Retrograde intrarenal surgery with or without ureteral access sheath: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT Introduction: The ureteral access sheath (UAS) is a medical device that enables repeated entrance into the ureter and collecting system during retrograde intrarenal surgery (RIRS). Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we performed a systematic review and meta-analysis comparing RIRS with versus without UAS for urolithiasis management. Purpose: To compare outcomes from retrograde intrarenal surgery (RIRS) for stone extraction with or without ureteral access sheath (UAS); evaluating stone-free rate (SFR), ureteral injuries, operative time, and postoperative complications. Materials and Methods: We systematically searched PubMed, Embase, and Cochrane Library in June 2024 for randomized controlled trials (RCTs) evaluating the efficacy and safety outcomes of UAS use in RIRS for urolithiasis treatment. Articles published between 2014 and 2024 were included. Pooled risk ratios (RRs) and mean differences (MDs) were calculated for binary and continuous outcomes, respectively. Results: Five RCTs comprising 466 procedures were included. Of these, 246 (52.7%) utilized UAS. The follow-up ranged from 1 week to 1 month. UAS reduced the incidence of postoperative fever (RR 0.49; 95% confidence interval [CI] 0.29-0.84; p=0.009), and postoperative infection (RR 0.50; 95% CI 0.30-0.83; p=0.008). There were no significant differences between groups in terms of SFR (RR 1.05; 95% CI 0.99-1.11; p=0.10), ureteral injuries (RR 1.29; 95% CI 0.95-1.75; p=0.11), operative time (MD 3.56 minutes; 95% CI −4.15 to 11.27 minutes; p=0.36), or length of stay (MD 0.32 days; 95% CI −0.42 to 1.07 days; p=0.40). Conclusion: UAS leads to a lower rate of post-operative fever and infection. However, UAS did not significantly reduce or increase the SFR or the rate of ureteral injuries during RIRS for patients with urolithiasis. The use of UAS should be considered to decrease the risk of infectious complications, particularly in those who may be at higher risk for such complications.

Robot-assisted radical nephroureterectomy using the KangDuo Surgical Robot-01 System versus the da Vinci System: a multicenter prospective randomized controlled trial

ABSTRACT Introduction: We aim to compare the safety and effectiveness of the KangDuo (KD)-Surgical Robot-01 (KD-SR-01) system and the da Vinci (DV) system for robot-assisted radical nephroureterectomy (RARNU). Materials and Methods: This multicenter prospective randomized controlled trial was conducted between March 2022 and September 2023. Group 1 included 29 patients undergoing KD-RARNU. Group 2 included 29 patients undergoing DV-RARNU. Patient demographic and clinical characteristics, perioperative data, and follow-up outcomes were collected prospectively and compared between the two groups. Results: There were no significant differences in patient baseline demographic and preoperative characteristics between the two groups. The success rates in both groups were 100% without conversion to open or laparoscopic surgery or positive surgical margins. No significant difference was observed in docking time [242 (120-951) s vs 253 (62-498) s, P = 0.780], console time [137 (55-290) min vs 105 (62-220) min, P = 0.114], operative time [207 (121-460) min vs 185 (96-305) min, P = 0.091], EBL [50 (10-600) mL vs 50 (10-700) mL, P = 0.507], National Aeronautics and Space Administration Task Load Index scores, and postoperative serum creatinine levels between the two groups. None of the patients showed evidence of distant metastasis, local recurrence, or equipment-related adverse events during the four-week follow-up. One (3.4%) patient in Group 2 experienced postoperative enterovaginal and enterovesical fistulas (Clavien-Dindo grade III). Conclusions: The KD-SR-01 system is safe and effective for RARNU compared to the DV Si or Xi system. Further randomized controlled studies with larger sample sizes and longer durations are required.

Factores relacionados al estado Todo-Menos-Tesis en la formación de grado de odontólogos de una universidad peruana / Factors Related to All-But-Dissertation Status in Undergraduate Dental Education at a Peruvian University

Resumen Introducción: Elaborar una tesis es un proceso complejo y algunos estudiantes no la culminan, la abandonan o entran en un estado de postergación permanente. Objetivo: Identificar los factores que se relacionan con la presencia del estado Todo-Menos-Tesis (TMT) en los graduados de un programa de odontología. Método: Estudio exploratorio con enfoque cualitativo donde participaron 21 graduados. Se utilizó la técnica de la encuesta y una entrevista semiestructurada. El cuestionario recopiló información relacionada a la condición laboral, características personales, tiempo de graduación y características familiares. La guía de entrevista recopiló las categorías de motivos (personales, académicos, económicos y laborales), consecuencias (repercusiones de la postergación de la tesis) y recomendaciones para evitar el estado TMT. Resultados: El 57,1 % (n = 12) fueron varones. Los principales motivos para postergar la tesis estuvieron relacionados con la adquisición de recursos económicos, pérdida de interés, prioridades familiares, alejamiento académico y sensaciones de habilidades inadecuadas. Los participantes recomiendan ofrecer otras modalidades de titulación, realizar capacitaciones académicas, mejorar las experiencias investigativas y brindar orientación al graduado. Conclusiones: Los graduados de la carrera de estomatología de la Universidad Científica del Sur presentan múltiples factores personales, cognitivos e institucionales que influyen en la decisión de continuar o retomar la elaboración de su tesis de licenciatura. La dedicación laboral y las responsabilidades familiares son los principales factores que limitan el tiempo de dedicación a la tesis.

