RESUMEN
BACKGROUND: Enhanced Recovery After Surgery (ERAS®) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult surgical specialties. There are currently no pediatric ERAS® Society guidelines. We created an ERAS® guideline designed to enhance quality of care in neonatal intestinal resection surgery. METHODS: A multidisciplinary guideline generation group defined the scope, population, and guideline topics. Systematic reviews were supplemented by targeted searching and expert identification to identify 3514 publications that were screened to develop and support recommendations. Final recommendations were determined through consensus and were assessed for evidence quality and recommendation strength. Parental input was attained throughout the process. RESULTS: Final recommendations ranged from communication strategies to antibiotic use. Topics with poor-quality and conflicting evidence were eliminated. Several recommendations were combined. The quality of supporting evidence was variable. Seventeen final recommendations are included in the proposed guideline. DISCUSSION: We have developed a comprehensive, evidence-based ERAS guideline for neonates undergoing intestinal resection surgery. This guideline, and its creation process, provides a foundation for future ERAS guideline development and can ultimately lead to improved perioperative care across a variety of pediatric surgical specialties.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/normas , Recuperación Mejorada Después de la Cirugía , Atención Perioperativa/normas , Cuidados Posoperatorios/normas , Guías de Práctica Clínica como Asunto , Antiinfecciosos/uso terapéutico , Profilaxis Antibiótica , Consenso , Medicina Basada en la Evidencia , Gastroenterología/organización & administración , Humanos , Recién Nacido , Comunicación Interdisciplinaria , Neonatología/organización & administración , Sociedades MédicasRESUMEN
Poor adolescent adherence to mental health psychosocial treatment significantly undermines effectiveness. Approximately one-third of all youth drop out or prematurely terminate from psychosocial treatment. This study examined youth adherence to psychosocial treatment from the perspective of community-based mental health clinicians (n =34) interviewed across three focus groups. A grounded theory analysis was applied to investigate the promoters and barriers influencing adolescent adherence to treatment. Clinicians identified four domains (adolescent, family, clinician, and agency) that serve as promoters and barriers to adherence. Barriers to adherence were located primarily in adolescent and family domains, whereas promoters were attributed within the clinician domain. Understanding of the complex influences on adolescent adherence may facilitate increased awareness and intervention options for clinicians.