Commitment to quality of the Spanish scientific societies

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García-Alegría, S. Vázquez-Fernández del Pozo, F. Salcedo-Fernández, J.M. García-Lechuz Moya, G. Andrés Zaragoza-Gaynor, M. López-Orive, S. García-San Jose, P. Casado-Durández" "autores" => array:8 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "García-Alegría" "email" => array:1 [ 0 => "jalegria@hcs.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Vázquez-Fernández del Pozo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Salcedo-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "García-Lechuz Moya" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "G." 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"apellidos" => "Casado-Durández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Sociedad Española de Medicina Interna, Agencia Pública Sanitaria Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto Aragonés de Ciencias de la Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "GA Zaragoza, Zaragoza, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Área de Sistemas Clínicos de Información, Subdirección General de Información Sanitaria e Innovación, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Subdirección General de Calidad y Cohesión, Dirección General de Salud Pública, Calidad e Innovación, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Compromiso por la calidad de las sociedades científicas en España" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 889 "Ancho" => 1670 "Tamanyo" => 170289 ] ] "descripcion" => array:1 [ "en" => "Methodology for the preliminary selection of “do not do” recommendations." ] ] ] "textoCompleto" => "BackgroundProfessional societies are committed and obliged to guide the health authorities and society as a whole on how to improve health care. The Charter of Professionalism (developed jointly by the European Federation of Internal Medicine and the American Board of Internal Medicine<a class="elsevierStyleCrossRef" href="#bib0100">1</a> and signed by numerous societies and institutions) included the professional commitment to better quality health care, to patient safety, to using health resources correctly, to the fair distribution of finite resources and to healthcare based on rational and effective management of these resources. It has been proposed that efficient, cost-conscious care should fall within the professional competency of clinicians.<a class="elsevierStyleCrossRefs" href="#bib0105">2,3</a> The Medical Code of Ethics states that medical professionals are obliged to seek the most efficient way to conduct their work and to seek the optimal performance of the means made available to them by society.<a class="elsevierStyleCrossRef" href="#bib0115">4</a> The commitment to efficiency should be a guiding force for all clinical actions, and it is especially necessary in the current context of Spain. Based on this, professionals aspire to offer solutions within their field of responsibility and to help improve the health system.<a class="elsevierStyleCrossRef" href="#bib0120">5</a>There is widespread evidence that certain diagnostic practices, health care profiles and treatments, some of which are costly, do not provide significant added value for patients. Decreasing these practices is a measure of efficiency that has no impact on the quality of care or health outcomes.One such example of this commitment is the American Board of Internal Medicine “Choosing Wisely” initiative, which seeks to improve the health system's overall efficiency in the US, with a commitment from multiple institutions. Since the launch of “Choosing Wisely”, a number of published articles have reviewed the general objectives of the project,<a class="elsevierStyleCrossRefs" href="#bib0125">6,7</a> offering practical recommendations for efficiency,<a class="elsevierStyleCrossRefs" href="#bib0135">8–10</a> commenting on low-value preventive activities,<a class="elsevierStyleCrossRef" href="#bib0150">11</a> reviewing the appropriate use of radiological<a class="elsevierStyleCrossRefs" href="#bib0155">12,13</a> and analytical tests<a class="elsevierStyleCrossRefs" href="#bib0165">14,15</a> and discussing the method for preparing recommendations and outcome measures.<a class="elsevierStyleCrossRef" href="#bib0175">16</a>In 2012, the Spanish Society of Internal Medicine (SEMI) proposed a project that would involve other Spanish scientific societies, with the aim of reducing low-value activities in Spain. The project was ultimately approved by the Ministry of Health, Social Services and Equality under the name “Commitment to Quality by Scientific Societies in Spain” and falls within the realm of activities of the Spanish Network of National Health System Technology and Services Assessment Agencies. This project has been jointly coordinated by the Ministry of Health, Social Services and Equality itself, the Aragon Institute of Health Sciences with the team from the Clinical Practice Guidelines program “GuíaSalud” and SEMI. It is an inclusive, participatory and open project aimed at practitioners, patients and health organizations, with a solid scientific base and distinct stages in its execution.The project's main objective is to reduce the number of unnecessary medical operations, i.e., those without proven effectiveness, with little or dubious effectiveness or those that are not cost-effective. The secondary objectives are to reduce clinical practice variability, to broadcast the commitment with the adequate use of health resources and to promote clinical safety and the quality of care. This article describes the methodology used for the selection and details the 135 final recommendations by 30 Spanish scientific societies.MethodologyThe methodology was structured in the following stages:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1.Identification of “do not do” recommendations in clinical practice guidelines and other evidence-based sources.</li><li class="elsevierStyleListItem" id="lsti0010">2.The preliminary list of “do not do” recommendations were selected and prepared by the scientific societies involved and the project coordinator group, with the aim of having a preliminary list of 15 “do not do” recommendations (10 proposed by the societies and 5 by the coordinators).</li><li class="elsevierStyleListItem" id="lsti0015">3.Establishment of the definitive list of 5 “do not do” recommendations by each scientific society, prioritized using the Delphi method.</li></ul>Stage 1: Identification of recommendationsThe process of selecting and identifying “do not do” recommendations required these recommendations to be revised and researched in the clinical practice guidelines from the Spanish National Health System's Program and Catalog of Guidelines, in sources such as the “Do not do” recommendations of the National Institute for Clinical Excellence and in similar sources from Canada,<a class="elsevierStyleCrossRef" href="#bib0180">17</a> Australia<a class="elsevierStyleCrossRef" href="#bib0185">18</a> and New Zealand.<a class="elsevierStyleCrossRef" href="#bib0190">19</a> Furthermore, other scientific sources were analyzed (e.g., systematic reviews, reports from health technology assessment agencies and randomized clinical trials).Stage 2: Selecting the preliminary list of 15 “do not do” recommendations: work performed jointly by the scientific societies and project coordinatorsEach scientific society established and proposed a preliminary list of 10 “do not do” recommendations, with scientific evidence to support them, choosing the recommendations from a clinical point of view and based on their suitability for the Spanish National Health System (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The group of experts who made the selection was not the same group that was involved in prioritizing the 5 final “do not do” recommendations.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The project coordinators proposed 5 “do not do” recommendations to each scientific society. Using the Delphi method, the societies and project coordinators had to jointly approve the “do not do” recommendations that were suggested prior to the prioritization process.Stage 3: Selecting the definitive list of 5 “do not do” recommendations by each scientific society, prioritized using the Delphi methodEach panel worked with a preliminary list of 15 “do not do” recommendations, 10 of which were proposed by the scientific societies and 5 by the project coordinators. Once the 5 “do not do” recommendations were definitively prioritized, all approved recommendations were published.Establishing the expert panelEach scientific society appointed a panel of 25 experts. The requirements for the panel were that it be established using a group that represented the scientific society in terms of member profiles (age and sex). The number of members from the society's board of directors could not exceed 15% of the total panel. Prior to their inclusion, each expert completed a declaration of interests.Prioritizing “do not do” recommendationsThe definitive selection system was performed by means of the Delphi method, using a Likert scale of agreement or disagreement with each recommendation from 1 to 9 (1=strongly disagree, 9=strongly agree).The following prioritization indicators were given for the established recommendations: (a) economic impact (cost of the measure×frequency), (b) clinical safety (risk×number of cases) and (c) high-cost and low-prevalence operations.Non-face-to-face surveys were conducted in 2 rounds to seek consensus through a mathematical procedure for aggregating individual assessments. Each expert participated by means of an online computer application (SurveyMonkey®), accessed through an email address.For the data analysis of the surveys, the median and interquartile range (IQR) was considered (25–75 percentiles). The criteria for assessing the level of agreement were as follows: a median of 7–9 points was deemed strong agreement; a median of 4–6 was neutral; and a median of 1–3 was strong disagreement. A low dispersion was considered with IQR≤2, and a high dispersion was considered with IQR>2.When consensus was not reached in the first round, a second round was held. In order for the panelists to make their reassessment, they were each sent the recommendations, the assessment they made in the previous round, the median and the IQR. Only recommendations with a median score ≥7 and an IQR≤2 were sent at that time.In the second round, on the same questionnaire as in the first, results were presented and participants were asked to reconsider their first-round response based on the whole group's results (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>ResultsIn 2013, the 12 participating scientific societies, with a total of 216 panelists, were as follows: Spanish Association of Pediatrics, Spanish Society of Cardiology, Spanish Society of Endocrinology and Nutrition, Spanish Society of Family and Community Medicine, SEMI, Spanish Society of Primary Care Physicians, Spanish Society of General Practitioners, Spanish Society of Family and Community Medicine, Spanish Society of Nephrology, Spanish Society of Pneumology and Thoracic Surgery, Spanish Society of Neurology, Spanish Society of Digestive Pathology and Spanish Society of Rheumatology. The representative primary care societies held a joint panel. The definitive recommendations chosen by the expert panels can be found in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>In 2014, the 10 participating societies, with a total of 232 panelists, were the following: Spanish Association of Medical Biopathology, Spanish Association of Surgeons, Spanish Society of Allergology and Clinical Immunology, Spanish Society of Anesthesiology, Reanimation and Pain Therapeutics, Spanish Society of Hematology and Hemotherapy, Spanish Society of Critical Intensive Medicine and Coronary Units, Spanish Society of Nuclear Medicine and Molecular Imaging, Spanish Society of Medical Oncology, Spanish Society of Medical Radiology and Spanish Society of Rehabilitation and Physical Medicine. The proposed recommendations can be found in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>In 2015, the 8 participating societies, with a total of 170 panelists, were as follows: Spanish Association of Urology, Spanish Society of Clinical Biochemistry and Molecular Pathology, Spanish Society of Care Quality, Spanish Society of Oral and Maxillofacial Surgery, Spanish Society of Orthopedics and Traumatology, Spanish Society of Geriatrics and Gerontology, Spanish Society of Geriatric Medicine and Spanish Society of Psychiatry. The Geriatrics societies held a joint panel and, their recommendations can be found in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The project is currently active, and there are 48 societies taking part. All those involved, along with all recommendations that were issued, are printable and can be accessed on the MSSSI website, in the Clinical Excellence section [in Spanish] (<a href="https://www.msssi.gob.es/profesionales/excelencia/home.htm">https://www.msssi.gob.es/profesionales/excelencia/home.htm</a>). In summary, this article presents 135 “do not do” recommendations prepared by 30 Spanish scientific societies, with the participation of 618 expert panelists. These recommendations were selected using a rigorous and predefined research and voting method and can be used to facilitate the decision-making process for clinicians, patients and health administration.