Aregbesola Alex, Abou-Setta Ahmed M, Okoli George N, Jeyaraman Maya M, Lam Otto, Kasireddy Viraj, Copstein Leslie, Askin Nicole, Sibley Kathryn M, Klassen Terry P
The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
PLoS One. 2021 Mar 24;16(3):e0248826. doi: 10.1371/journal.pone.0248826. eCollection 2021.
Implementation strategies are vital for the uptake of evidence to improve health, healthcare delivery, and decision-making. Medical or mental emergencies may be life-threatening, especially in children, due to their unique physiological needs when presenting in the emergency departments (EDs). Thus, practice change in EDs attending to children requires evidence-informed considerations regarding the best approaches to implementing research evidence. We aimed to identify and map the characteristics of implementation strategies used in the emergency management of children.
We conducted a scoping review using Arksey and O'Malley's framework. We searched four databases [Medline (Ovid), Embase (Ovid), Cochrane Central (Wiley) and CINAHL (Ebsco)] from inception to May 2019, for implementation studies in children (≤21 years) in emergency settings. Two pairs of reviewers independently selected studies for inclusion and extracted the data. We performed a descriptive analysis of the included studies.
We included 87 studies from a total of 9,607 retrieved citations. Most of the studies were before and after study design (n = 68, 61%) conducted in North America (n = 63, 70%); less than one-tenth of the included studies (n = 7, 8%) were randomized controlled trials (RCTs). About one-third of the included studies used a single strategy to improve the uptake of research evidence. Dissemination strategies were more commonly utilized (n = 77, 89%) compared to other implementation strategies; process (n = 47, 54%), integration (n = 49, 56%), and capacity building and scale-up strategies (n = 13, 15%). Studies that adopted capacity building and scale-up as part of the strategies were most effective (100%) compared to dissemination (90%), process (88%) and integration (85%).
Studies on implementation strategies in emergency management of children have mostly been non-randomized studies. This review suggests that 'dissemination' is the most common strategy used, and 'capacity building and scale-up' are the most effective strategies. Higher-quality evidence from randomized-controlled trials is needed to accurately assess the effectiveness of implementation strategies in emergency management of children.
实施策略对于采用证据以改善健康、医疗服务提供和决策至关重要。由于儿童在急诊科就诊时具有独特的生理需求，医疗或精神紧急情况可能危及生命，尤其是对儿童而言。因此，儿科急诊科的实践变革需要基于证据来考虑实施研究证据的最佳方法。我们旨在识别并梳理儿童急诊管理中使用的实施策略的特征。
我们使用阿克西和奥马利的框架进行了一项范围综述。我们检索了四个数据库[Medline（Ovid）、Embase（Ovid）、Cochrane Central（Wiley）和CINAHL（Ebsco）]，检索时间从建库至2019年5月，以查找针对急诊环境中儿童（≤21岁）的实施研究。两对评审员独立选择纳入研究并提取数据。我们对纳入研究进行了描述性分析。
我们从总共9607条检索到的文献中纳入了87项研究。大多数研究为北美地区开展的前后对照研究设计（n = 68，61%）；纳入研究中不到十分之一（n = 7，8%）为随机对照试验（RCT）。约三分之一的纳入研究使用单一策略来促进研究证据的采用。与其他实施策略相比，传播策略的使用更为普遍（n = 77，89%）；过程策略（n = 47，54%）、整合策略（n = 49，56%）以及能力建设和扩大规模策略（n = 13，15%）。与传播策略（90%）、过程策略（88%）和整合策略（85%）相比，将能力建设和扩大规模作为策略一部分的研究最为有效（100%）。
关于儿童急诊管理中实施策略的研究大多为非随机研究。本综述表明，“传播”是最常用的策略，而“能力建设和扩大规模”是最有效的策略。需要来自随机对照试验的更高质量证据来准确评估实施策略在儿童急诊管理中的有效性。
