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2.
Trials ; 20(1): 729-735, dez., 2019. tab., graf.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1049617

RESUMO

BACKGROUND: A considerable amount of randomized controlled trials (RCTs) have been published on statins and/or fibrates for diabetic retinopathy, a clinical condition associated with high social and economic burden. Adherence to the CONSORT statement items is imperative to ensure transparency and reproducibility in clinical research. The aim of this study is to assess the reporting quality and the adherence to CONSORT of RCTs assessing statins and/or fibrates for diabetic retinopathy. METHODS: We conducted a critical appraisal study at Discipline of Evidence-based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp). A sensitive literature search was performed to identify all relevant RCTs, with no time or language limits. Two authors independently evaluated the reporting quality of the selected RCTs using the CONSORT statement as a standard. RESULTS: Thirteen reports of RCTs were included in this study. The adherence of the reports to CONSORT items ranged from 24% to 68%. The median score was 11 (interquartile range (IQR) 8 to 13). When analyzed separately, the methods sections of the reports had a median of three items (IQR 2 to 4) judged adherent to the methods items of CONSORT (items 3 to 12). The most underreported items were those related to trial design, title and abstract, allocation concealment, implementation of the randomization sequence, and blinding. Other important items, such as the one related to the description of the inclusion criteria, also had low adherence. CONCLUSIONS: The overall adherence to the CONSORT checklist items was poor, especially in the items related to the methods section. RCT reports on statins and/or fibrates for diabetic retinopathy must be optimized to avoid reporting biases and to improve transparency and reproducibility. (AU)


Assuntos
Ensaios Clínicos como Assunto , Viés de Publicação , Inibidores de Hidroximetilglutaril-CoA Redutases , Retinopatia Diabética , Hipolipemiantes
3.
Diabetol Metab Syndr ; 11: 92, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31719846

RESUMO

Evidence from observational studies have found a relationship between serum cholesterol and diabetic retinopathy (DR). Apart of the assumption that cholesterolemic control has benefits for patients with diabetes with or without retinopathy, the effects of lipid-lowering drugs have not been properly mapped and critically assessed so far. The objective of this study was to evaluate the effects of statins and/or fibrates on prevention and progression of DR. We conducted a Systematic review of randomized controlled trials (RCTs) following the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance to PRISMA Statement. GRADE approach was used to summarize the certainty of the evidence. Eight RCTs that fulfilled our eligibility criteria were included, assessing the effects of fibrates (n = 4), statins (n = 3) and fibrate plus statins (n = 1) for therapy (n = 8) or prevention (n = 4) of DR. Overall, the main concern regarding risk of bias assessment was due to incomplete outcome data because high rate of losses in five RCTs. Furthermore, the risk of reporting bias was rated unclear due the lack of previously published protocol in seven RCTs. Fibrates seemed to be associated with a 45% risk reduction of macular edema incidence (Relative Risk 0.55, 95% confidence interval of 0.38 to 0.81, 1309 participants, 2 RCTs, I2 = 0%, low certainty of the evidence). The certainty of evidence for other outcomes was also very low or low, and we are uncertain regarding the effects of fibrates for DR. Overall, adverse events seemed to be similar between fibrate and placebo, but again based on the width of the confidence intervals, an important increase of adverse events cannot be rule out. The combination statin/fibrate did not seem to have benefit for visual acuity but is likely that further studies can modify this estimate since the current evidence is limited. Adverse events and quality of life were not measured or reported. Concluding, this study found eight RCTs, with limited methodological quality, that assessed the effects of fibrates and/or statins for DR. Based on these findings, we are uncertain about the effects of statins for DR. Fibrates seemed to reduce the incidence of macular edema (low certainty evidence) without increase adverse events (low to very low certainty evidence). Number of Protocol registration PROSPERO CRD42016029746.

