860 resultados para Practice Guidelines as Topic
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Background Physical activity in children with intellectual disabilities is a neglected area of study, which is most apparent in relation to physical activity measurement research. Although objective measures, specifically accelerometers, are widely used in research involving children with intellectual disabilities, existing research is based on measurement methods and data interpretation techniques generalised from typically developing children. However, due to physiological and biomechanical differences between these populations, questions have been raised in the existing literature on the validity of generalising data interpretation techniques from typically developing children to children with intellectual disabilities. Therefore, there is a need to conduct population-specific measurement research for children with intellectual disabilities and develop valid methods to interpret accelerometer data, which will increase our understanding of physical activity in this population. Methods Study 1: A systematic review was initially conducted to increase the knowledge base on how accelerometers were used within existing physical activity research involving children with intellectual disabilities and to identify important areas for future research. A systematic search strategy was used to identify relevant articles which used accelerometry-based monitors to quantify activity levels in ambulatory children with intellectual disabilities. Based on best practice guidelines, a novel form was developed to extract data based on 17 research components of accelerometer use. Accelerometer use in relation to best practice guidelines was calculated using percentage scores on a study-by-study and component-by-component basis. Study 2: To investigate the effect of data interpretation methods on the estimation of physical activity intensity in children with intellectual disabilities, a secondary data analysis was conducted. Nine existing sets of child-specific ActiGraph intensity cut points were applied to accelerometer data collected from 10 children with intellectual disabilities during an activity session. Four one-way repeated measures ANOVAs were used to examine differences in estimated time spent in sedentary, moderate, vigorous, and moderate to vigorous intensity activity. Post-hoc pairwise comparisons with Bonferroni adjustments were additionally used to identify where significant differences occurred. Study 3: The feasibility on a laboratory-based calibration protocol developed for typically developing children was investigated in children with intellectual disabilities. Specifically, the feasibility of activities, measurements, and recruitment was investigated. Five children with intellectual disabilities and five typically developing children participated in 14 treadmill-based and free-living activities. In addition, resting energy expenditure was measured and a treadmill-based graded exercise test was used to assess cardiorespiratory fitness. Breath-by-breath respiratory gas exchange and accelerometry were continually measured during all activities. Feasibility was assessed using observations, activity completion rates, and respiratory data. Study 4: Thirty-six children with intellectual disabilities participated in a semi-structured school-based physical activity session to calibrate accelerometry for the estimation of physical activity intensity. Participants wore a hip-mounted ActiGraph wGT3X+ accelerometer, with direct observation (SOFIT) used as the criterion measure. Receiver operating characteristic curve analyses were conducted to determine the optimal accelerometer cut points for sedentary, moderate, and vigorous intensity physical activity. Study 5: To cross-validate the calibrated cut points and compare classification accuracy with existing cut points developed in typically developing children, a sub-sample of 14 children with intellectual disabilities who participated in the school-based sessions, as described in Study 4, were included in this study. To examine the validity, classification agreement was investigated between the criterion measure of SOFIT and each set of cut points using sensitivity, specificity, total agreement, and Cohens kappa scores. Results Study 1: Ten full text articles were included in this review. The percentage of review criteria met ranged from 12%47%. Various methods of accelerometer use were reported, with most use decisions not based on population-specific research. A lack of measurement research, specifically the calibration/validation of accelerometers for children with intellectual disabilities, is limiting the ability of researchers to make appropriate and valid accelerometer use decisions. Study 2: The choice of cut points had significant and clinically meaningful effects on the estimation of physical activity intensity and sedentary behaviour. For the 71-minute session, estimations for time spent in each intensity between cut points ranged from: sedentary = 9.50 ( 4.97) to 31.90 ( 6.77) minutes; moderate = 8.10 ( 4.07) to 40.40 ( 5.74) minutes; vigorous = 0.00 ( .00) to 17.40 ( 6.54) minutes; and moderate to vigorous = 8.80 ( 4.64) to 46.50 ( 6.02) minutes. Study 3: All typically developing participants and one participant with intellectual disabilities completed the protocol. No participant met the