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres834087" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec830135" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres834086" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec830136" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methodology" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Stage 1: Identification of recommendations" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Stage 2: Selecting the preliminary list of 15 “do not do” recommendations: work performed jointly by the scientific societies and project coordinators" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Stage 3: Selecting the definitive list of 5 “do not do” recommendations by each scientific society, prioritized using the Delphi method" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Establishing the expert panel" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Prioritizing “do not do” recommendations" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-12-23" "fechaAceptado" => "2017-02-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec830135" "palabras" => array:5 [ 0 => "What not to do" 1 => "Scientific societies" 2 => "Appropriate precautions" 3 => "Commitment" 4 => "Spain" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec830136" "palabras" => array:5 [ 0 => "No hacer" 1 => "Sociedades científicas" 2 => "Cuidados apropiados" 3 => "Compromiso" 4 => "España" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "This article summarizes the objectives, methodology and initial conclusions of the project “Commitment to Quality of the Spanish Scientific Societies”, coordinated by the Ministry of Health, Social Services and Equality, the Spanish Society of Internal Medicine and the Aragon Institute of Health Sciences, in which 48 scientific societies participate. This project's objectives are to decrease the use of unnecessary medical interventions, which are those that have shown no efficacy, have little or questionable effectiveness or are not cost-effective; decrease variability in clinical practice; promote the commitment among physicians and patients to properly use healthcare resources; and to promote clinical safety. The document includes 135 final recommendations for what not to do, prepared by 30 Spanish scientific societies." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "En este artículo se resumen los objetivos, la metodología y las primeras conclusiones del proyecto «Compromiso por la calidad de las sociedades científicas en España», coordinado por el Ministerio de Sanidad, Servicios Sociales e Igualdad, la Sociedad Española de Medicina Interna y el Instituto Aragonés de Ciencias de la Salud, en el que participan 48 sociedades científicas. Los objetivos de este proyecto son: disminuir la utilización de intervenciones médicas innecesarias, que son las que no han demostrado eficacia, tienen escasa o dudosa efectividad, o no son coste-efectivas; disminuir la variabilidad en la práctica clínica; difundir entre médicos y pacientes el compromiso con el uso adecuado de recursos sanitarios y, por último, promover la seguridad clínica. En el documento se incluyen 135 recomendaciones finales de «no hacer» elaboradas por 30 sociedades científicas españolas." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: García-Alegría J, Vázquez-Fernández del Pozo S, Salcedo-Fernández F, García-Lechuz Moya JM, Andrés Zaragoza-Gaynor G, López-Orive M, et al. Compromiso por la calidad de las sociedades científicas en España. Rev Clin Esp. 2017;217:212–221." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 889 "Ancho" => 1670 "Tamanyo" => 170289 ] ] "descripcion" => array:1 [ "en" => "Methodology for the preliminary selection of “do not do” recommendations." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1688 "Ancho" => 2219 "Tamanyo" => 290583 ] ] "descripcion" => array:1 [ "en" => "Methodology for the final selection of “do not do” recommendations." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin ii receptor blockers; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CT, computed tomography; Ig, immunoglobulin; LABA, long-acting betamimetic bronchodilators; MRI, magnetic resonance imaging; NSAIDs, anti-inflammatory nonsteroidal drugs; PaO2, arterial oxygen pressure; PPI, proton pump inhibitors; PSA, prostate-specific antigen; QUS, quantitative ultrasound." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \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">Spanish Association of Pediatrics \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">1. Do not delay empirical antibiotic treatment when there is a suspicion of invasive meningococcal disease resulting from cultures (blood and/or cerebrospinal fluid). \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">2. Do not routinely perform electroencephalogram or neuroimaging (CT, MRI) studies on children with simple febrile seizures. \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">3. Do not routinely give antibiotics to children with gastroenteritis. \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">4. Do not use serological tests to diagnose celiac disease in children before gluten has been introduced into the diet. \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">5. The routine use of chest radiography is not recommended for acute bronchiolitis. \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"> \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">Spanish Society of Cardiology \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">1. Do not use clopidogrel as a first-line treatment in monotherapy after myocardial infarction. \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">2. Do not routinely prescribe fibrates for the primary prevention of cardiovascular disease. \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">3. Do not routinely use calcium channel blockers to reduce cardiovascular risk after a myocardial infarction. \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">4. In patients with left ventricular systolic dysfunction, do not use antiarrhythmic agents (in particular those in the I-C group), due to the drugs’ adverse effects (worsening of heart failure, proarrhythmia and death). \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">5. In patients with persistent atrial fibrillation when the cause has been corrected (e.g., pulmonary infection and fever) and cardioversion has been performed successfully, antiarrhythmic agents are not recommended for maintaining sinus rhythm, unless there are risk factors for recurrence. \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"> \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">Spanish Society of Endocrinology and Nutrition \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">1. Do not use glitazones in patients with diabetes and heart failure. \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">2. Do not use sulphonylureas when treating elderly patients with renal failure. \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">3. Do not determine thyroglobulin levels when initially evaluating a thyroid nodule's malignancy. \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">4. Do not repeat the antithyroid antibody determination in patients diagnosed with thyroid dysfunction who have already tested positive in the past. \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">5. Do not perform thyroid ultrasonography on patients with subclinical hypothyroidism. \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"> \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">Spanish Society of Family and Community Medicine (SEMFYC). Spanish Society of Primary Care Physicians Spanish Society of General Practitioners \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">1. Do not routinely request densitometry for postmenopausal women to assess the risk of osteoporotic fracture without first assessing the risk factors. \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">2. Do not use hormone therapy (estrogens or estrogens with progestogens) with the aim of preventing vascular disease in postmenopausal women. \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">3. Do not use test strips or glucose meters on patients with type 2 diabetes undergoing treatment with nonhypoglycemic oral drugs, except in situations of unstable glycemic control. \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">4. Do not systematically perform PSA measurements on asymptomatic individuals with no history of prostate cancer in a first-degree relative. \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">5. Do not use rifampicin together with pyrazinamide for the primary chemoprophylaxis of tuberculosis in immunocompetent individuals, due to their high toxicity. \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"> \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">Spanish Society of Internal Medicine \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">1. There are no indications to screen or treat asymptomatic bacteriuria, even in patients with bladder catheterization, except in pregnancy and urological surgical procedures. \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">2. Do not use acetylsalicylic acid as primary prevention in individuals who have no cardiovascular disease. \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">3. Do not use benzodiazepines to treat insomnia, agitation or delirium in the elderly. \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">4. The determination of natriuretic peptide levels is not indicated for the therapeutic decision-making process in chronic heart failure. \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">5. In the majority of cases in which high blood pressure readings are detected, there is no indication to initiate antihypertensive treatment immediately. \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"> \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">Spanish Society of Nephrology \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">1. Do not start renal replacement therapy with dialysis without having previously undergone the appropriate decision-making process involving the patient, family and doctor. \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">2. In elderly patients with CKD and proteinuria, a blood pressure target of less than 130/80mm Hg should not be routinely sought. \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">3. Do not routinely use the combination of a direct renin inhibitor and an ACEI or ARB. \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">4. Do not prescribe folic acid or vitamin C supplements specifically for treating anemia in chronic kidney disease. \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">5. Do not systematically measure plasma renin levels as a prognostic marker of hypertension in children with permanent kidney damage. \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"> \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">Spanish Society of Pulmonology and Thoracic Surgery \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">1. For patients with COPD and an arterial partial pressure of oxygen (PaO2) of more than 55mm Hg and without exercise desaturation, do not prescribe outpatient oxygen therapy. \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">2. In bronchial asthma, do not use LABAs as the only treatment. \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">3. Do not routinely perform magnetic resonance imaging to evaluate the stage of nonsmall-cell lung cancer. \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">4. Do not systematically use antibiotics to treat patients with COPD exacerbations without severity data and with just one Anthonisen criterion (other than sputum purulence). \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">5. For patients with difficulty maintaining sleep, do not use hypnotics without a previous etiological diagnosis. \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"> \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">Spanish Society of Neurology \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">1. Do not perform neuroimaging studies (MRIs and/or CTs) repeatedly for patients with primary headaches (migraines and tension headaches) without changes in the headache profile. \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">2. Do not routinely repeat electroencephalograms for patients with controlled epilepsy (without changes in the seizure profile) unless withdrawal of the medication is being considered. \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">3. Do