Niederstadt Christina
Institut für Medizinische Informatik, Medizinischen Hochschule Hannover.
Z Arztl Fortbild Qualitatssich. 2003;97(6):415-9.
In this article, the authors of the ,,General Practitioners' Guideline for the Diagnosis and Treatment of Urinary Incontinence" describe the logical and procedural steps involved in the development process of this evidence-based GPs' guideline for the management of urinary incontinence. Specifically, the following factors have been identified as crucial for a successful primary care guideline development process: The work group (authors) should comply in size with current recommendations for successful project work teams. It is recommended that authors should belong to opposing ends of the spectrum of practical versus theoretical medicine. We argue that the integration of both practical experience and theoretical knowledge/research experience be combined in order to collate guideline recommendations that are firmly grounded in scientific evidence and both applicable and acceptable in everyday practice. Proper work on a guideline development project should only start after ensuring that the well-known theoretical requirements for sensible guidelines are met, i.e. the problem in our special focus should be widespread or of considerable economic/public health importance, be amenable to proper medical intervention, and some quality issue regarding the current handling of this problem should have been demonstrated. Subsequently, a clear logical analysis of the problem's inherent functional/logical/practical subdivisions has to be conducted. Each author is then allocated his or her fair share of the work. The next step is considered to be extremely important and consists of discovering one's "illusive correlation", i.e. inherent ideas one has on the subject without being aware of one's own bias. The proposed "trick" now consists of making the implicit bias an explicit fact in the further guideline development process. The remaining work steps build on the integration of one's preformed ideas with current, published opinion from standard textbooks, as well as existing guidelines and non-guideline recommendations on the subject; plus taking into account the practical experience gathered from interviews and "on-location-visits". This integration process is performed within a structured framework to facilitate objectivity and transparency of the entire guideline.
在本文中，《尿失禁诊断与治疗全科医生指南》的作者描述了该循证全科医生尿失禁管理指南制定过程中涉及的逻辑和程序步骤。具体而言，已确定以下因素对成功制定初级保健指南过程至关重要：工作小组（作者）的规模应符合当前关于成功项目工作团队的建议。建议作者应来自实践医学与理论医学领域的两端。我们认为，应将实践经验与理论知识/研究经验相结合，以便整理出基于科学证据且在日常实践中既适用又可接受的指南建议。在确保满足明智指南的著名理论要求后，即我们特别关注的问题应广泛存在或具有相当的经济/公共卫生重要性、适合进行适当的医学干预且已证明当前处理该问题存在一些质量问题后，才应正式开展指南制定项目工作。随后，必须对问题固有的功能/逻辑/实际细分进行清晰的逻辑分析。然后为每位作者分配其应承担的合理工作量。下一步被认为极其重要，包括发现自己的“虚幻关联”，即对该主题的固有想法而未意识到自己的偏见。现在提出的“诀窍”是在进一步的指南制定过程中将隐含的偏见变为明确的事实。其余工作步骤基于将预先形成的想法与标准教科书中当前已发表的观点、以及关于该主题的现有指南和非指南建议相结合；再加上考虑从访谈和“实地考察”中收集的实践经验。此整合过程在结构化框架内进行，以促进整个指南的客观性和透明度。