4.
Diabetol. metab. syndr ; 00: 01-14, Nov. 2019. tabela, gráfico
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1025136

RESUMO

Abstract Evidence from observational studies have found a relationship between serum cholesterol and diabetic retinopathy (DR). Apart of the assumption that cholesterolemic control has benefits for patients with diabetes with or without retinopathy, the effects of lipid-lowering drugs have not been properly mapped and critically assessed so far. The objective of this study was to evaluate the effects of statins and/or fibrates on prevention and progression of DR. We conducted a Systematic review of randomized controlled trials (RCTs) following the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance to PRISMA Statement. GRADE approach was used to summarize the certainty of the evidence. Eight RCTs that fulfilled our eligibility criteria were included, assessing the effects of fibrates (n = 4), statins (n = 3) and fibrate plus statins (n = 1) for therapy (n = 8) or prevention (n = 4) of DR. Overall, the main concern regarding risk of bias assessment was due to incomplete outcome data because high rate of losses in five RCTs. Furthermore, the risk of reporting bias was rated unclear due the lack of previously published protocol in seven RCTs. Fibrates seemed to be associated with a 45% risk reduction of macular edema incidence (Relative Risk 0.55, 95% confidence interval of 0.38 to 0.81, 1309 participants, 2 RCTs, I2 = 0%, low certainty of the evidence). The certainty of evidence for other outcomes was also very low or low, and we are uncertain regarding the effects of fibrates for DR. Overall, adverse events seemed to be similar between fibrate and placebo, but again based on the width of the confidence intervals, an important increase of adverse events cannot be rule out. The combination statin/fibrate did not seem to have benefit for visual acuity but is likely that further studies can modify this estimate since the current evidence is limited. Adverse events and quality of life were not measured or reported. Concluding, this study found eight RCTs, with limited methodological quality, that assessed the effects of fibrates and/or statins for DR. Based on these findings, we are uncertain about the effects of statins for DR. Fibrates seemed to reduce the incidence of macular edema (low certainty evidence) without increase adverse events (low to very low certainty evidence). Number of Protocol registration PROSPERO CRD42016029746. (AU)


Assuntos
Metanálise , Inibidores de Hidroximetilglutaril-CoA Redutases , Retinopatia Diabética , Ácidos Fíbricos
5.
J Pain ; 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31513934

RESUMO

This systematic review investigated the effectiveness and safety of botulinum toxin type A (BTX-A) for painful temporomandibular disorders. We searched for randomized controlled trials (RCTs) in 10 databases, from inception to February 12, 2019 (MEDLINE, EMBASE, CENTRAL, LILACS, BBO, Web of Science, Scopus, ClinicalTrials.gov, WHO and OpenGrey). We included 12 RCTs that compared BTX-A versus inactive or active interventions. BTX-A was slightly more effective than placebo for pain reduction at 1 month: mean difference -1.74 points (0-10 scale), 95% confidence interval -2.94 to -.54, 3 RCTs, 60 participants, I-square (I2) = 0%. However, there were no significant differences at 3 and 6 months. BTX-A was similar to no treatment for pain reduction at 3 and 6 months. BTX-A was more effective than conventional treatment and low-level laser therapy for pain reduction at 1, 6, and 12 months, but less effective than facial manipulation for pain reduction at 3 months. BTX-A was not associated with a significant increase in the risk of adverse events. The quality of the evidence was low, and results are insufficient to support the use of BTX-A for painful temporomandibular disorders. High-quality RCTs are needed to increase confidence in effect estimates. PERSPECTIVE: BTX-A for painful temporomandibular disorders appears to be well tolerated. For pain reduction, BTX-A is slightly more effective than placebo only at 1 month; conventional treatment and low-level laser at 1, 6, and 12 months. Low-quality evidence limits the applicability of these findings and precludes recommendations for practice.

