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1.
Cochrane Database Syst Rev ; 6: CD012726, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32542676

RESUMO

BACKGROUND: Hydrocephalus is a common neurological disorder, caused by a progressive accumulation of cerebrospinal fluid (CSF) within the intracranial space that can lead to increased intracranial pressure, enlargement of the ventricles (ventriculomegaly) and, consequently, to brain damage. Ventriculo-peritoneal shunt systems are the mainstay therapy for this condition, however there are different types of shunt systems. OBJECTIVES: To compare the effectiveness and adverse effects of conventional and complex shunt devices for CSF diversion in people with hydrocephalus. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (2020 Issue 2); Ovid MEDLINE (1946 to February 2020); Embase (Elsevier) (1974 to February 2020); Latin American and Caribbean Health Science Information Database (LILACS) (1980 to February 2020); ClinicalTrials.gov; and World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA: We selected randomised controlled trials or quasi-randomised trials of different types of ventriculo-peritoneal shunting devices for people with hydrocephalus. Primary outcomes included: treatment failure, adverse events and mortality. DATA COLLECTION AND ANALYSIS: Two review authors screened studies for selection, assessed risk of bias and extracted data. Due to the scarcity of data, we performed a Synthesis Without Meta-analysis (SWiM) incorporating GRADE for the quality of the evidence. MAIN RESULTS: We included six studies with 962 participants assessing the effects of standard valves compared to anti-syphon valves, other types of standard valves, self-adjusting CSF flow-regulating valves and external differential programmable pressure valves. All included studies started in a hospital setting and offered ambulatory follow-up. Most studies were conducted in infants or children with hydrocephalus from diverse causes. The certainty of the evidence for most comparisons was low to very low. 1. Standard valve versus anti-syphon valve Three studies with 296 randomised participants were included under this comparison. We are uncertain about the incidence of treatment failure in participants with standard valve and anti-syphon valves (very low certainty of the evidence). The incidence of adverse events may be similar in those with standard valves (range 0 to 1.9%) and anti-syphon valves (range 0 to 2.9%) (low certainty of the evidence). Mortality may be similar in those with standard valves (0%) and anti-syphon valves (0.9%) (RD 0.01%, 95% CI -0.02% to 0.03%, low certainty of the evidence). Ventricular size and head circumference may be similar in those with standard valves and anti-syphon valves (low certainty of the evidence). None of the included studies reported the quality of life of participants. 2. Comparison between different types of standard valves Two studies with 174 randomised participants were included under this comparison. We are uncertain about the incidence of treatment failure in participants with different types of standard valves (early postoperative period: RR 0.41, 95% CI 0.13 to 1.27; at 12 months follow-up: RR 1.17, 95% CI 0.72 to 1.92, very low certainty of the evidence). None of the included studies reported adverse events beyond those included under "treatment failure". We are uncertain about the effects of different types of standard valves on mortality (range 2% to 17%, very low certainty of the evidence). The included studies did not report the effects of these interventions on quality of life, ventricular size reduction or head circumference. 3. Standard valve versus self-adjusting CSF flow-regulating valve One study with 229 randomised participants addressed this comparison. The incidence of treatment failure may be similar in those with standard valves (42.98%) and self-adjusting CSF flow-regulating valves (39.13%) (low certainty of the evidence). The incidence of adverse events may be similar in those with standard valves (range 0 to 1.9%) and those with self-adjusting CSF flow-regulating valves (range 0 to 7.2%) (low certainty of the evidence). The included study reported no deaths in either group in the postoperative period. Beyond the early postoperative period, the authors stated that nine patients died (no disaggregated data by each type of intervention was available, low certainty of the evidence). The included studies did not report the effects of these interventions on quality of life, ventricular size reduction or head circumference. 4. External differential programmable pressure valve versus non-programmable valve One study with 377 randomised participants addressed this comparison. The incidence of treatment failure may be similar in those with programmable valves (52%) and non-programmable valves (52%)  (RR 1.02, 95% CI 0.84 to 1.24, low certainty of the evidence). The incidence of adverse events may be similar in those with programmable valves (6.19%) and non-programmable valves (6.01%) (RR 0.97, 95% CI 0.44 to 2.15, low certainty of the evidence). The included study did not report the effect of these interventions on mortality, quality of life or head circumference. Ventricular size reduction may be similar in those with programmable valves and non-programmable valves (low certainty of the evidence). AUTHORS' CONCLUSIONS: Standard shunt valves for hydrocephalus compared to anti-syphon or self-adjusting CSF flow-regulating valves may cause little to no difference on the main outcomes of this review, however we are very uncertain due to the low to very low certainty of evidence. Similarly, different types of standard valves and external differential programmable pressure valves versus non-programmable valves may be associated with similar outcomes. Nevertheless, this review did not include valves with the latest technology, for which we need high-quality randomised controlled trials focusing on patient-important outcomes including costs.


Assuntos
Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/instrumentação , Criança , Desenho de Equipamento , Humanos , Hidrocefalia/complicações , Hidrocefalia/mortalidade , Lactente , Microcomputadores , Ensaios Clínicos Controlados Aleatórios como Assunto , Falha de Tratamento , Incerteza , Derivação Ventriculoperitoneal/efeitos adversos , Derivação Ventriculoperitoneal/mortalidade
2.
Arch. argent. pediatr ; 118(2): 125-: I-129, I, abr. 2020. tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1100167

RESUMO

Introducción. Investigadores canadienses desarrollaron un cuestionario autoadministrado para indagar sobre la intención de los participantes de actividades de desarrollo profesional continuo (DPC) de transferir los conocimientos adquiridos en ámbitos áulicos a la práctica clínica. Su uso podría facilitar los procesos de mejora de la calidad en dichas actividades de DPC.Objetivo. Realizar la traducción y adaptación transcultural y validación del cuestionario REACTION (A theoRy-basEd instrument to assess the impACT of continuing profesional development activities on profesional behavIOr chaNge) para su uso en la Argentina, a partir de la versión original en inglés.Población y métodos. Se realizó la traducción y adaptación transcultural de los 12 ítems del instrumento, con un proceso de cinco pasos. La validez de constructo se exploró mediante el análisis factorial exploratorio, y la confiabilidad, a través del coeficiente de Cronbach y el coeficiente G.Resultados. La versión final del cuestionario se aplicó a una muestra de 133 médicos asistentes a 9 actividades presenciales de DPC de un hospital universitario de la Ciudad de Buenos Aires (edad promedio: 38 años; el 23,3 %, hombres; el 76 %, médicos de familia). El análisis factorial exploratorio arrojó 3 factores (influencia social, confianza en las capacidades propias y criterio ético). El coeficiente de Cronbach fue 0,82 y el coeficiente G fue 0,72.Conclusiones. Se realizó la adaptación y validación de la versión argentina del instrumento REACTION para evaluar el impacto del DPC enfocado en el entrenamiento de habilidades clínicas en la intención de los médicos de implementarlo en su práctica.


