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1.
PLoS One ; 15(12): e0242007, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370307

RESUMO

PURPOSE: Progressive Tinnitus Management (PTM) is an evidence-based interdisciplinary stepped-care approach to improving quality of life for patients with tinnitus. PTM was endorsed by Department of Veterans Affairs (VA) Audiology leadership in 2009. Factors affecting implementation of PTM are unknown. We conducted a study to: 1) estimate levels of PTM program implementation in VA Audiology and Mental Health clinics across the country; and 2) identify barriers and facilitators to PTM implementation based on the experiences of VA audiologists and mental health providers. METHOD: We conducted an anonymous, web-based survey targeting Audiology and Mental Health leaders at 144 major VA facilities. Quantitative analyses summarized respondents' facility characteristics and levels of program implementation (full PTM, partial PTM, or no PTM). Qualitative analyses identified themes in factors influencing the implementation of PTM across VA sites. RESULTS: Surveys from 87 audiologists and 66 mental health clinicians revealed that few facilities offered full PTM; the majority offered partial or no PTM. Inductive analysis of the open-ended survey responses identified seven factors influencing implementation of PTM: 1) available resources, 2) service collaboration, 3) prioritization, 4) Veterans' preferences and needs, 5) clinician training, 6) awareness of (evidence-based) options, and 7) perceptions of scope of practice. CONCLUSION: Results suggest wide variation in services provided, a need for greater engagement of mental health providers in tinnitus care, and an interest among both audiologists and mental health providers in receiving tinnitus-related training. Future research should address barriers to PTM implementation, including methods to: 1) improve understanding among mental health providers of their potential role in tinnitus management; 2) enhance coordination of tinnitus-related care between health care disciplines; and 3) collect empirical data on Veterans' need for and interest in PTM, including delivery by telehealth modalities.


Assuntos
Medicina Baseada em Evidências/organização & administração , Implementação de Plano de Saúde/organização & administração , Hospitais de Veteranos/organização & administração , Zumbido/terapia , Audiologia/organização & administração , Progressão da Doença , Medicina Baseada em Evidências/estatística & dados numéricos , Implementação de Plano de Saúde/estatística & dados numéricos , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Serviços de Saúde Mental/organização & administração , Preferência do Paciente/psicologia , Preferência do Paciente/estatística & dados numéricos , Médicos/estatística & dados numéricos , Pesquisa Qualitativa , Qualidade de Vida , Inquéritos e Questionários/estatística & dados numéricos , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Zumbido/psicologia , Estados Unidos , United States Department of Veterans Affairs/organização & administração , Veteranos/psicologia
2.
Cochrane Database Syst Rev ; 10: CD012575, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33058172

RESUMO

BACKGROUND: Rehabilitation based upon research evidence gives stroke survivors the best chance of recovery. There is substantial research to guide practice in stroke rehabilitation, yet uptake of evidence by healthcare professionals is typically slow and patients often do not receive evidence-based care. Implementation interventions are an important means to translate knowledge from research to practice and thus optimise the care and outcomes for stroke survivors. A synthesis of research evidence is required to guide the selection and use of implementation interventions in stroke rehabilitation. OBJECTIVES: To assess the effects of implementation interventions to promote the uptake of evidence-based practices (including clinical assessments and treatments recommended in evidence-based guidelines) in stroke rehabilitation and to assess the effects of implementation interventions tailored to address identified barriers to change compared to non-tailored interventions in stroke rehabilitation. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and eight other databases to 17 October 2019. We searched OpenGrey, performed citation tracking and reference checking for included studies and contacted authors of included studies to obtain further information and identify potentially relevant studies. SELECTION CRITERIA: We included individual and cluster randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies comparing an implementation intervention to no intervention or to another implementation approach in stroke rehabilitation. Participants were qualified healthcare professionals working in stroke rehabilitation and the patients they cared for. Studies were considered for inclusion regardless of date, language or publication status. Main outcomes were healthcare professional adherence to recommended treatment, patient adherence to recommended treatment, patient health status and well-being, healthcare professional intention and satisfaction, resource use outcomes and adverse effects. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. The primary comparison was any implementation intervention compared to no intervention. MAIN RESULTS: Nine cluster randomised trials (12,428 patient participants) and three ongoing trials met our selection criteria. Five trials (8865 participants) compared an implementation intervention to no intervention, three trials (3150 participants) compared one implementation intervention to another implementation intervention, and one three-arm trial (413 participants) compared two different implementation interventions to no intervention. Eight trials investigated multifaceted interventions; educational meetings and educational materials were the most common components. Six trials described tailoring the intervention content to identified barriers to change. Two trials focused on evidence-based stroke rehabilitation in the acute setting, four focused on the subacute inpatient setting and three trials focused on stroke rehabilitation in the community setting. We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence was very low (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.53 to 2.64; 2 trials, 39 clusters, 1455 patient participants; I2 = 0%). Low-certainty evidence indicates implementation interventions in stroke rehabilitation may lead to little or no difference in patient adherence to recommended treatment (number of recommended performed outdoor journeys adjusted mean difference (MD) 0.5, 95% CI -1.8 to 2.8; 1 trial, 21 clusters, 100 participants) and patient psychological well-being (standardised mean difference (SMD) -0.02, 95% CI -0.54 to 0.50; 2 trials, 65 clusters, 1273 participants; I2 = 0%) compared with no intervention. Moderate-certainty evidence indicates implementation interventions in stroke rehabilitation probably lead to little or no difference in patient health-related quality of life (MD 0.01, 95% CI -0.02 to 0.05; 2 trials, 65 clusters, 1242 participants; I2 = 0%) and activities of daily living (MD 0.29, 95% CI -0.16 to 0.73; 2 trials, 65 clusters, 1272 participants; I2 = 0%) compared with no intervention. No studies reported the effects of implementation interventions in stroke rehabilitation on healthcare professional intention to change behaviour or satisfaction. Five studies reported economic outcomes, with one study reporting cost-effectiveness of the implementation intervention. However, this was assessed at high risk of bias. The other four studies did not demonstrate the cost-effectiveness of interventions. Tailoring interventions to identified barriers did not alter results. We are uncertain of the effect of one implementation intervention versus another given the limited very low-certainty evidence. AUTHORS' CONCLUSIONS: We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence is very low.


