Literatura Latino-Americana E Do Caribe Em Ciências Da Saúde Research Articles

Impactos causados pelo uso de telas durante a pandemia da COVID-19 em crianças e adolescentes: uma revisão integrativa

ABSTRACT Objective: To identify the scientific evidence on the impacts caused by the use of screens during the COVID-19 pandemic in children and adolescents, raising reflections for future interventions with this public. Data source: This is an integrative literature review, conducted in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), United States National Library of Medicine (PubMed), Scopus, Web of Science, and Embase, published from March 2020 to January 2022, in Portuguese, English and Spanish. Data synthesis: The search strategies allowed retrieving 418 articles, of which 218 were duplicates. The analysis of titles and abstracts resulted in the maintenance of 62 studies. Of these, 31 were excluded from the reading of the full text, since they did not clearly present the phenomenon investigated. Thirty-one were eligible, resulting in five categories: eye consequences; increased sedentary behavior and weight; change in eating habits; implications for sleep quality and impacts on mental health. Conclusions: The excessive use of screens during the pandemic led to numerous consequences for children and adolescents, with a higher incidence of visual damage, sedentary lifestyle, inadequate eating habit and increased weight gain, in addition to impaired sleep quality and mental health. This study provides subsidy for health professionals to carry out continuing education focused on this theme, and elaborate effective interventions for this public in this transition to the post-pandemic period.

PP81 Efficacy Of Transcranial Direct Current Stimulation For Depressive Episode Disorders

IntroductionDepression is a general term that describes different depressive disorders which are highly prevalent and disabling, characterized by decreases in quality of life. Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain modulation technique used, among other purposes, for the treatment of chronic pain and headache. In order to clarify the effect of this stimulation on depressive disorders, the objective of this review was to evaluate efficacy and safety of treatment with tDCS for depressive disorders.MethodsA systematic research study was carried out on 30 June 2022 in MEDLINE (by Pubmed), Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PsycInfo e Global Mental Health databases. Were included systematic reviews (SR) with meta-analysis that selected patients with depression, in use of tDCS, using as comparator sham stimulation (placebo) or any other treatment (pharmacologic or no) or any comparison between pre-and post-intervention.ResultsEight SR with meta-analysis of randomized clinical trials (RCTs) on the efficacy and safety of tDCS in the treatment of depressive disorders were retrieved. Subjects were assessed for clinical response, remission, change in scores on depression scales, occurrence of procedure-related adverse events, and treatment dropout. Three systematic reviews showed results that point to the effectiveness of tDCS for the clinical response outcome and one considering the remission outcome. As for the outcome measured by the change in depression scale scores, all included reviews showed favorable results for tDCS. It is noteworthy that the studies included in the reviews have methodological limitations. With regard to safety, an increased risk treatment-emergent mania or hypomania (TEM) has been observed.ConclusionsThe tDCS association with antidepressants showed favorable results to this technology in a sample with depression and varied clinical characteristics. Regarding safety of this technology, tDCS did not show adverse effects of greater severity, but was verified to have an increased risk of TEM.

Oral health surveys of Traditional Peoples and Communities in Brazil: a scoping review protocol

ObjectiveThe objective of this review protocol is to map the available evidence regarding all the oral health surveys of Traditional Peoples and Communities (TPCs) in Brazil.Methods and analysisThe review question...

Vascular closure devices in living-donor nephrectomy: a much-needed systematic review and meta-analysis focusing on safety.

To assess the safety of vascular closure devices in living-donor nephrectomy (LDN), as staplers and non-transfixion techniques (polymer locking and metal clips) are the methods employed to secure the renal vessels during laparoscopic and robotic LDN, but the use of clips has come into question since the United States Food and Drug Administration and manufacturers issued a contraindication. A systematic review and meta-analysis were conducted to assess the safety of vascular closure devices (International Prospective Register of Systematic Reviews [PROSPERO] registration: CRD42022364349). The PubMed, Scopus, the Excerpta Medica dataBASE (EMBASE), and the Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) databases were searched in September 2022. For comparative and non-comparative studies, incidence estimates and odds ratios (ORs), respectively, for the main variables regarding safety of vascular closure devices were pooled by using random effects meta-analyses. Quality assessment of the included comparative studies was conducted using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Of the 863 articles obtained, data were retrieved from 44 studies, which included 42 902 patients. In non-comparative studies, the pooled estimate rates for device failure, severe haemorrhage rate, conversion to open surgery, and mortality were similar for both clips and staplers. Regarding the meta-analyses for comparative studies (three studies), there were no significant differences between the two groups for the severe haemorrhage rate (OR 0.57, 95% confidence interval [CI] 0.18-1.75; P = 0.33), conversion to open surgery (OR 0.35, 95% CI 0.08-1.54; P = 0.16), or death rate (OR 3.64, 95% CI 0.47-28.45; P = 0.22). Based on weak evidence, device failure was lower in the polymer clip group (OR 0.41, 95% CI 0.23-0.75; P = 0.00). This study has confirmed that there is no evidence for the superiority of any vascular closure device in terms of safety in LDN. Standardised recommendations for vascular control in this context should be carefully designed and prospectively evaluated.

