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Hexom BJ, Quao NSA, Bandolin NS, Bonney J, Collier A, Dyal J, Lee JA, Nicholson BD, Rybarczyk MM, Rees CA, Roy CM, Bhaskar N, Kivlehan SM. Global Emergency Medicine: A Scoping Review of the Literature from 2022. Acad Emerg Med 2024; 31:71-85. [PMID: 37813813 DOI: 10.1111/acem.14816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE The objective was to identify the highest quality global emergency medicine (GEM) research published in 2022. The top articles are compiled in a comprehensive list of all the year's GEM articles and narrative summaries are performed on those included. METHODS A systematic PubMed search was conducted to identify all GEM articles published in 2022 and included a manual supplemental screen of 11 organizational websites for gray literature (GRAY). A team of trained reviewers and editors screened all identified titles and abstracts, based on three case definition categories: disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). Articles meeting these definitions were independently scored by two reviewers using rubrics for original research (OR), review (RE) articles, and GRAY. Articles that scored in the top 5% from each category as well as the overall top 5% of articles were included for narrative summary. RESULTS The 2022 search identified 58,510 articles in the main review, of which 524 articles screened in for scoring, respectively, 30% and 18% increases from last year. After duplicates were removed, 36 articles were included for narrative summary. The GRAY search identified 7755 articles, of which 33 were scored and one was included for narrative summary. ECRLS remained the largest category (27; 73%), followed by DHR (7; 19%) and EMD (3; 8%). OR articles remained more common than RE articles (64% vs. 36%). CONCLUSIONS The waning of the COVID-19 pandemic has not affected the continued growth in GEM literature. Articles related to prehospital care, mental health and resilience among patients and health care workers, streamlining pediatric infectious disease care, and disaster preparedness were featured in this year's review. The continued lack of EMD studies despite the global growth of GEM highlights a need for more scholarly dissemination of best practices.
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Affiliation(s)
- Braden J Hexom
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Nana Serwaa A Quao
- Department of Emergency Medicine, Accident and Emergency Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - N Shakira Bandolin
- Department of Emergency Medicine, University of California, Davis, California, USA
| | - Joseph Bonney
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Global Health and Infectious Disease Research Group, Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan Dyal
- Department of Emergency Medicine, University of Texas, Houston, Texas, USA
| | - J Austin Lee
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, USA
| | - Benjamin D Nicholson
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Megan M Rybarczyk
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charlotte M Roy
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California, USA
| | | | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
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Jafar AJN, Prager G, Ingham JF, Jones P, Kennedy H, Ingram C, Ndiaye H. Emergency medicine engagement in global health: what does 10 years of the global emergency medicine literature review tell us? Eur J Emerg Med 2023; 30:287-291. [PMID: 37387630 DOI: 10.1097/mej.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Anisa Jabeen Nasir Jafar
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester
- Emergency Department, Salford Royal Foundation Trust, Salford
| | - Gabrielle Prager
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester
| | | | - Peter Jones
- Emergency Department, Manchester Royal Infirmary
| | | | - Claire Ingram
- Tatton Unit, Pennine Care NHS Foundation Trust, Manchester, UK
| | - Haarith Ndiaye
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Massachusetts, USA
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3
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Kivlehan SM, Hexom BJ, Bonney J, Collier A, Nicholson BD, Quao NSA, Rybarczyk MM, Selvam A, Rees CA, Roy CM, Bhaskar N, Becker TK. Global emergency medicine: A scoping review of the literature from 2021. Acad Emerg Med 2022; 29:1264-1274. [PMID: 35913419 DOI: 10.1111/acem.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective was to identify the most important and impactful peer-reviewed global emergency medicine (GEM) articles published in 2021. The top articles are summarized in brief narratives and accompanied by a comprehensive list of all identified articles that address the topic during the year to serve as a reference for clinicians, researchers, and policy makers. METHODS A systematic PubMed search was carried out to identify all GEM articles published in 2021. Title and abstract screening was performed by trained reviewers and editors to identify articles in one of three categories based on predefined criteria: disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). Included articles were each scored by two reviewers using established rubrics for original (OR) and review (RE) articles. The top 5% of articles overall and the top 5% of articles from each category (DHR, ECRLS, EMD, OR, and RE) were included for narrative summary. RESULTS The 2021 search identified 44,839 articles, of which 444 articles screened in for scoring, 25% and 22% increases from 2020, respectively. After removal of duplicates, 23 articles were included for narrative summary. ECRLS constituted the largest category (n = 16, 70%), followed by EMD (n = 4, 17%) and DHR (n = 3, 13%). The majority of top articles were OR (n = 14, 61%) compared to RE (n = 9, 39%). CONCLUSIONS The GEM peer-reviewed literature continued to grow at a fast rate in 2021, reflecting the continued expansion and maturation of this subspecialty of emergency medicine. Few high-quality articles focused on DHR and EMD, suggesting a need for further efforts in those fields. Future efforts should focus on improving the diversity of GEM research and equitable representation.
