Considering a cost-effectiveness threshold of 1 unit of gross domestic product per capita (∼$19 000), CR is highly cost-effective for the public health system in Chile.
Introduction
Adult and pediatric patients admitted to intensive care units (ICUs) requiring invasive ventilatory support, sedation, and muscle blockade may present neuromusculoskeletal deterioration. Different physical rehabilitation interventions have been studied to evaluate their effectiveness in improving critically ill patients’ outcomes. Given that many published systematic reviews (SRs) aims to determine the effectiveness of different types of physical rehabilitation interventions, it is necessary to group them systematically and assess the methodological quality of SRs to help clinicians make better evidence-based decisions. This overview of SRs (OoSRs) aims to map the existing evidence and to determine the effectiveness of physical rehabilitation interventions to improve neuromusculoskeletal function and other clinical outcomes in adult and pediatric critically ill patients.
Methods
An OoSRs of randomized and non-randomized clinical trials involving critically ill adult and pediatric patients receiving physical rehabilitation intervention will be conducted. A sensitive search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos, and other search resources will be conducted. Two independent reviewers will conduct study selection, data extraction, and methodological quality assessment. Discrepancies will be resolved by consensus or a third reviewer. The degree of overlap of studies will be calculated using the corrected covered area. The methodological quality of the SRs will be measured using the AMSTAR-2 tool. The GRADE framework will report the certainty of evidence by selecting the "best" SR for each physical rehabilitation intervention and outcome.
Discussion
The findings of this overview are expected to determine the effectiveness and safety of physical rehabilitation interventions to improve neuromusculoskeletal function in adult and pediatric critically ill patients based on a wide selection of the best available evidence and to determine the knowledge gaps in this topic by mapping and assessing the methodological quality of published SRs.
Registration number
CRD42023389672.
Background The 2019 coronavirus disease outbreak (COVID-19) spread rapidly around the world. The extent and ultimate effect are still unclear, as it is an ongoing and constantly evolving pandemic. Aims To compile the literature and synthesize in Spanish-Latin American language the available international information describing the etiological, pathophysiological, epidemiological and management aspects of COVID-19. Methods Narrative review, using specific sections created in the databases. The criteria for selecting studies depended on the specific area addressed: etiological, pathophysiological, epidemiological aspects, treatment alternatives, etc. References in Spanish and English were included. Results The World Health Organization reports that COVID-19 is a disease of zoonotic origin that was transmitted to a human host. The first cases were identified in late 2019 and January 2020, in Wuhan city, China. It was categorized as highly contagious and transmissible between humans, which is attributed to the structural features of this novel coronavirus. The clinical presentation is variable and nonspecific, as well as its severity. With a clear tropism for the respiratory system, the most severe cases may develop pneumonia, respiratory failure, multiorgan failure and thus death. It occurs in all age groups, with a lower percentage in children under 19 years of age (2.4%). Mortality varies between countries and regions (between 1.5 to 9.3% over the total of reported cases). Associated risk factors are the presence of comorbidities, advanced age, and immunosuppression. Conclusions To date there have been thousands of scientific articles that attempt to explain the onset, progression, possible treatment options and global impact of the disease. There is still no certainty about the level or quality of this evidence. It is essential to generate documents synthesized and translated into Spanish or other languages that can bring this information to all the places and countries that are being impacted by this disease.
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