughing among children with acute coughs and for preventing allergic reactions to insect stings. CONCLUSION: Except for some specific uses of apitherapy (honey for burn wounds and for acute coughs and bee venom for allergic reactions to insect stings), the use of ten integrative practices that have recently been incorporated into SUS does not seem to be supported by evidence from Cochrane SRs.


Assuntos
Medicina Integrativa/métodos , Literatura de Revisão como Assunto , Apiterapia/métodos , Aromaterapia/métodos , Medicina Baseada em Evidências/normas , Humanos , Hipnose/métodos , Ozônio/uso terapêutico
11.
Säo Paulo med. j ; 136(3): 251-261, May-June 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-962722

RESUMO

ABSTRACT BACKGROUND: This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten integrative practices that were recently added to the Brazilian public healthcare system (SUS). DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). METHODS: Review of Cochrane SRs on the following interventions were identified, summarized and critically assessed: apitherapy, aromatherapy, bioenergetics, family constellation, flower therapy, chromotherapy, geotherapy, hypnotherapy, hand imposition or ozone therapy. RESULTS: We included a total of 16 SRs: 4 on apitherapy, 4 on aromatherapy, 6 on hypnotherapy and 2 on ozone therapy. No Cochrane SR was found regarding bioenergetics, family constellation, chromotherapy, clay therapy, flower therapy or hand imposition. The only high-quality evidence was in relation to the potential benefit of apitherapy, specifically regarding some benefits from honey dressings for partial healing of burn wounds, for reduction of coughing among children with acute coughs and for preventing allergic reactions to insect stings. CONCLUSION: Except for some specific uses of apitherapy (honey for burn wounds and for acute coughs and bee venom for allergic reactions to insect stings), the use of ten integrative practices that have recently been incorporated into SUS does not seem to be supported by evidence from Cochrane SRs.

12.
Säo Paulo med. j ; 136(2): 99-100, Mar.-Apr. 2018.
Artigo em Inglês | LILACS-Express | ID: biblio-904145
13.
Rev. Soc. Bras. Clín. Méd ; 15(2): 137-143, 20170000. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-875617

RESUMO

Chronic obstructive pulmonary disease (COPD) is among the most prevalent pulmonary diseases. This study aimed at assessing the efficacy and safety of anticholinergic tiotropium bromide (TB) in Chronic obstructive pulmonary disease patients. This is a systematic review of randomized clinical trials performed in the Brazilian Cochrane Center. Electronic database searched: Cochrane library, Medline, LILACS, Pubmed. There were no language, date or other restrictions. Participants: Patients with Chronic obstructive pulmonary disease. Intervention: tiotropium bromide. Comparison: Other bronchodilators or placebo. Outcomes: Mortality, Chronic obstructive pulmonary disease exacerbation, hospitalizations, adverse effects. Results: 14 studies were included in this systematic review. Mortality was lower in the tiotropium bromide group when compared with the salmeterol group [statistical significance: relative risk (RR) 0.16, confidence interval 95% (CI) 0.03 to 0.89, number needed to treat (NNT) of 100]. There was not a statistical difference in the mortality outcome in the comparison between tiotropium bromide and placebo groups (RR 0.88, CI 0.74 to 1.06). Chronic obstructive pulmonary disease exacerbation decreases significantly in the tiotropium bromide group when compared to placebo (statistical significance: RR 0.85, CI 0.77 to 0.93, NNT 25), but in comparison to the salmeterol group there was no statistical difference (RR 0.93, CI 0.80 to 1.08). The number of hospitalizations was lower in the tiotropium bromide group than in the placebo group (statistical significance:RR 0.77, CI 0.59 to 0.99, NNT 50). The results indicate that tiotropium bromide is an effective once-daily bronchodilator. Tiotropium bromide was associated with consistent health benefits, including reduced chronic obstructive pulmonary disease exacerbations, hospitalizations and even mortality when compared with salmeterol.(AU)


