Lack of systematic reviews in the biomedical literature: a correction

Al revisar los datos a partir de los cuales se realizó nuestro articulo "Carencia de revisiones sistemáticas en la literatura biomédica: el caso del tratamiento tripanocida en la enfermedad de Ghagas· (MEDUNAB 2.000; 3: 76-83) hemos encontrado un par de imprecisiones que consideramos necesario corregir. Las tablas 2 y 5 del artículo contienen datos erróneos. La siguiente serla la versión correcta, en la cual se resaltan los cambios necesarios: Nótese la ausencia del subrayado en et "articulo original publicado. señal sin la cual no es posible recalcular el índice Kappa. Finalmente, la mención al acuerdo general entre los evaluadores de los artículos de revisión a ser modificado.By reviewing the data from which Our article "Lack of systematic reviews in the biomedical literature: the case of trypanocidal treatment in Ghagas disease · (MEDUNAB 2.000; 3: 76-83) was carried out. found a couple of inaccuracies that we consider necessary to correct. Tables 2 and 5 of the article contain erroneous data. The following would be the correct version, in which the necessary changes are highlighted: Note the absence of the underline in et "Original article published. Signal without which it is not possible to recalculate the Kappa index. Finally, the mention of the general agreement between the reviewers of the review articles to be modified

Poderia associar-se o sedentarismo as conclusoes clínicas de alarme de doencas crónicas em adultos jovens? Análise no projeto CHICAMOCHA

