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Crizol GR, Sá KMM, Santos GM, Gonçalves MLL, Mendes GD, Bussadori SK, Pacheco RL, Riera R, Santos EM, Martimbianco ALC. Work-related musculoskeletal disorders in dockworkers. Systematic review and meta-analysis. Work 2024:WOR230666. [PMID: 38607782 DOI: 10.3233/wor-230666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Dockworkers are exposed to physical overloads that can contribute to the development of musculoskeletal disorders, leading to functional disability and absenteeism. OBJECTIVE to map, critically appraise, and synthesize the available evidence on the prevalence of musculoskeletal diseases associated with port occupational activities. METHODS A comprehensive search was conducted in structured and unstructured databases in August 2023, with no date or language restriction, to identify observational studies evaluating the prevalence of musculoskeletal disorders in dockworkers' occupational activity. The risk of bias was assessed using validated tools based on the included study designs. Data from studies were pooled in meta-analyses. The certainty of the evidence was assessed using the GRADE approach. RESULTS We identified 12 analytical cross-sectional studies involving 7821 participants in ports of five countries. Most studies (75%) had a moderate methodological quality according to the Joanna Briggs Institute tool. Considering the overall worker categories and any musculoskeletal disorders, the meta-analysis showed a prevalence of 58% (95% Confidence Interval [95% CI] 37% to 78%), with degenerative spinal diseases 42% (95% CI -0.6% to 91%) and low back pain 36% (95% CI 21% to 50%) being the most prevalent conditions. Symptoms were predominantly in foremen and stevedores. The certainty of the evidence was very low. CONCLUSIONS Musculoskeletal disorders seem prevalent among dockworkers, mainly degenerative spinal diseases and low back pain. Studies with greater methodological consistency are still needed to validate these hypotheses and assist in decision-making for implementing preventive and informational policies in maritime port management organizations. PROSPERO registry CRD42021257677.
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Affiliation(s)
- Giuliana Raduan Crizol
- Postgraduate Program of Health and Environment, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | | | | | | | - Gustavo Duarte Mendes
- Postgraduate Program of Health and Environment, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | | | - Rafael Leite Pacheco
- Centro Universitario São Camilo, São Paulo, SP, Brazil; Researcher, Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Rachel Riera
- Universidade Federal de São Paulo, Sao Paulo, SP, Brazil; Researcher, Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Elaine Marcílio Santos
- Postgraduate Program of Health and Environment, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Postgraduate Program of Health and Environment, Universidade Metropolitana de Santos, Santos, SP, Brazil. Researcher, Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, SP, Brazil
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Sá KMM, Rodrigues JC, da Silva LB, Santos GM, Colovati MES, Martimbianco ALC. Quality of systematic reviews on the treatment of vesiculobullous skin diseases. A meta-epidemiological study. An Bras Dermatol 2024; 99:223-232. [PMID: 37985301 PMCID: PMC10943289 DOI: 10.1016/j.abd.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Systematic reviews of Randomized Controlled Trials (RCTs) are considered high-level evidence to support a decision on therapeutic interventions, and their methodological quality is essential to provide reliable and applicable results. OBJECTIVE This meta-epidemiological study aimed to map and critically appraise systematic reviews assessing treatments for vesiculobullous skin diseases. METHODS We conducted a comprehensive search strategy on MEDLINE (via Pubmed) in December 2022 without restrictions to find systematic reviews evaluating pharmacological interventions for vesiculobullous skin diseases. The methodological quality was assessed using the AMSTAR-2 tool, and additional information was extracted. We identified nine systematic reviews published between 2002 and 2021, seven assessing pemphigus. RESULTS According to the AMSTAR-2 tool, 55.6% were classified as critically low quality, 22.2% as moderate quality, 11.1% as low and 11.1% as high quality. No review assessed the certainty of the evidence (GRADE); 86% of pemphigus reviews had at least two overlapping RCTs. There were some limitations regarding methodological flaws and the AMSTAR-2 tool use CONCLUSIONS: These findings reveal a frail methodological quality of systematic reviews about vesiculobullous diseases treatment that may impact the results. Therefore, methodological rigor is mandatory for future systematic reviews to avoid duplication of effort and increase the certainty of the evidence supporting decision-making.
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Affiliation(s)
| | | | | | | | | | - Ana Luiza Cabrera Martimbianco
- Postgraduate Program in Health and Environment, Department of Medicine, Universidade Metropolitana de Santos, Santos, SP, Brazil; Health Technology Assessment Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil
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Mozetic de Barros V, Pacheco RL, Cabrera Martimbianco AL, Mozetic V, Junior SC, Riera R. Definition and reporting of composite outcomes are often inadequate in randomized clinical trials on pharmacological interventions for coronary artery disease. J Clin Epidemiol 2024; 165:111212. [PMID: 37939745 DOI: 10.1016/j.jclinepi.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To estimate the frequency and critically appraise the use and reporting of composite outcomes in randomized clinical trials on pharmacological interventions for coronary artery disease. STUDY DESIGN AND SETTING A metaresearch study. A search strategy was developed to retrieve references from MEDLINE. We considered articles, published from 1st January 2020, to December 31, 2021, reporting results of clinical primary outcomes from randomized clinical trials which assessed pharmacological interventions, used alone or in combination, for the treatment or secondary prevention (previous coronary event) of coronary artery disease. RESULTS From the 34 included studies, 28 (82.35%) had a primary composite outcome. Thirteen unique composite primary outcomes were used with the most frequent being "cardiovascular death, myocardial infarction, stroke" (12/28, 42.86%). The term major adverse cardiac events was used for five distinct composite primary outcomes. A combination of 12 different components resulted in the 28 primary composite outcomes, with stroke being the most frequent component present in 96.43% (27/28) of the primary composite outcomes. From the included studies, 60.71% (17/28) reported the estimates for each individual component and the direction of the effect was consistent between all components and the composite outcomes in 58.82% (10/17) of them. Additionally, no included study discussed potential limitations and/or related advantages of the composite outcomes. CONCLUSION In randomized clinical trials on pharmacological interventions for coronary artery disease, composite outcomes are frequently used, but the definition of their components is very heterogeneous. The estimate for individual components within the composite outcome is often not fully reported, which prevents a complete analysis of their adequacy for clinical practice. The term major adverse cardiac events was used inconsistently and to refer to different set of components, which can also be misleading and confusing.
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Affiliation(s)
- Valéria Mozetic de Barros
- Cardiologist at Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, São Paulo, Brazil
| | - Rafael Leite Pacheco
- Researcher at Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês (HSL), São Paulo, São Paulo, Brazil; Professor at Department of Medicine, Centro Universitário São Camilo (CUSC), São Paulo, São Paulo, Brazil; Pesquisador, Disciplina de Economia e Gestão em Saúde, Universidade Federal de São Paulo (Unifesp), São Paulo, São Paulo, Brazil.
| | - Ana Luiza Cabrera Martimbianco
- Researcher at Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês (HSL), São Paulo, São Paulo, Brazil; Professor at Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (Unimes), São Paulo, São Paulo, Brazil
| | - Vânia Mozetic
- Ophthalmologist, Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
| | - Sebastião Castilho Junior
- Medical student at Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Rachel Riera
- Research coordinator at Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês (HSL), São Paulo, São Paulo, Brazil; Professor at Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, São Paulo, Brazil
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Jana Neto FC, Martimbianco ALC, de Medeiros DV, Felix FC, Mesquita-Ferrari RA, Bussadori SK, Duran CCG, Motta LJ, Barbosa EC, Fernandes KPS. Cost analysis of photobiomodulation in tibia fracture in the Brazilian public health system. PLoS One 2023; 18:e0294290. [PMID: 38064443 PMCID: PMC10707925 DOI: 10.1371/journal.pone.0294290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/28/2023] [Indexed: 12/18/2023] Open
Abstract
Managing tibial fractures requires substantial health resources, which costs the health system. This study aimed to describe the costs of photobiomodulation (PBM) with LEDs in the healing process of soft tissue lesions associated with tibial fracture compared to a placebo. Economic analysis was performed based on a randomized controlled clinical trial, with a simulation of the cost-effectiveness and incremental cost model. Adults (n = 27) hospitalized with tibia fracture awaiting definitive surgery were randomized into two distinct groups: the PBM Group (n = 13) and the Control Group with simulated phototherapy (n = 14). To simulate the cost-effectiveness and incremental cost model, the outcome was the evolution of wound resolution by the BATES-JENSEN scale and time of wound resolution in days. The total cost of treatment for the Control group was R$21,164.56, and a difference of R$7,527.10 more was observed when compared to the treatment of the PBM group. The proposed intervention did not present incremental cost since the difference in the costs to reduce measures between the groups was smaller for the PBM group. When analyzing the ICER (Incremental cost-effectiveness ratio), it would be possible to save R$3,500.98 with PBM and decrease by 2.15 points in the daily average on the BATES-JENSEN scale. It is concluded, therefore, that PBM can be a supportive therapy of clinical and economic interest in a hospital setting.
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Affiliation(s)
- Frederico Carlos Jana Neto
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Orthopedics and Traumatology Group Conjunto Hospitalar do Mandaqui, São Paulo, SP, Brazil
- Medicine School Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Postgraduate Program in Health and Environment. Universidade Metropolitana de Santos (UNIMES), Santos, SP, Brazil
- Health Technology Assessment Center, Hospital Sírio-Libanês (NATS-HSL), São Paulo, SP, Brazil
| | | | | | - Raquel Agnelli Mesquita-Ferrari
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Cinthya Cosme Gutierrez Duran
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Lara Jansiski Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Estela Capelas Barbosa
- Population Health Sciences, Bristol Medical School, Bristol University, Bristol, United Kingdom
| | - Kristianne Porta Santos Fernandes
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
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Marcílio Santos E, Kalil Bussadori S, Ratto Tempestini Horliana AC, Moraes Moriyama C, Jansiski Motta L, Pecoraro C, Cabrera Martimbianco AL. Functional orthopedic treatment for anterior open bite in children. A systematic review of randomized clinical trials. J Orofac Orthop 2023; 84:405-414. [PMID: 35438306 DOI: 10.1007/s00056-022-00388-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/06/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE This systematic review aimed to assess the effects of orthopedic functional appliances for anterior open bite (AOB) in primary or mixed dentition children. METHODS A search for randomized controlled trials (RCT) was conducted in November 2020 in electronic databases with no data or language restrictions. Primary outcomes were skeletal cephalometric variables and adverse events. We used the Cochrane risk-of-bias tool to assess methodological quality and the GRADE approach to assess the certainty of the evidence. RESULTS We identified five RCTs (220 participants). Very low certainty evidence showed an improvement in overbite (mean difference [MD] 3.60; 95% confidence interval [CI] 2.63-4.57) and in the angulation of the upper incisors to the palatal plane (MD 3.70; 95% CI 0.85-6.55) with Frankel's functional regulator, compared to no treatment. There was no difference in the measured cephalometric variables when comparing removable palatal crib to fixed palatal crib, bonded spurs, and chin cup. When comparing removable versus magnetic bite blocks, a beneficial effect was observed in overbite, overjet, skeletal anteroposterior angular measurements, and skeletal vertical linear measures in the magnetic group. No adverse events were reported. CONCLUSION There was insufficient evidence to infer the effects of these treatments for AOB, and high-quality RCTs are needed to increase the estimated effects. PROSPERO REGISTER CRD42020175634, prospectively registered (05 July 2020).
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Affiliation(s)
- Elaine Marcílio Santos
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Avenida Conselheiro Nébias, 536-Encruzilhada, 11045-002, Santos, SP, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | | | | | - Lara Jansiski Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Carla Pecoraro
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Avenida Conselheiro Nébias, 536-Encruzilhada, 11045-002, Santos, SP, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Avenida Conselheiro Nébias, 536-Encruzilhada, 11045-002, Santos, SP, Brazil.
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Pacheco RL, Martimbianco ALC, Riera R. What is an "ongoing" clinical trial? An analysis of different sources revealed heterogeneous definitions of when a clinical trial starts and ends: a meta-research study. SAO PAULO MED J 2023; 142:e20220634. [PMID: 37466498 PMCID: PMC10353842 DOI: 10.1590/1516-3180.2022.0634.r2.100523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Although the concept of an "ongoing study" seems self-explanatory, it is difficult to determine whether a trial is underway. OBJECTIVE To analyze the definitions of "ongoing clinical trial" across different clinical trial registries, methodological guidelines, and other sources. DESIGN AND SETTING This meta-research study was conducted at the Universidade Federal de São Paulo (UNIFESP), Brazil. METHODS We performed a cross-sectional analysis of relevant clinical trial registry databases, methodological guidelines for conducting systematic reviews, and other sources that would define or regulate clinical trials. RESULTS We identified various heterogeneous definitions used by eligible sources at both the start and end of a clinical trial. The starting criteria used were as follows: when the team is planning the protocol, when permission is given to conduct the study, or when the first participant is enrolled. Some sources used the time at which the last outcome data was collected as a criterion to determine the end of the trial. The International Committee of Medical Journal Editors stated that a study is still "ongoing" during the analysis process. Several sources use a vague definition or present no clear criteria for defining the start or end of a study. CONCLUSION The concept of "ongoing clinical trials" lacks a transparent and homogeneous definition across relevant sources. A consensus on this concept is important to facilitate the evaluation of available evidence and conduct research synthesis. Further efforts are necessary to determine the best definition for the start and end of a clinical trial.
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Affiliation(s)
- Rafael Leite Pacheco
- MSc. PhD. Physician and Researcher, Centre of Health Technology
Assessment, Hospital Sírio-Libanês, São Paulo (SP), Brazil. Researcher,
Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. Professor,
Centro Universitário São Camilo, São Paulo (SP), Brazil
| | - Ana Luiza Cabrera Martimbianco
- MSc, PhD. Physiotherapist and Researcher, Centre of Health
Technology Assessment, Hospital Sírio-Libanês, São Paulo (SP), Brazil.
