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BACKGROUND AND OBJECTIVE: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach is a systematic method for assessing the certainty of evidence (CoE) and strength of recommendations in health care. We aimed to verify the effects of an online-based GRADE course on multirater consistency in the evaluation of the CoE in systematic reviews (SRs) analysis. STUDY DESIGN AND SETTINGS: Sixty-five Brazilian methodologists and researchers participated in an online course over 8 weeks. Asynchronous lessons and weekly synchronous meetings addressed the GRADE system in the context of CoE assessment. We asked participants to evaluate the CoE of random SRs (two before and another two after the course). Analyzes focused on the multirater agreement with a standard response, in the interrater agreement, and before-after changes in the proportion of participants that rated down the domains. RESULTS: 48 individuals completed the course. Participants presented improvements in the raters' assessment of the CoE using the GRADE approach after the course. The multirater consistency of indirectness, imprecision, and the overall CoE increased after the course, as well as the agreement between raters and the standard response. Furthermore, interrater reliability increased for risk of bias, inconsistency, indirectness, publication bias, and overall CoE, indicating progress in between-raters consistency. After the course, approximately 78% of individuals rated down the overall CoE to a low/very low degree, and participants presented more explanations for the judgment of each domain. CONCLUSION: An online GRADE course improved the consistency and agreement of the CoE assessment by Brazilian researchers. Online training courses have the potential to improve skills in guideline methodology development.

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OBJECTIVE: This study evaluated the methodological quality of published systematic reviews on randomized and non-randomized clinical trials to synthesize evidence on the association between IL-6, immunosenescence, and aerobic and/or resistance exercise. METHOD: The Preferred Reporting Items for Overviews of Systematic Reviews (PRIO-harms) guideline was used, with registration number CRD42022346142-PROSPERO. Relevant databases such as Cochrane Library, PubMed, Web of Science, Scopus, and Google Scholar were searched using English Medical Subject Headings terms. Inclusion criteria were systematic reviews analyzing aerobic exercise, resistance exercise, or a combination of both and assessing IL-6 as a biomarker of cellular immunosenescence in humans. The Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) was employed. RESULTS: Out of 742 identified articles, 18 were eligible, and 13 were selected for analysis. Sample sizes ranged from 249 to 1421 participants, mostly female, with ages ranging from 17 to 95 years. Aerobic exercise was the most studied type (46.15%), followed by combined exercise (38.46%) and resistance exercise (15.38%). Aerobic exercise showed a statistically significant reduction in IL-6, C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) levels. Among the 13 reviews analyzed using AMSTAR-2, 8 were rated as critically low quality, and 5 were classified as low quality. CONCLUSION: Aerobic exercise has anti-inflammatory properties and the potential to modulate IL-6, CRP, and TNF-α levels in immunosenescence. However, the limited methodological quality of the analyzed systematic reviews highlights the urgent need for robust, high-quality studies to improve access to information and facilitate evidence-based decision-making in healthcare.

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Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.

La insuficiencia cardiaca crónica sigue siendo unas de las principales causas de afectación en el funcionamiento y en la calidad de vida de las personas que la presentan, así como una de las primeras causas de mortalidad en nuestro país y en todo el mundo. México tiene una alta prevalencia de factores de riesgo para desarrollar insuficiencia cardiaca, tales como hipertensión arterial, diabetes y obesidad, lo que hace imprescindible contar con un documento basado en la evidencia que brinde recomendaciones a los profesionales de la salud involucrados en el diagnóstico y el tratamiento de estos pacientes. Este documento establece la guía de práctica clínica (GPC) elaborada por iniciativa de la Sociedad Mexicana de Cardiología (SMC) en colaboración con la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con la finalidad de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario y multicolaborativo de expertos. Cumple con estándares internacionales de calidad, como los descritos por el Institute of Medicine de los Estados Unidos de América (IOM), el National Institute of Clinical Excellence (NICE) del Reino Unido, la Intercollegiate Network for Scottish Guideline Development (SIGN) de Escocia y la Guidelines International Network (G-I-N). El grupo de desarrollo de la guía se integró de manera interdisciplinaria con el apoyo de metodólogos con experiencia en revisiones sistemáticas de la literatura y en el desarrollo de GPC. Se llevó a cabo y se condujo metodología de panel Delphi modificado para lograr un nivel de consenso adecuado en cada una de las recomendaciones contenidas en esta GPC. Esperamos que este documento contribuya para la mejor toma de decisiones clínicas y se convierta en un punto de referencia para los clínicos que manejan pacientes con insuficiencia cardiaca crónica en todas sus etapas clínicas, y de esta manera logremos mejorar la calidad en la atención clínica, aumentar la calidad de vida de los pacientes y disminuir las complicaciones de la enfermedad.

