Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Hamilton, ON, Canada.
Curr Allergy Asthma Rep. 2011 Jun;11(3):261-8. doi: 10.1007/s11882-011-0185-8.
Decisions are like double-edged swords: they always come with benefits and downsides. That is, any decision in life bears desirable and undesirable consequences, even if the latter only involves the time it takes to make or think about the decision, which can be considered the harm of decision making. Therefore, it is impossible to adhere to the Hippocratic Oath's concept of "primum non nocere," which is frequently interpreted as "never do harm." The guiding principle for health care decision making should be to ensure that there is, in summary, more benefit than harm-in other words, "to do no net harm" ("primum non net nocere"). Practice guidelines support decision making and, as a consequence, would require the explicit consideration of both desirable and undesirable consequences, and assigning due considerations depending on the magnitude and importance of the consequences. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group ( http://www.gradeworkinggroup.org ) has made these considerations more explicit when developing health care recommendations. This article briefly summarizes the work of the GRADE working group based on examples of its application in the field of allergy and asthma, and provides an outlook for advances in the field of guideline development. These developments focus on funding of guidelines and handling conflict of interest, working with observational and diagnostic test accuracy studies, developing appropriate group processes, and the integration of values and preferences in the formulation of recommendations.
它们总是有利有弊。也就是说，生活中的任何决策都有可取和不可取的后果，即使后者只涉及做出或考虑决策所花费的时间，也可以被视为决策的危害。因此，不可能坚持希波克拉底誓言的“首要原则是不伤害”（primum non nocere），这一概念通常被解释为“不造成伤害”。医疗保健决策的指导原则应该是确保总体上利大于弊——换句话说，“不造成净伤害”（primum non net nocere）。实践指南支持决策，因此需要明确考虑可取和不可取的后果，并根据后果的大小和重要性给予适当的考虑。分级评估、制定与评价（GRADE）工作组（http://www.gradeworkinggroup.org）在制定医疗保健建议时使这些考虑更加明确。本文简要总结了 GRADE 工作组的工作，以过敏和哮喘领域的应用为例，并展望了指南制定领域的进展。这些发展侧重于指南的资金和利益冲突处理、与观察性和诊断性测试准确性研究合作、制定适当的小组流程，以及在建议制定中整合价值观和偏好。