Assuntos
Medicina Baseada em Evidências/métodos , Pessoal de Saúde/estatística & dados numéricos , Reabilitação do Acidente Vascular Cerebral/métodos , Medicina Baseada em Evidências/educação , Medicina Baseada em Evidências/estatística & dados numéricos , Pessoal de Saúde/educação , Nível de Saúde , Humanos , Cooperação do Paciente/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação do Acidente Vascular Cerebral/psicologia
4.
Plast Reconstr Surg ; 146(2): 177e-186e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740586

RESUMO

BACKGROUND: Evidence-based practices in medicine are linked with a higher quality of care and lower health care cost. For trigger finger, identifying patient factors associated with nonadherence to evidence-based practices will aid physicians in treatment decisions. The objectives were to (1) determine patient factors associated with treatment nonadherence, (2) examine the success rates of steroid injections, and (3) evaluate the economic consequences of nonadherence to treatment recommendations. METHODS: The authors used data from the Clinformatics DataMart database from 2010 to 2017 to conduct a population-based analysis of patients with single-digit trigger finger. The authors calculated rates of steroid injection success and examined associations between injection success and patient factors using chi-square tests. In addition, the authors analyzed differences in the cost to the insurer, the cost to the patient, and total cost. RESULTS: A total of 29,722 patients were included in this analysis. Injection success rates were similar for diabetic (72 percent) and nondiabetic patients (73 percent), women (73 percent), and men (73 percent). Nonetheless, diabetics (OR, 1.4; 95 percent CI, 1.4 to 1.5; p < 0.001) and women (OR, 1.2; 95 percent CI, 1.1 to 1.2; p < 0.001) were significantly more likely to receive nonadherent treatment. In total, $23 million (U.S. dollars) were spent on nonadherent trigger finger care. CONCLUSIONS: Diabetics and women have increased odds of having surgery without a prior steroid injection, despite similar success rates of steroid injections compared to nondiabetics and men. Because performing surgical release before any steroid injections may represent a higher cost treatment option, providers should provide steroid injections before surgery for all patients regardless of diabetes status or sex to minimize overtreatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Diabetes Mellitus/epidemiologia , Glucocorticoides/administração & dosagem , Procedimentos Ortopédicos/economia , Cooperação do Paciente/estatística & dados numéricos , Dedo em Gatilho/terapia , Idoso , Custos e Análise de Custo/estatística & dados numéricos , Medicina Baseada em Evidências/economia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Seguimentos , Glucocorticoides/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Injeções Intralesionais/economia , Injeções Intralesionais/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento , Dedo em Gatilho/economia
5.
Plast Reconstr Surg ; 146(2): 371-379, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740590

