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1.
Gac. sanit. (Barc., Ed. impr.) ; 34(5): 459-467, sept.-oct. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-198868

RESUMO

OBJECTIVE: To explore healthcare professionals' opinions about low-value practices, identify practices of this kind possibly present in the hospital and barriers and facilitators to reduce them. Low-value practices include those with little or no clinical benefit that may harm patients or lead to a waste of resources. METHOD: Using a mixed methodology, we carried out a survey and two focus groups in a tertiary hospital. In the survey, we assessed doctors' agreement, subjective adherence and perception of usefulness of 134 recommendations to reduce low-value practices from local and international initiatives. We also identified low-value practices possibly present in the hospital. In the focus groups with professionals from surgical and medical fields, using a phenomenological approach, we identified additional low-value practices, barriers and facilitators to reduce them. RESULTS: 169 doctors of 25 specialties participated (response rate: 7%-100%). Overall agreement with recommendations, subjective adherence and usefulness were 83%, 90% and 70%, respectively. Low-value practices form 22 recommendations (16%) were considered as possibly present in the hospital. In the focus groups, the professionals identified seven more. Defensive medicine and scepticism due to contradictory evidence were the main barriers. Facilitators included good leadership and coordination between professionals. CONCLUSIONS: High agreement with recommendations to reduce low-value practices and high perception of usefulness reflect great awareness of low-value care in the hospital. However, there are several barriers to reduce them. Interventions to reduce low-value practices should foster confidence in decision-making processes between professionals and patients and provide trusted evidence


OBJETIVO: Explorar las opiniones de profesionales sanitarios sobre las prácticas de poco valor, identificar aquellas posiblemente presentes en el hospital y las barreras y los facilitadores para reducirlas. Las prácticas de poco valor incluyen aquellas con poco beneficio clínico que pueden perjudicar a los pacientes o desperdiciar recursos. MÉTODO: Usando una metodología mixta se llevaron a cabo una encuesta y varios grupos focales en un hospital terciario. En la encuesta se evaluó el grado de acuerdo, la adherencia subjetiva y la percepción de utilidad de 134 recomendaciones para reducir las prácticas de poco valor de iniciativas locales e internacionales, y se identificaron aquellas que podrían estar realizándose en el hospital. En dos grupos focales con profesionales de campos médicos y quirúrgicos, utilizando un enfoque fenomenológico, se identificaron prácticas de poco valor adicionales, barreras y facilitadores para reducirlas. RESULTADOS: En la encuesta participaron 169 médicos de 25 especialidades (tasa de respuesta: 7-100%). El acuerdo con las recomendaciones, la adherencia subjetiva y la utilidad fueron del 83%, el 90% y el 70%, respectivamente. Se identificaron prácticas de poco valor de 22 recomendaciones (16%) posiblemente presentes en el hospital. En los grupos focales se identificaron siete prácticas de poco valor adicionales; la medicina defensiva y el escepticismo debido a evidencia contradictoria como principales barreras; y un buen liderazgo y la coordinación entre profesionales como facilitadores. CONCLUSIONES: El alto grado de acuerdo con las recomendaciones para reducir las prácticas de poco valor y la alta percepción de utilidad reflejan una gran concienciación sobre este problema en el hospital. Sin embargo, existen numerosas barreras para eliminarlas. Las intervenciones para reducirlas deberían fomentar la confianza en la toma de decisiones entre profesionales y pacientes, y proporcionar una evidencia confiable


Assuntos
Humanos , Assistência à Saúde/classificação , Imperícia/classificação , Padrões de Prática Médica/organização & administração , Grupos Focais , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , 25783 , Pessoal de Saúde/estatística & dados numéricos , Tomada de Decisão Clínica
2.
Gac Sanit ; 34(5): 459-467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30745093

RESUMO

OBJECTIVE: To explore healthcare professionals' opinions about low-value practices, identify practices of this kind possibly present in the hospital and barriers and facilitators to reduce them. Low-value practices include those with little or no clinical benefit that may harm patients or lead to a waste of resources. METHOD: Using a mixed methodology, we carried out a survey and two focus groups in a tertiary hospital. In the survey, we assessed doctors' agreement, subjective adherence and perception of usefulness of 134 recommendations to reduce low-value practices from local and international initiatives. We also identified low-value practices possibly present in the hospital. In the focus groups with professionals from surgical and medical fields, using a phenomenological approach, we identified additional low-value practices, barriers and facilitators to reduce them. RESULTS: 169 doctors of 25 specialties participated (response rate: 7%-100%). Overall agreement with recommendations, subjective adherence and usefulness were 83%, 90% and 70%, respectively. Low-value practices form 22 recommendations (16%) were considered as possibly present in the hospital. In the focus groups, the professionals identified seven more. Defensive medicine and scepticism due to contradictory evidence were the main barriers. Facilitators included good leadership and coordination between professionals. CONCLUSIONS: High agreement with recommendations to reduce low-value practices and high perception of usefulness reflect great awareness of low-value care in the hospital. However, there are several barriers to reduce them. Interventions to reduce low-value practices should foster confidence in decision-making processes between professionals and patients and provide trusted evidence.

