Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 30.318
Filtrar
1.
Medicine (Baltimore) ; 98(44): e17757, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689833

RESUMO

Nursing staff play a crucial role in maintaining a functional port. Nursing guidelines recommend standard maintenance with 10 ml irrigation without consideration for variations among patients and individual nursing staff. The aim of this study is to identify the efficacy of the current maintenance strategy and analyze the correlation between complications and actual port presentations, based on disassembled intravenous ports after removal from patients. We attempt to organize the information and propose a definite maintenance strategy.After treatment completion, or due to complications, 434 implanted intravenous ports were removed from patients. All ports were deconstructed to observe their actual presentations and were then analyzed in conjunction with medical records. The correlation between complications and actual presentations was analyzed.From March 2012 to December 2017, 434 implanted intravenous ports were removed from oncology patients after completion of treatment or catheter related complications. From the view of maintenance related presentations, injection chamber blood clot was highly correlated with chemotherapy completion (P < .001) and malfunction (P = .005), while tip blood clot (P = .043) was related with chemotherapy completion and catheter fibrin (P = .015) was related to malfunction. From the view of structure related presentations, broken catheter integrity was correlated to chemotherapy completion (P = .007), fracture (P < .001), and malfunction (P = .008). Compression groove was related to chemotherapy completion (P = .03) and broken catheter at protruding stud was related to fracture (P = .04), while diaphragm rupture was correlated to chemotherapy completion (P = .048) and malfunction. (P < .001).Current port maintenance is insufficient for ideal port maintenance, whereby maintenance-related presentations, including tip clot, catheter fibrin, and injection chamber blood clot were identified. We propose a recommended maintenance strategy based on our findings. Structure-related presentations, including broken catheter integrity, broken catheter at protruding stud and diaphragm rupture were seen in patients with longer implantation period. Removal of the implanted port may be considered after 5 years if no disease relapse is noted.


Assuntos
Cateteres de Demora/normas , Protocolos Clínicos , Neoplasias/enfermagem , Dispositivos de Acesso Vascular/normas , Adulto , Idoso , Cateteres de Demora/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Estudos Retrospectivos , Trombose/etiologia , Dispositivos de Acesso Vascular/efeitos adversos
2.
Medicine (Baltimore) ; 98(45): e17842, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702639

RESUMO

BACKGROUND: Insomnia is one of the most common diseases in modern society, the main characteristics of the patients were difficulty in falling asleep at night and/or failure to maintain effective sleep after falling asleep. It can lead to early awakening, short sleep, heavy sleeplessness, dreaming, poor sleep quality, and working hours after waking up, causes a series of negative emotions, such as fatigue, inefficiency, cognitive decline, social interaction, tension, and anxiety, which affect social harmony and stability. So Insomnia has gained more and more attention. At present, acupuncture has been proved effective in the treatment of insomnia by many studies. The purpose of this study is to evaluate the efficacy and safety of acupuncture in the treatment of insomnia, and to provide the latest evidence for clinical application. METHODS AND ANALYSIS: We collected the qualified literature on acupuncture treatment of insomnia by electronic retrieval of Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Disc (CBMDISC), PubMed, China Science and Technology Journal Database (VIP) and Wanfang Database, and manual retrieval of papers and internal reports. We will select the eligible studies published up to September 30, 2019. We use Insomnia Severity Index (ISI) as the main outcome of insomnia and Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale(HAMD) and Self-Rating Anxiety Scale (SAS) as secondary indicators to evaluate the efficacy and safety of acupuncture treatment of insomnia, we will use Revman v.5.3 software to calculate data synthesis, and if the results are appropriate, meta-analysis can also be carried out. RESULTS: This study will provide comprehensive evidence of high quality of acupuncture treatment for insomnia from ISI, PSQI, HAMD, SAS, and adverse reactions. CONCLUSION: The systematic review will provide a basis for evaluating the efficacy and safety of acupuncture in the treatment of insomnia. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019131957.