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Affiliation(s)
- Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Braden J Hexom
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph Bonney
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Global Health and Infectious Disease Research Group, Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Benjamin D Nicholson
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nana Serwaa A Quao
- Department of Emergency Medicine, Accident and Emergency Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Megan M Rybarczyk
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charlotte M Roy
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California, USA
| | | | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
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Ojeleke O, Groot W, Pavlova M. Care delivery among refugees and internally displaced persons affected by complex emergencies: a systematic review of the literature. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01343-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Aim
This study reviews the empirical evidence on care delivery in complex emergencies (CEs) to better understand ways of improving care delivery and mitigating inequity in care among refugees and internally displaced persons (IDPs) in CEs.
Subject and methods
A systematic search was conducted in Web of Science, MEDLINE, PubMed and Embase. A manual search was conducted in the WHO Global Index Medicus and Google Scholar. Peer-reviewed English-language publications that reported results on care delivery in CEs were included for review. There was no limitation on the year or the geographical location of the studies. The content of the publications was qualitatively analysed, and the results are thematically presented in tabular form.
Results
Thirty publications were identified. Information regarding coverage, accessibility, quality, continuity and comprehensiveness of care service delivery was extracted and synthesized. Findings showed that constant insecurity, funding, language barriers and gender differences were factors impeding access to and coverage and comprehensiveness of care delivery in CEs. The review also showed a preference for traditional treatment among some refugees and IDPs.
Conclusion
Evidence from this systematic review revealed a high level of unmet healthcare need among refugees and IDPs and the need for a paradigm shift in the approach to care delivery in CEs. We recommend further research aimed at a more critical evaluation of care delivery in CEs with a view to providing a more innovative and context-specific care service delivery in these settings.
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Trehan I, Kivlehan SM, Balhara KS, Bonney J, Hexom BJ, Pousson AY, Quao NSA, Rybarczyk MM, Selvam A, Nicholson BD, Bhaskar N, Becker TK, Balhara KS, Bandolin NS, Bannon‐Murphy H, Becker TK, Bhaskar N, Bonney J, Boone A, Broccoli MC, Charlton ADI, Cho DK, Ciano JD, Collier A, Dawson‐Amoah NA, Dyal JW, Flaherty KE, Hartford EA, Hayward AS, Hexom BJ, Hunter C, Jacobson AA, Joiner AP, Jones JE, Kampalath VN, Kivlehan SM, Laurence CE, Leanza J, Ledger E, Lee JA, Levine AC, Lowsby R, McCuskee S, Moretti KR, Nicholson BD, Pigoga JL, Pousson AY, Quao NSA, Rees CA, Roy CM, Rybarczyk MM, Selvam A, Skarpiak BJ, Strong JM, Trehan I, Vogel LD, Wang AH, Wegman KM, Winders WT. Global emergency medicine: A scoping review of the literature from 2020. Acad Emerg Med 2021; 28:1328-1340. [PMID: 34310782 DOI: 10.1111/acem.14356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective was to identify, screen, highlight, review, and summarize some of the most rigorously conducted and impactful original research (OR) and review articles (RE) in global emergency medicine (EM) published in 2020 in the peer-reviewed and gray literature. METHODS A broad systematic search of peer-reviewed publications related to global EM indexed on PubMed and in the gray literature was conducted. The titles and abstracts of the articles on this list were screened by members of the Global Emergency Medicine Literature Review (GEMLR) Group to identify those that met our criteria of OR or RE in the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and EM development. Those articles that met these screening criteria were then scored using one of three scoring templates appropriate to the article type. Those articles that scored in the top 5% then underwent in-depth narrative summarization. RESULTS The 2020 GEMLR search initially identified 35,970 articles, more than 50% more than last year's search. From these, 364 were scored based on their full text. Nearly three-fourths of the scored articles constituted OR, of which nearly three-fourths employed quantitative research methods. Nearly 10% of the articles identified this year were directly related to COVID-19. Research involving ECRLS again constituted most of the articles in this year's review, accounting for more than 60% of the literature scored. A total of 20 articles underwent in-depth narrative critiques. CONCLUSIONS The number of studies relevant to global EM identified by our search was very similar to that of last year. Revisions to our methodology to identify a broader range of research were successful in identifying more qualitative research and studies related to DHR. The number of COVID-19-related articles is likely to continue to increase in subsequent years.
