Medline

MEDLINE
  • 文章类型: Journal Article
    目的:确定生物医学系统评价搜索策略的可重复性。
    方法:在2021年11月对MEDLINE索引的100项系统评价的随机样本进行了横断面可重复性研究。主要结果指标是可以复制所有数据库搜索的系统评论的百分比,实施为完成6个关键的PRISMA-S报告指南项目,并使所有数据库搜索在原始结果数量的10%以内进行复制。关键报告准则项目包括数据库名称,多数据库搜索,完整的搜索策略,限制和限制,搜索日期,和总记录。
    结果:100篇系统综述文章包含453个数据库搜索。只有22个(4.9%)数据库搜索报告了所有六个PRISMA-S项目。可以在原始搜索结果数量的10%内复制47(10.4%)数据库搜索;最初报告的结果数量与复制数量之间的6个搜索差异超过1000%。只有一篇系统的评论文章提供了必要的搜索详细信息,可以完全重复。
    结论:系统评价检索报告较差。要纠正这一点,需要作者多方面的回应,同行审稿人,期刊编辑,和数据库提供商。
    OBJECTIVE: To determine the reproducibility of biomedical systematic review search strategies.
    METHODS: A cross-sectional reproducibility study was conducted on a random sample of 100 systematic reviews indexed in MEDLINE in November 2021. The primary outcome measure is the percentage of systematic reviews for which all database searches can be reproduced, operationalized as fulfilling six key Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension (PRISMA-S) reporting guideline items and having all database searches reproduced within 10% of the number of original results. Key reporting guideline items included database name, multi-database searching, full search strategies, limits and restrictions, date(s) of searches, and total records.
    RESULTS: The 100 systematic review articles contained 453 database searches. Only 22 (4.9%) database searches reported all six PRISMA-S items. Forty-seven (10.4%) database searches could be reproduced within 10% of the number of results from the original search; six searches differed by more than 1,000% between the originally reported number of results and the reproduction. Only one systematic review article provided the necessary search details to be fully reproducible.
    CONCLUSIONS: Systematic review search reporting is poor. To correct this will require a multifaceted response from authors, peer reviewers, journal editors, and database providers.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Meta-Analysis
    背景:支持自治的干预措施,如自决理论和指导自决干预,可以改善糖尿病患者的自我管理以及临床和社会心理结果。从未使用试验序贯分析方法对此类干预措施进行过系统的评估,以评估其益处和危害,并同时控制随机误差的风险。本系统综述调查了基于自决理论的干预措施与糖尿病患者常规护理相比的益处和危害。
    方法:我们使用Cochrane方法。在任何情况下,基于指导的自决或自决理论从理论上评估干预措施的随机临床试验都是合格的。在CENTRAL进行了全面搜索(最新搜索2022年4月),MEDLINE,Embase,LILACS,PsycINFO,SCI-扩展,CINAHL,SSCI,CPCI-S,和CPCI-SSH来确定相关试验。两位作者独立筛选,提取的数据,并使用Cochrane偏倚风险工具1.0对纳入的试验进行偏倚风险评估.我们的主要结果是生活质量,全因死亡率,和严重不良事件。我们的次要结果是糖尿病困扰,抑郁症状,和不认为严重的非严重不良事件。探索性结果是糖化血红蛋白和动机(自主性,控制,动机)。在干预结束时(主要时间点)和最大随访时评估结果。使用审查管理器5.4和试验顺序分析0.9.5.10进行分析。证据的确定性按等级进行了评估。
    结果:我们的搜索确定了5578项可能符合条件的研究,其中包括11项随机试验(6059名参与者)。所有试验均评估为总体偏倚高风险。我们发现,与常规护理相比,基于自决理论的干预措施对生活质量没有影响(平均差0.00分,95%CI-4.85,4.86,I2=0%;225名参与者,3试验,TSA-adjustedCI-11.83,11.83),全因死亡率,严重不良事件,糖尿病困扰,抑郁症状,不良事件,糖化血红蛋白A1c,或动机(受控)。对于所有结果,证据的确定性都很低。我们发现了对动机的有益影响(自主和无动机;低确定性证据)。
    结论:我们发现基于自决的干预措施对我们的主要或次要结局没有影响。证据的确定性很低。
    背景:PROSPEROCRD42020181144.
