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  1. Home
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Browsing by Author "Sepulveda, Dino"

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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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    CONSTRUCCIÓN Y VALIDACIÓN GUÍA PARA LAS BUENAS PRÁCTICAS DE COMUNICACIÓN DE RIESGO DURANTE CRISIS SANITARIAS
    (Pontificia Universidad Católica de Chile. Escuela de Enfermería, 2024) Dois C., Angelina M.; Fernández-González, Loreto; Martínez-Pereira, Alejandra; Villarroel del Pino, Luis A.; Russo, Moisés; Sepulveda, Dino; Bravo, Paulina
    © 2024, Escuela de Enfermeria Pontificia Universidad Catolica de Chile. All rights reserved.INTRODUCTION. The COVID-19 pandemic evidenced the need for effective risk communication strategies that promote informed community decision making. OBJECTIVE. to describe the construction and validation process by experts of a Guideline for Best Practice for Risk Communication during a health crisis (GBP-RC) in the Chilean context. METHODS. A multi methods study and validity study was carried out for the evaluation elements of the guideline. RESULTS. A GBP-RC was built that addresses central theoretical contents on risk communication (RC), ways of institutionalizing the strategy, its approach, and analysis of the implementation context. It includes recommendations on how to build, transmit and evaluate the message for an effective RC and rubrics to assess three central aspects of the CONCLUSION. The first Guideline for Best Practices for Risk Communication was built during a health crisis based on evidence and adjusted to the local reality.
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    High Burden of Intestinal Colonization With Antimicrobial-Resistant Bacteria in Chile: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
    (2023) Araos, Rafael; Smith, Rachel M.; Styczynski, Ashley; Sánchez Barría, Felipe Andrés; Acevedo, Johanna; Maureira, Lea; Paredes, Catalina; Gonzalez, Maite; Rivas, Lina; Spencer-Sandino, Maria; Peters, Anne; Khan, Ayesha; Sepulveda, Dino; Rojas Wettig, Loreto; Rioseco, Maria Luisa; Usedo, Pedro; Rojas Soto, Pamela; Huidobro, Laura Andrea; Ferreccio Readi, Catterina; Park, Benjamin J.; Undurraga Fourcade, Eduardo Andrés; D'Agata, Erika M. C.; Jara Vallejos, Alejandro Antonio; Munita, Jose M.
    We report a high colonization burden resulting from antimicrobial-resistant Gram-negative bacteria in hospitals and a community in Chile. Strikingly, 29% (95% confidence interval, 24-34) of community-dwelling adults carried extended-spectrum cephalosporin-resistant Enterobacterales, highlighting the magnitude of the community reservoir of antimicrobial resistance., Background Antimicrobial resistance is a global threat, heavily impacting low- and middle-income countries. This study estimated antimicrobial-resistant gram-negative bacteria (GNB) fecal colonization prevalence in hospitalized and community-dwelling adults in Chile before the coronavirus disease 2019 pandemic. Methods From December 2018 to May 2019, we enrolled hospitalized adults in 4 public hospitals and community dwellers from central Chile, who provided fecal specimens and epidemiological information. Samples were plated onto MacConkey agar with ciprofloxacin or ceftazidime added. All recovered morphotypes were identified and characterized according to the following phenotypes: fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR; as per Centers for Disease Control and Prevention criteria) GNB. Categories were not mutually exclusive. Results A total of 775 hospitalized adults and 357 community dwellers were enrolled. Among hospitalized subjects, the prevalence of colonization with FQR, ESCR, CR, or MDR-GNB was 46.4% (95% confidence interval [CI], 42.9-50.0), 41.2% (95% CI, 37.7-44.6), 14.5% (95% CI, 12.0-16.9), and 26.3% (95% CI, 23.2-29.4). In the community, the prevalence of FQR, ESCR, CR, and MDR-GNB colonization was 39.5% (95% CI, 34.4-44.6), 28.9% (95% CI, 24.2-33.6), 5.6% (95% CI, 3.2-8.0), and 4.8% (95% CI, 2.6-7.0), respectively. Conclusions A high burden of antimicrobial-resistant GNB colonization was observed in this sample of hospitalized and community-dwelling adults, suggesting that the community is a relevant source of antibiotic resistance. Efforts are needed to understand the relatedness between resistant strains circulating in the community and hospitals.
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    Participación ciudadana: mecanismos utilizados para captar información sobre valores y preferencias en procesos de decisiones de priorización o cobertura de salud. Una revisión pragmática
    (SOC MEDICA SANTIAGO, 2022) Rodriguez Ramirez, Maria Paz; Bravo Valenzuela, Paulina Fabiola; Sepulveda, Dino
    Health systems do not have the capacity to finance all services. The impact of choosing one option or another is important in order to prioritize health resources. Citizen participation can help to set priorities or to select the interventions that will receive public funding. We reviewed the literature searching for articles that reported mechanisms to gather information about citizens' values or preferences about health system coverage. We identified 363 publications, 18 articles were analyzed in full, and 7 articles were included in the review. Three articles were European, two were from Australia and two from Latin America. The most commonly used mechanisms to gather information were interviews and surveys. We conclude that there is a limited number of articles with examples of tools to capture information about values and preferences in health decision processes. The main barrier observed was the lack of standardized processes to collect the values and preferences of the community.
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    Using explicit thresholds for benefits and harms in partially contextualized GRADE guidelines. Pilot experience from a living COVID-19 guideline
    (2022) Neumann, Ignacio; Quinelen, Eduardo; Nahuelhual, Paula; Burdiles, Pamela; Celedon, Natalia; Cerda, Katherine; Herrera-Omegna, Paloma; Kraemer, Patricia; Cancino, Karen Dominguez; Valenzuela, Juan Pablo; Sepulveda, Dino; Morgano, Gian Paolo; Akl, Elie A.; Schunemann, Holger J.
    Objectives: Guideline panels must assess the magnitude of health benefits and harms to develop sensible recommendations. However, they rarely use explicit thresholds. In this paper we report on the piloting and the use thresholds for benefits and harms.Study Design and Setting: We piloted the use of thresholds in a Chilean COVID-19 living guideline. For each of the critical outcomes, we asked panelists to suggest values of the thresholds for large, moderate, small, or trivial or no effect. We collected this information through a survey and an on-line discussion.Results: Twelve panelists decided on thresholds for three critical outcomes (mortality, need for mechanical ventilation and serious adverse events). For all outcomes, an absolute risk reduction was considered larger with more than 50 events, moderate with less than 50 events, small with less than 25 events, and trivial with less than 10 events. Having these a priori thresholds in place significantly impacted on the development of recommendations. Conclusion: Explicit thresholds were a valuable addition to the judgment of the certainty in the evidence, to decide the direction and strength of the recommendation and to evaluate the need for update. We believe this is a line of research worth perusing.(c) 2022 Elsevier Inc. All rights reserved.

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