Development and validation of a minimum requirements checklist for snakebite envenoming treatment in the Brazilian Amazonia.
Development and validation of a minimum requirements checklist for snakebite envenoming treatment in the Brazilian Amazonia.
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DOI：
10.1371/journal.pntd.0011921
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发表时间：
2024-01
影响因子：
3.8
通讯作者：
中科院分区：
文献类型：
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目前，抗蛇毒血清是唯一的具体治疗蛇咬伤envenoming。在巴西，超过30%的患者无法在重症监护窗口内获得抗蛇毒血清。因此，研究人员建议将权力下放到社区卫生中心，以减少护理时间并改善发病率和死亡率。目前，没有循证方法来评估卫生单位的抗蛇毒血清治疗能力，也没有安全和有效的抗蛇毒血清管理和临床管理所需的绝对最低限度的供应和工作人员。本研究采用了一种改进的德尔菲法，开发和验证一个清单，以评估卫生单位的最低要求，以充分治疗蛇咬伤envenoming在亚马逊地区的巴西。改进的德尔菲法包括四轮：1）由专家指导委员会迭代制定初步清单; 2）通过专家评审调查对初步清单进行受控反馈; 3）由新专家评审解决未决项目的两阶段名义小组技术; 4）由专家指导委员会完成清单定稿和关闭标准。本研究选择的一致性指标为先验定义为≥ 75%的一致性百分比。一个有效的，可靠的，可行的检查表。开发过程突出了三个主要结果：（1）专家法官对社区卫生中心的定义及其基本项目清单符合巴西卫生部、世卫组织蛇咬伤战略计划和印度蛇咬伤能力一般指南（内部有效性），（2）抗蛇毒血清管理和临床管理的基本项目清单是可行的，并与临床护理文献保持一致（3）当地专家的参与对于制定和实施抗蛇毒血清分散战略至关重要（可行性）。这项研究加入了一套国际证据，倡导权力下放，增加其基本护理项目的定义的价值;在整个护理连续性的培训需求的识别;和示范的有效性，可靠性和可行性，由当地专家参与。就巴西而言，进一步的附加值来自于将清单用于卫生单位核证的潜在用途及其在物流和资源分配方面的应用。未来的研究重点应将此清单应用于巴西亚马逊地区的卫生单位，以确定哪些社区卫生中心能够或可能能够接受抗蛇毒血清，并将此专家驱动的清单和方法转化为其他环境中的蛇咬伤护理或其他疾病在低资源环境中。已经开发并验证了检查表，以提高患者的安全性和在几个领域的护理效果，包括急诊医学，重症监护和手术。巴西卫生部向卫生系统免费提供抗蛇毒血清。因此，AV服务仅限于医院，其中大多数在城市地区，农村、偏远地区和土著居民难以到达。目前，没有循证方法来评估卫生单位的AV治疗能力，也没有绝对最低限度的用品和工作人员是安全和有效的AV管理和临床管理所必需的。在这项研究中，我们的目标是开发和验证一个清单，以评估社区卫生中心的最低要求，以充分治疗蛇咬伤envenoming在亚马逊地区的巴西。这项研究加入了一套国际证据，倡导权力下放，增加其基本护理项目的定义，以人力资源，设备，用品和药品为代表，为偏远地区的SBE患者提供安全有效的治疗。
Currently, antivenoms are the only specific treatment available for snakebite envenoming. In Brazil, over 30% of patients cannot access antivenom within its critical care window. Researchers have therefore proposed decentralizing to community health centers to decrease time-to-care and improve morbidity and mortality. Currently, there is no evidence-based method to evaluate the capacity of health units for antivenom treatment, nor what the absolute minimum supplies and staff are necessary for safe and effective antivenom administration and clinical management. This study utilized a modified-Delphi approach to develop and validate a checklist to evaluate the minimum requirements for health units to adequately treat snakebite envenoming in the Amazon region of Brazil. The modified-Delphi approach consisted of four rounds: 1) iterative development of preliminary checklist by expert steering committee; 2) controlled feedback on preliminary checklist via expert judge survey; 3) two-phase nominal group technique with new expert judges to resolve pending items; and 4) checklist finalization and closing criteria by expert steering committee. The measure of agreement selected for this study was percent agreement defined a priori as ≥75%. A valid, reliable, and feasible checklist was developed. The development process highlighted three key findings: (1) the definition of community health centers and its list of essential items by expert judges is consistent with the Brazilian Ministry of Health, WHO snakebite strategic plan, and a general snakebite capacity guideline in India (internal validity), (2) the list of essential items for antivenom administration and clinical management is feasible and aligns with the literature regarding clinical care (reliability), and (3) engagement of local experts is critical to developing and implementing an antivenom decentralization strategy (feasibility). This study joins an international set of evidence advocating for decentralization, adding value in its definition of essential care items; identification of training needs across the care continuum; and demonstration of the validity, reliability, and feasibility provided by engaging local experts. Specific to Brazil, further added value comes in the potential use of the checklist for health unit accreditation as well as its applications to logistics and resource distribution. Future research priorities should apply this checklist to health units in the Amazon region of Brazil to determine which community health centers are or could be capable of receiving antivenom and translate this expert-driven checklist and approach to snakebite care in other settings or other diseases in low-resource settings. Checklists have been developed and validated to improve patient safety and effectiveness of care in several fields, including emergency medicine, intensive care, and surgery. The Brazilian Ministry of Health (MoH) supplies antivenoms (AVs) to the health system at no cost to patients. AV access is thus limited to hospitals, most of which are in urban areas and difficult for rural, remote, and indigenous populations to reach. Currently, there is no evidence-based method to evaluate the capacity of health units for AV treatment, nor what the absolute minimum supplies and staff are necessary for safe and effective AV administration and clinical management. In this study, we aim to develop and validate a checklist to evaluate the minimum requirements for community health centers to adequately treat snakebite envenoming in the Amazon region of Brazil. This study joins an international set of evidence advocating for decentralization, adding value in its definition of essential care items, represented by Human Resources, and Equipment, Supplies and Medicines, to provide safe and effective treatment for SBE patients in remote endemic areas.
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影响因子：
4.2
作者：
通讯作者：
--
影响因子：
3.8
作者：
Sapkota S;Pandey DP;Dhakal GP;Gurung DB
通讯作者：
Gurung DB
影响因子：
3.7
作者：
Chaaithanya IK;Abnave D;Bawaskar H;Pachalkar U;Tarukar S;Salvi N;Bhoye P;Yadav A;Mahale SD;Gajbhiye RK
通讯作者：
Gajbhiye RK
影响因子：
3.2
作者：
Andrade, Monica Viegas;Coelho, Augusto Quaresma;Castro, Marcia C.
通讯作者：
Castro, Marcia C.
DOI：
10.1111/j.1440-172x.2012.02017.x
发表时间：
2012-04-01
影响因子：
1.9
作者：
Harvey, Nichole;Holmes, Colin A.
通讯作者：
Holmes, Colin A.