如何写系统综述英文版.docx
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如何写系统综述英文版.docx
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如何写系统综述英文版
HowtoWriteanEvidence-BasedClinicalReviewArticle
JAYSIWEK,M.D.,andMARGARETL.GOURLAY,M.D.,GeorgetownUniversityMedicalCenter,WashingtonD.C.
DAVIDC.SLAWSON,M.D.,UniversityofVirginiaHealthSystem,Charlottesville,Virginia
ALLENF.SHAUGHNESSY,PHARM.D.,HarrisburgFamilyPracticeResidency,Harrisburg,Pennsylvania
AmFamPhysician. 2002 Jan 15;65
(2):
251-258.
Traditionalclinicalreviewarticles,alsoknownasupdates,differfromsystematicreviewsandmeta-analyses.Updatesselectivelyreviewthemedicalliteraturewhilediscussingatopicbroadly.Nonquantitativesystematicreviewscomprehensivelyexaminethemedicalliterature,seekingtoidentifyandsynthesizeallrelevantinformationtoformulatethebestapproachtodiagnosisortreatment.Meta-analyses(quantitativesystematicreviews)seektoanswerafocusedclinicalquestion,usingrigorousstatisticalanalysisofpooledresearchstudies.Thisarticlepresentsguidelinesforwritinganevidence-basedclinicalreviewarticlefor AmericanFamilyPhysician.First,thetopicshouldbeofcommoninterestandrelevancetofamilypractice.Includeatableofthecontinuingmedicaleducationobjectivesofthereview.Statehowtheliteraturesearchwasdoneandincludeseveralsourcesofevidence-basedreviews,suchastheCochraneCollaboration,BMJ's ClinicalEvidence,ortheInfoRetrieverWebsite.Wherepossible,useevidencebasedonclinicaloutcomesrelatingtomorbidity,mortality,orqualityoflife,andstudiesofprimarycarepopulations.Inarticlessubmittedto AmericanFamilyPhysician,ratethelevelofevidenceforkeyrecommendationsaccordingtothefollowingscale:
levelA(randomizedcontrolledtrial[RCT],meta-analysis);levelB(otherevidence);levelC(consensus/expertopinion).Finally,provideatableofkeysummarypoints.
AmericanFamilyPhysician isparticularlyinterestedinreceivingclinicalreviewarticlesthatfollowanevidence-basedformat.Clinicalreviewarticles,alsoknownasupdates,differfromsystematicreviewsandmeta-analysesinimportantways.1 Updatesselectivelyreviewthemedicalliteraturewhilediscussingatopicbroadly.Anexampleofsuchatopicis,“Thediagnosisandtreatmentofmyocardialischemia.”Systematicreviewscomprehensivelyexaminethemedicalliterature,seekingtoidentifyandsynthesizeallrelevantinformationtoformulatethebestapproachtodiagnosisortreatment.ExamplesaremanyofthesystematicreviewsoftheCochraneCollaborationorBMJ's ClinicalEvidence compendium.Meta-analysesareaspecialtypeofsystematicreview.Theyusequantitativemethodstoanalyzetheliteratureandseektoanswerafocusedclinicalquestion,usingrigorousstatisticalanalysisofpooledresearchstudies.Anexampleis,“Dobetablockersreducemortalityfollowingmyocardialinfarction?
”
Thebestclinicalreviewarticlesbasethediscussiononexistingsystematicreviewsandmeta-analyses,andincorporateallrelevantresearchfindingsaboutthemanagementofagivendisorder.Suchevidence-basedupdatesprovidereaderswithpowerfulsummariesandsoundclinicalguidance.
Inthisarticle,wepresentguidelinesforwritinganevidence-basedclinicalreviewarticle,especiallyonedesignedforcontinuingmedicaleducation(CME)andincorporatingCMEobjectivesintoitsformat.Thisarticlemaybereadasacompanionpiecetoapreviousarticleandaccompanyingeditorialaboutreadingandevaluatingclinicalreviewarticles.1,2 Somearticlesmaynotbeappropriateforanevidence-basedformatbecauseofthenatureofthetopic,theslantofthearticle,alackofsufficientsupportingevidence,orotherfactors.Weencourageauthorstoreviewtheliteratureand,whereverpossible,ratekeypointsofevidence.Thisprocesswillhelpemphasizethesummarypointsofthearticleandstrengthenitsteachingvalue.
TopicSelection
Chooseacommonclinicalproblemandavoidtopicsthatareraritiesorunusualmanifestationsofdiseaseorthathavecuriosityvalueonly.Wheneverpossible,choosecommonproblemsforwhichthereisnewinformationaboutdiagnosisortreatment.Emphasizenewinformationthat,ifvalid,shouldpromptachangeinclinicalpractice,suchastherecentevidencethatspironolactonetherapyimprovessurvivalinpatientswhohaveseverecongestiveheartfailure.3 Similarly,newevidenceshowingthatastandardtreatmentisnolongerhelpful,butmaybeharmful,wouldalsobeimportanttoreport.Forexample,patchingmosttraumaticcornealabrasionsmayactuallycausemoresymptomsanddelayhealingcomparedwithnopatching.4
SearchingtheLiterature
Whensearchingtheliteratureonyourtopic,pleaseconsultseveralsourcesofevidence-basedreviews(Table1).Lookforpertinentguidelinesonthediagnosis,treatment,orpreventionofthedisorderbeingdiscussed.Incorporateallhigh-qualityrecommendationsthatarerelevanttothetopic.Whenreviewingthefirstdraft,lookforallkeyrecommendationsaboutdiagnosisand,especially,treatment.Trytoensurethatallrecommendationsarebasedonthehighestlevelofevidenceavailable.Ifyouarenotsureaboutthesourceorstrengthoftherecommendation,returntotheliterature,seekingoutthebasisfortherecommendation.
