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儿科固体器官损伤治疗的临床实践指南建议:系统性审查
Natalie Yanchar1, Pier-Alexandre Tardif, Gabrielle Freire
1From the Department of Surgery (N.Y.), University of Calgary, Calgary; Population Health and Optimal Health Practices Research Unit (P.-A.T., M.B., S.B., A.F.T., F.L., L.M.), Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus); Department of Social and Preventative Medicine (L.M.), Université Laval, Quebec City, Quebec; Division of Emergency Medicine, Department of Paediatrics (G.F.), University of Toronto, Toronto; Faculty of Nursing (M.Bérubé), Université Laval, Quebec City, Quebec; Departments of Critical Care Medicine (H.T.S.), Medicine (H.T.S.), and Community Health Sciences (H.T.S.), O'Brien Institute for Public Health, University of Calgary, Calgary; Department of Paediatric Surgery (M.Beaudin), Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec; Pediatrics, Emergency Medicine, and Community Health Sciences (A.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta; Division of Emergency Medicine (S.B.), Hospital for Sick Children, University of Toronto, Toronto, Ontario; Centre Mère-Enfant Soleil du CHU de Québec (M.W.), Transplant Quebec, Quebec City, Quebec; Division of Emergency Medicine, Department of Pediatrics (M.L.), CHU Sainte-Justine, Université de Montréal, Montreal; Department of Pediatrics (R.Z.), Children's Hospital of Eastern Ontario, Ottawa; Division of Pediatric Emergency Medicine (I.J.G.), McGill University Health Centre, Montreal Children's Hospital, Montréal; Département de Pédiatrie (E.B.), Faculté de Médecine, Centre Hospitalier Universitaire de Québec, and Department of Anesthesiology and Critical Care Medicine (A.F.T., F.L.), Division of Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada; and School of Public Health and Preventive Medicine (B.G.), Monash University, Melbourne, Victoria, Australia.
对于儿科固体器官损伤 (SOI) 的临床实践指南各不相同. 这次审查发现很少有强有力的建议,强调需要改进指导方针的制定和更多的研究,以更好地管理儿科SOI.
科学领域:
- 儿科手术 儿科手术
- 创伤管理 创伤管理
- 临床实践指南 临床实践指南
背景情况:
- 治疗儿科固体器官损伤 (SOI) 的变化可能源于碎片化和方法上不同的临床实践指南 (CPG).
- 难以获取和整合建议,使得对儿科SOI的标准化护理变得复杂.
研究的目的:
- 系统地审查和综合CPG对儿科SOI管理的建议.
- 评估现有CPG的质量及其建议的证据基础.
主要方法:
- 对针对小儿SOI人群的CPG进行系统审查.
- 使用指导方针评估研究和评估II工具提取数据并进行质量评估.
- 综合从中等到高质量的CPG的建议,使用推矩阵.
主要成果:
- 确定了8个CPG,其中3个被评为中等质量或高质量.
- 方法上的局限性包括缺乏多样化的利益相关者参与和不清楚的人口定义.
- 只有高质量的CPG推的三分之一是基于中度证据或被评为强有力的.
结论:
- 从3个高质量的CPG中确定了儿童SOI管理的15条建议,但证据质量往往很低.
- 未来的CPG应该涉及多学科团队,患者和家庭,并包括实施支持.
- 迫切需要进行更强大的研究,以加强对儿科SOI护理的基于证据的建议.
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