A doença pulmonar obstrutiva crônica está entre as doenças pulmonares mais prevalentes. O objetivo deste estudo foi verificar a eficácia e segurança do brometo de tiotrópio em pacientes com doença pulmonar obstrutiva crônica. Trata-se de revisão sistemática de ensaios clínicos randomizados realizada no Centro Cochrane do Brasil. A estratégia de busca eletrônica foi realizada nos nas bases LILACS, MEDLINE, Biblioteca Cochrane, PubMed. Não houve restrições à linguagem e nem à data. Participaram pacientes com doença pulmonar obstrutiva crônica. A intervenção foi o uso de brometo de tiotrópio comparado a outros broncodilatadores ou placebo. Os desfechos analisados foram mortalidade, exacerbações da doença pulmonar obstrutiva crônica, hospitalização e efeitos adversos. A mortalidade foi menor no grupo brometo de tiotrópio quando comparado com o grupo salmeterol (significância estatística: risco relativo de 0,16; intervalo de confiança de 95% de 0,03-0,89, número necessário para tratar de 100). Não houve diferença estatística no desfecho mortalidade na comparação entre os grupos brometo de tiotrópio e placebo (risco relativo de 0,88; intervalo de confiança de 95% de 0,74-1,06). As exacerbações da doença pulmonar obstrutiva crônica diminuíram significantemente no grupo brometo de tiotrópio quando comparado ao placebo (significância estatística: risco relativo de 0,85; intervalo de confiança de 95% de 0,77-0,93; número necessário para tratar de 25), porém, quando comparado ao salmeterol não obteve significância estatística (risco relativo de 0,93; intervalo de confiança de 95% 0,80-1,08). O número de hospitalizações foi menor no grupo brometo de tiotrópio do que no grupo placebo (significância estatística: risco relativo de 0,77; intervalo de confiança de 95% 0,59-0,99; número necessário para tratar de 50). Os resultados indicam que o brometo de tiotrópio é um broncodilatador eficaz em dose única diária. O brometo de tiotrópio traz benefícios à saúde com resultados consistentes, incluindo redução de exacerbações da doença pulmonar obstrutiva crônica, internações e até mesmo a mortalidade quando comparados com salmeterol.(AU)


Assuntos
Broncodilatadores/uso terapêutico , Antagonistas Colinérgicos/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Brometo de Tiotrópio/uso terapêutico
14.
BMC Cardiovasc Disord ; 17(1): 148, 2017 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-28592234

RESUMO

BACKGROUND: Warfarin is a commonly used anticoagulant. Whether a given dose of the different formulations of Brazilian warfarin will result in the same effect on the international normalized ratio (INR) is uncertain. The aim of the WARFA trial is to determine whether the branded and two generic warfarins available in Brazil differ in their effect on the INR. METHODS: WARFA is a cross-over RCT comparing three warfarins. The formulations tested are the branded Marevan® (Uniao Quimica/Farmoquimica) and two generic warfarin (manufactured respectively by Uniao Quimica Farmaceutica Nacional and Laboratorio Teuto Brasileiro). All of them were manufactured in Brazil, are available in all settings of the Brazilian healthcare system and were purchased from retail drugstores. Eligible participants had atrial fibrillation or flutter, had been using warfarin for at least 2 months with a therapeutic range of 2.0-3.0 and had low variability in INR results during the 1st period of the trial. Our primary outcome, for which we have an equality hypothesis, is the difference between warfarins in the mean absolute difference between two INR results, obtained after three and 4 weeks with each drug. Our secondary outcomes, that will be tested for inequality (except for the mean INR, which will be tested for equality), include the difference in the warfarin dose, and time in therapeutic range. Clinical events and adherence were also recorded and will be reported. DISCUSSION: To our knowledge, WARFA will be the first comparison of the more readily applicable INR results between branded and generic warfarins in Brazil. WARFA is important because warfarins are commonly switched between in the course of a chronic treatment in Brazil. Final results of WARFA are expected in May 2017. TRIAL REGISTRATION: ClinicalTrials.gov NCT02017197 . Registered 11 December 2013.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Flutter Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Medicamentos Genéricos/administração & dosagem , Acidente Vascular Cerebral/prevenção & controle , Varfarina/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/química , Fibrilação Atrial/sangue , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Flutter Atrial/sangue , Flutter Atrial/complicações , Flutter Atrial/diagnóstico , Brasil , Protocolos Clínicos , Estudos Cross-Over , Composição de Medicamentos , Monitoramento de Medicamentos/métodos , Medicamentos Genéricos/efeitos adversos , Medicamentos Genéricos/química , Hemorragia/induzido quimicamente , Humanos , Coeficiente Internacional Normatizado , Adesão à Medicação , Projetos de Pesquisa , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Equivalência Terapêutica , Fatores de Tempo , Resultado do Tratamento , Varfarina/efeitos adversos , Varfarina/química
15.
Diagn. tratamento ; 22(2): 57-62, Abr.-Jun. 2017. tab
Artigo em Português | LILACS | ID: biblio-833680

