Efetividade da máquina de perfusão hipotérmica versus armazenamento estático para preservação do rim de doador falecido: revisão rápida / Effectiveness of hypothermic machine perfusion versus cold static storage for deceased donor kidney preservation: rapid review

Tecnologia: máquina de perfusão hipotérmica. Indicação: Transplante renal de doador falecido. Pergunta: Qual a efetividade da máquina de perfusão hipotérmica (HMP) para a preservação do rim de doador falecido, quando comparada ao armazenamento estático a frio (SCS)? Objetivo. Avaliar a efetividade da máquina de perfusão hipotérmica na preservação do rim de doador falecido, em comparação com o armazenamento estático a frio. Métodos: Revisão de revisões sistemáticas (overview) do tipo revisão rápida. Foi realizado um levantamento bibliográfico nas bases de dados: PubMed, Embase, BVS, Epistemonikos, Cochrane Library e em bases de registro de protocolos de revisões sistemáticas e ensaios clínicos, utilizando descritores e estratégias de busca predefinidas. A avaliação da qualidade metodológica dos estudos incluídos foi feita através da ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: Duas revisões sistemáticas atenderam aos critérios de elegibilidade e foram incluídas na análise. Uma delas apresentou alto nível de qualidade metodológica. Conclusão: O uso da HMP para a preservação de rins de doadores falecidos foi associado a melhores desfechos clínicos relacionados à função retardada e à sobrevida do enxerto e foi considerado custo-efetivo, quando comparado ao SCS. Faz-se necessária a geração de evidências mais robustas acerca dos custos e benefícios do uso desta tecnologia no âmbito do SUS

Technology: hypothermic machine perfusion. Indication: Deceased donor kidney transplantation. Question: How effective is hypothermic machine perfusion (HMP) for preserving deceased donor kidneys compared to static cold storage (SCS)? Objective: To evaluate the effectiveness of the hypothermic machine perfusion in preserving the deceased donor kidney, compared to static cold storage. Methods: Rapid review of systematic reviews (overview). A bibliographic survey was carried out in the databases: PubMed, Embase, VHL, Epistemonikos, Cochrane Library and in databases of systematic review protocols and clinical trials, using predefined descriptors and search strategies. The assessment of the methodological quality of the included studies was performed using the AMSTAR-2 tool (Assessing the Methodological Quality of Systematic Reviews Version 2). Results: Two systematic reviews met the eligibility criteria and were included in the analysis. One of them performed a high level of methodological quality. Conclusion: The use of HMP for the preservation of deceased donor kidneys was associated with better clinical outcomes related to delayed graft function and graft survival and was considered cost-effective. It is necessary to generate more evidence about the costs and benefits of using this technology within the Brazilian Unified System of Healthcare (SUS)

Effective interventions for the promotion of breastfeeding and healthy complementary feeding in the context of Primary Health Care / Intervenções efetivas para a promoção da amamentação e da alimentação complementar saudável no contexto da Atenção Primária à Saúde

Abstract Objective: To develop a rapid review on effective actions for the promotion of breastfeeding and healthy complementary feeding in primary health care and to summarize a list of actions and their elements for implementation. Data source: The review included systematic reviews on the effectiveness of interventions to promote breastfeeding and/or healthy complementary feeding for mothers and other caregivers, and/or professionals who work with this population, in comparison with any usual approach or none. Data synthesis: A total of 32 systematic reviews were included in the evidence synthesis. Ten types of interventions were evaluated in systematic reviews on promotion of breastfeeding and four types of interventions on promotion of healthy complementary feeding. The synthesis allowed six aspects to be discussed, and these must be considered to increase the chances of interventions' impact: type of intervention, target audience, timing of intervention, actors that can implement it, strategies and methods of intervention, and intensity of intervention. Conclusions: It was possible to assemble a list of actions whose effectiveness has already been demonstrated, providing elements for local adaptations. Evidence is expected to support and strengthen the implementation of programs aimed at promoting breastfeeding and complementary feeding in primary health care.

