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在肌缩侧面硬化症的预先指令 - 一个系统的审查和元分析

Anne Lisa Mangal¹, Martin Mücke², Roman Rolke¹

¹Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany.

BMC palliative care

|July 29, 2024

概括

预先护理规划 (ACP) 和预先指令 (AD) 对肌缩侧面硬化症 (ALS) 患者至关重要. 这次审查发现,随着时间的推移,AD使用量正在下降,并强调需要更好地将ACP纳入患者护理.

科学领域:

神经学神经学
抚慰性护理是一种缓解性护理.
医疗保健服务研究医疗服务研究

背景情况:

肌缩侧面硬化症 (ALS) 是一种进展性神经退行性疾病,影响运动神经元,导致严重的功能衰退和寿命缩短.
由于ALS的快速进展,需要全面的预先护理计划 (ACP),以解决,消化不良和通信丧失等关键需求.
预先指令 (AD) 和国际比较和在ALS中ACP应用对于改善患者护理和支持至关重要.

研究的目的:

进行系统性审查和元分析,比较预先指示 (AD) 和预先护理计划 (ACP) 在肌缩侧硬化症 (ALS) 的国际应用.
确定患者对ACP的偏好,确定研究缺口,并通过ACP制定改善患者护理的建议.
分析随着时间的推移和不同国家的AD使用和内容的趋势.

主要方法:

1999年至2024年间发表的定性和定量研究的系统文献综述和元分析,利用五个主要的电子数据库.
应用了包含标准来选择相关的初级文献,并系统地提取了关于预先指示 (AD) 数量和内容的数据.
进行了统计分析和元分析,以评估AD使用的国际差异和时间变化,并使用混合方法评估工具 (MMAT) 评估研究质量.

主要成果:

在998个被选的记录中,包括了26项研究,显示1999年至2024年出版物增加了88.9%.
在60.4%的患者 (1,629/2,696) 中记录了预先指示 (AD),但其使用率从78% (1999-2011) 显著下降到42% (2012-2024).
观察到关于AD含量的异质结果和显著的国际差异,定性和混合方法研究表明质量优越.

结论:

进一步的研究应侧重于对ALS的通风和人工营养的详细偏好,特别是在全球南方国家.
预先护理计划 (ACP) 必须是ALS患者个性化支持计划的组成部分,包括讨论首选死亡地点.
建议优先使用特定疾病的预先指示文件,以改善ALS患者的护理计划.

关键词:

提前护理计划提前护理计划预先指令预先指令肌缩侧面硬化症 (ALS) 是一种疾病.活着的意志活着的意志运动神经元疾病 (MND)

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