scholarly journals Método Bundle na redução de infecção do sítio cirúrgico: revisão sistemática

2022 ◽  
Vol 3 (14) ◽  
pp. 1104-1124
Author(s):  
Iara Gévila Lima da Silva ◽  
Keila Monteiro de Araújo ◽  
Renata Mendes Borges ◽  
Jacqueline Ramos de Andrade Antunes Gomes ◽  
João Paulo De Oliveira Castro ◽  
...  
Keyword(s):  
Cochrane Library ◽  
Assessment Development

Objetivo: conduzir uma revisão sistemática para examinar a evidência científica disponível sobre o efeito do método bundle como ferramenta na redução de infecção do sítio cirúrgico dos pacientes em pós operatório. Método: A busca foi realizada na LILACS, PubMed, Cochrane Library e Scopus. A pergunta de pesquisa foi desenvolvida com uso da estratégia PICOS e a qualidade da evidência foi avaliada pelo sistema Grading of Recommendation, Assessment, Development, and Evaluation (GRADE). Resultados: Das 261 publicações encontradas, dez foram analisadas. Observou-se a prevalência de bundles com 4 a 5 itens de intervenção, sendo que as intervenções com maior frequência foram a antibioticoprofilaxia (50%) e o banho pré-operatório (50%). Conclusão: Com base nas evidências disponíveis, o uso do método bundle na prevenção de infecção do sítio cirúrgico pode reduzir o número de infecções, embora a qualidade de evidência para o desfecho seja baixa. É necessário enfatizar que a qualidade da literatura sobre o assunto não se mostra forte, com pouquíssimos estudos randomizados e cegos.

Burst Suppression for ICP Control

2016 ◽  
Vol 32 (2) ◽  
pp. 130-139 ◽  
Author(s):  
Frederick A. Zeiler ◽  
Eva Akoth ◽  
Lawrence M. Gillman ◽  
Michael West
Keyword(s):  
Reference Lists ◽  
Burst Suppression ◽  
Suppressive Therapy ◽  
Cochrane Library ◽  
Infection Rates ◽  
Assessment Development ◽  
Severe Hypotension ◽  
Grade Methodology ◽  
Clinical Trials Registry ◽  
The Impact

Background: The goal of our study was to perform a systematic review of the literature to determine the effect that burst suppression has on intracranial pressure (ICP) control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to January 2015), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and the Grading of Recommendation Assessment Development and Education (GRADE) methodology. Results: Seven articles were considered for review. A total of 108 patients were studied, all receiving burst suppression therapy. Two studies failed to document a decrease in ICP with burst suppression therapy. There were reports of severe hypotension and increased infection rates with barbiturate-based therapy. Etomidate-based suppressive therapy was linked to severe renal dysfunction. Conclusions: There currently exists both Oxford level 2b and GRADE C evidence to support that achieving burst suppression reduces ICP, and also has no effect on ICP, in severe traumatic brain injury. The literature suggests burst suppression therapy may be useful for ICP reduction in certain cases, although these situations are currently unclear. In addition, the impact on patient functional outcome is unclear. Further prospective study is warranted.

scholarly journals Comparing the Effects of Docosahexaenoic and Eicosapentaenoic Acids on Inflammation Markers Using Pairwise and Network Meta-Analyses of Randomized Controlled Trials

2020 ◽  
Author(s):  
Cécile Vors ◽  
Janie Allaire ◽  
Sonia Blanco Mejia ◽  
Tauseef A Khan ◽  
John L Sievenpiper ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Necrosis Factor Alpha ◽  
Assessment Development ◽  
Evaluation Approach ◽  
Tnf Α ◽  
Mean Differences ◽  
Meta Analyses

