ELECTRIC BREAKDOWN AS A PROBABILITY PROCESS

ImportanceRecent estimates suggest that more than 26 million people worldwide have heart failure. The syndrome is associated with major symptoms, significantly increased mortality, and extensive use of health care. Evidence-based treatments influence all these outcomes in a proportion of patients with heart failure. Current management also often includes advice to reduce dietary salt intake, although the benefits are uncertain. ObjectiveTo systematically review randomized clinical trials of reduced dietary salt in adult inpatients or outpatients with heart failure. Evidence ReviewSeveral bibliographic databases were systematically searched, including the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and CINAHL. The methodologic quality of the studies was evaluated, and data associated with primary outcomes of interest (cardiovascular-associated mortality, all-cause mortality, and adverse events, such as stroke and myocardial infarction) and secondary outcomes (hospitalization, length of inpatient stay, change in New York Heart Association [NYHA] functional class, adherence to dietary low-salt intake, and changes in blood pressure) were extracted. FindingsOf 2655 retrieved references, 9 studies involving 479 unique participants were included in the analysis. None of the studies included more than 100 participants. The risks of bias in the 9 studies were variable. None of the included studies provided sufficient data on the primary outcomes of interest. For the secondary outcomes of interest, 2 outpatient-based studies reported that NYHA functional class was not improved by restriction of salt intake, whereas 2 studies reported significant improvements in NYHA functional class. Conclusions and RelevanceLimited evidence of clinical improvement was available among outpatients who reduced dietary salt intake, and evidence was inconclusive for inpatients. Overall, a paucity of robust high-quality evidence to support or refute current guidance was available. This review suggests that well-designed, adequately powered studies are needed to reduce uncertainty about the use of this intervention.</p

O sincretismo do processo civil brasileiro: uma análise da viabilidade de um sistema processual único e multifuncional

O Sincretismo do Processo Civil Brasileiro é uma análise da viabilidade de um sistema processual único e multifuncional, em contraposição à sua clássica repartição em espécies, ditas autônomas. Nega a realidade jurídica da autonomia dos “processos” de conhecimento, execução e cautelar, reconhecendo a inevitável alonomia entre eles. Constrói, assim, a idéia de um sistema processual único e composto das funções de conhecimento, execução e cognição sumária urgente

Lack of evidence for interventions offered in UK fertility centres.

Carl Heneghan and colleagues call for better quality evidence to help people seeking assisted reproduction make informed choices

Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care

OBJECTIVES: To compare the effectiveness and safety of naproxen and low-dose colchicine for treating gout flares in primary care. METHODS: This was a multicentre open-label randomised trial. Adults with a gout flare recruited from 100 general practices were randomised equally to naproxen 750 mg immediately then 250 mg every 8 hours for 7 days or low-dose colchicine 500 mcg three times per day for 4 days. The primary outcome was change in worst pain intensity in the last 24 hours (0-10 Numeric Rating Scale) from baseline measured daily over the first 7 days: mean change from baseline was compared between groups over days 1-7 by intention to treat. RESULTS: Between 29 January 2014 and 31 December 2015, we recruited 399 participants (naproxen n=200, colchicine n=199), of whom 349 (87.5%) completed primary outcome data at day 7. There was no significant between-group difference in average pain-change scores over days 1-7 (colchicine vs naproxen: mean difference -0.18; 95% CI -0.53 to 0.17; p=0.32). During days 1-7, diarrhoea (45.9% vs 20.0%; OR 3.31; 2.01 to 5.44) and headache (20.5% vs 10.7%; 1.92; 1.03 to 3.55) were more common in the colchicine group than the naproxen group but constipation was less common (4.8% vs 19.3%; 0.24; 0.11 to 0.54). CONCLUSION: We found no difference in pain intensity over 7 days between people with a gout flare randomised to either naproxen or low-dose colchicine. Naproxen caused fewer side effects supporting naproxen as first-line treatment for gout flares in primary care in the absence of contraindications. TRIAL REGISTRATION NUMBER: ISRCTN (69836939), clinicaltrials.gov (NCT01994226), EudraCT (2013-001354-95)

Cochrane corner: self-monitoring and self-management of oral anticoagulation.

