Browsing by Author "Munoz, Cecilia"

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    Clinical guidelines using the GRADE system (Grading of Recommendations Assessment, Development and Evaluation)
    (SOC MEDICA SANTIAGO, 2017) Mendoza, Carolina; Kraemer, Patricia; Herrera, Paloma; Burdiles, Pamela; Sepulveda, Dino; Nunez, Eliozka; Munoz, Cecilia; Neumann, Ignacio
    The Ministry of Health of Chile, aiming to improve the quality of clinical practice guidelines, gradually incorporated the GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) to develop evidence based recommendations. This system summarizes and evaluates the certainty of the available evidence. It moves from evidence to decision in a systematic and transparent manner, based on four main dimensions: balance between benefits and harms, certainty of evidence, patient's values and preferences and use of resources. The GRADE system produces strong and conditional recommendations. Strong recommendations provide confidence that the favorable consequences of an intervention clearly outweigh the adverse consequences, or vice versa. These recommendations apply to a broad range of patients and circumstances. Conditional recommendations, however, indicate that there is a close balance between favorable and unfavorable consequences of the intervention, there is uncertainty in the magnitude of benefits or adverse effects, there is uncertainty or variability in values and preferences of individuals or costs are not justified. These recommendations apply to many patients, but not all of them: ideally they should be discussed with each person. To achieve a better implementation of the recommendations made with GRADE methodology, health professionals should know the meaning of strong and conditional recommendations and they should be able to critically assess of them.
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    Pelvic intravenous leiomyomatosis with intracardiac extension. Report of two cases
    (SOC MEDICA SANTIAGO, 2012) Mertens, Renato; Valdes, Francisco; Munoz, Cecilia; Irarrazaval, Manuel; Branes, Jorge; Riquelme, Carlos; Marine, Leopoldo; Bergoeing, Michel; Kraemer, Albrecht
    Intravenous leiomyomatosis with extension into the heart is an infrequent entity described in 1907. Its clinical presentation is non-specific, although cardiac symptoms predominate. Diagnosis is based on clinical findings and appropriate imaging. We report two females, aged 35 and 51 years. One of them presented with a pelvic mass and dyspnea, the other patient had severe cardiac failure on admission. Computed axial tomography scan allowed an accurate preoperative diagnosis on both patients. Successful one stage resection of the tumor was performed under cardiopulmonary bypass. Both patients are asymptomatic on follow up at 6 months and 25 years. (Rev Med Chile 2012; 140: 906-909).