Oxman Andrew D, Lavis John N, Fretheim Atle
Norwegian Knowledge Centre for The Health Services.
World Hosp Health Serv. 2007;43(2):14-20.
WHO regulations, dating back to 1951, emphasise the role of expert opinion in the development of recommendations. However, the organisation's guidelines, approved in 2003, emphasise the use of systematic reviews for evidence of effects, processes that allow for the explicit incorporation of other types of information (including values), and evidence-informed dissemination and implementation strategies. We examined the use of evidence, particularly evidence of effects, in recommendations developed by WHO departments.
We interviewed department directors (or their delegates) at WHO headquarters in Geneva, Switzerland, and reviewed a sample of the recommendation-containing reports that were discussed in the interviews (as well as related background documentation). Two individuals independently analysed the interviews and reviewed key features of the reports and background documentation.
Systematic reviews and concise summaries of findings are rarely used for developing recommendations. Instead, processes usually rely heavily on experts in a particular specialty, rather than representatives of those who will have to live with the recommendations or on experts in particular methodological areas.
Progress in the development, adaptation, dissemination, and implementation of recommendations for member states will need leadership, the resources necessary for WHO to undertake these processes in a transparent and defensible way, and close attention to the current and emerging research Literature related to these processes.
世界卫生组织（WHO）自1951年起的相关规定强调专家意见在制定建议过程中的作用。然而，该组织在2003年批准的指南则强调使用系统评价来获取效应证据，采用能够明确纳入其他类型信息（包括价值观）的流程，以及基于证据的传播和实施策略。我们研究了WHO各部门在制定建议时对证据的使用情况，尤其是效应证据。
我们采访了位于瑞士日内瓦的WHO总部各部门主任（或其代表），并审查了采访中讨论的包含建议的报告样本（以及相关背景文件）。两名研究人员独立分析了采访内容，并审查了报告和背景文件的关键特征。
系统评价和研究结果的简要总结很少用于制定建议。相反，相关流程通常严重依赖特定专业领域的专家，而非那些将遵循这些建议的人群的代表或特定方法学领域的专家。
要在为成员国制定、调整、传播和实施建议方面取得进展，需要领导力、WHO以透明且合理的方式开展这些流程所需的资源，以及密切关注与这些流程相关的现有和新出现的研究文献。
