Kainberger Franz, Czembirek Heinrich, Frühwald Franz, Pokieser Peter, Imhof Herwig
Department of Diagnostic Radiology, University of Vienna, Allgemeines Krankenhaus, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Eur Radiol. 2002 Mar;12(3):673-9. doi: 10.1007/s003300101109. Epub 2001 Aug 31.
Guidelines can be regarded as special forms of algorithms and have been shown to be useful tools for supporting medical decision making. With the Council Directive 97/43/Euratom recommendations concerning referral criteria for medical exposure have to be implemented into national law of all EU member states. The time- and cost-consuming efforts of developing, implementing, and updating such guidelines are balanced by the acceptance in clinical practice and eventual better health outcomes. Clearly defined objectives with special attention drawn on national and regional differences among potential users, support from organisations with expertise in evidence-based medicine, separated development of the evidence component and the recommendations component, and large-scale strategies for distribution and implementation are necessary. Editors as well as users of guidelines for referral criteria have to be aware which expectations can be met and which cannot be fulfilled with this instrument; thus, dealing with guidelines requires a new form of "diagnostic reasoning" based on medical ethics.
指南可被视为算法的特殊形式，并已被证明是支持医疗决策的有用工具。根据欧盟理事会第97/43/Euratom号指令，有关医疗照射转诊标准的建议必须纳入所有欧盟成员国的国家法律。制定、实施和更新此类指南所耗费的时间和成本，会因临床实践中的接受度以及最终更好的健康结果而得到平衡。明确界定目标，特别关注潜在用户之间的国家和地区差异，获得循证医学专业组织的支持，将证据部分和建议部分分开制定，以及大规模的分发和实施策略都是必要的。转诊标准指南的编辑和使用者必须清楚该工具能够满足哪些期望，又无法实现哪些期望；因此，处理指南需要一种基于医学伦理的新型“诊断推理”。
