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是时候给医学文献“去 Guideline 化”了。

Time to detoxify medical literature from guideline overdose.

出版信息

World J Gastroenterol. 2012 Jul 14;18(26):3331-5. doi: 10.3748/wjg.v18.i26.3331.

Abstract

The current financial turmoil in the United States has been attributed to multiple reasons including healthcare expenditure. Health care spending has increased from 5.7 percent of the gross domestic product (GDP) in 1965 to 16 percent of the GDP in 2004. Healthcare is driven with a goal to provide best possible care available at that period of time. Guidelines are generally assumed to have the high level of certainty and security as conclusions generated by the conventional scientific method leading many clinicians to use guidelines as the final arbiters of care. To provide the standard of care, physicians follow guidelines, proposed by either groups of physicians or various medical societies or government organizations like National Comprehensive Cancer Network. This has lead to multiple tests for the patient and has not survived the test of time. This independence leads to lacunae in the standardization of guidelines, hence flooding of literature with multiple guidelines and confusion to patients and physicians and eventually overtreatment, inefficiency, and patient inconvenience. There is an urgent need to restrict articles with Guidelines and develop some strategy like have an intermediate stage of pre-guidelines and after 5-10 years of trials, a systematic launch of the Guidelines. There can be better ways than this for putting together guidelines as has been suggested by multiple authors and researchers.

摘要

当前美国的金融动荡可归因于多种原因,包括医疗支出。医疗保健支出从 1965 年占国内生产总值(GDP)的 5.7%增长到 2004 年的 16%。医疗保健的目标是提供当时可用的最佳护理。指南通常被认为具有高度的确定性和安全性,因为它们是通过传统科学方法得出的结论,这导致许多临床医生将指南作为护理的最终裁决者。为了提供护理标准,医生遵循由医生团体或各种医学协会或政府组织(如国家综合癌症网络)提出的指南。这导致对患者进行了多项检查,但未能经受住时间的考验。这种独立性导致指南标准化方面存在空白,因此文献中充斥着多种指南,使患者和医生感到困惑,最终导致过度治疗、效率低下和患者不便。迫切需要限制指南相关的文章,并制定一些策略,例如在指南之前有一个中间阶段,在经过 5-10 年的试验后,系统地推出指南。正如多位作者和研究人员所建议的那样,制定指南有更好的方法。

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