    Autonomy-supporting interventions, such as self-determination theory and guided self-determination interventions, may improve self-management and clinical and psychosocial outcomes in people with diabetes. Such interventions have never been systematically reviewed assessing both benefits and harms and concurrently controlling the risks of random errors using trial sequential analysis methodology. This systematic review investigates the benefits and harms of self-determination theory-based interventions compared to usual care in people with diabetes.
    We used the Cochrane methodology. Randomized clinical trials assessing interventions theoretically based on guided self-determination or self-determination theory in any setting were eligible. A comprehensive search (latest search April 2022) was undertaken in CENTRAL, MEDLINE, Embase, LILACS, PsycINFO, SCI-EXPANDED, CINAHL, SSCI, CPCI-S, and CPCI-SSH to identify relevant trials. Two authors independently screened, extracted data, and performed risk-of-bias assessment of included trials using the Cochrane risk-of-bias tool 1.0. Our primary outcomes were quality of life, all-cause mortality, and serious adverse events. Our secondary outcomes were diabetes distress, depressive symptoms, and nonserious adverse events not considered serious. Exploratory outcomes were glycated hemoglobin and motivation (autonomy, controlled, amotivation). Outcomes were assessed at the end of the intervention (primary time point) and at maximum follow-up. The analyses were conducted using Review Manager 5.4 and Trial Sequential Analysis 0.9.5.10. Certainty of the evidence was assessed by GRADE.
    Our search identified 5578 potentially eligible studies of which 11 randomized trials (6059 participants) were included. All trials were assessed at overall high risk of bias. We found no effect of self-determination theory-based interventions compared with usual care on quality of life (mean difference 0.00 points, 95% CI -4.85, 4.86, I2 = 0%; 225 participants, 3 trials, TSA-adjusted CI -11.83, 11.83), all-cause mortality, serious adverse events, diabetes distress, depressive symptoms, adverse events, glycated hemoglobulin A1c, or motivation (controlled). The certainty of the evidence was low to very low for all outcomes. We found beneficial effect on motivation (autonomous and amotivation; low certainty evidence).
    We found no effect of self-determination-based interventions on our primary or secondary outcomes. The evidence was of very low certainty.
    PROSPERO CRD42020181144.
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  • 文章类型: Journal Article
    背景:成人慢性疼痛是一种常见的临床症状,对患者的健康有显著影响。因此,充分的疼痛管理至关重要。虽然曲马多是一种常用的止痛药,考虑到观察到的不良事件,支持其使用的证据质量受到质疑.我们的目标是评估曲马多与安慰剂或不干预慢性疼痛相比的益处和危害。
    方法:我们将通过荟萃分析和试验序贯分析对随机临床试验进行系统评价,以评估任何剂量曲马多的有益和有害影响。配方,或持续时间。我们将接受安慰剂或无干预作为对照干预。我们将包括患有任何类型慢性疼痛的成年参与者,包括癌症相关的疼痛.我们将系统地搜索Cochrane图书馆,MEDLINE,EMBASE,科学引文索引,和生物学相关文献。我们将遵循Cochrane的建议以及系统审查和荟萃分析(PRISMA)声明的首选报告项目。将评估系统误差(\'偏差\')和随机误差(\'机会游戏\')的风险。将使用建议分级评估来评估证据的确定性,发展,和评估(等级)方法。
    结论:尽管曲马多经常用于治疗慢性疼痛,这种干预的有益和有害影响尚不清楚。本综述将系统地评估当前关于曲马多与安慰剂或无干预的益处和危害的证据,以告知临床实践和未来的研究。
    背景:PROSPEROCRD42019140334.
    Chronic pain in adults is a frequent clinical symptom with a significant impact on patient well-being. Therefore, sufficient pain management is of utmost importance. While tramadol is a commonly used pain medication, the quality of evidence supporting its use has been questioned considering the observed adverse events. Our objective will be to assess the benefits and harms of tramadol compared with placebo or no intervention for chronic pain.
