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Assessing prognosis in depression: comparing perspectives of AI models, mental health professionals and the general public. 评估抑郁症的预后:比较人工智能模型、心理健康专业人员和普通大众的观点。
IF 2.6 3区 医学 Q1 PRIMARY HEALTH CARE Pub Date : 2024-01-09 DOI: 10.1136/fmch-2023-002583
Zohar Elyoseph, Inbar Levkovich, Shiri Shinan-Altman

Background: Artificial intelligence (AI) has rapidly permeated various sectors, including healthcare, highlighting its potential to facilitate mental health assessments. This study explores the underexplored domain of AI's role in evaluating prognosis and long-term outcomes in depressive disorders, offering insights into how AI large language models (LLMs) compare with human perspectives.

Methods: Using case vignettes, we conducted a comparative analysis involving different LLMs (ChatGPT-3.5, ChatGPT-4, Claude and Bard), mental health professionals (general practitioners, psychiatrists, clinical psychologists and mental health nurses), and the general public that reported previously. We evaluate the LLMs ability to generate prognosis, anticipated outcomes with and without professional intervention, and envisioned long-term positive and negative consequences for individuals with depression.

Results: In most of the examined cases, the four LLMs consistently identified depression as the primary diagnosis and recommended a combined treatment of psychotherapy and antidepressant medication. ChatGPT-3.5 exhibited a significantly pessimistic prognosis distinct from other LLMs, professionals and the public. ChatGPT-4, Claude and Bard aligned closely with mental health professionals and the general public perspectives, all of whom anticipated no improvement or worsening without professional help. Regarding long-term outcomes, ChatGPT 3.5, Claude and Bard consistently projected significantly fewer negative long-term consequences of treatment than ChatGPT-4.

Conclusions: This study underscores the potential of AI to complement the expertise of mental health professionals and promote a collaborative paradigm in mental healthcare. The observation that three of the four LLMs closely mirrored the anticipations of mental health experts in scenarios involving treatment underscores the technology's prospective value in offering professional clinical forecasts. The pessimistic outlook presented by ChatGPT 3.5 is concerning, as it could potentially diminish patients' drive to initiate or continue depression therapy. In summary, although LLMs show potential in enhancing healthcare services, their utilisation requires thorough verification and a seamless integration with human judgement and skills.