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Affiliation(s)
- Indi Trehan
- Departments of Pediatrics, Global Health, and Epidemiology University of Washington Seattle Washington USA
| | - Sean M. Kivlehan
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
- Harvard Humanitarian Initiative Cambridge Massachusetts USA
| | - Kamna S. Balhara
- Department of Emergency Medicine Johns Hopkins University Baltimore Maryland USA
| | - Joseph Bonney
- Department of Emergency Medicine Komfo Anokye Teaching Hospital Kumasi Ghana
- Global Health and Infectious Disease Research Group Kumasi Center for Collaborative Research in Tropical Medicine Kumasi Ghana
| | - Braden J. Hexom
- Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA
| | - Amelia Y. Pousson
- Department of Emergency Medicine Johns Hopkins University Baltimore Maryland USA
| | - Nana S. A. Quao
- Department of Emergency Medicine, Accident and Emergency Centre Korle Bu Teaching Hospital Accra Ghana
| | - Megan M. Rybarczyk
- Department of Emergency Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Anand Selvam
- Department of Emergency Medicine Yale University New Haven Connecticut USA
| | - Benjamin D. Nicholson
- Department of Emergency Medicine Virginia Commonwealth University Richmond Virginia USA
| | | | - Torben K. Becker
- Department of Emergency Medicine University of Florida Gainesville Florida USA
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Trehan I, Kivlehan SM, Balhara KS, Hexom BJ, Pousson AY, Quao NSA, Rybarczyk MM, Selvam A, Bonney J, Bhaskar N, Becker TK. Global Emergency Medicine: A Review of the Literature From 2019. Acad Emerg Med 2021; 28:117-128. [PMID: 32772445 DOI: 10.1111/acem.14107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The annual systematic search of the peer-reviewed and gray literature relevant to global emergency medicine (EM) was conducted by the Global Emergency Medicine Literature Review (GEMLR) to screen, evaluate, and review the most rigorously conducted and relevant research in global EM published in 2019. METHODS After a broad search of PubMed and websites of organizations publishing relevant gray literature, all articles that were deemed relevant to the fields of disaster and humanitarian response, emergency care in resource-limited settings, and EM development by at least one reviewer, an editor, and the managing editors were then scored by two different reviewers using a 20-point scoring template relevant to either original research (OR) or review (RE) articles. This scoring system rates articles on their clarity, research design, ethics, importance to global EM, and breadth of impact. Articles that then scored in the top 5% were then critiqued in depth. RESULTS A total of 23,321 article titles and abstracts were screened by 22 reviewers with a wide swath of clinical and research experience in global EM. From these, a total of 356 articles underwent full-text review and scoring on the 20-point scale; 26% were categorized as disaster and humanitarian response, 58% as emergency care in resource-limited settings, and 15% as EM development. Of these 356 articles, 276 (77.5%) were OR articles and 80 (22.5%) were RE articles. The 16 articles that scored in the top 5% (>17.5 of 20 points) received full in-depth narrative summaries. CONCLUSIONS In 2019, the overall number of studies relevant to global EM that were identified by our search decreased from the prior year, but more high-scoring articles related to the development of EM clinical practice and as a specialty in resource-constrained settings were identified.
