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de Amesti F, Santander MJ, Winter M. Intratympanic gentamicin compared with placebo for Ménière's disease. Medwave 2022; 22:e8696. [PMID: 35323825 DOI: 10.5867/medwave.2022.02.8695] [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: 11/27/2022] Open
Abstract
INTRODUCTION Ménière's disease is a multifactorial disorder affecting the inner ear, characterized by episodes of spontaneous and recurrent vertigo, fluctuating hearing loss and tinnitus. Intratympanic gentamicin therapy has been used to reduce the intensity and frequency of attacks in intractable Ménière's disease, but it is associated with hearing loss. There is controversy regarding its efficacy and safety. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified 13 systematic reviews that included 80 primary studies overall, of which three correspond to randomized trials. We concluded that intratympanic gentamicin may improve the control of vertigo, and result in little or no difference to tinnitus, but the certainty of the evidence is low. Furthermore, we are uncertain whether intratympanic gentamicin reduces hearing or the frequency of vertigo attacks as the certainty of the evidence has been assessed as very low.
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Affiliation(s)
- Fernanda de Amesti
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Maria Jesus Santander
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Otorrinolaringología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Matias Winter
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Otorrinolaringología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Zambrano-Achig P, Viteri-García A, Verdugo-Paiva F. Chemo-mechanical removal versus conventional removal for deep caries lesion. Medwave 2022; 22:e8320. [PMID: 35100249 DOI: 10.5867/medwave.2022.01.8320] [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: 05/04/2020] [Accepted: 01/15/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Dental caries have been traditionally managed with the non-selective removal of carious tissue (total removal). However, the adverse effects and fear that this technique produces in patients has promoted the use of more conservative caries removal techniques such as chemo-mechanical removal, but there is still controversy regarding its effectiveness and safety. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings tables using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including 34 studies overall, of which 30 correspond to randomized trials. We concluded that chemo-mechanical caries removal probably reduces the need for anesthesia. Additionally, chemo-mechanical caries removal may decrease the pain experienced by the patient, decrease the risk of restoration failure and increase the time of the procedure for the removal of deep caries, but the certainty of the evidence is low. We are uncertain whether chemo-mechanical caries removal reduces the risk of pulp exposure as the certainty of the evidence has been assessed as very low.
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Affiliation(s)
- Paula Zambrano-Achig
- Universidad UTE, Centro Asociado Cochrane de Ecuador, Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Quito, Ecuador; Proyecto Epistemonikos, Santiago, Chile
| | - Andrés Viteri-García
- Universidad UTE, Centro Asociado Cochrane de Ecuador, Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Quito, Ecuador; Proyecto Epistemonikos, Santiago, Chile
| | - Francisca Verdugo-Paiva
- Proyecto Epistemonikos, Santiago, Chile; Centro Evidencia UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Massón M, Viteri-García A, Verdugo-Paiva F. Stepwise removal compared to complete removal for deep carious lesions. Medwave 2022; 22:e8227. [PMID: 35100250 DOI: 10.5867/medwave.2022.01.8226] [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: 02/26/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Carious lesions have traditionally been treated by non-selective (complete or total) removal of carious tissue. However, due to its risks and adverse effects, carious tissue removal techniques have been developed, based on the preservation of tooth tissue, including the stepwise removal. The objective of this summary is to clarify the uncertainty about the effectiveness and safety of the stepwise removal technique compared to complete removal. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by searching multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from identified reviews, reanalyzed data from primary studies, performed a meta-analysis, and prepared summary tables of results using the GRADE method. RESULTS AND CONCLUSIONS We identified three systematic reviews that included five primary studies, four of them corresponding to randomized trials. We concluded that stepwise removal may reduce the risk of pulp exposure, the risk of signs and symptoms of pulp disease and the risk of restoration failure, but the certainty of the evidence is low.