RESUMO

Contexto: Milhões de pessoas são atendidas nas emergências de todo o mundo e bilhões de dólares são gastos nos sistemas de saúde com exames, muitas vezes desnecessários. Dentre estes, o uso da tomografia computadorizada apresenta um crescimento importante nas últimas décadas, gerando preocupação com relação a riscos relacionados à exposição à radiação e custos. Vários autores têm alertado sobre o aumento de neoplasias cerebrais e leucemia principalmente em crianças e as evidências são crescentes, relacionando esse fato à exposição à radiação. Objetivo: Identificar as evidências sobre risco de desenvolvimento de neoplasias relacionados à radiação ionizante com o uso da tomografia computadorizada. Métodos: Revisão narrativa com busca sistematizada, incluindo estudos sobre a relação entre exposição à radiação por meio da tomografia computadorizada e desenvolvimento de neoplasias. Resultados: As doses associadas à tomografia estão entre as maiores na radiologia diagnóstica. Há evidências nos estudos epidemiológicos de que a dose correspondente a um exame tomográfico resulta em aumento do risco de neoplasias. Há estimativas, baseadas em modelos matemáticos, de que esse risco seja em torno de 5%. Nas crianças, estudos mostram associação de tomografia com aumento da incidência de leucemia e tumores cerebrais. Conclusões: Há indução de tumores cerebrais e leucemias em crianças expostas a tomografias. Exames radiológicos, como quaisquer exames, só devem ser pedidos na certeza de que poderão modificar a conduta e beneficiar o paciente. Protocolos clínicos com base nas melhores evidências científicas devem nortear a tomada de decisão.


Assuntos
Fidelidade a Diretrizes , Neoplasias Induzidas por Radiação , Radiação Ionizante , Revisão , Tomografia , Tomografia Computadorizada por Raios X
16.
Säo Paulo med. j ; 134(6): 555-556, Nov.-Dec. 2016.
Artigo em Inglês | LILACS-Express | ID: biblio-846259

RESUMO

ABSTRACT BACKGROUND: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES: To evaluate the effectiveness and safety of statins in aortic valve stenosis. METHODS: Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions. Selection criteria: Randomized controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life. Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. MAIN RESULTS: We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80; participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0.14; participants = 155; study = 1). Moderate-quality evidence showed no effect on freedom from valve replacement with statins (risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies = 4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75 to 1.09; participants = 2204; studies = 3; moderate-quality evidence). Low- and very low-quality evidence showed uncertainty around the effect of statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15; participants = 2297; studies = 3; low-quality evidence) and hospitalization for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants = 155; study = 1; very low-quality evidence). None of the four included studies reported on overall mortality and patient quality of life. AUTHORS CONCLUSIONS: Result findings showed uncertainty surrounding the effect of statins for aortic valve stenosis. The quality of evidence from the reported outcomes ranged from moderate to very low. These results give support to European and USA guidelines (2012 and 2014, respectively) that so far there is no clinical treatment option for aortic valve stenosis.

17.
Sao Paulo Med J ; 134(6): 555-556, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28076633

RESUMO

BACKGROUND:: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES:: To evaluate the effectiveness and safety of statins in aortic valve stenosis. METHODS:: Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions.Selection criteria: Randomized controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life.Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. MAIN RESULTS:: We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80; participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0.14; participants = 155; study = 1). Moderate-quality evidence showed no effect on freedom from valve replacement with statins (risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies = 4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75 to 1.09; participants = 2204; studies = 3; moderate-quality evidence). Low- and very low-quality evidence showed uncertainty around the effect of statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15; participants = 2297; studies = 3; low-quality evidence) and hospitalization for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants = 155; study = 1; very low-quality evidence). None of the four included studies reported on overall mortality and patient quality of life. AUTHORS CONCLUSIONS:: Result findings showed uncertainty surrounding the effect of statins for aortic valve stenosis. The quality of evidence from the reported outcomes ranged from moderate to very low. These results give support to European and USA guidelines (2012 and 2014, respectively) that so far there is no clinical treatment option for aortic valve stenosis.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Qualidade de Vida , Estenose da Valva Aórtica , Hospitalização , Humanos
18.
Indian J Med Res ; 144(4): 552-559, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28256463

