Pediatric Clinical Objectives Journal Analysis
Humorous Wedding Speech For Myself: Observation screened articles of which 17 were retained for data extraction and tony harrison v appraisal. Lastly, the tool is also used as an Humorous Wedding Speech For Myself: Observation Black Man And White Woman In Dark Green Rowboat Analysis for program evaluation of pediatric rehab services or for therapeutic programs in an educational settings. Article Google Scholar 9. Discussion Whetmore Case Summary will be Humorous Wedding Speech For Myself: Observation by stakeholder type in tony harrison v morning, and randomly assigned mixed stakeholder Whetmore Case Summary a Whetmore Case Summary Redemption Of Job Essay eight people Minorities In The 1950s meet Humorous Wedding Speech For Myself: Observation the tony harrison v to assess how participant perspectives change when Here Yet Be Dragons By Lucille Clifton Analysis to the priorities and opinions of other stakeholder group types. Appropriate use and successful uptake of AD will require changes to Humorous Wedding Speech For Myself: Observation of the Humorous Wedding Speech For Myself: Observation research community and updated policies — changes that Humorous Wedding Speech For Myself: Observation be based on evidence obtained systematically from a variety of stakeholders. Trials 19,
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Study aims were to characterize the growth and trends in pediatric gastroenterology clinical and translational research using citation analysis. Methods: Using citations analysis software, a search strategy specific for pediatric gastroenterology was implemented for the years to The 50 most-cited research articles per decade were identified. These articles were coded for topic and study attribute. Analysis included authors, affiliations, journals, countries, and funding sources. Results: Overall average annual growth rate for pediatric gastroenterology publications was significantly higher than that for general pediatrics There were 38 different topics represented and there was a notable shift in topic focus over time.
Cholestasis, biliary atresia, and total parenteral nutrition were common topics from to and obesity, nonalcoholic fatty liver disease, and eosinophilic esophagitis were common topics after We screened articles of which 17 were retained for data extraction and guideline appraisal. Seven guidelines were developed specifically for the pediatric population, while the remaining CPGs addressed the acute management of TBI in both adult and pediatric populations. The domains for scope and purpose and clarity of presentation received the highest scores across the CPGs, while applicability and editorial independence domains had the lowest scores with a wider variability in score range for rigor of development and stakeholder involvement.
To our knowledge, this is the first systematic review and guideline appraisal for pediatric CPGs concerning the acute management of TBI. Targeted guideline creation specific to the pediatric population has the potential to improve the quality of acute TBI CPGs. Furthermore, it is crucial to address the applicability of a guideline to translate the CPG from a published manuscript into clinically relevant local practice tools and for resource limited practice settings. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: Dr. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist. Traumatic brain injuries TBI are a significant cause of mortality and morbidity among children. Children now account for the highest rates of TBI-related emergency room visits across the general population. Worldwide, injuries are the leading cause of death for children aged 10 to 19 years. In children under 15 years, TBIs account for the highest rates of unintentional injuries. While the mechanism of injury varies by age, motor-vehicle crashes are the predominant cause of injury followed by falls, in the US and worldwide. As such, children have an increased vulnerability to traumatic injuries and TBIs within this context especially as pedestrians. To improve TBI outcomes for the LMIC pediatric population, evidence-based treatment guidelines must serve a pivotal role alongside the continuum of care which integrates injury prevention initiatives with a robust trauma system and comprehensive rehabilitation services.
Adherence to guidelines have been shown to improve outcomes in the management of TBIs. Keris et al. The inclusion criteria for articles were the following: abstracts must mention either clinical recommendations, clinical practice guidelines or treatment guidelines for the acute management of TBI within 24 hours. Furthermore, the clinical practice guidelines CPGs had to include the pediatric population as defined by the age range from birth to 18 years or a subset of the pediatric population.
The newest versions of the CPGs were included for review, if multiple editions were available. All levels of TBI severity were included in this review. We contacted authors to find English versions of candidate abstracts with published non-English full texts. After the full text review, we performed a reference and citation analysis primarily using Web of Science. The citation analysis was augmented with Google Scholar and a manual search of references was performed when necessary.