3.
J Clin Nurs ; 28(21-22): 4053-4061, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31287603

RESUMO

AIMS AND OBJECTIVES: To evaluate the opinion of hospital nurses on a group of recommendations aimed at reducing low-value nursing care and, based on these results, to detect low-value practices probably existing in the hospital. BACKGROUND: Low-value nursing care refers to clinical practices with poor or no benefit for patients that may be harmful and a waste of resources. Detecting these practices and understanding nurses' perceptions are essential to developing effective interventions to reduce them. METHODS: We conducted a survey in a tertiary hospital. STROBE guidelines were followed. The questionnaire appraised nurses' agreement, subjective adherence and perception of usefulness of a group of recommendations to reduce low-value nursing care from Choosing Wisely and other initiatives. Practices described in recommendations with an agreement over 70% and a subjective adherence under 70% were categorised as low-value practices probably existing in the hospital. RESULTS: A total of 265 nurses from eight areas of care participated in the survey. The response rate by area ranged between 2%-55%. From the 38 recommendations evaluated, agreement was 96% (95% confidence interval [95%CI], 95%-97%), median subjective adherence was 80% (95%CI, 80%-85%), and usefulness was 90% (95%CI, 89%-92%). Based on these results, we detected seven (0-15) low-value practices probably existing in our hospital, mostly on general practice, pregnancy care and wound care. CONCLUSIONS: We found a great understanding of low-value care between nurses, given the high agreement to recommendations and perception of usefulness. However, several low-value practices may be present in nursing care, requiring actions to reduce them, for instance, reviewing institutional protocols and involving patients in de-implementation. RELEVANCE TO CLINICAL PRACTICE: Hospitals and other settings should be aware of low-value practices and take actions to identify and reduce them. A survey may be a simple and helpful way to start this process.


Assuntos
Recursos Humanos de Enfermagem no Hospital/normas , Estudos Transversais , Assistência à Saúde/normas , Humanos , Processo de Enfermagem/normas , Padrões de Prática em Enfermagem/normas , Inquéritos e Questionários
4.
BMC Nephrol ; 20(1): 192, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138205

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is a worldwide public health problem. Clinical practice guidelines (CPGs) are being developed and implemented in order to improve clinical practice related to the detection and treatment of CKD. The objective of our study was to evaluate the quality of CPGs regarding the CKD and to examine whether there are factors which influence their quality. METHODS: A systematic search was conducted to identify all CPGs regarding the early diagnosis and treatment of CKD. The CPGs quality were evaluated by three reviewers using the AGREE II instrument to decide if the guidelines are recommended for their use in clinical practice. RESULTS: In total, 13 CPGs were identified: five from America, six from Europe, one from Asia, and one from Oceania. Five CPGs were recommended for their use in clinical practice; since all their domains achieved the medium or high category. Furthermore, six CPGs were recommended with modifications, as the stakeholders' involvement, applicability, and editorial independence domains were evaluated as low category. These domains, as well as the rigor of the development domain, reached the very low category in those CPGs that were not recommended for its use in clinical practice. In all CPGs, the domains with the lowest average were the stakeholder involvement and the applicability. When comparing the domains of the CPGs according to the origin, type of developer group, the checklist used during the development and the publication period, a significantly higher average in the domain stakeholder involvement was found in the CPGs from Asia and Oceania compared to the ones in Latin America. Additionally, a significantly higher average in the applicability domain was found in the CPGs developed by CPGs developer organizations compared to those developed by medical societies. CONCLUSIONS: In total, 85% of the CPGs regarding CKD were recommended or recommended with modifications. The stakeholder involvement and applicability domains are assessed in the low category, which might affect the CPGs implementation. In order to save resources in low- and middle-income countries, an adaptation of the recommended CPGs should be considered.


Assuntos
Guias de Prática Clínica como Assunto/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Lista de Checagem/métodos , Lista de Checagem/normas , Bases de Dados Factuais/normas , Humanos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Sociedades Médicas/normas
5.
Cochrane Database Syst Rev ; 8: CD012086, 2018 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-30125049