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Affiliation(s)
- María Massón
- Universidad UTE, Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC); Proyecto Epistemonikos
| | - Andrés Viteri-García
- Universidad UTE, Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC); Proyecto Epistemonikos
| | - Francisca Verdugo-Paiva
- Proyecto Epistemonikos; Centro Evidencia UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Castro MC, Rojas P. Preventive effectiveness of varicella vaccine in healthy unexposed patients. Medwave 2020; 20:e7983. [PMID: 32759893 DOI: 10.5867/medwave.2020.06.7982] [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: 05/23/2019] [Accepted: 11/28/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Chickenpox is an infectious disease caused by varicella-zoster virus. Varicella vaccine is conventionally used for its prevention, and its administration seeks to reduce the onset of the disease and complications associated. However, there is still controversy about its effectiveness. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified two systematic reviews including 16 studies overall, of which three were randomized trials. We concluded that the varicella vaccine decreases the risk of contracting the disease in the long term and probably reduces the risk of developing the disease in the short term in healthy unexposed patients. Nevertheless, the vaccination increases the occurrence of local reactions 48 hours after its administration and probably increases the presence of fever and chickenpox-like rash.
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Affiliation(s)
- María Catalina Castro
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Pamela Rojas
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Medicina Familiar del Niño, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Sanhueza A, González R. Pars plana vitrectomy plus scleral buckle versus pars plana vitrec-tomy in pseudophakic retinal detachment. Medwave 2020; 20:e7965. [PMID: 32759890 DOI: 10.5867/medwave.2020.06.7964] [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: 12/05/2019] [Accepted: 12/12/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Cataract surgery increases the risk for rhegmatogenous retinal detachment. Pars plana vitrectomy and scleral buckling are two surgical procedures used for its repair. The combination of both techniques had been proposed for rhegmatogenous retinal detachment in patients with previous cataract surgery (pseudophakic or aphakic), but its effectiveness remains unclear. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified four systematic reviews with eight studies overall, one of them was a randomized trial. With this data, we conclud-ed that pars plana vitrectomy plus scleral buckle may make little or no difference in primary or final retinal reattachment rate nor in final visual acuity, but the certainty of the evidence is low. In terms of surgery complications, we are uncertain if vitrecto-my plus scleral buckle increases the risk of proliferative vitreoretinopathy or reduces the risk of glaucoma because the certainty of the evidence is very low.
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Affiliation(s)
- Ana Sanhueza
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Raúl González
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Oftalmología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Abstract
INTRODUCTION Different interventions have been proposed to reinforce the use of the influenza vaccine. The use of reminders, whether through letters, phone calls, pamphlets or technological applications, among others, has stood out among those aimed at increasing ad-herence to treatment. However, its effectiveness is not clear. In this summary, which is part of a series of reminder evaluations, we assess the use of multiple mail reminders. METHODS We conducted a search in Epistemonikos, the largest database of systematic health reviews, which is maintained by screening multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted the data from the identified reviews, analyzed the data from the primary studies, performed a meta-analysis and prepared a summary table of the results using the GRADE method. RESULTS AND CONCLUSIONS We identified eight systematic reviews including 35 primary studies, of which four analyze the use of more than one letter as a reminder. We conclude that the use of multiple mail reminders probably increase adherence to influenza vaccination in patients over 60; while it may make little or no difference in children under 6 years, but the certainty of the evidence is low.
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Affiliation(s)
- Camila Julio
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Nicole Silva
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Ángela Ortigoza
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Dallaserra M, Cuéllar J, Villanueva J. [Coronectomy for lower third molars surgery]. Medwave 2020; 20:e7956. [PMID: 32678812 DOI: 10.5867/medwave.2020.06.7957] [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] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/07/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Matías Dallaserra
- Departamento de Cirugía y Traumatología Bucal y Maxilofacial, Facultad de Odontología, Universidad de Chile; Centro Cochrane Asociado de la Facultad de Odontología, Universidad de Chile; Unidad de Cirugía Máxilo Facial, Hospital Clínico San Borja Arriarán, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Javier Cuéllar
- Unidad de Cirugía Máxilo Facial, Hospital Clínico San Borja Arriarán, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Julio Villanueva
- Departamento de Cirugía y Traumatología Bucal y Maxilofacial, Facultad de Odontología, Universidad de Chile; Centro Cochrane Asociado de la Facultad de Odontología, Universidad de Chile; Unidad de Cirugía Máxilo Facial, Hospital Clínico San Borja Arriarán, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Garretón R, Gonzalez R. Aflibercept versus dexamethasone for macular edema secondary to central retinal vein occlusion. Medwave 2019; 19:e7739. [PMID: 31891353 DOI: 10.5867/medwave.2019.11.7738] [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: 09/24/2019] [Accepted: 12/19/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Macular edema is a frequent complication of central retinal vein occlusion that might lead to deterioration of visual acuity. The most commonly used treatments are dexamethasone implant and anti-vascular endothelial growth factor drugs, being aflibercept one of the most commonly used them. However, there is no consensus about which treatment constitute the best alternative. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified two systematic reviews that included four primary studies overall, all randomized trials. We concluded that it is not possible to establish whether aflibercept is superior to dexamethasone in terms of improvement of visual acuity and safety, because the certainty of the existing evidence has been evaluated as very low.
