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"textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0050" class="elsevierStylePara elsevierViewall">The Research Unit (RU) of the Spanish Society of Rheumatology (SER) was established in 2003 in order to provide methodological and research support to its members with a structure, level of professionalism and activity unencountered in any other scientific medical society in Spain. One of the most active and in demand areas of research covered by the RU-SER<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> is evidence-based medicine (EBM), where the RU develops clinical practice guidelines (CPG), recommendation documents, guides for patient and, to a lesser extent, other documents such as expert opinion documents (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The objective of the EBM documents produced in the RU-SER is to assist healthcare professionals, patients and other agents involved in making clinical decisions in daily clinical practice. To do this, information is collected, synthesized and evaluated through systematic searches, using the most used and internationally validated methodology,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), to identify the best available evidence for rheumatic disease management, reducing variability in clinical practice. The SER's EBM documents place the patient at the centre, encouraging their active and informed participation in decisions that affect their health.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Among the most important EBM documents is the CPG. A CPG is defined as a set of recommendations aimed at optimising patient care, which are based on the systematic review of evidence and the assessment of the benefits and risks of different therapeutic alternatives.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">CPGs also seek to reduce uncertainty and variability in the decision-making of the different people involved in patient management (patients, clinical professionals and other people such as managers or decision-makers). The development of a CPG is justified in clinical practice areas or issues where there is controversy or variability; when there is a significant health problem that must be addressed; when new treatments or procedures arise, or if there is perceived room for improvement in a specific area of ​​action.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The SER also prepares recommendation documents. With a structure similar to CPGs, these documents have more limited scope and objectives than CPGs and are intended to inform healthcare professionals about specific issues emerging from a specific pathology or set of treatments.</p><p id="par0075" class="elsevierStylePara elsevierViewall">This article describes the management process and methodology followed by the RU-SER to identify the topics of its MBE documents and how it coordinates and develops its Guidelines and Recommendations.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Management and selection of issues for the evidence-based documents of the Spanish Society of Rheumatology</span><p id="par0080" class="elsevierStylePara elsevierViewall">The SER's MBE documents are managed by the SER's Guidelines and Recommendations Commission, made up of members of the Board of Directors and rheumatologists who are experts in the preparation of this type of documents.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Recommendation topics are suggested by its members, depending on their interests and are scheduled annually by the Guidelines and Recommendations Commission according to criteria of overall interest and feasibility.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Regarding the CPGs, the SER currently prepares three: the Clinical Practice Guideline for the Management of Patients with Rheumatoid Arthritis (GUIPCAR), the Clinical Practice Guideline for the Treatment of Axial Spondyloarthritis and Psoriatic Arthritis (ESPOGUÍA) and the Clinical Practice Guideline for the Management of Patients with Gout (GuipClinGot). The CPGs are generally renewed every five years.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Preparation process of a Clinical Practice Guideline or document of recommendations of the Spanish Society of Rheumatology</span><p id="par0095" class="elsevierStylePara elsevierViewall">The process of preparing CPGs and SER Recommendation documents takes into account the quality criteria established by national and international organisations that set the methodology and assess the methodological rigour and transparency with which a guide is prepared.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> The preparation process phases are contained in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Creation of the development group (DG)</span>. Using the usual means of SER communication (website and newsletters), the initial evidence-based document is publicised among rheumatologists. Interested parties send a declaration of interests and their CV, focused on the document topic and the SER's Guidelines and Recommendations Commission, using meritocratic criteria, selects the members of the DG from among the applicant rheumatologists. The DG will comprise a clinical leader, a panel of experts with a variable number of between 4–5 for the Recommendations and 10–12 for the CPGs, and the RU’smethodological coordinators.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Professionals from other specialties related to the topic will also be invited to participate, either individually or if the document is a coordinated action between the SER and another scientific society, as representatives of their corresponding scientific societies. Patients (and other people such as informal caregivers, if necessary) are also incorporated into the DG. Patients participate in the SER EBM documents by contributing their vision of the disease and through qualitative techniques (see patient perspective section below), unmet needs in the clinical management of their disease are identified. The methodological experts of the RU coordinate the process in the different stages of the development of the Evidence-Based Document (EBD).</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Determination of scope and objectives.</span> The DG determines the scope and content of the document, establishing:<ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">•</span><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">General objective:</span> establish systematically developed and scientific evidence-based recommendations to help professionals and patients in decision-making when confronting the health condition or problem addressed by the guideline.