• 文章类型: Journal Article
    澳大利亚复发性妊娠丢失(RPL)的调查和管理指南的第二部分为RPL的管理提供了基于证据的指导。提供了遗传性和获得性血栓形成倾向对RPL的影响以及临床管理建议。自身免疫因素,包括人类白细胞抗原,细胞因子,抗核抗体和腹腔抗体,并对管理指导进行了讨论。感染,详细讨论了RPL的炎症和子宫内膜原因。环境和生活方式因素,概述了男性因素和无法解释的原因。所有基于证据的陈述都提供了证据水平和共识等级。
    Part II of the Australasian guideline for the investigation and management of recurrent pregnancy loss (RPL) provides evidence-based guidance on the management of RPL provided. The implications of inherited and acquired thrombophilia with respect to RPL and suggestions for clinical management are provided. Autoimmune factors, including human leukocyte antigen, cytokines, antinuclear antibodies and coeliac antibodies, and guidance for management are discussed. Infective, inflammatory and endometrial causes of RPL are discussed in detail. Environmental and lifestyle factors, male factor and unexplained causes are outlined. Levels of evidence and grades of consensus are provided for all evidence-based statements.
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  • 文章类型: Journal Article
    欧洲已经制定了复发性妊娠丢失(RPL)的调查和管理指南,美国和英国,但目前没有澳大利亚指南。澳大利亚生殖内分泌学和不孕症共识专家小组审判证据小组编写了一份两部分指南,为RPL的管理提供指导。在第一部分染色体中,解剖学,概述了内分泌因素以及相关的临床管理建议,证据水平和共识等级。在第二部分血栓形成倾向中,自身免疫因素,感染,炎症,和子宫内膜的原因,环境和生活方式因素,男性因素和无法解释的原因将被概述。
    Guidelines for the investigation and management of recurrent pregnancy loss (RPL) have been developed in Europe, USA and UK, but there is currently no Australasian guideline. The Australasian Certificate of Reproductive Endocrinology and Infertility Consensus Expert Panel on Trial Evidence group has prepared a two-part guideline to provide guidance on the management of RPL. In Part I chromosomal, anatomical, and endocrine factors are outlined along with relevant recommendations for clinical management, levels of evidence and grades of consensus. In Part II thrombophilia, autoimmune factors, infective, inflammatory, and endometrial causes, environmental and lifestyle factors, male factor and unexplained causes will be outlined.
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  • 文章类型: English Abstract
    Providing adequate and balanced nutrition for preterm infants, especially extremely/very preterm infants, is the material basis for promoting their normal growth and development and improving long-term prognosis. Enteral nutrition is the best way to feed preterm infants. Previous systematic reviews have shown that using evidence-based standardized feeding management strategies can effectively promote the establishment of full enteral feeding, reduce the duration of parenteral nutrition, improve the nutritional outcomes of preterm infants, and not increase the risk of necrotizing enterocolitis or death. Based on relevant research in China and overseas, the consensus working group has developed 20 recommendations in 5 aspects including the goal of enteral nutrition, transitioning to enteral nutrition, stable growth period enteral nutrition, supplementation of special nutrients, and monitoring of enteral nutrition for preterm infants, using the Grading of Recommendations Assessment, Development and Evaluation. The aim is to provide recommendations for healthcare professionals involved in the management of enteral nutrition for preterm infants, in order to improve the clinical outcomes of preterm infants.
    为早产儿尤其是极/超早产儿提供充足和均衡的营养是促进其正常生长发育和改善远期预后的物质基础,肠内营养是最佳的营养方式。既往系统回顾性分析显示使用基于循证医学的标准化喂养管理策略可有效促进全肠内喂养的建立,缩短肠外营养时间,改善早产儿的营养结局,而不增加坏死性小肠结肠炎或死亡的发生风险。基于国内外相关研究,该共识制订组采用证据推荐分级的评估、制订与评价方法(Grading of Recommendations Assessment, Development and Evaluation),从早产儿肠内营养的目标、过渡期的肠内营养、稳定生长期的肠内营养、肠内特殊营养素的补充及肠内营养的监测等5个方面提出20条推荐意见,旨在为相关从业人员提供早产儿肠内营养管理的建议,以改善早产儿的临床结局。.
