Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine： 2.Establishment of Guideline Working Group and Management of Conflict of Interests / 中医杂志

This paper summarized the key points and methods in terms of the establishment of the guideline working group and the management of conflict of interests， trying to provide reference for the development of clinical practice guidelines for Chinese patent medicine （CPM）. The establishment of the working group is the first important step for developing CPM guidelines. Considering the characteristics of the clinical practice guidelines for CPM， this study suggests that the three key elements of ‘multidisciplinarity’， ‘clinical relevance’ and ‘geographical representativeness’ should be put focus on when forming the working group. The guideline advisory committee， clinical expert group， evidence systematic evaluation group， secretary group and the external review group should be established. All group members should clarify the conflict of interest， and the process and management method of the conflict of interest should be clearly reported.

Evaluación de guías prácticas y preservación de la glándula submandibular en la disección del cuello

Introducción: Las guías prácticas de atención al cáncer de cabeza y cuello abordan actualmente la preservación funcional de algunos órganos dentro del tratamiento oncoespecífico. Objetivos: Evaluar guías de práctica clínica y cómo abordan la preservación de la glándula submandibular en la disección del cuello. Métodos: Se realizó una investigación cuantitativa, descriptiva y transversal, donde se evaluaron seis guías de atención al cáncer de cabeza y cuello, en cuanto a su calidad metodológica y la preservación de la glándula submandibular en la disección del cuello. Se utilizó el instrumento Appraisal of Guidelines Research and Evaluation y se conformó un equipo compuesto por cuatro evaluadores que dieron su consentimiento y fueron capacitados en su uso. Para el análisis de la información se empleó el Statistical Package for Social Sciences versión 21 y se calculó la puntuación de calidad para cada dominio y el coeficiente de correlación intraclase. Resultados: La mayor puntuación de calidad correspondió a los dominios 1, 4 y 6. La guía con mayor puntuación de calidad fue la de la Sociedad Europea de Oncología Médica, con una media de 94,3 %, mientras que la de la Sociedad China de Oncología Clínica obtuvo el menor valor para un 71,5 %. Tres guías obtuvieron la máxima puntuación de calidad (7) en la evaluación global. La mayor fuerza de concordancia entre los evaluadores correspondió a la guía de la Sociedad Americana de Oncología Clínica (1) y la menor a la del Instituto Nacional de Oncología y Radiobiología (0,93). Conclusiones: Las guías de práctica clínica del cáncer de cabeza y cuello evaluadas presentaron una alta calidad metodológica y la preservación de la glándula submandibular en la disección del cuello no fue abordada en ninguna.

Introduction: Practical guidelines for head and neck cancer care currently address the functional preservation of some organs within oncospecific treatment. Objectives: To evaluate clinical practice guidelines and how they address the preservation of the submandibular gland in neck dissection. Methods: A quantitative, descriptive and cross-sectional research was carried out to evaluate six guidelines for head and neck cancer care, in terms of their methodological quality and the preservation of the submandibular gland in neck dissection. The Appraisal of Guidelines Research and Evaluation instrument was used, a team was composed by four evaluators who gave their consent and were trained to use such instrument. For the analysis of the information, the Statistical Package for Social Sciences version 21 was used and the quality score for each domain and the intraclass correlation coefficient were calculated. Results: The highest quality score corresponded to domains 1, 4 and 6. The guide with the highest quality score was that of the European Society of Medical Oncology reporting an average of 94.3%, while that of the Chinese Society of Clinical Oncology obtained the lowest value (71.5%). Three guidelines had the highest quality score (7) in the global evaluation. The highest strength of agreement between the evaluators corresponded to the guideline of the American Society of Clinical Oncology (1) and the lowest to that of the National Institute of Oncology and Radiobiology (0.93). Conclusions: The head and neck cancer clinical practice guidelines evaluated presented high methodological quality and the preservation of the submandibular gland in neck dissection was not addressed in any of them.

Collaborative effort to catalyze the implementation of the Global Initiative for Childhood Cancer in the Central American subregion / Esfuerzo de colaboración para impulsar la aplicación de la Iniciativa Mundial contra el Cáncer Infantil en la subregión de Centroamérica / Esforço colaborativo para catalisar a implementação da Iniciativa Global para o Câncer Infantil na sub-região da América Central

ABSTRACT In Central America, childhood cancer is one of the leading causes of death. It is also a significant disease burden to health systems, with social and economic implications for families. The World Health Organization (WHO), the Executive Secretary of the Council of Ministers of Health of Central America and the Dominican Republic (SE-COMISCA), the Pan American Health Organization (PAHO), and St Jude Children's Research Hospital are working collaboratively to strengthen the health system's response to childhood cancer in Central America and the Dominican Republic. This collaboration's primary objective is to support the development of national pediatric cancer plans for each country in the subregion and improve overall survival rates and quality of care for children with cancer through a more comprehensive universal health coverage package. This collaborative effort has led to: (i) the development of childhood cancer national action plans; (ii) the launch of awareness and promotion campaigns; (iii) the design of childhood cancer educational material for children and their families; and (iv) a platform for professionals working in childhood cancer to share good practices and successful experiences. The countries of the subregion together with PAHO and St Jude Children's Research Hospital are working to develop standardized evidence-based clinical practice guidelines on childhood cancer for the region. This brief communication reports on this collaborative work.

