良好的实践陈述:一个说"再见"的时间? 对干预措施的规范性陈述的一种新类型学
1Consultant, Public Health, Portland, OR, USA.
Journal of clinical epidemiology
|April 27, 2024
概括
临床指导方针经常滥用推,评估,开发和评估 (GRADE) 的评级,以及良好实践陈述 (GPS). 本文提出了规范性陈述的新类型,根据证据基础区分它们,以提高指导方针的清晰度和应用.
科学领域:
- 临床和公共卫生指南开发指南.
- 基于证据的实践实践.
- 制定卫生政策 制定卫生政策
背景情况:
- 临床和公共卫生指南使用各种规范性陈述,其中"建议"通常是核心的,并基于系统性审查.
- 建议,评估,开发和评估 (GRADE) 的评级,良好实践陈述 (GPS) 用于重要的干预,证据质量很明显,但面临概念和方法问题.
- 误用GRADE GPS,包括过度使用,使用不足和解释不清楚,源于缺乏清晰度,广泛标记和证据评估的局限性.
研究的目的:
- 用GRADE GPS解决概念和方法方面的问题.
- 为指导方针中的规范性陈述提出一个新的类型.
- 为指南开发人员和最终用户提供更细致的陈述分类.
主要方法:
- 根据证据或基础的类型区分规范性陈述.
- 将陈述分类为有关干预使用和有关基本原则的陈述.
- 定义基于经验证据 (系统审查,科学基础,经验证据) 和人权,伦理或规范的陈述的类别.
主要成果:
- 拟议的类型学区分了规范性陈述的证据或道德基础.
- 它包含并取代了当前的GRADE GPS,提供了更精细的分类.
- 该类型包括关于干预使用 (基于经验证据) 和指导原则 (基于人权,伦理或规范) 的陈述.
结论:
- 关于GRADE GPS的概念和方法问题导致了错误的应用.
- 关于干预的规范性陈述提出了一个新的类型学,按干预的基础分类.
- 建议的类型与指南开发人员和最终用户进行进一步测试是必要的.
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