Abstract Introduction: Preparing a thesis is a complex process and some students do not complete it, abandon it or enter a permanent state of procrastination. Objective: To identify the factors that are related to the presence of the All-But-Dissertation (ABD) state in the graduates of a Dentistry program. Method: Exploratory study with a qualitative approach in which 21 graduates participated. The survey technique and a semi-structured interview were used. The questionnaire collected information related to employment status, personal characteristics, time of graduation, and family characteristics. The interview guide collected the categories of reasons (personal, academic, economic, and labor), consequences (repercussions of postponing the thesis), and recommendations to avoid the syndrome. Results: 57.1% (n = 12) were male. The main reasons for postponing the thesis were related to the acquisition of economic resources, loss of interest, family priorities, academic distance and feelings of inadequate skills. The participants recommend offering other degree modalities, academic training, improving research experiences, and providing orientation to the graduate. Conclusions: Stomatology graduates of the Universidad Científica del Sur present multiple personal, cognitive, and institutional factors that influence the decision to continue or resume the elaboration of their degree thesis. Work dedication and family responsibilities are the main factors that limit the time devoted to the thesis.

Intraoperative computed tomography for detection of residual stones in endourology procedures: systematic review and meta-analysis

ABSTRACT Background: Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more reinterventions and radiation exposure. Recently, the use of intraoperative computed tomography (ICT) scans has been hypothesized as a promising solution for improving outcomes in endourology procedures. With this considered, we conducted a comprehensive systematic review and meta-analysis encompassing all available studies that evaluate the impact of the use of intraoperative CT scans on surgical outcomes compared to conventional fluoroscopic-guided procedures. Methods: This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were systematically searched up to December of 2023. This study aimed to directly compare the use of an ICT scan with the standard non-ICT-guided procedure. The primary endpoint of interest was success rate, and the secondary endpoints were complications and reintervention rates, while radiation exposure was also evaluated. Data extraction and quality assessment were performed following Cochrane recommendations. Data was presented as an Odds ratio with 95%CI across trials and a random-effects model was selected for pooling of data. Results: A comprehensive search yielded 533 studies, resulting in the selection of 3 cohorts including 327 patients (103 ICT vs 224 in non-ICT). Primary outcome was significantly higher in the experimental group versus the control group (84.5% vs 41.4% respectively, 307 patients; 95% CI [3.61, 12.72]; p<0.00001; I2=0). Reintervention rates also decreased from 32.6% in the control to 12.6% in the ICT group (OR 0.34; 95%CI [0.12,0.94]; p =0.04; I2= 48%), whereas complication rates did not exhibit significant differences. Radiation exposure was also significantly reduced in two of the included studies. Conclusion: This meta-analysis highlights a favorable outcome with intraoperative CT scan use in PCNL procedures, showing a considerable increase in SFR when compared to standard fluoroscopy and nephroscopy. Despite limited studies, our synthesis underscores the potential of ICT scans to significantly reduce residual stones and their consequences for endourology patients, as reinterventions and follow-up ionizing radiation studies.

Comparison of the Functional Outcomes of Arthroscopic Anterior Cruciate Ligament Reconstruction through the All-inside and Outside-in Techniques: A Double-Blinded Randomized Controlled Trial / Comparação dos resultados funcionais da reconstrução artroscópica do ligamento cruzado anterior pelas técnicas all-inside e outside-in: Um ensaio clínico controlado, randomizado e duplo-cego

Abstract Objective To compare the functional outcomes of anterior cruciate ligament (ACL) reconstruction with hamstring autograft (HA) through the all-inside (AI) technique with adjustable-loop cortical Endobutton (Smith & Nephew, Watford, Hertfordshire, England) on the sides of the femur and tibia and through the outside-in (OI) technique using an interference screw on the tibial side and a cortical Endobutton on the femoral side. Materials and Methods The present is a double-blinded randomized controlled trial (RCT) of 44 patients undergoing arthroscopic ACL reconstruction from February 2019 to February 2022 in a tertiary care hospital. As per computer-based randomization, the patients were distributed into two groups: the AI and OI groups. Both groups were evaluated for 12 months using the Visual Analog Scale (VAS), the Lysholm Knee Scoring Scale, and part I (pain score) and part II (function score) of the Knee Society Score (KSS). Results On postoperative day 2,the VAS score was significantly higher in the OI group (p = 0.0001), but insignificant (p = 0.807) at 6 weeks. At 3, 6, and 12 months of follow-up, the score on the Lysholm Knee Scoring Scale was significantly higher (p = 0.001) in the AI group. At 6 months, both parts of the KSS showed a significant difference, with the AI group presenting a better outcome (p = 0.04). However, at 12 months, the AI group presented a better score on part I of the KSS, but no differences were observed regarding part II. Conclusion In a follow-up of 12 months, the patients submitted to the AI technique presented better outcome scores and pain relief than those submitted to the OI technique.

