DOAJ (DOAJ: Directory of Open Access Journals), Sep 1, 2020
Abstract Purpose: To summarize the evidence from Cochrane systematic reviews on interventions for... more Abstract Purpose: To summarize the evidence from Cochrane systematic reviews on interventions for Central or Branch Vein Occlusion. Methods: We included and summarized the results from Cochrane systematic reviews on interventions for both types of occlusion. The initial search retrieved was 21 reviews and four of them were selected. Results: The four systematic reviews included evaluated the effects of laser techniques and intravitreal injections of Anti-Vascular Endothelial Growth Factor (anti-VEGF) and corticosteroids on Branch and Central Retinal Vein Occlusions. Conclusions: In Branch Retinal Vein Occlusion was found some benefits in the use of grid laser when comparable to no intervention but insufficient evidence about the use of early grid laser, subthreshold laser, intravitreal triamcinolone or anti-VEGF over macular grid laser photocoagulation. In Central Retinal Vein Occlusion with Macular Edema was found insufficient evidence to determine the benefits of intravitreo steroids but ranibizumab may improve clinical and visual outcomes at six and 12 months and repeated intravitreal injection of anti-VEGF agents improved visual outcomes at six months when compared to no treatment.
Background: Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that affects... more Background: Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that affects extremely premature infants and is the leading cause of irreversible blindness in childhood. Objective: This study presents a review of Cochrane systematic reviews about ROP. Methods: We analyzed and summarized the results of all intervention, prevention and treatment, from Cochrane Systematic Reviews (SR) for ROP designed to the highest standard of rigor to show the current position and propose studies that are missing for decision making. Results: Eight SR were analyzed in this study, four in prophylaxis and four in treatment of ROP. The outcome 'Beneficial effect of oral beta-blockers on progression to stage 3 ROP but not to stage 2 ROP with plus disease or to stage 4 or 5 ROP was the only one that presented moderate evidence quality, all the others outcomes presented evidence quality floating from low to very low. Conclusion: There is a lack of studies showing the quality of evidence in the treatment and prevention of retinopathy of prematurity, particularly in long-term outcomes after treatment in order to assess the impact and quality of life of these patients.
Background A considerable amount of randomized controlled trials (RCTs) have been published on st... more Background A considerable amount of randomized controlled trials (RCTs) have been published on statins and/or fibrates for diabetic retinopathy, a clinical condition associated with high social and economic burden. Adherence to the CONSORT statement items is imperative to ensure transparency and reproducibility in clinical research. The aim of this study is to assess the reporting quality and the adherence to CONSORT of RCTs assessing statins and/or fibrates for diabetic retinopathy. Methods We conducted a critical appraisal study at Discipline of Evidence-based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp). A sensitive literature search was performed to identify all relevant RCTs, with no time or language limits. Two authors independently evaluated the reporting quality of the selected RCTs using the CONSORT statement as a standard. Results Thirteen reports of RCTs were included in this study. The adherence of the reports to CONSORT items ranged...
Evidence from observational studies have found a relationship between serum cholesterol and diabe... more Evidence from observational studies have found a relationship between serum cholesterol and diabetic retinopathy (DR). Apart of the assumption that cholesterolemic control has benefits for patients with diabetes with or without retinopathy, the effects of lipid-lowering drugs have not been properly mapped and critically assessed so far. The objective of this study was to evaluate the effects of statins and/or fibrates on prevention and progression of DR. We conducted a Systematic review of randomized controlled trials (RCTs) following the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance to PRISMA Statement. GRADE approach was used to summarize the certainty of the evidence. Eight RCTs that fulfilled our eligibility criteria were included, assessing the effects of fibrates (n = 4), statins (n = 3) and fibrate plus statins (n = 1) for therapy (n = 8) or prevention (n = 4) of DR. Overall, the main concern regarding risk of bias assessment was due to ...
The objective of clinical trials is to answer about intervention in the real-world, for which the... more The objective of clinical trials is to answer about intervention in the real-world, for which they must be properly designed and executed by presenting the results reliably with the findings and in a clear way. OBJECTIVES: To identify the risk of bias in clinical trials about interventions for diabetic retinopathy and/or diabetic macular edema from Cochrane systematic reviews. METHODS: A sensitive search strategy was designed to search Cochrane systematic reviews of interventions in diabetic retinopathy and diabetic macular edema. The assessment of the risk of bias was captured as presented by the author. FINDINGS: We found eight SR and one meta-analysis network totaling 116 randomized clinical trials. Our sample revealed that among the domains randomization, allocation secret, masking of participants and personnel, incomplete outcomes, selective outcomes and others, the risk of bias assessed as low ranged from 30.4 to 49.1%; unclear risk between 22 to 56% and high risk from 1 to 21...
