临床实践指南如何“保鲜”How to Keep Clinical Practice Guidelines “Fresh”
陈耀龙;王玲;杨楠;李舍予;王琪;黎国威;宋扬;苏珊;商洪才;杨克虎;
CHEN Yao-long;WANG Ling;YANG Nan;LI She-yu;WANG Qi;LI Guo-wei;SONG Yang;SU Shan;SHANG Hong-cai;YANG Ke-hu;Evidence-Based Medicine Center,School of Basic Medical Sciences,Lanzhou University;WHO Collaborating Center for Guideline Implementation and Knowledge Translation;Chinese GRADE Center;School of Public Health,Lanzhou University;Department of Endocrinology and Metabolism,West China Hospital,Sichuan University;Chinese Evidence-based Medicine Center,West China Hospital,Sichuan University;MAGIC C
摘要(Abstract):
临床实践指南是医疗实践的指导性文件,及时修订的指南推荐意见对于指导医生进行临床决策具有重要意义和价值。因此,指南应基于最新的研究证据,形成对当前医疗实践的最佳推荐意见,并保持与时俱进。本文针对指南修订的现状、方法、流程及存在的问题展开讨论,提出指南修订最长周期为5年,最短可以做到实时更新;修订方法目前国内外无统一标准,建议可参考本文提出的流程及RIGHT和CheckUp报告清单。此外,本文就如何有效开展修订工作,从指南管理者、制订者、研究者和使用者四个层面提出思考与建议。
Clinical practice guidelines are guiding documents in medical practices. Timely updated recommendations are important and valuable to guide physicians in making clinical decisions. Guidelines should be developed on the latest research evidence for the best recommendations in clinical practice and updated regularly to remain valid. Based on the discussion about the status quo, methods and procedures, and challenges of updating guidelines, our results showed that the longest update period is 5 years, and the shortest period can be constantly updated. Since there are no standardized methods for guideline updating, we proposed in this article the procedures for Chinese guideline developers, and recommended RIGHT and CheckUp as the reporting checklists. In addition, the related strategies and suggestions to effectively update guidelines were proposed for the guideline managers, developers, researchers, and users.
关键词(KeyWords):
临床实践指南;指南修订;系统评价;循证医学
clinical practice guideline;update of guideline;systematic review;evidence-based medicine
基金项目(Foundation): 国家重点研发计划(2018YFC1705500)
作者(Author):
陈耀龙;王玲;杨楠;李舍予;王琪;黎国威;宋扬;苏珊;商洪才;杨克虎;
CHEN Yao-long;WANG Ling;YANG Nan;LI She-yu;WANG Qi;LI Guo-wei;SONG Yang;SU Shan;SHANG Hong-cai;YANG Ke-hu;Evidence-Based Medicine Center,School of Basic Medical Sciences,Lanzhou University;WHO Collaborating Center for Guideline Implementation and Knowledge Translation;Chinese GRADE Center;School of Public Health,Lanzhou University;Department of Endocrinology and Metabolism,West China Hospital,Sichuan University;Chinese Evidence-based Medicine Center,West China Hospital,Sichuan University;MAGIC C
Email:
DOI:
参考文献(References):
- [1] Institute of Medicine.Clinical practice guidelines we can trust[M].Washington DC:the National Academy Press,2011.
- [2] 陈耀龙,罗旭飞,王吉耀,等.如何区分临床实践指南与专家共识[J].协和医学杂志,2019,10:403- 408.
- [3] Field MJ,Lohr KN.Guidelines for clinical practice:from development to use[M].Washington DC:the National Academy Press,1992.
- [4] Woolf SH,Grol R,Hutchinson A,et al.Clinical guide-lines:potential benefits,limitations,and harms of clinical guidelines[J].BMJ,1999,318:527- 530.
- [5] 陈耀龙,杨克虎.正确理解、制订和使用临床实践指南[J].协和医学杂志,2018,9:367- 373.
- [6] Guyatt GH,Rennie D.Users' guides to the medical literature[J].JAMA,1993,270:2096- 2097.