Resumo Objetivo Comparar os resultados funcionais da reconstrução do ligamento cruzado anterior (LCA) com autoenxerto de isquiotibiais pela técnica all-inside (AI) com Endobutton (Smith & Nephew, Watford, Hertfordshire, Inglaterra) cortical de alça ajustável nos lados do fêmur e da tíbia e pela técnica outside-in (OI) com parafuso de interferência no lado tibial e Endobutton cortical no lado femoral. Métodos Trata-se de um ensaio clínico controlado, randomizado e duplo-cego com 44 pacientes submetidos à reconstrução artroscópica do LCA de fevereiro de 2019 a fevereiro de 2022 em um hospital de cuidados terciários. De acordo com a randomização por computador, os pacientes foram distribuídos em dois grupos: AI e OI. Ambos os grupos foram avaliados durante 12 meses pela Escala Visual Analógica (EVA), a Escala de Pontuação do Joelho de Lysholm e pela parte I (pontuação de dor) e a parte II (pontuação de função) da escala Knee Society Score (KSS). Resultados No segundo dia de pós-operatório, a pontuação média na EVA foi significativamente maior no grupo OI (p = 0,0001), mas insignificante (p 0,807) às 6 semanas. Aos 3, 6 e 12 meses de acompanhamento, a pontuação na Escala de Lysholm (p = 0,001) foi significativamente maior no grupo AI. Aos 6 meses, ambas as partes da KSS apresentam uma diferença significativa, com o grupo AI apresentando um desfecho melhor (p = 0,04). No entanto, aos 12 meses, o grupo AI apresentou uma pontuação melhor na parte I da KSS, mas não foram observadas diferenças na parte II. Conclusão Em um acompanhamento de 12 meses, os pacientes submetidos à técnica AI apresentaram melhores pontuações de desfecho e alívio da dor do que aqueles submetidos à técnica OI.

Evaluación de la calidad de guías de práctica clínica para el tratamiento de adultos con COVID-19 leve o moderada, utilizando la herramienta AGREE II / Assessment of the quality of clinical practice guidelines on the treatment of adults with mild or moderate COVID-19, using the AGREE II tool

INTRODUCCIÓN: Varias guías de práctica clínica para el tratamiento de la COVID-19 se han desarrollado durante los dos últimos años de pandemia, sin embargo, su calidad metodológica es poco clara. OBJETIVO: Realizar una evaluación sistemática de la calidad de las guías de práctica clínica publicadas entre 2021 y octubre de 2022 para el tratamiento de la COVID-19, utilizando la herramienta AGREE II, e identificar las recomendaciones formuladas en dichas guías. JUSTIFICACIÓN: Durante la pandemia, surgieron múltiples guías, pero la claridad so-bre su calidad metodológica fue limitada. MÉTODOS: Se realizó una búsqueda sistemática de guías de práctica clínica sobre el tratamiento para la COVID-19 leve o moderada utilizando metabuscadores como Epistemonikos y Trip Database, y sitios web de organizaciones de sa-lud. Las guías seleccionadas fueron evaluadas con el instrumento AGREE II. RESULTADOS: Se evaluaron 11 GPC, presentando altas puntuaciones en los dominios de alcance y propósito (98,74 %), participación de los implicados (97,22 %), rigor en la elaboración (92 %), claridad de presentación (100 %), aplicabilidad (85,61 %), e independencia editorial (100 %). Aunque la ca-lidad general de las guías fue alta, se identificó la necesidad de mejorar en los aspectos de rigor en la elaboración y aplicabilidad de las recomendaciones. CONCLUSIONES: Encontramos que la calidad de las guías de práctica clínica evaluadas, en su mayoría es alta y, por lo tanto, son recomendables, aunque reconocemos la necesidad de mejorar la descripción de los dominios de rigor en la elaboración y aplicabilidad de las recomendaciones.

INTRODUCTION: Several clinical practice guidelines for the management of COVID-19 have been developed during the last two years of the pandemic, but their methodological quality is unclear. OBJECTIVE: To systematically assess the quality of clinical practice guidelines for the treatment of COVID-19 published between 2021 and October 2022 using the AGREE II tool, and to identify the recommendations made in these guidelines. JUSTIFICATION: During the pandemic, many guidelines were published, but clarity about their methodological quality was limited. METHODS: A systematic search for clinical practice guidelines on the management of mild-to-moderate COVID-19 was performed using meta-search engines such as Epistemoni-kos and Trip Database, as well as health organization websites. The selected guidelines were appraised using the AGREE II instrument. RESULTS: Eleven clinical practice guidelines (CPGs) were evaluated, showing high scores in the domains of scope and purpose (98.74%), stakehol-der involvement (97.22%), rigor of development (92%), clarity of presentation (100%), applica-bility (85.61%), and editorial independence (100%). Although the overall quality of the guidelines was high, there was identified a need for improvement in the areas of rigor of development and applicability of the recommendations. CONCLUSIONS: We found that the quality of the evalua-ted clinical practice guidelines is predominantly high, and therefore, they are recommendable. However, we recognize the need to improve the descriptions of the domains of rigor of develop-ment and applicability of the recommendations,

Kidney collecting system anatomy applied to endourology - a narrative review

ABSTRACT Objective: To evaluate the surgical anatomy of the kidney collecting system through a narrative review of the literature, highlighting its importance during diagnosis and its approach during surgical procedures for the treatment of renal stones. Material and Methods: We carried out a review about the anatomy of the kidney collecting system. We analyzed papers published in the past 40 years in the databases Pubmed, Embase and Scielo, and we included only papers in English and excluded case reports, editorials and opinions of specialists. Results: Renal collecting system could be divided in four groups: A1 - kidney midzone (KM), drained by minor calyx that are dependent on the superior or the inferior caliceal groups; A2 - KM drained by crossed calyx, one draining into the superior caliceal group and another draining into the inferior caliceal group; B1 - KM drained by a major caliceal group independent of both the superior and inferior groups; and B2 - KM drained by minor calyx entering directly into the renal pelvis. Some details and anatomic variations of the collecting system are related to clinical and radiological aspects, particularly perpendicular calyces, interpyelocalyx space, position of calyces in relation to renal border, classification of the renal collecting system, infundibular diameter and the angle between the lower infundibulum and renal pelvis. Conclusion: The knowledge of intra-renal collecting system divisions and variations as the angle between the renal pelvis and lower infundibula, position of the calices in relationship with renal edge and the diameter and position of the calyces are important for the planning of minimally invasive renal surgeries.