RESUMEN En Centroamérica, el cáncer infantil es una de las principales causas de muerte. La enfermedad también supone una carga considerable para los sistemas de salud y tiene implicaciones sociales y económicas para las familias. La Organización Mundial de la Salud (OMS), la Secretaría Ejecutiva del Consejo de Ministros de Salud de Centroamérica y República Dominicana (SE-COMISCA), la Organización Panamericana de la Salud (OPS) y el St Jude Children's Research Hospital están trabajando conjuntamente para fortalecer la respuesta de los sistemas de salud frente al cáncer infantil en Centroamérica y República Dominicana. El objetivo principal de esta colaboración es respaldar la elaboración de un plan nacional sobre el cáncer pediátrico para cada país de la subregión y mejorar las tasas de supervivencia global y la calidad de la atención que se presta a la población infantil con cáncer mediante un programa más completo de cobertura universal de salud. Este esfuerzo de colaboración ha dado lugar a: a) la elaboración de planes de acción nacionales sobre el cáncer infantil; b) la puesta en marcha de campañas de concientización y promoción; c) el diseño de materiales educativos sobre el cáncer en la infancia para la población infantil y sus familias; y d) una plataforma para que los profesionales que trabajan en cáncer infantil intercambien buenas prácticas y experiencias exitosas. Los países de la subregión, junto con la OPS y el St Jude Children's Research Hospital, están trabajando en la elaboración para Centroamérica de unas directrices de práctica clínica sobre cáncer infantil que estén estandarizadas y basadas en la evidencia.

RESUMO Na América Central, o câncer infantil é uma das principais causas de morte. O câncer também representa uma carga importante de doença para os sistemas de saúde, com implicações sociais e econômicas para as famílias. A Organização Mundial da Saúde (OMS), a Secretaria Executiva do Conselho de Ministros da Saúde da América Central e da República Dominicana (SE-COMISCA), a Organização Pan-Americana da Saúde (OPAS) e o St Jude Children's Research Hospital estão trabalhando em colaboração para fortalecer a resposta do sistema de saúde ao câncer infantil na América Central e na República Dominicana. O principal objetivo dessa colaboração é apoiar o desenvolvimento de planos nacionais para o câncer pediátrico em cada país da sub-região e melhorar as taxas gerais de sobrevida e a qualidade do atendimento a crianças com câncer por meio de um pacote mais abrangente de cobertura universal de saúde. Os resultados desse esforço colaborativo foram: a) desenvolvimento de planos de ação nacionais para o câncer infantil; b) lançamento de campanhas de conscientização e promoção; c) criação de material educativo sobre o câncer infantil para as crianças e suas famílias; e d) uma plataforma para que os profissionais que trabalham com câncer infantil compartilhem boas práticas e experiências bem-sucedidas. Os países da sub-região, juntamente com a OPAS e o St Jude Children's Research Hospital, estão trabalhando para desenvolver diretrizes regionais de prática clínica para o câncer infantil padronizadas e baseadas em evidências.

Current situation and reflections on art therapy guidelines / 中华行为医学与脑科学杂志

Art therapy plays an important role in enhancing the emotional expression of patients, treating mental and psychological diseases, and promoting the recovery of cancer patients.Due to its extensive meaning and various intervention measures, strengthening the guidance and monitoring of art therapy are important in improving the medical quality of related fields.Clinical practice guidelines are important tools to guide and standardize medical behavior, and also are important guarantees for the implementation effect of medical behavior.Therefore, this article will summarize the current situation of art therapy guidelines, and on this basis, reflect on the formulation and implementation of relevant guidelines and recommendations.

Evidence-based guideline for neonatal pain management in China (2023) / 中国当代儿科杂志

Pain disrupts neonatal vital signs and internal environment homeostasis and affects the recovery process, and recurrent pain stimulation is one of the important risk factors for neurodevelopmental disorders and some chronic diseases. In order to standardize pain management practice in neonatal wards in China and effectively prevent and reduce the adverse effects of pain on the physical and mental development of neonates, National Clinical Research Center for Child Health and Diseases (Children's Hospital of Chongqing Medical University) convened a multidisciplinary panel to formulate the evidence-based guideline for neonatal pain management in China (2023 edition) following the principles and methods for the guideline development issued by the World Health Organization. Based on the best evidence and expert consensus, this guideline gives 26 recommendations for nine clinical issues, i.e., the classification and definition of neonatal pain, common sources of pain, pain assessment principles, pain assessment methods, analgesic principle, non-pharmaceutical analgesic methods, pharmaceutical analgesic methods, parental participation in pain management, and recording methods for pain management, so as to provide medical staff with guidance and a decision-making basis for neonatal pain assessment and analgesia management.

