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1.
Recurso educacional aberto em Português | CVSP - Regional | ID: oer-3918

RESUMO

Sistema Fi-Admin Campos descritivos dos recursos educacionais


Assuntos
Gestão da Informação em Saúde , Medicina Baseada em Evidências/métodos
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
3.
J Trauma Stress ; 33(5): 634-642, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33007149

RESUMO

In response to COVID-19, continued workforce training is essential to ensure that evidence-based treatments are available on the frontline to meet communities' ongoing and emerging mental health needs. However, training during a pandemic imposes many new challenges. This paper describes a multisite training and implementation pilot program, facets of which allowed for continued training despite the onset of the COVID-19 pandemic and subsequent social distancing guidelines. This virtual facilitated learning collaborative in Written Exposure Therapy, an evidence-based treatment for posttraumatic stress disorder, included virtual workshop training, phone-based clinical consultation, implementation-focused video calls for program leadership, and program evaluation. Data are presented about program enrollees and patient impact following the onset of COVID-19-related social distancing restrictions. Challenges, successes, and practical guidance are discussed to inform the field regarding training strategies likely to be durable in an uncertain, dynamic healthcare landscape.


Assuntos
Infecções por Coronavirus/psicologia , Educação a Distância/organização & administração , Terapia Implosiva/educação , Pneumonia Viral/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Betacoronavirus , Medicina Baseada em Evidências/métodos , Humanos , Pandemias , Desenvolvimento de Programas/métodos , Transtornos de Estresse Pós-Traumáticos/psicologia , Redação
6.
JCO Glob Oncol ; 6: 1455-1460, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32997540

RESUMO

The core pillars of multimodal care of patients with cancer are surgical, radiation, and medical oncology. The global pandemic of coronavirus disease 2019 (COVID-19) has suddenly resurrected a new pillar in oncology care: teleoncology. With oncologists reaching out to patients through telemedicine, it is possible to evaluate and fulfill patients' needs; triage patients for elective procedures; screen them for influenza-like illness; provide them with guidance for hospital visits, if needed; and bridge oral medications and treatments when a hospital visit is not desirable because of any high risk-benefit ratio. Teleoncology can bring great reassurance to patients at times when reaching an oncology center is challenging, and more so in resource-constrained countries. Evidence-based treatment protocols, dispensable by teleoncology, already exist for many sites of cancer and they can provide a bridge to treatment when patients are unable to reach cancer centers for their standard treatment. The young pillar of teleoncology is going to remain much longer than COVID-19.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Oncologia/organização & administração , Neoplasias/diagnóstico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/organização & administração , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/normas , Medicina Baseada em Evidências/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Oncologia/métodos , Oncologia/normas , Oncologia/tendências , Neoplasias/terapia , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Telemedicina/normas , Telemedicina/tendências , Triagem/métodos , Triagem/organização & administração , Triagem/normas
7.
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
8.
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
9.
Plast Reconstr Surg ; 146(2): 423-435, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740600

RESUMO

Plastic surgery patients span the nutritional spectrum from generally healthy, nutritionally competent patients to inherently catabolic, nutritionally deficient, and chronic wound patients. Therefore, plastic and reconstructive surgery affords the opportunity to investigate the impact of nutrition across a heterogeneous patient population following a wide variety of procedures. Although patients may be nutritionally deficient in certain vitamins warranting perioperative repletion, other supplements have the potential to benefit all patients, regardless of nutritional status. Despite these putative benefits, there is a dearth of information regarding nutritional optimization, with the limited, available literature focusing mostly on herbal supplements and their potential side effects. A significant barrier to supplement use is the lack of education and available supporting information regarding the indications, contraindications, and physiology of these adjuncts. The goal of this article is to provide a comprehensive, evidence-based review of available nutritional supplements that can be considered for the plastic surgery patient in the perioperative period to optimize surgical outcomes while minimizing risk. Prospective, well-designed studies using validated, high-quality supplements will be critical in determining the significance that perioperative supplementation can have for surgical outcomes. Until well-done prospective studies are performed, the supplement, dose, and duration should be determined on an individual, patient-per-patient basis at the discretion of the operating surgeon.