Resumo Objetivo: Desenvolver uma revisão rápida sobre intervenções efetivas para a promoção do aleitamento materno e da alimentação complementar saudável na Atenção Primária à Saúde e sintetizar um cardápio de ações e seus elementos para implementação. Fontes de dados: Foram incluídas revisões sistemáticas que avaliaram a efetividade de intervenções para promoção do aleitamento materno e/ou alimentação complementar saudável com mães e outros cuidadores e/ou profissionais que atuam com essa população em comparação com qualquer abordagem usual ou nenhuma. Síntese dos dados: Na síntese das evidências, foram incluídas 32 revisões sistemáticas. Nas revisões sistemáticas, foram avaliados dez tipos de intervenções no tema "promoção do aleitamento materno" e quatro tipos de intervenções no tema "promoção da alimentação complementar saudável". A síntese dos resultados permitiu discutir seis aspectos da implementação que devem ser considerados para aumentar as chances de impacto das intervenções: tipo de intervenção, público-alvo, momento da intervenção, atores que podem implementar, estratégias e métodos para conduzir a intervenção, e intensidade da intervenção. Conclusões: Os resultados permitiram apresentar um cardápio de ações cuja efetividade já foi demonstrada, fornecendo elementos para adaptações locais. Espera-se que as evidências apresentadas possam apoiar e fortalecer a implementação de programas de promoção do aleitamento materno e da alimentação complementar saudável na Atenção Primária à Saúde.

Evaluation of Dominant Diseases of Traditional Chinese Medicine： A Case Study of Ischemic Stroke / 中国实验方剂学杂志

The present study explored the effective approaches to realize the leading role of traditional Chinese medicine （TCM） in preventing diseases， the synergistic role in treating serious diseases， the core role in the rehabilitation of diseases and summarized the experience to provide feasible plans for the evaluation of other dominant diseases of TCM. To evaluate the effectiveness， safety， and economy of TCM in the treatment of ischemic stroke， encephalopathy project team of the China Center for Evidence-based Traditional Chinese Medicine（CCEBTCM） established an evaluation group to determine the work plan and complete the evaluation work. The concepts of the evaluation involved high-quality evidence， expert opinion survey， expert interview， and drug catalog. Under the guidance of clinical experts and methodologists， the evaluation work was completed in accordance with four steps， i.e.， plan making， data collection and data extraction， evidence synthesis and evaluation， and report writing with the rapid review method. Through the review of TCM and western medicine experts， the advantage of TCM in the treatment of ischemic stroke was positioned in the convalescence period with the predominant effects of improving the neurological function defect and improving the daily living ability. In the convalescence period of stroke， TCM treatment could improve post-stroke motor dysfunction， post-stroke cognitive impairment， consciousness disorder， swallowing disorder， aphasia， constipation， urinary function， diplopia， etc.， and the advantages of acupuncture， Chinese medicine， and traditional exercise were more prominent. In terms of safety， TCM treatment of ischemic stroke showed lower incidence of adverse reactions， fewer adverse events， and a milder degree of related symptoms. In terms of economic performance， the combined treatment of TCM and western medicine played a synergistic role and made the treatment cost more reasonable. Compared with conventional intervention， the integrated TCM and western medicine rehabilitation program showed more economic and social benefits.

Intervenções dietéticas efetivas para o tratamento da obesidade e do sobrepeso em adultos / Effective dietary interventions for the treatment of obesity and overweight in adults

