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Roizenblatt M, Gehlbach PL, Marin VDG, Roizenblatt A, Saraiva VDS, Nakanami MH, Noia LDC, Watanabe SES, Yasaki ES, Passos RM, Magalhães O, Fernandes RAB, Stefanini FR, Caiado R, Jiramongkolchai K, Farah ME, Belfort R, Maia M. ASSESSMENT OF SIMULATED SURGICAL DEXTERITY AFTER MODIFIABLE EXTERNAL EXPOSURES AMONG NOVICE VERSUS EXPERIENCED VITREORETINAL SURGEONS. Retina 2024; 44:820-830. [PMID: 38194677 DOI: 10.1097/iae.0000000000004045] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
PURPOSE To evaluate novice and senior vitreoretinal surgeons after various exposures. Multiple comparisons ranked the importance of these exposures for surgical dexterity based on experience. METHODS This prospective cohort study included 15 novice and 11 senior vitreoretinal surgeons (<2 and >10 years' practice, respectively). Eyesi-simulator tasks were performed after each exposure. Day 1, placebo, 2.5 mg/kg caffeine, and 5.0 mg/kg caffeine; day 2, placebo, 0.2 mg/kg propranolol, and 0.6 mg/kg propranolol; day 3, baseline simulation, breathalyzer readings of 0.06% to 0.10% and 0.11% to 0.15% blood alcohol concentrations; day 4, baseline simulation, push-up sets with 50% and 85% repetitions maximum; and day 5, 3-hour sleep deprivation. Eyesi-generated score (0-700, worst-best), out-of-tolerance tremor (0-100, best-worst), task completion time (minutes), and intraocular pathway (in millimeters) were measured. RESULTS Novice surgeons performed worse after caffeine (-29.53, 95% confidence interval [CI]: -57.80 to -1.27, P = 0.041) and alcohol (-51.33, 95% CI: -80.49 to -22.16, P = 0.001) consumption. Alcohol caused longer intraocular instrument movement pathways (212.84 mm, 95% CI: 34.03-391.65 mm, P = 0.02) and greater tremor (7.72, 95% CI: 0.74-14.70, P = 0.003) among novices. Sleep deprivation negatively affected novice performance time (2.57 minutes, 95% CI: 1.09-4.05 minutes, P = 0.001) and tremor (8.62, 95% CI: 0.80-16.45, P = 0.03); however, their speed increased after propranolol (-1.43 minutes, 95% CI: -2.71 to -0.15 minutes, P = 0.029). Senior surgeons' scores deteriorated only following alcohol consumption (-47.36, 95% CI: -80.37 to -14.36, P = 0.005). CONCLUSION Alcohol compromised all participants despite their expertise level. Experience negated the effects of caffeine, propranolol, exercise, and sleep deprivation on surgical skills.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter L Gehlbach
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vitor D G Marin
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arnaldo Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vinicius da S Saraiva
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio H Nakanami
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luciana da C Noia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sung E S Watanabe
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Erika S Yasaki
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato M Passos
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Octaviano Magalhães
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rodrigo A B Fernandes
- Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | | | - Rafael Caiado
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Michel E Farah
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
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Roizenblatt M, Gehlbach PL, Marin VDG, Roizenblatt A, Saraiva VS, Nakanami MH, Noia LC, Song Watanabe SE, Yasaki ES, Passos RM, Magalhães Junior O, Fernandes RAB, Stefanini FR, Caiado R, Jiramongkolchai K, Farah ME, Belfort R, Maia M. A Polysomnographic Study of Effects of Sleep Deprivation on Novice and Senior Surgeons during Simulated Vitreoretinal Surgery. Ophthalmol Retina 2023; 7:940-947. [PMID: 37164313 DOI: 10.1016/j.oret.2023.05.001] [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: 02/20/2023] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE To assess the impact of a 3-hour polysomnography (PSG)-recorded night of sleep deprivation on next-morning simulated microsurgical skills among vitreoretinal (VR) surgeons with different levels of surgical experience and associate the sleep parameters obtained by PSG with Eyesi-generated performance. DESIGN Self-controlled cohort