Examinando por Autor "Pérez-Bracchiglione, Javier"
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Ítem Angiotensin-converting-enzyme inhibitors and angiotensin II re-ceptor blockers for COVID-19: A living systematic review of randomized clinical trials(Medwave, 2021) Meza, Nicolás; Pérez-Bracchiglione, Javier; Pérez, Ignacio; Carvajal, Cristhian; Ortiz-Muñoz, Luis; Olguín, Pablo; Rada, Gabriel; Madrid, EvaObjective: This living systematic review aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in the treatment of patients with COVID-19. Data sources: We conducted searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature and in a centralized repository in L·OVE (Living OVerview of Evidence), which retrieves articles from multiple sources such as PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, among other pre-print and protocols repositories. In response to the COVID-19 emergency, L·OVE (Living OVerview of Evidence) was adapted to expand the range of evidence and customized to group all COVID-19 evidence in one place on a daily search basis. The search covered a period of time up to July 31, 2020. Eligibility criteria for selecting studies and methods: We adapted an already published standard protocol for multiple parallel living systematic reviews to this question's specificities. We included randomized trials evaluating the effect of either suspension or indication of angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers as monotherapy, or in combination versus placebo or no treatment in patients with COVID-19.We searched for randomized trials evaluating the effect of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers versus placebo or no treatment in patients with COVID-19. Two reviewers independently screened each study for eligibility, extracted data, and assessed the risk of bias. We pooled the results using meta-analysis and applied the GRADE system to assess the certainty of the evidence for each outcome. We will resubmit results every time the conclusions change or whenever there are substantial updates. Results: We screened 772 records, but none was considered for eligibility. We identified 55 ongoing studies, including 41 randomized trials evaluating angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers for patients with COVID-19. Conclusions: We did not find a randomized clinical trial meeting our inclusion criteria, and hence there is no evidence for supporting the role of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in the treatment of patients with COVID-19. A substantial number of ongoing studies would provide valuable evidence to inform researchers and decision-makers in the near future.Ítem Graficando el cuerpo de la evidencia: lo esencial para comprender el enfoque de los mapas de brecha de evidencia(Medwave, 2021) Schuller-Martínez, Bastián; Meza, Nicolás; Pérez-Bracchiglione, Javier; Ariel Franco, Juan Victor; Loezar, Cristóbal; Madrid, EvaEl gran aumento en la producción de evidencia científica ha llevado a la creación de métodos para facilitar su revisión y síntesis, surgiendo distintos diseños según el objetivo principal que se busque cumplir. Los mapas de brecha de evidencia constituyen un enfoque novedoso de revisión de literatura. Corresponden a colecciones temáticas de un amplio campo de evidencia, utilizando una estrategia de búsqueda sistemática que destaca por identificar brechas o lagunas en el cuerpo de la evidencia disponible y por involucrar tempranamente a la audiencia definida como blanco para el diseño de un producto gráfico amigable. Se han establecido como una herramienta a considerar para guiar la agenda y el financiamiento de futuras investigaciones, y como apoyo en la toma de decisiones y en la creación de políticas basadas en evidencia. Los formatos más utilizados para representar sus hallazgos son el gráfico de burbujas y la grilla intervención-desenlace. Este artículo corresponde al sexto de una serie de revisiones narrativas acerca de tópicos generales en bioestadística y epidemiología clínica, y tiene por objetivo describir las características generales de los mapas de brecha de evidencia, destacar sus principales objetivos y utilidades, explorar los formatos de mapeo más utilizados y comparar este enfoque con otras propuestas de síntesis.