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1.
Recurso educacional aberto em Português | CVSP - Regional | ID: oer-3906

RESUMO

Esta aula faz parte da sessão tira duvidas realizada no 5 Encontro da Rede de Referencistas - RefNet


Assuntos
Projetos de Pesquisa , Bibliotecas Digitais
2.
J Environ Qual ; 49(5): 1073-1080, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33016437

RESUMO

Non-steady-state (NSS) chamber techniques have been used for decades to measure nitrous oxide (N2 O) fluxes from agricultural soils. These techniques are widely used because they are relatively inexpensive, easy to adopt, versatile, and adaptable to varying conditions. Much of our current understanding of the drivers of N2 O emissions is based on studies using NSS chambers. These chamber techniques require decisions regarding multiple methodological aspects (e.g., chamber materials and geometry, deployment, sample analysis, and data and statistical analysis), each of which may significantly affect the results. Variation in methodological details can lead to challenges in comparing results between studies and assessment of reliability and uncertainty. Therefore, the New Zealand Government, in support of the objectives of the Livestock Research Group of the Global Research Alliance on Agricultural Greenhouse Gases (GRA), funded two international projects to, first, develop standardized guidelines on the use of NSS chamber techniques and, second, refine them based on the most up to date knowledge and methods. This introductory paper summarizes a collection of papers that represent the revised guidelines. Each article summarizes existing knowledge and provides guidance and minimum requirements on chamber design, deployment, sample collection, storage and analysis, automated chambers, flux calculations, statistical analysis, emission factor estimation and data reporting, modeling, and "gap-filling" approaches. The minimum requirements are not meant to be highly prescriptive but instead provide researchers with clear direction on best practices and factors that need to be considered. Health and safety considerations of NSS chamber techniques are also provided with this introductory paper.


Assuntos
Óxido Nitroso/análise , Projetos de Pesquisa , Nova Zelândia , Reprodutibilidade dos Testes , Solo
3.
J Environ Qual ; 49(5): 1156-1167, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33016448

RESUMO

Static chambers are often used for measuring nitrous oxide (N2 O) fluxes from soils, but statistical analysis of chamber data is challenged by the inherently heterogeneous nature of N2 O fluxes. Because N2 O chamber measurements are commonly used to assess N2 O mitigation strategies or to determine country-specific emission factors (EFs) for calculating national greenhouse gas inventories, it is important that statistical analysis of the data is sound and that EFs are robustly estimated. This paper is one of a series of articles that provide guidance on different aspects of N2 O chamber methodologies. Here, we discuss the challenges associated with statistical analysis of heterogeneous data, by summarizing statistical approaches used in recent publications and providing guidance on assessing normality and options for transforming data that follow a non-normal distribution. We also recommend minimum requirements for reporting of experimental and metadata of N2 O studies to ensure that the robustness of the results can be reliably evaluated. This includes detailed information on the experimental site, methodology and measurement procedures, gas analysis, data and statistical analyses, and approaches to generate EFs, as well as results of ancillary measurements. The reliability, robustness, and comparability of soil N2 O emissions data will be improved through (a) application, and reporting, of more rigorous methodological standards by researchers and (b) greater vigilance by reviewers and scientific editors to ensure that all necessary information is reported in scientific publications.


Assuntos
Gases de Efeito Estufa , Projetos de Pesquisa , Óxido Nitroso/análise , Reprodutibilidade dos Testes , Solo
4.
J Environ Qual ; 49(5): 1092-1109, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33016455

