美国成人社区获得性肺炎诊断治疗指南（2007）连载

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Implementation of Guideline Recommendations

1Locally adapted guidelines should be implemented to improve process of care variables and relevant clinical outcomes. (Strong recommendation; level I evidence.)

   Enthusiasm for developing these guidelines derives, in large part, from evidence that previous CAP guidelines have led to improvement in clinically relevant outcomes. Consistently beneficial effects in clinically relevant parameters (listed in table 3) followed the introduction of a comprehensive protocol (including a combination of components from table 2) that increased compliance with published guidelines. The first recommendation, therefore, is that CAP management guidelines be locally adapted and implemented.

   Documented benefits.   

2. CAP guidelines should address a comprehensive set of elements in the process of care rather than a single element in isolation. (Strong recommendation; level III evidence.)

3. Development of local CAP guidelines should be directed toward improvement in specific and clinically relevant outcomes. (Moderate recommendation; level III evidence.)


指南推荐实施

1. 应因地制宜地使用CAP指南，以改善医疗和相关临床结局。（强烈推荐，Ⅰ级证据。）
以前的CAP指南使相关的临床结果得到改善，这是我们改进这些指南热情的主要来源。临床预后结果的参数（表3）都应一直遵循CAP管理指南的各个部分（表2），这可以增加已发表指南的适应性。

2.在医疗过程中应综合分析、灵活使用CAP指南。（强烈推荐，Ⅲ级证据。）
应用CAP指南使临床结果改善，是上述研究均综合运用了CAP指南推荐的治疗方案，而不是仅考虑CAP管理的某一方面。没有一项研究表明，某单一指标（如距首次抗生素剂量时间）与死亡率下降有关。CAP指南的重要元素见表2，其中快速、合理的经验性抗生素治疗与结局改善相关。

3.地方CAP指南应旨在改善特异的临床相关结局。（中度推荐，Ⅲ级证据）
CAP的临床预后参数（见表3）可用于评估CAP指南的实施效果。与不能集中于治疗的某一方面一样，也不能只研究结局的某一点，因为一个指标的改善可能伴随另一相关指标的恶化，例如，降低危重病人住院率，可能增加再次急诊或再住院的人数。