| Sažetak | Palijativna medicina nova je grana medicine koja liječi bolesnika s aktivnom i uznapredovalom bolešću ograničenog životnog vijeka, poboljšava kvalitetu života pacijenta i njihovih obitelji, a daje veliku pozornost liječenju boli i drugih simptoma što zahtijeva preciznu procjenu svakog pojedinca. Kao zasebna medicinska specijalizacija priznata je 1897. u Velikoj Britaniji. Od velike važnosti u donošenju najbolje odluke za pojedinca je medicina utemeljena na dokazima (eng. Evidence-based medicine, EBM), sa sustavnim pregledima literature kao jednim od važnih alata koji pružaju visoku razinu dokaza o učinkovitosti intervencija. Značaj EBM-a ujednačavanje je kliničke prakse i poboljšanje kvalitete skrbi za svakog pacijenta.
U ovaj rad uključili smo sve sustavne preglede koje su autori identificirali kao sustavne preglede u naslovu ili sažetku. Sljedeći kriterij uključenja odnosi se na populaciju palijativnih pacijenata neovisno o tome radi li se o terapiji, dijagnostici ili prognozi i neovisno o mjestu provođenja palijativne skrbi (bolnica, hospicij ili bolesnikov dom).
U diplomskom radu procijenili smo 50 sustavnih pregleda unutar palijativne medicine pomoću AMSTAR alata za procjenu kvalitete sustavnih pregleda i prikupili njihove epidemiološke karakteristike. Pojedine čestice AMSTAR-a granulirali smo na podčestice kako bismo dobili precizniju ocjenu. Pretražili smo MEDLINE, Cochrane Database of Systematic Review i Database of Abstract of Review of Effects koristeći se sljedećim ključnim riječima: palliative care, terminal care, end of life care i systematic review.
Na osnovu prikupljenih podataka, usporedili smo metodološku kvalitetu Cochraneovih sustavnih pregleda s onima izvan Cochrane kolaboracije, metodološku kvalitetu pregleda prije i poslije osnivanja AMSTAR-a, metodološku kvalitetu pregleda kroz dva načina ocjenjivanja (AMSTAR i AMSTAR granulirani) te kvalitetu pregleda američkih i europskih autora.
Obradom podataka zaključili smo da su Cochraneovi sustavni pregledi metodološki kvalitetniji (M=8,93, sd=2,40), za razliku od onih koji to nisu (M=6,26, sd=2,12). Sustavni pregledi objavljeni nakon osnivanja AMSTAR-a ostvarili su veći broj bodova (M=7,14, sd=2,58) u odnosu na preglede objavljene prije (M=6,50, sd=2,07). Prosječan broj bodova prilikom uobičajenog ocjenjivanja pomoću AMSTAR-a bio je veći (M=7,06, sd=2,51) u odnosu na granulirano ocjenjivanje (M=6,04, sd=6,04). Sustavni pregledi provedeni od strane europskih autora ostvarili su u prosjeku veći broj bodova (M=7,21, sd=2,40) od američkih autora (M=5,40, sd=2,88). |
| Sažetak (engleski) | Palliative medicine is a new medical branch that provides care for patients with active and advanced diseases of limited life expectancy, improves the life quality of patients and their family, and places special emphasis on treating pain and other symptoms, which requires an accurate estimation of each individual. Palliative care was first recognized as a separate medical specialization in Great Britain in 1897. What is of utmost importance for making the best decision for an individual is a medicine based upon evidence, i.e. evidence-based medicine (EBM) with a systematic review of research, which is one of the most important tools that provide strong evidence relating to the efficiency of interventions. The significance of EBM lies in standardising clinical practice and improving the quality of care for each patient.
This paper includes all those reviews that the authors have identified as systematic reviews in the title or the summary. The following inclusion criterion is related to the population of palliative patients, regardless of whether it concerns therapy, diagnostics or prognosis, and independent of the place of the provision of palliative care (hospital, hospice, or patient’s home).
In this Master’s thesis, fifty systematic reviews within the palliative medicine were estimated using AMSTAR measurement tool for assessing the quality of systematic reviews, and their epidemiological characteristics were obtained. Certain particles of AMSTAR were granulated into subparticles to make a more accurate assessment. We searched in the MEDLINE, the Cochrane Database of Systematic Review, and the Database of Abstracts of Reviews of Effects using the following key words: palliative care, terminal care, end of life care, and systematic review.
Based on the obtained data, we compared the methodological quality of Cochrane systematic reviews with the ones beyond Cochrane collaboration, the methodological quality before and after the launch of AMSTAR, the methodological quality of reviews through two means of assessing (AMSTAR and AMSTAR granulated), as well as the quality of reviews by American and European authors.
After data processing we concluded that Cochrane systematic reviews are of higher methodological quality (M=8,93, sd=2,40) compared to the rest (M=6,26, sd=2,12). The systematic reviews published after the launch of AMSTAR scored more points (M=7,14, sd=2,58) compared to the reviews published prior to it (M=6,50, sd=2,07). The average score when assessing using AMSTAR was higher (M=7,06, sd=2,51) compared to the granulated assessment (M=6,04, sd=6,04). The reviews conducted by European authors scored more points on average (M=7,21, sd=2,40) compared to the reviews by American authors. |