Trauma severity predictors

This review aimed to determine which are the indexes for early detection and evaluation of clinical and physiological deterioration of traumatized patients. A Scoping Review according to the methods proposed by Joanna Briggs Institute (JBI) was performed from February 2018 to December 2018 on LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde), National Library of Medicine (PubMed), and SCOPUS databases. Sixty-two studies were included, of which 43 evaluated patients with general trauma. A variety of physiological variables, such as Glasgow Coma Score, Glucose, Days in the Intensive Care Unit, Lactate, and predictor indexes - Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), Revisited Trauma Score (RTS), and APACHE II were identified. The values observed in the studies among patients were compared to the ones determined by the basic literature, being called Critical Values (CV). The group of gravity indexes, besides clinical and regulatory protocols, found in this review are the solidification of the healthcare process involving the traumatized patient’s responses to the actions of the healthcare team. The analysis of these indexes must be emphasized to determine, with greater reliability, the prognosis of the patient. With these data, it may be possible to effectively predict mortality rates.

Avaliação multidimensional de pessoas idosas na Atenção Primária à Saúde: uma revisão de escopo

Abstract Objective to map the publications on multidimensional geriatric assessment in the primary care setting. Method A scoping review using the Joanna Briggs Institute methodology was carried out on the databases Web of Science, Scopus, Medical Literature Analysis and Retrieval System Online (MEDLINE) and Literatura Latino Americana e do Caribe em Ciencias da Saude (LILACS). The studies addressed the population of older people aged ≥60 years, the concept of multidimensional assessment and the primary care setting. Results a total sample of 19 publications was included for qualitative analysis. The studies selected were of different designs (predominantly cross-sectional) and most were in English. The evaluation comprised three dimensions; instruments developed applicable to primary care; two types of information technologies used to support the evaluation; and the relevant findings about the practice. Conclusion this review identified tools that were based on several existing instruments. Strategies should be tailored for assessing older individuals in a quick feasible manner. Specific domains were commonly present in the instruments, considered important for providing a comprehensive assessment tailored for the older population.

The relationship between HIV status and clinical manifestations of urogenital infections in women during pregnancy: a scoping review

Introduction: Maternal and child health are essential to public health, especially during pregnancy, where urogenital infections can affect mothers and fetuses. Sexually transmitted infections (STIs) increase obstetric risks and have complex connections with the human immunodeficiency virus — HIV. In Brazil, pregnant women with HIV are a growing concern, requiring focus and appropriate interventions. Objective: This study aimed to examine the clinical and epidemiological characteristics of urogenital infections in pregnant women with and without HIV and to assess whether there are notable differences between these groups. Methods: A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses — Extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute guidelines. Databases such as Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Scientific Electronic Library Online (SciELO) were explored using relevant terms. Inclusion/exclusion criteria selected nine studies for analysis. A Population, Intervention, Comparison, Outcome, and Study Design (PICOS) approach directed the search. Results: Pregnant women with HIV had a high prevalence of STIs, including Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and bacterial vaginosis. HIV infection appears to influence the risk and severity of urogenital infections. Pregnancy increases the risk of STIs, regardless of HIV status. Male partners may also influence the presence of STIs in pregnant women, especially those with HIV. Conclusion: This study highlights the association between HIV status and urogenital infections in pregnant women, indicating the need for appropriate screening and care. Prevention and treatment of STIs in pregnant women are essential for maternal and child health, regardless of HIV status. An in-depth understanding of these issues can improve public policies, clinical practices, and preventive interventions that target the overall health of these vulnerable populations.

