Nouhi Mojtaba, Hadian Mohamad, Olyaeemanesh Alireza
School of Health Management and Information Sciences, Iran University of Medical Sciences.
National Institute of Health Research.
Medicine (Baltimore). 2018 Oct;97(42):e12439. doi: 10.1097/MD.0000000000012439.
Surgical intervention is one of the common therapeutic interventions applied to a vast class of diseases. Unwarranted variation in practice style in different locations is considered as practice style variations (PSVs), which cause undesirable effects on patient health status and economic consequences. The magnitude of the variations in surgical interventions and its effects on clinical outcomes of patients and also utilization of resources have been investigated in recent years. But the findings show considerable heterogeneities in magnitude and consequences. We develop a protocol to systematically review the current literature of PSV to explain the magnitude of PSV and its clinical and economic consequences.
This systematic review will include observational and experimental studies to investigate magnitude and consequences of PSV in common surgical interventions, cardiovascular disease, urological, and ophthalmological diseases. Source of information is scientific databases, theses, clinical trials registrations website, and grey literature. A comprehensive electronic search will be conducted through PubMed, Web of Science, EBSCO, EMBASE, and Scopus databases. Studies are assessed systematically by 2 investigators. Methodological quality of the included studies is evaluated by the STROBE and CONSORT checklists. In case of data availability, we will pool findings of included studies by meta-analysis techniques in the CMA software. Subgroup analyses are based on the type of the interventions and selected diseases.
This study has ethical approval from ethical committee of Iran University of Medical Sciences, ethic code: IR.IUMS.REC1395.9221504203. The results will be published in a peer-reviewed journal.
A systematic review is considered as an appropriate scientific method for reaching a consensus on magnitude as well as consequences of PSV. Results of this study will help clinical experts to attain more knowledge about PSV and encourage them to use some tools such as clinical guidelines and shared decision making to alleviate its consequences.
手术干预是应用于众多疾病的常见治疗手段之一。不同地区手术操作方式存在的不合理差异被视为手术操作方式差异（PSV），这会对患者健康状况和经济后果产生不良影响。近年来，人们对手术干预差异的程度及其对患者临床结局和资源利用的影响进行了研究。但研究结果显示，在差异程度和后果方面存在相当大的异质性。我们制定了一项方案，旨在系统回顾PSV的现有文献，以阐释PSV的程度及其临床和经济后果。
本系统评价将纳入观察性和实验性研究，以调查PSV在常见外科手术、心血管疾病、泌尿系统疾病和眼科疾病中的程度及后果。信息来源为科学数据库、论文、临床试验注册网站和灰色文献。将通过PubMed、科学网、EBSCO、EMBASE和Scopus数据库进行全面的电子检索。由2名研究人员对研究进行系统评估。采用STROBE和CONSORT清单评估纳入研究的方法学质量。若数据可得，我们将在CMA软件中运用荟萃分析技术汇总纳入研究的结果。亚组分析基于干预类型和所选疾病。
本研究已获得伊朗医科大学伦理委员会的伦理批准，伦理代码：IR.IUMS.REC1395.9221504203。研究结果将发表在同行评审期刊上。
系统评价被认为是就PSV的程度及其后果达成共识的合适科学方法。本研究结果将有助于临床专家更多地了解PSV，并鼓励他们使用临床指南和共同决策等工具来减轻其后果。
