Involving different stakeholders in prioritising outcomes to assess healthcare systems response for type 1 diabetes management: Using co-creation approaches in Peru.

BACKGROUND: Engaging diverse stakeholders in developing core outcome sets (COSs) can produce more meaningful metrics as well as research responsive to patient needs. The most common COS prioritisation method, Delphi surveys, has limitations related to selection bias and participant understanding, while qualitative methods like group discussions are less frequently used. This study aims to test a co-creation approach to COS development for type 1 diabetes (T1DM) in Peru. METHODS: Using a co-creation approach, we aimed to prioritise outcomes for T1DM management in Peru, incorporating perspectives from people with T1DM, caregivers, healthcare professionals, and decision-makers. A set of outcomes were previously identified through a systematic review and qualitative evidence synthesis. Through qualitative descriptive methods, including in-person workshops, each group of stakeholders contributed to the ranking of outcomes. Decision-makers also discussed the feasibility of measuring these outcomes within the Peruvian healthcare system. RESULTS: While priorities varied among participant groups, all underscored the significance of monitoring healthcare system functionality over mortality. Participants recognized the interconnected nature of healthcare system performance, clinical outcomes, self-management, and quality of life. When combining the rankings from all the groups, metrics related to economic impact on the individual and structural support, policies promoting health, and protecting those living with T1DM were deemed more important in comparison to measuring clinical outcomes. CONCLUSION: We present the first COS for T1DM focused on low-and-middle-income countries and show aspects of care that are relevant in this setting. Diverse prioritisation among participant groups underscores the need of inclusive decision-making processes. By incorporating varied perspectives, healthcare systems can better address patient needs and enhance overall care quality.

Religious leaders' perceptions of the identification and referral of people with mental health problems in a Peruvian city.

INTRODUCTION: Religious leaders have the potential to play a significant role in the identification and referral of individuals with mental health problems. OBJECTIVE: This study sought to understand the perceptions of religious leaders in regards to identifying and referring parishioners with mental health issues to healthcare professionals, in Chimbote, Peru. METHODS: We performed a cross-sectional study that covered religious leaders of different religious groups in Chimbote. The leaders completed a survey that assessed their characteristics, past experiences of detecting and referring those with mental health problems to healthcare professionals, and perceptions of four clinical cases (for which we used the Clergy's Perception of Mental Illness Survey instrument). RESULTS: We included 109 religious' leaders of four religious groups (11 Catholics, 70 Evangelicals, 21 Mormons, and 7 Adventists). Of these, 50.5% had received at least one request for help with mental health issues from a parishioner in the previous month, over 85% expressed a desire for training in identifying mental health problems, and 22-30% reported receiving any training. While the majority of leaders were able to correctly identify cases of depression, alcohol dependence, and drug problems, only 62% correctly classified a case of schizophrenia. Despite this, 80% stated that they would refer their parishioners to healthcare professionals. CONCLUSION: Parishioners tend to consult their religious leaders regarding their mental health and approximately 80% stated they would refer such cases to a healthcare professional. However, less than one-third of the leaders had received training to detect mental health problems. These results suggest that there is a need for training programs to improve the ability of religious leaders to identify and refer individuals with mental health issues.

Effectiveness and Cost-Effectiveness of Self-Management Interventions for Adults Living with Heart Failure to Improve Patient-Important Outcomes: An Evidence Map of Randomized Controlled Trials.

Self-management interventions (SMIs) may enhance heart failure (HF) outcomes and address challenges associated with disease management. This study aims to review randomized evidence and identify knowledge gaps in SMIs for adult HF patients. Within the COMPAR-EU project, from 2010 to 2018, we conducted searches in the databases MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO. We performed a descriptive analysis using predefined categories and developed an evidence map of randomized controlled trials (RCTs). We found 282 RCTs examining SMIs for HF patients, comparing two to four interventions, primarily targeting individual patients (97%) globally (34 countries, only 31% from an European country). These interventions involved support techniques such as information sharing (95%) and self-monitoring (62%), often through a mix of in-person and remote sessions (43%). Commonly assessed outcomes included quality of life, hospital admissions, mortality, exercise capacity, and self-efficacy. Few studies have focused on lower socio-economic or minority groups. Nurses (68%) and physicians (30%) were the primary providers, and most studies were at low risk of bias in generating a random sequence for participant allocation; however, the reporting was noticeably unclear of methods used to conceal the allocation process. Our analysis has revealed prevalent support techniques and delivery methods while highlighting methodological challenges. These findings provide valuable insights for researchers, clinicians, and policymakers striving to optimize SMIs for individuals living with HF.

Self-Management Interventions for Adults Living with Type II Diabetes to Improve Patient-Important Outcomes: An Evidence Map.

Self-management interventions (SMIs) may be promising in the treatment of Diabetes Mellitus Type 2 (T2DM). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study summarizes intervention components and characteristics in randomized controlled trials (RCTs) related to T2DM using a taxonomy for SMIs as a framework and identifies components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Following evidence mapping methodology, we searched MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO from 2010 to 2018 for randomized controlled trials (RCTs) on SMIs for T2DM. We used the terms 'self-management', 'adult' and 'T2DM' for content. For data extraction, we used an online platform based on the taxonomy for SMIs. Two independent reviewers assessed eligible references; one reviewer extracted data, and a second checked accuracy. We identified 665 RCTs for SMIs (34% US, 21% Europe) including 164,437 (median 123, range 10-14,559) adults with T2DM. SMIs highly differed in design and content, and characteristics such as mode of delivery, intensity, location and providers involved were poorly described. The majority of interventions aimed to improve clinical outcomes like HbA1c (83%), weight (53%), lipid profile (45%) or blood pressure (42%); 27% (also) targeted quality of life. Improved knowledge, health literacy, patient activation or satisfaction with care were hardly used as outcomes (<16%). SMIs most often used education (98%), self-monitoring (56%), goal-setting (48%) and skills training (42%) to improve outcomes. Management of emotions (17%) and shared decision-making (5%) were almost never mentioned. Although diabetes is highly prevalent in some minority groups, in only 13% of the SMIs, these groups were included. Our findings highlight the large heterogeneity that exists in the design of SMIs for T2DM and the way studies are reported, making accurate comparisons of their relative effectiveness challenging. In addition, SMIs pay limited attention to outcomes other than clinical, despite the importance attached to these outcomes by patients. More standardized and streamlined research is needed to better understand the effectiveness and cost-effectiveness of SMIs of T2DM and benefit patient care.

