Preoperative physiotherapeutic intervention for patients undergo resection for lung cancer: systematic review

INTRODUCTION: The physiotherapy has been advocated as an important component in the treatment and prevention of postoperative pulmonary complications, being used in both pre and postoperative periods of lung resection surgery. The objective of this study was to assess the efficacy and safety of preoperative physiotherapy for patients who will undergo resection surgery for lung cancer. MATERIALS AND METHODS: Systematic review of randomized clinical trials carried out in accordance with the Cochrane metodology. The electronic search was performed in Cochrane Library, PEDro, MEDLINE, EMBASE, CINAHL, LILACS. We also searched for both non-published and on-going studies in the Current Controlled Trials database. In addition, a manual search in the references of all relevant studies was performed, and the authors were contacted for additional non-published data. RESULTS: Twenty-eight papers were considered potentially relevant; among them, 26 were excluded. Two randomized controlled trials met the inclusion criteria. One study compared non invasive ventilation (BILEVEL) associated to standard treatment with standard treatment alone; and other study compared inspiratory muscle training and incentive spirometry with no training. There was just one common outcome between the studies, but was not possible to perform the meta-analysis due to missing data. CONCLUSION: There is no sufficient evidence to state that the preoperative physiotherapeutic intervention has efficacy and safety for patients who will undergo resection surgery for lung cancer.INTRODUÇÃO: A Fisioterapia tem sido defendida como um componente importante na prevenção e no tratamento de complicações pulmonares pós-operatórias, sendo utilizada nas fases pré e pós-operatória de ressecções pulmonares. A efetividade e a segurança da fisioterapia pré-operatória em pacientes que serão submetidos a cirurgias de ressecção pulmonar por câncer precisam ser avaliadas. MATERIAIS E MÉTODOS: Revisão sistemática de ensaios clínicos randomizados com metodologia Cochrane. A busca eletrônica foi realizada nas bases de dados Cochrane Central Register of Controlled Trials (CENTRAL); PEDro; MEDLINE; EMBASE; CINAHL; e LILACS. Realizamos também uma busca por estudos em andamento e/ou não publicados, através da Current Controlled Trials Database. Além disso, realizamos uma busca adicional na lista de referências de todos os estudos incluídos e contato com os autores, quando necessário. RESULTADOS: Vinte e oito estudos foram considerados potencialmente relevantes; destes, 26 foram excluídos. Dois ensaios clínicos randomizados preencheram os critérios de inclusão desta revisão. Um estudo comparou a ventilação mecânica não invasiva (BILEVEL) associada ao tratamento padrão versus tratamento padrão sendo atribuído de forma única; e o outro estudo comparou o treinamento muscular inspiratório e a espirometria de incentivo a nenhum tratamento. Um único desfecho foi comum entre os estudos, mas não foi possível realizar uma metanálise devida à insuficiência de informações. CONCLUSÕES: Não há evidência suficiente na literatura para se afirmar que a intervenção fisioterapêutica pré-operatória seja efetiva e segura para pacientes que serão submetidos à ressecção pulmonar por câncer.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP) Centro Cochrane do BrasilUniversidade IguaçuCentro Cochrane do Brasil/Universidade Federal de São Paulo (UNIFESP)Instituto Fernandes Figueira/Fundação Oswaldo CruzUniversidade Federal de São Paulo (UNIFESP)UNIFESP, Centro Cochrane do BrasilCentro Cochrane do Brasil/UNIFESPSciEL

Guidelines for the treatment of severe sepsis and septic shock: management of the infectious agent, source control and antimicrobial treatment

Sepsis is a common and lethal condition that carries a substantial financial burden. In addition, it is the main cause of death in intensive care units. Early diagnosis and treatment of patients has been clearly shown to improve prognosis. Therefore, early diagnosis of the infecting agent, control of the primary infection site and the use of appropriate antibiotic therapy are fundamental to improving outcomes. This guideline reviews the available evidence in the literature concerning infection control and therapy strategies.A sepse tem alta incidência, alta letalidade e custos elevados, sendo a principal causa de mortalidade em unidades de terapia intensiva. Está claramente demonstrado que pacientes reconhecidos e tratados precocemente tem melhor prognóstico. Nesse sentido, a abordagem precoce do agente infeccioso, tanto no sentido do controle do foco infeccioso como da antibioticoterapia adequada são fundamentais para a boa evolução do paciente. A presente diretriz aborda as evidências disponíveis na literatura em relação às principais estratégias para controle e tratamento.Sociedade Brasileira de Infectologia – SBIAssociação de Medicina Intensiva Brasileira – AMIBAssociação Médica Brasileira – AMBInstituto Latino Americano de Sepse – ILASUNIFESP, EPMSciEL

Avaliação do conhecimento dos estudantes de medicina sobre diagnóstico e prevenção do câncer de colo uterino / Assessment of the knowledge of medical students about the diagnosis and prevention of uterine cervical cancer

