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Sultan M, Zewdie A, Priyadarshani D, Hassen E, Tilahun M, Geremew T, Beane A, Haniffa R, Berenholtz SM, Checkley W, Hansoti B, Laytin AD. Implementing an ICU registry in Ethiopia-Implications for critical care quality improvement. J Crit Care 2024; 81:154525. [PMID: 38237203 PMCID: PMC10996997 DOI: 10.1016/j.jcrc.2024.154525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Intensive care units (ICUs) in low- and middle-income countries have high mortality rates, and clinical data are needed to guide quality improvement (QI) efforts. This study utilizes data from a validated ICU registry specially developed for resource-limited settings to identify evidence-based QI priorities for ICUs in Ethiopia. MATERIALS AND METHODS A retrospective cohort analysis of data from two tertiary referral hospital ICUs in Addis Ababa, Ethiopia from July 2021-June 2022 was conducted to describe casemix, complications and outcomes and identify features associated with ICU mortality. RESULTS Among 496 patients, ICU mortality was 35.3%. The most common reasons for ICU admission were respiratory failure (24.0%), major head injury (17.5%) and sepsis/septic shock (13.3%). Complications occurred in 41.0% of patients. ICU mortality was higher among patients with respiratory failure (46.2%), sepsis (66.7%) and vasopressor requirements (70.5%), those admitted from the hospital ward (64.7%), and those experiencing major complications in the ICU (62.3%). CONCLUSIONS In this study, ICU mortality was high, and complications were common and associated with increased mortality. ICU registries are invaluable tools to understand local casemix and clinical outcomes, especially in resource-limited settings. These findings provide a foundation for QI efforts and a baseline to evaluate their impact.
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Affiliation(s)
- Menbeu Sultan
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Ayalew Zewdie
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia; Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | | | - Ephrem Hassen
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Melkamu Tilahun
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Tigist Geremew
- Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | - Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Scotland, UK.
| | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Scotland, UK.
| | - Sean M Berenholtz
- Johns Hopkins University School of Medicine, Department of Anesthesia and Critical Care Medicine, Baltimore, MD, USA.
| | - William Checkley
- Johns Hopkins University School of Medicine, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA.
| | - Bhakti Hansoti
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, MD, USA.
| | - Adam D Laytin
- Johns Hopkins University School of Medicine, Department of Anesthesia and Critical Care Medicine, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, MD, USA.
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Prabhune A, Bhat S, Mallavaram A, Mehar Shagufta A, Srinivasan S. A Situational Analysis of the Impact of the COVID-19 Pandemic on Digital Health Research Initiatives in South Asia. Cureus 2023; 15:e48977. [PMID: 38111408 PMCID: PMC10726017 DOI: 10.7759/cureus.48977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
The objective of this paper was to evaluate and compare the quantity and sustainability of digital health initiatives in the South Asia region before and during the COVID-19 pandemic. The study used a two-step methodology of (a) descriptive analysis of digital health research articles published from 2016 to 2021 from South Asia in terms of stratification of research articles based on diseases and conditions they were developed, geography, and tasks wherein the initiative was applied and (b) a simple and replicable tool developed by authors to assess the sustainability of digital health initiatives using experimental or observational study designs. The results of the descriptive analysis highlight the following: (a) there was a 40% increase in the number of studies reported in 2020 when compared to 2019; (b) the three most common areas wherein substantive digital health research has been focused are health systems strengthening, ophthalmic disorders, and COVID-19; and (c) remote consultation, health information delivery, and clinical decision support systems are the top three commonly developed tools. We developed and estimated the inter-rater operability of the sustainability assessment tool ascertained with a Kappa value of 0.806 (±0.088). We conclude that the COVID-19 pandemic has had a positive impact on digital health research with an improvement in the number of digital health initiatives and an improvement in the sustainability score of studies published during the COVID-19 pandemic.