RESUMO

BACKGROUND: Brain metastases occur when cancer cells spread from their original site to the brain and are a frequent cause of morbidity and death in people with cancer. They occur in 20% to 40% of people during the course of their disease. Brain metastases are also the most frequent type of brain malignancy. Single and solitary brain metastasis is infrequent and choosing the most appropriate treatment is a clinical challenge. Surgery and stereotactic radiotherapy are two options. For surgery, tumour resection is performed using microsurgical techniques, while in stereotactic radiotherapy, external ionising radiation beams are precisely focused on the brain metastasis. Stereotactic radiotherapy may be given as a single dose, also known as single dose radiosurgery, or in a number of fractions, also known as fractionated stereotactic radiotherapy. There is uncertainty regarding which treatment (surgery or stereotactic radiotherapy) is more effective for people with single or solitary brain metastasis. OBJECTIVES: To assess the effectiveness and safety of surgery versus stereotactic radiotherapy for people with single or solitary brain metastasis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, March 2018), MEDLINE and Embase up to 25 March 2018 for relevant studies. We also searched trials databases, grey literature and handsearched relevant literature. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing surgery versus stereotactic radiotherapy, either a single fraction (stereotactic radiosurgery) or multiple fractions (fractionated stereotactic radiotherapy) for treatment of single or solitary brain metastasis. DATA COLLECTION AND ANALYSIS: Two review authors screened all references, evaluated the quality of the included studies using the Cochrane tool for assessing risk of bias, and performed data extraction. The primary outcomes were overall survival and adverse events. Secondary outcomes included progression-free survival and quality of life . We analysed overall survival and progression-free survival as hazard ratios (HRs) with 95% confidence intervals (CIs), and analysed adverse events as risk ratios (RRs). For quality of life we used mean difference (MD). MAIN RESULTS: Two RCTs including 85 participants met our inclusion criteria. One study included people with single untreated brain metastasis (n = 64), and the other included people with solitary brain metastasis (22 consented to randomisation and 21 were analysed). We identified a third trial reported as completed and pending results this may be included in future updates of this review. The two included studies were prematurely closed due to poor participant accrual. One study compared surgery plus whole brain radiotherapy (WBRT) versus stereotactic radiosurgery alone, and the second study compared surgery plus WBRT versus stereotactic radiosurgery plus WBRT. Meta-analysis was not possible due to clinical heterogeneity between trial interventions. The overall certainty of evidence was low or very low for all outcomes due to high risk of bias and imprecision.We found no difference in overall survival in either of the two comparisons. For the comparison of surgery plus WBRT versus stereotactic radiosurgery alone: HR 0.92, 95% CI 0.48 to 1.77; 64 participants, very low-certainty evidence. We downgraded the certainty of the evidence to very low due to risk of bias and imprecision. For the comparison of surgery plus WBRT versus stereotactic radiosurgery plus WBRT: HR 0.53, 95% CI 0.20 to 1.42; 21 participants, low-certainty evidence. We downgraded the certainty of the evidence to low due to imprecision. Adverse events were reported in both trial groups in the two studies, showing no differences for surgery plus WBRT versus stereotactic radiosurgery alone (RR 0.31, 95% CI 0.07 to 1.44; 64 participants) and for surgery plus WBRT versus stereotactic radiosurgery plus WBRT (RR 0.37, 95% CI 0.05 to 2.98; 21 participants). Most of the adverse events were related to radiation toxicities. We considered the certainty of the evidence from the two comparisons to be very low due to risk of bias and imprecision.There was no difference in progression-free survival in the study comparing surgery plus WBRT versus stereotactic radiosurgery plus WBRT (HR 0.55, 95% CI 0.22 to 1.38; 21 participants, low-certainty evidence). We downgraded the evidence to low certainty due to imprecision. This outcome was not clearly reported for the other comparison. In general, there were no differences in quality of life between the two studies. The study comparing surgery plus WBRT versus stereotactic radiosurgery plus WBRT found no differences after two months using the QLQ-C30 global scale (MD -10.80, 95% CI -44.67 to 23.07; 14 participants, very low-certainty evidence). We downgraded the certainty of evidence to very low due to risk of bias and imprecision. AUTHORS' CONCLUSIONS: Currently, there is no definitive evidence regarding the effectiveness and safety of surgery versus stereotactic radiotherapy on overall survival, adverse events, progression-free survival and quality of life in people with single or solitary brain metastasis, and benefits must be decided on a case-by-case basis until well powered and designed trials are available. Given the difficulties in participant accrual, an international multicentred approach should be considered for future studies.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Radiocirurgia/métodos , Neoplasias Encefálicas/mortalidade , Terapia Combinada/métodos , Terapia Combinada/mortalidade , Irradiação Craniana/métodos , Irradiação Craniana/mortalidade , Humanos , Intervalo Livre de Progressão , Radiocirurgia/efeitos adversos , Radiocirurgia/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Cochrane Database Syst Rev ; 6: CD009567, 2018 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-29959871

RESUMO

BACKGROUND: Acute high altitude illness is defined as a group of cerebral and pulmonary syndromes that can occur during travel to high altitudes. It is more common above 2500 metres, but can be seen at lower elevations, especially in susceptible people. Acute high altitude illness includes a wide spectrum of syndromes defined under the terms 'acute mountain sickness' (AMS), 'high altitude cerebral oedema' and 'high altitude pulmonary oedema'. There are several interventions available to treat this condition, both pharmacological and non-pharmacological; however, there is a great uncertainty regarding their benefits and harms. OBJECTIVES: To assess the clinical effectiveness, and safety of interventions (non-pharmacological and pharmacological), as monotherapy or in any combination, for treating acute high altitude illness. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS, ISI Web of Science, CINAHL, Wanfang database and the World Health Organization International Clinical Trials Registry Platform for ongoing studies on 10 August 2017. We did not apply any language restriction. SELECTION CRITERIA: We included randomized controlled trials evaluating the effects of pharmacological and non-pharmacological interventions for individuals suffering from acute high altitude illness: acute mountain sickness, high altitude pulmonary oedema or high altitude cerebral oedema. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility of study reports, the risk of bias for each and performed the data extraction. We resolved disagreements through discussion with a third author. We assessed the quality of evidence with GRADE. MAIN RESULTS: We included 13 studies enrolling a total of 468 participants. We identified two ongoing studies. All studies included adults, and two studies included both teenagers and adults. The 13 studies took place in high altitude areas, mostly in the European Alps. Twelve studies included participants with acute mountain sickness, and one study included participants with high altitude pulmonary oedema. Follow-up was usually less than one day. We downgraded the quality of the evidence in most cases due to risk of bias and imprecision. We report results for the main comparisons as follows.Non-pharmacological interventions (3 studies, 124 participants)All-cause mortality and complete relief of AMS symptoms were not reported in the three included trials. One study in 64 participants found that a simulated descent of 193 millibars versus 20 millibars may reduce the average of symptoms to 2.5 vs 3.1 units after 12 hours of treatment (clinical score ranged from 0 to 11 ‒ worse; reduction of 0.6 points on average with the intervention; low quality of evidence). In addition, no complications were found with use of hyperbaric chambers versus supplementary oxygen (one study; 29 participants; low-quality evidence).Pharmacological interventions (11 trials, 375 participants)All-cause mortality was not reported in the 11 included trials. One trial found a greater proportion of participants with complete relief of AMS symptoms after 12 and 16 hours when dexamethasone was administered in comparison with placebo (47.1% versus 0%, respectively; one study; 35 participants; low quality of evidence). Likewise, when acetazolamide was compared with placebo, the effects on symptom severity was uncertain (standardized mean difference (SMD) -1.15, 95% CI -2.56 to 0.27; 2 studies, 25 participants; low-quality evidence). One trial of dexamethasone in comparison with placebo in 35 participants found a reduction in symptom severity (difference on change in the AMS score: 3.7 units reported by authors; moderate quality of evidence). The effects from two additional trials comparing gabapentin with placebo and magnesium with placebo on symptom severity at the end of treatment were uncertain. For gabapentin versus placebo: mean visual analogue scale (VAS) score of 2.92 versus 4.75, respectively; 24 participants; low quality of evidence. For magnesium versus placebo: mean scores of 9 and 10.3 units, respectively; 25 participants; low quality of evidence). The trials did not find adverse events from either treatment (low quality of evidence). One trial comparing magnesium sulphate versus placebo found that flushing was a frequent event in the magnesium sulphate arm (percentage of flushing: 75% versus 7.7%, respectively; one study; 25 participants; low quality of evidence). AUTHORS' CONCLUSIONS: There is limited available evidence to determine the effects of non-pharmacological and pharmacological interventions in treating acute high altitude illness. Low-quality evidence suggests that dexamethasone and acetazolamide might reduce AMS score compared to placebo. However, the clinical benefits and harms related to these potential interventions remain unclear. Overall, the evidence is of limited practical significance in the clinical field. High-quality research in this field is needed, since most trials were poorly conducted and reported.


