Roos Eveline J, Vatopoulou Anastasia
Tergooi, Department of Obstetrics & Gynaecology, van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands.
Paediatric & Adolescent Gynaecology Clinic, 1st Dept of Obstetrics & Gynaecology Aristotle's University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
Eur J Obstet Gynecol Reprod Biol. 2019 Apr;235:110-115. doi: 10.1016/j.ejogrb.2018.08.022. Epub 2018 Aug 24.
Paediatric and adolescent gynaecology is a special field of interest within general gynaecology and obstetrics. The care for children and young people differs from adults. In gynaecology, children should not be treated like little adults. Within Europe, there is great variability in the provision of care, availability of clinical networks and lack of national standards within paediatric and adolescent gynaecology. Therefore, this review aims to summarize the current evidence regarding best clinical practice within Europe.
A search was performed in Embase and Medline from 1974 onwards. Inclusion criteria were paediatric and adolescent population, gynaecology or reproductive health, care provision and evidence based clinical guidelines. In most papers recommendations were made, so no outcome measures could be used. It was, therefore, not possible to perform a meta-analysis. The risk of bias of the studies was assessed according to the GRADE and AGREE-2 guidelines.
91 papers were identified and a total of 7 papers were included in the final analysis. The main recommendations are: - improvement for accessibility for healthcare facility, - training of healthcare staff in communication and examination according to developmental age, - develop evidence based clinical guidelines and standardize content of care delivered, - add training in general adolescent topics to training curriculum of paediatric and adolescent gynaecology.
There is limited information about best clinical practice and low quality of evidence of healthcare service available in the field of Paediatric and Adolescent Gynaecology. As a result there is a need to refine standards of training and care. EURAPAG should encourage adaptation of the unified standards of care in each European country. Furthermore, at this moment, there is insufficient inclusion of curriculum related to PAG in the undergraduate and post graduate training for recognition of patterns and symptoms in young women. EURAPAG should not only take a lead to develop common curriculum for undergraduate and post graduate education and training to address this unmet need but should also lead on their implementation within Europe.
儿科与青少年妇科是普通妇产科领域内一个特殊的关注方向。对儿童和青少年的护理与成人不同。在妇科领域，儿童不应被当作小成年人来对待。在欧洲，儿科与青少年妇科护理的提供、临床网络的可用性以及缺乏国家标准方面存在很大差异。因此，本综述旨在总结欧洲目前关于最佳临床实践的证据。
对1974年起的Embase和Medline进行检索。纳入标准为儿科和青少年人群、妇科或生殖健康、护理提供以及循证临床指南。大多数论文都给出了建议，所以无法使用结局指标。因此，无法进行荟萃分析。根据GRADE和AGREE - 2指南评估研究的偏倚风险。
共识别出91篇论文，最终分析纳入了7篇论文。主要建议包括：改善医疗设施的可及性；根据发育年龄对医护人员进行沟通和检查方面的培训；制定循证临床指南并规范所提供护理的内容；在儿科与青少年妇科培训课程中增加一般青少年主题的培训。
在儿科与青少年妇科领域，关于最佳临床实践的信息有限，医疗服务证据质量较低。因此，需要完善培训和护理标准。欧洲儿科与青少年妇科协会（EURAPAG）应鼓励欧洲各国采用统一的护理标准。此外，目前在本科和研究生培训中，与儿科与青少年妇科相关的课程对年轻女性疾病模式和症状识别的涵盖不足。EURAPAG不仅应带头制定本科和研究生教育及培训的通用课程以满足这一未被满足的需求，还应在欧洲范围内引领其实施。