背景:人工智能(AI)已迅速渗透到包括医疗保健在内的各个领域,凸显了其在促进心理健康评估方面的潜力。本研究探讨了人工智能在评估抑郁障碍的预后和长期结果方面所起的作用这一尚未充分探索的领域,为人工智能大型语言模型(LLMs)如何与人类视角进行比较提供了见解:我们使用案例小故事进行了一项比较分析,涉及不同的 LLM(ChatGPT-3.5、ChatGPT-4、Claude 和 Bard)、心理健康专业人员(全科医生、精神病医生、临床心理学家和心理健康护士)以及之前报告过的普通大众。我们评估了 LLM 生成预后的能力、有无专业干预的预期结果,以及对抑郁症患者的长期积极和消极影响的设想:结果:在大多数受检病例中,四种 LLM 始终将抑郁症作为主要诊断,并建议采用心理治疗和抗抑郁药物治疗相结合的方法。ChatGPT-3.5 与其他地方语言学家、专业人士和公众相比,表现出明显的悲观预后。ChatGPT-4、克劳德和巴德与心理健康专业人士和公众的观点非常一致,他们都预计在没有专业帮助的情况下不会有任何改善或恶化。在长期结果方面,ChatGPT3.5、Claude 和 Bard 预测的长期治疗的负面影响明显少于 ChatGPT-4:本研究强调了人工智能在补充心理健康专业人员的专业知识和促进心理保健合作模式方面的潜力。观察发现,在涉及治疗的场景中,四种 LLM 中的三种与心理健康专家的预测密切相关,这凸显了该技术在提供专业临床预测方面的前景价值。ChatGPT 3.5 所呈现的悲观前景令人担忧,因为它可能会削弱患者开始或继续抑郁治疗的动力。总之,尽管 LLM 在提高医疗服务方面显示出了潜力,但其使用还需要全面验证,并与人类的判断和技能完美结合。
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引用次数: 0
Liver abnormalities following SARS-CoV-2 infection in children 1 to 10 years of age 1 至 10 岁儿童感染 SARS-CoV-2 后出现肝脏异常
IF 6.1 3区 医学 Q1 PRIMARY HEALTH CARE Pub Date : 2024-01-01 DOI: 10.1136/fmch-2023-002655
Pauline Terebuh, Veronica R Olaker, Ellen K Kendall, David C Kaelber, Rong Xu, Pamela B Davis
Objective Beginning in October 2021 in the USA and elsewhere, cases of severe paediatric hepatitis of unknown aetiology were identified in young children. While the adenovirus and adenovirus-associated virus have emerged as leading aetiological suspects, we attempted to investigate a potential role for SARS-CoV-2 in the development of subsequent liver abnormalities. Design We conducted a study using retrospective cohorts of deidentified, aggregated data from the electronic health records of over 100 million patients contributed by US healthcare organisations. Results Compared with propensity score matched children with other respiratory infections, children aged 1–10 years with COVID-19 had a higher risk of elevated transaminases (HR (95% CI) 2.16 (1.74 to 2.69)) or total bilirubin (HR (95% CI) 3.02 (1.91 to 4.78)), or new diagnoses of liver diseases (HR (95% CI) 1.67 (1.21 to 2.30)) from 1 to 6 months after infection. Patients with pre-existing liver abnormalities, liver abnormalities surrounding acute infection, younger age (1–4 years) or illness requiring hospitalisation all had similarly elevated risk. Children who developed liver abnormalities following COVID-19 had more pre-existing conditions than those who developed abnormalities following other infections. Conclusion These results indicate that SARS-CoV-2 may prime the patient for subsequent development of liver infections or non-infectious liver diseases. While rare (~1 in 1000), SARS-CoV-2 is a risk for subsequent abnormalities in liver function or the diagnosis of diseases of the liver. No data are available. We used a cloud-based database and cannot download the data set. In addition, the database is constantly being upgraded with new information, so the actual data from which the analysis was done will not be available at a subsequent time. That is why we indicate when the database was accessed and which specific data set was used. The EMR data are deidentified and so individual data cannot be made available to us or anyone else.
目的 从 2021 年 10 月开始,在美国和其他地区发现了病因不明的重症小儿肝炎病例。虽然腺病毒和腺病毒相关病毒已成为主要的病因,但我们试图研究 SARS-CoV-2 在随后的肝脏异常发展中可能扮演的角色。设计 我们利用美国医疗机构提供的超过 1 亿名患者的电子健康记录中的去标识化汇总数据进行了一项回顾性队列研究。结果 与倾向得分匹配的其他呼吸道感染儿童相比,感染 COVID-19 的 1-10 岁儿童在感染后 1-6 个月内转氨酶升高(HR (95% CI) 2.16 (1.74 to 2.69))或总胆红素升高(HR (95% CI) 3.02 (1.91 to 4.78))或新诊断肝病(HR (95% CI) 1.67 (1.21 to 2.30))的风险更高。原有肝功能异常、急性感染时肝功能异常、年龄较小(1-4 岁)或需要住院治疗的患者的风险也同样升高。与感染其他疾病后出现肝功能异常的儿童相比,感染 COVID-19 后出现肝功能异常的儿童的原有病症更多。结论 这些结果表明,SARS-CoV-2 可能为患者日后患上肝脏感染或非感染性肝病埋下隐患。SARS-CoV-2虽然罕见(约为千分之一),但却有可能导致随后的肝功能异常或肝脏疾病诊断。目前尚无相关数据。我们使用的是云数据库,无法下载数据集。此外,数据库还在不断更新,因此分析所依据的实际数据在随后的时间里将无法获得。因此,我们会注明访问数据库的时间以及使用的具体数据集。EMR 数据是去标识化的,因此无法向我们或其他任何人提供个人数据。
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引用次数: 0
Attitudes, beliefs, behaviours and perspectives on barriers and enablers of Australian general practitioners towards non-drug interventions: a national survey 澳大利亚全科医生对非药物干预措施的态度、信念、行为以及对障碍和促进因素的看法:全国调查
IF 6.1 3区 医学 Q1 PRIMARY HEALTH CARE Pub Date : 2024-01-01 DOI: 10.1136/fmch-2023-002457
Loai Albarqouni, Hannah Greenwood, Caroline Dowsett, Tammy Hoffmann, Rae Thomas, Paul Glasziou
Background Many guidelines recommend non-drug interventions (NDIs) for managing common conditions in primary care. However, compared with drug interventions, NDIs are less widely known, promoted and used. We aim to (1) examine general practitioners’ (GPs’) knowledge, attitudes and practices for NDIs, including their use of the Royal Australian College of General Practitioners (RACGP) Handbook of Non-Drug Interventions (HANDI), and (2) identify factors influencing their use of NDIs and HANDI. Methods We conducted a web-based cross-sectional survey of practicing GP members in Australia during October–November 2022. The survey contained five sections: characteristics of GP; knowledge and use of NDIs; attitudes towards NDIs; barriers and enablers to using HANDI; and suggestions of NDIs and ideas to improve the uptake of NDIs in primary care. Results Of the 366 GPs who completed the survey, 242 (66%) were female, and 248 (74%) were ≥45 years old. One in three GPs reported that they regularly (‘always’) recommend NDIs to their patients when appropriate (34%), whereas one-third of GPs were unaware of HANDI (39%). GPs identified several factors that improve the uptake of HANDI, including ‘access and integration of HANDI in clinical practice’, ‘content and support to use in practice’ and ‘awareness and training’. Conclusions While many GPs are aware of the effectiveness of NDIs and often endorse their use, obstacles still prevent widespread adoption in primary care. The results of this survey can serve as a foundation for developing implementation strategies to improve the uptake of effective evidence-based NDIs in primary care. Data are available upon reasonable request. The authors had full access to all of the data in the study. Aggregated data that underlie the results reported in this article are available on request to the corresponding author.
背景 许多指南都建议采用非药物干预措施(NDI)来控制初级保健中的常见疾病。然而,与药物干预相比,非药物干预的知名度、推广和使用程度都较低。我们的目的是:(1)研究全科医生(GPs)对非药物干预的认识、态度和实践,包括他们对澳大利亚皇家全科医师学院(RACGP)非药物干预手册(HANDI)的使用情况;(2)确定影响他们使用非药物干预和HANDI的因素。方法 我们在 2022 年 10 月至 11 月期间对澳大利亚的执业全科医生会员进行了一次基于网络的横断面调查。调查包括五个部分:全科医生的特点;对无创伤药的了解和使用;对无创伤药的态度;使用 HANDI 的障碍和有利因素;以及对无创伤药的建议和提高无创伤药在初级保健中使用率的想法。结果 在完成调查的 366 名全科医生中,242 名(66%)为女性,248 名(74%)年龄≥45 岁。三分之一的全科医生表示,他们会定期("总是")在适当的时候向患者推荐无创诊断(34%),而三分之一的全科医生不知道有 HANDI(39%)。全科医生认为有几个因素可以提高 HANDI 的使用率,包括 "临床实践中 HANDI 的获取和整合"、"在实践中使用的内容和支持 "以及 "意识和培训"。结论 虽然许多全科医生都了解 NDI 的有效性,并经常赞同使用 NDI,但仍有一些障碍阻碍了 NDI 在基层医疗机构的广泛应用。这项调查的结果可作为制定实施策略的基础,以提高以证据为基础的有效 NDIs 在初级保健中的使用率。如有合理要求,可提供相关数据。作者可以完全访问研究中的所有数据。本文报告结果所依据的汇总数据可向通讯作者索取。
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引用次数: 0
Community cancer screening at primary care level in Northern India: determinants and policy implications for cancer prevention. 印度北部初级保健层面的社区癌症筛查:癌症预防的决定因素和政策影响。
IF 6.1 3区 医学 Q1 PRIMARY HEALTH CARE Pub Date : 2023-12-17 DOI: 10.1136/fmch-2023-002397
Priyanka Sharma, Divya Khanna, Satyajit Pradhan, Praveen Birur

Objective: Despite the established cancer screening programme for oral, breast and cervical cancer by the Government of India, the screening coverage remains inadequate. This study aimed to describe the determinants for oral, breast and cervical cancer prevention in a rural community at the primary care level of Northern India and its policy implications.

