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OBJECTIVES: A network meta-analysis (NMA) was performed to assess which adhesive strategy is most clinically effective in treating non-carious cervical lesions (NCCLs). MATERIAL AND METHODS: Studies were identified by a systematic search of electronic databases including MEDLINE via PubMed, Brazilian Library in Dentistry (BBO), Cochrane Library, EMBASE, Latin American and Caribbean Health Sciences Literature database (LILACS), Scopus, and Web of Science without restrictions on publication year or language. The grey literature was also consulted. Only randomized clinical trials that compared different adhesive strategies in NCCLs in adult patients were included. The risk of bias was evaluated by using the Cochrane Collaboration tool. A random-effects Bayesian mixed treatment comparison model was used to compare adhesive strategies (3ER, 2ER, 2SE, and 1SE) at different follow-up times. The surface under cumulative ranking curve (SUCRA) was estimated for each strategy. Heterogeneity was assessed by using the Cochran Q test and I2 statistics. The quality of evidence was evaluated using the GRADE approach. RESULTS: A total of 5058 studies were identified, 66 of which met the eligibility criteria and of these 5 were judged "low" risk of bias and 57 were meta-analyzed. We did not observe significant differences in the NMA analysis for any two pairs of adhesives, except for the shortest follow-up for 2ER vs 3ER. The material 2SE ranked highest, although it differed only slightly from the other bonding strategies. CONCLUSIONS: No bonding strategy is better than the others. CLINICAL RELEVANCE: Adhesive efficacy cannot be characterized by its bonding strategy.

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OBJECTIVES: To derive care targets and evaluate the impact of displaying them at the point of care on postoperative length of stay (LOS). STUDY DESIGN: A prospective cohort study using 2 years of historical controls within a freestanding, academic children's hospital. Patients undergoing benchmark cardiac surgery between May 4, 2014, and August 15, 2016 (preintervention) and September 6, 2016, to September 30, 2018 (postintervention) were included. The intervention consisted of displaying at the point of care targets for the timing of extubation, transfer from the intensive care unit (ICU), and hospital discharge. Family satisfaction, reintubation, and readmission rates were tracked. RESULTS: The postintervention cohort consisted of 219 consecutive patients. There was a reduction in variation for ICU (difference in SD -2.56, P < .01) and total LOS (difference in SD -2.84, P < .001). Patients stayed on average 0.97 fewer days (P < .001) in the ICU (median -1.01 [IQR -2.15, -0.39]), 0.7 fewer days (P < .001) on mechanical ventilation (median -0.54 [IQR -0.77, -0.50]), and 1.18 fewer days (P < .001) for the total LOS (median -2.25 [IQR -3.69, -0.15]). Log-transformed multivariable linear regression demonstrated the intervention to be associated with shorter ICU LOS (ß coefficient -0.19, SE 0.059, P < .001), total postoperative LOS (ß coefficient -0.12, SE 0.052, P = .02), and ventilator duration (ß coefficient -0.21, SE 0.048, P < .001). Balancing metrics did not differ after the intervention. CONCLUSIONS: Target-based care is a simple, novel intervention associated with reduced variation in LOS and absolute LOS across a diverse spectrum of complex cardiac surgeries.

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In winemaking, a large amount of grape pomace is produced that is rich in polyphenolics and highly beneficial for human health, as phenols are useful for skin ultraviolet (UV) protection. In this investigation, we evaluated the safety and clinical efficacy of a sunscreen system containing a grape pomace extract from Vitis vinifera L. as a bioactive ingredient. The recovery of phenolics in the waste was performed by percolation. Nine emulsions were developed using a factorial design and two were evaluated clinically: Formulation E, containing only UV filters (butylmethoxydibenzoyl methane, ethylhexyl methoxycinnamate and ethylhexyl dimethyl PABA), and F, with the extract at 10.0% w/w + UV filters. The antioxidant activity was determined by the DPPH assay and the in vitro efficacy was established by sun protection factor (SPF) measurements (Labsphere UV-2000S). Clinical tests were performed to determine safety (human repeated insult patch test) and to confirm efficacy (photoprotective effectiveness in participants). The results showed a synergistic effect between the sunscreen system and the extract on UVB protection and antioxidant activity. Both samples were considered safe. Formulation F was 20.59% more efficient in protecting skin against UVB radiation, taking approximately 21% more time to induce erythema compared to the extract-free sample.