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">•</span><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Specific objectives:</span> reduce the variability of clinical practice.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">•</span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Healthcare aspects:</span> prevention and/or screening and/or diagnosis and/or treatment, etc.</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">•</span><p id="par0130" class="elsevierStylePara elsevierViewall">Target population at which the recommendations are intended to be applied.</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">•</span><p id="par0135" class="elsevierStylePara elsevierViewall">End users at whom the guideline is aimed.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">•</span><p id="par0140" class="elsevierStylePara elsevierViewall">Clinical questions at which a response is aimed.</p></li></ul></p><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Formulation of clinical research questions. PICO questions</span>. The EG decides which questions could have the greatest impact. Next, it is determined which of them need to be answered by asking the question Patient, Intervention, Comparison, Outcome (PICO). The number of clinical questions will depend on the type of document, its dimension, scope and objectives. Generally, in recommendation documents there are between two and four questions, and in CPG between 10 and 12 questions.</p><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Systematic bibliographic search and selection of evidence</span>. EBD SER recommendations are essentially based on systematic reviews (SR) of the evidence to answer the clinical questions raised. The bibliographic search for the evidence is carried out by an expert documentarian, generally in the PubMed (MEDLINE), EMBASE (Elsevier) and Cochrane Library (Wiley Online) databases. The process is completed with a manual search in the references of the identified studies, as well as the examination of other references that the reviewers and experts provide.</p><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Evaluation and synthesis of scientific evidence</span>. Evidence quality assessment is carried out in keeping with the methodology of the international GRADE<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> working group, by a group of rheumatologists who are experts in this methodology (SER evidence-based rheumatology [EBR]) work group, assisted by RU staff and by external specialists. To determine the quality or certainty of the evidence, in addition to the design and methodological quality of individual studies, the GRADE system involves the evaluation of other factors that influence confidence in study estimates. The following are analysed: the consistency of outcomes between the studies; the direct/indirect nature of the evidence (indirect comparison of the interventions of interest and/or differences in the population, the intervention, the comparator and/or the outcomes of interest with respect to the objectives of this report); the precision of the estimates, and the publication bias (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> with the classification of the quality of the evidence using the GRADE system). According to the combination of all the factors described, the quality of the evidence is classified as high (it is very unlikely that new studies will change the estimate), moderate (it is likely that new studies will change the confidence we have in the outcome), low (it is highly likely that new studies will have an impact on the confidence we have in the outcome and could modify it) or very low (any estimated outcome is highly doubtful).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Formulation of recommendations.</span> After completing evidence assessment and synthesis, relevant information on the different aspects of the recommendations is available for each of the questions. In the process of integrating these aspects, the frameworks proposed by GRADE (evidence to decision frameworks) are used, specifically created to guide the making of the necessary judgments.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These frameworks assess:<ul class="elsevierStyleList" id="lis0055"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">•</span><p id="par0165" class="elsevierStylePara elsevierViewall">The quality or certainty of the scientific evidence identified.</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">•</span><p id="par0170" class="elsevierStylePara elsevierViewall">Patient values and preferences.</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">•</span><p id="par0175" class="elsevierStylePara elsevierViewall">The balance between desirable and undesirable effects of interventions.</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">•</span><p id="par0180" class="elsevierStylePara elsevierViewall">Aspects related to costs.</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">•</span><p id="par0185" class="elsevierStylePara elsevierViewall">Aspects such as equity, acceptability and feasibility of implementation.</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">•</span><p id="par0190" class="elsevierStylePara elsevierViewall">Other considerations.</p></li></ul></p><p id="par0195" class="elsevierStylePara elsevierViewall">All the collected information is used to formulate the recommendations, their classification into categories of strength such as strong or weak/conditional and opinion (for or against), and the drafting of the justification for them by the DG. The different implications for the different users are contained in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0200" class="elsevierStylePara elsevierViewall">Furthermore, there are occasions when the DG may consider aspects require emphasis and for which there is no quality scientific evidence to support them. In general, these cases are related to an aspect of the treatment considered good clinical practice (GCP) and that no one would normally question. These aspects are valued as GCP points or recommendations.</p><p id="par0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">External review</span>. To increase document validity and ensure recommendation accuracy, the final draft of the EBDs undergoes an external review process. For this task, several professionals are selected (between 2 and 3) for their knowledge of the pathology addressed and the methodology in preparing the EBD. They comment on the document content and robustness.