Bernardo Garcia de Oliveira Soares

The Effectiveness of Psychological Interventions for the Treatment of Erectile Dysfunction: Systematic Review and Meta‐Analysis, Including Comparisons to Sildenafil Treatment, Intracavernosal Injection, and Vacuum Devices

INTRODUCTION In contrast to the impressive advances in somatic research of erectile dysfunction (ED), scientific literature shows contradictory reports on the results of psychotherapy for the treatment of ED. AIM Authors conducted a meta-analysis to evaluate the effectiveness of psychological interventions for the treatment of ED compared to oral drugs, local injection, vacuum devices, or other psychological intervention. METHOD Distinct sources of randomized controlled trials (RCTs) were searched: electronic databases (between 1966 and 2007), cross checking of references, and contact with scientific societies. MAIN OUTCOME MEASURES For dichotomous outcomes the pooled relative risks were calculated and for continuous outcomes mean differences between interventions. Statistical heterogeneity was addressed. RESULTS Eleven RCTs involving 398 men met the inclusion criteria. CONCLUSIONS There is evidence that group therapy improves ED. Focused sex group therapy showed greater efficacy than control group. Men randomized to receive psychotherapy plus sildenafil showed significant improvement of ED and were less likely than those receiving only sildenafil to drop out. Regarding to the effectiveness of psychological interventions for the treatment of ED compared to local injection and vacuum devices no difference was found.

Hormonal cryptorchidism therapy: systematic review with metanalysis of randomized clinical trials

The importance of cryptorchidism treatment concerns the possibility of diminishing risk of malignant degeneration and improving fertility. Success rates of hormonal treatment vary: 0–55%with human chorionic gonadotropin (hCG) and 9–78% with gonadotropin-releasing hormone (GnRH). Due to uncertainties regarding the effectiveness of this treatment, a systematic review and meta-analysis of randomized controlled trials (RCTs) on hormonal cryptorchidism treatment was done using the methodology of Cochrane Collaboration. Two studies compared hCG with GnRH, with a testicular descent rate of 25% vs. 18%, respectively. Nine trials compared intranasal LHRH with placebo, with complete testicular descent rates of 19% vs. 5%. Two other studies comparing doses and administration intervals could not be pooled together due to heterogeneity. With the information analyzed until the present, the evidence for the use of hCG vs. GnRH shows advantages for hCG, and this review also shows that there is evidence that luteinizing hormone releasing hormone (LHRH) is more effective than placebo. But because this evidence is based on few trials, with small sample sizes and moderated risk of bias, this treatment cannot be recommended for everyone, and there is no evidence that supports hCG’s use in larger doses and larger intervals. Results from this systematic review are important for developing better RCTs that may decrease the uncertainty of cryptorchidism treatment.

Comparison of carbamazepine and lithium in treatment of bipolar disorder: A systematic review of randomized controlled trials

To review data from randomized controlled trials (RCTs) assessing the comparative efficacy of carbamazepine and lithium in treatment of acute manic and maintenance phase of bipolar disorder (BD).

A systematic review of the interventions to promote the wearing of hearing protection

CONTEXT AND OBJECTIVE Noise-induced hearing loss can only be prevented by eliminating or lowering noise exposure levels. When the source of the noise cannot be eliminated, workers have to rely on hearing protection equipment. The aim here was to summarize the evidence for the effectiveness of interventions to enhance the wearing of hearing protection among workers exposed to noise in the workplace. DATA SOURCE Studies with random assignment were identified by an electronic search of the medical literature up to 2005. Data were double-entered into the Review Manager software, version 4.2.5. DATA SYNTHESIS Two studies were found. A computer-based intervention tailored to individual workers risks and lasting 30 minutes was not found to be more effective than a video providing general information for workers. A second randomized controlled trial evaluated the effect of a four-year school-based hearing loss prevention program among schoolchildren working on their parents farms. The intervention group was twice as likely to wear some kind of hearing protection as was the control group (which received only minimal intervention). REVIEWERS CONCLUSIONS: The limited evidence does not show whether tailored interventions are more or less effective than general interventions among workers, 80% of whom already use hearing protection. Long-lasting school-based interventions may increase the use of hearing protection substantially. Better interventions to enhance the use of hearing protection need to be developed and evaluated in order to increase the prevention of noise-induced hearing loss among workers.

Efficacy and safety of atypical antipsychotic drugs (quetiapine, risperidone, aripiprazole and paliperidone) compared with placebo or typical antipsychotic drugs for treating refractory schizophrenia: overview of systematic reviews

CONTEXT AND OBJECTIVE According to some cohort studies, the prevalence of refractory schizophrenia (RS) is 20-40%. Our aim was to evaluate the effectiveness and safety of aripiprazole, paliperidone, quetiapine and risperidone for treating RS. METHODS This was a critical appraisal of Cochrane reviews published in the Cochrane Library, supplemented with reference to more recent randomized controlled trials (RCTs) on RS. The following databases were searched: Medical Literature Analysis and Retrieval System Online (Medline) (1966-2009), Controlled Trials of the Cochrane Collaboration (2009, Issue 2), Embase (Excerpta Medica) (1980-2009), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) (1982-2009). There was no language restriction. Randomized controlled trials, systematic reviews and meta-analyses evaluating atypical antipsychotics for treating RS were included. RESULTS Seven Cochrane systematic reviews and 10 additional RCTs were included in this review. The data generally showed minor differences between the atypical antipsychotics evaluated and typical antipsychotics, regarding improvement in disease symptoms, despite better adherence to treatment with atypical antipsychotics. Risperidone was specifically evaluated in patients with RS in one of the systematic reviews included, with favorable outcomes, but without definitive superiority compared with other drugs of proven efficacy, like amisulpride, clozapine and olanzapine. CONCLUSIONS The findings underscore the difficulty in treating these patients, with high dropout rates and treatment patterns of modest improvement in assessments of effectiveness. Atypical antipsychotics have advantages over typical antipsychotics mainly through their better safety profile, which leads to better adherence to treatment. A combination of antipsychotics may also be an option for some refractory patients.

Estresse pós-traumático: uma abordagem baseada em evidências

The interventions used in the clinical management of posttraumatic stress disorder (PTSD) focus on: 1. Prevention of the development of the disorder, after a traumatic event 2. Treatment of the disorder, once it is already established, 3. Maintenance of long term functioning and quality of life. A variety of psychotherapies and pharmacological treatments have been proposed as therapeutic options in the treatment of PTSD. However, many of these treatment modalities lack scientific background. In this article authors present the treatment modalities of PTSD which are supported by scientific evidence and discuss its applications and drawbacks.

The value of publishing negative results from a randomized controlled trial: the Rosenheck's study

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