TABLE1
SomeSourcesofEvidence-BasedMedicine
AgencyforHealthcareResearchandQuality(AHRQ),formerlyknownastheAgencyforHealthCarePolicyandResearch(AHCPR):
ClinicalGuidelinesandEvidenceReports*
http:
//www.ahrq.gov/clinic
TheAHRQWebsiteincludeslinkstotheNationalGuidelineClearinghouse,EvidenceReportsfromtheAHRQ's12Evidence-basedPracticeCenters(EPC),andPreventiveServices.TheAHCPRreleased19ClinicalPracticeGuidelinesbetween1992and1996thatwerenotsubsequentlyupdated.
AmericanCollegeofPhysiciansJournalClub(ACPJC)
http:
//www.acponline.org/journals/acpjc/jcmenu.htm
ACPJournalClub evaluatesevidenceinindividualarticles.CommentarybyACPauthoroffersclinicalrecommendations.Accesstotheonlineversionof ACPJC isabenefitformembersoftheACP-ASIM,butwillbeopentoalluntilatleasttheendof2001.
Bandolier*
http:
//www.jr2.ox.ac.uk/bandolier/
Featuresshortevaluations/discussionsofindividualarticlesdealingwithevidence-basedclinicalpractice.
CentreforEvidenceBasedMedicine(CEBM)
TheUniversityofOxford/OxfordRadcliffeHospitalClinicalSchoolWebsiteincludeslinkstoCEBMwithintheFacultyofMedicine,aCATbank(CriticallyAppraisedTopics),linkstoevidence-basedjournals,andEBM-relatedteachingmaterials.
CenterforResearchSupport,TRIPDatabase
TheAHRQbegantheTranslatingResearchintoPractice(TRIP)initiativein1990toimplementevidence-basedtoolsandinformation.TheTRIPDatabasefeatureshyperlinkstothelargestcollectionofEBMmaterialsontheinternet,includingNGC,POEM,DARE,CochraneLibrary,CATbank,andindividualarticles.AgoodstartingplaceforanEBMliteraturesearch.
ClinicalEvidence,BMJPublishingGroup*
http:
//www.clinicalevidence.org
SearchesBMJ's ClinicalEvidence compendiumforup-to-dateevidenceregardingeffectivehealthcare.Listsavailabletopicsanddescribesthesupportingbodyofevidencetodate(e.g.,numberofrelevantrandomizedcontrolledtrialspublishedtodate).Concludeswithinterventions“likelytobebeneficial”versusthosewith“unknowneffectiveness.”IndividualswhohavereceivedafreecopyofClinicalEvidence Issue5fromtheUnitedHealthFoundationarealsoentitledtofreeaccesstothefullonlinecontent.
CochraneDatabaseofSystematicReviews*
http:
//www.cochrane.org/
SystematicevidencereviewsthatareupdatedperiodicallybytheCochraneGroup.ReviewersdiscusswhetheradequatedataareavailableforthedevelopmentofEBMguidelinesfordiagnosisormanagement.
DatabaseofAbstractsofReviewsofEffectiveness(DARE)*
http:
//www.crd.york.ac.uk/crdweb/
StructuredabstractswrittenbyUniversityofYorkCRDreviewers(seeNHSCRD).Abstractsummariesreviewarticlesondiagnosticortreatmentinterventionsanddiscussclinicalimplications.
EffectiveHealthCare*
http:
//www.york.ac.uk/inst/crd/ehcb.htm
Bi-monthly,peer-reviewedbulletinformedicaldecision-makers.Basedonsystematicreviewsandsynthesisofresearchontheclinicaleffectiveness,cost-effectivenessandacceptabilityofhealthserviceinterventions.
Evidence-BasedMedicine*
http:
//www.evidence-
Bimonthlypublicationlaunchedin1995bytheBMJPublishingGroup.Articlesummariesincludecommentariesbyclinicalexperts.Subscriptionisrequired.
Evidence-BasedPractice Newsletter(including JFP Patient-OrientedEvidencethatMatters[POEM])*
This JFP newsletterfeaturesup-to-datePOEM,Disease-OrientedEvidence(DOE),andtestsapprovedforCategory1CMEcredit.Subscriptionrequired.
InfoPOEMs
IncludestheInfoRetrieversearchsystemforthecompletePOEMsdatabaseandsixadditionalevidence-baseddatabases.Subscriptionisrequired.
InstituteforClinicalSystemsImprovement(ICSI)*
http:
//www.ICSI.org
ICSIisanindependent,nonprofitcollaborationofhealthcareorganizations,includingtheMayoClinic,Rochester,Minn.WebsiteincludestheICSIguidelinesforpreventiveservicesanddiseasemanagement.
NationalGuidelineClearinghouse(NGC)
http:
//www.guideline.gov/
Comprehensivedatabaseofevidence-basedclinicalpracticeguidelinesfromgovernmentagenciesandhealthcareorganizations.Describesandcomparesguidelinestatementswithrespecttoobjectives,methods,outcomes,evidenceratingscheme,andm
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