Design: This was a camp-based project conducted for 1 year, using oral visual examination, clinical breast examination and visual inspection of cervix by application of 5% acetic acid according to primary healthcare operational guidelines. During the project, screen-positive participants were followed through reverse navigation. Information about socio-demographic profile, clinical and behavioural history and screening were collected. Predictors for screen-positivity and follow-up compliance were identified through multivariable analysis.

Settings: Based on the aim of project, one of the remotely located and low socioeconomic rural blocks, having 148 villages (estimated population of 254 285) in Varanasi district, India was selected as the service site. There is an established healthcare delivery and referral system as per the National Health Mission of Government of India. Oral, breast, gallbladder and cervical cancers are the leading cancers in the district.

Participants: We invited all men and women aged 30-65 years residing in the selected block for the last 6 months for the screening camps. Unmarried women, women with active vaginal bleeding, those currently pregnant and those who have undergone hysterectomy were excluded from cervical cancer screening.

Results: A total of 14 338 participants were screened through 190 camps and the majority (61.9%) were women. Hindu religion, tobacco use, intention to quit tobacco and presence of symptoms were significantly associated with screen-positivity. Nearly one-third (220; 30.1%) of the screened-positives complied with follow-up. Young age and illiteracy were significantly associated with lower compliance.

Conclusion: Poor follow-up compliance, despite the availability of tertiary cancer care, patient navigation, free transportation and diagnostic services, calls for research to explore the role of contextual factors and develop pragmatic interventions to justify 'close the care gap'. Community cancer screening needs strengthening through cancer awareness, establishing referral system and integration with the National Tobacco Control and Cancer Registry Programmes.

目的:尽管印度政府制定了口腔癌、乳腺癌和宫颈癌筛查计划,但筛查覆盖率仍然不足。本研究旨在描述印度北部农村社区初级保健层面预防口腔癌、乳腺癌和宫颈癌的决定因素及其政策影响:设计:这是一个以营地为基础的项目,为期一年,根据初级保健操作指南,采用口腔目视检查、临床乳房检查和涂抹 5%醋酸目视检查宫颈的方法。项目期间,通过反向导航对筛查呈阳性的参与者进行跟踪。收集了有关社会人口概况、临床和行为史以及筛查的信息。通过多变量分析,确定了筛查阳性和随访依从性的预测因素:根据项目的目标,我们选择了印度瓦拉纳西地区一个位置偏远、社会经济水平较低的农村街区作为服务地点,该街区共有 148 个村庄(估计人口为 254 285 人)。根据印度政府的国家卫生使命,这里有一个成熟的医疗保健服务和转诊系统。口腔癌、乳腺癌、胆囊癌和宫颈癌是该地区的主要癌症:我们邀请过去 6 个月中居住在选定街区的所有 30-65 岁的男性和女性参加筛查营。未婚女性、有阴道出血症状的女性、正在怀孕的女性和接受过子宫切除术的女性不在宫颈癌筛查范围内:结果:190 个筛查营共筛查了 14 338 人,其中大多数(61.9%)为女性。印度教宗教信仰、吸烟情况、戒烟意愿和是否有症状与筛查阳性率有显著相关性。近三分之一(220 人;30.1%)的筛查阳性者接受了随访。年轻和文盲与较低的依从性明显相关:尽管有三级癌症护理、患者指导、免费交通和诊断服务,但随访依从性较差,这就要求开展研究,探索环境因素的作用,并制定实用的干预措施,以证明 "缩小护理差距 "是合理的。社区癌症筛查需要通过提高癌症意识、建立转诊系统以及与国家烟草控制和癌症登记计划相结合来加强。
{"title":"Community cancer screening at primary care level in Northern India: determinants and policy implications for cancer prevention.","authors":"Priyanka Sharma, Divya Khanna, Satyajit Pradhan, Praveen Birur","doi":"10.1136/fmch-2023-002397","DOIUrl":"10.1136/fmch-2023-002397","url":null,"abstract":"<p><strong>Objective: </strong>Despite the established cancer screening programme for oral, breast and cervical cancer by the Government of India, the screening coverage remains inadequate. This study aimed to describe the determinants for oral, breast and cervical cancer prevention in a rural community at the primary care level of Northern India and its policy implications.</p><p><strong>Design: </strong>This was a camp-based project conducted for 1 year, using oral visual examination, clinical breast examination and visual inspection of cervix by application of 5% acetic acid according to primary healthcare operational guidelines. During the project, screen-positive participants were followed through reverse navigation. Information about socio-demographic profile, clinical and behavioural history and screening were collected. Predictors for screen-positivity and follow-up compliance were identified through multivariable analysis.</p><p><strong>Settings: </strong>Based on the aim of project, one of the remotely located and low socioeconomic rural blocks, having 148 villages (estimated population of 254 285) in Varanasi district, India was selected as the service site. There is an established healthcare delivery and referral system as per the National Health Mission of Government of India. Oral, breast, gallbladder and cervical cancers are the leading cancers in the district.</p><p><strong>Participants: </strong>We invited all men and women aged 30-65 years residing in the selected block for the last 6 months for the screening camps. Unmarried women, women with active vaginal bleeding, those currently pregnant and those who have undergone hysterectomy were excluded from cervical cancer screening.</p><p><strong>Results: </strong>A total of 14 338 participants were screened through 190 camps and the majority (61.9%) were women. Hindu religion, tobacco use, intention to quit tobacco and presence of symptoms were significantly associated with screen-positivity. Nearly one-third (220; 30.1%) of the screened-positives complied with follow-up. Young age and illiteracy were significantly associated with lower compliance.</p><p><strong>Conclusion: </strong>Poor follow-up compliance, despite the availability of tertiary cancer care, patient navigation, free transportation and diagnostic services, calls for research to explore the role of contextual factors and develop pragmatic interventions to justify 'close the care gap'. Community cancer screening needs strengthening through cancer awareness, establishing referral system and integration with the National Tobacco Control and Cancer Registry Programmes.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"11 Suppl 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10729271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Should I take aspirin? A qualitative study on the implementation of a decision aid on taking aspirin for bowel cancer prevention. 我应该吃阿司匹林吗?服用阿司匹林预防肠癌决策辅助实施的定性研究。
IF 6.1 3区 医学 Q1 PRIMARY HEALTH CARE Pub Date : 2023-11-30 DOI: 10.1136/fmch-2023-002423
Shakira Onwuka, Jennifer McIntosh, Lucy Boyd, Napin Karnchanachari, Finlay Macrae, George Fishman, Jon Emery