Assuntos
Doença da Altitude/terapia , Acetazolamida/uso terapêutico , Doença Aguda , Adolescente , Adulto , Aminas/uso terapêutico , Anticonvulsivantes/uso terapêutico , Pressão Atmosférica , Ácidos Cicloexanocarboxílicos/uso terapêutico , Dexametasona/uso terapêutico , Gabapentina , Glucocorticoides/uso terapêutico , Humanos , Hipertensão Pulmonar/terapia , Magnésio/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Ácido gama-Aminobutírico/uso terapêutico
10.
PLoS One ; 11(2): e0147943, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26840451

RESUMO

OBJECTIVE: To describe the development of a novel on-line database aimed to serve as a source of information concerning healthcare interventions appraised for their clinical value and appropriateness by several initiatives worldwide, and to present a retrospective analysis of the appraisals already included in the database. METHODS AND FINDINGS: Database development and a retrospective analysis. The database DianaHealth.com is already on-line and it is regularly updated, independent, open access and available in English and Spanish. Initiatives are identified in medical news, in article references, and by contacting experts in the field. We include appraisals in the form of clinical recommendations, expert analyses, conclusions from systematic reviews, and original research that label any health care intervention as low-value or inappropriate. We obtain the information necessary to classify the appraisals according to type of intervention, specialties involved, publication year, authoring initiative, and key words. The database is accessible through a search engine which retrieves a list of appraisals and a link to the website where they were published. DianaHealth.com also provides a brief description of the initiatives and a section where users can report new appraisals or suggest new initiatives. From January 2014 to July 2015, the on-line database included 2940 appraisals from 22 initiatives: eleven campaigns gathering clinical recommendations from scientific societies, five sets of conclusions from literature review, three sets of recommendations from guidelines, two collections of articles on low clinical value in medical journals, and an initiative of our own. CONCLUSIONS: We have developed an open access on-line database of appraisals about healthcare interventions considered of low clinical value or inappropriate. DianaHealth.com could help physicians and other stakeholders make better decisions concerning patient care and healthcare systems sustainability. Future efforts should be focused on assessing the impact of these appraisals in the clinical practice.


Assuntos
Bases de Dados Factuais , Assistência à Saúde , Serviços de Saúde , Navegador , Tomada de Decisões , Humanos , Estudos Retrospectivos
11.
Cochrane Database Syst Rev ; (12): CD009745, 2015 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-26633306