Improving acupuncture research: progress, guidance, and future directions / 中国针灸

This paper makes an interpretation of the collection Acupuncture: how to improve the evidence base published by BMJ & BMJ Open. Studies show that the quality of randomized controlled trial (RCT) of acupuncture is low, and multivariable Meta-regression analysis fails to confirm most factors commonly believed to influence the effect of acupuncture. The methodological challenges in design and conduct of RCT in acupuncture were analyzed, and a consensus on how to design high-quality acupuncture RCT was developed. The number of acupuncture systematic reviews was huge but the evidence was underused in clinical practice and health policy, and a large number of western clinical practice guidelines recommended acupuncture therapy, but the usefulness of recommendations needed to be improved. In view of the problems in clinical research on acupuncture mentioned in this collection, combined with the analysis of the purpose of clinical research on acupuncture, perspectives, study types, as well as the relationship between evidence and clinical decision-making, a five-stage study paradigm of clinical research on acupuncture is proposed.

Brazilian society of rheumatology methodological guide for the development of evidence-based clinical guidelines in rheumatology

Abstract Clinical practice guidelines (CPG) are developed to align standards of health care around the world, aiming to reduce the incidence of misconducts and enabling more effective use of health resources. Considering the complexity, cost, and time involved in formulating CPG, strategies should be used to facilitate and guide authors through each step of this process. The main objective of this document is to present a methodological guide prepared by the Epidemiology Committee of the Brazilian Society of Rheumatology for the elaboration of CPG in rheumatology. Through an extensive review of the literature, this study compiles the main practical recommendations regarding the following steps of CPG drafting: distribution of working groups, development of the research question, search, identification and selection of relevant studies, evidence synthesis and quality assessment of the body of evidence, the Delphi methodology for consensus achievement, presentation and dissemination ofthe recommendations, CPG quality assessment and updating. This methodological guide serves as an important tool for rheumatologists to develop reliable and high-quality CPG, standardizing clinical practices worldwide.

Obesidad en adultos: guía de práctica clínica adaptada para Chile / Obesity in adults: Clinical practice guideline adapted for Chile

Introducción La Sociedad Chilena de Cirugía Bariátrica y Metabólica, junto a otras sociedades científicas, lideró el proceso de adaptación de la guía de práctica clínica de obesidad en adultos para Chile, tomando como base las directrices desarrolladas para Canadá. La guía canadiense buscó, entre sus principales objetivos, proponer cambios en el enfoque del manejo de la obesidad como una enfermedad crónica y para mejorar los desenlaces de salud centrados en los pacientes, en lugar de enfocarse en la pérdida de peso como principal y único objetivo. Métodos Se convocó a un grupo de 58 profesionales para el desarrollo del proyecto, quienes revisaron y utilizaron el método para el análisis de las recomendaciones originales y desarrollo de recomendaciones . Para la elaboración de nuevas recomendaciones, se llevó a cabo una búsqueda de revisiones sistemáticas en la base de datos Epistemonikos, y se utilizó metodología GRADE y el marco para la evaluación de la evidencia y la descripción de la recomendación. Resultados Se adoptaron 76 de las 80 recomendaciones de la guía canadiense, se adaptó una recomendación y se desarrollaron 12 preguntas nuevas con sus respectivas recomendaciones. Conclusiones El proceso de adaptación permitió acortar el tiempo necesario para elaborar una guía de práctica clínica en obesidad del adulto para nuestro país. El cambio en el enfoque hacia una aproximación sin estigma y centrada en la salud y no en el peso, es universal y posible de aplicar en diferentes países y contextos.

Introduction The Chilean Society of Bariatric and Metabolic Surgery, together with other scientific societies, led a process for adapting the Canadian clinical practice guideline for obesity in adults for Chile. The aim of the Canadian guideline, among its main objectives, was to propose changes in obesity management using a chronic disease framework and focusing on improving patient-centered health outcomes, rather than focusing on weight loss alone. Methods A group of 58 healthcare professionals applied the GRADE-Adolopment method to analyze and adapt the original recommendations and to create de novo recommendations. New recommendations were developed through a systematic review of the evidence using the Epistemonikos database and based on the GRADE-Evidence to Decision (EtD) framework. Results Seventy-six (76) of the 80 original recommendations were adopted, one recommendation was adapted, and 12 new recommendations were created. Conclusions The adaptation process reduced the time needed to develop a Chilean clinical practice guideline for the management of obesity in adults. The change in obesity management approaches towards non-stigmatizing and patient-centered strategies focused on improving health outcomes and not solely on weight reduction is universal and it is possible to apply this approach in different countries and contexts.

