Accuracy of Doppler ultrasound in the diagnosis of giant cell arteritis: a systematic review and meta-analysis.

BACKGROUND: Giant cell arteritis (GCA) is the most common primary systemic vasculitis in people 50 years of age and over, and it is considered a medical emergency due to the potential risk of permanent visual loss. Color Doppler ultrasound (CDU) of the temporal arteries is a rapid, noninvasive method to diagnose GCA. This study aims to determine the diagnostic accuracy of the halo sign in temporal arteries by CDU in people with suspected GCA. METHODS: The systematic literature review included the search for publications in the following electronic databases: PubMed, Embase, CENTRAL, LILACS, WHO ICTRP, ClinicalTrials.gov, gray literature up to December 2022, and no date or language restrictions were applied. We analyzed studies including patients over 50 years of age with suspected GCA evaluating CDU of temporal arteries as a diagnostic tool against clinical diagnosis as a standard reference. Paper titles and abstracts were selected by two investigators independently for all available records. The quality of the studies was assessed using the Quality of Diagnostic Accuracy Studies tool (QUADAS-2) and the R software (version 4.2.1) was used for data analysis. The protocol of this review is registered with PROSPERO (CRD42016033079). RESULTS: Twenty-two studies including 2893 participants with suspected GCA who underwent temporal artery CDU were evaluated. The primary analysis results showed a sensitivity of 0.76 [95% confidence interval (95 CI) 0.69-0.81] and specificity of 0.93 (95 CI 0.89-0.95) when the halo sign was compared to clinical diagnosis. The sensitivity value of 0.84 (95 CI 0.72-0.92) and specificity of 0.95 (95 CI 0.88-0.98) were found in five studies involving 1037 participants that analyzed the halo sign and temporal artery compression sign. A sensitivity of 0.86 (95 CI 0.78-0.91) and specificity of 0.95 (95 CI 0.89-0.98) were found in four studies with 603 participants where the halo sign was evaluated CDU on temporal and axillary arteries. CONCLUSION: The detection of the halo sign by CDU of temporal arteries has good accuracy for the diagnosis of cranial GCA. The compression sign in temporal arteries and the addition of axillary arteries assessment improves the diagnostic performance of CDU for GCA. TRIAL REGISTRATION: PROSPERO CRD42016046860.

Accuracy of Doppler ultrasound in the diagnosis of giant cell arteritis: a systematic review and meta-analysis

Abstract Background Giant cell arteritis (GCA) is the most common primary systemic vasculitis in people 50 years of age and over, and it is considered a medical emergency due to the potential risk of permanent visual loss. Color Doppler ultrasound (CDU) of the temporal arteries is a rapid, noninvasive method to diagnose GCA. This study aims to determine the diagnostic accuracy of the halo sign in temporal arteries by CDU in people with suspected GCA. Methods The systematic literature review included the search for publications in the following electronic databases: PubMed, Embase, CENTRAL, LILACS, WHO ICTRP, ClinicalTrials.gov, gray literature up to December 2022, and no date or language restrictions were applied. We analyzed studies including patients over 50 years of age with suspected GCA evaluating CDU of temporal arteries as a diagnostic tool against clinical diagnosis as a standard reference. Paper titles and abstracts were selected by two investigators independently for all available records. The quality of the studies was assessed using the Quality of Diagnostic Accuracy Studies tool (QUADAS-2) and the R software (version 4.2.1) was used for data analysis. The protocol of this review is registered with PROSPERO (CRD42016033079). Results Twenty-two studies including 2893 participants with suspected GCA who underwent temporal artery CDU were evaluated. The primary analysis results showed a sensitivity of 0.76 [95% confidence interval (95 CI) 0.69-0.81] and specificity of 0.93 (95 CI 0.89-0.95) when the halo sign was compared to clinical diagnosis. The sensitivity value of 0.84 (95 CI 0.72-0.92) and specificity of 0.95 (95 CI 0.88-0.98) were found in five studies involving 1037 participants that analyzed the halo sign and temporal artery compression sign. A sensitivity of 0.86 (95 CI 0.78-0.91) and specificity of 0.95 (95 CI 0.89-0.98) were found in four studies with 603 participants where the halo sign was evaluated CDU on temporal and axillary arteries. Conclusion The detection of the halo sign by CDU of temporal arteries has good accuracy for the diagnosis of cranial GCA. The compression sign in temporal arteries and the addition of axillary arteries assessment improves the diagnostic performance of CDU for GCA. Trial registration PROSPERO CRD42016046860.

