BMC Med Inform Decis Mak - In pursuit of certainty: can the systematic review process deliver?

Tópicos

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{ blood(1257) pressur(1144) flow(957) }
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{ patient(2315) diseas(1263) diabet(1191) }
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Resumo

CKGROUND: There 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.METHODS: We 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.RESULTS: Of 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.CONCLUSIONS: These 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.

Resumo Limpo

ckground increas emphasi evidencebas approach improv patient outcom rigor standardis wellvalid approach clinic guidelin drive process larg develop base find systemat review srs paper present discuss sr process provid decis inform shape guid clinic practic use purposebuilt review databas cochran review focuss high preval medic condit hypertensionmethod search cochran databas identifi relev srs incorpor clinic trial review term blood pressur hypertens titl includ select inclus abstract assess independ two author capac inform influenc clinic decisionmak inclus independ audit third authorresult srs form sampl provid conclus find inform particular treatment pathway evidencebas approach offer promis assist clinic decisionmak clariti case manag blood pressur half srs sampl highlight gap evid methodolog limit thirteen review inconclus eight includ four conclus srs note lack adequ report potenti advers effect incid harmconclus find emphasis import distil interpret synthesi inform assist clinician studi question util evidencebas approach unidimension approach improv clinic care underscor import standardis approach includ advers event incid harm patient need prefer clinician expertis discret

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