制定中西医结合临床指南应注意问题.docVIP

制定中西医结合临床指南应注意问题 　【摘要】 一部好的中西医结合临床指南的制定，应由多学科专家，包括中西医结合临床专家、中医临床专家、西医临床专家、不同层次医疗保健机构的医务人员、有关临床科研人员、基础医学研究者、统计学家、临床流行病学家、临床经济学家和医学决策与管理专家共同参与；遵循以下程序：中西医结合学会和（或）各专科分会确定指南题目，组成专题指南制定小组（或以研究项目的形式确定），系统文献评价，草拟初稿，同行咨询及评议，向学术界公开内容，收集反馈意见与建议并进行分析，对指南进行修改，发表与发行，各地应用，反馈审计与评价，再修订完善；在循证医学基础上强调科学证据与证据更新，不断补充和完善原定的指南版本；坚持病证结合，以病统证，规范证型标准，合理设置证型数量，在典型证型基础上，设置加减治疗的标准与方法；注意原则性与灵活性相结合，强调指南只能作为临床医生的诊疗参考，实际应用应灵活处理，不能机械照搬；注重指南的实用性，使使用者看后很容易使用与操作，同时指南制定组织有义务对医务人员进行培训，以推进临床指南的实施。只有这样，才能确保所制定的中西医结合临床指南具有一定的科学性、权威性、规范性与适用性，达到制定指南的目的。 【关键词】 指南; 中西医结合; 决策 Abstract: A good clinical guideline for integrated traditional Chinese and Western medicine (ITCWM) should be established by multi-subject specialists, including clinical expert of ITCWM, traditional Chinese medicine and Western medicine, and medical staff from different levels of health care organization, clinical and preclinical medicine researcher, statistician, clinical epidemiologist and economist, medical decision-maker and administrative expert. Establishment of guideline should be abided by the following scientific procedure: association of ITCWM (AITCWM) or the branch of AITCWM decides the subject of clinical guideline, set up a team of special subject of clinical guideline (or decided by research project), evaluate literature systematically, prepare a draft manuscript, consult and appraise it in the same occupation, announce the content in the academic circle, collect feedback opinions and proposals and then make analysis, modify the clinical guideline, publish the clinical guideline, apply the clinical guideline, collect and appraise feedback opinions and proposals, modify and consummate the clinical guideline. In order to supply and consummate original guideline, scientific and renewed evidence should be emphasized on the basis of evidence-based medicine. The author also suggested insistence on the combination of disease and syndrome, syndrome being governed by disease, standardization of syndrome type, establishment of reasona