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首页> 外文期刊>Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery >The relationship between evidence and guidelines.
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The relationship between evidence and guidelines.

机译：证据与准则之间的关系。

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摘要

This reflection aims to soothe some frustrations, to cool current debates, and to encourage an understanding whereby the relationship between evidence and guidelines can be more productive in future. The relationship of evidence to guidelines, an important link between research and application, is not as simple and unidirectional as is often imagined. The recent emphasis on evidence of high quality and aggregation of evidence is appropriate but can be modified and extended. There are other important elements in guidelines besides the available evidence (which is centered on efficacy and effectiveness). Available evidence may be poor, or not be the most relevant to the decision at hand. To offset the limitations to which this predicament leads, effort is also appropriate to develop more rigorous principles for interpretation and evaluation of evidence, so as to make better use of what is available. The processes for generating guidelines from evidence emphasize reliability, generalizability of a limitedkind, and freedom from bias to be achieved via systematic review. If the inclusion criterion for studies is too stringent, there may be little to say from evidence alone, or the evidence that remains may suffer limitations of relevance due to context, or it may be misapplied, simply because it has been endorsed as to quality. Knowledge-based medicine (KBM) would acknowledge a greater role for the scientific principles underlying particular pieces of evidence and deploy a fuller understanding of the health-care context. It should thus make guidelines more professionally accepted and useful in the future.
机译：这种思考旨在缓解一些挫败感，冷却当前的辩论，并鼓励人们理解，使证据和指南之间的关系在将来变得更有成效。证据与准则之间的关系，即研究与应用之间的重要联系，并不像通常想象的那么简单和单向。最近强调高质量证据和证据汇总是适当的，但可以修改和扩展。指南中除了可用证据（以有效性和有效性为中心）以外，还有其他重要元素。现有的证据可能不充分，或者与当前的决定最不相关。为了弥补这种困境带来的局限性，还应努力制定更严格的证据解释和评估原则，以便更好地利用现有的证据。从证据中产生指导方针的过程强调了可靠性，有限种类的可概括性以及通过系统性审查而不会偏见的自由。如果研究的纳入标准过于严格，仅凭证据就无话可说了，或者由于上下文的缘故，剩下的证据可能会受到相关性的限制，或者可能仅仅因为它已被认可就被误用了。基于知识的医学（KBM）将承认作为特定证据基础的科学原理将发挥更大的作用，并充分理解卫生保健背景。因此，它应该使准则在将来更加专业地被接受和使用。

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