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Affiliation(s)
- Akash Prabhune
- Health and Information Technology, Institute of Health Management Research, Bangalore, IND
| | - Sachin Bhat
- Health and Information Technology, Institute of Health Management Research, Bangalore, IND
| | | | | | - Surya Srinivasan
- Health and Information Technology, Institute of Health Management Research, Bangalore, IND
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3
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Rashan A, Beane A, Ghose A, Dondorp AM, Kwizera A, Vijayaraghavan BKT, Biccard B, Righy C, Thwaites CL, Pell C, Sendagire C, Thomson D, Done DG, Aryal D, Wagstaff D, Nadia F, Putoto G, Panaru H, Udayanga I, Amuasi J, Salluh J, Gokhale K, Nirantharakumar K, Pisani L, Hashmi M, Schultz M, Ghalib MS, Mukaka M, Mat-Nor MB, Siaw-frimpong M, Surenthirakumaran R, Haniffa R, Kaddu RP, Pereira SP, Murthy S, Harris S, Moonesinghe SR, Vengadasalam S, Tripathy S, Gooden TE, Tolppa T, Pari V, Waweru-Siika W, Minh YL. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units. Wellcome Open Res 2023; 8:29. [PMID: 37954925 PMCID: PMC10638482 DOI: 10.12688/wellcomeopenres.18710.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
Background Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be led by local stakeholders, performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.
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Affiliation(s)
- The Collaboration for Research, Implementation and Training in Critical Care in Asia and Africa (CCAA)
- Institute of Health Informatics, University College London, London, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Anaesthesia and Intensive Care Medicine, Makerere University, Kampala, Uganda
- Department of Critical Care Medicine, Apollo Hospitals Educational and Research Foundation, Chennai, India
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
- National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
- Uganda Heart Institute, University of Makerere, Makerere, Uganda
- D'Or Institute for Research and Education, Sao Paulo, Brazil
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Critical Care, Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- Centre for Preoperative Medicine, University College London, London, UK
- Department of Intensive Care Anaesthesiology, International Islamic University Malaysia, Kuala Lumpur, Malaysia
- Department of Planning and Operational Research, Doctors with Africa CUAMM, Padova, Italy
- Department of Global Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
- Intensive Care Medicine, University of Amsterdam, Amsterdam, The Netherlands
- General Surgery, Wazir Akbar Khan Hospital, Kabul, Afghanistan
- Department of Anaesthesiology and Intensive care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Sri Lanka
- Department of Anaesthesia, The Aga Khan University, Nairobi, Kenya
- Department of Targeted Intervention, University College London, London, UK
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
- Teaching Hospital Jaffna, Jaffna, Sri Lanka
- AII India Institute of Medical Sciences, New Delhi, India
- Chennai Critical Care Consultants Private Limited, Chennai, India
| | - Aasiyah Rashan
- Institute of Health Informatics, University College London, London, UK
| | - Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Aniruddha Ghose
- Department of Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arthur Kwizera
- Department of Anaesthesia and Intensive Care Medicine, Makerere University, Kampala, Uganda
| | | | - Bruce Biccard
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Cassia Righy
- National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - C. Louise Thwaites
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Cornelius Sendagire
- Uganda Heart Institute, University of Makerere, Makerere, Uganda
- D'Or Institute for Research and Education, Sao Paulo, Brazil
| | - David Thomson
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Dilanthi Gamage Done
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Diptesh Aryal
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- D'Or Institute for Research and Education, Sao Paulo, Brazil
- Department of Critical Care, Nepal Intensive Care Research Foundation, Kathmandu, Nepal
| | - Duncan Wagstaff
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Preoperative Medicine, University College London, London, UK
| | - Farah Nadia
- Department of Intensive Care Anaesthesiology, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Giovanni Putoto
- Department of Planning and Operational Research, Doctors with Africa CUAMM, Padova, Italy
| | - Hem Panaru
- Department of Critical Care, Nepal Intensive Care Research Foundation, Kathmandu, Nepal
| | - Ishara Udayanga
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
| | - John Amuasi
- Department of Global Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jorge Salluh
- D'Or Institute for Research and Education, Sao Paulo, Brazil
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Luigi Pisani
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Madiha Hashmi
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
| | - Marcus Schultz
- Intensive Care Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mohammed Basri Mat-Nor
- Department of Intensive Care Anaesthesiology, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Moses Siaw-frimpong
- Department of Anaesthesiology and Intensive care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
| | - Ronnie P Kaddu
- Department of Anaesthesia, The Aga Khan University, Nairobi, Kenya
| | | | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Steve Harris
- Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Swagata Tripathy
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- AII India Institute of Medical Sciences, New Delhi, India
| | - Tiffany E Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timo Tolppa
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
| | - Vrindha Pari
- Chennai Critical Care Consultants Private Limited, Chennai, India
| | | | - Yen Lam Minh
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
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Rashan A, Beane A, Ghose A, Dondorp AM, Kwizera A, Vijayaraghavan BKT, Biccard B, Righy C, Thwaites CL, Pell C, Sendagire C, Thomson D, Done DG, Aryal D, Wagstaff D, Nadia F, Putoto G, Panaru H, Udayanga I, Amuasi J, Salluh J, Gokhale K, Nirantharakumar K, Pisani L, Hashmi M, Schultz M, Ghalib MS, Mukaka M, Mat-Nor MB, Siaw-frimpong M, Surenthirakumaran R, Haniffa R, Kaddu RP, Pereira SP, Murthy S, Harris S, Moonesinghe SR, Vengadasalam S, Tripathy S, Gooden TE, Tolppa T, Pari V, Waweru-Siika W, Minh YL. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18710.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Background: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods: Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions: The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.
