结核病临床决策中的不确定性:一个包含系统方法和主题分析的综合性审查
Francesca Wanda Basile1,2, Sedona Sweeney2, Maninder Pal Singh2
1Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.
PLOS global public health
|July 23, 2024
概括
了解影响结核病检测和治疗决策的因素是关键. 这次审查确定了多个层面的障碍和促进者,突出了不确定性如何影响诊断和护理,特别是在资源有限的环境中.
科学领域:
- 全球健康 全球健康
- 传染性疾病 传染性疾病
- 临床决策 - 临床决策
背景情况:
- 结核病 (TB) 仍然是一个重大的全球卫生挑战,具有诊断局限性.
- 目前的结核病诊断往往缺乏准确性和护理点的可用性,特别是对于非排泄患者.
- 结核病检测和治疗的临床决定经常基于非诊断因素.
研究的目的:
- 确定影响结核病检测和治疗临床决策的上下文因素.
- 开发一个框架来理解结核病临床决策中的不确定性.
- 为改善结核病的诊断和治疗策略提供信息.
主要方法:
- 一项总体审查系统地搜索了七个数据库,寻找相关的系统审查.
- 结果被归类为测试和治疗决策的障碍和促进者.
- 使用医疗保健不确定性的多层次模型进行了主题分析.
主要成果:
- 测试的促进因素包括提供者资格和自动诊断;障碍包括知识不足和资源短缺.
- 实证治疗的促进因素包括患者的年龄和严重程度;障碍包括沟通问题和过度依赖负面测试结果.
- 在患者,提供者,诊断和系统层面确定不确定性,影响决策.
结论:
- 复杂的不确定性决定因素显著影响结核病诊断和治疗决策.
- 了解患者提供者动态,医疗保健环境和诊断特征至关重要.
- 解决这些因素可以改善临床实践,并促进采用新的结核病诊断方法.
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