Tran Kim-Anh, Pollock Neal William, Rhéaume Caroline, Razdan Payal Sonya, Fortier Félix-Antoine, Dutil-Fafard Lara, Morin Camille, Monnot David Pierre-Marie, Huot-Lavoie Maxime, Simard-Sauriol Philippe, Chandavong Sam, Le Pabic Geneviève, LeBlanc Jean-Philippe, Lafond Daniel, Marion Andréanne, Archambault Patrick Michel
Faculty of Medicine, Université Laval, Quebec, QC, Canada.
Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centres intégrés de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada.
JMIR Res Protoc. 2021 Mar 29;10(3):e24323. doi: 10.2196/24323.
Future long-duration space exploration missions, such as traveling to Mars, will create an increase in communication time delays and disruptions and remove the viability of emergency returns to Earth for timely medical treatment. Thus, higher levels of medical autonomy are necessary. Crew selection is proposed as the first line of defense to minimize medical risk for future missions; however, the second proposed line of defense is medical preparedness and crew member autonomy. In an effort to develop a decision support system, the Canadian Space Agency mandated a team of scientists from Thales Research and Technology Canada (Québec, QC) and Université Laval (Québec, QC) to create an evidence-based medical condition database linking mission-critical human conditions with key causal factors, diagnostic and treatment information, and probable outcomes.
To complement this database, we are currently conducting a scoping review to better understand the depth and breadth of evidence about managing medical conditions in space.
This scoping review will adhere to quality standards for scoping reviews, employing Levac, Colquhoun, and O'Brien's 6-stage methodology; the reported results will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. In stage 1, we identified the research question in collaboration with the Canadian Space Agency (CSA), the main knowledge user. We prioritized 10 medical conditions: (1) acute coronary syndrome, (2) atrial fibrillation, (3) eye penetration, (4) herniated disk, (5) nephrolithiasis, (6) pulmonary embolism, (7) retinal detachment, (8) sepsis, (9) stroke, and (10) spaceflight associated neuro-ocular syndrome. In stage 2, with the help of an information specialist from Cochrane Canada Francophone, papers were identified through searches of the following databases: ARC, Embase, IeeeXplore, Medline Ovid, PsychINFO, and Web of Science. In stage 3, studies will be selected and assessed using a 3-step process and emerging, refined exclusion criteria. In stage 4, the data will be charted in a table based on parameters required by the CSA and developed using Google spreadsheets for shared access. In stage 5, evidence-based descriptive summaries will be produced for each condition, as well as descriptive analyses of collected data. Finally, in stage 6, the findings will be shared with the CSA to guide the completion of this project.
This study was planned in December 2018. Stage 1 has been completed. The initial database search strategy with all target conditions combined identified a total of 10,403 citations to review through title and abstract screening and after duplicate removal. We plan to complete stages 2-6 by the beginning of 2021.
This scoping review will map the literature on the management of 10 priority medical conditions in space. It will also enable us to identify knowledge gaps that must be addressed in future research, ensuring successful and medically safe future missions as humankind embarks upon new frontiers of space exploration.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24323.
未来的长期太空探索任务，如前往火星，将导致通信时间延迟和中断增加，并且排除了紧急返回地球接受及时医疗救治的可能性。因此，更高水平的医疗自主性是必要的。机组人员选拔被提议作为降低未来任务医疗风险的第一道防线；然而，第二道防线是医疗准备和机组人员的自主性。为了开发一个决策支持系统，加拿大航天局委托加拿大泰雷兹研究与技术公司（魁北克省魁北克市）和拉瓦尔大学（魁北克省魁北克市）的一组科学家创建一个基于证据的医疗状况数据库，将关键任务中的人类状况与关键因果因素、诊断和治疗信息以及可能的结果联系起来。
为补充这个数据库，我们目前正在进行一项范围综述，以更好地了解关于太空医疗状况管理的证据的深度和广度。
这项范围综述将遵循范围综述的质量标准，采用勒瓦克、科尔昆和奥布赖恩的六阶段方法；报告的结果将遵循系统评价和Meta分析的首选报告项目（PRISMA）范围综述扩展版。在第1阶段，我们与主要知识用户加拿大航天局（CSA）合作确定了研究问题。我们将10种医疗状况列为优先事项：（1）急性冠状动脉综合征，（2）心房颤动，（3）眼球穿通伤，（4）椎间盘突出症，（5）肾结石，（6）肺栓塞，（7）视网膜脱离，（8）脓毒症，（9）中风，以及（10）航天相关神经-眼综合征。在第2阶段，在加拿大法语区Cochrane的一名信息专家的帮助下，通过搜索以下数据库来识别论文：ARC、Embase、IeeeXplore、Medline Ovid、PsychINFO和Web of Science。在第3阶段，将使用一个三步流程以及新出现的、完善的排除标准来选择和评估研究。在第4阶段，将根据CSA要求的参数在表格中绘制数据，并使用谷歌电子表格进行开发以实现共享访问。在第5阶段，将为每种状况生成基于证据的描述性总结以及对收集数据的描述性分析。最后，在第6阶段，将研究结果与CSA分享，以指导该项目的完成。
本研究于2018年12月规划。第1阶段已完成。对所有目标状况进行综合搜索的初始数据库检索策略共识别出10403条引文，需通过标题和摘要筛选以及去除重复项后进行审查。我们计划在2021年初完成第2至6阶段。
这项范围综述将梳理关于太空10种优先医疗状况管理的文献。它还将使我们能够识别未来研究中必须解决的知识空白，确保人类在开启太空探索新领域时未来任务的成功和医疗安全。
国际注册报告识别号（IRRID）：DERR1-10.2196/24323