Cerebrovascular disease and mortality in hospitalized patients with COVID-19 in a Latin American country, Peru / Accidente cerebrovascular y mortalidad en pacientes hospitalizados con COVID-19 en un país de Latinoamérica, Perú

SUMMARY Objective : This study aimed at: 1) Assessment of the frequency of stroke and related mortality rate in patients hospitalized for COVID-19 in two major hospital referral centers in Peru; 2) Exploration of factors associated to mortality and dependency in these patients; 3) Comparisons of frequency of admissions of stroke patients and reperfusion treatments in similar periods of time prior to (2019) and during the pandemia occurrence. Material and Methods : A retrospective cohort study was conducted in two of the largest referral hospital centers for COVID-19 in Peru. The study included patient victims of stroke and COVID-19, hospitalized between April and August 2020. Demographic, clinical and laboratory data, radiological findings, and severity levels measured by the NIHSS scale were collected. Poisson regression models to evaluate associated factors to mortality and dependency were applied. Results : A 31% reduction of admissions for stroke, and of 81% of intravenous reperfusion treatment, respectively, were found in 2020 when compared with 2019. 1.37% of the patients with COVID-19 experienced a stroke, with an overall mortality rate of 40.6%, and a dependency rate of 68.3% at discharge time (Rankin > 2). An age increase of 10 years was found in mortality, associated with a 29% increase in mortality risk. As well, having hypertension, chronic kidney disease, inflammatory markers (D dimer and ferritin) and the severity of the stroke were associated with mortality. Finally, the severity of stroke, lymphopenia, and inflammatory markers (D dimer and fibrinogen) were associated with greater risk of dependency. Conclusions : The care system of stroke patients was affected by the COVID-19 pandemic in two of Perú's major public hospitals. There was a decrease in admissions and reperfusion treatments of stroke cases, and 1.37% of patients with COVID-19 presented a stroke. Age, hypertension, chronic kidney disease, inflammatory markers and severity of stroke were associated with mortality in these patients.

RESUMEN Objetivo : Los objetivos del presente trabajo fueron: 1) Evaluar la frecuencia de accidente cerebrovascular (ACV) y de la tasa de mortalidad en pacientes hospitalizados por COVID-19 en dos importantes centros hospitalarios de referencia en Perú, 2) Exploración de factores asociados a mortalidad y dependencia en estos pacientes, 3) Comparar la frecuencia de admisiones de pacientes con ACV y de los tratamientos de reperfusión en tiempo de pandemia y en periodos previos (2019). Material y Métodos : Se realizó un estudio retrospectivo en dos de los mayores centros hospitalarios de referencia en Perú, incluyendo pacientes con ACV y COVID-19 hospitalizados entre abril y agosto del 2020. Se recolectó información demográfica, clínica y de laboratorio, hallazgos radiológicos y niveles de severidad medidos por la escala NIHSS, y se utilizó un modelo de regresión de Poisson para evaluar los factores asociados a mortalidad y dependencia. Resultados : Se encontró una disminución del 31% de admisiones hospitalarias de pacientes con ACV (ictus) y del 81% de los tratamientos de reperfusión endovenosa en el 2020 con respecto al 2019. Un 1.37% de pacientes con COVID-19 experimentaron ACV, con una mortalidad global de 40.6% y dependencia al alta del 58.3% (rankin >2). Un incremento de 10 años en edad se asoció con un aumento del 29% en el riesgo de mortalidad. Hipertensión arterial, enfermedad renal crónica, marcadores inflamatorios (Dímero D y ferritina) y la gravedad del ictus se encontraron asociados con mortalidad. La gravedad del ictus, la linfopenia y los marcadores inflamatorios (Dimero D y fibrinógeno) estuvieron asociados a un mayor riesgo de dependencia. Conclusión : El sistema de atención de ACVs se vio afectado por la pandemia del COVID-19 en dos de los centros hospitalarios públicos más grandes del Perú. Se encontró una disminución en las admisiones hospitalarias y en los tratamientos de reperfusión de estos pacientes durante la pandemia. Edad, hipertensión, enfermedad renal crónica, marcadores inflamatorios y gravedad del ictus fueron factores asociados con la mortalidad de pacientes con COVID-19 y ACV.

Performance of the CKD-EPI and MDRD equations for estimating glomerular filtration rate: a systematic review of Latin American studies

ABSTRACT BACKGROUND: The most-used equations for estimating the glomerular filtration rate (GFR) are the CKD Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations. However, it is unclear which of these shows better performance in Latin America. OBJECTIVE: To assess the performance of two equations for estimated GFR (eGFR) in Latin American countries. DESIGN AND SETTING: Systematic review and meta-analysis in Latin American countries. METHODS: We searched in three databases to identify studies that reported eGFR using both equations and compared them with measured GFR (mGFR) using exogenous filtration markers, among adults in Latin American countries. We performed meta-analyses on P30, bias (using mean difference [MD] and 95% confidence intervals [95% CI]), sensitivity and specificity; and evaluated the certainty of evidence using the GRADE methodology. RESULTS: We included 12 papers, and meta-analyzed six (five from Brazil and one from Mexico). Meta-analyses that compared CKD-EPI using creatinine measured with calibration traceable to isotope dilution mass spectrometry (CKD-EPI-Cr IDMS) and using MDRD-4 IDMS did not show differences in bias (MD: 0.55 ml/min/1.73m2; 95% CI: -3.34 to 4.43), P30 (MD: 4%; 95% CI: -2% to 11%), sensitivity (76% and 75%) and specificity (91% and 89%), with very low certainty of evidence for bias and P30, and low certainty of evidence for sensitivity and specificity. CONCLUSION: We found that the performances of CKD-EPI-Cr IDMS and MDRD-4 IDMS did not differ significantly. However, since most of the meta-analyzed studies were from Brazil, the results cannot be extrapolated to other Latin American countries. REGISTRATION: PROSPERO (CRD42019123434) - https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019123434.