Assuntos
Terapia por Acupuntura/métodos , Distúrbios do Início e da Manutenção do Sono/terapia , Terapia por Acupuntura/efeitos adversos , China , Protocolos Clínicos , Humanos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(45): e17847, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702642

RESUMO

BACKGROUND: Lumbar herniated intervertebral disc (LHIVD) is a frequent disease among patients attending Korean medicine hospitals, and it is associated with considerable medical expenses for the patients. Although several recent randomized clinical trials (RCTs) have reported that thread-embedding acupuncture (TEA) has a more favorable therapeutic effect on LHIVD than other types of acupuncture or other treatments, the evidence remains limited because these trials used poor assessment methods and had a high risk of bias. This study aims to evaluate the evidence for the effectiveness and safety of TEA for LHIVD. In this article, we describe our methods and plan for a systematic review. METHODS: We will conduct an electronic search of the following databases from their inception to May 2018: MEDLINE; EMBASE; COCHRANE; China National Knowledge Infrastructure (CNKI) (a Chinese database); CiNii and J-STAGE (Japanese databases); and KoreaMed, Korean Medical Database (KMbase), Korean Studies Information Service System (KISS), National Digital Science Library (NDSL), Korea Institute of Science and Technology Information (KISTI), Oriental Medicine Advanced Searching Integrated System (OASIS). RCTs investigating any type of TEA will be included. The risk of bias in each study will be evaluated using the Cochrane risk of bias tool. Risk ratios or mean differences with 95% confidence intervals will be used to show the effects of TEA if it will be possible to conduct a meta-analysis. Sensitivity analyses will also be conducted in this study. ETHICS AND DISSEMINATION: Ethical approval is not necessary as this paper does not involve patient data. The review will be published in a peer-reviewed journal or presented in a conference. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019133060.


Assuntos
Terapia por Acupuntura/métodos , Deslocamento do Disco Intervertebral/terapia , Terapia por Acupuntura/efeitos adversos , Adulto , Protocolos Clínicos , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Resultado do Tratamento
4.
J Indian Soc Pedod Prev Dent ; 37(4): 327-332, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31710005

RESUMO

Introduction: Dental caries is the most prevailing disease not only affecting permanent dentition, but also involving deciduous dentition. Deciduous teeth are considered a best space maintainer and preserve arch integrity for eruption of succedaneous permanent teeth. General dental practitioners (GDPs) seem to be less interventionist in their investigation and treatment planning and many times, the treatment done remains incomplete either due to the lack of knowledge of the dentist or due to noncooperation of the child and/or parents. Purpose: The aim of this study was to assess the knowledge, attitude, and practice among GDPs of Vadodara city regarding standardized treatment protocol (STP) for pulp therapy in deciduous dentition. Materials and Methods: This questionnaire-based, cross-sectional study was conducted to assess the knowledge, attitude, and practice regarding standardized treatment options available for pulp therapy in deciduous dentition. The distribution of the self-made questionnaire pro forma was done in person to all the GDPs after obtaining their prior appointments. The GDPs were grouped on the basis of qualification and total clinical experience in years. The questionnaire consisted of 11 questions. The data were collected, and descriptive statistical analysis was performed. The Chi-square test was used to assess the knowledge, attitude, and practice among different groups of GDPs. Results: A statistically significant difference was observed in knowledge regarding STP for pulp therapy in deciduous dentition among both the groups, which is based on the qualification and on the year of clinical experience. Conclusion: Qualification and years of clinical practice among GDPs affect the knowledge and treatment regarding pulp therapy in deciduous dentition. Most of the GDPs lack knowledge about the STP for pulp therapy in deciduous dentition.


Assuntos
Cárie Dentária , Criança , Protocolos Clínicos , Estudos Transversais , Humanos , Índia , Dente Decíduo
5.
Codas ; 31(5): e20180230, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31691746

RESUMO

PURPOSE: To develop a protocol for the evaluation of acquired speech disorders in individuals with Parkinson's disease (PADAF) and to validate its content and determine its inter-judge reliability. METHODS: The study was carried out in three stages: in the first one, the protocol was prepared and its content validated through the analysis of seven specialists; in the second, the instrument was applied to 25 individuals with idiopathic Parkinson's disease (PD); in the third and last stage, the inter-judge reliability was determined. RESULTS: The final version of PADAF consisted of 32 items that evaluated breathing, phonation, resonance, articulation, and prosody. It was shown to be valid, with a content validity index (CVI) much higher than that established in the literature, and with perfect agreement in the determination of inter-judge reliability. CONCLUSION: PADAF for PD individuals was developed and its content was validated, showing perfect instrument reliability.


