目的:病假用药指导(SDMG)涉及在可能导致低血压等并发症的急性疾病的背景下扣留或调整特定的药物,急性肾损伤(AKI),或低血糖。我们试图在临床专家之间就SDMG的建议达成共识,这些建议可以在未来的干预研究中进行研究。
方法:遵循Delphi研究报告指南的改进的Delphi流程。
方法:通过目的性和滚雪球抽样招募了一组具有与SDMG相关专业知识的国际临床医生。对文献进行了范围审查,接下来是三轮连续的发展,精致,对建议进行表决。会议是虚拟和结构化的,以使与会者能够提供他们的意见,并迅速确定优先次序和完善想法。
结果:参与者的意见以同意每个建议的百分比来衡量,而共识被定义为>75%的一致性。
方法:使用计数和百分比汇总定量数据。进行了定性内容分析,以了解围绕建议和与会者提出的任何其他考虑因素进行讨论的背景。
结果:最终小组包括来自四个国家和10个临床学科的26名临床医生参与者。与会者就42项具体建议达成共识:5项关于应引发SDMG的容量耗尽的体征和症状;6项关于应促使与医疗保健提供者紧急接触的体征,包括意识水平降低,严重呕吐,低血压,酮的存在,心动过速,和发烧;14与患者自我管理的情景和策略有关,包括频繁的血糖监测,检查酮,液体摄入,和食物的消费,以防止低血糖。有共识,肾素-血管紧张素系统抑制剂,利尿剂,非甾体抗炎药,钠-葡萄糖协同转运蛋白-2抑制剂,和二甲双胍应暂时停止。参与者建议胰岛素,磺酰脲类,只有当血糖较低时,才会保留美格列丁,如果血糖升高,则基础胰岛素和推注胰岛素增加10-20%。关于在症状缓解后24-48小时内恢复药物治疗以及存在正常饮食模式的六项建议达成了共识。
结论:参与者来自高收入国家,主要是加拿大。结果可能无法推广到其他设置中的实现。
结论:多学科临床医生小组就存在容量耗尽的体征和症状的SDMG建议达成共识。以及这种情况下的自我管理策略和用药说明。这些建议可能会为未来SDMG策略的试验设计提供信息。
Sick day medication guidance (SDMG) involves withholding or adjusting specific medications in the setting of acute illnesses that could contribute to complications such as hypotension, acute kidney injury (AKI), or hypoglycemia. We sought to achieve consensus among clinical experts on recommendations for SDMG that could be studied in future intervention studies.
A modified Delphi process following guidelines for conducting and reporting Delphi studies.
An international group of clinicians with expertise relevant to SDMG was recruited through purposive and snowball sampling. A scoping review of the literature was presented, followed by 3 sequential rounds of development, refinement, and voting on recommendations. Meetings were held virtually and structured to allow the participants to provide their input and rapidly prioritize and refine ideas.
Opinions of participants were measured as the percentage who agreed with each recommendation, whereas consensus was defined as >75% agreement.
Quantitative data were summarized using counts and percentages. A qualitative content analysis was performed to capture the context of the discussion around recommendations and any additional considerations brought forward by participants.
The final panel included 26 clinician participants from 4 countries and 10 clinical disciplines. Participants reached a consensus on 42 specific recommendations: 5 regarding the signs and symptoms accompanying volume depletion that should trigger SDMG; 6 regarding signs that should prompt urgent contact with a health care provider (including a reduced level of consciousness, severe vomiting, low blood pressure, presence of ketones, tachycardia, and fever); and 14 related to scenarios and strategies for patient self-management (including frequent glucose monitoring, checking ketones, fluid intake, and consumption of food to prevent hypoglycemia). There was consensus that renin-angiotensin system inhibitors, diuretics, nonsteroidal anti-inflammatory drugs, sodium/glucose cotransporter 2 inhibitors, and metformin should be temporarily stopped. Participants recommended that insulin, sulfonylureas, and meglitinides be held only if blood glucose was low and that basal and bolus insulin be increased by 10%-20% if blood glucose was elevated. There was consensus on 6 recommendations related to the resumption of medications within 24-48 hours of the resolution of symptoms and the presence of normal patterns of eating and drinking.
Participants were from high-income countries, predominantly Canada. Findings may not be generalizable to implementation in other settings.
A multidisciplinary panel of clinicians reached a consensus on recommendations for SDMG in the presence of signs and symptoms of volume depletion, as well as self-management strategies and medication instructions in this setting. These recommendations may inform the design of future trials of SDMG strategies.