Introducción: La asociación entre sedentarismo y enfermedades crónicas no transmisibles (ECNT) requiere décadas de exposición. Es posible que esta se manifieste más tempranamente, por algunos hallazgos clÍnicos en adultos jóvenes. Objetivo: Probar la hipótesis de que en adultos jóvenes el sedentarismo se asocia con algunos signos o sÍntomas de alarma para el desarrollo posterior de ECNT. MetodologÍa: Usando la evaluación inicial (años 2000-2003) del proyecto CHICAMOCHA, en 1539 donantes de sangre clÍnicamente saludables con pruebas de tamización negativas (edad media 36, DE 8,3 años, 66% hombres) se estudió la asociación entre sedentarismo y una serie de hallazgos clÍnicos. Se definió sedentarismo como reportar actividad fÍsica moderada-intensa ≤150 minutos/semana (incluyendo el trabajo). El desenlace primario fue el compuesto de 11 hallazgos (5 sÍntomas y 6 signos) de alarma encontrados en la valoración médica. La asociación fue estimada usando un modelo regresión logÍstica ajustado por covariables. Resultados: Se encontró que 56.9% (IC95% 54.3–59.3) de los participantes eran sedentarios. En el análisis multivariado, el sedentarismo se asoció positivamente con el estado civil soltero y negativamente con estar empleado. No se encontraron asociaciones significativas en el compuesto agregado de 5 sÍntomas (OR ajustado 1.07, IC95% 0.90– 1.26), 6 signos (OR ajustado 1.01, IC95% 0.79 – 1.28). Sin embargo, se observó un gradiente positivo no significativo por el número de hallazgos presentes (1 hallazgo OR=0.91, IC95% 0.61–1.35), 2 hallazgos (OR=1.20, IC95% 0.84–1.73), 3 o más hallazgos (OR=1.31, IC95% 0.91–1.89) . Conclusiones: Más de la mitad de la población estudiada se encontró sedentaria. Aunque este factor no se encontró asociado con signos o sÍntomas individualmente, se identificó un gradiente no significativo con el número de estos hallazgos, posiblemente relacionado con el tiempo de exposición relativamente breve. [Villar JC, Herrera VM, Moreno-Medina KJ, Castellanos-DomÍnguez YZ, MartÍnez LX, Cortés OL. ¿Puede asociarse el sedentarismo con hallazgos clÍnicos de alarma de enfermedad crónica en adultos jóvenes? Un análisis en el proyecto CHICAMOCHA. MedUNAB 2015; 18 (1): 42-50]Introduction: The association between Sedentary Lifestyle (SL) and Chronic Non-Communicable Diseases (NCD) takes decades of exposure. It is possible to be seen at an early stage in young adults due to some clinical findings. Objective: Test the hypothesis that a sedentary lifestyle in young adults is associated with some signs or symptoms of alarm for the further development of NCD. Methodology: Using the initial evaluation (years 2000-2003) of CHICAMOCHA project, it was found that 1539 blood donors were healthy with negative screening test results (mean age 36, SD 8.3 years, 66% male). The association between sedentary lifestyle and a series of clinical findings was studied. Sedentary Lifestyle was defined as moderate-intense physical activity of ≤150 minutes/week (including work). The primary outcome was the composite of 11 findings (5 symptoms and 6 signs) found in the medical assessment. We computed multivariate logistic regression models for both individual and pooled outcomes. Results: SL was found in 56.9% (IC95% 54.3–59.3) participants. In multivariate analysis SL was positively associated with single marital status and negatively associated with being employed. There were no significant associations between SL and the composite of 5 symptoms (Covariate-adjusted pooled OR 1.07, 95%CI 0.90–1.26), or 6 signs (Covariate-adjusted pooled OR 1.01, 95%CI 0.79–1.28). However, a positive non-significant gradient in association with the number of findings (Covariate-adjusted OR for any one clinical finding OR=0.91, 95%CI 0.61–1.35; any two findings OR=1.20, 95%CI 0.84 – 1.73, or 3 or more findings OR=1.31, 95%CI 0.91–1.89) was observed. Conclusions: It was found that more than half of the studied population presented a sedentary lifestyle. Even though this factor was not associated with individual signs and symptoms, a non-significant gradient was found, possibly related to a short exposure that may explain these results. [Villar JC, Herrera VM, Moreno-Medina KJ, Castellanos-DomÍnguez YZ, MartÍnez LX, Cortés OL. Can Sedentarism be Associated with Alarm Clinical Findings of Chronic Diseases in Young Adults?. An Analysis in CHICAMOCHA Project. CHICAMOCHA. MedUNAB 2015; 18(1):42-50]Introdução: Aassociação entre sedentarismo e doenças crônicas não transmissíveis (DCNT) requer décadas de exposição. É possível que esta se manifeste mais cedo, pelo que se tem observado clinicamente em alguns adultos jovens. Objetivo: Testar a hipótese de que um estilo de vida sedentário em adultos jovens está associada com alguns sinaisousinaisdealertaparaodesenvolvimentode doençasnãotransmissíveis.Metodologia:Usandoa avaliação inicial (2000-2003) do projeto CHICAMOCHA, em 1539 doadores de sangue clinicamente saudáveis com testes de rastreio negativos (idade média de 36 anos, 8.3 anos, 66% do sexo masculino), estudou-se a associação entre sedentarismo e uma série de achados clínicos. O sedentarismo foi definido como atividade física moderada-intensa≤150minutos/semana(incluindotrabalho).O desfecho primário foi o composto de 11 resultados (cinco sintomas e 6 sinais) de alarme encontrados na avaliação médica. Aassociação foi estimada utilizando um modelo de regressão logística ajustado para co-variáveis. Resultados:Verificou-seque56.9%(IC95%54.3-59.3)dos participantes eram sedentários. Na análise multivariada, o sedentarismo foi positivamente associado com o estado civil de solteiro e negativamente ao fato de estar empregado. Nãoforamencontradasassociaçõessignificativasno agregado composto por 5 sintomas (ORajustado 1,07, IC95% 0,90-1,26), 6 sinais (ORajustado 1.01, IC95% 0.79–1.28). No entanto, é observado, um gradiente positivo, nada significativo pela descoberta presente (1 resultado OR= 0.91, IC95% 0.61-1.35), 2 resultados (OR= 1.20, IC95% 0.84-1.73), 3 ou mais resultados (OR= 1.31, IC95% 0.91–1.89). Conclusões:Mais da metade da população do estudo foi encontrada sedentária. Embora este fator não foi encontradoassociadocomsinaisousintomas individualmente,foiidentificadoumgradientenão significativo com o número destes achados, possivelmente relacionada com o tempo de exposição relativamente curto. [Villar JC, Herrera VM, Moreno-Medina KJ, Castellanos-Domínguez YZ, Martínez-Contreras LX, Cortés OL. Poderia associar-seosedentarismoàsconclusõesclínicasde alarme de doenças crônicas em adultos jovens? Análise no projeto CHICAMOCHA. MedUNAB2015; 18 (1): 42-50

¿Puede asociarse el sedentarismo con hallazgos clínicos de alarma de enfermedad crónica en adultos jóvenes? Un análisis en el proyecto CHICAMOCHA

