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Health 2015年第3期7卷 355-364页

作者： Hellen Lívia Oliveira Catunda elizian braga rodrigues bernardo Lara Leite de Oliveira Mirna Fontenele de Oliveira Régia Christina Moura Barbosa Castro Priscila de Souza Aquino Ana Karina Bezerra Pinheiro Department of Nursing Federal University of Ceará Fortaleza Brazil Department of Nursing Federal University of Cariri Juazeiro do Norte Brazil

This is a cross-sectional, correlational and quantitative study conducted on 210 postpartum women from January to July 2013 at the breastfeeding outpatient clinic of a public maternity. The study was carried out in order to assess the determining factors in maintaining an exclusive breastfeeding in the first month of the newborn’s life, the participation of the nurse in encouraging this process, and the reasons leading to a premature weaning. Prior births proved to be a positive factor for exclusive breastfeeding (Odds Ratio (OR) 0.359;CI 95% 0.137 - 0.941;p = 0.031). The absence of a nurse in the medical appointments resulted in a threefold risk to have no prenatal exclusive breastfeeding guidance whatsoever (OR 3.025;CI 95% 1.567 - 5.840;p = 0.001). The reported reasons for a premature weaning were difficulty latching-on, cracked nipples, poor milk that does not satiate the baby’s hunger, and production of little or no milk at all. The results provide information for the adoption of strategies during pregnancy and the postpartum period aimed to promote an exclusive breastfeeding, checking for the possible influence of the woman’s personal circumstances in her choosing exclusive breastfeeding, as well as the participation of the nurse in the mother’s decision.

关键词： Breastfeeding Weaning Health Promotion Nursing

Maternal Predictors for Quality of Life during the Postpartum in Brazilian Mothers

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Health 2015年第3期7卷 371-380页

作者： Mirna Fontenele de Oliveira Leslie Parker Hyochol Ahn Hellen Lívia Oliveira Catunda elizian braga rodrigues bernardo Mara Fontenele de Oliveira Samila Gomes Ribeiro Cinthia Gondim Pereira Calou Franz Janco Antezana Paulo César Almeida Régia Christina Moura Barbosa Castro Priscila de Souza Aquino Ana Karina Bezerra Pinheiro College of Nursing University of Florida Gainesville USA Department of Nursing Federal University of Ceará Fortaleza Brazil

Introduction: The postpartum period can have a significant physical, emotional, and social impact on the quality of a woman’s life. Most postpartum research has focused on physical complications and only a few studies have specifically investigated quality of life. The purpose of this study was to explore predictors affecting the quality of life of postpartum Brazilian mothers. Study Design and Methods: A cross-sectional Quality of Life survey was performed in 210 Brazilian mothers during the early postpartum period. Data were collected using an interview technique and two instruments: 1) a maternal questionnaire and the 2) Maternal Postpartum Quality of Life tool/Brazilian version. The association between maternal characteristics and quality of life in the post-partum period was investigated with bivariate and multivariable analyses. Results: Mothers who had the best Quality of Life were white, registered students, 30 - 40 years of age, who were married or living with a partner, and without physical complaints;in addition, they had at least an 8th grade education, more than 4 children, and had attended more than 8 prenatal visits with a nurse. The stepwise model indicated that white race (p < 0.05) and married or living with a partner (p < 0.05) were the best predictors of Quality of Life in postpartum women. Conclusions and Clinical Implications: Marital status and race conditions may predict quality of life in postpartum Brazilian mothers. In addition, improved knowledge concerning the postpartum, maternal experience may help develop health interventions to enhance the quality of life of this population.

关键词： Mothers Postpartum Quality of Life Predictors

Biliary drainage in inoperable malignant biliary distal obstruction: A systematic review and meta-analysis

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World Journal of Gastrointestinal Surgery 2021年第5期13卷 493-506页

作者： Maria Vitória Cury Vieira Scatimburgo Igor braga Ribeiro Diogo Turiani Hourneaux de Moura Vitor Massaro Takamatsu Sagae Bruno Salomão Hirsch Mateus Bond Boghossian Thomas R McCarty Marcos EduardoLera dos Santos Tomazo Antonio Prince Franzini Wanderley Marques bernardo Eduardo GuimarãesHourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil Division of Gasteoenterology Hepatology and EndoscopyBrigham and Women's HospitalBostonMA 02115United States

