Abstract. This article summarizes the clinical practice guide (CPG) for the management of patients with atrial fibrillation (AF) in the Social Security of Peru (EsSalud). Objective. To provide clinical recommendations based on evidence for the management of patients with AF in EsSalud. Methods. A CPG for the management of patients with AF in EsSalud was developed. To this end, a guideline development group (GDG) was established, including medical specialists and methodologists. The GDG formulated 9 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and, when it was considered pertinent, primary studies were conducted in Medline during 2017. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and the flowchart of the CPG. Finally, the CPG was approved with Resolution No. 91 - IETSI - ESSALUD - 2018. Results. This CPG addressed 9 clinical questions, divided into three topics: prevention of thromboembolic events, maintenance therapy and management of AF. Based on these questions, 12 recommendations (6 strong recommendations and 6 weak recommendations), 29 points of good clinical practice, and 2 algorithms were formulated. Conclusion. This article summarizes the methodology and evidence-based conclusions from the CPG for the management of AF in EsSalud.

Introducción. El presente artículo resume la guía de práctica clínica (GPC) para el manejo de pacientes con fibrilación auricular (FA) en el Seguro Social del Perú (EsSalud). Objetivo. Proveer recomendaciones clínicas basadas en evidencia para el manejo de pacientes con FA en EsSalud. Métodos. Se conformó un grupo elaborador (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 9 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y, cuando fue considerado pertinente, estudios primarios en Medline durante el 2017. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y los flujogramas de la GPC. Finalmente, la GPC fue aprobada con Resolución N° 91 - IETSI - ESSALUD - 2018. Resultados. La presente GPC abordó 9 preguntas clínicas, divididas en tres temas: prevención de eventos tromboembólicos, estrategias de control y manejo de FA en emergencias. En base a dichas preguntas se formularon 12 recomendaciones (6 recomendaciones fuertes y 6 recomendaciones condicionales), 29 puntos de buena práctica clínica, y 2 algoritmos. Conclusión. El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para manejo de pacientes con FA en EsSalud.

Measurement process is a part of everyday work of health professionals. Technological advances have created precise and sensitive instruments whose results are highly accurate and cast little doubts. However, health care has diversified, becoming a multidimensional and complex task. This means that new aspects, that are difficult to measure, must be addressed, such as health perception by patients or cost usefulness ratios of health actions. Therefore, clinicians and researchers must have a good perception of the quality of measures that they use in their daily work, to make the correct diagnostic, therapeutic or prognostic decisions. This article explores the operational concepts that help in the development and assessment of measuring instruments in terms of validity and truthfulness (Rev Méd Chile 2008; 136: 125-30)

Este artigo procura decifrar a reforma psiquiátrica a partir da suposição de que em seu bojo convivem determinações teórico-práticas distintas, ora associadas, ora concorrentes. De início, abordamos a questão de forma conceitual. Posteriormente, um breve histórico procura resgatar as motivações emancipatórias da reforma. Por fim, sustentamos uma pequena análise sobre essas determinações, com o intuito de iniciar um debate quanto às modificações estratégicas que o movimento deve empreender para evitar retrocessos em suas práticas.

This effort to decipher psychiatric reform starts from the supposition that the reform contains within itself distinct theoretical-practical determinations, at times associated, at times competing. We begin by addressing the issue from a conceptual standpoint, from there moving to a short historical overview that seeks to uncover the emancipatory motivations underlying the reform. Lastly, these determinations are analyzed in brief, our purpose being to initiate a debate about the strategic changes that the movement should enact if it is to avoid retrogression in its practices.

Este trabalho teve como objetivo avaliar o desempenho produtivo e os aspectos econômicos de dez clones de seringueira [Hevea brasiliensis (Willd. ex Adr. de Juss.) Muell. Arg.] em diferentes freqüências de sangria e com estimulação à base de ethefon. O experimento foi instalado na Fazenda Indiana, no município de Indiana, SP, sob o delineamento de blocos ao acaso com parcelas subdivididas. Os tratamentos principais foram os clones GT 1, RRIM 701, RRIM 600, PB 235, PR 261, PB 252, Fx 4098, Fx 2261, Fx 3864 e IAN 873, submetidos a três sistemas de sangria: 1/2S d/2 6d/7 (testemunha), 1/2S d/4 6d/7.10m/y. ET 5,0% Ba 10y e 1/2S d/6 6d/7.10m/y. ET 5,0% Ba 10/y. As variáveis estudadas foram: perímetro do caule, produção, secamento do painel e os aspectos econômicos. Os resultados mostraram superioridade no sistema 1/2S d/2 6d/7 na maioria dos clones, exceto o GT 1 e o PB 235, que no sistema 1/2S d/4 ET 5,0% apresentaram ganhos líquidos de 12,0% e 54,0%, respectivamente, acima do obtido no sistema testemunha. Somente os clones Fx 3864 e PB 235 apresentaram ganhos líquidos de 18,0% e 28,0% no sistema 1/2S d/6 ET 5% superiores em relação ao obtido no sistema testemunha. A maior porcentagem de secamento do painel foi observada no clone PB 235 no sistema 1/2S d/4 ET 5,0%.

The objective of this paper was to evaluate yield of performance and economic aspects of ten clones of rubber tree [Hevea brasiliensis (Willd. ex. Adr. de Juss.) Muell. Arg.] in different frequencies of tapping and with stimulation with ethefon. The trial was placed at the Indiana farm, in the county of Indiana, SP, Brazil, under a split-plot design. The main treatments were the GT 1, RRIM 701, RRIM 600, PB 235, PR 261, PB 252, Fx 4098, Fx 2261, Fx 3864 and IAN 873 clones submitted to three systems of tapping 1/2S d/2 6d/7 (check), 1/2S d/4 6d/7.10m/y. ET 5.0% Ba 10y and 1/2S d/6 6d/7.10m/y. ET 5.0% Ba 10y. The variables were: girth increment, yield, panel desiccation and economic aspects. Results indicated superiority in the 1/2S d/2 6d/7 system in most of the clones, except for GT 1 and PB 235 clones, that in the 1/2S d/4 ET 5.0% system showed superiority of net gain of 12.0% and 54.0%, respectively, compared with the check tapping system. Only the Fx 3864 and PB 235 clones showed liquid gain of 18.0% and 28.0%, respectively, in the 1/2S d/6 ET 5.0% system, compared with the check. The highest incidence of panel desiccation was observed in the PB 235 clone in the 1/2S d/4 ET 5.0% system.