Resilience Programs for Children and Adolescents: A Systematic Review and Meta-Analysis.

Resilience may be defined as the ability to recover and adapt to adverse situations. Given that resilience involves cognitive and behavioral aspects, it could be promoted based on strategies that favor them, especially during childhood and adolescence. As a result, several resilience-focused programs have been developed and studied. This systematic review of Randomized Controlled Trials (RCTs) aimed to assess resilience-focused programs for children (<12 years old) and adolescents (12-22 years old) compared to active (treatment as usual, other program modalities, and educational curriculum at school) or inactive (waiting list, no treatment) control groups. We performed a systematic review of meta-analyses of RCTs. The following databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and PsycINFO. Two authors independently selected the studies, extracted the data, and assessed the studies' risk of bias. Meta-analyses of random effects were conducted to calculate the standard mean differences (SMD) and 95% confidence interval (CI) of program effectiveness. Of the 17 RCTs that met the inclusion criteria, 13 provided sufficient data to assess the effectiveness of the programs after their implementation. Meta-analyses indicated overall effectiveness of the programs in promoting resilience (SMD = 0.48, 95% CI [0.15, 0.81], p = 0.0077). The subgroup analysis indicated effectiveness only among adolescents' resilience (SMD = 0.48, 95% CI [0.08, 0.88], p = 0.02). The follow-up analysis also indicated evidence of continuation of results within a period of up to 6 months up (SMD = 0.12, 95% CI [-0.44, 0.69], p = 0.02). These results indicated the effectiveness of promoting resilience, especially in adolescents, and its continuation in follow-up analyses. These findings are promising in the field of resilience programs; however, further studies are necessary to analyze the different possible characteristics of programs and their results. Clinical Trial Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020179874], [CRD42020179874].

lilacs search strategy for systematic reviews of diagnostic test accuracy studies.

BACKGROUND: There are few publications on search strategies to identify diagnostic test accuracy (DTA) studies in lilacs. OBJECTIVE: To translate and customise medline search strategies for use in lilacs and assess their retrieval of studies in Cochrane DTA systematic reviews. METHOD: We developed a six-step process to translate and customise medline search strategies for use in lilacs (iAHx interface). We identified medline search strategies of published Cochrane DTA reviews, translated/customised them for use in lilacs, ran searches in lilacs and compared the retrieval results of our translated search strategy versus the one used in the published reviews. RESULTS: Our lilacs search strategies translated/customised from the medline strategies retrieved studies in 70 Cochrane DTA reviews. Only 29 of these reviews stated that they had searched the lilacs database and 21 published their lilacs search strategies. Few had used the lilacs database search tools, none exploded the subject headings, and 86% used only English terms. CONCLUSION: Translating and tailoring a medline search strategy for the lilacs database resulted in the retrieval of DTA studies that would have been missed otherwise.

Statins for aortic valve stenosis

ABSTRACT BACKGROUND: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES: To evaluate the effectiveness and safety of statins in aortic valve stenosis. METHODS: Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions. Selection criteria: Randomized controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life. Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. MAIN RESULTS: We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80; participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0.14; participants = 155; study = 1). Moderate-quality evidence showed no effect on freedom from valve replacement with statins (risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies = 4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75 to 1.09; participants = 2204; studies = 3; moderate-quality evidence). Low- and very low-quality evidence showed uncertainty around the effect of statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15; participants = 2297; studies = 3; low-quality evidence) and hospitalization for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants = 155; study = 1; very low-quality evidence). None of the four included studies reported on overall mortality and patient quality of life. AUTHORS CONCLUSIONS: Result findings showed uncertainty surrounding the effect of statins for aortic valve stenosis. The quality of evidence from the reported outcomes ranged from moderate to very low. These results give support to European and USA guidelines (2012 and 2014, respectively) that so far there is no clinical treatment option for aortic valve stenosis.