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5
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Rashan A, Beane A, Ghose A, Dondorp AM, Kwizera A, Vijayaraghavan BKT, Biccard B, Righy C, Thwaites CL, Pell C, Sendagire C, Thomson D, Done DG, Aryal D, Wagstaff D, Nadia F, Putoto G, Panaru H, Udayanga I, Amuasi J, Salluh J, Gokhale K, Nirantharakumar K, Pisani L, Hashmi M, Schultz M, Ghalib MS, Mukaka M, Mat-Nor MB, Siaw-frimpong M, Surenthirakumaran R, Haniffa R, Kaddu RP, Pereira SP, Murthy S, Harris S, Moonesinghe SR, Vengadasalam S, Tripathy S, Gooden TE, Tolppa T, Pari V, Waweru-Siika W, Minh YL. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18710.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods: Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions: The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.
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Brommeyer M, Whittaker M, Mackay M, Ng F, Liang Z. Building health service management workforce capacity in the era of health informatics and digital health - A scoping review. Int J Med Inform 2023; 169:104909. [PMID: 36347141 DOI: 10.1016/j.ijmedinf.2022.104909] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Health informatics and digital health, two rapidly growing disciplines, are becoming increasingly important to the sustainability of health service provision, highlighted especially through the COVID-19 pandemic. To maximise the benefits of the adoption and growth of health informatics and digital health, health service managers play a critical role in leading and managing the implementation and transformation of the system, both strategically and operationally, whilst still needing to manage 'business as usual'. OBJECTIVES The objectives of the paper are to present and discuss the findings from a scoping review identifying: 1) competencies required for health service managers leading the implementation and transformation of informatics and digital technology in the health sector; and 2) factors that are critical to building the management workforce capacity in the era of health informatics and digital health. METHODS A scoping review of the literature was conducted in 2020 focussing on identifying empirical articles published in the English language since the year 2000 using a number of keywords such as 'health informatics', 'digital health', 'electronic health', 'competencies', 'capability', 'proficiency', 'qualification', 'certification', 'health manager', 'health executive' and 'health administrator'. The literature search was guided by a PRISMA approach searching within eight databases: Scopus, ProQuest, Web of Science, ACM Digital Library, CINAHL, PubMed, Google Scholar and ProQuest Dissertations. RESULTS After duplicates were removed, 941 publications were included for title screening as the result of an initial review. Title screening selected 185 articles to be included for abstract screening by two reviewers confirming 19 papers relevant to the focus of the current paper which were included in data extraction and content analysis. The analysis identified the additional competency of 'information and data management' be included as a core competency for health service managers. The analysis also confirmed additional elements for the following four core management competencies that are important to health service managers working in the digital health context, including: 1) leadership; 2) operational and resource management; 3) personal, interpersonal and professional qualities, and 4) understanding the industry and environment. Factors that are critical to developing the system and organization capacity in the use of health informatics and digital health technology, and leading and managing the adoption in the healthcare organizations were identified in three categories: 1) policy/system; 2) organizational structure and processes; and 3) people factors. CONCLUSIONS This paper has taken an important step in confirming the competency requirements for health services managers that are relevant to leading and managing in the health informatics and digital health space, consequently indicating the directions for developing a competent workforce in meeting the existing and emerging healthcare delivery challenges, both now and in the future.