not use drugs with potential extrapyramidal adverse effects (e.g., antiemetic, antivertiginous and prokinetic agents) in patients with Parkinson's disease. \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">4. Do not routinely use anticoagulants to treat acute strokes. \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">5. Do not use long-term corticosteroid therapy for patients with multiple sclerosis. \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"> \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">Spanish Society of Digestive Pathology \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">1. Do not schedule revisions or colonoscopies within 5 years when following up with postpolypectomy patients with 1 or 2 adenomas smaller than 1cm (without high-grade dysplasia) that were completely excised during a high-quality colonoscopy. \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">2. Do not administer antibiotic prophylaxis to individuals with mild acute pancreatitis. \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">3. Do not prescribe PPIs as gastroprotection for patients with no risk factors for gastrointestinal complications. \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">4. Do not restrict the fluid intake of patients with ascites, except in the presence of dilutional hyponatremia with natremia below 125mEq/L. \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">5. Do not use the detection of IgA or antigliadin IgG antibodies for the diagnosis of celiac disease. \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"> \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">Spanish Society of Rheumatology \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">1. Do not use 2 or more NSAIDs simultaneously, because it will increase toxicity while not improving the efficacy. \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">2. Do not use therapeutic injections locally for nonspecific lower back pain. \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">3. Arthroscopic lavage with debridement is not indicated for patients with knee osteoarthritis unless there is a clear history of mechanical blockage. \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">4. Do not use QUS or simple radiography to diagnose osteoporosis. \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">5. Performing CTs or MRIs is not recommended for cervicalgia or nonspecific lower back pain without warning signs. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1406598.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations selected by each of the 12 scientific societies included in the first stage of the project in alphabetical order (2013)." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: AMI, acute myocardial infarction; CET, cranioencephalic trauma; CK, creatine kinase; CK-MB, creatine kinase M-B; CT, computed tomography; ECG, electrocardiogram; EGFR, epidermal growth factor receptor; FNAC, Fine-needle aspiration cytology; FT4, free thyroxine; Hb, hemoglobin; HbA1c, glycated hemoglobin; HER2, human epidermal growth factor receptor 2; ICU, intensive care unit; Ig, immunoglobulin; KRAS, Kirsten rat sarcoma viral oncogene; MPS, myocardial perfusion scintigraphy; MRI, magnetic resonance imaging; PET-FDG, positron emission tomography with fludeoxyglucose; SPECT-CT, single-photon emission computed tomography; TENS, transcutaneous electrical nerve stimulation; TSH, thyroid-stimulating hormone or thyrotropin." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \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">Spanish Association of Medical Biopathology \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">1. Do not request serological tumor markers as population screening (unless the population belongs to the defined risk groups for each type of tumor). \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">2. For patients with diabetes and good clinical and metabolic control, do not perform HbA1c readings more than twice a year. If HbA1c readings need to be performed more frequently, ensure that they are not conducted at less than 3-month intervals. \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">3. Do not perform thyroid screenings for hospitalized patients. When performing these screenings on outpatients, only assess TSH. The laboratory test may be expanded to FT4 and other measurements, where appropriate. \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">4. Do not reevaluate antinuclear antibodies within a period of less than 3 months. \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">5. Do not use CK or CK-MB to diagnose AMI. \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"> \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">Spanish Association of Surgeons \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">1. Do not perform cholecystectomies in patients with asymptomatic cholelithiasis. \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">2. Do not keep bladder catheterization for more than 48h following gastrointestinal surgery. \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">3. Do not prolong antibiotic prophylaxis treatment for more than 24h following a surgical procedure. \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">4. Do not perform routine antibiotic prophylaxis for clean and uncomplicated nonprosthetic surgery. \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">5. Do not indicate postoperative antibiotic therapy in uncomplicated appendicitis. \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"> \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">Spanish Society of Allergology and Clinical Immunology \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">1. Do not conduct skin or in vitro tests with allergens without having previously performed a detailed medical history. \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">2. Do not perform diagnostic tests or therapeutic procedures involving risk in allergology, without quality and clinical safety guarantees. \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">3. Do not perform diagnostic tests with dubious effectiveness, such as IgG or indiscriminate IgE testing of allergens when studying allergies. \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">4. In anaphylactic reactions, do not use antihistamines or corticosteroids as first-line treatment; the use of adrenaline should be prioritized. \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">5. Do not treat bronchial asthma with medium or long-acting bronchodilators without inhaled corticosteroids. \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"> \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">Spanish Society of Anaesthesiology, Reanimation and Pain Therapeutics \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">1. Do not maintain deep sedation levels in critically ill patients without a specific indication. \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">2. Do not perform a chest radiography for patients under 40 years of age with low anesthetic risk according to the American Association of Anesthesiologists (ASA I or II). \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">3. Do not systematically perform preoperative tests for cataract surgery, unless indicated through a medical history and physical examination. \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">4. Do not schedule elective surgery with a risk of bleeding in patients with anemia until an adequate diagnosis and treatment analysis has been conducted. \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">5. Do not perform laboratory tests (hemogram, biochemistry and coagulation analysis) in patients with no systemic disease (ASA I and II) prior to low-risk surgeries, with minimal estimated blood loss. \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"> \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">Spanish Society of Hematology and Hemotherapy \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">1. Do not administer plasma or prothrombin complexes to reverse vitamin K antagonists in nonemergency situations (e.g., unless there is severe bleeding, intracranial hemorrhage or emergency surgery). \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">2. Do not transfuse more packed red blood cells than necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7–8g/dL in stable noncardiac patients). \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">3. Do not transfuse packed red blood cells into patients with iron-deficient anemia and no hemodynamic instability. \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">4. In adult patients with anemia who receive an erythropoiesis stimulator, routine correction is not recommended for hemoglobin levels above 12g/dL (adjust dose for the desired Hb level between 10 and 12g/dL). \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">5. Do not perform FNA to diagnose a patient with lymphadenopathy where there is suspicion of a neoplastic lymphoid origin. \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"> \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">Spanish Society of Critical Intensive Medicine and Coronary Units \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">1. Do not continue empiric antibiotic treatment, initiated after admission for severe infection, without daily assessments of its relevance and possible de-escalation. \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">2. Do not routinely conduct blood tests outside of the specific clinical indications. \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">3. Do not routinely perform a daily chest X-ray in intensive care units. \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">4. Do not maintain isolation measures, established in patients with confirmed transmissible disease, throughout their stay in the ICU. Measures should be routinely maintained for the duration of the infectious disease or colonization. \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">5. Red blood cell concentrates should not be transfused in critical but hemodynamically stable patients who are not bleeding, have no cardiac or central nervous system impairment and a Hb concentration greater than 7g/dL. \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"> \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">Spanish Society of Nuclear Medicine and Molecular Imaging \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">1. Do not conduct PET-FDGs as a population screening technique for prostate cancer. \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">2. Do not substitute the isotopic sentinel lymph node technique with other nonisotopic techniques until the latter techniques achieve the same diagnostic safety levels and have the same scientific evidence as are currently available for the former technique. \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">3. Do not perform MPS to diagnose ischemic heart disease in asymptomatic patients with low risk of the disease, in patients with low pretest probability with an interpretable ECG and capacity for exercise and in patients for preoperative assessment for low-risk surgery. \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">4. Do not conduct parathyroid gammagraphy with SPECT-CT to locate parathyroid adenomas in patients without a biochemical diagnosis of hyperparathyroidism or in patients who are not candidates for surgery. \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">5. Do not perform surgery for breast cancer or melanoma with criteria for sentinel node indication using radioactive tracers, if the medical and surgical team does not have sufficient experience in managing the surgery. \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"> \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">Spanish Society of Medical Oncology \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">1. Do not concomitantly administer anti-EGFR antibodies and antiangiogenic antibodies in native KRAS metastatic colorectal cancer. \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">2. In breast cancer, do not concomitantly administer adjuvant chemotherapy with adjuvant endocrine therapy. \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">3. Do not start neoadjuvant therapy (primary systemic therapy) for breast cancer without a prior, complete histological study (including hormone receptors and HER2) and without prior tumor marking. \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">4. Bisphosphonates are not recommended for preventing bone metastases in patients with prostate cancer. \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">5. Do not administer adjuvant treatment to patients diagnosed with stage IA nonsmall cell lung cancer (T1a-bN0M0) if the margins are negative. \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"> \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">Spanish Society of Medical Radiology \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">1. Do not routinely perform simple skull radiographs in patients with CET, except with a confirmation or suspicion of an nonaccidental cause of CET. \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">2. Do not routinely conduct simple abdominal radiography on children or adolescents with acute abdominal pain unless there is suspicion of an intestinal obstruction or perforation. \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">3. Do not conduct a pelvic radiograph in multiple trauma patients if a full-body CT is going to be performed. \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">4. Do not perform CTs or MRIs on children with simple febrile seizures. \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">5. Do not perform MRI screenings of breast cancer in asymptomatic women without risk factors. \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"> \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">Spanish Society of Rehabilitation and Physical Medicine \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">1. Do not use adhesive neuromuscular dressings indiscriminately or as first-line treatment to reduce pain and improve functionality in all neuromuscular diseases. \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">2. Do not systematically use low-intensity lasers to treat musculoskeletal pain, without estimating the possible response according to the etiology. \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">3. Do not conduct imaging testing (radiography, MRI, CT) in patients with acute lower back pain with no warning signs. \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">4. In the treatment of patellofemoral syndrome, do not use physical therapy modalities (thermotherapy, TENS) in isolation. \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">5. Do not recommend bed rest for patients with acute or subacute lower back pain. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1406600.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations selected by each of the 10 scientific societies included in the second stage of the project in alphabetical order (2014)." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: Apo E, apolipoprotein E; AST, aspartate aminotransferase; CK, creatine kinase; CK-MB, creatine kinase M-B; CRP, C-reactive protein; CT, computed tomography; ESR, erythrocyte sedimentation rate, HbA1c, glycated hemoglobin; Ig, immunoglobulin; LDH, lactate dehydrogenase; PSA, prostate-specific antigen; TSH, thyroid-stimulating hormone or thyrotropin." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \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">Spanish Association of Urology \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">1. Do not conduct staging CTs or bone scintigraphy for patients with clinically-localized prostate cancer if the PSA level is below 10 and the Gleason score is below 8. \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">2. Do not treat overactive bladders before excluding other diseases that could cause similar symptomatology. \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">3. Do not restrict the calcium intake of patients with recurrent calcium kidney stones if their diet is deemed adequate. \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">4. For asymptomatic patients with below normal PSA levels, do not perform PSA assessments in shorter than 1-year intervals. \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">5. Do not conduct fertility studies for women and men without having at least 2 seminograms that do not meet normal parameters. \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"> \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">Spanish Society of Clinical Biochemistry and Molecular Pathology \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">1. Do not request multiple tests in the initial assessment of a patient with suspected thyroid disease. First request a TSH reading and, if the results are abnormal, continue with additional testing or treatment based on the findings. \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">2. The assessment of CK, CK-MB, AST, LDH or myoglobin is not recommended for the diagnosis of myocardial damage (or myocardial infarction). \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">3. Do not conduct allergen-specific IgE testing without a medical history of adverse reactions or with no prior in vivo testing. In any case, do not perform systematic analyses of several immunoglobulins against allergens without a thorough review of the patient's medical history. \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">4. Do not conduct population-based vitamin D deficiency screenings using serum concentrations of 1,25-dihydroxyvitamin D (calcidiol). \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">5. Do not request an ESR to assess inflammation in patients with undefined diagnoses. To detect proinflammatory status during acute phase, request CRP. \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"> \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">Spanish Society of Care Quality \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">1. Do not use permanent urinary catheters in patients without appropriate indication. \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">2. Do not routinely use topical antibiotics or antiseptics to treat pressure ulcers in adults. \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">3. Do not use abbreviations when writing prescriptions. \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">4. Do not separate mothers from their children after giving birth, unless there are medical reasons. \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">5. Do not use standard informed consent documents without providing adequate discussion and personalized information on the problems. \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"> \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">Spanish Society of Oral and Maxillofacial Surgery \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">1. Do not extract wisdom teeth in young people and adolescents when there is enough space for their eruption. Wisdom teeth can reach functional positions in the dental arcade. Do not extract wisdom teeth in children, even if the teeth appear impacted, because they can change position. \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">2. Do not extract deeply impacted wisdom teeth without evidence of disease, when fully covered with bone and/or soft tissue. \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">3. Do not perform an excisional biopsy without a safety margin on oral mucosal lesions suspected to be cancerous. \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">4. Do not use guided bone regeneration techniques on noncritical bone defects of the jaw (e.g., in postextraction sockets or cystic cavities when only one wall is missing). \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">5. Do not perform systematic antibiotic prophylaxis in minor oral surgery, including dental extractions, without signs of previous infection. \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"> \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">Spanish Society of Orthopedics and Traumatology \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">1. Do not delay hip fracture surgery in the elderly for more than 48h in the absence of formal medical contraindication. \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">2. Do not prolong antibiotic prophylaxis for more than 24h after an uncomplicated surgical procedure. \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">3. Do not indicate a joint prosthesis in the first episode of acute knee or hip pain, even if there are arthroscopic radiographic signs. \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">4. Do not prescribe opioids for acute disabling lower back pain before evaluating and considering other alternatives. \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">5. Do not conduct chest X-rays during the preoperative assessment of healthy, young patients. \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"> \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">Spanish Society of Geriatrics and Gerontology Spanish Society of Geriatric Medicine \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">1. Do not use intensive therapeutic measures to achieve an HbA1 reduction <7.5% in multimorbid, fragile, dependent elderly people with a life expectancy <10 years. \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">2. Do not prescribe drugs without considering the previous treatment or evaluating interactions and the degree of adherence to compliance. \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">3. Do not make clinical decisions for those older than 75 years without evaluating their functional status. \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">4. Do not indicate nasogastric tube placement or percutaneous gastrostomy for patients with advanced stage dementia. \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">5. Do not indicate the assessment of genetic risk factors for dementia (such as ApoE genotype) for genetic counseling purposes for asymptomatic subjects. \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"> \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">Spanish Society of Psychiatry \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">1. Do not use the serotonin plasma level measurements as a diagnostic criterion for depressive disorder. \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">2. Do not use antipsychotics to treat generalized anxiety disorders in primary care. \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">3. Do not prescribe antihistamines to treat panic disorders. \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">4. Do not administer long half-life benzodiazepines to treat insomnia in the long-term in individuals older than 65 years. \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">5. The use of a loading dose of antipsychotics (rapid neuroleptic technique) is not recommended for childhood schizophrenia and psychosis. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1406599.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations selected by each of the 8 scientific societies included in the third stage of the project in alphabetical order (2015)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La profesión médica en el nuevo milenio: estatutos para la regulación de la práctica médica" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Fundación American Board of Internal Medicine, la Fundación American College of Physicians-American Society of Internal Medicine, Federación Europea de Medicina Interna" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2002" "volumen" => "118" "paginaInicial" => "704" "paginaFinal" => "706" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0105" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Providing high-value, cost-conscious care: a critical seventh general competency for physicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.E. 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Guest" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2012.476" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2012" "volumen" => "307" "paginaInicial" => "1801" "paginaFinal" => "1802" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22492759" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0130" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Choosing wisely: low-value services, utilization, and patient cost sharing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.G. Volpp" 1 => "G. Loewenstein" 2 => "D.A. 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Siwek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Fam Physician" "fecha" => "2012" "volumen" => "86" "paginaInicial" => "128" "paginaFinal" => "133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22962925" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0140" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Critical and honest conversations: the evidence behind the “Choosing Wisely” campaign recommendations by the American Society of Nephrology" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American Society of Nephrology Quality, and Patient Safety Task Force" "etal" => true "autores" => array:6 [ 0 => "A.W. Williams" 1 => "A.C. Dwyer" 2 => "A.A. Eddy" 3 => "J.C. Fink" 4 => "B.L. Jaber" 5 => "S.L. Linas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.04970512" "Revista" => array:6 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "1664" "paginaFinal" => "1672" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22977214" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0145" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Choosing wisely or beyond the guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.J. 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Special Article