RESUMO

Adequately estimating soil nitrous oxide (N2 O) emissions using static chambers is challenging due to the high spatial variability and episodic nature of these fluxes. We discuss how to design experiments using static chambers to better account for this variability and reduce the uncertainty of N2 O emission estimates. This paper is part of a series, each discussing different facets of N2 O chamber methodology. Aspects of experimental design and sampling affected by spatial variability include site selection and chamber layout, size, and areal coverage. Where used, treatment application adds a further level of spatial variability. Time of day, frequency, and duration of sampling (both individual chamber closure and overall experiment duration) affect the temporal variability captured. We also present best practice recommendations for chamber installation and sampling protocols to reduce further uncertainty. To obtain the best N2 O emission estimates, resources should be allocated to minimize the overall uncertainty in line with experiment objectives. Sometimes this will mean prioritizing individual flux measurements and increasing their accuracy and precision by, for example, collecting four or more headspace samples during each chamber closure. However, where N2 O fluxes are exceptionally spatially variable (e.g., in heterogeneous agricultural landscapes, such as uneven and woody grazed pastures), using available resources to deploy more chambers with fewer headspace samples per chamber may be beneficial. Similarly, for particularly episodic N2 O fluxes, generated for example by irrigation or freeze-thaw cycles, increasing chamber sampling frequency will improve the accuracy and reduce the uncertainty of temporally interpolated N2 O fluxes.


Assuntos
Monitoramento Ambiental , Projetos de Pesquisa , Agricultura , Óxido Nitroso/análise , Solo
6.
J Am Board Fam Med ; 33(5): 645-649, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32989057

RESUMO

The COVID-19 outbreak is a stark reminder of the ongoing challenge of emerging and reemerging disease, the human cost of pandemics and the need for robust research.1 For primary care, the advent of COVID-19 has forced an unprecedented wave of practice change. In turn, Practice-Based Research Networks (PBRNs) must rapidly pivot to address the changing environment and the critical challenges faced by primary care. The pandemic has also impacted the ability of PBRNs to deploy traditional research methods such as face-to-face patient and provider interactions, practice facilitation, and stakeholder engagement. Providers need more relevant, patient-centered evidence and the skills to effect change. These skills will become more important than ever as primary care practices evolve in response to the current COVID-19 pandemic and the disparities in health outcomes highlighted by COVID-19 and the global Black Lives Matter social movement for justice. Throughout this issue, authors detail the work conducted by PBRNs that demonstrate many of these evolving concepts. Articles explore how PBRNs can evaluate COVID-19 in primary care, the role of PBRNs in quality improvement, stakeholder engagement, prevention and chronic care management, and patient safety in primary care.


Assuntos
Betacoronavirus , Redes Comunitárias/tendências , Infecções por Coronavirus , Pesquisa sobre Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/tendências , Redes Comunitárias/organização & administração , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Projetos de Pesquisa , Participação dos Interessados , Estados Unidos
7.
J Am Board Fam Med ; 33(5): 774-778, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32989072

RESUMO

BACKGROUND: Primary care practice-based research networks (PBRNs) are critical laboratories for generating evidence from real-world settings, including studying natural experiments. Primary care's response to the novel coronavirus-19 (COVID-19) pandemic is arguably the most impactful natural experiment in our lifetime. EVALUATING THE IMPACT OF COVID-19: We briefly describe the OCHIN PBRN of community health centers (CHCs), its partnership with implementation scientists, and how we are leveraging this infrastructure and expertise to create a rapid research response evaluating how CHCs across the country responded to the COVID-19 pandemic. COVID-19 RESEARCH ROADMAP: Our research agenda focuses on asking: How has care delivery in CHCs changed due to COVID-19? What impact has COVID-19 had on the delivery of preventive services in CHCs? Which PBRN services (e.g., data surveillance, training, evidence synthesis) are most impactful to real-world practices? What decision-making strategies were used in the PBRN and its practices to make real-time changes in response to the pandemic? What critical factors in successfully and sustainably transforming primary care are illuminated by pandemic-driven changes? DISCUSSION AND CONCLUSIONS: PBRNs enable real-world evaluation of practice change and natural experiments, and thus are ideal laboratories for implementation science research. We present a real-time example of how a PBRN Implementation Laboratory activated a response to study a historic natural experiment, to help other PBRNs charting a course through this pandemic.