Depressive symptoms and mortality in older people in Latin America: systematic review and meta-analysisSíntomas de depresión y mortalidad en personas mayores en América Latina: revisión sistemática con metanálisis

To determine the existence of association between depressive symptoms and mortality in older individuals in Latin America. A systematic review with meta-analysis was performed based on published studies indexed in PubMed, Scientific Electronic Library Online (SciELO), Web of Science, Cochrane Library, Scopus, and LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde). The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO), and structured according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Meta-analysis was performed using random effects models, and the data analyzed included crude relative risk (RR) and heterogeneity, with poin estimates and 95% confidence intervals (95%CI). Five studies, performed in Brazil and Mexico, were included in the meta-analysis, for a total of 8 954 older individuals. RR for mortality in the presence of depressive symptoms was 1.44 (95%CI: 1.16; 1.78). Heterogeneity was 80.87%. Meta-regression showed that the higher the proportion of women in the sample, the higher the mortality risk associated with depressive symptoms; and that the longer the study follow-up, the lower the risk of mortality associated with depressive symptoms. The presence of depressive symptoms was positively associated with mortality in older Latin American individuals. The RR for death was 44.0% higher in individuals with depressive symptoms as compared to those without depressive symptoms. The main study limitations were the lower number of studies retrieved through systematic review and the variety of scales used to determine the presence of depressive symptoms.

The Effectiveness and Safety of Metformin Compared to Sulfonylureas in Diabetic Nephropathy: A Systematic Review.

Metformin and sulphonylureas are the most commonly used first-line anti-diabetic agents. However, medical practice guidelines and clinical experience caution against using these drugs in severe diabetic kidney disease. Consequently, the choice of anti-diabetic medicine in various stages of diabetic nephropathy should balance the benefits and risks to the patient. We aim to synthesize available evidence on the effectiveness and safety of metformin concerning sulfonylureas in patients with diabetic renal disease. The COSMOS-E (Guidance on conducting systematic reviews and meta-analyses of observational studies of etiology) and MOOSE (Meta-Analyses and Systematic Reviews of Observational Studies in Epidemiology) guidelines were followed when designing the systematic review. The present study assessed the effectiveness of metformin and sulphonylurea monotherapy regarding renal function. Studies published from 2001 to 2022 were included. We have identified 570 records from PubMed, BioMed Central, LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde), ScienceDirect, and PLoS (The Public Library of Science) Medicine databases. Eight cohort studies met the inclusion criteria. All studies reported adjusted hazard ratios with confidence limits. Metformin was found to be more effective in the following events: all-cause mortality, GFR (glomerular filtration rate), ESRD (end-stage renal disease) or death events, one-year risk of death or end-stage renal disease, cardiovascular events, heart failure hospitalization, and hypoglycemic episodes. However, metformin was less effective in acute renal replacement therapy, end-stage renal disease, and/or death, with a one-year risk of acute dialysis. Lactic acidosis was not significant with metformin. The present study recommends that metformin therapy is safe compared to sulfonylurea therapy in diabetic nephropathy patients, provided that the contraindications given in the guidelines are strictly adhered to.

Educational Strategies for Liver Transplant Candidates and Recipients: An Integrative Literature Review

Abstract:Objective: To examine evidence in the literature on educational strategies for liver transplant candidates and recipients. Methods: This is an integrative literature review. The literature search was conducted in the following databases: National Library of Medicine and the National Institutes of Health (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Embase. The identified records were exported to the EndNote reference manager for organization and removal of duplicates, and subsequently to the web application Rayyan for peer-blinded selection of studies. Two reviewers performed the selection of studies by reading the title and abstract (phase 1) and by reading the full article (phase 2). In both phases, the consensus meeting was held with a third reviewer. Data were analyzed descriptively. Results: Among 488 studies identified, seven articles were selected for the knowledge synthesis. Most studies brought health education strategies on medications, nutrition, digital technologies and related to complications, with a focus on transplant patients, identifying significant results for rehabilitation and patient adherence to the proposed treatment. We also observed a predominance of studies that addressed educational strategies with a focus on postoperative complications and that encompassed the multiprofessional areas (three studies), pharmacy (two studies), medicine (one study), and nursing (one study). Conclusion: The literature has shown that immunosuppressants, concern for complications, technology, and nutrition are essential in a comprehensive education plan for this clientele. Despite this, a limited number of studies were identified in the national and international literature on educational strategies about liver transplantation.