Introduction. Canadian researchers developed a self-administered questionnaire to ask participants of continuing professional development (CPD) activities about their intention to translate the knowledge acquired in the classroom into clinical practice. The questionnaire may facilitate quality improvement processes in such CPD activities.Objective. To translate, cross-culturally adapt and validate the original English REACTION questionnaire (A theoRy-basEd instrument to assess the impACT of continuing professional development activities on professional behavIOr chaNge) for its use in Argentina.Population and methods. The 12 questionnaire items were translated and cross-culturally adapted using a five-step process. The construct validity was assessed using an exploratory factor analysis, whereas reliability, with Cronbach's coefficient and the G coefficient.Results. The final questionnaire version was administered to a sample of 133 physicians who attended 9 CPD activities at a teaching hospital in the Autonomous City of Buenos Aires (average age: 38 years; 23.3 %, men; 76 %, family physicians). The exploratory factor analysis showed 3 factors (social influence, confidence in one's abilities, and ethical judgment). Cronbach's coefficient was 0.82 and the G coefficient, 0.72.Conclusions. The Argentine version of the REACTION questionnaire was adapted and validated to assess the impact of CPD centered on clinical skills training on physicians' intention to implement it in their practice


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Médicos/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Educação Médica Continuada , Tradução , Atitude do Pessoal de Saúde , Coleta de Dados , Inquéritos e Questionários , Reprodutibilidade dos Testes , Adaptação
3.
Arch Argent Pediatr ; 118(2): 125-129, 2020 04.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32199047

RESUMO

INTRODUCTION: Canadian researchers developed a self-administered questionnaire to ask participants of continuing professional development (CPD) activities about their intention to translate the knowledge acquired in the classroom into clinical practice. The questionnaire may facilitate quality improvement processes in such CPD activities. OBJECTIVE: To translate, cross-culturally adapt and validate the original English REACTION questionnaire (A theoRy-basEd instrument to assess the impACT of continuing professional development activities on professional behavIOr chaNge) for its use in Argentina. POPULATION AND METHODS: The 12 questionnaire items were translated and cross-culturally adapted using a five-step process. The construct validity was assessed using an exploratory factor analysis, whereas reliability, with Cronbach's coefficient and the G coefficient. RESULTS: The final questionnaire version was administered to a sample of 133 physicians who attended 9 CPD activities at a teaching hospital in the Autonomous City of Buenos Aires (average age: 38 years; 23.3 %, men; 76 %, family physicians). The exploratory factor analysis showed 3 factors (social influence, confidence in one's abilities, and ethical judgment). Cronbach's coefficient was 0.82 and the G coefficient, 0.72. CONCLUSIONS: The Argentine version of the REACTION questionnaire was adapted and validated to assess the impact of CPD centered on clinical skills training on physicians' intention to implement it in their practice.

4.
BJU Int ; 125(4): 490-496, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31899937

RESUMO

OBJECTIVE: To assess the effects of pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). PATIENTS AND METHODS: We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was July 2019. We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available pharmacological interventions. Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. The primary outcomes were prostatitis symptoms and adverse events. The secondary outcomes were sexual dysfunction, urinary symptoms, quality of life, anxiety and depression. RESULTS: We included 99 unique studies in 9119 men with CP/CPPS, with assessments of 16 types of pharmacological interventions. Most of our comparisons included short-term follow-up information. The median age of the participants was 38 years. Most studies did not specify their funding sources; 21 studies reported funding from pharmaceutical companies. We found low- to very low-quality evidence that α-blockers may reduce prostatitis symptoms based on a reduction in National Institutes of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) scores of >2 (but <8) with an increased incidence of minor adverse events such as dizziness and hypotension. Moderate- to low-quality evidence indicates that 5α-reductase inhibitors, antibiotics, anti-inflammatories, and phytotherapy probably cause a small decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse events. Intraprostatic botulinum toxin A (BTA) injection may cause a large reduction in prostatitis symptoms with procedure-related adverse events (haematuria), but pelvic floor muscle BTA injection may not have the same effects (low-quality evidence). Allopurinol may also be ineffective for reducing prostatitis symptoms (low-quality evidence). We assessed a wide range of interventions involving traditional Chinese medicine; low-quality evidence showed they may reduce prostatitis symptoms without an increased incidence in adverse events. Moderate- to high-quality evidence indicates that the following interventions may be ineffective for the reduction of prostatitis symptoms: anticholinergics, Escherichia coli lysate (OM-89), pentosan, and pregabalin. Low- to very low-quality evidence indicates that antidepressants and tanezumab may be ineffective for the reduction of prostatitis symptoms. Low-quality evidence indicates that mepartricin and phosphodiesterase inhibitors may reduce prostatitis symptoms, without an increased incidence in adverse events. CONCLUSIONS: Based on the findings of low- to very low-quality evidence, this review found that some pharmacological interventions such as α-blockers may reduce prostatitis symptoms with an increased incidence of minor adverse events such as dizziness and hypotension. Other interventions may cause a reduction in prostatitis symptoms without an increased incidence of adverse events while others were found to be ineffective.


