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肛门直肠畸形(ARM)患者治疗和随访优化的核心结局集制定方案:ARM 和结局回顾(ARMOUR)项目。

Protocol for the development of a core outcome set for the optimisation of treatment and follow-up of patients with an anorectal malformation (ARM): The ARM and OUtcome Review (ARMOUR)-project.

机构信息

Department of Pediatric Surgery, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands

Department of Pediatric Surgery, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands.

出版信息

BMJ Paediatr Open. 2023 Mar;7(1). doi: 10.1136/bmjpo-2022-001691.

Abstract

BACKGROUND

Primary treatment of an anorectal malformation (ARM) is surgical restoration of the anatomy. These children can experience many problems later in life; therefore, a long-term follow-up by an experienced team is needed. The aim of the ARM and OUtcome Review (ARMOUR-study) is to identify the lifetime outcomes that are important from a medical and patients' perspective and develop a core outcome set (COS) that can be implemented in a care pathway to support individual ARM management decisions.

METHODS

First, a systematic review will identify clinical and patient-reported outcomes described in studies conducted in patients with an ARM. Second, qualitative interviews with patients of different age categories and their caregivers will be held to ensure that the COS will include outcomes that are relevant from the patient's perspective. Finally, the outcomes will be taken forward to a Delphi consensus exercise. Using multiple web-based Delphi rounds, key stakeholders (medical experts, clinical researchers and patients) will prioritise outcomes. During a face-to-face consensus meeting, the final COS will be determined. These outcomes can be evaluated in a life-long care pathway for patients with ARM.

DISCUSSION

The development of a COS for ARMs aims to reduce heterogeneity in outcome reporting between (clinical) studies, enhancing the availability of comparable data, which will facilitate evidence-based patient care. Assessment of the outcomes in the COS during individual care pathways for ARM can support shared decisions regarding management. The ARMOUR-project has ethical approval and is registered with the Core Outcome Measures in Effectiveness Trials (COMET) initiative.

LEVEL OF EVIDENCE

Treatment study level II.

摘要

背景

肛门直肠畸形(ARM)的主要治疗方法是手术重建解剖结构。这些儿童在以后的生活中可能会遇到许多问题;因此,需要由经验丰富的团队进行长期随访。肛门直肠畸形和结局回顾(ARMOUR 研究)的目的是确定从医学和患者角度重要的终生结局,并制定一个核心结局集(COS),可以将其纳入护理途径,以支持个体 ARM 管理决策。

方法

首先,系统评价将确定在 ARM 患者中进行的研究中描述的临床和患者报告的结局。其次,将对不同年龄段的患者及其照顾者进行定性访谈,以确保 COS 将包括患者角度的相关结局。最后,这些结局将被推进到 Delphi 共识练习中。使用多个基于网络的 Delphi 轮次,关键利益相关者(医学专家、临床研究人员和患者)将对结局进行优先级排序。在面对面的共识会议上,将确定最终的 COS。这些结局可以在 ARM 患者的终身护理途径中进行评估。

讨论

为 ARM 制定 COS 的目的是减少(临床)研究之间结局报告的异质性,增强可比数据的可用性,从而促进基于证据的患者护理。在 ARM 的个体护理途径中评估 COS 中的结局可以支持关于管理的共同决策。ARMOUR 项目已获得伦理批准,并在有效性试验核心结局测量(COMET)倡议中注册。

证据水平

治疗研究二级。

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