study. PARTICIPANTS Eleven junior VR surgery fellows with < 2 years of surgical experience and 11 senior surgeons with > 10 years of surgical practice. METHODS Surgical performance was assessed at 7am after a 3-hour sleep-deprived night using the Eyesi simulator and compared with each subject's baseline performance. MAIN OUTCOME MEASURES Changes in Eyesi-generated score (0-700, worst to best), time for task completion (minutes), tremor-specific score (0-100, worst to best), and out-of-tolerance tremor percentage. Polysomnography was recorded during sleep deprivation. RESULTS Novice surgeons had worse simulated surgical performance after sleep deprivation compared with self-controlled baseline dexterity in the total score (559.1 ± 39.3 vs. 593.8 ± 31.7; P = 0.041), time for task completion (13.59 ± 3.87 minutes vs. 10.96 ± 1.95 minutes; P = 0.027), tremor-specific score (53.8 ± 19.7 vs. 70.0 ± 15.3; P = 0.031), and out-of-tolerance tremor (37.7% ± 11.9% vs. 28.0% ± 9.2%; P = 0.031), whereas no performance differences were detected in those parameters among the senior surgeons before and after sleep deprivation (P ≥ 0.05). Time for task completion increased by 26% (P = 0.048) in the post-sleep deprivation simulation sessions for all participants with a high apnea-hypopnea index (AHI) and by 37% (P = 0.008) among surgeons with fragmented sleep compared with those with normal AHI and < 10 arousals per hour, respectively. Fragmented sleep was the only polysomnographic parameter associated with a worse Eyesi-generated score, with a 10% (P = 0.005) decrease the following morning. CONCLUSIONS This study detected impaired simulated surgical dexterity among novice surgeons after acute sleep deprivation, whereas senior surgeons maintained their surgical performance, suggesting that the impact of poor sleep quality on surgical skills is offset by increased experience. When considering the 2 study groups together, sleep fragmentation and AHI were associated with jeopardized surgical performance after sleep deprivation. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil; The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Peter L Gehlbach
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vitor D G Marin
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arnaldo Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vinicius S Saraiva
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio H Nakanami
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luciana C Noia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sung E Song Watanabe
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Erika S Yasaki
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato M Passos
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Rafael Caiado
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Michel E Farah
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
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Roizenblatt A, Henriques C, Carvalho MF, Takihi FA, Koch Nogueira PC. Children on chronic hemodialysis before the first year of age in Brazil: A 3-year survival analysis. Semin Dial 2021; 35:66-70. [PMID: 34405466 DOI: 10.1111/sdi.13015] [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] [Received: 11/26/2020] [Revised: 07/15/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The limited data on survival rates of small children undergoing hemodialysis preclude comparison with other countries. The goal of this study was to determine the mortality rate and its risk factors in children starting hemodialysis during their first year of life. METHODS We performed a retrospective cohort study, based on data from a reference dialysis center in São Paulo city. Data from 47 (8 females) children who underwent chronic hemodialysis before the first year of age were analyzed. Survival was characterized using Kaplan-Meier methods and log-rank tests, followed by a multivariable Cox regression model. RESULTS The survival rates were 93%, 75%, and 64% at 1, 2, and 3 years, respectively. Only cardiovascular comorbidity was significantly associated with the mortality outcome (HR = 5.7, 95% CI = 1.7-19.6, p = 0.006). CONCLUSION The survival rate among children who started hemodialysis in their first year of life was reasonable, similar to international standards.