Assuntos
Betacoronavirus , Centros Comunitários de Saúde/tendências , Redes Comunitárias/tendências , Infecções por Coronavirus , Assistência à Saúde/tendências , Pesquisa sobre Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/tendências , Centros Comunitários de Saúde/organização & administração , Redes Comunitárias/organização & administração , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Prática Clínica Baseada em Evidências , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Ciência da Implementação , Disseminação de Informação , Inovação Organizacional , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Participação dos Interessados , Estados Unidos
9.
J Am Med Inform Assoc ; 27(9): 1476-1487, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32940705

RESUMO

OBJECTIVE: The 2019 novel coronavirus disease (COVID-19) outbreak progressed rapidly from a public health (PH) emergency of international concern (World Health Organization [WHO], 30 January 2020) to a pandemic (WHO, 11 March 2020). The declaration of a national emergency in the United States (13 March 2020) necessitated the addition and modification of terminology related to COVID-19 and development of the disease's case definition. During this period, the Centers for Disease Control and Prevention (CDC) and standard development organizations released guidance on data standards for reporting COVID-19 clinical encounters, laboratory results, cause-of-death certifications, and other surveillance processes for COVID-19 PH emergency operations. The CDC COVID-19 Information Management Repository was created to address the need for PH and health-care stakeholders at local and national levels to easily obtain access to comprehensive and up-to-date information management resources. MATERIALS AND METHODS: We introduce the clinical and health-care informatics community to the CDC COVID-19 Information Management Repository: a new, national COVID-19 information management tool. We provide a description of COVID-19 informatics resources, including data requirements for COVID-19 data reporting. RESULTS: We demonstrate the CDC COVID-19 Information Management Repository's categorization and management of critical COVID-19 informatics documentation and standards. We also describe COVID-19 data exchange standards, forms, and specifications. CONCLUSIONS: This information will be valuable to clinical and PH informaticians, epidemiologists, data analysts, standards developers and implementers, and information technology managers involved in the development of COVID-19 situational awareness and response reporting and analytics.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Gestão da Informação em Saúde , Pandemias , Pneumonia Viral , Vocabulário Controlado , Centers for Disease Control and Prevention, U.S. , Infecções por Coronavirus/epidemiologia , Assistência à Saúde , Interoperabilidade da Informação em Saúde , Gestão da Informação em Saúde/organização & administração , Gestão da Informação em Saúde/normas , Humanos , Disseminação de Informação , Laboratórios , Pneumonia Viral/epidemiologia , Saúde Pública , Projetos de Pesquisa/normas , Estados Unidos
10.
S Afr Med J ; 110(7): 640-641, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880339

RESUMO

The basis of a manuscript is the research question, which is reported within a standard publication structure. The 'Background' section clarifies the question. The 'Methods' section describes what was done in the study. The 'Results' section describes the data observed and the analysis of these data. The 'Discussion' section describes how findings of the study relate to current knowledge and the practical implications of the results, and suggests future studies. This structure differs from that of a thesis, the aims of which are broader than reporting on a specific research question.


Assuntos
Revisão da Pesquisa por Pares , Editoração , Humanos , Publicações Periódicas como Assunto , Projetos de Pesquisa
11.
Medicine (Baltimore) ; 99(38): e22043, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957324