RESUMO

BACKGROUND: A blood transfusion is an acute intervention, implemented to solve life and health-threatening conditions on a short-term basis. However, blood transfusions have adverse events, some of them potentially related to immune modulation or to a direct transmission of infectious agents (e.g. cytomegalovirus). Leukoreduction is a process in which the white blood cells are intentionally reduced in packed red blood cells (PRBCs) in order to reduce the risk of adverse reactions. The potential benefits of leukoreduced PRBCs in all types of transfused patients for decreasing infectious and non-infectious complications remain unclear. OBJECTIVES: To determine the clinical effectiveness of leukoreduction of packed red blood cells for preventing adverse reactions following allogeneic blood transfusion. SEARCH METHODS: We ran the most recent search on 10th November 2015. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), MEDLINE (OvidSP), Embase(OvidSP), CINAHL Plus (EBSCO), LILACS (BIREME), and clinical trials registers. In addition, we checked the reference lists of all relevant trials and reviews identified in the literature searches. SELECTION CRITERIA: Randomised clinical trials including patients of all ages requiring PRBC allogeneic transfusion. Any study was eligible for inclusion, regardless of the length of participant follow-up or country where the study was performed. The primary outcome was transfusion-related acute lung injury (TRALI). Secondary outcomes were death from any cause, infection from any cause, non-infectious complications and any other adverse event. DATA COLLECTION AND ANALYSIS: At least two review authors independently performed study selection, 'Risk of bias' assessments and data extraction. We estimated pooled relative risk for dichotomous outcomes, and we measured statistical heterogeneity using I² statistic. The random-effects model was used to synthesise results. We conducted a trial sequential analysis to assess the risk of random errors in cumulative meta-analyses. MAIN RESULTS: Thirteen studies, most including adult patients, met the eligibility criteria. We found no clear evidence of an effect of leukoreduced PRBC versus non-leukoreduced PRBC in patients that were randomised to receive transfusion for the following outcomes: TRALI: RR 0.96, 95% CI 0.67 to 1.36, P = 0.80 from one trial reporting data on 1864 trauma patients. The accrued information of 1864 participants constituted only 28.5% of the diversity-adjusted required information size (DARIS) of 6548 participants. The quality of evidence was low. Death from any cause: RR 0.81, 95% CI 0.58 to 1.12, I² statistic = 63%, P = 0.20 from nine trials reporting data on 6485 cardiovascular surgical patients, gastro-oncology surgical patients, trauma patients and HIV infected patients. The accrued information of 6485 participants constituted only 55.3% of the DARIS of 11,735 participants. The quality of evidence was very low. Infection from any cause: RR 0.80, 95% CI 0.62 to 1.03, I² statistic = 84%, P = 0.08 from 10 trials reporting data on 6709 cardiovascular surgical patients, gastro-oncology surgical patients, trauma patients and HIV infected patients. The accrued information of 6709 participants constituted only 60.6% of the DARIS of 11,062 participants. The quality of evidence was very low. Adverse events: The only adverse event reported as an adverse event was fever (RR 0.81, 95% CI 0.64 to 1.02; I² statistic= 0%, P = 0.07). Fever was reported in two trials on 634 cardiovascular surgical and gastro-oncology surgical patients. The accrued information of 634 participants constituted only 84.4% of the DARIS of 751 participants. The quality of evidence was low. Incidence of other non-infectious complications: This outcome was not assessed in any included trial. AUTHORS' CONCLUSIONS: There is no clear evidence for supporting or rejecting the routine use of leukoreduction in all patients requiring PRBC transfusion for preventing TRALI, death, infection, non-infectious complications and other adverse events. As the quality of evidence is very low to low, more evidence is needed before a definitive conclusion can be drawn.


Assuntos
Transfusão de Eritrócitos/efeitos adversos , Procedimentos de Redução de Leucócitos , Adolescente , Adulto , Causas de Morte , Feminino , Humanos , Infecções/etiologia , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
Health Info Libr J ; 32(4): 276-86, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26192997

RESUMO

OBJECTIVES: Journals in languages other than English that publish original clinical research are often not well covered in the main biomedical databases and therefore often not included in systematic reviews. This study aimed to identify Spanish language biomedical journals from Spain and Latin America and to describe their main features. METHODS: Journals were identified in electronic databases, publishers' catalogues and local registries. Eligibility was determined by assessing data from these sources or the journals' websites, when available. FINDINGS: A total of 2457 journals were initially identified; 1498 met inclusion criteria. Spain (27.3%), Mexico (16.0%), Argentina (15.1%) and Chile (11.9%) had the highest number of journals. Most (85.8%) are currently active; 87.8% have an ISSN. The median and mean length of publication were 22 and 29 years, respectively. A total of 66.0% were indexed in at least one database; 3.0% had an impact factor in 2012. A total of 845 journals had websites (56.4%), of which 700 (82.8%) were searchable and 681 (80.6%) free of charge. CONCLUSIONS: Most of the identified journals have no impact factor or are not indexed in any of the major databases. The list of identified biomedical journals can be a useful resource when conducting hand searching activities and identifying clinical trials that otherwise would not be retrieved.


Assuntos
Bases de Dados Bibliográficas/provisão & distribução , Idioma , Editoração/tendências , Humanos , Fator de Impacto de Revistas , América Latina , Editoração/provisão & distribução , Pesquisa/estatística & dados numéricos , Espanha
13.
Cochrane Database Syst Rev ; (7): CD007887, 2015 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-26176166

