■我们进行了这项系统审查,以确定当前国际上跨性别和性别多样化(TGD)人群护理指南中急诊科(ED)的相关建议。
■使用PRISMA标准,我们对OvidMedline进行了系统搜索,EMBASE,和CINAHL,并手动搜索2021年6月31日之前发布的临床实践指南(CPG)或最佳实践声明(BPS)的灰色文献。如果文章是英文的,包括任何年龄的TGD人群的医疗或辅助医疗护理,在任何设置中,地区或国家,并且在范围上是国家或国际的。排除标准包括初级研究,评论文章,叙述性评论或其他非CPG或BPS,社论,或者给编辑的信,区域或个别医院范围的文章,非医学文章,文章不是英文的,或者是否存在最新版本的指南。确定了与ED护理相关的建议,记录,并使用AGREE-II和AGREE-REX标准进行质量评估。我们对评分者间可靠性进行了类间相关系数。在急诊室期间,针对相关护理点编写了建议(分诊,注册,房间,调查,等。).
■我们筛选了1,658篇独特文章,1,555人被排除在外。在其余103篇文章中,七个有与急诊室护理相关的建议,共10条建议。四项准则和八项建议是高质量的。其中包括测试建议,预防,转介,并提供艾滋病毒暴露后预防,以及对TGD人的文化胜任护理。
这是迄今为止最全面的指南和最佳实践声明,为EDTGD患者的护理提供建议。有几个可以立即采取行动。也有许多机会建立社区主导的研究计划,以综合和告知在紧急情况下照顾TGD人员的全面专门指南。
UNASSIGNED: We conducted this systematic
review to identify emergency department (ED) relevant recommendations in current guidelines for care of transgender and gender-diverse (TGD) people internationally.
UNASSIGNED: Using PRISMA criteria, we did a systematic search of Ovid Medline, EMBASE, and CINAHL and a hand search of gray literature for clinical practice guidelines (CPG) or best practice statements (BPS) published until June 31, 2021. Articles were included if they were in English, included medical or paramedical care of TGD populations of any age, in any setting, region or nation, and were national or international in scope. Exclusion criteria included primary research studies,
review articles, narrative reviews or otherwise non-CPG or BPS, editorials, or letters to the editor, articles of regional or individual hospital scope, non-medical articles, articles not in English, or if a more recent version of the guideline existed. Recommendations relevant to ED care were identified, recorded, and assessed for quality using the AGREE-II and AGREE-REX criteria. We performed interclass correlation coefficient for interrater reliability. Recommendations were coded for the relevant point of care while in the ED (triage, registration, rooming, investigations, etc.).
UNASSIGNED: We screened 1,658 unique articles, and 1,555 were excluded. Of the remaining 103 articles included, seven had recommendations relevant to care in the ED, comprising a total of 10 recommendations. Four guidelines and eight recommendations were of high quality. They included recommendations for testing, prevention, referral, and provision of post-exposure prophylaxis for HIV, and culturally competent care of TGD people.
UNASSIGNED: This is the most comprehensive
review to date of guidelines and best practices statements offering recommendations for care of ED TGD patients, and several are immediately actionable. There are also many opportunities to build community-led research programs to synthesize and inform a comprehensive dedicated guideline for care of TGD people in emergency settings.