Factores asociados a mortalidad en pacientes hospitalizados con COVID-19: cohorte prospectiva en un hospital de referencia nacional de Perú / Factors associated with mortality in patients hospitalized with COVID-19: a prospective cohort in a Peruvian national referral hospital

Objetivos Describir las características clínicas y evaluar los factores asociados con la mortalidad de los pacientes adultos con la nueva enfermedad causada por coronavirus 2019 (COVID-19) ingresados a un hospital de referencia nacional de Perú. Métodos Se realizó un estudio de cohorte prospectivo. Se incluyó a pacientes mayores de 18 años hospitalizados con el diagnóstico de infección por coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2). Se excluyó a quienes ingresaron con prueba rápida serológica positiva al ingreso, sin clínica sugestiva ni imágenes compatibles. Los datos se recolectaron a partir de la historia clínica. Resultados Se incluyó un total de 813 adultos, 544 (66,9%) tuvieron COVID-19 confirmado. La media de la edad fue de 61,2 años (desviación estándar: 15) y 575 (70,5%) fueron de sexo masculino. Las comorbilidades más frecuentes fueron hipertensión arterial (34,1%) y obesidad (25,9%). Los síntomas más frecuentes al ingreso fueron disnea (82,2%) y tos (53,9%). Un total de 114 (14%) pacientes recibieron ventilación mecánica, 38 (4,7%) ingresaron a unidad de cuidados intensivos y 377 (46,4%) fallecieron. Se asociaron a la mortalidad el requerimiento de soporte ventilatorio, el mayor compromiso pulmonar y los marcadores inflamatorios. Encontramos que por cada 10 años que aumentó la edad, el riesgo de morir se incrementó en 32% (riesgo relativo: 1,32; intervalo de confianza 95%: 1,25 a 1,38). Aquellos pacientes que requirieron ingreso a unidad de cuidados intensivos y ventilación mecánica tuvieron 1,39 (intervalo de confianza 95%: 1,13 a 1,69) y 1,97 (intervalo de confianza 95%: 1,69 a 2,29) veces el riesgo de morir, respectivamente. Conclusión La mortalidad encontrada en nuestro estudio fue alta y estuvo asociada a la edad, marcadores inflamatorios y compromiso respiratorio.

Objectives To describe and assess clinical characteristics and factors associated with mortality in adult patients with COVID-19 admitted to a national referral hospital in Peru. Methods We conducted a prospective cohort study that included hospitalized patients older than 18 years with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis. Patients with a positive rapid serological test on admission but no respiratory symptoms nor compatible images were excluded. We collected the data from clinical records. Results A total of 813 adults were included, 544 (66.9%) with confirmed COVID-19. The mean age was 61.2 years (standard deviation: 15.0), and 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%). On admission, the most frequent symptoms were dyspnea (82.2%) and cough (53.9%). A total of 114 (14.0%) patients received mechanical ventilation, 38 (4.7%) were admitted to the intensive care unit, and 377 (46.4%) died. The requirement for ventilatory support, greater lung involvement, and inflammatory markers were associated with higher mortality. It was found that for every 10-year age increase, the risk of dying increased 32% (relative risk: 1.32; 95% confidence interval: 1.25 to 1.38). Those who were admitted to the intensive care unit and and were placed on mechanical ventilation had 1.39 (95% confidence interval: 1.13 to 1.69) and 1.97 (95% confidence interval: 1.69 to 2.29) times the risk of dying compared to those who did not, respectively. Conclusion We found a high mortality rate among hospitalized patients associated with older age, higher inflammatory markers, and greater lung involvement.

Cumulative incidence of lethal congenital anomalies in Peru / Incidencia acumulada de anomalías fetales incompatibles con la vida en Perú

Abstract Introduction: Lethal congenital anomalies (LCA) are anomalies associated with early stillbirth or newborn death. Currently, there are no data on the incidence of LCAs in Peru. Objectives: To estimate the cumulative incidence of LCAs in Peru, the Department of Lima, and six hospitals located in the city of Lima (Peru), and to describe the characteristics of LCA cases reported between 2012 and 2016 at Instituto Nacional Materno Perinatal (INMP), located in Lima, Perú. Materials and methods: Cumulative incidence of LCAs in Peru was determined based on the cases reported in a five-year period, which varied depending on data accessibility (20112015 and 2012-2016). In addition, the medical records of neonates with LCA registered at INMP were reviewed to identify the characteristics of these cases. Results: Cumulative incidence of LCAs in Peru was 0.89 cases per 10 000 newborns, while at INMP it was 7.19 cases. Out of 48 newborns with LCAs treated at INMP during the study period, 54.2% were born with neonatal depression, and 83.3% died during their hospital stay. Conclusion: Cumulative incidences of LCAs reported here (Lima, Department of Lima, and Peru) were lower than those described by international epidemiological surveillance systems, which might be caused due to shortcomings related to the registration of these cases in the health institutions and records analyzed here.

Resumen Introducción. Las anomalías fetales incompatibles con la vida (AFIV) son aquellas que se asocian con la muerte temprana del feto o del recién nacido. En la actualidad, se desconoce la magnitud de este problema en Perú. Objetivos. Estimar la incidencia acumulada de AFIV en Perú, en el departamento de Lima y en seis hospitales de la ciudad de Lima, y describir las características de este tipo de anomalías reportadas entre 2012 y 2016 en el Instituto Nacional Materno Perinatal (INMP) de Lima, Perú. Materiales y métodos. Se determinó la incidencia acumulada de las AFIV reportadas en un período de cinco años en Perú, el cual varió dependiendo de la disponibilidad de los datos (2011-2015 y 2012-2016). Además, se revisaron las historias clínicas de los neonatos con AFIV registradas en el INMP para obtener sus características. Resultados. La incidencia acumulada de AFIV en todo el Perú fue de 0.89 por cada 10 000 recién nacidos y en el INMP fue 7.19. De los 48 recién nacidos con AFIV atendidos en el INMP, 54.2% nacieron con depresión neonatal y 83.3% fallecieron en el hospital. Conclusión. Las incidencias acumuladas de AFIV encontradas fueron menores a las reportadas por los sistemas internacionales de vigilancia epidemiológica, lo que podría deberse a falencias en su registro en las instituciones de salud y registros analizados.