BACKGROUND Endoscopic drainage remains the treatment of choice for unresectable or inoperable malignant distal biliary obstruction(MDBO).AIM To compare the safety and efficacy of plastic stent(PS)vs self-expanding metal stent(SEMS)placement for treatment of *** This meta-analysis was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.A comprehensive search was performed in MEDLINE,Cochrane,Embase,Latin American and Caribbean Health Sciences Literature,and grey literature to identify randomized clinical trials(RCTs)comparing clinical success,adverse events,stent dysfunction rate,reintervention rate,duration of stent patency,and mean *** difference(RD)and mean difference(MD)were calculated and heterogeneity was assessed with I2 *** analyses were performed by SEMS *** Twelve RCTs were included in this study,totaling 1005 *** was no difference in clinical success(RD=-0.03,95%confidence interval[CI]:-0.01,0.07;I 2=0%),rate of adverse events(RD=-0.03,95%CI:-0.10,0.03;I2=57%),and mean patient survival(MD=-0.63,95%CI:-18.07,19.33;I2=54%)between SEMS vs PS ***,SEMS placement was associated with a lower rate of reintervention(RD=-0.34,95%CI:-0.46,-0.22;I2=57%)and longer duration of stent patency(MD=125.77 d,95%CI:77.5,174.01).Subgroup analyses revealed both covered and uncovered SEMS improved stent patency compared to PS(RD=152.25,95%CI:37.42,267.07;I2=98%and RD=101.5,95%CI:38.91,164.09;I2=98%;respectively).Stent dysfunction was higher in the covered SEMS group(RD=-0.21,95%CI:-0.32,-0.1;I²=205%),with no difference in the uncovered SEMS group(RD=-0.08,95%CI:-0.56,0.39;I²=87%).CONCLUSION While both stent types possessed a similar clinical success rate,complication rate,and patient-associated mean survival for treatment of MDBO,SEMS were associated with a longer duration of stent patency compared to PS.

关键词： Biliary tract neoplasms Stents Protheses Malignancy Biliary system Cancer

Propofol vs traditional sedatives for sedation in endoscopy:A systematic review and meta-analysis

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World Journal of Gastrointestinal Endoscopy 2019年第12期11卷 573-588页

作者： Aureo Augusto de Almeida Delgado Diogo Turiani Hourneaux de Moura Igor braga Ribeiro Ahmad Najdat Bazarbashi Marcos Eduardo Lera dos Santos Wanderley Marques bernardo Eduardo Guimaraes Hourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao PauloSao Paulo 05403000Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States

BACKGROUND Propofol is commonly used for sedation during endoscopic *** suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines and opioids with more rapid onset of action and improved postprocedure recovery times for ***,Propofol requires administration by trained healthcare providers,has a narrow therapeutic index,lacks an antidote and increases risks of cardio-pulmonary *** To compare,through a systematic review of the literature and meta-analysis,sedation with propofol to traditional sedatives with or without propofol during endoscopic *** A literature search was performed using MEDLINE,Scopus,EMBASE,the Cochrane Library,Scopus,LILACS,BVS,Cochrane Central Register of Controlled Trials,and The Cumulative Index to Nursing and Allied Health Literature *** last search in the literature was performed on March,2019 with no restriction regarding the idiom or the year of *** randomized clinical trials with full texts published were *** divided sedation therapies to the following groups:(1)Propofol versus benzodiazepines and/or opiate sedatives;(2)Propofol versus Propofol with benzodiazepine and/or opioids;and(3)Propofol with adjunctive benzodiazepine and opioid versus benzodiazepine and *** following outcomes were addressed:Adverse events,patient satisfaction with type of sedation,endoscopists satisfaction with sedation administered,dose of propofol administered and time to recovery post ***-analysis was performed using RevMan5 software version *** A total of 23 clinical trials were included(n=3854)from the initial search of 6410 *** Group I(Propofol vs benzodiazepine and/or opioids):The incidence of bradycardia was not statistically different between both sedation arms(RD:-0.01,95%CI:-0.03–+0.01,I2:22%).In 10 studies,the incidence of hypotension was not statistically difference between sedation arms(RD:0.01,95%CI

关键词： Sedation Digestive endoscopy Propofol Benzodiazepines Opioids Adverse events

Endoscopic retrograde cholangiopancreatography drainage for palliation of malignant hilar biliary obstruction——stent-in-stent or side-by-side?A systematic review and meta-analysis