RESUMO

BACKGROUND: This is an updated version of the original Cochrane review published in Issue 8, 2011, on 'Drug therapy for treating post-dural puncture headache'.Post-dural puncture headache (PDPH) is the most common complication of lumbar puncture, an invasive procedure frequently performed in the emergency room. Numerous pharmaceutical drugs have been proposed to treat PDPH but there are still some uncertainties about their clinical effectiveness. OBJECTIVES: To assess the effectiveness and safety of drugs for treating PDPH in adults and children. SEARCH METHODS: The searches included the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 6), MEDLINE and MEDLINE in Process (from 1950 to 29 July 2014), EMBASE (from 1980 to 29 July 2014) and CINAHL (from 1982 to July 2014). There were no language restrictions. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) assessing the effectiveness of any pharmacological drug used for treating PDPH. Outcome measures considered for this review were: PDPH persistence of any severity at follow-up (primary outcome), daily activity limited by headache, conservative supplementary therapeutic option offered, epidural blood patch performed, change in pain severity scores, improvements in pain severity scores, number of days participants stay in hospital, any possible adverse events and missing data. DATA COLLECTION AND ANALYSIS: Review authors independently selected studies, assessed risk of bias and extracted data. We estimated risk ratios (RR) for dichotomous data and mean differences (MD) for continuous outcomes. We calculated a 95% confidence interval (CI) for each RR and MD. We did not undertake meta-analysis because the included studies assessed different sorts of drugs or different outcomes. We performed an intention-to-treat (ITT) analysis. MAIN RESULTS: We included 13 small RCTs (479 participants) in this review (at least 274 participants were women, with 118 parturients after a lumbar puncture for regional anaesthesia). In the original version of this Cochrane review, only seven small RCTs (200 participants) were included. Pharmacological drugs assessed were oral and intravenous caffeine, subcutaneous sumatriptan, oral gabapentin, oral pregabalin, oral theophylline, intravenous hydrocortisone, intravenous cosyntropin and intramuscular adrenocorticotropic hormone (ACTH).Two RCTs reported data for PDPH persistence of any severity at follow-up (primary outcome). Caffeine reduced the number of participants with PDPH at one to two hours when compared to placebo. Treatment with caffeine also decreased the need for a conservative supplementary therapeutic option.Treatment with gabapentin resulted in better visual analogue scale (VAS) scores after one, two, three and four days when compared with placebo and also when compared with ergotamine plus caffeine at two, three and four days. Treatment with hydrocortisone plus conventional treatment showed better VAS scores at six, 24 and 48 hours when compared with conventional treatment alone and also when compared with placebo. Treatment with theophylline showed better VAS scores compared with acetaminophen at two, six and 12 hours and also compared with conservative treatment at eight, 16 and 24 hours. Theophylline also showed a lower mean "sum of pain" when compared with placebo. Sumatriptan and ACTH did not show any relevant effect for this outcome.Theophylline resulted in a higher proportion of participants reporting an improvement in pain scores when compared with conservative treatment.There were no clinically significant drug adverse events.The rest of the outcomes were not reported by the included RCTs or did not show any relevant effect. AUTHORS' CONCLUSIONS: None of the new included studies have provided additional information to change the conclusions of the last published version of the original Cochrane review. Caffeine has shown effectiveness for treating PDPH, decreasing the proportion of participants with PDPH persistence and those requiring supplementary interventions, when compared with placebo. Gabapentin, hydrocortisone and theophylline have been shown to decrease pain severity scores. Theophylline has also been shown to increase the proportion of participants that report an improvement in pain scores when compared with conventional treatment.There is a lack of conclusive evidence for the other drugs assessed (sumatriptan, adrenocorticotropic hormone, pregabalin and cosyntropin).These conclusions should be interpreted with caution, due to the lack of information to allow correct appraisal of risk of bias, the small sample sizes of the studies and also their limited generalisability, as nearly half of the participants were postpartum women in their 30s.


Assuntos
Analgésicos/uso terapêutico , Cefaleia Pós-Punção Dural/tratamento farmacológico , Punção Espinal/efeitos adversos , Hormônio Adrenocorticotrópico/uso terapêutico , Adulto , Aminas/uso terapêutico , Placa de Sangue Epidural/métodos , Cafeína/uso terapêutico , Ácidos Cicloexanocarboxílicos/uso terapêutico , Feminino , Gabapentina , Humanos , Hidrocortisona/uso terapêutico , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sumatriptana/uso terapêutico , Teofilina/uso terapêutico , Resultado do Tratamento , Ácido gama-Aminobutírico/uso terapêutico
14.
Rev Esp Cardiol (Engl Ed) ; 67(2): 94-100, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24795115

RESUMO

INTRODUCTION AND OBJECTIVES: In Spain, various SCORE tables are available to estimate cardiovascular risk: tables for low-risk countries, tables calibrated for the Spanish population, and tables that include high-density lipoprotein values. The aim of this study is to assess the impact of using one or another SCORE table in clinical practice. METHODS: In a cross-sectional study carried out in two primary health care centers, individuals aged 40 to 65 years in whom blood pressure and total cholesterol levels were recorded between March 2010 and March 2012 were selected. Patients with diabetes or a history of cardiovascular disease were excluded. Cardiovascular risk was calculated using SCORE for low-risk countries, SCORE with high-density lipoprotein cholesterol, and the calibrated SCORE. RESULTS: Cardiovascular risk was estimated in 3716 patients. The percentage of patients at high or very high risk was 1.24% with SCORE with high-density lipoprotein cholesterol, 4.73% with the low-risk SCORE, and 15.44% with the calibrated SCORE (P<.01). Treatment with lipid-lowering drugs would be recommended in 10.23% of patients using the calibrated SCORE, 3.12% of patients using the low-risk SCORE, and 0.67% of patients using SCORE with high-density lipoprotein cholesterol. CONCLUSIONS: The calibrated SCORE table classifies a larger number of patients at high or very high risk than the SCORE for low-risk countries or the SCORE with high-density lipoprotein cholesterol. Therefore, its use would imply treating more patients with lipid-lowering medication. Validation studies are needed to assess the most appropriate SCORE table for use in our setting.


Assuntos
Doenças Cardiovasculares/epidemiologia , Medição de Risco/métodos , Adulto , Idoso , Pressão Sanguínea , Doenças Cardiovasculares/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Estudos Transversais , Feminino , Humanos , Hipolipemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumar/epidemiologia , Espanha/epidemiologia
15.
Rev. esp. cardiol. (Ed. impr.) ; 67(2): 94-100, feb. 2014. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-120480

