Background: Medical schools have used mindfulness meditation as a strategy to assist students in stress management. This study aimed to seek evidence regarding the effectiveness of mindfulness-based training programs in reducing psychological distress and promoting the well-being of medical students. Methods: We conducted a systematic review and meta-analysis. Cochrane Library, Embase, PubMed/MEDLINE, PsycINFO/PsycNet, LILACS/BVS, ERIC (ProQuest), Web of Science, OpenGrey, and Google Scholar were searched for randomized clinical trials published until March 2022, without time or language restrictions. Two authors independently screened the articles, extracted data using a standardized extraction form, and assessed the methodological quality of the included studies using the Cochrane’s Risk of Bias 2 (ROB 2) tool and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Results: Of the 848 articles retrieved, 8 met the inclusion criteria. Mindfulness-based training improved the outcomes: mindfulness (small post-intervention effect: SMD = 0.29; 95% CI: 0.03 to 0.54; p = 0.03; I² = 46%; high evidence quality, and small effect at follow-up: SMD = 0.37; 95% CI: 0.04 to 0.70; p = 0.03; I² = 53%; low evidence quality), psychological well-being/health (there was no statistically significant difference between the groups in the post-intervention effect: SMD = − 0.27; 95% CI: − 0.67 to 0.13; p = 0.18; I² = 76%; moderate evidence quality, and a significant difference at follow-up: SMD = − 0.73; 95% CI: − 1.23 to − 0.23; p = 0.004; I² = 61%; low evidence quality), and stress (small post-intervention effect: SMD = − 0.29; CI of 95%: − 0.56 to − 0.02; p = 0.04; I² = 57%; moderate evidence quality, and moderate effect at follow-up: SMD = − 0.45, 95% CI: − 0.67 to − 0.22, p = 0.0001, I² = 0%, moderate evidence quality). The quality of evidence for the anxiety, depression, and resilience outcomes is low and for the empathy outcome, very low. Conclusion: The results indicate that the students who participated in the mindfulness training perceived improvements in the stress and psychological distress symptoms and improved health perception and psychological well-being. However, the significant heterogeneity among studies should be considered when interpreting these findings. Systematic review registration: PROSPERO CRD42020153169.

Mottling score, a tissue perfusion parameter, is correlated with outcome in septic shock patients. However, its predictive value on mortality according to prognostic covariates such as vasopressor dose and other tissue perfusion parameters remains unknown. Mottling score and tissue perfusion parameters were recorded at ICU admission (H0), H-6, H 12, and H-24 and used to assess the predictive value of mottling score on 14-day mortality in a development cohort. Results were then validated in an independent cohort of septic shock patients in Brazil. Overall, 259 patients with sepsis or septic shock were included, 14-day mortality was 37%. Factors associated with death were mottling score (OR 2.26 [95% CI, 1.72–2.97]), arterial lactate level (OR 1.29 [1.11–1.5]), and urine output < 0.5 ml/Kg/h (OR 3.03 [1.37–6.69]). The C statistic for the model was 0.90 in the development cohort and 0.76 in the validation cohort. The predictive value of mottling score was not affected by vasopressor doses (p for interaction = 0.33): OR for mottling score ranged from 2.34 [1.10–3.15] in patients without vasopressor to 3.84 [1.98–7.43] in patients infused with high doses of vasopressor (> 0.8 μg/kg/min). There was no difference in the effect of mottling score on mortality according to mean arterial pressure, heart rate, cardiac index, and urine output, but we found a significant interaction between arterial lactate level and mottling score (p = 0.04). The predictive value of the mottling score remains significant when using the recent SEPSIS-3 definition of septic shock. Finally, a decrease of mottling score during resuscitation was significantly associated with better outcome after adjustment on SOFA score (p = 0.001). Our results support the high prognostic value of mottling score for 14-day mortality in septic patients, whatever vasopressor dosage and other perfusion parameters. Mottling score variations during resuscitation are also predictive of mortality.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumonia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Resumo Objetivo Identificar as evidências quanto à infecção pelo SARS-CoV-2 e óbitos dos profissionais de saúde e fatores de risco relacionados. Métodos Realizou-se uma revisão sistemática buscando-se artigos nas bases de dados Scopus, Portal Regional da BVS, Pubmed e Embase, relacionados à infecção e óbito de profissionais da saúde envolvidos no tratamento de pacientes com a COVID-19. Não houve restrição quanto a data de publicação, idioma ou tipo de estudo. Para a busca foi considerado publicações até 14 de abril [...] Resumo Objetivo Identificar as evidências quanto à infecção pelo SARS-CoV-2 e óbitos dos profissionais de saúde e fatores de risco relacionados. Métodos Realizou-se uma revisão sistemática buscando-se artigos nas bases de dados Scopus, Portal Regional da BVS, Pubmed e Embase, relacionados à infecção e óbito de profissionais da saúde envolvidos no tratamento de pacientes com a COVID-19. Não houve restrição quanto a data de publicação, idioma ou tipo de estudo. Para a busca foi considerado publicações até 14 de abril

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.