USE OF THE HUMAN PLACENTA IN THE HEALING OF FOOT ULCERS IN PEOPLE WITH DIABETES: INTEGRATIVE REVIEW

Objective: To identify in the literature the contributions of the use of the human placenta in the healing of foot ulcers in people with diabetes. Method: An integrative review study carried out by searching articles in Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, National Library of Medicine (PubMed), Web of Science and Scopus, using the search strategies: Placenta AND “Diabetic foot” and Placenta AND “Diabetic Foot”. Results: The initial search resulted in 148 articles. After applying the inclusion and exclusion criteria, a final sample of 12 articles was obtained. It was observed that the placenta has the potential to promote the improvement of granulation tissue and peripheral circulation, greater epithelialization, and reduction in the wound area, with the majority use of cryopreserved placental and amniotic membrane allograft. Conclusion: The human placenta is a nutrient-rich biological material that has the potential to contribute to the tissue repair of foot ulcers in people with diabetes in a shorter period of time.

Hearing Loss in Patients With Morquio Syndrome: Protocol for a Scoping Review.

BackgroundMild to moderate hearing loss is common in patients with mucopolysaccharidosis (MPS) IVA. The hearing loss can be conductive, sensorineural, or mixed. However, in these patients, the mixed form is frequent, attributed to the combination of conductive and neurosensory elements, with slowly progressive evolution. Conductive hearing loss may be secondary to recurrent upper respiratory tract infections, serous otitis media, and deformities of the ear ossicles due to the accumulation of glycosaminoglycans (GAGs). Meanwhile, the sensorineural form is mainly attributed to the accumulation of GAGs in the auditory system.ObjectiveThe aim of this scoping review is to understand the extent and type of evidence in relation to the physiopathology, classification, epidemiology, and clinical management of hearing loss and the effect of therapy for hearing loss in patients with MPS IVA.MethodsThis scoping review includes participants across all genders and of no particular age group who are diagnosed with MPS IVA and develop hearing loss as a comorbidity. No exclusion criteria (country, language, or document type) will be applicable. The information sources will include experimental and quasi-experimental, analytical observational, observational, and qualitative studies. Unpublished literature will not be covered. Grey literature will be covered. A total of 2 independent reviewers will participate in the process of screening the literature, paper selection, and data extraction, and this process will be performed blindly. When all manuscripts have been selected, disagreements that arise between the 2 reviewers at each stage of the selection process will be resolved through discussion or with an additional reviewer. Results will be reported with descriptive statistics and information will be displayed in a diagrammatic or tabular manner, as explained in the JBI guidelines.ResultsThe literature search was performed in November 2021 in MEDLINE, LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde), the Cochrane Library, ScienceDirect, Google Scholar, and OpenGrey; a total of 780 results were retrieved. Completion of the review is expected in mid-2022.ConclusionsThis scoping review will be the first to describe the extent of the information regarding the development of hearing loss in the MPS IVA population. The data gathered by this review may lead to an understanding of the grade of hearing loss in this population and allow for the assessment of possible interventions according to the disease pattern.International Registered Report Identifier (IRRID)PRR1-10.2196/32986

Association between sense of coherence and oral clinical conditions in adults and the elderly: systematic review and meta-analysis.

This study systematically reviews the evidence on the relationship between sense of coherence (SOC) and oral clinical conditions in adults and elderly people. PubMed, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences - Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Brazilian Dentistry Bibliography - Bibliografia Brasileira de Odontologia (BBO), Cochrane Library and grey literature were searched. Observational studies involving adults and elderly people that evaluated SOC with a valid instrument and investigated oral clinical measurements as outcomes were included. Two review authors independently assessed the studies for inclusion and extracted data. The quality of studies was assessed using the Downs and Black checklist. Meta-analysis used the random-effect inverse-variance method to obtain pooled odds ratios (OR) and 95% Confidence Intervals (CI) for each oral clinical condition. From a total of 872 identified studies, ten observational cross-sectional and one longitudinal study were included. Nine studies were judged of medium or high risk of bias. Meta-analyses showed that adults and elderly people with higher SOC were less likely to present dental caries (OR 0.84; 95%CI = 0.73-0.96), periodontal disease (OR 0.58; 95%CI = 0.30-0.85), gingivitis (OR 0.54; 95%CI = 0.18-0.90) or dental biofilm (OR 0.65; 95%CI = 0.43-0.86). Current evidence suggests that better SOC is positively related to better oral clinical status in adults and elderly people. Longitudinal and intervention studies are needed to confirm these findings.

Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review protocol.

Several measurement tools commonly used in face-to-face neurological rehabilitation have been used in telerehabilitation. However, it is not known whether these tools have adequate measurement properties and clinical utility. This systematic review aims to investigate the measurement properties and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological diseases. A systematic review to investigate the measurement properties and clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions will be conducted. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. this systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 28 May 2021 (registration number: CRD42021257662). Electronic searches will be performed in following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE Ovid), Excerpta Medica Database (Embase Classic + Embase Ovid), Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (Scielo), and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Two trained independent reviewers will select the studies according to the inclusion criteria, and will also extract the data, evaluate the clinical utility and methodological quality. The relevant data such as design, participants, settings, and mode of administration, measurement properties, and clinical utility will be summarized. Disagreements between reviewers will be resolved by consensus or by the decision of a third independent reviewer. Hand searches of other relevant studies will be employed. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the clinical utility scale will be used to assess the methodological quality and clinical utility of these tools, respectively. This systematic review will provide information regarding the measurement properties and the clinical utility of the measurement tools used in neurological telerehabilitation. This information will be useful to assist health professionals in choosing adequate measurement tools and planning new research studies.

Metodologia Lean Healthcare e a Odontologia: Uma Revisão Da Literatura

This study aimed to carry out a literature review on the lean method, assessing its applicability in dentistry. The research has a bibliographic, descriptive, and retrospective scope. Thus, we selected scientific articles that addressed concepts on the lean method and dentistry. We researched the following databases: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Regional de Medicina (BIREME), Scientific Electronic Library Online (SciELO), and Public MEDLINE (PubMed). We included, essentially, articles from the last 35 years (1987-2022) with abstracts (in English or Portuguese) that presented the following terms: “Lean Methodology” and “Health Management and Dentistry.” Worldwide healthcare has experienced an explosion in knowledge, innovation, and the ability to manage formerly fatal conditions. However, it is still far from the expected standard of quality, results, cost, and equity. Lean Methodology has been implemented in clinics, offices, and hospitals to attain improvements in dental and oral health service processes, resulting in significant advances in these, as well as in the quality of care and cost reduction for organizations. The Lean Method can be applied in dentistry since it can act in reducing waste, eliminating redundancies in activities, and increasing the safety of care.

DIGITAL HEALTH AND SELF-CARE IN PEOPLE WITH INTESTINAL OSTOMIES: AN INTEGRATIVE REVIEW

Objective: synthesize the scientific production related to digital health in ostomies to promote self-care. Method: integrative review with research in online databases, seeking to answer the following guiding question: What are the digital approaches used to teach self-care to patients with ostomy identified in the publications? Results: six different ways of using digital health to promote self-care in people living with intestinal ostomies were identified. Five were published in the National Library of Medicine (MEDLINE) database and one published in the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Base de Dados de Enfermagem da Biblioteca Virtual em Saúde (BDENF),in the period from 2017 to 2020. Conclusion: the six approaches studied can be used simultaneously in individuals with ostomies and can be considered complementary, as they act in different aspects of the individual’s routine, with the ultimate goal being to improve the quality of life of the person with an intestinal ostomy.

Cranial Base Angle in Patients With Cleft Lip and Palate-A Systematic Review and Meta-Analysis.

Background: Diverse findings have been reported for the cranial base angle (CBA) in patients with CLP (cleft lip and palate) and non-CLP controls. Objective: The aim of this study is to assess and evaluate the CBA in patients with CLP and non-CLP controls. Methods: Data from PubMed, OVID Technologies, Inc., Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus, Web of Science, and EMBASE for Excerpta Medica dataBASE (EMBASE) with relevant terms was extracted until December 31, 2020. Inclusion criteria were data of patients with non-syndromic unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). In the case of UCLP and BCLP, patients with craniofacial syndromes were excluded. The study proposal was registered with PROSPERO (Registration number: CRD42021228632). Results: Fifteen studies with a total of 2032 participants were included for the systematic review and 14 studies with a total of 1972 participants were included for the meta-analysis. The risk of bias was assessed using the Modified Newcastle Ottawa scale under seven domains by two authors. Thirteen studies were graded as "good" and two as "satisfactory." The CBA in patients with CLP were greater than the non CLP Class I controls in six of the 15 studies. CBA was greater in patients with CLP than non-CLP controls by 1.21° (95% CI of 0.19-2.22). Meta-analysis reported considerable heterogeneity (I2 = 86%). Anterior (ACB) and posterior cranial base (PCB) lengths were shorter in patients with CLP than in the non-cleft Class I controls by 2.14 mm (95% CI of 0.99-3.30) and 2.06 mm (95% CI of 1.52-2.60), respectively. Conclusion: Most studies were graded as good. Patients with CLP had greater CBA and shorter ACB and PCB lengths when compared to non-CLP controls.