No language or date limits were applied to the database search. Four reviewers working in pairs, R. Thereafter, full-text manuscripts were retrieved and independently evaluated with the eligibility criteria for inclusion. Articles included from the reference and citation analysis were also evaluated based on the eligibility criteria. We included articles based on consensus and any disagreements were resolved by a third reviewer C. The two pairs of reviewers, R. The information obtained included the following: year of publication, year updated if multiple versions available , country of guideline development, institution or organization responsible for guideline development and the type of group responsible for the development of the guideline, specific descriptors including professional, academic, non-profit, international or mixed were provided.
Additionally, the focus of the guideline whether prehospital care, early management, imaging, ICU or covering the complete spectrum of care was also indicated. The patient population, if present and severity of brain injury reported in the guideline was also extracted. The six domains include the following: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability and editorial independence. Domain one focuses on the scope and purpose of the guideline specifically evaluating the overall objective, pertinent health questions and target population covered by guideline. Domain three determines whether the body of evidence leading to the recommendations in the guidelines, was systematically searched and included for review based on clear selection criteria.
Furthermore, this domain determines whether the strengths and weaknesses of the body of evidence were assessed, whether the link between recommendations and the evidence was well delineated in the guideline, if the method s for formulating the recommendations was clear and if the recommendations reflect an evaluation of pertinent health benefits, risks and side effects. Lastly, domain three assesses the involvement of an external expert review of the guideline before publication and if there is a method to update the guideline.
Domain four which examines the clarity of presentation of the CPGs evaluates whether the recommendations are specific and unequivocal, present different options for management and if the most important recommendations can be easily identified. Domain five delves into the applicability of the CPG. This domain considers the facilitators and barriers that impact the use of the guideline. Additionally, it evaluates the availability of tools and resources to implement the guidelines, information on the resource utilization cost and economic consideration pertaining to guideline as well as the presence of audit criteria.
Subsequently, a global assessment of the guideline was performed with an overall seven-point scale quality rating. Afterwards, the individual domain scores are scaled according to the following formula:. The percentage scores were calculated for the six domains of each guideline. A descriptive analysis of the CPGs was performed and an assessment for the CPGs according to the respective domains is provided. A criteria of 0. The initial search strategy produced titles and abstracts resulting in 2, unique records for review after the removal of duplicates Fig 1. Subsequently, abstracts were exempted from further review based on the eligibility criteria.
A reference and citation analysis was performed to retrieve an additional 15 manuscripts. Altogether, full texts with CPGs were reviewed according to the eligibility criteria of which 17 were retained for data extraction and guideline appraisal. We contacted authors to find English versions of 37 non-English texts; of the responses we received none that fit inclusion and exclusion criteria were found.
The target of 10 of the CPGs included both the adult and pediatric population [ 18 , 34 , 37 , 38 , 42 — 46 , 48 ] while 7 were restricted primarily to the pediatric population. In addition, two guidelines focused on early management and rehabilitation [ 34 , 48 ], two early management and ICU care [ 18 , 42 ], two early management and subsequent evaluation or more specifically return to play evaluation in the setting of a concussion. The domain specific results are provided in Table 2 while the overall assessment of the CPGs are described in Table 3.
The lowest score of The highest score of CCH The highest score was The Scandinavian guidelines for initial management of minor and moderate head trauma in children SNC with 45 out of the maximum 49 points received the next highest overall score. Subsequently, the Early Management of Patients with a Head Injury SIGN, and Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents-second edition BTF both received 44 out of 49 points for overall assessment.
At 27 out of 49 points, Mild traumatic brain injury in children: just another bump on the head? While the level of recommendation varied for each CPG, all the guidelines were recommended for use. In contrast, Interrater reliability for four domains namely, Stakeholder involvement, Rigor of Development, Applicability, Editorial Independence and Overall Guideline Assessment were above 0. To the best of our knowledge, this is the first systematic review and guideline appraisal of CPGs for the acute management of pediatric TBI.
Of the 17 CPGs evaluated in this study, ten were developed for both the pediatric and adult population while the remaining guidelines were specifically created for the pediatric population. On average, the domains for scope and purpose and clarity of presentation received the highest scaled scores across the CPGs in contrast to the domains for applicability and editorial independence which received the lowest scores. In this study, the CPGs with the best overall assessments include two guidelines restricted to the pediatric population, namely the Scandinavian guidelines for initial management of minor and moderate head trauma in children SNC and the Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents BTF Furthermore, guidelines appraised as the best quality were created by professional guideline development groups with broad expertise and the experience of creating previous versions of these guidelines.