Statins for aortic valve stenosis.

BACKGROUND:: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES:: To evaluate the effectiveness and safety of statins in aortic valve stenosis. METHODS:: Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions.Selection criteria: Randomized controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life.Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. MAIN RESULTS:: We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80; participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0.14; participants = 155; study = 1). Moderate-quality evidence showed no effect on freedom from valve replacement with statins (risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies = 4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75 to 1.09; participants = 2204; studies = 3; moderate-quality evidence). Low- and very low-quality evidence showed uncertainty around the effect of statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15; participants = 2297; studies = 3; low-quality evidence) and hospitalization for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants = 155; study = 1; very low-quality evidence). None of the four included studies reported on overall mortality and patient quality of life. AUTHORS CONCLUSIONS:: Result findings showed uncertainty surrounding the effect of statins for aortic valve stenosis. The quality of evidence from the reported outcomes ranged from moderate to very low. These results give support to European and USA guidelines (2012 and 2014, respectively) that so far there is no clinical treatment option for aortic valve stenosis.

Accelerated partial irradiation for breast cancer: systematic review and meta-analysis of 8653 women in eight randomized trials.

BACKGROUND AND PURPOSE: Accelerated partial breast irradiation (APBI) is the strategy that allows adjuvant treatment delivery in a shorter period of time in smaller volumes. This study was undertaken to assess the effectiveness and outcomes of APBI in breast cancer compared with whole-breast irradiation (WBI). MATERIAL AND METHODS: Systematic review and meta-analysis of randomized controlled trials of WBI versus APBI. Two authors independently selected and assessed the studies regarding eligibility criteria. RESULTS: Eight studies were selected. A total of 8653 patients were randomly assigned for WBI versus APBI. Six studies reported local recurrence outcomes. Two studies were matched in 5 years and only one study for different time of follow-up. Meta-analysis of two trials assessing 1407 participants showed significant difference in the WBI versus APBI group regarding the 5-year local recurrence rate (HR=4.54, 95% CI: 1.78-11.61, p=0.002). Significant difference in favor of WBI for different follow-up times was also found. No differences in nodal recurrence, systemic recurrence, overall survival and mortality rates were observed. CONCLUSIONS: APBI is associated with higher local recurrence compared to WBI without compromising other clinical outcomes.

Methodological quality of systematic reviews and clinical trials on women's health published in a Brazilian evidence-based health journal.

OBJECTIVES: To assess the quality of systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based health journal. METHOD: All systematic reviews and clinical trials on women's health published in the last five years in the Brazilian Journal of Evidence-based Health were retrieved. Two independent reviewers critically assessed the methodological quality of reviews and trials using AMSTAR and the Cochrane Risk of Bias Table, respectively. RESULTS: Systematic reviews and clinical trials accounted for less than 10% of the 61 original studies on women's health published in the São Paulo Medical Journal over the last five years. All five reviews were considered to be of moderate quality; the worst domains were publication bias and the appropriate use of study quality in formulating conclusions. All three clinical trials were judged to have a high risk of bias. The participant blinding, personnel and outcome assessors and allocation concealment domains had the worst scores. CONCLUSIONS: Most of the systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based journal are of low to moderate quality. The quality of these types of studies needs improvement.

Evaluation of a national evidence-based health care course via teleconference in a developing country.

RATIONALE, AIMS AND OBJECTIVES: Continuing health education is essential but challenged. In 2006, the Brazilian Cochrane Center, in collaboration with the Ministry of Health, launched a mass teaching initiative in evidence-based health care (EBH) for public-sector professionals via teleconferencing. This 152-hour, interactive EBH course has enrolled over 4500 professionals. This study aimed to assess the acquisition EBH knowledge and skills, as well as the attitudes and perceptions of a sample of students enrolled in the 2009 course via teleconferencing. METHODS: This prospective cohort study analyzed three aspects of this 152-hour EBH course that recruited 1040 volunteer participants, all public health sector employees working in 131 different hospitals or health agencies. Pre- and post-course tests using a modified version of the Berlin questionnaire with 20 multiple-choice questions were used to examine knowledge acquisition in a sample of 297 students. Tests were completed upon registration and at course completion. The research projects submitted by 872 participants were evaluated to assess skill acquisition. Answers to an anonymous survey assessed the attitudes and perceptions of 914 participants. RESULTS: There was a significant increase in knowledge from baseline to course completion (mean scores 8.2 ± 3.3 versus 13.7 ± 3.0, P < 0.001). Over 90% of the research projects were judged to be of adequate quality (appropriate rationale for the study, well-formulated research question and feasible execution); over 95% of the participants were satisfied with the course. CONCLUSION: The Brazilian EBH course via teleconference improved the knowledge and skills of public-sector health professionals and was approved by the vast majority of students.