Quais são as mais efetivas estratégias alimentares para o tratamento de pessoas com obesidade ou sobrepeso em serviços de saúde? As buscas na literatura foram realizadas em quatro bases de dados, com restrição de ano de publicação (a partir do ano 2015). Foram incluídas revisões sistemáticas em inglês, português e espanhol que avaliaram o efeito de dietas no tratamento da obesidade e sobrepeso na população adulta em serviços de saúde. Nesta revisão rápida, produzida em dez dias, a seleção dos artigos, a extração dos dados de interesse e avaliação da qualidade metodológica (por meio do instrumento AMSTAR 2) foram realizadas por um(a) único(a) pesquisador(a). Foram incluídas 09 revisões sistemáticas, a maioria com qualidade metodológica criticamente baixa, de acordo com critérios do AMSTAR 2. Dentre as intervenções analisadas, foram identificadas dietas com foco na restrição de energia, redução de macronutrientes específicos (com ou sem redução de energia), ciclos de "jejum" intermitente e dietas específicas (como a Dieta Mediterrânea e a Dieta Nórdica). Considerando os desfechos de interesse, a maioria dos estudos avaliou a redução do peso ou Índice de Massa Corporal (IMC), e um trabalho apresentou dados sobre o perímetro da cintura. No geral, as dietas foram descritas como efetivas para obter resultados positivos nos desfechos relacionados à obesidade ou ao sobrepeso. Apenas um estudo trouxe informações sobre eventos adversos (queda de cabelo, aumento das infecções do trato respiratório superior e constipação intestinal) relacionados ao modelo de ciclos de "jejum" intermitente. Os estudos incluídos nesta revisão, apesar de informarem resultados positivos das dietas nos desfechos relacionados à obesidade ou ao sobrepeso (redução de peso, de IMC ou do perímetro da cintura), foram avaliados com qualidade criticamente baixa ou baixa. Isso significa que o grau de confiança que pode ser atribuído a esses achados é pequeno e, portanto, mais estudos são necessários para afirmar com segurança o efeito das dietas nos desfechos de obesidade e sobrepeso. Esta revisão possui outras limitações que precisam ser consideradas na interpretação dos achados, como as restrições relativas à metodologia de sínteses rápidas, com filtros, processos de seleção e extração e critérios de elegibilidade reduzidos. Em relação às limitações dos estudos primários que compõem as revisões sistemáticas incluídas, de maneira geral, estes apresentaram número pequeno de indivíduos, além de populações e intervenções muito heterogêneas e pequenos períodos de seguimento, o que dificulta a análise da efetividade de diferentes estratégias dietéticas, bem como a extrapolação dos resultados para contextos diversos.

What are the most effective dietary strategies for treating people with obesity or overweight in health services? Literature searches were conducted in four databases, with publication year restriction (from the year 2015). Systematic reviews in English, Portuguese, and Spanish that evaluated the effect of diets in the treatment of obesity and overweight in the adult population in health services were included. In this rapid review, produced in ten days, the selection of articles, extraction of data of interest, and assessment of methodological quality (using the AMSTAR 2 instrument) were performed by a single researcher. Nine systematic reviews were included, most with critically low methodological quality according to AMSTAR 2 criteria. Among the interventions analyzed, diets focused on energy restriction, specific macronutrient reduction (with or without energy reduction), intermittent "fasting" cycles, and specific diets (such as the Mediterranean Diet and Nordic Diet) were identified. Considering the outcomes of interest, most studies evaluated weight reduction or Body Mass Index (BMI), and one paper presented data on waist circumference. Overall, diets were described as effective in achieving positive outcomes related to obesity or overweight. Only one study provided information on adverse events (hair loss, increased upper respiratory tract infections, and constipation) related to the intermittent "fasting" cycle model. The studies included in this review, despite reporting positive results of diets on outcomes related to obesity or overweight (reduction in weight, BMI, or waist circumference), were assessed with critically low or poor quality. This means that the degree of confidence that can be attributed to these findings is small, and therefore more studies are needed to confidently state the effect of diets on the outcomes of obesity and overweight. This review has other limitations that need to be considered when interpreting the findings, such as the restrictions regarding the rapid synthesis methodology, with filters, selection and extraction processes, and narrow eligibility criteria. Regarding the limitations of the primary studies that make up the included systematic reviews, in general, they presented a small number of individuals, besides very heterogeneous populations and interventions, and short follow-up periods, which hinders the analysis of the effectiveness of different dietary strategies, as well as the extrapolation of results for different contexts.