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BACKGROUND: Ischemic heart disease is the leading cause of death in the world and is associated with dyslipidemia, high blood pressure, diabetes mellitus, and other factors. OBJECTIVE: To determine the clinical effectiveness on the lipid profile of the rosuvastatin + fenofibric acid combination in Colombian patients with high cardiovascular risk and mixed dyslipidemia. METHODS: Longitudinal observational study in a random sample of patients with a diagnosis of mixed dyslipidemia and moderate, high, or very high cardiovascular risk who were treated with rosuvastatin + fenofibric acid. Anthropometric, clinical, laboratory, comorbidity, and pharmacological variables were identified. Effectiveness on the lipid profile was determined. RESULTS: A total of 386 patients were analyzed. They had a mean age of 60.8 ± 11.4 years, 53.1% were female, and 75.6% had high/very high cardiovascular risk. The initial evaluation showed a mean LDL cholesterol of 138.4 ± 67.1 mg/dL and triglycerides of 679.7 ± 573.6 mg/dL. At the end of follow-up, mean LDL cholesterol was 87.5 ± 41.2 mg/dL (reduced by 43.3%; P < .001), and triglycerides were 243.5 ± 170.5 mg/dL (reduced by 64.2%; P < .001). Only 35.4% (n = 73) of patients with very high risk reached the goal of metabolic control, compared to 61.6% (n = 53) with high risk and 55.4% (n = 46) with moderate risk. Belonging to the very high-risk group was associated with a lower probability of achieving the control goal (OR: 0.32; 95%CI: 0.192-0.539). CONCLUSION: The combination of rosuvastatin + fenofibric acid is an effective option in patients with mixed dyslipidemia and high cardiovascular risk, providing a therapeutic alternative for those conditions that require it.

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Objective: To evaluate the safety and efficacy of a 5 mg sublingual dose of zolpidem, compared to a 10 mg oral dose, at bedtime and "as needed" following middle-of-the-night awakenings. Methods: Participants were randomized into an oral group (oral zolpidem 10 mg and sublingual placebo at bedtime and "as-needed") and a sublingual group (oral placebo and sublingual zolpidem 5 mg at bedtime and "as-needed"). Participants underwent medical evaluation, polysomnography, the psychomotor vigilance test, and completed questionnaires. Results: Of 85 patients, 67 met the criteria for insomnia (48±10 years; 79% women) and were randomized. Of these, 46 completed 92±5 days of treatment. Mild-to-moderate adverse events were reported by 25% of the participants, including headache, sleepiness, and dizziness. Both treatments decreased middle-of-the-night awakenings by an average of -3.1±2.3 days/week and increased total sleep time by 1.5 hours. Changes in sleep quality and insomnia severity scores were also favorable and comparable between groups: variation depended on continuation of treatment. Regarding PSG findings, sleep latency decreased more in the sublingual group than the oral group (-14±42 vs. 10±29 min; p = 0.03). The psychomotor vigilance test showed minor residual effects 30 minutes after awakening, which reversed after 2 hours. Conclusions: The safety and efficacy of both zolpidem formulations are comparable. The sublingual 5 mg dose induced sleep more rapidly. Clinical trial registration: NCT01896336