Factores asociados a la percepción de la validez científica de la homeopatía en un grupo de médicos generales de Perú / Factors associated with the perception of scientific evidence regarding homeopathy in a group of general practitioners from Peru

Resumen Introducción. La homeopatía es una terapia ampliamente utilizada en diversas partes del mundo; sin embargo, su eficacia no se ha comprobado científicamente. Objetivo. Evaluar los factores asociados a la percepción de la validez científica de la homeopatía en médicos generales de Perú. Materiales y métodos. Estudio transversal analítico. Se realizaron encuestas autoaplicadas a médicos generales que asistieron a los cursos de capacitación y orientación vocacional en especialidad y residentado en salud del Colegio Médico del Perú en 2017. La variable principal del estudio se evaluó por medio de la siguiente pregunta: ¿considera que la eficacia de la homeopatía está científicamente probada? Para evaluar los factores asociados se calcularon razones de pre-valencia crudas (RP) y ajustadas (RPa), así como sus intervalos de confianza al 95% (IC95%). Resultados. Se incluyeron 285 médicos generales (55.1% mujeres) con una edad mediana de 28 años. Del 67.4% que reportó haber escuchado sobre la homeopatía, 22.5% consideró que su eficacia estaba científicamente comprobada. Lo anterior fue más frecuente en mujeres (RPa: 1.80; IC95%: 1.03-3.16) y menos frecuente en quienes habían publicado algún artículo científico (RPa: 0.23; IC95%:0.06-0.88). Conclusiones. Casi un cuarto de los médicos que habían escuchado sobre homeopatía consideraron que esta terapia está científicamente comprobada. Lo anterior puede deberse a vacíos en la educación médica con respecto a las terapias médicas alternativas y complementarias, así como a la influencia de la educación no formal en la toma de decisiones.

Abstract Introduction: Homeopathy is a widely used therapy in different parts of the world. However, its effectiveness has not been scientifically proven. Objective: To assess the factors associated with the perception of homeopathy scientific validity in Peruvian general practice (GP) physicians. Materials and methods: Cross-sectional analytical study. A group of GP physicians who attended training and career guidance courses on medical specialties and residencies offered by Colegio Médico del Perú (Medical Association of Peru) in 2017 were asked to complete a self-administered survey. The main study variable was evaluated using the following question: Do you consider that homeopathy effectiveness has been scientifically proven? Prevalence ratios (PR) and adjusted prevalence ratios (aPR), as well as their 95% confidence intervals (95%CI) were calculated to assess the factors associated with considering homeopathy effectiveness as scientifically proven. Results: 285 GP physicians completed the survey (55.1% were women; median age: 28 years); 67.4% reported having heard about homeopathy, and out of these, 22.5% considered that homeopathy effectiveness was scientifically proven. Perceiving this type of therapy as scientifically valid was more frequent in women (aPR:1.80, 95%CI:1.03-3.16) and less frequent in those who had published at least one scientific paper (aPR:0.23, 95%CI:0.06-0.88). Conclusions: Almost a quarter of the physicians who had heard about homeopathy considered that this therapy had been scientifically proven. This might be caused by gaps in their medical training regarding alternative and complementary medicine therapies, and the influence that non-formal education has on decision-making.

Motivos para la elección y preferencias de la especialidad médica en médicos generales del Perú / Reasons for the election and preferences of the medical specialty in general practitioners of Peru

RESUMEN Objetivo : describir los factores que influyen en la elección de la especialidad médica en médicos generales en Perú y calcular la distribución de postulantes y vacantes en el examen de residentado médico en el 2018. Materiales y métodos : estudio descriptivo en médicos generales que asistieron a un evento que tuvo por objetivo informar sobre las especialidades médicas, realizado por el Colegio Médico del Perú. Durante dicho evento, se distribuyó un cuestionario autoaplicado para recolectar las variables de interés. Los análisis estadísticos se realizaron con el programa Stata v14. Resultados : se incluyeron 298 participantes, de los cuales, el 54,4% fueron mujeres, 46,3% tenían menos de 28 años, 59,8% estudió su pregrado en Lima y 52,3% culminaron sus estudios entre 2014-2016. El 49,7%, 46,6%, y 3,7% prefirió elegir una especialidad quirúrgica, clínica, y alguna otra, respectivamente. Entre los factores para elegir a qué especialidad médica postular, aquellos considerados importantes o muy importantes por la mayor parte de los encuestados fueron: la alta probabilidad de conseguir empleo (98,7%), tener retos intelectuales (94,9%), ver casos interesantes (93,2%), y tener buenos ingresos económicos (90,8%). Las especialidades con mayor cantidad de postulantes para cada vacante fueron cirugía plástica y dermatología, mientras que las que tuvieron menos postulantes que vacantes fueron medicina familiar y medicina interna. Conclusiones : los factores económicos y académicos son los más importantes para la elección de una especialidad médica, en el contexto donde las especialidades del primer nivel de atención tienen pocos postulantes. Esto permite entender mejor este proceso, informar adecuadamente a los médicos sobre las especialidades disponibles, e impulsar estrategias para aumentar el interés de los médicos en especialidades necesarias en el país.

ABSTRACT Objective : to describe the reasons that influence the choice of medical specialty in general physicians in Peru, and to calculate the applicants and vacancies in the national medical residency exam in 2018. Materials and methods : descriptive cross-sectional study in general physicians who attended an event that aimed to inform about medical specialties, carried out by the Peruvian Medical College. During this event, a self-applied questionnaire was distributed to collect the variables of interest. The statistical analyzes were performed with the Stata v.14 program. Results : surveys of 298 participants were analyzed, of which 54.4% were women, 46.3% had less than 28 years old, 59.8% studied their undergraduate studies in Lima, and 52.3% completed their career between 2014-2016. 49.7%, 46.6%, and 3.7% preferred choosing a surgical specialty, clinic, and some other, respectively. The reasons considered important or very important to choose a specialty were: the high probability of getting a job (98.7%), having intellectual challenges (94.9%), see interesting cases (93.2%), and have good economic income (90.8%). Plastic surgery and dermatology were the specialties with greatest number of applicants for each vacant, while family medicine and internal medicine had less applicants than vacancies. Conclusions : Peruvian physicians consider economic and academic reasons as the most important ones, when choosing a specialty, in a context where primary care specialties had few applicants. This allows us to better understand the process behind choosing and specialty, adequately inform to the physicians about the specialties available, and promote strategies to increase the interest of doctors in specialties needed in the country.