¿Cuáles son las estrategias dietéticas más eficaces para tratar a las personas con obesidad o sobrepeso en los servicios de salud? Se realizaron búsquedas bibliográficas en cuatro bases de datos, con restricción del año de publicación (desde 2015). Se incluyeron revisiones sistemáticas en inglés, portugués y español que evaluaron el efecto de las dietas en el tratamiento de la obesidad y el sobrepeso en la población adulta en los servicios de salud. En esta revisión rápida, realizada en diez días, la selección de los artículos, la extracción de los datos de interés y la evaluación de la calidad metodológica (mediante el instrumento AMSTAR 2) fueron realizadas por un solo investigador. Se incluyeron nueve revisiones sistemáticas, la mayoría con una calidad metodológica críticamente baja según los criterios de AMSTAR 2. Entre las intervenciones analizadas, se identificaron las dietas centradas en la restricción energética, la reducción de macronutrientes específicos (con o sin reducción energética), los ciclos de "ayuno" intermitente y las dietas específicas (como la Dieta Mediterránea y la Dieta Nórdica). En cuanto a los resultados de interés, la mayoría de los estudios evaluaron la reducción de peso o el Índice de Masa Corporal (IMC), y un artículo presentó datos sobre el perímetro de la cintura. En general, las dietas se describieron como eficaces para obtener resultados positivos en los resultados relacionados con la obesidad o el sobrepeso. Sólo un estudio proporcionó información sobre los efectos adversos (pérdida de pelo, aumento de las infecciones del tracto respiratorio superior y estreñimiento) relacionados con el modelo de ciclo de "ayuno" intermitente. Los estudios incluidos en esta revisión, a pesar de informar resultados positivos de las dietas en los resultados relacionados con la obesidad o el sobrepeso (reducción del peso, del IMC o del perímetro de la cintura), fueron evaluados con una calidad críticamente baja o baja. Esto significa que el grado de confianza que puede atribuirse a estos resultados es pequeño y, por lo tanto, se necesitan más estudios para afirmar con seguridad el efecto de las dietas en los resultados de la obesidad y el sobrepeso. Esta revisión tiene otras limitaciones que deben ser consideradas en la interpretación de los resultados, como las restricciones en cuanto a la metodología de síntesis rápida, con filtros, procesos de selección y extracción y criterios de elegibilidad reducidos. En relación a las limitaciones de los estudios primarios que conforman las revisiones sistemáticas incluidas, en general, presentaron un número reducido de individuos, además de poblaciones e intervenciones muy heterogéneas y periodos de seguimiento cortos, lo que dificulta el análisis de la efectividad de las diferentes estrategias dietéticas, así como la extrapolación de los resultados para diferentes contextos.

Revisión rápida de los efectos de la variación de la temperatura y la humedad en la morbilidad y mortalidad por Covid-19 / Rapid review of the effects of temperature and humidity variation on the Covid-19 morbidity and mortality

Resumen: Objetivo: Resumir y analizar la evidencia de la asociación entre Covid-19 y factores climáticos. Material y métodos: Se utilizó la metodología de revisiones rápidas de Cochrane. Se buscaron artículos publicados del 1 de enero al 27 de abril de 2020 en una base de datos académica y preprints. Los títulos y resúmenes fueron revisados por dos investigadores y los textos completos por cinco investigadores. Resultados: De 354 artículos identificados, 26 cumplieron los criterios de elegibilidad establecidos. De éstos, 20 observaron una asociación inversa. Al evaluar su calidad, nueve calificaron con validez moderada, porque si bien ajustaron por covariables en el análisis, son estudios ecológicos. Conclusiones: A pesar de la homogeneidad de resultados, los factores climáticos explican un porcentaje pequeño de la variación de Covid-19. Son necesarios estudios con periodo de análisis más largo que capten tendencia y estacionalidad e incluyan factores de riesgo individuales.

Abstract: Objective: To summarize and analyze the evidence of the association between Covid-19 and climatic factors Materials and methods: We used the Cochrane rapid review methodology. An academic database and preprints were examined with the searches restricted from January 1 to April 27. Titles and abstracts were reviewed by two researchers and full texts were reviewed by the five authors. Results: We identified 354 articles, 26 met the established eligibility criteria. Of these, 20 reported an inverse association. When evaluating their quality, nine were qualified with moderate validity, this is because they adjusted for covariates in the analysis, but they are ecological studies. Conclusions: Despite homogeneity of results, climatic factors explained a small percentage of Covid-19 incidence variability. Future studies need to include individual risk factors and longer period of data to capture trend or seasonality.