Assuntos
Prostatite/tratamento farmacológico , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
6.
Evid. actual. práct. ambul ; 23(2): e002042, 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1103530

RESUMO

Este artículo resume las diferentes formas de presentación clínica de la enfermedad COVID-19 causada por el virus SARS-Co-2 documentadas fundamentalmente en las tres principales revisiones sistemáticas disponibles. Entre las manifestaciones clínicas de frecuente aparición se destacan la fiebre (83 %), la tos (60 %) y la fatiga (38 %), seguidas por las mialgias (29 %), el aumento de la producción del esputo (27 %) y la disnea (25 %). Entre los hallazgos de laboratorio,predominan el aumento de los valores de proteína C reactiva (69 %), la linfopenia (57 %) y el aumento de los niveles de lactato-deshidrogenasa (52 %). Respecto de las manifestaciones radiológicas, tienen especial importancia las opacificaciones en vidrio esmerilado (80 %), la neumonía bilateral (73 %) y la afectación de tres lóbulos pulmonares o más (57 %).Si bien la evidencia sintetizada tiene limitaciones, permite una aproximación actualizada a los conocimientos disponibles sobre la clínica de esta nueva enfermedad en la población adulta. (AU)


This article summarizes the different forms of clinical presentation of COVID-19, caused by the SARS-Co-2 virus, synthesizing the information collected mainly by three published systematic reviews. Frequent clinical manifestations include fever(83 %), cough (60 %), and fatigue (38 %), followed by myalgia (29 %), increased sputum production (27 %) and dyspnea(25 %). Among the laboratory findings, the most common are the increase in C-reactive protein values (69 %), lymphopenia (57 %) and the increase in lactate dehydrogenase levels (52 %).. Most remarkable radiological features include ground glass opacifications (80 %), bilateral pneumonia (73 %) and the involvement of three or more lung lobes (57 %). Although the synthesized evidence has limitations, it allows an updated approach to the available knowledge about the clinical symptoms of this new disease in the adult population. (AU)


Assuntos
Humanos , Adulto , Adulto Jovem , Pneumonia Viral/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Betacoronavirus/patogenicidade , Pneumonia Viral/complicações , Pneumonia Viral/etiologia , Pneumonia Viral/diagnóstico por imagem , Escarro , Proteína C-Reativa/metabolismo , China , Infecções por Coronavirus/complicações , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/diagnóstico por imagem , Tosse/diagnóstico , Tosse/fisiopatologia , Tosse/sangue , Dispneia/diagnóstico , Dispneia/fisiopatologia , Dispneia/sangue , Fadiga/diagnóstico , Fadiga/fisiopatologia , Fadiga/sangue , Pandemias , Febre/diagnóstico , Febre/fisiopatologia , Febre/sangue , Mialgia/diagnóstico , Mialgia/fisiopatologia , Mialgia/sangue , L-Lactato Desidrogenase/sangue , Linfopenia/sangue
8.
Rev Fac Cien Med Univ Nac Cordoba ; 76(4): 283-241, 2019 12 04.
Artigo em Espanhol | MEDLINE | ID: mdl-31833748

RESUMO

Background: Although prostate cancer (PC) screening with prostate-specific antigen (PSA) determination could decrease mortality, concerns about the potential risk of overdiagnosis led to recommendations against this preventive practice. The objective of this study was to describe the trend in PSA determinations in men between 40 and 79 years old, affiliated to a Health Maintenance Organization (HMO) of an academic hospital in the city of Buenos Aires, Argentina, and its association with the recommendations stated by the U.S. Preventive Task Force (USPSTF) and the Instituto Nacional del Cáncer in Argentina. Methods: We analyzed a time series of aggregated data. We calculated the annual age-standardized rates of accumulated determinations of PSA for every 100 affiliates without a personal history of PC. Additionally, we compared trends by age groups every 10 years. We used Joinpoint and MS Excel programs. Results: Between 2006 and 2011 there was a growing trend in the number of PSA determinations, with an annual average of + 1.2% (95% CI, -1.0 to +3.5). Between 2011 and 2015, the number of determinations began to decrease, with a percentage annual average of -4.1% (-6.9 to -1.1). Conclusion: We found a gradual decrease in PSA utilization in men between 40 and 79 years old after the 2012 USPSTF recommendation against prostate cancer screening.


Assuntos
Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Adulto , Fatores Etários , Idoso , Argentina , Detecção Precoce de Câncer , Humanos , Masculino , Pessoa de Meia-Idade , Análise Espaço-Temporal
9.
Cochrane Database Syst Rev ; 10: CD012552, 2019 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-31587256

