Department of Urology, University of Michigan Health System, 1500 East Medical Center Drive, TC 3875, Ann Arbor, MI 48109-5330, USA.
World J Urol. 2011 Jun;29(3):303-9. doi: 10.1007/s00345-011-0656-5. Epub 2011 Feb 18.
With the volume of medical research currently published, any one practitioner cannot independently review the literature to determine best evidence-based medical care. Additionally, non-specialists usually do not have the experience to know best practice for all of the frequent clinical circumstances for which there is no good evidence. Clinical practice guidelines (CPGs) help clinicians to address these problems because they are systematically created documents that summarize knowledge and provide guidance to assist in delivering high-quality medicine. They aim to improve health care by identifying evidence that supports the best clinical care and making clear which practices appear to be ineffective.
Non-structured literature review.
CPGs combine evidence-based medicine (on topics for which evidence exists) with expert opinion (on topics for which there is no evidence). The optimal CPG applies structured and transparent judgments, from an unbiased and diverse panel which includes both clinical experts and non-physicians, to a systematic evidence review. It includes decisions in areas in which clinical data are both available and unavailable. The resulting guideline statements should be clearly linked to the quality of the available evidence and the target patient(s) should be clearly defined, so that the reader can assess strength and applicability of the statements to an individual patient.
The application of high-quality CPGs improves patient care, but all too often CPGs are not used to the greatest advantage because of inadequate dissemination and incorporation into practice. This article provides an overview of CPGs, focusing on their justification, creation, improvement, and use.
目前发表的医学研究数量庞大，任何一位医生都无法独立查阅文献来确定最佳循证医学护理。此外，非专家通常没有经验来了解所有常见临床情况下的最佳实践，而这些情况没有很好的证据支持。临床实践指南 (CPG) 有助于临床医生解决这些问题，因为它们是系统编写的文件，总结了知识并提供了指导，以帮助提供高质量的医疗服务。它们旨在通过确定支持最佳临床护理的证据，并明确哪些实践似乎无效，来改善医疗保健。
非结构化文献综述。
CPG 将基于证据的医学（针对存在证据的主题）与专家意见（针对没有证据的主题）相结合。最佳 CPG 将对系统的证据审查进行无偏见和多元化的小组（包括临床专家和非医生）进行结构化和透明的判断。它包括在临床数据既有又没有的领域的决策。由此产生的指南陈述应明确与可用证据的质量相关联，并且应明确界定目标患者，以便读者可以评估陈述对个体患者的强度和适用性。
应用高质量的 CPG 可改善患者护理，但由于传播和纳入实践不足，CPG 往往不能发挥最大优势。本文概述了 CPG，重点介绍了它们的合理性、制定、改进和应用。
