ABSTRACT
BACKGROUND@#Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE).@*METHODS@#This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE.@*RESULTS@#This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively.@*CONCLUSIONS@#Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.
ABSTRACT
There are multiple proposals and classifications that hierarchize evidence, which may confuse those who are dedicated to generate it both in health technology assessments, as for the development of clinical guidelines, etc. The aim of this manuscript is to describe the most commonly used classifications of levels of evidence and grades of recommendation, analyzing their main differences and applications so that the user can choose the one that better suits your needs and take this health decisions basing their practice on the best available evidence. A systematic literature search was performed in PubMed and MEDLINE databases and in Google, Yahoo and Ixquick search engines. A wealth of information concerning levels of evidence and degrees recommendation was obtained. It was summarized the information of the 11 proposals more currently used (CTFPHC, Sackett, USPSTF, CEBM, GRADE, SIGN, NICE, NHMRC, PCCRP, ADA y ACCF/AHA), between which it emphasizes the GRADE WORKING GROUP, incorporated by around 90 national and international organizations such as the World Health Organization, The Cochrane Library, American College of Physicians, American Thoracic Society, UpToDate, etc.; and locally by the Ministry of Health to create clinical practice guidelines.
Existen múltiples propuestas y clasificaciones que jerarquizan la evidencia, que pueden confundir a quienes se dedican a generar la evidencia tanto en evaluaciones de tecnología sanitaria, elaboración de guías clínicas, etc. El objetivo de este artículo es actualizar la información y describir las clasificaciones más utilizadas para valorar la evidencia en el ámbito de la salud, analizando sus principales diferencias y aplicaciones para que el usuario pueda elegir la que mejor se adapte a sus necesidades y tomar de este modo decisiones sanitarias basando su práctica en la mejor evidencia disponible. Se realizó una búsqueda sistemática de la literatura en las bases de datos PubMed y MEDLINE y en los buscadores Google, Yahoo e Ixquick. Se obtuvo una gran cantidad de información referente a niveles de evidencia y grados de recomendación, para finalmente resumir la información de 11 de las propuestas más utilizadas en la actualidad (CTFPHC, Sackett, USPSTF, CEBM, GRADE, SIGN, NICE, NHMRC, PCCRP, ADA y ACCF/AHA), entre las que destaca la del GRADE WORKING GROUP, incorporada por alrededor de 90 organizaciones nacionales e internacionales, tales como la World Health Organization, The Cochrane Library, American College of Physicians, American Thoracic Society, UpToDate, etc. y a nivel local por el Ministerio de Salud, para generar guías de práctica clínica.