BACKGROUND: Clinical trials are well-designed papers that aim to answer questions in the real wor... more BACKGROUND: Clinical trials are well-designed papers that aim to answer questions in the real world. However, sometimes they present missing, dubious and unclear outcomes that make it difficult to apply in practice. OBJECTIVE: The objective of this work is to evaluate the way and the frequency with which the outcomes in randomized clinical trials of intervention in diabetic retinopathy can be presented in an unclear way to readers. Make an analysis of how these dubious presentations can lead to misinterpretations, why this happens and how they can be remedied. METHODS AND MATERIALS: We conducted a search for RCT about DR intervention in PubMed published over the past five years. RESULTS: Seventy RCT were included, 27 in peripheral diabetic retinopathy (PDR) and 43 in diabetic macular edema (DME). In the DME group we found 25.6% reporting and publication bias; 34.9% subjective outcomes, 44.1% presented a lack of presentation of the baseline and 51.1% underreporting adverse events. In...
BACKGROUND: Meta-analysis is a very seductive term in scientific papers because it summarizes a c... more BACKGROUND: Meta-analysis is a very seductive term in scientific papers because it summarizes a compilation of quantitative results; however its interpretation must be done carefully. OBJECTIVE: Search the diabetic retinopathy intervention literature for the occurrence of the term meta-analysis in non-systematic reviews, showing the reader the frequency that they occur and alert to the dangers that inadequate interpretation can cause. METHODS AND MATERIALS: An extensive search in Pubmed was performed for works with the term meta-analysis in the title, abstract and keywords (ti, abs, kw) without date or language restriction. The selected papers were read fully in search of characteristics of systematic review (SR) or not. The results are presented objectively with a critical analysis of each analysed term. RESULTS: We found 39 papers with the term meta-analysis on (ti, abs, kw). 12 (30.8%) of them did not write the study design in the abstract. 14 (35.9%) did not present the search s...
Sao Paulo medical journal = Revista paulista de medicina, Jan 25, 2018
This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten ... more This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten integrative practices that were recently added to the Brazilian public healthcare system (SUS). Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). Review of Cochrane SRs on the following interventions were identified, summarized and critically assessed: apitherapy, aromatherapy, bioenergetics, family constellation, flower therapy, chromotherapy, geotherapy, hypnotherapy, hand imposition or ozone therapy. We included a total of 16 SRs: 4 on apitherapy, 4 on aromatherapy, 6 on hypnotherapy and 2 on ozone therapy. No Cochrane SR was found regarding bioenergetics, family constellation, chromotherapy, clay therapy, flower therapy or hand imposition. The only high-quality evidence was in relation to the potential benefit of apitherapy, specifically regarding some benefits from hon...
CONTEXT AND OBJECTIVE: Diabetic retinopathy is a disease caused by increased permeability of reti... more CONTEXT AND OBJECTIVE: Diabetic retinopathy is a disease caused by increased permeability of retinal vessels. Its incidence and prevalence have been increasing due to urbanization, greater life expectancy and the habits of modern life. Its onset is insidious and it may lead to blindness in 75% of individuals who have been diabetic for more than 20 years. The aim here was to evaluate the evidence from Cochrane systematic reviews on interventions relating to diabetic retinopathy. DESIGN AND SETTING: Review of systematic reviews, conducted at Cochrane Brazil. METHODS: We included Cochrane systematic reviews on interventions relating to diabetic retinopathy. Two researchers evaluated the inclusion criteria, summarized the reviews and presented the results narratively. RESULTS: Ten reviews met the inclusion criteria. They showed some evidence of benefits from: (a) photocoagulation for diabetic retinopathy; (b) strict glucose and pressure control for postponing the onset of retinopathy; (...
