TY -的盟Maggio劳伦盟——Aakre,克里斯托弗•AU -▽Fiol Guilherme AU - Shellum简非盟-库克,大卫PY - 2019 DA - 2019/7/25 TI -影响临床医生的使用电子资源的临床知识和学习成果:系统回顾和荟萃分析乔- J地中海互联网Res SP - e13315六世- 21 - 7 KW -医学教育KW -信息系统KW -教育技术KW -临床决策支持KW - AB健康信息技术背景:临床医生使用电子知识资源，如Micromedex、UpToDate和维基百科，提供循证护理并参与即时护理学习。尽管在临床实践中有这种应用，但它们对患者护理和学习结果的影响尚不完全清楚。关于电子知识资源有效性的现有证据的全面综合将指导临床医生、卫生保健系统管理员、医学教育工作者和信息学家就其购买、实施和使用做出基于证据的决定。目的:本综述的目的是量化电子知识资源对临床和学习结果的影响。方法:检索MEDLINE、Embase、PsycINFO和Cochrane图书馆1991 - 2017年发表的文章。两位作者独立筛选了纳入的研究，并提取了与知识、技能、态度、行为、患者疗效和成本相关的结果。我们使用随机效应元分析来汇总各研究之间的标准化平均差异(SMDs)。结果:在筛选出的10811项研究中，我们确定了2003年至2016年间发表的25项符合条件的研究。共有5项研究是随机试验，22项涉及执业或培训的医生，10项报告了潜在的利益冲突。 A total of 15 studies compared electronic knowledge resources with no intervention. Of these, 7 reported clinician behaviors, with a pooled SMD of 0.47 (95% CI 0.27 to 0.67; P<.001), and 8 reported objective patient effects with a pooled SMD of 0.19 (95% CI 0.07 to 0.32; P=.003). Heterogeneity was large (I2>50%) across studies. When compared with other resources—7 studies, not amenable to meta-analytic pooling—the use of electronic knowledge resources was associated with increased frequency of answering questions and perceived benefits on patient care, with variable impact on time to find an answer. A total of 2 studies compared different implementations of the same electronic knowledge resource. Conclusions: Use of electronic knowledge resources is associated with a positive impact on clinician behaviors and patient effects. We found statistically significant associations between the use of electronic knowledge resources and improved clinician behaviors and patient effects. When compared with other resources, the use of electronic knowledge resources was associated with increased success in answering clinical questions, with variable impact on speed. Comparisons of different implementation strategies of the same electronic knowledge resource suggest that there are benefits from allowing clinicians to choose to access the resource, versus automated display of resource information, and from integrating patient-specific information. A total of 4 studies compared different commercial electronic knowledge resources, with variable results. Resource implementation strategies can significantly influence outcomes but few studies have examined such factors. SN - 1438-8871 UR - //www.mybigtv.com/2019/7/e13315/ UR - https://doi.org/10.2196/13315 UR - http://www.ncbi.nlm.nih.gov/pubmed/31359865 DO - 10.2196/13315 ID - info:doi/10.2196/13315 ER -