RESUMO

Introducción y objetivos. En España disponemos de tablas SCORE para el cálculo del riesgo cardiovascular en países de bajo riesgo, tablas calibradas para la población española, y unas tablas que permiten incluir el colesterol unido a lipoproteínas de alta densidad. Este estudio pretende evaluar el impacto de la utilización de una u otra tabla de riesgo en la práctica clínica. Métodos. Estudio transversal realizado en dos centros de salud. Se seleccionó a sujetos de entre 40 y 65 años de edad que contaran con un registro de presión arterial y colesterol total entre marzo de 2010 y marzo de 2012. Se excluyó a los sujetos con antecedente de diabetes mellitus o enfermedad cardiovascular. Se calculó el riesgo utilizando las tablas SCORE para países de bajo riesgo, tablas SCORE con colesterol unido a lipoproteínas de alta densidad y tablas SCORE calibrado. Resultados. Se calculó el riesgo cardiovascular a 3.716 pacientes. Los pacientes de alto o muy alto riesgo fueron el 1,24% con SCORE con colesterol unido a lipoproteínas de alta densidad, el 4,73% con SCORE para países de bajo riesgo y el 15,44% con SCORE calibrado (p < 0,01). Utilizando el SCORE calibrado, deberíamos tratar con hipolipemiantes al 10,23% de los pacientes; con el SCORE para países de bajo riesgo, al 3,12%, y con el SCORE con colesterol unido a lipoproteínas de alta densidad, al 0,67%. Conclusiones. La tabla SCORE calibrado identifica a más pacientes de alto riesgo que las del SCORE de bajo riesgo y el SCORE con colesterol unido a lipoproteínas de alta densidad, por lo que su utilización implicaría tratar a más pacientes con estatinas. Son necesarios estudios de validación del SCORE para valorar la tabla más adecuada en nuestro medio (AU)


Introduction and objectives. In Spain, various SCORE tables are available to estimate cardiovascular risk: tables for low-risk countries, tables calibrated for the Spanish population, and tables that include high-density lipoprotein values. The aim of this study is to assess the impact of using one or another SCORE table in clinical practice. Methods. In a cross-sectional study carried out in two primary health care centers, individuals aged 40 to 65 years in whom blood pressure and total cholesterol levels were recorded between March 2010 and March 2012 were selected. Patients with diabetes or a history of cardiovascular disease were excluded. Cardiovascular risk was calculated using SCORE for low-risk countries, SCORE with high-density lipoprotein cholesterol, and the calibrated SCORE. Results. Cardiovascular risk was estimated in 3716 patients. The percentage of patients at high or very high risk was 1.24% with SCORE with high-density lipoprotein cholesterol, 4.73% with the low-risk SCORE, and 15.44% with the calibrated SCORE (P<.01). Treatment with lipid-lowering drugs would be recommended in 10.23% of patients using the calibrated SCORE, 3.12% of patients using the low-risk SCORE, and 0.67% of patients using SCORE with high-density lipoprotein cholesterol. Conclusions. The calibrated SCORE table classifies a larger number of patients at high or very high risk than the SCORE for low-risk countries or the SCORE with high-density lipoprotein cholesterol. Therefore, its use would imply treating more patients with lipid-lowering medication. Validation studies are needed to assess the most appropriate SCORE table for use in our setting (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco , Doenças Cardiovasculares , Técnicas de Diagnóstico Cardiovascular/instrumentação , Técnicas de Diagnóstico Cardiovascular , Estudos Transversais/métodos , Estudos Transversais , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Análise de Variância
16.
Implement Sci ; 8: 42, 2013 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-23574918

RESUMO

BACKGROUND: The objective of this research is to generate quality of care indicators from systematic reviews to assess the appropriateness of obstetric care in hospitals. METHODS: A search for systematic reviews about hospital obstetric interventions, conducted in The Cochrane Library, clinical evidence and practice guidelines, identified 303 reviews. We selected 48 high-quality evidence reviews, which resulted in strong clinical recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The 255 remaining reviews were excluded, mainly due to a lack of strong evidence provided by the studies reviewed. RESULTS: A total of 18 indicators were formulated from these clinical recommendations, on antepartum care (8), care during delivery and postpartum (9), and incomplete miscarriage (1). Authors of the systematic reviews and specialists in obstetrics were consulted to refine the formulation of indicators. CONCLUSIONS: High-quality systematic reviews, whose conclusions clearly claim in favour or against an intervention, can be a source for generating quality indicators of delivery care. To make indicators coherent, the nuances of clinical practice should be considered. Any attempt made to evaluate the extent to which delivery care in hospitals is based on scientific evidence should take the generated indicators into account.


Assuntos
Assistência à Saúde/normas , Hospitalização , Complicações na Gravidez/terapia , Cuidado Pré-Natal/normas , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Medicina Baseada em Evidências , Estudos de Viabilidade , Feminino , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Literatura de Revisão como Assunto
17.
Rev. colomb. cancerol ; 17(1): 3-10, ene.-mar. 2013. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-729549

RESUMO

Objetivo: Describir las características epidemiológicas, clínicas y de tratamiento de los pacientes con tumores de tejidos blandos, melanoma y carcinomas escamocelulares del Servicio de Seno y Tejidos Blandos del instituto nacional de Cancerologìa con amputaciones mayores de extremidades entre los años 1998 y 2008. Métodos: Se revisaron 80 historias clínicas de pacientes adultos en quienes se realizó amputación mayor de una extremidad entre enero de 1998 y diciembre de 2008, en el Servicio de Seno y Tejidos Blandos del instituto nacional de Cancerología. Resultados: Se identificaron 24 pacientes con hemipelvectomía clásica, 22 con desarticulación de cadera, 19 con desarticulación interescapulotorácica, 8 con hemihemipelvectomía y 7 con desarticulación de hombro. los diagnósticos en orden de frecuencia fueron: sarcomas de tejidos blandos, 72,5%; carcinomas escamocelulares, 21,2%; melanoma, 6,2%. la intención de la cirugía fue curativa en 50% de los casos. En los pacientes en los cuales la intención de la cirugía fue paliativa, se presentó un mayor número de complicaciones, con significancia estadística solo para necrosis de los colgajos (22,5 vs. 5% p = 0,02). la supervivencia en los pacientes con intención curativa luego del primer año de cirugía fue de 67,5 vs. 42,5% para cirugía paliativa (p = 0,038). Conclusiones: En pacientes con tumores proximales de las extremidades con imposibilidad de cirugías preservadoras, las amputaciones mayores continúan siendo una opción terapéutica válida, a pesar de su alto índice de complicaciones.


