Strategies for promoting mental health among residents: scoping review protocol.

Health professionals are encouraged to attend a residency period of two to seven years after graduating. The typical demands of this in-service training modality have been associated with reduced sleep quality, decreased exercise frequency, and detachment from family and social relationships, leading to an increased diagnosis of anxiety, depression, and burnout syndrome. Therefore, conducting a scoping review to identify strategies aimed at promoting mental health and wellbeing among residents from different health areas is essential to support any forthcoming preventive action

Minimally invasive interventions for biopsy of malignancy-suspected pulmonary nodules: a systematic review and meta-analysis

ABSTRACT BACKGROUND: Imaging tests are important for diagnosis during the management of pulmonary nodules; however, biopsy is required to confirm the malignancy. OBJECTIVES: To compare the effects of different techniques used for the biopsy of a pulmonary nodule. DESIGN AND SETTING: Systematic review and meta-analysis were conducted using Cochrane methodology in São Paulo, São Paulo, Brazil. METHODS: We conducted a systematic review of randomized controlled trials (RCTs) on minimally invasive techniques, including tomography-guided percutaneous biopsy (PERCUT), transbronchial biopsies with fluoroscopy (FLUOR), endobronchial ultrasound (EBUSR), and electromagnetic navigation (NAVIG). The primary outcomes were diagnostic yield, major adverse events, and need for another approach. RESULTS: Seven RCTs were included (913 participants; 39.2% female, mean age: 59.28 years). Little to no increase was observed in PERCUT over FLUOR (P = 0.84), PERCUT over EBUSR (P = 0.32), and EBUSR over NAVIG (P = 0.17), whereas a slight increase was observed in NAVIG over FLUOR (P = 0.17); however, the evidence was uncertain. EBUSR may increase the diagnostic yield over FLUOR (P = 0.34). PERCUT showed little to no increase in all bronchoscopic techniques, with uncertain evidence (P = 0.02). CONCLUSION: No biopsy method is definitively superior to others. The preferred approach must consider availability, accessibility, and cost, as safety and diagnostic yield do not differ. Further RCTs planned, conducted, and reported with methodological rigor and transparency are needed, and additional studies should assess cost and the correlation between nodule size and location, as well as their association with biopsy results. SYSTEMATIC REVIEW REGISTRATION: PROSPERO database, CRD42018092367 -https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=92367

What do Cochrane systematic reviews say about interventions for vitamin D supplementation?

CONTEXT AND OBJECTIVE: Despite the high prevalence of vitamin D supplementation, its use remains controversial. The objective of this review was to identify and summarize the evidence from Cochrane systematic reviews regarding vitamin D supplementation for preventing or treating any clinical condition. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo. METHODS: A search was conducted to identify all Cochrane systematic reviews that fulfilled the inclusion criteria. Titles and abstracts were screened by two authors. RESULTS: We included 27 Cochrane systematic reviews: 10 assessing use of vitamin D for prevention and 17 for treatment. The reviews found moderate to high quality of evidence regarding the benefit of vitamin D for pregnant women (prevention of adverse events: preterm birth risk [rate ratio, RR 0.3695% confidence interval, CI 0.14 to 0.93] and low birthweight risk [RR 0.4095% CI 0.24 to 0.67]) and for asthma patients (reduction of severe exacerbations [RR 0.6395% CI 0.45 to 0.88]). No benefit was found regarding vitamin D supplementation alone (without calcium) for preventing hip or any new fracture. For all other outcomes assessed under various conditions, the current quality of evidence is low or unknown, and therefore insufficient for any recommendation. CONCLUSION: Based on moderate to high quality of evidence, the Cochrane systematic reviews included here showed that there were some benefits from vitamin D supplementation for pregnant women and asthma patients and no benefits for preventing fractures.Univ Fed Sao Paulo EPM Unifesp, Escola Paulista Med, Discipline Evidence Based Hlth, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM Unifesp, Escola Paulista Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Postgrad Evidence Based Hlth Program, Sao Paulo, SP, BrazilCochrane Brazil, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM Unifesp, Escola Paulista Med, Discipline Evidence Based Hlth, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM Unifesp, Escola Paulista Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Postgrad Evidence Based Hlth Program, Sao Paulo, SP, BrazilWeb of Scienc