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Affiliation(s)
- Arnaldo Roizenblatt
- Department of Pediatrics, Pediatric Nephrology Division, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, Brazil
| | - Cristina Henriques
- Department of Pediatrics, Pediatric Nephrology Division, Hospital Samaritano Higienópolis-Americas Serviços Médicos, São Paulo, Brazil
| | - Maria Fernanda Carvalho
- Department of Pediatrics, Pediatric Nephrology Division, Hospital Samaritano Higienópolis-Americas Serviços Médicos, São Paulo, Brazil
| | - Fabio Akio Takihi
- Department of Pediatrics, Pediatric Nephrology Division, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, Brazil
| | - Paulo C Koch Nogueira
- Department of Pediatrics, Pediatric Nephrology Division, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, Brazil.,Department of Pediatrics, Pediatric Nephrology Division, Hospital Samaritano Higienópolis-Americas Serviços Médicos, São Paulo, Brazil
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Oliveira LM, Roizenblatt S, Silva FD, Roizenblatt A, Fernandes ARC, Szejnfeld VL. Relationship of the sacral slope with early gait derangements in robust older women. Adv Rheumatol 2021; 61:35. [PMID: 34118988 DOI: 10.1186/s42358-021-00191-7] [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: 10/16/2020] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trunk pelvic dissociation is fundamental to the compensatory mechanism for muscle weakness during body bending. We carried out an early investigation of gait changes in a sample of community-dwelling women ≥60 years without gait complaints. The primary objective was to correlate spine and pelvic angles with performance tests and accelerometry parameters. The secondary objective was to correlate performance tests with accelerometry. METHODS In this cross-sectional study, 54 community-dwelling women ≥60 years were subjected to Falls Efficacy Scale-International (FES-I), performance tests (Berg Balance Scale, Timed Up and Go, and Gait analysis), and radiographic analysis of sagittal alignment (Thoracic and Lumbar Cobb, Pelvic Incidence, Sacral Slope, and Pelvic Tilt angles). Gait speed was assessed in a 10-m comfortable walk, and accelerometry parameters were obtained in a 30-m walk distance. RESULTS The sample, aged 72 ± 6 years, exhibited moderate correlation between Sacral Slope and Step Length (+ 0.615). Sacral Slope weakly correlated with FES-I (- 0.339), Berg Balance Scale (+ 0.367), and with further accelerometry data in the AP plane: RMS, (+ 0.439) and Stride Regularity (+ 0.475), p < 0.05, all. Lumbar Cobb weakly correlated with the following accelerometry data in the AP plane: Step Length (+ 0.405), RMS, (+ 0.392), and Stride Regularity (+ 0.345), p < 0.05, all. Additionally, Stride Regularity in AP moderately correlated with FES-I (0,561, p < 0.05), among other weak correlations between performance tests and accelerometry data in AP. CONCLUSIONS Early alterations in Sacral Slope and gait abnormalities in the AP plane may provide understanding of the early gait changes in robust older women.
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Affiliation(s)
| | - Suely Roizenblatt
- Department of Internal Medicine, Universidade Federal de Sao Paulo (UNIFESP), Rua Angelina Maffei Vita 670. CEP:01455070, Sao Paulo, SP, Brazil.
| | - Flavio Duarte Silva
- Department of Diagnostic Imaging, Universidade Federal de Sao Paulo (UNIFESP), São Paulo, Brazil
| | - Arnaldo Roizenblatt
- Medical Student Universidade Federal de Sao Paulo (UNIFESP), São Paulo, Brazil
| | | | - Vera Lucia Szejnfeld
- Rheumatology Division, Universidade Federal de Sao Paulo (UNIFESP), São Paulo, Brazil
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Roizenblatt M, Fidalgo TM, Polizelli M, Cruz NFSD, Roizenblatt A, Jiramongkolchai K, Gehlbach PL, Farah ME, Belfort R, Maia M. Effect of chronic cocaine use on fine motor coordination tested during ophthalmic vitreoretinal simulated performance. J Psychiatr Res 2021; 132:7-12. [PMID: 33035762 DOI: 10.1016/j.jpsychires.2020.09.032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/06/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
We conducted a case-control study using the Eyesi simulator to assess the surgical performance of 24 chronic cocaine users (CCUs) and 24 sex-/age-matched controls to numerically quantify ophthalmic microsurgical simulator performance and fine motor deficiencies. The inclusion criteria were no exposure to illicit drugs other than cocaine, marijuana, or alcohol within the previous month and no health conditions that could impact manual task performance. The outcomes included surgical scores (0-100, worst-best) and task completion time (minutes). Fisher's exact test, analysis of variance, Mann-Whitney U test, and Kruskal-Wallis test followed by Dunn-Bonferroni post-hoc were conducted for statistical analysis. The Eyesi scores were lower among CCUs compared to controls for bimanual tasks (4.50 ± 14.30 vs. 18.46 ± 26.64, p = 0.012), for exercises demanding upper and lower limb coordination (both hands and two foot pedals, respectively) (74.13 ± 35.01 vs. 85.21 ± 24.1, p = 0.045), and in the overall score for all three tasks (27.38 ± 15.06 vs. 39.5 ± 18.66, p = 0.021). CCUs took longer to complete tasks when performing exercises demanding upper and lower limb coordination compared to controls (1.26 ± 0.38 vs. 1.02 ± 0.44 min, p = 0.006). Individuals who used cocaine during the previous month had an independent lower bimanual score compared to controls (1.42 ± 4.91 vs. 18.46 ± 26.64, p = 0.018). No differences in performance among the CCUs were attributable to sporadic cannabis or alcohol use. Chronic use of cocaine negatively impacted fine dexterity as measured by bimanual tasks or maneuvers that required simultaneous coordination of the upper and lower limbs. This was most notable among individuals who used cocaine during the 1-month period before the simulation.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil; Wilmer Eye Institute, Johns Hopkins University, 600 N. Broadway, Maumenee 724, 21287, Baltimore, MD, USA.
