Office of Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, Toronto, Canada.
J Gen Intern Med. 2011 Apr;26(4):419-26. doi: 10.1007/s11606-010-1506-7. Epub 2010 Oct 16.
Systematic reviews have the potential to inform clinical decisions, yet little is known about the impact of interventions on increasing the use of systematic reviews in clinical decision-making.
To systematically review the evidence on the impact of interventions for seeking, appraising, and applying evidence from systematic reviews in decision-making by clinicians.
Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and LISA were searched from the earliest date available until July 2009.
Two independent reviewers selected studies for inclusion if the intervention intended to increase seeking, appraising, or applying evidence from systematic reviews by a clinician. Information about the study population, features of each intervention, methods used to measure the use of systematic reviews and those used to measure professional performance or health care outcomes, existence and use of statistical tests, study outcomes, and comparative data were extracted.
A total of 8,104 titles and abstracts were reviewed, leading to retrieval of 189 full-text articles for assessment; five of these studies met all inclusion criteria. All five studies reported on professional performance behavior; none reported on patient health outcomes. One study reported positive outcomes in improving preventive care. Three studies focused on obstetrical care, with two reporting no impact on professional practice change, and one study reporting increases in the use of prophylactic oxytocin and episiotomy. One study found no improvement in the sealant rate of newly erupted molars among dentists in Scotland.
The small number of studies available for examination indicates the difficulty in summarizing and identifying key aspects in successful strategies that encourage clinicians to use systematic reviews in decision-making. Other concerns lay in selective reporting and lack of blinding during data collection.
The limited empirical data render the strength of evidence weak for the effectiveness and types of interventions that encourage clinicians to use systematic reviews in clinical decision making.
系统评价有可能为临床决策提供信息，但对于干预措施在增加临床医生在决策中使用系统评价的作用知之甚少。
系统评价干预措施在寻求、评价和应用系统评价证据以指导临床医生决策方面的效果。
从可获得的最早日期到 2009 年 7 月，检索了 Medline、EMBASE、CINAHL、Cochrane 对照试验中心注册库和 LISA 数据库。
如果干预措施旨在增加临床医生对系统评价证据的寻求、评价或应用，则由两名独立评审员选择纳入研究。提取研究人群信息、每项干预措施的特点、用于测量系统评价使用情况和用于测量专业表现或医疗保健结果的方法、统计检验的存在和使用、研究结果和比较数据。
共评价了 8104 篇标题和摘要，导致检索到 189 篇全文文章进行评估；其中 5 项研究符合所有纳入标准。这 5 项研究均报告了专业表现行为；无一项报告了患者健康结果。一项研究报告了在改善预防保健方面的积极结果。三项研究集中在产科护理方面，两项研究报告对专业实践改变没有影响，一项研究报告了预防性催产素和会阴切开术使用的增加。一项研究发现苏格兰牙医在新萌出磨牙封剂率方面没有改善。
可用于检查的研究数量较少，表明难以总结和确定鼓励临床医生在决策中使用系统评价的成功策略的关键方面。其他问题在于数据收集过程中的选择性报告和缺乏盲法。
有限的经验数据使得鼓励临床医生在临床决策中使用系统评价的干预措施的有效性和类型的证据强度较弱。