RESUMO

BACKGROUND: As a component of the Maintenance of Certification process from 2003 to 2019, the American Board of Plastic Surgery tracked 20 common plastic surgery operations. By evaluating the data collected over 16 years, the authors are able to examine the practice patterns of pediatric/craniofacial surgeons in the United States. METHODS: Cumulative tracer data for cleft palate repair was reviewed as of April of 2014 and September of 2019. Evidence-based medicine articles were reviewed. Results were tabulated in three categories: pearls, or topics that were covered in both the tracer data and evidence-based medicine articles; topics that were covered by evidence-based medicine articles but not collected in the tracer data; and topics that were covered in tracer data but not addressed in evidence-based medicine articles. RESULTS: Two thousand eight hundred fifty cases had been entered as of September of 2019. With respect to pearls, pushback, von Langenbeck, and Furlow repairs all declined in use, whereas intravelar veloplasty increased. For items not in the tracer, the quality of studies relating to analgesia is among the highest of all areas of study regarding cleft palate repair. In terms of variables collected by the tracer but not studied, in 2019, 41 percent of patients received more than 1 day of antibiotics. CONCLUSIONS: This article provides a review of cleft palate tracer data and summarizes the research in the field. Review of the tracer data enables cleft surgeons to compare their outcomes to national norms and provides an opportunity for them to consider modifications that may enhance their practice.


Assuntos
Fissura Palatina/cirurgia , Medicina Baseada em Evidências/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgiões/legislação & jurisprudência , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/legislação & jurisprudência , Cirurgia Plástica/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos , Adulto Jovem
6.
BMJ ; 370: m2980, 2020 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-32732190

RESUMO

OBJECTIVE: To compare the effects of treatments for coronavirus disease 2019 (covid-19). DESIGN: Living systematic review and network meta-analysis. DATA SOURCES: US Centers for Disease Control and Prevention COVID-19 Research Articles Downloadable Database, which includes 25 electronic databases and six additional Chinese databases to 20 July 2020. STUDY SELECTION: Randomised clinical trials in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles. METHODS: After duplicate data abstraction, a bayesian random effects network meta-analysis was conducted. Risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach. For each outcome, interventions were classified in groups from the most to the least beneficial or harmful following GRADE guidance. RESULTS: 23 randomised controlled trials were included in the analysis performed on 26 June 2020. The certainty of the evidence for most comparisons was very low because of risk of bias (lack of blinding) and serious imprecision. Glucocorticoids were the only intervention with evidence for a reduction in death compared with standard care (risk difference 37 fewer per 1000 patients, 95% credible interval 63 fewer to 11 fewer, moderate certainty) and mechanical ventilation (31 fewer per 1000 patients, 47 fewer to 9 fewer, moderate certainty). These estimates are based on direct evidence; network estimates for glucocorticoids compared with standard care were less precise because of network heterogeneity. Three drugs might reduce symptom duration compared with standard care: hydroxychloroquine (mean difference -4.5 days, low certainty), remdesivir (-2.6 days, moderate certainty), and lopinavir-ritonavir (-1.2 days, low certainty). Hydroxychloroquine might increase the risk of adverse events compared with the other interventions, and remdesivir probably does not substantially increase the risk of adverse effects leading to drug discontinuation. No other interventions included enough patients to meaningfully interpret adverse effects leading to drug discontinuation. CONCLUSION: Glucocorticoids probably reduce mortality and mechanical ventilation in patients with covid-19 compared with standard care. The effectiveness of most interventions is uncertain because most of the randomised controlled trials so far have been small and have important study limitations. SYSTEMATIC REVIEW REGISTRATION: This review was not registered. The protocol is included as a supplement. READERS' NOTE: This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.


Assuntos
Antivirais/uso terapêutico , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Respiração Artificial/estatística & dados numéricos , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Betacoronavirus/patogenicidade , Centers for Disease Control and Prevention, U.S./estatística & dados numéricos , China/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Bases de Dados Factuais/estatística & dados numéricos , Combinação de Medicamentos , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Glucocorticoides/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Lopinavir/uso terapêutico , Metanálise em Rede , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Ritonavir/uso terapêutico , Índice de Gravidade de Doença , Padrão de Cuidado , Resultado do Tratamento , Estados Unidos/epidemiologia
7.
PLoS One ; 15(8): e0237720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32834011