Objectives: Australian guidelines recommend 50-70 years consider taking aspirin to reduce their bowel cancer risk. We trialled a decision aid in general practice to facilitate the implementation of these guidelines into clinical practice. This publication reports on the qualitative results from the process evaluation of the trial. We aimed to explore general practitioners' (GPs) and their patients' approach to shared decision-making (SDM) about taking aspirin to prevent bowel cancer and how the decision aids were used in practice.

Methods: Semistructured interviews were conducted with 17 participants who received the decision aid and 12 GPs who participated in the trial between June and November 2021. The interviews were coded inductively, and emerging themes were mapped onto the Revised Programme Theory for SDM.

Results: The study highlighted the dynamics of SDM for taking aspirin to prevent bowel cancer. Some participants discussed the decision aid with their GPs as advised prior to taking aspirin, others either took aspirin or dismissed it outright without discussing it with their GPs. Notably, participants' trust in their GPs, and participants' diverse worldviews played pivotal roles in their decisions. Although the decision aid supported SDM for some, it was not always prioritised in a consultation. This was likely impacted during the trial period as the COVID-19 pandemic was the focus for general practice.

Conclusion: In summary, this study illustrated the complexities of SDM through using a decision aid in general practice to implement the guidelines for low-dose aspirin to prevent bowel cancer. While the decision aid prompted some participants to speak to their GPs, they were also heavily influenced by their unwavering trust in the GPs and their different worldviews. In the face of the COVID-19 pandemic, SDM was not highly prioritised. This study provides insights into the implementation of guidelines into clinical practice and highlights the need for ongoing support and prioritisation of cancer prevention in general practice consultations.

Trial registration number: ACTRN12620001003965.

目的:澳大利亚指南建议50-70岁的人考虑服用阿司匹林来降低肠癌的风险。我们在全科实践中试用了一种决策辅助工具,以促进这些指南在临床实践中的实施。本出版物报道了试验过程评估的定性结果。我们的目的是探讨全科医生(gp)和他们的患者在服用阿司匹林预防肠癌方面的共同决策(SDM)方法,以及决策辅助工具在实践中的使用情况。方法:在2021年6月至11月期间,对17名接受决策辅助的参与者和12名参与试验的全科医生进行半结构化访谈。访谈被归纳编码,新出现的主题被映射到SDM的修订计划理论。结果:该研究强调了服用阿司匹林预防肠癌的SDM动力学。一些参与者在服用阿司匹林之前与他们的全科医生讨论了建议的决策辅助,其他人要么服用阿司匹林,要么在没有与全科医生讨论的情况下完全放弃服用阿司匹林。值得注意的是,参与者对全科医生的信任以及参与者不同的世界观在他们的决策中发挥了关键作用。虽然决策援助对一些国家支持可持续发展机制,但它并不总是在协商中被列为优先事项。这在试验期间可能会受到影响,因为COVID-19大流行是一般实践的重点。结论:总之,本研究通过在一般实践中使用决策辅助来实施低剂量阿司匹林预防肠癌的指南,说明了SDM的复杂性。虽然决策援助促使一些参与者与他们的全科医生交谈,但他们也受到对全科医生坚定不移的信任和不同世界观的严重影响。面对COVID-19大流行,SDM没有得到高度重视。本研究为指南在临床实践中的实施提供了见解,并强调了在全科医生咨询中持续支持和优先考虑癌症预防的必要性。试验注册号:ACTRN12620001003965。
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引用次数: 0
Supporting and retaining competent primary care workforce in low-resource settings: lessons learned from a prospective cohort study. 在资源匮乏的环境中支持和留住合格的初级保健劳动力:从前瞻性队列研究中吸取的教训。
IF 6.1 3区 医学 Q1 PRIMARY HEALTH CARE Pub Date : 2023-11-01 DOI: 10.1136/fmch-2023-002421
Mingyue Li, Haoqing Tang, Huixian Zheng, Yiran Tian, Xiaoran Cheng, Haozhe Cheng, Xiaotian Zhang, Dan Hu, Xiaoyun Liu

Objective: Assess whether local health facilities can adequately support the performance of general practitioners (GPs) trained by China's national compulsory services programme (CSP).

Design: Prospective cohort study.

Setting: Health facilities in middle and western rural areas in China, 2015-2022.

Participants: Cohorts of CSP graduates from 2015 to 2019 in four major medical universities.

Main outcomes: Job performance measured by a 12-item Job Performance Scale; productivity measured by outpatient volume per day; turnover measured by ever changing jobs within the past year.