Introdução: o câncer de colo uterino é o terceiro mais incidente na população feminina brasileira, segundo o Instituto Nacional de Câncer (INCA). Diante de tamanha incidência seu diagnóstico e prevenção são de extrema importância e o médico exerce papel importante na orientação e no esclarecimento de dúvidas aos pacientes. Objetivo: Avaliar o conhecimento dos estudantes de medicina sobre diagnóstico e prevenção do câncer de colo uterino. Método: Pesquisa transversal, aprovada no Comitê de Ética em Pesquisa. CAAE: 33622719.4.0000.5701. Aplicação de questionário para estudantes de Medicina avaliando múltiplos aspectos sobre câncer de colo de útero e seu diagnostico e prevenção.  Resultados: Foram incluídos na pesquisa 48 estudantes de Medicina do Centro Universitário de Belém/PA. 27 foram entrevistados no início do terceiro período de curso, e 21 no final do período, ambos no segundo semestre letivo de 2020, após ministração das aulas específicas. Ttodos os estudantes foram unânimes em responder que já ouviram falar sobre o Papiloma Vírus Humano (HPV). Quando questionados sobre o modo de transmissão do vírus, observou-se um conhecimento parcial do tema mesmo após a segunda aplicação do questionário depois do módulo de Ginecologia e Obstetrícia (GO). Conclusão: Observou-se que, apesar dos alunos terem tido progressão em seu conhecimento durante o período de GO, alguns domínios permanecem deficitários e merecem maior ênfase, como vacinas de HPV e seus subtipos

De-escalation of antimicrobial treatment for adults with sepsis, severe sepsis or septic shock

BackgroundMortality rates among patients with sepsis, severe sepsis or septic shock are highly variable throughout different regions or services and can be upwards of 50%. Empirical broad-spectrum antimicrobial treatment is aimed at achieving adequate antimicrobial therapy, thus reducing mortality; however, there is a risk that empirical broad-spectrum antimicrobial treatment can expose patients to overuse of antimicrobials. De-escalation has been proposed as a strategy to replace empirical broad-spectrum antimicrobial treatment by using a narrower antimicrobial therapy. This is done by reviewing the patient's microbial culture results and then making changes to the pharmacological agent or discontinuing a pharmacological combination.ObjectivesTo evaluate the effectiveness and safety of de-escalation antimicrobial treatment for adult patients diagnosed with sepsis, severe sepsis or septic shock caused by any micro-organism.Search methodsIn this updated version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10); MEDLINE via PubMed (from inception to October 2012); EMBASE (from inception to October 2012); LILACS (from inception to October 2012); Current Controlled Trials; bibliographic references of relevant studies; and specialists in the area. We applied no language restriction. We had previously searched the databases to August 2010.Selection criteriaWe planned to include randomized controlled trials (RCTs) comparing de-escalation (based on culture results) versus standard therapy for adults with sepsis, severe sepsis or septic shock. the primary outcome was mortality (at 28 days, hospital discharge or at the end of the follow-up period). Studies including patients initially treated with an empirical but not adequate antimicrobial therapy were not considered for inclusion.Data collection and analysisTwo authors planned to independently select and extract data and to evaluate methodological quality of all studies. We planned to use relative risk (risk ratio) for dichotomous data and mean difference (MD) for continuous data, with 95% confidence intervals. We planned to use the random-effects statistical model when the estimate effects of two or more studies could be combined in a meta-analysis.Main resultsOur search strategy retrieved 493 studies. No published RCTs testing de-escalation of antimicrobial treatment for adult patients diagnosed with sepsis, severe sepsis or septic were included in this review. We found one ongoing RCT.Authors' conclusionsThere is no adequate, direct evidence as to whether de-escalation of antimicrobial agents is effective and safe for adults with sepsis, severe sepsis or septic shock. This uncertainty warrants further research via RCTs and the authors are awaiting the results of an ongoing RCT testing the de-escalation of empirical antimicrobial therapy for severe sepsis.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Ctr Estudos Med Baseada Evidencias & Avaliacao Te, Brazilian Cochrane Ctr, BR-04038000 São Paulo, BrazilUniv Estado Para, Dept Publ Hlth, Belem, Para, BrazilUniversidade Federal de São Paulo, Dept Med, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, São Paulo, BrazilWeb of Scienc

Intervenção fisioterapêutica pré-operatória para pacientes submetidos à ressecção pulmonar por câncer: revisão sistemática