Investigación cualitativa en el contexto de la Salud Pública: actualización de conceptos

Los enfoques cualitativos en la investigación han sido fundamentales en las ciencias sociales y son cruciales para el estudio de la salud y los servicios sanitarios. Con el progreso en medicina, mayor especialización, expectativas crecientes de los pacientes y la complejidad de los servicios de salud, los profesionales se enfrentan a un entorno laboral cada vez más complicado. Los métodos cualitativos, aunque distintos de las técnicas experimentales y cuantitativas de la investigación clínica y biomédica, son indispensables para la investigación en servicios de salud. Esto se debe a que permiten explorar aspectos no medibles cuantitativamente, como las creencias sobre la salud, y porque proporcionan una base -descriptiva necesaria para la investigación cuantitativa, especialmente en campos con escasa investigación previa.

Qualitative approaches in research have been fundamental in the social sciences and are crucial to the study of health and health services. With progress in medicine, greater specialization, increasing patient expectations and the complexity of health services, professionals face an increasingly complicated work environment. Qualitative methods, although different from the experimental and quantitative techniques of clinical and biomedical research, are essential for health services research. This is because they allow us to explore aspects that are not quantitatively measurable, such as beliefs about health, and because they provide a necessary descriptive basis for quantitative research, especially in fields with little previous research.

Estudios bibliométricos. Una opción para desarrollar investigación en cirugía y disciplinas afines

La bibliometría es la aplicación de métodos estadísticos para analizar libros, artículos y otras publicaciones, especialmente científicos. Muy relacionada con la cienciometría e informetría, al punto de superponerse y confundirse. La bibliometría se refiere al estudio de la dinámica de las disciplinas reflejado en la producción de su literatura. Incluye desde el registro de cambios en la producción de una disciplina académica a lo largo del tiempo y entre países, hasta el problema de la colección bibliotecaria. En este artículo se explicarán algunos conceptos históricos, definiciones y objetivos de la bibliometría; así como las Leyes de la bibliometría; los tipos de análisis e indicadores bibliométricos más utilizados; para terminar con algunos ejemplos de diferentes tipos de estudios bibliométricos publicados, para que el lector pueda formarse una idea general de lo que puede hacer en este campo, aplicando estas metodologías a disciplinas quirúrgicas y otras también. El objetivo de este manuscrito fue generar un documento de estudio respecto de la bibliometría como alternativa para desarrollar investigación en cirugía y disciplinas afines.

Bibliometrics is the application of statistical methods to analyze books, articles and other publications, especially scientific ones. Closely related to scientometrics and informetrics, to the point of overlapping and confusing. Bibliometrics refers to the study of the dynamics of the disciplines reflected in the production of their literature. It includes everything from the record of changes in the production of an academic discipline over time and between countries or regions, to the problem of the library collection. In this article some historical concepts, definitions and objectives of bibliometrics will be explained; as well as the Laws of bibliometrics; the types of analysis and bibliometric indicators most used; to finish with some examples of different types of published bibliometric studies, so that the reader can form a general idea of what he can do in this field, applying these methodologies to surgical disciplines and others as well. The aim of this manuscript was to generate a study document regarding bibliometrics as an alternative to develop research in surgery and related disciplines.

Valoración crítica de la guía de práctica clínica colombiana para la prevención, el diagnóstico y el tratamiento de la ideación y/o la conducta suicida (adopción) / Critical Appraisal of the Colombian Clinical Practice Guide for the Prevention, Diagnosis and Treatment of Suicidal Ideation and/or Behaviour (Adoption)

RESUMEN Introducción: El suicidio es un complejo problema de salud pública global. La guía colombiana de práctica clínica es un insumo relevante para su prevención, diagnóstico y tratamiento. El objetivo es evaluar la calidad metodológica, la credibilidad y la aplicabilidad de la guía de práctica clínica colombiana sobre la conducta suicida. Métodos: Un grupo académico de 12 evaluadores se estandarizó para la valoración de la guía y sus recomendaciones mediante los instrumentos AGREE-II y AGREE-REX. Las valoraciones se dieron en el intervalo de 0,0-1,0, con 0,7 como punto de corte para apropiada calidad. Resultados: La valoración global del AGREE-II fue >0,7 en las dimensiones «alcance y objetivo¼ (0,86), «claridad de la presentación¼ (0,89), «aplicabilidad¼ (0,73) e «independencia editorial¼ (0,89). Los menores puntajes fueron para «participación de los implicados¼ (0,67) y «rigor en la elaboración¼ (0,69). Con el AGREE-REX los resultados en todas las dimensiones estuvieron por debajo de 0,70, lo cual indica menores calidad e idoneidad de uso. Conclusiones: El proceso de adopción de la guía colombiana sobre conducta suicida fue un proceso riguroso en lo metodológico, en tanto que las recomendaciones de práctica se valoraron como de baja aplicabilidad por el escaso sustento en evidencia local. Se requiere fortalecer la generación y la síntesis de evidencia en el país para dar más soporte y aplicabilidad a las recomendaciones de práctica.

