Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
J Am Geriatr Soc. 2014 Apr;62(4):754-61. doi: 10.1111/jgs.12768. Epub 2014 Apr 2.
The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom developed guidelines for the diagnosis, prevention, and management of delirium in July 2010 that included 10 recommendations for delirium prevention. The Hospital Elder Life Program (HELP) is a targeted multicomponent strategy that has proven effective and cost-effective at preventing functional and cognitive decline in hospitalized older persons. HELP provided much of the basis for seven of the NICE recommendations. Given interest by new HELP sites to meet NICE guidelines, three new protocols addressing hypoxia, infection, and pain that were not previously included in the HELP program were developed. In addition, the NICE dehydration guideline included constipation, which was not specifically addressed in the HELP protocols. This project describes the systematic development of three new protocols (hypoxia, infection, pain) and the expansion of an existing HELP protocol (constipation and dehydration) to achieve alignment between the HELP protocols and NICE guidelines. Following the Institute of Medicine recommendations for developing trustworthy guidelines, an interdisciplinary group of experts conducted a systematic review of current literature, rated the quality of the evidence, developed intervention protocols based on the highest-quality evidence, and submitted the protocols first to internal review and then to external review by an interdisciplinary panel of experts. The protocols were revised based on the review process and incorporated into the HELP materials. Inclusion of these protocols enhances the scope of the HELP program and allows fulfillment of NICE guideline recommendations for delirium prevention. The rigorous process applied may provide a useful example for updating existing guidelines or protocols that may be applicable to a broad range of clinical applications.
英国国家卫生与临床优化研究所（NICE）于 2010 年 7 月制定了关于谵妄的诊断、预防和管理指南，其中包括 10 项谵妄预防建议。医院老年人生活项目（HELP）是一种有针对性的多组分策略，已被证明在预防住院老年人的功能和认知能力下降方面是有效且具有成本效益的。HELP 为 NICE 的 7 项建议提供了很大的依据。鉴于新的 HELP 站点对符合 NICE 指南感兴趣，针对先前未包含在 HELP 计划中的缺氧、感染和疼痛制定了三个新的协议。此外，NICE 脱水指南包含了便秘，而 HELP 协议中并未特别提及便秘。本项目描述了三个新协议（缺氧、感染、疼痛）的系统开发以及现有 HELP 协议（便秘和脱水）的扩展，以实现 HELP 协议与 NICE 指南之间的一致性。根据制定可靠指南的医学研究所建议，一个跨学科的专家小组对现有文献进行了系统审查，对证据质量进行了评分，根据最高质量的证据制定了干预协议，并首先将协议提交内部审查，然后由跨学科专家小组进行外部审查。根据审查过程对协议进行了修订，并将其纳入 HELP 材料中。这些协议的纳入增强了 HELP 计划的范围，并允许满足 NICE 关于预防谵妄的指南建议。所应用的严格流程可能为更新可能适用于广泛临床应用的现有指南或协议提供有用的范例。
