The certainty of the evidence for interventions is the certainty or confidence that the true effect is within a particular range or relative to a threshold. In the new pyramid of evidence, systematic reviews represent the magnifying glass through which this certainty is evaluated. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach arises in response to the existence of multiple evidence classification systems, and it offers a transparent and structured process to develop and present summaries of evidence considering its certainty and, in a second step, the strength of the recommendations that they inform. The GRADE process begins with an explicit question that includes all important and critical outcomes explicitly. The main domains used to assess the certainty of the evidence are risk of bias, inconsistency, indirectness of evidence, imprecision, and publication bias. The factors that can increase the certainty of the evidence are dose-response gradient, large magnitude of an effect, and effect of plausible residual confounding. Finally, the Summary of Findings tables summarize the process in a simplified way and with controlled language. This narrative review’s purpose is to address the GRADE approach’s theoretical and practical underlying concepts in a simplified way and with practical examples.

The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology provides a framework for assessing the certainty of the evidence and making recommendations. The Evidence to Decision Framework (EtD) is a transparent and structured system for formulating health recommendations. Once the problem is identified and the certainty of the evidence is assessed, EtD provides several criteria for formulating a recommendation. These criteria include the trade-off between benefits and harms, patients’ values and preferences, acceptability, feasibility, resource use, and impact on equity. The resulting recommendations may differ in strength (strong or weak) and direction (for or against). The process is transparent, allowing other users to adjust the framework of recommendations by modifying the criteria to fit the desired context through an adaptation-adoption process. Given the extensive information available on EtD and the GRADE methodology in general, this narrative review seeks to explain the main concepts involved in decision-making in health by using simplified and friendly descriptions, accompanied by practical examples, thus facilitating its understanding by inexperienced readers.

Introducción: El cáncer gástrico es de los tumores malignos más comunes en el mundo y es de alta prevalencia en Chile. La tasa de mortalidad anual es de 26/100.000 habitantes para hombres y 12/100.000 para mujeres. La cirugía es el tratamiento con mayor probabilidad de curación, prolonga la sobrevida global y libre de enfermedad. La sobrevida global a 5 años reportada a nivel mundial es cercana al 30%. No contamos con datos en la región de Valparaíso sobre la sobrevida en pacientes con cáncer gástrico. Objetivo: Caracterizar a los pacientes operados por adenocarcinoma y estimar su sobrevida a 5 años. Materiales y Método: Realizamos un estudio retrospectivo a partir de la revisión de fichas clínicas de pacientes sometidos a gastrectomía por adenocarcinoma gástrico. La variable principal analizada fue la sobrevida a 5 años. Resultados: Se incluyeron 69 pacientes, el promedio de sobrevida fue de 31,7 (DE 25,3) meses y la sobrevida fue de 46% a 5 años. Encontramos diferencia al comparar grados de compromiso ganglionar según TNM (p = 0,0001). Según estadio se obtuvo un valor P cercano a la significancia estadística (p = 0,083). Otras variables sugieren diferencia en sobrevida sin lograr significancia estadística. Discusión: Presentamos resultados similares a estudios nacionales, posicionándonos con mejores resultados que países de occidente, pero aún muy por debajo de la sobrevida reportada en Japón (> 70%). Conclusión: Logramos caracterizar acabadamente a los pacientes operados por adenocarcinoma, su sobrevida a 5 años, además de apoyar la asociación entre distintos grados de compromiso ganglionar.

Background Postoperative pain management contributes to reducing postoperative morbidity and unscheduled readmission. Compared to other opioids that manage postoperative pain like morphine, few randomized trials have tested the efficacy of intraoperatively administered methadone to provide evidence for its regular use or be included in clinical guidelines. Methods We conducted a randomized clinical trial comparing the use of intraoperative methadone to assess its impact on postoperative pain. Eighty-six patients undergoing elective laparoscopic cholecystectomy were allocated to receive either methadone (0.08 mg/kg) or morphine (0.08 mg/kg). Results Individuals who received methadone required less rescue morphine in the Post Anesthesia Care Unit for postoperative pain than those who received morphine (p = 0.0078). The patients from the methadone group reported less pain at 5 and 15 minutes and 12 and 24 hours following Post Anesthesia Care Unit discharge, exhibiting fewer episodes of nausea. Time to eye-opening was equivalent between the two groups. Conclusion Intraoperative use of methadone resulted in better management of postoperative pain, supporting its use as part of a multimodal pain management strategy for laparoscopic cholecystectomy under remifentanil-based anesthesia.

BackgroundLatin American and Caribbean Health Sciences Literature (LILACS) is the main reference database in the region; however, the way in which this resource is used in Cochrane systematic reviews has not been studied.ObjectivesTo assess the search methods of Cochrane reviews that used LILACS as a source of information and explore the Cochrane community's perceptions about this resource.MethodsWe identified all Cochrane reviews of interventions published during 2019, which included LILACS as a source of information, and analysed their search methods and also ran a survey through the Cochrane Community.ResultsWe found 133 Cochrane reviews that reported the full search strategies, identifying heterogeneity in search details. The respondents to our survey highlighted many areas for improvement in the use of LILACS, including the usability of the search platform for this purpose.DiscussionThe use and reporting of LILACS in Cochrane reviews demonstrate inconsistencies, as evidenced by the analysis of search reports from systematic reviews and surveys conducted among members of the Cochrane community.ConclusionWith better guidance on how LILACS database is structured, information specialists working on Cochrane reviews should be able to make more effective use of this unique resource.