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Affiliation(s)
- Indi Trehan
- From the Departments of Pediatrics and Global Health University of Washington Seattle WAUSA
| | - Sean M. Kivlehan
- the Department of Emergency Medicine Brigham and Women’s Hospital Boston MAUSA
- the Harvard Humanitarian Initiative Cambridge MAUSA
| | - Kamna S. Balhara
- the Department of Emergency Medicine Johns Hopkins University Baltimore MDUSA
| | - Braden J. Hexom
- the Department of Emergency Medicine Rush University Medical Center Chicago ILUSA
| | - Amelia Y. Pousson
- the Department of Emergency Medicine Johns Hopkins University Baltimore MDUSA
| | | | - Megan M. Rybarczyk
- the Department of Emergency Medicine Brigham and Women’s Hospital Boston MAUSA
| | - Anand Selvam
- the Department of Emergency Medicine Yale University New Haven CTUSA
| | - Joseph Bonney
- the Department of Emergency Medicine Komfo Anokye Teaching Hospital Kumasi Ghana
| | | | - Torben K. Becker
- and the Department of Emergency Medicine University of Florida Gainesville FLUSA
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Fernandez E, Rahman N, Hayton J, Crichton C, DeWitt V, Cattermole G, Corn O, Gidwani S, Harrison HL, Lowsby R, Bruijns S. Global health and the Royal College of Emergency Medicine: a cross-sectional survey of members and fellows. Emerg Med J 2020; 38:14-20. [PMID: 32862139 DOI: 10.1136/emermed-2020-209432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/25/2020] [Accepted: 07/09/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is growing interest in global health participation among emergency care doctors in the UK. The aim of this paper was to describe the demographics of members and fellows of the Royal College of Emergency Medicine involved in global health, the work they are involved in, as well as the benefits and barriers of this work. METHODS We conducted a survey to include members and fellows of the Royal College of Emergency Medicine describing the context of their global health work, funding arrangements for global health work and perceived barriers to, and benefits of, global health work. RESULTS The survey collected 1134 responses of which 439 (38.7%) were excluded. The analysis was performed with the remaining 695 (61.3%) responses. Global health involvement concentrated around South Asia and Africa. Work contexts were mainly direct clinical service (267, 38%), curriculum development (203, 29%) and teaching short courses (198, 28%). Activity was largely self-funded, both international (539, 78%) and from UK (516, 74%). Global health work was not reported to contribute to appraisal by many participants (294, 42.3%). Funding (443, 64%) and protected time (431, 62%) were reported as key barriers to global health productivity. DISCUSSION Participants largely targeted specialty development and educational activities. Lack of training, funding and supported time were identified as barriers to development. Galvanising support for global health through regional networks and College support for attracting funding and job plan recognition will help UK-based emergency care clinicians contribute more productively to this field.