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BACKGROUND: Key performance indicators (KPIs) are quantifiable measures used to monitor the quality of health services. Implementation guidelines for clinical pharmacy services (CPS) do not specify KPIs. AIM: To assess the quality of the studies that have developed KPIs for CPS in inpatient hospital settings. METHOD: A systematic review was conducted by searching in Web of Science, Scopus, and PubMed, supplemented with citation analyses and grey literature searches, to retrieve studies addressing the development of KPIs in CPS for hospital inpatients. Exclusions comprised drug- or disease-specific studies and those not written in English, French, Portuguese, or Spanish. The Appraisal of Indicators through Research and Evaluation (AIRE) instrument assessed methodological quality. Domain scores and an overall score were calculated using an equal-weight principle. KPIs were classified into structure, process, and outcome categories. The protocol is available at https://doi.org/10.17605/OSF.IO/KS2G3 . RESULTS: We included thirteen studies that collectively developed 225 KPIs. Merely five studies scored over 50% on the AIRE instrument, with domains #3 (scientific evidence) and #4 (formulation and usage) displaying low scores. Among the KPIs, 8.4% were classified as structure, 85.8% as process, and 5.8% as outcome indicators. The overall methodological quality did not exhibit a clear association with a major focus on outcomes. None of the studies provided benchmarking reference values. CONCLUSION: The KPIs formulated for evaluating CPS in hospital settings primarily comprised process measures, predominantly suggested by pharmacists, with inadequate evidence support, lacked piloting or validation, and consequently, were devoid of benchmarking reference values.

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This is a protocol for an overview to summarize the findings of Systematic Reviews (SR) dealing with Photodynamic Inactivation (PDI) for control of oral diseases. Specific variables of oral infectious will be considered as outcomes, according to dental specialty. Cochrane Database of Systematic Reviews (CDSR), MEDLINE, LILACS, Embase, and Epistemonikos will be searched, as well as reference lists. A search strategy was developed for each database using only terms related to the intervention (PDI) aiming to maximize sensitivity. After checking for duplicate entries, selection of reviews will be performed in a two-stage technique: two authors will independently screening titles and abstracts, and then full texts will be assessed for inclusion/exclusion criteria. Any disagreement will be resolved through discussion and/or consultation with a third reviewer. Data will be extracted following the recommendations in Chapter V of Cochrane Handbook and using an electronic pre-specified form. The evaluation of the methodological quality and risk of bias (RoB) of the SR included will be carried out using the AMSTAR 2 and ROBIS. Narrative summaries of relevant results from the individual SR will be carried out and displayed in tables and figures. A specific summary will focus on PDI parameters and study designs, such as the type and concentration of photosensitizer, pre-irradiation time, irradiation dosimetry, and infection or microbiological models, to identify the PDI protocols with clinical potential. We will summarize the quantitative results of the SRs narratively.