Commitment to quality of the Spanish scientific societies

Compromiso por la calidad de las sociedades científicas en España

J. García-Alegríaa,

Corresponding author

jalegria@hcs.es

Corresponding author.

, S. Vázquez-Fernández del Pozob, F. Salcedo-Fernándezb, J.M. García-Lechuz Moyac, G. Andrés Zaragoza-Gaynord, M. López-Orivee, S. García-San Josef, P. Casado-Durándezg

a Sociedad Española de Medicina Interna, Agencia Pública Sanitaria Costa del Sol, Marbella, Málaga, Spain

b Instituto Aragonés de Ciencias de la Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain

c Hospital Universitario Miguel Servet, Zaragoza, Spain

d GA Zaragoza, Zaragoza, Spain

e Área de Sistemas Clínicos de Información, Subdirección General de Información Sanitaria e Innovación, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain

f Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain

g Subdirección General de Calidad y Cohesión, Dirección General de Salud Pública, Calidad e Innovación, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Professional societies are committed and obliged to guide the health authorities and society as a whole on how to improve health care&#46; The Charter of Professionalism &#40;developed jointly by the European Federation of Internal Medicine and the American Board of Internal Medicine<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> and signed by numerous societies and institutions&#41; included the professional commitment to better quality health care&#44; to patient safety&#44; to using health resources correctly&#44; to the fair distribution of finite resources and to healthcare based on rational and effective management of these resources&#46; It has been proposed that efficient&#44; cost-conscious care should fall within the professional competency of clinicians&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">2&#44;3</span></a> The Medical Code of Ethics states that medical professionals are obliged to seek the most efficient way to conduct their work and to seek the optimal performance of the means made available to them by society&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> The commitment to efficiency should be a guiding force for all clinical actions&#44; and it is especially necessary in the current context of Spain&#46; Based on this&#44; professionals aspire to offer solutions within their field of responsibility and to help improve the health system&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is widespread evidence that certain diagnostic practices&#44; health care profiles and treatments&#44; some of which are costly&#44; do not provide significant added value for patients&#46; Decreasing these practices is a measure of efficiency that has no impact on the quality of care or health outcomes&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">One such example of this commitment is the American Board of Internal Medicine &#8220;Choosing Wisely&#8221; initiative&#44; which seeks to improve the health system&#39;s overall efficiency in the US&#44; with a commitment from multiple institutions&#46; Since the launch of &#8220;Choosing Wisely&#8221;&#44; a number of published articles have reviewed the general objectives of the project&#44;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6&#44;7</span></a> offering practical recommendations for efficiency&#44;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">8&#8211;10</span></a> commenting on low-value preventive activities&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a> reviewing the appropriate use of radiological<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">12&#44;13</span></a> and analytical tests<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">14&#44;15</span></a> and discussing the method for preparing recommendations and outcome measures&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In 2012&#44; the Spanish Society of Internal Medicine &#40;SEMI&#41; proposed a project that would involve other Spanish scientific societies&#44; with the aim of reducing low-value activities in Spain&#46; The project was ultimately approved by the Ministry of Health&#44; Social Services and Equality under the name &#8220;Commitment to Quality by Scientific Societies in Spain&#8221; and falls within the realm of activities of the Spanish Network of National Health System Technology and Services Assessment Agencies&#46; This project has been jointly coordinated by the Ministry of Health&#44; Social Services and Equality itself&#44; the Aragon Institute of Health Sciences with the team from the Clinical Practice Guidelines program &#8220;Gu&#237;aSalud&#8221; and SEMI&#46; It is an inclusive&#44; participatory and open project aimed at practitioners&#44; patients and health organizations&#44; with a solid scientific base and distinct stages in its execution&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The project&#39;s main objective is to reduce the number of unnecessary medical operations&#44; i&#46;e&#46;&#44; those without proven effectiveness&#44; with little or dubious effectiveness or those that are not cost-effective&#46; The secondary objectives are to reduce clinical practice variability&#44; to broadcast the commitment with the adequate use of health resources and to promote clinical safety and the quality of care&#46; This article describes the methodology used for the selection and details the 135 final recommendations by 30 Spanish scientific societies&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030"><span class="elsevierStyleBold">Methodology</span></span><p id="par0030" class="elsevierStylePara elsevierViewall">The methodology was structured in the following stages&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Identification of &#8220;do not do&#8221; recommendations in clinical practice guidelines and other evidence-based sources&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">The preliminary list of &#8220;do not do&#8221; recommendations were selected and prepared by the scientific societies involved and the project coordinator group&#44; with the aim of having a preliminary list of 15 &#8220;do not do&#8221; recommendations &#40;10 proposed by the societies and 5 by the coordinators&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Establishment of the definitive list of 5 &#8220;do not do&#8221; recommendations by each scientific society&#44; prioritized using the Delphi method&#46;</p></li></ul></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Stage 1&#58; Identification of recommendations</span><p id="par0050" class="elsevierStylePara elsevierViewall">The process of selecting and identifying &#8220;do not do&#8221; recommendations required these recommendations to be revised and researched in the clinical practice guidelines from the Spanish National Health System&#39;s Program and Catalog of Guidelines&#44; in sources such as the &#8220;Do not do&#8221; recommendations of the National Institute for Clinical Excellence and in similar sources from Canada&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> Australia<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> and New Zealand&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> Furthermore&#44; other scientific sources were analyzed &#40;e&#46;g&#46;&#44; systematic reviews&#44; reports from health technology assessment agencies and randomized clinical trials&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Stage 2&#58; Selecting the preliminary list of 15 &#8220;do not do&#8221; recommendations&#58; work performed jointly by the scientific societies and project coordinators</span><p id="par0055" class="elsevierStylePara elsevierViewall">Each scientific society established and proposed a preliminary list of 10 &#8220;do not do&#8221; recommendations&#44; with scientific evidence to support them&#44; choosing the recommendations from a clinical point of view and based on their suitability for the Spanish National Health System &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The group of experts who made the selection was not the same group that was involved in prioritizing the 5 final &#8220;do not do&#8221; recommendations&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The project coordinators proposed 5 &#8220;do not do&#8221; recommendations to each scientific society&#46; Using the Delphi method&#44; the societies and project coordinators had to jointly approve the &#8220;do not do&#8221; recommendations that were suggested prior to the prioritization process&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Stage 3&#58; Selecting the definitive list of 5 &#8220;do not do&#8221; recommendations by each scientific society&#44; prioritized using the Delphi method</span><p id="par0065" class="elsevierStylePara elsevierViewall">Each panel worked with a preliminary list of 15 &#8220;do not do&#8221; recommendations&#44; 10 of which were proposed by the scientific societies and 5 by the project coordinators&#46; Once the 5 &#8220;do not do&#8221; recommendations were definitively prioritized&#44; all approved recommendations were published&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Establishing the expert panel</span><p id="par0070" class="elsevierStylePara elsevierViewall">Each scientific society appointed a panel of 25 experts&#46; The requirements for the panel were that it be established using a group that represented the scientific society in terms of member profiles &#40;age and sex&#41;&#46; The number of members from the society&#39;s board of directors could not exceed 15&#37; of the total panel&#46; Prior to their inclusion&#44; each expert completed a declaration of interests&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Prioritizing &#8220;do not do&#8221; recommendations</span><p id="par0075" class="elsevierStylePara elsevierViewall">The definitive selection system was performed by means of the Delphi method&#44; using a Likert scale of agreement or disagreement with each recommendation from 1 to 9 &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>strongly disagree&#44; 9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>strongly agree&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The following prioritization indicators were given for the established recommendations&#58; &#40;a&#41; economic impact &#40;cost of the measure<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>frequency&#41;&#44; &#40;b&#41; clinical safety &#40;risk<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>number of cases&#41; and &#40;c&#41; high-cost and low-prevalence operations&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Non-face-to-face surveys were conducted in 2 rounds to seek consensus through a mathematical procedure for aggregating individual assessments&#46; Each expert participated by means of an online computer application &#40;SurveyMonkey&#174;&#41;&#44; accessed through an email address&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">For the data analysis of the surveys&#44; the median and interquartile range &#40;IQR&#41; was considered &#40;25&#8211;75 percentiles&#41;&#46; The criteria for assessing the level of agreement were as follows&#58; a median of 7&#8211;9 points was deemed strong agreement&#59; a median of 4&#8211;6 was neutral&#59; and a median of 1&#8211;3 was strong disagreement&#46; A low dispersion was considered with IQR<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2&#44; and a high dispersion was considered with IQR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">When consensus was not reached in the first round&#44; a second round was held&#46; In order for the panelists to make their reassessment&#44; they were each sent the recommendations&#44; the assessment they made in the previous round&#44; the median and the IQR&#46; Only recommendations with a median score &#8805;7 and an IQR<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2 were sent at that time&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the second round&#44; on the same questionnaire as in the first&#44; results were presented and participants were asked to reconsider their first-round response based on the whole group&#39;s results &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">In 2013&#44; the 12 participating scientific societies&#44; with a total of 216 panelists&#44; were as follows&#58; Spanish Association of Pediatrics&#44; Spanish Society of Cardiology&#44; Spanish Society of Endocrinology and Nutrition&#44; Spanish Society of Family and Community Medicine&#44; SEMI&#44; Spanish Society of Primary Care Physicians&#44; Spanish Society of General Practitioners&#44; Spanish Society of Family and Community Medicine&#44; Spanish Society