6.
Diagn. tratamento ; 24(3): [119-125], jul - set. 2019.
Artigo em Português | LILACS | ID: biblio-1026704

RESUMO

Contexto: Estima-se que no Brasil 72% das pessoas ativas no mercado de trabalho apresentem algum problema relacionado ao estresse ocupacional, e aproximadamente 32% delas são diagnosticadas como tendo síndrome de burnout. Objetivo: Apresentar as evidências de revisões sistemáticas (RSs) Cochrane sobre eficácia e segurança das estratégias de tratamento e prevenção da síndrome de burnout. Métodos: RSs foram incluídas a partir de busca sistematizada realizada na Biblioteca Cochrane e após a adequação aos critérios de elegibilidade. O resumo e a certeza no corpo das evidências encontradas por cada revisão foram apresentados. Resultados: Foram incluídas seis RSs que avaliaram estratégias de prevenção e tratamento de burnout e outros sintomas relacionados ao desgaste emocional do trabalho em diferentes categorias profissionais. A certeza no corpo das evidências obtidas foi baixa ou muito baixa para a maioria dos desfechos. A única evidência com moderada certeza de seus resultados mostrou que técnicas de relaxamento, quando comparadas a nenhuma intervenção, parecem reduzir o estresse de profissionais da saúde. Conclusão: Apesar da elevada prevalência e das crescentes estimativas de incidência no Brasil e em todo o mundo, ainda há poucos estudos primários e RSs Cochrane avaliando os efeitos de intervenções com potencial de prevenir ou tratar a síndrome de burnout. Nenhuma das RSs identificadas aqui forneceu evidências robustas de alta certeza sobre intervenções para o manejo desta síndrome. RSs conduzidas sob o rigor da metodologia Cochrane precisam ainda esclarecer os efeitos (benefícios e riscos) de alternativas terapêuticas farmacológicas e não farmacológicas já usadas na prática clínica para promoção da saúde do trabalhador no sentido de prevenir e tratar a síndrome de burnout.


Assuntos
Humanos , Masculino , Feminino , Esgotamento Profissional , Revisão , Medicina Baseada em Evidências , Prática Clínica Baseada em Evidências , Tomada de Decisão Clínica
7.
BMJ Evid Based Med ; 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266765

RESUMO

A review of systematic reviews (SRs) and a critical appraisal study was conducted at Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp). The objectives of this review are (1) to identify all published SRs comparing the effectiveness and safety of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) for carotid artery stenosis, (2) to assess their methodological quality and (3) to compare the primary studies contained in each SR. We included 17 SRs published between 2005 and 2017. None of the SRs fulfilled all items of AMSTAR-2. The overall confidence in the results was graded as critically low for 16 SRs (94%) and low for 1 SR (6%). Five items were judged inadequate in all SRs: reference to a published protocol, explanation to the selection of study design, comprehensive search of the literature, methods for statistical combination of findings and consideration of the risk of bias on the results of meta-analysis. In total, 15 randomised clinical trials (RCTs) were included at least in one SR. The number of included RCTs in each SR was inconsistent (4 to 15) and was not related to the year of publication of the SR. Our study found redundant and low methodological quality SR comparing CAS versus CEA for carotid stenosis.

8.
J Child Neurol ; 34(11): 679-686, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31179823

RESUMO

AIM: To assess the effects of neurodevelopmental treatment for children with cerebral palsy. METHODS: We conducted a systematic review following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance to PRISMA Statement. Through a comprehensive literature search we considered all randomized clinical trials that compared neurodevelopmental treatment with conventional physical therapy for children with cerebral palsy. We used the Cochrane Risk of Bias Table to assess the risk of bias of the included randomized clinical trial, and the GRADE approach to evaluate the certainty of the body of the evidence. RESULTS: We found 3 randomized clinical trials (2 published and 1 ongoing) comprising 66 children. Published randomized clinical trials presented methodological and reporting limitations and only 1 provided data for outcomes of interest. No difference between neurodevelopmental treatment and conventional physical therapy was found for gross motor function (mean difference 1.40; 95% confidence interval -5.47 to 8.27, low certainty evidence). CONCLUSION: This review found that the effects of neurodevelopmental treatment for children with cerebral palsy are still uncertain. Further studies are required to assess the efficacy and safety of neurodevelopmental treatment for this purpose and until there, current evidence do not support its routinely use in practice. Number of protocol registration in PROSPERO database: CRD42017082817 (available from https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=82817 ).