RESUMO

BACKGROUND: Underweight, overweight, and obesity are major public health challenges among reproductive-age women of lower- and middle-income countries (including Tanzania). In those settings, obesogenic factors (attributes that promote excessive body weight gain) are increasing in the context of an existing high burden of undernutrition. The present study investigated factors associated with underweight, overweight, and obesity among reproductive age women in Tanzania. METHODS: This study used 2015-16 Tanzania Demographic and Health Survey data (n = 11735). To account for the hierarchical nature of the data (i.e., reproductive age women nested within clusters), multilevel multinomial logistic regression models were used to investigate the association between individual-level (socioeconomic, demographic and behavioural) and community-level factors with underweight, overweight, and obesity. RESULTS: Reproductive age women who were informally employed (relative risk ratio [RRR] = 0.79; 95% confidence interval [CI]: 0.64, 0.96), those who were currently married (RRR = 0.59; 95% CI: 0.43, 0.82) and those who used contraceptives (RRR = 0.70; 95% CI: 0.54, 0.90) were less likely to be underweight. Reproductive age women who attained secondary or higher education (RRR = 1.48; 95% CI: 1.11, 1.96), those who resided in wealthier households (RRR = 2.31; 95% CI: 1.78, 3.03) and those who watched the television (RRR = 1.26; 95% CI: 1.06, 1.50) were more likely to be overweight. The risk of experiencing obesity was higher among reproductive age women who attained secondary or higher education (RRR = 1.79; 95% CI: 1.23, 2.61), those who were formally employed (RRR = 1.50; 95% CI: 1.14, 1.98), those who resided in wealthier households (RRR = 4.77; 95% CI: 3.03, 7.50), those who used alcohol (RRR = 1.43; 95% CI: 1.12, 1.82) and/or watched the television (RRR = 1.70; 95% CI: 1.35, 2.13). CONCLUSION: Our study suggests that relevant government jurisdictions need to identify, promote, and implement evidence-based interventions that can simultaneously address underweight and overweight/obesity among reproductive age women in Tanzania.


Assuntos
Necessidades e Demandas de Serviços de Saúde/organização & administração , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Saúde Reprodutiva/estatística & dados numéricos , Magreza/epidemiologia , Adolescente , Adulto , Estudos Transversais , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Obesidade/fisiopatologia , Obesidade/prevenção & controle , Sobrepeso/fisiopatologia , Sobrepeso/prevenção & controle , Prevalência , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/estatística & dados numéricos , Reprodução/fisiologia , Fatores de Risco , Fatores Socioeconômicos , Tanzânia/epidemiologia , Magreza/fisiopatologia , Magreza/prevenção & controle , Adulto Jovem
8.
Eur J Vasc Endovasc Surg ; 60(5): 747-751, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32763119

RESUMO

OBJECTIVE: Major limb amputations are physiologically stressful and subject patients to peri-operative cardiovascular risk. Up to 90% of major lower extremity amputations (LEAMP) are being performed under general anaesthesia, despite regional anaesthesia being an acceptable option in most cases. Obtaining a better understanding of who would benefit from regional vs. general anaesthesia could reduce complications and help establish best evidence based practice. It was hypothesised that patients undergoing LEAMP with regional anaesthesia would have better post-operative outcomes than patients receiving general anaesthesia. METHODS: This retrospective cohort study used the U.S. Vascular Quality Initiative lower extremity amputation module to identify patients (≥18 years) who underwent LEAMP from 2013 to 2018. Outcomes included 30 day incidence of major adverse cardiac events (MACE) and all cause mortality. Multivariable logistic regression models were used to compute odds ratios (OR) and 95% confidence intervals (CI). Time to death was analysed using standard survival analysis. RESULTS: The final sample included 5 567 patients (median age: 65 years, 67% white, 65% male). Only 719 (13%) of patients received regional anaesthesia. Compared with patients undergoing general anaesthesia, patients in the regional group were older (67 vs. 65 years, p < .001) and more likely to have diabetes (78% vs. 69%; p < .001), end stage renal disease (26% vs. 18%; p < .001), congestive heart failure (33% vs. 27%; p < .01) and coronary artery disease (35% vs. 30%; p < .01). The overall incidence of MACE, death, and MACE or death was 5%, 6%, and 9%, respectively. There was no statistically significant difference by anaesthesia groups for MACE (OR 0.98, 95% CI 0.69-1.39) or mortality (HR 1.03, 95% CI 0.90-1.17). CONCLUSION: There was no difference in outcomes between regional or general anaesthesia techniques in patients undergoing LEAMP, despite the regional group having more comorbidities. Regional anaesthesia may be under used for high risk patients undergoing LEAMP. Further studies are needed to establish best practices in LEAMP procedures.


Assuntos
Amputação/efeitos adversos , Anestesia por Condução/efeitos adversos , Anestesia Geral/efeitos adversos , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anestesia por Condução/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Recuperação Pós-Cirúrgica Melhorada , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Estimativa de Kaplan-Meier , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
9.
Int J Dermatol ; 59(9): 1043-1056, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32621284