ABSTRACT Recent data from randomized clinical trials (RCTs) suggest that DHA may have stronger anti-inflammatory effects than EPA. This body of evidence has not yet been quantitatively reviewed. The aim of this study was to compare the effect of DHA and EPA on several markers of systemic inflammation by pairwise and network meta-analyses of RCTs. MEDLINE, EMBASE, and The Cochrane Library were searched through to September 2019. We included RCTs of ≥7 d on adults regardless of health status that directly compared the effects of DHA with EPA and RCTs of indirect comparisons, in which the effects of DHA or EPA were compared individually to a control fatty acid. Differences in circulating concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and adiponectin were the primary outcome measures. Data were pooled by pairwise and network meta-analysis and expressed as mean differences (MDs) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic) in the pairwise meta-analysis. Inconsistency and transitivity were evaluated in the network meta-analysis. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Eligibility criteria were met by 5 RCTs (N = 411) for the pairwise meta-analysis and 20 RCTs (N = 1231) for the network meta-analysis. In the pairwise meta-analysis, DHA and EPA had similar effects on plasma CRP [MDDHA versus EPA = 0.14 mg/L (95% CI: –0.57, 0.85); I2 = 61%], IL-6 [MDDHA versus EPA = 0.10 pg/mL (–0.15, 0.34); I2 = 40%], and TNF-α [MDDHA versus EPA = –0.10 pg/mL (–0.37, 0.18); I2 = 40%]. In the network meta-analysis, the effects of DHA and EPA on plasma CRP [MDDHA versus EPA = –0.33 mg/L (–0.75, 0.10)], IL-6 [MDDHA versus EPA = 0.09 pg/mL (–0.12, 0.30)], and TNF-α [MDDHA versus EPA = –0.02 pg/mL (–0.25, 0.20)] were also similar. DHA and EPA had similar effects on plasma adiponectin in the network meta-analysis. Results from pairwise and network meta-analyses suggest that supplementation with either DHA or EPA does not differentially modify systemic markers of subclinical inflammation.

scholarly journals Systematic review and meta-analysis of the relationship between sleep disorders and suicidal behaviour in patients with depression

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaofen Wang ◽  
Sixiang Cheng ◽  
Huilan Xu
Keyword(s):  
Suicidal Ideation ◽  
Suicide Attempt ◽  
Sleep Disorders ◽  
Suicidal Behaviour ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Assessment Development ◽  
Depressed Patients ◽  
Completed Suicide

Abstract Background The potential link between sleep disorders and suicidal behaviour has been the subject of several reviews. We performed this meta-analysis to estimate the overall association between sleep disorders and suicidal behaviour and to identify a more specific relationship in patients with depression. Methods A systematic search strategy was developed across the electronic databases PubMed, EMBASE and the Cochrane Library from inception to January 1, 2019 for studies that reported a relationship between sleep disorders and suicidal behaviour in depressed patients. The odds ratio (OR) and corresponding 95% confidence interval (CI) were used to measure the outcomes. Heterogeneity was evaluated by Cochran’s Q test and the I2 statistic. The Newcastle-Ottawa Scale (NOS) was adopted to evaluate the methodological quality of each of the included studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of the evidence. We calculated the overall association between sleep disorders and suicidal behaviour and estimated more specific categories, including insomnia, nightmares, hypersomnia, suicidal ideation, suicide attempt, and completed suicide. Results A total of 18 studies were included in this study. Overall, sleep disorders were closely related to suicidal behaviour in patients with depression (OR = 2.45 95% CI: 1.33 4.52). The relatively increased risks of sleep disorders with suicidal ideation, suicide attempt and completed suicide ranged from 1.24 (95% CI: 1.00 1.53) to 2.41 (95% CI: 1.45 4.02). Nightmares were found to be highly correlated with the risk of suicidal behaviour (OR = 4.47 95% CI: 2.00 9.97), followed by insomnia (OR = 2.29 95% CI: 1.69 3.10). The certainty of the evidence was rated as very low for the overall outcome and the major depression subgroup and was rated as low for the depression subgroup. Conclusions This meta-analysis supports the finding that sleep disorders, particularly nightmares and insomnia, increase the risk of suicidal behaviour in depressed patients. Considering that all included studies were observational, the quality of the evidence is rated as very low. More well-designed studies are needed to confirm our findings and to better explain the mechanisms by which sleep disorders aggravate suicidal behaviour in depressed patients.

