Cómo interpretar guías de práctica clínica elaboradas con metodología GRADE / Clinical guidelines using the GRADE system (Grading of Recommendations Assessment, Development and Evaluation)

The Ministry of Health of Chile, aiming to improve the quality of clinical practice guidelines, gradually incorporated the GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) to develop evidence based recommendations. This system summarizes and evaluates the certainty of the available evidence. It moves from evidence to decision in a systematic and transparent manner, based on four main dimensions: balance between benefits and harms, certainty of evidence, patient's values and preferences and use of resources. The GRADE system produces strong and conditional recommendations. Strong recommendations provide confidence that the favorable consequences of an intervention clearly outweigh the adverse consequences, or vice versa. These recommendations apply to a broad range of patients and circumstances. Conditional recommendations, however, indicate that there is a close balance between favorable and unfavorable consequences of the intervention, there is uncertainty in the magnitude of benefits or adverse effects, there is uncertainty or variability in values and preferences of individuals or costs are not justified. These recommendations apply to many patients, but not all of them: ideally they should be discussed with each person. To achieve a better implementation of the recommendations made with GRADE methodology, health professionals should know the meaning of strong and conditional recommendations and they should be able to critically assess of them.

Toma de decisiones basada en evidencia: cuándo vale la pena / Evidence-based decision-making: when it is worthwhile

Todos los días, los profesionales de la salud nos vemos enfrentados a decenas de decisiones respecto del cuidado que ofrecemos a nuestros pacientes. Incorporar la evidencia científica en nuestro proceso de decisión no es algo fácil, y la primera habilidad que necesitamos para un resultado exitoso es aprender a reconocer las circunstancias en que la evidencia de estudios científicos puede ser de ayuda.

Every day health professionals have to make dozens of decisions regarding patient care and management. It is not easy to integrate scientific evidence in this process. The primary ability we need in order to achieve successful results is learning how to recognize the circumstances in which evidence arising from results of scientific trials may help.

Inhibidores directos del Factor Xa para la prevención del tromboembolismo en pacientes sometidos a reemplazo total de cadera o de rodilla. Protocolo de una revisión sistemática / Direct Factor Xa inhibitors for the prevention of thromboembolism in patients undergoing total replacement of hip or knee.Protocol of a systematic review

Los reemplazos articulares de cadera y la rodilla se encuentran entre los procedimientos quirúrgicos más comunes en América del Norte y Europa y están aumentando en frecuencia. La enfermedad tromboembólica es la complicación médica más frecuente en este tipo de pacientes. Por esta razón, las guías de práctica clínicas actuales recomiendan la tromboprofilaxis de rutina con heparinas de bajo peso molecular (HBPM), antagonistas de la vitamina K (AVK) o pentasacáridos sintéticos (fondaparinux) después de estos procedimientos. (AU)

Hip and knee joint replacements are among the most common surgical procedures in North America and Europe and are increasing in frequency. Thromboembolic disease is the most common medical complication in this type of patients. For this reason, current clinical practice guidelines recommend routine thromboprophylaxis with low molecular weight heparins (LMWH), vitamin K antagonists (AVK) or synthetic pentasaccharides (fondaparinux) after these procedures(AU)