RESUMO

BACKGROUND: Atopic dermatitis (AD) is a common eczematous skin disorder that profoundly reduces the quality of life due to intractable pruritus. Excellent therapeutic success of the anti-interleukin 4 receptor-α antibody dupilumab in clinical trials and a real-world clinical context indicates the crucial roles of interleukin (IL)-4 and IL-13 in the pathogenesis of AD. Along with the clinical improvement in skin scores and pruritus, dupilumab significantly and progressively reduces and normalizes the upregulated expression of T helper type 2 signatures such as Chemokine (C-C motif) ligand (CCL)17, CCL18, CCL22, and CCL26 in the lesional skin of AD. However, no blood/serum biomarkers are known to predict good or poor outcome in patients with AD treated with dupilumab. METHODS: Patients are at least 18 years of age and have moderate-to-severe AD with Eczema Area and Severity Index (EASI) ≥16, Investigator's Global Assessment ≥3, and body surface area ≥10%. We are going to enroll more than 130 subjects from 18 medical facilities. Clinical objective findings will be evaluated by EASI. Subjective symptoms will be assessed by Patient-Oriented Eczema Measure, Numerical Rating Scale for Pruritus (Pruritus-NRS), Skin Comfort-NRS, and Treatment Satisfaction-NRS. We will measure 18 blood/serum biomarkers including % eosinophils in blood cell count, lactate dehydrogenase, total IgE, soluble interleukin 2 receptor, CCL17, CCL18, CCL22, CCL26, CCL27, IL-13, IL-22, IL-24, IL-25, IL-31, IL-33, thymic stromal lymphopoietin, periostin, and squamous cell carcinoma antigen-2. The clinical evaluation and biomarker sampling will be performed at 0, 2, 4, 8, and 16 weeks of dupilumab treatment. We will also perform proteomic analysis (of roughly 300 proteins) of the patients' sera obtained at 0 and 2 weeks of treatment. The primary endpoint is the association between "baseline levels of 18 biomarkers" and "% change from baseline of EASI at 16 weeks of dupilumab treatment." DISCUSSION: This is the first clinical trial to explore the biomarkers, including potential proteomic markers, most strongly associated with improvement in EASI in patients with moderate-to-severe AD treated with dupilumab for 16 weeks (B-PAD study). A limitation is that we will only enroll Japanese patients.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Biomarcadores/sangue , Dermatite Atópica/tratamento farmacológico , Humanos , Projetos de Pesquisa , Índice de Gravidade de Doença
12.
Medicine (Baltimore) ; 99(38): e22066, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957328

RESUMO

INTRODUCTION: Type 2 diabetes mellitus(T2DM) is a widespread attention of the world's major health problems. The international diabetes federation (IDF) has released the "global overview of diabetes (ninth edition)". By 2019. It can lead to complications and even death. Among them, the use of Rhizoma Coptidis (Huanglian) at large dose has also been proved to be effective in clinical practice. However, due to the lack of evidence, there is no specific method or suggestion, so it is necessary to carry out systematic evaluation on coptis coptis and provide effective evidence for further research. METHODS AND ANALYSIS: We will search the following electronic databases from their inception to May 2020: Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure. Primary outcomes:fasting blood glucose and glycosylated haemoglobin (A1c). SECONDARY OUTCOMES: plasma insulin,blood lipid profile,adverse events,and cost associated with the intervention and hospital visit. Data will be extracted by 2 researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0. RESULTS: The results of this study will systematically evaluate the effectiveness and safety of large dose of Huanglian intervention for people with T2DM. CONCLUSION: The systematic review of this study will summarize the current published evidence of large dose of Huanglian for the treatment of T2DM, which can further guide the promotion and application of it. ETHICS AND DISSEMINATION: This study is a systematic review, the outcomes are based on the published evidence, so examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations.Open Science Framework(OSF)registration number: July 21, 2020. https://osf.io/w7bj6.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Projetos de Pesquisa , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Medicine (Baltimore) ; 99(38): e22104, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957330

RESUMO

INTRODUCTION: Smoking is well-known to increase cancer risk, particularly risk of lung cancer, and negatively affects efficacy of cancer treatment. However, recent evidence suggests that among cancer patients, paradoxically, smokers respond to treatment better than non-smokers. We propose to conduct a focused review and meta-analysis to compare response to drug treatment between smoking and non-smoking cancer patients. METHODS AND DESIGN: We will collect data from large clinical trials of therapies for cancer patients which have included smokers and non-smokers. We will search PubMed, PMC/ MEDLINE, SCOPUS, Embase, and the registries for clinical trials and four major clinical journals up to June 30, 2019. Search terms will be "Drug name" phase-3" or "Drug name" phase-III." Data collection will be focused on randomized clinical trials of cancer drugs that enrolled at least 100 participants and reporting treatment results from smoking and nonsmoking patients. Initial selection criteria will be clinical trial studies of drug treatment of 100 or more cancer patients, and reporting hazard ratios (HR) for smokers and non-smokers. Two persons will be searching such publications independently, or data will be provided, double checked, or confirmed by authors. Multiple sub-group analyses will be conducted by at least two persons to avoid bias or experimental errors. DISCUSSION: The results will clarify whether smoking and response to treatment of cancer are linked not. Our results may possibly identify drug/s that work better among cancer patients who are smokers. TRIAL REGISTRATION: PROSPERO registration number: CRD42019146402.