Methodological quality of systematic reviews and clinical trials on women's health published in a Brazilian evidence-based health journal

OBJECTIVES: To assess the quality of systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based health journal. METHOD: All systematic reviews and clinical trials on women's health published in the last five years in the Brazilian Journal of Evidence-based Health were retrieved. Two independent reviewers critically assessed the methodological quality of reviews and trials using AMSTAR and the Cochrane Risk of Bias Table, respectively. RESULTS: Systematic reviews and clinical trials accounted for less than 10% of the 61 original studies on women's health published in the São Paulo Medical Journal over the last five years. All five reviews were considered to be of moderate quality; the worst domains were publication bias and the appropriate use of study quality in formulating conclusions. All three clinical trials were judged to have a high risk of bias. The participant blinding, personnel and outcome assessors and allocation concealment domains had the worst scores. CONCLUSIONS: Most of the systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based journal are of low to moderate quality. The quality of these types of studies needs improvement. .

Mandibular manipulation for the treatment of temporomandibular disorder.

The aim of this study was to conduct a systematic review to identify the randomized clinical studies that had investigated the following research question: Is the mandibular manipulation technique an effective and safe technique for the treatment of the temporomandibular joint disk displacement without reduction? The systematic search was conducted in the electronic databases: PubMed (Medical Publications), LILACS (Latin American and Caribbean Literature in Health Sciences), EMBASE (Excerpta Medica Database), PEDro (Physiotherapy Evidence Database), BBO (Brazilian Library of Odontology), CENTRAL (Library Cochrane), and SciELO (Scientific Electronic Library Online). The abstracts of presentations in physical therapy meetings were manually selected, and the articles of the ones that meet the requirements were investigated. No language restrictions were considered. Only randomized and controlled clinical studies were included. Two studies of medium quality fulfilled all the inclusion criteria. There is no sufficient evidence to support the effectiveness of the mandibular manipulation therapy, and therefore its use remains questionable. Being minimally invasive, this therapy is attractive as an initial approach, especially considering the cost of the alternative approaches. The analysis of the results suggests that additional high-quality randomized clinical trials are necessary on the topic, and they should focus on methods for data randomization and allocation, on clearly defined outcomes, on a priori calculated sample size, and on an adequate follow-up strategy.

Low-level laser therapy for treatment of pain associated with orthodontic elastomeric separator placement: a placebo-controlled randomized double-blind clinical trial.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of the use of irradiation with a low-level laser therapy (LLLT), wavelength 830 nm, for treating pain inherent to tooth movement caused by orthodontic devices, simulated by positioning interdental elastomeric separators. METHODS: Sixty orthodontic patients were randomly assigned to two groups: GA (ages 12-25 years; mean 17.1 years) was the control, and GB (ages 12-26 years; mean 17.9 years) the intervention group. All patients received elastomeric separators on the mesial and distal surfaces of one of the lower first molars, and immediately after insertion of the separators received irradiation as randomly indicated. The intervention group (GB) received irradiation with LLLT (aluminum gallium arsenide diode), by a single spot in the region of the radicular apex at a dose of 2 J/cm(2) and application along the radicular axis of the buccal surface with three spots of 1 J/cm(2) (wavelength 830 nm; infrared). Control group (GA) received irradiation with a placebo light in the same way. This was a double-blind study. All the patients received a questionnaire to be filled out at home describing their levels of pain 2, 6, and 24 h and 3 and 5 days after orthodontic separator placement, in situations of relaxed and occluded mouth. RESULTS: The patients in the intervention group (LLLT) had lower mean pain scores in all the measures. The incidence of complete absence of pain (score=0) was significantly higher the intervention group. CONCLUSIONS: Based on this study, authors concluded that single irradiation with LLLT of wavelength 830 nm efficiently controlled the pain originating from positioning interdental elastomeric separators, to reproduce the painful sensation experienced by patients when fixed orthodontic devices are used.

