Navegando por Palavras-chave "randomized controlled trials"
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- ItemSomente MetadadadosAngiotensin II antagonists for hypertension: Are there differences in efficacy?(Elsevier B.V., 2000-04-01) Conlin, P. R.; Spence, J. D.; Williams, B.; Ribeiro, A. B.; Saito, I; Benedict, C.; Bunt, AMG; Brigham & Womens Hosp; Harvard Univ; Univ Western Ontario; Univ Leicester; Universidade Federal de São Paulo (UNIFESP); Keio Univ; Univ Texas; Merck & Co IncWe compared the antihypertensive efficacy of available drugs in the new angiotensin-II-antagonist (AIIA) class. the antihypertensive efficacy of losartan, valsartan, irbesartan, and candesartan was evaluated from randomized controlled trials (RCT) by performing a metaanalysis of 43 published RCT. These trials involved AIIA compared with placebo, other antihypertensive classes, and direct comparisons between AIIA. A weighted-average for diastolic and systolic blood pressure reduction with AIIA monotherapy, dose titration, and with addition of low-dose hydrochlorothiazide (HCTZ) were calculated. Weighted-average responder rates were also determined. the metaanalysis assessed a total of 11,281 patients. the absolute weighted-average reductions in diastolic (8.2 to 8.9 mm Hg) and systolic (10.4 to 11.8 mm Hg) blood pressure reductions (not placebo-corrected) for AIIA monotherapy were comparable for all AIIA. Responder rates for AIIA monotherapy were 48% to 55%. Dose titration resulted in slightly greater blood pressure reduction and an increase in responder rates to 53% to 63%. AIIA/hydrochlorothiazide combinations produced substantially greater reduction in systolic (16.1 to 20.6 mm Hg) and diastolic (9.9 to 13.6 mm Hg) blood pressure reductions than AIIA monotherapy and responder rates for AIIA/HCTZ combinations were 56% to 70%. This comprehensive analysis shows comparable antihypertensive efficacy within the AIIA class, a near-flat AIIA-dose response when titrating from starting to maximum recommended dose, and substantial potentiation of the antihypertensive effect with addition of HCTZ. (C) 2000 American Journal of Hypertension, Ltd.
- ItemAcesso aberto (Open Access)Assessing Risk of Bias in Randomized Controlled Trials for Autism Spectrum Disorder(Frontiers Media Sa, 2017) Martins Okuda, Paola Matiko [UNIFESP]; Klaiman, Cheryl; Bradshaw, Jessica; Reid, Morganne; Cogo-Moreira, Hugo [UNIFESP]Aim: To determine construct validity and reliability indicators of the Cochrane risk of bias (RoB) tool in the context of randomized clinical trials (RCTs) for autism spectrum disorder (ASD). Methods: Confirmatory factor analysis was used to evaluate a unidimensional model consisting of 9 RoB categorical indicators evaluated across 94 RCTs addressing interventions for ASD. Results: Only five of the nine original RoB items returned good fit indices and so were retained in the analysis. Only one of this five had very high factor loadings. The remaining four indicators had more measurement error than common variance with the RoB latent factor. Together, the five indicators showed poor reliability (omega = 0.687; 95% CI: 0.613-0.761). Conclusion: Although the Cochrane model of RoB for ASD exhibited good fit indices, the majorities of the items have more residual variance than common variance and, therefore, did not adequately capture the RoB in ASD intervention trials.