of Nephrology&#44; Spanish Society of Pneumology and Thoracic Surgery&#44; Spanish Society of Neurology&#44; Spanish Society of Digestive Pathology and Spanish Society of Rheumatology&#46; The representative primary care societies held a joint panel&#46; The definitive recommendations chosen by the expert panels can be found in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">In 2014&#44; the 10 participating societies&#44; with a total of 232 panelists&#44; were the following&#58; Spanish Association of Medical Biopathology&#44; Spanish Association of Surgeons&#44; Spanish Society of Allergology and Clinical Immunology&#44; Spanish Society of Anesthesiology&#44; Reanimation and Pain Therapeutics&#44; Spanish Society of Hematology and Hemotherapy&#44; Spanish Society of Critical Intensive Medicine and Coronary Units&#44; Spanish Society of Nuclear Medicine and Molecular Imaging&#44; Spanish Society of Medical Oncology&#44; Spanish Society of Medical Radiology and Spanish Society of Rehabilitation and Physical Medicine&#46; The proposed recommendations can be found in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">In 2015&#44; the 8 participating societies&#44; with a total of 170 panelists&#44; were as follows&#58; Spanish Association of Urology&#44; Spanish Society of Clinical Biochemistry and Molecular Pathology&#44; Spanish Society of Care Quality&#44; Spanish Society of Oral and Maxillofacial Surgery&#44; Spanish Society of Orthopedics and Traumatology&#44; Spanish Society of Geriatrics and Gerontology&#44; Spanish Society of Geriatric Medicine and Spanish Society of Psychiatry&#46; The Geriatrics societies held a joint panel and&#44; their recommendations can be found in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The project is currently active&#44; and there are 48 societies taking part&#46; All those involved&#44; along with all recommendations that were issued&#44; are printable and can be accessed on the MSSSI website&#44; in the Clinical Excellence section &#91;in Spanish&#93; &#40;<a href="https://www.msssi.gob.es/profesionales/excelencia/home.htm">https&#58;&#47;&#47;www&#46;msssi&#46;gob&#46;es&#47;profesionales&#47;excelencia&#47;home&#46;htm</a>&#41;&#46; In summary&#44; this article presents 135 &#8220;do not do&#8221; recommendations prepared by 30 Spanish scientific societies&#44; with the participation of 618 expert panelists&#46; These recommendations were selected using a rigorous and predefined research and voting method and can be used to facilitate the decision-making process for clinicians&#44; patients and health administration&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Stage 2&#58; Selecting the preliminary list of 15 &#8220;do not do&#8221; recommendations&#58; work performed jointly by the scientific societies and project coordinators"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Stage 3&#58; Selecting the definitive list of 5 &#8220;do not do&#8221; recommendations by each scientific society&#44; prioritized using the Delphi method"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Establishing the expert panel"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Prioritizing &#8220;do not do&#8221; recommendations"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflicts of interest"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-12-23"
    "fechaAceptado" => "2017-02-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec830135"
          "palabras" => array:5 [
            0 => "What not to do"
            1 => "Scientific societies"
            2 => "Appropriate precautions"
            3 => "Commitment"
            4 => "Spain"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec830136"
          "palabras" => array:5 [
            0 => "No hacer"
            1 => "Sociedades cient&#237;ficas"
            2 => "Cuidados apropiados"
            3 => "Compromiso"
            4 => "Espa&#241;a"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This article summarizes the objectives&#44; methodology and initial conclusions of the project &#8220;Commitment to Quality of the Spanish Scientific Societies&#8221;&#44; coordinated by the Ministry of Health&#44; Social Services and Equality&#44; the Spanish Society of Internal Medicine and the Aragon Institute of Health Sciences&#44; in which 48 scientific societies participate&#46; This project&#39;s objectives are to decrease the use of unnecessary medical interventions&#44; which are those that have shown no efficacy&#44; have little or questionable effectiveness or are not cost-effective&#59; decrease variability in clinical practice&#59; promote the commitment among physicians and patients to properly use healthcare resources&#59; and to promote clinical safety&#46; The document includes 135 final recommendations for what not to do&#44; prepared by 30 Spanish scientific societies&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En este art&#237;culo se resumen los objetivos&#44; la metodolog&#237;a y las primeras conclusiones del proyecto <span class="elsevierStyleItalic">&#171;Compromiso por la calidad de las sociedades cient&#237;ficas en Espa&#241;a&#187;</span>&#44; coordinado por el Ministerio de Sanidad&#44; Servicios Sociales e Igualdad&#44; la Sociedad Espa&#241;ola de Medicina Interna y el Instituto Aragon&#233;s de Ciencias de la Salud&#44; en el que participan 48 sociedades cient&#237;ficas&#46; Los objetivos de este proyecto son&#58; disminuir la utilizaci&#243;n de intervenciones m&#233;dicas innecesarias&#44; que son las que no han demostrado eficacia&#44; tienen escasa o dudosa efectividad&#44; o no son coste-efectivas&#59; disminuir la variabilidad en la pr&#225;ctica cl&#237;nica&#59; difundir entre m&#233;dicos y pacientes el compromiso con el uso adecuado de recursos sanitarios y&#44; por &#250;ltimo&#44; promover la seguridad cl&#237;nica&#46; En el documento se incluyen 135 recomendaciones finales de &#171;no hacer&#187; elaboradas por 30 sociedades cient&#237;ficas espa&#241;olas&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a-Alegr&#237;a J&#44; V&#225;zquez-Fern&#225;ndez del Pozo S&#44; Salcedo-Fern&#225;ndez F&#44; Garc&#237;a-Lechuz Moya JM&#44; Andr&#233;s Zaragoza-Gaynor G&#44; L&#243;pez-Orive M&#44; et al&#46; Compromiso por la calidad de las sociedades cient&#237;ficas en Espa&#241;a&#46; Rev Clin Esp&#46; 2017&#59;217&#58;212&#8211;221&#46;</p>"
      ]
    ]
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Methodology for the final selection of &#8220;do not do&#8221; recommendations&#46;</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; ACEI&#44; angiotensin-converting enzyme inhibitors&#59; ARB&#44; angiotensin <span class="elsevierStyleSmallCaps">ii</span> receptor blockers&#59; CKD&#44; chronic kidney disease&#59; COPD&#44; chronic obstructive pulmonary disease&#59; CT&#44; computed tomography&#59; Ig&#44; immunoglobulin&#59; LABA&#44; long-acting betamimetic bronchodilators&#59; MRI&#44; magnetic resonance imaging&#59; NSAIDs&#44; anti-inflammatory nonsteroidal drugs&#59; PaO<span class="elsevierStyleInf">2</span>&#44; arterial oxygen pressure&#59; PPI&#44; proton pump inhibitors&#59; PSA&#44; prostate-specific antigen&#59; QUS&#44; quantitative ultrasound&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \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"><span class="elsevierStyleItalic">Spanish Association of Pediatrics</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not delay empirical antibiotic treatment when there is a suspicion of invasive meningococcal disease resulting from cultures &#40;blood and&#47;or cerebrospinal fluid&#41;&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not routinely perform electroencephalogram or neuroimaging &#40;CT&#44; MRI&#41; studies on children with simple febrile seizures&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not routinely give antibiotics to children with gastroenteritis&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not use serological tests to diagnose celiac disease in children before gluten has been introduced into the diet&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; The routine use of chest radiography is not recommended for acute bronchiolitis&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Cardiology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not use clopidogrel as a first-line treatment in monotherapy after myocardial infarction&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not routinely prescribe fibrates for the primary prevention of cardiovascular disease&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not routinely use calcium channel blockers to reduce cardiovascular risk after a myocardial infarction&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; In patients with left ventricular systolic dysfunction&#44; do not use antiarrhythmic agents &#40;in particular those in the I-C group&#41;&#44; due to the drugs&#8217; adverse effects &#40;worsening of heart failure&#44; proarrhythmia and death&#41;&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; In patients with persistent atrial fibrillation when the cause has been corrected &#40;e&#46;g&#46;&#44; pulmonary infection and fever&#41; and cardioversion has been performed successfully&#44; antiarrhythmic agents are not recommended for maintaining sinus rhythm&#44; unless there are risk factors for recurrence&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Endocrinology and Nutrition</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not use glitazones in patients with diabetes and heart failure&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not use sulphonylureas when treating elderly patients with renal failure&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not determine thyroglobulin levels when initially evaluating a thyroid nodule&#39;s malignancy&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not repeat the antithyroid antibody determination in patients diagnosed with thyroid dysfunction who have already tested positive in the past&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not perform thyroid ultrasonography on patients with subclinical hypothyroidism&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Family and Community Medicine &#40;SEMFYC&#41;&#46;</span><br><span class="elsevierStyleItalic">Spanish Society of Primary Care Physicians</span><br><span class="elsevierStyleItalic">Spanish Society of General Practitioners</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not routinely request densitometry for postmenopausal women to assess the risk of osteoporotic fracture without first assessing the risk factors&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not use hormone therapy &#40;estrogens or estrogens with progestogens&#41; with the aim of preventing vascular disease in postmenopausal women&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not use test strips or glucose meters on patients with type 2 diabetes undergoing treatment with nonhypoglycemic oral drugs&#44; except in situations of unstable glycemic control&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not systematically perform PSA measurements on asymptomatic individuals with no history of prostate cancer in a first-degree relative&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not use rifampicin together with pyrazinamide for the primary chemoprophylaxis of tuberculosis in immunocompetent individuals&#44; due to their high toxicity&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Internal Medicine</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; There are no indications to screen or treat asymptomatic bacteriuria&#44; even in patients with bladder catheterization&#44; except in pregnancy and urological surgical procedures&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not use acetylsalicylic acid as primary prevention in individuals who have no cardiovascular disease&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not use benzodiazepines to treat insomnia&#44; agitation or delirium in the elderly&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; The determination of natriuretic peptide levels is not indicated for the therapeutic decision-making process in chronic heart failure&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; In the majority of cases in which high blood pressure readings are detected&#44; there is no indication to initiate antihypertensive treatment immediately&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Nephrology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not start renal replacement therapy with dialysis without having previously undergone the appropriate decision-making process involving the patient&#44; family