RESUMO

Recommendations were made recently to limit or stop the use of oral and systemic immunotherapies for skin diseases due to potential risks to the patients during the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 pandemic. Herein, we attempt to identify potentially safe immunotherapies that may be used in the treatment of cutaneous diseases during the current COVID-19 pandemic. We performed a literature review to approximate the risk of SARS-CoV-2 infection, including available data on the roles of relevant cytokines, cell subsets, and their mediators in eliciting an optimal immune response against respiratory viruses in murine gene deletion models and humans with congenital deficiencies were reviewed for viral infections risk and if possible coronaviruses specifically. Furthermore, reported risk of infections of biologic and non-biologic therapeutics for skin diseases from clinical trials and drug data registries were evaluated. Many of the immunotherapies used in dermatology have data to support their safe use during the COVID-19 pandemic including the biologics that target IgE, IL-4/13, TNF-α, IL-17, IL-12, and IL-23. Furthermore, we provide evidence to show that oral immunosuppressive medications such as methotrexate and cyclosporine do not significantly increase the risk to patients. Most biologic and conventional immunotherapies, based on doses and indications in dermatology, do not appear to increase risk of viral susceptibility and are most likely safe for use during the COVID-19 pandemic. The limitation of this study is availability of data on COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Síndrome da Liberação de Citocina/imunologia , Fármacos Dermatológicos/efeitos adversos , Suscetibilidade a Doenças/induzido quimicamente , Pneumonia Viral/epidemiologia , Dermatopatias/tratamento farmacológico , Animais , Betacoronavirus/imunologia , Produtos Biológicos/efeitos adversos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Síndrome da Liberação de Citocina/virologia , Dermatologia/métodos , Dermatologia/estatística & dados numéricos , Modelos Animais de Doenças , Suscetibilidade a Doenças/imunologia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Humanos , Fatores Imunológicos/efeitos adversos , Camundongos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Índice de Gravidade de Doença , Dermatopatias/imunologia
10.
Recurso na Internet em Inglês, Espanhol, Português | LIS - Localizador de Informação em Saúde | ID: lis-47632

RESUMO

O mapa apresenta uma visão geral das evidências sobre os efeitos das Plantas Medicinais e Fitoterapia para cicatrização e doenças agudas. A partir de uma ampla busca bibliográfica foram incluídos no mapa 16 estudos de revisão sistemática. Todos os estudos foram avaliados, caracterizados e categorizados por um grupo de pesquisadores do Laboratório de Pesquisa & Desenvolvimento de Práticas Integrativas e Complementares (LabPICs) da Faculdade de Farmácia da Universidade Federal do Rio de Janeiro. El mapa presenta una visión general de la evidencia sobre los efectos de las plantas medicinales y la fitoterapia para cicatrización y las enfermedades agudas. A partir de una amplia búsqueda bibliográfica, se incluyeron 16 estudios de revisión sistemática en el mapa. Todos los estudios fueron evaluados, caracterizados y categorizados por un grupo de investigadores del Laboratorio de Investigación y Desarrollo para Prácticas Integrativas y Complementarias (LabPIC) en la Facultad de Farmacia de la Universidad Federal de Rio de Janeiro. The map presents an overview of the evidence on the effects of Medicinal Plants and Phytotherapy for for wound healing and acute diseases. From a wide bibliographic search, 16 systematic review studies were included in the map. All studies were evaluated, characterized and categorized by a group of researchers from the Research & Development Laboratory for Integrative and Complementary Practices (LabPICs) at the Faculty of Pharmacy, Federal University of Rio de Janeiro.


Assuntos
Fitoterapia/métodos , Plantas Medicinais/fisiologia , Medicina Baseada em Evidências/estatística & dados numéricos , Resultado do Tratamento , Cicatrização/fisiologia
11.
Recurso na Internet em Inglês, Espanhol, Português | LIS - Localizador de Informação em Saúde | ID: lis-47570

RESUMO

O mapa apresenta uma visão geral das evidências sobre os efeitos da Meditação para diversas condições clínicas e de saúde da população em geral. A partir de uma ampla busca bibliográfica de estudos publicados e não publicados, foram incluídos no Mapa 191 revisões (78 revisões sistemáticas, 110 metanálises, 2 metassínteses e 1 revisão integrativa). Sobre os tipos de meditação: 147 revisões avaliaram resultados a partir de técnicas de mindfulness ou derivados, 34 revisões avaliaram meditação geral, 8 revisões meditação transcendental, 3 revisões técnicas de compaixão e 1 revisão avaliou práticas de atenção focada. Todos os estudos foram selecionados, avaliados, caracterizados e categorizados por pares de pesquisadores da área de Meditação. El mapa muestra una vista general de las experiencias sobre los efectos de la meditación para diversas condiciones clínicas y de la salud de la población en general. A partir de una amplia búsqueda bibliográfica de estudios publicados y no publicados, fueron incluidas 191 revisiones: 78 revisiones sistemáticas, 110 metanálises, 2 metassínteses y 1 revisión integrativa. Sobre los tipos de meditación: 147 revisiones disponibles resultados de partir de técnicas de mindfulness o derivados, 34 revisiones disponibles meditación general, 8 revisiones medita trascendental, 3 revisiones técnicas de comparación y 1 revisión acerca prática de atención focada. Todos los estudios fueron seleccionados, evaluados, y caracterizados por pares de investigadores del área de Meditación. The map provides an overview of the evidence on the effects of Meditation for various clinical and health conditions of the general population. From a wide bibliographic search of published and unpublished studies, 191 reviews were included in the Map: 78 systematic reviews, 110 meta-analyzes, 2 meta-syntheses and 1 integrative review. About types of meditation: 147 reviews evaluated results for mindfulness techniques or derivatives, 34 reviews evaluated general meditation, 8 reviews transcendental meditation, 3 compassion technique and 1 review evaluated practices of focused attention. All studies were selected, evaluated, characterized and categorized by pairs of researchers in the area of ​​Meditation.