Use of oral anticoagulants such as warfarin is increasing. Part of the reason for this is the rising prevalence of atrial fibrillation, an ageing population, and the widening indications for treatment based on evidence of benefit in reducing risk of stroke. A meta-analysis of 29 randomized trials including 28,044 participants with atrial fibrillation found warfarin decreased the absolute risk of stroke by 2.7% per year (number needed to treat [NNT] 37) compared to placebo or no treatment, and by 0.7% per year (NNT = 143) when compared to aspirin. Management of warfarin, however, is challenging because of the considerable variability in warfarin’s action and the narrow ‘therapeutic range,’ which requires frequent testing of international normalized ratio (INR) values and appropriate adjustment to prevent major complications. Often, poor control means that much of the potential benefit is not realised. Point-of-care devices, which allow self-testing of INR, with a drop of whole blood, are one of the options to optimise management by potentially reducing the need to attend anticoagulation clinics and offering the possibility for more continuous measurement. [2] The first randomized trial of patient self-testing, published in 1989, included 50 patients on warfarin but with poorly controlled INRs, found that self-testing in the home setting provided accurate measurements, was feasible and achieved superior control when compared with standard anticoagulation clinic care. [3] Over time there have been a number of further randomized controlled trials (RCTs) done to establish the effectiveness of selfmonitoring. In parallel, self-testing devices have generally proved to be reliable and analytically accurate. Trials that have evaluated self-monitoring usually adopt two types of self-monitoring models. In some, a (trained participant tests their INR test and informs their healthcare provider of the result. In others, there is a greater degree of self-management where a trained participant tests their INR, interprets the result, and adjusts the drug dosage accordingly. [5] Given the growing evidence base, we updated our systematic review of the impact of patient self-monitoring or self-management on treatment with oral anticoagulation therapy.</p

Cochrane corner: self-monitoring and self-management of oral anticoagulation.

Use of oral anticoagulants such as warfarin is increasing. Part of the reason for this is the rising prevalence of atrial fibrillation, an ageing population, and the widening indications for treatment based on evidence of benefit in reducing risk of stroke. A meta-analysis of 29 randomized trials including 28,044 participants with atrial fibrillation found warfarin decreased the absolute risk of stroke by 2.7% per year (number needed to treat [NNT] 37) compared to placebo or no treatment, and by 0.7% per year (NNT = 143) when compared to aspirin. Management of warfarin, however, is challenging because of the considerable variability in warfarin’s action and the narrow ‘therapeutic range,’ which requires frequent testing of international normalized ratio (INR) values and appropriate adjustment to prevent major complications. Often, poor control means that much of the potential benefit is not realised. Point-of-care devices, which allow self-testing of INR, with a drop of whole blood, are one of the options to optimise management by potentially reducing the need to attend anticoagulation clinics and offering the possibility for more continuous measurement. [2] The first randomized trial of patient self-testing, published in 1989, included 50 patients on warfarin but with poorly controlled INRs, found that self-testing in the home setting provided accurate measurements, was feasible and achieved superior control when compared with standard anticoagulation clinic care. [3] Over time there have been a number of further randomized controlled trials (RCTs) done to establish the effectiveness of selfmonitoring. In parallel, self-testing devices have generally proved to be reliable and analytically accurate. Trials that have evaluated self-monitoring usually adopt two types of self-monitoring models. In some, a (trained participant tests their INR test and informs their healthcare provider of the result. In others, there is a greater degree of self-management where a trained participant tests their INR, interprets the result, and adjusts the drug dosage accordingly. [5] Given the growing evidence base, we updated our systematic review of the impact of patient self-monitoring or self-management on treatment with oral anticoagulation therapy.</p