and doctor&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; In elderly patients with CKD and proteinuria&#44; a blood pressure target of less than 130&#47;80<span class="elsevierStyleHsp" style=""></span>mm&#160;Hg should not be routinely sought&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not routinely use the combination of a direct renin inhibitor and an ACEI or ARB&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not prescribe folic acid or vitamin C supplements specifically for treating anemia in chronic kidney disease&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not systematically measure plasma renin levels as a prognostic marker of hypertension in children with permanent kidney damage&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Pulmonology and Thoracic Surgery</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; For patients with COPD and an arterial partial pressure of oxygen &#40;PaO2&#41; of more than 55<span class="elsevierStyleHsp" style=""></span>mm&#160;Hg and without exercise desaturation&#44; do not prescribe outpatient oxygen therapy&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; In bronchial asthma&#44; do not use LABAs as the only treatment&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not routinely perform magnetic resonance imaging to evaluate the stage of nonsmall-cell lung cancer&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not systematically use antibiotics to treat patients with COPD exacerbations without severity data and with just one Anthonisen criterion &#40;other than sputum purulence&#41;&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; For patients with difficulty maintaining sleep&#44; do not use hypnotics without a previous etiological diagnosis&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Neurology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not perform neuroimaging studies &#40;MRIs and&#47;or CTs&#41; repeatedly for patients with primary headaches &#40;migraines and tension headaches&#41; without changes in the headache profile&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not routinely repeat electroencephalograms for patients with controlled epilepsy &#40;without changes in the seizure profile&#41; unless withdrawal of the medication is being considered&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not use drugs with potential extrapyramidal adverse effects &#40;e&#46;g&#46;&#44; antiemetic&#44; antivertiginous and prokinetic agents&#41; in patients with Parkinson&#39;s disease&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not routinely use anticoagulants to treat acute strokes&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not use long-term corticosteroid therapy for patients with multiple sclerosis&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Digestive Pathology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not schedule revisions or colonoscopies within 5 years when following up with postpolypectomy patients with 1 or 2 adenomas smaller than 1<span class="elsevierStyleHsp" style=""></span>cm &#40;without high-grade dysplasia&#41; that were completely excised during a high-quality colonoscopy&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not administer antibiotic prophylaxis to individuals with mild acute pancreatitis&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not prescribe PPIs as gastroprotection for patients with no risk factors for gastrointestinal complications&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not restrict the fluid intake of patients with ascites&#44; except in the presence of dilutional hyponatremia with natremia below 125<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not use the detection of IgA or antigliadin IgG antibodies for the diagnosis of celiac disease&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Rheumatology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not use 2 or more NSAIDs simultaneously&#44; because it will increase toxicity while not improving the efficacy&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not use therapeutic injections locally for nonspecific lower back pain&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Arthroscopic lavage with debridement is not indicated for patients with knee osteoarthritis unless there is a clear history of mechanical blockage&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not use QUS or simple radiography to diagnose osteoporosis&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Performing CTs or MRIs is not recommended for cervicalgia or nonspecific lower back pain without warning signs&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Recommendations selected by each of the 12 scientific societies included in the first stage of the project in alphabetical order &#40;2013&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; AMI&#44; acute myocardial infarction&#59; CET&#44; cranioencephalic trauma&#59; CK&#44; creatine kinase&#59; CK-MB&#44; creatine kinase M-B&#59; CT&#44; computed tomography&#59; ECG&#44; electrocardiogram&#59; EGFR&#44; epidermal growth factor receptor&#59; FNAC&#44; Fine-needle aspiration cytology&#59; FT4&#44; free thyroxine&#59; Hb&#44; hemoglobin&#59; HbA1c&#44; glycated hemoglobin&#59; HER2&#44; human epidermal growth factor receptor 2&#59; ICU&#44; intensive care unit&#59; Ig&#44; immunoglobulin&#59; KRAS&#44; Kirsten rat sarcoma viral oncogene&#59; MPS&#44; myocardial perfusion scintigraphy&#59; MRI&#44; magnetic resonance imaging&#59; PET-FDG&#44; positron emission tomography with fludeoxyglucose&#59; SPECT-CT&#44; single-photon emission computed tomography&#59; TENS&#44; transcutaneous electrical nerve stimulation&#59; TSH&#44; thyroid-stimulating hormone or thyrotropin&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \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"><span class="elsevierStyleItalic">Spanish Association of Medical Biopathology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not request serological tumor markers as population screening &#40;unless the population belongs to the defined risk groups for each type of tumor&#41;&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; For patients with diabetes and good clinical and metabolic control&#44; do not perform HbA1c readings more than twice a year&#46; If HbA1c readings need to be performed more frequently&#44; ensure that they are not conducted at less than 3-month intervals&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not perform thyroid screenings for hospitalized patients&#46; When performing these screenings on outpatients&#44; only assess TSH&#46; The laboratory test may be expanded to FT4 and other measurements&#44; where appropriate&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not reevaluate antinuclear antibodies within a period of less than 3 months&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not use CK or CK-MB to diagnose AMI&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Association of Surgeons</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not perform cholecystectomies in patients with asymptomatic cholelithiasis&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not keep bladder catheterization for more than 48<span class="elsevierStyleHsp" style=""></span>h following gastrointestinal surgery&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not prolong antibiotic prophylaxis treatment for more than 24<span class="elsevierStyleHsp" style=""></span>h following a surgical procedure&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not perform routine antibiotic prophylaxis for clean and uncomplicated nonprosthetic surgery&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not indicate postoperative antibiotic therapy in uncomplicated appendicitis&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Allergology and Clinical Immunology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not conduct skin or in vitro tests with allergens without having previously performed a detailed medical history&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not perform diagnostic tests or therapeutic procedures involving risk in allergology&#44; without quality and clinical safety guarantees&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not perform diagnostic tests with dubious effectiveness&#44; such as IgG or indiscriminate IgE testing of allergens when studying allergies&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; In anaphylactic reactions&#44; do not use antihistamines or corticosteroids as first-line treatment&#59; the use of adrenaline should be prioritized&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not treat bronchial asthma with medium or long-acting bronchodilators without inhaled corticosteroids&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Anaesthesiology&#44; Reanimation and Pain Therapeutics</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not maintain deep sedation levels in critically ill patients without a specific indication&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not perform a chest radiography for patients under 40 years of age with low anesthetic risk according to the American Association of Anesthesiologists &#40;ASA I or II&#41;&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not systematically perform preoperative tests for cataract surgery&#44; unless indicated through a medical history and physical examination&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not schedule elective surgery with a risk of bleeding in patients with anemia until an adequate diagnosis and treatment analysis has been conducted&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not perform laboratory tests &#40;hemogram&#44; biochemistry and coagulation analysis&#41; in patients with no systemic disease &#40;ASA I and II&#41; prior to low-risk surgeries&#44; with minimal estimated blood loss&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Hematology and Hemotherapy</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not administer plasma or prothrombin complexes to reverse vitamin K antagonists in nonemergency situations &#40;e&#46;g&#46;&#44; unless there is severe bleeding&#44; intracranial hemorrhage or emergency surgery&#41;&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not transfuse more packed red blood cells than necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range &#40;7&#8211;8<span class="elsevierStyleHsp" style=""></span>g&#47;dL in stable noncardiac patients&#41;&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not transfuse packed red blood cells into patients with iron-deficient anemia and no hemodynamic instability&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; In adult patients with anemia who receive an erythropoiesis stimulator&#44; routine correction is not recommended for hemoglobin levels above 12<span class="elsevierStyleHsp" style=""></span>g&#47;dL &#40;adjust dose for the desired Hb level between 10 and 12<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41;&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not perform FNA to diagnose a patient with lymphadenopathy where there is suspicion of a neoplastic lymphoid origin&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Critical Intensive Medicine and Coronary Units</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not continue empiric antibiotic treatment&#44; initiated after admission for severe infection&#44; without daily assessments of its relevance and possible de-escalation&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not routinely conduct blood tests outside of the specific clinical indications&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not routinely perform a daily chest X-ray in intensive care units&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not maintain isolation measures&#44; established in patients with confirmed transmissible disease&#44; throughout their stay in the ICU&#46; Measures should be routinely maintained for the duration of the infectious disease or colonization&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Red blood cell concentrates should not be transfused in critical but hemodynamically stable patients who are not bleeding&#44; have no cardiac or central nervous system impairment and a Hb concentration greater than 7<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Nuclear Medicine and Molecular Imaging</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not conduct PET-FDGs as a population screening technique for prostate cancer&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not substitute the isotopic sentinel lymph node technique with other nonisotopic techniques