RESUMO

BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms. We considered a 25% decrease of NIH-CPSI baseline score or a six-point reduction as MCID. OBJECTIVES: To assess the effects of pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome. SEARCH METHODS: We performed a comprehensive search using CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, trial registries, grey literature and conference proceedings, with no restrictions on the language of publication or publication status. The date of the latest search of all databases was July 2019. SELECTION CRITERIA: We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available pharmacological interventions compared to placebo or in head-to-head comparisons. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data, and assessed the risks of bias of included studies. We assessed the quality of the evidence (QoE) using the GRADE approach. MAIN RESULTS: We included 99 unique studies in 9119 men with CP/CPPS, with assessments of 16 types of pharmacological interventions. Unless stated otherwise, our comparisons were based on short-term follow-up (less than 12 months). Most studies did not specify their funding sources; 21 studies reported funding from pharmaceutical companies.1. Alpha blockers: (24 studies, 2061 participants). We are uncertain about the effects of these drugs on prostatitis symptoms when compared to placebo at short-term follow-up (mean difference (MD) in total NIH-CPSI score -5.01, 95% confidence interval (CI) -7.41 to -2.61; 18 studies, 1524 participants, very low QoE) and at long-term follow-up (MD -5.60, 95% CI -10.89 to -0.32; 4 studies, 235 participants, very low QoE). Alpha blockers may be associated with an increased incidence of adverse events, such as dizziness and postural hypotension (risk ratio (RR) 1.60, 95% CI 1.09 to 2.34; 19 studies, 1588 participants; low QoE). Alpha blockers probably result in little to no difference in sexual dysfunction, quality of life and anxiety and depression (moderate to low QoE).2. 5-alpha reductase inhibitors (5-ARI): (2 studies, 177 participants). Finasteride probably reduces prostatitis symptoms compared to placebo (NIH-CPSI score MD -4.60, 95% CI -5.43 to -3.77; 1 study, 64 participants; moderate QoE) and may not be associated with an increased incidence of adverse events (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.3. Antibiotics: (6 studies, 693 participants). Antibiotics (quinolones) may reduce prostatitis symptoms compared to placebo (NIH-CPSI score MD -2.43, 95% CI -4.72 to -0.15; 5 studies, 372 participants; low QoE) and are probably not associated with an increased incidence in adverse events (moderate QoE). Antibiotics probably result in little to no difference in sexual dysfunction and quality of life (moderate QoE). There was no information on anxiety or depression.4. Anti-inflammatories: (7 studies, 585 participants). Anti-inflammatories may reduce prostatitis symptoms compared to placebo (NIH-CPSI scores MD -2.50, 95% CI -3.74 to -1.26; 7 studies, 585 participants; low QoE) and may not be associated with an increased incidence in adverse events (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.5. Phytotherapy: (7 studies, 551 participants). Phytotherapy may reduce prostatitis symptoms compared to placebo (NIH-CPSI scores MD -5.02, 95% CI -6.81 to -3.23; 5 studies, 320 participants; low QoE) and may not be associated with an increased incidence in adverse events (low QoE). Phytotherapy may not improve sexual dysfunction (low QoE). There was no information on quality of life or anxiety and depression.6. Botulinum toxin A (BTA): Intraprostatic BTA injection (1 study, 60 participants) may cause a large reduction in prostatitis symptom (NIH-CPSI scores MD -25.80, 95% CI -30.15 to -21.45), whereas pelvic floor muscle BTA injection (1 study, 29 participants) may not reduce prostatitis symptoms (low QoE). Both comparisons used a placebo injection. These interventions may not be associated with an increased incidence in adverse events (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.7. Allopurinol: (2 studies, 110 participants). Allopurinol may result in little to no difference in prostatitis symptoms and adverse events when compared to placebo (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.8. Traditional Chinese medicine (TCM): (7 studies, 835 participants); TCM may reduce prostatitis symptoms (NIH-CPSI score, MD -3.13, 95% CI -4.99 to -1.28; low QoE) and may not be associated with an increased incidence in adverse events (low QoE). TCM probably does not improve sexual dysfunction (moderate QoE) and may not improve symptoms of anxiety and depression (low QoE). There was no information on quality of life.The most frequent reasons for downgrading the QoE were study limitations, inconsistency and imprecision. We found few trials with active comparators. AUTHORS' CONCLUSIONS: We found low- to very low-quality evidence that alpha blockers, antibiotics, 5-ARI, anti-inflammatories, phytotherapy, intraprostatic BTA injection, and traditional Chinese medicine may cause a reduction in prostatitis symptoms without an increased incidence of adverse events in the short term, except for alpha blockers which may be associated with an increase in mild adverse events. We found few trials with active comparators and little evidence of the effects of these drugs on sexual dysfunction, quality of life or anxiety and depression. Future clinical trials should include a full report of their methods, including adequate masking, consistent assessment of all patient-important outcomes, including potential treatment-related adverse events, and appropriate sample sizes.

10.
Arch. argent. pediatr ; 117(5): 301-305, oct. 2019. ilus, tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1054956

RESUMO

Introducción. El cuestionario Car, Relax, Alone, Forget, Family and Friends, Trouble (CRAFFT) es un instrumento de tamizaje de riesgo de consumo problemático, abuso o dependencia de alcohol y sustancias en adolescentes. Si bien cuenta con una versión validada y adaptada al castellano para su utilización en adolescentes argentinos (CRAFFTa), su uso no puede generalizarse, ya que no ha sido evaluado en diferentes contextos socioculturales. Objetivo. Evaluar la transferibilidad del CRAFFTa como herramienta de pesquisa de consumo problemático, abuso y dependencia de alcohol y otras sustancias en una población adolescente de bajo nivel socioeconómico. Población y métodos. Se encuestó en forma anónima a una muestra de adolescentes de una localidad de bajos recursos del conurbano bonaerense que concurrían a dos escuelas secundarias. Se aplicó el cuestionario CRAFFT adaptado al español y validado para su uso en Argentina, y se empleó el cuestionario Problem Oriented Screening Instrument for Teenagers substance use and abuse subscale (POSITuas) como prueba de referencia. Resultados. Se obtuvieron 146 cuestionarios completos (tasa de respuesta del 89,6 %). La confiabilidad fue 0,681; validez de criterio: 0,697; sensibilidad: 93,4; especificidad: 72,5; precisión: 0,886. Valor predictivo positivo: 0,898; y negativo: 0,966. La fiabilidad compuesta fue 0,872; varianza media extractada: 0,718. La validez convergente fue aceptable en el análisis factorial confirmatorio, y se empleó una estructura unifactorial. Conclusiones. Las características operativas del CRAFFTa son aceptables para su uso en el rastreo de consumo problemático de alcohol y abuso de sustancias en una población adolescente de bajos recursos.


Introduction: The Car, Relax, Alone, Forget, Family and Friends, Trouble (CRAFFT) questionnaire is an instrument used in the screening for problematic alcohol and substance use, abuse or dependence in adolescents. While there is a Spanish-adapted and validated version for Argentine adolescents (CRAFFTa), it cannot be applied indiscriminately because it has not been assessed in different sociocultural settings. Objective: To assess the transferability of the CRAFFTa as a screening tool for problematic alcohol and drug use, abuse or dependence in an adolescent population of low socio-economic level. Population and methods: An anonymous survey was administered to low-income adolescents living in Greater Buenos Aires and attending two secondary schools. The Spanish-adapted version of the CRAFFT questionnaire, validated for its use in Argentina, was administered, while the Problem Oriented Screening Instrument for Teenagers, substance use and abuse subscale (POSITuas) questionnaire was used as a reference test. Results: A total of 146 questionnaires were completed (completion rate: 89.6 %). Reliability was 0.681; criterion validity: 0.697; sensitivity: 93.4; specificity: 72.5; precision: 0.886; positive predictive value: 0.898; negative predictive value: 0.966. Compound reliability was 0.872; average variance extracted: 0.718. Convergent validity was acceptable in the confirmatory factor analysis, and a single-factor structure was used. Conclusions: The operating characteristics of the CRAFFTa questionnaire are acceptable for its use in the screening for problematic alcohol and substance use, abuse or dependence in a low-income adolescent population.


Assuntos
Humanos , Criança , Adolescente , Detecção do Abuso de Substâncias , Programas de Rastreamento , Adolescente , Transtornos Relacionados ao Uso de Substâncias , Consumo de Álcool por Menores
12.
BJU Int ; 124(2): 197-208, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30019814

RESUMO

OBJECTIVE: To assess the effects of non-pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). PATIENTS AND METHODS: We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017. We included randomized controlled trials in men with a diagnosis of CP/CPPS. We included all available non-pharmacological interventions. Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the Grading of Recommendations Assessment, Development and Evaluation methods. The primary outcomes were prostatitis symptoms and adverse events. The secondary outcomes were sexual dysfunction, urinary symptoms, quality of life, anxiety and depression. RESULTS: We included 38 unique studies in 3290 men with CP/CPPS across 23 comparisons, reporting outcomes mostly at short-term follow-up. Our analysis showed that acupuncture probably leads to clinically meaningful reduction in prostatitis symptoms compared with a sham procedure (mean difference [MD] in total National Institutes of Health - Chronic Prostatitis Symptom Index [NIH-CPSI] score -5.79, 95% confidence interval [CI] -7.32 to -4.26, moderate QoE). Acupuncture may result in little or no difference in adverse events (low QoE). Acupuncture may also lead to a clinically meaningful reduction in prostatitis symptoms compared with standard medical therapy (MD -6.05, 95% CI -7.87 to -4.24, two studies, 78 participants, low QoE). Lifestyle modifications may be associated with a reduction in prostatitis symptoms compared with control (risk ratio for improvement in NIH-CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE), but we found no information regarding adverse events. A physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH-CPSI score MD -2.50, 95% CI -4.69 to -0.31, low QoE), but we found no information regarding adverse events. It was uncertain whether prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE) and we found no information regarding adverse events. Extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH-CPSI score MD -6.18, 95% CI -7.46 to -4.89, high QoE), but these results may not be sustained at medium-term follow-up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE). Transrectal thermotherapy, alone or in combination with medical therapy, may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH-CPSI score MD -2.50, 95% CI -3.82 to -1.18, low QoE). One included study reported that participants may experience transient adverse events. CONCLUSIONS: Based on the findings with moderate to high QoE, this review found that some non-pharmacological interventions, such as acupuncture and extracorporeal shockwave therapy, are likely to result in a decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse events. The QoE for most other comparisons was predominantly low. Future clinical trials should include a full report of their methods, including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.


Assuntos
Dor Crônica/terapia , Dor Pélvica/terapia , Prostatite/terapia , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Humanos , Masculino , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Prostatite/complicações , Prostatite/diagnóstico
13.
Rev. Hosp. Ital. B. Aires (2004) ; 38(2): 62-69, jun. 2018. graf.
Artigo em Espanhol | LILACS | ID: biblio-1023082

RESUMO

Objetivo: conocer e interpretar las representaciones sociales que tienen las personas con diabetes mellitus (DM) tipo 2 en una comunidad de bajo nivel socioeconómico del Gran Buenos Aires. Metodología: investigación cualitativa, tipo estudio de caso. Se realizaron entrevistas semiestructuradas a personas con diagnóstico de DM tipo 2, atendidas en un centro de atención primaria del Bajo Boulogne, partido de San Isidro, Buenos Aires. Mediante un muestreo teórico o por conveniencia, a partir de las historias clínicas generadas entre enero de 2001 y julio de 2017. Se incluyeron personas con diagnóstico reciente y otras con más de 15 años de evolución, hasta la saturación del discurso. Se realizó un análisis temático. Resultados: se realizaron 20 entrevistas. La mayoría de las personas entrevistadas tenían entre 60 y 69 años y eran de sexo femenino. La DM es vivida como una enfermedad que no tiene cura y que no condiciona a quienes la padecen en lo cotidiano. No impresionó ser una carga, excepto para las personas insulinizadas, quienes le asignan una connotación negativa a esa terapia. No encontramos diferencias de acuerdo con el sexo, la edad o los años de evolución. Los entrevistados asociaron la DM con malos hábitos alimentarios y escasa o nula actividad física. Conclusiones: en esta comunidad, la DM es vivida con naturalidad, en especial por quienes llevan años padeciéndola. La red familiar constituye la principal fuente de apoyo, acompañamiento, contención y provisión de cuidados. No se identificaron otras redes además de la familia o el sistema médico tradicional. (AU)


Objective: to recognize and to understand the social representations of people with type 2 diabetes mellitus (DM) in a community with a low socioeconomic level of suburban Buenos Aires. Methods: qualitative research, case study type. Semi-structured interviews were administered to people diagnosed with type 2 DM, who attended a primary care center in Bajo Boulogne, San Isidro district, Buenos Aires. Through a theoretical or convenience sampling, from the clinical records generated between January 2001 and July 2017. We included people with a recent diagnosis and others with more than 15 years of evolution, until speech saturation. We carried out a thematic analysis. Results: we conducted 20 interviews. Most of the people were aged between 60 and 69 years and were female. DM is lived as a disease without a cure and which does not condition the daily activities of people who suffer from it. It did not impress to be a burden, except for insulinized people, who assigned a negative connotation to that therapy. We did not find differences according to sex, age or years of evolution. Patients associated DM with poor eating habits and little or no physical activity. Conclusions: in this community, DM is lived naturally, especially by those who have been suffering from it for years. The family network constitutes the main source of support, accompaniment, containment, and provision of care. No other networks were identified, besides the family or the traditional medical system. (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Autocuidado/psicologia , Percepção Social , Diabetes Mellitus Tipo 2/epidemiologia , Serviços Preventivos de Saúde/tendências , Mudança Social , Classe Social , Meio Social , Medicina Social , Estudos de Avaliação como Assunto/estatística & dados numéricos , Processo Saúde-Doença , Saúde Pública/educação , Doença Crônica/psicologia , Inquéritos e Questionários , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Medicina de Família e Comunidade , Comportamento Alimentar , Comportamento Sedentário , Cooperação e Adesão ao Tratamento , Promoção da Saúde/tendências
14.
Rev. Hosp. Ital. B. Aires (2004) ; 38(2): 70-77, jun. 2018. ilus., tab.
Artigo em Espanhol | LILACS | ID: biblio-1023102

RESUMO

A través de la revisión de documentos históricos y otras fuentes bibliográficas, y desde la perspectiva de la enfermería, se describen los recursos y prácticas sanitarias con que contaba el equipo de salud que acompañó al cuerpo del Ejército de los Andes al mando del general José de San Martín desde el inicio del cruce de los Andes el 19 de enero en las Provincias Unidas del Río de la Plata, hasta finalizada la batalla de Chacabuco, en la Capitanía General de Chile, el 12 de febrero de 1817. Este trabajo nos permite conocer el trabajo de los primeros sanitarios militares que asistieron en el cuidado de los soldados de los ejércitos patrios y contribuir así a difundir la historia de la Medicina Argentina. (AU)


Through the review of historical documents and other bibliographic sources, and from the perspective of nursing, we describe the health resources and practices held by the health team that accompanied the Army of Los Andes under the command of General José de San Martín, from the start of crossing Los Andes on January 19th in the Provincias Unidas del Río de la Plata, to finish in the battle of Chacabuco, in the General Captaincy of Chile on February 12th, 1817. This work allows us to know the work of the first military health professionals who assisted in the care of the soldiers of the patriotic armies and contribute to spread the history of the Argentine Medicine. (AU)


Assuntos
Humanos , História do Século XIX , Serviços Preventivos de Saúde/história , Enfermagem Primária/história , Hospitais Militares/história , Enfermagem Militar/história , Militares/história , Argentina , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/provisão & distribução , Dieta , Chile , Vestuário/estatística & dados numéricos , Ecossistema Andino/história , Enfermagem Holística/história , História da Medicina , América Latina
15.
Res Synth Methods ; 9(3): 408-416, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29761662

RESUMO

OBJECTIVE: Search strategies are essential for the adequate retrieval of studies in a systematic review (SR). Our objective was to identify problems in the design and reporting of search strategies in a sample of new Cochrane SRs first published in The Cochrane Library in 2015. STUDY DESIGN AND SETTING: We took a random sample of 70 new Cochrane SRs of interventions published in 2015. We evaluated their design and reporting of search strategies using the recommendations from the Cochrane Handbook for Systematic Reviews of Interventions, the Methodological Expectations of Cochrane Intervention Reviews, and the Peer Review of Electronic Search Strategies evidence-based guideline. RESULTS: Most reviews complied with the reporting standards in the Cochrane Handbook and the Methodological Expectations of Cochrane Intervention Reviews; however, 8 SRs did not search trials registers, 3 SRs included language restrictions, and there was inconsistent reporting of contact with individuals and searches of the gray literature. We found problems in the design of the search strategies in 73% of reviews (95% CI, 60-84%) and 53% of these contained problems (95% CI, 38-69%) that could limit both the sensitivity and precision of the search strategies. CONCLUSION: We found limitations in the design and reporting of search strategies. We consider that a greater adherence to the guidelines could improve their quality.


Assuntos
Bases de Dados Bibliográficas , Armazenamento e Recuperação da Informação , Literatura de Revisão como Assunto , Estudos Transversais , Medicina Baseada em Evidências , Fidelidade a Diretrizes , Guias como Assunto , Humanos , Reprodutibilidade dos Testes , Projetos de Pesquisa
16.
Cochrane Database Syst Rev ; 5: CD012551, 2018 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-29757454

RESUMO

BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms. OBJECTIVES: To assess the effects of non-pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). SEARCH METHODS: We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017. SELECTION CRITERIA: We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available non-pharmacological interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the GRADE methods. MAIN RESULTS: We included 38 unique studies with 3290 men with CP/CPPS across 23 comparisons.1. Acupuncture: (three studies, 204 participants) based on short-term follow-up, acupuncture probably leads to clinically meaningful reduction in prostatitis symptoms compared with sham procedure (mean difference (MD) in total NIH-CPSI score -5.79, 95% confidence interval (CI) -7.32 to -4.26, high QoE). Acupuncture may result in little to no difference in adverse events (low QoE). Acupuncture may not reduce sexual dysfunction when compared with sham procedure (MD in the International Index of Erectile Function (IIEF) Scale -0.50, 95% CI -3.46 to 2.46, low QoE). Acupuncture may also lead to a clinically meaningful reduction in prostatitis symptoms compared with standard medical therapy (MD -6.05, 95% CI -7.87 to -4.24, two studies, 78 participants, low QoE). We found no information regarding quality of life, depression or anxiety.2. Lifestyle modifications: (one study, 100 participants) based on short-term follow-up, lifestyle modifications may be associated with a reduction in prostatitis symptoms compared with control (risk ratio (RR) for improvement in NIH-CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE). We found no information regarding adverse events, sexual dysfunction, quality of life, depression or anxiety.3. Physical activity: (one study, 85 participants) based on short-term follow-up, a physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH-CPSI score MD -2.50, 95% CI -4.69 to -0.31, low QoE). This programme may not reduce anxiety or depression (low QoE). We found no information regarding adverse events, sexual dysfunction or quality of life.4. Prostatic massage: (two studies, 115 participants) based on short-term follow-up, we are uncertain whether the prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE). We found no information regarding adverse events, sexual dysfunction, quality of life, depression or anxiety.5. Extracorporeal shockwave therapy: (three studies, 157 participants) based on short-term follow-up, extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH-CPSI score MD -6.18, 95% CI -7.46 to -4.89, high QoE). These results may not be sustained at medium-term follow-up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE). This treatment probably improves sexual dysfunction (MD in the IIEF Scale MD 3.34, 95% CI 2.68 to 4.00, one study, 60 participants, moderate QoE). We found no information regarding quality of life, depression or anxiety.6. Transrectal thermotherapy compared to medical therapy: (two studies, 237 participants) based on short-term follow-up, transrectal thermotherapy alone or in combination with medical therapy may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH-CPSI score MD -2.50, 95% CI -3.82 to -1.18, low QoE). One included study reported that participants may experience transient adverse events. We found no information regarding sexual dysfunction, quality of life, depression or anxiety.7. Other interventions: there is uncertainty about the effects of most of the other interventions included in this review. We found no information regarding psychological support or prostatic surgery. AUTHORS' CONCLUSIONS: Based on the findings of moderate quality evidence, this review found that some non-pharmacological interventions such as acupuncture and extracorporeal shockwave therapy are likely to result in a decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse event. The QoE for most other comparisons was predominantly low. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.