Results: 91.2%, 92.0% and 90.5% GPs working in township health centres reported inadequate medication, equipment and external assistance from higher level hospitals, while CSP graduates working in secondary or tertiary hospitals reported a lower rate of less than 60%. The top three tests reported as lacking were blood gases (67.7%), microbiology (61.6%) and cancer biomarkers (49.7%); the top three lacked procedures were CT scan (64.8%), MRI scan (58.1%) and ambulatory BP monitoring (55.8%); and the top three lacked drugs were drugs for cardiovascular diseases (23.3%), systematic hormonal preparations (17.7%) and traditional Chinese medicines (13.0%). Multivariable analysis showed that facility support was positively associated with job performance-adequate medication increased job performance by 2.2 points (95% CI 0.7 to 3.8), and adequate external assistance increased job performance by 3.3 points (95% CI 1.8 to 4.8). Facility support was also positively associated with productivity-adequate medication increased outpatients seen per day by 20% (95% CI 0.1 to 0.3), and adequate equipment increased outpatients seen per day by 12% (95% CI 0.0 to 0.2). Facility support did not have significant impact on turnover, but GPs who changed jobs in the past year were 1.9-2.3 times more likely to report adequate facility support.

Conclusion: GPs in township health centres experienced a high prevalence of shortage in facility support. The identification of a positive association between facility support and performance and productivity has implications for future research and resources deployment in primary healthcare.

目的:评估当地卫生机构是否能够充分支持接受中国国家义务服务计划(CSP)培训的全科医生的表现。设计:前瞻性队列研究。背景:2015-2022年中国中西部农村卫生设施。参与者:四所主要医科大学2015年至2019年CSP毕业生。主要结果:通过12项工作表现量表衡量工作表现;以每天门诊量衡量的生产力;通过过去一年中不断变化的工作来衡量营业额。结果:91.2%、92.0%和90.5%在乡镇卫生中心工作的全科医生报告上级医院的药物、设备和外部援助不足,而在二级或三级医院工作的CSP毕业生报告的比率较低,不到60%。报告缺乏的前三项测试是血气(67.7%)、微生物学(61.6%)和癌症生物标志物(49.7%);前三位缺乏手术的是CT扫描(64.8%)、MRI扫描(58.1%)和动态血压监测(55.8%);缺乏药物的前三位是心血管疾病药物(23.3%)、系统激素制剂(17.7%)和中药(13.0%)。多变量分析显示,设施支持与工作表现呈正相关。充足的药物使工作表现提高2.2分(95%CI 0.7 至3.8),充分的外部援助使工作表现提高了3.3个百分点(95%置信区间1.8 至4.8)。设施支持也与生产力呈正相关——充足的药物使每天就诊的门诊患者增加20%(95%CI 0.1 到0.3),并且足够的设备使每天就诊的门诊患者增加了12%(95%置信区间0.0 至0.2)。设施支持对人员流动没有显著影响,但在过去一年中换了工作的全科医生报告足够设施支持的可能性高出1.9-2.3倍。结论:乡镇卫生中心的全科医生普遍存在设施支持不足的问题。确定设施支持与绩效和生产力之间的正相关关系,对初级医疗保健的未来研究和资源部署具有重要意义。
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引用次数: 0
Health-related quality of life among adolescents with type 1 diabetes since the second wave of the COVID-19 pandemic in Germany. 自德国第二波COVID-19大流行以来,青少年1型糖尿病患者的健康相关生活质量
IF 6.1 3区 医学 Q1 PRIMARY HEALTH CARE Pub Date : 2023-11-01 DOI: 10.1136/fmch-2023-002415
Juliane Regina Framme, Su-Jong Kim-Dorner, Bettina Heidtmann, Thomas Michael Kapellen, Karin Lange, Olga Kordonouri, Heike Saßmann

Objective: The COVID-19 pandemic had an impact on everyday life and in general, reduced the health-related quality of life (HRQoL) of adolescents. In this study, we assess the HRQoL of adolescents with type 1 diabetes (T1D) in Germany since the second wave of the COVID-19 pandemic by using self-report and parent-proxy reports, to identify risk factors, to compare to peers and to examine the agreement of HRQoL between parents and their children.

Methods: A total of 445 adolescents (12-18 years) and 413 parents participated in an anonymous cross-sectional survey conducted at three German diabetes centres from January 2021 to June 2022. Inclusion criteria were diabetes duration ≥1 year and German-speaking. Teen HRQoL was assessed by using self-report and parent-proxy report versions of the KIDSCREEN-10 index.

Results: The majority of adolescents reported average (75.5%) HRQoL. Approximately 11.3% of teens reported high and 13.2% low HRQoL. Teen's female gender, older age, higher diabetes burden and parental depression symptoms contributed to lower self-reported HRQoL among teens. For parent-proxy reports, increasing diabetes burdens, parental depression symptoms, non-migrant status, high education and ketoacidosis contributed to lower scores on teen HRQoL. The mean scores of the KIDSCREEN-10 index for adolescents did not differ from the German norm. In comparison to healthy peers during the first wave of the pandemic, adolescents in the current study reported higher HRQoL. The overall teen-parent agreement was fair although parents reported significantly lower teen HRQoL than adolescents did.

Conclusions: HRQoL of most adolescents with T1D during the COVID-19 pandemic was average with parents reporting significantly lower scores. Self-reported and parent-proxy-reported HRQoL and the level of agreement due to different perspectives can provide important information for clinical care and intervention planning.