ABSTRACT Introduction: Suicide is a complex, global public health problem. The Colombian clinical practice guideline provides relevant input for its prevention, diagnosis and treatment. The objective was to evaluate the methodological quality, credibility and applicability of the Colombian clinical practice guideline for suicidal behaviour. Methods: An academic group of 12 evaluators was established to assess the guide and its recommendations in a standardised way, using the AGREE-II and AGREE-REX instruments. The evaluations were given in the range of 0.0-1.0 with 0.7 as a cut-off point for appropriate quality. Results: The global assessment of the AGREE-II was greater than 0.7 in the dimensions: "scope and objective" (0.86), "clarity of presentation" (0.89), "applicability" (0.73) and "editorial independence" (0.89). The lowest scores were for "participation of those involved" (0.67) and "rigour in preparation" (0.69). With the AGREE-REX, the results in all dimensions were below 0.70, which indicates lower quality and suitability for use. Conclusions: The adoption process of the Colombian guideline for suicidal behaviour was a rigorous methodological process, while the practice recommendations were valued as of low applicability due to low support in local evidence. It is necessary to strengthen the genera-tion and synthesis of evidence at the national level to give greater support and applicability to the practice recommendations.

¿Ensayos clínicos de superioridad, equivalencia o no inferioridad? / ¿Clinical trials of superiority, non-inferiority or equivalence?

La eficacia de una nueva intervención se establece generalmente a través de ensayos clínicos (EC) con asignación aleatoria (AA). Sin embargo, entre otros tantos desafíos metodológicos, el especificar la hipótesis de un EC con AA, sigue siendo un problema complejo de resolver para los investigadores clínicos. En este manuscrito discutimos las características de tres variantes de los EC con AA: EC de superioridad (ECS), EC de no-inferioridad (ECNI), y EC de equivalencia (ECE). Estos tres tipos de EC tienen supuestos diferentes sobre los efectos de una intervención, por lo que plantear hipótesis y definir objetivos requiere conocer algunos supuestos subyacentes a estos EC, incluso hasta elementos relacionados con la estimación del tamaño de muestra para cada cual. El objetivo de este manuscrito fue describir las diferencias metodológicas entre ECS, ECNI y ECE.

Efficacy and effectivity of new interventions are generally established through randomized clinical trials (RCTs). However, among many other methodological challenges, specifying the hypothesis of a RCT remains complex problem for clinical researchers. In this manuscript we discuss the characteristics of three variants of RCTs: superiority RCT (SRCT), non-inferiority RCT (NIRCT), and equivalence RCT (ERCT). These three types of RCT have different assumptions about the effects of an intervention, so setting hypotheses and defining objectives requires knowing some assumptions underlying these RCTs, including elements related to the estimation of the sample size for each one. The aim of this manuscript was to describe methodological differences between SRCT, NIRCT and ERCT.

World Café no ensino em saúde e pesquisa científica: protocolo de revisão de escopo / World Café in health education and scientific research: scope review protocol

OBJETIVO: Identificar as evidências científicas para a aplicação do World Café em disciplinas de saúde e pesquisas. MÉTODO: Registrado na Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/TM7QR), o método seguirá as etapas propostas no Manual de Revisão da JBI: identificação da questão de pesquisa; identificação dos estudos relevantes; seleção dos estudos; análise dos dados; agrupamento, síntese e apresentação dos dados. A estratégia de busca foi elaborada em consulta aos descritores DeCS/MeSH e linguagem natural das bases de dados consultadas (Web of Science, MEDLINE/Pubmed, CINAHL e Biblioteca Virtual de Saúde). Os critérios de inclusão são: artigos disponíveis na íntegra nos idiomas português, inglês ou espanhol que utilizaram a metodologia do World Café. Editoriais, cartas, resumos de congressos, notas ou resenhas serão excluídos. Espera-se sistematizar e apoiar o conhecimento sobre o uso do World Café nas intervenções de saúde e em pesquisas científicas, contribuindo para advogar pelo uso desta metodologia dialógica e qualitativa, na cocriação de conhecimento científico.

OBJECTIVE: To identify scientific evidence for the application of World Café in health disciplines and research. METHOD: Registered in the Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/TM7QR), the method will follow the steps proposed in the JBI Review Manual: identification of the research question; identification of relevant studies; selection of studies; data analysis; grouping, synthesis, and presentation of data. The search strategy was developed in consultation with the descriptors DeCS/MeSH and the natural language of the consulted databases (Web of Science, MEDLINE/Pubmed, CINAHL, and Virtual Health Library). The inclusion criteria are: articles available in full in Portuguese, English, or Spanish languages that used the World Café methodology. Editorials, letters, congress abstracts, notes, or reviews will be excluded. It is expected to systematize and support knowledge about the use of World Café in health interventions and scientific research, contributing to advocate for the use of this dialogical and qualitative methodology, in the co-creation of scientific knowledge.

What is the most dangerous sexual position that caused the penile fracture? A systematic review and meta-analysis

ABSTRACT Purpose: Penile fracture (PF) affects 1,14 to 10,48 men in every 100.000 men in East Asia, and the primary aetiology is sexual intercourse, but the knowledge regarding the most dangerous sexual position is not well explained. This study compares three sexual positions: man on top position (MTP), woman on top position (WTP), and doggy style position (DSP), leading to PF potential. Materials and methods: A search of sexual position-related PF in Google Scholar, PubMed, Cochrane, and PMC Europe was performed. Criteria inclusion was the full text of relevant articles which describ the number of sexual positions. It was analyzed by odds ratio, random model effect, and the OR and 95%CI were calculated. Results: Twelve relevant papers involving 490 patients comprised 169 MTP, 120 WTP, 158 DSP, and 43 no intercourse cases. Meta-analysis of all sexual positions was a MTP P= 0,04, WTP P=0,49, and DSP P=0,0005. Conclusions: The man-dominant positions (MTP and DSP) were significantly potential for PF, which speculated that when a man is dominant and very excited, intercourse may become highly vigorous and impact trauma. This study found that man's dominant position consists of DSP and the MTP significantly lead to PF.