</p><p id="par0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Public exposure</span>. The EBM documents are submitted to a public exposure process by SER members and different stakeholders, such as other scientific societies, the pharmaceutical sector, patient associations, etc., who have not participated in the previous stages of drafting and external review. The objective is to collect their appraisal and scientific commentary on the methodology and recommendations made. The CPG or the recommendations document, in draft phase, is available for a period of two to three weeks on the SER website, along with a form for formulating affirmations. The affirmations are assessed within approximately four weeks by the DG who will ultimately decide whether or not to take them on board and whether to do so partially or totally. All affirmations, together with the arguments behind them and the DG's responses are contained on the SER website.</p><p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Final draft and dissemination of the SER EBM document</span>s. The drafting of the documents is the DG’s responsibility, in accordance with a previously established index and format. The RU coordinates its final edition, prepares the section related to the methodology and also ensures document coherence and style. When considered appropriate, additional materials will be included such as: summarised version, information version or chapter for patients, therapeutic and/or diagnostic algorithms, brochures and charts or diagrams.</p><p id="par0220" class="elsevierStylePara elsevierViewall">EBM documents are published in various formats. CPGs are published as complete or summartised versions on the SER website, as well as in paper format. They are also published as a special article in Clinical Rheumatology, the SER’s communication channel. For recommendation documents, the full report is disseminated on the SER website and the article version in Clinical Rheumatology.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Inclusion of the patient’s perspective in the evidence-based documents of the Spanish Society of Rheumatology</span><p id="par0225" class="elsevierStylePara elsevierViewall">Obtaining information about how patients perceive their health status can help professionals involved in their care understand other factors that influence the disease process.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">The SER EBM documents contain the patient’s viewpoint using several different procedures:<ul class="elsevierStyleList" id="lis0060"><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">1)</span><p id="par0235" class="elsevierStylePara elsevierViewall">Direct participation of one or two patient representatives in the DG.</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">2)</span><p id="par0240" class="elsevierStylePara elsevierViewall">Undertaking a systematic review of existing scientific studies on the experience of patients and their family members and/or carers.</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">3)</span><p id="par0245" class="elsevierStylePara elsevierViewall">Undertaking a primary qualitative study with patients who voluntarily wish to recount their experiences and concerns regarding the disease.</p></li></ul></p><p id="par0250" class="elsevierStylePara elsevierViewall">The information and outcomes obtained using these procedures are subsequently reflected in the CPG or recommendation documents.<ul class="elsevierStyleList" id="lis0065"><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">1</span><p id="par0255" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patient representatives in the DG.</span> Patient representatives in the DG are either participants in primary qualitative research or are patient representatives recruited through patient associations. Although no formal qualification is required for recruitment, some of the following criteria are taken into account: disease experience; degree of knowledge; understanding; availability; skills in expressing opinion, and the ability to work as a team. Patients work at the same level and in the same phases as professionals and receive specific training for the methodological comprehension of the process.</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">2</span><p id="par0260" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Systematic review of qualitative evidence.</span> A systematic review of scientific studies on patient experience of the disease is performed to collect their concerns and needs and those of their families and caregivers.</p></li></ul></p><p id="par0265" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Study inclusion and exclusion criteria:</span> The clinical questions are drafted using the Setting, Perspective, Intervention, Comparison, Evaluation (SPICE)<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> format.</p><p id="par0270" class="elsevierStylePara elsevierViewall">Only qualitative studies are considered for inclusion, and descriptive studies (questionnaires, surveys) are excluded.</p><p id="par0275" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Search for and selection of studies:</span> The bibliographic search is carried out in the databases used for quantitative studies including PubMed (MEDLINE), EMBASE (Elsevier), Cochrane Library (Wiley Online) and other more specific qualitative research databases such as Cinahl and PsycInfo. The search strategies specify key and free text terms related to the pathology and include methodological filters to identify qualitative evidence.</p><p id="par0280" class="elsevierStylePara elsevierViewall">Appraisal of qualitative evidence quality, analysis, and synthesis:</p><p id="par0285" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>• To assess the methodological limitations of each selected study, an instrument agreed upon by the Health Technology Assessment Agencies/Units (Quality Plan for the SNS of the MSSSI)<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> is used, selecting the five key questions in which an affirmative answer provides significant value to the study quality.