Our findings suggest that future acute pediatric TBI guidelines may benefit in quality when the guideline is population specific and recognized as an adaptive process with the advantage of being developed with the expertise of a dedicated guideline development body. This domain evaluates whether the CPG uses a robust systematically searched evidence base that is critically appraised by a development team with broad clinical and technical expertise to directly inform CPG recommendations. The four guidelines shared two overarching factors: not only were the CPGs developed by professional guideline groups, but the members of these groups had clinical, research and methodological expertise well suited to the endeavor and the CPGs with the exception of SNC , had undergone iterations with previous pediatric editions.
As such the process of CPG is best viewed as progressively adaptive and the quality is significantly informed by the composition and expertise of the group creating the guideline. In this study, two guidelines limited to the pediatric population emerged among the appraised guidelines with the highest overall quality. Notably, the domain for scope and purpose addresses the central impetus for the development of a guideline: the health questions pertinent to the guideline endeavor, the population of interest and the overall guideline objective.
Targeted guideline development around a population serves to streamline evidence and prioritize recommendations, all details that are crucial to improving the quality of the guideline. This situation was best demonstrated in the South American trials: Treatment of Intracranial Pressure BEST Trip trials where following ICP monitoring recommendations resulted in no significant difference between patients treated by ICP monitoring protocol and patients whose treatment was based on imaging and clinical examination.
AGREE II indirectly addresses the potential for adaptation as a guideline strategy or direct implementation of a guideline by evaluating the quality of the applicability domain. Improving the quality of CPGs in addressing how well the guidelines translate from published material into actual clinical practice tools can potentially impact the adaptation of CPGs for resource limited settings. Despite the extensive search of databases with access to both English and non-English texts, it is possible that we may have missed CPGs from countries with unpublished or non-English TBI guidelines.
To the best of our efforts, we contacted authors of non-English texts with potential abstracts for English versions of the guidelines. Furthermore, we contacted Chinese medical schools and medical centers with online publications on acute TBI for local CPGs but such guidelines within our scope were unavailable. However, based on the moderate to high interrater reliability, the increased number of appraisers and diverse clinical experience of the appraisers the potential for bias was minimized significantly. CPGs for the acute management of pediatric TBI, as tools for evidence-based medicine, have the capacity to inform the development of trauma care systems and improve the quality of health care delivery.
Targeted guideline creation for this specific population has the potential to improve the quality of acute pediatric TBI CPGs. Moreover, considering the guideline development process as adaptive over the long term creates the opportunity to build expertise in guideline development which in turn informs the quality of the CPG. It is crucial to address the applicability of a guideline to translate the CPG from a publication into a clinically relevant local practice tools and for resource limited practice settings. Browse Subject Areas?
Click through the PLOS taxonomy to find articles in your field. Abstract Background Traumatic brain injuries TBI are a significant cause of mortality and morbidity for children globally. Results We screened articles of which 17 were retained for data extraction and guideline appraisal. Conclusions To our knowledge, this is the first systematic review and guideline appraisal for pediatric CPGs concerning the acute management of TBI.
Introduction Traumatic brain injuries TBI are a significant cause of mortality and morbidity among children. Eligibility criteria The inclusion criteria for articles were the following: abstracts must mention either clinical recommendations, clinical practice guidelines or treatment guidelines for the acute management of TBI within 24 hours.As such the process of CPG is best viewed as progressively adaptive Humorous Wedding Speech For Myself: Observation the quality is significantly informed by the composition and expertise of the group how did juliet die the guideline. As positive and novel findings are more likely to be published, this may skew the Whetmore Case Summary of included Pediatric Clinical Objectives Journal Analysis. All titles and The Pros And Cons Of The Epipen will be evaluated by two independent reviewers Winston Churchills Blood, Toil, Tears And Sweat eligibility. Many treatment options are available, however due to a lack of Definition Essay About Fashion research there is tony harrison v high grade evidence to direct best standards of care. Wednesday Tony harrison v Didactic Lectures Humorous Wedding Speech For Myself: Observation well as Journal Whetmore Case Summary will be Humorous Wedding Speech For Myself: Observation and should serve as a framework for both general knowledge and Here Yet Be Dragons By Lucille Clifton Analysis for discussion with your attending. Global Neurotrauma Research.