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ABSTRACT Purpose: Penile fracture (PF) affects 1,14 to 10,48 men in every 100.000 men in East Asia, and the primary aetiology is sexual intercourse, but the knowledge regarding the most dangerous sexual position is not well explained. This study compares three sexual positions: man on top position (MTP), woman on top position (WTP), and doggy style position (DSP), leading to PF potential. Materials and methods: A search of sexual position-related PF in Google Scholar, PubMed, Cochrane, and PMC Europe was performed. Criteria inclusion was the full text of relevant articles which describ the number of sexual positions. It was analyzed by odds ratio, random model effect, and the OR and 95%CI were calculated. Results: Twelve relevant papers involving 490 patients comprised 169 MTP, 120 WTP, 158 DSP, and 43 no intercourse cases. Meta-analysis of all sexual positions was a MTP P= 0,04, WTP P=0,49, and DSP P=0,0005. Conclusions: The man-dominant positions (MTP and DSP) were significantly potential for PF, which speculated that when a man is dominant and very excited, intercourse may become highly vigorous and impact trauma. This study found that man's dominant position consists of DSP and the MTP significantly lead to PF.

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PURPOSE: Penile fracture (PF) affects 1,14 to 10,48 men in every 100.000 men in East Asia, and the primary aetiology is sexual intercourse, but the knowledge regarding the most dangerous sexual position is not well explained. This study compares three sexual positions: man on top position (MTP), woman on top position (WTP), and doggy style position (DSP), leading to PF potential. MATERIALS AND METHODS: A search of sexual position-related PF in Google Scholar, PubMed, Cochrane, and PMC Europe was performed. Criteria inclusion was the full text of relevant articles which describ the number of sexual positions. It was analyzed by odds ratio, random model effect, and the OR and 95%CI were calculated. RESULTS: 12 relevant papers involving 490 patients comprised 169 MTP, 120 WTP, 158 DSP, and 43 no intercourse cases. Meta-analysis of all sexual positions was a MTP P= 0,04, WTP P=0,49, and DSP P=0,0005. CONCLUSION: The man-dominant positions (MTP and DSP) were significantly potential for PF, which speculated that when a man is dominant and very excited, intercourse may become highly vigorous and impact trauma. This study found that man's dominant position consists of DSP and the MTP significantly lead to PF.

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BACKGROUND: Systematic reviews of Randomized Controlled Trials (RCTs) are considered high-level evidence to support a decision on therapeutic interventions, and their methodological quality is essential to provide reliable and applicable results. OBJECTIVE: This meta-epidemiological study aimed to map and critically appraise systematic reviews assessing treatments for vesiculobullous skin diseases. METHODS: We conducted a comprehensive search strategy on MEDLINE (via Pubmed) in December 2022 without restrictions to find systematic reviews evaluating pharmacological interventions for vesiculobullous skin diseases. The methodological quality was assessed using the AMSTAR-2 tool, and additional information was extracted. We identified nine systematic reviews published between 2002 and 2021, seven assessing pemphigus. RESULTS: According to the AMSTAR-2 tool, 55.6% were classified as critically low quality, 22.2% as moderate quality, 11.1% as low and 11.1% as high quality. No review assessed the certainty of the evidence (GRADE); 86% of pemphigus reviews had at least two overlapping RCTs. There were some limitations regarding methodological flaws and the AMSTAR-2 tool use CONCLUSIONS: These findings reveal a frail methodological quality of systematic reviews about vesiculobullous diseases treatment that may impact the results. Therefore, methodological rigor is mandatory for future systematic reviews to avoid duplication of effort and increase the certainty of the evidence supporting decision-making.

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Abstract Background Systematic reviews of Randomized Controlled Trials (RCTs) are considered high-level evidence to support a decision on therapeutic interventions, and their methodological quality is essential to provide reliable and applicable results. Objective This meta-epidemiological study aimed to map and critically appraise systematic reviews assessing treatments for vesiculobullous skin diseases. Methods We conducted a comprehensive search strategy on MEDLINE (via Pubmed) in December 2022 without restrictions to find systematic reviews evaluating pharmacological interventions for vesiculobullous skin diseases. The methodological quality was assessed using the AMSTAR-2 tool, and additional information was extracted. We identified nine systematic reviews published between 2002 and 2021, seven assessing pemphigus. Results According to the AMSTAR-2 tool, 55.6% were classified as critically low quality, 22.2% as moderate quality, 11.1% as low and 11.1% as high quality. No review assessed the certainty of the evidence (GRADE); 86% of pemphigus reviews had at least two overlapping RCTs. There were some limitations regarding methodological flaws and the AMSTAR-2 tool use Conclusions These findings reveal a frail methodological quality of systematic reviews about vesiculobullous diseases treatment that may impact the results. Therefore, methodological rigor is mandatory for future systematic reviews to avoid duplication of effort and increase the certainty of the evidence supporting decision-making.

