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Abstract：
Guideline methods to develop recommendations dedicate most effort around organising discovery and corroboration knowledge following the evidence-based medicine (EBM) framework. Guidelines typically use a single dimension of information, and generally discard contextual evidence and formal expert knowledge and consumer\'s experiences in the process. In recognition of the limitations of guidelines in complex cases, complex interventions and systems research, there has been significant effort to develop new tools, guides, resources and structures to use alongside EBM methods of guideline development. In addition to these advances, a new framework based on the philosophy of science is required. Guidelines should be defined as implementation decision support tools for improving the decision-making process in real-world practice and not only as a procedure to optimise the knowledge base of scientific discovery and corroboration. A shift from the model of the EBM pyramid of corroboration of evidence to the use of broader multi-domain perspective graphically depicted as \'Greek temple\' could be considered. This model takes into account the different stages of scientific knowledge (discovery, corroboration and implementation), the sources of knowledge relevant to guideline development (experimental, observational, contextual, expert-based and experiential); their underlying inference mechanisms (deduction, induction, abduction, means-end inferences) and a more precise definition of evidence and related terms. The applicability of this broader approach is presented for the development of the Canadian Consensus Guidelines for the Primary Care of People with Developmental Disabilities.
摘要：
制定建议的指导方法致力于按照循证医学（EBM）框架组织发现和确证知识。准则通常使用单一维度的信息，通常会丢弃上下文证据和正式的专家知识以及消费者在此过程中的经验。认识到准则在复杂情况下的局限性，复杂的干预措施和系统研究，已经做出了巨大的努力来开发新工具，指南,与EBM方法一起使用的资源和结构。除了这些进步，需要一个基于科学哲学的新框架。准则应被定义为实施决策支持工具，以改善现实世界实践中的决策过程，而不仅仅是优化科学发现和佐证知识库的程序。可以考虑从证据佐证的EBM金字塔模型转向使用更广泛的多领域视角，以图形方式描绘为“希腊神庙”。该模型考虑了科学知识的不同阶段(发现，证实和实施)，与指南开发相关的知识来源(实验性，观察,上下文,以专家为基础和经验)；它们的潜在推理机制(演绎、归纳法,绑架,手段-最终推论)和更精确的证据和相关术语的定义。提出了这种更广泛的方法的适用性，以制定《加拿大关于发育障碍者初级保健的共识准则》。