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  • 文章类型: Journal Article
    目的:静脉血栓栓塞是产后最严重的并发症之一,国际社会有各种预防血栓的指南。这项研究将美国妇产科学院(ACOG)和皇家妇产科学院(RCOG)的产后静脉血栓预防建议与现实生活中的临床实践进行了比较。
    方法:在三级护理中心对1000名产后妇女进行数据分析,重点是患者的人口统计学,静脉血栓栓塞危险因素,和临床血栓预防实践。在ACOG和RCOG指南之间比较了患者特定的危险因素,评估低分子量肝素的剂量和持续时间。遵守准则,治疗不足/过度治疗率,和所需数量的预充式低分子量肝素注射器进行了评估。
    结果:在ACOG和RCOG指南之间观察到显著差异,特别是在低分子量肝素的剂量和持续时间。临床方法的共识率约为53%,不一致倾向于治疗不足(RCOG)和治疗过度(ACOG)。根据ACOG,与RCOG指南相比,所需的预填充低分子量肝素注射器的数量明显更高。
    结论:美国妇产科学院和皇家妇产科学院的产后静脉血栓栓塞预防指南显示出实质性差异,导致临床实践的变化。进一步研究静脉血栓栓塞危险因素的意义对于改进风险评估工具和完善妊娠相关静脉血栓栓塞预防的指南建议至关重要。
    OBJECTIVE: Venous thromboembolism is one of the most serious complications of the postpartum period, and international societies have various thromboprophylaxis guidelines for its prevention. This study compares postpartum venous thromboprophylaxis recommendations from the American College of Obstetrics and Gynecology (ACOG) and the Royal College of Obstetricians and Gynecologists (RCOG) with real-life clinical practices.
    METHODS: Data analysis of 1000 postpartum women at a tertiary care center focused on patient demographics, venous thromboembolism risk factors, and clinical thromboprophylaxis practices. Patient-specific risk factors were compared between ACOG and RCOG guidelines, assessing Low-Molecular-Weight-Heparin dosages and durations. Guideline compliance, undertreatment/overtreatment rates, and the required number of prefilled Low-Molecular-Weight-Heparin syringes were evaluated.
    RESULTS: Significant discrepancies were observed between ACOG and RCOG guidelines, particularly in Low Molecular Weight Heparin dosages and durations. Consensus rates with clinical approaches were around 53%, with inconsistencies leaning towards undertreatment (RCOG) and overtreatment (ACOG). The number of required prefilled Low-Molecular-Weight-Heparin syringes was notably higher according to ACOG compared to RCOG guidelines.
    CONCLUSIONS: Postpartum Venous thromboembolism prophylaxis guidelines from American College of Obstetrics and Gynecology and Royal College of Obstetricians and Gynecologists exhibit substantial differences, leading to variations in clinical practice. Further research on the significance of Venous thromboembolism risk factors is essential for improving risk assessment tools and refining guideline recommendations for pregnancy-related Venous thromboembolism prevention.
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  • 文章类型: Journal Article
    围产期抑郁和焦虑是影响新加坡约十分之一女性的公共卫生问题,有明确的证据表明与母亲和孩子的各种不良结局有关,包括低出生体重,早产和对婴儿神经发育的负面影响,气质和行为。成立了一个工作组来制定建议,以解决患有抑郁症和焦虑症的妇女的围产期心理健康需求。该方法基础广泛,旨在纳入易于适用于支持育龄妇女的护理提供者网络的整体方法。
    评级和建议评估,制定和评估(等级)决策框架的证据被用来制定这些准则。由围产期心理健康和产科医学领域的专家组成的工作组成员审议了目标人群的公共卫生需求,并回顾了2001年至2022年发表的与改善孕前和围产期抑郁和焦虑女性健康相关的文献。
    举行了一次共识会议,涉及更广泛的专业网络,包括家庭医生,儿科医生,精神病医生,新加坡的社会服务和健康促进委员会。
    制定了十项共识声明,专注于实现抑郁症和焦虑症妇女围产期最佳心理健康的总体目标。它们涉及对孕前心理健康的认识和建议,筛查和评估,优化护理和治疗。建议对遭受严重孕产妇事件的妇女特别考虑,为有特殊需要的青少年和妇女量身定制护理,解决婴儿心理健康需求。
    UNASSIGNED: Perinatal depression and anxiety are public health concerns affecting approximately 1 in 10 women in Singapore, with clear evidence of association with various adverse outcomes in mother and child, including low birthweight, preterm birth and negative impact on infant neurodevelopment, temperament and behaviour. A workgroup was formed to develop recommendations to address the perinatal mental health needs of women with depression and anxiety. The approach was broad-based and aimed to incorporate holistic methods that would be readily applicable to the network of care providers supporting childbearing women.