Assuntos
Disartria/diagnóstico , Doença de Parkinson/complicações , Inquéritos e Questionários , Idoso , Protocolos Clínicos , Disartria/etiologia , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fonação , Reprodutibilidade dos Testes
6.
Adv Exp Med Biol ; 1192: 313-329, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705502

RESUMO

With vigorous researches related to novel treatment in psychiatric field, paradigm shift is emerging with its design and assessment. Comprehension of the psychiatric phenomenon expanded beyond disease model, with dimensional approach. Assessment of patients' clinical state includes subjective reports related to problematic symptoms, functional change, and quality of life. They also include objective findings collected from mobile e-wearable monitoring system and advanced neuroimaging modalities. Novel treatment protocols are not just limited to pharmacology itself or psychotherapy itself, but the approach is integrated with stratification; pharmacological treatment enhanced by cognitive behavioral management and psychotherapeutic intervention has been emerged and studied for its impact. Numerous studies were conducted to understand placebo response and to differentiate this phenomenon with novel treatments. Trials to draw good adherence to research protocol with good compliance to treatment in real are strengthened by integrated approach, so-called psychopharmacology. With these paradigm shifts observed from recent researches, it is promising for great advance in quality of life and our mental health.


Assuntos
Psicofarmacologia , Psicoterapia , Protocolos Clínicos , Humanos , Psicotrópicos , Qualidade de Vida , Pesquisa
7.
Medicine (Baltimore) ; 98(40): e17451, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577771

RESUMO

INTRODUCTION: Prostate-specific antigen (PSA) is the main tool for early detection, risk stratification and monitoring of prostate cancer (PCa). However, there are controversies about the use of PSA as a population screening test because of the high potential for overdiagnosis and overtreatment associated. The net benefit of screening is unclear and according to the available recommendations, it should be offered to well-informed men with an adequate health status and a life-expectancy of at least 10 years or to men at elevated risk of having PCa. In addition, the factors that influence test results are unclear, as is impact of false positive or negative results on patient health.Our objective is to assess the clinical and analytical factors associated with the presence of false positive and false negative results and the diagnostic/therapeutic process followed by these patients. METHODS AND ANALYSIS: A prospective observational cohort study will be carried out. We will include a cohort of patients with a positive PSA result (1.081 patients) and a sample of patients with negative results (572 patients); both will be followed for 2 years by reviewing medical records to assess the variables associated with these results, as well as characteristics of patient management after a positive PSA value. We will include those patients with a PSA determination from 2 hospitals in the Valencian Community. Patients who have been previously diagnosed with prostate cancer or who are being followed for previous high PSA values will be excluded. DISCUSSION: The study will estimate the frequency of false positive and false negative PSA results in routine clinical practice, and allow us to quantify the potential harm caused. STUDY REGISTRATION: Clinicaltrials.gov (https://clinicaltrials.gov/): NCT03978299, June 7, 2019.


Assuntos
Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Protocolos Clínicos , Estudos de Coortes , Detecção Precoce de Câncer , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Masculino
8.
Medicine (Baltimore) ; 98(43): e17353, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651840

RESUMO

BACKGROUND: Patients with simple obesity suffer from poor quality of life, as well as high risk of hypertension, diabetes, cardiovascular, and cerebrovascular accidents. Lots of Clinical trials suggested that acupuncture is beneficial for simple obesity, and it aims to gather solid evidence in order to provide reliable reference in establishing guidelines for acupuncture treatment of simple obesity in this study. METHODS: Relevant databases including Cochrane Library, PubMed, Cochrane Central Register of Controlled Trials, Medline University Resource Center, Chinese Biomedical Literature Service System, and China National Knowledge Infrastructure will be retrieved from January 1950 to November 2018. Two authors will screen studies independently according to the inclusion and exclusion criteria and extract the data in a form of sheet. Quality evaluations and bias risk assessments will be performed for the methodology of included studies. Dichotomous data will be analyzed using odds ratio (OR), and continuous data using mean differences. Network meta-analysis will be conducted by using Stata 14.0. The Development and Evaluation approach will be used to rate the certainty of the evidence of estimates derived from meta-analysis. The primary outcome is body mass index (BMI), and the secondary outcomes are triglycerides, total cholesterol, low-density lipoprotein-cholesterol, effective rate, adverse effects, and recurrence rate. Trial registration number is CRD42019117387. RESULTS: Based on current evidence, this review will rank the efficacy and safety of the various acupuncture regimen in decreasing BMI, triglycerides, total cholesterol of patients with simple obesity, and to summarize a prioritization regimen. CONCLUSION: This evidence may be useful for clinicians, patients, and guideline-makers to select the optimum proposal of acupuncture for the simple obesity treatment.