    We will conduct a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis to assess the beneficial and harmful effects of tramadol in any dose, formulation, or duration. We will accept placebo or no intervention as control interventions. We will include adult participants with any type of chronic pain, including cancer-related pain. We will systematically search the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and BIOSIS for relevant literature. We will follow the recommendations by Cochrane and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The risk of systematic errors (\'bias\') and random errors (\'play of chance\') will be assessed. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
    Although tramadol is often being used to manage chronic pain conditions, the beneficial and harmful effects of this intervention are unknown. The present review will systematically assess the current evidence on the benefits and harms of tramadol versus placebo or no intervention to inform clinical practice and future research.
    PROSPERO CRD42019140334.
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  • 文章类型: Review
    背景:进行随机对照试验是不切实际的,另一种选择是进行观察性研究。然而,由于存在多种统计偏差的风险,从观测数据中做出有效的因果推断是具有挑战性的.2016年,Hernán和Robins提出了“目标试验框架”,作为最佳设计和分析观察性研究的指南,同时防止最常见的偏见。这个框架包括(1)明确定义一个关于干预的因果问题,(2)指定假设试验的方案,(3)解释如何使用观测数据来模拟它。
    方法:本范围审查的目的是确定和审查所有医学领域的试验模拟研究的所有明确尝试。Embase,搜索了Medline和WebofScience,以获取从数据库开始到2021年2月25日以英文发表的试验仿真研究。以下信息是从被认为有资格审查的研究中提取的:主题领域,他们利用的观察数据的类型,以及他们用来解决以下偏见的统计方法:(A)混杂偏见,(B)不朽的时间偏见,和(C)选择偏差。
    结果:搜索得出617项研究,其中38个我们认为有资格审查。在这38项研究中,最专注于心脏病学,传染病或肿瘤学,大多数使用电子健康记录/电子病历数据和队列研究数据。使用不同的统计方法来解决基线和选择偏差的混淆问题,主要取决于混杂因素(N=18/49,37%)和审查权重的逆概率(N=7/20,35%)。不同的方法被用来解决不朽的时间偏差,在随访开始时根据他们在该特定时间获得的数据(N=21,55%)将个体分配到治疗策略,使用序贯试验模拟方法(N=11,29%)或克隆方法(N=6,16%)。
    结论:可以利用不同的方法来解决(A)混淆偏差,(B)不朽的时间偏见,和(C)选择偏差。在处理观测数据时,如果可能的话,应使用“目标试验”框架,因为它为观察性研究提供了结构化的概念性方法.
    When conducting randomised controlled trials is impractical, an alternative is to carry out an observational study. However, making valid causal inferences from observational data is challenging because of the risk of several statistical biases. In 2016 Hernán and Robins put forward the \'target trial framework\' as a guide to best design and analyse observational studies whilst preventing the most common biases. This framework consists of (1) clearly defining a causal question about an intervention, (2) specifying the protocol of the hypothetical trial, and (3) explaining how the observational data will be used to emulate it.
    The aim of this scoping review was to identify and review all explicit attempts of trial emulation studies across all medical fields. Embase, Medline and Web of Science were searched for trial emulation studies published in English from database inception to February 25, 2021. The following information was extracted from studies that were deemed eligible for review: the subject area, the type of observational data that they leveraged, and the statistical methods they used to address the following biases: (A) confounding bias, (B) immortal time bias, and (C) selection bias.
    The search resulted in 617 studies, 38 of which we deemed eligible for review. Of those 38 studies, most focused on cardiology, infectious diseases or oncology and the majority used electronic health records/electronic medical records data and cohort studies data. Different statistical methods were used to address confounding at baseline and selection bias, predominantly conditioning on the confounders (N = 18/49, 37%) and inverse probability of censoring weighting (N = 7/20, 35%) respectively. Different approaches were used to address immortal time bias, assigning individuals to treatment strategies at start of follow-up based on their data available at that specific time (N = 21, 55%), using the sequential trial emulations approach (N = 11, 29%) or the cloning approach (N = 6, 16%).
    Different methods can be leveraged to address (A) confounding bias, (B) immortal time bias, and (C) selection bias. When working with observational data, and if possible, the \'target trial\' framework should be used as it provides a structured conceptual approach to observational research.