until the latter techniques achieve the same diagnostic safety levels and have the same scientific evidence as are currently available for the former technique&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not perform MPS to diagnose ischemic heart disease in asymptomatic patients with low risk of the disease&#44; in patients with low pretest probability with an interpretable ECG and capacity for exercise and in patients for preoperative assessment for low-risk surgery&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not conduct parathyroid gammagraphy with SPECT-CT to locate parathyroid adenomas in patients without a biochemical diagnosis of hyperparathyroidism or in patients who are not candidates for surgery&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not perform surgery for breast cancer or melanoma with criteria for sentinel node indication using radioactive tracers&#44; if the medical and surgical team does not have sufficient experience in managing the surgery&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Medical Oncology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not concomitantly administer anti-EGFR antibodies and antiangiogenic antibodies in native KRAS metastatic colorectal cancer&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; In breast cancer&#44; do not concomitantly administer adjuvant chemotherapy with adjuvant endocrine therapy&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not start neoadjuvant therapy &#40;primary systemic therapy&#41; for breast cancer without a prior&#44; complete histological study &#40;including hormone receptors and HER2&#41; and without prior tumor marking&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Bisphosphonates are not recommended for preventing bone metastases in patients with prostate cancer&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not administer adjuvant treatment to patients diagnosed with stage IA nonsmall cell lung cancer &#40;T1a-bN0M0&#41; if the margins are negative&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Medical Radiology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not routinely perform simple skull radiographs in patients with CET&#44; except with a confirmation or suspicion of an nonaccidental cause of CET&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not routinely conduct simple abdominal radiography on children or adolescents with acute abdominal pain unless there is suspicion of an intestinal obstruction or perforation&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not conduct a pelvic radiograph in multiple trauma patients if a full-body CT is going to be performed&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not perform CTs or MRIs on children with simple febrile seizures&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not perform MRI screenings of breast cancer in asymptomatic women without risk factors&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Rehabilitation and Physical Medicine</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not use adhesive neuromuscular dressings indiscriminately or as first-line treatment to reduce pain and improve functionality in all neuromuscular diseases&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not systematically use low-intensity lasers to treat musculoskeletal pain&#44; without estimating the possible response according to the etiology&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not conduct imaging testing &#40;radiography&#44; MRI&#44; CT&#41; in patients with acute lower back pain with no warning signs&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; In the treatment of patellofemoral syndrome&#44; do not use physical therapy modalities &#40;thermotherapy&#44; TENS&#41; in isolation&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not recommend bed rest for patients with acute or subacute lower back pain&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Recommendations selected by each of the 10 scientific societies included in the second stage of the project in alphabetical order &#40;2014&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; Apo E&#44; apolipoprotein E&#59; AST&#44; aspartate aminotransferase&#59; CK&#44; creatine kinase&#59; CK-MB&#44; creatine kinase M-B&#59; CRP&#44; C-reactive protein&#59; CT&#44; computed tomography&#59; ESR&#44; erythrocyte sedimentation rate&#44; HbA1c&#44; glycated hemoglobin&#59; Ig&#44; immunoglobulin&#59; LDH&#44; lactate dehydrogenase&#59; PSA&#44; prostate-specific antigen&#59; TSH&#44; thyroid-stimulating hormone or thyrotropin&#46;</p>"
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                  <table border="0" frame="\n
                  \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"><span class="elsevierStyleItalic">Spanish Association of Urology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not conduct staging CTs or bone scintigraphy for patients with clinically-localized prostate cancer if the PSA level is below 10 and the Gleason score is below 8&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not treat overactive bladders before excluding other diseases that could cause similar symptomatology&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not restrict the calcium intake of patients with recurrent calcium kidney stones if their diet is deemed adequate&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; For asymptomatic patients with below normal PSA levels&#44; do not perform PSA assessments in shorter than 1-year intervals&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not conduct fertility studies for women and men without having at least 2 seminograms that do not meet normal parameters&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Clinical Biochemistry and Molecular Pathology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not request multiple tests in the initial assessment of a patient with suspected thyroid disease&#46; First request a TSH reading and&#44; if the results are abnormal&#44; continue with additional testing or treatment based on the findings&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; The assessment of CK&#44; CK-MB&#44; AST&#44; LDH or myoglobin is not recommended for the diagnosis of myocardial damage &#40;or myocardial infarction&#41;&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not conduct allergen-specific IgE testing without a medical history of adverse reactions or with no prior in vivo testing&#46; In any case&#44; do not perform systematic analyses of several immunoglobulins against allergens without a thorough review of the patient&#39;s medical history&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not conduct population-based vitamin D deficiency screenings using serum concentrations of 1&#44;25-dihydroxyvitamin D &#40;calcidiol&#41;&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not request an ESR to assess inflammation in patients with undefined diagnoses&#46; To detect proinflammatory status during acute phase&#44; request CRP&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Care Quality</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not use permanent urinary catheters in patients without appropriate indication&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not routinely use topical antibiotics or antiseptics to treat pressure ulcers in adults&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not use abbreviations when writing prescriptions&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not separate mothers from their children after giving birth&#44; unless there are medical reasons&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not use standard informed consent documents without providing adequate discussion and personalized information on the problems&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Oral and Maxillofacial Surgery</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not extract wisdom teeth in young people and adolescents when there is enough space for their eruption&#46; Wisdom teeth can reach functional positions in the dental arcade&#46; Do not extract wisdom teeth in children&#44; even if the teeth appear impacted&#44; because they can change position&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not extract deeply impacted wisdom teeth without evidence of disease&#44; when fully covered with bone and&#47;or soft tissue&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not perform an excisional biopsy without a safety margin on oral mucosal lesions suspected to be cancerous&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not use guided bone regeneration techniques on noncritical bone defects of the jaw &#40;e&#46;g&#46;&#44; in postextraction sockets or cystic cavities when only one wall is missing&#41;&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not perform systematic antibiotic prophylaxis in minor oral surgery&#44; including dental extractions&#44; without signs of previous infection&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Orthopedics and Traumatology</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not delay hip fracture surgery in the elderly for more than 48<span class="elsevierStyleHsp" style=""></span>h in the absence of formal medical contraindication&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not prolong antibiotic prophylaxis for more than 24<span class="elsevierStyleHsp" style=""></span>h after an uncomplicated surgical procedure&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not indicate a joint prosthesis in the first episode of acute knee or hip pain&#44; even if there are arthroscopic radiographic signs&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not prescribe opioids for acute disabling lower back pain before evaluating and considering other alternatives&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not conduct chest X-rays during the preoperative assessment of healthy&#44; young patients&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Geriatrics and Gerontology</span><br><span class="elsevierStyleItalic">Spanish Society of Geriatric Medicine</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not use intensive therapeutic measures to achieve an HbA1 reduction &#60;7&#46;5&#37; in multimorbid&#44; fragile&#44; dependent elderly people with a life expectancy &#60;10 years&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not prescribe drugs without considering the previous treatment or evaluating interactions and the degree of adherence to compliance&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not make clinical decisions for those older than 75 years without evaluating their functional status&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not indicate nasogastric tube placement or percutaneous gastrostomy for patients with advanced stage dementia&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; Do not indicate the assessment of genetic risk factors for dementia &#40;such as ApoE genotype&#41; for genetic counseling purposes for asymptomatic subjects&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&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"><span class="elsevierStyleItalic">Spanish Society of Psychiatry</span>&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"><span class="elsevierStyleHsp" style=""></span>1&#46; Do not use the serotonin plasma level measurements as a diagnostic criterion for depressive disorder&#46;&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"><span class="elsevierStyleHsp" style=""></span>2&#46; Do not use antipsychotics to treat generalized anxiety disorders in primary care&#46;&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"><span class="elsevierStyleHsp" style=""></span>3&#46; Do not prescribe antihistamines to treat panic disorders&#46;&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"><span class="elsevierStyleHsp" style=""></span>4&#46; Do not administer long half-life benzodiazepines to treat insomnia in the long-term in individuals older than 65 years&#46;&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"><span class="elsevierStyleHsp" style=""></span>5&#46; The use of a loading dose of antipsychotics &#40;rapid neuroleptic technique&#41; is not recommended for childhood schizophrenia and psychosis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Recommendations selected by each of the 8 scientific societies included in the third stage of the project in alphabetical order &#40;2015&#41;&#46;</p>"
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Article information

ISSN: 22548874
Original language: English

DOI:10.1016/j.rceng.2017.02.006

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