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ABSTRACT Objective: This bibliometric study aimed to analyze the citation metrics, journal and author characteristics, and subject domains of the 100 top-cited Systematic Reviews (SR) and Meta-Analysis (MA) in orthodontics. Material and Methods: An electronic database search was conducted for SR and MA in the Web of Science on 16th July 2023, without language and time restrictions. Of the 802 hits returned, the 100 top-cited orthodontic articles were shortlisted. They were analyzed for citation metrics, journal characteristics (journal, year of publication, impact factor-IF), author and affiliation characteristics (number, primary and corresponding author's affiliation, and country), study domain, and keywords. Results: These articles were published from 1996 to 2021 in 20 journals, with an impact factor of 1.9 to 10.5, by 351 researchers affiliated with 104 universities. Their citations ranged from 45 to 344, and 34 poised to be classified as classic (≥ 100 citations). The maximum number of articles was published in the American Journal of Orthodontics and Dentofacial Orthopedics (n=38), the European Journal of Orthodontics (n=18), and the Angle Orthodontist (n=8). The authors for individual papers ranged from 1 to 10, with 5 being the most common (n=58). Europe had the highest contribution regarding the number of corresponding authors, institutions, and citations. Bone anchorage and orthodontic tooth movement/Biomechanics were the most frequently researched domains (n=11 each). The most common keyword used was Orthodontics (n=19), followed by Systematic Review (n=16) and Meta-analysis (n=9). Conclusion: In general, the top cited SR and MA were published in high-impact orthodontic journals, were multi-authored, and reflected the collaborative work from different universities.

RESUMO Objetivo: Este estudo bibliométrico teve como objetivo analisar as métricas de citação, as características dos periódicos e dos autores, e os domínios temáticos das 100 Revisões Sistemáticas (RS) e Meta-Análises (MA) mais citadas em Ortodontia. Material e Métodos: Uma pesquisa em banco de dados eletrônico foi realizada para RS e MA na Web of Science no dia 16 de julho de 2023, sem restrições de idioma e data de publicação. Dos 802 resultados encontrados, foram selecionados os 100 artigos ortodônticos mais citados. Eles foram analisados quanto a métricas de citação, características do periódico (revista, ano de publicação e fator de impacto [FI]), características dos autores e afiliação (quantidade, afiliação dos autores principal e correspondente, e país), domínio do estudo e palavras-chave. Resultados: Esses artigos foram publicados entre 1996 e 2021 em 20 periódicos com fator de impacto de 1,9 a 10,5, por 351 pesquisadores afiliados a 104 universidades. Suas citações variaram de 45 a 344, com 34 prestes a serem classificados como clássicos (≥ 100 citações). A maior quantidade de artigos foi publicada na American Journal of Orthodontics and Dentofacial Orthopedics (n=38), na European Journal of Orthodontics (n=18), e no The Angle Orthodontist (n=8). A quantidade de autores por artigo variou de 1 a 10, sendo 5 o mais frequente (n=58). A Europa teve a maior contribuição em relação ao número de autores correspondentes, instituições e citações. Ancoragem óssea e movimentação dentária ortodôntica/Biomecânica foram os domínios mais abordados (n=11 cada). A palavra-chave mais utilizada foi Ortodontia (n=19), seguida de Revisão Sistemática (n=16) e Meta-análise (n=9). Conclusão: No geral, as RS e MA mais citadas foram publicadas em revistas ortodônticas de alto impacto, eram de autoria múltipla e refletiam o trabalho colaborativo de diferentes universidades.