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Affiliation(s)
| | - Najeeb Rahman
- Emergency Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Hayton
- Emergency Department, North Cumbria University Hospitals NHS Trust, Whitehaven, UK
| | - Claire Crichton
- Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Giles Cattermole
- Emergency Department, Princess Royal University Hospital, Orpington, UK
| | - Olivia Corn
- Emergency Department, Newham University Hospital NHS Trust, London, UK
| | - Shweta Gidwani
- Emergency Department, Chelsea and Westminster Hospital, London, UK
| | | | - Richard Lowsby
- Emergency Department, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
| | - Stevan Bruijns
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Rybarczyk MM, Ludmer N, Broccoli MC, Kivlehan SM, Niescierenko M, Bisanzo M, Checkett KA, Rouhani SA, Tenner AG, Geduld H, Reynolds T. Emergency Medicine Training Programs in Low- and Middle-Income Countries: A Systematic Review. Ann Glob Health 2020; 86:60. [PMID: 32587810 PMCID: PMC7304456 DOI: 10.5334/aogh.2681] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Despite the growing interest in the development of emergency care systems and emergency medicine (EM) as a specialty globally, there still exists a significant gap between the need for and the provision of emergency care by specialty trained providers. Many efforts to date to expand the practice of EM have focused on programs developed through partnerships between higher- and lower-resource settings. Objective To systematically review the literature to evaluate the composition of EM training programs in low- and middle-income countries (LMICs) developed through partnerships. Methods An electronic search was conducted using four databases for manuscripts on EM training programs - defined as structured education and/or training in the methods, procedures, and techniques of acute or emergency care - developed through partnerships. The search produced 7702 results. Using a priori inclusion and exclusion criteria, 94 manuscripts were included. After scoring these manuscripts, a more in-depth examination of 26 of the high-scoring manuscripts was conducted. Findings Fifteen highlight programs with a focus on specific EM content (i.e. ultrasound) and 11 cover EM programs with broader scopes. All outline programs with diverse curricula and varied educational and evaluative methods spanning from short courses to full residency programs, and they target learners from medical students and nurses to mid-level providers and physicians. Challenges of EM program development through partnerships include local adaptation of international materials; addressing the local culture(s) of learning, assessment, and practice; evaluation of impact; sustainability; and funding. Conclusions Overall, this review describes a diverse group of programs that have been or are currently being implemented through partnerships. Additionally, it highlights several areas for program development, including addressing other topic areas within EM beyond trauma and ultrasound and evaluating outcomes beyond the level of the learner. These steps to develop effective programs will further the advancement of EM as a specialty and enhance the development of effective emergency care systems globally.
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Affiliation(s)
- Megan M. Rybarczyk
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Nicholas Ludmer
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, US
| | | | - Sean M. Kivlehan
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Michelle Niescierenko
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, US
| | - Mark Bisanzo
- Division of Emergency Medicine, Department of Surgery, University of Vermont, US
| | - Keegan A. Checkett
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, US
| | - Shada A. Rouhani
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Andrea G. Tenner
- Department of Emergency Medicine, University of California, San Francisco, US
| | - Heike Geduld
- University of Cape Town/Stellenbosch University, College of Emergency Medicine of South Africa, ZA
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Mitchell RD, O'Reilly GM, Phillips GA, Sale T, Roy N. Developing a research question: A research primer for low- and middle-income countries. Afr J Emerg Med 2020; 10:S109-S114. [PMID: 33304792 PMCID: PMC7718466 DOI: 10.1016/j.afjem.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022] Open
Abstract
As demand for emergency care (EC) systems in low- and middle-income countries (LMICs) grows, there is an urgent need to expand the evidence base for clinical and systems interventions in resource limited EC settings. Clinicians are well placed to identify, define and address unanswered research questions using both quantitative and qualitative approaches. This paper summarises established research priorities for global EC and provides a step-wise approach to developing a research question. Research priorities for global EC broadly fall into two categories: systems-based research and research with a clinical care focus. Systems research is integral to understanding the essential components of safe and effective EC delivery, while clinical research aims to answer questions related to particular disease states, presentations or population groups. Developing a specific research question requires an enquiring, questioning and critical approach to EC delivery. In quantitative research, use of the PECO formula (Population, Exposure, Comparator, Outcome) can help frame a research question. Qualitative research, which aims to understand, explore and examine, often requires application of a theoretical framework. Writing a brief purpose statement can be a helpful tool to clarify the objectives of a qualitative study. This paper includes lists of tips, pitfalls and resources to assist EC clinical researchers in developing research questions. Application of these tools and frameworks will assist EC clinicians in resource limited settings to perform impactful research and improve outcomes for patients with acute illness and injury.