Introdução: A Fisioterapia tem sido defendida como um componente importante na prevenção e no tratamento de complicações pulmonares pós-operatórias, sendo utilizada nas fases pré e pós-operatória de ressecções pulmonares. A efetividade e a segurança da fisioterapia pré-operatória em pacientes que serão submetidos a cirurgias de ressecção pulmonar por câncer precisam ser avaliadas. Materiais e métodos: Revisão sistemática de ensaios clínicos randomizados com metodologia Cochrane. A busca eletrônica foi realizada nas bases de dados Cochrane Central Register of Controlled Trials (CENTRAL); PEDro; MEDLINE; EMBASE; CINAHL; e LILACS. Realizamos também uma busca por estudos em andamento e/ou não publicados, através da Current Controlled Trials Database. Além disso, realizamos uma busca adicional na lista de referências de todos os estudos incluídos e contato com os autores, quando necessário. Resultados: Vinte e oito estudos foram considerados potencialmente relevantes; destes, 26 foram excluídos. Dois ensaios clínicos randomizados preencheram os critérios de inclusão desta revisão. Um estudo comparou a ventilação mecânica não invasiva (BILEVEL) associada ao tratamento padrão versus tratamento padrão sendo atribuído de forma única; e o outro estudo comparou o treinamento muscular inspiratório e a espirometria de incentivo a nenhum tratamento. Um único desfecho foi comum entre os estudos, mas não foi possível realizar uma metanálise devida à insuficiência de informações. Conclusões: Não há evidência suficiente na literatura para se afirmar que a intervenção fisioterapêutica pré-operatória seja efetiva e segura para pacientes que serão submetidos à ressecção pulmonar por câncer

Conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain

BackgroundMusculoskeletal, ligamentous and osseous groin injuries are common in athletes and may result in a delay of several months to resume sports. Even then, this may not be at the former level of sport activity. the treatment of exercise-related groin pain is mainly conservative (non-surgical), using interventions such as exercises, electrotherapy, manual therapy and steroid injections.ObjectivesTo assess the effects (benefits and harms) of conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain.Search methodsWe searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2011); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); MEDLINE (1948 to November week 3 2011); EMBASE (1980 to Week 49 2011); CINAHL (1982 to December 2011); LILACS (1982 to December 2011); PEDro (1929 to December 2011), SPORTDiscus (1985 to December 2011), OTseeker (to December 2011), reference lists of papers and conference proceedings (2000 to 2011).Selection criteriaRandomized controlled trials and quasi-randomized controlled trials evaluating conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain were included. Studies comparing conservative with surgical treatments were excluded.Data collection and analysisTwo review authors independently extracted data and conducted risk of bias assessments. There was no pooling of data.Main resultsTwo studies, involving a total of 122 participants who had experienced adductor-related groin pain for at least two months, were included in this review. All but one of the participants were male athletes aged between 18 and 50 years old. Both studies were assessed as 'high risk of bias' for at least one source of bias domain. the 'successful treatment' outcome reported in both studies was based primarily on pain measures.One study, based on an intention-to-treat analysis, found a significant difference favouring exercise therapy (strengthening with an emphasis on the adductor and abdominal muscles and training muscular co-ordination) compared with 'conventional' physiotherapy (stretching exercises, electrotherapy and transverse friction massage) in successful treatment at 16-week follow-up (25/34 (74%) versus 10/34 (29%); risk ratio (RR) 2.50, 95% CI 1.43 to 4.37, P = 0.001). Similarly, of those followed-up significantly more athletes treated by exercise therapy returned to sport at the same level (23/29 (79%) versus 4/30 (13%); RR 5.95, 95% CI 2.34 to 15.09, P = 0.0002). Although still favouring the exercise group, the differences between the two groups in patients' subjective global assessment at 16 weeks and successful treatment at 8 to 12 years follow-up were not statistically significant.The second study (54 participants) found no significant differences at 16-week follow-up between a multi-modal treatment (heat, manual therapy and stretching) and exercise therapy (the same intervention as in the above study) for the outcomes of successful treatment (14/26 (54%) versus 12/22 (55%); RR 0.99, 95% CI 0.59 to 1.66, P = 0.96) and return to full sports participation (13/26 (50%) versus 12/22 (55%); RR 0.92, 95% CI 0.53 to 1.58, P = 0.75). Those returning to full sports participation returned on average 4.5 weeks earlier after receiving multi-modal therapy (mean difference -4.50 weeks, 95% CI -8.60 to -0.40, P = 0.03) than those in the exercise therapy group. This study reported that there were no complications or side effects found in either intervention group.Authors' conclusionsThe available evidence from the randomized trials is insufficient to advise on any specific conservative modality for treating exercise-related groin pain. While still low quality, the best evidence is from one trial which found that exercise therapy (strengthening of hip and abdominal muscles) in athletes improves short-term outcomes (based primarily on pain measures) and return to sports compared with physiotherapy consisting of passive modalities. Given the low quality of the available evidence from both included trials, further randomized trials are necessary to reinforce their findings.Ctr Estudos Med Baseada Evidencias & Avaliacao Te, Brazilian Cochrane Ctr, BR-04038000 São Paulo, BrazilUniv Estado Para, Dept Publ Hlth, Belem, Para, BrazilUniversidade Federal de São Paulo, Dept Human Movement Sci, Santos, BrazilUniversidade Federal de São Paulo, Dept Human Movement Sci, Santos, BrazilWeb of Scienc