A scoping review on compliance in orthokeratology among children and adolescents / 中国学校卫生

Objective@#To describe and analyze the current research status of compliance in orthokeratology among children and adolescents in and beyond China, so as to guide future research in this field.@*Methods@#By combining subject words with free words, the paper systematically searched the research related to the compliance of children and adolescents wearing orthokeratology lenses in PubMed, Web of Science, Embase, Scopus, Cochrane Library, China National Knowledge Infrastructure, Wanfang, VIP and China Biomedical Literature Database. The retrieval time limit was until September 1, 2023.Two researchers independently screened and extracted data.@*Results@#A total of 35 articles were included, and four themes were identified:the current level of compliance, evaluation indicators, influencing factors, and intervention programs. The evaluation indicators of orthokeratology lenswearing compliance were diverse, and the influencing factors involved general demographic characteristics, personal internal factors, external factors, and specific clinical situations related to orthokeratology.@*Conclusions@#Multiple factors are associated with compliance in orthokeratology. Eyecare practitioners should choose suitable evaluation tools based on specific conditions and implement diverse and practical intervention strategies guided by theory to enhance the safety and effectiveness of orthokeratology lenswearing among children and adolescents.

What is an "ongoing" clinical trial? An analysis of different sources revealed heterogeneous definitions of when a clinical trial starts and ends: a meta-research study

ABSTRACT BACKGROUND: Although the concept of an "ongoing study" seems self-explanatory, it is difficult to determine whether a trial is underway. OBJECTIVE: To analyze the definitions of "ongoing clinical trial" across different clinical trial registries, methodological guidelines, and other sources. DESIGN AND SETTING: This meta-research study was conducted at the Universidade Federal de São Paulo (UNIFESP), Brazil. METHODS: We performed a cross-sectional analysis of relevant clinical trial registry databases, methodological guidelines for conducting systematic reviews, and other sources that would define or regulate clinical trials. RESULTS: We identified various heterogeneous definitions used by eligible sources at both the start and end of a clinical trial. The starting criteria used were as follows: when the team is planning the protocol, when permission is given to conduct the study, or when the first participant is enrolled. Some sources used the time at which the last outcome data was collected as a criterion to determine the end of the trial. The International Committee of Medical Journal Editors stated that a study is still "ongoing" during the analysis process. Several sources use a vague definition or present no clear criteria for defining the start or end of a study. CONCLUSION: The concept of "ongoing clinical trials" lacks a transparent and homogeneous definition across relevant sources. A consensus on this concept is important to facilitate the evaluation of available evidence and conduct research synthesis. Further efforts are necessary to determine the best definition for the start and end of a clinical trial.

Use of podcasts for health education: a scoping review / Uso de podcasts para educación en salud: una revisión de alcance / Uso de podcasts para educação em saúde: uma revisão de escopo

ABSTRACT Objectives: to map the scientific evidence related to the characteristics, themes, and outcomes of using health education podcasts aimed at individuals over 18 years of age in intra or extrahospital environments. Methods: a scoping review, based on the Joanna Briggs Institute method, conducted in 11 databases, including studies from 2004 to 2022. Results: 11 studies were selected, categorized, highlighting the characteristics, evaluated outcomes, areas, and conditions of podcast application, indicating it as an effective tool for promoting behavioral change, health promotion, and social interaction, demonstrating its potential to improve well-being, quality of life, and user/client autonomy. Conclusions: the use of podcasts proves to be an effective, innovative, and low-cost tool, with a significant social impact, being effective for behavioral change, satisfaction, and social interaction. However, the lack of comprehensive studies on podcast development methodologies represents challenges to be overcome.

RESUMEN Objetivos: mapear las evidencias científicas relacionadas con las características, temáticas y resultados del uso de podcasts de educación en salud dirigidos a individuos mayores de 18 años en entornos intra o extrahospitalarios. Métodos: revisión de alcance, basada en el método del Joanna Briggs Institute, realizada en 11 bases de datos, incluyendo estudios de 2004 a 2022. Resultados: se seleccionaron 11 estudios, categorizados y destacando las características, resultados evaluados, áreas y condiciones de aplicación del podcast, señalándolo como una herramienta eficaz para promover el cambio de comportamiento, la promoción de la salud y la interacción social, evidenciando su potencial para mejorar el bienestar, la calidad de vida y la autonomía de los usuarios/clientes. Conclusiones: el uso del podcast demuestra ser una herramienta eficaz, innovadora y de bajo costo, con un impacto social significativo, siendo eficaz para el cambio de comportamiento, la satisfacción y la interacción social. Sin embargo, la falta de estudios exhaustivos sobre las metodologías de desarrollo de podcasts representa desafíos a superar.

RESUMO Objetivos: mapear as evidências científicas relacionadas às características, temáticas e desfechos do uso de podcasts de educação em saúde direcionados para indivíduos maiores de 18 anos nos ambientes intra ou extrahospitalares. Métodos: revisão de escopo, baseando-se no método do Joanna Briggs Institute, realizada em 11 bases de dados, incluindo estudos de 2004 a 2022. Resultados: foram selecionados 11 estudos, categorizados e destacando as características, desfechos avaliados, áreas e condições de aplicação do podcast, apontando-o como uma ferramenta eficaz para promover a mudança comportamental, a promoção da saúde e a interação social, evidenciando seu potencial para melhorar o bem-estar, qualidade de vida e autonomia dos usuários/clientes. Conclusões: o uso do podcast demonstra ser uma ferramenta eficaz, inovadora e de baixo custo, com impacto social significativo, sendo eficaz para mudança comportamental, satisfação e interação social. No entanto, a falta de estudos abrangentes sobre as metodologias de desenvolvimento de podcasts representam desafios a serem superados.