    UNASSIGNED: The Grading and Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to draw these guidelines. Workgroup members-comprising experts in the field of perinatal mental health and obstetric medicine-deliberated on the public health needs of the target population, and reviewed literature published from 2001 to 2022 that were relevant to improve the well-being of women with depression and anxiety during the preconception and perinatal periods.
    UNASSIGNED: A consensus meeting was held involving a wider professional network, including family physicians, paediatricians, psychiatrists, social services and the Health Promotion Board in Singapore.
    UNASSIGNED: Ten consensus statements were developed, focusing on the overall aim of achieving optimal perinatal mental health for women with depression and anxiety. They relate to awareness and advice on preconception mental health, screening and assessment, optimising care and treatment. Special considerations were recommended for women who suffered severe maternal events, tailoring care for adolescents and women with special needs, and addressing infant mental health needs.
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  • 文章类型: Journal Article
    目的:波兰妇科医生和妇产科医师学会(PSGO)泌尿系妇科委员会任命的团队的目的是制定本跨学科指南,用于诊断盆腔器官脱垂(POP)在女性中,根据现有文献,专业知识和意见,以及日常练习。
    方法:文献综述,包括当前的国际准则和PSGO关于持久性有机污染物的早期建议(2010-2020年),进行了。
    结果:POP患者的诊断评估步骤,细分为初始诊断和专门诊断,已提交。还列出了专门诊断评估的适应症。在手术治疗的情况下,患者可以仅基于初始诊断或在完成专门诊断的某些要素之后被转诊。
    结论:由于数据不确定,POP诊断过程的范围是针对每位患者的个性化诊断,并取决于患者报告的症状,初步诊断结果,手术史,管理计划,设备的可用性,和成本。
    OBJECTIVE: The aim of the team appointed by the Board of the Urogynecology Section of the Polish Society of Gynecologists and Obstetricians (PSGO) was to develop this interdisciplinary Guideline for the diagnostic assessment of pelvic organ prolapse (POP) in women, based on the available literature, expert knowledge and opinion, as well as everyday practice.
    METHODS: A review of the literature, including current international guidelines and earlier PSGO recommendations (2010-2020) about POP, was conducted.
    RESULTS: The steps of the diagnostic assessment for patients with POP, subdivided into initial and specialized diagnostics, have been presented. Indications for specialized diagnostic assessment have also been listed. In case of surgical treatment, the patient may be referred solely based on the initial diagnostics or after certain elements of the specialized diagnostics have been completed.
    CONCLUSIONS: Due to inconclusive data, the scope of the diagnostic process for POP is individualized for each patient and depends on patient-reported symptoms, initial diagnostic findings, surgical history, management plan, availability of the equipment, and cost.
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  • 文章类型: Journal Article
    背景:最近几十年揭示了有关未降睾丸AQ2(UDT)的生育力和潜在恶性肿瘤的新科学知识。因此,许多指南改变了他们关于治疗时机的建议,目标是更早的手术时间。
    方法:我们分析了新诊断的数量,并在报销的德国医院强制性年度报告中提供的预定年龄组进行了手术。信息“-2006年至2020年之间的工具。
    结果:总体而言,对124,741例病例进行分析。我们显示,第一年进行的手术每年略有增加2%,直到2011年为止主要增加,第一年和第四年之间的手术数量恒定,而在生活的5至14年之间的手术减少,直到2009年每年减少3%。
    结论:即使我们的研究结果表明指南的建议越来越适应,仍有相当多的患者接受后期治疗。需要对后者的原因和情况进行更多的研究。
    BACKGROUND: The last decades revealed new scientific knowledge regarding the fertility and potential malignancy of undescended testis AQ2(UDT). Accordingly, many guidelines changed their recommendation concerning timing of therapy, with the goal of an earlier time of surgery.
    METHODS: We analyzed the number of new diagnosis and performed surgeries in predefined age groups provided by the obligatory annual reports of German hospitals in the reimbursement.INFO\"-tool between 2006 and 2020.
    RESULTS: Overall, 124,741 cases were analyzed. We showed a slight increase in performed surgeries in the first year by 2% per year with a main increase till 2011, a constant number of surgeries between first and 4th year and a decrease of surgeries between 5 and 14th year of living with a main decrease till 2009 by 3% per year.
    CONCLUSIONS: Even if our results illustrate an increasing adaption of the guideline\'s recommendation, there is still a significant number of patients who receive later treatment. More research about the reasons and circumstances for the latter is needed.
