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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">According to the Bible&#44; during the journey of the Israelites from Egypt to the Promised Land&#44; God summoned Moses to Mount Sinai &#40;Horeb&#41;&#46; The top of the mountain was covered with dense cloud for 6 days&#44; but on the 7th day&#44; Moses obeyed God&#39;s order to climb up through the clouds&#44; and stayed there for 40 days and 40 nights&#46; After he had talked to Moses about how his people should lead their lives&#44; the Lord recorded his words on 2 stone tablets&#44; written by the finger of God&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Moses carried these 2 stone tablets down from the mountain and called them the Commandments of the Lord&#58; he read them out to the Israelites and told them to learn them by heart&#46; Since then&#44; these commandments&#44; or guidelines&#44; have been the moral basis for thought in Western civilization&#44; and their principles have been adopted for millennia as the fundamental model for human conduct&#44; even by those who believe in other religions or in no religion at all&#46; There have been other guidelines for governing human conduct&#44; such as the Code of Ur-Nammu from the Sumerian period&#44; which dates from around 2100 B&#46;C&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> and the Hammurabi code&#44; dating from around 1750 B&#46;C&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> &#8722; though neither of these codes was handed down by such a supreme authority as God&#46; More importantly&#44; these codes are very long &#8211; the Hammurabi code contains 282 laws &#8211; and look very much like our modern documents&#46; The story of Moses is familiar to many of us&#44; mainly because we&#44; too&#44; had to learn the Commandments by heart&#46; Fortunately&#44; it was not such an arduous task&#44; as there were only 10 simple rules&#44; short and easily remembered&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">So what has Moses got to do with chronic obstructive pulmonary disease &#40;COPD&#41; and why are we talking about him in a scientific journal&#63; Well&#44; we believe that we can learn several things from the Commandments that could be useful for developing clinical practice guidelines&#46; After having worked for many years on different aspects of COPD&#44; it is gratifying to see the recognition that this disease has achieved in recent years&#44; and how its impact on the health of patients all over the world is being alleviated&#46; As a consequence&#44; or as we would like to see it&#44; as a direct result of this awareness&#44; many national and international scientific societies have drawn up guidelines for orienting healthcare professionals in the care of their COPD patients&#46; Yet&#44; the authors of most of these documents&#44; in their attempt to publish comprehensive&#44; updated information&#44; have produced large&#44; complex instructions that are difficult to memorize and put into practice&#46; There are several reasons why they are not more widely applied&#46; Firstly&#44; patients generally have more than 1 non-communicable chronic disease&#44; making it necessary for physicians to simultaneously manage several different conditions&#44; each of which has its own specific and independent guidelines&#46; Secondly&#44; healthcare professionals have limited time to devote to each patient&#44; and moreover&#44; are expected to meet administrative targets which leave them little time to reflect on their actions and compare them with guideline recommendations&#46; Thirdly&#44; clinical evidence changes over time&#44; and scientific societies must update existing guidelines or issue new ones to include these changes&#46; This makes it difficult to follow these recommendations due to the delay between the publication of the guidelines and their implementation in clinical practice&#46; In the case of COPD&#44; it is obvious from reports in the literature that even with the best intentions&#44; the guidelines are often imperfectly followed&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">So&#44; what can we learn from the story of the 10 Commandments&#63; Firstly&#44; they are simple and direct&#46; They have only one possible interpretation&#44; and no exceptions are made for special circumstances&#46; Alternative interpretations and exceptions to the rule are problems often encountered by experts sequestered in conclaves over long periods of time&#46; In an attempt to provide &#8220;comprehensive&#8221; instruments that are applicable to any circumstance&#44; the documents they produce are long and complex&#46; Instead of guidelines&#44; they are more like encyclopedias&#44; and like encyclopedias&#44; contain too much information to be memorized&#46; Secondly&#44; the story reminds us that the Commandments were not evidence-based&#44; in fact they were not even based on expert consensus&#44; since Moses went up the mountain alone and returned with the 2 tablets&#46; Unfortunately&#44; the current trend is that any recommendation included in the guidelines must be strictly evidence-based&#46; However&#44; in many real world situations&#44; evidence is not available&#44; nor is the considerable time and money needed to obtain it&#46; Consequently&#44; some recommendations generate confusion and are difficult to implement&#46; In our opinion&#44; when irrefutable evidence is lacking on certain aspects of clinical management&#44; common sense and good practices should prevail&#46; It is the old chestnut of recommending the use of a parachute&#44; when its efficacy has not been proven in randomized trials&#46; While avoiding these extremes&#44; some recommendations in the field of COPD should be implemented without the need for large randomized trials&#46; Indeed&#44; there is no randomized trial supporting the benefit of smoking cessation&#44; yet it is recommended in all guidelines&#46; One of the responsibilities of a physician is to interpret their patients&#8217; individual problems&#46; Specific situations very often do not slot into any specific guideline recommendation&#46; An analogy would be the case of a judge having to interpret the law and how to apply it in each particular trial&#46; Judges often have to interpret how to apply the law&#44; because the case in question does not exactly fit the letter of the law as written&#46; Despite these impediments&#44; judges and doctors in their daily practice employ not only their technical knowledge&#44; but also their common sense&#44; which is not always based on irrefutable evidence&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To return to the example of Moses&#44; we have brought together the recommendations derived from scientific knowledge in the area of COPD&#44; and&#44; following the worthy example of a passage from the Old Testament that has served humanity for thousands of years&#44; have set them down in 10 COPD commandments &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; This simple guideline constitutes an attractive&#44; easy and practical approach to the management of COPD in all its variations&#44; and will give physicians the freedom to provide the best possible care to their patients&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">The International BODE Group as an entity has not received public or private funding from the time it was founded until the date of publication of this manuscript&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Marin JM&#44; Cote C&#44; Casanova C&#44; Pinto-Plata V&#44; Montes de Oca M&#44; Divo MJ&#44; de Torres JP&#44; Zulueta J&#44; Cabrera C&#44; Carrizo S&#44; Polverino F&#44; Celli BR&#44; en representaci&#243;n del grupo BODE&#46; Simplificando las gu&#237;as&#58; los 10 mandamientos de la epoc&#46; Arch Bronconeumol&#46; 2016&#59;52&#58;179&#8211;180&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prevention&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Help to eliminate smoking and environmental pollution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="middle">Diagnosis</td><td class="td" title="table-entry  " align="left" valign="top">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Suspect COPD in cases of dyspnea&#44; cough or chronic expectoration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Confirm the diagnosis&#46; Perform spirometry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Quantify dyspnea&#44; BMI&#44; functional capacity&#44; and risk of exacerbation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Identify comorbidities&#44; particularly heart disease&#44; cancer&#44; osteoporosis&#44; depression and gastroesophageal reflux&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="middle">Treatment</td><td class="td" title="table-entry  " align="left" valign="top">VI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Promote vaccination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Promote exercise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VIII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Start patient-specific treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Supervise the correct use of inhalers and other medications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Establish a follow-up plan and measure response to treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "texto" => "<p id="par0030" class="elsevierStylePara elsevierViewall">This manuscript is especially dedicated to our dear deceased friend and founding member of the BODE Collaborative Group&#44; Dr Claudia Cote&#46;</p>"
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