Professor, Universidade Metropolitana de Santos (UNIMES), Santos (SP),
Brazil
| | - Rachel Riera
- MSc. PhD. Physician Adjunct Professor, Discipline of
Evidence-Based Health, Escola Paulista de Medicina (EPM), Universidade Federal
de São Paulo (UNIFESP), São Paulo (SP), Brazil. Coordinator, Centre of Health
Technology Assessment, Hospital Sírio-Libanês, São Paulo (SP), Brazil
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Riera R, de Oliveira Cruz Latorraca C, Padovez RCM, Pacheco RL, Romão DMM, Barreto JOM, Machado MLT, Gomes R, da Silva SF, Martimbianco ALC. Strategies for communicating scientific evidence on healthcare to managers and the population: a scoping review. Health Res Policy Syst 2023; 21:71. [PMID: 37430348 DOI: 10.1186/s12961-023-01017-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/14/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Health evidence needs to be communicated and disseminated in a manner that is clearly understood by decision-makers. As an inherent component of health knowledge translation, communicating results of scientific studies, effects of interventions and health risk estimates, in addition to understanding key concepts of clinical epidemiology and interpreting evidence, represent a set of essential instruments to reduce the gap between science and practice. The advancement of digital and social media has reshaped the concept of health communication, introducing new, direct and powerful communication platforms and gateways between researchers and the public. The objective of this scoping review was to identify strategies for communicating scientific evidence in healthcare to managers and/or population. METHODS We searched Cochrane Library, Embase®, MEDLINE® and other six electronic databases, in addition to grey literature, relevant websites from related organizations for studies, documents or reports published from 2000, addressing any strategy for communicating scientific evidence on healthcare to managers and/or population. RESULTS Our search identified 24 598 unique records, of which 80 met the inclusion criteria and addressed 78 strategies. Most strategies focused on risk and benefit communication in health, were presented by textual format and had been implemented and somehow evaluated. Among the strategies evaluated and appearing to yield some benefit are (i) risk/benefit communication: natural frequencies instead of percentages, absolute risk instead relative risk and number needed to treat, numerical instead nominal communication, mortality instead survival; negative or loss content appear to be more effective than positive or gain content; (ii) evidence synthesis: plain languages summaries to communicate the results of Cochrane reviews to the community were perceived as more reliable, easier to find and understand, and better to support decisions than the original summaries; (iii) teaching/learning: the Informed Health Choices resources seem to be effective for improving critical thinking skills. CONCLUSION Our findings contribute to both the knowledge translation process by identifying communication strategies with potential for immediate implementation and to future research by recognizing the need to evaluate the clinical and social impact of other strategies to support evidence-informed policies. Trial registration protocol is prospectively available in MedArxiv (doi.org/10.1101/2021.11.04.21265922).
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Affiliation(s)
- Rachel Riera
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Carolina de Oliveira Cruz Latorraca
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | | | - Rafael Leite Pacheco
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil.
- Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Davi Mamblona Marques Romão
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Instituto Veredas, São Paulo, Brazil
| | - Jorge Otávio Maia Barreto
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Fundação Oswaldo Cruz, Brasília, Brazil
| | - Maria Lúcia Teixeira Machado
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Federal de São Carlos, São Carlos, Brazil
| | - Romeu Gomes
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Fundação Oswaldo Cruz, Brasília, Brazil
| | | | - Ana Luiza Cabrera Martimbianco
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Metropolitna de Santo (Unimes), Santos, Brazil
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Jana Neto FC, Martimbianco ALC, Mesquita-Ferrari RA, Bussadori SK, Alves GP, Almeida PVD, Delgado FG, Fonseca LR, Gama MZG, Jorge MD, Hamblin MR, Fernandes KPS. Effects of multiwavelength photobiomodulation for the treatment of traumatic soft tissue injuries associated with bone fractures: A double-blind, randomized controlled clinical trial. J Biophotonics 2023; 16:e202200299. [PMID: 36640122 DOI: 10.1002/jbio.202200299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/01/2022] [Accepted: 12/25/2022] [Indexed: 05/17/2023]
Abstract
This study evaluated the efficacy and safety of multiwavelength photobiomodulation (MPBM) in healing soft tissue injuries associated with tibial and/or ankle fractures. Participants were randomized into the MPBM or control group. Primary outcome was wound healing, measured by the Bates-Jensen scale. Assessments were performed daily. Twenty-seven hospitalized adults were included. MPBM showed an improvement in the daily mean Bates-Jensen scale (MPBM 32.1 vs. control 34.2; p = 0.029), daily mean pain score change (MPBM 0.5 vs. control 0.2; p = 0.04) and occurrence of infection at the site of the external fixator pins (MPBM 15.3% vs. control 57.1%; p = 0.02). MPBM group also showed faster-wound resolution (MPBM 13.1 vs. control 23.1 days). Subgroup analysis showed improvement in the MPBM group among less severe patients on the Bates-Jensen scale (MPBM 27.4 vs. control 34.7; p = 0.0081) and mean time for wound resolution (MPBM 7.0 vs. control 14.6 days; p = 0.03). MPBM appears safe and effective in reducing wound resolution time, infection in the surgical pin sites, reported pain and time before definitive surgery.
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Affiliation(s)
- Frederico Carlos Jana Neto
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE) Rua Vergueiro, São Paulo, Brazil
- Orthopedics and Traumatology Group, Conjunto Hospitalar do Mandaqui. R. Voluntários da Pátria, São Paulo, Brazil
- Medicine School Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Health Technology Assessment Center, Hospital Sírio-Libanês (NATS-HSL), São Paulo, Brazil
| | - Raquel Agnelli Mesquita-Ferrari
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE) Rua Vergueiro, São Paulo, Brazil
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE) Rua Vergueiro, São Paulo, Brazil
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Gustavo Porto Alves
- Orthopedics and Traumatology Group, Conjunto Hospitalar do Mandaqui. R. Voluntários da Pátria, São Paulo, Brazil
| | - Paulo Victor Dias Almeida
- Orthopedics and Traumatology Group, Conjunto Hospitalar do Mandaqui. R. Voluntários da Pátria, São Paulo, Brazil
| | - Felipe Guimaraes Delgado
- Orthopedics and Traumatology Group, Conjunto Hospitalar do Mandaqui. R. Voluntários da Pátria, São Paulo, Brazil
| | - Lucas Resende Fonseca
- Orthopedics and Traumatology Group, Conjunto Hospitalar do Mandaqui. R. Voluntários da Pátria, São Paulo, Brazil
| | | | | | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Johannesburg, South Africa
| | - Kristianne Porta Santos Fernandes
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE) Rua Vergueiro, São Paulo, Brazil
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Riera R, Padovez RDFCM, Pacheco RL, Latorraca CDOC, Martimbianco ALC. Supporting Decisions of the Brazilian Regulatory Agency for Supplementary Healthcare: A Case Study. Value Health Reg Issues 2023; 34:65-70. [PMID: 36513025 DOI: 10.1016/j.vhri.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study aimed to report implementation and partial results of the project "Supporting the Brazilian regulatory agency for supplementary healthcare through health technology assessment actions" conducted at Hospital Sírio-Libanês, Brazil, from 2020 to 2023, through Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde, a Brazilian Ministry of Health initiative. METHODS This was a case study conducted at Health Technology Center, Hospital Sírio-Libanês. RESULTS From its inception, in 2020, to July 2022, the following activities and products were completed: 59 technical-methodological reports assessing the efficacy, safety, cost-effectiveness, and budget impact of technologies received by Agência Nacional de Saúde Suplementar (ANS) to compose its catalog of drugs products and services; 50 analyses of society contributions from public consultation; 34 methodological or clinical tutorial sessions to support ANS team; 2 templates to systematize the update process of ANS catalog; and one training course on systematic reviews and meta-analysis for ANS team. CONCLUSION The project has contributed to increasing ANS autonomy in the health technology assessment, collaborating to efficiency in technologies offer to the users. By adopting and fostering evidence-based knowledge construction, the project reinforces its bridging role for supporting the consonance between public and supplementary healthcare sectors in Brazil.
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Affiliation(s)
- Rachel Riera
- Hospital Sírio-Libanês, São Paulo, Brazil; Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | | | - Rafael Leite Pacheco
- Hospital Sírio-Libanês, São Paulo, Brazil; Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil; Centro Universitário São Camilo (CUSC), São Paulo, Brazil
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10
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Beltramin RZ, Martimbianco ALC, Gonçalves MLL, Rocha MM, Silva SM, Horliana ACRT, Santos EM, Turcio KH, Mesquita-Ferrari RA, Fernandes KPS, Motta LJ, Bussadori SK. Abnormal Activity of Masticatory Muscles in Patients with Diagnosis of Cerebral Palsy. A Systematic Review and Meta-Analysis of Observational Studies. Phys Occup Ther Pediatr 2023; 43:548-563. [PMID: 36760123 DOI: 10.1080/01942638.2023.2173038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 01/05/2023] [Accepted: 01/14/2023] [Indexed: 02/11/2023]
Abstract
AIMS to map and synthesize the results from studies that assessed whether individuals diagnosed with cerebral palsy (CP) have abnormal masseter and temporal muscles activation during the masticatory cycle. METHODS Six databases were searched for comparative observational studies assessing masticatory muscles activation in individuals with CP through electromyography analysis. Methodological quality was evaluated using the Joanna Briggs Critical Appraisal Checklist. Outcome data were combined in meta-analysis using the Review Manager software. RESULTS We included five cross-sectional studies with an overall low risk of bias. Meta-analyses showed no difference between CP and healthy individuals regarding maximum voluntary isometric contraction: right masseter (Standard mean difference [SMD] - 0.95; 95% CI -2.03 to 0.13); left masseter (SMD -0.92; 95% CI -1.93 to 0.09); right temporal (SMD -0.72; 95% CI -1.63 to 0.18); and left temporal (SMD -0.68; 95% CI -1.76 to 0.40). Electrical activity amplitude in the inactive period was superior in the CP group, and maximum bite pressure presented higher values in the control group (Mean difference [MD] - 17.38; CI 95% -26.62 to -10.15). CONCLUSIONS Based on observational studies with a lower level of evidence, individuals with CP seem to present difficulties activating masticatory muscles. Future prospective cohort studies with rigorous methodology are still necessary to support these findings. PROSPERO register CRD42020208444.
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Affiliation(s)
- Rafael Zaratin Beltramin
- Postgraduation Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | - Marcela Leticia Leal Gonçalves
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Dentistry College, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Monise Mendes Rocha
- Postgraduation Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Soraia Micaela Silva
- Postgraduation Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | - Elaine Marcílio Santos
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Dentistry College, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Karina Helga Turcio
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), School of Dentistry - Aracatuba, São Paulo, Brazil
| | | | | | - Lara Jansiski Motta
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Postgraduation Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
- Dentistry College, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
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Pacheco RL, Riera R, Santos GM, Martins Sá KM, Peres Bomfim LG, da Silva GR, de Oliveira FR, Martimbianco ALC. Many systematic reviews with a single author are indexed in PubMed. J Clin Epidemiol 2023; 156:124-126. [PMID: 36716980 DOI: 10.1016/j.jclinepi.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 01/29/2023]
Affiliation(s)
- Rafael Leite Pacheco
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil; Centro Universitário São Camilo, Departamento de Medicina, São Paulo, São Paulo, Brazil; Universidade Federal de São Paulo (Unifesp), Núcleo de Ensino e Pesquisa em Saúde Baseada em Evidências e Avaliação de Tecnologias em Saúde (NEP-SBEATS), São Paulo, São Paulo, Brazil.
| | - Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil; Universidade Federal de São Paulo (Unifesp), Discipline of Evidence-Based Health, São Paulo, São Paulo, Brazil
| | - Giovanna Marcílio Santos
- Universidade Metropolitana de Santos (UNIMES), Departamento de Medicina, Santos, São Paulo, Brazil
| | - Kamilla Mayr Martins Sá
- Universidade Metropolitana de Santos (UNIMES), Departamento de Medicina, Santos, São Paulo, Brazil
| | | | | | | | - Ana Luiza Cabrera Martimbianco
- Universidade Metropolitana de Santos (UNIMES), Departamento de Medicina, Santos, São Paulo, Brazil; Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
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Galvão RA, Pavon B, Morán MCB, Barbin MVC, Martimbianco ALC, Colares Neto GDP. Dietary calcium intake in Brazilian preschoolers and schoolchhildren: review of the literature. Rev paul pediatr 2023; 41:e2021253. [PMID: 35830164 PMCID: PMC9273125 DOI: 10.1590/1984-0462/2023/41/2021253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022]
Abstract
Objective: The objective of this study was to map and synthesize evidence on the adequacy of dietary calcium intake and dairy products in Brazilian preschoolers and schoolchildren. Data source: Evidence searches were performed in the MEDLINE (via PubMed) and Latin American and Caribbean Health Sciences Literature (LILACS; via BVS) databases, with no restriction on date or language of publication. Experimental or observational studies that evaluated healthy Brazilian children between 2 and 12 incomplete years old were included. Data synthesis: A total of 18 studies were included. Seven of 11 studies of 11 studies (63.6%) identified mean values of dietary calcium intake below the age recommendation, especially in schoolchildren, with the progression of the age group. Among preschoolers, studies with direct weighing of food showed higher mean values of dietary calcium ingested compared to those with dietary recall. Children attending public daycare centers on a part-time basis tended to have inadequate calcium intake. The consumption of milk and dairy products was lower among older children, especially schoolchildren. Conclusions: Inadequate dietary calcium intake seems to be prevalent in Brazil during childhood, especially among schoolchildren. Therefore, the evaluation of milk and dairy products intake must be considered in order to desgn appropriate corrective actions.
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Martimbianco ALC, Moreira RDFC, Pacheco RL, Latorraca CDOC, Dos Santos APP, Logullo P, Riera R. Efficacy and safety of hemodialysis strategies for pregnant women with chronic kidney disease: Systematic review. Semin Dial 2023; 36:3-11. [PMID: 35934871 DOI: 10.1111/sdi.13120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/28/2022] [Accepted: 07/10/2022] [Indexed: 02/01/2023]
Abstract
Pregnancy in chronic kidney disease (CKD) women is relatively rare, and the less risky choice of hemodialysis is unknown. The objective of this systematic review was to identify, systematically evaluate and summarize the available evidence on the efficacy and safety of hemodialysis strategies for pregnant CKD women. Sensitive search strategies were applied to six databases without data or language restrictions. Comparative (randomized and non-randomized) studies were prioritized. Two reviewers independently selected, extracted, and critically evaluated data from studies. The risk of bias assessment was performed using the ROBINS-I tool, considering the study design (non-randomized comparative observational studies). The certainty of the evidence was assessed using the GRADE approach. From 7210 references identified, six retrospective cohort studies were included (576 women). The effects of intensive hemodialysis (over 20 h/week) are uncertain for maternal and neonatal mortality (Peto odds ratio [OR] 0.85; 95% confidence interval [95% CI] 0.26-2.80), miscarriage (Peto OR 0, 38; 95% CI 0.12-1.23), stillbirths (Peto OR 0, 56; 95% CI 0.13-2.31), preterm birth (Peto OR 0.87; 95% CI 0.33-2.28), low birth weight (Peto OR 0.71; 95% CI 0.20-2.50) and congenital anomalies rates. The certainty of the evidence was very low due to studies methodological limitations and effect estimates imprecision. The uncertainty about intensive versus conventional hemodialysis effects for pregnant women with CKD and the imprecision in the estimated effects precludes any recommendation. The strategy choice must consider treatment availability, costs, and maternal social aspects until future studies provide more reliable evidence. PROSPERO CRD42021259237.