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Affiliation(s)
- Rodolfo Garretón
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Raul Gonzalez
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Oftalmología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Rubilar F, Navia A, Dagnino B. Autologous versus prosthetic reconstruction for women with breast cancer who will undergo post-reconstruction radiotherapy. Medwave 2019; 19:e7728. [PMID: 31821317 DOI: 10.5867/medwave.2019.10.7727] [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: 12/04/2018] [Accepted: 12/28/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Radiotherapy is frequently used after breast reconstruction in patients with locally advanced breast cancer or metastases in axillary lymph nodes. However, there might be differences between autologous and prosthetic reconstruction in terms of effectiveness and safety of post-reconstruction radiotherapy. METHODS To answer this question we searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified five systematic reviews including nine primary studies overall, of which all were observational studies. We concluded that in patients who will undergo post reconstructive radiotherapy, autologous breast reconstruction could reduce reoperations due to general complications compared to prosthetic breast reconstruction. However, it probably increases the risk of skin or flap necrosis. It is not clear whether there are differences in other outcomes as the certainty of evidence has been assessed as very low.
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Affiliation(s)
- Francisco Rubilar
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Alfonso Navia
- Proyecto Epistemonikos, Santiago, Chile; Sección de Cirugía Plástica y Reconstructiva, División de Cirugía, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bruno Dagnino
- Proyecto Epistemonikos, Santiago, Chile; Sección de Cirugía Plástica y Reconstructiva, División de Cirugía, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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González C, Cuadrado C. Interventions to reduce the impact of dual practice in the public health sector. Medwave 2019; 19:e7644. [PMID: 31348767 DOI: 10.5867/medwave.2019.05.7643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/08/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Dual practice (i.e. workers who work in the public and private sector) has an impact on health services in terms of quality and costs. However, the effectiveness of regulatory policies has not been proven. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews that included 23 primary studies overall, of which all correspond to observational studies. We concluded it is not clear whether the interventions to reduce the negative consequences of dual practice in the health system are effective because the certainty of the available evidence is very low.
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Affiliation(s)
- Cristián González
- Escuela de Salud Pública, Universidad de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Cristóbal Cuadrado
- Escuela de Salud Pública, Universidad de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile. . Address: Escuela de Salud Pública, Universidad de Chile, Avda. Independencia 939, Independencia, Santiago, Chile
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Abstract
INTRODUCTION It has been suggested that environmental and lifestyle factors might contribute to the severity and progression of inflammation in rheumatoid arthritis. An intervention generating high interest due to its supposed anti-inflammatory properties is the Mediterranean diet. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including four primary studies, of which only one corresponded to a randomized trial. We concluded Mediterranean diet may make little or no difference in pain or disease activity and may slightly increase weight in rheumatoid arthritis patients, but the certainty of the evidence is low. On the other hand, it was not possible to clearly establish whether Mediterranean diet has any effect on functionality, morning stiffness or quality of life as the certainty of the existing evidence has been assessed as very low.