RESUMO

BACKGROUND & OBJECTIVES: Sudden cardiac arrest (CA) represents one of the greatest challenges for medicine due to the vast number of cases and its social and economic impact. Despite advances in cardiopulmonary resuscitation (CPR) techniques, mortality rates have not significantly decreased over decades. This study was undertaken to characterize patients that have suffered CA and to identify factors related to mortality. METHODS: This prospective study was conducted at Emergency Department of São Paulo Hospital, Brazil. Two hundred and eighty five patients were followed for one year after treatment for CA. The mean age was 66.3±17.2 yr, and they were predominantly male (55.8%) and Caucasian (71.9%). Mortality rate and factors associated with mortality were the primary and secondary outcome measures. Data were collected using an in-hospital Utstein-style report. A logistic regression analysis was used to determine which variables were related to mortality. RESULTS: Regarding the characteristics of CPR, 76.5 per cent occurred in hospital, respiratory failure was the most common presumed immediate cause of CA (30.8%) and pulseless electrical activity was the most frequent initial rhythm (58.7%). All attempts at CPR utilized chest compressions and ventilation and the most utilized interventions were epinephrine (97.2%) and intubation (68.5%). Of all patients treated, 95.4 per cent died. Patients with pulseless electrical activity had a higher risk of death than those patients with ventricular fibrillation. INTERPRETATION & CONCLUSIONS: The findings of the study highlighted that the mortality rate among CA patients was high. The variable that best explained mortality was the initial CA rhythm.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Serviços Médicos de Emergência , Parada Cardíaca/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Reanimação Cardiopulmonar , Morte Súbita Cardíaca/patologia , Feminino , Parada Cardíaca/fisiopatologia , Parada Cardíaca/terapia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade
19.
Int J Nurs Knowl ; 27(3): 175-80, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25962690

RESUMO

PURPOSE: To identify the possible defining characteristics (DCs) and related factors of the nursing diagnosis (ND) decreased cardiac tissue perfusion. METHODS: Cross-sectional study using medical charts of adults admitted to an emergency department with the chief complaint of chest pain in a hospital in São Paulo, Brazil. FINDINGS: DCs identified: crushing chest pain, elevated markers of myocardial necrosis, ischemic electrocardiogram changes, sweating, nausea, and vomiting. Related factors identified: interruption of arterial blood flow and coronary spasm. CONCLUSION: This ND was clinically identified due to significant differences in the DCs of patients with and without the diagnosis. PRACTICE IMPLICATIONS: The clinical indicators identified in this study can be the starting point for the DCs for this ND.


Assuntos
Coração/fisiopatologia , Diagnóstico de Enfermagem , Adulto , Estudos Transversais , Humanos , Registros de Enfermagem , Perfusão
20.
World Neurosurg ; 86: 399-418, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26485412

RESUMO

BACKGROUND: Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. OBJECTIVE: To perform a detailed critical appraisal of all randomized controlled trials (RCTs) of surgical treatments for chronic subdural hematomas and to quantify their intervention effects. METHODS: We performed a broad search for all RCTs with no language or date restrictions, asked the authors for missing data, and applied the Cochrane methods. RESULTS: A total of 24 RCTs involved 1900 patients and 15 comparisons. All outcomes of practical interest were analyzed. Postoperative drainage after burr-hole evacuation reduced the rate of recurrence (risk ratio 0.48, 95% confidence interval 0.34-0.66, P < 0.00001) with no other clear benefits or complications. CONCLUSIONS: This comprehensive, best evidence-based, quantitative, systematic review indicates that the use of a closed system drainage after burr-hole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions.


Assuntos
Hematoma Subdural Crônico/cirurgia , Craniotomia , Drenagem , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
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