Assuntos
Terapia por Acupuntura/métodos , Obesidade/terapia , Adulto , Índice de Massa Corporal , Colesterol/sangue , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Meta-Análise em Rede , Projetos de Pesquisa , Revisão Sistemática como Assunto , Resultado do Tratamento , Triglicerídeos/sangue
9.
Medicine (Baltimore) ; 98(38): e17260, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568000

RESUMO

INTRODUCTION: This study is a prospective, assessor-blinded, parallel-group, randomized controlled pilot trial to explore the effectiveness of 12-week adjuvant moxibustion therapy for arthralgia in menopausal females at stage I to III breast cancer on aromatase inhibitor (AI) administration, compared with those receiving usual care. METHODS/DESIGN: Forty-six menopausal female patients with breast cancer who completed cancer therapy will be randomly allocated to either adjuvant moxibustion or usual care groups with a 1:1 allocation ratio. The intervention group will undergo 24 sessions of adjuvant moxibustion therapy with usual care for 12 weeks, whereas the control group will receive only usual care during the same period. The usual care consists of acetaminophen administration on demand and self-directed exercise education to manage AI-related joint pain. The primary outcome is the mean change of the worst pain level according to the Brief Pain Inventory-Short Form between the initial visit and the endpoint. The mean changes in depression, fatigue, and quality of life will also be compared between groups. Safety and pharmacoeconomic evaluations will also be included. DISCUSSION: Continuous variables will be compared by an independent t test or Wilcoxon rank-sum test between the adjuvant moxibustion and usual care groups. Adverse events will be analyzed using the chi-square or Fisher exact test. The statistical analysis will be performed by a 2-tailed test at a significance level of .05.


Assuntos
Inibidores da Aromatase/efeitos adversos , Artralgia/terapia , Neoplasias da Mama/tratamento farmacológico , Moxibustão , Idoso , Inibidores da Aromatase/uso terapêutico , Artralgia/induzido quimicamente , Artralgia/economia , Protocolos Clínicos , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Pessoa de Meia-Idade , Moxibustão/efeitos adversos , Moxibustão/economia , Projetos Piloto , Pós-Menopausa , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(38): e17278, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568009

RESUMO

INTRODUCTION: Pneumonia is one of the leading causes of death worldwide, represents a potentially life-threatening condition. In recent studies, adjuvant corticosteroids therapy has been shown to improve outcome in severe community-acquired pneumonia (CAP); however, the treatment response to corticosteroids vary. It is important to select patients likely to benefit from the treatment. Currently, the optimal patient selection of corticosteroids treatment is not yet clearly defined. METHODS: Sphingosine-1-phosphate and pneumonia (SOPN) trial is a double-blinded, randomized, placebo-controlled trial that will investigate if sphingosine-1-phosphate (S1P) can be an indicator for initiating adjuvant corticosteroids therapy in patients with severe CAP. Participants will be recruited from the emergency department and randomized to receive 20 mg of methylprednisolone twice daily or placebo for 5 days. The primary outcome will be "in-hospital mortality." Secondary outcomes will include intensive care unit (ICU) admission, length of ICU stay, length of hospital stay, and clinical outcomes at Day 7 and Day 14. CONCLUSION: SOPN trial is the first randomized placebo-controlled trial to investigate whether S1P can be a predictive biomarker for adjuvant corticosteroids therapy in patients with severe CAP. The trial will add additional data for the appropriate use of adjuvant corticosteroids therapy in patients with severe CAP. Results from this clinical trial will provide foundational information supporting that if the S1P is appropriate for guiding the patient selection for corticosteroids adjuvant therapy.


