Department of Pediatrics, Division of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Pediatr Nephrol. 2021 Nov;36(11):3493-3497. doi: 10.1007/s00467-021-05105-9. Epub 2021 May 20.
Clinical practice guidelines (CPGs) are systematically developed statements backed by scientific evidence to assist practitioners in management in clinical practice. An international cross-sectional survey was conducted by the IPNA to examine the perceptions of pediatric nephrologists on guidelines and their usage and to identify important diseases for future clinical practice guidelines (CPGs). The survey found that the majority of pediatric nephrologists find CPGs useful in clinical practice and admitted to using them most of the time. Developing CPGs is challenging and there are standards available to develop trustworthy guidelines. While evidence-based global guidelines are ideal, pediatric nephrologists expressed the desire that they address regional differences. Most respondents (89.2%) to the survey agreed that adult guidelines did not cover the pediatric perspective adequately and 71.4% opined that consensus-based pediatric guidelines can be developed when evidence for the pediatric population is lacking. The development of high-quality practice guidelines requires substantial resources and may not be feasible in resource-poor countries. Adaptation of an existing guideline has been suggested as an alternative and the ADAPTE collaboration provides a systematic approach to adapting guidelines. Several diseases where pediatric guidelines are needed as a priority including IgA and C3 glomerulopathy were identified in the survey. Implementation of guideline-based care is challenging and the survey found that lack of availability of guidelines (43%) and resources (22.8%) are important reasons for poor implementation in lower-middle and low-income countries. Perceived complexity of guidelines, physician attitudes, and lack of training also contribute to non-adherence to guidelines.
临床实践指南（CPGs）是基于科学证据制定的系统陈述，旨在帮助临床医生进行管理。国际儿科肾脏病学会（IPNA）进行了一项国际横断面调查，以调查儿科肾脏病医生对指南的看法及其使用情况，并确定未来临床实践指南（CPGs）的重要疾病。调查发现，大多数儿科肾脏病医生认为 CPG 在临床实践中有用，并承认他们大部分时间都在使用它们。制定 CPG 具有挑战性，并且有制定可靠指南的标准。虽然基于证据的全球指南是理想的，但儿科肾脏病医生表示希望它们能解决地区差异。调查的大多数受访者（89.2%）认为成人指南不能充分涵盖儿科观点，71.4%的人认为在缺乏儿科人群证据时可以制定基于共识的儿科指南。高质量实践指南的制定需要大量资源，在资源匮乏的国家可能不可行。已经提出了对现有指南进行改编的替代方法，ADAPTE 合作提供了一种系统的方法来改编指南。调查确定了一些需要优先制定儿科指南的疾病，包括 IgA 和 C3 肾小球病。基于指南的护理的实施具有挑战性，调查发现，缺乏指南（43%）和资源（22.8%）是中低收入国家实施不佳的重要原因。指南的复杂性、医生的态度以及缺乏培训也导致了不遵守指南的情况。
