Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
PLoS One. 2018 Jan 10;13(1):e0190045. doi: 10.1371/journal.pone.0190045. eCollection 2018.
Complex wounds such as leg and foot ulcers are common, resource intensive and have negative impacts on patients' wellbeing. Evidence-based decision-making, substantiated by high quality evidence such as from systematic reviews, is widely advocated for improving patient care and healthcare efficiency. Consequently, we set out to classify and map the extent to which up-to-date systematic reviews containing robust evidence exist for wound care uncertainties prioritised by community-based healthcare professionals.
We asked healthcare professionals to prioritise uncertainties based on complex wound care decisions, and then classified 28 uncertainties according to the type and level of decision. For each uncertainty, we searched for relevant systematic reviews. Two independent reviewers screened abstracts and full texts of reviews against the following criteria: meeting an a priori definition of a systematic review, sufficiently addressing the uncertainty, published during or after 2012, and identifying high quality research evidence.
The most common uncertainty type was 'interventions' 24/28 (85%); the majority concerned wound level decisions 15/28 (53%) however, service delivery level decisions (10/28) were given highest priority. Overall, we found 162 potentially relevant reviews of which 57 (35%) were not systematic reviews. Of 106 systematic reviews, only 28 were relevant to an uncertainty and 18 of these were published within the preceding five years; none identified high quality research evidence.
Despite the growing volume of published primary research, healthcare professionals delivering wound care have important clinical uncertainties which are not addressed by up-to-date systematic reviews containing high certainty evidence. These are high priority topics requiring new research and systematic reviews which are regularly updated. To reduce clinical and research waste, we recommend systematic reviewers and researchers make greater efforts to ensure that research addresses important clinical uncertainties and is of sufficient rigour to inform practice.
腿部和足部溃疡等复杂伤口很常见，耗费资源且对患者的健康状况产生负面影响。基于证据的决策，以系统评价等高质量证据为依据，广泛用于改善患者护理和医疗保健效率。因此，我们着手对社区医疗保健专业人员优先考虑的伤口护理不确定性进行分类和绘制，以确定最新的系统评价中包含了多少强有力的证据。
我们要求医疗保健专业人员根据复杂伤口护理决策对不确定性进行优先排序，然后根据决策的类型和级别对 28 个不确定性进行分类。对于每个不确定性，我们都搜索了相关的系统评价。两名独立评审员根据以下标准筛选了综述的摘要和全文：符合系统评价的预先定义、充分解决不确定性、发表在 2012 年及以后，以及确定高质量的研究证据。
最常见的不确定性类型是“干预措施”24/28（85%）；大多数与伤口水平决策有关 15/28（53%），但服务提供水平决策（10/28）被给予最高优先级。总体而言，我们发现了 162 篇潜在相关的综述，其中 57 篇（35%）不是系统评价。在 106 篇系统评价中，只有 28 篇与不确定性相关，其中 18 篇发表在过去五年内；没有一篇确定了高质量的研究证据。
尽管发表的原始研究数量不断增加，但提供伤口护理的医疗保健专业人员仍存在重要的临床不确定性，这些不确定性未被最新的包含高确定性证据的系统评价所涵盖。这些都是高优先级的主题，需要新的研究和系统评价，并定期更新。为了减少临床和研究浪费，我们建议系统评价者和研究人员更加努力确保研究解决重要的临床不确定性，并具有足够的严谨性来为实践提供信息。