| | - Thiago Marques Fidalgo
- Department of Psychiatry, Universidade Federal de São Paulo, 570, Borges Lagoa Street, 04038-000, Administrative Office, São Paulo, Brazil.
| | - Murilo Polizelli
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil.
| | - Natasha Ferreira Santos da Cruz
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil.
| | - Arnaldo Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil.
| | - Kim Jiramongkolchai
- Wilmer Eye Institute, Johns Hopkins University, 600 N. Broadway, Maumenee 724, 21287, Baltimore, MD, USA.
| | - Peter Louis Gehlbach
- Wilmer Eye Institute, Johns Hopkins University, 600 N. Broadway, Maumenee 724, 21287, Baltimore, MD, USA.
| | - Michel Eid Farah
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil.
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil.
| | - Mauricio Maia
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil.
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Pacheco RL, Roizenblatt A, de Góis AFT, Latorraca CDOC, Mota CFMGP, Riera R. What do Cochrane systematic reviews say about the management of irritable bowel syndrome? SAO PAULO MED J 2019; 137:82-91. [PMID: 31116276 PMCID: PMC9721215 DOI: 10.1590/1516-3180.2018.053740119] [Citation(s) in RCA: 5] [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: 12/20/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a clinical disorder associated with high socioeconomic burden. Despite its importance, management of IBS remains difficult and several interventions have been hypothesized as beneficial for this condition. This study identified and summarized all Cochrane systematic reviews (SRs) about the effects of interventions for managing IBS patients. DESIGN AND SETTING Review of systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS Review of Cochrane SRs addressing interventions for IBS. RESULTS We included six SRs assessing acupuncture, bulking agents, antispasmodics, antidepressants, herbal medicines, homeopathy, hypnotherapy and psychological therapy for IBS. The certainty of evidence ranged from unknown to moderate, mainly due to imprecision in the estimates and high risk of bias from the primary studies included. There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life, compared with sham acupuncture. There was also very low certainty of evidence that homeopathic asafoetida, used alone or in association with nux, was better than placebo regarding self-reported overall improvement. CONCLUSION There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life. Further well-designed and well-conducted randomized clinical trials are needed in order to reduce the uncertainties regarding the most commonly used interventions for patients with IBS.
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Affiliation(s)
- Rafael Leite Pacheco
- MD. Postgraduate Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), and Assistant Researcher, Cochrane Brazil, São Paulo (SP), Brazil.
| | - Arnaldo Roizenblatt
- Undergraduate Medical Student, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Aécio Flávio Teixeira de Góis
- MD, MSc, PhD. Cardiologist and Adjunct Professor, Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Carolina de Oliveira Cruz Latorraca
- MSc. Psychologist and Postgraduate Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), and Assistant Researcher, Cochrane Brazil, São Paulo (SP), Brazil.
| | - Carolina Frade Magalhães Girardin Pimentel Mota
- MD, MSc, PhD. Gastroenterologist and Adjunct Professor, Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Rachel Riera
- MD, MSc, PhD. Rheumatologist and Adjunct Professor, Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), and Researcher, Cochrane Brazil, São Paulo (SP), Brazil.
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