Klinik karar analizi ile preterm olguların yönetimi
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Date
2023-07-05
Authors
Dinçgez, Burcu
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Sağlık sisteminde birçok alanda kanıtların yetersiz olması, hekim ya da hastanın subjektifliği ya da olayın tekrarlanabilir özellikte olmaması nedeni ile zorlaşan karar verme sürecini geliştirmeye yönelik karar analizi yöntemleri geliştirilmiştir. Klinik karar analizi, hasta ve sağlık çalışanı tercihlerini içeren ampirik verilerin değerlendirilerek tıbba entegre edildiği karar verme metodolojisidir. Çalışmamızda bireyselleştirilmiş yaklaşımın önerildiği preterm olgularda doğum, sadece antibiyotik, sadece steroid, tokolitik ve steroid, antibiyotik ve steroid, nöroprotektif magnezyum ve steroid ile antibiyotik, nöroprotektif magnezyum ve steroid stratejilerinin neonatal sonuçlar üzerine olan etkisi araştırılmıştır. Çalışmaya Sağlık Bilimleri Üniversitesi, Bursa Yüksek İhtisas Eğitim Araştırma Hastanesi’nde Ocak 2015 ve Aralık 2021 tarihleri arasında preterm doğum yapan 4577 hasta dahil edilmiştir. Karar ağacı oluşturulmasında tedavi kolları yenidoğan yoğun bakım ünitesi yatışı, major ve minör morbidite varlığına göre dallara ayrılmış ve çıktı olarak neonatal ölümler kaydedilmiştir. Çalışmamız, preterm ve geç preterm olgularda en yüksek ölüm olasılığının doğum; en düşük ölüm olasılığının ise antibiyotik kolunda olduğunu göstermiştir. Erken preterm olgularda doğum kolunda ölüm olasılığının en yüksek ve antibiyotik ve steroidin birlikte uygulandığı kolda en düşük olduğu gözlenmiştir. Alt grup analizlerinde, 24-28 hafta arasında nöroprotektif magnezyum ve steroid uygulanan olgularda, 28-34 hafta arasında antibiyotik, nöroprotektif magnezyum ile steroid uygulananlarda ölüm olasılığının en düşük olduğu; her iki grupta da doğum kolunda ölüm olasılığının en yüksek olduğu bulunmuştur .Sonuçta çalışmamız, kanıtsal verinin sınırlı olduğu preterm olgu yönetiminde klinik karar analizinin, karar verme sürecinde klinisyen için son derece önemli olduğunu göstermesi bakımından önemlidir.
Decision analysis methods have been developed to improve the decision-making process, which is difficult due to insufficient evidence in many areas in the health system, the subjectivity of the physician or the patient, or the unrepeatability of the event. Clinical decision analysis is a decision-making methodology in which empirical data including patient and healthcare worker preferences are evaluated and integrated into medicine. In our study, the effects of delivery, only antibiotics, only steroids, tocolytics and steroids, antibiotics and steroids, neuroprotective magnesium and steroids, and antibiotic, neuroprotective magnesium and steroid strategies on neonatal outcomes were investigated in preterm cases where an individualized approach was recommended. The study included 4577 patients who had preterm birth between January 2015 and December 2021 at Health Sciences University, Bursa Yüksek İhtisas Training and Research Hospital. In the creation of the decision tree, the treatment arms were divided into branches according to the presence of neonatal intensive care unit admission, major and minor morbidity, and neonatal deaths were recorded as output. In our study, the highest probability of death in preterm and late preterm cases was delivery; showed that the lowest probability of death was in the antibiotic arm. It was observed that the probability of death was highest in the delivery arm in early preterm cases and the lowest in the arm in which antibiotics and steroids were administered together. In subgroup analyzes, it was found that the probability of death was the lowest in patients who received neuroprotective magnesium and steroids between 24-28 weeks, and those who received antibiotics, neuroprotective magnesium and steroids between 28-34 weeks; it was found that the probability of death in the birth arm was highest in both groups.In conclusion, our study is important in that it shows that clinical decision analysis is extremely important for the clinician in the decision-making process in the management of preterm cases, where the evidence data is limited.
Decision analysis methods have been developed to improve the decision-making process, which is difficult due to insufficient evidence in many areas in the health system, the subjectivity of the physician or the patient, or the unrepeatability of the event. Clinical decision analysis is a decision-making methodology in which empirical data including patient and healthcare worker preferences are evaluated and integrated into medicine. In our study, the effects of delivery, only antibiotics, only steroids, tocolytics and steroids, antibiotics and steroids, neuroprotective magnesium and steroids, and antibiotic, neuroprotective magnesium and steroid strategies on neonatal outcomes were investigated in preterm cases where an individualized approach was recommended. The study included 4577 patients who had preterm birth between January 2015 and December 2021 at Health Sciences University, Bursa Yüksek İhtisas Training and Research Hospital. In the creation of the decision tree, the treatment arms were divided into branches according to the presence of neonatal intensive care unit admission, major and minor morbidity, and neonatal deaths were recorded as output. In our study, the highest probability of death in preterm and late preterm cases was delivery; showed that the lowest probability of death was in the antibiotic arm. It was observed that the probability of death was highest in the delivery arm in early preterm cases and the lowest in the arm in which antibiotics and steroids were administered together. In subgroup analyzes, it was found that the probability of death was the lowest in patients who received neuroprotective magnesium and steroids between 24-28 weeks, and those who received antibiotics, neuroprotective magnesium and steroids between 28-34 weeks; it was found that the probability of death in the birth arm was highest in both groups.In conclusion, our study is important in that it shows that clinical decision analysis is extremely important for the clinician in the decision-making process in the management of preterm cases, where the evidence data is limited.
Description
Keywords
Erken preterm, Geç preterm, Karar ağacı, Klinik karar analizi, Preterm, Early preterm, Late preterm, Decision tree, Clinical decision analysis
Citation
Dinçgez, B. (2023). Klinik karar analizi ile preterm olguların yönetimi. Yayınlanmamış yüksek lisans tezi. Bursa Uludağ Üniversitesi Sağlık Bilimleri Enstitüsü.