Recommendations for the development of Clinical Practice Guidelines / Recomendações para o desenvolvimento de Diretrizes de Prática Clínica

Clinical practice guidelines are statements that include recommendations intended to optimize patient care, are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options, and ensure that the best available clinical knowledge is used to provide effective and quality care. They can reduce inappropriate care and variability in clinical practice and can support the translation of new research knowledge into clinical practice. Recommendations from clinical practice guidelines can support health professionals by facilitating the decision-making process, empowering them to make more informed health care choices, clarifying which interventions should be priorities based on a favorable tradeoff, and discouraging the use of those that have proven ineffective, dangerous, or wasteful. This review aims to summarize the key components of high-quality and trustworthy guidelines. Articles were retrieved from various libraries, databases, and search engines using free-text term searches adapted for different databases, and selected according to author discretion. Clinical practice guidelines in geriatrics can have a major impact on prevention, diagnosis, treatment, rehabilitation, health care, and the management of diseases and conditions, but they should only be implemented when they have high-quality, rigorous, and unbiased methodologies that consider older adult priorities and provide valid recommendations.

As diretrizes de prática clínica são declarações que incluem recomendações destinadas a otimizar o atendimento ao paciente, informadas por uma revisão sistemática de evidências e uma avaliação dos benefícios e malefícios de opções alternativas de atendimento, garantindo que o melhor conhecimento clínico disponível seja usado para fornecer atendimento eficaz e de qualidade. Elas contribuem reduzindo os cuidados inadequados e a variabilidade na prática clínica e podem apoiar a tradução de novos conhecimentos de pesquisa. As recomendações dessas diretrizes podem apoiar os profissionais de saúde, facilitando o processo de tomada de decisão, capacitando-os a fazer escolhas de cuidados de saúde mais informadas, esclarecendo quais intervenções devem ser prioritárias com base em um trade-off favorável e desencorajando o uso daquelas comprovadamente ineficazes, perigosas ou que consistam em desperdício. Esta revisão visa resumir os principais componentes de diretrizes confiáveis e de alta qualidade. Os artigos foram recuperados de várias bibliotecas, bancos de dados e mecanismos de busca por meio de buscas de termos de texto livre adaptados para diferentes bancos de dados e selecionados de acordo com o critério do autor. As diretrizes de prática clínica em geriatria podem ter grande impacto na prevenção, diagnóstico, tratamento, reabilitação, assistência à saúde e manejo de doenças e condições, mas só devem ser implementadas quando tiverem metodologias de alta qualidade, rigorosas e imparciais, que considerem as prioridades da pessoa idosa e forneçam recomendações válidas.

Quality evaluation of clinical practice guidelines in medical imaging using reporting items for practice guidelines in healthcare / 中华放射学杂志

Objective:To evaluate the reporting quality of clinical practice guidelines in medical imaging.Methods:Medical imaging guidelines were searched in CNKI, Wanfang data, CBM, Web of Science, PubMed, and other guideline-related websites. The search period is from January 1, 2017 to February 26, 2022. According to the reporting items for practice guidelines in healthcare (RIGHT) checklist, two researchers separately extracted information from the included guidelines and evaluated the reporting quality, and cross-checked them.Results:Eighteen guidelines in Chinese were included. The average reporting rate was (56.2±14.3) %. The reporting rate of basic information in Domain 1 (75.9%, 82/108) and other information in Domain 7 (68.5%, 37/54) were the highest, while funding and declaration and management of interests in Domain 6 (25.0%, 18/72) had the lowest reporting rate. The included guidelines had a lower reporting rate in item 2 (executive summary of recommendations, 27.8%, 5/18), item 11a (type of systematic review on which the guideline is based, 5.6%, 1/18), item 14a (patient preferences and values, 22.2%, 4/18), item 15 (evidence to decision processes recommendations, 22.2%, 4/18), and item 16 (external review, 16.7%, 3/18).Conclusions:The overall reporting quality of medical imaging guidelines needs to be improved. It is recommended that future guideline developers master the guideline research and evaluation tools, such as the RIGHT statement, and fully report the details and key information to improve the transparency and comprehensiveness of the guidelines.

Interpretation for Evidence-based Practice Guideline of Medication Therapy of High-dose Methotrexate in China / 中国药房

Evidence-based Practice Guideline of Medication Therapy of High-dose Methotrexate in China was published in the British Journal of Clinical Pharmacology in February 2022. The guideline followed the latest definition of clinical practice guideline and the methodology specification for the guideline development of WHO. The Grading of Recommendations Assessment ， Development，and Evaluation （GRADE）approach was applied to rate the quality of evidence and determine the strength of recommendations. Finally ，this guideline presents 28 recommendations covering the whole process of clinical medication of high-dose methotrexate ，involving evaluation prior to administration （liver and renal function ，pleural effusion and ascites ， comedication，genetic testing ），pre-treatment and routine dosing regimen （pretreatment of hydration and alkalization ，urine alkalization，routine dosing regimen ），therapeutic drug monitoring （necessity，method，timing，target concentration ），leucovorin rescue（rescue timing ，rescue regimen ，rescue dose optimization ），and management of toxicities （liver and kidney function monitoring，supportive treatment ，blood purification treatment ）. This article aims to summarize and interpret the recommendations of this guideline ，so as to promote the better promotion and implementation of this guideline and provide comprehensive technical support and suggestions for whole-course individualized administration of high-dose methotrexate in China.

