临床指南的制定、应用与患者的个体化问题

The Establishment and Application of Clinical Guidelines and the Individualized Problem of Patients

临床指南是针对每一种疾病诊断方法、诊断标准、规范的治疗方法作出明确的规定,采用程式化的流程,避免和减少不同医院和不同医生医疗水平的差异。高水平的指南应具备:对现有证据的系统分析;来自专业团队;适当考虑患者群体的偏好;制定过程透明;合理地解释各种备选干预措施及相应的结局之间的关系,对证据的质量和推荐意见进行分级;当有重要新证据时,对原有指南进行重新审议和修正。此外,高水平的指南在实施过程中也需要强调个体化。因为时间和空间的限制,指南必须通过不断修订和更新来完善自身,而指南相关问题上,最不容忽视的是明确相关利益冲突问题。据此,建议更加清晰地辨明指南的应用是非常重要的。

Clinical guidelines provide clear guidelines for each disease's diagnosis,diagnostic criteria,and standard of care,and use stylized procedures to avoid and reduce differences between hospitals and doctors.A high level of guidance should include:a systematic analysis of the available evidence,input from a professional team,due consideration of the preferences of the patient population,transparency in the design of the process,and a reasonable explanation of the relationship between the various alternative interventions and the corresponding outcomes.It could grade the quality of evidence and recommendations,review and revise existing guidelines when new evidence is presented.However,high level guidelines also need to emphasize individualization in their implementation.Due to time and space constraints,guidelines have to be constantly revised and updated to improve themselves.It is essentially necessary to clarify conflicts of interest.It is also wisely suggested to apply the guideline dialectically.