目的:2019冠状病毒病大流行对青少年的日常生活产生了影响,总体上降低了与健康相关的生活质量(HRQoL)。在本研究中,我们通过自我报告和父母代理报告评估了自第二波COVID-19大流行以来德国1型糖尿病青少年(T1D)的HRQoL,以确定危险因素,与同龄人进行比较,并检查父母与子女之间HRQoL的一致性。方法:共有445名青少年(12-18岁)和413名家长参加了2021年1月至2022年6月在德国三家糖尿病中心进行的匿名横断面调查。纳入标准为糖尿病病程≥1年和会讲德语。青少年HRQoL采用KIDSCREEN-10指数的自我报告和父母代理报告版本进行评估。结果:大多数青少年的HRQoL为平均水平(75.5%)。大约11.3%的青少年报告HRQoL高,13.2%报告HRQoL低。青少年女性、年龄较大、较高的糖尿病负担和父母抑郁症状导致青少年自我报告的HRQoL较低。在父母代理报告中,增加的糖尿病负担、父母抑郁症状、非移民身份、高学历和酮症酸中毒导致青少年HRQoL得分较低。青少年KIDSCREEN-10指数的平均得分与德国标准没有差异。与第一波大流行期间的健康同龄人相比,目前研究中的青少年报告了更高的HRQoL。尽管父母报告的青少年的HRQoL明显低于青少年,但总体上青少年与父母的共识是公平的。结论:在COVID-19大流行期间,大多数T1D青少年的HRQoL处于平均水平,父母报告的评分明显较低。自我报告和父母代理报告的HRQoL以及不同视角下的一致程度可以为临床护理和干预计划提供重要信息。
{"title":"Health-related quality of life among adolescents with type 1 diabetes since the second wave of the COVID-19 pandemic in Germany.","authors":"Juliane Regina Framme, Su-Jong Kim-Dorner, Bettina Heidtmann, Thomas Michael Kapellen, Karin Lange, Olga Kordonouri, Heike Saßmann","doi":"10.1136/fmch-2023-002415","DOIUrl":"10.1136/fmch-2023-002415","url":null,"abstract":"<p><strong>Objective: </strong>The COVID-19 pandemic had an impact on everyday life and in general, reduced the health-related quality of life (HRQoL) of adolescents. In this study, we assess the HRQoL of adolescents with type 1 diabetes (T1D) in Germany since the second wave of the COVID-19 pandemic by using self-report and parent-proxy reports, to identify risk factors, to compare to peers and to examine the agreement of HRQoL between parents and their children.</p><p><strong>Methods: </strong>A total of 445 adolescents (12-18 years) and 413 parents participated in an anonymous cross-sectional survey conducted at three German diabetes centres from January 2021 to June 2022. Inclusion criteria were diabetes duration ≥1 year and German-speaking. Teen HRQoL was assessed by using self-report and parent-proxy report versions of the KIDSCREEN-10 index.</p><p><strong>Results: </strong>The majority of adolescents reported average (75.5%) HRQoL. Approximately 11.3% of teens reported high and 13.2% low HRQoL. Teen's female gender, older age, higher diabetes burden and parental depression symptoms contributed to lower self-reported HRQoL among teens. For parent-proxy reports, increasing diabetes burdens, parental depression symptoms, non-migrant status, high education and ketoacidosis contributed to lower scores on teen HRQoL. The mean scores of the KIDSCREEN-10 index for adolescents did not differ from the German norm. In comparison to healthy peers during the first wave of the pandemic, adolescents in the current study reported higher HRQoL. The overall teen-parent agreement was fair although parents reported significantly lower teen HRQoL than adolescents did.</p><p><strong>Conclusions: </strong>HRQoL of most adolescents with T1D during the COVID-19 pandemic was average with parents reporting significantly lower scores. Self-reported and parent-proxy-reported HRQoL and the level of agreement due to different perspectives can provide important information for clinical care and intervention planning.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"11 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10660822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Service evaluation: identification of gaps in choking prevention advice for children in the South Coast of England, UK. 服务评估:确定英国英格兰南海岸儿童窒息预防建议的差距。
IF 6.1 3区 医学 Q1 PRIMARY HEALTH CARE Pub Date : 2023-10-01 DOI: 10.1136/fmch-2022-001966
Saira Khan, Karen Patterson, Katy Fidler
© Author(s) (or their employer(s)) 2023. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Choking, also known as foreign body airway obstruction, is the blockage of respiration by a foreign body in the airway including the trachea, hypopharynx and pharynx. Among young children, choking is one of the leading causes of death among unintentional injuries, thus making it a significant public health issue. Children under 5 have the highest risk of choking compared with other children and adults. In 2016, of the approximately 1900 choking episodes resulting in emergency calls in London, 40% were for children under 5. Common items that children may choke on include food, toys and coins. Round objects that can adapt to the shape of a child’s airway are most likely to cause complete obstruction of the airways such as grapes, peanuts and hard sweets. To reduce the incidence of these events, choking prevention advice for parents/ caregivers is critical. One study showed that parents who lacked awareness of food choking hazards were more likely to give foods to their children that increase choking risk. Conversely, studies conducted in Israel and Crete showed a decline in choking cases in children after implementing educational choking prevention programmes. Healthcare professionals (HCPs) such as general practitioners (GPs), paediatric nurses and health visitors play a significant role in providing choking prevention advice to parents/caregivers. Examples of choking prevention advice recommended by the Child Accident Prevention Trust are shown in box 1. During their professional training, these HCPs have typically received choking prevention and management teaching. However, in clinical practice, it is unclear how routinely these roles are being carried out. Aims and objectives Our service evaluation had a primary objective to identify the type of HCPs providing choking prevention advice and how consistently this advice was delivered. Secondary objectives included assessing the use of choking prevention resources by HCPs and determining where HCPs think choking prevention advice is best placed.
{"title":"Service evaluation: identification of gaps in choking prevention advice for children in the South Coast of England, UK.","authors":"Saira Khan,&nbsp;Karen Patterson,&nbsp;Katy Fidler","doi":"10.1136/fmch-2022-001966","DOIUrl":"https://doi.org/10.1136/fmch-2022-001966","url":null,"abstract":"© Author(s) (or their employer(s)) 2023. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Choking, also known as foreign body airway obstruction, is the blockage of respiration by a foreign body in the airway including the trachea, hypopharynx and pharynx. Among young children, choking is one of the leading causes of death among unintentional injuries, thus making it a significant public health issue. Children under 5 have the highest risk of choking compared with other children and adults. In 2016, of the approximately 1900 choking episodes resulting in emergency calls in London, 40% were for children under 5. Common items that children may choke on include food, toys and coins. Round objects that can adapt to the shape of a child’s airway are most likely to cause complete obstruction of the airways such as grapes, peanuts and hard sweets. To reduce the incidence of these events, choking prevention advice for parents/ caregivers is critical. One study showed that parents who lacked awareness of food choking hazards were more likely to give foods to their children that increase choking risk. Conversely, studies conducted in Israel and Crete showed a decline in choking cases in children after implementing educational choking prevention programmes. Healthcare professionals (HCPs) such as general practitioners (GPs), paediatric nurses and health visitors play a significant role in providing choking prevention advice to parents/caregivers. Examples of choking prevention advice recommended by the Child Accident Prevention Trust are shown in box 1. During their professional training, these HCPs have typically received choking prevention and management teaching. However, in clinical practice, it is unclear how routinely these roles are being carried out. Aims and objectives Our service evaluation had a primary objective to identify the type of HCPs providing choking prevention advice and how consistently this advice was delivered. Secondary objectives included assessing the use of choking prevention resources by HCPs and determining where HCPs think choking prevention advice is best placed.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"11 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/11/fmch-2022-001966.PMC10565162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association of COVID-19 with respiratory syncytial virus (RSV) infections in children aged 0-5 years in the USA in 2022: a multicentre retrospective cohort study. 2022年美国0-5岁儿童新冠肺炎与呼吸道合胞病毒(RSV)感染的关联:一项多中心回顾性队列研究。
IF 6.1 3区 医学 Q1 PRIMARY HEALTH CARE Pub Date : 2023-10-01 DOI: 10.1136/fmch-2023-002456
Lindsey Wang, Pamela B Davis, Nathan Berger, David C Kaelber, Nora Volkow, Rong Xu

