ブックタイトルカテーテル関連尿路感染の予防のためのCDCガイドライン 2009｜株式会社メディコン

概要

カテーテル関連尿路感染の予防のためのCDCガイドライン 2009｜株式会社メディコン

Data Extraction and SynthesisData on the study author, year, design, objective, population, setting, sample size, power, followup,and definitions and results of clinically relevant outcomes were extracted into evidence tables(Appendix * 2). Three evidence tables were developed, each of which represented one of our keyquestions. Studies were extracted into the most relevant evidence table. Then, studies wereorganized by the common themes that emerged within each evidence table. Data were extractedby one author (R.K.A.) and cross-checked by another (C.V.G.). Disagreements were resolved bythe remaining authors. Data and analyses were extracted as originally presented in the includedstudies. Meta-analyses were performed only where their use was deemed critical to arecommendation, and only in circumstances where multiple studies with sufficiently homogenouspopulations, interventions, and outcomes could be analyzed. Systematic reviews were included inour review. To avoid duplication of data, we excluded primary studies if they were also included ina systematic review captured by our search. The only exception to this was if the primary studyalso addressed a relevant question that was outside the scope of the included systematic review.Before exclusion, data from the primary studies that we originally captured were abstracted intothe evidence tables and reviewed. We also excluded systematic reviews that analyzed primarystudies that were fully captured in a more recent systematic review. The only exception to thiswas if the older systematic review also addressed a relevant question that was outside the scopeof the newer systematic review. To ensure that all relevant studies were captured in the search,the bibliography was vetted by a panel of clinical experts.Grading of EvidenceFirst, the quality of each study was assessed using scales adapted from existing methodologychecklists, and scores were recorded in the evidence tables. Appendix * 3 includes the sets ofquestions we used to assess the quality of each of the major study designs. Next, the quality ofthe evidence base was assessed using methods adapted from the GRADE Working Group. 32Briefly, GRADE tables were developed for each of the interventions or questions addressed withinthe evidence tables. Included in the GRADE tables were the intervention of interest, anyoutcomes listed in the evidence tables that were judged to be clinically important, the quantity andtype of evidence for each outcome, the relevant findings, and the GRADE of evidence for eachoutcome, as well as an overall GRADE of the evidence base for the given intervention orquestion. The initial GRADE of evidence for each outcome was deemed high if the evidence baseincluded a randomized controlled trial (RCT) or a systematic review of RCTs, low if the evidencebase included only observational studies, or very low if the evidence base consisted only ofuncontrolled studies. The initial GRADE could then be modified by eight criteria. 34 Criteria whichcould decrease the GRADE of an evidence base included quality, consistency, directness,precision, and publication bias. Criteria that could increase the GRADE included a largemagnitude of effect, a dose-response gradient, or inclusion of unmeasured confounders thatwould increase the magnitude of effect (Table 3). GRADE definitions are as follows:1. High - further research is very unlikely to change confidence in the estimate of effect2. Moderate - further research is likely to affect confidence in the estimate of effect and maychange the estimate3. Low - further research is very likely to affect confidence in the estimate of effect and is likelyto change the estimate4. Very low - any estimate of effect is very uncertain原文78 < 原文 > VII. Methods