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World Journal of Hepatology 2021年第5期13卷 595-610页

作者： Gabriel Mayo Vieira de Souza Igor braga Ribeiro Mateus Pereira Funari Diogo Turiani Hourneaux de Moura Maria Vitória Cury Vieira Scatimburgo João Remíde Freitas Júnior Sergio A Sánchez-Luna Renato Baracat Eduardo Turiani Hourneaux de Moura Wanderley Marques bernardo Eduardo Guimarães Hourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil Division of Gastroenterology Hepatology and NutritionCenter for Advanced Therapeutic EndoscopyAllegheny Health NetworkPittsburghPA 15212United States Division of Gastroenterology and Hepatology Department of Internal MedicineBasil I.Hirschowitz Endoscopic Center of ExcellenceBirminghamAL 35294United States

BACKGROUND Biliary drainage,either by the stent-in-stent(SIS)or side-by-side(SBS)technique,is often required when treating a malignant hilar biliary obstruction(MHBO).Both methods differ from each other and have distinct *** To compare both techniques regarding their efficacy and safety in achieving drainage of *** A comprehensive search of multiple electronic databases(MEDLINE,Embase,LILACS,BIREME,Cochrane)was conducted and grey literature from their inception until December 2020 with no restrictions regarding the year of publication or language,since there was at least an abstract in *** included studies compared SIS and SBS techniques through endoscopic retrograde *** analyzed included technical and clinical success,early and late adverse events(AEs),stent patency,reintervention,and procedure-related *** Four cohort studies and one randomized controlled trial evaluating a total of 250 patients(127 in the SIS group and 123 in the SBS group)were included in this *** were no statistically significant differences between the two groups concerning the evaluated outcomes,except for stent patency,which was higher in the SIS compared with the SBS technique[mean difference(d)=33.31;95%confidence interval:9.73 to 56.90,I2=45%,P=0.006].CONCLUSION The SIS method showed superior stent patency when compared to SBS for achieving bilateral drainage in *** techniques are equivalent in terms of technical success,clinical success,rates of both early and late AEs,reintervention,and procedure-related mortality.

关键词： Endoscopic retrograde cholangiopancreatography Biliary tract neoplasms Biliary Hilar Stenting Drainage

Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis:A systematic review and meta-analysis of randomized controlled trials

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World Journal of Gastrointestinal Endoscopy 2020年第8期12卷 241-255页

作者： John Alexander Lata Guacho Diogo Turiani Hourneaux de Moura Igor braga Ribeiro Alberto Machado da Ponte Neto Shailendra Singh Marina Gammaro Baldavira Tucci Wanderley Marques bernardo Eduardo Guimarães Hourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil Division of Gastroenterology Department of Internal MedicineWest Virginia UniversityCharlestonWV 25304United States

BACKGROUND Patients with cirrhosis frequently require sedation for elective endoscopic *** sedation protocols are available,but choosing an appropriate sedative in patients with cirrhosis is *** To conduct a systematic review and meta-analysis to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best *** This systematic review and meta-analysis was conducted using the PRISMA *** searches were performed using MEDLINE,EMBASE,Central Cochrane,LILACS *** randomized control trials(RCTs)were *** outcomes studied were procedure time,recovery time,discharge time,and adverse events(bradycardia,hypotension,and hypoxemia).The risk of bias assessment was performed using the Revised Cochrane Risk-of-Bias tool for randomized trials(RoB-2).Quality of evidence was evaluated by *** meta-analysis was performed using Review *** The search yielded 3,576 *** of these,8 RCTs with a total of 596 patients(302 in the propofol group and 294 in the midazolam group)were included for the final *** time was similar between midazolam and propofol groups(MD:0.25,95%CI:-0.64 to 1.13,P=0.59).Recovery time(MD:-8.19,95%CI:-10.59 to-5.79,P<0.00001).and discharge time were significantly less in the propofol group(MD:-12.98,95%CI:-18.46 to-7.50,P<0.00001).Adverse events were similar in both groups(RD:0.02,95%CI:0-0.04,P=0.58).Moreover,no significant difference was found for bradycardia(RD:0.03,95%CI:-0.01 to 0.07,P=0.16),hypotension(RD:0.03,95%CI:-0.01 to 0.07,P=0.17),and hypoxemia(RD:0.00,95%CI:-0.04 to 0.04,P=0.93).Five studies had low risk of bias,two demonstrated some concerns,and one presented high *** quality of the evidence was very low for procedure time,recovery time,and adverse events;while low for discharge *** This systematic review and meta-analysis based on RCTs sh