scholarly journals Intra-articular corticosteroids for treatment of temporomandibular joint internal disorders: protocol for systematic review and network meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e034327
Author(s):  
Daniela Torres ◽  
Carlos Zaror ◽  
Verónica Iturriaga ◽  
Aurelio Tobias
Keyword(s):  
Minimally Invasive ◽  
Temporomandibular Joint ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Minimally Invasive Therapy ◽  
Risk Of Bias ◽  
The Body ◽  
Cochrane Library ◽  
Invasive Therapy ◽  
Assessment Development

IntroductionInternal temporomandibular joint (TMJ) disorders are present in approximately 80% of patients with symptomatic temporomandibular disorders. Among the minimally invasive therapies, we find the intra-articular infiltration of substances, such as corticosteroids, hyaluronic acid or platelet-rich plasma accompanied or not by an arthrocentesis. There are several studies on minimally invasive therapy for internal TMJ disorders; however, none compares the effectiveness of the different intra-articular corticosteroids to each other.The purpose of this study is to evaluate the effectiveness of the different intra-articular corticosteroids for the treatment of internal disorders of the TMJ and compare them to each other or to other minimally invasive therapies.Methods and analysisA systematic search will be carried out up to December 2019 in the electronic databases: Medline, Cochrane Library, EMBASE, SCOPUS and LILACS.Randomised clinical trials evaluating patients with internal disorders of the TMJ, with intra-articular corticosteroid therapy and comparing these to each other and/or to other minimally invasive therapy will be included. The main outcomes will be pain and range of motion measured through validated scales.Two review authors will independently screen search results, extract data from included studies and assess the risk of bias in those studies using the Revised Cochrane Risk of Bias Tool (RoB 2.0). In the case of any discrepancy and failure to reach consensus, this will be resolved by a third reviewer.A network meta-analysis will be conducted based on direct comparisons to generate indirect comparisons of the different treatments. Data will be combined in a meta-analysis using a random effects model.The principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system will be used to assess the overall quality of the body of evidence associated with the main results.Ethics and disseminationThis protocol will not require ethical approval. The results of this review will be disseminated through peer-reviewed publications.Trial registration numberCRD42019129014.

scholarly journals Over-the-Counter Tooth Whitening Agents: A Review of Literature

2020 ◽  
Vol 31 (3) ◽  
pp. 221-235 ◽  
Author(s):  
Arti. S. Naidu ◽  
Vincent Bennani ◽  
John M. Aarts Paul Brunton ◽  
Paul Brunton
Keyword(s):  
Cochrane Library ◽  
Cochrane Central Register ◽  
Short Term ◽  
Tooth Whitening ◽  
Over The Counter ◽  
Assessment Development ◽  
Ranking Criteria ◽  
Central Register ◽  
The Cochrane Library

Abstract There is an increased accessibility of over-the-counter (OTC) whitening agents with very little data in the literature regarding their effectiveness. This review was done to determine their effectiveness of the predominant OTC whitening agents from 2006 until 2018 where a comparison of each agent was made with a placebo, no treatment or with other OTC whitening agents. The major categories of OTC whitening agents such as dentifrices, whitening strips and paint on gels. Dentist prescribed bleaching applied at home and in-office bleaching studies and studies that demonstrated whitening products to participants were excluded. Articles were searched for in the databases of Medline (Ovid), PubMed, the Cochrane Library and Cochrane Central Register of Controlled Trials. Twenty-four articles were included in the systematic review and the quality of studies was determined by the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) ranking criteria. Compared to other OTC, strips are reported to be effective. Two studies determined whitening strips to be effective. Whitening strips have been shown to be effective when compared with placebos and other OTC whitening agents. Dentifrices are effective in changing the shade of the tooth “by removing extrinsic stains” when compared to a placebo and non-whitening dentifrices, but they are not as effective in comparison to whitening strips. There is a lack of evidence with regards to the effectiveness of paint-on gels. While there is some evidence that OTC can alter shade in the short term, there is a need for better-designed studies.