Background: Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus... more Background: Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus, and more than 75% of patients who have had diabetes for more than 20 years will have some degree of DR. This disease is highly destructive to self-esteem and puts a high burden on public health and pension systems due to the effects that it has on people of working age. The current mainstay of treatment is laser photocoagulation, which causes impairment of vision and discomfort to patients. Thus, finding a systemic drug that could act on all microcirculation and prevent direct manipulation of the eyes would be highly desirable. Objective: To assess the efficacy and safety of the drugs in the statin and/or fibrate groups for the prevention and treatment of DR. Methods: In this systematic review, we will select randomized controlled trials of fibrates or statins used for the treatment or prevention of DR. Our search strategy will include free text terms and controlled vocabulary (eg, MeSH, Emtree) for, "diabetic retinopathy", "statins", "fibrates", "hypolipidemic agents", and for drugs from both groups. Databases that will be used include Medical Literature Analysis and Retrieval System/PubMed, Embase,
DOAJ (DOAJ: Directory of Open Access Journals), Sep 1, 2020
Abstract Purpose: To summarize the evidence from Cochrane systematic reviews on interventions for... more Abstract Purpose: To summarize the evidence from Cochrane systematic reviews on interventions for Central or Branch Vein Occlusion. Methods: We included and summarized the results from Cochrane systematic reviews on interventions for both types of occlusion. The initial search retrieved was 21 reviews and four of them were selected. Results: The four systematic reviews included evaluated the effects of laser techniques and intravitreal injections of Anti-Vascular Endothelial Growth Factor (anti-VEGF) and corticosteroids on Branch and Central Retinal Vein Occlusions. Conclusions: In Branch Retinal Vein Occlusion was found some benefits in the use of grid laser when comparable to no intervention but insufficient evidence about the use of early grid laser, subthreshold laser, intravitreal triamcinolone or anti-VEGF over macular grid laser photocoagulation. In Central Retinal Vein Occlusion with Macular Edema was found insufficient evidence to determine the benefits of intravitreo steroids but ranibizumab may improve clinical and visual outcomes at six and 12 months and repeated intravitreal injection of anti-VEGF agents improved visual outcomes at six months when compared to no treatment.
Background: Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that affects... more Background: Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that affects extremely premature infants and is the leading cause of irreversible blindness in childhood. Objective: This study presents a review of Cochrane systematic reviews about ROP. Methods: We analyzed and summarized the results of all intervention, prevention and treatment, from Cochrane Systematic Reviews (SR) for ROP designed to the highest standard of rigor to show the current position and propose studies that are missing for decision making. Results: Eight SR were analyzed in this study, four in prophylaxis and four in treatment of ROP. The outcome 'Beneficial effect of oral beta-blockers on progression to stage 3 ROP but not to stage 2 ROP with plus disease or to stage 4 or 5 ROP was the only one that presented moderate evidence quality, all the others outcomes presented evidence quality floating from low to very low. Conclusion: There is a lack of studies showing the quality of evidence in the treatment and prevention of retinopathy of prematurity, particularly in long-term outcomes after treatment in order to assess the impact and quality of life of these patients.
Background A considerable amount of randomized controlled trials (RCTs) have been published on st... more Background A considerable amount of randomized controlled trials (RCTs) have been published on statins and/or fibrates for diabetic retinopathy, a clinical condition associated with high social and economic burden. Adherence to the CONSORT statement items is imperative to ensure transparency and reproducibility in clinical research. The aim of this study is to assess the reporting quality and the adherence to CONSORT of RCTs assessing statins and/or fibrates for diabetic retinopathy. Methods We conducted a critical appraisal study at Discipline of Evidence-based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp). A sensitive literature search was performed to identify all relevant RCTs, with no time or language limits. Two authors independently evaluated the reporting quality of the selected RCTs using the CONSORT statement as a standard. Results Thirteen reports of RCTs were included in this study. The adherence of the reports to CONSORT items ranged...
Evidence from observational studies have found a relationship between serum cholesterol and diabe... more Evidence from observational studies have found a relationship between serum cholesterol and diabetic retinopathy (DR). Apart of the assumption that cholesterolemic control has benefits for patients with diabetes with or without retinopathy, the effects of lipid-lowering drugs have not been properly mapped and critically assessed so far. The objective of this study was to evaluate the effects of statins and/or fibrates on prevention and progression of DR. We conducted a Systematic review of randomized controlled trials (RCTs) following the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance to PRISMA Statement. GRADE approach was used to summarize the certainty of the evidence. Eight RCTs that fulfilled our eligibility criteria were included, assessing the effects of fibrates (n = 4), statins (n = 3) and fibrate plus statins (n = 1) for therapy (n = 8) or prevention (n = 4) of DR. Overall, the main concern regarding risk of bias assessment was due to ...
The objective of clinical trials is to answer about intervention in the real-world, for which the... more The objective of clinical trials is to answer about intervention in the real-world, for which they must be properly designed and executed by presenting the results reliably with the findings and in a clear way. OBJECTIVES: To identify the risk of bias in clinical trials about interventions for diabetic retinopathy and/or diabetic macular edema from Cochrane systematic reviews. METHODS: A sensitive search strategy was designed to search Cochrane systematic reviews of interventions in diabetic retinopathy and diabetic macular edema. The assessment of the risk of bias was captured as presented by the author. FINDINGS: We found eight SR and one meta-analysis network totaling 116 randomized clinical trials. Our sample revealed that among the domains randomization, allocation secret, masking of participants and personnel, incomplete outcomes, selective outcomes and others, the risk of bias assessed as low ranged from 30.4 to 49.1%; unclear risk between 22 to 56% and high risk from 1 to 21...