maximal criteria for the graded exercise test or attained a steady state during the resting measurements. Limitations were identified with the usability of respiratory gas exchange equipment and the validity of measurements. The school-based recruitment strategy was not effective, with a participation rate of 6%. Therefore, a laboratory-based calibration protocol was not feasible for children with intellectual disabilities. Study 4: The optimal vertical axis cut points (cpm) were 507 (sedentary), 10082300 (moderate), and 2301 (vigorous). Sensitivity scores ranged from 8188%, specificity 8185%, and AUC .87.94. The optimal vector magnitude cut points (cpm) were 1863 (sedentary), 2610 (moderate) and 4215 (vigorous). Sensitivity scores ranged from 8086%, specificity 7782%, and AUC .86.92. Therefore, the vertical axis cut points provide a higher level of accuracy in comparison to the vector magnitude cut points. Study 5: Substantial to excellent classification agreement was found for the calibrated cut points. The calibrated sedentary cut point ( =.66) provided comparable classification agreement with existing cut points ( =.55.67). However, the existing moderate and vigorous cut points demonstrated low sensitivity (0.3333.33% and 1.3353.00%, respectively) and disproportionately high specificity (75.44.98.12% and 94.61100.00%, respectively), indicating that cut points developed in typically developing children are too high to accurately classify physical activity intensity in children with intellectual disabilities. Conclusions The studies reported in this thesis are the first to calibrate and validate accelerometry for the estimation of physical activity intensity in children with intellectual disabilities. In comparison with typically developing children, children with intellectual disabilities require lower cut points for the classification of moderate and vigorous intensity activity. Therefore, generalising existing cut points to children with intellectual disabilities will underestimate physical activity and introduce systematic measurement error, which could be a contributing factor to the low levels of physical activity reported for children with intellectual disabilities in previous research.
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Introduction: In the last few years a significant number of papers have related the use of proton-pump inhibitors (PPIs) to potential serious adverse effects that have resulted in social unrest. Objective: The goal of this paper was to provide a literature review for the development of an institutional position statement by Sociedad Espaola de Patologa Digestiva (SEPD) regarding the safety of long-term PPI use. Material and methods: A comprehensive review of the literature was performed to draw conclusions based on a critical assessment of the following: a) current PPI indications; b) vitamin B12 deficiency and neurological disorders; c) magnesium deficiency; d) bone fractures; e) enteric infection and pneumonia; f) interactions with thienopyridine derivatives; e) complications in cirrhotic patients. Results: Current PPI indications have remained unchanged for years now, and are well established. A general screening of vitamin B12 levels is not recommended for all patients on a PPI; however, it does seem necessary that magnesium levels be measured at therapy onset, and then monitored in subjects on other drugs that may induce hypomagnesemia. A higher risk for bone fractures is present, even though causality cannot be concluded for this association. The association between PPIs and infection with Clostridium difficile is mild to moderate, and the risk for pneumonia is low. In patients with cardiovascular risk receiving thienopyridines derivatives it is prudent to adequately consider gastrointestinal and cardiovascular risks, given the absence of definitive evidence regardin potential drug-drug interactions; if gastrointestinal risk is found to be moderate or high, effective prevention should be in place with a PPI. PPIs should be cautiously indicated in patients with decompensated cirrhosis. Conclusions: PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.
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Buses are considered a slow, low comfort and low reliability transport system, thus its negative and por image. In the framework of the 3iBS project (2012), several examples of innovative and/or effective solutions regarding the Level of Service (LoS) were analysed aiming to provide operators, practitioners and policy makers with a set of Good Practice Guidelines to strengthen the competitiveness of the bus in the urban environment. The identification of the key indicators regarding vehicles, infrastructure and operation was possible through the analysis of a set of case studies -among which Barcelona (Spain), Cagliari (Italy), London (United Kingdom), Paris and Nantes (France). A cross comparison between the case studies was carried out for contrasting the level of achievement of the different criteria considered. The information provided on Regulatory, Financial and Technical issues allows the identification of a number of specific factors influencing the implementation of a high quality transport scheme, and set the basis for the elaboration of a set of Guidelines for the implementation of an intelligent, innovative and integrated bus system, including the main barriers to be tackled.