9.
Sao Paulo Med J ; 137(1): 82-91, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31116276

RESUMO

BACKGROUND: Irritable bowel syndrome (IBS) is a clinical disorder associated with high socioeconomic burden. Despite its importance, management of IBS remains difficult and several interventions have been hypothesized as beneficial for this condition. This study identified and summarized all Cochrane systematic reviews (SRs) about the effects of interventions for managing IBS patients. DESIGN AND SETTING: Review of systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: Review of Cochrane SRs addressing interventions for IBS. RESULTS: We included six SRs assessing acupuncture, bulking agents, antispasmodics, antidepressants, herbal medicines, homeopathy, hypnotherapy and psychological therapy for IBS. The certainty of evidence ranged from unknown to moderate, mainly due to imprecision in the estimates and high risk of bias from the primary studies included. There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life, compared with sham acupuncture. There was also very low certainty of evidence that homeopathic asafoetida, used alone or in association with nux, was better than placebo regarding self-reported overall improvement. CONCLUSION: There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life. Further well-designed and well-conducted randomized clinical trials are needed in order to reduce the uncertainties regarding the most commonly used interventions for patients with IBS.


Assuntos
Gerenciamento Clínico , Síndrome do Intestino Irritável/terapia , Revisão Sistemática como Assunto , Medicina Baseada em Evidências , Humanos , Síndrome do Intestino Irritável/psicologia , Psicoterapia/métodos , Resultado do Tratamento
10.
Säo Paulo med. j ; 137(1): 82-91, Jan.-Feb. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1004735

RESUMO

ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) is a clinical disorder associated with high socioeconomic burden. Despite its importance, management of IBS remains difficult and several interventions have been hypothesized as beneficial for this condition. This study identified and summarized all Cochrane systematic reviews (SRs) about the effects of interventions for managing IBS patients. DESIGN AND SETTING: Review of systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: Review of Cochrane SRs addressing interventions for IBS. RESULTS: We included six SRs assessing acupuncture, bulking agents, antispasmodics, antidepressants, herbal medicines, homeopathy, hypnotherapy and psychological therapy for IBS. The certainty of evidence ranged from unknown to moderate, mainly due to imprecision in the estimates and high risk of bias from the primary studies included. There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life, compared with sham acupuncture. There was also very low certainty of evidence that homeopathic asafoetida, used alone or in association with nux, was better than placebo regarding self-reported overall improvement. CONCLUSION: There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life. Further well-designed and well-conducted randomized clinical trials are needed in order to reduce the uncertainties regarding the most commonly used interventions for patients with IBS.

11.
Int J Clin Pract ; 73(2): e13295, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30444561

RESUMO

INTRODUCTION: Stroke is a major cause of death and disability worldwide. The use of modafinil, a wakefulness-promoting agent, is hypothesised to benefit stroke patients. METHODS: We performed a systematic review in accordance with the Cochrane Handbook for Systematic Reviews of Interventions recommendations to assess the efficacy and safety of modafinil in poststroke patients. We prospectively registered the review protocol in PROSPERO (CRD42017078465) and reported the systematic review following the PRISMA statement. RESULTS: Two published studies (77 participants) and one ongoing randomised controlled trial, with limited methodological quality, assessed the effects of modafinil (200 mg or 400 mg) for adults from 14 days poststroke up to 3 months poststroke and fulfilled our inclusion criteria. The clinical and methodological variability between studies precluded meta-analyses. Overall, these studies showed some benefit of modafinil for fatigue, but no benefit for disability, cognition, and for subscores of stroke-specific quality of life. Data for adverse events were scarce and mortality was not considered by studies. Due to very low quality related to the evidence, we are uncertain about the effects of modafinil for all outcomes assessed by our systematic review. CONCLUSION: Based on two small randomised controlled trial, which provided very low quality evidence, the effects (benefits and harms) of modafinil for stroke patients are unclear and do not support its routinely use in clinical practice for this clinical situation. Number of Protocol registration in PROSPERO database: CRD42017078465 (available from http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017078465).