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  • 文章类型: Journal Article
    2002年,美国国家医学图书馆(NLM)引入了使用医学文本索引器(MTI)对Medline进行半自动索引。2021年,NLM宣布将在2022年中期之前通过改进的MTI在Medline中完全自动化其索引。这项试点研究使用2000年Medline的记录样本进行索引,以及早期,公共版本的MTI输出与人工索引器创建的记录进行比较。
    这项试点研究检查了2000年的20条Medline记录,即MTI作为MeSH术语推荐器引入的前一年。我们根据期刊影响因子(JIF)确定了20种影响较高和较低的生物医学期刊,并通过将其PubMed记录输入交互式MTI工具来检查论文的索引。
    在示例中,我们发现自动和人工索引Medline记录之间的关键差异:MTI分配了更多的术语,并在较高的JIF组中更准确地使用它们进行引用,MTI倾向于对男性检查标签的排名高于女性检查标签,并省略老化检查标签。有时MTI选择比人类索引者更具体的术语,但在应用特异性原则方面不一致。
    NLM过渡到生物医学文献的全自动索引可能会在Medline中引入或延续不一致和偏见。图书馆员和搜索者应评估索引术语的变化,以及它们对PubMed的一系列主题的映射功能的影响。未来的研究应该评估自动化索引,因为它涉及到有效地寻找临床信息,并进行系统的搜索。
    UNASSIGNED: In 2002, the National Library of Medicine (NLM) introduced semi-automated indexing of Medline using the Medical Text Indexer (MTI). In 2021, NLM announced that it would fully automate its indexing in Medline with an improved MTI by mid-2022. This pilot study examines indexing using a sample of records in Medline from 2000, and how an early, public version of MTI\'s outputs compares to records created by human indexers.
    UNASSIGNED: This pilot study examines twenty Medline records from 2000, a year before the MTI was introduced as a MeSH term recommender. We identified twenty higher- and lower-impact biomedical journals based on Journal Impact Factor (JIF) and examined the indexing of papers by feeding their PubMed records into the Interactive MTI tool.
    UNASSIGNED: In the sample, we found key differences between automated and human-indexed Medline records: MTI assigned more terms and used them more accurately for citations in the higher JIF group, and MTI tended to rank the Male check tag more highly than the Female check tag and to omit Aged check tags. Sometimes MTI chose more specific terms than human indexers but was inconsistent in applying specificity principles.
    UNASSIGNED: NLM\'s transition to fully automated indexing of the biomedical literature could introduce or perpetuate inconsistencies and biases in Medline. Librarians and searchers should assess changes to index terms, and their impact on PubMed\'s mapping features for a range of topics. Future research should evaluate automated indexing as it pertains to finding clinical information effectively, and in performing systematic searches.
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  • 文章类型: Clinical Trial Protocol
    背景:随机对照试验(RCTs)在循证医学中起着重要作用。然而,一篇报道质量低的文章可能会误导专家和公众做出错误的决定。数据共享可以促进审判的真实性和透明度。针灸RCT近年来增长迅速,但针灸RCT的报告质量和数据共享水平尚不清楚。因此,本研究将提供针灸RCT报告质量和数据共享水平的现状。
    方法:将进行横断面研究。包括MEDLINE在内的七个数据库,EMBASE,中部,CBM,CNKI,万方数据库和VIP将在2012年1月1日至2022年10月15日之间进行搜索,以确定针灸RCT。将总结纳入试验的基本特征。纳入RCT的报告质量将通过《2010年综合试验报告标准》声明和《针灸对照试验干预报告标准》进行评估。数据共享水平将通过开放科学实践进行评估。
    背景:本研究不需要伦理批准。该协议已在开放科学框架注册局注册。这项研究的结果将提交给同行评审的学术期刊。
    Randomised controlled trials (RCTs) play an important role in evidence-based medicine. However, an article with low reporting quality may mislead both experts and the general public into an erroneous decision. Data sharing can contribute to the truthfulness and transparency of trials. Acupuncture RCTs have been increasing rapidly these years, but the reporting quality and data-sharing level of acupuncture RCTs are not clear. Thus, this study will provide the current status of the reporting quality and data-sharing level of acupuncture RCTs.
