| Sažetak | Dojenje je čin prijenosa mlijeka između majke i djeteta te je pravo svakog djeteta i majke. Jedina je prirodna prehrana za novorođenče i dojenče, a djetetu osigurava svu energiju i nutrijente potrebne u prvim mjesecima života, polovinu ili više nutritivnih potreba unutar drugih šest mjeseci života i do trećine nutritivnih potreba tijekom druge godine života, te ima mogućnost prilagodbe energijskim i nutritivnim potrebama djeteta. Dojenje trenutno ali i dugoročno gledano, nudi majci i djetetu mnoge koristi.
Kako bi liječnici i medicinske sestre mogli provoditi praksu temeljenu na dokazima, moraju pratiti nova istraživanja koja je danas moguće pronaći sabrane u sustavni pregled literature (eng. systematic review). Oni, iako donose mnogo dobroga, mogu varirati u kvaliteti.
Cilj ovog istraživanja bio je procijeniti metodološku kvalitetu sustavnih pregleda o temi dojenja, pri čemu je korišten jedan od alata za procjenu metodološke kvalitete sustavnih pregleda literature- AMSTAR. AMSTAR je nastao 2007., a naziv dolazi od eng. A Measurement Tool to Assess Systematic Reviews ili mjerni alat za procjenu sustavnih pregleda literature. Koristimo ga za razvoj i ocjenjivanje pregleda, kao vodič u provedbi sustavnih pregleda te kao pomoć u učenju o sustavnim pregledima literature.
U ovom diplomskom radu pretraženo je nekoliko elektronskih baza podataka: Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Ovid MEDLINE from 1946 i CINAHL. Među dobivenim radovima odabrano je njih 50. AMSTAR alatom oni su procijenjeni na dva načina ocjenjivanja- dihotomno i granulirano.
Analizirali smo je li objava AMSTAR alata povezana s promjenama u metodološkoj kvaliteti objavljenih sustavnih pregleda, postoji li povezanost broja autora s procijenjenom kvalitetom sustavnih pregleda, te postoje li razlike u kvaliteti između Cochrane sustavnih pregleda i sustavnih pregleda objavljenih izvan Cochrane kolaboracije. Konačno, analizirane su razlike između ocjena dobivenih dihotomnim i granuliranim načinom ocjenjivanja kvalitete sustavnih pregleda primjenom AMSTAR alata. Prikupili smo i tablično prikazali epidemiološke karakteristike sustavnih pregleda literature uključenih u ovaj rad.
Istraživanje je pokazalo da su studije objavljene prije AMSTAR-a (M=6,00, sd=2,00; M=6,43, sd=2,14) u prosjeku bolje ocijenjene od onih objavljenih poslije (M=4,96, sd=2,35; M=6,08, sd=2,08), bez obzira jesu li uspoređivane ocjene dobivenim dihotomnim ili granuliranim AMSTAR-om. Broj autora bio je slabo povezan sa brojem bodova na dihotomnom (r=0,14) i granuliranom AMSTAR-u (r=0,21). Utvrđeno je da pri oba načina ocjenjivanja postoji statistički značajna razlika u bodovima između sustavnih pregleda s obzirom na uključenost u Cochrane kolaboraciju (t=2,39, df=48, p<0,01; t=1,83, df=48, p<0,01) - studije uključene u Cochrane kolaboraciju u prosjeku ostvaruju veće bodove. Prosječan broj bodova dobiven dihotomnim AMSTAR-om (M=5,02, sd=2,33) bio je manji od prosječnog broja bodova dobivenog granuliranim AMSTAR-om (M=6,10, sd=2,06). |
| Sažetak (engleski) | The Academy of Breastfeeding Medicine defines “breastfeeding” as “the mother/child act of milk transference”. It is right of every child and every mother. Breastfeeding is the only natural nutrition for newborns and infants, it provides the child with all the energy and nutrients needed for the first months of life, half or more nutritional needs within the next six months and up to one third of nutritional needs during the second year of life. Mother’s milk has the ability to adapt to child’s energy and nutritional needs. Breastfeeding brings many benefits for both- mother and child, in the moment and for the long term.
In order for doctors and nurses to carry out evidence-based practice, they have to follow new researches that can be nowadays found summarized into a systematic reviews. Although systematic reviews can provide many good things, they may vary in quality.
The aim of this study was to evaluate the methodological quality of systematic reviews on the subject of breastfeeding, using one of the tools for assessing the methodological quality of the systematic reviews- AMSTAR. AMSTAR was first created in 2007, and the name stands for “A Measurement Tool to Assess Systematic Reviews”. We use AMSTAR to develop and evaluate the reviews, as a guide to conduct systematic reviews, and as an aid in teaching about systematic literature reviews.
For this Master’s thesis several electronic databases were searched: Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Ovid MEDLINE from 1946 and CINAHL. Among the obtained works, fifty were selected and evaluated with AMSTAR tool in two ways of grading- dichotomous and granulated. We have analyzed whether the publication of the AMSTAR tool is related to changes in the methodological quality of published systematic reviews, whether there is a correlation between the number of authors with the estimated quality of systematic reviews and whether there are differences in quality between Cochrane systematic reviews and systematic reviews published outside Cochrane Collaboration. Finally, the difference between grades obtained by the dichotomous and granulated method of assessing the quality of systematic reviews using the AMSTAR tool were analyzed. We have also collected and presented the epidemiological characteristics of the systematic reviews included in this paper.
Research has shown that studies published before AMSTAR (M = 6.00, sd = 2.00; M = 6.43, sd = 2.14) were better rated on average than those published later (M = 4.96 , sd = 2.35; M = 6.08, sd = 2.08), regardless of whether the grades were obtained with dichotomous or granulated AMSTAR. The number of authors was poorly correlated with the number of points on the dichotomous (r = 0.14) and the granular AMSTAR (r = 0.21). It was found that in both modes of assessment there is a statistically significant difference between points of systematic reviews included in Cochrane Collaboration (t = 2.39, df = 48, p <0.01, t = 1.83, df = 48, p <0.01) - Cochrane Collaboration studies on average have higher points. The average number of points obtained with dichotomous AMSTAR (M = 5.02, sd = 2.33) was lower than the average score obtained with granulated AMSTAR (M = 6.10, sd = 2.06). |