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Affiliation(s)
- Rob D. Mitchell
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Corresponding author. @robdmitchell
| | - Gerard M. O'Reilly
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Georgina A. Phillips
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency Department, St Vincent's Hospital, Melbourne, Australia
| | - Trina Sale
- National Referral Hospital, Honiara, Solomon Islands
| | - Nobhojit Roy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Dept of Surgery, BARC Hospital (Govt. of India), Mumbai, India
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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10
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Gul SS, Cohen SA, Avery KL, Balakrishnan MP, Balu R, Chowdhury MAB, Crabb D, Huesgen KW, Hwang CW, Maciel CB, Murphy TW, Han F, Becker TK. Cardiac arrest: An interdisciplinary review of the literature from 2018. Resuscitation 2020; 148:66-82. [PMID: 31945428 DOI: 10.1016/j.resuscitation.2019.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/23/2019] [Accepted: 12/15/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct a systematic annual search of peer-reviewed literature relevant to cardiac arrest (CA). The goals of the review are to illustrate best practices and help reduce knowledge silos by disseminating clinically relevant advances in the field of CA across disciplines. METHODS An electronic search of PubMed using keywords related to CA was conducted. Title and abstracts retrieved by these searches were screened for relevancy, separated by article type (original research or review), and sorted into 7 categories. Screened manuscripts underwent standardized scoring of overall methodological quality and importance. Articles scoring higher than 99 percentiles by category-type were selected for full critique. Systematic differences between editors and reviewer scores were assessed using Wilcoxon signed-rank test. RESULTS A total of 9119 articles were identified on initial search; of these, 1214 were scored after screening for relevance and deduplication, and 80 underwent full critique. Prognostication & Outcomes category comprised 25% and Epidemiology & Public Health 17.5% of fully reviewed articles. There were no differences between editor and reviewer scoring. CONCLUSIONS The total number of articles demonstrates the need for an accessible source summarizing high-quality research findings to serve as a high-yield reference for clinicians and scientists seeking to absorb the ever-growing body of CA-related literature. This may promote further development of the unique and interdisciplinary field of CA medicine.
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Affiliation(s)
- Sarah S Gul
- Department of Surgery, Yale University, New Haven, CT, United States
| | - Scott A Cohen
- Department of Emergency Medicine, University of Florida, Gainesville, FL, United States
| | - K Leslie Avery
- Division of Pediatric Critical Care, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | | | - Ramani Balu
- Division of Neurocritical Care, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | | | - David Crabb
- Department of Emergency Medicine, University of Florida, Gainesville, FL, United States
| | - Karl W Huesgen
- Department of Emergency Medicine, University of Florida, Gainesville, FL, United States
| | - Charles W Hwang
- Department of Emergency Medicine, University of Florida, Gainesville, FL, United States
| | - Carolina B Maciel
- Division of Neurocritical Care, Department of Neurology, University of Florida, Gainesville, FL, United States; Department of Neurology, Yale University, New Haven, CT, United States
| | - Travis W Murphy
- Department of Emergency Medicine, University of Florida, Gainesville, FL, United States
| | - Francis Han
- Department of Emergency Medicine, University of Florida, Gainesville, FL, United States
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, United States.
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Trehan I, Osei‐Ampofo M, Balhara KS, Hexom BJ, Kivlehan SM, Modi P, Pousson AY, Selvam A, Quao NSA, Cho DK, Becker TK, Levine AC, Bannon‐Murphy H, Bartels SA, Beyene T, Bonney J, Collier AT, Cook J, Dyal JW, Enriquez KT, Gomes DJ, Hayward AS, Ibrahim WMA, Keefe DM, Lee JA, Lee S, Lowsby R, Mediratta RP, Mickman CT, Nicholson BD, O'Reilly GM, Relan P, Ragins KT, Reid EA, Roy CM, Rybarczyk MM, Schultz ML, Stanford KA, Vogel LD, Wang AH, Zewdie A. Global Emergency Medicine: A Review of the Literature from 2018. Acad Emerg Med 2019; 26:1186-1196. [PMID: 31313411 DOI: 10.1111/acem.13832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/06/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts a systematic annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most rigorously conducted and widely relevant research in global EM. METHODS An electronic search of PubMed, a comprehensive retrieval of articles from specific journals, and search of the gray literature were conducted. Title and abstracts retrieved by these searches were screened by a total of 22 reviewers based on their relevance to the field of global EM, across the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). All articles that were deemed relevant by at least one reviewer, their editor, and the managing editor underwent formal scoring of overall methodologic quality and importance to global EM. Two independent reviewers scored all articles; editors provided a third score in cases of widely discrepant scores. RESULTS A total of 19,102 articles were identified by the searches and, after screening and removal of duplicates, a total of 517 articles underwent full review. Twenty-five percent were categorized as DHR, 61% as ECRLS, and 15% as EMD. Inter-rater reliability testing between the reviewers revealed a Cohen's kappa score of 0.213 when considering the complete score or 0.426 when excluding the more subjective half of the score. A total of 25 articles scored higher than 17.5 of 20; these were selected for a full summary and critique. CONCLUSIONS In 2018, the total number of articles relevant to global EM that were identified by our search continued to increase. Studies and reviews focusing on pediatric infections, several new and traditionally underrepresented topics, and landscape reviews that may help guide clinical care in new settings represented the majority of top-scoring articles. A shortage of articles related to the development of EM as a specialty was identified.