Quality of clinical practice guidelines approved in Peru between 2015 and 2017 / Calidad de las guías de práctica clínica aprobadas en Perú entre 2015 y 2017

Abstract Introduction: The diagnosis and management of patients with the same medical condition may vary significantly depending on the treating physician. Clinical practice guidelines (CPG) are used to reduce this variation and to promote evidence-based management in clinical practice. Objectives: To describe the characteristics of the CPGs adopted by public health institutions in Peru from July 2015 to September 2017. Materials and methods: Cross-sectional, descriptive study. The following quality criteria were assessed in each CPG: the panel of experts responsible for the development of the CPG; protocols regarding the evidence identification, collection and assessment systems; and the level of evidence supporting each recommendation. Results: 558 CPGs were included, of which 65.8% did not provide information on having an explicit author or only listed one author. In addition, 81.5% did not have citations, nor a reference list, and 97.7% did not clearly provide supporting evidence on how the recommendations were reached. Conclusions: Most of the CPGs did not meet the quality criteria assessed in the present study, thus it is necessary to improve the skills of Peruvian health professionals to develop quality CPGs that adjust to their local context.

Resumen Introducción. El diagnóstico y el manejo de pacientes con la misma condición médica pueden variar de manera significativa de profesional a profesional. Una manera de controlar esta variación y promover un manejo basado en evidencias es mediante el uso de guías de práctica clínica (GPC). Objetivos. Describir las características de las GPC aprobadas por entidades públicas de salud de Perú entre julio de 2015 y setiembre de 2017. Materiales y métodos. Se realizó un estudio transversal descriptivo donde se evaluaron los siguientes criterios de calidad de las GPC: panel de expertos que elaboró la guía; protocolos respecto a los sistemas de identificación, recogida y evaluación de la evidencia, y nivel de evidencia que sustenta cada recomendación. Resultados. Se incluyeron 558 GPC, de las cuales 65.8% no contaba con autor explícito o solo describía un autor y no una lista, 81.5% no contaba con citas ni referencias bibliográficas y 97.7% no sustentaba de forma clara la elaboración de sus recomendaciones. Conclusiones. La mayoría de las GPC no cumplieron los criterios de calidad evaluados en el presente estudio, por tanto es necesario mejorar las habilidades de los profesionales de la salud en Perú para elaborar GPC de calidad.

Asociación entre índice de ruralidad y satisfacción laboral en médicos y enfermeros de Perú / Association between the rurality index and work satisfaction in Peruvian physicians and nurses

Introducción: La satisfacción laboral en el contexto de la salud es importante porque su ausencia se asocia a trastornos mentales o psicosociales e influye de forma negativa en los servicios prestados, en el bienestar del paciente y disminuyen el rendimiento del sistema de salud. Objetivo: Evaluar la asociación entre el índice de ruralidad del distrito donde se ubica el establecimiento de salud y la satisfacción laboral en médicos y enfermeros que laboran en estos establecimientos en Perú. Métodos: Se realizó un análisis secundario de la Encuesta Nacional de Satisfacción de Usuarios en Salud, 2016. Esta encuesta se realizó a 5098 profesionales de la salud, el 43,5 por ciento eran médicos La ruralidad fue medida como la densidad poblacional (habitantes/km2) del distrito donde se ubica el establecimiento de salud. Para evaluar la asociación de interés, se utilizó un modelo lineal generalizado de la familia de Poisson para estimar razones de prevalencia crudas y ajustadas. Resultados: El porcentaje de médicos y enfermeros con satisfacción laboral fue de 75,1 por ciento y 76,7 por ciento, respectivamente. Entre los médicos no se encontró asociación entre el índice de ruralidad y satisfacción laboral en el modelo crudo (1,01 IC 95 por ciento: 0,96 a 1,05) ni ajustado (1,01 IC 95 por ciento: 0,97 a 1,05). En enfermeros tampoco se encontró asociación en el modelo crudo (98 IC 95 por ciento: 0,95 a 1,00) ni ajustado (0,97 IC 95 por ciento: 0,93 a 1,00). Se encontró asociación entre la satisfacción con ciertas características laborales y el índice de ruralidad. Conclusiones: Se evidencia que no existe asociación entre la satisfacción laboral del personal de salud y el índice de ruralidad del distrito donde se ubica el establecimiento de salud(AU)

ABSTRACT Introduction: Work satisfaction in the health context is important because its absence is associated with mental or psychosocial disorders and adversely affects the services provided, the well-being of the patient and also decrease the performance of the health system. Objective: To assess the association between the rurality index of the district where it is located the health institution and the work satisfaction in doctors and nurses working in these institutions in Peru. Methods: It was made a secondary analysis of the National Survey of Health Users Satisfaction, 2016. This survey was conducted to 5098 health professionals, 43.5 percent of them were physicians. Rurality was measured as population density (inhabitants/km2) of the district where the health facility is. To evaluate the association of interest, it was used a Poisson´s generalized linear model of the family to estimate crude and adjusted prevalence ratios. Results: The percentage of doctors and nurses with work satisfaction was 75.1 percent and 76.7 percent, respectively. Among the physicians no association was found between the rurality index and job satisfaction in the crude model (1.01 CI 95 percent: 0.96 1.05 to 1.05) nor the adjusted one (1,01 IC 95 percent: 0.97 to 1.05). In nurses association was not found in the crude model (98 CI 95 percent: 0.95 to 1.00) nor in the adjusted one (0.97 IC 95 percent: 0.93 to 1.00). An association was found between satisfaction with certain characteristics and the rurality index. Conclusions: There is evidence that there is no association between work satisfaction of health personnel and the rurality index of the district where the health facility is(AU)

Guía de práctica clínica para el tamizaje y manejo del episodio depresivo leve en el primer nivel de atención del Seguro Social del Perú (EsSalud) / Clinical practice guideline for the screening and management of the mild depressive episode at the first level of care for the Peruvian Social Security (EsSalud)

El presente artículo resume la guía de práctica clínica (GPC) para el tamizaje y el manejo del episodio depresivo leve en el primer nivel de atención en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló 06 preguntas clínicas. Para responder cada pregunta se realizó búsquedas sistemáticas en PubMed y en repositorios de GPC, y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron siete recomendaciones (tres fuertes y cuatro condicionales), 28 puntos de buena práctica clínica, y dos flujogramas.

