Navegando por Palavras-chave "Systematic reviews"

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    Mapeamento das evidências da colaboração Cochrane para condutas em saúde
    (Universidade Federal de São Paulo (UNIFESP), 2006-01-01) El Dib, Regina Paolucci [UNIFESP]; Atallah, Álvaro Nagib [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Context: we consider systematic reviews the best level of evidence for the decision making in the health care, which methodological severity offers a diversity of implications to clinical practice and to scientific research. Objective: to assess the proportion of the complete systematic reviews of Cochrane Colaboration that allow practice application of results and implication to scientific research. Design and Setting: Cross-sectional study of systematic reviews of Cochrane Library issue 4, 2004. Main Outcomes Measures: 1016 systematic reviews published throughout 50 Cochrane Collaborative Review Groups were analysed randomly. Data extraction was based on the authors’ conclusions, meta-analysis interpretations and on the context of each systematic review. The implications to practice had been classified in three categories: A) evidences that support the use of the tested intervention. B) evidences that contraindicate the intervention use. C) absence of evidences to recommend or discourage the intervention. The implications to scientific research had been categorized in: 1) recommendation to further research and 2) no necessity to recommend new studies. Number of included studies and meta-analysis were also quantified. Results: 1016 systematic reviews were analyzed, which corresponded to 46,60% of the available totality in the Cochrane Library, issue 4, 2004. The proportions and confidence interval (CI) of 95% of the implications to clinical practice were: A) 44,39 (95% IC, 42,16 – 46,62) %; B) 6,79 (95% IC, 5,66 – 7,92)%; C) 48,81 (95% IC, 46,57 – 51,07)%. The totality of systematic reviews that recommend the accomplishment of further studies was 13.830 (medium 8 and mode 2) and the totality of included meta-analysis of the evaluated systematic reviews, 6.641 (medium 2 and mode 0). Conclusion: the great majority of systematic reviews do not bring specific orientations with relations to the benefit or curse of an intervention, comparatively to control group for certain clinical situation. There are a significant proportion of systematic reviews that suggest recommendations of new studies to answer to the clinical question of the review. There are few primary studies that answer the inclusion criterion of the systematic review and suggest a poor methodological quality. There is a little amount of meta-analysis by systematic review for the clinical outcomes of interest.
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    Psiquiatria baseada em evidências
    (Associação Brasileira de Psiquiatria - ABP, 2000-09-01) Lima, Mauricio Silva de [UNIFESP]; Soares, Bernardo Go; Bacaltchuk, Josué [UNIFESP]; Universidade Federal de Pelotas Departamento de Saúde Mental; Universidade Federal de Pelotas; Universidade Federal de São Paulo (UNIFESP)
    The unnecessary variability often seen in the clinical practice can be related to both the absence of reliable evidence and unawareness of the existence of good quality evidence. Evidence-Based Medicine (EBM) is a set of linked strategies designed to assist clinicians in keeping themselves up-to-date with the best available evidence. Such evidence must be incorporated into the clinical practice. EBM concepts are discussed here through common aspects and challenges doctors face when treating patients with dysthymia, bulimia nervosa, and schizophrenia. In the light of some results from three systematic reviews it is concluded that Evidence-Based Psychiatry strategies, rather than replacing the traditional ones, may be a valuable tool to improving quality in a good clinical practice.