关键词： Sedation Midazolam Propofol Cirrhosis Endoscopic Endoscopy Metaanalysis

Effects of intragastric balloon placement in metabolic dysfunctionassociated fatty liver disease: A systematic review and metaanalysis

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World Journal of Hepatology 2021年第7期13卷 815-829页

作者： João Remíde Freitas Júnior Igor braga Ribeiro Diogo Turiani Hourneaux de Moura Vitor Massaro Takamatsu Sagae Gabriel Mayo Vieira de Souza Guilherme Henrique Peixoto de Oliveira Sergio A Sánchez-Luna Thiago Ferreira de Souza Eduardo Turiani Hourneaux de Moura Cláudia Pinto Marques Souza de Oliveira Wanderley Marques bernardo Eduardo Guimarães Hourneaux de Moura Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP Departamento de GastroenterologiaFaculdade de MedicinaUniversidade de Sao PauloSao PauloSPBR Division of Gastroenterology and Hepatology Department of Internal MedicineBasil I.Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at BirminghamBirminghamAL 35294United States Department of Gastroenterology Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil

BACKGROUND Metabolic dysfunction-associated fatty liver disease corresponds to a clinical entity that affects liver function triggered by the accumulation of fat in the liver and is linked with metabolic *** To evaluate the effects of the intragastric balloon(IGB)in patients with metabolic dysfunction-associated fatty liver disease through the assessment of liver enzymes,imaging and several metabolic *** A comprehensive search was done of multiple electronic databases(MEDLINE,EMBASE,LILACS,Cochrane and Google Scholar)and grey literature from their inception until February *** criteria involved patients with a body mass index>25 kg/m2 with evidence or previous diagnosis of hepatic *** analyzed before and after 6 mo of IGB removal were alanine aminotransferase(IU/L),gamma-glutamyltransferase(IU/L),glycated hemoglobin(%),triglycerides(mg/dL),systolic blood pressure(mmHg),homeostatic model assessment,abdominal circumference(cm),body mass index(kg/m2)and liver volume(cm3).RESULTS Ten retrospective cohort studies evaluating a total of 508 patients were *** 6 mo of IGB placement,this significantly reduced alanine aminotransferase[mean difference(MD):10.2,95%confidence interval(CI):8.12-12.3],gammaglutamyltransferase(MD:9.41,95%CI:6.94-11.88),glycated hemoglobin(MD:0.17%,95%CI:0.03-0.31),triglycerides(MD:38.58,95%CI:26.65-50.51),systolic pressure(MD:7.27,95%CI:4.79-9.76),homeostatic model assessment(MD:2.23%,95%CI:1.41-3.04),abdominal circumference(MD:12.12,95%CI:9.82-14.41)and body mass index(MD:5.07,95%CI:4.21-5.94).CONCLUSION IGB placement showed significant efficacy in improving alanine aminotransferase and gamma-glutamyltransferase levels in patients with metabolic dysfunctionassociated fatty liver disease as well as improving metabolic markers related to disease progression.

关键词： Intragastric balloon Metabolic dysfunction-associated fatty liver disease Homeostatic model assessment Abdominal circumference Body mass index

Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding:A systematic review and metaanalysis

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World Journal of Gastrointestinal Endoscopy 2018年第12期10卷 400-421页

作者： Hélcio Pedrosa Brito Igor braga Ribeiro Diogo Turiani Hourneaux de Moura Wanderley Marques bernardo Dalton Marques Chaves Rogério Kuga Ethan Dwane Maahs Robson Kiyoshi Ishida Eduardo Turiani Hourneaux de Moura Eduardo Guimaraes Hourneaux de Moura Department of Endoscopy of Clinics Hospital of Sao Paulo University Sao Paulo 05403-00Brazil Molecular and Cell Biology University of CaliforniaCaliforniaBerkeleyCA 94720United States

