McGuckin M, Stineman M, Goin J, Williams S
School of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia, USA.
Ostomy Wound Manage. 1996 Nov-Dec;42(10A Suppl):62S-66S.
In early 1996 the Venous Leg Ulcer Guideline was developed for the diagnosis and treatment of venous leg ulcers. In order to discuss the development of standards in general, and the Venous Leg Ulcer Guideline in particular, we first need to understand the difference between the following terms: Critical pathway, consensus statement, guideline, and standard. There are advantages and disadvantages to the use of guidelines. In the development of a guideline, endorsement by a respected colleague is important. Development of the Venous Leg Ulcer Guideline began with a consensus statement and then underwent review by a national advisory panel and national peer review through publication. A revised guideline has now been developed which will be tested in a pilot study for clinical efficacy, effect on cost, and impact on quality of life. Validation will require implementation in a prospective clinical trial. Diagnostic and Treatment Algorithm forms for the diagnosis and treatment of venous leg ulcers were developed as part of the preliminary testing of the guideline. Although guidelines do not substitute for good clinical judgement, they can encourage clinical judgement and help reduce fragmented care and the costs associated with inappropriate treatments.
1996年初制定了《下肢静脉溃疡诊疗指南》用于下肢静脉溃疡的诊断和治疗。为了总体讨论标准的制定，特别是《下肢静脉溃疡诊疗指南》的制定，我们首先需要了解以下术语之间的区别：关键路径、共识声明、指南和标准。使用指南有其优点和缺点。在制定指南时，获得受尊敬同事的认可很重要。《下肢静脉溃疡诊疗指南》的制定始于一份共识声明，然后经过一个全国咨询小组的审查，并通过发表进行全国同行评审。现已制定了一份修订后的指南，将在一项试点研究中对其临床疗效、成本影响和生活质量影响进行测试。验证将需要在前瞻性临床试验中实施。作为该指南初步测试的一部分，制定了用于下肢静脉溃疡诊断和治疗的诊断与治疗算法表。虽然指南不能替代良好的临床判断，但它们可以鼓励临床判断，并有助于减少分散的护理以及与不适当治疗相关的成本。