Objective: To describe the epidemiological, clinical and treatment characteristics of patients with soft tissue tumours, melanoma, and squamous cell carcinomas of the Breast and Soft Tissue Department of the Instituto Nacional de Cancerología, who had major limb amputations between the years 1998 and 2008. Methods: a review was made of the clinical records of 80 patients in whom a major limb amputation was performed between January 1998 and December 2008 in the Breast and Soft Tissue Department of the Instituto Nacional de Cancerología. Results: Of the 80 patients studied, 24 had a classic hemipelvectomy, 22 with hip disarticulation, 19 with interscapular-thoracic disarticulation, 8 with hemi-hemipelvectomy, and 7 with shoulder disarticulation. The diagnoses, in order of frequency were: soft tissue sarcomas, 72.5%; squamous cell carcinomas, 21.2%; and melanoma, 6.2%. The intention of the surgery was curative in 50% of the cases. There was a greater number of complications in the patients where the intention of the surgery was palliative, with a significant significance only for necrosis of flaps (22.5% vs. 5% p=.02). The one-year survival in the patients with intention to cure surgery was 67.5% vs. 42.5% for palliative surgery (p=.038). Conclusions: in patients with tumours proximal to the limbs, where preservative surgery is impossible, major amputations continue to be a valid therapeutic option, despite its high rate of complications.


Assuntos
Humanos , Cirurgia Geral , Amputação , Neoplasias , Terapêutica , Registros , Oncologia
18.
Rev. colomb. cancerol ; 13(2): 69-76, jun. 2009. tab, graf
Artigo em Espanhol | LILACS | ID: lil-661677

RESUMO

Objetivo: Determinar la cobertura de examen clínico y mamografía de tamización para cáncer de mama en un grupo de mujeres bogotanas afiliadas a seguros de salud. Métodos: Se realizó una encuesta telefónica a 4.526 mujeres entre 50 y 69 años, residentes en Bogotá y en municipios vecinos, afiliadas a tres compañías de seguros de salud. Se excluyeron las mujeres con antecedente personal de cáncer de mama. La cobertura de tamización se valoró como la proporción de mujeres con antecedente de mamografía y examen clínico de la mama. Se estimó la frecuencia en la vida, en los últimos dos años y en el último año. Se analizaron factores asociados a la práctica de tamización, mediante el cálculo de OR ajustados. Resultados: La frecuencia de vida de uso del examen clínico y mamografía fue de 59,3% y 79,8% respectivamente; el 49,7% y el 65,6% de las mujeres se realizó los exámenes con fines de tamización; el resto, con fines diagnósticos (sintomáticas). El 34,2% tenía examen clínico en el último año, y el 54%, mamografía en los últimos dos años. La educación y el antecedente familiar de cáncer de mama estuvieron asociados a la práctica de tamización. Conclusiones: La cobertura de examen clínico de la mama como método de tamización es baja. Las coberturas de mamografía son superiores a lo exigido por el sistema colombiano, pero inferiores a las coberturas útiles reportadas en países desarrollados.


Objectives: To determine the coverage of clinical breast examination (CBE) and mammography for screening of breast cancer among a group of insured women in Bogotá. Methods: A telephone survey was carried out with 4,526 women between the ages of 50 and 69, residing in Bogotá or its suburbs, who were insured by one of three commercial health plans. Women with a history of breast cancer were excluded. Screening coverage was estimated as the proportion of women who had had a mammography or CBE. Estimates were established for lifetime frequency, two years prior the survey, and one year prior the survey. Factors associated with screening procedures were analyzed with calculations based on adjusted OR. Results: Lifetime frequency of CBE was 59.3% and 79.8% for mammography; and 49.7% and 65.6% of women respectively underwent the tests for screening purposes; the remainder, for diagnostic purposes (breast symptoms). CBE reported a 34.2% one year coverage and mammography reported a 54% two years coverage. Screening was associated to cancer education and family history of breast cancer. Conclusion: Coverage of CBE for screening purposes is low. Mammography coverage is above that required by the Colombian Health Ministry, but below that reported by developed countries.


Assuntos
Humanos , Adulto , Feminino , Neoplasias da Mama , Estudos de Coortes , Programas de Rastreamento/métodos , Cobertura de Serviços de Saúde , Inquéritos Epidemiológicos , Colômbia
19.
Breast Care (Basel) ; 3(1): 29-32, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-20824017

RESUMO

Breast cancer is increasing in developing countries, and Colombia has a double burden from cervical and breast cancer. Suitable guidelines for breast cancer early detection are needed, and the Breast Health Global Initiative provides a favorable framework for breast cancer control in low resource nations. The Colombian National Cancer Institute developed evidence-based guidelines for breast cancer early detection in which coordinated early detection in symptomatic women and hospital-based screening in women aged 50-69 are recommended. A pilot project to evaluate programmatic approaches (opportunistic screening) was designed, and it is expected that organized hospital-based screening for breast cancer will represent a move towards population-based screening in the near future in accordance with country specific conditions.

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