Portuguese Advance Directives-a twist against futility? A cross sectional study

ABSTRACT BACKGROUND: Advance Directive documents allow citizens to choose the treatments they want for end-of-life care without considering therapeutic futility. OBJECTIVES: To analyze patients' and caregivers' answers to Advance Directives and understand their expectations regarding their decisions. DESIGN AND SETTING: This study analyzed participants' answers to a previously published trial, conceived to test the document's efficacy as a communication tool. METHODS: Sixty palliative patients and 60 caregivers (n = 120) registered their preferences in the Advance Directive document and expressed their expectations regarding whether to receive the chosen treatments. RESULTS: In the patient and caregiver groups, 30% and 23.3% wanted to receive cardiorespiratory resuscitation; 23.3% and 25% wanted to receive artificial organ support; and 40% and 35% chose to receive artificial feeding and hydration, respectively. The participants ignored the concept of therapeutic futility and expected to receive invasive treatments. The concept of therapeutic futility should be addressed and discussed with both the patients and caregivers. Legal Advanced Directive documents should be made clear to reduce misinterpretations and potential legal conflicts. CONCLUSION: The authors suggest that all citizens should be clarified regarding the futility concept before filling out the Advance Directives and propose a grammatical change in the document, replacing the phrase "Health Care to Receive / Not to Receive" with the sentence "Health Care to Accept / Refuse" so that patients cannot demand treatments, but instead accept or refuse the proposed therapeutic plans. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT05090072 URL: https://clinicaltrials.gov/ct2/show/NCT05090072.

Jogos das Escolas Públicas do Rio Grande do Sul (JEPURS): fragmentação na estrutura esportiva estadual / Jogos das Escolas Públicas do Rio Grande do Sul (JEPURS): fragmentation in the state sports structure / Jogos das Escolas Públicas do Rio Grande do Sul (JEPURS): fragmentaciónen la estructura deportiva estatal

Introdução: Atualmente denominado Jogos Escolares do Rio Grande do Sul, o programa JERGS foi implementado no estado na década de 1970, com o objetivo de promover a participação da comunidade escolar sul-rio-grandense em um evento esportivo que contemplasse o maior número de estudantes da rede pública e particular de ensino do Rio Grande do Sul. Após 25 anos desde sua primeira edição, uma expressiva mudança alterou as conformações históricas dos JERGS, quando, em 1996, o evento foi ofertado exclusivamente a estudantes matriculados na rede pública do estado, denominando-se Jogos das Escolas Públicas do Rio Grande do Sul (JEPURS). Objetivo: Compreender que fatores históricos e sociopolíticos contribuíram para a modificação sucedida nas conformações históricas dos JEPURS noano de 1996, referente ao público escolar contemplado pelo evento. Metodologia: As informações foram coletadas por meio de fontes orais produzidas por entrevistas de História Oral e por fontes documentais. Resultados e Discussão: Evidenciamos que a modificação investigada foi decorrente de movimentos reivindicatórios promovidos por professores(as) de Educação Física que almejavam uma competição escolar exclusiva às escolas da rede pública do estado, tendo em vista algumas desvantagens e discrepâncias que estas possuíam quando comparadas ao ensino privado, tais como instalações físicas, materiais didáticos e condições de trabalho dos(as) professores(as)/treinadores(as). Considerações Finais: Este acontecimento demarcou o início de uma nova fase na história esportiva deste evento escolar sul-rio-grandense

Introduction: Currently called Jogos Escolares do Rio Grande do Sul, the JERGS program was implemented in the state in the 1970, with the aim of promoting the participation of the school community in Rio Grande do Sul in a sporting event that would include the largest number of students in the network. public and private schools in Rio Grande do Sul. After 25 years since its first edition, a significant change altered the historical conformations of the JERGS, when, in 1996, the event was offered exclusively to students enrolled in the state public network, called Jogos das Escolas Públicas do Rio Grande do Sul (JEPURS). Goal: Understand which historical and socio-political factors contributed to the successful modification in the historical conformations of the JEPURS in 1996, referring to the school public contemplated by the event. Methodology: Information was collected through oral sources produced by Oral History interviews and documentary sources. Results and Discussion: We evidence that the investigated modification was due to demanding movements promoted by Physical Education teachers who aimed for an exclusive school competition to the public schools of the state, having in view of some disadvantages and discrepancies that these had when compared to private education, such as physical facilities, teaching materials and working conditions of teachers/coaches. Final Considerations: This event marked the beginning of a new phase in the sporting history of this school event in Rio Grande do Sul.

Introducción: Actualmente conocido como Jogos Escolares do Rio Grande do Sul, el programa JERGS fue implementado en el estado en la década de 1970, con el objetivo de promover la participación de la comunidad escolar de Rio Grande do Sul en un evento deportivo que contó con la mayor cantidad de estudiantes en la Red. escuelas públicas y privadas de Rio Grande do Sul. Después de 25 años de su primera edición, un cambio significativo alteró la conformación histórica de los JERGS, cuando, en 1996, el evento fue ofrecido exclusivamente a los alumnos inscritos en la red pública estatal, denominada Jogos das Escolas Públicas do Rio Grande do Sul (JEPURS). Meta: Comprender qué factores históricos y sociopolíticos contribuyeron a la modificación exitosa en las conformaciones históricas de los JEPURS en 1996, referente al público escolar contemplado por el evento. Metodología: La información fue recolectada a través de fuentes orales producidas por entrevistas de Historia Oral y fuentes documentales. Resultados y Discusión: Evidenciamos que la modificación investigada se debió a movimientos de reivindicación promovidos por los profesores de Educación Física que pretendían una competencia escolar exclusiva a las escuelas públicas del estado, teniendo en vista de algunas desventajas y discrepancias que estas tenían en comparación con la educación privada, como las instalaciones físicas, los materiales didácticos y las condiciones de trabajo de los profesores/entrenadores. Consideraciones Finales: Este evento marcó el inicio de una nueva etapa en la historia deportiva de este evento escolar en Rio Grande do Sul.