- [7] Bastian H,Glasziou P,Chalmers I.Seventy-five trials and eleven systematic reviews a day:how will we ever keep up?[J].PLoS Med,2010,7:e1000326.
- [8] Becker M,Neugebauer EA,Eikermann M.Partial updat-ing of clinical practice guidelines often makes more sense than full updating:a systematic review on methods and the development of an updating procedure[J].J Clin Epidemiol,2014,67:33- 45.
- [9] Vernooij RW,Sanabria AJ,Solà I,et al.Guidance for updating clinical practice guidelines:a systematic review of methodological handbooks[J].Implement Sci,2014,9:3.
- [10] Brouwers MC,Kho ME,Browman GP,et al.AGREEⅡ:advancing guideline development,reporting and evaluation in health care[J].CMAJ,2010,182:E839-E842..
- [11] Shekelle P,Eccles MP,Grimshaw JM,et al.When should clinical guidelines be updated?[J].BMJ,2001,323:155- 157.
- [12] SPRINT Research Group,Wright JT,Williamson JD,et al.A randomized trial of intensive versus standard blood-pressure control[J].N Engl J Med,2015,373:2103-2116.
- [13] Whelton PK,Carey RM,Aronow WS,et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention,detection,evaluation,and management of high blood pressure in adults:a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines[J].Circulation,2018,138:e484-e594.
- [14] Wang YJ,Wang YL,Zhao XQ,et al.Clopidogrel with aspirin in acute minor stroke or transient ischemic attack[J].N Engl J Med,2013,369:11- 19.
- [15] Kernan WN,Ovbiagele B,Black HR,et al,American Heart Association Stroke Council,Council on Cardiovascular and Stroke Nursing,Council on Clinical Cardiology,and Council on Peripheral Vascular Disease.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45:2160- 236.
- [16] Zhao JG,Zeng XT,Wang J,et al.Association between calcium or vitamin D supplementation and fracture incidence in community-dwelling older adults:a systematic review and meta-analysis[J].JAMA,2017,318:2466- 2482.
- [17] Kahwati LC,Weber RP,Pan H,et al.Vitamin D,calcium,or combined supplementation for the primary prevention of fractures in community-dwelling adults:evidence report and systematic review for the US Preventive Services Task Force[J].JAMA,2018,319:1600- 1612.
- [18] Chatham-Stephens K,Roguski K,Jang Y,et al.Characteristics of hospitalized and nonhospitalized patients in a nationwide outbreak of e-cigarette,or vaping,product use-associated lung injury—United States,November 2019[J].MMWR Morb Mortal Wkly Rep,2019,68:1076- 1080.
- [19] Jatlaoui TC,Wiltz JL,Kabbani S,et al.Update:interim guidance for health care providers for managing patients with suspected e-cigarette,or vaping,product use-associated lung injury—United States,November 2019[J].MMWR Morb Mortal Wkly Rep,2019,68:1081- 1086.
- [20] 中华医学会生殖医学分会.中国高龄不孕女性辅助生殖临床实践指南[J].中国循证医学杂志,2019,19:253- 270.
- [21] 国家药品监督管理局.进口药品:注射用贝利尤单抗[EB/OL].http://app1.sfda.gov.cn/datasearchcnda/face3/base.jsp?tableId=36&tableName=TABLE36&title=%E8%BF%9B%E5%8F%A3%E8%8D%AF%E5%93%81&bcId=152904858822343032639340277073.
- [22] 中华医学会风湿病学分会,国家皮肤与免疫疾病临床医学研究中心,中国系统性红斑狼疮研究协作组.2020中国系统性红斑狼疮诊疗指南[J].中华内科杂志,2020,59:172- 185.
- [23] 中华医学会感染病学分会,中华医学会肝病学分会.慢性乙型肝炎防治指南(2019年版)[J].临床肝胆病杂志,2019,35:2648- 2669.