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Objectives: Pesticide application has become necessary to increase crop productivity and reduce losses. However, the use of these products can produce toxic effects. Farmers are individuals occupationally exposed to pesticides, thus subject to associated diseases as well as cognitive impairment. However, this relation is not well established in the literature, requiring further investigation. To assess the potential association between farmers' pesticide exposure and cognitive impairment, we followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, considering participants, interventions, comparators, outcomes, and study strategies. Materials and Methods: This study included articles published between 2000 and 2021 on the Scopus, Web of Science, ScienceDirect, and PubMed databases, retrieved by the terms "pesticides and cognition" and "pesticides and memory." Results: In total, ten studies fit the established criteria and were included in the sample. All had farmers occupationally exposed to pesticides in their sample and only one study dispensed with a control group. Of the neurobehavioral tests, four studies used mini-mental state examination, six neurobehavioral core test batteries (tests recognized in the area), and the remaining, other tests. We observed that 90% of articles found an association between cognitive impairment and pesticide exposure. Overall, five studies measured the activity of cholinesterases in their sample, of which three found significant differences between groups, confirming intoxication in those exposed. Conclusion: Despite the limited number of trials, we found scientific evidence to support the existence of adverse effects of pesticides on farmers' cognition. We recommend that future studies research similar projects, expanding knowledge on the subject.

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Background: As current ethical codes preclude determining whether the clinical improvements obtained with the use of three-dimensional (3D)-printed scaffolds represent true periodontal regeneration, the histological proof of evidence for regeneration must be demonstrated in animal models. Thus, this systematic review investigated the regenerative potential of 3D-printed scaffolds in animal models of periodontal defects. Materials and Methods: A systematic search was performed in four databases (Medline, Embase, Web of Science, and Scopus) to identify preclinical controlled studies that investigated the use of 3D-printed scaffolds for periodontal regeneration. Studies limited to periodontal defects treated with 3D scaffolds were eligible for inclusion. The primary outcome was periodontal regeneration, assessed histologically as new bone, cementum, and periodontal ligament (PDL). This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality was assessed according to the SRYCLE score. Results: Six studies met the inclusion criteria. Scaffolds were designed using computer-aided design software. While the absence of a scaffold resulted in defects repaired mainly with fibrous connective tissue, the use of nonguiding 3D scaffolds promoted some bone formation. Notably, the regeneration of cementum and functional PDL fibers perpendicularly inserted into the root surface and the alveolar bone was limited to the defects treated with multi-compartment fiber-guiding or ion-containing 3D scaffolds. Nevertheless, the quality of the evidence was limited due to the unclear risk of bias. Conclusions: Despite the limitations of the available evidence, the current data suggest that the use of printed multi-compartment fiber-guiding or ion-containing 3D scaffolds improves periodontal regeneration in animal models.

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PURPOSE: Soil-transmitted helminthiasis (STH) is one of the most common chronic infections in developing countries associated with poor socioeconomic and sanitary conditions. The main objective of this overview was to evaluate the influence of environmental factors, risk factors related to the host, and control strategies on the prevalence of STH in different regions of the world. METHODS: LILACS, PubMed, Web of Knowledge, Embase, the Cochrane Library, and Clinical Trials (gray literature) databases were used to obtain the systematic reviews published until December 2020. The methodological quality of systematic reviews was assessed using the standard criteria recommended by AMSTAR. RESULTS: The initial results of the bibliographic search identified 1448 articles, of which 66 studies were read in full and 16 met the inclusion criteria. All the reviews included in this overview associated variations in the global prevalence of STH with at least one of the factors related to the environment, host, and/or control strategies. Climate, temperature, soil moisture, precipitation, mass drug administration, lack of access to water, sanitation and hygiene (WASH), and non-use of footwear were considered the main factors associated with the prevalence of STH. Socioeconomic factors, low educational level, and wearing shoes were universal factors related to prevalence, regardless of the location studied. CONCLUSION: The combination of environmental factors, with factors associated with hosts that predispose infection and reinfection of helminths, as well as the adoption of control strategies based on the treatment of target populations instead of the entire population, influenced the prevalence of STH in all the continents evaluated.