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A Interveno psicomotora atua como promotora do desenvolvimento global do indivduo, a partir do movimento e do ldico. Nas Perturbaes do Espetro do autismo existe algum comprometimento a nvel motor e comportamental, caracterizado pelos interesses repetitivos e estereotipados da comunicao e consequentemente das relaes interpessoais, aspetos que podem ser promovidos atravs de interveno psicomotora. Neste mbito fulcral a criao de uma relao emptica com o indivduo, a qual atua como facilitadora no processo de interveno. Assim, o presente relatrio de estgio descreve o trabalho desenvolvido durante o ano letivo de 2014/2015 com crianas e jovens, com diagnstico de Perturbaes do Espetro do Autismo e outras comorbilidades associadas, pertencentes s trs Unidades de Ensino Estruturado do Agrupamento de Escolas Dr. Azevedo Neves no Concelho da Amadora. O mesmo engloba uma reviso da literatura relativa s Perturbaes do Espetro do Autismo e prtica psicomotora, o enquadramento legal e institucional, uma descrio dos alunos acompanhados, com especial enfoque nos dois estudos de caso, os quais beneficiaram de interveno psicomotora de cariz individual e de grupo, e apresentado o processo de interveno e avaliao de cada individuo, bem como do restante grupo. Aps o processo de interveno foi possvel constatar alguns progressos psicomotores e comportamentais dos indivduos.
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A Ordem dos Enfermeiros (OE) aprovou em Assembleia Geral de 2007 uma proposta de alterao estatutria em termos de regulao e desenvolvimento profissional. Surge assim o Modelo de Desenvolvimento Profissional (MDP) que traz uma nova dimenso certificao de competncias de enfermeiro e enfermeiro especialista. Se at aqui a OE certificava estas competncias a partir dos documentos acadmicos apresentados, a partir desta alterao a certificao passa por uma prtica tutelada de exerccio profissional e s depois de dar a atribuio do ttulo profissional. O Exerccio Profissional Tutelado (EPT) s poder ocorrer em servios de sade com idoneidade formativa acreditada pela OE. Para determinar esta idoneidade formativa dos contextos de prtica clnica de enfermagem, construdo um referencial, que parte do documento Padres de Qualidade dos Cuidados de Enfermagem, tendo como eixo organizador o enunciado descritivo sobre A organizao dos cuidados de enfermagem. Este trabalho reflete o estgio realizado num contexto de prtica clnica (Unidade de Cuidados de Sade Personalizados) onde foi feita uma avaliao em termos de idoneidade formativa. De Abril a Junho de 2011 foi feita observao documental e da prtica de enfermagem, aplicada uma grelha de avaliao de idoneidade formativa e entrevistado o enfermeiro chefe. Os resultados apresentados so de no evidncia de idoneidade formativa, aps o que se tentou estabelecer um Plano de Aco, para cumprimento dos critrios estabelecidos para a certificao. Com base no mesmo enunciado, a organizao dos cuidados de enfermagem, foram delineadas algumas intervenes que, a seu tempo, podero certificar esta unidade para a prtica do exerccio profissional tutelado. Destacamos o necessrio envolvimento de todos os elementos de enfermagem, com uma conduo de liderana forte e motivadora, no sentido criar um contexto de prtica clnica congruente com as orientaes da OE para a certificao e, em simultneo, melhorar a qualidade dos cuidados de enfermagem prestados.
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Les patients atteints de diabte de type 1 (DbT1) semblent sur-traiter leurs hypoglycmies par rapport aux recommandations des Lignes directrices Canadiennes en diabte. Objectifs : 1) Dcrire les habitudes des patients DbT1 pour le traitement des hypoglycmies et estimer les impacts sur le profil de risque cardio-mtabolique et 2) explorer les excursions glycmiques suite un traitement dhypoglycmie qui respecte les recommandations. Mthodologie (analyses secondaires) : Objectif 1 : 121 patients DbT1 ont complt un journal alimentaire et de glycmies de 48 h. Des variables cardio-mtaboliques ont t mesures et un questionnaire sur la peur des hypoglycmies a t complt. Objectif 2 : 57 patients DbT1 ont complt les bras contrles de notre programme sur le pancras artificiel (traitement des hypoglycmies standardis). Les valeurs de glycmie taient disponibles aux 5 minutes. Rsultats : Projet 1 : Les patients ont fait en moyenne 1,45 hypoglycmies/jour et 73% sur-traitaient avec une consommation moyenne de glucides de 32 24 g. Ce sur-traitement est associ avec un plus jeune ge et une peur des hypoglycmies plus importante, mais pas avec un profil de risque cardio-mtabolique plus dfavorable. Projet 2 : Dans 20% des cas, traiter une hypoglycmie avec 15 g de glucides tait efficace pour ramener la glycmie 4,0 mmol/L en 15 minutes, le temps moyen tant de 24 12 minutes. La proportion dinsuline basale, le temps depuis le dernier repas et la pratique dactivit physique sont les lments qui semblent avoir le plus dimpact sur lefficacit du traitement. Conclusion : Lducation entourant le traitement des hypoglycmies a besoin dtre renforce et dautres tudes sont ncessaires afin de valider les recommandations.