Assuntos
Modafinila/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Promotores da Vigília/uso terapêutico , Cognição , Fadiga/tratamento farmacológico , Fadiga/etiologia , Humanos , Modafinila/efeitos adversos , Qualidade de Vida , Acidente Vascular Cerebral/complicações , Promotores da Vigília/efeitos adversos
12.
Säo Paulo med. j ; 136(6): 579-585, Nov.-Dec. 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-991688

RESUMO

ABSTRACT CONTEXT AND OBJECTIVE: Insomnia is a frequent complaint that generates more than five million visits to doctors per year in the United States. This study summarizes all Cochrane systematic reviews (SRs) that evaluated interventions to treat insomnia. DESIGN AND SETTING: Review of SRs, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: A sensitive search was carried out in the Cochrane Database of Systematic Reviews to identify Cochrane SRs that assessed the effects of any type of intervention for people with insomnia. The results, main characteristics of the SRs and the certainty of the evidence obtained from them were synthesized and discussed. RESULTS: Seven SRs were included. They addressed the benefits and harm of acupuncture (n = 1), behavioral interventions (n = 1), music (n = 1), pharmacotherapy (n = 2), phototherapy (n = 1) and physical exercise (n = 1). The certainty of the evidence ranged from moderate to very low. CONCLUSION: Acupuncture, music, physical exercise, paroxetine, doxepin, trimipramine and trazodone seem to present some benefit for patients with insomnia. However, the uncertainty around these results means that no robust and definitive recommendations for clinical practice can be made until the benefits and harms from each intervention for patients with insomnia have been confirmed through further studies.

13.
Sao Paulo Med J ; 136(5): 472-478, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30365598

RESUMO

BACKGROUND: The therapeutic effects of cannabinoid compounds have been the center of many investigations. This study provides a synthesis on all Cochrane systematic reviews (SRs) that assessed the use of cannabinoids as a therapeutic approach. DESIGN AND SETTING: Review of SRs, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: A broad search was conducted in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed the efficacy and safety of cannabinoids as a therapeutic approach. The results and key characteristics of all reviews included were summarized and discussed. RESULTS: Eight SRs were included. They assessed the use of cannabinoids for the following types of conditions: neurological (two SRs), psychiatric (two SRs), rheumatological (one SR), infectious (one SR) and oncological (two SRs). There was moderate-quality evidence showing that the use of cannabinoids reduced nausea and vomiting among adults, compared with placebo. Additionally, there was moderate-quality evidence showing that there was no difference between cannabinoids and prochlorperazine regarding the number of participants who reported vomiting, in this same population. CONCLUSIONS: This review identified eight Cochrane systematic reviews that provided evidence of unknown to moderate quality regarding the use of cannabinoids as a therapeutic intervention. Further studies are still imperative for solid conclusions to be reached regarding practical recommendations.


Assuntos
Canabinoides/uso terapêutico , Revisão Sistemática como Assunto , Demência/tratamento farmacológico , Epilepsia/tratamento farmacológico , Medicina Baseada em Evidências/normas , Fibromialgia/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Humanos , Náusea/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Síndrome de Tourette/tratamento farmacológico , Vômito/tratamento farmacológico
14.
Säo Paulo med. j ; 136(5): 472-478, Sept.-Oct. 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-979377

RESUMO

ABSTRACT BACKGROUND: The therapeutic effects of cannabinoid compounds have been the center of many investigations. This study provides a synthesis on all Cochrane systematic reviews (SRs) that assessed the use of cannabinoids as a therapeutic approach. DESIGN AND SETTING: Review of SRs, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: A broad search was conducted in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed the efficacy and safety of cannabinoids as a therapeutic approach. The results and key characteristics of all reviews included were summarized and discussed. RESULTS: Eight SRs were included. They assessed the use of cannabinoids for the following types of conditions: neurological (two SRs), psychiatric (two SRs), rheumatological (one SR), infectious (one SR) and oncological (two SRs). There was moderate-quality evidence showing that the use of cannabinoids reduced nausea and vomiting among adults, compared with placebo. Additionally, there was moderate-quality evidence showing that there was no difference between cannabinoids and prochlorperazine regarding the number of participants who reported vomiting, in this same population. CONCLUSIONS: This review identified eight Cochrane systematic reviews that provided evidence of unknown to moderate quality regarding the use of cannabinoids as a therapeutic intervention. Further studies are still imperative for solid conclusions to be reached regarding practical recommendations.