Assuntos
Glucocorticoides/uso terapêutico , Lisofosfolipídeos/sangue , Metilprednisolona/uso terapêutico , Pneumonia/tratamento farmacológico , Esfingosina/análogos & derivados , Adjuvantes Farmacêuticos , Adulto , Biomarcadores/sangue , Protocolos Clínicos , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/mortalidade , Método Duplo-Cego , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pneumonia/sangue , Pneumonia/mortalidade , Esfingosina/sangue
11.
Medicine (Baltimore) ; 98(39): e17064, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574805

RESUMO

BACKGROUND: Most systematic reviews have explored the efficacy of treatments on symptoms associated with post-traumatic stress disorder (PTSD), which is a chronic and often disabling condition. Previous network meta-analysis (NMA) had limitations such as focusing on pharmacological or psychotherapies. Our review is aims to explore the relative effectiveness of both pharmacological and psychotherapies and we will establish the differential efficacy of interventions for PTSD in consideration of both symptom reduction and functional recovery. METHODS: We will conduct a network meta-analysis of randomized controlled trials evaluating treatment interventions for PTSD. We will systematically search Medline, PILOT, Embase, CINHAL, AMED, Psychinfo, Health Star, DARE and CENTRAL to identify trials that: (1) enroll adult patients with PTSD, and (2) randomize them to alternative interventions or an intervention and a placebo/sham arm. Independent reviewers will screen trials for eligibility, assess risk of bias using a modified Cochrane instrument, and extract data. Our outcomes of interest include PTSD symptom reduction, quality of life, functional recovery, social and occupational impairment, return to work and all-cause drop outs. RESULTS: We will conduct frequentist random-effects network meta-analysis to assess relative effects of competing interventions. We will use a priori hypotheses to explore heterogeneity between studies, and assess the certainty of evidence using the GRADE approach. CONCLUSION: This network meta-analysis will determine the comparative effectiveness of therapeutic options for PTSD on both symptom reduction and functional recovery. Our results will be helpful to clinicians and patients with PTSD, by providing a high-quality evidence synthesis to guide shared-care decision making.


Assuntos
Transtornos de Estresse Pós-Traumáticos/terapia , Protocolos Clínicos , Pesquisa Comparativa da Efetividade , Avaliação da Deficiência , Humanos , Meta-Análise em Rede , Psicoterapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Retorno ao Trabalho , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico
12.
Medicine (Baltimore) ; 98(39): e17121, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574810

RESUMO

BACKGROUND: Dry eye disease is a common eye disease mainly manifests with eye fatigue, foreign body sensation, dry and astringent eyes and other symptoms. Growing evidence shows that qiming granule may have beneficial effects on the clinical treatment of dry eye disease. However, no systematic review and meta-analysis collate and assess these clinical evidences. The purpose of this study protocol is to provide a comprehensive and reliable evaluation of the clinical evidence of qiming granule in the treatment of DED. METHODS AND ANALYSIS: Three English database and 4 Chinese databases other sources will be searched. Two methodological trained researchers will read the title, abstract and full texts and independently select the qualified literature according to inclusion and exclusion criteria. After assessment of the risk of bias and data extraction, we will conduct meta-analyses for outcomes including central macular thickness, optimum corrected vision, overall effect rates and adverse effects. The heterogeneity of data will be investigated by Cochrane X and I tests. We build 3 hypotheses for subgroup analysis according to the guidance for a credible subgroup effect: Disease status at baseline, duration of intervention, type of concomitant medication. Sensitivity analysis will be conducted to evaluate the stability of the results. Then publication bias assessment will be conducted by funnel plot analysis and Egger test. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluate system to evaluate the quality of evidence. RESULTS: The results of our research will be published in a peer-reviewed journal. CONCLUSION: Our study is the first meta-analysis to evaluate the clinical efficacy and safety of qiming granule in the treatment of DED. It will provide more options for clinical treatment of the disease. PROSPERO REGISTRATION NUMBER: CRD42018109183.