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Les patients atteints de diabte de type 1 (DbT1) semblent sur-traiter leurs hypoglycmies par rapport aux recommandations des Lignes directrices Canadiennes en diabte. Objectifs : 1) Dcrire les habitudes des patients DbT1 pour le traitement des hypoglycmies et estimer les impacts sur le profil de risque cardio-mtabolique et 2) explorer les excursions glycmiques suite un traitement dhypoglycmie qui respecte les recommandations. Mthodologie (analyses secondaires) : Objectif 1 : 121 patients DbT1 ont complt un journal alimentaire et de glycmies de 48 h. Des variables cardio-mtaboliques ont t mesures et un questionnaire sur la peur des hypoglycmies a t complt. Objectif 2 : 57 patients DbT1 ont complt les bras contrles de notre programme sur le pancras artificiel (traitement des hypoglycmies standardis). Les valeurs de glycmie taient disponibles aux 5 minutes. Rsultats : Projet 1 : Les patients ont fait en moyenne 1,45 hypoglycmies/jour et 73% sur-traitaient avec une consommation moyenne de glucides de 32 24 g. Ce sur-traitement est associ avec un plus jeune ge et une peur des hypoglycmies plus importante, mais pas avec un profil de risque cardio-mtabolique plus dfavorable. Projet 2 : Dans 20% des cas, traiter une hypoglycmie avec 15 g de glucides tait efficace pour ramener la glycmie 4,0 mmol/L en 15 minutes, le temps moyen tant de 24 12 minutes. La proportion dinsuline basale, le temps depuis le dernier repas et la pratique dactivit physique sont les lments qui semblent avoir le plus dimpact sur lefficacit du traitement. Conclusion : Lducation entourant le traitement des hypoglycmies a besoin dtre renforce et dautres tudes sont ncessaires afin de valider les recommandations.
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Background: Excess weight places a significant burden on health. Clinical practice guidelines advise healthcare professionals to provide weight management interventions to patients with overweight and obesity. Chiropractic practice may provide a unique opportunity to deliver weight management interventions to those with overweight and obesity. However, little has been done to address overweight and obesity within the chiropractic profession. Identifying the extent of this evidence-practice gap in chiropractic practice is the first step in addressing this issue. Objectives: This thesis was to assess the clinical practices of weight loss provided by chiropractors. The primary objectives were to 1) determine the prevalence of overweight and obesity in the adult patient population that sought chiropractic care, 2) describe the frequency and distribution of chiropractor directed weight management intervention, 3) identify associations between chiropractor directed weight management interventions and specific patient-level and chiropractor-level variables, and 4) examine the interaction between patient weight and comorbid conditions and whether chiropractors offered weight management interventions. Methods: Data from the Ontario Chiropractic Observational and Analysis Study was used (N = 42 chiropractors, N = 3523 patient encounters). Multilevel logistic regression was performed. Patient-level as well as chiropractor-level variables were investigated and associations with weight management provided by chiropractors were identified. Results: The majority of patients who sought chiropractic were overweight or obese (61.2%). Weight loss was provided to only 5.4% of patients. Chiropractors who graduated between 1995 and 2005 (OR: 0.02, 95% CI: 0.00 - 0.13) or prior to 1995 (OR: 0.08, 95% CI: 0.01 - 0.42) provided weight management significantly less than chiropractors who graduated between 2005 and 2014. No significant interaction was observed between patient adiposity and comorbid conditions with chiropractors directed weight loss. Conclusion: The majority of patients who seek chiropractic care are overweight and obese. Chiropractors are in a unique position to help improve patient health through offering weight management. However, this opportunity has not been fully realized by the chiropractic profession.
