产后出血管理期间远程医疗的实用性：一项系统综述。
完整摘要 · 中文译文
目的：本系统性文献综述旨在评估远程医疗在产后出血管理中的效果。 数据来源：检索了MEDLINE (Ovid)、Embase (Ovid) 和 Cochrane Library，检索时间从建库至2024年3月27日。 研究选择：纳入评估远程医疗干预（包括远程教育、远程会诊、用于改善医院流程的虚拟干预）在产后出血管理中的研究，不限研究设计。 数据收集与分析：进行数据提取和质量评价。由于各研究间存在显著异质性，未进行荟萃分析，结果采用叙述性综合。队列研究的偏倚风险采用纽卡斯尔-渥太华量表进行评估。 结果：共纳入19项研究。大多数研究在低收入和中等收入国家进行（n=17/19），并采用观察性或准实验设计（n=15/19）。四项整群随机对照试验评估了虚拟培训策略的有效性，但其中仅有一项纳入了临床变量。多数研究报告了远程医疗干预后过程相关或临床结局的改善。报告的障碍包括资金有限、在本地医院实施建议存在挑战，以及缺乏持续使用的激励机制。 局限性：纳入的研究在设计、干预措施和结局方面存在异质性，且大多数为观察性设计，限制了证据强度。 结论：开发并维持—— 在资源匮乏的环境中建立强有力的卫生系统以应对产后出血，需要采取创新方法，使技术适应具体情况，从而改善健康结局。其中一种创新可能是远程医疗，但还需要进一步研究实施障碍，以及将教育和患者与专家团队之间及时互动的潜在益处转化为改善的临床结局。PROSPERO：＃CRD42023448275。
完整摘要 · 英文原文
OBJECTIVE: This literature systematic review aims to evaluate tele-medicine's effect in managing postpartum hemorrhage. DATA SOURCES: MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library were consulted from inception to March 27, 2024. STUDY SELECTION: Studies evaluating tele-medicine interventions (including tele-education, tele-consultation, virtual interventions for improving hospital processes) in the management of postpartum hemorrhage were included, without restrictions on study design. DATA COLLECTION AND ANALYSIS: Data extraction and quality assessment were performed. Due to substantial heterogeneity across studies, a meta-analysis was not conducted, and results were synthesized narratively. Risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies. RESULTS: Nineteen studies were included. Most were conducted in low and middle-income countries (n=17/19) and used observational or quasi-experimental design (n=15/19). Four cluster randomized controlled trials evaluated the effectiveness of virtual training strategies, although only in one of them clinical variables were incorporated. Most studies reported improvements in process-related or clinical outcomes following telemedicine interventions. Reported barriers included limited funding, challenges in implementing recommendations at local hospitals, and lack of incentives for sustained use. LIMITATIONS: The included studies were heterogeneous in design, interventions, and outcomes, and most had observational designs, limiting the strength of the evidence. CONCLUSION: Developing and maintaining resilient health systems to address postpartum hemorrhage in low-resource settings requires innovative approaches that adapt technology to the context to enhance health outcomes. One such innovation could be tele-medicine, but further research is needed on barriers to implementation and translating the potential benefits of education and timely interaction between patients and expert groups into improved clinical outcomes.PROSPERO: #CRD42023448275.