scholarly journals Effect of Soy Isoflavones Supplementation on Adiponectin Levels in Postmenopausal Women

2021 ◽  
Vol 11 ◽  
pp. 184-195
Author(s):  
Sara Tutunchi ◽  
Mehdi Koushki ◽  
Nasrin Amiri-Dashatan ◽  
Hadi Khodabandehloo ◽  
Hossein Hosseini ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Treatment Duration ◽  
Meta Analysis ◽  
Herbal Product ◽  
Soy Isoflavones ◽  
Cochrane Library ◽  
Assessment Development ◽  
Subgroup Analyses ◽  
Meta Regression ◽  
The Impact

Decreased adiponectin levels has been demonstrated in postmenopausal (PMP) women. Soy isoflavones, as an herbal product have been shown to increase adiponectin level but the results are inconclusive and inconsistent. The present study reassessed the data on the impact of soy isoflavones supplementation on adiponectin levels in PMP women through a meta-analysis. A systematic search was performed in the databases of PubMed, Web of science, Scopus and the Cochrane library. The literature search identified 830 studies with duplicates. Out of those, 80 were screened for title and abstract and 12 articles were ultimately selected for the analysis. Meta-regression and subgroup analyses, based on the moderator variables such as treatment duration, dose of soy isoflavones and BMI were performed. The quality of the studies was evaluated using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. The results revealed that soy isoflavones supplementation significantly increased the circulating level of adiponectin in PMP women (SMD: 0.36 µg/mL; 95% CI (0.05 to 0.66); P= 0.02). No publication bias was observed using Begg's (P = 0.38) and Egger's (P = 0.07) tests. Sensitivity analysis indicated the results were completely powerful and stable. Moreover, Meta-regression and subgroup analyses indicated a significant increase of adiponectin levels in subgroups of dose > 50 mg and treatment duration less or equal 3 months. Our findings showed significantly increase in adiponectin levels after isoflavones-supplemented soy consumption in postmenopausal women, who received dose > 50 mg of soy isoflavones in treatment duration ≤ 3 months.

scholarly journals Prevención y manejo clínico de pre eclampsia y eclampsia: Guía de práctica clínica basada en evidencias del instituto de referencia nacional en salud materna del Perú

2019 ◽  
Vol 80 (2) ◽  
pp. 243-9
Author(s):  
Enrique Guevara Ríos ◽  
Carlos Pérez Aliaga ◽  
Walter De la Peña Meniz ◽  
Oscar Limay Ríos ◽  
Luis Meza Santibáñez1 ◽  
...  
Keyword(s):  
Cochrane Library ◽  
Assessment Development

Introducción. En Perú, los trastornos hipertensivos del embarazo son la segunda causa de mortalidad materna. Objetivo. La presente guía de práctica clínica basada en evidencias (GPC-BE) brinda recomendaciones para la prevención y tratamiento de la pre-eclampsia y eclampsia. Métodos. Se elaboró una GPC-BE adaptada mediante un proceso sistemático, riguroso y transparente con un grupo elaborador conformado por metodólogos y profesionales de la salud expertos en el manejo de la enfermedad. La guía cuenta con dieciséis preguntas clínicas y dieciséis recomendaciones. Se realizó la búsqueda y preselección de GPC, las mismas que fueron evaluadas mediante el instrumento “Appraisal of Guidelines for Research and Evaluation II” (AGREEII), para su adaptación. La búsqueda sistemática de evidencias para responder las preguntas clínicas se realizó en múltiples bases de datos: MEDLINE/PubMed, EMBASE/Ovid, Cochrane Library, LILACS y SciELO. Las evidencias fueron seleccionadas y analizadas críticamente por pares clínicos y metodológicos; las recomendaciones fueron elaboradas mediante la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados. Con la participación de un panel de expertos clínicos del Instituto Nacional Materno Perinatal, redes de salud y otras instituciones de referencia, se elaboraron 16 recomendaciones dirigidas a la prevención y tratamiento de mujeres gestantes en riesgo de pre-eclampsia, gestantes con pre-eclampsia, eclampsia o enfermedad hipertensiva. Conclusiones. Este artículo resume la guía de práctica clínica basada en evidencias para la prevención y tratamiento de pre-eclampsia y eclampsia en gestantes en el instituto de referencia nacional en salud materna y neonatal del Perú.

