Schünemann Holger J, Hill Suzanne R, Kakad Meetali, Vist Gunn E, Bellamy Richard, Stockman Lauren, Wisløff Torbjørn Fosen, Del Mar Chris, Hayden Frederick, Uyeki Timothy M, Farrar Jeremy, Yazdanpanah Yazdan, Zucker Howard, Beigel John, Chotpitayasunondh Tawee, Hien Tran Tinh, Ozbay Bülent, Sugaya Norio, Oxman Andrew D
Italian National Cancer Institute Regina Elena, Department of Epidemiology, Rome, Italy.
PLoS Med. 2007 May;4(5):e119. doi: 10.1371/journal.pmed.0040119.
Emerging health problems require rapid advice. We describe the development and pilot testing of a systematic, transparent approach used by the World Health Organization (WHO) to develop rapid advice guidelines in response to requests from member states confronted with uncertainty about the pharmacological management of avian influenza A (H5N1) virus infection. We first searched for systematic reviews of randomized trials of treatment and prevention of seasonal influenza and for non-trial evidence on H5N1 infection, including case reports and animal and in vitro studies. A panel of clinical experts, clinicians with experience in treating patients with H5N1, influenza researchers, and methodologists was convened for a two-day meeting. Panel members reviewed the evidence prior to the meeting and agreed on the process. It took one month to put together a team to prepare the evidence profiles (i.e., summaries of the evidence on important clinical and policy questions), and it took the team only five weeks to prepare and revise the evidence profiles and to prepare draft guidelines prior to the panel meeting. A draft manuscript for publication was prepared within 10 days following the panel meeting. Strengths of the process include its transparency and the short amount of time used to prepare these WHO guidelines. The process could be improved by shortening the time required to commission evidence profiles. Further development is needed to facilitate stakeholder involvement, and evaluate and ensure the guideline's usefulness.
新出现的健康问题需要迅速提供建议。我们描述了世界卫生组织（WHO）采用的一种系统、透明的方法的制定和试点测试情况，该方法用于应面临甲型H5N1禽流感病毒感染药物管理不确定性的成员国的请求，制定快速建议指南。我们首先检索了关于季节性流感治疗和预防的随机试验的系统评价，以及关于H5N1感染的非试验性证据，包括病例报告、动物和体外研究。召集了一个由临床专家、有治疗H5N1患者经验的临床医生、流感研究人员和方法学家组成的小组，举行为期两天的会议。小组成员在会议前审查了证据并就流程达成一致。组建一个团队来编写证据概要（即关于重要临床和政策问题的证据总结）花了一个月时间，而该团队在小组会议前仅用了五周时间来编写和修订证据概要并准备指南草案。小组会议后的10天内就完成了一份供发表的手稿草稿。该流程的优点包括其透明度以及编写这些WHO指南所用的时间较短。可以通过缩短委托编写证据概要所需的时间来改进该流程。需要进一步发展以促进利益相关者的参与，并评估和确保指南的实用性。