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Affiliation(s)
- Ana Luiza Cabrera Martimbianco
- Núcleo de Ensino e Pesquisa e Saúde Baseada em Evidências e Avaliação de Tecnologias em Saúde (NEP-SBEATS), Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês (NATS-HSL), São Paulo, SP, Brazil.,Programa de Pós-graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos (UNIMES), Santos, SP, Brazil
| | - Roberta de Fátima Carreira Moreira
- Núcleo de Ensino e Pesquisa e Saúde Baseada em Evidências e Avaliação de Tecnologias em Saúde (NEP-SBEATS), Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês (NATS-HSL), São Paulo, SP, Brazil.,Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Rafael Leite Pacheco
- Núcleo de Ensino e Pesquisa e Saúde Baseada em Evidências e Avaliação de Tecnologias em Saúde (NEP-SBEATS), Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês (NATS-HSL), São Paulo, SP, Brazil.,Centro Universitário São Camilo (CUSC), São Paulo, SP, Brazil.,Núcleo de Avaliação de Tecnologias em Saúde, Associação Paulista para o Desenvolvimento da Escola Paulista de Medicina (NATS-SPDM), São Paulo, SP, Brazil
| | - Carolina de Oliveira Cruz Latorraca
- Núcleo de Ensino e Pesquisa e Saúde Baseada em Evidências e Avaliação de Tecnologias em Saúde (NEP-SBEATS), Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Núcleo de Avaliação de Tecnologias em Saúde, Associação Paulista para o Desenvolvimento da Escola Paulista de Medicina (NATS-SPDM), São Paulo, SP, Brazil
| | - Ana Paula Pires Dos Santos
- Núcleo de Ensino e Pesquisa e Saúde Baseada em Evidências e Avaliação de Tecnologias em Saúde (NEP-SBEATS), Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Patrícia Logullo
- Núcleo de Ensino e Pesquisa e Saúde Baseada em Evidências e Avaliação de Tecnologias em Saúde (NEP-SBEATS), Universidade Federal de São Paulo, São Paulo, SP, Brazil.,UK EQUATOR Network Centre, University of Oxford, Oxford, UK
| | - Rachel Riera
- Núcleo de Ensino e Pesquisa e Saúde Baseada em Evidências e Avaliação de Tecnologias em Saúde (NEP-SBEATS), Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês (NATS-HSL), São Paulo, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
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Martimbianco ALC, Sá KMM, Santos GM, Santos EM, Pacheco RL, Riera R. Most Cochrane systematic reviews and protocols did not adhere to the Cochrane's risk of bias 2.0 tool. Rev Assoc Med Bras (1992) 2023; 69:469-472. [PMID: 36820779 PMCID: PMC10004297 DOI: 10.1590/1806-9282.20221593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/15/2022] [Indexed: 02/22/2023]
Abstract
OBJECTIVE The aim of this study was to identify the frequency of Cochrane systematic reviews and Cochrane systematic reviews protocols using (or planning to use) the risk of bias 2.0 tool to assess the risk of bias of the included randomized clinical trials. STUDY DESIGN This is a meta-research study. METHODS We included Cochrane systematic reviews or Cochrane systematic reviews protocols that planned to include randomized clinical trials. We assessed the Cochrane Database of Systematic Reviews and screened for issues published after the launch of risk of bias 2.0 tool (2019-2022). Two independent investigators performed the study selection and data extraction. RESULTS We analyzed 440 Cochrane systematic reviews and 536 Cochrane systematic reviews protocols. Overall, 4.8% of the Cochrane systematic reviews and 28.5% of the Cochrane systematic reviews protocols used or planned to use risk of bias 2.0 tool. Although low, adherence is increasing over time. In 2019, 0% of Cochrane systematic reviews used risk of bias 2.0 tool, compared to 24.1% in 2022. In Cochrane systematic reviews protocols, adherence increased from 6.9% in 2019 to 41.5% in 2022. A total of 274 (62.1%) Cochrane systematic reviews had their protocols published before 2018; only one used risk of bias 2.0 tool and reported the change of versions in the "Differences between protocol and revision" section. CONCLUSION The Cochrane's risk of bias 2.0 tool has low adherence among Cochrane protocols and systematic reviews. Further efforts are necessary to facilitate the implementation of this new tool.
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Affiliation(s)
- Ana Luiza Cabrera Martimbianco
- Hospital Sírio-Libanês, Centre of Health Technology Assessment, - São Paulo (SP), Brazil.,Universidade Metropolitana de Santos, Postgraduate Program of Health and Environment - Santos (SP), Brazil
| | | | | | - Elaine Marcílio Santos
- Universidade Metropolitana de Santos, Postgraduate Program of Health and Environment - Santos (SP), Brazil
| | - Rafael Leite Pacheco
- Hospital Sírio-Libanês, Centre of Health Technology Assessment, - São Paulo (SP), Brazil.,Universidade Federal de São Paulo - São Paulo (SP), Brazil.,Centro Universitário São Camilo - São Paulo (SP), Brazil
| | - Rachel Riera
- Hospital Sírio-Libanês, Centre of Health Technology Assessment, - São Paulo (SP), Brazil.,Universidade Federal de São Paulo, Escola Paulista de Medicina, Discipline of Evidence-Based Health - São Paulo (SP), Brazil
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Pacheco RL, Martimbianco ALC, Riera R. Blinding of interventions in clinical trials helps to prevent selection bias by making the allocation sequence difficult to decipher. J Eval Clin Pract 2022; 28:1050-1052. [PMID: 35384156 DOI: 10.1111/jep.13682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Rafael Leite Pacheco
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, Bela Vista, Brazil.,Núcleo de Ensino e Pesquisa em Saúde Baseada em Evidências e Medicina Baseada em Evidências (Nep-Sbeats), Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.,Centro de Pesquisa Médica, Centro Universitário São Camilo, São Paulo, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, Bela Vista, Brazil.,Programa de Pós-graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, Bela Vista, Brazil.,Discipline of Evidence-Based Health, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
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Rosa MMB, Fragoso YD, Scaciota ACL, Crizol GR, Colovati MES, Moura ECD, Martimbianco ALC. Evidence from Cochrane systematic reviews on pharmacological treatment compared to placebo for panic disorder. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT. Panic disorder is an anxiety condition characterized by recurrent and unexpected panic attacks. The comparison between active treatment and placebo is essential to analyze an intervention’s efficacy and safety. It is important to identify and summarize the studies with higher evidence to assist health professionals and public policy managers in clinical decision-making. Objective: The aim of this study was to identify and summarize all Cochrane systematic reviews (SRs) that compared the efficacy and safety of any drug treatment compared to placebo for panic disorder patients. Methods: SRs published in the Cochrane Library were included without date restriction. All outcomes presented were analyzed. The methodological quality of the SRs was evaluated using the AMSTAR-2 tool. Results: We included three Cochrane SRs of high methodological quality on the effects of antidepressants, benzodiazepines, and azapirones for panic disorder. All medications showed benefits in response to treatment, symptom improvement, and reduced panic attacks. Dropouts were lower with tricyclic antidepressants and benzodiazepines and higher with azapirones. The occurrence of adverse events was higher for drug groups. Conclusions: Very low to moderate certainty evidence (GRADE) showed that antidepressants and benzodiazepines seem to improve clinical symptoms in individuals with short-term panic disorder compared to placebo. In addition, the use of azapirones seems to have greater adherence by patients than placebo. However, there is insufficient evidence to support its clinical efficacy.
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Bezerra DT, La Selva A, Cecatto RB, Deana AM, Prates RA, Bussadori SK, Mesquita-Ferrari RA, Motta LJ, Fernandes KPS, Martimbianco ALC, Frochot C, Pereira BJ, Rossi F, Mimica MJ, Horliana ACRT. Antimicrobial Photodynamic Therapy in the Nasal Decolonization of Maintenance Hemodialysis Patients: A Pilot Randomized Trial. Am J Kidney Dis 2022; 81:528-536.e1. [PMID: 36396084 DOI: 10.1053/j.ajkd.2022.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022]
Abstract
RATIONALE & OBJECTIVE Infections are an important cause of mortality among patients receiving maintenance hemodialysis. Staphylococcus aureus is a frequent etiological agent, and previous nasal colonization is a risk factor for infection. Repeated antimicrobial decolonization reduces infection in this population but can induce antibiotic resistance. We compared photodynamic therapy, a promising bactericidal treatment that does not induce resistance, to mupirocin treatment among nasal carriers of S aureus. STUDY DESIGN Randomized controlled pilot study. SETTING & PARTICIPANTS 34 patients receiving maintenance hemodialysis who had nasal carriage of S aureus. INTERVENTIONS Patients were randomly assigned to decolonization with a single application of photodynamic therapy (wavelength of 660nm, 400mW/cm2, 300 seconds, methylene blue 0.01%) or with a topical mupirocin regimen (twice a day for 5 days). OUTCOME Nasal swabs were collected at time 0 (when the carrier state was identified), directly after treatment completion, 1 month after treatment, and 3 months after treatment. Bacterial isolates were subjected to proteomic analysis to identify the species present, and antimicrobial susceptibility was characterized. RESULTS All 17 participants randomized to photodynamic therapy and 13 of 17 (77%) randomized to mupirocin were adherent to treatment. Directly after treatment was completed, 12 participants receiving photodynamic therapy (71%) and 13 participants treated with mupirocin (77%) had cultures that were negative for S aureus (risk ratio, 0.92 [95% CI, 0.61-1.38]; P=0.9). Of the patients who had negative cultures directly after completion of photodynamic therapy, 67% were recolonized within 3 months. There were no adverse events in the photodynamic therapy group. LIMITATIONS Testing was restricted to assessing nasal colonization; infectious complications were not assessed. CONCLUSIONS Photodynamic therapy is a feasible approach to treating nasal carriage of S aureus. Future larger studies should be conducted to determine whether photodynamic therapy is equivalent to the standard of care with mupirocin. FUNDING Government grant (National Council for Scientific and Technological Development process 3146682020-9). TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT04047914.
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Affiliation(s)
- Daniella Teixeira Bezerra
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Andreia La Selva
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Rebeca Boltes Cecatto
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Alessandro Melo Deana
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Renato Araujo Prates
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil; Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Raquel Agnelli Mesquita-Ferrari
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil; Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Lara Jansiski Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | | | - Céline Frochot
- Le Laboratoire Réactions et Génie des Procédés, University of Lorraine, CNRS, Nancy, France
| | - Benedito Jorge Pereira
- Renal Division, Internal Medicine, Clinical Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Flávia Rossi
- Clinical Microbiology Laboratory, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo Jenne Mimica
- Discipline of Microbiology, Department of Pathological Sciences, Santa Casa de São Paulo School of Medicine, São Paulo, Brazil
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Martimbianco ALC, Pacheco RL, Bagattini ÂM, de Fátima Carreira Moreira Padovez R, Azevedo LCP, Riera R. Vitamin C-based regimens for sepsis and septic shock: Systematic review and meta-analysis of randomized clinical trials. J Crit Care 2022; 71:154099. [PMID: 35763993 DOI: 10.1016/j.jcrc.2022.154099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/16/2022] [Accepted: 06/13/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE to critically appraise and synthesize the evidence on the effects of vitamin C-based regimens for patients with sepsis or septic shock. METHODS a broad search was performed on May 2021 to identify randomized clinical trials (RCTs) assessing vitamin C-based regimens as adjuvant therapy for adults with sepsis or septic shock. We used the Cochrane Risk of Bias table to assess the methodological quality of the included RCTs and the GRADE approach to evaluate the evidence certainty. RESULTS We included 20 RCTs (2124 participants). Evidence from low to very low certainty showed that vitamin C compared to placebo may reduce all-cause mortality up to 28 days (relative risk [RR] 0.60, 95% confidence interval (CI) 0.45 to 0.80, 4 RCTs, 335 participants). Considering the other comparisons (vitamin C alone or combined with thiamine and/or hydrocortisone, compared to placebo, standard care or hydrocortisone), there were a little to no difference or very uncertain evidence for adverse events, SOFA score, ICU length of stay, acute kidney injury, mechanical ventilation- and vasoactive drugs-free days up to 28 days. CONCLUSION Further RCTs with higher methodological quality, an increased number of participants and assessing clinically relevant outcomes are needed to provide better decision-making guidance. PROSPERO REGISTER CRD42021251786.
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Affiliation(s)
- Ana Luiza Cabrera Martimbianco
- Hospital Sírio-Libanês (HSL), São Paulo, SP, Brazil; Universidade Metropolitana de Santos (Unimes), Santos, SP, Brazil; Oxford-Brazil EBM Alliance, Brazil
| | - Rafael Leite Pacheco
- Hospital Sírio-Libanês (HSL), São Paulo, SP, Brazil; Oxford-Brazil EBM Alliance, Brazil; Centro Universitário São Camilo (CUSC), São Paulo, SP, Brazil; Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | | | | | | | - Rachel Riera
- Hospital Sírio-Libanês (HSL), São Paulo, SP, Brazil; Oxford-Brazil EBM Alliance, Brazil; Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
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Brisola AA, Colovati MES, Cernach MCSP, Riera R, Pacheco RL, Crizol GR, Martimbianco ALC. Association between genetic polymorphisms and osteoarthritis development. Overview of systematic reviews. Int J Rheum Dis 2022; 25:733-742. [PMID: 35678085 DOI: 10.1111/1756-185x.14362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/07/2022] [Accepted: 05/19/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify, critically evaluate and synthesize the evidence obtained from systematic reviews on the association between genetic polymorphisms and osteoarthritis (OA) development. METHODS Considering gene polymorphisms associated with OA susceptibility (risk or protection), a comprehensive search was conducted in the following databases, without date or language restrictions: MEDLINE, via Pubmed; Embase, via Elsevier; Cochrane Database of Systematic Reviews, via Wiley; Biblioteca Virtual em Saúde. Gray literature was also searched through the OpenGrey database. The AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews) was used to assess the methodological quality of the included systematic reviews. RESULTS We included 14 systematic reviews of case-control studies comparing individuals with a radiographic diagnosis of all OA types and healthy controls, all submitted to the genetic examination of different polymorphisms in candidate genes. Meta-analyses showed a protective effect against knee and hand OA associated with GDF-5 gene (odds ratio [OR] 0.90, 95% confidence interval (CI) 0.85-0.95), and knee OA with ESRα gene (OR 0.63, 95% CI 1.26-1.97). SMAD3 gene was associated with knee and hip OA risk (OR 1.21. 95% CI 1.07-1.38) and MMP-1 gene was associated with temporomandibular OA (OR 1.58. 95% CI 1.26-1.97). CONCLUSION Based on low-quality to critically-low-quality systematic reviews, some gene polymorphisms seem to be associated with risk or protection for OA. Further high-quality studies are needed to validate these hypotheses, contribute to disease understanding, and possibly help the decision-making related to early diagnosis and treatment options for OA. PROSPERO register CRD42021234231.
