临床指南应用的相关因素 Relevance x Validity Usefulness= Work Usefulness: 指南的实用性 Relevance: 与具体病人相符合的程度 Validity: 文献的真实性、科学性 Work: 获得证据所花的时间、精力和难易程度 Figure.Usefulness equation.Slawson DC,Becoming a medical information master: feeling good about not knowing everything.J Fam Pract 1994;38:505-13
临床指南的变革 >证据的评估与推荐方法学上的进步和飞 跃 >指南的作用将对医学质量和资源效率起 重要作用 >指南的指定所涉及的范围更为广泛 资深专家组制定评估/标准/使用范围医疗资源 与费用/可操作性/地域及文化背景
Health Care Question(PICO) Systematic review Studias1s2勹s的s4s5☐ Outcomas Oc OC2 OC3 OC4 2rao5 Gonerate an ostimate of offoct for each outcomo Renaayaeoraamama Ransmoaneddowna Final rating of quality for oach outcome:high,moderate,low,or very low Also labeled conditional Decide if any revision of direction or strength is necessary considering:Recource uee discretionary
Prioritize problems Establish review team and/or guideline panel Define questions to be addressed (varches.soleetoror Cuvcon and analysi (Re)assess the relative importance of outcomes Prepare an evidence profile GRADE An mnt of the quidence tor och outcome A summary of the findings Assess tne ovoaior evidence on the)and trengh of the Draft the systematic review or guideline Consult with stakeholders and/or external peer reviewers Disseminate the review or guideline Update review or guideline when needed Adapt guideline,if needed Prioritize recommendations for implementation Implement or support implementation of the quideline Evaluate the impact of the guideline and implementation strategies Update the systematic review and guideline