Introduction: The association between Sedentary Lifestyle (SL) and Chronic Non-Communicable Diseases (NCD) takes decades of exposure.  It is possible to be seen at an early stage in young adults due to some clinical findings.  Objective: Test the hypothesis that a sedentary lifestyle in young adults is associated with some signs or symptoms of alarm for the further development of NCD. Methodology: Using the initial evaluation (years 2000-2003) of CHICAMOCHA project, it was found that 1539 blood donors were healthy with negative screening test results (mean age 36, SD 8.3 years, 66% male).  The association between sedentary lifestyle and a series of clinical findings was studied.  Sedentary Lifestyle was defined as moderate-intense physical activity of ≤150 minutes/week (including work).  The primary outcome was the composite of 11 findings (5 symptoms and 6 signs) found in the medical assessment. We computed multivariate logistic regression models for both individual and pooled outcomes. Results: SL was found in 56.9% (IC95% 54.3–59.3) participants. In multivariate analysis SL was positively associated with single marital status and negatively associated with being employed. There were no significant associations between SL and the composite of 5 symptoms (Covariate-adjusted pooled OR 1.07, 95%CI 0.90–1.26), or 6 signs (Covariate-adjusted pooled OR 1.01, 95%CI 0.79–1.28).  However, a positive non-significant gradient in association with the number of findings (Covariate-adjusted OR for any one clinical finding OR=0.91, 95%CI 0.61–1.35; any two findings OR=1.20, 95%CI 0.84 – 1.73, or 3 or more findings OR=1.31, 95%CI 0.91–1.89) was observed. Conclusions: It was found that more than half of the studied population presented a sedentary lifestyle.  Even though this factor was not associated with individual signs and symptoms, a non-significant gradient was found, possibly related to a short exposure that may explain these results. [Villar JC, Herrera VM, Moreno-Medina KJ, Castellanos-Domínguez YZ, Martínez LX, Cortés OL. Can Sedentarism be Associated with Alarm Clinical Findings of Chronic Diseases in Young Adults?.  An Analysis in CHICAMOCHA Project.  CHICAMOCHA. MedUNAB 2015; 18(1):42-50]Introducción: La asociación entre sedentarismo y enfermedades crónicas no transmisibles (ECNT) requiere décadas de exposición. Es posible que esta se manifieste más tempranamente, por algunos hallazgos clínicos en adultos jóvenes. Objetivo: Probar la hipótesis de que en adultos jóvenes el sedentarismo se asocia con algunos signos o síntomas de alarma para el desarrollo posterior de ECNT. Metodología: Usando la evaluación inicial (años 2000-2003) del proyecto CHICAMOCHA, en 1539 donantes de sangre clínicamente saludables con pruebas de tamización negativas (edad media 36, DE 8,3 años, 66% hombres) se estudió la asociación entre sedentarismo y una serie de hallazgos clínicos. Se definió sedentarismo como reportar actividad física moderada-intensa ≤150 minutos/semana (incluyendo el trabajo). El desenlace primario fue el compuesto de 11 hallazgos (5 síntomas y 6 signos) de alarma encontrados en la valoración médica. La asociación fue estimada usando un modelo regresión logística ajustado por covariables. Resultados: Se encontró que 56.9% (IC95% 54.3–59.3) de los participantes eran sedentarios. En el análisis multivariado, el sedentarismo se asoció positivamente con el estado civil soltero y negativamente con estar empleado. No se encontraron asociaciones significativas en el compuesto agregado de 5 síntomas (OR ajustado 1.07, IC95% 0.90– 1.26), 6 signos (OR ajustado 1.01, IC95% 0.79 – 1.28). Sin embargo, se observó un gradiente positivo no significativo por el número de hallazgos presentes (1 hallazgo OR=0.91, IC95% 0.61–1.35), 2 hallazgos (OR=1.20, IC95% 0.84–1.73), 3 o más hallazgos (OR=1.31, IC95% 0.91–1.89) . Conclusiones: Más de la mitad de la población estudiada se encontró sedentaria. Aunque este factor no se encontró asociado con signos o síntomas individualmente, se identificó un gradiente no significativo con el número de estos hallazgos, posiblemente relacionado con el tiempo de exposición relativamente breve. [Villar JC, Herrera VM, Moreno-Medina KJ, Castellanos-Domínguez YZ, Martínez LX, Cortés OL. ¿Puede asociarse el sedentarismo con hallazgos clínicos de alarma de enfermedad crónica en adultos jóvenes? Un análisis en el proyecto CHICAMOCHA. MedUNAB 2015; 18 (1): 42-50]&nbsp

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)