Fernando José Camello de Lima

Quality assessment of systematic reviews regarding immediate placement of dental implants into infected sites: An overview

Statement of problem. With the increased number of published systematic reviews and in view of their wide clinical applicability, these studies must be carefully assessed before professionals begin to use their recommendations in daily practice, and above all, the methodological quality of this study design must be considered. In implant dentistry, one topic that has been arousing particular interest is the immediate placement of dental implants into infected sites. Purpose. The purpose of this systematic review was to determine the methodological quality of systematic reviews that evaluated the immediate placement of dental implants into infected sites. Material and methods. A systematic search was performed by 2 independent reviewers of PubMed, LILACS, and ISI Web of Knowledge up to March 2016. All selected articles were published in the English language. Systematic reviews of original papers that assessed the immediate placement of dental implants into infected sites were eligible for the overview. Narrative reviews, randomized clinical trials, and case reports were excluded. Methodological quality assessment was performed using A Measurement Tool to Assess Systematic Reviews. Results. Of the 5 selected systematic reviews, 3 were low methodological quality and 2 were assessed as moderate. None were high methodological quality. The first systematic review of the topic was published in 2010, and the most recent, published in 2015, was the only one that performed meta‐analysis. Conclusions. The systematic reviews that assessed the immediate placement of dental implants into infected sites were assessed as low or moderate methodological quality. The topic focus remains controversial because the implant survival rate, the main outcome considered for the implant placement prognosis, presents contradictory results.

Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis

BACKGROUND AND OBJECTIVES Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables. RESULTS 17 original articles analyzed. Meta-analysis of mortality (RD=-0.01, 95% CI=-0.03 to 0.01), CVA (RR=0.79, 95% CI=0.32-1.95), MI (RR=0.96, 95% CI=0.52-1.79) and LHS (MD=-1.94, 95% CI=-3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR=0.68, 95% CI=0.50-0.93). ICUS was lower in NA (MD=-2.09, 95% CI=-2.92 to -1.26). CONCLUSION There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.

Risk of bias assessment of systematic reviews regarding dental implant placement in smokers: An umbrella systematic review

Statement of problem. Although dental implant treatment has a high success rate, patient‐related factors may cause implant failure. In this context, smoking is associated with adverse effects on implant osseointegration. In spite of systematic reviews addressing this topic, the risk of bias in these reviews must be assessed to inform readers whether the studies were conducted with methodological rigor and whether their recommendations are viable in daily clinical practice. Purpose. The purpose of this umbrella systematic review was to assess the risk of bias of systematic reviews regarding dental implant placement in smokers. Material and methods. Systematic review articles with meta‐analysis regarding dental implant placement in smokers were eligible for this study. The following were excluded: articles in which implant survival or failure rate was not the primary outcome; articles in which implant survival or failure rate was not related to smokers; and duplicated articles. The search was performed by 2 independent reviewers on MEDLINE (PubMed), Scopus, Web of Science, LILACS, DARE‐Cochrane, and SIGLE via OpenGrey. Non–peer‐reviewed literature was sought on SIGLE via OpenGrey without language restrictions. Reviewers read titles and/or abstracts to select potential eligible studies, and articles initially selected were read fully. A third reviewer was consulted in cases of disagreement. References of the selected articles were also screened to identify articles of potential interest. The last search was performed on April 29, 2017. Risk of bias assessment was performed with the Risk of Bias in Systematic Reviews (ROBIS) tool. Results. Of the initial 2539 results, 6 systematic reviews with meta‐analysis were eligible for the umbrella review (kappa=0.90; very good agreement). All studies were published in the last 11 years. One meta‐analysis (16.7%) presented low risk of bias, 3 (50.0%) were assessed as of unclear risk of bias, and 2 (33.3%) received a score of high risk of bias according to the assessment with the ROBIS tool, which also indicated that the criteria most commonly not met were study eligibility criteria and identification and selection of studies. Conclusions. Five of the 6 included meta‐analyses had a risk of bias (high or unclear). Therefore, their conclusions and recommendations required careful review. Future meta‐analyses must focus especially on study eligibility criteria and identification and selection of studies.