Diseño y Validación de Contenido de una Guía de Análisis Funcional para Población con Depresión / Design and Validation of Content of a Guide for Functional Analysis for Population with Depression

Resumen El objetivo de esta investigación fue establecer el diseño y la validez de contenido de una Guía de Práctica Clínica (GPC) de análisis funcional (AF) para población con trastorno depresivo mayor (TDM). Se realizó por medio de una metodología cuantitativa de tipo instrumental, implementando la técnica de validación por jueces expertos, con la participación de seis jueces con experiencia en psicología clínica y cuatro en análisis del comportamiento. Resultado de la evaluación de los jueces, se obtuvo un índice de validez de contenido de 0.85, permitiendo establecer la validez de la GPC de análisis funcional para evaluar el TDM. Se concluye que los procedimientos para realizar AF en TDM corresponden con los referentes teórico-prácticos disponibles y con la tradición del enfoque conductual en psicología.

Abstract The objective of this research was to establish the design and content validity of a Clinical Practice Guideline (CPG) for Functional Analysis (FA) for a population with Major Depressive Disorder (MDD). It was carried out by means of an instrumental quantitative methodology, implementing the validation technique by expert judges, with the participation of six judges with experience in clinical psychology and four in behavior analysis. Result of the evaluation of the judges, a Content Validity Index of 0.85 was obtained, allowing to establish the validity of the Functional Analysis CPG to evaluate the TDM. It is concluded that the procedures to perform FA in TDM correspond with the available theoretical-practical references and with the tradition of the behavioral approach in psychology.

Avaliação de guidelines para atenção pós-parto na Atenção Primária: revisão sistemática / Guidelines evaluation for postpartum attention in Primary Care: systematic review

Resumo Introdução O cuidado após o parto, denominado de pós-natal, pós-parto ou puerpério, é um importante período para desenvolvimento de estratégias de atenção à saúde das mulheres para redução da morbimortalidade. Com o aumento de publicações de diretrizes clínicas, há preocupações quanto à qualidade delas. Objetivo Avaliar a qualidade de guidelines sobre a atenção às mulheres no pós-parto na Atenção Primária à Saúde. Método Revisão sistemática de guidelines publicados entre 2008 e 2017, nas bases de dados Lilacs e PubMed, e página da internet do National Guideline Clearinghouse, National Institute for Health and Care Excellence e Google®. A ferramenta Appraisal of Guidelines for Research and Evaluation II foi utilizada para avaliação da qualidade dos guidelines nos domínios: escopo e finalidade; envolvimento das partes interessadas (stakeholders); rigor do desenvolvimento; clareza e apresentação; aplicabilidade; e independência editorial. Resultados Foram analisados dez guidelines que apresentaram escore médio geral de avaliação de 77%, com melhor avaliação para "escopo e finalidade" (92%) e pior para "aplicabilidade" (57%). Conclusão Os guidelines apresentaram boa qualidade geral com necessidade de melhorar sua elaboração no domínio aplicabilidade.

Abstract Background Postpartum care, known as postnatal care, postpartum or puerperium, is an important period for the development of health care strategies for women aiming to reduce morbidity and mortality. With the increase of publications of clinical guidelines, there are concerns about their quality. Objective To evaluate guidelines quality on women postpartum care in Primary Health Care. Method Systematic review of guidelines published between 2008 and 2017, in Lilacs and PubMed databases, and the National Guideline Clearing House, National Institute for Health and Care Excellence and Google®. Appraisal of Guidelines for Research and Evaluation II tool was used to assess the quality of the guidelines as to: scope and purpose; stakeholders involvement; accuracy of development; transparency and presentation; applicability; and editorial independence. Results Ten 10 guidelines that presented a general average score of 77%, with a better evaluation for "scope and purpose" (92%) and worse for "applicability" (57%) were analyzed. Conclusion The guidelines presented good overall quality, however, they need to improve their elaboration regarding applicability.

