| Purpose Network meta-analysis was used to evaluate the preventive effect of different oral care solutions on oral mucositis（OM）in patients with radiotherapy and chemotherapy in the study,and rank their effects to screen out the best oral care solution.Investigate the current situation of oral care solution use in clinical practice and compare it with the results of network meta-analysis to evaluate the evidencebased practice readiness of evidence application projects,identify possible barriers in the process of clinical practice,and promote evidence transformation.Methods（1）Network meta-analysis of the preventive effect of different oral care solutions on OM: The major Chinese and English databases,clinical trial registries,and published systematic reviews or meta-analysis were searched,randomized controlled trials（RCTs）of oral care solution for the prevention of OM in patients with radiotherapy and（or）chemotherapy published by June 30,2021 were collected,and the literature was screened strictly according to the inclusion and exclusion criteria.The risk of bias of included RCTs was assessed using Ro B 2,which is the latest assessment tool for risk of bias by Cochrane,the quality of evidence was graded for all outcomes using Confidence in Network Meta-Analysis（CINe MA）software,which is an online network meta-analysis evidence grading application.R and Stata software were used to conduct network meta-analysis and effect ranking of different oral care solutions in the prevention of OM.（2）Using status of oral care solutions and evidencebased nursing practice readiness survey: Using the general information questionnaire,oral care solutions use status questionnaire,and Clinic Readiness to Evidence-based Nursing Assessment（CREBNA）scale,a questionnaire survey was conducted in the form of questionnaire star among the nurses in radiotherapy and chemotherapy-related departments in nine hospitals,and SPSS 26.0 software was used for statistical analysis.To understand the current status of oral care solution use,evaluate the evidence-based practice readiness of the "honey oral care solution" practice scheme,and identify barriers that may be faced in the process of evidence-based nursing practice.Results（1）Network Meta-analysis of the preventive effect of different oral care solutions on oral mucositis: A total of 41 RCTs were included,involving 10 oral care solutions,they were honey,sucralfate,normal saline,benzydamine,kangfuxin solution,compound borax solution,sodium bicarbonate,chlorhexidine,povidoneiodine and granulocyte-macrophage colony-stimulating factor.All included RCTs were at a certain risk of bias.36 RCTs have reported the incidence of severe OM,the results of the network meta-analysis showed that compared with placebo,honey[OR=0.23,95%CI（0.11,0.46）] and sucralfate [OR=0.34,95%CI（0.12,0.93）] had a lower incidence of severe OM;compared with the compound borax,honey [OR=0.17,95%CI（0.04,0.76）] and kangfuxin [OR=0.24,95%CI（0.07,0.91）] had a lower incidence of severe OM;compared with normal saline,honey [OR=0.18,95%CI（0.06,0.50）],benzydamine [OR=0.25,95%CI（0.08,0.76）] and kangfuxin [OR=0.25,95%CI（0.09,0.70）] had a lower incidence of severe OM.The ranking of oral care solution from best to worst in reducing the incidence of severe OM was: honey >benzydamine > kangfuxin solution > sucralfate > povidone-iodine > granulocyte macrophage-colony stimulating factor > sodium bicarbonate > chlorhexidine >compound borax solution > normal saline.Seven RCTs reported the incidence of treatment interruption,and the results of the network meta-analysis showed that compared with placebo,honey [OR=0.08,95%CI（0.01,0.64）] had a lower incidence of treatment interruption.The ranking results from low to high incidence of treatment interruption was: honey > granulocyte-macrophage colony-stimulating factor >povidone-iodine > benzydamine > sucralfate > sodium bicarbonate.（2）Using status of oral care solutions and evidence-based nursing practice readiness survey: A total of192 valid questionnaires were collected,the survey results showed that the top three oral care solutions usages were chlorhexidine,compound chlorhexidine and kangfuxin,honey oral care solution was less used,the choice of oral care solution was mainly based on the requirements of the department.The total score of CREBNA was123.67±10.46,of which,the evidence subscale was 46.98±3.70,the organizational environment subscale was 37.78±3.39,and the promoting factors subscale was38.90±3.38.The results of univariate analysis showed that there were significant differences in the total score of CREBNA between highest degree,whether or not presided over or participated in scientific research projects（with any level）,different levels of understanding of evidence-based nursing practice,and whether they had participated in relevant training in evidence synthesis and evaluation of evidencebased nursing practice（P<0.05）.Multivariate linear stepwise regression analysis indicated that whether or not participated in relevant training on evidence synthesis and evaluation of evidence-based nursing practice and different levels of understanding of evidence-based nursing practice were the main factors affecting the total score of CREBNA,and the difference was statistically significant（P<0.05）.Conclusions The results of network meta-analysis showed that compared with the other several oral care solutions,honey oral care solution had advantages in reducing the incidence of severe OM and the incidence of treatment interruption in patients with radiotherapy and（or）chemotherapy.Combined with patients’ conditions,clinical nurses could use honey oral care solution to prevent OM.The results of this study suggest that there is a gap between oral care solution use and the best evidence for the prevention of OM in patients with radiotherapy and（or）chemotherapy.The CREBNA scale was used to evaluate the readiness of the current evidence-based practice,and it was found that the readiness of the "honey oral care solution" practice program was acceptable.Preliminary findings showed that evidence has not been transformed into a form that is easily disseminated,leaders have not widely listened to the views and perspectives of frontline nurses,and lack of information resources needed to carry out evidence-based practice are obstacles to the development of current evidence application projects.However,due to the limitation of sample size and survey hospitals,it is suggested that further research can be carried out for verification in the future. |
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