<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0213-9111</journal-id>
<journal-title><![CDATA[Gaceta Sanitaria]]></journal-title>
<abbrev-journal-title><![CDATA[Gac Sanit]]></abbrev-journal-title>
<issn>0213-9111</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS)]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0213-91112018000200012</article-id>
<article-id pub-id-type="doi">10.1016/j.gaceta.2017.03.008</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Marcos GRADE de la evidencia a la decisión (EtD): un enfoque sistemático y transparente para tomar decisiones sanitarias bien informadas. 2: Guías de práctica clínica]]></article-title>
<article-title xml:lang="en"><![CDATA[GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alonso-Coello]]></surname>
<given-names><![CDATA[Pablo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Oxman]]></surname>
<given-names><![CDATA[Andrew D]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Moberg]]></surname>
<given-names><![CDATA[Jenny]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Brignardello-Petersen]]></surname>
<given-names><![CDATA[Romina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Akl]]></surname>
<given-names><![CDATA[Elie A]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Davoli]]></surname>
<given-names><![CDATA[Marina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Treweek]]></surname>
<given-names><![CDATA[Shaun]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mustafa]]></surname>
<given-names><![CDATA[Reem A]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vandvik]]></surname>
<given-names><![CDATA[Per O]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Meerpohl]]></surname>
<given-names><![CDATA[Joerg]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Guyatt]]></surname>
<given-names><![CDATA[Gordon H]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
<xref ref-type="aff" rid="A0"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Schünemann]]></surname>
<given-names><![CDATA[Holger J]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
<xref ref-type="aff" rid="A0"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,CIBERESP-IIB Sant Pau  ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>Spain</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,McMaster University Department of Clinical Epidemiology and Biostatistics ]]></institution>
<addr-line><![CDATA[Hamilton ]]></addr-line>
<country>Canada</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Norwegian Institute of Public Health Global Health Unit ]]></institution>
<addr-line><![CDATA[Oslo ]]></addr-line>
<country>Norway</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidad de Chile Facultad de Odontología Unidad de Odontología Basada en la Evidencia]]></institution>
<addr-line><![CDATA[Santiago ]]></addr-line>
<country>Chile</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,American University of Beirut Medical Center Department of Internal Medicine, Clinical Epidemiology Unit ]]></institution>
<addr-line><![CDATA[Beirut ]]></addr-line>
<country>Lebanon</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Lazio Regional Health Service Department of Epidemiology ]]></institution>
<addr-line><![CDATA[Roma ]]></addr-line>
<country>Italy</country>
</aff>
<aff id="Af7">
<institution><![CDATA[,University of Aberdeen Health Services Research Unit ]]></institution>
<addr-line><![CDATA[Aberdeen ]]></addr-line>
<country>United Kingdom</country>
</aff>
<aff id="Af8">
<institution><![CDATA[,University of Missouri-Kansas City Department of Medicine ]]></institution>
<addr-line><![CDATA[Kansas City Missouri]]></addr-line>
<country>USA</country>
</aff>
<aff id="Af9">
<institution><![CDATA[,University of Freiburg Faculty of Medicine ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Germany</country>
</aff>
<aff id="A10">
<institution><![CDATA[,McMaster University Department of Medicine ]]></institution>
<addr-line><![CDATA[Hamilton ]]></addr-line>
<country>Canada</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2018</year>
</pub-date>
<volume>32</volume>
<numero>2</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S0213-91112018000200012&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S0213-91112018000200012&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S0213-91112018000200012&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen Los médicos no disponen del tiempo ni de los recursos para considerar la evidencia subyacente en las innumerables decisiones que tienen que tomar diariamente. En consecuencia, dependen de las recomendaciones de las guías de práctica clínica. Los paneles de las guías deben considerar todos los criterios relevantes que influyen en una decisión o recomendación de manera estructurada, explícita y transparente, y proporcionar a los médicos recomendaciones factibles. En este artículo describiremos los marcos de la evidencia a la decisión (EtD) para las recomendaciones de práctica clínica. La estructura general de un marco EtD para recomendaciones clínicas es similar a la de los marcos EtD para otras recomendaciones y decisiones, e incluye la formulación de la pregunta, la evaluación de los distintos criterios y las conclusiones. Las recomendaciones clínicas requieren que los criterios se consideren de forma diferente, dependiendo de si se adopta una perspectiva individual o poblacional. Por ejemplo, desde la perspectiva individual, los gastos personales son un aspecto importante a considerar, mientras que desde la perspectiva poblacional son más importantes el uso de recursos (no solo los gastos personales) y el coste-efectividad. Son también importantes desde la perspectiva poblacional la equidad, la aceptabilidad y la factibilidad, mientras que la importancia de estos criterios suele ser limitada en el caso de la perspectiva individual. Los subgrupos específicos para los cuales pueden necesitarse recomendaciones deben estar claramente identificados y considerados con relación a cada criterio, porque los juicios pueden variar entre subgrupos. El siguiente artículo es una traducción del artículo original publicado en British Medical Journal. Los marcos EtD se utilizan actualmente en el Programa de Guías de Práctica Clínica en el Sistema Nacional de Salud, coordinado por GuíaSalud.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Clinicians do not have the time or resources to consider the underlying evidence for the myriad decisions they must make each day and, as a consequence, rely on recommendations from clinical practice guidelines. Guideline panels should consider all the relevant factors (criteria) that influence a decision or recommendation in a structured, explicit, and transparent way and provide clinicians with clear and actionable recommendations. In this article, we will describe the Evidence to Decision (EtD) frameworks for clinical practice recommendations. The general structure of the EtD framework for clinical recommendations is similar to EtD frameworks for other types of recommendations and decisions, and includes formulation of the question, an assessment of the different criteria, and conclusions. Clinical recommendations require considering criteria differently, depending on whether an individual patient or a population perspective is taken. For example, from an individual patient's perspective, out-of-pocket costs are an important consideration, whereas, from a population perspective, resource use (not only out-of-pocket costs) and cost effectiveness are important. From a population perspective, equity, acceptability, and feasibility are also important considerations, whereas the importance of these criteria is often limited from an individual patient perspective. Specific subgroups for which different recommendations may be required should be clearly identified and considered in relation to each criterion because judgments might vary across subgroups. This article is a translation of the original article published in the British Medical Journal.The EtD frameworks are currently used in the Clinical Practice Guideline Programme of the Spanish National Health System, co-ordinated by GuíaSalud.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Recomendaciones clínicas]]></kwd>
<kwd lng="es"><![CDATA[Guías de práctica clínica]]></kwd>
<kwd lng="es"><![CDATA[Decisiones sanitarias]]></kwd>
<kwd lng="es"><![CDATA[Salud pública]]></kwd>
<kwd lng="es"><![CDATA[Sistemas sanitarios]]></kwd>
<kwd lng="es"><![CDATA[Cobertura]]></kwd>
<kwd lng="en"><![CDATA[Clinical recommendations]]></kwd>
<kwd lng="en"><![CDATA[Clinical practice guidelines]]></kwd>
<kwd lng="en"><![CDATA[Healthcare decisions]]></kwd>
<kwd lng="en"><![CDATA[Public health]]></kwd>
<kwd lng="en"><![CDATA[Healthcare systems]]></kwd>
<kwd lng="en"><![CDATA[Coverage]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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