Assuntos
Neoplasias/tratamento farmacológico , Projetos de Pesquisa , Fumantes , Ensaios Clínicos como Assunto , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
14.
Medicine (Baltimore) ; 99(38): e22150, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957337

RESUMO

BACKGROUND: Nausea and vomiting are the most common complications after chemotherapy, which cannot be completely controlled even with commonly prescribed antiemetic drugs, particularly in patients receiving highly emetogenic chemotherapy Acupuncture therapy is an effective replacement method for chemotherapy-induced nausea and vomiting (CINV), which effectiveness and safety have been observed by many clinicians. However, different acupuncture treatments have various effectiveness. Based on enough clinical researches, the study aims to uses Bayesian network meta-analysis (NMA) to evaluate the effectiveness of different acupuncture therapies used for preventing CINV. METHODS: Authors will search PubMed/Medline, Cochrane library, Web of Science, Ebsco, Ovid/Embase, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine from setup time to July 2020. All randomized control trails meet the standard will be included. Quality evaluation of included studies will be implemented with Cochrane risk-of-bias tool. STATA 14.0 will be used to perform pairwise meta-analysis. Addis 1.16.8 (University Medical Center Groningen (UMCG), Groningen, NL) and OpenBUGS 3.2.3 (Medical Research Council (MRC), London, UK) will be used to conduct NMA. RESULTS: The results of this review will generate a comprehensive review of current evidence and be published on a peer-reviewed journal. CONCLUSION: The result of this systematic review and Bayesian NMA may offer better options for patients in relieving CINV.Systematic review registration number: INPLASY202070070.


Assuntos
Terapia por Acupuntura/métodos , Antineoplásicos/efeitos adversos , Náusea/prevenção & controle , Projetos de Pesquisa , Vômito/prevenção & controle , Teorema de Bayes , Humanos , Náusea/induzido quimicamente , Metanálise em Rede , Revisões Sistemáticas como Assunto , Vômito/induzido quimicamente
15.
Medicine (Baltimore) ; 99(38): e22181, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957343

RESUMO

BACKGROUND: By now, the incidence of chronic kidney disease (CKD) is increasing. The development of various CKD is attributed to the continuous aggravation of renal interstitial fibrosis (RIF) in the process of end-stage renal disease (ESRD). Oral treatment of traditional Chinese medicine (TCM) is one of the therapies for RIF. Randomized controlled trials (RCTs) of TCM treatment RIF have been reported, but its effectiveness and safety have yet been systematically investigated. Therefore, through the systematic analysis and meta-analysis, our study will summarize the effectiveness and safety of oral treatment RIF of TCM, in order to provides scientific reference for clinical practice. METHODS: This protocol follows Preferred Reporting Items for Systematic Evaluation and Meta-Analysis. RCTs will be only selected. Such databases as the PubMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Excerpt Medical Database (Embase), WanFan Data, Chinese Biomedical Literature Database (CBM), WHO International Clinical Trials Registry Platform will be searched from the inception to June, 2020 to collect the RCTs about taking TCM orally in treating RIF. The literature according to the inclusion and exclusion criteria, data-extracted and the methodological quality evaluated will be performed independently by 2 reviewers. The clinical outcomes including renal function indices (Scr, BUN, 24-hour urinary protein quantity) and Indicators of RIF (TGF-ß1, Notch1, Jagged-1). The risk of bias included in the RCTs will be evaluated by the bias risk assessment tool provided in the Cochrane System Evaluation Manual 5.1.0. Review Manager 5.3 provided by the Cochrane collaboration network will be used to process the data. RESULTS AND CONCLUSION: Some more targeted and practical results about the efficacy of taking TCM orally in RIF have been provided by our study. The available evidence suggests that the therapeutic effects of combining TCM with Western medicine therapies is much better for RIF than Western medicine therapies only.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Nefropatias/tratamento farmacológico , Projetos de Pesquisa , Fibrose , Humanos , Medicina Tradicional Chinesa , Metanálise como Assunto , Revisões Sistemáticas como Assunto
16.
N Z Med J ; 133(1520): 83-90, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994596