Assuntos
Medicina Baseada em Evidências/métodos , Desnutrição/dietoterapia , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Humanos , Desnutrição/complicações , Desnutrição/diagnóstico , Estado Nutricional , Complicações Pós-Operatórias/etiologia
11.
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
12.
Int J Radiat Oncol Biol Phys ; 108(2): 379-389, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32798063

RESUMO

PURPOSE: Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study. METHODS AND MATERIALS: Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. The American Society for Radiation Oncology quality of evidence criteria were used to rank the schedules. Process-related statistics and changes in distributions of quality ratings of the highest-rated versus recommended COVID-19 era schedules were described by disease groups and for specific clinical scenarios. RESULTS: From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19-adapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from established higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P = .022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence "pre-COVID" vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications. CONCLUSIONS: A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these potentially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.


Assuntos
Infecções por Coronavirus/epidemiologia , Fracionamento da Dose de Radiação , Medicina Baseada em Evidências/métodos , Pandemias , Pneumonia Viral/epidemiologia , Publicações , Humanos
14.
J Endovasc Ther ; 27(5): 805-817, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32633653

RESUMO

The accrual of clinical studies poses important challenges to researchers and practitioners, especially in the field of endovascular therapy, where patient, lesion, technique, and device subtleties abound. Systematic reviews and meta-analyses may prove particularly fruitful in such settings by increasing statistical precision and bolstering external validity if the evidence base on a specific topic is consistent or by highlighting important discrepancies in the opposite scenario. However, mastering the correct approach to systematic review and meta-analysis is challenging for careful readers or for those interested in conducting such an evidence synthesis exercise. The present article highlights a stepwise approach to systematic reviews and meta-analyses, focusing on endovascular interventions, which will prove useful to anyone reading or wishing to synthesize the evidence base on endovascular topics to optimize decision making or shape future research efforts.


Assuntos
Procedimentos Endovasculares , Medicina Baseada em Evidências/métodos , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Doenças Vasculares/terapia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Fatores de Risco , Stents , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/fisiopatologia
15.
Drug Discov Ther ; 14(3): 149-150, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32669523

RESUMO

Coronavirus disease 2019 (COVID-19) broke out in 2019 and spread rapidly around the world, causing a global pandemic. Traditional Chinese medicine has a history of more than 2,000 years in the prevention and treatment of epidemics and plagues. In guidelines on fighting COVID-19, the National Health Commission (NHC) has recommended some traditional Chinese medicines (TCM), including Jinhua Qinggan granules, Lianhua Qingwen capsules, XueBijing injections, a Qingfei Paidu decoction, a Huashi Baidu decoction, and a Xuanfei Baidu decoction. Based on current results, TCM has displayed some efficacy in combating COVID-19. However, TCM faces many challenges in terms of being recognized around the world. Therefore, evidence-based research is crucial to the development of TCM.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Medicamentos de Ervas Chinesas/uso terapêutico , Medicina Baseada em Evidências/métodos , Medicina Tradicional Chinesa/métodos , Pneumonia Viral/terapia , China/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Medicina Baseada em Evidências/tendências , Humanos , Medicina Tradicional Chinesa/tendências , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Resultado do Tratamento
16.
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
17.
Arch Gynecol Obstet ; 302(3): 763-777, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32661753

RESUMO

This short version of the interdisciplinary S3 guideline "Peri- and Postmenopause-Diagnosis and Interventions" is intended as a decision-making instrument for physicians who counsel peri- and postmenopausal women. It is designed to assist daily practice. The present short version summarizes the full version of the guideline which contains detailed information on guideline methodology, particularly regarding the critical appraisal of the evidence and the assignment of evidence levels. The statements and recommendations of the full version of the guideline are quoted completely in the present short version including levels of evidence (LoE) and grades of recommendation. The classification system developed by the Centre for Evidence-based Medicine in Oxford was used in this guideline.


Assuntos
Sociedades Médicas , Medicina Baseada em Evidências/métodos , Feminino , Alemanha , Guias como Assunto , Humanos , Pessoa de Meia-Idade , Perimenopausa , Pós-Menopausa
18.
Emerg Med J ; 37(9): 572-575, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32651176

RESUMO

The COVID-19 pandemic has led to a surge of information being presented to clinicians regarding this novel and deadly disease. There is a clear urgency to collate, review, appraise and act on this information if we are to do the best for clinicians and patients. However, the speed of the pandemic is a threat to traditional models of knowledge translation and practice change. In this concepts paper, we argue that clinicians need to be agile in their thinking and practice in order to find the right time to change. Adoption of new methods should be based on clinical judgement, the weight of evidence and the balance of probabilities that any new technique, test or treatment might work. The pandemic requires all of us to reach a new level of evidence-based medicine characterised by scepticism, thoughtfulness, responsiveness and clinically agility in practice.