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Affiliation(s)
- Maximiliano Porras
- Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Gabriel Rada
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Josefina Durán
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Inmunología y Reumatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Abstract
INTRODUCTION Knee osteoarthritis is a highly prevalent chronic disease, associated with various risk factors and with multiple treatment options. Overweight is among the main risk factors and also constitutes an aggravating factor of the symptoms. It has been suggested that weight loss would be able to improve symptoms and to stop the progression. It can be achieved by several methods: exercise, diet, drugs, surgery, or a combination of them. Apparently, diet is a reasonable option given its availability, low technical complexity and greater acceptability, especially in the population susceptible to developing knee osteoarthritis, but it is not clear whether the benefit of diet as the only intervention leads to symptomatic improvement. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including six primary studies overall, all corresponding to randomized trials. We concluded diet may improve functionality and quality of life, with probably minimal or no adverse effects. However, we are uncertain whether diet reduces pain as the certainty of the evidence has been assessed as very low.
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Affiliation(s)
- Clemente Ríos
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Sebastián Irarrázaval
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Traumatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Corsi O, Rada G, Peña J. PET-CT for the management of testicular seminoma patients with post-chemotherapy residual masses. Medwave 2019; 19:e7625. [PMID: 31075095 DOI: 10.5867/medwave.2019.04.7625] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 04/05/2019] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION The use of PET-CT could select a subgroup of advanced testicular seminoma patients that display post-chemotherapy residual masses measuring >3 cm and could be managed with surveillance, avoiding unnecessary surgical resection of unviable tumor masses. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews that included eleven primary studies; none of these were randomized trials. We concluded the assessment of postchemotherapy residual masses by PET-CT in testicular seminoma patients may prevent unnecessary surgeries, but the certainty of the evidence is low. Furthermore, PET-CT could also offer a favorable risk/benefit and cost/benefit ratio for the management of testicular seminoma patients. However, systematic reviews and primary studies assessing the direct diagnostic impact of PET-CT are required.
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Affiliation(s)
- Oscar Corsi
- Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Gabriel Rada
- Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile; Centro Evidencia UC, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Peña
- Proyecto Epistemonikos, Santiago, Chile; Departamento Hemato-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro de Cáncer Nuestra Señora de la Esperanza, Red de Salud UC-Christus, Santiago, Chile; Centro Oncológico, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Pérez-Argandoña E, Verdaguer J, Zacharías S, González R. Preoperative intravitreal bevacizumab for proliferative diabetic retinopathy patients undergoing vitrectomy - First update. Medwave 2019; 19:e7512. [PMID: 30816881 DOI: 10.5867/medwave.2019.01.7511] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/11/2018] [Indexed: 11/27/2022] Open
Abstract
UPDATE This Living FRISBEE (Living FRIendly Summary of the Body of Evidence using Epistemonikos) is an update of the summary published in December 2014. INTRODUCTION Proliferative diabetic retinopathy can cause severe vision loss and even blindness if left untreated. Vitrectomy is often required in the treatment of more severe cases. Preoperative administration of bevacizumab, a humanized anti-vascular endothelial growth factor would improve intraoperative variables that facilitate surgery and improve postoperative course. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified five systematic reviews including 16 studies overall, of which 14 were randomized trials. We concluded the preoperative use of intravitreal bevacizumab reduces the rate of vitreous hemorrhage in the early postoperative period, and probably also in the late postoperative period, but its effect on visual acuity is not clear. Furthermore, it probably decreases the surgical time and may decrease the incidence of iatrogenic retinal breaks. Although we are uncertain whether preoperative bevacizumab decreases intraoperative bleeding, it may reduce the need for endodiathermy.
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Affiliation(s)
- Efraín Pérez-Argandoña
- Fundación Oftalmológica Los Andes, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | | | | | - Raúl González
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Oftalmología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. - Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Abstract
INTRODUCTION The treatment of acute appendicitis using laparoscopy reduces the risk of wound infection, hospitalization time and return to normal activity. However, it increases the risk of intra-abdominal abscess, which is one the main complications of complicated appendicitis. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified six systematic reviews including 55 studies overall, of which four were randomized trials. We concluded that the used of laparoscopy, compared to open appendectomy, probably reduces the time of hospital stay, and may reduce the risk of wound infection, but there's no clarity regarding the incidence of intra-abdominal abscess due to the very low certainty of the evidence available.