Manejo De Las Crisis Glucémicas En Pacientes Adultos Con Diabetes Mellitus: Guía De Práctica Clínica Basada En Evidencia, Lima - Perú / Management of glycemic crises in adult patients with diabetes mellitus: Evidence-based Clinical Practice Guideline, Lima - Peru

The manuscript summarizes the process of elaboration of the Clinical Practice Guide (CPG) for the management of glycemic crises in adult patients with diabetes mellitus of the AUNA Clinic Network. A multidisciplinary team of medical assistants and methodologists carried out the development of the CPG and then there was an external review by a specialist in the field. The Elaboration Group of the CPG (GEG) concluded on 10 PICO questions. A systematic search for CPG, systematic reviews and primary studies was carried out to answer these PICO questions. To make recommendations we used the "GRADE-Adolopment" methodology and the guidelines of the national regulations. Ten recommendations were made (nine strong and one weak), 18 points of good clinical practice and two flowcharts for management (one for diagnosis and the other for the treatment of glycemic crises), 04 consensus tables on management and 01 table for surveillance and monitoring. The topics covered by the recommendations for the management of glycemic crises were hyperglycemic crises (glycosylated hemoglobin evaluation; b-hydroxybutyrate evaluation; insulin, potassium, 0.9% sodium chloride, phosphorus, sodium bicarbonate treatments) and hypoglycemic crises (carbohydrate administration, monitoring, educational program to avoid reentry)

El artículo resume el proceso de elaboración de la Guía de Práctica Clínica (GPC) para el manejo de las crisis glucémicas en pacientes adultos con diabetes mellitus de la Red de Clínicas AUNA. El proceso de elaboración se llevó a cabo con la participación de un equipo multidisciplinario de médicos asistenciales, metodólogos y un revisor externo (un especialista con dominio en la metodología y el tema). La priorización de preguntas PICO fue realizada por el Grupo Elaborador de la GPC (GEG) luego de lo cual se concluyó en trabajar 10 preguntas PICO. Para dar respuesta a las preguntas se realizó una búsqueda sistemática de GPC, revisiones sistemáticas y estudios primarios. Se utilizó la metodología "GRADE-Adolopment" y los lineamientos de la normativa nacional para la formulación de recomendaciones. Se formularon 10 recomendaciones (nueve fuertes y una débil), 18 puntos de buena práctica clínica, dos flujogramas para el manejo (uno para el diagnóstico y el otro para el tratamiento de crisis glucémicas), cinco (05) tablas resumen sobre el manejo y una (01) tabla para la vigilancia y seguimiento. Los temas que abarcaron las recomendaciones para el manejo de las crisis glucémicas fueron: crisis hiperglucémicas (evaluación de hemoglobina glucosilada; evaluación de b-hidroxibutirato; tratamiento con insulina, potasio, cloruro de sodio 0.9%, fósforo, bicarbonato de sodio) y crisis hipoglucémicas (administración de carbohidratos, monitoreo, programa educativo para evitar el reingreso).

Guía de Práctica Clínica para el manejo de pacientes con Leucemia Linfoblástica Aguda en el Seguro Social del Perú (EsSalud) / Clinical practice guideline for the management of patients with acute lymphoblastic leukemia in Peruvian Social Security (EsSalud)

RESUMEN El presente artículo resume recomendaciones clínicas basadas en evidencia para la evaluación y el manejo de pacientes con Leucemia Linfoblástica Aguda (LLA) en EsSalud. Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 8 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en PubMed y CENTRAL durante el 2019. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de evaluación y manejo. La presente GPC abordó 8 preguntas clínicas, divididas en cuatro temas: diagnóstico, medidas generales, manejo quimioterápico de LLA, y trasplante. En base a dichas preguntas se formuló 5 recomendaciones (3 recomendaciones fuertes y 2 recomendaciones condicionales), 20 puntos de buena práctica clínica, y 3 flujogramas.

ABSTRACT This paper summarizes the evidence-based clinical recommendations for the assessment and management of patients with acute lymphoblastic leukemia (ALL) in Peruvian Social Security (EsSalud). A guide writing team (GWT) was convened, which included specialized physicians and methodologists. The GWT asked 8 clinical questions to be responded by the Clinical Practice Guidelines (CPG). Detailed searches of systematic reviews and - when it was considered as pertinent - primary studied featured in PubMed and CENTRAL during 2019 were performed. Evidence for responding each of the proposed clinical questions was selected. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In scheduled workshops, the GWT used the GRADE methodology for reviewing the evidence and propose recommendations, the points for good clinical practice, and the assessment and management flowcharts. This CPG worked on 8 clinical questions, which were divided in 4 topics: diagnosis, general measures, chemotherapy management for ALL, and transplantation. On the basis of these questions, 5 recommendations were formulated (3 strong recommendations and 2 conditional recommendations), 20 points for good clinical practice, and 3 flow charts.