RESUMO

AIM: To critically analyse the reliability of an article which claims to be evidence that the End of Life Choice Act 2019 provides a "potential hotspot for family, community and social discord that may not be easily remedied" should the legislation receive public support in New Zealand's September 2020 referendum. METHODS: The subject article was reviewed multiple times by all authors and critiqued against three criteria: a reliability pyramid developed to weigh evidence about assisted dying; principles that guide the conduct of social science research; and the use of reliable and current social science literature to support factual claims. RESULTS: The study being analysed involved a single interview and so is located at the second bottom row of the reliability pyramid. Its research design is also unable to support the broad findings that are asserted. Other flaws in method included findings being extended beyond the data, and failure to state appropriate limitations in the research method. Further, claims are made that are unsupported by the weight of reliable social science literature. CONCLUSION: The subject article is methodologically and factually flawed so is unreliable as evidence. It should not be considered in the assisted dying debates preceding the forthcoming referendum.


Assuntos
Suicídio Assistido , Peso Corporal , Humanos , Nova Zelândia , Reprodutibilidade dos Testes , Projetos de Pesquisa
18.
Int J Chron Obstruct Pulmon Dis ; 15: 2127-2133, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982205

RESUMO

Pulmonary rehabilitation (PR) is an important, evidence-based treatment that improves outcomes for people with COPD. Individualized exercise programmes aim to improve exercise capacity; self-management education and psychological support are also provided. Translating increased exercise capacity into sustained behavioural change of increased physical activity is difficult. Other unresolved problems with PR programmes include improving uptake, completion, response and sustaining long-term benefit. We offer a different perspective drawn from clinical experience of PR, quantitative and qualitative studies of singing groups for people with COPD, and stroke rehabilitation research that gives psychological factors a more central role in determining outcomes after PR. We discuss Take Charge; a simple but effective psychological intervention promoting self-management--that could be used as part of a PR programme or in situations where PR was declined or unavailable. This may be particularly relevant now when traditional face-to-face group programmes have been disrupted by COVID-19 precautions.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Terapia por Exercício , Comportamentos Relacionados com a Saúde , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Pesquisa de Reabilitação , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Terapia por Exercício/métodos , Terapia por Exercício/organização & administração , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Sistemas de Apoio Psicossocial , Doença Pulmonar Obstrutiva Crônica/psicologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Projetos de Pesquisa , Autogestão/métodos , Autogestão/psicologia , Resultado do Tratamento
19.
PLoS One ; 15(9): e0239554, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991604

