[Are the guidelines guiding us reliable? Evaluation of the Spanish clinical practice guidelines]. / Las guías que nos guían son fiables? Evaluación de las guías de práctica clínica españolas.

BACKGROUND AND OBJECTIVE: There is a large proliferation of clinical practice guidelines (CPG), there being doubts on inconsistencies between the recommendations made and internal incongruencies, that affect the role of the guidelines as instruments helping the clinicians. This study aims to analyze the quality of a group of Spanish CPG and to assess the feasibility of use and consistency of the AGREE Instrument in its Spanish version, designed to evaluate the CPG. METHOD: A total of 278 CPG produced in Spain between January 1990 and December 2002 were identified. The originals of 61 guidelines were recovered from their authors and passed to the AGREE Instrument independently by four raters. Quality of the guidelines feasibility and reproducibility of AGREE were analyzed. RESULTS: For all the attributes of AGREE except in the editorial independence, more than 60% of the guidelines evaluated obtained a poor quality score, there being no domain in which more than 10% of the guidelines was excellent. The worst grading areas are those of applicability, participation and rigour of development of the guidelines. Of the 61 guidelines evaluated, the reviewers graded 25 as "very poor quality", 26 as "non recommendable" and 6 and 4 as "recommendable" or "highly recommendable", respectively. Interrater consistency was high. CONCLUSIONS: The mean quality of the Spanish guidelines evaluated is very low. The AGREE Instrument in its Spanish version is consistent for the Spanish guidelines and easy to use.

¿Las guías que nos guían son fiables? Evaluación de las guías de práctica clínica españolas / Are the guidelines guiding us reliable? Evaluation of the Spanish clinical practice guidelines

Fundamento y objetivo. Hay gran proliferación de guías de práctica clínica (GPC), existiendo dudas sobre inconsistencias entre las recomendaciones que realizan e incongruencias internas que comprometen el papel de las guías como instrumentos de ayuda a los clínicos. El estudio pretende analizar la calidad de un conjunto de GPC españolas, así como valorar la factibilidad de uso y consistencia del Instrumento AGREE en su versión en español, diseñado para la evaluación de GPC. Método. Se identificaron 278 GPC producidas en España entre enero de 1990 y diciembre del 2002. Se recuperaron, mediante solicitud a sus autores, originales de 61 guías a las que se pasó el Instrumento AGREE de forma independiente por cuatro evaluadores. Se analizó la calidad de las guías, la factibilidad y reproducibilidad del AGREE. Resultados. Para todos los atributos del AGREE, excepto en la independencia editorial, más del 60% de las guías evaluadas obtienen una puntuación de mala calidad, no habiendo ningún dominio en el que más del 10% de las guías sea excelente. Las áreas de peor calificación son las de aplicabilidad, participación y rigor en el desarrollo de las guías. De las 61 guías evaluadas, los revisores a 25 las califican de «muy poco recomendables», a 26 de «no recomendables» y tan sólo a 6 y 4 guías como «recomendables» o «muy recomendables», respectivamente. La consistencia entre evaluadores fue alta. Conclusiones. La calidad media de las guías españolas evaluadas es muy baja. El Instrumento AGREE, en su versión en español es consistente para las guías españolas y de uso fácil

Background and objective. There is a large proliferation of clinical practice guidelines (CPG), there being doubts on inconsistencies between the recommendations made and internal incongruencies, that affect the role of the guidelines as instruments helping the clinicians. This study aims to analyze the quality of a group of Spanish CPG and to assess the feasibility of use and consistence of the AGREE Instrument in its Spanish version, designed to evaluate the CPG. Method. A total of 278 CPG produced in Spain between Jannuary 1990 and December 2002 were identified. The originals of 61 guidelines were recovered from their authors and passed to the AGREE Instrument independently by four raters. Quality of the quidelines feasibility and reproducibility of AGREE were analyzed. Results. For all the attributes of AGREE except in the editorial independence, more than 60% of the guidelines evaluated obtained a poor quality score, there being no domain in which more than 10% of the guidelines was excellent. The worst grading areas are those of applicability, participation and rigour of development of the guidelines. Of the 61 guidelines evaluated, the reviewers graded 25 as «very poor quality», 26 as «non recommendable» and 6 and 4 as «recommendable» or «highly recommendable», respectively. Interrater consistency was high. Conclusions. The mean quality of the Spanish guidelines evaluated is very low. The AGREE Instrument in its Spanish version is consistent for the Spanish guidelines and easy to use