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Affiliation(s)
| | | | | | - Rachel Riera
- Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.,Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês (NATS-HSL), São Paulo, Brazil.,Cochrane Brazil-Afilliate Centre Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Leite Pacheco
- Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.,Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês (NATS-HSL), São Paulo, Brazil.,Cochrane Brazil-Afilliate Centre Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giuliana Raduan Crizol
- Programa de Pós-graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Programa de Pós-graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil.,Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês (NATS-HSL), São Paulo, Brazil.,Cochrane Brazil-Afilliate Centre Rio de Janeiro, Rio de Janeiro, Brazil
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Marta GN, Riera R, Pacheco RL, Cabrera Martimbianco AL, Meattini I, Kaidar-Person O, Poortmans P. Moderately hypofractionated post-operative radiation therapy for breast cancer: Systematic review and meta-analysis of randomized clinical trials. Breast 2022; 62:84-92. [PMID: 35131647 PMCID: PMC9073333 DOI: 10.1016/j.breast.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction We provide a critical assessment regarding current evidence for the use of moderately hypofractionated irradiation for patients with breast cancer. The aim of the study was to summarize the available evidence regarding outcomes after moderately hypofractionated compared with conventional radiation doses in the post-operative treatment of patients with breast cancer. Material and methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS databases were searched until March 25, 2021. All randomized phase 3 clinical trials that compared moderately hypofractionated with conventional radiation doses in the post-operative treatment of patients with breast cancer were selected. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results Eight clinical trials satisfied the eligibility criteria and were the focus of the analysis. A total of 12,139 breast cancer patients was randomly assigned for moderately hypofractionated compared with conventional irradiation. Meta-analysis of the trials regarding local recurrence, loco-regional recurrence, disease-free survival, and overall survival outcomes did not demonstrate any significant difference between moderately hypofractionated irradiation and conventional radiation doses groups. The rate of severe side effects was low in both groups; acute and late side effects and cosmesis were similar or even tended to be lower after moderately hypofractionated than after conventional irradiation. Conclusions Moderately hypofractionated is at least as effective and safe as conventional radiation irradiation regimens and should be considered as a treatment option for most, if not all, breast cancer patients. Evidence for the use of moderately hypofractionated RT (MHRT) for breast cancer. Meta-analysis of clinical trials. MHRT is at least as safe and effective as conventionally fractionated regimens.
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21
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Gomes AO, Martimbianco ALC, Brugnera Junior A, Horliana ACRT, da Silva T, Santos EM, Fragoso YD, Fernandes KPS, Nammour S, Bussadori SK. Photobiomodulation for the Treatment of Primary Headache: Systematic Review of Randomized Clinical Trials. Life (Basel) 2022; 12:life12010098. [PMID: 35054491 PMCID: PMC8781567 DOI: 10.3390/life12010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/24/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the efficacy and safety of photobiomodulation as an adjuvant treatment for primary headache. A systematic review of randomized clinical trials was performed. For such, electronic searches were performed in the MEDLINE, Embase, Cochrane Library, LILACS, PEDro, PsycInfo, Clinicaltrials.gov., and WHO/ICTRP databases, with no restrictions imposed regarding language or year of publication. We included studies that assessed any photobiomodulation therapy as an adjuvant treatment for primary headache compared to sham treatment, no treatment, or another intervention. The methodological assessment was conducted using the Cochrane Risk of Bias tool. The certainty of the evidence was classified using the GRADE approach. Four randomized clinical trials were included. Most of the included studies had an overall high risk of bias. Compared to sham treatment, photobiomodulation had a clinically important effect on pain in individuals with primary headache. Despite the benefits reported for other outcomes, the estimates were imprecise, and the certainty of the evidence was graded as low. These findings are considered insufficient to support the use of photobiomodulation in the treatment of primary headache. Randomized clinical trials, with higher methodological quality, are needed to enhance the reliability of the estimated effects.
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Affiliation(s)
- Andréa Oliver Gomes
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Street Vergueiro, 235/249-Liberdade, São Paulo 05503-900, Brazil; (A.O.G.); (T.d.S.)
| | - Ana Luiza Cabrera Martimbianco
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), São Paulo 05503-900, Brazil; (A.L.C.M.); (E.M.S.); (Y.D.F.)
| | - Aldo Brugnera Junior
- Physics Institute of São Carlos (IFSC/USP), Universidade de São Paulo, São Paulo 05503-900, Brazil;
| | - Anna Carolina Ratto Tempestini Horliana
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo 05503-900, Brazil; (A.C.R.T.H.); (K.P.S.F.)
| | - Tamiris da Silva
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Street Vergueiro, 235/249-Liberdade, São Paulo 05503-900, Brazil; (A.O.G.); (T.d.S.)
| | - Elaine Marcílio Santos
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), São Paulo 05503-900, Brazil; (A.L.C.M.); (E.M.S.); (Y.D.F.)
| | - Yara Dadalti Fragoso
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), São Paulo 05503-900, Brazil; (A.L.C.M.); (E.M.S.); (Y.D.F.)
| | - Kristianne Porta Santos Fernandes
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo 05503-900, Brazil; (A.C.R.T.H.); (K.P.S.F.)
| | - Samir Nammour
- Department of Dental Science, Faculty of Medicine, University of Liege, 4000 Liege, Belgium;
| | - Sandra Kalil Bussadori
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Street Vergueiro, 235/249-Liberdade, São Paulo 05503-900, Brazil; (A.O.G.); (T.d.S.)
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo 05503-900, Brazil; (A.C.R.T.H.); (K.P.S.F.)
- Correspondence: ; Tel.: +55-11-3385924
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22
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Motta PDB, Motta LJ, Campos TM, Gonçalves MLL, Santos EM, Martimbianco ALC, de Andrade DJC, Mesquita-Ferrari RA, Fernandes KPS, Horliana ACRT, Bussadori SK. Effect of Photodynamic Therapy on Halitosis: A Systematic Review of Randomized Controlled Trials. Sensors (Basel) 2022; 22:469. [PMID: 35062433 PMCID: PMC8780921 DOI: 10.3390/s22020469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND This systematic review aimed to assess the effectiveness and safety of aPDT for the treatment of halitosis. METHODS Search strategies were conducted in October 2021 without language or data restrictions, on the following databases: MEDLINE, EMBASE, CENTRAL, LILACS and BBO, as well as a manual search. Randomized clinical trials (RCTs) with parallel design were considered for inclusion, assessing individuals (adolescents and adults) with a clinical diagnosis of halitosis treated with photodynamic therapy (aPDT). Primary outcomes assessed were halitosis measurements, adverse events and quality of life. The risk of bias for each included study was evaluated with the Cochrane Risk of Bias tool and the certainty of the body of the evidence was assessed with the GRADe approach. RESULTS Six RCTs (total of 225 participants) were included and due to clinical diversities it was not possible to group the outcome data in meta-analyses. Based on very low-certainty evidence (GRADE) the results showed that, when compared to tongue scraper, aPDT seems to promote a little to no difference in reducing halitosis and in the microbiological analysis. No adverse events were reported. Considering aPDT combined with tongue scraper, better outcome results were observed when compared to tongue scraper alone. CONCLUSIONS Based on very low-certainty evidence, the findings of this review are uncertain about the effects of aPDT for halitosis control. Further RCTs with higher number of participants and long term assessments need to be conducted to support the use of this intervention. The protocol was registered in the PROSPERO database (number: CRD42020215319) on 19 November 2020-retrospectively registered.
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Affiliation(s)
- Pamella de Barros Motta
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo 01504-001, SP, Brazil; (P.d.B.M.); (L.J.M.); (T.M.C.); (M.L.L.G.); (R.A.M.-F.); (K.P.S.F.); (A.C.R.T.H.)
| | - Lara Jansiski Motta
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo 01504-001, SP, Brazil; (P.d.B.M.); (L.J.M.); (T.M.C.); (M.L.L.G.); (R.A.M.-F.); (K.P.S.F.); (A.C.R.T.H.)
| | - Thalita Molinos Campos
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo 01504-001, SP, Brazil; (P.d.B.M.); (L.J.M.); (T.M.C.); (M.L.L.G.); (R.A.M.-F.); (K.P.S.F.); (A.C.R.T.H.)
| | - Marcela Leticia Leal Gonçalves
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo 01504-001, SP, Brazil; (P.d.B.M.); (L.J.M.); (T.M.C.); (M.L.L.G.); (R.A.M.-F.); (K.P.S.F.); (A.C.R.T.H.)
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos 11045-002, SP, Brazil; (E.M.S.); (A.L.C.M.)
| | - Elaine Marcílio Santos
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos 11045-002, SP, Brazil; (E.M.S.); (A.L.C.M.)
| | - Ana Luiza Cabrera Martimbianco
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos 11045-002, SP, Brazil; (E.M.S.); (A.L.C.M.)
| | | | - Raquel Agnelli Mesquita-Ferrari
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo 01504-001, SP, Brazil; (P.d.B.M.); (L.J.M.); (T.M.C.); (M.L.L.G.); (R.A.M.-F.); (K.P.S.F.); (A.C.R.T.H.)
| | - Kristianne Porta Santos Fernandes
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo 01504-001, SP, Brazil; (P.d.B.M.); (L.J.M.); (T.M.C.); (M.L.L.G.); (R.A.M.-F.); (K.P.S.F.); (A.C.R.T.H.)
| | - Anna Carolina Ratto Tempestini Horliana
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo 01504-001, SP, Brazil; (P.d.B.M.); (L.J.M.); (T.M.C.); (M.L.L.G.); (R.A.M.-F.); (K.P.S.F.); (A.C.R.T.H.)
| | - Sandra Kalil Bussadori
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo 01504-001, SP, Brazil; (P.d.B.M.); (L.J.M.); (T.M.C.); (M.L.L.G.); (R.A.M.-F.); (K.P.S.F.); (A.C.R.T.H.)
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Rocha MM, Martimbianco ALC, Beltramin RZ, Horliana ACRT, Santos EM, Mesquita-Ferrari RA, Fernandes KPS, Motta LJ, Turcio KH, Gonçalves MLL, Bussadori SK. Non-surgical interventions for the treatment of masticatory muscular spasticity in patients with cerebral palsy. Systematic review of randomized clinical trials. J Bodyw Mov Ther 2022; 29:68-73. [PMID: 35248291 DOI: 10.1016/j.jbmt.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/29/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Muscle disorders caused by cerebral palsy (CP) can affect oral function. The treatment for masticatory muscle spasticity is important to minimize muscle hyperactivity and preclude oral damages. OBJECTIVES To evaluate the efficacy and safety of non-surgical interventions for the treatment of masticatory muscle spasticity in CP patients. METHODS A comprehensive search was performed in the following databases: MEDLINE, Embase, Cochrane Library, LILACS, BBO, PEDro, Clinicaltrials.gov and WHO/ICTRP, without date and language restrictions. Randomized controlled trials (RCT) evaluating non-surgical interventions were considered. Primary outcomes such as masticatory function and adverse events were planned to be assessed. The risk of bias assessment was performed using the Cochrane risk of bias tool. The certainty of the evidence was assessed using the GRADE approach. RESULTS Three RCT assessing the effects of botulinum toxin, functional masticatory training and neuromuscular electrostimulation (NMES) were included. Evidence with a very low certainty showed: (i) no difference between botulinum toxin and placebo regarding maximum chewing strength, chewing efficiency and global oral health scale; (ii) improvement in masticatory function in favor of functional masticatory training versus conventional exercises, and (iii) in favor of strengthening exercises plus NMES versus placebo. CONCLUSIONS There was insufficient evidence to support the use of botulinum toxin and masticatory muscle strengthening programs alone and associated with NMES for the treatment of masticatory muscle in patients with PC. The clinical decision must be individualized, and further studies are needed to support or refute the use of different non-surgical interventions for PC. PROSPERO register number CRD42020209761.
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Affiliation(s)
- Monise Mendes Rocha
- Postgraduation Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Vergueiro Street, 235/249 - Liberdade, ZIP 01504-001, São Paulo, SP, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Conselheiro Nébias Avenue - Encruzilhada, ZIP 11045-002, Santos, SP, Brazil
| | - Rafael Zaratin Beltramin
- Postgraduation Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Vergueiro Street, 235/249 - Liberdade, ZIP 01504-001, São Paulo, SP, Brazil
| | - Anna Carolina Ratto Tempestini Horliana
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Vergueiro Street, 235/249 - Liberdade, ZIP 01504-001, São Paulo, SP, Brazil
| | - Elaine Marcílio Santos
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Conselheiro Nébias Avenue - Encruzilhada, ZIP 11045-002, Santos, SP, Brazil; Dentistry College, Universidade Metropolitana de Santos (UNIMES), Conselheiro Nébias Avenue - Encruzilhada, ZIP 11045-002, Santos, SP, Brazil
| | - Raquel Agnelli Mesquita-Ferrari
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Vergueiro Street, 235/249 - Liberdade, ZIP 01504-001, São Paulo, SP, Brazil
| | - Kristianne Porta Santos Fernandes
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Vergueiro Street, 235/249 - Liberdade, ZIP 01504-001, São Paulo, SP, Brazil
| | - Lara Jansiski Motta
- Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Vergueiro Street, 235/249 - Liberdade, ZIP 01504-001, São Paulo, SP, Brazil
| | - Karina Helga Turcio
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), School of Dentistry, Aracatuba, SP, Brazil
| | - Marcela Leticia Leal Gonçalves
- Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Conselheiro Nébias Avenue - Encruzilhada, ZIP 11045-002, Santos, SP, Brazil; Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Vergueiro Street, 235/249 - Liberdade, ZIP 01504-001, São Paulo, SP, Brazil; Dentistry College, Universidade Metropolitana de Santos (UNIMES), Conselheiro Nébias Avenue - Encruzilhada, ZIP 11045-002, Santos, SP, Brazil
| | - Sandra Kalil Bussadori
- Postgraduation Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Vergueiro Street, 235/249 - Liberdade, ZIP 01504-001, São Paulo, SP, Brazil; Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Vergueiro Street, 235/249 - Liberdade, ZIP 01504-001, São Paulo, SP, Brazil; Dentistry College, Universidade Metropolitana de Santos (UNIMES), Conselheiro Nébias Avenue - Encruzilhada, ZIP 11045-002, Santos, SP, Brazil.