</p><p id="par0290" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>• To analyse the studies, the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach is used, evaluating the confidence in the outcomes from primary studies and reviews of qualitative evidence synthesis (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The CERQual approach, developed by the Cochrane group, is based on the principles of the GRADE method used for reviews of quantitative studies. Confidence assessment is based on four components<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). Confidence is judged as high, moderate, low or very low.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0295" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>• Finally, in the evidence synthesis process, the main themes must be identified. Each theme contains different findings and these are evidenced by the preparation of a thematic map.<ul class="elsevierStyleList" id="lis0070"><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">3</span><p id="par0300" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Primary qualitative study.</span> Qualitative research allows us to investigate the experiences that patients have with the disease, within our cultural context. For this, focus group and in-depth interview techniques are used. The information obtained is transcribed and classified to interpret outcomes. The most relevant patient issues may therefore be identified and analysed. All of this is used to complete the information obtained with the systematic review of the literature.</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Information development for patients</span><p id="par0305" class="elsevierStylePara elsevierViewall">With a guideline based on the recommendations of the CPG or the recommendations document and based on the information obtained by the systematic review of qualitative studies, a model version for patients is prepared. This information is prepared in a language and style format adapted to the recipients at whom it is directed and includes aspects of the disease that may be most useful to them (SER website).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0310" class="elsevierStylePara elsevierViewall">The developers of this information come from a specific work subgroup which includes some of the clinicians and patients who participate in the DG.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="par0315" class="elsevierStylePara elsevierViewall">The SER has been preparing MBE documents for over 20 years. These documents, in which clinical experts and SER evidence reviewers participate, are coordinated from the RU by a group of professionals with extensive experience in the systematic collection of information and its evaluation using GRADE. With this methodology, the SER produces solid documents that have the necessary prestige to be considered useful by the community of rheumatologists in Spain. This demonstrates SER's commitment to continually improving patient care and promoting excellence in rheumatology.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0320" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleGrantSponsor" id="gs0005">Spanish Foundation of Rheumatology</span>.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0325" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare in relation to this methodology document.</p></span></span>"
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"resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The Spanish Society of Rheumatology (SER) brings together the majority of Spain's rheumatologists and, among the many services it offers its members, has a Research Unit (RU). This unit provides methodological support to SER members in clinical and epidemiological research, coordinates and carries out research projects, designs and maintains large patient databases, develops qualitative research projects and produces evidence-based medicine (EBM) documents. Through this last activity, the RU of the SER produces clinical practice guidelines and recommendation documents on topics relevant to rheumatology that meet the most demanding methodological standards. The aim of this article is to describe the management process and methodology followed by the UI of the SER to identify the topics of its EBM documents and how it executes and develops its guidelines and recommendations.</p></span>"
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"resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La Sociedad Española de Reumatología (SER) reúne a la mayoría de los especialistas en reumatología de España y entre los muchos servicios que ofrece a sus socios, cuenta con una Unidad de Investigación (UI). Esta unidad da apoyo metodológico en investigación clínica y epidemiológica a los socios de la SER, coordina y ejecuta proyectos de investigación, diseña y mantiene grandes bases de datos de pacientes, desarrolla proyectos de investigación cualitativa y realiza documentos de medicina basada en la evidencia (MBE). Mediante esta última actividad, la UI de la SER realiza guías de práctica clínica y documentos de recomendaciones sobre temas relevantes para la reumatología, que cumplen con los estándares metodológicos más exigentes. El objetivo de este artículo es describir el proceso de gestión y la metodología seguidos por la UI de la SER para identificar los temas de sus documentos de MBE y como ejecuta y desarrolla sus Guías y Recomendaciones.</p></span>"
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<table border="0" frame="\n
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\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Document name \t\t\t\t\t\t\n
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\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Objectives \t\t\t\t\t\t\n
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\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Disease studied \t\t\t\t\t\t\n
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\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
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\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Methodology \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
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\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Databases consulted \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of review \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of questions \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
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\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Final report/article \t\t\t\t\t\t\n
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\t\t\t\t">SER recommendations on treatment of uveitis \t\t\t\t\t\t\n