15.
Diagn. tratamento ; 23(4): [141-146], out-dez 2018. tab, fig
Artigo em Português | LILACS | ID: biblio-987476

RESUMO

Introdução: Guidelines em saúde somente terão benefícios potenciais se tiverem sido planejadas e desenvolvidas com alto rigor metodológico. Objetivos: Apresentar e descrever os itens da ferramenta Appraisal of Guidelines for Research & Evaluation, AGREE II. Métodos: Estudo descritivo realizado na Disciplina de Medicina Baseada em Evidências da Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). Resultados: Os 23 itens da ferramenta AGREE II foram apresentados em sua versão em português, assim como as recomendações para sua aplicação. Conclusão: O AGREE II é uma ferramenta internacional, já disponível em vários idiomas, e que avalia o rigor metodológico e a transparência com que uma guideline é desenvolvida. Pode ser aplicada a guidelines novas, já existentes ou atualizações de guidelines prévias. O uso do AGREE II no desenvolvimento de guidelines em saúde precisa ser disseminado, uma vez que tais guidelines somente terão benefícios potenciais se tiverem sido planejadas e desenvolvidas com alto rigor metodológico.


Assuntos
Protocolos Clínicos , Guias de Prática Clínica como Assunto , Medicina Baseada em Evidências , Fidelidade a Diretrizes , Metodologia
16.
Diagn. tratamento ; 23(4): [160-169], out-dez 2018. tab
Artigo em Português | LILACS | ID: biblio-987493

RESUMO

Contexto: A pancreatite aguda é uma inflamação aguda do pâncreas, na qual as enzimas digestivas pancreáticas são ativadas no parênquima do próprio órgão e na circulação sanguínea, levando a uma resposta inflamatória sistêmica. Diversos testes diagnósticos e intervenções terapêuticas são opções no manejo desses participantes. Objetivo: avaliar as evidências de revisões sistemáticas Cochrane sobre acurácia, efetividade e segurança no manejo da pancreatite aguda. Métodos: Foram incluídas revisões sistemáticas a partir de busca sistematizada na Biblioteca Cochrane. Dois autores avaliaram a concordância com os critérios de inclusão das revisões encontradas e apresentaram uma síntese qualitativa de seus achados. Resultados: Foram incluídas 11 revisões sistemáticas Cochrane que encontraram evidências de qualidade variada sobre testes diagnósticos e intervenções terapêuticas para pancreatite aguda. Nenhuma evidência atual é de alta qualidade. Nenhuma análise comparativa de acurácia foi realizada entre os testes diagnósticos. Evidência de qualidade moderada demonstrou superioridade da dieta enteral sobre a parenteral, e não houve evidência de benefícios da colangiopancreatografia retrógrada endoscópica precoce para casos em que não haja colangite ou coledocolitíase associada à pancreatite aguda. Conclusão: A única evidência de moderada qualidade (e, portanto, que pode ser modificada após a inclusão de novos estudos) é referente à maior efetividade e segurança da dieta enteral quando comparada à parenteral na pancreatite aguda.


