MANAGEMENT OF BRONCHIOLITIS: REASONS FOR PRACTICE BEHAVIOURS AND A PROPOSED ALTERNATIVE APPROACH
Notice bibliographique
Résumé
BACKGROUND: Bronchiolitis is a common childhood respiratory illness leading to hospitalization of 1–3% of all children under the age of two 1. There are guidelines for the management of bronchiolitis established by various institutions including the Canadian Paediatric Society. It is common knowledge that there are variations in the management of bronchiolitis in spite of standard guidelines 2. OBJECTIVES: We sought to find out the reasons for such variations and the possibility of an alternative approach to management. This was done by reviewing practices in a secondary level referral centre. DESIGN/METHODS: 61 charts of children (0–24 months) admitted for bronchiolitis between November 2014 and April 2016 were reviewed. Interviews were conducted with 24 attending clinicians (8 Pediatricians, 14 Emergency Physicians and 2 Nurse Practitioners) on the management of bronchiolitis based on guidelines of the Canadian Paediatric Society 3. Exclusion criteria included extreme prematurity and chronic lung conditions. RESULTS: 3766 pieces of information were obtained relating to various interventions including the use of salbutamol, epinephrine, steroids, and oxygen supplementation. 63.9% of patients were prescribed bronchodilators, 42% prescribed steroids, 78% prescribed nebulized saline, 65.6% received supplemental oxygen and 11.7% were prescribed epinephrine. Most interventions have no evidence for their effectiveness. Reasons for variations from guidelines included a perceived passive guideline, limitations of evidence-based medicine in clinical practice, nursing and parental pressures, similarity between the presentation of asthma and bronchiolitis, non-consideration of the disease process, and some physicians positive experience with the use of steroids in patients with a personal or immediate family history of atopy. There was difficulty differentiating between bronchiolitis and the first episode of asthma. CONCLUSION: The lack of adherence to the guidelines may be due to the perception that it is inadequate. Based on the experience of some Pediatricians (level 4 evidence), a personal or immediate family history of atopy may be pivotal in directing treatment with steroids. Whilst some studies suggest the non-effectiveness of steroids in the treatment of bronchiolitis 4, no studies have specifically looked at the treatment of bronchiolitis in this subgroup of children with a history of atopy 5. We acknowledge the limiting power of this exercise, and that further studies are needed to validate the effectiveness of steroids and bronchodilators in the atopic subgroup.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,013 | 0,045 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,003 | 0,004 |
| Communication savante | 0,005 | 0,005 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,004 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».