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Background: Excess weight places a significant burden on health. Clinical practice guidelines advise healthcare professionals to provide weight management interventions to patients with overweight and obesity. Chiropractic practice may provide a unique opportunity to deliver weight management interventions to those with overweight and obesity. However, little has been done to address overweight and obesity within the chiropractic profession. Identifying the extent of this evidence-practice gap in chiropractic practice is the first step in addressing this issue. Objectives: This thesis was to assess the clinical practices of weight loss provided by chiropractors. The primary objectives were to 1) determine the prevalence of overweight and obesity in the adult patient population that sought chiropractic care, 2) describe the frequency and distribution of chiropractor directed weight management intervention, 3) identify associations between chiropractor directed weight management interventions and specific patient-level and chiropractor-level variables, and 4) examine the interaction between patient weight and comorbid conditions and whether chiropractors offered weight management interventions. Methods: Data from the Ontario Chiropractic Observational and Analysis Study was used (N = 42 chiropractors, N = 3523 patient encounters). Multilevel logistic regression was performed. Patient-level as well as chiropractor-level variables were investigated and associations with weight management provided by chiropractors were identified. Results: The majority of patients who sought chiropractic were overweight or obese (61.2%). Weight loss was provided to only 5.4% of patients. Chiropractors who graduated between 1995 and 2005 (OR: 0.02, 95% CI: 0.00 - 0.13) or prior to 1995 (OR: 0.08, 95% CI: 0.01 - 0.42) provided weight management significantly less than chiropractors who graduated between 2005 and 2014. No significant interaction was observed between patient adiposity and comorbid conditions with chiropractors directed weight loss. Conclusion: The majority of patients who seek chiropractic care are overweight and obese. Chiropractors are in a unique position to help improve patient health through offering weight management. However, this opportunity has not been fully realized by the chiropractic profession.
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While catch-and-release (C&R) is a well-known practice in several European freshwater recreational fisheries, studies on the magnitude and impact of this practice in Europeanmarine recreational fisheries are limited. To provide an overview of the practice andmagnitude of C&R among marine recreational anglers in Europe, the existing knowledge of C&R and its potential associated release mortality was collected andsummarized. The present study revealed that in several European countries over half of the total recreational catch is released by marine anglers. High release proportions of > 60% were found for Atlantic cod (Gadus morhua), European sea bass (Dicentrarchus labrax), pollack (Pollachius pollachius), and sea trout (Salmo trutta) in at least one of the studied European countries. In the case of the German recreational Baltic Sea cod fishery, release proportions varied considerably between years, presumably tracking a strong year class ofundersized fish. Reasons for release varied between countries and species, and included legal restrictions (e.g. minimumlanding sizes and daily bag limits) and voluntary C&R. Considering the magnitude of C&R practice among European marine recreational anglers, post-release mortalities of released fish may need to be accounted for in estimated fishingmortalities.However, as the survival rates of Europeanmarine species aremostly unknown, there is a need to conduct post-release survival studies and to identify factors affecting post-release survival. Such studies could also assist in developing species-specific, best-practice guidelines to minimize the impacts of C&R on released marine fish in Europe.
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El sndrome antifosfolpido es un desorden autoinmune caracterizado por hipercoagulabilidad que requiere terapia anticoagulante como pilar fundamental, siendo la warfarina el tratamiento de eleccin en los casos que requieren manejo por largos periodos. Sin embargo, los pacientes con anticoagulante lpico positivo representan un reto porque tienen mayor riesgo de presentar eventos trombticos, sumado a que el seguimiento con el International Normalized Ratio (INR) no es confiable, ya que estos anticuerpos generan interferencia con las pruebas de laboratorio basadas en fosfolpidos, como es el caso del tiempo de protrombina (PT) con INR basal prolongado, incluso antes del inicio de la terapia anticoagulante. Por tal razn, se ilustra el caso de una paciente con sndrome antifosfolpido primario y anticoagulante lpico positivo quien ha presentado mltiples episodios trombticos, a pesar de recibir terapia anticoagulante. Adems se hace una revisin de la literatura disponible y se postulan nuevas metas de INR en estos pacientes diferentes de las que se plantean actualmente.
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Introduccin: Entre las diferentes herramientas clnicas para evaluar la presencia de enfermedad coronaria mediante puntajes, la ms usada es la Escala de Riesgo cardiovascular de Framingham. Desde hace unos aos, se cre el puntaje de calcio coronario el cual mide el riesgo cardiovascular segn la presencia de placas ateromatosas vistas por tomografa computarizada. Se evalu la asociacin entre la escala de Framigham y el puntaje de calcio coronario en una poblacin de sujetos sanos asintomticos. Metodologa: Se realiz un estudio transversal para evaluar la asociacin entre el puntaje de calcio coronario y la escala de Framingham en sujetos asintomticos que se practicaron exmen mdico preventivo en la Fundacin Cardioinfantil- Instituto de Cardiologa (FCI-IC) en el periodo comprendido entre 1 de Julio 2011 hasta el 31 de octubre de 2015. Resultados: Se evaluaron 262 pacientes en total. La prevalencia de riesgo cardiovascular fue bajo en un 77.86% de la poblacin, medio en 18.70% y alto en 3.44%, segn la escala de Framingham. El riesgo cardiovascular segn el puntaje de Calcio coronario fue nulo 70.99%, bajo en 21.75%, medio en 4.19%, severo en 3.05%. Se encontr una asociacin entre ambos puntajes para riesgo estadsticamente significativa (p0,00001) Discusin: El riesgo cardiovascular establecido por escala de Framingham se relaciona de forma significativa con la presencia de placas ateriosclerticas. El estudio demostr que en una muestra de sujetos asintomticos, hay una alteracin estructural coronaria temprana.
