歐洲慢性靜脈疾病診療指南 | ESVS前言篇五

    本指南由時任ESVS大會副主席Marianne De Maeseneer女士，全權授權予紀永威教授(中國臺灣)將歐洲慢性靜脈疾病診療指南，為海峽兩岸及港澳地區以及其他使用中文服務于患者的醫生同業提供無償服務。紀教授邀請陳忠教授、符偉國教授、郭偉教授三位教授共同編譯，連續連載，為廣大醫療專業人士提供重要的資源，幫助他們根據最新的臨床證據為CVD患者制定個性化的治療方案。

☆6.指南的修訂過程和更新☆

    指南文件經過外部審查，由ESVS指南指導委員會成員和該領域的其他獨立專家對內容和推薦意見進行評估。在每一輪審查之后，審查員的大體意見及詳細意見會匯編成一份文件。隨后根據審查員的意見對底稿進行了修改，所有修改都得到了GWC所有成員的討論和批準。此外，還向審查員進行了點對點的答復。經過三輪審查和后續修訂，最終文件獲得核準，并于2021年11月10日提交給《歐洲血管和腔內血管外科雜志》。根據ESVS每四年更新一次血管外科醫生核心課程的所有指南的政策，這些指南將在2026年更新。

☆7.患者視角☆

    患者和公眾參與臨床指南制定的重要性已被廣泛認可和接受。他們的參與不僅提升了指南的有效性，也提高了治療決策的質量，這一點得到了各國和國際組織的積極推崇。為了增強患者和公眾的可訪問性和可理解性，我們為本指南編寫了一份簡明的英文摘要，并經過了非專業審查程序。每個章節都包含了患者相關的信息，并由血管護理專家及至少一名非專業人員或患者審閱和修改。

    簡明摘要由一個患者焦點小組進行評估，該小組由英國國家衛生局的8名CVD患者（包括6名C2~C5級別患者和2名C6級別患者）以及3名無CVD病史的普通公眾組成。在召開會議之前，焦點小組的所有成員都收到了簡明摘要。會議上，我們介紹了ESVS CVD指南的背景和基本原理，并系統地收集了焦點小組對各部分內容的反饋。

    所有受邀參與的焦點小組成員對這一過程表示歡迎，許多人分享了他們個人護理經歷與指南中建議的治療方式存在的差異。特別是，在專科靜脈評估的轉診過程中通常會出現延遲，盡管這可能是英國國家衛生局的特例。部分患者反映穿戴彈性壓力襪的困難，焦點小組強調了在建議患者使用這種襪子時提供協助的重要性。

    此外，焦點小組成員認為關于淺靜脈腔內消融的描述過于復雜，建議進行簡化。在討論中，有6名焦點小組成員提到他們接受了靜脈腔內消融手術，強調了共同決策在治療選擇中的重要性，并表達了即使當地無法提供某些治療方式，也希望能夠探討其他潛在的治療方案。

    這些焦點小組的反饋被納入指南的修訂過程中，有助于進一步優化簡明摘要的內容，確保其更貼近患者和公眾的實際需求和理解水平。

☆6. The revision process and update of  guidelines. ☆ 

        The guide lines document underwent external review for critical evalu ation of the content and recommendations by members of the ESVS Guidelines Steering Committee, and by other indepen dent experts in the field. After each review round, the re viewers’general and detailed comments were compiled into one document. The manuscript was then revised according to the reviewers comments and all amendments were discussed and approved by all members of the GWC. In addition, a point to point reply to the reviewers was provided. After three re view and subsequent revision rounds, the final document was approved and submitted to the European Journal of Vascular and Endovascular Surgery on 10 November 2021. These guidelines will be updated in 2026, according to the ESVS policy to update all guidelines which are part of the core curriculum of the vascular surgeon every four years.

☆ 7. The patient perspective. ☆ 

       The importance of patient and public involvement in clinical guideline development is widely recognised and accepted. Patient engagement im proves validity, increases quality of decisions, and is encouraged by national and international groups.

       To improve accessibility and interpretability for patients and the public, a plain English summary has been produced for this guideline and subjected to a lay review process. Information for patients was drafted for each subchapter which was read and amended by a vascular nurse specialist and at least one lay person or patient.

       Lay summaries were evaluated by a patient focus group, consisting of eight patients in the United Kingdom National Health Service with a history of CVD (six patients with C2-C5 disease and two patients with C6 disease) and three lay members of the public without CVD. All members of the focus group had been sent the lay summaries prior to the meeting, which was held virtually because of COVID-19 restrictions. At the meeting, the background and rationale for the ESVS CVD guidelines were presented and focus group feedback was obtained for each section of the document, systematically. All members of the focus group welcomed the invitation to contribute to the process and many commented that their personal experiences of care had been very different to the treatments recommended in the guidelines. Specifically, referral for specialist venous assessment had often been very delayed, although this may be a specific reflection of the United Kingdom National Health Service.

       Several patients stated that they had tried compression garments but found them difficult to wear. The group felt it important to express that where compression is recom mended to patients, aids to help donning and removal of the stockings should be provided. The section describing superfi-cial venous ablation procedures was found to be complex by the patients and lay members of the focus group and was simplified accordingly. Six of the patients in the focus group had been treated with endovenous ablation procedures. The group emphasised the importance of shared decision making and stated that they would want to discuss potential treat ment options even if not locally available. Feedback from the focus group was used to amend the lay summaries.