Division of Evidence Based Medicine (dEBM), Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia.
J Eur Acad Dermatol Venereol. 2016 Mar;30(3):395-403. doi: 10.1111/jdv.13358. Epub 2015 Oct 14.
Clinical practice guidelines are systematically developed tools to assist clinicians and health policy makers in decision making for clearly defined clinical situations. In the light of the demand for evidence-based medicine and quality in health care and the increasing methodological requirements concerning guidelines development, it is important to evaluate existing practice guidelines to systematically identify strengths and weaknesses. Currently, the most accepted tool for the methodological evaluation of guidelines is the Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument. Intention of this assessment is to identify and critically appraise clinical practice guidelines commissioned by the European Dermatology Forum (EDF). A quality assessment of a predefined set of guidelines, including all available clinical practice guidelines published on the EDF guidelines internet site, was performed using the AGREE II instrument. To assure an objective assessment, four independent assessments were performed by evaluators situated in different European countries. Twenty-five EDF guidelines covering different dermatological topics were identified and evaluated. The assessment included seven guidelines developed on the highest methodological standard (systematic literature search and structured consensus conference, S3). Eighteen guidelines were identified that were based on either a structured consensus process (S2k), a systematic literature assessment (S2e) or on informal consensus only (S1). The methodological and reporting quality among the evaluated guidelines was heterogeneous. S3 guidelines generally received the highest scores. The domains 'clarity of presentation' and 'scope and purpose' achieved the highest mean ratings within the different domains of assessment, whereas the domains of 'applicability', 'stakeholder involvement' and 'editorial independence' scored poorly. Considering the large variations in the achieved scores, there is need for methodological harmonization within the EDF guidelines to achieve comparable methodological standards.
临床实践指南是系统开发的工具，旨在帮助临床医生和卫生政策制定者在明确界定的临床情况下做出决策。鉴于对循证医学和医疗保健质量的需求以及对指南制定方法学要求的不断提高，评估现有的实践指南以系统地识别其优缺点非常重要。目前，评估指南的最常用方法学工具是 AGREE 工具（评估指南研究与评价工具）。该评估旨在识别和批判性地评价欧洲皮肤病学会（EDF）委托制定的临床实践指南。使用 AGREE II 工具对一组预先定义的指南进行质量评估，包括 EDF 指南网站上发布的所有可用临床实践指南。为了确保客观评估，由位于不同欧洲国家的评估员进行了四次独立评估。确定并评估了涵盖不同皮肤病学主题的 25 条 EDF 指南。评估包括 7 条基于最高方法学标准（系统文献检索和结构化共识会议，S3）制定的指南。还确定了 18 条基于结构化共识过程（S2k）、系统文献评估（S2e）或仅基于非正式共识（S1）制定的指南。评估指南的方法学和报告质量存在异质性。S3 指南通常获得最高分。在不同评估领域中，“表述清晰”和“范围和目的”两个领域的平均评分最高，而“适用性”、“利益相关者参与”和“编辑独立性”三个领域的评分较低。考虑到所获得分数的巨大差异，EDF 指南需要在方法学上进行协调，以实现可比的方法学标准。