BACKGROUND: Clinical trials are well-designed papers that aim to answer questions in the real wor... more BACKGROUND: Clinical trials are well-designed papers that aim to answer questions in the real world. However, sometimes they present missing, dubious and unclear outcomes that make it difficult to apply in practice. OBJECTIVE: The objective of this work is to evaluate the way and the frequency with which the outcomes in randomized clinical trials of intervention in diabetic retinopathy can be presented in an unclear way to readers. Make an analysis of how these dubious presentations can lead to misinterpretations, why this happens and how they can be remedied. METHODS AND MATERIALS: We conducted a search for RCT about DR intervention in PubMed published over the past five years. RESULTS: Seventy RCT were included, 27 in peripheral diabetic retinopathy (PDR) and 43 in diabetic macular edema (DME). In the DME group we found 25.6% reporting and publication bias; 34.9% subjective outcomes, 44.1% presented a lack of presentation of the baseline and 51.1% underreporting adverse events. In...
BACKGROUND: Meta-analysis is a very seductive term in scientific papers because it summarizes a c... more BACKGROUND: Meta-analysis is a very seductive term in scientific papers because it summarizes a compilation of quantitative results; however its interpretation must be done carefully. OBJECTIVE: Search the diabetic retinopathy intervention literature for the occurrence of the term meta-analysis in non-systematic reviews, showing the reader the frequency that they occur and alert to the dangers that inadequate interpretation can cause. METHODS AND MATERIALS: An extensive search in Pubmed was performed for works with the term meta-analysis in the title, abstract and keywords (ti, abs, kw) without date or language restriction. The selected papers were read fully in search of characteristics of systematic review (SR) or not. The results are presented objectively with a critical analysis of each analysed term. RESULTS: We found 39 papers with the term meta-analysis on (ti, abs, kw). 12 (30.8%) of them did not write the study design in the abstract. 14 (35.9%) did not present the search s...
Sao Paulo medical journal = Revista paulista de medicina, Jan 25, 2018
This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten ... more This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten integrative practices that were recently added to the Brazilian public healthcare system (SUS). Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). Review of Cochrane SRs on the following interventions were identified, summarized and critically assessed: apitherapy, aromatherapy, bioenergetics, family constellation, flower therapy, chromotherapy, geotherapy, hypnotherapy, hand imposition or ozone therapy. We included a total of 16 SRs: 4 on apitherapy, 4 on aromatherapy, 6 on hypnotherapy and 2 on ozone therapy. No Cochrane SR was found regarding bioenergetics, family constellation, chromotherapy, clay therapy, flower therapy or hand imposition. The only high-quality evidence was in relation to the potential benefit of apitherapy, specifically regarding some benefits from hon...
CONTEXT AND OBJECTIVE: Diabetic retinopathy is a disease caused by increased permeability of reti... more CONTEXT AND OBJECTIVE: Diabetic retinopathy is a disease caused by increased permeability of retinal vessels. Its incidence and prevalence have been increasing due to urbanization, greater life expectancy and the habits of modern life. Its onset is insidious and it may lead to blindness in 75% of individuals who have been diabetic for more than 20 years. The aim here was to evaluate the evidence from Cochrane systematic reviews on interventions relating to diabetic retinopathy. DESIGN AND SETTING: Review of systematic reviews, conducted at Cochrane Brazil. METHODS: We included Cochrane systematic reviews on interventions relating to diabetic retinopathy. Two researchers evaluated the inclusion criteria, summarized the reviews and presented the results narratively. RESULTS: Ten reviews met the inclusion criteria. They showed some evidence of benefits from: (a) photocoagulation for diabetic retinopathy; (b) strict glucose and pressure control for postponing the onset of retinopathy; (...
Background: Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus... more Background: Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus, and more than 75% of patients who have had diabetes for more than 20 years will have some degree of DR. This disease is highly destructive to self-esteem and puts a high burden on public health and pension systems due to the effects that it has on people of working age. The current mainstay of treatment is laser photocoagulation, which causes impairment of vision and discomfort to patients. Thus, finding a systemic drug that could act on all microcirculation and prevent direct manipulation of the eyes would be highly desirable. Objective: To assess the efficacy and safety of the drugs in the statin and/or fibrate groups for the prevention and treatment of DR. Methods: In this systematic review, we will select randomized controlled trials of fibrates or statins used for the treatment or prevention of DR. Our search strategy will include free text terms and controlled vocabulary (eg, MeSH, Emtree) for, "diabetic retinopathy", "statins", "fibrates", "hypolipidemic agents", and for drugs from both groups. Databases that will be used include Medical Literature Analysis and Retrieval System/PubMed, Embase,
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