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\t\t\t\t">Develop recommendations for the management of patients with non-infectious, non-neoplastic and non-demyelinating uveitis. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
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\t\t\t\t">Non-infectious, non-neoplastic and non-demyelinating uveitis \t\t\t\t\t\t\n
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\t\t\t\t">GRADE \t\t\t\t\t\t\n
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\t\t\t\t">PubMed, Embase and Cochrane Library \t\t\t\t\t\t\n
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\t\t\t\t">Systematic \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">3 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">DOI 10.1016/j.reumae.2023.07.003 \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">SER recommendations on the treatment of refractory Behçet's disease \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Develop recommendations for the management of patients with Behçet's Disease refractory or recurrent to conventional treatment. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Behçet’s disease \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">GRADE \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">PubMed, Embase and Cochrane Library \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Systematic \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">4 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">DOI 10.1016/j.reuma.2023.12.001 \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="middle">SER recommendations on risk management of treatment with targeted biological and synthetic DMARDs in patients with rheumatoid arthritis.</td><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="middle">Develop recommendations to minimise the risk of using targeted therapy in patients with rheumatoid arthritis.</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Rheumatoid arthritis</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">GRADE</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">PubMed, Embase and Cochrane Library</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Systematic</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">6</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">DOI 10.1016/j.reuma.2023.07.001 \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleInterRef" id="intr0005" href="https://www.ser.es/wp-content/uploads/2023/06/Recomendaciones-SER-gesti%C3%B3n-de-riesgo_AR.pdf">https://www.ser.es/wp-content/uploads/2023/06/Recomendaciones-SER-gesti%C3%B3n-de-riesgo_AR.pdf</span> \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Update of the SER Recommendations on the use of biological therapies in SLE \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Update of recommendations for the management of SLE with biological treatments. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Systemic lupus erythematosus \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">GRADE \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">PubMed, Embase and Cochrane Library \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Systematic \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">3 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Under development \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">SER recommendations on management of periodontitis in patients with rheumatoid arthritis \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Develop recommendations for the management of periodontitis in patients with rheumatoid arthritis. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Rheumatoid arthritis \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">GRADE \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">PubMed, Embase and Cochrane Library \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Systematic \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">3 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Under development \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">SER special article on the use of platelet-rich plasma (PRP) applied to rheumatic pathologies \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Description and classification of the technology used to obtain PRP and its indications in patients with knee osteoarthritis, shoulder tendinosis, enthesitis and fasciitis. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Knee osteoarthritis, shoulder tendinosis, enthesitis and fasciitis \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Article based on expert opinion \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">PubMed \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Narrative \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">3 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Under development \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="middle"></td><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead rowgroup " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Description and characterisation of the technique and its indications in patients with scleroderma and related pathologies. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="middle">Scleroderma, dermatomyositis and MCTD</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Article based on expert opinion</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">PubMed</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Narrative</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">3</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Under development</td></tr><tr title="table-row"><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Interpretation and parameters through a standardised form that allows the homogenisation of criteria. \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">SER consensus document on the use of targeted biological and synthetic therapies in rheumatoid arthritis. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Update the SER consensus on the use of biological therapies and targeted synthetic drugs in patients with rheumatoid arthritis \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Rheumatoid arthritis \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Article based on expert opinion \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">PubMed \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Narrative \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">15 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Pending publication \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">ESPOGUÍA 2024. