PDF(Pubmed)
Abstract：
BACKGROUND: Early detection of long-term, often asymptomatic, middle ear infection in young Aboriginal and Torres Strait Islander children is more likely to be achieved when ear health and hearing checks are routinely undertaken in primary healthcare. Evidence consistently demonstrates the adverse impacts of this condition on the development and wellbeing of children and their families. We aimed to develop feasible, evidence- and consensus-based primary healthcare recommendations addressing the components and timing of ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years, not already known to have, nor being actively managed for, ear and hearing problems.
METHODS: A 22-person working group comprising Aboriginal and Torres Strait Islander and non-Indigenous members from the primary healthcare, ear, hearing, and research sectors provided guidance of the project. A systematic scoping review addressed research questions relating to primary health ear health and hearing checks for Aboriginal and Torres Strait Islander and other populations at increased risk of persistent ear health problems. Twelve primary studies and eleven guidelines published between 1998 and 2020 were identified and reviewed. Quality and certainty of evidence and risk of bias ratings were completed for studies and guidelines. In the absence of certain and direct evidence, findings and draft recommendations were presented for consensus input to a 79-member expert panel using a modified e-Delphi process. Recommendations were finalised in consultation with working group members and presented to expert panel members for input on considerations relating to implementation.
RESULTS: Overall, the quality, certainty, and directness of evidence in the studies and guidelines reviewed was low. However, the findings provided a basis and structure for the draft recommendations presented during the consensus-building process. After two e-Delphi rounds, seven goals and eight recommendations on the components and timing of Ear Health and Hearing Checks in primary healthcare for young Aboriginal and Torres Strait Islander children were developed.
CONCLUSIONS: The systematic scoping review and consensus-building process provided a pragmatic approach for producing strong recommendations within a reasonably short timeframe, despite the low quality and certainty of evidence, and paucity of studies pertaining to primary healthcare settings.
METHODS: A 22-person working group comprising Aboriginal and Torres Strait Islander and non-Indigenous members from the primary healthcare, ear, hearing, and research sectors provided guidance of the project. A systematic scoping review addressed research questions relating to primary health ear health and hearing checks for Aboriginal and Torres Strait Islander and other populations at increased risk of persistent ear health problems. Twelve primary studies and eleven guidelines published between 1998 and 2020 were identified and reviewed. Quality and certainty of evidence and risk of bias ratings were completed for studies and guidelines. In the absence of certain and direct evidence, findings and draft recommendations were presented for consensus input to a 79-member expert panel using a modified e-Delphi process. Recommendations were finalised in consultation with working group members and presented to expert panel members for input on considerations relating to implementation.
RESULTS: Overall, the quality, certainty, and directness of evidence in the studies and guidelines reviewed was low. However, the findings provided a basis and structure for the draft recommendations presented during the consensus-building process. After two e-Delphi rounds, seven goals and eight recommendations on the components and timing of Ear Health and Hearing Checks in primary healthcare for young Aboriginal and Torres Strait Islander children were developed.
CONCLUSIONS: The systematic scoping review and consensus-building process provided a pragmatic approach for producing strong recommendations within a reasonably short timeframe, despite the low quality and certainty of evidence, and paucity of studies pertaining to primary healthcare settings.
摘要：
背景：早期发现长期，通常无症状，在初级卫生保健中常规进行耳部健康和听力检查时,年轻土著和托雷斯海峡岛民儿童中耳感染的可能性更大.证据一致表明，这种情况对儿童及其家庭的发展和福祉产生不利影响。我们的目标是开发可行的，基于证据和共识的初级医疗保健建议，涉及6岁以下原住民和托雷斯海峡岛民儿童的耳朵健康和听力检查的组成部分和时机，还不知道有，也没有积极管理，耳朵和听力问题。
方法：由土著和托雷斯海峡岛民以及来自初级卫生保健的非土著成员组成的22人工作组，耳朵,听力,研究部门为该项目提供了指导。一项系统的范围审查研究了与原住民和托雷斯海峡岛民以及其他持续存在耳朵健康问题风险增加的人群的初级健康耳朵健康和听力检查有关的研究问题。确定并审查了1998年至2020年之间发表的12项主要研究和11项指南。完成了研究和指南的证据质量和确定性以及偏倚风险评级。在缺乏某些直接证据的情况下,使用修改后的e-Delphi程序,向79名成员的专家小组提交了研究结果和建议草案,以获得共识意见.建议是在与工作组成员协商后最后确定的，并提交给专家小组成员，以就与执行有关的考虑提出意见。
结果：总体而言，质量,确定性，在所审查的研究和指南中,证据的直接性很低.然而,调查结果为建立共识过程中提出的建议草案提供了基础和结构。经过两次E-Delphi测试,针对初级卫生保健中针对年轻土著和托雷斯海峡岛民儿童的耳朵健康和听力检查的组成部分和时间制定了7项目标和8项建议。
结论：系统范围审查和建立共识过程为在合理的短时间内提出强有力的建议提供了一种务实的方法，尽管证据的质量和确定性都很低，以及缺乏与初级医疗保健环境有关的研究。
方法：由土著和托雷斯海峡岛民以及来自初级卫生保健的非土著成员组成的22人工作组，耳朵,听力,研究部门为该项目提供了指导。一项系统的范围审查研究了与原住民和托雷斯海峡岛民以及其他持续存在耳朵健康问题风险增加的人群的初级健康耳朵健康和听力检查有关的研究问题。确定并审查了1998年至2020年之间发表的12项主要研究和11项指南。完成了研究和指南的证据质量和确定性以及偏倚风险评级。在缺乏某些直接证据的情况下,使用修改后的e-Delphi程序,向79名成员的专家小组提交了研究结果和建议草案,以获得共识意见.建议是在与工作组成员协商后最后确定的，并提交给专家小组成员，以就与执行有关的考虑提出意见。
结果：总体而言，质量,确定性，在所审查的研究和指南中,证据的直接性很低.然而,调查结果为建立共识过程中提出的建议草案提供了基础和结构。经过两次E-Delphi测试,针对初级卫生保健中针对年轻土著和托雷斯海峡岛民儿童的耳朵健康和听力检查的组成部分和时间制定了7项目标和8项建议。
结论：系统范围审查和建立共识过程为在合理的短时间内提出强有力的建议提供了一种务实的方法，尽管证据的质量和确定性都很低，以及缺乏与初级医疗保健环境有关的研究。
