Schnabel Alexander, Kranke Peter
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikums Münster.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2010 Jul;45(7-8):510-8. doi: 10.1055/s-0030-1262480. Epub 2010 Jul 21.
Once rather a niche business, evidence-based medicine (EBM) as an approach to clinical decision-making requiring the integration of the best available research evidence with individual clinical expertise and patient values, has gained widespread acceptance and support within the healthcare community. This review article covers the basic principles of systematic reviews and meta-analyses, and their role in the process of evidence-based decision-making. The strengths and weaknesses of traditional narrative reviews are discussed, as well as the way systematic reviews limit bias associated with the assembly, critical appraisal and synthesis of studies addressing specific clinical questions. The authors provide a step-by-step introduction for the most relevant issues in writing a systematic review from the initial formulation of a research question according to the PICO-rule to sensitivity analyses in conjunction with the combined analysis of the pooled data. Special emphasis is put on important issues that need to be considered when appraising a systematic review or meta-analysis, thus providing a description on how to use systematic reviews for clinical decision-making. Some of the terms that are frequently used in the reporting of systematic reviews and meta-analyses, such as relative risk, confidence interval, Forest plot or L'Abbé plot, will be introduced and explained.
循证医学（EBM）曾经是一个相对小众的领域，如今作为一种临床决策方法，它要求将可得的最佳研究证据与个人临床专业知识及患者价值观相结合，已在医疗界获得广泛认可与支持。这篇综述文章涵盖了系统评价和荟萃分析的基本原则，以及它们在循证决策过程中的作用。文中讨论了传统叙述性综述的优缺点，以及系统评价如何限制与针对特定临床问题的研究的收集、批判性评价和综合相关的偏倚。作者从根据PICO原则最初提出研究问题到结合汇总数据的综合分析进行敏感性分析，逐步介绍了撰写系统评价中最相关的问题。特别强调了在评估系统评价或荟萃分析时需要考虑的重要问题，从而说明了如何将系统评价用于临床决策。还将介绍和解释系统评价和荟萃分析报告中经常使用的一些术语，如相对风险、置信区间、森林图或拉贝图。