This paper summarizes the clinical practice guide (CPG) for the screening and management of mild depressive episode at the first level of care in the Social Security of Peru (EsSalud). A guideline development group (GDG) was established for develop this CPG, which included clinical and methodology specialists, who formulated 06 clinical questions. Systematic searches were conducted in Pubmed and GPC repositories to answer each question, and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology for reviewing the evidence and for developing recommendations. At the end, this CPG formulated 07 recommendations (03 strong and 04 conditional), 28 points of good clinical practice, and 02 flow charts were formulated.

Autoría de regalo: una aproximación a su frecuencia en una revista peruana / Gift authorship: An approach to its frequency in a Peruvian journal

Resumen Introducción. La autoría injustificada o 'autoría de regalo' es una práctica inadecuada que consiste en nombrar como autores a personas que no cumplen los criterios de autoría. Los informes de investigaciones científicas suelen ser publicados como artículos originales en revistas científicas y pueden presentar estas prácticas inadecuadas. Objetivos. Determinar la prevalencia de autoría de regalo en publicaciones de artículos originales. Materiales y métodos. Se trata de un estudio descriptivo en el cual se revisó la sección de contribuciones de autoría de todos los artículos publicados en una revista peruana desde enero de 2013 hasta marzo de 2017. Se consideró una autoría de regalo cuando un autor no cumplía con, al menos, uno de los criterios establecidos por el International Committee of Medical Journal Editors (ICMJE). Resultados. De los 209 artículos originales publicados, 11 fueron excluidos debido a que no reportaron las contribuciones de autoría. La prevalencia de autoría de regalo de los 198 artículos incluidos fue de 106 (53,5 %). Los criterios que menos cumplieron fueron la aprobación final del manuscrito (23,2 %), y su redacción y revisión crítica (16,8 %). Conclusiones. Es necesario que las instituciones educativas capaciten a los investigadores para que discriminen entre autoría y contribución. Además, es necesario que las revistas soliciten y corroboren las contribuciones reportadas.

Abstract Introduction: Unjustified authorship or "gift authorship" is an inadequate practice of authorship that consists of naming as authors people who do not meet the authorship criteria. Reports of scientific research are often published as original articles in scientific journals and may present these inappropriate practices. Objective: Determine the prevalence of gift authorship in original articles for publication. Materials and methods:. Descriptive study in which the authorship contributions section of all the articles published between 2013 and the first quarter of 2017 in a Peruvian magazine was reviewed. Gift authorship was considered when an author did not meet at least one of the criteria established by the International Committee of Medical Journal Editors (ICMJE). Results: Of the 209 original articles published, 11 were excluded because they did not report authorship contributions. The prevalence of gift authorship was 53.5% (106). The critreria least met were the final approval of the manuscript (23.2%) and the writing and critical review of this manuscript. (16.8%). Conclusions: It is necessary that educational institutions train researchers to distinguish between authorship and contribution. In addition, it is necessary that the journals request and corroborate the reported contributions.

Training opportunities for noncommunicable diseases research in Latin America: A scoping review

[ABSTRACT]. Objective. To identify gaps in postgraduate training and options for building capacity in noncommunicable disease (NCDs) research in Latin America. Methods. This was a scoping review of postgraduate opportunities in NCDs at top universities in Latin America and of training grants awarded by international funding bodies. Three global university rankings were considered—the QS Ranking, the Shanghai Ranking, and the Times Ranking. Latin American universities appearing in at least two of these were selected. University websites were searched for current graduate programs in biostatistics, epidemiology, global health, health economics, and public health. Information was extracted, summarized, and evaluated to identify any programs focused on NCDs. In addition, seven international funding bodies’ websites were searched for training grants. Results. In all, 33 universities offering 72 postgraduate programs met the inclusion criteria. One of these programs was exclusively devoted to NCD, and 12 offered NCDs as a dissertation research topic. Only two training grants were awarded to a Latin American institution for NCD capacity building. There are few NCD research training programs in Latin America and only one program exclusively focused on NCDs. Conclusion. There seem to be few NCD-specific research training programs in Latin America. Leveraging existing programs and expanding those with a focus on NCDs could help enhance NCD research capacity in the region. These initiatives should be supported by international funding agencies through more funding opportunities.

[RESUMEN]. las capacidades de investigación sobre enfermedades no transmisibles (ENT) en América Latina. Métodos. Se realizó una revisión exploratoria de los programas de posgrado sobre las ENT disponibles en las mejores universidades de América Latina y de las becas para investigadores otorgadas por los organismos internacionales de financiamiento. Se consideraron tres listas de clasificación académica de universidades del mundo: QS Ranking, Shanghai Ranking y Times Ranking. Se seleccionaron las universidades de América Latina que figuraban en al menos dos de ellas. Se utilizaron los sitios web de las universidades para buscar los programas de posgrado actuales en las áreas de bioestadística, epidemiología, salud mundial, economía de la salud y salud pública. La información se extrajo, se resumió y se evaluó para encontrar todos los programas centrados en las ENT. Además, se realizó una búsqueda de las becas de formación ofrecidas en los sitios web de siete organismos internacionales de financiamiento. Resultados. En total, 33 universidades que ofrecían 72 programas de posgrado reunieron los criterios de inclusión. Uno de estos programas estaba exclusivamente dedicado a las ENT, y doce incluían las ENT como tema de investigación en tesis de grado. Solo dos becas de formación fueron otorgadas a una institución latinoamericana para fortalecer las capacidades de investigación sobre las ENT. Existen pocos programas para la formación de investigadores sobre las ENT en América Latina y hay un solo programa exclusivamente centrado en las ENT. Conclusiones. Al parecer, hay pocos programas específicos para la formación de investigadores sobre las ENT en América Latina. Aprovechar mejor los programas existentes y ampliar aquellos que se centran en las ENT podría ayudar a aumentar las capacidades de investigación sobre ENT en la región. Estas iniciativas deben contar con el apoyo de los organismos internacionales de financiamiento mediante el aumento de las oportunidades de financiamiento.