scholarly journals Ziprasidone, haloperidol and clonazepam intramuscular administration in the treatment of agitation symptoms in Chinese patients with schizophrenia: A network meta-analysis

2018 ◽  
Vol 31 (2) ◽  
pp. e000016
Author(s):  
Liang Su ◽  
Zheng Lu ◽  
Shenxun Shi ◽  
Yifeng Xu
Keyword(s):  
Primary Outcome ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Acute Stage ◽  
Chinese Patients ◽  
Cochrane Library ◽  
Assessment Development ◽  
Excessive Sedation ◽  
Made In

BackgroundAgitation is very common in patients with acute stage schizophrenia, and injection of antipsychotics and clonazepam is widely used. Network meta-analysis of these comparisons among three injection treatments has been seldom reported.AimTo compare the efficacy and safety of various injections for agitation symptoms in Chinese patients with schizophrenia.MethodsSearches were made in PubMed, Embase and Web of Knowledge, Cochrane Library, Wanfang data, CNKI, SinoMed and VIP databases up to 18 February 2018. Standard search strategies were performed by two reviewers according to the Cochrane Review Group. The Consolidated Standards of Reporting Trials statement was used to assess the methodological quality of the studies. STATA was used to perform meta-analysis. The Cochrane Grades of Recommendation, Assessment, Development and Evaluation (GRADE) was used to assess the strength of evidence.ResultsA total of 15 studies were included in the network meta-analysis. There were 11 studies comparing ziprasidone with haloperidol, and four studies comparing haloperidol with clonazepam. The results showed that ziprasidone is more effective than haloperidol and clonazepam (sucra: 77.2, 72.8 and 0) in the treatment of agitation symptoms. There was the effect size (standardised mean difference (SMD)) in the three groups: haloperidol: SMD=2.278, 95% CI 1.836 to 2.719; ziprasidone: SMD=2.536, 95% CI 2.082 to 2.990; and clonazepam: SMD=1.360, 95% CI 0.127 to 2.593. The acceptability was assessed by the incidence of excessive sedation, which showed that ziprasidone and haloperidol were similar with both being superior to clonazepam (sucra: 0.3, 0.7 and 99.0). Ziprasidone had significantly less adverse effects than haloperidol in effects of extrapyramidal system (EPS) (z=5.01, p<0.001). There were no statistically significant differences between haloperidol and ziprasidone in tachycardia and abnormal ECG (z=1.69, p=0.091; z=0.87, p=0.386; respectively). Based on GRADE, the strength of the evidence for primary outcome was ‘medium’.ConclusionOur results suggested that ziprasidone was more suitable than haloperidol and clonazepam in the treatment of agitation symptoms in Chinese patients with schizophrenia, according to the efficacy and acceptability of these three intramuscular injection medications.

scholarly journals Lower Fixed Retainers: Bonded On All Teeth Or Only On Canines? A Systematic review

2019 ◽  
Vol 90 (1) ◽  
pp. 125-143
Author(s):  
Larissa Barbosa Moda ◽  
Ana Luiza Correa da Silva Barros ◽  
Nathalia Carolina Fernandes Fagundes ◽  
David Normando ◽  
Lucianne Cople Maia ◽  
...  
Keyword(s):  
Risk Of Bias ◽  
Cochrane Library ◽  
Evaluation Tool ◽  
Qualitative Synthesis ◽  
Assessment Development ◽  
Anterior Teeth ◽  
Randomized Studies ◽  
Breakage Rate ◽  
The Stability ◽  
Fixed Retainers