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Mancini de Sousa M, Nakata MTK, Baldini CES, de Oliveira-Sales EB, Boim MA, Martimbianco ALC, Maquigussa E. Creatine Supplementation in Type 2 Diabetic Patients: A Systematic Review of Randomized Clinical Trials. Curr Diabetes Rev 2022; 18:e120721194709. [PMID: 34931982 DOI: 10.2174/1573399817666210712151737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 11/22/2022]
Abstract
Type 2 Diabetes Mellitus (DM) is the most common form of diabetes. The initial treatment of type 2 DM consists of the adoption of healthy lifestyle habits together with several classes of hypoglycemic agents. However, these medications are not always able to reduce the blood glucose levels in all patients. Therefore, creatine supplementation has emerged as a new putative candidate for type 2 DM treatment. This systematic review aimed to investigate the effects (benefits and harms) of creatine supplementation in patients with type 2 diabetes through a systematic review. The studies were searched in MEDLINE, EMBASE, LILACS, CENTRAL, SPORTDiscus, and CINAHL databases, without date or language restrictions. Methodological quality was assessed using the Cochrane risk-of-bias table. The certainty of the evidence was classified using the Grading of Recommendations Assessment, Development and Evaluation approach. Three randomized controlled trials (RCTs) were included (87 participants). Overall, the methodological quality was classified as unclear to a high risk of bias. Each trial compared creatine supplementation with a different control group (placebo, metformin, and glibenclamide). Creatine supplementation seems to be effective in decreasing glycemic levels and glycosylated hemoglobin concentrations compared to placebo. No difference was observed compared to metformin or glibenclamide with creatine, and all treatments were able to reduce blood glucose levels. No major adverse effects were observed. Based on the low certainty of evidence, creatine supplementation was shown to be a hypoglycemic intervention for patients with type 2 diabetes, without major adverse events reported. However, well- designed RCTs with larger sample sizes and long-term outcomes are needed to support this evidence.
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Affiliation(s)
- Marcella Mancini de Sousa
- Postgraduate Program of Health and Environment, Universidade Metropolitana de Santos, Santos, Brazil
| | | | | | | | - Mirian Aparecida Boim
- Postgraduate Program of Health and Environment, Universidade Metropolitana de Santos, Santos, Brazil
- Renal Division, Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Edgar Maquigussa
- Postgraduate Program of Health and Environment, Universidade Metropolitana de Santos, Santos, Brazil
- Renal Division, Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
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Santos GM, Santos EM, Mendes GD, Fragoso YD, Souza MR, Martimbianco ALC. A review of Cochrane reviews on pharmacological treatment for attention deficit hyperactivity disorder. Dement Neuropsychol 2021; 15:421-427. [PMID: 35509804 PMCID: PMC9018091 DOI: 10.1590/1980-57642021dn15-040001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/07/2021] [Indexed: 01/11/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most frequent childhood psychiatric problems.
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Mazzoni A, Navarro RS, Fernandes KPS, Horliana ACRT, Mesquita-Ferrari RA, Motta PB, Silva T, Gomes AO, Martimbianco ALC, Sobral APT, Santos EM, Motta LJ, Bussadori SK. Evaluation of the effects of high-level laser and electrocautery in lingual frenectomy surgeries in infants: protocol for a blinded randomised controlled clinical trial. BMJ Open 2021; 11:e050733. [PMID: 34848514 PMCID: PMC8634217 DOI: 10.1136/bmjopen-2021-050733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Ankyloglossia (tongue-tie) is an anomaly characterised by an abnormally short, thick or small lingual frenulum that restricts tongue movements. This condition is considered one of the factors that can interfere with breast feeding by diminishing the ability of the newborn to latch adequately. According to the Brazilian Health Ministry, the prevalence of this anomaly among newborns is 3%-16%. Frenectomy is the most suitable surgical procedure for the treatment of ankyloglossia. The aim of this study is to compare the performance of electrocautery and high-power diode laser as forms of frenectomy. METHODS AND ANALYSIS The proposed study will be a randomised, controlled, blind clinical trial involving the participation of healthy infants 0-3 months of age with breastfeeding difficulty and a diagnosis of tongue-tie with an indication for lingual frenectomy. The guardians will receive clarifications regarding the procedures and will authorise the participation of the infants by signing a statement of informed consent. A non-blinded researcher will perform the screening and procedures and a blinded researcher will perform the postoperative evaluations. Fifty-six infants will be randomly allocated into two groups (n=28): the electrocautery group or the high-power laser group. The preparation of the patients, asepsis and infection control procedures will rigorously follow biosafety norms. For both groups, patient histories will be taken, clinical evaluations will be performed and a standardised photograph of the lingual frenulum will be taken before surgery. The Bristol Tongue Assessment Tool will be used. We will evaluate pain in the mother during breast feeding before, immediately after, and 15 days after surgery. ETHICS AND DISSEMINATION This protocol was submitted to the Research Ethics Committee of Nove de Julho University, having been given a favourable opinion (Number: 4387769). Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NCT04487418.
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Affiliation(s)
- Adriana Mazzoni
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | | | | | - Raquel Agnelli Mesquita-Ferrari
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Pamella Barros Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Tamiris Silva
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Andréa Oliver Gomes
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Center of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil
- Cochrane Brazil Rio de Janeiro, Cochrane, Petrópolis, Brazil
| | - Ana Paula Taboada Sobral
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Elaine Marcilio Santos
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Lara Jansiski Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
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Riera R, Pacheco RL, Bagattini ÂM, Martimbianco ALC. Efficacy and safety of therapeutic use of cannabis derivatives and their synthetic analogs: Overview of systematic reviews. Phytother Res 2021; 36:5-21. [PMID: 34841610 DOI: 10.1002/ptr.7263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 08/05/2021] [Accepted: 08/14/2021] [Indexed: 01/08/2023]
Abstract
The debate on the use of cannabinoids for therapeutic purposes is constantly on the rise. This overview aimed to map the evidence on the therapeutic effects of cannabis derivatives and their synthetic analogs. Systematic reviews (SRs) of randomized trials were identified through a comprehensive search in several databases, and their methodological quality were evaluated with AMSTAR-2. The results for main outcomes are presented, prioritizing those from updated and better quality SRs. Finally, 68 SRs, addressing 37 different health conditions, were included. The methodological quality was high for eight SRs. The evidence certainty (GRADE) for the effects of cannabinoids is not high for any of the outcomes identified. Evidence certainty was moderate for the following: (a) cannabidiol appears to be beneficial for quality of life but increases the risk of adverse events in ulcerative colitis; (b) cannabinoids in general appear to have no clinically important benefit for chronic non-oncologic pain, spasticity-related pain in multiple sclerosis, or for acute post-operative pain; (c) cannabinoids in general appear to have a benefit in reducing chemotherapy-related nausea and vomiting. For all other outcomes from remaining comparisons, the evidence certainty was low, very low, or not evaluated, which prevents recommendations for or against their routine use.
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Affiliation(s)
- Rachel Riera
- Health Technology Assessment Centre, Hospital Sírio-Libanês, São Paulo - SP, Brazil.,Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo - SP, Brazil
| | - Rafael Leite Pacheco
- Health Technology Assessment Centre, Hospital Sírio-Libanês, São Paulo - SP, Brazil.,Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo - SP, Brazil.,Centro de Pesquisa Médica, Centro Universitário São Camilo (CUSC), São Paulo - SP, Brazil
| | - Ângela Maria Bagattini
- Health Technology Assessment Centre, Hospital Sírio-Libanês, São Paulo - SP, Brazil.,Instituto de Medicina Tropical e Saúde Publica, Universidade Federal de Goiás (UFG), Goiânia - GO, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Health Technology Assessment Centre, Hospital Sírio-Libanês, São Paulo - SP, Brazil.,Mestrado Profissional em Saúde e Meio Ambiente, Universidade Metropolitana de Santos (Unimes), Santos - SP, Brazil
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Pacheco RL, Martimbianco ALC, Riera R. Let's end 'real-world evidence' terminology usage: a study should be identified by its design. J Clin Epidemiol 2021; 142:249-251. [PMID: 34780982 DOI: 10.1016/j.jclinepi.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/27/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rafael Leite Pacheco
- MSc. MD. Researcher at Centre of Health Technology Assessment, Hospital Sírio-Libanês; Researcher at Universidade Federal de São Paulo (Unifesp); Professor at Centro Universitário São Camilo.
| | - Ana Luiza Cabrera Martimbianco
- MSc, PhD. Researcher at Centre of Health Technology Assessment, Hospital Sírio-Libanês; Professor at Universidade Metropolitana de Santos (UNIMES).
| | - Rachel Riera
- MSc. PhD. Adjunct Professor of the Discipline of Evidence-Based Health at Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), and Coordinator - Centre of Health Technology Assessment, Hospital Sírio-Libanês.
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Cabrera Martimbianco AL, Pacheco RL, Bagattini ÂM, Riera R. Frequency, signs and symptoms, and criteria adopted for long COVID-19: A systematic review. Int J Clin Pract 2021; 75:e14357. [PMID: 33977626 PMCID: PMC8236920 DOI: 10.1111/ijcp.14357] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/07/2021] [Indexed: 01/04/2023] Open
Abstract
AIMS To identify, systematically evaluate and summarise the best available evidence on the frequency of long COVID-19 (post-acute COVID-19 syndrome), its clinical manifestations, and the criteria used for diagnosis. METHODS Systematic review conducted with a comprehensive search including formal databases, COVID-19 or SARS-CoV-2 data sources, grey literature, and manual search. We considered for inclusion clinical trials, observational longitudinal comparative and non-comparative studies, cross-sectional, before-and-after, and case series. We assessed the methodological quality by specific tools based on the study designs. We presented the results as a narrative synthesis regarding the frequency and duration of long COVID-19, signs and symptoms, criteria used for diagnosis, and potential risk factors. RESULTS We included 25 observational studies with moderate to high methodological quality, considering 5440 participants. The frequency of long COVID-19 ranged from 4.7% to 80%, and the most prevalent signs/symptoms were chest pain (up to 89%), fatigue (up to 65%), dyspnea (up to 61%), and cough and sputum production (up to 59%). Temporal criteria used to define long COVID-19 varied from 3 to 24 weeks after acute phase or hospital discharge. Potentially associated risk factors were old age, female sex, severe clinical status, a high number of comorbidities, hospital admission, and oxygen supplementation at the acute phase. However, limitations related to study designs added uncertainty to this finding. None of the studies assessed the duration of signs/symptoms. CONCLUSION The frequency of long COVID-19 reached up to 80% over the studies included and occurred between 3 and 24 weeks after acute phase or hospital discharge. Chest pain, fatigue, dyspnea, and cough were the most reported clinical manifestations attributed to the condition. Based on these systematic review findings, there is an urgent need to understand this emerging, complex and challenging medical condition. Proposals for diagnostic criteria and standard terminology are welcome.
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Affiliation(s)
- Ana Luiza Cabrera Martimbianco
- Núcleo de Avaliação de Tecnologias em SaúdeHospital Sírio‐Libanês (HSL)São PauloBrazil
- Centro de Pesquisa MédicaCentro Universitário São Camilo (CUSC)São PauloBrazil
- Postgraduate program in health and environmentalUniversidade Metropolitana de Santos (Unimes)SantosBrazil
- Oxford‐Brazil EBM AllianceOxford‐Brazil EBM AllianceSão PauloBrazil
| | - Rafael Leite Pacheco
- Núcleo de Avaliação de Tecnologias em SaúdeHospital Sírio‐Libanês (HSL)São PauloBrazil
- Centro de Pesquisa MédicaCentro Universitário São Camilo (CUSC)São PauloBrazil
- Oxford‐Brazil EBM AllianceOxford‐Brazil EBM AllianceSão PauloBrazil
| | - Ângela Maria Bagattini
- Núcleo de Avaliação de Tecnologias em SaúdeHospital Sírio‐Libanês (HSL)São PauloBrazil
- Instituto de Patologia Tropical e Saúde PúblicaUniversidade Federal de Goiás (UFG)São PauloBrazil
| | - Rachel Riera
- Núcleo de Avaliação de Tecnologias em SaúdeHospital Sírio‐Libanês (HSL)São PauloBrazil
- Oxford‐Brazil EBM AllianceOxford‐Brazil EBM AllianceSão PauloBrazil
- Escola Paulista de MedicinaUniversidade Federal de São Paulo (Unifesp)São PauloBrazil
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Pacheco RL, Bagattini AM, Pachito DV, Martimbianco ALC, Rodrigues FDA, Moreira RDFC, Riera R. Distance practical course on systematic reviews to support decisions of Brazilian regulatory agency for supplementary healthcare system. BMJ Evid Based Med 2021; 26:261-262. [PMID: 33431426 DOI: 10.1136/bmjebm-2020-111617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Rafael Leite Pacheco
- Center of Health Technology Assessment, Hospital Sírio-Libanês, Sao Paulo, São Paulo, Brazil
- Departamento de Medicina, Centro Universitário São Camilo, São Paulo, São Paulo, Brazil
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, São Paulo, Brazil
| | - Angela Maria Bagattini
- Center of Health Technology Assessment, Hospital Sírio-Libanês, Sao Paulo, São Paulo, Brazil
- Institute of Tropical Pathology and Public Health, Universidade Federal de Goiás, Goiania, GO, Brazil
- Instituto Nacional de Ciência e Tecnologia de Avaliação em Tecnologias em Saúde (INCT/IATS), Porto Alegre, RS, Brazil
| | - Daniela Vianna Pachito
- Center of Health Technology Assessment, Hospital Sírio-Libanês, Sao Paulo, São Paulo, Brazil
- Instituto de Desenvolvimento Educacional, Fundação Getúlio Vargas, São Paulo, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Departamento de Medicina, Centro Universitário São Camilo, São Paulo, São Paulo, Brazil
- Programa de pos-graduação em saúde e meio ambiente, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Fernanda D Athayde Rodrigues
- Instituto Nacional de Ciência e Tecnologia de Avaliação em Tecnologias em Saúde (INCT/IATS), Porto Alegre, RS, Brazil
| | | | - Rachel Riera
- Center of Health Technology Assessment, Hospital Sírio-Libanês, Sao Paulo, São Paulo, Brazil
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, São Paulo, Brazil
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Torloni MR, Siaulys M, Riera R, Martimbianco ALC, Pacheco RL, Latorraca CDOC, Widmer M, Betran AP. Route of oxytocin administration for preventing blood loss at caesarean section: a systematic review with meta-analysis. BMJ Open 2021; 11:e051793. [PMID: 34531222 PMCID: PMC8449971 DOI: 10.1136/bmjopen-2021-051793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Assess the effects of different routes of prophylactic oxytocin administration for preventing blood loss at caesarean section (CS). DESIGN Systematic review and meta-analysis. METHODS Medline, EMBASE, CINAHL, Cochrane Library, BVS, SciELO and Global Index Medicus were searched through 24 May 2020 for randomised controlled trials (RCTs) comparing different routes of prophylactic oxytocin administration during CS. Study selection, data extraction and quality assessment were conducted by two investigators independently. We pooled results in fixed effects meta-analyses and calculated average risk ratio (RR), mean difference (MD) and 95% CI. We used GRADE to assess the overall quality of evidence for each outcome. RESULTS Three trials (180 women) were included in the review. All studies compared intramyometrial (IMY) versus intravenous oxytocin in women having prelabour CS. IMY compared with intravenous oxytocin administration may result in little or no difference in the incidence of postpartum haemorrhage (RR 0.14, 95% CI 0.01 to 2.70; N=100 participants; 1 RCT), hypotension (RR 1.00, 95% CI 0.29 to 3.45; N=40; 1 RCT), headache (RR 3.00, 95% CI 0.13 to 69.52; N=40; 1 RCT) or facial flushing (RR 0.50, 95% CI 0.05 to 5.08; N=40; 1 RCT); IMY oxytocin may reduce nausea/vomiting (RR 0.13, 95% CI 0.02 to 0.69; N=140; 2 RCTs). We are very uncertain about the effect IMY versus intravenous oxytocin on the need for additional uterotonics (RR 0.82; 95% CI 0.25 to 2.69; N=140; 2 RCTs). IMY oxytocin may reduce blood loss slightly (MD -57.40 mL, 95% CI -101.71 to -13.09; N=40; 1 RCT). CONCLUSIONS There is limited, low to very low certainty evidence on the effects of IMY versus intravenous oxytocin at CS for preventing blood loss. The evidence is insufficient to support choosing one route over another. More trials, including studies that assess intramuscular oxytocin administration, are needed on this relevant question. PROSPERO REGISTRATION NUMBER CRD42020186797.