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AIMS: Evaluate the existing evidence of osteoradionecrosis (ORN) treatment in adults with head and neck cancer, the methodological quality and the evidence grade within systematic reviews (SRs). METHODS: An extensive systematic literature search of SRs that addressed ORN in head and neck cancer patients was conducted with screening of eligible studies, data extraction, methodological (AMSTAR 2) and evidence quality assessment (GRADE) of the SRs by independent and calibrated authors. RESULTS: A total of six SRs were enrolled. Based primarily on studies from the 1990s, there is critically low- or moderate-quality evidence that hyperbaric oxygen therapy (HBO) improves ORN healing. From 2005 onward, evidence has been discovered in relation to treatment with pentoxifylline and tocopherol (PENTO). The SRs indicate that the management of ORN with PENTO appears to be promising. The greatest rates of healing are seen in mild and moderate stages of ORN. However, the quality of evidence regarding PENTO, surgery and other treatments remains critically low. CONCLUSION: There is no standardized protocol to treat ORN. PENTO appears to be the most promising conservative treatment; however, the current level of evidence regarding PENTO is still critically low. More robust clinical studies are needed to establish the best treatment for ORN.

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La expansión y consolidación de la práctica clínica basada en la evidencia ha llevado entre otras, a la necesidad de realizar una variedad cada vez mayor de tipos de revisión de la literatura científica; lo que permite avanzar en el conocimiento y comprender la amplitud de la investigación sobre un tema de interés, teniendo en cuenta que una de las propiedades del conocimiento es su carácter acumulativo. Sin embargo, la diversidad de la terminología utilizada genera confusión de términos y conceptos. El objetivo de este manuscrito fue proporcionar un listado de los tipos de revisiones de la literatura más frecuentemente utilizados con sus características y algunos ejemplos de ellas. Revisión cualitativa. Se examinaron de forma dirigida las bases de datos PubMed, WoS y Scopus, en búsqueda de términos asociados a tipos de revisiones y síntesis de la literatura científica. Se encontraron 21 tipos de revisión; y 29 variantes y sinonimias asociadas; las que ilustran los procesos de cada una de ellas. Se da una descripción general de las características de cada cual, junto con las fortalezas y debilidades percibidas. No obstante, se verificó que sólo algunos tipos de revisión poseen metodologías propias y explícitas. Este enfoque, proporciona un punto de referencia para quienes realizan o interpretan revisiones en el ámbito sanitario, y sugiere dos tipos de propuestas de clasificación.

SUMMARY: The expansion and consolidation of evidence-based clinical practice has led, among other things, to the need to carry out an increasing variety of types of literature reviews, which allows advancing in knowledge and understanding the breadth of research on a topic of interest. However, the diversity of the terminology used generates confusion of terms and concepts. The aim of this manuscript was to provide a list of the most frequently used review types with their characteristics and some examples. Qualitative review. PubMed, WoS and Scopus databases were examined in a directed way, searching for terms associated with types of reviews and syntheses of the scientific literature. Twenty-one types of review, and 29 variants and associated synonymies were found; those that illustrate the processes of each of them. An overview of the characteristics of each is given, along with perceived strengths and weaknesses. However, it was verified that only some types of review have their own explicit methodologies. This approach, provides a point of reference for those who perform or interpret reviews in the health field and suggests two classification proposals.

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The increasing production of primary research and literature reviews in the last decades has made it necessary to develop a new methodological design to synthesize the evidence: the overviews. An overview is a type of evidence synthesis that uses systematic reviews as the unit of analysis, with the aim of extracting and analyzing the results for a new or broader research question, helping the shared decision-making processes. The aim of this article is to introduce the reader to this type of evidence summaries, highlighting the differences between overviews and other types of synthesis, the unique methodological aspects of overviews, and future challenges. This is the twelfth article from a collaborative methodological series of narrative reviews about biostatistics and clinical epidemiology.