[Analysis of the scales of measures, the efficacy of the treatments and the health/social impact of Alzheimer disease in the Basque Country, Spain]. / Análisis de las escalas de medición, eficacia de los tratamientos e impacto sociosanitario de la enfermedad de Alzheimer en el País Vasco.

BACKGROUND: The purpose of this study is to review the clinical analyses regarding efficacy of the different drugs used in the treatment of Alzheimer, across distinct scales of measures in order out the progression of the Alzheimer's Disease (AD). Along with this an economic analysis of the health/social impact of this illness in the Basque Country has been carried out. METHODS: A selection and synthesis of the relevant scientific evidence was made by means of a bibliographical research in the main data bases (Medline, Embase, Cross, Iowa Drug Information System, Healthstar and The Cochrane Library). The value of the costs was carried out from a social perspective. During 1998 a health social costs analysis of this pathology was undertaken in the Basque Country, Spain, starting from a table of assumptions. RESULTS: ADAS and PDS are the only cognitive and functional scales developed and validated specifically for the AD. The drugs specifically prescribed for the AD (tacrine, donepezil, and revastigmine) contribute a slight benefit, whose clinical meaning is unknown. During 1998 the global cost of treating the AD in the Basque Country has been at least 55,858 million pesetas (US$ 360.5 millions dollars). The social cost (nursing homes, day centres, home help, help from family and friends) comes to represent 98.4% of this global cost. CONCLUSIONS: At the moment, there is not any effective drug in the treatment of the AD. The informal cost (help from family and friends) comes to represent 88.4% of the total social costs.

[The International Network of Agencies for Health Technology Assessment (INAHTA) or the need for collaboration in evaluating health technologies]. / International Network of Agencies for Health Technology Assessment (INAHTA) o la necesidad de colaboración en evaluación de tecnologías sanitarias.

Given the current situation of globalization, rapidity of changes and open market, the problems in the health care sector also go beyond the local boundary. Thus, it is frequent for different health systems to have similar evaluation needs. The assessment reports are among the main tools that assessment agencies use to communicate with the health care professionals and policy makers in any responsibility: politics, management, or clinical care. Occasionally different evaluation teams have to deal with similar topics. It is in this context, with the aim to avoid duplicity and to join efforts, that the idea of collaboration within assessment agencies started, with an obvious benefit to all of them. The International Network of Agencies for Health Technology Assessment (INAHTA) was created with the aim of serving as a forum to identify common interests of agencies for health technology assessment. In these five years, a lot of activities and important outcomes have been achieved. Among others, we can mention the implementation of data bases with all the information produced by the member agencies, the establishment of an Internet Web site, the periodical publication of the newsletter, the joint assessment projects and the collaboration with developing countries. New projects for the future are currently under discussion.

[The indications for the appropriate use of magnetic resonance. The Health Technologies Evaluation Service of the Department of Health of the Basque Government, Osteba]. / Indicaciones de uso apropiado de resonancia magnética. Servicio de Evaluación de Technologías Sanitarias del Departamento de Sanidad del Gobierno Vasco, Osteba.

Magnetic resonance imaging (MRI) allows the non-invasive obtention of diagnostic images, with no ionizing radiation emission and in any space plane. It has a great capacity to differentiate anatomic structures, and it is very useful for planning surgery or radiotherapy. It is the first choice diagnostic technique in conditions involving the central nervous system, useful for establishing diagnosis, surgery planning, and following lesions involving the spinal cord and spine. In the musculoskeletal system it may become and appropriate alternative to arthroscopy. Nevertheless, it is of limited use for the diagnosis of chest, abdominal and pelvic pathology.