EtD框架在指南推荐意见制订中的应用

Application of EtD framework in the process of recommendation forming of clinical practice guideline

本文主要介绍了GRADE(grading of recommendations assessment,development and evaluation),即推荐分级的评价、制定与评估工作组开发的基于证据形成推荐意见的EtD(evidence to decision),即证据到决策框架,该框架包含提出问题、评价证据和形成推荐意见3个部分,为从证据形成推荐意见提供了结构化的决策工具。然后以“妊娠期糖尿病非药物管理患者指南”中1个临床问题“与常规护理或者不进行有氧运动相比,有氧运动是否能够降低妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇的血糖水平,改善妊娠结局?”为例,根据EtD框架,呈现如何从提出问题、评价证据到形成推荐意见的完整过程,为指南制订者形成推荐意见提供思路和方法。

This article mainly introduced the Evidence to decision(EtD) framework for forming recommendations based on evidence developed by Grading of Recommendations Assessment,Development,and Evaluation(GRADE) working group,which contained three parts:Raising questions,evaluating evidence,and forming recommendations,providing a structured decision tool from evidence to recommendation in the development of guidelines.This article also gave an example of one question of "Compared with standard nursing or no aerobic excise,whether aerobic exercise decreased the blood glucose and improve pregnant outcomes for women with gestational diabetes mellitus(GDM) " in the "Guidelines for Patients with Nonpharmaceutical Management for Women with GDM".According to EtD framework,this article gave an example of the whole process of how to raise questions,evaluate evidence,and form recommendation opinions,which provided ideas and methods for recommendation forming for guideline developer.