El aumento de la producción de investigación primaria y de las revisiones de la literatura durante las últimas décadas ha hecho necesario el desarrollo de un nuevo diseño metodológico para sintetizar la evidencia: los overviews. Un overview es un diseño de síntesis de evidencia que toma como unidad de análisis a las revisiones sistemáticas, con el objetivo de extraer y analizar los resultados para una pregunta de interés nueva o más amplia, ayudando así a mejorar los procesos de toma de decisiones informadas. El objetivo de este artículo es introducir al lector a este tipo de resúmenes de evidencia, destacando las diferencias con los otros tipos de síntesis de evidencia, los aspectos metodológicos particulares de los overviews, y los desafíos pendientes. Este artículo es el duodécimo de una serie metodológica colaborativa de revisiones narrativas sobre temáticas de bioestadística y epidemiología clínica.

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El aumento de la producción de investigación primaria y de las revisiones de la literatura durante las últimas décadas ha hecho necesario el desarrollo de un nuevo diseño metodológico para sintetizar la evidencia: los overviews. Un overview es un diseño de síntesis de evidencia que toma como unidad de análisis a las revisiones sistemáticas, con el objetivo de extraer y analizar los resultados para una pregunta de interés nueva o más amplia, ayudando así a mejorar los procesos de toma de decisiones informadas. El objetivo de este artículo es introducir al lector a este tipo de resúmenes de evidencia, destacando las diferencias con los otros tipos de síntesis de evidencia, los aspectos metodológicos particulares de los overviews, y los desafíos pendientes. Este artículo es el duodécimo de una serie metodológica colaborativa de revisiones narrativas sobre temáticas de bioestadística y epidemiología clínica.

The increasing production of primary research and literature reviews in the last decades has made it necessary to develop a new methodological design to synthesize the evidence: the overviews. An overview is a type of evidence synthesis that uses systematic reviews as the unit of analysis, with the aim of extracting and analyzing the results for a new or broader research question, helping the shared decision-making processes. The aim of this article is to introduce the reader to this type of evidence summaries, highlighting the differences between overviews and other types of synthesis, the unique methodological aspects of overviews, and future challenges. This is the twelfth article from a collaborative methodological series of narrative reviews about biostatistics and clinical epidemiology.

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SUMMARY OBJECTIVE: The aim of this study was to identify the frequency of Cochrane systematic reviews and Cochrane systematic reviews protocols using (or planning to use) the risk of bias 2.0 tool to assess the risk of bias of the included randomized clinical trials. STUDY DESIGN: This is a meta-research study. METHODS: We included Cochrane systematic reviews or Cochrane systematic reviews protocols that planned to include randomized clinical trials. We assessed the Cochrane Database of Systematic Reviews and screened for issues published after the launch of risk of bias 2.0 tool (2019-2022). Two independent investigators performed the study selection and data extraction. RESULTS: We analyzed 440 Cochrane systematic reviews and 536 Cochrane systematic reviews protocols. Overall, 4.8% of the Cochrane systematic reviews and 28.5% of the Cochrane systematic reviews protocols used or planned to use risk of bias 2.0 tool. Although low, adherence is increasing over time. In 2019, 0% of Cochrane systematic reviews used risk of bias 2.0 tool, compared to 24.1% in 2022. In Cochrane systematic reviews protocols, adherence increased from 6.9% in 2019 to 41.5% in 2022. A total of 274 (62.1%) Cochrane systematic reviews had their protocols published before 2018; only one used risk of bias 2.0 tool and reported the change of versions in the "Differences between protocol and revision" section. CONCLUSION: The Cochrane's risk of bias 2.0 tool has low adherence among Cochrane protocols and systematic reviews. Further efforts are necessary to facilitate the implementation of this new tool.