Ítem Graphical representation of the body of the evidence: the essentials for understanding the evidence gap map approach(Medwave, 2021) Schuller-Martínez, Bastián; Meza, Nicolás; Pérez-Bracchiglione, Javier; Ariel Franco, Juan Victor; Loezar, Cristóbal; Madrid, EvaThe significant increase in scientific evidence production has led to the creation of methods to facilitate evidence review and synthesis. This has turned, this has resulted in the emergence of different designs depending on the review’s objective. Evidence gap maps constitute a novel approach for literature review. They are thematic collections of a broad field of evidence, using a systematic search strategy that identifies gaps in knowledge and engages, early on, the target audience to design a friendly graphic product. Evidence maps are a tool to be considered in the roster of options available for research funders in that they are particularly useful for evidence-based decision-making and evidence-based policy development. The most commonly used formats to display the findings of evidence gap search designs are the bubble plot and the intervention-outcome framework. This article corresponds to the sixth of a series of narrative reviews on general topics of biostatistics and clinical epidemiology. The purpose of this review is to describe the principal features of evidence gap maps, highlighting their main objectives and utility, exploring the most commonly used mapping formats, and comparing this approach with other evidence synthesis designs.Ítem Inclusión de salud basada en evidencia en carreras de la salud en Chile y el modelo integrado Metodología de la Investigación Científica-Medicina Basada en Evidencia en la Universidad de Valparaíso(Elsevier, 2019) Papuzinski, Cristian; Loézar, Cristóbal; Carvajal, Natalia; Vargas, Manuel; Borgeat, Marjorie; Madrid, Eva; Pérez-Bracchiglione, Javier; Arancibia, MarceloIntroducción: La salud basada en evidencia (SBE) integra el uso de la mejor evidencia, la experiencia clínica y los valores y preferencias del paciente para la toma de decisiones. Su incorporación en las carreras sanitarias de Chile es desconocida. Métodos: Se realizó un estudio de corte transversal para evaluar la incorporación de SBE en los programas de las carreras sanitarias en Chile hasta 2019. Se describe la integración del modelo Metodología de la Investigación Científica (MIC)-Medicina Basada en la Evidencia (MBE) en la Escuela de Medicina de la Universidad de Valparaíso. Resultados: Un total de 49 universidades imparten carreras sanitarias. Un 8,13% incorpora SBE como asignatura explícitamente. Todas incorporan asignaturas que potencialmente incluyen contenidos de SBE. Las carreras de Medicina y Enfermería son las que más incorporan SBE, pero solo una carrera de Medicina incluye SBE como asignatura por más de un semestre. El modelo integrado MIC/MBE (4 semestres), orientado en competencias y centrado en el alumno, involucra el diseno ̃ y ejecución de un protocolo de investigación, así como el análisis crítico de la mejor evidencia, integrado con los valores de los pacientes. Conclusión: La incorporación de SBE como asignatura es muy infrecuente en carreras sanitarias chilenas. Se enfatiza su inclusión transdisciplinaria como asignatura individual desde un modelo que integre la ensenanza ̃ de MIC, sobre todo en universidades estatales.Ítem Intravitreal antivascular endothelial growth factor in diabetic macular oedema: scoping review of clinical practice guidelines recommendations(Bmj, 2021) Vargas-Peirano, Manuel; Verdejo, Catalina; Vergara-Merino, Laura; Loézar, Cristóbal; Hoehmann, Martín; Pérez-Bracchiglione, JavierBackground Diabetic macular oedema (DME) is a, worldwide major cause of low vision and blindness. Intravitreal antivascular endothelial growth factor (anti-VEGF) constitutes an effective treatment. linical practice guidelines (CPGs) are synthesis documents that seek to improve patient care. Objectives To identify CPGs that make anti-VEGF recommendations for DME and to assess their reporting quality and their considerations when making recommendations. Eligibility criteria CPGs published between December 2009 and December 2019 that make explicit anti-VEGF recommendations in DME. Sources of evidence Sensitive search strategy in Embase, Google Scholar and hand-searching on 165 websites. Methods We extracted information from each CPG with a previously piloted sheet. Two independent authors applied theAppraisal of Guidelines, Research and Evaluation tool (AGREE-II) assessment for each CPG. Results The 21 included CPGs recommend anti-VEGF for DME, but there is a wide variation among the clinical aspects included, such as location of DME, visual acuity required, therapeutical