    A cross-sectional study will be conducted. The seven databases including MEDLINE, EMBASE, CENTRAL, CBM, CNKI, Wanfang Database and VIP will be searched between 1 January 2012 and 15 October 2022 to identify acupuncture RCTs. The basic characteristics of included trials will be summarised. The reporting quality for included RCTs will be assessed by the Consolidated Standards for Reporting Trials 2010 statement and the Standards for Reporting Interventions in Controlled Trials of Acupuncture. The data-sharing level will be assessed by open science practices.
    Ethical approval is not required for this study. This protocol has been registered in Open Science Framework Registries. The findings of this study will be submitted to a peer-reviewed academic journal.
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  • 文章类型: Journal Article
    最近开发了两个用于MEDLINE的去处方搜索过滤器和一个用于Embase的去处方搜索过滤器,包括客观开发的搜索过滤器。本案例研究的目的是在系统评价(SR)搜索策略中实施这三个取消处方的搜索过滤器,并评估其对性能的影响。选择独立开发原始搜索策略(OSS)的SR。去处方过滤器在每个OSS中实现,在MEDLINE中生成两个已实施的搜索策略(ISS1和ISS2),在Embase中生成一个ISS(ISS3)。OSS与ISS在同一日期重新运行。计算并比较了ISS和OSS的性能。包括两个SR(SR1和SR2)。对于MEDLINE,SR1包括12篇文章。OSS的灵敏度为50%,58%的ISS1和42%的ISS2。SR2包括四篇文章。OSS的灵敏度,ISS1和2为25%。对于Embase,SR1包括12篇文章。OSS的灵敏度为33%,ISS3的灵敏度为58%。SR2包括四篇文章。所包含的四篇文章均未通过OSS或ISS3检索到。虽然OSS的敏感性是中等的,客观开发的去处方过滤器在实施时保持或略微改善了这种灵敏度。
    Two deprescribing search filters for MEDLINE and one deprescribing search filter for Embase have been recently developed, including objectively developed search filters. The objective of this case study was to implement these three deprescribing search filters in systematic review (SR) search strategies and to assess their effect on performances. SR that independently developed original search strategies (OSS) were selected. The deprescribing filters were implemented in each OSS, generating two implemented search strategies (ISS1 and ISS2) in MEDLINE and one ISS (ISS3) in Embase. OSS were re-run on the same date as ISS. The performances of ISS and OSS were calculated and compared. Two SR were included (SR1 and SR2). For MEDLINE, SR1 included 12 articles. The sensitivity was 50% for OSS, 58% for ISS1 and 42% for ISS2. SR2 included four articles. The sensitivity of OSS, ISS 1 and 2 was 25%. For Embase, SR1 included 12 articles. The sensitivity was 33% for OSS and 58% for ISS3. SR2 included four articles. None of the four included articles were retrieved with OSS or ISS3. While sensitivity of OSS was moderate, the objectively developed deprescribing filters maintained or slightly improved this sensitivity when implementing.
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  • 文章类型: Journal Article
    背景:随机对照试验(RCT)的系统评价(SRs)被认为是最可靠的研究类型之一。通过系统全面的文献检索,研究人员的目标是收集所有与其目的相关的研究。数据库的选择可能具有挑战性,并且取决于感兴趣的主题。Cochrane手册建议至少搜索以下三个数据库:CochraneLibrary,MEDLINE,和EMBASE。然而,这对于一般的肌肉骨骼领域的评论并不总是足够的。这项研究旨在检查研究人员在脊柱操纵疗法(SMT)的SR中使用的数据库的频率和选择。其次,分析SRs中包含的RCT,以确定进行有效文献检索SMTSRs所需的最佳数据库组合。
    方法:通过在PubMed和Epistemonikos中进行搜索(所有条目至搜索日期2022年2月25日),确定了调查SMT对任何患者报告的结局指标的影响的SR。对于每个SR,检索数据库并收集RCT.在9个数据库中单独搜索RCT(Cochrane图书馆,MEDLINE/PubMed,EMBASE,谷歌学者,CINAHL,WebofScience,脊椎按摩文学索引,PEDro,和AMED)。覆盖率是使用数据库或数据库组合检索的RCT数量除以RCT总数来计算的。
    结果:发表的85份SR符合入选标准,并检索到442个独特的随机对照试验。搜索频率最高的数据库是MEDLINE/PubMed。Cochrane图书馆的总体覆盖率最高,并且包含第三大独特的RCT。虽然100%的检索是不可能的,因为在九个数据库中的任何一个数据库中都无法检索到18个RCT,科克伦图书馆的结合,谷歌学者,PEDro检索到所有可能的RCT,综合覆盖率为95.9%。
    结论:对于SMT上的SR,我们建议使用Cochrane图书馆的Cochrane手册建议的组合,MEDLINE/PubMed,Embase,此外,推拿文献的PEDro和索引。GoogleScholar还可以用作搜索灰色文献和质量保证的工具。
    Systematic reviews (SRs) of randomized controlled trials (RCTs) are considered one of the most reliable study types. Through a systematic and thorough literature search, researchers aim to collect all research relevant to their purpose. The selection of databases can be challenging and depend on the topic of interest. The Cochrane Handbook suggests searching at least the following three databases: Cochrane Library, MEDLINE, and EMBASE. However, this is not always sufficient for reviews on the musculoskeletal field in general. This study aimed to examine the frequency and choice of databases used by researchers in SRs of spinal manipulative therapy (SMT). Secondly, to analyze the RCTs included in the SRs to determine the optimal combination of databases needed to conduct efficient literature searches for SRs of SMT.