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Affiliation(s)
- Maria Regina Torloni
- Obstetrics Department, Hospital e Maternidade Santa Joana, Sao Paulo, Brazil
- Evidence-Based Healthcare Post-Graduate Program, São Paulo Federal University-UNIFESP, Sao Paulo, Brazil
| | - Monica Siaulys
- Anaesthesiology Department, Hospital e Maternidade Santa Joana, Sao Paulo, Brazil
| | - Rachel Riera
- Evidence-Based Healthcare Post-Graduate Program, São Paulo Federal University-UNIFESP, Sao Paulo, Brazil
- Centre of Health Technology Assessment, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Evidence-Based Healthcare Post-Graduate Program, São Paulo Federal University-UNIFESP, Sao Paulo, Brazil
- Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Rafael Leite Pacheco
- Evidence-Based Healthcare Post-Graduate Program, São Paulo Federal University-UNIFESP, Sao Paulo, Brazil
- Centro Universitário São Camilo, Sao Paulo, Brazil
| | | | - Mariana Widmer
- Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Ana Pilar Betran
- Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Pereira GC, Prates G, Medina M, Ferreira C, Latorraca CDOC, Pacheco RL, Martimbianco ALC, Riera R. High frequency of spin bias in controlled trials of cannabis derivatives and their synthetic analogues: A meta-epidemiologic study. J Clin Epidemiol 2021; 140:3-12. [PMID: 34450305 DOI: 10.1016/j.jclinepi.2021.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the frequency and perform a qualitative analysis of spin bias in publications of controlled trials assessing the therapeutic use of cannabis derivatives and their synthetic analogues. STUDY DESIGN AND SETTING Meta-epidemiologic study carried out at the Universidade Federal de São Paulo, Brazil. RESULTS A total of 65 publications with at least one efficacy primary outcome were considered. The results analysis for the primary outcome indicated statistically significant effects in 44.6% (29/65) of the publications, and 70.7% (45/65) of the conclusions were considered favorable to the intervention. Among the 36 publications that found statistically nonsignificant results for the primary outcome, 44.4% (16/36) presented conclusions favorable to or recommending the intervention, which represents spin bias according to the definition adopted in this study. Qualitative analysis of the 16 studies with spin bias showed selective outcomes reporting (elevating secondary outcomes that had positive results or reporting only subgroup results), deviations from the planned statistical analysis, and failure to consider or report uncertainty in the estimates of treatment effects. CONCLUSION The frequency of spin bias among publications of controlled trials with statistically nonsignificant results assessing the therapeutic use of cannabis derivatives and their synthetic analogues reached 44.4%. When not observed by readers, such deviation can lead to misconduct in clinical practice through the adoption of interventions that are not effective or whose effectiveness is uncertain.
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Affiliation(s)
| | - Gabriela Prates
- Universidade Federal de São Paulo (Unifesp), São Paulo - SP, Brazil
| | - Matheus Medina
- Universidade Federal de São Paulo (Unifesp), São Paulo - SP, Brazil
| | | | | | - Rafael Leite Pacheco
- Centro Universitário São Camilo (CUSC), São Paulo - SP, Brazil. Hospital Sírio-Libanês. Universidade Federal de São Paulo (Unifesp). Oxford-Brazil EBM Alliance.
| | | | - Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil. Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo - SP, Brazil. Oxford-Brazil EBM Alliance
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Martimbianco ALC, Pacheco RL, Latorraca CDOC, Ferreira RES, Riera R. Systematic reviews on interventions for COVID-19 have rarely graded the certainty of the evidence. SAO PAULO MED J 2021; 139:511-513. [PMID: 34378740 PMCID: PMC9632526 DOI: 10.1590/1516-3180.2021.0107.27052021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Numerous systematic reviews on coronavirus disease-19 (COVID-19) treatment have been developed to provide syntheses of the large volume of primary studies. However, the methodological quality of most of these reviews is questionable and the results provided may therefore present bias. OBJECTIVE To investigate how many systematic reviews on the therapeutic or preventive options for COVID-19 assessed the certainty of the evidence through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. METHODS We conducted a sensitive search in MEDLINE (via PubMed) and included all systematic reviews that assessed any intervention for COVID-19. The systematic reviews included were examined to identify any planned and/or actual assessment using the GRADE approach (or absence thereof) regarding the certainty of the evidence. RESULTS We included 177 systematic reviews and found that only 37 (21%; 37/177) assessed and reported the certainty of the evidence using the GRADE approach. This number reduced to 27 (16.2%; 27/167) when Cochrane reviews (n = 10), in which an evaluation using GRADE is mandatory, were excluded. CONCLUSION Most of the systematic reviews on interventions relating to COVID-19 omitted assessment of the certainty of the evidence. This is a critical methodological omission that must not be overlooked in further research, so as to improve the impact and usefulness of syntheses relating to COVID-19.
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Affiliation(s)
- Ana Luiza Cabrera Martimbianco
- PhD. Professor, Centro Universitário São Camilo, São Paulo (SP), Brazil; and Professor, Universidade Metropolitana de Santos (UNIMES), Santos (SP), Brazil.
| | - Rafael Leite Pacheco
- MSc. Professor, Centro Universitário São Camilo, São Paulo (SP), Brazil; and Researcher, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil.
| | | | | | - Rachel Riera
- PhD. Adjunct Professor, Discipline of Evidence-Based Health, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil; and Coordinator, Health Technology Assessment Center, Hospital Sírio-Libanês, São Paulo (SP), Brazil.
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Ferreira RES, Pacheco RL, de Oliveira Cruz Latorraca C, Riera R, Eid RG, Martimbianco ALC. Effects of Caffeine Supplementation on Physical Performance of Soccer Players: Systematic Review and Meta-Analysis. Sports Health 2021; 13:347-358. [PMID: 33666113 PMCID: PMC8645316 DOI: 10.1177/1941738121998712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
CONTEXT Caffeine is 1 of the most popular supplements consumed by athletes, and the evidence for improving soccer performance remains limited. OBJECTIVE To investigate and update the effects (benefits and harms) of caffeine to improve performance on soccer players. DATA SOURCES Electronic search in Medline (via PubMed), CENTRAL, Embase, SPORTDiscus, and LILACS, from inception to March 28, 2020. STUDY SELECTION Randomized clinical trials (RCTs) assessing the effects of caffeine on the performance of soccer players. STUDY DESIGN Systematic review with meta-analysis. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION Data extraction was conducted independently by 2 authors using a piloted form. We assessed methodological quality (Cochrane risk-of-bias [RoB] table) and the certainty of the evidence (GRADE [Grading of Recommendations Assessment, Development and Evaluation] approach). RESULTS Sixteen RCTs were included. Overall methodological quality was classified as unclear to low risk of bias. When assessing aerobic endurance, meta-analyses did not demonstrate the differences between caffeine and placebo (mean difference [MD], 44.9 m; 95% confidence interval [CI], -77.7 to 167.6). Similarly, no difference was observed during time to fatigue test (MD, 169.8 seconds; 95% CI, -71.8 to 411.6). Considering anaerobic power, meta-analyses also did not find differences for vertical jump (MD, 1.01 cm; 95% CI, -0.68 to 2.69) and repeated sprint tests (MD, -0.02 seconds; 95% CI, -0.09 to 0.04), as well as reaction time agility test (MD, 0.02 seconds; 95% CI, -0.01 to 0.04) and rating of perceived exertion (MD, 0.16 points; 95% CI, -0.55 to 0.87). Regarding safety, a few minor adverse events were reported. Based on the GRADE approach, the certainty of this evidence was classified as very low to low. CONCLUSION We found no significant improvement in soccer-related performance with caffeine compared with placebo or no intervention. However, caffeine appears to be safe.
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Affiliation(s)
| | - Rafael Leite Pacheco
- Centro Universitário São Camilo, São Paulo, SP, Brazil
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Rachel Riera
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, SP, Brazil
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Pacheco RL, Latorraca COC, Martimbianco ALC, Miranda E, Fontes LES, Nunan D, Riera R. Adherence to conflicts of interest policy in Cochrane reviews where authors are also editorial board members: A cross-sectional analysis. Res Synth Methods 2021; 13:6-11. [PMID: 34165922 DOI: 10.1002/jrsm.1507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/18/2021] [Accepted: 06/20/2021] [Indexed: 11/12/2022]
Abstract
Cochrane devolves most editorial governance of the Cochrane Database of Systematic Reviews (CDSR), including title prioritization, protocol registration, peer-review, editorial oversight and subsequent review deposition, to specific Cochrane Review Group (CRG) editorial boards. Current Cochrane policy stipulates authors of reviews who are also members of the supporting CRG declare this non-financial conflict of interest and confirm no involvement in the review editorial process. The aim of this cross-sectional analysis was to assess adherence to Cochrane's editorial conflict of interest policy. All 260 published Cochrane reviews (CR) in issues 1 to 6 from 2019 of the CDSR were reviewed. A total of 133 (51.2%, 133/260) of CRs had at least one author that was also listed as an editor in the CRG. Of these, only five (3.8%, 5/133) appropriately declared the conflict according to Cochrane policy. In 6.5% (17/133) CRs, the contact author had a leading editorial position within the CRG and in only four of 17 was this declared according to Cochrane policy. No CR with the contact author who also had a leading editorial position described methods to prevent any potential issues related to this scenario during the editorial process in accordance with Cochrane policy. We propose a specific form to improve the transparency and reliability of editorial conflict of interest reporting in CRs. The suggested form can be adapted to other contexts.
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Affiliation(s)
- Rafael Leite Pacheco
- Universidade Federal de São Paulo (Unifesp), Sao Paulo; and Centro Universitário São Camilo, Sao Paulo, Oxford-Brazil EBM Alliance, Brazil
| | | | - Ana Luiza Cabrera Martimbianco
- Centro Universitário São Camilo, Sao Paulo; and Universidade Metropolitana de Santos (Unimes), Santos, Oxford-Brazil EBM Alliance, Brazil
| | - Enderson Miranda
- Centre for Evidence Based Medicine (CEBM), University of Oxford, Oxford, UK; and, Oxford-Brazil EBM Alliance, Brazil
| | - Luis Eduardo Santos Fontes
- Faculdade de Medicina de Petrópolis, Cochrane Brazil - Rio de janeiro Affiliate Centre, Petrópolis; Oxford-Brazil EBM Alliance, Brazil
| | - David Nunan
- Centre for Evidence Based Medicine (CEBM), Nuffield Department of Primary Care, Health Sciences, University of Oxford, Oxford, UK
| | - Rachel Riera
- Discipline of Evidence-Based Health at Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), Sao Paulo. Centre of Health Technology Assessment, Hospital Sirio-Libanês, Sao Paulo. Oxford-Brazil EBM Alliance, Brazil
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Torloni MR, Siaulys M, Riera R, Cabrera Martimbianco AL, Leite Pacheco R, Latorraca CDOC, Widmer M, Betrán AP. Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis. PLoS One 2021; 16:e0252491. [PMID: 34081734 PMCID: PMC8174699 DOI: 10.1371/journal.pone.0252491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022] Open
Abstract
Background There is no consensus on the best timing for prophylactic oxytocin administration during cesarean section (CS) to prevent post-partum hemorrhage (PPH). Objectives Assess the effects of administrating prophylactic oxytocin at different times during CS. Methods We searched nine databases to identify relevant randomized controlled trials (RCT). We pooled results and calculated average risk ratios (RR), mean differences (MD), and 95% confidence intervals (CI). We used GRADE to assess the overall evidence certainty. Results We screened 13,389 references and included four trials. We found no statistically significant differences between oxytocin given before versus after fetal delivery on PPH (RR 0.60, 95%CI 0.15–2.47; 1 RCT, N = 300) or nausea/vomiting (RR 1.21, 95%CI 0.69–2.13; 1 RCT, N = 300). There was a significant reduction in the need for additional uterotonics when oxytocin was given immediately before uterine incision versus after fetal delivery (RR 0.37, 95%CI 0.18–0.73; I2 = 0%; 2 RCTs; N = 301). Oxytocin given before fetal delivery significantly reduced intra-operative blood loss (MD -146.77mL, 95%CI -168.10 to -125.43; I2 = 0%; 3 RCTs, N = 601) but did not change the incidence of blood transfusion (RR 0.50, 95%CI 0.13–1.95; I2 = 0%; 2 RCTs, N = 301) or hysterectomy (RR 3.00; 95%CI 0.12–72.77; I2 = 0%; 2 RCTs, N = 301). One trial (N = 100) compared prophylactic oxytocin before versus after placental separation and found no significant differences on PPH, additional uterotonics, or nausea/vomiting. Conclusions In women having pre-labor CS, there is limited evidence indicating no significant differences between prophylactic oxytocin given before versus after fetal delivery on PPH, nausea/vomiting, blood transfusion, or hysterectomy. Earlier oxytocin administration may reduce the volume of blood loss and need for additional uterotonics. There is very limited evidence suggesting no significant differences between prophylactic oxytocin given before versus after placental separation on PPH, need for additional uterotonic, or nausea/vomiting. The overall certainty of the evidence was mostly low or very low due to imprecision. Protocol: CRD42020186797.