Cuidados gerais e higiene oral para prevenção de cáries em crianças / General care and oral hygiene to prevent tooth decay in children

Recomenda-se evitar o contato direto entre a saliva da mãe e da criança, pois a transmissão do Streptococos mutans ocorre por meio da saliva, de forma direta (beijo na boca) ou indireta (soprar alimentos, usar os mesmos talheres e copos). Sabe-se que quanto mais precoce a colonização da cavidade bucal pelo S. mutans, maior o risco de cárie na dentição decídua, ou seja, nos dentes de leite.O flúor é um importante agente na luta contra o aparecimento da cárie. Pode ser de uso individual (creme dental e o enxaguatório) ou profissional (gel, verniz e selantes). O creme dental com flúor, usado diariamente, é uma medida fundamental, pois oferece o flúor em baixas concentrações e em alta frequência, atuando na remineralização do esmalte.Os selantes de fóssulas e fissuras podem ser usados para prevenir o aparecimento de cáries nas crianças.É importante além desses meios de prevenção a mudança de hábitos alimentares, priorizando o consumo de uma dieta saudável rica em verduras, frutas e legumes e reduzindo a quantidade e a frequência do consumo de carboidratos refinados, principalmente, os doces presentes entre as refeições, já que dificilmente a criança higienizará seus dentes após o seu consumo.

Methodological adequacy of articles published in two open-access Brazilian cardiology periodicals.

CONTEXT AND OBJECTIVE: The use of rigorous scientific methods has contributed towards developing scientific articles of excellent methodological quality. This has made it possible to promote their citation and increase the impact factor. Brazilian periodicals have had to adapt to certain quality standards demanded by these indexing organizations, such as the content and the number of original articles published in each issue. This study aimed to evaluate the methodological adequacy of two Brazilian periodicals within the field of cardiology that are indexed in several databases and freely accessible through the Scientific Electronic Library Online (SciELO), and which are now indexed by the Web of Science (Institute for Scientific Information, ISI). DESIGN AND SETTING: Descriptive study at Brazilian Cochrane Center. METHODS: All the published articles were evaluated according to merit assessment (content) and form assessment (performance). RESULTS: Ninety-six percent of the articles analyzed presented study designs that were adequate for answering the objectives. CONCLUSIONS: These two Brazilian periodicals within the field of cardiology published methodologically adequate articles, since they followed the quality standards. Thus, these periodicals can be considered both for consultation and as vehicles for publishing future articles. For further analyses, it is essential to apply other indicators of scientific activity such as bibliometrics, which evaluates quantitative aspects of the production, dissemination and use of information, and scientometrics, which is also concerned with the development of science policies, within which it is often superimposed on bibliometrics.

Methodological adequacy of articles published in two open-access Brazilian cardiology periodicals / Adequação metodológica dos artigos publicados em dois periódicos brasileiros de cardiologia disponíveis em open-access

CONTEXT AND OBJECTIVE: The use of rigorous scientific methods has contributed towards developing scientific articles of excellent methodological quality. This has made it possible to promote their citation and increase the impact factor. Brazilian periodicals have had to adapt to certain quality standards demanded by these indexing organizations, such as the content and the number of original articles published in each issue. This study aimed to evaluate the methodological adequacy of two Brazilian periodicals within the field of cardiology that are indexed in several databases and freely accessible through the Scientific Electronic Library Online (SciELO), and which are now indexed by the Web of Science (Institute for Scientific Information, ISI). DESIGN AND SETTING: Descriptive study at Brazilian Cochrane Center. METHODS: All the published articles were evaluated according to merit assessment (content) and form assessment (performance). RESULTS: Ninety-six percent of the articles analyzed presented study designs that were adequate for answering the objectives. CONCLUSIONS: These two Brazilian periodicals within the field of cardiology published methodologically adequate articles, since they followed the quality standards. Thus, these periodicals can be considered both for consultation and as vehicles for publishing future articles. For further analyses, it is essential to apply other indicators of scientific activity such as bibliometrics, which evaluates quantitative aspects of the production, dissemination and use of information, and scientometrics, which is also concerned with the development of science policies, within which it is often superimposed on bibliometrics.