AIM To compare the diagnostic accuracy of video capsule endoscopy(VCE) and double-balloon enteroscopy(DBE) in cases of obscure gastrointestinal bleeding(OGIB) of vascular *** MEDLINE(via PubMed), LILACS(via BVS) and Cochrane/CENTRAL virtual databases were searched for studies dated before 2017. We identified prospective and retrospective studies, including observational, cohort, single-blinded and multicenter studies, comparing VCE and DBE for the diagnosis of OGIB, and data of all the vascular sources of bleeding were collected. All patients were subjected to the same gold standard method. Relevant data were then extracted from each included study using a standardized extraction form. We calculated study variables(sensitivity, specificity, prevalence, positive and negative predictive values and accuracy) and performed a meta-analysis using Meta-Disc *** In the per-patient analysis, 17 studies(1477 lesions) were included. We identified3150 exams(1722 VCE and 1428 DBE) in 2043 patients and identified 2248 sources of bleeding, 1467 of which were from vascular lesions. Of these lesions, 864(58.5%) were diagnosed by VCE, and 613(41.5%) were diagnosed by DBE. The pretest probability for bleeding of vascular origin was 54.34%. The sensitivity of DBE was 84%(95%CI: 0.82-0.86; heterogeneity: 78.00%), and the specificity was92%(95%CI: 0.89-0.94; heterogeneity: 92.0%). For DBE, the positive likelihood ratio was 11.29(95%CI: 4.83-26.40; heterogeneity: 91.6%), and the negative likelihood ratio was 0.20(95%CI: 0.15-0.27; heterogeneity: 67.3%). Performing DBE after CE increased the diagnostic yield of vascular lesion by 7%, from 83% to90%.CONCLUSION The diagnostic accuracy of detecting small bowel bleeding from a vascular source is increased with the use of an isolated video capsule endoscope compared with isolated DBE. However, concomitant use increases the detection rate of the bleeding source.

关键词： Small bowel bleeding Hemorrhage Upper gastrointestinal bleeding Obscure hemorrhage Enteroscopy

Sodium picosulphate or polyethylene glycol before elective colonoscopy in outpatients?A systematic review and meta-analysis

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World Journal of Gastrointestinal Endoscopy 2018年第12期10卷 422-441页

作者： Rodrigo Silva de Paula Rocha Igor braga Ribeiro Diogo Turiani Hourneaux de Moura Wanderley Marques bernardo Maurício Kazuyoshi Minata Flávio Hiroshi Ananias Morita Júlio Cesar Martins Aquino Elisa Ryoka Baba Nelson Tomio Miyajima Eduardo Guimaraes Hourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Cliicas da Faculdade de Medicina da Universidade de Sao PauloSao Paulo 05403-010Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States

AIM To determine the best option for bowel preparation [sodium picosulphate or polyethylene glycol(PEG)] for elective colonoscopy in adult *** A systematic review of the literature following the PRISMA guidelines was performed using Medline, Scopus, EMBASE, Central, Cinahl and Lilacs. No restrictions were placed for country, year of publication or language. The last search in the literature was performed on November 20th, 2017. Only randomized clinical trials with full texts published were included. The subjects included were adult outpatients who underwent bowel cleansing for elective colonoscopy. The included studies compared sodium picosulphate with magnesium citrate(SPMC)and PEG for bowel preparation. Exclusion criteria were the inclusion of inpatients or groups with specific conditions, failure to mention patient status(outpatient or inpatient) or dietary restrictions, and permission to have unrestricted diet on the day prior to the exam. Primary outcomes were bowel cleaning success and/or tolerability of colon preparation. Secondary outcomes were adverse events, polyp and adenoma detection rates. Data on intention-totreat were extracted by two independent authors and risk of bias assessed through the Jadad scale. Funnel plots, Egger's test, Higgins' test(I2) and sensitivity analyses were used to assess reporting bias and heterogeneity. The meta-analysis was performed by computing risk difference(RD) using MantelHaenszel(MH) method with fixed-effects(FE) and random-effects(RE) *** Manager 5(RevMan 5) version 6.1(The Cochrane Collaboration) was the software chosen to perform the ***662 records were identified but only 16 trials with 6200 subjects were included for the meta-analysis. High heterogeneity among studies was found and sensitivity analysis was needed and performed to interpret data. In the pooled analysis,SPMC was better for bowel cleaning [MH FE, RD 0.03, IC(0.01, 0.05), P = 0.003, I2= 33%, NNT 34], for tole

关键词： Sodium picosulphate Polyethylene glycol Bowel cleaning success Tolerability Colonoscopy Randomized clinical trials Meta-analysis