Revisión rápida del uso de cubrebocas quirúrgicos en ámbito comunitario e infecciones respiratorias agudas / Rapid review of the community-wide use of surgical masks and acute respiratory infections

Resumen: Objetivo: Evaluar la efectividad del uso de cubrebocas quirúrgico en ámbitos comunitarios para reducir la probabilidad de contagio por SARS-CoV-2 u otra infección respiratoria aguda viral, en comparación con no usar cubrebocas. Material y métodos: Se utilizó la metodología de revisiones rápidas de Cochrane. La estrategia de búsqueda abarcó una base de datos académica y pre-prints hasta el 1 de abril de 2020. Los títulos y resúmenes fueron revisados por un investigador. La revisión de textos completos fue dividida entre tres investigadores. Los resultados fueron sintetizados de forma narrativa. Resultados: Se identificaron 713 manuscritos, de los cuales 21 cumplieron los criterios de inclusión. De seis revisiones sistemáticas, cuatro no encontraron reducciones en la probabilidad de contagio y seis estudios experimentales en hogares no encontraron diferencias en la probabilidad de contagio asociado con el uso de cubrebocas. Únicamente un estudio de modelaje estimó una reducción de 20% en la incidencia de enfermedad respiratoria, asumiendo que 10 a 50% de la población hace uso correcto de cubrebocas quirúrgicos. Conclusiones: La evidencia científica no es concluyente para recomendar o desalentar el uso de cubrebocas a nivel poblacional. Considerando los potenciales efectos negativos, las recomendaciones gubernamentales deberían esperar a los resultados de los experimentos naturales en países que han recomendado la utilización poblacional de cubrebocas.

Abstract: Objective: To assess the effectiveness of using surgical masks in community settings to reduce the probability of infection by SARS-CoV-2 or other acute viral respiratory infection, compared to not using surgical masks. Materials and methods: We followed the Cochrane rapid review methodology. The search strategy encompasses one academic database and pre-prints until April 1, 2020. Titles and abstracts were reviewed by one investigator. The full text review was divided among three researchers. The results were synthesized in a narrative way. Result: 713 manuscripts were identified, of which 21 met the inclusion criteria. Of six systematic reviews, four found no reduction in the probability of transmission. Experimental home studies found no differences in the probability of contagion associated with the use of mouth masks. Only one modeling study estimated a 20% reduction in the incidence of acute respiratory disease, assuming that 10 to 50% of the population use the surgical masks correctly. Conclusions: The scientific evidence is inconclusive to recommend or discourage the use of surgical masks at the population level. Considering the potential negative effects, official recommendations should await for the results of natural experiments currently occurring in countries that have recommended the use of face masks at the population level.

A rapid review of nurses’ experiences working in hospital settings during the COVID-19 pandemic

Background@#Being at the frontline, nurses working in hospital settings are vulnerable to a range of experiences that impact their wellbeing. Measures to protect their health and welfare during the COVID-19 pandemic have been the focus of discussion among policymakers and administrators. There is a need to collectively understand their personal experiences to inform relevant policy decisions.@*Objective@#To synthesize and present the best available evidence describing the experiences of nurses working in hospital settings during the COVID-19 pandemic.@*Design@#This is a rapid review using Tricco's seven stage process. @*Data sources@#A structured search using PubMed, CINAHL, Scopus, and a local database Herdin was conducted.@*Review Methods@#A rapid review of studies published from January to August 2020, describing nurses' experiences of working in hospital facilities during the COVID-19 pandemic were included regardless of methodology. Following data screening and extraction, a narrative synthesis of the findings was conducted.@*Results@#Nineteen articles were included in the review. The experiences of nurses described in these articles generated a total of fifteen categories, based on similarities of meaning. Four synthesized findings were identified from the categories: (a) supportive nursing culture; (b) physical, emotional, and psychological impact of frontline work; (c) organizational responsiveness; (d) and maintaining standards of care.@*Conclusions@#Nurses' experiences working in hospital settings during the COVID-19 pandemic are diverse, profound, and dependent on the context of practice and prevailing healthcare system and organization. These experiences reflect personal encounters and shifts in healthcare delivery that ensure protection and safety while maintaining standards of care. Robust studies are needed to capture and explore the breadth of these experiences and heighten the discussions that advocate for nurses' welfare and safety during pandemics.

