对于成年人Ross程序的传播和实施分析:是时候更新指南了吗?
Kyle S Bilodeau1, David C Mauchley2, Scott DeRoo1
1Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, WA USA.
The cardiothoracic surgeon
|December 28, 2023
概括
传播和实施 (D&I) 的挑战影响了罗斯程序.
科学领域:
- 心血管外科心血管外科
- 医疗保健服务研究 医疗服务研究
- 实施科学 实施科学
背景情况:
- 传播和实施 (D&I) 科学解决了将基于证据的实践纳入常规护理中的挑战.
- 研究了罗斯手术的历史背景及其D&I,以了解其在临床实践中的采用.
- 实施失败可能源于不完美的应用,而不是治疗效率低下.
研究的目的:
- 审查罗斯程序的历史背景及其对传播和实施的影响.
- 分析影响罗斯手术在临床实践中的采用和整合因素.
主要方法:
- 从最初的描述到最近的出版物,建立了罗斯程序的上下文基准.
- 传播和实施 (D&I) 评估使用了实施研究综合框架 (CFIR).
- 来自五个领域的CFIR构造确定了影响程序D&I的关键决定因素.
主要成果:
- 所有五个CFIR领域都与影响罗斯程序接受和热情的因素相关.
- 该程序的复杂性需要调整,中心体积显著影响了旧研究中没有考虑的结果.
- 发表的结果影响了大动脉外科社区的社会和文化背景,导致不确定性和指导方针的缓慢整合.
结论:
- 罗斯手术的D&I受到技术复杂性和患者选择标准的低估的阻碍.
- 对有效性的误解,源于对复杂的大动脉手术的经验不足,导致有效的手术被驳回.
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