循证医学临床实践指南检索

Retrieval research of evidence based clinical practice guidelines

学术背景:长期以来,医疗相关部门和管理机构制定指南都是通过收集不全面的临床试验和(或)专家意见而完成,在医疗资源有限的情况下,如何满足人们日益增长的健康需求刻不容缓。循证医学的出现为解决这一矛盾开辟了新的思路,尤其是循证医学临床实践指南能更合理地制定临床决策,并减轻患者的医疗负担。好的指南必须使用循证医学的原则和方法加以制定和完善,而临床医生工作繁忙、时间有限,详细了解循证临床实践指南的产生、制作过程几乎不太可能,如何快速有效的查找和利用循证临床实践指南少见报道。目的:为使众多的医务工作者了解循证医学临床实践指南,详细阐述临床实践指南的意义及产生过程、网络资源及检索方法。检索策略:由四川大学华西医院图书信息中心的图书馆员应用计算机检索PubMed、NGC及Cochrane Library数据库1990-01/2007-05的相关文献,检索词"evidence based medicine,clinical practice,guideline,search",并限定文章语言种类为English。同时计算机检索CBMdisc、CNKI、VIP中文数据库1999-01/2007-05的相关文献,检索词"循证医学,临床实践,指南,检索",并限定文章语言种类为中文。共检索到109篇文献,对资料进行初审,纳入标准:①临床实践指南研究。②采用循证医学原理与方法。③阐述内容完整,结论真实可靠。排除标准:重复性研究。文献评价:对符合纳入标准的内容进行循证医学系统评价,文献的筛选由两位作者独立完成,不同意见协商解决,协商不成咨询第3方。所选用的35篇文献中,9篇为综述,12篇为应用研究(包括临床循证治疗),其余均为临床或基础实验研究。资料综合:制定临床实践指南过程复杂,通过搜索现有的临床实践指南信息资源,可以有效提高指南的质量和制定效率。目前国内循证医学指南还没有整合的网站,但有一些专业循证医学指南杂志或网站提供检索服务。检索方式主要为计算机检索,不同的数据库和系统有各自的检索途径和界面,灵活使用检索技术与掌握多种检索方法是提高查全率和查准率的关键。循证临床实践逐渐受到医疗、管理、保险等相关行业的重视,借此系统评价希望达到以下目标:①在有限的医疗卫生资源下,医生能更好的做出医疗决策,避免或减少医疗差错的发生。②患者能得到更有效、及时的治疗,同时能更节省医疗费用。③管理和保险等相关职能部门在制定决策时能采用循证决策。④医生在诊治患者的过程中懂得正确查找和有效利用循证临床实践指南。结论:通过对循证临床实践指南的检索研究,能够让更多的医务工作者了解和掌握一些重要的临床实践指南信息资源,在临床实践过程中快速查找并加以有效利用。有关循证临床实践指南的制作未详细阐述,需要参阅更多的专门研究。

BACKGROUND： The guidelines for the clinical and managerial work were usually prepared by selective collection of clinical trials and experts. This, however, cannot address the problems that confront the clinical and managerial work. The emergence of evidence-based medicine has been a new approach to these problems, in particular, the evidence-based clinical practice guidelines have provided the new hope for the treatments and relieve medical burden of patients. Good guidelines need evidence-based medicine to improve. However, clinicians are busy, and cannot be available to search and use the evidence-based clinical practice guidelines. Currently, there is no such literature. Thus this research was conducted to inform the readers of interest. OBJECTIVE： To make clinicians understand evidence-based clinical practice guidelines, and to overview the roles, the processing, availability and retrieving approach of clinical practice guidelines. RETRIEVE STRATEGY： The librarians from Books ＆ Information Center, West China Hospital, Sichuan University searched the literature from the Pubmed, NGC and the Cochrane Library between January 1990 and May 2007 with the key words of ＂evidence based medicine,clinical practice,guideline,search＂ in English. Simultaneously, the Chinese CBM disc, CNKI, VIP databases were searched for relevant articles published from January 1999 to May 2007 with the key words.of ＂evidence based medicine,clinical practice,guideline,search＂. A total of 109 papers were searched, and the literature was screened firstly. Inclusive criteria included ①clinical practice guideline research, ②the methods of evidence based medicine, and ③the articles with full content and reliable conclusion. Exclusive criterion included articles with repetitive studies. LITERATURE EVALUATION： Systematic review of relevant studies was conducted. Two reviewers screened and appraised the literature independently, and resolved the discrepancy through discussion and third-party consultation. Of the 35 studies included, nine were reviews, twelve were applied research （including clinical evidence based medicine） and the others were clinical or basic research. DATA SYNTHESIS： The guidelines for the clinical practice are complicated to make. To search present information of clinical practice guidelines can effectively elevate the quality and efficiency to make the guidelines. At present, no internal integrated web site on evidence based medicine appears, but some evidence based medicine guideline journal orweb site can be retrieved. By computer, different databases and systems hold individual retrieve pathway and interface. Flexible retrieve skills and many retrieve methods can enhance full retrieve rate and exact retrieve rate. Evidence-based clinical practice is receiving more attention from the clinical, managerial and insurance staffs. This study is conducted for the following aims： ②clinicians improve clinical decision and reduce medical errors, patients receive safe, effective, and cost-effective treatments, ③managerial and insurance staffs make evidence-based decisions, and ④clinicians practice on the basis of evidence-based medicine. CONCLUSION： The study on evidence-based practice guidelines can help clinicians understand and use the information from clinical practice guidelines efficiently. These include rapid search and efficient use of clinical practice guideline. However, the studies on preparation of the guidelines need to be further strengthened.