Assuntos
Medicamentos de Ervas Chinesas/efeitos adversos , Medicamentos de Ervas Chinesas/uso terapêutico , Síndromes do Olho Seco/tratamento farmacológico , Protocolos Clínicos , Feminino , Humanos , Masculino
13.
Medicine (Baltimore) ; 98(39): e17122, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574811

RESUMO

BACKGROUND: In this study, we intend to assess the efficacy of zolpidem combined with cognitive-behavioral therapy (CBT) for patients with primary insomnia (PI). METHODS: A predefined search strategy will be used to search for associated literature from inception to the July 1, 2019: PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, Google Scholar, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure with no language limitation. In addition, we will also retrieve reference lists of included studies and relevant reviews, as well as the conference proceedings. All randomized controlled trials related to the zolpidem and CBT for PI will be included. Two authors will perform study selection, data collection, and study quality, respectively. We will also apply RevMan 5.3 software for statistical analysis. RESULTS: This study will provide a comprehensive overview of the available evidence of the benefits and safety of zolpidem and CBT for PI. Primary outcomes are sleep quality and severity of sleep disorders. Secondary outcomes consist of sleep-onset latency, total sleep duration, sleep efficiency, and frequency and adverse events. CONCLUSION: The results of this study will inform clinical and policy decisions regarding the benefits and harm of zolpidem and CBT for patients with PI. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019142796.


Assuntos
Terapia Cognitivo-Comportamental , Medicamentos Indutores do Sono/efeitos adversos , Medicamentos Indutores do Sono/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/terapia , Zolpidem/efeitos adversos , Zolpidem/uso terapêutico , Protocolos Clínicos , Terapia Combinada , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Medicine (Baltimore) ; 98(39): e17364, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574883

RESUMO

OBJECTIVE: We performed a meta-analyisis to evaluate the efficacy of maintenance dexamethasone against acute or delayed chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately or highly emetic risk chemotherapy regimen. METHODS: PubMed, Embase, and Cochrane Library were searched for eligible studies. Data comparing maintenance dexamethasone with single-dose dexamethasone during the acute, delayed, and overall phase of CINV were extracted. Overall risk ratio (RR) was used to estimate the efficacy and adverse effects. RESULTS: Nine studies were included. In delayed phase, maintenance dexamethasone has similar efficacy to single-dose dexamethasone for no emetic episodes (RR, 1.06; 95% confidence interval [CI], 1.00-1.14), complete response (RR, 1.04; 95% CI, 0.98-1.11), complete control (RR, 1.07; 95% CI, 0.98-1.16), and total control (RR, 1.06; 95% CI, 0.91-1.23). In overall phase, maintenance dexamethasone has similar efficacy to single-dose dexamethasone for no emetic episodes (RR, 1.02; 95% CI, 0.94-1.11), complete response (RR, 1.02; 95% CI, 0.95 -1.09), complete control (RR, 1.03; 95% CI, 0.94-1.13), total control (RR, 1.05; 95% CI, 0.90-1.23), and no rescue medication (RR, 1.07; 95% CI, 0.97-1.19). Maintenance dexamethasone was only superior to single-dose dexamethasone for no rescue medication during delayed phase (RR, 1.10; 95% CI, 1.01-1.21, P = .034). The incidence of hiccup was observed higher in maintenance dexamethasone group (RR = 3.16, 95% CI, 1.12-8.92). CONCLUSION: The single-dose dexamethasone regimen offers high and similar overall control of symptoms as the maintenance dexamethasone regimen in this population. Multiple-day dexamethasone was suitable for patients who used rescue medication during the delayed phase.


Assuntos
Antieméticos/administração & dosagem , Antineoplásicos/efeitos adversos , Dexametasona/administração & dosagem , Náusea/prevenção & controle , Vômito/prevenção & controle , Protocolos Clínicos , Humanos , Náusea/induzido quimicamente , Vômito/induzido quimicamente
15.
Am Surg ; 85(9): 1044-1050, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638522

RESUMO

Enhanced recovery after surgery (ERAS) may improve patients' postoperative course. Our center implemented the ERAS protocol for the colorectal service in 2016, and then expanded to multiple service lines over the course of 1.5 years. Our aim was to determine whether broad implementation of ERAS protocols across different service lines could improve patient care. All ERAS patients from 2018 were captured prospectively. For each service line using ERAS, one full year of data preceding ERAS was compared. ERAS service lines included colorectal, gynecology laparoscopic, gynecology open, hepatopancreaticobiliary, urology - nephrectomy and cystectomy, spinal fusion, cardiac surgery-coronary artery bypass grafting. ERAS and pre-ERAS services were compared based on length of stay (LOS), complications, readmission, and mortality rates. In addition, hospital costs were collected during this time frame. ERAS protocols significantly decreased LOS for colorectal, gynecology, and spine. Complications were significantly decreased in colorectal, gynecology, urology, and spine. Readmissions did not significantly increase in any service line except spine. There was no significant change in mortality. ERAS proved to save the hospital 1847 days and cost saving of almost $5 million in 2018. Implementing ERAS broadly improved patient outcomes (LOS, complications, readmission, and mortality) while providing cost savings to the hospital.