RESUMO

BACKGROUND: Without any pharmaceutical intervention and vaccination, the only way to combat Coronavirus Disease 2019 (COVID-19) is to slow down the spread of the disease by adopting non-pharmaceutical public health interventions (PHIs). Patient isolation, lockdown, quarantine, social distancing, changes in health care provision, and mass screening are the most common non-pharmaceutical PHIs to cope with the epidemic. However, there is neither systematic evidence on the effectiveness of non-pharmaceutical PHIs in controlling the COVID-19 nor on how these interventions work in different contexts. Therefore, in this study we will address two main objectives: 1) to assess the effectiveness of the non-pharmaceutical PHIs in controlling the spread of COVID-19 using a systematic review and meta-analyses; 2) to explore why, how, and for whom these interventions work using a realist review. MATERIALS AND METHODS: This review study has two main phases. In the first phase of this study, we will extract data from two main types of studies including quasi-experimental studies (such as quasi-randomized trials, controlled before-after studies (CBAs) and interrupted time series studies (ITSs)) and observational studies (such as cohort, case-control, and cross-sectional studies), written in the English language. We will explore effectiveness of the non-pharmaceutical PHIs targeted either suppression or mitigation strategies (or a combination of both) in controlling the COVID-19 epidemics in the community level. Effectiveness will be considered as the changes in mortality rate, incidence rate, basic reproduction number rate, morbidity rate, rates of hospitalization, rates of intensive care unit (ICU) hospitalization, and other health outcomes where possible. We will perform random-effects meta-analyses, if possible, using CMA software. In the second phase, we will conduct a realist review to find out how, why, for whom, and in what circumstances the non-pharmaceutical PHIs work. At the realist review, we will identify and explore Context-Mechanism-Outcome configurations to provide a robust explanation on the effectiveness of the interventions in different contexts using Pawson's 5-step realist review template including: "clarify scope; search for evidence; appraise primary studies and extract data; synthesize evidence and draw conclusions; and disseminate, implement and evaluate". Although the steps are presented in a linear manner, in practice, we will follow them in iterative stages to fill any potential overlap. DISCUSSION: The findings of this research will provide a crucial insight into how and in which context the non-pharmaceutical PHIs work in controlling the spread of COVID-19. Conducting a systematic review and meta-analysis in line with a realist review will allow us to draw a robust conclusion on the effects and the way in which the interventions work. Understanding the role of contextual factors in the effectiveness of non-pharmaceutical PHIs and the mechanism of this process could enable policymakers to implement appropriate policies and manage the COVID-19 epidemics more efficiently. SYSTEMATIC REVIEW REGISTRATION: CRD42020186855.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Número Básico de Reprodução , Betacoronavirus , Estudos Controlados Antes e Depois , Infecções por Coronavirus/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Metanálise como Assunto , Ensaios Clínicos Controlados não Aleatórios como Assunto , Estudos Observacionais como Assunto , Pneumonia Viral/mortalidade , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
20.
J Int Med Res ; 48(9): 300060520955037, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32960106

RESUMO

BACKGROUND: The roles of inflammation and hypercoagulation in predicting outcomes of coronavirus disease 2019 (COVID-19) are unclear. METHODS: Adult patients diagnosed with COVID-19 from 28 January 2020 to 4 March 2020 in Tongji Hospital, Wuhan were recruited. Data on related parameters were collected. Univariate analysis and multivariable binary logistic regression were used to explore predictors of critical illness and mortality. RESULTS: In total, 199 and 44 patients were enrolled in the training and testing sets, respectively. Elevated ferritin, tumor necrosis factor-α and D-dimer and decreased albumin concentration were associated with disease severity. Older age, elevated ferritin and elevated interleukin-6 were associated with 28-day mortality. The FAD-85 score, defined as age + 0.01 * ferritin +D-dimer, was used to predict risk of mortality. The sensitivity, specificity and accuracy of FAD-85 were 86.4%, 81.8% and 86.4%, respectively. A nomogram was established using age, ferritin and D-dimer to predict the risk of 28-day mortality. CONCLUSIONS: Thrombo-inflammatory parameters provide key information on the severity and prognosis of COVID-19 and can be used as references for clinical treatment to correct inflammatory and coagulation abnormalities.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/mortalidade , Coagulação Intravascular Disseminada/mortalidade , Pneumonia Viral/mortalidade , Trombose/mortalidade , Adulto , Idoso , Biomarcadores/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Coagulação Intravascular Disseminada/complicações , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/virologia , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Interleucina-6/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Prognóstico , Projetos de Pesquisa , Estudos Retrospectivos , Albumina Sérica/metabolismo , Índice de Gravidade de Doença , Análise de Sobrevida , Trombose/complicações , Trombose/diagnóstico , Trombose/virologia , Fator de Necrose Tumoral alfa/sangue
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