Assuntos
Meditação/métodos , Resultado do Tratamento , Medicina Baseada em Evidências/estatística & dados numéricos , Terapias Complementares/estatística & dados numéricos
12.
Proc Natl Acad Sci U S A ; 117(25): 14042-14051, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32513684

RESUMO

Evidence is valuable because it informs decisions to produce better outcomes. However, the same evidence that is complete for some individuals or groups may be incomplete for others, leading to inefficiencies in decision making and growth in disparities in outcomes. Specifically, the presence of treatment effect heterogeneity across some measure of baseline risk, and noisy information about such heterogeneity, can induce self-selection into randomized clinical trials (RCTs) by patients with distributions of baseline risk different from that of the target population. Consequently, average results from RCTs can disproportionately affect the treatment choices of patients with different baseline risks. Using economic models for these sequential processes of RCT enrollment, information generation, and the resulting treatment choice decisions, we show that the dynamic consequences of such information flow and behaviors may lead to growth in disparities in health outcomes across racial and ethnic categories. These disparities arise due to either the differential distribution of risk across those categories at the time RCT results are reported or the different rate of change of baseline risk over time across race and ethnicity, even though the distribution of risk within the RCT matched that of the target population when the RCT was conducted. We provide evidence on how these phenomena may have contributed to the growth in racial disparity in diabetes incidence.


Assuntos
Medicina Baseada em Evidências/normas , Disparidades nos Níveis de Saúde , Modelos Estatísticos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Tomada de Decisão Clínica , Diabetes Mellitus/epidemiologia , Medicina Baseada em Evidências/estatística & dados numéricos , Humanos , Incidência , Fatores Socioeconômicos
13.
BMC Public Health ; 20(1): 993, 2020 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-32580720

RESUMO

BACKGROUND: Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS. METHODS: A restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline. RESULTS: Seventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable. CONCLUSIONS: Delivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of "best bet" interventions.


Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
14.
Recurso na Internet em Inglês, Espanhol, Português | LIS - Localizador de Informação em Saúde | ID: lis-47543

RESUMO

O mapa apresenta uma visão geral das evidências sobre os efeitos clínicos da prática do Yoga em diversas condições de saúde, qualidade de vida e bem-estar. A partir de uma ampla busca bibliográfica foram incluídos no mapa 150 estudos de revisão sistemática. Todos os estudos foram avaliados, caracterizados e categorizados por um grupo de pesquisadores em Yoga. El mapa proporciona una visión general de la evidencia sobre los efectos clínicos de la práctica del yoga en diversas condiciones de salud, calidad de vida y bienestar. A partir de una amplia búsqueda bibliográfica, se incluyeron 150 estudios de revisión sistemática en el mapa. Todos los estudios fueron evaluados, caracterizados y categorizados por un grupo de investigadores en Yoga. The map provides an overview of the evidence on clinical effects of Yoga practice on various health conditions, quality of life and well-being. From a wide bibliographic search, 150 studies of systematic review were included in the map. All studies were evaluated, characterized and categorized by a group of researchers in Yoga.


Assuntos
Ioga , Resultado do Tratamento , Medicina Baseada em Evidências/estatística & dados numéricos
15.
Recurso na Internet em Inglês, Espanhol, Português | LIS - Localizador de Informação em Saúde | ID: lis-47545

