Graham Ian D, Harrison Margaret B, Lorimer Karen, Piercianowski Tadeusz, Friedberg Elaine, Buchanan Maureen, Harris Connie
School of Nursing, University of Ottawa, and Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Adv Skin Wound Care. 2005 Jul-Aug;18(6):307-18. doi: 10.1097/00129334-200507000-00011.
Because of growing resources devoted to individuals requiring community care for leg ulcers, the authority responsible for home care in Ottawa, Ontario, Canada, established and evaluated a demonstration leg ulcer service. In an effort to provide current and evidence-based care, existing leg ulcer clinical practice guidelines were identified and appraised for quality and suitability to the new service.
The Practice Guideline Evaluation and Adaptation Cycle guided development of a local protocol for leg ulcer care, which included: (1) systematically searching for practice guidelines, (2) appraising the quality of identified guidelines using a validated guideline appraisal instrument, (3) conducting a content analysis of guideline recommendations, (4) selecting recommendations to include in the local protocol, and (5) obtaining practitioner and external expert feedback on the proposed protocol. Updating the protocol followed a similar process.
Of 19 identified leg ulcer practice guidelines, 14 were not evaluated because they did not meet the criteria (ie, treatment-focused guidelines, written in English and developed after 1998). Of the 5 remaining guidelines, 3 were fairly well developed and made similar recommendations. The level of evidence supporting specific recommendations ranged from randomized clinical trial evidence to expert opinion. By comparing the methodologic quality and content of the guidelines, the Task Force reached consensus regarding recommendations appropriate for local application. Two additional guidelines were subsequently identified and incorporated into the local protocol during a scheduled update.
Local adaptation of international and national guidelines is feasible following facilitation of the Practice Guidelines Evaluation and Adaptation Cycle.
由于用于腿部溃疡社区护理患者的资源不断增加，加拿大安大略省渥太华负责家庭护理的机构设立并评估了一项腿部溃疡示范服务。为了提供当前的循证护理，对现有的腿部溃疡临床实践指南进行了识别，并对其质量和对新服务的适用性进行了评估。
实践指南评估与调整周期指导了腿部溃疡护理地方方案的制定，该方案包括：（1）系统检索实践指南；（2）使用经过验证的指南评估工具评估所识别指南的质量；（3）对指南建议进行内容分析；（4）选择纳入地方方案的建议；（5）征求从业者和外部专家对拟议方案的反馈意见。方案更新遵循类似过程。
在识别出的19项腿部溃疡实践指南中，14项未被评估，因为它们不符合标准（即聚焦治疗的指南、用英文撰写且于199年后制定）。在其余5项指南中，3项制定得相当完善且提出了类似建议。支持具体建议的证据水平从随机临床试验证据到专家意见不等。通过比较指南的方法学质量和内容，特别工作组就适用于当地的建议达成了共识。随后在定期更新期间又识别出两项指南并将其纳入地方方案。
在实践指南评估与调整周期的推动下，对国际和国家指南进行地方调整是可行的。
