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From the EBM pyramid to the Greek temple: a new conceptual approach to Guidelines as implementation tools in mental health

机译：从EBM金字塔到希腊神庙：作为心理健康实施工具的指南的新概念方法

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Guideline methods to develop recommendations dedicate most effort around organising discovery and corroboration knowledge following the evidence-based medicine (EBM) framework. Guidelines typically use a single dimension of information, and generally discard contextual evidence and formal expert knowledge and consumer's experiences in the process. In recognition of the limitations of guidelines in complex cases, complex interventions and systems research, there has been significant effort to develop new tools, guides, resources and structures to use alongside EBM methods of guideline development. In addition to these advances, a new framework based on the philosophy of science is required. Guidelines should be defined as implementation decision support tools for improving the decision-making process in real-world practice and not only as a procedure to optimise the knowledge base of scientific discovery and corroboration. A shift from the model of the EBM pyramid of corroboration of evidence to the use of broader multi-domain perspective graphically depicted as ‘Greek temple’ could be considered. This model takes into account the different stages of scientific knowledge (discovery, corroboration and implementation), the sources of knowledge relevant to guideline development (experimental, observational, contextual, expert-based and experiential); their underlying inference mechanisms (deduction, induction, abduction, means-end inferences) and a more precise definition of evidence and related terms. The applicability of this broader approach is presented for the development of the Canadian Consensus Guidelines for the Primary Care of People with Developmental Disabilities.
机译：根据循证医学（EBM）框架，制定建议的指南方法将大部分精力用于组织发现和确证知识。指南通常只使用单一维度的信息，并且通常会在此过程中丢弃上下文证据和正式的专家知识以及消费者的经验。认识到指南在复杂案例，复杂干预措施和系统研究中的局限性，已经做出了巨大的努力来开发新的工具，指南，资源和结构，以与EBM指南制定方法一起使用。除了这些进步之外，还需要基于科学哲学的新框架。指南应被定义为用于改进实际操作中决策过程的实施决策支持工具，而不仅应作为优化科学发现和确证的知识库的程序。可以考虑从循证医学的循证医学金字塔模型转变为使用更广泛的多领域视角（图形化地描述为“希腊神庙”）。该模型考虑了科学知识的不同阶段（发现，证实和实施），与准则制定有关的知识来源（实验，观察，背景，基于专家和经验）;它们的基本推理机制（演绎，归纳，绑架，均值推断）和更精确的证据和相关术语定义。提出了这种更广泛方法的适用性，以开发《加拿大发育障碍者基本护理共识指南》。

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