alternatives or discontinuation. Most have a poor quality of reporting based on the AGREE-II tool assessment, especially those developed by ophthalmological societies, those that have an exclusive content about DME, and those where most of their authors disclose conflict of interest (COI) with pharmaceutical industry or where their authors did not report COIs. Pharmaceutical-sponsored CPGs did not use systematic reviews (SRs) to support their recommendations. Very few recommendations consider patient values and preferences, equity, acceptability and feasibility of the intervention. Conclusions Most of the CPGs that made recommendations of anti-VEGF for DME have poor quality of reporting, do not use SRs and do not consider patients’ values and preferences.Ítem Maternal and perinatal outcomes related to COVID-19 and pregnancy: An overview of systematic reviews(Wiley, 2021) Vergara-Merino, Laura; Meza, Nicolás; Couve-Pérez, Constanza; Carrasco, Cynthia; Ortiz-Muñoz, Luis; Madrid, Eva; Bohorquez-Blanco, Sandra; Pérez-Bracchiglione, JavierIntroduction: Evidence about coronavirus disease 2019 (COVID-19) and pregnancy has rapidly increased since December 2019, making it difficult to make rigorous evidence-based decisions. The objective of this overview of systematic reviews is to conduct a comprehensive analysis of the current evidence on prognosis of COVID-19 in pregnant women. Material and methods: We used the Living OVerview of Evidence (L·OVE) platform for COVID-19, which continually retrieves studies from 46 data sources (including PubMed/MEDLINE, Embase, other electronic databases, clinical trials registries, and preprint repositories, among other sources relevant to COVID-19), mapping them into PICO (population, intervention, control, and outcomes) questions. The search covered the period from the inception date of each database to 13 September 2020. We included systematic reviews assessing outcomes of pregnant women with COVID-19 and/or their newborns. Two authors independently screened the titles and abstracts, assessed full texts to select the studies that met the inclusion criteria, extracted data, and appraised the risk of bias of each included systematic review. We measured the overlap of primary studies included among the selected systematic reviews by building a matrix of evidence, calculating the corrected covered area, and assessing the level of overlap for every pair of systematic reviews. Results: Our search yielded 1132 references. 52 systematic reviews met inclusion criteria and were included in this overview. Only one review had a low risk of bias, three had an unclear risk of bias, and 48 had a high risk of bias. Most of the included reviews were highly overlapped among each other. In the included reviews, rates of maternal death varied from 0% to 11.1%, admission to intensive care from 2.1% to 28.5%, preterm deliveries before 37 weeks from 14.3% to 61.2%, and cesarean delivery from 48.3% to 100%. Regarding neonatal outcomes, neonatal death varied from 0% to 11.7% and the estimated infection status of the newborn varied between 0% and 11.5%. Conclusions: Only one of 52 systematic reviews had a low risk of bias. Results were heterogeneous and the overlap of primary studies was frequently very high between pairs of systematic reviews. High-quality evidence syntheses of comparative studies are needed to guide future clinical decisions.Ítem Patient decision aids for adults with advanced chronic kidney disease with a medical recommendation to start dialysis: a scoping review protocol(JBI, 2021) Salas-Gama, Karla; Díaz, Juan Manuel; Coronado, Jorge; Pérez-Bracchiglione, Javier; Requeijo, Carolina; Samsó, Laura; Suclupe, Stefanie; Bolíbar, IgnasiObjective: This review will identify and describe the content and assess the quality of available decision aids aimed at adults with advanced chronic kidney disease with medical indication to start dialysis who need to choose one of the two dialysis modalities. Introduction: The lack of evidence regarding the superiority of the different options for dialysis, hemodialysis, and peritoneal dialysis, indicated in advanced chronic kidney disease, makes the shared decision-making process especially important. Inclusion criteria: We will include decision aids from published studies and non-published material aimed at adults with advanced chronic kidney disease. Methods: We will perform searches in MEDLINE, CINAHL, Embase, PsycINFO, the Cochrane Library, and Epistemonikos. In addition, we will search unpublished studies in OpenGrey, ClinicalTrials.gov, and Open Access Theses and Dissertations. We will also identify decision aids through a specific search in Google and by searching websites of nephrology societies or associations. We will include decision aids in English or Spanish aimed at adults with advanced chronic kidney disease with medical indication to start dialysis. Two independent reviewers will screen, select, and extract the data. General aspects and attributes of the decision aids will be collected. Their quality will be evaluated, and their recommendations for implementation in clinical practice will be analyzed.