RESUMO

O mapa apresenta uma visão geral das evidências sobre os efeitos das Plantas Medicinais e Fitoterapia para Distúrbios Metabólicos e Fisiológicos. A partir de uma ampla busca bibliográfica foram incluídos no mapa 48 estudos de revisão sistemática. Todos os estudos foram avaliados, caracterizados e categorizados por um grupo de pesquisadores do Laboratório de Pesquisa & Desenvolvimento de Práticas Integrativas e Complementares (LabPICs) da Faculdade de Farmácia da Universidade Federal do Rio de Janeiro. El mapa presenta una visión general de la evidencia sobre los efectos de las plantas medicinales y la fitoterapia para el trastornos metabólicos y fisiológicos. A partir de una amplia búsqueda bibliográfica, se incluyeron 48 estudios de revisión sistemática en el mapa. Todos los estudios fueron evaluados, caracterizados y categorizados por un grupo de investigadores del Laboratorio de Investigación y Desarrollo para Prácticas Integrativas y Complementarias (LabPIC) en la Facultad de Farmacia de la Universidad Federal de Rio de Janeiro. The map presents an overview of the evidence on the effects of Medicinal Plants and Phytotherapy for Metabolic and Physiological Disorders. From a wide bibliographic search, 48 systematic review studies were included in the map. All studies were evaluated, characterized and categorized by a group of researchers from the Research & Development Laboratory for Integrative and Complementary Practices (LabPICs) at the Faculty of Pharmacy, Federal University of Rio de Janeiro.


Assuntos
Medicina Baseada em Evidências/estatística & dados numéricos , Resultado do Tratamento , Fitoterapia/estatística & dados numéricos , Saúde Mental , Qualidade de Vida/psicologia
16.
Recurso na Internet em Inglês, Espanhol, Português | LIS - Localizador de Informação em Saúde | ID: lis-47544

RESUMO

O mapa apresenta uma visão geral das evidências sobre os efeitos das Plantas Medicinais e Fitoterapia para Saúde Mental e Qualidade de Vida. A partir de uma ampla busca bibliográfica foram incluídos no mapa 37 estudos de revisão sistemática. Todos os estudos foram avaliados, caracterizados e categorizados por um grupo de pesquisadores do Laboratório de Pesquisa & Desenvolvimento de Práticas Integrativas e Complementares (LabPICs) da Faculdade de Farmácia da Universidade Federal do Rio de Janeiro. El mapa presenta una visión general de la evidencia sobre los efectos de las plantas medicinales y la fitoterapia para ela salud mental y calidad de vida. A partir de una amplia búsqueda bibliográfica, se incluyeron 37 estudios de revisión sistemática en el mapa. Todos los estudios fueron evaluados, caracterizados y categorizados por un grupo de investigadores del Laboratorio de Investigación y Desarrollo para Prácticas Integrativas y Complementarias (LabPIC) en la Facultad de Farmacia de la Universidad Federal de Rio de Janeiro. The map presents an overview of the evidence on the effects of Medicinal Plants and Phytotherapy for mental health and quality of life. From a wide bibliographic search, 37 systematic review studies were included in the map. All studies were evaluated, characterized and categorized by a group of researchers from the Research & Development Laboratory for Integrative and Complementary Practices (LabPICs) at the Faculty of Pharmacy, Federal University of Rio de Janeiro.


Assuntos
Resultado do Tratamento , Medicina Baseada em Evidências/estatística & dados numéricos , Fitoterapia/métodos , Saúde Mental , Qualidade de Vida/psicologia , Fitoterapia/estatística & dados numéricos
17.
Recurso na Internet em Inglês, Espanhol, Português | LIS - Localizador de Informação em Saúde | ID: lis-47547

RESUMO

O mapa apresenta uma visão geral das evidências sobre os efeitos das Plantas Medicinais e Fitoterapia para dor e doenças crônicas. A partir de uma ampla busca bibliográfica foram incluídos no mapa 49 estudos de revisão sistemática. Todos os estudos foram avaliados, caracterizados e categorizados por um grupo de pesquisadores do Laboratório de Pesquisa & Desenvolvimento de Práticas Integrativas e Complementares (LabPICs) da Faculdade de Farmácia da Universidade Federal do Rio de Janeiro. El mapa presenta una visión general de la evidencia sobre los efectos de las plantas medicinales y la fitoterapia para el dolor y las enfermedades crónicas. A partir de una amplia búsqueda bibliográfica, se incluyeron 49 estudios de revisión sistemática en el mapa. Todos los estudios fueron evaluados, caracterizados y categorizados por un grupo de investigadores del Laboratorio de Investigación y Desarrollo para Prácticas Integrativas y Complementarias (LabPIC) en la Facultad de Farmacia de la Universidad Federal de Rio de Janeiro. The map presents an overview of the evidence on the effects of Medicinal Plants and Phytotherapy for pain and chronic diseases. From a wide bibliographic search, 49 systematic review studies were included in the map. All studies were evaluated, characterized and categorized by a group of researchers from the Research & Development Laboratory for Integrative and Complementary Practices (LabPICs) at the Faculty of Pharmacy, Federal University of Rio de Janeiro.