ABSTRACT Objective To evaluate the stability after orthodontic treatment between two types of lower fixed retainers: those bonded onto all anterior teeth or those bonded only onto the canines. Materials and Methods The following electronic databases were consulted: PubMed, Scopus, Web of Science, Cochrane Library, Lilacs, OpenGrey, ClinicalTrials, and Google Scholar. No restriction of language or year were applied. After selection of studies, risk-of-bias evaluation and qualitative synthesis of the included studies were performed using The Cochrane Collaboration's tool for randomized studies and the “Risk of Bias in Non-randomized Studies of Interventions” (ROBINS-I) tool for nonrandomized studies, and a summary of the overall strength of evidence was presented using the “Grading of recommendations, assessment, development and evaluation” tool. Results Among the 180 studies retrieved from the searches, five were included in this review. Three of them showed a low risk of bias, while two presented a high risk of bias. With regard to stability, two studies reported better stability for retainers bonded to all six teeth, while the other three showed no difference. The retainer bonded to all teeth presented a higher breakage rate in one study. Conclusions Stability seems better with lower fixed retainers bonded on all anterior teeth. The breakage rate may not change according to the bonding. However, studies with greater methodological soundness are necessary to reach a more reliable conclusion.

Acupuncture for post-stroke cognitive impairment: a systematic review and meta-analysis

2021 ◽  
pp. 096452842110095
Author(s):  
Xu Kuang ◽  
Wenjuan Fan ◽  
Jiawei Hu ◽  
Liqun Wu ◽  
Wei Yi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Qualitative Synthesis ◽  
China National Knowledge Infrastructure ◽  
Quality Of Evidence ◽  
Post Stroke ◽  
Assessment Development

Objectives: The aim of this study was to evaluate the effectiveness and safety of acupuncture for the treatment of post-stroke cognitive impairment (PSCI). Methods: The Cochrane Library, Embase, Medline, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical (VIP), Wanfang, and Chinese Biological Medicine (CBM) databases were electronically searched from their inception to 10 April 2019. The Montreal Cognitive Assessment (MoCA) scale and Mini-Mental State Examination (MMSE) scale were used as outcomes to assess effectiveness with respect to cognitive function. Assessment of risk of bias (ROB) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment were performed by two reviewers independently. Data were analyzed using Review Manager (RevMan) 5.3. Results: A total of 28 trials with 2144 participants were included in the qualitative synthesis and meta-analysis. Four of the 28 trials (14%) were assessed as being at overall low ROB, 24 of the 28 trials (86%) were assessed as having overall high ROB. The quality of evidence for both MoCA and MMSE were deemed to be very low by the GRADE criteria. Results indicated that acupuncture groups may be benefiting more than non-acupuncture groups with respect to variation of MoCA scores (merged mean difference (MMD): 2.66, 95% confidence interval (CI): 2.18 to 3.13, p < 0.00001; heterogeneity: χ2 = 35.52, p = 0.0007, I2 = 63%), and the heterogeneity decreased in both subgroup analysis and sensitivity analysis. In addition, acupuncture groups might be benefiting more than non-acupuncture groups in terms of changes in MMSE score (MMD = 2.97, 95% CI = 2.13 to 3.80, p < 0.00001; heterogeneity: χ2 = 269.75; p < 0.00001; I2 = 92%), and the heterogeneity decreased in subgroup analysis. Only one RCT addressed adverse events, and the symptoms were mild and did not affect treatment and evaluation. Conclusion: Acupuncture could be effective and safe for PSCI. Nevertheless, the results should be interpreted cautiously due to the high ROB of included trials and very low quality of evidence for assessed outcomes.

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