Sistema GRADE: metodología para la realización de recomendaciones para la práctica clínica.

Sanabria AJ, et al. Sistema GRADE: metodología para la realización de recomendaciones para la práctica clínica. Aten Primaria. 2014. http://dx.doi.org/10.1016/j.aprim.2013.12.013

Las guías de práctica clínica proporcionan recomendaciones sobre los beneficios y desventajas de diferentes intervenciones disponibles en la asistencia sanitaria. Su adecuado desarrollo e implementación permitirían reducir la variabilidad en la práctica clínica, así como mejorar su calidad y su seguridad. El sistema GRADE es una herramienta que permite evaluar la calidad de la evidencia y graduar la fuerza de las recomendaciones en el contexto de desarrollo de guías de práctica clínica, revisiones sistemáticas o evaluación de tecnologías sanitarias. El objetivo de este artículo es describir las principales características del sistema GRADE a través de ejemplos relevantes en el contexto de la atención primaria.

Clinical guidelines for postpartum women and infants in primary care: a systematic review.

BMC Pregnancy Childbirth. 2014 Jan 29;14:51.doi: 10.1186/1471-2393-14-51.

Haran C, van Driel M, Mitchell BL, Brodribb WE(1).

BACKGROUND: While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care.

METHODS: PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument.

RESULTS: Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest.

CONCLUSIONS: Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines.

Autism. Recognition, referral and diagnosis of children and young people on the autism spectrum.

National Institute for Health and Clinical Excellence (NICE). Autism. Recognition, referral and diagnosis of children and young people on the autism spectrum. London (UK): National Institute for Health and Clinical Excellence (NICE); 2011 Sep. 51 p. (Clinical guideline; no. 128). This guideline covers the recognition, referral and diagnosis of autism in children and young people from birth up to 19 years. 'The term autism describes qualitative differences and impairments in reciprocal social interaction and social communication, combined with restricted interests and rigid and repetitive behaviours. Autism spectrum disorders are diagnosed in children, young people and adults if these behaviours meet the criteria defined in the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders DSM-IV Fourth Edition (DSM-IV) and have a significant impact on function. The over-arching category term used in ICD-10 and DSM-IV is pervasive developmental disorder (PDD), a term now used synonymously with autism spectrum disorder (excluding Rett's syndrome); it is a behaviourally defined group of disorders, which is heterogeneous in both cause and manifestation. The guideline development group recognised that individuals and groups prefer a variety of terms, including autism spectrum disorder, autistic spectrum condition, autistic spectrum difference and neuro-diversity. For clarity and consistency, in this guideline the term 'autism' is used throughout, in keeping with the use of 'autism' in recent Department of Health[1], National Audit Office and Public Accounts Committee documents. However in this guideline 'autism' refers to 'autism spectrum disorders'.

Using decision analysis to better evaluate pediatric clinical guidelines.

Health Aff (Millwood). 2008 Sep-Oct;27(5):1467-75.

Cohen JT, Neumann PJ.Tufts

Although systematic and explicit, existing evidentiary criteria for clinicalguidelines tend to use study design as a surrogate for evidence quality.Moreover, they do not independently characterize evidence quality and netbenefits and do not systematically evaluate research needs. Decision analysis,which quantifies the range of potential net benefits based on whatever evidenceis available, can augment traditional frameworks. It is particularly useful forpediatric research, where randomized controlled trials are often unavailable and infeasible. Policymakers should incorporate decision analysis into comparativeeffectiveness research and clinical guidelines.

El artículo aún no es accesible a texto completo on-line (es un precoz PubMed - in process), pero el resumen promete.

Prevención en salud bucodental en la infancia

En esta semana de mayo se ha incorporado a la Web de NGC la guía “Clinical guideline on periodicity of examination, preventive dental services, anticipatory guidance, and oral treatment for infants, children, and adolescents" cuya fuente es:

American Academy of Pediatric Dentistry. Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Chicago (IL): American Academy of Pediatric Dentistry; 2007.

ICSI.Guía de actividades preventivas para niños y adolescentes

El Institute for Clinical Systems Improvement (ICSI) editó en Octubre del 2007 la nueva guia de salud para niños y adolescentes,13ª edición.
Como siempre lo hace basada en las mejores pruebas científicas, ordena las actividades según niveles de evidencia, las distribuye por grupos de edad.
Recomendable para ver el estado de las intervenciones y recomendaciones que se realizan en nuestro modelo de atención primaria en el área de la prevención y comparar con lo hallado en la bibliografía actual.
Se puede descargar todo el documento en formato PDF en: http://www.icsi.org/home/preventive_services_for_children_and_adolescents_762.html

Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary].

CMAJ. 2007 Apr 10;176(8):S1-13.2006

Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E;

Obesity CanadaClinical Practice Guidelines Expert Panel. Department of Medicine, Julia McFarlane Diabetes Research Centre, Diabetes andEndocrine Research Group, University of Calgary, Calgary, Alta.dcwlau@ucalgary.ca

We have attempted to use a rigorous, evidence-based approach to the development of the practice recommendations, while also acknowledging the breadth of topics to be assessed and the inherent limitations of the obesity literature on these topics.
In addition to making recommendations for treatment interventions, the most common application of clinical practice guidelines, we have also provided recommendations on interventions related to screening and prevention at the individual and population levels.
The recommendations are based on a prespecified process that was overseen by the Steering Committee. Specific chapters of the guidelines were delegated to a group of content experts within the Expert Panel, who performed a systematic literature review and were responsible for drafting the recommendations for each chapter. Recommendations were appraised by an independent Evidence-based Review Committee, members of which assessed whether the assigned level of evidence reflected the strength of the existing literature. The interactive process by which the recommendations were developed, reviewed and revised included 4 joint meetings of the Steering Committee and Expert Panel. The final draft of the guidelines was reviewed by the Steering Committee and by external stakeholders and experts, who included representatives from academia, industry and government and non government officials.

American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors.

Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris DG, Goldie SJ, HarperDM, Kinney W, Moscicki AB, Noller KL, Wheeler CM, Ades T, Andrews KS, DoroshenkMK, Kahn KG, Schmidt C, Shafey O, Smith RA, Partridge EE, Garcia F.

University of Arizona National Center of Excellence in Women's Health and theArizona Hispanic Center of Excellence, Tucson, AZ.

The American Cancer Society (ACS) has developed guidelines for the use of the prophylactic human papillomavirus (HPV) vaccine for the prevention of cervical intraepithelial neoplasia and cervical cancer. These recommendations are basedon a formal review of the available evidence. They address the use of prophylactic HPV vaccines, including who should be vaccinated and at what age, as well as a summary of policy and implementation issues. Implications for screening are also discussed.