背景:糖尿病相关的足部疾病(DFD)是澳大利亚疾病负担的主要原因。2011年澳大利亚DFD指南已经过时。我们旨在开发方法,使适当的国际指南系统地适应澳大利亚的情况,成为新的澳大利亚基于证据的DFD指南。
方法:我们遵循了澳大利亚国家健康医学研究委员会(NHMRC)的指南。我们系统地搜索了所有国际DFD指南记录。对所有确定的记录进行独立筛选并评估合格性。那些被认为合格的人被进一步评估和包括如果得分至少中等质量,使用AGREEII和NHMRC工具的适用性和货币。纳入的国际准则将所有建议提取到六个子领域:预防、伤口分类,外周动脉疾病,感染,卸载和伤口愈合。六个国家小组,每人由6-8名多学科国家专家组成,使用ADAPTE表格筛选了子领域中的所有建议,以在澳大利亚获得可接受性和适用性。如果专家组不确定任何可接受性和适用性项目,使用“从证据到决策”工具进行全面评估。通过了建议,适应,或排除在外,基于专家组和国际准则的判决之间的协议。每个小组都起草了一份指南,其中包括他们的所有建议,理由,理据,和实施考虑。所有人都接受了公众咨询,最终修订,并获得国家高峰机构的批准。
结果:我们筛选了182条确定的记录,评估了24条全文记录,在进一步的质量之后,适用性,和货币评估,一个记录被认为是合适的国际准则,国际工作组糖尿病足指南(IWGDF指南)。六个小组共同评估了100项IWGDF建议,71号被采纳,27适应,和两个被排除在澳大利亚的背景下。我们收到了47份公众谘询回复,超过80%(强烈)同意指引应该获得批准,十个国家高峰机构批准了最后六个准则。这六个准则和这个协议可以在:https://www上找到。diabetesfeetaustralia.org/new-guidelines/结论:通过采用合适的国际指南,十年来首次开发了新的澳大利亚基于证据的DFD指南。为适应而开发的方法可能对其他与足部相关的状况有用。这些新指南现在将成为澳大利亚DFD护理的国家多学科最佳实践标准。
BACKGROUND: Diabetes-related foot disease (DFD) is a leading cause of the Australian disease burden. The 2011 Australian DFD guidelines were outdated. We aimed to develop methodology for systematically adapting suitable international guidelines to the Australian context to become the new Australian evidence-based guidelines for DFD.
METHODS: We followed the Australian National Health Medical Research Council (NHMRC) guidelines for adapting
guidelines. We systematically searched for all international DFD
guideline records. All identified records were independently screened and assessed for eligibility. Those deemed eligible were further assessed and included if scoring at least moderate quality, suitability and currency using AGREE II and NHMRC instruments. The included international guidelines had all recommendations extracted into six sub-fields: prevention, wound classification, peripheral artery disease, infection, offloading and wound healing. Six national panels, each comprising 6-8 multidisciplinary national experts, screened all recommendations within their sub-field for acceptability and applicability in Australia using an ADAPTE form. Where panels were unsure of any acceptability and applicability items, full assessments were undertaken using a GRADE Evidence to Decision tool. Recommendations were adopted, adapted, or excluded, based on the agreement between the panel\'s and international
guideline\'s judgements. Each panel drafted a
guideline that included all their recommendations, rationale, justifications, and implementation considerations. All underwent public consultation, final revision, and approval by national peak bodies.
RESULTS: We screened 182 identified records, assessed 24 full text records, and after further quality, suitability, and currency assessment, one record was deemed a suitable international
guideline, the International Working Group Diabetic Foot Guidelines (IWGDF guidelines). The six panels collectively assessed 100 IWGDF recommendations, with 71 being adopted, 27 adapted, and two excluded for the Australian context. We received 47 public consultation responses with > 80% (strongly) agreeing that the guidelines should be approved, and ten national peak bodies endorsed the final six guidelines. The six guidelines and this protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/ CONCLUSION: New Australian evidence-based guidelines for DFD have been developed for the first time in a decade by adapting suitable international guidelines. The methodology developed for adaptation may be useful for other foot-related conditions. These new guidelines will now serve as the national multidisciplinary best practice standards of DFD care in Australia.