Powe N R, Turner J A, Maklan C W, Ersek M
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
Med Care. 1994 Jul;32(7 Suppl):JS22-37.
Formal literature review and synthesis is an important component of Patient Outcomes Research Teams (PORTs) and the development of clinical practice guidelines supported by the Agency for Health Care Policy and Research (AHCPR). Investigators face unresolved methodological issues and practical problems in carrying out this work because the use of such systematic reviews is relatively new in medicine. In addition, standard meta-analytic methods may not readily be applied to the literature pertinent to most PORTs. Representatives of the InterPORT Work Group on Literature Review and Meta-Analysis exchanged information to identify and assess their respective approaches to these challenges. All 12 PORTs used systematic approaches to identifying relevant studies and to gather and analyze data abstracted from these studies. Most PORTs had undertaken or made plans for several separate reviews, which focused on a specific question about the outcomes of therapeutic health care services or procedures, diagnosis, prevention or prognosis. The descriptive information provided by PORTs reveals substantial commonalities in their methods for searching literature and organizing bibliographic databases. However, there was considerable variation in other aspects of reviews, such as selection/exclusion criteria, the use of blinding, and the techniques used to assess the quality of studies. Alternative approaches to literature review and synthesis warrant further examination because they have implications for research and health policy both in terms of the substantive conclusions and efficiency of reviews.
正式的文献综述与综合是患者预后研究团队（PORTs）以及由医疗保健政策与研究机构（AHCPR）支持的临床实践指南制定工作的重要组成部分。由于这种系统综述在医学领域的应用相对较新，研究人员在开展这项工作时面临着尚未解决的方法学问题和实际困难。此外，标准的荟萃分析方法可能无法轻易应用于与大多数PORTs相关的文献。文献综述与荟萃分析跨PORT工作组的代表们交流了信息，以识别和评估他们应对这些挑战的各自方法。所有12个PORTs都采用系统方法来识别相关研究，并收集和分析从这些研究中提取的数据。大多数PORTs已经开展或制定了多项单独综述的计划，这些综述聚焦于有关治疗性医疗服务或程序的结果、诊断、预防或预后的特定问题。PORTs提供的描述性信息揭示了它们在文献检索方法和书目数据库组织方面存在大量共性。然而，在综述的其他方面，如选择/排除标准、盲法的使用以及用于评估研究质量的技术，存在相当大的差异。文献综述与综合的替代方法值得进一步研究，因为它们在综述的实质性结论和效率方面对研究及卫生政策都有影响。
