Rodrigo Antonini Ribeiro

The quality of reporting of trial abstracts is suboptimal: Survey of major general medical journals

OBJECTIVE To evaluate the quality of reporting of abstracts describing randomized controlled trials (RCTs) published in four major general medical journals. STUDY DESIGN AND SETTING Systematic survey of published RCT abstracts, with two reviewers independently extracting data. We searched MEDLINE and identified 227 RCT abstracts published in the New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), British Medical Journal (BMJ), and The Lancet in the year 2006. RESULTS Most abstracts identified the study as a randomized trial (98.7%), reported the objectives (92.5%), described the population (90.3%), detailed the intervention (81.5%), and defined the primary outcome (71.3%). Methodological quality was poorly reported: one (0.4%) described allocation concealment; 21 (9.3%) clearly specified blinding; 51 (22.5%) described intention-to-treat analysis; and 32 (14.1%) outlined losses to follow-up. Most of the abstracts reported the effect size and the confidence intervals (62.3%), but just half of them reported side effects or harms. CONCLUSION The quality of reporting of RCT abstracts published in main general medical journals is suboptimal. Space limitations notwithstanding, with the recent recommendations from the CONSORT for Abstracts, it is expected that the transparency of abstract reporting can and should improve.

Annual cost of ischemic heart disease in Brazil: public and private perspective

OBJECTIVE To estimate the annual cost of coronary artery disease (CAD) management in Public Health Care System (SUS) and HMOs values in Brazil. METHODS Cohort study, including ambulatory patients with proven CAD. Clinic visits, exams, procedures, hospitalizations and medications were considered to estimate direct costs. Values of appointments and exams were obtained from the SUS and the Medical Procedure List (LPM 1999) reimbursement tables. Costs of cardiovascular events were obtained from admissions in public and private hospitals with similar diagnoses-related group classifications in 2002. The price of medications used was the lowest found in the market. RESULTS The 147 patients (65 +/- 12 years old, 63% men, 69% hypertensive, 35% diabetic and 59% with previous AMI) had an average follow-up of 24 +/- 8 months. The average estimated annual cost per patient was R

Educational interventions in childhood obesity: a systematic review with meta-analysis of randomized clinical trials.

2,733.00, for the public sector, and R

Inspiratory muscle training in patients with heart failure: meta-analysis of randomized trials

6,788.00, for private and fee-for-service plans. Expenses with medications (R

Physical activity and cardiovascular risk factors in children: meta-analysis of randomized clinical trials.

1,154.00) represented 80% and 55% of outpatient costs, and 41% and 17% of total expenses, in public and non-public sectors, respectively. The occurrence of cardiovascular event had a great impact (R

A model to optimize public health care and downstage breast cancer in limited-resource populations in southern Brazil. (Porto Alegre Breast Health Intervention Cohort)

4,626.00 vs. R

Avaliação econômica em saúde: aplicações em doenças infecciosas

1,312.00, in SUS, and R

Association of anemia with clinical outcomes in stable coronary artery disease.

13,453.00 vs. R

Levosimendan na insuficiência cardíaca descompensada: revisão sistemática e metanálise

1,789.00, for HMOs, p<0.01) on the results. CONCLUSION The average annual cost of CAD management was high, being the pharmacological treatment the main determinant of public costs. Such estimates may subsidize economical analyses in this area, and foster related healthcare policies.

Cost-Effectiveness of Implantable Cardioverter-Defibrillators in Brazil: Primary Prevention Analysis in the Public Sector

OBJECTIVE To assess the effectiveness of educational interventions including behavioral modification, nutrition and physical activity to prevent or treat childhood obesity through a systematic review and meta-analysis of randomized trials. METHOD A search of databases (PubMed, EMBASE and Cochrane CENTRAL) and references of published studies (from inception until May 2012) was conducted. Eligible studies were randomized trials enrolling children 6 to 12 years old and assessing the impact of educational interventions during 6 months or longer on waist circumference, body mass index (BMI), blood pressure and lipid profile to prevent or treat childhood obesity. Calculations were performed using a random effects method and pooled-effect estimates were obtained using the final values. RESULTS Of 22.852 articles retrieved, 26 trials (23.617 participants) were included. There were no differences in outcomes assessed in prevention studies. However, in treatment studies, educational interventions were associated with a significant reduction in waist circumference [-3.21 cm (95%CI -6.34, -0.07)], BMI [-0.86 kg/m(2) (95%CI -1.59, -0.14)] and diastolic blood pressure [-3.68 mmHg (95%CI -5.48, -1.88)]. CONCLUSIONS Educational interventions are effective in treatment, but not prevention, of childhood obesity and its consequences.