Circulating MicroRNAs as Novel Potential Diagnostic Biomarkers for Osteosarcoma: A Systematic Review.

Osteosarcoma (OS) is a fast-progressing bone tumor with high incidence in children and adolescents. The main diagnostic methods for OS are imaging exams and biopsies. In spite of the several resources available for detecting the disease, establishing an early diagnosis is still difficult, resulting in worse prognosis and lower survival rates for patients with OS. The identification of novel biomarkers would be helpful, and recently, circulating microRNAs (miRNAs) have been pointed to as possible non-invasive biomarkers. In order to assess the effectiveness of miRNA research, we performed a systematic review to assess the potential role of circulating miRNAs as biomarkers for OS diagnosis. We performed a search in various databases—PubMed, LILACS (Literatura Latino-americana e do Caribe em Ciências da Saúde), VHL (Virtual Health Library), Elsevier, Web of Science, Gale Academic One File—using the terms: “Circulating microRNAs” OR “plasma microRNAs” OR “serum microRNAs” OR “blood microRNAs” OR “cell-free microRNAs” OR “exosome microRNAs” OR “extracellular vesicles microRNAs” OR “liquid biopsy” AND “osteosarcoma” AND “diagnostic”. We found 35 eligible studies that were independently identified and had had their quality assessed according to Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) guidelines. Despite the useful number of publications on this subject and the fact that several microRNAs showed excellent diagnostic performance for OS, the lack of consistency in results suggests that additional prospective studies are needed to confirm the role of circulating miRNAs as non-invasive biomarkers in OS.

Total Arterial Coronary Bypass Graft Surgery is Associated with Better Long-Term Survival in Patients with Multivessel Coronary Artery Disease: a Systematic Review with Meta-Analysis.

IntroductionThe benefit of total arterial revascularization (TAR) in coronary artery bypass grafting (CABG) remains a controversial issue. This study sought to evaluate whether there is any difference on the long-term results of TAR and non-TAR CABG patients.MethodsThe Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Clinical Trials.gov, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Google Scholar databases were searched for studies published by October 2020. Randomized clinical trials and observational studies with propensity score matching comparing TAR versus non-TAR CABG were included. Random-effects meta-analysis was performed. The current barriers to implementation of TAR in clinical practice and measures that can be used to optimize outcomes were reviewed.ResultsFourteen publications (from 2012 to 2020) involving a total of 22,746 patients (TAR: 8,941 patients; non-TAR: 13,805 patients) were included. The pooled hazard ratio (HR) for long-term mortality (over 10 years) was lower in the TAR group than in the non-TAR group (random effect model: HR 0.676, 95% confidence interval 0.586-0.779, P<0.001). There was evidence of low heterogeneity of treatment effect among the studies for mortality, and none of the studies had a particular impact on the summary result. The result was not influenced by age, sex, or comorbidities. We identified low risk of publication bias related to this outcome.ConclusionThis review found that TAR presents the best long-term results in patients who undergo CABG. Given that many patients are likely to benefit from TAR, its use should be encouraged.

Instructor-led oral debriefing technique in clinical nursing simulation: integrative review.

To analyze available scientific evidence in literature pertaining to the elements that make the instructor-led oral debriefing technique in clinical nursing simulation feasible. An Integrative literature review along the following information sources: PubMed®, Scopus, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) [Latin American and Caribbean Health Sciences Literature], Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Educational Resources Information Centre (ERIC). 284 studies were identified, and 5 composed the sample. Four elements constitute oral debriefing: characteristics of the instructor; discussion format, debriefing structure; and time frame. The main benefit was to develop cognitive and psychomotor skills; and the challenge was to establish training for instructors. The studies showed high methodological quality. The scientific deepening as to the elements, benefits, and challenges of oral debriefing enables its execution and offers quality to the nursing process.