Nan Yang, Dong Roman Xu, Janne Estill, Yaolong Chen
A clinical practice guideline ecosystem framework is proposed, interlinking seven core elements of the guideline lifecycle into a dynamic, coordinated, and closed-loop system.Guideline pre-registration and protocol development are emphasized as crucial for enhancing transparency, efficiency, and avoiding duplication, yet remain underutilized in current practice.Guideline implementation and updating are critical to the ecosystem, requiring the integration of implementation science and novel approaches like artificial intelligence to overcome the "guideline bubble" and maintain currency.A call is made for establishing standardized frameworks to coordinate the elements and stakeholders within the ecosystem, systematically promoting the development, dissemination, and application of high-quality guidelines.