CONTEXTO E OBJETIVO: A utilização de métodos científicos rigorosos tem contribuído para o desenvolvimento de artigos científicos de excelente qualidade metodológica, o que permite a promoção da sua citação, bem como o aumento do fator de impacto. Os periódicos nacionais tiveram que se adequar a alguns padrões de qualidade exigidos pelos indexadores, como por exemplo o conteúdo e o número de artigos originais publicados em cada fascículo. O objetivo foi avaliar a adequação metodológica de dois periódicos brasileiros, na área de cardiologia, indexados em várias bases de dados e disponíveis em livre acesso na Scientific Electronic Library Online (SciELO) e atualmente indexados na Web of Science (Institute for Scientific Information, ISI). TIPO DE ESTUDO E LOCAL: Estudo descritivo realizado no Centro Cochrane do Brasil. MÉTODO: Todos os artigos foram avaliados quanto ao mérito (conteúdo) e quanto à forma (desempenho). RESULTADO: Foi observada uma taxa de 96 por cento de adequação metodológica entre os artigos avaliados, que apresentaram desenho de estudo adequado para responder o objetivo proposto. CONCLUSÕES: Esses dois periódicos brasileiros na área da cardiologia publicaram artigos metodologicamente adequados, considerando os critérios de qualidade utilizados. Assim, esses periódicos podem ser considerados para consulta e como veículos para a publicação de artigos futuros. Para análises posteriores, é essencial a aplicação de outros indicadores de atividade científica, como a bibliometria, que avalia aspectos quantitativos da produção, disseminação e uso da informação, e a cienciometria, que também considera o desenvolvimento de políticas de ciência, e que muitas vezes se sobrepõe à bibliometria.

Evidence in dentistry guidelines / Evidências nos guidelines de odontologia

CONTEXT AND OBJECTIVE: Guidelines are suggestions for clinical practice based on the best available scientific evidence. Nevertheless, in drafting such guidelines, existing systematic reviews are often ignored and are replaced by general consensuses. This ends up compromising the quality of the instructions through bias. Our objective was to investigate whether Cochrane systematic reviews were present among the bibliographic references of prevention and treatment guidelines for dentistry that have been published in databases. DESIGN AND SETTING: This retrospective, observational study was conducted at the Brazilian Cochrane Center. METHODS: The databases were searched for guidelines. Any guidelines obtained were then checked to find whether Cochrane systematic reviews were present in the bibliographic references of the guidelines. In their absence, we checked whether such reviews had not been included because no reviews existed yet, or because such reviews had not been consulted despite already existing. RESULTS: 223 studies were initially selected; of these, 77 were excluded. Of the 146 guidelines included, 46 could have made reference to existing systematic reviews, but only 13 studies did so. Among these 13 studies, eight were systematic reviews following Cochrane methodology. Thirty-three guidelines had not been drafted using published systematic reviews as references, and 100 guidelines had been unable to use Cochrane references because no reviews existed yet. CONCLUSION: It is necessary to increase awareness of the importance of using systematic reviews in drafting dentistry guidelines. Likewise, it is necessary to develop systematic reviews that answer questions on the various topics that remain unanswered.

