非洲临床环境中的儿科手术镇静:非洲提供者镇静实践的混合方法研究

IF 1.4 4区 医学 Q3 EMERGENCY MEDICINE
Megan L. Schultz , Andrew Melby , Rebecca Gray , Faye M. Evans , Sarah Benett , Michelle L. Niescierenko
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引用次数: 0

摘要

背景尽管对儿童的紧急护理非常有用,但人们对非洲的儿科手术镇静实践知之甚少。本研究描述了使用儿科程序镇静的非洲医疗提供者的临床经验,包括临床适应症、药物、不良事件、培训、临床指南使用和舒适度。本研究的目的是描述非洲资源有限环境中的儿童镇静实践,并确定提供安全儿童镇静的潜在障碍。方法这项混合方法研究使用半结构化访谈描述了非洲提供者的儿科程序镇静实践。有目的的抽样用于确定在非洲资源有限的环境中工作的关键信息提供者,涵盖广泛的地理、经济和专业范围。收集了关于提供者背景和镇静实践的定量数据,同时收集了关于儿童程序镇静的感知障碍的定性数据,以及在其环境中改进儿童镇静实践的建议。所有访谈都被转录、编码,并针对主要主题进行分析。结果38名关键信息员参与,代表19个国家和麻醉、外科、儿科、重症监护、急诊医学和全科医学专业。儿童镇静最常见的适应症是影像学(42%),最常见的药物是氯胺酮(92%),缺氧是最常见的不良事件(61%)。尽管92%的关键线人表示儿科手术镇静对他们的实践至关重要,但只有一半的人表示感觉受到了充分的训练。在他们的环境中,关于儿童安全镇静障碍的三个主要定性主题是:缺乏资源,缺乏教育,以及站点和提供者之间缺乏标准化。结论这项研究的结果表明,培训专门的儿童镇静团队,创建便携式“儿童镇静试剂盒”,并制定当地相关的儿童镇静指南,可能有助于减少目前在资源有限的非洲环境中提供安全儿童镇静的障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pediatric procedural sedation in African clinical settings: A mixed methods study of African providers’ sedation practices

Background

Little is known about the practice of pediatric procedural sedation in Africa, despite being incredibly useful to the emergency care of children. This study describes the clinical experiences of African medical providers who use pediatric procedural sedation, including clinical indications, medications, adverse events, training, clinical guideline use, and comfort level. The goals of this study are to describe pediatric sedation practices in resource-limited settings in Africa and identify potential barriers to the provision of safe pediatric sedation.

Methods

This mixed methods study describes the pediatric procedural sedation practices of African providers using semi-structured interviews. Purposive sampling was used to identify key informants working in African resource-limited settings across a broad geographic, economic, and professional range. Quantitative data about provider background and sedation practices were collected concurrently with qualitative data about perceived barriers to pediatric procedural sedation and suggestions to improve the practice of pediatric sedation in their settings. All interviews were transcribed, coded, and analyzed for major themes.

Results

Thirty-eight key informants participated, representing 19 countries and the specialties of Anesthesia, Surgery, Pediatrics, Critical Care, Emergency Medicine, and General Practice. The most common indication for pediatric sedation was imaging (42%), the most common medication used was ketamine (92%), and hypoxia was the most common adverse event (61%). Despite 92% of key informants stating that pediatric procedural sedation was critical to their practice, only half reported feeling adequately trained. The three major qualitative themes regarding barriers to safe pediatric sedation in their settings were: lack of resources, lack of education, and lack of standardization across sites and providers.

Conclusions

The results of this study suggest that training specialized pediatric sedation teams, creating portable “pediatric sedation kits,” and producing locally relevant pediatric sedation guidelines may help reduce current barriers to the provision of safe pediatric sedation in resource-limited African settings.

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来源期刊
CiteScore
2.40
自引率
7.70%
发文量
78
审稿时长
85 days
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