International Survey Reveals Opportunities to Improve Tuberculous Meningitis Management and the Need for Standardized Guidelines.
International Survey Reveals Opportunities to Improve Tuberculous Meningitis Management and the Need for Standardized Guidelines.
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DOI：
10.1093/ofid/ofaa445
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发表时间：
2020-11
影响因子：
4.2
通讯作者：
Rohlwink U
中科院分区：
文献类型：
--
作者：
Tucker EW;Marais S;Seddon JA;van Crevel R;Ganiem AR;Ruslami R;Zhang W;Sun F;Zhou X;Solomons RS;Cresswell FV;Wilmshurst J;Rohlwink U
脑膜炎（TBM）是一种医疗紧急情况，但没有标准化的治疗指南，这些患者的医疗或神经外科管理和神经重症监护的数据很少。我们进行了一项国际调查，以了解当前的医疗和神经外科TBM管理和资源可用性，为未来解决未回答的临床研究问题和建立标准化指南的多中心试验提供所需的基线数据。通过电子邮件邀请、国际组织成员分布以及组织网页或社交媒体上的直接链接，以匿名链接的形式分发了针对治疗TBM的临床医生/护士的涵盖医疗和神经外科TBM管理的77个问题的在线调查。调查持续了5个月。用频率和百分比总结数据。调查收到了来自6大洲43个国家的222份答复。大多数受访者来自三级医疗机构，有广泛的医疗和神经外科资源。一般支持性治疗存在显著异质性，TBM特异性管理与当前标准治疗实践存在相当大的差异。缺乏标准化的指导方针被认为是隧道掘进机管理的一个主要挑战。一般和神经重症监护基本上是缺席。床边支持性护理和无创监测的资源广泛可用。这些研究结果表明，通过基于现有证据建立国际公认的治疗指南，可以改善当前的TBM管理，并且许多中心拥有参与未来多中心试验的资源，即使是基本干预措施，也可能进一步改善全球患者的结局。脑膜炎是一种医疗紧急情况，但没有标准化的治疗指南。我们调查了来自43个国家的治疗和资源可用性，这些国家显示了异质性和与标准治疗的差异。床边支持性护理和监测资源广泛可用。
Tuberculous meningitis (TBM) is a medical emergency, yet there are no standardized treatment guidelines for the medical or neurosurgical management of these patients and little data on neurocritical care. We conducted an international survey to understand current medical and neurosurgical TBM management and resource availability to provide baseline data needed for future multicenter trials addressing unanswered clinical research questions and the establishment of standardized guidelines. An online survey of 77 questions covering medical and neurosurgical TBM management aimed at clinicians/nurses treating TBM was distributed as an anonymous link through email invitation, international organizations’ membership distribution, and direct links on organizational webpages or social media. The survey remained open for 5 months. Data were summarized with frequencies and percentages. The survey had 222 responses from 43 countries representing 6 continents. Most respondents were from tertiary care facilities, with broad access to medical and neurosurgical resources. There was significant heterogeneity in general supportive care, and TBM-specific management demonstrated considerable divergence from current standard-of-care practices. The lack of standardized guidelines was identified as a major challenge in TBM management. General and neurocritical care were largely absent. Resources for bedside supportive care and noninvasive monitoring were broadly accessible. These findings suggest that current TBM management could be improved by the establishment of internationally accepted treatment guidelines based on available evidence, and that numerous centers have resources available to participate in future multicenter trials, even for basic interventions, that may further improve patient outcomes globally. Tuberculous meningitis is a medical emergency, yet no standardized treatment guidelines exist. We surveyed treatment and resource availability from 43 countries, which demonstrated heterogeneity and divergence from standard of care. Resources for bedside supportive care and monitoring were broadly accessible.
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
DOI：
10.1093/cid/ciw757
发表时间：
2017-02-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Marais BJ;Heemskerk AD;Marais SS;van Crevel R;Rohlwink U;Caws M;Meintjes G;Misra UK;Mai NTH;Ruslami R;Seddon JA;Solomons R;van Toorn R;Figaji A;McIlleron H;Aarnoutse R;Schoeman JF;Wilkinson RJ;Thwaites GE;Tuberculous Meningitis International Research Consortium
通讯作者：
Tuberculous Meningitis International Research Consortium
影响因子：
4.8
作者：
Carney, Nancy;Totten, Annette M.;Ghajar, Jamshid
通讯作者：
Ghajar, Jamshid
影响因子：
7.7
作者：
Mai, Nguyen T. H.;Dobbs, Nicholas;Thwaites, Guy E.
通讯作者：
Thwaites, Guy E.
影响因子：
4.4
作者：
Misra, Usha K.;Kalita, Jayantee;Singh, Rajesh K.
通讯作者：
Singh, Rajesh K.