World Organization of Family Doctors (Wonca) Forum, Beijing, 2006William K. Dolen, MD Medical College of Georgia, AugustaGuidelines for Evaluation and Guidelines for Evaluation and Management of Respiratory DiseasesManagement of Respiratory Diseases 呼吸道疾病的评定和处理指南呼吸道疾病的评定和处理指南http:/www.who.int/respiratory/gard/en/GARD 全球防慢性呼吸疾病联盟 Working towards the common goal of fighting Working towards the common goal of fighting chronic respiratory diseaseschronic respiratory diseases 针对向慢性呼吸病斗争的一般目标的工作针对向慢性呼吸病斗争的一般目标的工作 Identifying problems Identifying problems 确认问题确认问题 Promoting solutions Promoting solutions 推动解决推动解决 Coordinating activities Coordinating activities 协调活动协调活动 Sharing expertise; encouraging and facilitating Sharing expertise; encouraging and facilitating information exchangeinformation exchange参与的专家；鼓励支持信息交流参与的专家；鼓励支持信息交流Shared expertise 技术共享 Throughout the world, physician groups have Throughout the world, physician groups have developed “guidelines” for the diagnosis and developed “guidelines” for the diagnosis and management of respiratory diseasemanagement of respiratory disease 全世界的医生组织都制订了呼吸病诊断治疗指南全世界的医生组织都制订了呼吸病诊断治疗指南 These guidelines are mostly evidence-basedThese guidelines are mostly evidence-based 这些指南大多为循证性这些指南大多为循证性 Most are available from the World-Wide WebMost are available from the World-Wide Web 大多数可从大多数可从全世界范围的网络上找到全世界范围的网络上找到Advantages of guidelines 指南的优点 Guidelines reflect a consensus of many experts on various Guidelines reflect a consensus of many experts on various non-controversial and controversial topicsnon-controversial and controversial topics反映许多专家在各种无争议反映许多专家在各种无争议/ /有争议领域的一致意见有争议领域的一致意见 Evidence-based Evidence-based 循证性循证性 The authors of guidelines have done a very detailed review The authors of guidelines have done a very detailed review and analysis of published literatureand analysis of published literature作者对已出版的文献做了详细的回顾和分析作者对已出版的文献做了详细的回顾和分析 Many guidelines have been studied prospectively to verify Many guidelines have been studied prospectively to verify that they are appropriate for usethat they are appropriate for use一些前瞻性研究已证明其实用性一些前瞻性研究已证明其实用性 Some of the guidelines have international acceptanceSome of the guidelines have international acceptance有些已被许多国家接受有些已被许多国家接受Disadvantages of guidelines 指南的不足 Since guidelines are consensus Since guidelines are consensus recommendations, they are not appropriate for all recommendations, they are not appropriate for all patients patients 指南为共性的推荐内容，不一定适用于所有患者指南为共性的推荐内容，不一定适用于所有患者 Guidelines are not a substitute for clinical Guidelines are not a substitute for clinical thinking thinking 指南不能代替临床思维指南不能代替临床思维 Guidelines must be regularly updated to remain Guidelines must be regularly updated to remain useful; physicians must be kept aware of updates useful; physicians must be kept aware of updates 医生应意识到指南必须经常性修改，保持先进与实用医生应意识到指南必须经常性修改，保持先进与实用 Guidelines differ from country to country, Guidelines differ from country to country, reflecting different practice stylesreflecting different practice styles 不同国家有适合本国服务方式的不同国家有适合本国服务方式的指南指南Examples 1 例-1 Global Initiative for Asthma Global Initiative for Asthma (GINA)(GINA) 哮喘全球行动哮喘全球行动 http:/www.ginasthma.orghttp:/www.ginasthma.org Global Initiative for chronic Obstructive Lung Global Initiative for chronic Obstructive Lung Disease Disease (GOLD)(GOLD) 慢阻肺慢阻肺全球行动全球行动 http:/www.goldcopd.orghttp:/www.goldcopd.org Allergic Rhinitis and its Impact on Asthma Allergic Rhinitis and its Impact on Asthma (ARIA)(ARIA) http:/www.whiar.orghttp:/www.whiar.org 过敏性鼻炎及其过敏性鼻炎及其对哮喘的威胁对哮喘的威胁Examples 2 例-2 International Primary Care Airways Group (IPAG) International Primary Care Airways Group (IPAG) primary care workbook primary care workbook 国际呼吸道疾病基层医疗国际呼吸道疾病基层医疗( (IPAG) - IPAG) - 基层医疗业务手册基层医疗业务手册 Available from WONCA Available from WONCA 可从可从WONCAWONCA得到帮助得到帮助 Addresses diagnosis and management of rhinitis, Addresses diagnosis and management of rhinitis, asthma, COPDasthma, COPD 提出鼻炎、哮喘、慢阻肺的诊断处理提出鼻炎、哮喘、慢阻肺的诊断处理 Based on GINA, GOLD, ARIA guidelinesBased on GINA, GOLD, ARIA guidelines以以GINA, GOLD, ARIA GINA, GOLD, ARIA 指南为基础指南为基础 Symptom-based, easy to use Symptom-based, easy to use 症状为基础症状为基础, ,便于使用便于使用Examples 3 例-3 International Primary Care Respiratory Group International Primary Care Respiratory Group (IPCRG) Guidelines(IPCRG) Guidelines国际呼吸道疾病基层医疗组织国际呼吸道疾病基层医疗组织(IPCRG)(IPCRG)指南指南 http:/www.theipcrg.org/guidelines/index.phphttp:/www.theipcrg.org/guidelines/index.php Entire issue of Primary Care Respiratory Journal Entire issue of Primary Care Respiratory Journal 2006;15(1):1-742006;15(1):1-74 呼吸道疾病基层医疗的整体研究杂志呼吸道疾病基层医疗的整体研究杂志2006;15(1):1-742006;15(1):1-74 Detailed, extensive Detailed, extensive 细节与延伸细节与延伸Examples 4 例-4 National Heart, Lung, and Blood Institute (NHLBI) National Heart, Lung, and Blood Institute (NHL