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Patients hospitalized for acute asthma treated with a pre-established algorithm could decrease hospital stay and critical bed (PICU) requirement. The objective of this article was to implement and evaluate the impact of a pre-established algorithm to treat children hospitalized for acute asthma. It is a cross-sectional and comparative study, with a prospective sample for convenience, of asthmatic children between 5 and 15 years admitted during 2017 without response to the first line of treatment in the emergency department. Patients with cardiorespiratory comorbidities and with direct admission to PICU were excluded. An algorithm was applied for 2 hours and its effectiveness was evaluated by a clinical score (PAS: English Pediatric Asthma Score). 55 patients were admitted, mean age 8.02 years, 41.8% female. The PAS decreased from 8 to 5 points at the end of the algorithm (p <0.001). When comparing the results obtained with the group treated the previous year, without algorithm application in 51 patients with similar demographic characteristics, a shorter hospitalization was observed (0.6 days versus 0.95 days (p <0.0368)). The algorithm in acute asthma unified treatment criteria and times in its application. A rapid decrease in clinical score and a shorter hospital stay were observed.

Los pacientes hospitalizados por asma agudo tratados con un algoritmo preestablecido, podrían disminuir la estancia hospitalaria y requerimiento de cama crítica (UCIP). El objetivo de este trabajo fue el de implementar y evaluar el impacto de un algoritmo preestablecido para tratar a niños hospitalizados por asma aguda. Es un estudio transversal y comparativo, con una muestra prospectiva por conveniencia, de niños asmáticos entre 5 y 15 años ingresados durante el 2017 sin respuesta a la primera línea de tratamiento en el servicio de urgencia. Se excluyeron pacientes con comorbilidades cardiorespiratorias y con ingreso directo a UCIP. Se aplicó un algoritmo durante 2 horas evaluando su efectividad mediante puntaje clínico (PAS, por su sigla en inglés Pediatric Asthma Score). Ingresaron 55 pacientes, edad media 8,02 años, 41,8% sexo femenino. El PAS disminuyó de 8 a 5 puntos al finalizar algoritmo (p <0,001). Al comparar los resultados obtenidos con el grupo tratado el año anterior, sin aplicación de algoritmo en 51 pacientes con similares características demográficas, se observó una hospitalización más breve (0,6 días versus 0,95 días (p < 0,0368)). El algoritmo en asma aguda unificó criterios de tratamiento y los tiempos en su aplicación. Se observó una rápida disminución del puntaje clínico y menor estancia hospitalaria.

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Resumen: Actualmente, la Medicina Basada en Evidencia tiene un papel fundamental en la toma de decisiones médicas, ya que intenta, a través de los métodos de la ciencia, justificar las diferentes alternativas que se le pueden ofrecer a un paciente. Para entender la evolución histórica de esta forma de practicar la medicina, es necesario revisar la contribución de uno de los principales participantes en este movimiento cultural: Archibald Leman Cochrane, quien ayudó a definir el marco teórico que ha permitido incorporar la ciencia a la práctica de la medicina. Su papel, al insistir en la necesidad de integrar la evidencia científica y conjuntarla con la experiencia clínica, constituyó un elemento fundamental y decisivo en el desarrollo de una nueva disciplina, la Medicina Basada en Evidencia.

Abstract: Nowadays, Evidence-Based Medicine plays a fundamental role while making medical decisions, considering that through the methods of science, it attempts to justify the variety of alternatives that may be offered to patients. In order to understand the historical evolution of this way of practicing medicine, it is necessary to review the contribution of one of the main participants in this cultural movement: Archibald Leman Cochrane, who helped to define the theoretical framework that has allowed the integration of science into the practice of medicine. Since he insisted in the need of integrating scientific evidence into clinical experience, his role became a fundamental and decisive element in the development of a new discipline: Evidence-Based Medicine.

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Nowadays, Evidence-Based Medicine plays a fundamental role while making medical decisions, considering that through the methods of science, it attempts to justify the variety of alternatives that may be offered to patients. In order to understand the historical evolution of this way of practicing medicine, it is necessary to review the contribution of one of the main participants in this cultural movement: Archibald Leman Cochrane, who helped to define the theoretical framework that has allowed the integration of science into the practice of medicine. Since he insisted in the need of integrating scientific evidence into clinical experience, his role became a fundamental and decisive element in the development of a new discipline: Evidence-Based Medicine.

