1,720,956 research outputs found
Efeitos da imunonutrição perioperatória na inflamação pós-operatória e marcadores imunológicos no Câncer de Pâncreas: uma revisão sistemática e meta-análise
No full textPancreatic cancer is one of the most aggressive neoplasms, associated with high mortality rates and significant immune impairment, aggravated by the immunosuppressive tumor microenvironment and systemic inflammation. Immunonutrition, which combines immunomodulatory nutrients such as arginine, omega-3 fatty acids and nucleotides, has emerged as a promising strategy in the perioperative period. This study carried out a systematic review and meta-analysis to assess the impact of immunonutrition on the immune and inflammatory response in pancreatic cancer patients undergoing surgery. Five randomized clinical trials were included, identified in 5 different databases, totaling 157 patients. The meta-analysis indicated a 29% reduction in the risk of infectious complications in the group receiving immunonutrition (RR = 0.71; 95%CI: 0.50-1.02; p = 0.06), although without statistical significance. No relevant impact on IL-1 levels was observed (mean difference = -0.06; 95%CI: -15.58 to 15.47; p = 0.99), with high heterogeneity between studies (I2 = 71%). Isolated studies have reported immunological improvements, such as an increase in the CD4/CD8 ratio and a reduction in inflammatory markers, suggesting potential benefits. However, the variability in nutritional formulations and the small sample size limit the generalizability of the results. We conclude that perioperative immunonutrition is a promising approach, but the current evidence is limited by methodological heterogeneity and risk of bias. Studies of greater methodological rigour and representative samples are needed to standardize formulations and confirm the clinical benefits of this intervention in the management of pancreatic cancer.O câncer pancreático é uma das neoplasias mais agressivas, associada a altos índices de mortalidade e comprometimento imunológico significativo, agravado pelo microambiente tumoral imunossupressor e inflamação sistêmica. A imunonutrição, que combina nutrientes imunomoduladores como arginina, ácidos graxos ômega-3 e nucleotídeos, tem emergido como uma estratégia promissora no período perioperatório. Este estudo realizou uma revisão sistemática e meta-análise para avaliar o impacto da imunonutrição na resposta imunológica e inflamatória em pacientes com câncer pancreático submetidos a cirurgia. Foram incluídos cinco ensaios clínicos randomizados, identificados em 5 diferentes bases de referências, totalizando 157 pacientes. A meta-análise indicou uma redução de 29% no risco de complicações infecciosas no grupo que recebeu imunonutrição (RR = 0,71; IC95%: 0,50–1,02; p = 0,06), embora sem significância estatística. Não foi observado impacto relevante nos níveis de IL-1 (diferença média = -0,06; IC95%: -15,58 a 15,47; p = 0,99), com alta heterogeneidade entre os estudos (I² = 71%). Estudos isolados relataram melhorias imunológicas, como aumento na razão CD4/CD8 e redução de marcadores inflamatórios, sugerindo benefícios potenciais. No entanto, a variabilidade nas formulações nutricionais e o tamanho amostral reduzido limitam a generalização dos resultados. Conclui-se que a imunonutrição perioperatória é uma abordagem promissora, mas a evidência atual é limitada por heterogeneidade metodológica e risco de viés. São necessários estudos de maior rigor metodológico e amostras representativas para padronizar formulações e confirmar os benefícios clínicos desta intervenção no manejo do câncer pancreático
Accuracy of ankle-brachial index In screening peripheral arterial disease In people with diabetes
No full textIntroduction: Peripheral arterial disease (PAD) is a prevalent condition that, although it results in peripheral complications, is also characterized as a systemic condition affecting cardiovascular morbidity and mortality. The ankle-brachial index (ABI) is a tool with reasonable accuracy. Still, it may have low sensitivity, especially in screening people with diabetes, due to the occurrence of arterial calcification in this population. Evidence on the performance of the ABI in asymptomatic individuals with DM is limited and does not reflect the diversity of community populations.
Objective: To evaluate the accuracy of the ankle-brachial index in screening for peripheral arterial disease in people with diabetes mellitus in a community setting.
Case, Material, and Methods: An observational diagnostic accuracy study involved individuals with DM in a community setting. Primary data were obtained through structured interviews, including sociodemographic information and subsequent clinical assessments. Researchers measured the ABI and used duplex scanning as the reference standard. Descriptive analysis presented categorical variables as percentages and continuous variables as means with standard deviations or medians with interquartile ranges. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and likelihood ratios (LR+ and LR-) of ABI were analyzed.
Results: Among the 105 participants, the mean age was 58.5 years, and females predominated (76.2%). A total of 75.2% had DM diagnosed less than ten years ago. Approximately 15.2% adhered to drug treatment. Intermittent claudication occurred in 7.6%. Only 1.9% had diabetic foot ulcers, and 3.8% had some amputation. Protective plantar sensitivity was present in 72.4%. In the accuracy study, 194 limbs of 99 participants were evaluated, with a prevalence of PAD of 15.98%. The ABI demonstrated an accuracy of 87.63%, with a sensitivity of 35.48%, specificity of 97.55%, PPV of 73.33%, NPV of 89.83%, LR+ of 14.46, and LR- of 0.66.