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Affiliation(s)
- Indi Trehan
- Lao Friends Hospital for Children Luang Prabang Lao PDR
- Department of Pediatrics Washington University in St. Louis St. Louis MO
| | - Maxwell Osei‐Ampofo
- Emergency Medicine Directorate Komfo Anokye Teaching Hospital, and the Department of Anaesthesia and Intensive Care Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Kamna S. Balhara
- Department of Emergency Medicine Johns Hopkins University Baltimore MD
| | - Braden J. Hexom
- Department of Emergency Medicine Rush University Medical Center Chicago IL
| | - Sean M. Kivlehan
- Department of Emergency Medicine Brigham and Women's Hospital Boston MA
- Harvard Humanitarian Initiative Cambridge MA
| | - Payal Modi
- Department of Emergency Medicine University of Massachusetts Worcester MA
| | - Amelia Y. Pousson
- Department of Emergency Medicine Johns Hopkins University Baltimore MD
| | - Anand Selvam
- Department of Emergency Medicine Yale University New Haven CT
| | - Nana Serwaa A. Quao
- Department of Emergency Medicine Korle Bu Teaching Hospital (NSAQ) Accra Ghana
| | | | - Torben K. Becker
- Department of Emergency Medicine University of Florida Gainesville FL
| | - Adam C. Levine
- and the Department of Emergency Medicine Brown University Providence RI
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Balhara KS, Bustamante ND, Selvam A, Winders WT, Coker A, Trehan I, Becker TK, Levine AC. Bystander Assistance for Trauma Victims in Low- and Middle-Income Countries: A Systematic Review of Prevalence and Training Interventions. PREHOSP EMERG CARE 2018; 23:389-410. [PMID: 30141702 DOI: 10.1080/10903127.2018.1513104] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Lack of organized prehospital care may contribute to the disproportionate burden of trauma-related deaths in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends bystander training in basic principles of first aid and victim transport; however, prevalence of bystander or layperson assistance to trauma victims in LMICs has not been well-described, and organized reviews of existing evidence for bystander training are lacking. This systematic review aims to 1) describe the prevalence of bystander or layperson aid or transport for trauma victims in the prehospital setting in LMICs and 2) ascertain impacts of bystander training interventions in these settings. METHODS A systematic search of OVID Medline, Cochrane Library, and relevant gray literature was conducted. We included 1) all studies detailing prevalence of bystander-administered aid or transport for trauma victims in LMICs and 2) all randomized controlled trials and observational studies evaluating bystander training interventions. We extracted study characteristics, interventions, and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. RESULTS Sixty-two studies detailed prevalence of bystander transport and aid. Family members, police, and bus or taxi drivers commonly transported patients; a majority of patients, up to >94%, received aid from bystanders. Twenty-four studies examined impacts of training interventions. Only one study looked at transport interventions; the remainder addressed first aid training. Interventions varied in content, duration, and target learners. Evidence was generally of low quality, but all studies demonstrated improvements in layperson knowledge and skills. Five studies reported a mortality reduction. CONCLUSIONS Heterogeneity in data reporting and outcomes limited formal meta-analysis. However, this review shows high rates of bystander involvement in prehospital trauma care and transport in LMICs and highlights the need for bystander training. Bystander training in these settings is feasible and may have an important impact on meaningful outcomes such as mortality. Categories of involved bystanders varied by region and training interventions should be targeted at relevant groups. "Train the trainer" models appear promising in securing community engagement and maximizing participation. Further research is needed to examine the value of bystander transport networks in trauma.
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