Löhler Jan, Akcicek B, Müller F, Dreier G, Meerpohl J J, Vach W, Werner J A
German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery, Bonn, Germany; Scientific Institute for Applied Otolaryngology, Bad Bramstedt, Germany.
Scientific Institute for Applied Otolaryngology, Bad Bramstedt, Germany.
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2016 Dec 15;15:Doc10. doi: 10.3205/cto000137. eCollection 2016.
As in other disciplines, the burgeoning knowledge in ENT medicine long ago surpassed our ability to adequately absorb it and maintain a proper overview. This can give rise to actual or assumed evidence gaps that can impede the progress of the discipline and evidence-based treatment of patients. Clinics and medical practices also hold to traditional doctrines that shape day-to-day medicine, without these schools being challenged based on evidence. Between February and June 2015, 160 ENT clinics, including 34 university hospitals, and 2,670 ENT practices took part in a two-arm online survey on existing or perceived evidentiary gaps in ENT medicine using a previously developed questionnaire. The survey used for half of the participants was open in form; the other half were given a closed survey with systematics of the field for orientation. The survey was augmented with additional data such as the number of publications and focus areas in the clinics and the age and type of practice of the established physicians. The return rate from the clinics was 39.7%; the return rate of the closed surveys was 29.3%. Of the physicians in medical practice, 14.6% responded to the closed and 18.6% to the open survey. There were no major differences between the two forms of survey. Otological and oncological issues comprised approximately 30% of the list of answers from clinics. Corresponding questions were formulated regarding the current diagnostic and therapeutic problems, such as with stage-related tumor treatment or implantable hearing aids. Diagnostic procedures, e.g., special new procedures in audiology and vestibulogy, dominated the surveys from the practices. However clinics and practices alike cited marginal areas of the discipline that are of daily relevance. The cited evidence gaps then needed to be verified or refuted and clarified based on research of the literature as to whether the existing evidence actually reached healthcare providers in the form of guidelines, publications, conferences, or continuing training for application in daily practice. Other steps would include prioritizing future research, evidence mapping, deciding on further systematic reviews, and targeted studies in conjunction with procuring third-party funding and in cooperation with patient associations. The knowledge thus gained should ultimately be transferred in improved form for application in daily clinical practice. Ten questions of key importance each needed to be formulated for the hospitals and practices.
与其他学科一样，耳鼻喉医学领域迅速增长的知识早已超出了我们充分吸收并全面掌握的能力。这可能导致实际存在或被认为存在的证据缺口，进而阻碍该学科的发展以及对患者的循证治疗。诊所和医疗实践也遵循着塑造日常医疗的传统学说，而这些学说并未基于证据受到挑战。2015年2月至6月期间，160家耳鼻喉诊所（包括34家大学医院）以及2670家耳鼻喉医疗实践机构参与了一项双臂在线调查，该调查使用之前编制的问卷，针对耳鼻喉医学中已存在的或被察觉到的证据缺口展开。用于一半参与者的调查形式是开放式的；另一半则收到一份封闭式调查，并附有该领域的系统知识以供参考。该调查还补充了其他数据，如诊所的出版物数量和重点领域，以及执业医生的年龄和执业类型。诊所的回复率为39.7%；封闭式调查的回复率为29.3%。在医疗实践中的医生中，14.6%回复了封闭式调查，18.6%回复了开放式调查。两种调查形式之间没有重大差异。耳科和肿瘤学问题约占诊所答案列表的30%。针对当前的诊断和治疗问题，如与分期相关的肿瘤治疗或可植入式助听器，提出了相应问题。诊断程序，例如听力学和前庭学中的特殊新程序，在医疗实践机构的调查中占主导地位。然而，诊所和医疗实践机构都提到了该学科中具有日常相关性的边缘领域。随后需要根据文献研究来验证、反驳并澄清所提及的证据缺口，即现有证据是否实际上以指南、出版物、会议或继续培训的形式传达给了医疗服务提供者，以便在日常实践中应用。其他步骤将包括确定未来研究的优先级、证据映射、决定进一步的系统评价，以及结合获取第三方资金和与患者协会合作开展有针对性的研究。最终，由此获得的知识应以改进的形式转化，以便应用于日常临床实践。需要分别为医院和医疗实践机构各制定十个至关重要的问题。