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This report presents the work done on the design, publication, and impact of updates on evidence-based COVID-19 interventions, in order to support decision-making with updated evidence syntheses based on living systematic reviews of therapeutic interventions. To this end, a specific working group was created within the National Commission for Health Technology Assessment (CONETEC) of the Ministry of Health of Argentina, in collaboration with the Pan American Health Organization (PAHO). A methodology was designed to develop and publish assessment documents aimed at supporting decision-making. These update reports were based on the exploration of three areas: health effects, feasibility of implementation, and evidence-based recommendations. A color-coded system was used to present the conclusions according to the balance between their positive and negative effects in different clinical scenarios, in order to improve their interpretation and implementation. In 2021, 16 evidence synthesis reports were published (13 original reports and three full updates). These were downloaded many times from the CONETEC website and the Regional Database of Health Technology Assessment Reports of the Americas (BRISA), highlighting the need for robust, up-to-date, reliable evidence summaries adapted for implementation in the country's health system. Other challenges include constant updating of information, appropriate dissemination, and sustained rigorous preparation of the reports.

Este relatório tem como objetivo apresentar o trabalho realizado sobre o delineamento, publicação e impacto das atualizações para intervenções em COVID-19 baseadas em evidências, que visam fornecer sínteses de evidências atualizadas provenientes de revisões sistemáticas vivas sobre intervenções terapêuticas para apoiar a tomada de decisões. Para isso, foi criado um grupo de trabalho específico no âmbito da Comissão Nacional de Avaliação de Tecnologias de Saúde (CONETEC, na sigla em espanhol), do Ministério da Saúde da Argentina, em parceria com a Organização Pan-Americana da Saúde (OPAS). Foi desenhada uma metodologia para a elaboração e publicação de documentos de avaliação destinados a apoiar a tomada de decisões. Esses relatórios de atualização se basearam na exploração de três domínios: efeitos na saúde, viabilidade da implementação e recomendações baseadas em evidências. As conclusões foram adaptadas a uma escala semafórica de acordo com o equilíbrio entre os benefícios e os aspectos negativos para os diferentes cenários clínicos, de forma a melhorar a sua interpretação e aplicação. Durante o ano de 2021, foram publicados 16 relatórios de síntese de evidências (13 originais e 3 atualizações completas), que receberam um número significativo de consultas no site da CONETEC e da Base Regional de Informes de Avaliação de Tecnologias em Saúde das Américas (BRISA). Assim, tornou-se visível a necessidade de contar com resumos de evidências robustos, atualizados e confiáveis adaptados ao contexto de aplicação no sistema de saúde do país. A atualização constante das informações, sua divulgação adequada e a manutenção do rigor na elaboração dos relatórios também apresentam desafios.

RESUMO

Introduction: Navigation technologies have improved accuracy and precision in positioning glenoid components during shoulder arthroplasty. The influence of navigation on baseplate screw placement has not been independently investigated. This study aimed to evaluate and synthesize the best scientific evidence on the influence of intraoperative navigation on the length and number of screws for primary baseplate fixation in reverse total shoulder arthroplasty procedures. Methods: In August 2022, PubMed, Scopus, and Embase databases were accessed. We analyzed the screw purchase length, the number of screws required for the fixation of the baseplate, and the proportion of cases fixed with two screws in all clinical trials, comparing navigation to standard instrumentation for reverse shoulder arthroplasty. Following an evaluation of the heterogeneity of the studies, DerSimonian-Laird random-effects models were utilized to merge data from separate studies. Results: The systematic search revealed a total of 2034 articles. After excluding duplicates and irrelevant studies, 633 shoulder arthroplasties from 6 trials were included in the analysis. The pooled mean difference in screw purchase length was 5.839 mm (95 %CI 4.496 to 7. 182) in favor of navigation (P < .001). In addition, significant differences were also found in the number of screws per case (- 0.547, 95 %CI -0.890 to -0.203, P = .002) and in the proportion of cases fixed with two screws (Odds Ratio 3.182 95 %CI 1.057 to 9.579, P = .040) in favor of the navigation group. Conclusions: Intraoperative navigation improves the baseplate screw placement, allowing for a greater screw purchase length and fewer screws to achieve primary fixation of the glenoid component during reverse shoulder arthroplasty. It is unclear whether these improvements will increase the longevity of the prosthesis or the clinical outcomes of the patients.