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Affiliation(s)
- Maria Regina Torloni
- Department of Obstetrics, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
- Evidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Monica Siaulys
- Department of Anesthesiology, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
| | - Rachel Riera
- Evidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Center of Health Technology Assessment, Hospital Sirio-Libanês, São Paulo, SP, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Evidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Universidade Metropolitana de Santos (UNIMES), Santos, SP, Brazil
| | - Rafael Leite Pacheco
- Evidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Centro Universitário São Camilo, São Paulo, SP, Brazil
| | | | - Mariana Widmer
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Ana Pilar Betrán
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
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Scaciota ACL, Matos D, Rosa MMB, Colovati MES, Bellotto EFBC, Martimbianco ALC. INTERVENTIONS FOR THE TREATMENT OF IRRITABLE BOWEL SYNDROME: A REVIEW OF COCHRANE SYSTEMATIC REVIEWS. Arq Gastroenterol 2021; 58:120-126. [PMID: 33909790 DOI: 10.1590/s0004-2803.202100000-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a complex gastrointestinal disorder, whose understanding is relatively uncertain, and the treatment guidance decision still represents a challenge. OBJECTIVE To identify and critically appraise systematic reviews (SRs) published in the Cochrane Database of SRs (CDSR) on the effects of interventions (pharmacological and non-pharmacological) for the treatment of IBS. METHODS The search was conducted at the Cochrane Library in May 2020. The methodological quality of the SRs was evaluated by the AMSTAR-2 tool. RESULTS Eight SRs with moderate to high quality were included, which addressed the treatments: (a) pharmacological: volume agents, antispasmodics, antidepressants and tegaserod; and (b) non-pharmacological: homeopathy, acupuncture, phytotherapy, biofeedback, psychological interventions and hypnotherapy. The results were favorable to antispasmodic drugs and antidepressants regarding the improvement of clinical symptoms. There was no difference between volume agents or tegaserod when compared to placebo. Acupuncture and homeopathy showed a little improvement in symptoms compared to placebo, but the certainty of this evidence was considered low to very low. Psychological interventions seem to improve the overall assessment of the patient and relief symptoms such as abdominal pain. However, there was no long-term follow-up of these patients. The results of the other treatments were considered uncertain due to the high risk of bias. CONCLUSION Considering the low quality of the studies included in the SRs, pharmacological treatment with antispasmodics and antidepressants seems to be beneficial for patients with IBS. Among non-pharmacological interventions, psychological interventions seem to be beneficial. However, further clinical trials are recommended with greater methodological rigor to prove these findings.
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Affiliation(s)
| | - Delcio Matos
- Universidade Metropolitana de Santos (UNIMES), Departamento de Medicina, Santos, SP, Brasil
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Garcia MT, Mota BS, Cardoso N, Martimbianco ALC, Ricci MD, Carvalho FM, Gonçalves R, Soares Junior JM, Filassi JR. Accuracy of frozen section in intraoperative margin assessment for breast-conserving surgery: A systematic review and meta-analysis. PLoS One 2021; 16:e0248768. [PMID: 33735315 PMCID: PMC7971883 DOI: 10.1371/journal.pone.0248768] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES It is well established that tumor-free margin is an important factor for reducing local recurrence and reoperation rates. This systematic review with meta-analysis of frozen section intraoperative margin assessment aims to evaluate the accuracy, and reoperation and survival rates, and to establish its importance in breast-conserving surgery. METHODS A thorough review was conducted in all online publication-databases for the related literature up to March 2020. MeSH terms used: "Breast Cancer", "Segmental Mastectomy" and "Frozen Section". We included the studies that evaluated accuracy of frozen section, reoperation and survival rates. To ensure quality of the included articles, the QUADAS-2 tool (adapted) was employed. The assessment of publication bias by graphical and statistical methods was performed using the funnel plot and the Egger's test. The review protocol was registered in PROSPERO (CRD42019125682). RESULTS Nineteen studies were deemed suitable, with a total of 6,769 cases. The reoperation rate on average was 5.9%. Sensitivity was 0.81, with a Confidence Interval of 0.79-0.83, p = 0.0000, I2 = 95.1%, and specificity was 0.97, with a Confidence Interval of 0.97-0.98, p = 0.0000, I-2 = 90.8%, for 17 studies and 5,615 cases. Accuracy was 0.98. Twelve studies described local recurrence and the highest cumulative recurrence rate in 3 years was 7.5%. The quality of the included studies based on the QUADAS-2 tool showed a low risk of bias. There is no publication bias (p = 0.32) and the funnel plot showed symmetry. CONCLUSION Frozen section is a reliable procedure with high accuracy, sensitivity and specificity in intraoperative margin assessment of breast-conserving surgery. Therefore, this modality of margin assessment could be useful in reducing reoperation rates.
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Affiliation(s)
| | - Bruna Salani Mota
- Department of Gynaecology/Obstetrics, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Rodrigo Gonçalves
- Department of Gynaecology/Obstetrics, University of São Paulo, São Paulo, Brazil
| | | | - José Roberto Filassi
- Department of Gynaecology/Obstetrics, University of São Paulo, São Paulo, Brazil
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Pacheco RL, Martimbianco ALC, Roitberg F, Ilbawi A, Riera R. Impact of Strategies for Mitigating Delays and Disruptions in Cancer Care Due to COVID-19: Systematic Review. JCO Glob Oncol 2021; 7:342-352. [PMID: 33656910 PMCID: PMC8081509 DOI: 10.1200/go.20.00632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Delays and disruptions in health systems because of the COVID-19 pandemic were identified by a previous systematic review from our group. For improving the knowledge about the pandemic consequences for cancer care, this article aims to identify the effects of mitigation strategies developed to reduce the impact of such delays and disruptions. METHODS Systematic review with a comprehensive search including formal databases, cancer and COVID-19 data sources, gray literature, and manual search. We considered clinical trials, observational longitudinal studies, cross-sectional studies, before-and-after studies, case series, and case studies. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the included studies was assessed by specific tools. The mitigation strategies identified were described in detail and their effects were summarized narratively. RESULTS Of 6,692 references reviewed, 28 were deemed eligible, and 9 studies with low to moderate methodological quality were included. Five multiple strategies and four single strategies were reported, and the possible effects of mitigating delays and disruptions in cancer care because of COVID-19 are inconsistent. The only comparative study reported a 48.7% reduction observed in the number of outpatient visits to the hospital accompanied by a small reduction in imaging and an improvement in radiation treatments after the implementation of a multiple organizational strategy. CONCLUSION The findings emphasize the infrequency of measuring and reporting mitigation strategies that specifically address patients' outcomes and thus a scarcity of high-quality evidence to inform program development. This review reinforces the need of adopting standardized measurement methods to monitor the impact of the mitigation strategies proposed to reduce the effects of delays and disruptions in cancer health care because of COVID-19.
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Affiliation(s)
- Rafael Leite Pacheco
- Centro Universitário São Camilo (CUSC), São Paulo, Brazil.,Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Centro Universitário São Camilo (CUSC), São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil.,Programa de Pós-graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Felipe Roitberg
- Instituto do Câncer do Estado de São Paulo/HCFMUSP, World Health Organization (WHO), São Paulo, Brazil.,Department of Noncommunicable Diseases, World Health Organization (WHO) Headquarters, Geneva, Switzerland.,European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization (WHO) Headquarters, Geneva, Switzerland
| | - Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil.,Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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40
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Mendoza JFW, Latorraca CDOC, Oliveira RDÁ, Pachito DV, Martimbianco ALC, Pacheco RL, Riera R. Methodological quality and redundancy of systematic reviews that compare endarterectomy versus stenting for carotid stenosis. BMJ Evid Based Med 2021; 26:14-18. [PMID: 31266765 DOI: 10.1136/bmjebm-2018-111151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 12/14/2022]
Abstract
A review of systematic reviews (SRs) and a critical appraisal study was conducted at Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp). The objectives of this review are (1) to identify all published SRs comparing the effectiveness and safety of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) for carotid artery stenosis, (2) to assess their methodological quality and (3) to compare the primary studies contained in each SR. We included 17 SRs published between 2005 and 2017. None of the SRs fulfilled all items of AMSTAR-2. The overall confidence in the results was graded as critically low for 16 SRs (94%) and low for 1 SR (6%). Five items were judged inadequate in all SRs: reference to a published protocol, explanation to the selection of study design, comprehensive search of the literature, methods for statistical combination of findings and consideration of the risk of bias on the results of meta-analysis. In total, 15 randomised clinical trials (RCTs) were included at least in one SR. The number of included RCTs in each SR was inconsistent (4 to 15) and was not related to the year of publication of the SR. Our study found redundant and low methodological quality SR comparing CAS versus CEA for carotid stenosis.
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Affiliation(s)
- Juan Fulgencio Welko Mendoza
- Discipline of Evidence-Based Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, São Paulo, Brazil
| | | | - Ricardo de Ávila Oliveira
- Discipline of Evidence-Based Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, São Paulo, Brazil
- Department of Surgery, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Daniela Vianna Pachito
- Center of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Postgraduate of Health and Environment, Universidade Metropolitana de Santos, Santos, São Paulo, Brazil
- Medical Research Center, Centro Universitário São Camilo, São Paulo, São Paulo, Brazil
| | - Rafael Leite Pacheco
- Discipline of Evidence-Based Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, São Paulo, Brazil
- Medical Research Center, Centro Universitário São Camilo, São Paulo, São Paulo, Brazil
| | - Rachel Riera
- Discipline of Evidence-Based Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, São Paulo, Brazil
- Center of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
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41
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Bussadori SK, Motta LJ, Horliana ACRT, Santos EM, Martimbianco ALC. The Current Trend in Management of Bruxism and Chronic Pain: An Overview of Systematic Reviews. J Pain Res 2020; 13:2413-2421. [PMID: 33061557 PMCID: PMC7533232 DOI: 10.2147/jpr.s268114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Abstract
Bruxism, specifically sleep bruxism (SB), is a worldwide discussed topic in the literature; however, there is insufficient evidence to define and support a standard approach for the treatment of SB. The purpose of this overview was to map the evidence from systematic reviews (SR), examining the effects of interventions to improve chronic pain related to bruxism. The methodological quality of SRs was assessed using the AMSTAR-2 tool. We conducted a comprehensive literature search in April 2020, in the following databases: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, LILACS, BBO, and Epistemonikos. Nine SRs with critically low to high methodological quality were included. Considering the main findings, botulinum toxin type A (BTX-A) showed a significant pain and sleep bruxism frequency reduction when compared to placebo or conventional treatment (behavioral therapy, occlusal splints, and drugs), after 6 and 12 months. Occlusal splints combined to muscle massage showed some benefit in pain reduction. There was no difference in pain and bruxism frequency between biofeedback therapy and an inactive control group. Regarding drug therapy, there is no difference when amitriptyline, bromocriptine, clonidine, propranolol, and levodopa were compared to placebo. In conclusion, there is some evidence to support the use of occlusal splints plus massage, and BTX-A to reduce chronic pain related to SB. No evidence was provided to support the recommendation of biofeedback therapy and drug therapy. There is still a need for more methodologically rigorous randomized clinical trials (RCT) to be conducted on the efficacy and safety of different therapies for SB.
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Affiliation(s)
- Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove De Julho (UNINOVE), São Paulo, Brazil
| | - Lara Jassiski Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove De Julho (UNINOVE), São Paulo, Brazil
| | | | - Elaine Marcílio Santos
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove De Julho (UNINOVE), São Paulo, Brazil.,Postgraduate Program in Health and Environment, Universidade Metropolitana De Santos (UNIMES), Santos, Sao Paulo, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Postgraduate Program in Health and Environment, Universidade Metropolitana De Santos (UNIMES), Santos, Sao Paulo, Brazil
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Diaz RMM, Rezende FC, Moscon AC, Franciozi CEDS, Martimbianco ALC, Duarte A. Return to Sports after ACL Reconstruction with Resection or Remnant-Preserving Technique. Rev Bras Ortop 2020; 55:432-437. [PMID: 32904857 PMCID: PMC7458750 DOI: 10.1055/s-0039-3402461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/21/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives
To analyze the results of anterior cruciate ligament (ACL) reconstruction with remnant-preserving versus remnant-resecting technique, concerning the return to pre-lesion activity level.
Methods
The present retrospective cohort study has assessed adults > 18 years old who underwent ACL anatomical reconstruction between 2010 and 2014. The main outcomes assessed were: level of physical activity (4-point scale), sports participation rate, ACL rerupture defined as documented lesion requiring revision surgery and the numeric pain scale rate (NPSR).
Results
A total of 83 individuals were included in the study, with a mean age of 31.8 years old and follow-up mean time of 4.2 years after the surgery. A total of 34 patients underwent ACL reconstruction with remnant-preserving technique, and 49 without remnant preservation. No statistically significant difference was found between groups in all outcomes assessed: level of physical activity before the lesion and after the surgery, ACL rerupture rates and postoperative pain level. Subgroup analysis has shown a statistically significant decrease in the activity level in both groups. The most practiced sport was football; 72% of patients in the remnant group have resumed football activity versus 52.6% of the control group.
Conclusion
Based in these findings, the comparison between ACL reconstruction with remnant preserving technique and remnant resecting technique has shown no differences concerning the return to prelesion activity level.
