Navegando por Palavras-chave "meta-análise"

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    Mastectomia preservadora do complexo aréolo-papilar para o tratamento do câncer de mama invasivo ou in situ: revisão sistemática da literatura
    (Universidade Federal de São Paulo (UNIFESP), 2014-11-30) Mota, Bruna Salani [UNIFESP]; Riera, Rachel Riera [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate the efficacy and safety of nipple sparing mastectomy in the treatment of breast cancer. Methods: A systematic literature review according to the methodology of the Cochrane Collaboration was performed. Electronic searches were performed in the databases CENTRAL, MEDLINE via PubMed, Embase via OVID, LILACS, WHO and ClinicalTrials.gov until September 8th 2014, search of records in clinical trials, and manual search of the reference lists of relevant studies. Randomized, quasi-randomized, non-randomized trials were included, as well as comparative observational studies (cohort and case-control) which evaluated the nipple sparing mastectomy in the treatment of women with invasive breast cancer or in situ. Two researchers independently assessed the studies obtained in searches as eligibility criteria and assessed their risk of bias through the assessment tool of risk of bias of the Cochrane Effective Practice and Organisation of Care Group. Data from studies were summarized in graphs of meta-analyses when possible Results: Ten cohort studies were included, evaluating a total of 6,332 participants undergoing 6,748 procedures: 2,167 underwent a nipple sparing mastectomy (NSM), 904 underwent skin sparing mastectomy (SSM) and 3,378 underwent modified radical mastectomy (MRM). None of them underwent areola sparing mastectomy. Overall survival was statistically similar between the NSM and SSM (RR = 0.93, 95% CI 0.73 to 1.18, four trials, 1250 participants) and between NSM and MRM (RR = 1.05; 95% CI = 1.01 to 1.10, five trials, 2783 participants). Local recurrence was evaluated in ten studies and was not statistically different with NSM compared with SSM (RR = 0.71, 95% CI 0.46 to 1.09, six studies, 1603 participants) and MRM (RR = 1.43, 95% CI = 0.96 to 2.14; six studies, 4843 participants). The overall risk of complications was similar in NSM when compared to other types of mastectomy in general (RR = 0.21, 95% CI 0.02 to 2.51, three trials, 1575 participants). With respect to skin necrosis, we observed 83% increased risk with NSM when compared with other types of mastectomy (RR = 1.83, 95% CI 1.06 to 3.14, three studies, 1004 participants). No statistically significant difference among the three techniques with respect to the risk of local infection was observed (RR = 0.85, 95% CI 0.44 to 1.63, three studies, 1004 participants). Meta-analysis was not possible for the cosmetic outcomes and quality of life, but in general the NSM studies have shown that given a favorable aesthetic result and a gain in quality of life compared with the other types of mastectomy. Conclusion: According to the evidence from observational studies of low methodological quality, five-year survival, local recurrence and the overall risk of complications were similar between the nipple sparing mastectomy and skin sparing mastectomy and radical mastectomy treatment for breast cancer invasive or in situ. However, patients undergoing NSM showed an 83% higher risk of developing skin necrosis.
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    Ventilação não invasiva com pressão positiva para prevenção de complicações após ressecção pulmonar em pacientes com câncer de pulmão: revisão sistemática da literatura
    (Universidade Federal de São Paulo (UNIFESP), 2016-01-27) Torres, Maria Fernanda Santos [UNIFESP]; Riera, Rachel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To assess the efficacy and safety of NIPPV for prevention of complications in patients who underwent pulmonary resection for lung cancer. Methods: It was developed a systematic review according to Cochrane Collaboration methodology. We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS and PEDro (last search on 17 March 2015) to identify potentially eligible trials. We did not use any date or language restrictions in the electronic searches for trials. We searched the reference lists of relevant papers and contacted experts in the field for information about additional published and unpublished studies. Additionally we accessed the Register of Controlled Trials (www.controlled-trials.com) and ClinicalTrials.gov (clinicaltrials.gov) to identify ongoing studies. We considered randomised or quasi-randomised clinical trials that compared NIPPV in the immediate postoperative pulmonary resection with no intervention or conventional respiratory therapy. Two authors collected data and assessed trial risk of bias. Where possible, we pooled data from the individual studies using a fixed-effect model (quantitative synthesis) otherwise we tabulated or presented the data in the main text (qualitative synthesis). Where a substantial heterogeneity existed, we applied a random-effects model. Results: From the 155 references retrieved from search strategies, six randomised clinical trials (RCTs) and one quasi-randomised trial fulfilled the eligibility criteria for this review, including a total of 436 patients. There was no statistical difference between the use or not of NIPPV when: (a) pulmonary complications rate (RR 1,03; IC 95% 0,72 to 1,47; five studies), (b) intubation rate (RR 0,55; IC 95% 0,25 to 1,20; three studies), (c) mortality (RR 0,60; 95% CI 0,24 to 1,53; five studies), (d) length of intensive care unit stay (DM-0,75; IC 95% -3,93 to 2,43; two studies), (e) length of hospital stay (DM-0,12; 95% CI -6,15 to 5,90; four studies). None study describe any complications related to NIPPV. Regarding the quality of evidence, four studies were considered "low risk of bias" in all domains evaluated; two were considered 'high risk of bias" to allocation concealment domain where one of those also considered at "high risk of bias" to random sequence generation domain. One study was considered "high risk of bias" because inclusion of participants with more severe clinical conditions compared to participants from other studies. Conclusions: This review demonstrated that there was no additional benefit of using NIPPV in postoperative pulmonary resection for all outcomes analysed (pulmonary complications, rate of intubation, mortality, rate of non-pulmonary complications, postoperative consumption of antibiotics, length of intensive care unit stay, length of hospital stay and adverse effects related to NIPPV). However, the quality of evidence is "very low", "low" and "moderate" since there were few studies, with small sample size and low frequency of outcomes. New welldesigned and well-conducted randomised trials are needed to answer the questions of this review with greater certainty.