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Thinking about the Development of Rapid Recommendation Based on the Status of COVID-19 Evidence
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摘要: 随着新型冠状病毒肺炎在全球暴发及快速传播，大量相关研究证据迅速产生。然而，因证据质量参差不齐、证据转化质量不佳、证据转化速度较慢等问题，卫生决策者、临床医生及患者如何作出正确决策面临巨大挑战。基于快速系统评价证据，快速建议指南可及时、有效地将当前最新证据转化为指导临床实践的推荐意见。面对全球突发公共卫生事件，通过构建新型证据生态系统，形成证据从生产、评价到应用、转化的完整闭环，从而提高医疗实践水平、减少卫生资源浪费。Abstract: With the outbreak and rapid spread of the COVID-19 worldwide, a large amount of relevant research evidence has quickly emerged. However, due to the uneven quality of evidence, poor quality and slow speed of evidence translation, it is a big challenge for health decision-makers, clinicians, and patients to make evidence-based decisions. Based on rapid systematic review of evidence, the rapid advice-guidelines can promptly and effectively transform the latest current evidence into recommendations guiding clinical practice. In the face of global public health emergencies, by building a new type of evidence ecosystem, a completely closed loop of evidence from production and evaluation to application and transformation is formed to improve the level of medical practice and reduce the waste of health resources.作者贡献：曾力楠负责查阅文献和撰写文章；张伶俐负责构思和修订文章。利益冲突：无
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表 1 WHO主要指南分类及特点[36]
指南类型 目的 适用性 指南制订者 建议类型 制订时长 标准指南 针对特定主题或条件提供推荐意见 针对性或全面性 WHO技术人员 通常为新制定的；如予以适当评估和更新，可能包含现有推荐意见 6个月~2年 汇编指南 综合所有针对疾病或病况的现有指导 全面性 WHO技术人员 经评估并确定为符合目前情况的现有推荐意见；可能包含一些新的推荐意见 1~2年 暂行指南 出现新的干预、传播或疾病或新证据变为可用或数据可能不完整时提供指导 针对性 WHO技术人员 新的推荐意见 6~9个月 应急指南 短期内开展修订过程以应对紧急性或紧迫性公共卫生需求 针对性 WHO技术人员 通常为新制定的；如予以适当评估和更新，可能包含现有推荐意见 数天~3个月 WHO: 世界卫生组织 
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表 2 BMJ制定的快速建议指南[41]
序号 指南名称 发表年份 1 《世界卫生组织关于COVID-19药物指南》 2020 2 《瑞德西韦用于严重COVID-19的临床实践指南》(已更新) 2020 3 《重症患者的胃肠道出血预防：临床实践指南》 2020 4 《通过粪便免疫化学检测、乙状结肠镜或结肠镜筛查大肠癌：临床实践指南》 2019 5 《甲状腺激素治疗亚临床甲状腺功能减退症：临床实践指南》 2019 6 《成人肩关节疼痛的肩峰以下减压手术：临床实践指南》 2019 7 《阿司匹林和氯吡格雷双重抗血小板治疗可用于急性高危短暂性脑缺血发作和轻度缺血性脑卒中》 2018 8 《急性病患者的氧气疗法：临床实践指南》 2018 9 《使用前列腺特异性抗原(PSA)筛查前列腺癌：临床实践指南》 2018 10 《败血症的皮质类固醇疗法：临床实践指南》 2018 11 《卵圆孔封闭闭锁，抗血小板或抗凝治疗仅用于治疗隐源性脑卒中？》 2018 12 《无创(铅笔点)与传统针头进行腰穿：临床实践指南》 2018 13 《抗生素用于切口和引流后的简单皮肤脓肿：临床实践指南》 2018 14 《咽痛的皮质类固醇疗法：临床实践指南》 2017 15 《HIV感染孕妇的抗逆转录病毒疗法：临床实践指南》 2017 16 《关节镜手术治疗退行性膝关节炎和半月板撕裂：临床实践指南》 2017 17 《低强度脉冲超声(LIPUS)进行骨愈合：临床实践指南》 2017 18 《经导管或外科主动脉瓣置换术用于重度、症状性、主动脉瓣狭窄的中低手术风险患者》 2016 COVID-19：同图 1
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