Beitz Janice M, Bolton Laura L
Rutgers University School of Nursing - Camden, Camden, NJ.
Robert Wood Johnson University Medical School, New Brunswick, NJ.
Ostomy Wound Manage. 2015 Nov;61(11):26-42.
Good quality systematic reviews (SRs) summarizing best available evidence can help inform clinical decisions, improv- ing patient and wound outcomes. Weak SRs can misinform readers, undermining care decisions and evidence-based practice. To examine the strengths and weaknesses of SRs and meta-analyses and the role of SRs in contemporary evidence-based wound care practice, and using the search terms systematic review, meta-analysis, and evidence-based practice, the authors searched Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for important terminology and recommendations to help clinicians evaluate SRs with meta-analysis. Reputable websites, recent textbooks, and synthesized available literature also were reviewed to describe and summarize SR strengths and weaknesses. After developing a checklist for critically evaluating SR objectives, inclusion/exclusion criteria, study quality, data extraction and synthesis methods, meta-analysis homogeneity, accuracy of results, interpretation, and consistency between significant findings and abstract or conclusions, the checklist was applied to topical wound care SRs identified in Cochrane and MEDLINE searches. Best available evidence included in the SRs from 169 randomized controlled trials on 11,571 patients supporting topical intervention healing effects on burns, surgical sites, and diabetic, venous, or pressure ulcers was summarized and showed SRs and clinical trials can demonstrate different outcomes because the information/data are compiled differently. The results illustrate how evidence insufficient to support firm conclusions may still meet immediate needs to guide carefully considered clinical wound and patient care decisions while encouraging better future science.
高质量的系统评价（SRs）总结了现有最佳证据，有助于为临床决策提供信息，改善患者和伤口治疗结果。质量不佳的系统评价可能会误导读者，破坏护理决策和循证实践。为了研究系统评价和荟萃分析的优缺点以及系统评价在当代循证伤口护理实践中的作用，作者使用“系统评价”“荟萃分析”和“循证实践”等检索词，在医学文献数据库（Medline）和护理学与健康相关文献累积索引数据库（CINAHL）中搜索重要术语和建议，以帮助临床医生评估包含荟萃分析的系统评价。还查阅了知名网站、近期教科书以及综合现有文献，以描述和总结系统评价的优缺点。在制定了一份用于严格评估系统评价的目标、纳入/排除标准、研究质量、数据提取和综合方法、荟萃分析的同质性、结果准确性、解读以及重要发现与摘要或结论之间一致性的清单后，该清单被应用于在Cochrane和MEDLINE检索中确定的局部伤口护理系统评价。对169项针对11571例患者的随机对照试验的系统评价中包含的支持局部干预对烧伤、手术切口以及糖尿病性、静脉性或压疮愈合效果的现有最佳证据进行了总结，结果表明系统评价和临床试验可能显示出不同的结果，因为信息/数据的汇编方式不同。研究结果说明了证据虽不足以支持确切结论，但仍可满足当下需求，以指导经过审慎考虑的临床伤口和患者护理决策，同时鼓励未来开展更好的科学研究。