Assuntos
Infecções por Coronavirus , Procedimentos Clínicos , Medicina Baseada em Evidências , Pandemias , Pneumonia Viral , Pesquisa Médica Translacional , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Medicina Baseada em Evidências/educação , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/organização & administração , Humanos , Gestão do Conhecimento , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Melhoria de Qualidade , Capacidade de Resposta ante Emergências , Pesquisa Médica Translacional/educação , Pesquisa Médica Translacional/tendências
19.
Metas enferm ; 23(6): 73-78, jul. 2020.
Artigo em Espanhol | IBECS | ID: ibc-194599

RESUMO

En 1859, Florence Nightingale aseveró "For the sick it is important to have the best", la única forma de identificar lo mejor es investigando sobre los cuidados. La investigación es la herramienta válida que permite generar o consolidar el conocimiento disciplinar y profesional. En la actualidad los estudios liderados por Linda Aiken han demostrado, en el ámbito internacional y durante más de tres décadas, que los resultados de los pacientes no se explican en función de las características de los hospitales, sino por la calidad de los cuidados que se les dispensan. Este artículo tiene por objetivo reflexionar sobre la importancia de la investigación en cuidados, su relación con la práctica basada en la evidencia y los resultados en salud de los pacientes, además de revisar los apoyos a la investigación como son Investén del Instituto de Salud Carlos III, el Plan Estratégico de Investigación e Innovación en Salud (PERIS) y la European Academy of Nursing Science (EANS). Sin lugar a dudas la pandemia de la COVID-19 ha situado a las enfermeras en un punto de inflexión que solo, y según su respuesta para incrementar la visibilidad, será ascendente o descendente. La investigación constituye la pieza clave para dar respuesta al reto


In 1859, Florence Nightingale stated: "For the sick it is important to have the best"; and the only way to identify the best is through healthcare research, which is the valid tool that allows generating or strengthening disciplinary and professional knowledge. Current studies led by Linda Aiken have demonstrated in the international setting, and for over three decades, that patient outcomes cannot be explained through the hospital characteristics, but by the quality of care provided. This article aims to reflect on the importance of healthcare research, its association with evidence-based practice and health outcomes in patients; also to review support for research such as INVESTEN from the Instituto de Salud Carlos III, the Strategic Plan for Research and Innovation in Health (PERIS), and the European Academy of Nursing Science (EANS). Undoubtedly, the COVID-19 pandemic has placed nurses at a tipping point that will only be ascending or descending based on their response to increase visibility. Research represents the key element to address this challenge


Assuntos
Humanos , Pesquisa Biomédica/métodos , Pesquisa em Enfermagem , Teoria de Enfermagem , Cuidados de Enfermagem/organização & administração , Sistemas de Saúde/organização & administração , Medicina Baseada em Evidências/métodos , Enfermagem Baseada em Evidências/organização & administração
20.
Ceska Gynekol ; 85(2): 139-143, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32527109

RESUMO

OBJECTIVE: To informed about international surveillance network severe maternal morbidity and mortality - INOSS. DESIGN: Literature review. SETTINGS: 1st Department of Gynaecology and Obstetrics Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic. METHODS: Literate review of articles published till august 2019. RESULTS: The International Network of Obstetric Survey Systems (INOSS) is an international network that connects countries with the same or similar system of surveillance of acute severe maternal morbidity and mortality. The INOSS was established in year 2010 by twelve countries. Nowadays 19 countries are involved in the INOSS. The cooperation between member countries is focused on the acquisition of relevant data about rare severe acute maternal morbidities. INOSS in 2017 year unified definitions of 8 severe acute maternal morbidities according Delphi method: eclampsia, amniotic fluid embolism, peripartum hysterectomy, severe primary postpartum haemorrhage, uterine rupture, abnormally invasive placenta, spontaneous hemoperitoneum in pregnancy, and cardiac arrest in pregnancy. CONCLUSION: The international cooperation allows the acquisition of relevant epidemiologic data and the optimalization of the treatment according the evidence-based medicine.


Assuntos
Coleta de Dados/métodos , Medicina Baseada em Evidências/organização & administração , Mortalidade Materna , Morbidade , Complicações do Trabalho de Parto , Vigilância da População , Complicações na Gravidez , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Cooperação Internacional , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Sistema de Registros , Eslováquia/epidemiologia , Inquéritos e Questionários
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