Application of evidence-based rapid review in studying nephrotoxicity of Tripterygium wilfordii preparation / 中国中药杂志

To investigate the feasibility of applying the evidence-based rapid review in studying the nephrotoxicity of Tripterygium wilfordii preparation. We used four methods in relevant studies on the nephrotoxicity of T. wilfordii preparation. The first method had no limitation on any search terms， which was a traditional approach to retrieve systematic reviews. The second method limited the relevant search terms of T. wilfordii preparation to "all of CHMs containing T. wilfordii preparation approved by CFDA". The third method was to limit the relevant retrieval terms of nephrotoxicity as the "most frequently reported terms related to nephrotoxicity found in the study literature screening process in the early stage of systematic review". The fourth method was to limit the search terms relating to both T. wilfordii preparation and nephrotoxicity. Finally， the results of the last three search methods were compared with those of the first search method， and the feasibility of the rapid review method in the study for the nephrotoxicity of CHM was discussed. For the total number of literatures searched， the fourth method had the smallest number of literatures. For the number of articles in line with the inclusion criteria， the second method had the largest number of eligible literatures. For the type of literatures included， the forth method had a higher coincidence degree. The forth method was the best one， because it was not only consistent with the results， but also could minimize the workload. Rapid review is feasible in the study of nephrotoxicity of T. wilfordii.

Gerontecnología: rapid review y tendencias mundiales / Gerontechnology: rapid review and global trends

La actual transición demográfica y epidemiológica por la que atraviesan varias regiones en el mundo, incluyendo México, están desafiando la sustentabilidad de los sistemas de salud, conduciendo al desarrollo de nuevos enfoques de atención para la población de adultos mayores (AM). La estrategia central está enfocada en un envejecimiento saludable donde el aumento de la esperanza de vida sea libre de discapacidad. La gerontecnología pretende contribuir a la disminución de los problemas de los AM que conllevan las transiciones del envejecimiento apoyando el cumplimiento de la estrategia central. La realización de rapid review en gerontecnología demuestra que Holanda y E.U.A. encabezan la lista de países promotores de investigaciones y desarrollos gerontecnológicos a nivel mundial, con 14 y 10 publicaciones respectivamente. México aporta a la generación de conocimientos en el campo con una publicación. A nivel mundial la tendencia es la generación de grupos multidisciplinarios con profesionales de las ciencias de Sociología, Demografía (Gerontología) en conjunto con profesionales de las áreas de Comunicación e Informática (Tecnología); teniendo como principal objetivo el Apoyo y Organización en los cuidados de los adultos mayores en los dominios de Vivienda y Actividades de la Vida Diaria.

Current demographic and epidemiological transitions being experienced by several regions in the world, including Mexico, are challenging the sustainability of health systems, leading to the development of new approaches to care for the elderly population. The core strategy is focused on healthy aging where increased life expectancy is free of disability. Gerontechnology intended to help reduce the problems of seniors that involve transitions of aging by supporting the implementation of the core strategy. Conducting rapid review in gerontechnology shows that the Netherlands and United States top the list of countries promoting research and gerontechnologic developments worldwide, with 14 and 10 publications respectively. Mexico contributes to the generation of knowledge in the field with one publication. Worldwide the trend is the generation of multidisciplinary groups with science professionals on Sociology, Demography (Gerontology) in conjunction with professionals in the areas of Communication and Information Technology (Technology); having as main objective the support and organization in care of the elderly in the domains of Housing and Activities of Daily Living.