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Occupational therapy is a profession concerned with the promotion of health and quality of life through occupation and engagement in activities. Dementia has an individual and social impact related to disability, dependency, need for daily support and exclusion from participation in situations and activities ofdaily living, matters ofinterest to occupational therapists. The aim of this article is to synthetize occupational therapy interventions in dementia care, describing perspectives of intervention, identifying current evidence for potential benefits and stablishing criteria for referral. Occupational therapy’sperspective in dementia care involves a dynamic view of the impact of cognitive, psychological and behavioral symptoms on the participation of the person with dementia in activities and situations ofdaily living and the relation with others and the physical environment. Increasing evidence suggests that occupational therapy can enhance the maintenance ofparticipation in activities of daily living as a way to moderate dependency and disability, to promote management ofcognitive, psychological and behavioral symptoms and adjusting the abilities of caregivers to face challenging situations of daily living. This synthesis has a clinical relevance as it helps to define occupational therapy framework in dementia care in order to contribute to the design and evaluation of occupational therapy interventions.

La terapia ocupacional es una profesión que busca la promoción de salud y calidad de vida a través de la ocupación y el involucramiento en actividades. El aumento del número de personas con demencia demanda progresivamente la intervención de terapia ocupacional en diferentes contextos de atención. La demencia tiene un impacto individual y social relacionado con discapacidad, dependencia, necesidad de apoyo diario y exclusión de participación, problemas de interés para los terapeutas ocupacionales. El propósito de este artículo es sintetizar intervenciones de terapia ocupacional en el tratamiento de las demencias, describiendo sus principales enfoques, identificando evidencia y potenciales y estableciendo recomendaciones para su referencia. Los enfoques de terapia ocupacional en demencia incluyen una perspectiva dinámica del impacto que los síntomas cognitivos, psicológicos y conductuales tiene usualmente en la participación de la persona con demencia en situaciones y actividades de la vida diaria, en los otros y en el ambiente físico. Existe evidencia creciente de los potenciales beneficios de terapia ocupacional en la mantención de participación en actividades de la vida diaria como moderadora de dependencia, de síntomas cognitivos, psicológicos y conductuales asociados con la patología, y del ajuste de las habilidades de cuidadores familiares. Esta síntesis tiene una relevancia clínica al colaborar en la delimitación de las acciones de terapia ocupacional en el tratamiento de las demencias, facilitando el diseño de intervenciones y su evaluación.

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La asociación entre trastornos psicopatológicos y variables de funcionamiento psicosocial ha sido documentada, pero son escasos los estudios que evalúan su impacto sobre la eficacia de los tratamientos psicológicos. El objetivo de este estudio fue evaluar la organización vital de 78 pacientes de un servicio de atención psicológica y examinar la relación con variables clínicas y con el éxito del tratamiento. Esta organización se evaluó mediante una escala confeccionada ad hoc para este estudio. El área de pareja resultó la menos organizada frente a la familiar y personal, con las mayores puntuaciones. La organización vital se relacionó de forma significativa con distintos ejes del DSM-IV-TR. Se confirmó que pacientes con baja organización vital requieren un mayor número de objetivos terapéuticos.

The association between psychological disorders and psychosocial functioning variables has been previously documented, but relatively few studies have examined the impact of these variables on psychological treatment outcomes. The aim of this study was to assess the life functioning of 78 patients from a psychological service centre, and to examine its relationship with clinical variables and treatment success. Life functioning was evaluated with a scale elaborated ad hoc for this study. The partner area of functioning was the most impaired while family and personal areas obtained the highest functioning scores. Patient's life functioning was significantly associated with several axis of DSM-IV-TR. It was confirmed that patients with poorer life functioning required a greater number of treatment objectives.