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Increased risk of bleeding after major orthopedic surgery (MOS) has been widely documented in general population. However, this complication has not been studied in elderly patients. The purpose of this study is to determine whether the risk of major bleeding after MOS is higher in elderly patients, compared with those operated at a younger age. Methods: This retrospective cohort study included total hip and total knee arthroplasty patients operated during 5 consecutive years. The main outcome was the occurrence of major bleeding. Patients with other causes of bleeding were excluded. Relative risks (RRs) and confidence intervals (CIs) were calculated, anda multivariate analysis was performed. Results: A total of 1048 patients were included, 56% of patients were hip arthroplasties. At the time of surgery, 553 (53%) patients were older than 70 years. Patients aged >70 years showed an increased risk of major bleeding (RR: 2.42 [95% CI: 1.54-3.81]). For hip arthroplasty, the RR of bleeding was 2.61 (95%CI: 1.50-4.53) and 2.25 (95% CI: 1.03-4.94) for knee arthroplasty. After multivariate analysis, age was found to be independently associated with higher risk of major bleeding. Conclusion: According to European Medicines Agency criteria, patients aged 70 years are at a higher risk of major bleeding after MOS, result of a higher frequency of blood transfusions in this group of patients. Standardized protocols for blood transfusion in these patients are still required.
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El trasplante heptico es una opcin teraputica para enfermedad heptica avanzada cada vez ms frecuente en Colombia. La sobrevida del 80% a 5 aos conlleva a un aumento del riesgo cardiovascular y de eventos cardiovasculares, por esta razn esta investigacin determina el comportamiento del riesgo cardiovascular en los pacientes con trasplante heptico de la Fundacin Cardioinfantil, realizado en 3 aos de seguimiento . Lo encontrado en esta investigacin es que existe un aumento del riesgo cardiovascular a tres aos en pacientes post trasplante heptico, estadsticamente significativo, principalmente secundario a hipertensin, diabetes e hipertrigliceridemia. El aumento es mayor a lo descrito en la poblacin general, y similar a otros pacientes trasplantados, en un periodo de 5 aos
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Contexto: La eficacia de los cannabinoides en el dolor neuroptico es desconocida. El control del dolor es determinante en los pacientes ya que genera un impacto negativo en la calidad de vida de los pacientes. Objetivo: El presente trabajo pretende demostrar la evidencia sobre la eficacia de los medicamentos cannabinoides en el control del dolor neuroptico oncolgico, mediante la evaluacin de la literatura disponible. Metodologa: Se realiz una revisin sistemtica de literatura incluyendo estudios experimentales, observacionales y revisiones sistemticas en un periodo de 15 aos. Se incluyeron todos los estudios desde el aos 2000 con evidencia IB segn la escala de evidencia de Oxford. Resultados: Cuatro estudios cumplieron criterios para su inclusin, sin embargo la evidencia es baja y no permite recomendar o descartar los cannabinoides como terapia coadyuvante en control del dolor neuroptico oncolgico. La combinacin de THC/CDB (Sativex) parece ser un medicamento seguro pues no se reportaron muertes asociadas a su uso, sin embargo la presentacin de eventos adversos a nivel gastrointestinal y neurolgico podra aumentar el riesgo de interacciones medicamentosas y tener un impacto negativo en la calidad de vida de los pacientes oncolgicos. Conclusiones: No hay suficiente literatura y la evidencia no es suficiente para recomendar o descartar el uso de los cannabinoides en dolor neuroptico oncolgico. Futuros estudios deben realizarse para analizar el beneficio de estos medicamentos. Aunque tica y socialmente hay resistencia para el uso de los cannabinoides, actualmente hay una gran discusin poltica en el mundo y en Colombia para su aceptacin como terapia en el control del dolor.
