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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the level of agreement on the GEMA 2009 clinical recommendations by a Spanish expert panel on asthma&#46;</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study was divided into four stages&#58; 1&#41; establishment of a 9 member scientific committee &#40;GEMA authors&#41; for selection of GEMA recommendations to use in the survey&#59; 2&#41; formation of a panel of 74 professionals with expertise in this field &#40;pulmonologists&#44; allergists&#44; family doctors&#44; ear&#44; nose and throat and paediatric specialists&#41;&#59; 3&#41; Delphi survey in two rounds&#44; sent by mail&#44; with intermediate processing of opinions and a report to the panel members&#59; and 4&#41; analysis and discussion of results for the Scientific Committee&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Seventy four participants completed the two rounds of survey&#46; During the first round&#44; a consensus was reached in 49 out of 56 questions analysed&#46; Following discussion by the panel&#44; the consensus was increased to a total of 53 items in the survey&#46; With respect to the remaining questions&#44; Insufficient consensus was obtained on the rest of the questions&#44; due to differing views between sub-specialists&#44; or lack of criteria by most of the experts&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The external analysis by asthma experts from different specialities showed a high level of professional agreement with the GEMA 2009 recommendations in Spain &#40;96&#46;5 &#37;&#41;&#46; The disagreement shown in three recommendations reflect the lack of a high level evidence&#46; These issues represent areas of interest for future research&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Valorar el grado de acuerdo de un panel de expertos en asma de diferentes especialidades con las recomendaciones que propone la Gu&#237;a Espa&#241;ola para el Manejo del Asma &#40;GEMA&#41; 2009&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El estudio se efectu&#243; en 4 fases&#58; 1&#41; constituci&#243;n del comit&#233; cient&#237;fico formado por los 9 coordinadores de GEMA2009&#44; para la selecci&#243;n de las recomendaciones de la Gu&#237;a que conforman el cuestionario Delphi del estudio &#40;56 &#237;tems&#41;&#59; 2&#41; selecci&#243;n de un panel estatal multic&#233;ntrico con 74 expertos en asma de todas las especialidades implicadas en la Gu&#237;a &#40;neum&#243;logos&#44; alerg&#243;logos&#44; m&#233;dicos de familia&#44; otorrinolaring&#243;logos&#44; y especialistas de pediatr&#237;a&#41;&#59; 3&#41; encuesta Delphi en 2 rondas &#40;con valoraci&#243;n personal de cada &#237;tem mediante escala Likert de 5 puntos&#41;&#44; por correo electr&#243;nico&#44; con informe a panelistas de resultados intermedios&#59; y 4&#41; an&#225;lisis y discusi&#243;n de resultados por el comit&#233; cient&#237;fico del proyecto&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se apreci&#243; un consenso de criterio en 49 de las 56 cuestiones analizadas ya en la primera ronda&#46; Tras la interacci&#243;n del panel&#44; se lograron consensuar 53 &#237;tems de la encuesta&#44; en el sentido favorable al acuerdo del panel con las recomendaciones GEMA&#46; En una de las cuestiones no consensuadas&#44; sobre indicaci&#243;n de inmunoterapia en asma al&#233;rgica&#44; se apreci&#243; una significativa disparidad de opini&#243;n entre especialidades&#46; En otra&#44; sobre las medidas de control ambiental en alergia a &#225;caros&#44; se apreci&#243; una manifiesta oposici&#243;n del panel &#40;55 &#37;&#41;&#44; y en la &#250;ltima&#44; sobre la necesidad de cambiar de trabajo en pacientes con s&#237;ndrome reactivo de disfunci&#243;n de la v&#237;a a&#233;rea&#44; se observ&#243; una ausencia significativa de criterio establecido en buena parte de los encuestados &#40;40 &#37; expresan &#8220;ni de acuerdo ni en desacuerdo&#8221;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La valoraci&#243;n externa por expertos en asma de diferentes especialidades constata un elevado nivel de acuerdo profesional con las recomendaciones formuladas en GEMA2009 &#40;93 &#37;&#41;&#46; Probablemente el desacuerdo evidenciado en 3 de las recomendaciones reflejan la escasez de evidencias&#44; o su gran variabilidad&#44; para establecer recomendaciones consistentes&#46; Estas cuestiones podr&#237;an representar &#225;reas susceptibles de un mayor esfuerzo investigador futuro&#46;</p>"
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Vol. 46. Issue 8.
Pages 411-419 (January 2010)
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Vol. 46. Issue 8.
Pages 411-419 (January 2010)
Original Article
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External Assessment of the GEMA2009 Recommendations by a Multidisciplinary Expert Panel on Asthma
Valoración externa de las recomendaciones de la GEMA2009 por un panel multiprofesional de expertos en asma
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Fernando Caballero Martíneza, Vicente Plazab,
Corresponding author
vplaza@santpau.cat

