制定临床医学指南需要指南

Guideline for developing clinical guidelines

目前，世界许多国家都通过开发本国的临床医学指南来指导临床工作，从而提高整体的临床实践水平。与欧美发达国家医学专业团体编写的临床医学指南相比，我国指南制定工作仍有不足之处。分析这些不足之处产生原因，除了指南制定者对指南的理解不正确之外，主要原因是我国目前还没有制定统一的、规范的指南开发程序，也就是制定临床医学指南的指南。当然缺乏国内的随机对照研究（RCT） 和 队列研究资料也是我们明显的薄弱之处。指南的开发程序是以开发指南为目的设计的结构运行和协调机制，通常涉及（1）指南的制定程序；（2）指南的传播途径；（3）指南的合理应用办法；（4）指南的评价反馈与更新机制等几个方面。随着国家临床医学指南开发程序的建立，我国指南制定的项目选择会更加合理，选择范围会逐步扩大，指南开发速度会稳步加快，指南水平和实用性会大大提高。

Clinical practice guidelines have been widely applied worldwide. Compared with the developed countries, however, the development of guidelines still has many limitations in China, which is mainly due to the lack of a guideline for guiding this process. Such a guideline, defined as ＂a structured and coordinated programme designed with the specific aim of producing several clinical practice guidelines＂ should be able to specify the development, dissemination, implementation, evaluation, and update of each clinical practice guideline. Furthermore, the lack of high-quality randomized controlled trials and cohort studies also restricts the development of high-level guidelines. After the development of such a guideline for developing guidelines, we can expect the faster development of Chinese clinical practice guidelines that are more carefully designed, more reliable, and more practical.