Conclusions: The findings suggest that a normal ABI result reduces, but does not eliminate, the possibility of PAD. Adopting additional diagnostic approaches may be essential to increase the effectiveness of PAD screening in this group. Recognizing the limitations of the ABI and discussing more accurate identification strategies is crucial for effectively managing the condition.Programa Pesquisa para o Sistema Único de Saúde (PPSUS/BA) 2020 7ª edição, parecer nº 4411/2020Introdução: A doença arterial periférica (DAP) é uma condição prevalente que, embora resulte em complicações periféricas, também se caracteriza como uma condição sistêmica, afetando a morbimortalidade cardiovascular. O índice tornozelo-braquial (ITB) é uma ferramenta que possui boa acurácia, mas pode ter baixa sensibilidade, especialmente no rastreamento em pessoas com diabetes, devido à ocorrência de calcificação arterial nessa população. Evidências sobre a performance do ITB em indivíduos assintomáticos com DM são limitadas e não refletem a diversidade das populações comunitárias.
Objetivo: Avaliar a acurácia do índice tornozelo-braquial no rastreamento da doença arterial periférica em pessoas com diabetes mellitus em um contexto comunitário.
Casuística, Material e Métodos: Foi conduzido um estudo observacional de acurácia diagnóstica envolvendo indivíduos com DM em um contexto comunitário. Dados primários foram obtidos por meio de entrevistas estruturadas que incluíam informações sociodemográficas e avaliações clínicas subsequentes. O ITB foi medido, e o duplex scan foi utilizado como padrão de referência. A análise descritiva apresentou variáveis categóricas como percentuais e contínuas como médias com desvios-padrão ou medianas com intervalos interquartis. Foram analisadas a sensibilidade, especificidade, valores preditivos positivo e negativo (VPP e VPN), e razões de verossimilhança (RV+ e RV-) do ITB.
Resultados: Entre os 105 participantes, a idade média foi de 58,5 anos, predominando o sexo feminino (76,2%). Um total de 75,2% tinham DM diagnosticado há menos de dez anos. Cerca de 15,2% aderiam ao tratamento medicamentoso. Claudicação intermitente ocorreu em 7,6%. Apenas 1,9% tinham úlceras de pé diabético e 3,8% apresentavam alguma amputação. A sensibilidade plantar protetora estava presente em 72,4%. No estudo de acurácia, 194 membros de 99 participantes foram avaliados, com prevalência de DAP de 15,98%. O ITB demonstrou uma acurácia de 87,63%, com sensibilidade de 35,48%, especificidade de 97,55%, VPP de 73,33%, VPN de 89,83%, RV+ de 14,46 e RV- de 0,66.
Conclusões: Os achados sugerem que um resultado normal do ITB reduz, mas não elimina a possibilidade de DAP. A adoção de abordagens diagnósticas adicionais pode ser essencial para aumentar a eficácia do rastreamento de DAP nesse grupo. Reconhecer as limitações do ITB e discutir estratégias de identificação mais precisas é crucial para um manejo eficaz da condição
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Effectiveness of telehealth interventions to promote mental health among healthcare professionals: a systematic revew
No full textIntroduction: Telehealth interventions are being widely disseminated due to their advantageous application characteristics, despite the lack of evidence regarding their effectiveness among professionals who work directly in the health sector. Objective: Investigate the effectiveness of telehealth programs targeting healthcare workers. Materials and Methods: This is a systematic review, with a search carried out in the databases Medical Literature Analysis and Retrieval System Online (Medline/PubMed), Cochrane Register of Controlled Trials (CENTRAL CCTR / Cochrane Library) and Latin American and Caribbean Literature on Health Sciences (LILACS). Randomized clinical trials that investigated the effectiveness of telehealth aimed at healthcare professionals were included. The outcome analyzed was the improvement in the mental health of health professionals. The Revised Cochrane risk-of-bias tool for randomized trials 2.0 was applied to assess the risk of bias. Results: Two randomized clinical trials were analyzed, both with low risk of bias. There was a significant improvement in the mental health of healthcare professionals associated with telehealth programs. Conclusion: There is initial evidence with low risk of bias that telehealth is effective in improving the mental health of healthcare professionals.Introdução: As intervenções por meio da telessaúde estão sendo amplamente disseminadas devido às suas características vantajosas de aplicação, apesar da falta de comprovação sobre sua efetividade entre os profissionais que atuam diretamente na área da saúde. Objetivo: Investigar a efetividade dos programas de telessaúde direcionados aos trabalhadores da saúde. Materiais e Métodos: Trata-se de uma revisão sistemática, com busca realizada nas bases de dados Medical Literature Analysis and Retrieval System Online (Medline/PubMed), Cochrane Register of Controlled Trials (CENTRAL CCTR / Cochrane Library) e Latin American and Caribbean Literature on Health Sciences (LILACS). Foram incluídos ensaios clínicos randomizados que investigaram a eficácia da telessaúde voltados para os profissionais de saúde. O desfecho analisado foi a melhora da saúde mental dos profissionais de saúde. A ferramenta Revised Cochrane risk-of-bias tool for randomized trials 2.0 foi aplicada para avaliação do risco de viés. Resultados: Foram analisados dois ensaios clínicos randomizados, ambos com baixo risco de viés. Houve melhora significativa favorável à saúde mental dos profissionais de saúde associado a programas de telessaúde. Conclusões: Há evidências iniciais com baixo risco de viés de que a telessaúde é eficaz para a melhora da saúde mental dos profissionais de saúde
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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