Corresponding author.
, Santiago Quirce Gancedoc, Margarita Fernández Benítezd, Fernando Gómez Ruize, Antolín López Viñaf, Jesús Molina Parísg, José Antonio Quintano Jiménezh, Ramona Soler Vilarrasai, José Ramón Villa Asensij, Santiago Balmes Estradab
a Unidad de Formación e Investigación, Área 6 Servicio Madrileño Salud, Madrid, Spain
b Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
c Servicio de Alergología, Hospital Universitario La Paz, Madrid, Spain
d Servicio de Alergología Infantil, Clínica Universidad de Navarra, Pamplona, Spain
e Servicio de Medicina de Familia, Centro de Salud de Bargas, Toledo, Spain
f Servicio de Neumología, Hospital Universitario Puerta de Hierro, Madrid, Spain
g Servicio de Medicina de Familia, EAP Francia I, Fuenlabrada, Madrid, Spain
h Servicio de Medicina de Familia, Centro de Salud Lucena I, Lucena, Córdoba, Spain
i Servicio de Otorrinolaringología, Hospital de Son Dureta, Palma de Mallorca, Spain
j Servicio de Neumología Pediátrica, Hospital Infantil del Niño Jesús, Madrid, Spain
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Abstract
Objectives

To assess the level of agreement on the GEMA 2009 clinical recommendations by a Spanish expert panel on asthma.

Materials and methods

The study was divided into four stages: 1) establishment of a 9 member scientific committee (GEMA authors) for selection of GEMA recommendations to use in the survey; 2) formation of a panel of 74 professionals with expertise in this field (pulmonologists, allergists, family doctors, ear, nose and throat and paediatric specialists); 3) Delphi survey in two rounds, sent by mail, with intermediate processing of opinions and a report to the panel members; and 4) analysis and discussion of results for the Scientific Committee.

Results

Seventy four participants completed the two rounds of survey. During the first round, a consensus was reached in 49 out of 56 questions analysed. Following discussion by the panel, the consensus was increased to a total of 53 items in the survey. With respect to the remaining questions, Insufficient consensus was obtained on the rest of the questions, due to differing views between sub-specialists, or lack of criteria by most of the experts.

Conclusions

The external analysis by asthma experts from different specialities showed a high level of professional agreement with the GEMA 2009 recommendations in Spain (96.5 %). The disagreement shown in three recommendations reflect the lack of a high level evidence. These issues represent areas of interest for future research.

Keywords:
Asthma
Clinical guideline
Professional consensos
Delphi
Resumen
Objetivos

Valorar el grado de acuerdo de un panel de expertos en asma de diferentes especialidades con las recomendaciones que propone la Guía Española para el Manejo del Asma (GEMA) 2009.

Material y métodos

El estudio se efectuó en 4 fases: 1) constitución del comité científico formado por los 9 coordinadores de GEMA2009, para la selección de las recomendaciones de la Guía que conforman el cuestionario Delphi del estudio (56 ítems); 2) selección de un panel estatal multicéntrico con 74 expertos en asma de todas las especialidades implicadas en la Guía (neumólogos, alergólogos, médicos de familia, otorrinolaringólogos, y especialistas de pediatría); 3) encuesta Delphi en 2 rondas (con valoración personal de cada ítem mediante escala Likert de 5 puntos), por correo electrónico, con informe a panelistas de resultados intermedios; y 4) análisis y discusión de resultados por el comité científico del proyecto.

Resultados

Se apreció un consenso de criterio en 49 de las 56 cuestiones analizadas ya en la primera ronda. Tras la interacción del panel, se lograron consensuar 53 ítems de la encuesta, en el sentido favorable al acuerdo del panel con las recomendaciones GEMA. En una de las cuestiones no consensuadas, sobre indicación de inmunoterapia en asma alérgica, se apreció una significativa disparidad de opinión entre especialidades. En otra, sobre las medidas de control ambiental en alergia a ácaros, se apreció una manifiesta oposición del panel (55 %), y en la última, sobre la necesidad de cambiar de trabajo en pacientes con síndrome reactivo de disfunción de la vía aérea, se observó una ausencia significativa de criterio establecido en buena parte de los encuestados (40 % expresan “ni de acuerdo ni en desacuerdo”).

Conclusiones

La valoración externa por expertos en asma de diferentes especialidades constata un elevado nivel de acuerdo profesional con las recomendaciones formuladas en GEMA2009 (93 %). Probablemente el desacuerdo evidenciado en 3 de las recomendaciones reflejan la escasez de evidencias, o su gran variabilidad, para establecer recomendaciones consistentes. Estas cuestiones podrían representar áreas susceptibles de un mayor esfuerzo investigador futuro.

Palabras clave:
Asma
Guía Práctica Clínica
Consenso profesional
Delphi
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Copyright © 2010. Sociedad Española de Neumología y Cirugía Torácica
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