Assuntos
Protocolos Clínicos , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/normas , Custos Hospitalares , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/normas , Melhoria de Qualidade , Mortalidade Hospitalar , Humanos , Tempo de Internação/economia , Readmissão do Paciente/economia , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/prevenção & controle
16.
Medicine (Baltimore) ; 98(38): e17004, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567937

RESUMO

BACKGROUND: Septic shock is a serious disease with high morbidity, which will lead to organ dysfunction. Shen fu injection (SFI) has been widely used for septic shock as a treatment in China. Many clinical trials have been reported that it could assess the efficacy and safety of SFI to cure septic shock and accelerate resuscitation. Reassessing the efficacy and safety of SFI as a treatment of patients with septic shock is the objective of this updated systematic review. METHODS: The following electronic databases major in English and Chinese will be conducted a systematic search until September 2018: PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Chinese BioMedical Literature Database, and Wan-fang Database. Randomized controlled trials of SFI will be included. Review Manager 5.2 software will be used for assessment of risk of bias, data synthesis, and subgroup analysis. We will conduct the GRADE system to assess the quality of evidence, if possible. RESULTS: This study will provide a rational synthesis of current evidences for SFI on septic shock. CONCLUSION: We hope our research results will provide an objective and reliable evidence to patients, clinicians and healthcare policymakers who are concerning the treatment options of SFI in septic shock. REGISTRATION: PROSPERO CRD42016049332.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Choque Séptico/terapia , Protocolos Clínicos , Medicamentos de Ervas Chinesas/administração & dosagem , Humanos , Injeções , Fitoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Medicine (Baltimore) ; 98(38): e17110, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567948

RESUMO

BACKGROUND: Systemic sclerosis (SSc) is a clinically complex and challenging disease, the most frequent complication of which is interstitial lung disease, which leads to a worse prognosis. In this situation, cyclophosphamide is considered the criterion standard for treatment, despite the controversies regarding its efficacy and toxicity. However, studies using rituximab (RTX) have shown that this drug may be a promising therapeutic option. The objective is to describe a protocol of a systematic review (SR) that analyzes the scientific evidence on the effects of RTX on SSc. METHODS: This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. The databases to be searched are PubMed, Scopus, SciELO, LILACS, ScienceDirect, Web of Science, COCHRANE, WHOLIS, PAHO, and EMBASE. The studies that would be included in SR are clinical trials that evaluate the use of RTX in patients with SSc who meet the classification criteria for the disease according to American College of Rheumatology and European League Against Rheumatism (2013) and/or LeRoy criteria will be included in the SR. The data to be extracted are related to the characteristics of the studies: authors, year of publication, study location, type of study, sample size and age, patient characteristics, duration of intervention, therapeutic scheme, follow-up time, main variables, and main results. RESULTS: In our study, we hope to find articles presenting new evidence supporting treatment of SSc with RTX. CONCLUSIONS: The SR will present results of scientific evidence for the effects of RTX in SSc. We hope that the results could strengthen clinical decisions for the best treatment of SSc and guide future researches. PROSPERO REGISTRATION NUMBER: CRD42019132018.


Assuntos
Antirreumáticos/uso terapêutico , Rituximab/uso terapêutico , Escleroderma Sistêmico/tratamento farmacológico , Antirreumáticos/administração & dosagem , Protocolos Clínicos , Humanos , Rituximab/administração & dosagem , Revisão Sistemática como Assunto
18.
Medicine (Baltimore) ; 98(38): e17115, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567949