Assuntos
Dor Crônica/terapia , Dor Pélvica/terapia , Prostatite/terapia , Terapia por Acupuntura/efeitos adversos , Terapia por Acupuntura/métodos , Adulto , Doença Crônica , Circuncisão Masculina/efeitos adversos , Radiação Eletromagnética , Exercício Físico , Tratamento por Ondas de Choque Extracorpóreas/efeitos adversos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Humanos , Hipertermia Induzida/efeitos adversos , Hipertermia Induzida/métodos , Estilo de Vida , Masculino , Massagem/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Cochrane Database Syst Rev ; 1: CD012551, 2018 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-29372565

RESUMO

BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms. OBJECTIVES: To assess the effects of non-pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). SEARCH METHODS: We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017. SELECTION CRITERIA: We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available non-pharmacological interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the GRADE methods. MAIN RESULTS: We included 38 unique studies with 3290 men with CP/CPPS across 23 comparisons.1. Acupuncture: (three studies, 204 participants) based on short-term follow-up, acupuncture reduces prostatitis symptoms in an appreciable number of participants compared with sham procedure (mean difference (MD) in total NIH-CPSI score -5.79, 95% confidence interval (CI) -7.32 to -4.26, high QoE). Acupuncture likely results in little to no difference in adverse events (moderate QoE). It probably also decreases prostatitis symptoms compared with standard medical therapy in an appreciable number of participants (MD -6.05, 95% CI -7.87 to -4.24, two studies, 78 participants, moderate QoE).2. Circumcision: (one study, 713 participants) based on short-term follow-up, early circumcision probably decreases prostatitis symptoms slightly (NIH-CPSI score MD -3.00, 95% CI -3.82 to -2.18, moderate QoE) and may not be associated with a greater incidence of adverse events compared with control (a waiting list to be circumcised, low QoE).3. Electromagnetic chair: (two studies, 57 participants) based on short-term follow-up, we are uncertain of the effects of the use of an electromagnetic chair on prostatitis symptoms. It may be associated with a greater incidence of adverse events compared with sham procedure (low to very low QoE).4. Lifestyle modifications: (one study, 100 participants) based on short-term follow-up, lifestyle modifications may be associated with a greater improvement in prostatitis symptoms in an appreciable number of participants compared with control (risk ratio (RR) for improvement in NIH-CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE). We found no information regarding adverse events.5. Physical activity: (one study, 85 participants) based on short-term follow-up, a physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH-CPSI score MD -2.50, 95% CI -4.69 to -0.31, low QoE). We found no information regarding adverse events.6. Prostatic massage: (two studies, 115 participants) based on short-term follow-up, we are uncertain whether the prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE). We found no information regarding adverse events.7. Extracorporeal shockwave therapy: (three studies, 157 participants) based on short-term follow-up, extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH-CPSI score MD -6.18, 95% CI -7.46 to -4.89, high QoE). These results may not be sustained at medium-term follow-up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE).8. Transrectal thermotherapy compared to medical therapy: (two studies, 237 participants) based on short-term follow-up, transrectal thermotherapy alone or in combination with medical therapy may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH-CPSI score MD -2.50, 95% CI -3.82 to -1.18, low QoE). One included study reported that participants may experience transient adverse events.9. Other interventions: there is uncertainty about the effects of other interventions included in this review. We found no information regarding psychological support or prostatic surgery. AUTHORS' CONCLUSIONS: Some of the interventions can decrease prostatitis symptoms in an appreciable number without a greater incidence of adverse events. The QoE was mostly low. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.


Assuntos
Dor Crônica/terapia , Dor Pélvica/terapia , Prostatite/terapia , Terapia por Acupuntura/efeitos adversos , Terapia por Acupuntura/métodos , Adulto , Doença Crônica , Circuncisão Masculina/efeitos adversos , Radiação Eletromagnética , Exercício Físico , Tratamento por Ondas de Choque Extracorpóreas/efeitos adversos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Humanos , Hipertermia Induzida/efeitos adversos , Hipertermia Induzida/métodos , Estilo de Vida , Masculino , Massagem/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Cochrane Database Syst Rev ; 1: CD006544, 2018 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-29318581

RESUMO

BACKGROUND: Peripheral arterial occlusive disease (PAOD) is a common cause of morbidity and mortality due to cardiovascular disease in the general population. Although numerous treatments have been adopted for patients at different disease stages, no option other than amputation is available for patients presenting with critical limb ischaemia (CLI) unsuitable for rescue or reconstructive intervention. In this regard, prostanoids have been proposed as a therapeutic alternative, with the aim of increasing blood supply to the limb with occluded arteries through their vasodilatory, antithrombotic, and anti-inflammatory effects. This is an update of a review first published in 2010. OBJECTIVES: To determine the effectiveness and safety of prostanoids in patients with CLI unsuitable for rescue or reconstructive intervention. SEARCH METHODS: For this update, the Cochrane Vascular Information Specialist searched the Specialised Register (January 2017) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1). In addition, we searched trials registries (January 2017) and contacted pharmaceutical manufacturers, in our efforts to identify unpublished data and ongoing trials. SELECTION CRITERIA: Randomised controlled trials describing the efficacy and safety of prostanoids compared with placebo or other pharmacological control treatments for patients presenting with CLI without chance of rescue or reconstructive intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data. We resolved disagreements by consensus or by consultation with a third review author. MAIN RESULTS: For this update, 15 additional studies fulfilled selection criteria. We included in this review 33 randomised controlled trials with 4477 participants; 21 compared different prostanoids versus placebo, seven compared prostanoids versus other agents, and five conducted head-to-head comparisons using two different prostanoids.We found low-quality evidence that suggests no clear difference in the incidence of cardiovascular mortality between patients receiving prostanoids and those given placebo (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.41 to 1.58). We found high-quality evidence showing that prostanoids have no effect on the incidence of total amputations when compared with placebo (RR 0.97, 95% CI 0.86 to 1.09). Adverse events were more frequent with prostanoids than with placebo (RR 2.11, 95% CI 1.79 to 2.50; moderate-quality evidence). The most commonly reported adverse events were headache, nausea, vomiting, diarrhoea, flushing, and hypotension. We found moderate-quality evidence showing that prostanoids reduced rest-pain (RR 1.30, 95% CI 1.06 to 1.59) and promoted ulcer healing (RR 1.24, 95% CI 1.04 to 1.48) when compared with placebo, although these small beneficial effects were diluted when we performed a sensitivity analysis that excluded studies at high risk of bias. Additionally, we found evidence of low to very low quality suggesting the effects of prostanoids versus other active agents or versus other prostanoids because studies conducting these comparisons were few and we judged them to be at high risk of bias. None of the included studies assessed quality of life. AUTHORS' CONCLUSIONS: We found high-quality evidence showing that prostanoids have no effect on the incidence of total amputations when compared against placebo. Moderate-quality evidence showed small beneficial effects of prostanoids for rest-pain relief and ulcer healing when compared with placebo. Additionally, moderate-quality evidence showed a greater incidence of adverse effects with the use of prostanoids, and low-quality evidence suggests that prostanoids have no effect on cardiovascular mortality when compared with placebo. None of the included studies reported quality of life measurements. The balance between benefits and harms associated with use of prostanoids in patients with critical limb ischaemia with no chance of reconstructive intervention is uncertain; therefore careful assessment of therapeutic alternatives should be considered. Main reasons for downgrading the quality of evidence were high risk of attrition bias and imprecision of effect estimates.