Manejo de las crisis glucémicas en pacientes adultos con diabetes mellitus: Guía de práctica clínica basada en evidencias

Introducción: El artículo resume el proceso de elaboración de la Guía de Práctica Clínica (GPC) para el manejo de las crisis glucémicas en pacientes adultos con diabetes mellitus de la Red de Clínicas AUNA. Métodos: Las preguntas PICO fueron priorizadas por el Grupo Elaborador de la GPC (GEG) luego de lo cual se concluyó en trabajar 10 preguntas PICO. Para dar respuesta a las preguntas se realizó una búsqueda sistemática de GPC, revisiones sistemáticas y estudios primarios. Se utilizó la metodología "GRADE-Adolopment" y los lineamientos de la normativa nacional para la formulación de recomendaciones. Resultados: Se formularon 10 recomendaciones (nueve fuertes y una débil), 18 puntos de buena práctica clínica, dos flujogramas para el manejo (uno para el diagnóstico y el otro para el tratamiento de crisis glucémicas), 5 tablas resumen sobre el manejo y 1 tabla para la vigilancia y seguimiento. Los temas que abarcaron las recomendaciones para el manejo de las crisis glucémicas fueron: crisis hiperglucémicas (evaluación de hemoglobina glucosilada; evaluación de b-hidroxibutirato; tratamiento con insulina, potasio, cloruro de sodio 0.9%, fósforo y bicarbonato de sodio) y crisis hipoglucémicas (administración de carbohidratos, monitoreo y programa educativo para evitar el reingreso). Conclusión: El presente artículo resume la metodología y las recomendaciones basadas en evidencia de la GPC para el manejo de la crisis glucémica en pacientes con diabetes mellitus de la Red de Clínicas AUNA.

Introduction: The manuscript summarizes the process of elaboration of the Clinical Practice Guide (CPG) for the management of glycemic crises in adult patients with diabetes mellitus of the AUNA Clinic Network. A multidisciplinary team of medical assistants and methodologists carried out the development of the CPG and then there was an external review by a specialist in the field. Methods: The Elaboration Group of the CPG (GEG) concluded on 10 PICO questions. A systematic search for CPG, systematic reviews and primary studies was carried out to answer these PICO questions. To make recommendations we used the "GRADE-Adolopment" methodology and the guidelines of the national regulations. Results: Ten recommendations were made (nine strong and one weak), 18 points of good clinical practice and two flowcharts for management (one for diagnosis and the other for the treatment of glycemic crises), 04 consensus tables on management and 01 table for surveillance and monitoring. The topics covered by the recommendations for the management of glycemic crises were hyperglycemic crises (glycosylated hemoglobin evaluation; b-hydroxybutyrate evaluation; insulin, potassium, 0.9% sodium chloride, phosphorus, sodium bicarbonate treatments) and hypoglycemic crises (carbohydrate administration, monitoring, educational program to avoid reentry). Conclusion: This article summarizes the methodology and evidence-based recommendations of the CPG for the management of glycemic crisis in patients with diabetes mellitus in AUNA.

Rondas interprofesionales de heridas antes y después de Best Practice Spotlight Organization (BPSO) / Interprofessional wound rounds before and after becoming a Best Practice Spotlight Organization (BPSO) / Rondas interprofissionais de feridas antes e depois da Organização de Best Practice Spotlight Organization (BPSO)

Introducción. El modelo de cuidado a pacientes en el Salvation Army Toronto Grace Health Centre Hospital está basado en los principios de cuidado centrado en el paciente y la familia como parte integral del equipo interprofesional. Dentro de este marco se diseñan y se implementan diferentes programas para que se mejore constantemente y se mantenga un buen nivel de cuidados y calidad de vida de los pacientes, dentro de las limitaciones que conlleva el estar hospitalizado, esto después de convertirse en Best Practice Spotlight. Objetivo. Presentar la experiencia de las rondas interprofesionales de heridas antes y después de Best Practice Spotlight.Síntesis. Antes de ser BPSO los documentos de pólizas y procedimientos que guiaban las prácticas alrededor de úlceras o heridas por presión, en el hospital se utilizaban como referencia las guías basadas en las evidencias de la Asociación de Enfermeras de Ontario (RNAO). Sin embargo, no estaba formalizada la ejecución o aplicación de estas prácticas al punto de cuidado directo al paciente. En este artículo se presenta la transición y los aspectos relevantes para que sea una realidad el cuidado centrado en el paciente y la familia como parte del equipo interprofesional en el componente de las rondas interprofesionales de heridas. Conclusiones. El éxito de la implementación efectiva de las guías ha sido el programa BPSO, que se ha convertido en una identidad colectiva de organizaciones que trabajan en pro de los mejores resultados en las organizaciones de salud en instituciones nacionales e internacionales

Introduction. The patient care model at the Salvation Army Toronto Grace Health Centre Hospital is based on principles of patient- and family-centered care provided by the interprofessional team. In this framework, different programs are designed and implemented to constantly improve and keep a good level of care and quality of life of the patients, within the limitations involved in hospitalization, once they have become a Best Practice Spotlight Objective. Present the experience of the interprofessional wound rounds before and after being recognized as a Best Practice Spotlight.Summary. Before becoming a BPSO, the policy and procedure documents guiding the hospital's practices on ulcers or pressure wounds used as reference the evidence-based guidelines of the Registered Nurses' Association of Ontario (RNAO). However, the implementation or application of these practices had not been formalized directly at the point of patient care. This article presents the transition and the relevant aspects for making patient- and family-centered care a reality for the interprofessional team in the component of interprofessional wound rounds. Conclusions. The success in the effective implementation of the guidelines of the BPSO program has become a collective identity for the organizations that work towards the best results in healthcare organizations in national and international institutions.