Assuntos
Resultado do Tratamento , Dor Crônica/prevenção & controle , Medicina Baseada em Evidências/estatística & dados numéricos , Fitoterapia/estatística & dados numéricos
18.
PLoS Med ; 17(5): e1003119, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32421717

RESUMO

BACKGROUND: Criminal justice involvement is common among pregnant women with opioid use disorder (OUD). Medications for OUD improve pregnancy-related outcomes, but trends in treatment data among justice-involved pregnant women are limited. We sought to examine trends in medications for OUD among pregnant women referred to treatment by criminal justice agencies and other sources before and after the Affordable Care Act's Medicaid expansion. METHODS AND FINDINGS: We conducted a serial, cross-sectional analysis using 1992-2017 data from pregnant women admitted to treatment facilities for OUD using a national survey of substance use treatment facilities in the United States (N = 131,838). We used multiple logistic regression and difference-in-differences methods to assess trends in medications for OUD by referral source. Women in the sample were predominantly aged 18-29 (63.3%), white non-Hispanic, high school graduates, and not employed. Over the study period, 26.3% (95% CI 25.7-27.0) of pregnant women referred by criminal justice agencies received medications for OUD, which was significantly less than those with individual referrals (adjusted rate ratio [ARR] 0.45, 95% CI 0.43-0.46; P < 0.001) or those referred from other sources (ARR 0.51, 95% CI 0.50-0.53; P < 0.001). Among pregnant women referred by criminal justice agencies, receipt of medications for OUD increased significantly more in states that expanded Medicaid (n = 32) compared with nonexpansion states (n = 18) (adjusted difference-in-differences: 12.0 percentage points, 95% CI 1.0-23.0; P = 0.03). Limitations of this study include encounters that are at treatment centers only and that do not encompass buprenorphine prescribed in ambulatory care settings, prisons, or jails. CONCLUSIONS: Pregnant women with OUD referred by criminal justice agencies received evidence-based treatment at lower rates than women referred through other sources. Improving access to medications for OUD for pregnant women referred by criminal justice agencies could provide public health benefits to mothers, infants, and communities. Medicaid expansion is a potential mechanism for expanding access to evidence-based treatment for pregnant women in the US.


Assuntos
Medicina Baseada em Evidências/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/terapia , Adulto , Feminino , Hispano-Americanos , Humanos , Patient Protection and Affordable Care Act , Gravidez , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
19.
São Paulo; BIREME/OPAS/OMS; maio 29, 2020.
Não convencional em Inglês, Espanhol, Português | PIE | ID: biblio-1097703

RESUMO

O mapa apresenta uma visão geral das evidências sobre os efeitos da Meditação para diversas condições clínicas e de saúde da população em geral. A partir de uma ampla busca bibliográfica de estudos publicados e não publicados, foram incluídos no Mapa 191 revisões (78 revisões sistemáticas, 110 metanálises, 2 metassínteses e 1 revisão integrativa). Sobre os tipos de meditação: 147 revisões avaliaram resultados a partir de técnicas de mindfulness ou derivados, 34 revisões avaliaram meditação geral, 8 revisões meditação transcendental, 3 revisões técnicas de compaixão e 1 revisão avaliou práticas de atenção focada. Todos os estudos foram selecionados, avaliados, caracterizados e categorizados por pares de pesquisadores da área de Meditação.


El mapa muestra una vista general de las experiencias sobre los efectos de la meditación para diversas condiciones clínicas y de la salud de la población en general. A partir de una amplia búsqueda bibliográfica de estudios publicados y no publicados, fueron incluidas 191 revisiones: 78 revisiones sistemáticas, 110 metanálises, 2 metassínteses y 1 revisión integrativa. Sobre los tipos de meditación: 147 revisiones disponibles resultados de partir de técnicas de mindfulness o derivados, 34 revisiones disponibles meditación general, 8 revisiones medita trascendental, 3 revisiones técnicas de comparación y 1 revisión acerca prática de atención focada. Todos los estudios fueron seleccionados, evaluados, y caracterizados por pares de investigadores del área de Meditación.


The map provides an overview of the evidence on the effects of Meditation for various clinical and health conditions of the general population. From a wide bibliographic search of published and unpublished studies, 191 reviews were included in the Map: 78 systematic reviews, 110 meta-analyzes, 2 meta-syntheses and 1 integrative review. About types of meditation: 147 reviews evaluated results for mindfulness techniques or derivatives, 34 reviews evaluated general meditation, 8 reviews transcendental meditation, 3 compassion technique and 1 review evaluated practices of focused attention. All studies were selected, evaluated, characterized and categorized by pairs of researchers in the area of ​​Meditation.


Assuntos
Humanos , Resultado do Tratamento , Meditação/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Medicina Integrativa/métodos
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