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Update on the safety and effectiveness of therapy in the management of patients with axial spondyloarthritis and psoriatic arthritis.</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Axial spondyloarthritis and psoriatic arthritis</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">GRADE</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">PubMed, Embase and Cochrane Library</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Systematic/restrictive bibliographic search</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">7 Systematics \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Under development</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Update of the Clinical Practice Guideline for the treatment of axial spondyloarthritis and psoriatic arthritis \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">8 narratives \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="middle">GUIPCAR 2025. Update of the Clinical Practice Guideline for the Management of Patients with Rheumatoid Arthritis</td><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="middle">Update on the safety and effectiveness of therapy in the management of patients with rheumatoid arthritis</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Rheumatoid arthritis</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">GRADE</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">PubMed, Embase and Cochrane Library</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Systematic/restrictive bibliographic search</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">5 Systematics \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="2" align="left" valign="middle">Under development</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">16 narratives \t\t\t\t\t\t\n
\t\t\t\t</td></tr></tbody></table>
"""
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"leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">RCT: randomised clinical trial; RR: relative risk.</p>"
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<table border="0" frame="\n
\t\t\t\t\tvoid\n
\t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Quality \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study design \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lower if<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Raise if<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n
\t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">High ⊕⊕⊕⊕ \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">RCT \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">Quality limitation (design):</p></li></ul> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Association: \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Moderate ⊕⊕⊕⊖ \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">-- \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Important (-1) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">Scientific evidence of a strong association (RR > 2 or < .5 based on observational studies without confounding factors) (+1)</p></li></ul> \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="10" align="left" valign="middle">Low ⊕⊕⊖⊖</td><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " rowspan="10" align="left" valign="middle">Observational studies</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Very important (-2) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Scientific evidence of a very strong association (RR > 5 or < .2 based on studies with no possibility of bias) (+2)</p></li></ul> \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">Inconsistency:</p></li></ul> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0025" class="elsevierStylePara elsevierViewall">Dose-response gradient (+1)</p></li></ul> \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">important (-1) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " rowspan="9" align="left" valign="middle"><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0030" class="elsevierStylePara elsevierViewall">Possible factors of confusion could have lowered the observed effect (+1)</p></li></ul></td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Very important (-2) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">Direct evidence:</p></li></ul> \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Important (-1) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Very important (-2) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">•</span><p id="par0040" class="elsevierStylePara elsevierViewall">Imprecision:</p></li></ul> \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Important (-1) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Very important (-2) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Veyr low ⊕⊖⊖⊖ \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Other types of design \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">High probability of publication bias: (-1)</p></li></ul> \t\t\t\t\t\t\n
\t\t\t\t</td></tr></tbody></table>
"""
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0 => array:3 [
"identificador" => "tblfn0005"
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"nota" => "<p class="elsevierStyleNotepara" id="npar0005">In the case of RCTs, the rating of the quality of the scientific evidence can be lowered.</p>"
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1 => array:3 [
"identificador" => "tblfn0010"
"etiqueta" => "**"
"nota" => "<p class="elsevierStyleNotepara" id="npar0010">In the case of observational studies, the quality rating of the scientific evidence can be raised.</p>"
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]
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"descripcion" => array:1 [
"en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Classification of scientific evidence quality in the GRADE<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> system.</p>"
]
]
3 => array:8 [
"identificador" => "tbl0015"
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"tabla" => array:1 [
0 => """
<table border="0" frame="\n
\t\t\t\t\tvoid\n
\t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendation \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinicians \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Managers/planners \t\t\t\t\t\t\n