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Affiliation(s)
| | - Rodrigo Muñoz
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gabriel Rada
- Proyecto Epistemonikos, Santiago, Chile; Centro Evidencia UC, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Domínguez JI, Ramos A, Achurra P. Video games as a method of training basic laparoscopic skills. Medwave 2018; 18:e7345. [PMID: 30507895 DOI: 10.5867/medwave.2018.07.7344] [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: 04/08/2018] [Accepted: 11/12/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The use of video games has been proposed as an alternative to shorten the learning curve of basic laparoscopic skills. However, it is not yet clar how useful this practice is. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews including eight primary studies, of which four were randomized trials. We concluded video games training could help shorten the learning curve of basic laparoscopic visuospatial skills measured in a virtual platform, but the certainty of the available evidence is low.
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Affiliation(s)
- José Ignacio Domínguez
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Alexis Ramos
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Pablo Achurra
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Cirugía, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Suazo Y, Rada G. Non-contrast computed tomography for the diagnosis of non-traumatic subarachnoid hemorrhage. Medwave 2018; 18:e7322. [PMID: 30451817 DOI: 10.5867/medwave.2018.07.7321] [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: 06/03/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Subarachnoid hemorrhage is a neurosurgical emergency that requires timely diagnosis due to its severity and the existence of therapeutic measures that are effective when carried out in time. The most used diagnostic sequence to rule it out is computed tomography without contrast which, if negative, is followed by lumbar puncture. However, it has been suggested that a negative non-contrast computed tomography (without blood) may rule out the diagnosis. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews including nine studies. We concluded the diagnostic accuracy of non-contrast computed tomography is probably very high, but the clinical impact of relying only on this test has not yet been evaluated.
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Affiliation(s)
- Yerko Suazo
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Gabriel Rada
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro Evidencia UC, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; The Cochrane Collaboration; GRADE working group. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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Martínez-Mujica MT, Retamal J, González R. Scleral buckle versus pneumatic retinopexy for rhegmatogenous retinal detachments. Medwave 2018; 18:e7278. [PMID: 30339142 DOI: 10.5867/medwave.2018.06.7277] [Citation(s) in RCA: 2] [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: 08/27/2018] [Accepted: 09/08/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Rhegmatogenous retinal detachment is caused by a tear in the retina and is a frequent cause of vision loss. Its treatment is mainly surgical and the following alternatives can be identified: scleral buckling or classic surgery, pneumatic retinopexy and vitrectomy. Between the first two options, most professionals prefer scleral buckling over pneumatic retinopexy, but the latter is a simpler, cheaper and lower-risk procedure, so it is still considered as an option for selected patients. However, there is little evidence comparing both interventions. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews including six studies overall, of which three were randomized trials. We concluded the anatomic result might be better with scleral buckling in terms of retinal reattachment and risk of recurrence, but the risk of ocular adverse events might be lower with pneumatic retinopexy.
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Affiliation(s)
- María-Teresa Martínez-Mujica
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - José Retamal
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Raúl González
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Oftalmología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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de Amesti M, Ortiz-Muñoz L, Irarrázaval S. What are the benefits and risks of total arthroplasty in arthrodesed knees? Medwave 2018; 18:e7258. [PMID: 30312290 DOI: 10.5867/medwave.2018.05.7258] [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: 04/10/2018] [Accepted: 09/06/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The conversion of a previously arthrodesed knee to a total knee arthroplasty is an alternative seldom used. However, arthroplasty would provide greater functionality to the arthrodesed joint. Since it is a technically demanding procedure, not exempt from complications, there is controversy about the role of this intervention. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified two systematic reviews including 10 studies overall, none of which corresponded to a randomized trial. We concluded the conversion of knee arthrodesis to total knee arthroplasty could increase the functionality, but it is not clear whether it increases the complications or if it has any impact on pain or patient satisfaction because the certainty of the evidence is very low.
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Affiliation(s)
- Martín de Amesti
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Luis Ortiz-Muñoz
- Proyecto Epistemonikos, Santiago, Chile; Centro Evidencia UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Irarrázaval
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Ortopedia y Traumatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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