Ítem Reporting results in manual therapy clinical trials: A need for improvement(Elsevier, 2021) Núñez-Cortés, Rodrigo; Alvarez, Gerard; Pérez-Bracchiglione, Javier; Cabanas-Valdés, Rosa; Calvo-Sanz, Jordi; Bonfill, Xavier; Urrutia, GerardBackground. The number of randomized clinical trials (RCTs) for manual therapy (MT) has increased exponentially in recent years but the quality of reporting is heterogeneous. Objective. To assess the quality of the reporting of results in RCTs manual therapy, both in the text and in the graphs. Study design. Methodological review. Methods. We reviewed a random sample of 120 RCTs in MT published between 2000 and 2020 in indexed journals. We identified the primary outcome for each trial, and evaluated the completeness and correctness of reporting of results in the text and in the graphs. Results. Forty per cent of the RCTs explicitly identified the primary outcome and 47.5% reported a sample size calculation. In 46.7% of the trials, the reporting of between groups comparisons was complete (including effect size and precision). Only 29.2% used the confidence interval as a measure of precision. Fifty-eight per cent of the trials reported significant differences in the results, and 30.8% reported a value of clinical relevance for at least one variable of the study. Forty-seven per cent reported the primary outcome graphically but only 19.6% of the graphs were self explanatory and 66.1% had problems of visual clarity. Conclusions. Our findings suggest that the reporting of the results in MT trials is generally incomplete and graphics are often poor. These shortcomings could affect the interpretation of the results and their application in clinical practice. Improvements are needed in the reporting of results in order to advance clinical practice and research in manual therapy.Ítem The perspectives of patients and their caregivers on self-management interventions for chronic conditions: a protocol for a mixed-methods overview [version 2,peer review: 2 approved](2021) Niño De Guzmán, Ena; Martínez García, Laura; González, Ana I.; Heijmans, Monique; Huaringa, Jorge; Immonen, Kaisa; Ninov, Lyudmil; Orrego-Villagrán, Carola; Pérez-Bracchiglione, Javier; Salas-Gama, Karla; Viteri-García, Andrés; Alonso-Coello, PabloIntroduction: Self-management (SM) interventions are complex interventions and one of the main components of high-quality chronic disease care for which the incorporation of the perspectives of patients and their informal caregivers is crucial. We aim to identify, appraise and synthesise the evidence exploring patients’ and caregivers’ perspectives on SM interventions. More precisely, we aim to 1) describe how they value the importance of outcomes of SM interventions, and 2) identify the factors that might impact on acceptability and feasibility of SM interventions based on their preferences and experiences. Methods and analysis: We will conduct four mixed-methods overviews as part of COMPAR-EU, a European Union (EU) funded project aimed to identify the most effective and cost-effective SM interventions for chronic obstructive pulmonary disease (COPD), heart failure (HF), obesity, and type 2 diabetes mellitus (T2DM). We will search in MEDLINE, CINAHL, and PsycINFO for systematic reviews of studies addressing patients’ preferences on outcomes, or their experiences with SM alongside their disease trajectory or with SM interventions, published in English. Selection of studies and data extraction will be conducted in pairs. We will assess the overlap of studies and methodological quality. We will follow a three-step synthesis process: 1) narrative synthesis for quantitative evidence, 2) thematic synthesis for qualitative evidence, and 3) integration of findings in the interpretation phase. Additionally, we will consult on the relevance of findings with patients and their caregivers.