Objective: To investigate whether COVID-19 infection was associated with increased risk for incident respiratory syncytial virus (RSV) infections and associated diseases among young children that might have contributed to the 2022 surge of severe paediatric RSV cases in the USA.

Design: This is a retrospective population-based cohort study. Five outcomes were examined, including overall RSV infection, positive lab test-confirmed RSV infection, clinically diagnosed RSV diseases, RSV-associated bronchiolitis and unspecified bronchiolitis. Risk ratio (RR) and 95% CI of the outcomes that occurred during the 2022 and 2021 RSV seasons were calculated by comparing propensity-score matched cohorts.

Setting: Nationwide multicentre database of electronic health records (EHRs) of 61.4 million patients in the USA including 1.7 million children 0-5 years of age, which was accessed through TriNetX Analytics that provides web-based and secure access to patient EHR data from hospitals, primary care and specialty treatment providers.

Participants: The study population consisted of 228 940 children of 0-5 years with no prior RSV infection who had medical encounters in October 2022. Findings were replicated in a separate study population of 370 919 children of 0-5 years with no prior RSV infection who had medical encounters in July 2021-August 2021 during a non-overlapping time period.

Results: For the 2022 study population (average age 2.4 years, 46.8% girls, 61% white, 16% black), the risk for incident RSV infection during October 2022-December 2022 was 6.40% for children with prior COVID-19 infection, higher than 4.30% for the matched children without COVID-19 (RR 1.40, 95% CI 1.27 to 1.55); and among children aged 0-1 year, the overall risk was 7.90% for those with prior COVID-19 infection, higher than 5.64% for matched children without (RR 1.40, 95% CI 1.21 to 1.62). For the 2021 study population (average age 2.2 years, 46% girls, 57% white, 20% black), the risk for incident RSV infection during July 2021-December 2021 was 4.85% for children with prior COVID-19 infection, higher than 3.68% for the matched children without COVID-19 (RR 1.32, 95% CI 1.12 to 1.56); and 7.30% for children aged 0-1 year with prior COVID-19 infection, higher than 4.98% for matched children without (RR 1.47, 95% CI 1.18 to 1.82).

Conclusion: COVID-19 was associated with a significantly increased risk for RSV infections among children aged 0-5 years in 2022. Similar findings were replicated for a study population of children aged 0-5 years in 2021. Our findings suggest that COVID-19 contributed to the 2022 surge of RSV cases in young children through the large buildup of COVID-19-infected children and the potential long-term adverse effects of COVID-19 on the immune and respiratory system.

