Apostoli Pietro, Cortesi Ilenia, Baldasseroni Alberto, Cristaudo Alfonso, Imbriani Marcello, Magrini Andrea, Mutti Antonio, Candiani Giulia, Daghini Raffaella, Bertazzi Pier Alberto, Isolani Lucia, Manno Maurizio, Mosconi Giovanni, Ossicini Adriano, Romano Canzio, Dri Pietro, Abbritti Giuseppe
Dipartimento di Medicina Sperimentale e Applicata, Sezione di Medicina del Lavoro e Igiene Industriale Università degli Studi di Brescia.
G Ital Med Lav Ergon. 2009 Oct-Dec;31(4):371-406.
Starting from the experience of last five years, during which 24 guide liens about the most important aspects of Occupational Physician activity have been produced, the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) delegated a specific working group for updating the methodology to be adopted for guide lines and other instruments for improving and standardizing the current activity in our professional field. SIMLII produced in the context of the specific Education and Accreditation Programme for occupational physicians prepared from 2002 25 guide lines or other informative instruments on the most important and controversial themes in which our discipline is involved. They were considered and treated to meet the need to improve and standardise activities and to modify the current approach of occupational physicians and aimed not only at improving the effectiveness of preventive actions but also at constantly adopting rigorous methodologies based where possible on evidence based or on consensus procedures. The Directive of SIMLII was firmly convinced about the opportunity-necessity to critically evaluate the experience carried out during the last years, at the light of the National Program for Guide Lines edited By Italian National Health Institute since 2002 and which concerns preparation, dissemination, updating, implementation of guide lines in Medicine. The guide lines were defined as rational critical effective aid addressed to professionals and patients for health services organization. Relevant was the new Framework Act for the occupational safety and health (Decreto legislativo 81/08) too signed by the President of the Italian Republic on April 9, 2008, which for the first time includes and defines in a legislative act the different possible instruments (technical normative, good practices, guide lines). In this paper we present the new methodology defined by our Society for producing the different kind of instruments such as guide lines, consensus conference reports, technology assessments, good practices statements guide lines focusing as the main aspects those related to definitions, argument choice, working group and coordinator identification, producing methods, evidence evaluation, grading, quality evaluation using AGREE method, dissemination procedure, the conflict of interest and the possible use for distance formation procedure focusing the recommendations that take a practical-applicative approach.
从过去五年的经验出发，在此期间制定了24条关于职业医生活动最重要方面的指导方针，意大利职业医学与工业卫生协会（SIMLII）委派了一个特定的工作组来更新用于指导方针和其他工具的方法，以改进和规范我们专业领域的当前活动。SIMLII在2002年开始制定的职业医生特定教育与认证计划的背景下，就我们学科所涉及的最重要和最具争议性的主题制定了25条指导方针或其他信息工具。这些方针和工具经过审议和处理，以满足改进和规范活动的需求，并改变职业医生当前的方法，其目的不仅在于提高预防行动的有效性，还在于尽可能不断采用基于循证或共识程序的严谨方法。SIMLII的指令坚信，有必要根据意大利国家卫生研究院自2002年起编辑的国家指导方针计划，批判性地评估过去几年所开展的经验，该计划涉及医学领域指导方针的制定、传播、更新和实施。指导方针被定义为面向专业人员和患者的用于卫生服务组织的合理、关键且有效的辅助工具。同样相关的还有2008年4月9日由意大利共和国总统签署的新的职业安全与健康框架法案（第81/08号立法令），该法案首次在一项立法行为中纳入并定义了不同的可能工具（技术规范、良好实践、指导方针）。在本文中，我们介绍了我们协会定义的用于制作不同类型工具的新方法，如指导方针、共识会议报告、技术评估、良好实践声明等，指导方针主要关注与定义、论据选择、工作组和协调员确定、制作方法、证据评估、分级、使用AGREE方法进行质量评估、传播程序、利益冲突以及可能用于远程培训程序等相关的主要方面，并着重介绍了采用实际应用方法的建议。