RESUMO

BACKGROUND: The program aims to evaluate the effectiveness and safety of cupping in patients with chronic urticaria (CU). METHODS: We will search the databases including PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China Science Journal Database, China National Knowledge Infrastructure, Wan-fang Database, and China Biomedical Literature Database from their inception to May 2019. In addition, we will manually search the list of medical journals as a supplement. The clinical randomized controlled trials or quasi-randomized controlled trials related to cupping for the treatment of CU will be included in the study. Data were synthesized by using a fixed-effect model or random effect model depend on the heterogeneity test. The primary outcome is the total effective rate. Secondary outcomes include skin disease quality of life index scores, adverse events, and recurrence rates. RevMan V.5.3 statistical software will be used for meta-analysis. If it is not appropriate for a meta-analysis, then a descriptive analysis will be conducted. Data synthesis will use the risk ratio and the standardized or weighted average difference of continuous data to represent the results. RESULTS: This study will provide a comprehensive review of the available evidence to assess the effectiveness and safety of cupping for patients with CU. CONCLUSION: This systematic review (SR) will provide evidence to judge whether cupping is an effective intervention for patients with CU. ETHICS AND DISSEMINATION: The protocol of the SR does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and presented at relevant conferences. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019137451.


Assuntos
Terapia por Acupuntura , Urticária/terapia , Protocolos Clínicos , Humanos , Revisão Sistemática como Assunto
19.
Medicine (Baltimore) ; 98(38): e17193, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567965

RESUMO

BACKGROUND: Sleep bruxism is a masticatory muscle activity characterized as rhythmic (phasic) or nonrhythmic (tonic). In children and adolescents, etiological factors, such as breathing pattern and sleep quality, have recently been addressed in studies investigating sleep bruxism. New therapies for adults, such as botulinum toxin, have been investigated, but such techniques are not applicable for individuals in the growth and development phase. METHODS: The participants will be 76 children, which will be randomly allocated to a control group, that is group 1, absence of bruxism; group 2, children with bruxism treated with infrared light-emitting diode (LED); and group 3, bruxism treated with occlusal splint. All participants will be submitted to a clinical evaluation to evaluate muscle activity and salivary biomarkers, before and after treatments. Muscle activity will be verified by electromyography of muscles mastication, masseter and temporal, and salivary biomarkers observed will be cortisol and dopamine levels. DISCUSSION: Photobiomodulation therapy has piqued the interest of researchers, as this noninvasive method has demonstrated positive results in problems related to muscle tissues. This document describes the protocol for a proposed study to evaluate morphological and psychosocial aspects in children and adolescents with awake bruxism and their responses to photobiomodulation therapy with infrared LED. CLINICAL TRIALS:.


Assuntos
Terapia com Luz de Baixa Intensidade/métodos , Bruxismo do Sono/radioterapia , Criança , Protocolos Clínicos , Humanos , Raios Infravermelhos/uso terapêutico , Músculos da Mastigação/fisiopatologia , Músculos da Mastigação/efeitos da radiação , Placas Oclusais , Bruxismo do Sono/fisiopatologia , Bruxismo do Sono/terapia
20.
Medicine (Baltimore) ; 98(38): e17237, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567988

RESUMO

INTRODUCTION: With the second-generation antipsychotics (SGAs) widely applied to treat patients with schizophrenia, adverse effects, especially the metabolic syndrome (MetS), were paid more attention following by the efficacy of SGAs. Several studies have suggested that acupuncture could be an effective and safe intervention for MetS. Here, we present a study protocol to investigate the effect of electroacupuncture on MetS due to olanzapine and risperidone. METHODS: This study is a prospective, randomized, single-centered, patient-assessor-blinded, parallel-controlled clinical pilot trial. In all, 36 patients will be randomized to an experimental group or control group by a 1:1 ratio. All patients will receive lifestyle interventions. The experimental group will receive electroacupuncture treatment. The control group will receive sham electroacupuncture treatment. The primary outcomes are body mass index (BMI) and waist circumference (WC). The secondary outcome measures include blood pressure (BP), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), leptin, and adiponectin. We will assess at baseline, 8 weeks after intervention and at the end of 3 months' follow-up. DISCUSSION: The results of this trial are expected to provide data on the efficacy and safety of electroacupuncture on MetS due to olanzapine and risperidone, and potential biochemical mechanism.


Assuntos
Antipsicóticos/efeitos adversos , Eletroacupuntura , Síndrome Metabólica/terapia , Olanzapina/efeitos adversos , Risperidona/efeitos adversos , Antipsicóticos/uso terapêutico , Protocolos Clínicos , Eletroacupuntura/efeitos adversos , Eletroacupuntura/métodos , Humanos , Síndrome Metabólica/induzido quimicamente , Olanzapina/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA