In pursuit of certainty: can the systematic review process deliver?

BMC Medical Informatics and Decision Making

Research Article

Debra Jackson¹  Patricia M Davidson¹  Phillip J Newton¹  Deborah Saltman² 

[1] Faculty of Health, University of Technology Sydney (UTS), Australia;Faculty of Health, University of Technology Sydney (UTS), Australia;Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK;

关键词: Systematic review;    Research-in-practice;    Research implementation;    Translational research;    Evidence-based practice;    Clinical decision-making;   

DOI  :  10.1186/1472-6947-13-25

 received in 2012-09-14, accepted in 2013-02-05,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundThere has been increasing emphasis on evidence-based approaches to improve patient outcomes through rigorous, standardised and well-validated approaches. Clinical guidelines drive this process and are largely developed based on the findings of systematic reviews (SRs). This paper presents a discussion of the SR process in providing decisive information to shape and guide clinical practice, using a purpose-built review database: the Cochrane reviews; and focussing on a highly prevalent medical condition: hypertension.MethodsWe searched the Cochrane database and identified 25 relevant SRs incorporating 443 clinical trials. Reviews with the terms ‘blood pressure’ or ‘hypertension’ in the title were included. Once selected for inclusion, the abstracts were assessed independently by two authors for their capacity to inform and influence clinical decision-making. The inclusions were independently audited by a third author.ResultsOf the 25 SRs that formed the sample, 12 provided conclusive findings to inform a particular treatment pathway. The evidence-based approaches offer the promise of assisting clinical decision-making through clarity, but in the case of management of blood pressure, half of the SRs in our sample highlight gaps in evidence and methodological limitations. Thirteen reviews were inconclusive, and eight, including four of the 12 conclusive SRs, noted the lack of adequate reporting of potential adverse effects or incidence of harm.ConclusionsThese findings emphasise the importance of distillation, interpretation and synthesis of information to assist clinicians. This study questions the utility of evidence-based approaches as a uni-dimensional approach to improving clinical care and underscores the importance of standardised approaches to include adverse events, incidence of harm, patient’s needs and preferences and clinician’s expertise and discretion.

【 授权许可】

Unknown   
© Saltman et al; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.