Assuntos
Pancreatite , Revisão , Medicina Baseada em Evidências , Prática Clínica Baseada em Evidências , Tomada de Decisão Clínica
18.
Diagn. tratamento ; 23(3): [101-104], jul.-set. 2018. fig, tab
Artigo em Português | LILACS | ID: biblio-969297

RESUMO

Introdução: O registro prospectivo de protocolos de revisões sistemáticas (RSs) permite avaliar a condução do estudo e a qualidade do relato de seus resultados, aumentando a transparência e a reprodutibilidade. Objetivos: Apresentar a base de registros PROSPERO e descrever suas principais características. Métodos: Estudo descritivo realizado na Disciplina de Medicina Baseada em Evidências da Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). Resultados: A PROSPERO é uma base de registros de RSs, gratuita, mantida pelo Centre of Reviews and Dissemination, da Universidade de York, e financiada pelo National Institute for Health Research (NIHR). Atualmente, há mais de 35.000 registros de RSs em andamento em humanos ou animais que estudam desfechos em saúde. Conclusão: PROSPERO é uma base pública de registro de protocolos de revisões sistemáticas criada em 2011, que conta até o momento com mais de 35.000 protocolos registrados. O registro prospectivo desses protocolos já é recomendado por muitos periódicos em saúde com o objetivo de minimizar o risco de viés de publicação e a duplicidade de revisões para responder a uma mesma questão clínica.


Assuntos
Sistema de Registros , Protocolos Clínicos , Métodos Epidemiológicos , Revisão , Medicina Baseada em Evidências
19.
Sao Paulo Med J ; 136(4): 354-360, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30133547

RESUMO

CONTEXT AND OBJECTIVE: Psoriasis is a common chronic inflammatory skin disease characterized by abnormal and increased growth of the cells that produce keratin and abnormal functioning of the immune system. We aimed to summarize the evidence available regarding interventions for patients with psoriasis. DESIGN AND SETTING: Review of systematic reviews, developed in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: A systematic search was conducted to identify Cochrane systematic reviews that fulfilled the eligibility criteria. Two authors screened titles and abstracts that had been retrieved through the search strategy. The results from all the Cochrane systematic reviews that were included were summarized and presented in a narrative synthesis. RESULTS: We included six Cochrane systematic reviews assessing interventions for treating psoriasis. The findings from high-quality evidence were that (a) etanercept reduced the psoriasis severity index, compared with placebo and (b) steroids plus vitamin D, compared with vitamin D alone, improved the skin clearance rate, as assessed by investigators, but was associated with a higher proportion of participants who dropped out due to adverse events. For all other comparisons, the quality of the evidence ranged from moderate to very low. CONCLUSION: This review included six Cochrane systematic reviews that provided evidence ranging in quality from unknown to high, regarding management of psoriasis. Further randomized controlled trials are imperative to reduce the uncertainties relating to several treatments that are already used in clinical practice.


Assuntos
Ensaios Clínicos como Assunto , Medicina Baseada em Evidências , Psoríase/terapia , Revisão Sistemática como Assunto , Humanos
20.
Säo Paulo med. j ; 136(4): 354-360, July-Aug. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-962731

RESUMO

ABSTRACT CONTEXT AND OBJECTIVE: Psoriasis is a common chronic inflammatory skin disease characterized by abnormal and increased growth of the cells that produce keratin and abnormal functioning of the immune system. We aimed to summarize the evidence available regarding interventions for patients with psoriasis. DESIGN AND SETTING: Review of systematic reviews, developed in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: A systematic search was conducted to identify Cochrane systematic reviews that fulfilled the eligibility criteria. Two authors screened titles and abstracts that had been retrieved through the search strategy. The results from all the Cochrane systematic reviews that were included were summarized and presented in a narrative synthesis. RESULTS: We included six Cochrane systematic reviews assessing interventions for treating psoriasis. The findings from high-quality evidence were that (a) etanercept reduced the psoriasis severity index, compared with placebo and (b) steroids plus vitamin D, compared with vitamin D alone, improved the skin clearance rate, as assessed by investigators, but was associated with a higher proportion of participants who dropped out due to adverse events. For all other comparisons, the quality of the evidence ranged from moderate to very low. CONCLUSION: This review included six Cochrane systematic reviews that provided evidence ranging in quality from unknown to high, regarding management of psoriasis. Further randomized controlled trials are imperative to reduce the uncertainties relating to several treatments that are already used in clinical practice.

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