[RESUMO]. Objetivo. Identificar lacunas no ensino de pós-graduação e cursos de formação em pesquisa em doenças não transmissíveis na América Latina. Métodos. Trata-se de uma revisão da literatura do tipo scoping review das oportunidades de pós-graduação em doenças não transmissíveis nas principais universidades da América Latina e das bolsas de estudo oferecidas por organismos internacionais de financiamento. O estudo se baseou em três rankings mundiais de universidades – QS Ranking, Ranking de Xangai e The Times Higher Education World University Ranking – e as universidades latino-americanas que figuravam em pelo menos dois destes rankings foram incluídas na análise. Nos sites das universidades, foi feito um levantamento dos cursos atuais de pós-graduação em bioestatística, epidemiologia, saúde global, economia da saúde e saúde pública. As informações obtidas foram sumarizadas e avaliadas para identificar os cursos em doenças não transmissíveis. Além disso, nos sites de sete organismos internacionais de financiamento, foi feita uma pesquisa das bolsas de estudo oferecidas. Resultados. Ao todo, 33 universidades com 72 cursos de pós-graduação atenderam os critérios de inclusão no estudo. Verificou-se que um curso tinha foco exclusivo no estudo de doenças não transmissíveis e 12 cursos tinham doenças não transmissíveis como tópico de pesquisa de dissertação. Foram concedidas somente duas bolsas de estudo em doenças não transmissíveis a uma instituição latino-americana. Observou-se um pequeno número de programas de formação em pesquisa de doenças não transmissíveis na América Latina, com apenas um programa com foco exclusivo nestas doenças. Conclusões. Existem poucos programas de formação em pesquisa especificamente dedicados ao estudo de doenças não transmissíveis na América Latina. Faz-se necessário tirar proveito dos programas existentes e ampliar os programas com foco em doenças não transmissíveis para melhorar a capacidade de pesquisa em doenças não transmissíveis na Região. Essas iniciativas devem receber o apoio de organismos internacionais com maior oferta de bolsas de estudo.

Tendencias en el número de médicos titulados anualmente en el Perú, 2007-2016 / Trends in the number of physicians annually graduating in Peru, 2007-2016

Objetivo: Describir la tendencia en el número de médicos que se titularon durante el periodo 2007-2016 en Perú, en forma general y en subgrupos de acuerdo a las características ligadas a la universidad en la que cursaron los estudios de pregrado. Materiales y métodos: Estudio descriptivo. Se obtuvo el listado de todos los médicos colegiados entre 2007-2016 por medio de la página web del Colegio Médico del Perú; mientras que la fecha de titulación y universidad de procedencia provino de la página web de la Superintendencia Nacional de Educación Superior Universitaria (SUNEDU). Para evaluar las tendencias, se utilizó la prueba de correlación de Spearman. Resultados: En el periodo de estudio se colegiaron 27 611 médicos a nivel nacional, con una tendencia anual creciente en la cantidad de médicos titulados (p<0,001). Entre los egresados de universidades peruanas, se encontró un incremento del número de médicos que estudiaron en universidades de Lima (p<0,001) y de la región costa (p<0,001). Adicionalmente, se evidenció un incremento en la cantidad de titulados provenientes de universidades privadas de Lima (p<0,001) y de provincias (p<0,001). Conclusiones: El número de médicos titulados aumenta anualmente, con predominio de aquellos provenientes de universidades de Lima, la costa y universidades privadas. Se evidencia la necesidad urgente de políticas que regulen este crecimiento, con la finalidad de evitar problemas de calidad educativa y empleabilidad.

Objective. To describe the trends in the number of physicians who graduated from 2007 to 2016 in Peru, both in a general manner as well as in subgroups based on the school they studied. Materials and Methods. This is a descriptive and retrospective study. A list of all physicians who graduated during the 2007-2016 period was obtained from the Peruvian College of Physicians website. Their graduating dates and the schools where they studied were obtained from the National University Education Superintendence (SUNEDU, according to its Spanish initials). Trends were assessed using the Spearman correlation test. Results: During the study period, 27,611 physicians graduated in Peru. There was an annual increase in the total number of graduates (p<0.001). Amongst graduates from Peruvian medical schools, there was an increase in the number of physicians who studied in Lima (p<0.001) and in the Peruvian coast (p<0.001). Also, there were a greater number of graduated physicians from Lima (p<0.001) and other provinces medical schools (p<0.001). Conclusions. The number of graduated physicians annually increases, particularly those who studied in Lima, the coast, and private medical schools. We evidence an urgent need for policies for regulating this growth, aiming to avoid employability and educational quality problems.

Aspectos básicos sobre la lectura de revisiones sistemáticas y la interpretación de meta-análisis / Some basic concepts about reading systematic reviews and interpreting meta-analysis

Las revisiones sistemáticas (RS) son estudios que buscan resumir la evidencia disponible sobre una pregunta de investigación, para lo cual pueden usar estrategias estadísticas conocidas como meta-análisis (MA). En la actualidad, las RS son fundamentales para tomar decisiones basadas en evidencias, por lo cual resulta de suma importancia que los profesionales de la salud sepan enfrentarse a este tipo de estudios. Por ello, el presente artículo tiene por objetivo familiarizar al lector con los aspectos básicos para realizar una correcta lectura de RS e interpretación de MA, para lo cual se utiliza un ejemplo hipotético de una condición ficticia llamada "Síndrome del glotón". Asimismo, se aborda la interpretación de la certeza de la evidencia según la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Systematic reviews (SR) are studies that seek to summarize the available evidence regarding a research question, for which they can use statistical strategies known as meta-analysis (MA). Currently, SRs are fundamental to making evidence-based decisions, which is why it is very important for health professionals to know how to face this type of studies. Therefore, this article aims to familiarize the reader with the basic concepts to make a correct appraisal of SRs and interpretation of MAs, for which a hypothetical example of a fictitious condition called "Glutton Syndrome" is used. In addition, the interpretation of the certainty of the evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology is addressed.