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  • 文章类型: Journal Article
    背景:孕前健康有可能改善父母,怀孕和婴儿结局。本范围审查旨在(1)提供战略概述,政策,指导方针,框架,以及英国和爱尔兰提供的解决孕前健康和护理的建议,确定有针对性的常见方法和健康影响因素;(2)进行审核,以探索医疗保健专业人员对范围审查中发现的资源的认识和使用,验证和语境相关的北爱尔兰的发现。
    方法:灰色文献资源是通过Google高级搜索确定的,Nice,OpenAire,ProQuest和相关的公共卫生和政府网站。如果已发布,则包括资源,reviewed,或在2011年1月至2022年5月之间更新。将数据提取到Excel中并使用NVivo进行编码。审查设计包括“健康生殖年”患者和公众参与和参与咨询小组的参与。
    结果:搜索确定了273个资源,随后对北爱尔兰的医疗保健专业人员进行的审计发现了另外五个与孕前健康相关的资源。确定了广泛的资源类型,孕前健康通常不是审查资源的唯一重点。资源提出了改善孕前健康和护理的方法,例如需要提高意识和获得护理的机会,概念前的咨询,多学科合作,并采用生命课程方法。许多行为(例如,叶酸摄入量,吸烟),生物医学(例如,精神和身体健康状况),以及环境和社会(例如,剥夺)因素在审查的资源中进行了识别和处理。特别是,先前存在的身体健康状况经常被提及,解决心理因素和心理健康的资源较少。总的来说,有更多的关注女性,而不是男人的,行为。
    结论:本范围审查综合了英国和爱尔兰现有的资源,以确定影响孕前健康和护理的各种常见方法和因素。需要努力落实已确定的资源(例如,战略,准则),以支持育龄人群获得孕前护理并优化其孕前健康。
    BACKGROUND: Preconception health has the potential to improve parental, pregnancy and infant outcomes. This scoping review aims to (1) provide an overview of the strategies, policies, guidelines, frameworks, and recommendations available in the UK and Ireland that address preconception health and care, identifying common approaches and health-influencing factors that are targeted; and (2) conduct an audit to explore the awareness and use of resources found in the scoping review amongst healthcare professionals, to validate and contextualise findings relevant to Northern Ireland.
    METHODS: Grey literature resources were identified through Google Advanced Search, NICE, OpenAire, ProQuest and relevant public health and government websites. Resources were included if published, reviewed, or updated between January 2011 and May 2022. Data were extracted into Excel and coded using NVivo. The review design included the involvement of the \"Healthy Reproductive Years\" Patient and Public Involvement and Engagement advisory panel.
    RESULTS: The searches identified 273 resources, and a subsequent audit with healthcare professionals in Northern Ireland revealed five additional preconception health-related resources. A wide range of resource types were identified, and preconception health was often not the only focus of the resources reviewed. Resources proposed approaches to improve preconception health and care, such as the need for improved awareness and access to care, preconceptual counselling, multidisciplinary collaborations, and the adoption of a life-course approach. Many behavioural (e.g., folic acid intake, smoking), biomedical (e.g., mental and physical health conditions), and environmental and social (e.g., deprivation) factors were identified and addressed in the resources reviewed. In particular, pre-existing physical health conditions were frequently mentioned, with fewer resources addressing psychological factors and mental health. Overall, there was a greater focus on women\'s, rather than men\'s, behaviours.
    CONCLUSIONS: This scoping review synthesised existing resources available in the UK and Ireland to identify a wide range of common approaches and factors that influence preconception health and care. Efforts are needed to implement the identified resources (e.g., strategies, guidelines) to support people of childbearing age to access preconception care and optimise their preconception health.
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  • 文章类型: Journal Article
    幼儿期是生长发育的关键时期。在此期间采取健康的生活方式行为是未来福祉的基础,并为预防非传染性疾病提供了最佳保护。新加坡的研究表明,许多幼儿没有达到体育锻炼的建议,久坐的行为和睡眠。成立了一个工作组,为婴儿照顾者制定建议,幼儿和学龄前儿童(年龄<7岁)如何在每日24小时内整合有益活动,以实现最佳发育和代谢健康。
    建议评估的分级,开发和评估(等级)-采用了ADOLOPMENT方法,建议的适应或从头发展。国际和国家准则被用作参考,通过电子搜索PubMed,对截至2021年9月的文献综述进行了更新,Embase和Cochrane中央对照试验登记册(CENTRAL)数据库。
    针对每个年龄组制定了四个共识声明:婴儿,幼儿和学龄前儿童。声明的重点是通过定期的体育锻炼来实现良好的代谢健康,限制久坐行为,达到充足的睡眠和积极的饮食习惯。第13项共识声明承认,在24小时内整合这些活动有助于获得最佳结果。
    这组建议指导和鼓励新加坡婴儿的照顾者,幼儿和学龄前儿童在每个24小时内采取有益的生活方式活动。
    UNASSIGNED: Early childhood is a critical period for growth and development. Adopting healthy lifestyle behaviours during this period forms the foundation for future well-being and offers the best protection against non-communicable diseases. Singapore studies have shown that many young children are not achieving the recommendations on physical activity, sedentary behaviour and sleep. A workgroup was set up to develop recommendations for caregivers of infants, toddlers and preschoolers (aged <7 years) on how to integrate beneficial activities within a daily 24-hour period for optimal development and metabolic health.