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Objetivo: determinar la eficacia clínica de la plata iónica en hidrogel (SilverCare®), en pacientes con heridas agudas o crónicas con colonización crítica bacteriana o heridas infectadas que hayan sido intervenidos en el Servicio de Cirugía Cardiovascular del Hospital Universitario de Caracas, Venezuela, entre los meses de julio y diciembre del 2011. Pacientes y métodos: de un total de 34 pacientes con estudios bacteriológicos positivos, se incluyeron 25 pacientes entre 18 y 70 años, intervenidos por patología cardiaca central o periférica que presentaron heridas agudas o crónicas con colonización crítica o infección bacteriana registrada por cultivo de secreción. Resultados: de los 25 pacientes, 5 fueron pacientes con cirugía cardíaca, postoperados principalmente de revascularización miocárdica quirúrgica complicada con infección de herida esternal o safenectomía, y 20 fueron pacientes con postoperatorio de cirugía vascular periférica (exploración vascular por herida por arma de fuego 15 pacientes, otras cirugías periféricas 5 pacientes). Se registró un total de 25 resultados de cultivos positivos para los siguientes gérmenes: Escherichia coli (8 casos 32%), Acinetobacter baumannii (4 casos­16%), Stafilococo aureus meticilino resistente (4 casos ­ 16%), Psedomona aeruginosa (3 casos­12%), Acinetobacter SP multirresistente (1 caso­4%), Enterobacter agglomerans (1 caso­4%), Klebsiella S.P.P. (1 caso 4%), Dos o más gérmenes (3 casos­12%). Se encontró bacterias multiresistentes en 10 casos (40%). Se pudo determinar una reducción de más del 25% de los diámetros de las heridas a la cuarta semana de tratamiento en 23 casos (92%), control de la infección en 24 casos (96%), además de eliminación del dolor y olor en el 96% de los casos, disminución de la cantidad de exudado en 88%. No hubo recidiva de la infección en la herida a los 60 días de seguimiento. Conclusión: se confirma la eficacia clínica del uso de hidrogel con plata (SilverCare®) en el control de la infección y cicatrización en pacientes con heridas infectadas con poco a moderado exudado, considerando que la reducción de la velocidad de cicatrización fue debida al hidrogel y el control de la infección a la plata iónica(AU)

Objective: to determine the clinical efficacy of the ionic silver in hydrogel (SilverCare ®) in patients with acute or chronic bacterial critical colonization with wounds or infected wounds that have been operated in the service of Cardiovascular Surgery of the Hospital Universitario de Caracas, between the months of July and December 2011. Method: a total of 34 patients with positive bacteriological studies, included 25 patients between 18 and 70 years, operated by central or peripheral heart disease presenting with acute or chronic wounds with critical colonization or bacterial infection registered by culture of drainage. Results: of 25 patients, 5 were patients with cardiac surgery, undergone mainly myocardial revascularization surgery complicated with saphenectomy or sternal wound infection, and 20 patients with postoperative peripheral vascular surgery (vascular injury by firearm scan 15 patients, other peripheral surgeries 5 patients). There was a total of 25 results of positive cultures for the following germs: Escherichia coli (8 cases-32%), Acinetobacter baumannii (4 cases-16%), S. aureus aureus Methicillin resistant (4 cases - 16%), sedomona aeruginosa (3 cases-12%), multidrug-resistant Acinetobacter SP (1 case-4%), Enterobacter agglomerans (case 1-4%), Klebsiella S.P.P. (case 1-4%), two or more germs (3 cases-12%). Found multi-resistant bacteria in 10 cases (40%). It was determined a reduction of more than 25% of the diameters of the wounds a fourth week of treatment in 23 cases (92%), infection control in 24 cases (96%), in addition to eliminating the pain and smell in 96% of cases, decrease in the amount of exudate by 88%. There was no recurrence of the infection in the wound to 60 days of follow-up. Conclusion: is confirmed the clinical efficacy of the use of hydrogel with silver (SilverCare®) in the control of infection and scarring in patients with wounds infected with little to moderate exudate, considering that the reduction of the speed of healing was due to the Hydrogel and control of infection to the Ionic silver(AU)

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