O'Day D M, Steinberg E P, Dickersin K
Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee.
Trans Am Ophthalmol Soc. 1993;91:421-36; discussion 437-8.
The purpose of this paper was to evaluate the quality and scope of the published literature on functional impairment due to cataract in adults as reviewed for the Agency for Health Care Policy and Research Clinical Practice Guideline. We examined the method of literature retrieved and analysis performed in the course of development of literature-based recommendations for the guideline panel. To collect data, we reviewed the process of literature acquisition and identification and the quality assessments made by reviewers of 14 individual topics composed of 77 issues related to the guideline. We collated this information to provide an assessment of the quality and scope of the relevant literature. Less than 4% (310) of the approximately 8,000 articles initially identified as potentially relevant to the guideline were ultimately used. The majority covered three topics (surgery and complication, 100; Nd:YAG capsulotomy, 77; and potential vision testing, 40). Three other topics--indications for surgery, preoperative medical evaluation, and rehabilitation--were devoid of articles meeting inclusion criteria. For 43 issues, there was no identifiable relevant literature. With few exceptions, the quality of the literature was rated fair to poor owing to major flaws in experimental design. Case series (256 reports) of one type or another accounted for the majority of the included literature. There were 17 random controlled trials. This review revealed a sparse and generally low-quality literature relevant to the management of functional impairment due to cataract, despite a relatively large data base in reputable peer-reviewed journals.
本文的目的是评估为医疗保健政策与研究机构临床实践指南所综述的、已发表的关于成人白内障所致功能损害的文献的质量和范围。我们考察了在为指南小组制定基于文献的建议过程中检索文献和进行分析的方法。为收集数据，我们回顾了文献获取与识别过程以及由评审员对由与该指南相关的77个问题构成的14个单独主题所做的质量评估。我们整理这些信息以对相关文献的质量和范围进行评估。最初确定的约8000篇文章中，最终只有不到4%（310篇）被采用。大多数文章涵盖三个主题（手术及并发症，100篇；钕：钇铝石榴石晶状体囊切开术，77篇；以及潜在视力测试，40篇）。另外三个主题——手术指征、术前医学评估和康复——没有符合纳入标准的文章。对于43个问题，没有可识别的相关文献。除少数例外，由于实验设计存在重大缺陷，文献质量被评为一般到较差。各类病例系列报告（256份）占所纳入文献的大部分。有17项随机对照试验。本综述表明，尽管在著名的同行评审期刊中有相对庞大的数据库，但与白内障所致功能损害管理相关的文献稀少且总体质量较低。
