中低收入国家任务转移在糖尿病视网膜病变检测中的有效性：一项快速综述方案
Effectiveness of task-shifting for the detection of diabetic retinopathy in low- and middle-income countries: a rapid review protocol.
作者信息
Bascaran Covadonga, Mwangi Nyawira, D'Esposito Fabrizio, Gordon Iris, Ulloa Juan Alberto Lopez, Mdala Shaffi, Ramke Jacqueline, Evans Jennifer R, Burton Matthew
机构信息
London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Kenya Medical Training College, Nairobi, Kenya.
出版信息
Syst Rev. 2021 Jan 4;10(1):4. doi: 10.1186/s13643-020-01553-w.
BACKGROUND
Diabetic retinopathy is the most common ocular complication of diabetes and a cause of vision loss in adults. Diabetic retinopathy screening leading to early identification of the disease followed by timely treatment, can prevent vision loss in people living with diabetes. A key barrier to the implementation of screening services in low- and middle-income countries is the low number of ophthalmologists per million population. Interventions that shift screening to non-ophthalmology cadres have been implemented in programmes in low- and middle-income countries and are routinely used in high-income countries. The aim of this rapid review is to summarise the published literature reporting the effectiveness of task-shifting interventions for the detection of diabetic retinopathy by non-ophthalmologists in low- and middle-income countries.
METHODS
We will search MEDLINE, Embase, Global Health and Cochrane Register of Studies for studies reporting task-shifting interventions for diabetic retinopathy detection. The review will include studies published in the last 10 years in the English language. We will include any interventional or observational comparative study measuring outcomes in terms of participation or access to diabetic retinopathy detection services (uptake) and quality of diabetic retinopathy detection services (detection, severity, diagnostic accuracy). For included studies, cost-effectiveness of the task-shifting intervention will also be presented. Two reviewers will screen search results independently. The risk of bias assessment and data extraction will be carried out by one reviewer with verification of 10% of the papers by a second reviewer. The results will be synthesised narratively.
DISCUSSION
Differences in health systems organization, structure and resources will determine the need and success of task-shifting interventions for DR screening. The review will examine how these interventions have been used and/or tested in LMICs. The results will be of interest to policy makers and programme managers tasked with designing and implementing services to prevent and manage diabetes and its complications in similar settings.
SYSTEMATIC REVIEW REGISTRATION
OSF: https://osf.io/dfhg6/ .
背景
糖尿病视网膜病变是糖尿病最常见的眼部并发症，也是成年人视力丧失的一个原因。糖尿病视网膜病变筛查可早期发现该病，随后及时治疗，能够预防糖尿病患者视力丧失。在低收入和中等收入国家，实施筛查服务的一个关键障碍是每百万人口中眼科医生数量较少。将筛查工作转移至非眼科医护人员的干预措施已在低收入和中等收入国家的项目中实施，并在高收入国家中常规使用。本快速综述的目的是总结已发表的文献，这些文献报告了在低收入和中等收入国家由非眼科医生进行糖尿病视网膜病变检测的任务转移干预措施的有效性。
方法
我们将检索MEDLINE、Embase、全球健康数据库和Cochrane研究注册库，查找报告糖尿病视网膜病变检测任务转移干预措施的研究。该综述将纳入过去10年以英文发表的研究。我们将纳入任何测量糖尿病视网膜病变检测服务的参与度或可及性（接受率）以及糖尿病视网膜病变检测服务质量（检测、严重程度、诊断准确性）结果的干预性或观察性比较研究。对于纳入的研究，还将呈现任务转移干预措施的成本效益。两名评审员将独立筛选检索结果。由一名评审员进行偏倚风险评估和数据提取，另一名评审员对10%的论文进行核查。结果将进行叙述性综合。
讨论
卫生系统组织、结构和资源的差异将决定糖尿病视网膜病变筛查任务转移干预措施的必要性和成功与否。该综述将研究这些干预措施在低收入和中等收入国家是如何被使用和/或测试的。研究结果将对负责在类似环境中设计和实施预防及管理糖尿病及其并发症服务的政策制定者和项目管理者具有参考价值。
系统综述注册
OSF：https://osf.io/dfhg6/ 。
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