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Advantages of Developing Clinical Practice Guidelines Using International Standards

机译：使用国际标准开发临床实践指南的优势

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The American Psychological Association (APA) recently adopted three clinical practice guidelines (CPGs), including one on the treatment of posttraumatic stress disorder that engendered considerable controversy because it recommended several trauma-focused therapies that have been extensively tested but not that widely practiced and not other forms of treatment that are widely practiced but not extensively tested. Concerns have been raised that the guideline hewed too closely to procedures established by the Institute of Medicine (IOM) and relied too exclusively on efficacy data from randomized controlled trials. Both the IOM model and the APA's evidence-based practice model recommend basing treatment decisions on the best available scientific evidence as channeled through clinical expertise in a manner consistent with patient values and preferences. Despite this shared framework, questions remain as to how to prioritize different sources of evidence and how much weight to give methodologies other than randomized controlled trials. We describe the need for CPGs and the APA's reasons for following the rigorous procedures recommended by the IOM. We also describe our hope that future CPGs will consider a broader range of scientific evidence and better integrate clinical expertise in the guideline text to provide context for applying their recommendations. This will enable discussion of treatments that are often excluded from systematic reviews and recognize the importance of individualizing care. These proposed updates to the guideline development process would allow CPGs to stay true to the rigor reflected in the IOM standards, while more fully recognizing the contributions of a wider range of evidence bases.
机译：美国心理协会（APA）最近通过了三种临床实践指南（CPG），其中包括治疗精神争议的诊断，因为它推荐了几种具有广泛测试的创伤疗法，但不是广泛实践的创伤疗法其他形式的治疗方式广泛实践但未进行广泛测试。令人担忧的是，指导方针与医学研究所（IOM）建立的程序过于密切，并依赖于来自随机对照试验的疗效数据。 IOM模型和APA的基于证据的实践模型建议基于最佳可用科学证据的基于治疗决策，以通过与患者价值和偏好一致的方式通过临床专业知识。尽管这一共同框架，但仍然是如何优先考虑不同的证据来源以及提供除随机对照试验之外的方法的重量。我们描述了CPG的需求和APA遵循IOM推荐的严格程序的原因。我们还描述了我们希望未来的CPG将考虑更广泛的科学证据，并更好地整合指南文本中的临床专业知识，以提供适用其建议的背景。这将能够讨论经常被排除在系统评价中的治疗，并认识到个性化护理的重要性。这些建议的准则开发过程的更新将使CPGS保持符合IOM标准的严格反映，同时更充分认识到更广泛的证据基础的贡献。

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