目的:调查新冠肺炎感染是否与幼儿中呼吸道合胞病毒(RSV)感染和相关疾病的风险增加有关,这些疾病可能导致2022年美国儿科严重呼吸道合胞肺炎病例激增。设计:这是一项基于人群的回顾性队列研究。检查了五种结果,包括总体呼吸道合胞病毒感染、实验室检测阳性确认的呼吸道合胞菌感染、临床诊断的呼吸道合病毒疾病、呼吸道合胞杆菌相关细支气管炎和未指明的细支气管炎。通过比较倾向评分匹配的队列,计算2022年和2021年呼吸道合胞病毒季节发生的结果的风险比(RR)和95%CI。设置:全国电子健康记录多中心数据库61.4 美国有100万名患者,其中170人 百万0-5岁儿童,通过TriNetX Analytics访问,该分析提供了对医院、初级保健和专科治疗提供者的患者EHR数据的基于网络的安全访问。参与者:研究人群由228人组成 940名0-5岁的儿童,之前没有感染呼吸道合胞病毒,他们在2022年10月接受过医疗治疗。研究结果在370名单独的研究人群中进行了复制 919名0-5岁的儿童,之前没有感染呼吸道合胞病毒,他们在2021年7月至2021年8月的非重叠时间段内就诊。结果:对于2022年研究人群(平均年龄2.4岁,46.8%为女孩,61%为白人,16%为黑人),在2020年10月至2022年12月期间,既往感染新冠肺炎的儿童发生呼吸道合胞病毒感染的风险为6.40%,高于未感染新冠肺炎的匹配儿童的4.30%(RR 1.40,95% CI 1.27至1.55);以及0-1岁的儿童 年,既往感染新冠肺炎的儿童的总体风险为7.90%,高于未感染的匹配儿童的5.64%(RR 1.40,95% CI 1.21至1.62)。对于2021年研究人群(平均年龄2.2岁,46%为女孩,57%为白人,20%为黑人),在2021年7月至2021年12月期间,既往感染新冠肺炎的儿童发生呼吸道合胞病毒感染的风险为4.85%,高于未感染新冠肺炎的匹配儿童的3.68%(RR 1.32,95% CI 1.12至1.56);0-1岁儿童为7.30% 既往感染新冠肺炎的一年,高于未感染的匹配儿童的4.98%(RR 1.47,95% CI 1.18至1.82)。结论:新冠肺炎与2022年0-5岁儿童RSV感染风险显著增加相关。2021年,类似的发现也被复制到0-5岁儿童的研究人群中。我们的研究结果表明,新冠肺炎通过大量感染新冠肺炎的儿童以及新冠肺炎对免疫和呼吸系统的潜在长期不良影响,导致2022年幼儿呼吸道合胞病毒病例激增。
{"title":"Association of COVID-19 with respiratory syncytial virus (RSV) infections in children aged 0-5 years in the USA in 2022: a multicentre retrospective cohort study.","authors":"Lindsey Wang, Pamela B Davis, Nathan Berger, David C Kaelber, Nora Volkow, Rong Xu","doi":"10.1136/fmch-2023-002456","DOIUrl":"10.1136/fmch-2023-002456","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether COVID-19 infection was associated with increased risk for incident respiratory syncytial virus (RSV) infections and associated diseases among young children that might have contributed to the 2022 surge of severe paediatric RSV cases in the USA.</p><p><strong>Design: </strong>This is a retrospective population-based cohort study. Five outcomes were examined, including overall RSV infection, positive lab test-confirmed RSV infection, clinically diagnosed RSV diseases, RSV-associated bronchiolitis and unspecified bronchiolitis. Risk ratio (RR) and 95% CI of the outcomes that occurred during the 2022 and 2021 RSV seasons were calculated by comparing propensity-score matched cohorts.</p><p><strong>Setting: </strong>Nationwide multicentre database of electronic health records (EHRs) of 61.4 million patients in the USA including 1.7 million children 0-5 years of age, which was accessed through TriNetX Analytics that provides web-based and secure access to patient EHR data from hospitals, primary care and specialty treatment providers.</p><p><strong>Participants: </strong>The study population consisted of 228 940 children of 0-5 years with no prior RSV infection who had medical encounters in October 2022. Findings were replicated in a separate study population of 370 919 children of 0-5 years with no prior RSV infection who had medical encounters in July 2021-August 2021 during a non-overlapping time period.</p><p><strong>Results: </strong>For the 2022 study population (average age 2.4 years, 46.8% girls, 61% white, 16% black), the risk for incident RSV infection during October 2022<b>-</b>December 2022 was 6.40% for children with prior COVID-19 infection, higher than 4.30% for the matched children without COVID-19 (RR 1.40, 95% CI 1.27 to 1.55); and among children aged 0<b>-</b>1 year, the overall risk was 7.90% for those with prior COVID-19 infection, higher than 5.64% for matched children without (RR 1.40, 95% CI 1.21 to 1.62). For the 2021 study population (average age 2.2 years, 46% girls, 57% white, 20% black), the risk for incident RSV infection during July 2021<b>-</b>December 2021 was 4.85% for children with prior COVID-19 infection, higher than 3.68% for the matched children without COVID-19 (RR 1.32, 95% CI 1.12 to 1.56); and 7.30% for children aged 0<b>-</b>1 year with prior COVID-19 infection, higher than 4.98% for matched children without (RR 1.47, 95% CI 1.18 to 1.82).</p><p><strong>Conclusion: </strong>COVID-19 was associated with a significantly increased risk for RSV infections among children aged 0-5 years in 2022. Similar findings were replicated for a study population of children aged 0-5 years in 2021. Our findings suggest that COVID-19 contributed to the 2022 surge of RSV cases in young children through the large buildup of COVID-19-infected children and the potential long-term adverse effects of COVID-19 on the immune and respiratory system.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"11 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b2/27/fmch-2023-002456.PMC10582888.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trustworthy evidence-based versus untrustworthy guidelines: detecting the difference. 值得信赖的循证指南与不值得信赖的指南:检测差异。
IF 6.1 3区 医学 Q1 PRIMARY HEALTH CARE Pub Date : 2023-10-01 DOI: 10.1136/fmch-2023-002437
João Pedro Lima, Wimonchat Tangamornsuksan, Gordon H Guyatt

Guidelines are essential tools in healthcare decision-making. Trustworthy guidelines inform clinicians not only on the direction (against or in favour) and strength (strong or weak/conditional) of recommendations but also on the certainty of the underlying evidence. Developing trustworthy guidelines requires panellists with clinical and methodological expertise who consider patients' values and preferences. Adherence to trustworthiness standards remains variable; clinicians should, therefore, be able to distinguish trustworthy from untrustworthy guidelines. In this paper, we offer eight domains of disparities between trustworthy evidence-based guidelines and less trustworthy guidelines.

指导方针是医疗保健决策的重要工具。值得信赖的指南不仅告知临床医生建议的方向(反对或赞成)和力度(强或弱/有条件),还告知潜在证据的确定性。制定值得信赖的指南需要具有临床和方法学专业知识的小组成员,他们考虑患者的价值观和偏好。遵守可信度标准的情况仍然不尽相同;因此,临床医生应该能够区分值得信赖和不值得信赖的指南。在本文中,我们提供了值得信赖的循证指南和不太值得信赖的指南之间的八个差异领域。
{"title":"Trustworthy evidence-based versus untrustworthy guidelines: detecting the difference.","authors":"João Pedro Lima,&nbsp;Wimonchat Tangamornsuksan,&nbsp;Gordon H Guyatt","doi":"10.1136/fmch-2023-002437","DOIUrl":"10.1136/fmch-2023-002437","url":null,"abstract":"<p><p>Guidelines are essential tools in healthcare decision-making. Trustworthy guidelines inform clinicians not only on the direction (against or in favour) and strength (strong or weak/conditional) of recommendations but also on the certainty of the underlying evidence. Developing trustworthy guidelines requires panellists with clinical and methodological expertise who consider patients' values and preferences. Adherence to trustworthiness standards remains variable; clinicians should, therefore, be able to distinguish trustworthy from untrustworthy guidelines. In this paper, we offer eight domains of disparities between trustworthy evidence-based guidelines and less trustworthy guidelines.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"11 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/7d/fmch-2023-002437.PMC10565152.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41139475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
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Family Medicine and Community Health
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