Pielenz Charline, Schneider Marco, Salveridou-Hof Eva, Flick Marisa, Gaigl Gabriele, Khorikian-Ghazari Naiiri, Güler Duygu, Halms Theresa, Kapfhammer Angelika, Lorenz Carolin, Röh Astrid, Wagner Elias, Falkai Peter, Leucht Stefan, Gaebel Wolfgang, Hasan Alkomiet
Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany; WHO Collaborating Centre in Quality Assurance and Empowerment in Mental Health DEU-131.
Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany.
Z Evid Fortbild Qual Gesundhwes. 2022 Nov;174:20-31. doi: 10.1016/j.zefq.2022.07.004. Epub 2022 Aug 28.
The goal of living guidelines is keeping recommendations in guidelines up-to-date as new evidence becomes available. This review aims at scoping the prevalence and formal characteristics of living guidelines in the field of medicine and explore differences between formats.
A selective search of living guidelines in MEDLINE via PubMed, Google Scholar and six relevant online repositories for guidelines (MAGICApp, AWMF, GIN, NICE, WHO-Iris, BIGG) was conducted. Authors and editors were contacted to receive previous non-living guideline versions. Living guidelines were subsequently analyzed according to pre-defined methodological criteria as described below (inter-comparison). Differences between living and their conventional (non-living) versions were assessed (intra-comparison).
83 living guidelines were identified and selected for further screening, out of which 26 were eligible for analysis. 61.5% were new publications (de-novo guidelines) and 38.5% updates of pre-existing guidelines. There are some concepts defining, for example, the update cycle (AWMF, maximum of 12 months) but not all living guidelines follow or refer to existing concepts. The analysis shows that living guidelines in line with the established standards for (non-living) clinical guidelines involve an evidence standard, an extensive consensus process (often in the form of a Delphi process), and the inclusion of stakeholders (patients/relatives) in the development process, despite the high frequency of updates. When comparing living and conventional guidelines with the descriptive approach changes were found in update frequency (being more frequent with living guidelines, annually at the latest) and publication format (towards more digital) and public consultation (living guidelines offered more possibilities), no substantial methodological differences were observed in the description of consensus processes, changes in number of recommendations, inclusion of patient representatives. Given the small number of comparable pairs, the results reflect a tendency in the analyzed sample.
The definition and development of living guidelines varied. Standardization (i. e. in the form of a checklist, procedure template) is needed to assess quality of the living process.
动态指南的目标是随着新证据的出现，使指南中的建议保持最新。本综述旨在确定医学领域动态指南的患病率和形式特征，并探讨不同形式之间的差异。
通过PubMed在MEDLINE中进行选择性检索，同时检索谷歌学术以及六个相关的指南在线存储库（MAGICApp、AWMF、GIN、NICE、WHO-Iris、BIGG）。与作者和编辑联系以获取以前的非动态指南版本。随后根据以下预定义的方法标准对动态指南进行分析（相互比较）。评估动态指南与其传统（非动态）版本之间的差异（内部比较）。
共识别并选择了83份动态指南进行进一步筛选，其中26份符合分析条件。61.5%为新出版物（全新指南），38.5%为现有指南的更新版本。存在一些定义更新周期的概念（如AWMF规定最长为12个月），但并非所有动态指南都遵循或参考现有概念。分析表明，符合既定（非动态）临床指南标准的动态指南涉及证据标准、广泛的共识过程（通常采用德尔菲法），并且在制定过程中纳入了利益相关者（患者/亲属），尽管更新频率很高。在采用描述性方法比较动态指南和传统指南时，发现更新频率（动态指南更频繁，最迟每年更新）、出版形式（向数字化发展）和公众咨询方面存在变化（动态指南提供了更多可能性），但在共识过程的描述、建议数量的变化、患者代表的纳入方面未观察到实质性的方法差异。鉴于可比较的对子数量较少，结果反映了分析样本中的一种趋势。
动态指南的定义和制定各不相同。需要进行标准化（例如以清单、程序模板的形式）来评估动态过程的质量。