Protocolo do Nascer no Brasil II: Pesquisa Nacional sobre Aborto, Parto e Nascimento / Protocolo del Nacer en Brasil II: Encuesta Nacional sobre Aborto, Parto y Nacimiento / Protocol of Birth in Brazil II: National Research on Abortion, Labor and Childbirth

Resumo: Com o passar do tempo, o Brasil vem apresentando avanços na assistência obstétrica em hospitais públicos e privados; no entanto, ainda existem pontos frágeis que necessitam de atenção. O Ministério da Saúde, ciente dessa necessidade, financiou a segunda versão da pesquisa Nascer no Brasil. Os objetivos gerais são: avaliar a assistência pré-natal, ao parto e nascimento, ao puerpério e ao aborto, comparando com os resultados do Nascer no Brasil I, e analisar os principais determinantes da morbimortalidade perinatal; avaliar a estrutura e processos assistenciais dos serviços de obstetrícia e neonatologia das maternidades; analisar os conhecimentos, atitudes e práticas de profissionais de saúde que prestam assistência ao parto e ao aborto; e identificar as principais barreiras e facilitadores para essa assistência no país. Com escopo nacional e amostra probabilística em dois estágios (1-hospitais e 2-mulheres), dividida em 59 estratos, foram selecionados 465 hospitais com total planejado de, aproximadamente, 24.255 mulheres, 2.205 por motivo de aborto e 22.050 por motivo de parto. A coleta de dados, realizada por meio de seis instrumentos eletrônicos, ocorre durante a internação hospitalar para o parto ou aborto, com duas ondas de seguimento, aos dois e quatro meses. Com o intuito de expandir o número de casos de morbidade materna grave, mortalidade materna e perinatal, três estudos caso controle foram incorporados ao Nascer no Brasil II. O trabalho de campo foi iniciado em novembro de 2021 com término previsto para 2023. Os resultados permitirão comparar a atenção atual ao parto e ao nascimento com a retratada no primeiro inquérito e, com isso, avaliar os avanços alcançados no decorrer desses 10 anos.

Resumen: Aunque Brasil ha presentado avances en la atención obstétrica en hospitales públicos y privados, todavía hay puntos débiles que necesitan atención. El Ministerio de Salud, consciente de esta necesidad, financió la segunda versión de la encuesta Nacer en Brasil. Los objetivos generales son: evaluar la atención prenatal, el parto y el nacimiento, el puerperio y el aborto, comparando con los resultados del Nacer en Brasil I, y analizar los principales determinantes de la morbimortalidad perinatal; evaluar la estructura y los procesos de atención de los servicios de obstetricia y neonatología en las maternidades; analizar los conocimientos, prácticas y actitudes de los profesionales de la salud que brindan atención para el parto y el aborto; e identificar las principales barreras y facilitadores para esta atención en el país. Tiene un alcance nacional y muestra probabilística en dos etapas (1-hospitales y 2-mujeres), la cual se dividió en 59 estratos; y se seleccionaron 465 hospitales con un total planificado de aproximadamente 24.255 mujeres, de las cuales 2.205 tuvieron procedimientos por aborto y 22.050 por parto. Para la recolección de datos se aplicó seis instrumentos electrónicos, que se realizó durante la hospitalización por parto o aborto, con dos rondas de seguimiento, a los dos y cuatro meses. Con el fin de ampliar el número de casos de morbilidad materna grave, mortalidad materna y perinatal, se incorporaron tres estudios de casos y controles en Nacer en Brasil II. El trabajo de campo comenzó en noviembre de 2021 y finalizará en 2023. Los resultados nos permitirán evaluar la atención al parto y al nacimiento actual con lo que se retrató en la primera encuesta, de esta manera se podrá evaluar los avances alcanzados a lo largo de estos 10 años.

Abstract: Brazil has made advances in obstetric care in public and private hospitals; however, weaknesses in this system still require attention. The Brazilian Ministry of Health, aware of this need, funded the second version of the Birth in Brazil survey. This study aimed to evaluate: prenatal, labor and birth, postpartum, and abortion care, comparing the results with those of Birth in Brazil I; and analyze the main determinants of perinatal morbidity and mortality; evaluate the care structure and processes of obstetrics and neonatology services in maternity hospitals; analyze the knowledge, practices, and attitudes of health professionals who provide birth and abortion care; and identify the main barriers and facilitators related to care of this nature in Brazil. With a national scope and a 2-stage probability sample: 1-hospitals and 2-women, stratified into 59 strata, 465 hospitals were selected with a total planned sample of around 24,255 women - 2,205 for abortion reasons and 22,050 for labor reasons. Data collection was conducted using six electronic instruments during hospital admission for labor or abortion, with two follow-up waves, at two and four months. In order to expand the number of cases of severe maternal morbidity, maternal and perinatal mortality, three case control studies were incorporated into Birth in Brazil II. The fieldwork began in November 2021 and is scheduled to end in 2023. It will allow a comparison between current labor and birth care results and those obtained in the first study and will evaluate the advances achieved in 10 years.