CONTEXTO E OBJETIVO: Diretrizes são sugestões de condutas clínicas baseadas nas melhores evidências científicas disponíveis. No entanto, muitas vezes, para a construção da diretriz, as revisões sistemáticas existentes são desconsideradas e substituídas por consensos, o que acaba comprometendo a qualidade das suas instruções por serem enviesadas. O objetivo foi verificar a presença das revisões sistemáticas Cochrane nas referências bibliográficas das diretrizes de prevenção e tratamento na odontologia publicados nas bases de dados. LOCAL E TIPO DE ESTUDO: Estudo retrospectivo observacional, conduzido no Centro Cochrane do Brasil. MÉTODOS: Busca das diretrizes foi realizada nas bases de dados. A partir da obtenção delas, foram checadas a existência de revisões sistemáticas Cochrane nas suas referências bibliográficas. Na sua ausência, era verificada se a revisão sistemática não foi incluída porque ainda não existe ou porque, existindo, não foi consultada. RESULTADOS: Foram previamente selecionados 223 estudos, e destes, 77 foram excluídos. Das 146 diretrizes incluídas, 46 poderiam incluir em suas referências as revisões sistemáticas existentes, mas apenas 13 estudos o fizeram, dentre eles somente 8 eram revisões sistemáticas com metodologia Cochrane. Trinta e três diretrizes não usaram para a sua construção as referências de revisões sistemáticas já publicadas e em 100 delas não seria possível a inclusão das referências Cochrane por ainda não existirem as revisões. CONCLUSÕES: É necessária a conscientização da importância do uso das revisões sistemáticas na construção de diretrizes em odontologia, bem como o desenvolvimento de revisões sistemáticas que respondam perguntas que versam sobre os diversos temas ainda não respondidos.

Aperfeiçoamento em saúde baseada em evidências por teleconferência / Health improvement based on teleconferencing evidence

.A medicina baseada em evidências surgiu com o objetivo de auxiliar os profissionais da área da saúde a tomarem as melhores decisões para prevenção, diagnóstico e tratamento da população.O curso Saúde Baseada em Evidências teve como objetivo capacitar os profissionais da área da saúde a tomarem as decisões baseadas nas melhores evidências, buscando proporcionar mais benefícios do que riscos aos pacientes e usar, de maneira consciente e econômica, os recursos tecnológicos e financeiros disponibilizados pelo Ministério de Saúde para o atendimento da população.Dos 2.000 inscritos, 1.374 assistiram o curso e 957 apresentaram trabalho de conclusão de curso, ou seja, 70% dos alunos participaram ativamente das atividades no decorrer do ano.Os alunos aprenderam conceitos relacionados à avaliação crítica de evidências e à metodologia de pesquisa clínica. Eles foram treinados a fazer análise apurada dos métodos de pesquisa, valorizando o desenho, a condução e a análise estatística do estudo. Em novembro de 2008 uma nova edição do curso foi iniciada, com cerca de 2.900 profissionais inscritos. O aumento significativo do número de inscrições (mais do que o dobro da edição anterior) reflete o impacto do curso na vida dos profissionais e traduz a importância da busca das melhores evidências para a tomada de decisão.Em função dessas experiências, hoje o Brasil é o país que conta com o maior curso de aperfeiçoamento de Saúde Baseada em Evidências. Tais iniciativas superam todos os cursos já ministrados em países desenvolvidos, como Reino Unido, Canadá, Austrália e outros, que têm por base a Medicina Baseada em Evidências nas suas tomadas de decisão

Evidence in dentistry guidelines.

CONTEXT AND OBJECTIVE: Guidelines are suggestions for clinical practice based on the best available scientific evidence. Nevertheless, in drafting such guidelines, existing systematic reviews are often ignored and are replaced by general consensuses. This ends up compromising the quality of the instructions through bias. Our objective was to investigate whether Cochrane systematic reviews were present among the bibliographic references of prevention and treatment guidelines for dentistry that have been published in databases. DESIGN AND SETTING: This retrospective, observational study was conducted at the Brazilian Cochrane Center. METHODS: The databases were searched for guidelines. Any guidelines obtained were then checked to find whether Cochrane systematic reviews were present in the bibliographic references of the guidelines. In their absence, we checked whether such reviews had not been included because no reviews existed yet, or because such reviews had not been consulted despite already existing. RESULTS: 223 studies were initially selected; of these, 77 were excluded. Of the 146 guidelines included, 46 could have made reference to existing systematic reviews, but only 13 studies did so. Among these 13 studies, eight were systematic reviews following Cochrane methodology. Thirty-three guidelines had not been drafted using published systematic reviews as references, and 100 guidelines had been unable to use Cochrane references because no reviews existed yet. CONCLUSION: It is necessary to increase awareness of the importance of using systematic reviews in drafting dentistry guidelines. Likewise, it is necessary to develop systematic reviews that answer questions on the various topics that remain unanswered.