- [24] 国家卫生健康委办公厅,国家中医药管理局办公室.国卫办医函[2020]184号:关于印发新型冠状病毒肺炎诊疗方案(试行第七版)的通知[EB/OL].[2020- 03- 03].http://www.gov.cn/zhengce/zhengceku/2020- 03/04/content_5486705.htm.
- [25] 蒋朱明,詹思延,贾晓巍,等.制订/修订《临床诊疗指南》的基本方法及程序[J].中华医学杂志,2016,96:250- 253.
- [26] World Health Organization.WHO handbook for guideline development[M/OL].Second edition.2014.http://apps.who.int/medicinedocs/en/m/abstract/Js22083en/.
- [27] National Institute for Health and Care Excellence (Great Britain).Developing NICE guidelines:the manual[M/OL].2014.https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview.
- [28] Scottish Intercollegiate Guidelines Network (SIGN).SIGN 50:a guideline developer's handbook[M/OL].2015.https://www.sign.ac.uk/sign- 50.
- [29] Alonso-Coello P,García L M,Carrasco J M,et al.The updating of clinical practice guidelines:insights from an international survey[J].Implement Sci,2011,6:107.
- [30] 陈耀龙,王小琴,吴琼芳,等.中国临床实践指南更新情况调查[J].中国循证医学杂志,2014,14:178- 183.
- [31] Chen Y,Yang K,Maru?ic A,et al.A reporting tool for practice guidelines in health care:the RIGHT statement[J].Ann Intern Med,2017,166:128- 132.
- [32] 陈耀龙,王小琴,王琪,等.遵循指南报告规范提升指南报告质量[J].中华内科杂志,2018,57:168- 170.
- [33] Vernooij RW,Alonso-Coello P,Brouwers M,et al.Report-ing items for updated clinical guidelines:checklist for the reporting of updated guidelines (CheckUp)[J].PLoS Med,2017,14:e1002207.
- [34] 王丽琼,严毓倩,梁宁,等(译).更新临床实践指南需要报告的条目:更新版指南的报告清单[J].中国中西医结合杂志,2017,37:589- 595.
- [35] Kowalski SC,Morgan RL,Falavigna M,et al.Development of rapid guidelines:1.systematic survey of current practices and methods[J].Health Res Policy Syst,2018,16:61.
- [36] Chen Y,Wang C,Shang H,et al.Clinical practice guidelines in China[J].BMJ,2018,360:j5158.
- 临床实践指南
- 指南修订
- 系统评价
- 循证医学
clinical practice guideline - update of guideline
- systematic review
- evidence-based medicine
- 陈耀龙
- 王玲
- 杨楠
- 李舍予
- 王琪
- 黎国威
- 宋扬
- 苏珊
- 商洪才
- 杨克虎
CHEN Yao-long- WANG Ling
- YANG Nan
- LI She-yu
- WANG Qi
- LI Guo-wei
- SONG Yang
- SU Shan
- SHANG Hong-cai
- YANG Ke-hu
- Evidence-Based Medicine Center
- School of Basic Medical Sciences
- Lanzhou University
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation
- Chinese GRADE Center
- School of Public Health
- Lanzhou University
- Department of Endocrinology and Metabolism
- West China Hospital
- Sichuan University
- Chinese Evidence-based Medicine Center
- West China Hospital
- Sichuan University
- MAGIC C
- 陈耀龙
- 王玲
- 杨楠
- 李舍予
- 王琪
- 黎国威
- 宋扬
- 苏珊
- 商洪才
- 杨克虎
CHEN Yao-long- WANG Ling
- YANG Nan
- LI She-yu
- WANG Qi
- LI Guo-wei
- SONG Yang
- SU Shan
- SHANG Hong-cai
- YANG Ke-hu
- Evidence-Based Medicine Center
- School of Basic Medical Sciences
- Lanzhou University
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation
- Chinese GRADE Center
- School of Public Health
- Lanzhou University
- Department of Endocrinology and Metabolism
- West China Hospital
- Sichuan University
- Chinese Evidence-based Medicine Center
- West China Hospital
- Sichuan University
- MAGIC C