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Affiliation(s)
| | - Fernando Cury Rezende
- Grupo do Joelho da Ortocity, SP, Brasil.,Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | | | - Ana Luiza Cabrera Martimbianco
- Grupo do Joelho da Ortocity, SP, Brasil.,Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos Santos, SP, Brasil
| | - Aires Duarte
- Grupo do Joelho da Ortocity, SP, Brasil.,Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
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Pacheco RL, Latorraca CDOC, Martimbianco ALC, Fontes LES, Vieira R, Miranda E, Nunan D, Riera R. Translation of Oxford's CEBM catalogue of bias into Portuguese: contributing to the dissemination of conscientious thinking on health research. BMJ Evid Based Med 2020; 25:122-124. [PMID: 32217614 DOI: 10.1136/bmjebm-2019-111329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Rafael Leite Pacheco
- Evidence-Based Healthcare Postgraduate Program, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
- Research Center for Medical School, Centro Universitário São Camilo, São Paulo, Brazil
| | | | - Ana Luiza Cabrera Martimbianco
- Research Center for Medical School, Centro Universitário São Camilo, São Paulo, Brazil
- Health and Environment Postgraduate Program, Universidade Metropolitana de Santos, Santos, Brazil
| | - Luis Eduardo Santos Fontes
- Evidence-Based Healthcare Research Group, Faculdade de Medicina de Petrópolis, Petrópolis, Brazil
- Centre for Evidence-Based Medicine (CEBM), University of Oxford, Oxford, UK
| | - Regis Vieira
- Evidence-Based Healthcare Postgraduate Program, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
- Family and Community Medicine Department, Hospital Albert Einstein, São Paulo, Brazil
| | - Enderson Miranda
- Centre for Evidence-Based Medicine (CEBM), University of Oxford, Oxford, UK
| | - David Nunan
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel Riera
- Evidence-Based Medicine Discipline, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil
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Martimbianco ALC, Pacheco RL, Vilarino FL, Latorraca CDOC, Torloni MR, Riera R. Tribulus Terrestris for Female Sexual Dysfunction: A Systematic Review. Rev Bras Ginecol Obstet 2020; 42:427-435. [PMID: 32736394 PMCID: PMC10316844 DOI: 10.1055/s-0040-1712123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We performed a systematic review to assess the effectiveness and safety of Tribulus terrestris to treat female sexual dysfunction (FSD). DATA SOURCES We performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR, Clinicaltrials.gov and OpenGrey databases. SELECTION OF STUDIES We included any randomized controlled trials (RCTs) that compared T. terrestris versus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n = 279 participants) were included. DATA COLLECTION Data extraction was performed by two reviewers with a preestablished data collection formulary. DATA SYNTHESIS Due to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RESULTS After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores. Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, which means that we have very little confidence in the effect estimates, and future studies are likely to change these estimates. CONCLUSION More RCTs are needed to support or refute the use of T. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process.Number of Protocol registration in PROSPERO database: CRD42019121130.
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Affiliation(s)
| | | | - Fábia Lima Vilarino
- Department of Medicine, Centro Universitário São Camilo, São Camilo, SP, Brazil
| | | | - Maria Regina Torloni
- Discipline of Evidence-Based Health, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rachel Riera
- Discipline of Evidence-Based Health, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Centre of Health Technology Assessment, Hospital Sirio-Libanês, São Paulo, SP, Brazil
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Santos GM, Pacheco RL, Bussadori SK, Santos EM, Riera R, de Oliveira Cruz Latorraca C, Mota P, Benavent Caldas Bellotto EF, Martimbianco ALC. Effectiveness and Safety of Ozone Therapy in Dental Caries Treatment: Systematic Review and Meta-analysis. J Evid Based Dent Pract 2020; 20:101472. [PMID: 33303100 DOI: 10.1016/j.jebdp.2020.101472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/22/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to investigate the effectiveness and safety of ozone therapy for treating dental caries. METHODS We searched for randomized controlled trials (RCTs) in 8 databases, from inception to April 4, 2020 (MEDLINE, EMBASE, CENTRAL, LILACS, Bibliografia Brasileira de Odontologia, ClinicalTrials.gov, WHO, and OpenGrey). Primary outcome measures were antimicrobial effect and adverse events. We used the Cochrane risk of bias tool to evaluate methodological quality of included RCTs and GRADE approach to evaluate the certainty of the evidence. We used the Review Manager software to conduct meta-analyses. RESULTS We included 12 RCTs comparing ozone therapy with no ozone, chlorhexidine digluconate, fissure sealants (alone and added to ozone), and fluoride. Considering primary outcomes, ozone therapy showed (a) lower reduction in the bacterial number than chlorhexidine digluconate in children (mean difference [MD]: -5.65 [-9.79 to -1.51]), but no difference was observed in adults (MD: -0.10 [-1.07 to 0.88]); (b) higher reduction in the bacterial number than sealant (MD: 12.60 [3.86-21.34]), but no difference was observed after final excavation (MD: -0.00 [-0.01 to 0.01]). Regarding safety of ozone therapy, results from individual studies presented no adverse events during or after treatment. Most of these results are imprecise and should be interpreted with caution because of clinical and methodological concerns, small sample size, and wide confidence interval, precluding to determine the real effect direction. CONCLUSION Based on a very low certainty of evidence, there is not enough support from published RCTs to recommend the use of ozone for the treatment of dental caries. Well-conducted studies should be encouraged, measuring mainly the antimicrobial effects of ozone therapy at long term and following the recommendations of the CONSORT statement for the reporting of RCTs.
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Affiliation(s)
| | - Rafael Leite Pacheco
- Centro Universitário São Camilo, São Paulo, São Paulo, Brazil; Cochrane Brazil Affiliate Center - Rio de Janeiro, Petrópolis, Rio de Janeiro, Brazil; Discipline of Evidence Based Health at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, São Paulo, Brazil
| | - Elaine Marcílio Santos
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, São Paulo, Brazil
| | - Rachel Riera
- Cochrane Brazil Affiliate Center - Rio de Janeiro, Petrópolis, Rio de Janeiro, Brazil; Discipline of Evidence Based Health at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil; Centre of Health Technology Assessment, Hospital Sirio Libanês, São Paulo, São Paulo, Brazil
| | - Carolina de Oliveira Cruz Latorraca
- Cochrane Brazil Affiliate Center - Rio de Janeiro, Petrópolis, Rio de Janeiro, Brazil; Discipline of Evidence Based Health at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Pamela Mota
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, São Paulo, Brazil
| | | | - Ana Luiza Cabrera Martimbianco
- Cochrane Brazil Affiliate Center - Rio de Janeiro, Petrópolis, Rio de Janeiro, Brazil; Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, São Paulo, Brazil.
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Neto FCJ, Martimbianco ALC, de Andrade RP, Bussadori SK, Mesquita-Ferrari RA, Fernandes KPS. Effects of photobiomodulation in the treatment of fractures: a systematic review and meta-analysis of randomized clinical trials. Lasers Med Sci 2020; 35:513-522. [PMID: 30982176 DOI: 10.1007/s10103-019-02779-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/20/2019] [Indexed: 12/22/2022]
Abstract
Several therapeutic strategies have been proposed to optimize the conventional treatment of fractures. Photobiomodulation (PBM) appears to help reduce pain and control inflammation, and it also accelerates bone repair. This systematic review aimed to evaluate the effectiveness and safety of PBM with low-level laser therapy (LLLT) in the bone fracture healing process. We included randomized controlled trials (RCTs) comparing the effects of PBM with those of any other intervention in adults with lower or upper limb bone fractures. The primary outcomes investigated were pain reduction, radiographic healing, and adverse events. The searches were conducted in October 2018. Two RCTs were included that compared PBM to the placebo. A meta-analysis showed significant difference in favor of PBM for pain reduction (MD 1.19, 95% CI [0.61 to 1.77], 106 participants, two RCTs), but this difference was not clinically significant. One RCT (50 participants) showed a clinical and statistical improvement in physical function (MD - 14.60, 95% CI [- 21.39 to - 7.81]) and no difference in radiographic healing, regarding absence of fracture line (RR 1.00, 95% CI [0.93 to 1.08]) and visible bone callus (RR 0.33, 95% CI [0.01 to 7.81]). The certainty of evidence was classified as low to very low. Based on the evidence of low to very low certainty, PBM seems to be associated with the improvement of pain and function. Therefore, new RCTs are required that meet the recommendations of CONSORT to prove the effectiveness and safety of this intervention and support its recommendation in clinical practice.
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Affiliation(s)
| | - Ana Luiza Cabrera Martimbianco
- Universidade Metropolitana de Santos (UNIMES), Avenida Conselheiro Nébias, 536 -Encruzilhada, Santos, SP, 11045-002, Brazil.
| | | | - Sandra Kalil Bussadori
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Raquel Agnelli Mesquita-Ferrari
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
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Martimbianco ALC, Ferreira RES, Latorraca CDOC, Bussadori SK, Pacheco RL, Riera R. Photobiomodulation with low-level laser therapy for treating Achilles tendinopathy: a systematic review and meta-analysis. Clin Rehabil 2020; 34:713-722. [DOI: 10.1177/0269215520912820] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this study was to determine the benefits and harms of low-level laser therapy for Achilles tendinopathy. Data sources: Search strategies were conducted (from inception to February 2020) in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino Americana em Ciências da Saúde e do Caribe (LILACS), Physiotherapy Evidence Database (PEDro), SPORTDiscus, ClinicalTrials.gov, World Health Organization (WHO)-ICTRP and OpenGrey databases, to retrieve all randomized controlled trials that compared laser therapy with inactive/active interventions. Review methods: This study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The risk of bias was assessed using the Cochrane Risk of bias table. Meta-analyses were performed on dependence of homogeneity, otherwise results were reported narratively. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Four trials (119 participants) were analyzed. Laser therapy associated to eccentric exercises when compared to eccentric exercises and sham had very low to low certainty of evidence in pain and function assessment. Despite one trial favored laser therapy at two months (mean difference (MD) −2.55, 95% confidence interval (95% CI) −3.87 to −1.23), the CIs did not include important differences between groups at 3 and 13 months. The function assessment showed an improvement favoring the placebo group at one month (MD 9.19, 95% CI −16.16 to −2.23) and non-significant difference between groups at 3 and 13 months. Adverse events were poorly reported but restricted to minor events related to the exercises. Conclusion: The certainty of evidence was low to very low, and the results are insufficient to support the routine use laser therapy for Achilles tendinopathy.
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Affiliation(s)
| | | | | | - Sandra Kalil Bussadori
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Rafael Leite Pacheco
- Centro Universitário São Camilo, São Paulo, Brazil
- Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Rachel Riera
- Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil
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Machado D, Martimbianco ALC, Bussadori SK, Pacheco RL, Riera R, Santos EM. Botulinum Toxin Type A for Painful Temporomandibular Disorders: Systematic Review and Meta-Analysis. The Journal of Pain 2020; 21:281-293. [DOI: 10.1016/j.jpain.2019.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/29/2019] [Accepted: 08/11/2019] [Indexed: 01/02/2023]
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Peres KC, Riera R, Martimbianco ALC, Ward LS, Cunha LL. Body Mass Index and Prognosis of COVID-19 Infection. A Systematic Review. Front Endocrinol (Lausanne) 2020; 11:562. [PMID: 32922366 PMCID: PMC7456965 DOI: 10.3389/fendo.2020.00562] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023] Open
Abstract
A better understanding of the SARS-CoV-2 virus behavior and possible risk factors implicated in poor outcome has become an urgent need. We performed a systematic review in order to investigate a possible association between body weight and prognosis among patients diagnosed with COVID-19. We searched in Cochrane Library, EMBASE, MEDLINE, WHO-Global Literature on Coronavirus Disease, OpenGrey, and Medrxiv. We used the ROBINS-I tool or Cross-Sectional/Prevalence Study Quality tool from AHRQ, to evaluate the methodological quality of included studies. Nine studies (two prospective cohorts, four retrospective cohorts and three cross-sectional) were included and assessed the relationship between obesity and COVID-19 prognosis. Risk of bias of the included studies ranged from moderate to critical. Clinical and methodological heterogeneity among them precluded meta-analyses. Most of the included studies showed some degree of association to: (a) higher BMI and worse clinical presentation and (b) obesity and need of hospitalization. The results were inconsistent about the impact of obesity on mortality. Based on limited methodological quality studies, obesity seems to predict poor clinical evolution in patients with COVID-19. Further studies with appropriate prospective design are needed to reduce the uncertainty on this evidence.
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Affiliation(s)
- Karina Colombera Peres
- Laboratory of Cancer Molecular Genetics, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Rachel Riera
- Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos, São Paulo, Brazil
- Centro Universitário São Camilo, São Paulo, Brazil
| | - Laura Sterian Ward
- Laboratory of Cancer Molecular Genetics, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Lucas Leite Cunha
- Laboratory of Cancer Molecular Genetics, School of Medical Sciences, University of Campinas, Campinas, Brazil
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- *Correspondence: Lucas Leite Cunha
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Pacheco RL, Cruz Latorraca CO, Cabrera Martimbianco AL, Riera R. Reasons for "awaiting classification" studies are often inadequate and underreported: a cross-sectional analysis of cochrane reviews. J Clin Epidemiol 2019; 118:116-118. [PMID: 31622659 DOI: 10.1016/j.jclinepi.2019.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/22/2019] [Accepted: 09/24/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Rafael Leite Pacheco
- Candidate in the Evidence Based Health Program at Universidade Federal de São Paulo, Researcher at Centro Universitário São Camilo, Oxford-Brazil EBM Alliance, Sao Paulo, SP, Brazil
| | - Carolina Oliveira Cruz Latorraca
- Candidate in the Evidence Based Health Program at Universidade Federal de São Paulo, Oxford-Brazil EBM Alliance, Sao Paulo, SP, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Professor at Centro Universitário São Camilo, Professor at Universidade Metropolitana de Santos (UNIMES), Oxford-Brazil EBM Alliance, Sao Paulo, SP, Brazil; Adjunct Professor of the Discipline of Evidence-Based Health at Escola Paulista de Medicina, Universidade Federal de São Paulo, Coordinator - Centre of Health Technology Assessment, Hospital Sirio-Libanês, Oxford-Brazil EBM Alliance, Sao Paulo, SP, Brazil.
| | - Rachel Riera
- Adjunct Professor of the Discipline of Evidence-Based Health at Escola Paulista de Medicina, Universidade Federal de São Paulo, Coordinator - Centre of Health Technology Assessment, Hospital Sirio-Libanês, Oxford-Brazil EBM Alliance, Sao Paulo, SP, Brazil
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