Nonino F, Liberati A
Centre for Evaluation of the Effectiveness of Medical Care (CeVEAS), Viale Muratori 201, I-41100 Modena, Italy.
Neurol Sci. 2004 Apr;25(1):2-7. doi: 10.1007/s10072-004-0217-7.
We explored whether local practice guidelines (PGs) on stroke management had undergone a process of local adaptation in relation to the appropriate and feasible configuration of stroke units (SUs). We critically appraised 7 PGs developed by 6 Italian local healthcare units, using explicit criteria to evaluate internal validity and their adequacy relative to local implementation issues. All PGs were developed by multidisciplinary working groups. In 4 of 6 PGs recommending SUs for stroke care, methodology for evidence retrieval was poor. Although organisational aspects were addressed in 4 of 6 PGs, details on how a SU should be organised were not provided in any of the examined PGs. Despite availability of national and international stroke PGs, at local level guidelines developers seem to spend time in "reinventing the wheel" rather than concentrating on what matters for local implementation. Besides being inefficient, this seems to lead to methodologically poor products inappropriate for what should be done to assure that interventions that work are packaged in a way that is compatible with their uptake into the ongoing services activities.
我们探讨了关于卒中管理的地方实践指南（PGs）是否经历了与卒中单元（SUs）的适当且可行配置相关的地方适应性过程。我们严格评估了由6个意大利地方医疗保健单位制定的7份PGs，使用明确的标准来评估内部有效性及其相对于地方实施问题的充分性。所有PGs均由多学科工作小组制定。在6份推荐设立卒中护理SUs的PGs中，有4份的证据检索方法较差。虽然6份PGs中有4份涉及了组织方面的内容，但在所审查的任何一份PGs中均未提供关于SU应如何组织的详细信息。尽管有国家和国际卒中PGs，但在地方层面，指南制定者似乎在“重新发明轮子”上花费时间，而不是专注于对地方实施至关重要的事情。这不仅效率低下，而且似乎导致了方法上较差的产品，不适合用于确保将有效的干预措施以与纳入现有服务活动相兼容的方式进行打包。