Guía de práctica clínica para el diagnóstico y manejo de la osteoartritis en el Seguro Social del Perú (EsSalud) / Clinical practice guidelines for the diagnosis and management of osteoarthritis in Peruvian Social Security (EsSalud)

Este artículo resume la guía de práctica clínica (GPC) para el diagnóstico y manejo de pacientes con osteoartritis (OA) del Seguro Social del Perú (EsSalud). Para su desarrollo se conformó un grupo elaborador de la guía (GEG) que incluyó a especialistas clínicos y metodólogos. Para responder las 13 preguntas clínicas planteadas se realizaron búsquedas sistemáticas en PubMed y repositorios de GPC. Se usó la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE) para evaluar la certeza de la evidencia. Se emitieron 11 recomendaciones: tres fuertes (no solicitar de forma rutinaria radiografías para el diagnóstico de OA, brindar un plan individualizado de medidas de educación y autocuidado, indicar la realización de ejercicio físico) y ocho débiles (intervenciones para reducir el peso en personas con obesidad o sobrepeso, evitar el uso de paracetamol para el manejo de OA, promover el uso de AINE orales para el manejo de OA, evitar el uso de condroitín sulfato para el manejo de OA, evitar el uso de proloterapia para el manejo de OA, en adultos con OA y dolor refractario a manejo farmacológico considerar terapias adyuvantes como ultrasonido o similares, evitar el uso de terapia laser como adyuvante para el manejo de OA, evitar el uso de acupuntura para el manejo de OA); además, 20 puntos de buena práctica clínica y un flujograma de trabajo.

This paper summarizes the clinical practice guideline (CPG) for the diagnosis and management of patients with osteoarthritis (OA) in the Peruvian Social Security health system (EsSalud). A working group was formed for producing this guideline, and this group included both clinical specialists and methodologists. Systematic searches in PubMed and CPG repositories were performed aiming to answer the 13 clinical questions that were asked. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method was used aiming to determine the certainty of evidence. Eleven recommendations were issued: three were strong (do not request X-ray films as routine practice, give an individualized plan including educational and self-care measures, and prescribe physical activity; and eight were weak (weight-reducing interventions for persons with obesity or who are overweight, avoid the use of paracetamol for OA management, promote the use of oral non-steroidal anti-inflammatory drugs for OA management, avoid the use of chondroitin sulfate for OA management, avoid the use of prolotherapy for OA management in affected adults, particularly in those with refractory pain not responding to drug therapy, consider the use of adjuvant therapy, such as ultrasound and the like, avoid the use of laser therapies as adjuvant for OA management, and avoid the use of acupuncture for OA management); also, 20 items for good clinical practice and a workflow sheet were issued.

Guía de práctica clínica para la prevención y manejo del parto pretérmino en el Seguro Social del Perú (EsSalud), 2018 / Peruvian Social Security (EsSalud) 2018 Clinical Practice Guidelines for prevention and management of preterm births

El presente artículo resume la guía de práctica clínica (GPC) para la prevención y manejo del parto pretérmino en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló 11 preguntas clínicas. Para responder cada pregunta se realizó búsquedas sistemáticas en Pubmed y en repositorios de GPC, y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron 20 recomendaciones (13 fuertes y 7 condicionales), 24 puntos de buena práctica clínica, una recomendación de implementación y un flujograma.

This paper features a summary of the Peruvian Social Security (EsSalud) Clinical Practice Guidelines (CPG) for prevention and management of preterm birth. A specialized group was formed for writing this CPG, which included clinical and methodology specialists, who formulated 11 clinical questions. Systematic searches in PubMed and CPG repositories were performed aiming to answer the questions, and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In regular work meetings, the specialized group used the GRADE approach for reviewing the evidence and for developing recommendations. At the end, this CPG formulated twenty recommendations (13 strong and 7 conditional), 24 good clinical practice points, one recommendation for implementation, and a flowchart.

Guía de práctica clínica para el manejo de pacientes con fibrilación auricular en el Seguro Social del Perú (EsSalud)

Introducción. El presente artículo resume la guía de práctica clínica (GPC) para el manejo de pacientes con fibrilación auricular (FA) en el Seguro Social del Perú (EsSalud). Objetivo. Proveer recomendaciones clínicas basadas en evidencia para el manejo de pacientes con FA en EsSalud. Métodos. Se conformó un grupo elaborador (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 9 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y, cuando fue considerado pertinente, estudios primarios en Medline durante el 2017. 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 los flujogramas de la GPC. Finalmente, la GPC fue aprobada con Resolución N° 91 - IETSI - ESSALUD - 2018. Resultados. La presente GPC abordó 9 preguntas clínicas, divididas en tres temas: prevención de eventos tromboembólicos, estrategias de control y manejo de FA en emergencias. En base a dichas preguntas se formularon 12 recomendaciones (6 recomendaciones fuertes y 6 recomendaciones condicionales), 29 puntos de buena práctica clínica, y 2 algoritmos. Conclusión. El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para manejo de pacientes con FA en EsSalud.

This article summarizes the clinical practice guide (CPG) for the management of patients with atrial fibrillation (AF) in the Social Security of Peru (EsSalud). Objective. To provide clinical recommendations based on evidence for the management of patients with AF in EsSalud. Methods. A CPG for the management of patients with AF in EsSalud was developed. To this end, a guideline development group (GDG) was established, including medical specialists and methodologists. The GDG formulated 9 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and, when it was considered pertinent, primary studies were conducted in Medline during 2017. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and the flowchart of the CPG. Finally, the CPG was approved with Resolution No. 91 - IETSI - ESSALUD - 2018. Results. This CPG addressed 9 clinical questions, divided into three topics: prevention of thromboembolic events, maintenance therapy and management of AF. Based on these questions, 12 recommendations (6 strong recommendations and 6 weak recommendations), 29 points of good clinical practice, and 2 algorithms were formulated. Conclusion. This article summarizes the methodology and evidence-based conclusions from the CPG for the management of AF in EsSalud.