\t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Strong \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Most people would agree with the recommended action and only a small proportion of them would not. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Most patiens should receive the recommended intervention. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">The recommendation may be adopted as a healthcare policy in most situations. \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Weak or conditional \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Most people would agree with the recommended action but a large number of them would not. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">It recognises that different opinions would be appropriate for different patients and that the doctor has to help each patient to make the decision most in keeping with the patient’s values and preferences. \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">There is a need for serious debate and participation from stakeholders. \t\t\t\t\t\t\n
\t\t\t\t</td></tr></tbody></table>
"""
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"descripcion" => array:1 [
"en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Implications of the strength of recommendation in the GRADE<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> system.</p>"
]
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4 => array:8 [
"identificador" => "tbl0020"
"etiqueta" => "Table 4"
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"mostrarFloat" => true
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"detalles" => array:1 [
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"identificador" => "at0035"
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"tabla" => array:1 [
"tablatextoimagen" => array:1 [
0 => array:2 [
"tabla" => array:1 [
0 => """
<table border="0" frame="\n
\t\t\t\t\tvoid\n
\t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">1. <span class="elsevierStyleItalic">Methodological limitations of the included studies:</span> the degree of concern regarding the quality of the design or conduct of the primary studies included as evidence for each of the conclusions of the review. \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">2. <span class="elsevierStyleItalic">Consistency of review results</span>: an assessment of how clear and convincing the relationship is between the data from the primary studies and a review conclusion that synthesizes that data. By “convincing,” we mean well supported. \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">3. <span class="elsevierStyleItalic">Adequacy of data contributing to a review conclusion:</span> the overall determination of the degree of richness and quantity of data supporting a review conclusion. \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">4<span class="elsevierStyleItalic">. Relevance of included studies to the review question:</span> The extent to which the body of evidence from primary studies supporting a conclusion of the review is applicable to the context (population or perspective, phenomenon of interest, setting) specified in the review question. \t\t\t\t\t\t\n
\t\t\t\t</td></tr></tbody></table>
"""
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"en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Component of the study confidence appraisal.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p>"
]
]
]
"bibliografia" => array:2 [
"titulo" => "References"
"seccion" => array:1 [
0 => array:2 [
"identificador" => "bibs0005"
"bibliografiaReferencia" => array:11 [
0 => array:3 [
"identificador" => "bib0005"
"etiqueta" => "1"
"referencia" => array:1 [
0 => array:1 [
"referenciaCompleta" => "Sociedad Española de Reumatología. Available from: <a target="_blank" href="https://www.ser.es/">https://www.ser.es/</a>."
]
]
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1 => array:3 [
"identificador" => "bib0010"
"etiqueta" => "2"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Grading quality of evidence and strength of recommendations"
"autores" => array:1 [
0 => array:2 [
"etal" => true
"autores" => array:6 [
0 => "D. Atkins"
1 => "D. Best"
2 => "P.A. Briss"
3 => "M. Eccles"
4 => "Y. Falck-Ytter"
5 => "S. Flottorp"
]
]
]
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"host" => array:1 [
0 => array:2 [
"doi" => "10.1136/bmj.328.7454.1490"
"Revista" => array:5 [
"tituloSerie" => "BMJ."
"fecha" => "2004"
"volumen" => "328"
"paginaInicial" => "1490"
"link" => array:1 [
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"url" => "https://www.ncbi.nlm.nih.gov/pubmed/15205295"
"web" => "Medline"
]
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]
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2 => array:3 [
"identificador" => "bib0015"
"etiqueta" => "3"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:1 [
"autores" => array:1 [
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"colaboracion" => "Institute of Medicine Committee on Standards for Developing Trustworthy Clinical Practice G"
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0 => array:1 [
"LibroEditado" => array:3 [
"editores" => "R.Graham, M.Mancher, D.Miller Wolman, S.Greenfield, E.Steinberg"
"titulo" => "Clinical Practice Guidelines We Can Trust"
"serieFecha" => "2011"
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"link" => "https://nap.nationalacademies.org/catalog/13058/clinical-practice-guidelineswe-can-trust"
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3 => array:3 [
"identificador" => "bib0020"
"etiqueta" => "4"
"referencia" => array:1 [
0 => array:1 [
"referenciaCompleta" => "Grupo de trabajo para la actualización del Manual de Elaboración de GPC. Elaboración de Guías de Práctica Clínica en el Sistema Nacional de Salud. Actualización del Manual Metodológico [Internet]. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad; Zaragoza: Instituto Aragonés de Ciencias de la Salud (IACS); 2016 [Accessed 4 Apr 2024]. Available from: <a target="_blank" href="http://portal.guiasalud.es/wp-content/uploads/2019/01/manual_gpc_completo.pdf">http://portal.guiasalud.es/wp-content/uploads/2019/01/manual_gpc_completo.pdf</a>."
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"contribucion" => array:1 [
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"titulo" => "AGREE II: advancing guideline development, reporting and evaluation in health care"
"autores" => array:1 [
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"etal" => true
"autores" => array:6 [
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5 => "G. Feder"
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