    UNASSIGNED: The Grading of Recommendations Assessment, Development and Evaluation (GRADE)- ADOLOPMENT approach was employed for adoption, adaption or de novo development of recommendations. International and national guidelines were used as references, and an update of the literature reviews up to September 2021 was conducted through an electronic search of PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases.
    UNASSIGNED: Four consensus statements were developed for each age group: infants, toddlers and preschoolers. The statements focus on achieving good metabolic health through regular physical activity, limiting sedentary behaviour, achieving adequate sleep and positive eating habits. The 13th consensus statement recognises that integration of these activities within a 24-hour period can help obtain the best results.
    UNASSIGNED: This set of recommendations guides and encourages caregivers of Singapore infants, toddlers and preschoolers to adopt beneficial lifestyle activities within each 24-hour period.
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  • 文章类型: Journal Article
    背景:与白人女性相比,黑人女性被诊断为子宫内膜异位症的可能性较小。没有证实的生物学基础,所以这可能代表了围绕医疗保健的结构性障碍。缺乏证据探索种族与症状或护理和治疗经验之间的联系。
    目的:在子宫内膜异位症指南的证据中绘制社会人口统计学差异的记录图。
    方法:纳入研究设置,种族,年龄,在美国国家健康与护理卓越研究所(NICE)NG73(2017)子宫内膜异位症诊断和管理中引用的证据中记录了社会经济地位。包括44项研究,43个样本组来自章节:“体征和症状”,\'信息和支持\',和“诊断”。数据由两名研究人员独立提取。
    结果:没有在初级保健中进行研究。“体征和症状”和“诊断”中引用的证据仅来自三级护理。“信息和支持”包括来自三级保健的9/16研究,7/16通过社区和宣传网络征聘。为了种族,4/44研究正式报告了参与者的种族(三个来自“信息和支持”,一个来自\'诊断\')。在这些中,93%,90%,60%,75%的参与者是白人/白种人(平均79.5%).对于年龄,3/44研究包括青少年。许多研究排除了被认为超过生育年龄的女性。对于社会经济地位,八项研究,全部来自“信息和支持”,以某种形式报告社会经济地位。大多数参与者都受过高等教育。
    结论:这些结果突出了在子宫内膜异位症国家指南中引用的证据中缺少的人口统计学特征。这些与子宫内膜异位症诊断中的不平等现象一致,值得紧急关注。
    BACKGROUND: Women who are black are less likely to be diagnosed with endometriosis than white women. There is no confirmed biological basis, so this likely represents structural barriers around health care. There is a lack of evidence exploring the interface between ethnicity and symptoms or experience of care and treatment.
    OBJECTIVE: To map recording of sociodemographic diversity in the evidence informing an endometriosis guideline.
    METHODS: Inclusion of study setting, ethnicity, age, and socioeconomic status was documented within the evidence cited in National Institute for Health and Care Excellence (NICE) NG73 (2017) Endometriosis diagnosis and management. Included were 44 studies with 43 sample groups from the chapters: \'Signs and Symptoms\', \'Information and Support\', and \'Diagnosis\'. Data were extracted independently by two researchers.
    RESULTS: No studies were conducted in primary care. The evidence cited in \'Signs and Symptoms\' and \'Diagnosis\' was exclusively from tertiary care. \'Information and Support\' included 9/16 studies from tertiary care, and 7/16 recruited through community and advocacy networks. For ethnicity, 4/44 studies formally reported participant ethnicity (three from \'Information and Support\', one from \'Diagnosis\'). In these, 93%, 90%, 60%, and 75% of participants were white/Caucasian (mean 79.5%). For age, 3/44 studies included adolescents. Many studies excluded women who were deemed outside reproductive age. For socioeconomic status, eight studies, all from \'Information and Support\', reported socioeconomic status in some form. The majority of participants were tertiary educated.
    CONCLUSIONS: These results highlight the missing demographics within evidence cited in a national guideline for endometriosis. These align with documented inequities in diagnosis of endometriosis and warrant urgent attention.
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