- ItemSomente MetadadadosCochrane report - A systematic review of mannitol therapy for acute ischemic stroke and cerebral parenchymal hemorrhage(Lippincott Williams & Wilkins, 2000-11-01) Bereczki, Daniel; Liu, Ming; Prado, Gilmar Fernandes do [UNIFESP]; Fekete, Istvan; Univ Debrecen; W China Univ Med Sci; Universidade Federal de São Paulo (UNIFESP)Background-Mannitol was reported to decrease cerebral edema associated with tissue damage and is used to treat acute stroke in many countries.Summary of Review-We tested whether there is any evidence from unconfounded randomized clinical trials that treatment with mannitol reduces short- and long-term case fatality and dependency if administered after ischemic stroke or cerebral parenchymal hemorrhage. Trials were identified by the standard search strategy of the Cochrane Collaboration Stroke Review Group. A supplementary MEDLINE search was performed, and the Chinese Stroke Trials Register and the Latin-American databank LILACS were checked. A search was performed of master's and PhD degree theses in the databank of Sao Paulo University and in abstracts of medical congresses on neurology and neurosurgery during 1965-1997 in Brazil. Investigators were contacted for unpublished information. Only truly randomized unconfounded clinical trials were eligible for inclusion. Two of the reviewers independently extracted data from the trials. Data synthesis and analysis was performed with the use of the Cochrane Review Manager software RevMan version 4.0.4).Conclusions-Only 1 trial fulfilled the inclusion criteria. The number of included patients was small, and the follow-up was short. Case fatality, the proportion of dependent patients, and side effects were not reported and were not available from the investigators. As a result of lack of appropriate randomized trials, currently no conclusion can be drawn on the effects of mannitol in acute stroke. The routine use of mannitol in all patients with acute stroke is not supported by evidence from randomized controlled clinical trials.
- ItemAcesso aberto (Open Access)A efetividade de intervenções de educação nutricional nas escolas para prevenção e redução do ganho excessivo de peso em crianças e adolescentes: uma revisão sistemática(Sociedade Brasileira de Pediatria, 2011-10-01) Silveira, Jonas Augusto Cardoso da [UNIFESP]; Taddei, Jose Augusto de Aguiar Carrazedo [UNIFESP]; Guerra, Paulo Henrique; Nobre, Moacyr Roberto Cuce; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)OBJECTIVE: To evaluate the effectiveness of school-based nutrition education in reducing or preventing overweight and obesity in children and adolescents. SOURCES: Systematic search in 14 databases and five systematic reviews for randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. Body mass index and fruit and vegetable intake were used as primary and secondary measures of outcome, respectively. There was no restriction by date of publication or language, except for languages with structured logograms. We excluded studies on specific populations presenting eating disorders, dyslipidemia, diabetes, and physical or mental disabilities, as well as studies that used drugs or food supplements as components of the intervention. The assessment by title and abstract and the quality assessment were performed independently by two researchers. We used the Centre for Reviews and Dissemination's guidance for undertaking reviews in health care and the software EPPI-Reviewer 3. SUMMARY OF THE FINDINGS: From the initially retrieved 4,809 references, 24 articles met the inclusion criteria. The extracted data show that there is evidence of positive effects on anthropometry and of increase in fruit and vegetable consumption. Characteristics of the interventions that demonstrated effectiveness are: duration > 1 year, introduction into the regular activities of the school, parental involvement, introduction of nutrition education into the regular curriculum, and provision of fruits and vegetables by school food services. CONCLUSION: Interventions in schools to reduce overweight and obesity, as well as to increase fruits and vegetable consumption, have demonstrated effectiveness in the best-conducted studies.
- ItemAcesso aberto (Open Access)Treatment of Non-neurogenic Overactive Bladder with OnabotulinumtoxinA: Systematic Review and Meta-analysis of Prospective, Randomized, Placebo-controlled Clinical Trials(Federacao Brasileira Soc Ginecologia & Obstetricia-Febrasgo, 2018) Arruda, Raquel Martins [UNIFESP]; Takano, Claudia Cristina [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Haddad, Jorge Milhem; Aleixo, Gabriel Francisco; Castro, Rodrigo Aquino [UNIFESP]We performed a systematic review and meta-analysis of randomized placebo-controlled trials that studied non-neurogenic overactive bladder patients who were treated with 100 units of onabotulinumtoxinA or placebo. The primary purpose of our study was to evaluate the clinical effectiveness with regard to urinary urgency, urinary frequency, nocturia, and incontinence episodes. Our secondary purpose consisted of evaluating the adverse effects. Our initial search yielded 532 entries. Of these, seven studies met all the inclusion criteria (prospective, randomized, placebo-controlled studies, >= 3 points on the Jadad scale) and were selected for analysis. For all primary endpoints, the toxin was more effective than placebo (p < 0.0001