Palliative care interventions for people with multiple sclerosis

Objetivo: Avaliar os efeitos (benefícios e riscos) das intervenções em cuidados paliativos comparadas ao tratamento usual para pessoas com qualquer apresentação de esclerose múltipla (EM) ou qualquer nível de impacto dos sintomas. Nosso objetivo também foi comparar os efeitos de diferentes intervenções em cuidados paliativos. Métodos: Revisão sistemática Cochrane de ensaios clínicos randomizados (ECRs). As seguintes bases de dados eletrônicas foram utilizadas: CENTRAL, MEDLINE, Embase, LILACS, PsycINFO, PEDro, CINAHL, Opengrey, clinicaltrials.gov e WHO-ICTRP. Não houve restrição de idioma ou data de publicação. Foram incluídos ECRs, ECRs do tipo cluster e primeira fase de ECRs do tipo cross-over que avaliaram qualquer intervenção em cuidados paliativos comparadas a qualquer outro tipo de intervenção ou a nenhuma intervenção para pessoas com EM adultos de qualquer idade. Desfechos primários: qualidade de vida e eventos adversos. Desfechos secundários: fadiga, função cognitiva, incapacidade, ansiedade, depressão, admissão hospitalar e sobrevida livre de progressão da doença. A seleção, extração dos dados e avaliação do risco de viés dos estudos incluídos foram realizadas por dois revisores, de forma independente. A certeza da evidência foi avaliada segundo o Grading of Recommendations Assessment, Development and Evaluation (GRADE). Como medidas resumo das estimativas de tamanho do efeito, foi calculado o risco relativo (RR) para os dados dicotômicos e a diferença de média (DM) para os dados contínuos, com intervalo de confiança de 95% (IC 95%). Resultados: Foram incluídos três estudos (146 participantes). Dois estudos compararam cuidados paliativos realizado por equipe multiprofissional de encaminhamento imediato versus lista de espera enquanto recebiam cuidado usual multiprofissional; e um estudo comparou cuidados paliativos em abordagem multiprofissional versus cuidado usual multiprofissional em diferentes períodos de tempo (12, 16 e 24 semanas). Dois estudos eram ECRs paralelos (total de 94 participantes) e um era um ECR cross-over (52 participantes). Os três estudos avaliaram cuidados paliativos como uma intervenção realizada na casa do participante. Um dos três estudos incluiu participantes com doenças neurodegenerativas, sendo que os participantes com EM eram um subgrupo da população randomizada. Nós avaliamos o risco de viés dos estudos incluídos através da ferramenta de avaliação de risco de viés da Cochrane. Não foi identificada diferença entre os grupos intervenção e controle no tempo de seguimento de longo prazo (> de seis meses após a intervenção) para os desfechos: diferença média em qualidade de vida (SEIQoL – escore alto significa melhor qualidade de vida; DM 4,80, IC 95% -12,32 a 21,92; 62 participantes; 1 estudo; certeza da evidência muito baixa), eventos adversos (RR 0,97, IC 95% 0,44 a 2,12; 76 participantes; 1 estudo; 22 eventos; certeza da evidência baixa) e admissão hospitalar (RR 0,78, IC 95% 0,24 a 2,52; 76 participantes; 1 estudo; 10 eventos; certeza da evidência baixa). No entanto, os intervalos de confiança das estimativas de efeitos foram amplos, adicionando muita imprecisão aos resultados. Nenhum dos três ECRs incluídos avaliou algum dos seguintes desfechos no tempo de seguimento de longo prazo (> de seis meses após a intervenção): fadiga, função cognitiva, incapacidade, ansiedade, depressão e sobrevida livre de progressão da doença. Conclusões: Baseado nos achados dos ECRs incluídos nesta revisão, as evidências sobre os efeitos de intervenções em cuidados paliativos para pessoas com EM são incerta ou muito provavelmente podem ser modificadas por resultados de estudos futuros.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Hypofractionated radiotherapy for newly diagnosed elderly glioblastoma patients: A systematic review and network meta-analysis.

OBJECTIVE To evaluate different hypofractionated radiotherapy (HRT) regimens for newly diagnosed elderly glioblastoma (GBM) patients. METHODS We performed a systematic review with network meta-analysis (NMA), including searches on CENTRAL, Medline, EMBASE, CINAHL, clinical trial databases and manual search. Only randomized clinical trials (RCTs) were included. Primary outcomes: overall survival (OS) and adverse events (AE). Secondary outcomes: progression-free-survival (PFS) and quality of life (QoL). We used the Cochrane Risk of Bias (RoB) table for assessing individual studies and CINeMA for evaluating the certainty of the final body of evidence. RESULTS Four RCTs (499 patients) were included. For OS, the estimates from NMA did not provide strong evidence of a difference between the HRTs: 40 Gray (Gy) versus 45 Gy (HR: 0.89; CI 95%: 0.42, 1.91); 34 Gy versus 45 Gy (HR: 0.85; CI 95% 0.43, 1.70); 25 Gy versus 45 Gy (HR: 0.81; CI 95% 0.32, 2.02); 34 Gy versus 40 Gy (HR: 0.95; CI 95% 0.57, 1.61); and 25 Gy versus 34 Gy (HR: 0.95; CI 95% 0.46, 1.97). We performed qualitative synthesis for AE and QoL due to data scarcity and clinical heterogeneity among studies. The four studies reported a similar QoL (assessed by different methods) between arms. One RCT reported grade ≥ 3 AE, with no evidence of a difference between arms. PFS was reported in one study (25 Gy versus 40 Gy), with no evidence of a difference between arms. CONCLUSION This review found no evidence of a difference between the evaluated HRTs for efficacy and safety