Assuntos
Isquemia/tratamento farmacológico , Perna (Membro)/irrigação sanguínea , Doenças Vasculares Periféricas/tratamento farmacológico , Prostaglandinas/uso terapêutico , Alprostadil/uso terapêutico , Amputação/estatística & dados numéricos , Epoprostenol/uso terapêutico , Humanos , Iloprosta/uso terapêutico , Isquemia/mortalidade , Perna (Membro)/cirurgia , Úlcera da Perna/tratamento farmacológico , Nafronil/uso terapêutico , Ácidos Nicotínicos/uso terapêutico , Pentoxifilina/uso terapêutico , Prostaglandinas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Vasodilatadores/uso terapêutico
19.
Hip Int ; 28(1): 18-28, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28665454

RESUMO

INTRODUCTION: Although the preferred treatment for displaced femoral neck fractures in the elderly is hip arthroplasty, the treatment for impacted or undisplaced femoral neck fractures (UFNF) is still a subject of controversy. Our purpose was to systematically review studies of elderly patients with UFNF treated with internal fixation using screws: (i) what is the reported mortality; (ii) what is the reoperation rate; (iii) what are the clinical and radiological outcomes; and (iv) what is the methodological quality of the included studies? METHODS: This systematic review was performed through a search of PubMed and the Cochrane database using a structured search algorithm including studies enrolling patients older than 60 years old, with UFNF treated with internal fixation using screws. Our literature search returned 950 studies and 11 were selected for final abstraction. RESULTS: 6 studies reported mortality rate. At 1-year follow-up mortality was reported by 3 studies: 18.8%; 22%, and 19%. At 5 years, 1 study reported mortality rate of 42%. Overall reoperation rate was reported by 9 studies and ranged from 8%-19%, while conversion to hip arthroplasty was performed in the range between 8% and 16% according to 6 studies. CONCLUSIONS: Internal fixation with cannulated screws for UFNF in the elderly is a valuable option, although it has substantial reoperation and mortality rates. Further prospective high-quality, randomised controlled trials are required to establish the optimal approach for the treatment of UFNF.


Assuntos
Parafusos Ósseos , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Reoperação , Resultado do Tratamento
20.
Archiv. med. fam. gen. (En línea) ; 14(1): 6-11, mayo 2017. tab
Artigo em Espanhol | LILACS | ID: biblio-907419

RESUMO

Las actuales guías de cuidados preventivos recomiendan el rastreo del cáncer colorrectal (CCR) a través de varias estrategias, entre ellas la pesquisa anual de sangre oculta en materia fecal (SOMF), que de resultar positiva, debe ir seguida de una evaluación completa de la mucosa colónica para identificar lesiones con riesgo de evolucionar hacia la malignidad. Con el objetivo de describir la cascada diagnóstica consecutiva a la realización de SOMF y sus resultados en el contexto de un programa de rastreo de CCR en una población asintomática de riesgo promedio, realizamos un estudio de cohorte retrospectiva basado en datos secundarios obtenidos de historias clínicas electrónicas de 42.770 pacientes de 50 a 75 años de edad, afiliados al Plan de Salud del Hospital Italiano de Buenos Aires, durante 2009.La tasa de rastreo anual con SOMF fue de 13,6% (n=5816). El 25% de estos pacientes presentó SOMF positiva (n=1454), y 53% realizó algún estudio de evaluación colónica (n=775, videocolonoscopía en 96%). Como resultado de esta estrategia de rastreo se diagnosticaron 174 adenomas (41 de ellos de alto riesgo) y 5 casos de CCR. El valor predictivo positivo de la SOMF para lesiones neoplásicas relevantes (adenomas de alto riesgo y CCR) fue de 3%, mientras que para la VCC a continuación de una SOMF positiva, de 6%.


Current preventive care guidelines recommend screening for colorectal cancer (CRC) through a number of strategies, including the annual fecal occult blood test (FOBT), which should be followed by a full assessment of the colonic mucosa in order to identify lesions at risk of developing into malignancy. With the objective of describing the diagnostic cascade following FOBT and its results in the context of a CRC screening program in an asymptomatic population of average risk, we designed a retrospective cohort study based on secondary data obtained from electronic medical records of 42,770 patients, aged between 50 and 75 years, affiliated to the Health Plan of the Hospital Italiano de Buenos Aires during 2009. FOBT screening rate was 13.6% for that period (n=5816). Twenty-five percent of the patients presented positive FOBT results (n=1454), and 53.3% performed some colonic evaluation study (n=775, videocolonoscopy in 96%). As a result of this screening strategy 174 adenomas (41 high risk adenomas), and 5 cases of CRC were diagnosed. Positive predictive values for relevant neoplastic lesions (high risk adenomas and CRC) were 3% and 6% for FOBT and videocolonoscopy after a positive FOBT, respectively.


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Neoplasias do Colo , Prevenção de Doenças , Detecção Precoce de Câncer , Sangue Oculto , Peneiramento de Líquidos , Técnicas e Procedimentos Diagnósticos , Avaliação de Resultado de Ações Preventivas
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