Keuken D G, Haafkens J A, Moerman C J, Klazinga N S, ter Riet G
Department of General Practice, Academic Medical Center-University of Amsterdam, Division of Clinical Methods and Public Health, Amsterdam, The Netherlands.
J Womens Health (Larchmt). 2007 Jan-Feb;16(1):82-92. doi: 10.1089/jwh.2006.0004.
Clinical practice guidelines describe optimal strategies for disease prevention, diagnosis, or treatment. Increasing evidence indicates that sex-related factors may have an impact on these strategies. We examined the way in which two Dutch guideline organizations address evidence on sex factors in their guideline development methodologies. We then determined whether attention to these factors could be improved and, if so, how this could be done.
We selected seven recent guidelines on four conditions: hypertension, depression, osteoporosis, and rheumatoid arthritis. We studied information obtained from interviews with members of the guideline committees and analyzed the content of the guideline documents themselves. Our findings were discussed at an expert meeting.
We found that all the guideline committees concerned applied an internationally accepted framework for guideline development. The proportion of male members ranged from 67% to 100%. None of the guidelines included a question (or subquestion) focusing on sex-related factors. In the literature searches no sex-specific search terms were used. Critical appraisals did not include any systematic focus on sex-related factors or effects. The number of sex-specific recommendations (relative to the total number of recommendations) ranged from 0 of 82 and 0 of 148 in the guidelines on depression to 16 of 84 in one of the guidelines on osteoporosis.
We found that when developing guidelines, none of the committees systematically focused on sex-related factors that might be relevant to the way in which evidence is identified, appraised, or described. A number of recommendations were made with the aim to facilitate greater attention to sex-related factors in the current methods of guideline development.
临床实践指南描述了疾病预防、诊断或治疗的最佳策略。越来越多的证据表明，与性别相关的因素可能会对这些策略产生影响。我们研究了荷兰两个指南制定组织在其指南制定方法中处理性别因素证据的方式。然后，我们确定对这些因素的关注是否可以改进，如果可以，该如何改进。
我们选择了近期关于四种病症的七项指南：高血压、抑郁症、骨质疏松症和类风湿性关节炎。我们研究了从指南委员会成员访谈中获得的信息，并分析了指南文件本身的内容。我们的研究结果在一次专家会议上进行了讨论。
我们发现，所有相关指南委员会都采用了国际认可的指南制定框架。男性成员的比例从67%到100%不等。没有一项指南包含关注性别相关因素的问题（或子问题）。在文献检索中未使用任何针对性别的检索词。批判性评价未对性别相关因素或影响进行任何系统性关注。特定性别的建议数量（相对于建议总数）在抑郁症指南中从82条中的0条到148条中的0条，在一项骨质疏松症指南中为84条中的16条。
我们发现，在制定指南时，没有一个委员会系统性地关注可能与证据识别、评估或描述方式相关的性别因素。我们提出了一些建议，旨在促使在当前指南制定方法中更多地关注性别相关因素。
