Developing and introducing evidence based clinical practice guidelines for serious illness in Kenya.
Developing and introducing evidence based clinical practice guidelines for serious illness in Kenya.
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DOI：
10.1136/adc.2007.126508
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发表时间：
2008-09
影响因子：
5.2
通讯作者：
English M
中科院分区：
文献类型：
--
作者：
Irimu G;Wamae A;Wasunna A;Were F;Ntoburi S;Opiyo N;Ayieko P;Peshu N;English M
大多数发展中国家的5岁以下儿童死亡率仍然很高，但如果将现有知识付诸实践，许多死亡是可以避免的。对于住院的重病儿童，低收入国家的调查通常显示诊断和治疗不正确，处方错误频繁。为了帮助改善医院对住院儿童死亡主要原因的管理，我们制定了简单的临床指南，供低收入环境的肯尼亚使用。参与过程中，我们用来适应现有的世界卫生组织的材料，并进一步制定和建立支持这样的准则进行了讨论。为了便利使用这些准则，我们还为准则的传播和执行制定了工作助手和为期5.5天的培训方案。我们试图将我们的培训建立在围绕成人学习的现代理论基础上，并故意试图以低成本在每个机构内培训“临界质量”的卫生工作者。我们的经验表明，通过持续努力，有可能在相关利益攸关方的参与下，为重病儿童的紧急和初步医院护理制定当地拥有的适当临床实践指南。早期经验表明，为支持准则而开展的培训尽管对许多既定做法提出了挑战，但受到欢迎，适合肯尼亚一线卫生工作者的需要，而且可行。据我们所知，在肯尼亚所述的进程是全球为实施世卫组织/儿童基金会儿童疾病综合管理办法中住院或转诊护理部分所作的少数尝试之一。然而，指南的传播和实施是否会提高我们环境中的护理质量还有待观察。
The under-5 mortality rate in most developing countries remains high yet many deaths could be averted if available knowledge was put into practice. For seriously ill children in hospital investigations in low-income countries commonly demonstrate incorrect diagnosis and treatment and frequent prescribing errors. To help improve hospital management of the major causes of inpatient childhood mortality we developed simple clinical guidelines for use in Kenya, a low-income setting. The participatory process we used to adapt existing WHO materials and further develop and build support for such guidelines is discussed. To facilitate use of the guidelines we also developed job-aides and a 5.5 days training programme for their dissemination and implementation. We attempted to base our training on modern theories around adult learning and deliberately attempted to train a ‘critical mass’ of health workers within each institution at low cost. Our experience suggests that with sustained effort it is possible to develop locally owned, appropriate clinical practice guidelines for emergency and initial hospital care for seriously ill children with involvement of pertinent stake holders throughout. Early experience suggests that the training developed to support the guidelines, despite the fact that it challenges many established practices, is well received, appropriate to the needs of front line health workers in Kenya and feasible. To our knowledge the process described in Kenya is among a handful of attempts globally to implement inpatient or referral care components of WHO / UNICEF’s Integrated Management of Childhood Illness approach. However, whether guideline dissemination and implementation result in improved quality of care in our environment remains to be seen.
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影响因子：
120.7
作者：
DAVIS, DA;THOMSON, MA;HAYNES, RB
通讯作者：
HAYNES, RB
影响因子：
158.5
作者：
Berkley, JA;Lowe, BS;Scott, JAG
通讯作者：
Scott, JAG
影响因子：
158.5
作者：
MARSH, K;FORSTER, D;SNOW, R
通讯作者：
SNOW, R
影响因子：
168.9
作者：
English, M;Esamai, F;Peshu, N
通讯作者：
Peshu, N
影响因子：
5.2
作者：
Armon, K;Stephenson, T;Werneke, U
通讯作者：
Werneke, U