Introdução. O modelo de cuidados ao paciente no Salvation Army Toronto Grace Health Centre Hospital é baseado nos princípios de cuidados centrado no paciente e na família como parte integrante da equipe interprofissional. Dentro deste quadro, diferentes programas são concebidos e implementados para melhorar constantemente e manter um bom nível de cuidados e qualidade de vida para os pacientes, dentro das limitações de estarem hospitalizados, isto após se tornar um Best Practice Spotlight. Objetivo. Apresentar a experiência de rondas interprofissionais de feridas antes e depois do Best Practice Spotlight.Síntese. Antes de ser BPSO, a política e os documentos de procedimento que orientavam as práticas em relação às úlceras ou feridas de pressão, o hospital usava as diretrizes baseadas em evidências da Associação de Enfermeiros de Ontário (RNAO) como referência. No entanto, a execução ou aplicação dessas práticas até o atendimento direto ao paciente não estava formalizada. Este artigo apresenta a transição e aspectos relevantes para tornar uma realidade os cuidados centrados no paciente e na família como parte da equipe interprofissional no componente de rondas interprofissionais de feridas. Conclusões. O sucesso da implementação efetiva das diretrizes tem sido o programa BPSO, que se tornou uma identidade coletiva de organizações que trabalham em prol dos melhores resultados nas organizações de saúde em instituições nacionais e internacionais.

Status Quo and Analysis of the Cardiovascular Clinical Practice Guidelines/Expert Consensuses of Chinese and Integrative Medicine: A Systematic Review / 中国结合医学杂志

OBJECTIVE@#To describe and analyze the status quo of cardiovascular clinical practice guidelines or expert consensuses including both Chinese medicine (CM) and integrative medicine, through systematic literatures searching and quality assessment.@*METHODS@#Data bases including Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, Wanfang Data, China Science and Technology Journal Database were searched for published CM or integrative cardiovascular clinical practice guidelines or expert consensuses. The website www. medlive.cn was also retrieved as supplementary. The clinical practice evaluation tool AGREE II was used to assess the quality of included guidelines or consensuses.@*RESULTS@#A total of 31 relevant clinical practice guidelines or expert consensuses were included, covering diagnosis, treatment, Chinese patent and patient fields. Common cardiovascular diseases like coronary heart diseases, heart failure and arrhythmia were also involved. Through analysis it was found that both the quantity and quality of included guidelines have been improved year by year. A total of 4 evidence-based clinical practice guideline has been found, one of which was a guideline project plan. Except that, the remaining 27 reports were all consensus-based guidelines. The scores of each field, from highest to lowest, were clarity of presentation (58%), scope and purpose (54%), stakeholder involvement (28%), rigor of development (21%), applicability (13%) and editorial independence (8%).@*CONCLUSIONS@#Although clinical practice guidelines in cardiovascular domain of Chinese have gained increasing concern, with both quantity and quality improved, there is still huge gap in methodology and reporting standards between CM guidelines and international ones. On the one hand, it is essential to improve and standardize the methodology of developing CM guidelines. On the other hands, the evaluation system of evidence and recommendation with CM characters should be developed urgently.

Exploration of Stratified Evidence Scoring Method of Acupuncture Clinical Practice Guidelines / 中国结合医学杂志

Due to its own internal laws of development, Chinese medicine (CM) seems more inclined to empirical medicine in a relatively long historical period. It is considered to be lacking objective and unified clinical practice guidelines (CPGs), and the difficulties in diagnosis and therapeutic effect evaluation comes with it, have restricted its further inheritance, development and international communication. Over the years, our research group has been committed to improving the standardization theory and methodology of CM, also perfecting relative techniques for further application, which are all based on the stratified evidence scoring method. We have already applied this method to 45 issued guidelines, including 5 national guidelines, 3 industrial guidelines, and 37 formulation/revision social organization guidelines. The stratified evidence scoring method has been recognized and used widely. It helps scholars and applicators to study, formulate, publish and popularize the acupuncture therapy clinical practice guidelines better, thus further promotes the development of acupuncture therapy.

Reflections on development of American College of Obstetricians and Gynecologists clinical practice guidelines and clinical consensus methodology for development of Chinese guidelines in obstetrics and gynecology / 中华围产医学杂志

This article introduces two methodological articles published by the American College of Obstetricians and Gynecologists in September 2021 on their development of clinical practice guidelines and clinical expert consensus, focusing on the composition of the guidelines committee, declaration and management of conflicts of interest, and the detailed development process. On this basis, reflections and suggestions for the development of guidelines and consensus in obstetrics and gynecology in China are presented from the perspective of developing a handbook for standardized guideline development, registration and reporting of guidelines, use of available evidence, management of conflicts of interest, and regular evaluations of relevant published guidelines.