    SRs investigating the effect of SMT on any patient-reported outcome measure were identified through searches in PubMed and Epistemonikos (all entries till date of search February 25, 2022). For each SR, databases searched and included RCTs were collected. RCTs were searched individually in nine databases (Cochrane Library, MEDLINE/PubMed, EMBASE, Google Scholar, CINAHL, Web of Science, Index to Chiropractic Literature, PEDro, and AMED). Coverage rates were calculated using the number of retrieved RCTs by the database or combinations of databases divided by the total number of RCTs.
    Eighty-five SRs published met the inclusion criteria, and 442 unique RCTs were retrieved. The most frequently searched database was MEDLINE/PubMed. Cochrane Library had the highest overall coverage rate and contained the third most unique RCTs. While a 100% retrieval was not possible, as 18 RCTs could not be retrieved in any of the nine databases, the combination of Cochrane Library, Google Scholar, and PEDro retrieved all possible RCTs with a combined coverage rate of 95.9%.
    For SRs on SMT, we recommend using the combination suggested by the Cochrane Handbook of Cochrane Library, MEDLINE/PubMed, Embase, and in addition, PEDro and Index to Chiropractic Literature. Google Scholar might be used additionally as a tool for searching gray literature and quality assurance.
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  • 文章类型: Journal Article
    我们的目的是识别和综合荟萃研究的结果,以确定临床健康研究中原始研究的作者在设计新研究时是否以及如何使用系统评价。
    对于本系统综述,我们搜索了MEDLINE(OVID),Embase(OVID)和Cochrane方法论登记册。我们纳入了荟萃研究,主要结果是使用系统评价设计研究的原始研究的百分比。使用临时创建的十个项目列表评估偏差风险。结果以叙述性综合和荟萃分析的形式呈现。
    共纳入16项研究。使用系统评价来告知新临床研究的设计在0%至73%之间变化。平均百分比为17%。使用以前系统审查的信息的设计组件数量从3到11不等。
    临床健康研究的特点是系统评价用于指导设计的程度存在差异。当设计新的临床健康研究时,有必要采用循证研究(EBR)方法进行研究设计,以减少潜在的研究冗余并增加最终用户价值。
    Our aim was to identify and synthesize the results from meta-research studies to determine whether and how authors of original studies in clinical health research use systematic reviews when designing new studies.
    For this systematic review, we searched MEDLINE (OVID), Embase (OVID) and the Cochrane Methodology Register. We included meta-research studies and primary outcome was the percentage of original studies using systematic reviews to design their study. Risk of bias was assessed using an ad hoc created list of ten items. The results are presented both as a narrative synthesis and a meta-analysis.
    Sixteen studies were included. The use of a systematic review to inform the design of new clinical studies varied between 0% and 73%, with a mean percentage of 17%. The number of components of the design in which information from previous systematic reviews was used varied from three to 11.
    Clinical health research is characterized by variability regarding the extent to which systematic reviews are used to guide the design. An evidence-based research (EBR) approach towards research design when new clinical health studies are designed is necessary to decrease potential research redundancy and increase end-user value.
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