Accuracy of ultrasound to detect thrombosis in pregnancy: A systematic review

Objective: To determine the diagnostic accuracy of ultrasound to detect deep--vein thrombosis in pregnant patients. Method: We searched Pubmed, LILACS, Scopus, Google Scholar and System for Information on Grey Literature from inception to April 2016. The reference lists of the included studies were analyzed. Original articles from accuracy studies that analyzed ultrasonography to diagnose deep-vein thrombosis in pregnant women were included. Reference standard was the follow-up time. The QUADAS-2 score was used for quality assessment. Results: Titles and summaries from 2,129 articles were identified. Four studies that evaluated deep-vein thrombosis in pregnant women were included. In all, 486 participants were enrolled. High risk of bias was seen in three out of four studies included regarding flow and timing domain of QUADAS-2. Negative predictive value was 99.39%. Conclusion: Accuracy of ultrasonography to diagnose deep-vein thrombosis in pregnant women was not determined due to the absence of data yielding positive results. Further studies of low risk of bias are needed to determine the diagnostic accuracy of ultrasonography in this clinical scenario.

Importância do uso adequado da estatística básica nas pesquisas clínicas

BACKGROUND AND OBJECTIVE The inadequate use of basic statistics is the main responsible for scientific article misinterpretation. The purpose of this review article was to review some basic statistical topics to alert authors and readers about the importance of basic statistics proper reporting. CONTENT A bibliographical and cross-sectional study was carried out,which analyzed publications in books and articles in the following databases: SciELO (Scientific Electronic Library Online) and PubMed (Available from the National Center for Biotechnology Information). Medical research is not free from the risk of false positive and false negative results due to the choice of statistical tests and presence of small sample sizes. CONCLUSION Understanding the correct use of basic statistics leads to fewer errors in reporting the results of studies performed and in the interpretation of their conclusions.

Prevalência da Síndrome de Burnout em cirurgiões plantonistas de um hospital de referência para trauma e sua correlação com carga horária semanal de trabalho: estudo transversal

Objective: to determine the prevalence of Burnout Syndrome (BS) for surgeons working in referral hospital for trauma in Maceio and to evaluate the possible correlation between BS and weekly workload. Methods: cross-sectional study with 43 on-call surgeons at Professor Osvaldo Brandão Vilela General State Hospital, Maceió, between July and December, 2015. A self-administered form was used to evaluate BS through the Maslach Burnout Inventory (MBI) and socio-demographic characteristics among participants. Spearmans S test was used to compare BS and weekly workload. Significant level was 5%. Results: among the surgeons studied, 95.35% were male and the mean age was 43.9 ± 8.95 years. The mean weekly workload on call in trauma was 33.90 ± 16.82 hours. The frequency of high scores in at least one of the three dimensions of MBI was 46.5%. Professional achievement was correlated with weekly workload (P = 0.020). Conclusion: the prevalence of Burnout Syndrome among on-call surgeons in referral hospital for trauma was 46.5%. In this sample there was correlation between weekly workload and the Burnout Syndrome. Objetivo: determinar a prevalência da Síndrome de Burnout (SB) em médicos cirurgiões que trabalham em hospital de referência para o trauma em Maceió e avaliar a possível correlação entre SB e a carga horária semanal de trabalho. Métodos: estudo transversal com 43 cirurgiões de plantão do Hospital Geral do Estado Professor Osvaldo Brandão Vilela, Maceió, entre julho e dezembro de 2015. Um formulário autoadministrado foi utilizado para avaliar SB por meio do Maslach Burnout Inventory (MBI) e as características sociodemográficas entre os participantes. Foi utilizado o teste de Spearman S para comparar SB e carga horária semanal. O nível de significância foi 5%. Resultados: entre os cirurgiões estudados, 95,35% eram do sexo masculino e a média de idade foi 43,9±8,95 anos. A média da carga horária semanal de plantão no trauma foi 33,90±16,82 horas. A frequência de pontuações elevadas em pelo menos uma das três dimensões do MBI foi 46,5%. Realização profissional foi correlacionada com a carga de trabalho semanal (P=0,020). Conclusão: a prevalência da Síndrome de Burnout entre cirurgiões plantonistas em hospital de referência para o trauma foi 46,5%. Nesta amostra houve correlação entre a carga horária semanal de trabalho e a Síndrome de Burnout.

Efetividade da associação da anestesia regional à anestesia geral na redução da mortalidade em revascularização miocárdica: metanálise ☆

BACKGROUND AND OBJECTIVES Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables. RESULTS 17 original articles analyzed. Meta-analysis of mortality (RD=-0.01, 95% CI=-0.03 to 0.01), CVA (RR=0.79, 95% CI=0.32 to 1.95), MI (RR=0.96, 95% CI=0.52 to 1.79) and LHS (MD=-1.94, 95% CI=-3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR=0.68, 95% CI=0.50 to 0.93). ICUS was lower in NA (MD=-2.09, 95% CI=-2.92 to -1.26). CONCLUSION There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.