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Affiliation(s)
- Mark Brommeyer
- James Cook University, Townsville, Queensland, Australia; Flinders University, Adelaide, Australia.
| | | | - Mark Mackay
- James Cook University, Townsville, Queensland, Australia
| | - Fowie Ng
- Tung Wah College, Hong Kong, China
| | - Zhanming Liang
- James Cook University, Townsville, Queensland, Australia
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Irani Z, Abril RM, Weerakkody V, Omar A, Sivarajah U. The impact of legacy systems on digital transformation in European public administration: Lesson learned from a multi case analysis. GOVERNMENT INFORMATION QUARTERLY 2022. [DOI: 10.1016/j.giq.2022.101784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Kanesamoorthy S, Sheron VA, Uruthirakumar P, Kodippily C, Kumarendran B, Gooden TE, Thomas GN, Nirantharakumar K, Lip GYH, Guruparan M, Haniffa R, Surenthirakumaran R, Beane A, Subaschandran K. Prevalence of atrial fibrillation in Northern Sri Lanka: a study protocol for a cross-sectional household survey. BMJ Open 2022; 12:e056480. [PMID: 36418134 PMCID: PMC9685242 DOI: 10.1136/bmjopen-2021-056480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common arrhythmia globally. It is associated with a fivefold risk in stroke, but early diagnosis and effective treatment can reduce this risk. AF is often underdiagnosed, particularly in low-income and middle-income countries (LMICs) where screening for AF is not always feasible or considered common practice in primary care settings. Epidemiological data on AF in LMICs is often incomplete particularly in vulnerable populations. This LMIC research collaborative aims to identify the prevalence of AF in the Northern Sri Lankan community. METHODS AND ANALYSIS A cross-sectional household survey piloted and codesigned through a series of community engagement events will be administered in all five districts in Northern Province, Sri Lanka. A multistage cluster sampling approach will be used starting at district level, then the Divisional Secretariats followed by Grama Niladhari divisions. Twenty households will be selected from each cluster. The study aims to recruit 10 000 participants aged 50 years or older, 1 participant per household. Demographic and socioeconomic characteristics, well-being and lifestyle and anthropometric measurements will be collected using a digital data platform (REDCap, Research Electronic Data Capture) by trained data collectors. Participants will be screened for AF using a fingertip single-lead ECG via a smartphone application (AliveCor) with rhythm strips reviewed by a consultant cardiologist. Prevalence of AF and risk factors will be established at province and district-levels. Adjusted ORs and population attributable fractions for AF risk factors will be determined. ETHICS AND DISSEMINATION This study was approved by the Ethics Review Committee of Faculty of Medicine at University of Jaffna. Written informed consent will be obtained from all participants. Findings will be disseminated through publication in a peer-reviewed journal and presentations at conferences. The findings will enable early treatment for new AF diagnoses and inform interventions to improve community-based management of AF in LMICs.
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Affiliation(s)
- Shribavan Kanesamoorthy
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
| | | | - Powsiga Uruthirakumar
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
| | - Chamira Kodippily
- National Intensive Care Surveillance-Mahidol Oxford Tropical Medicine Research Unit, Jaffna, Sri Lanka
| | - Balachandran Kumarendran
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
| | - Tiffany E Gooden
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
| | - Graham Neil Thomas
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
| | | | - Gregory Y H Lip
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, Merseyside, UK
| | - Mahesan Guruparan
- Department of Cardiology, Jaffna Teaching Hospital, Jaffna, Sri Lanka
| | - Rashan Haniffa
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | | | - Abi Beane
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Kumaran Subaschandran
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
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9
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Brommeyer M, Liang Z. A Systematic Approach in Developing Management Workforce Readiness for Digital Health Transformation in Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13843. [PMID: 36360722 PMCID: PMC9658786 DOI: 10.3390/ijerph192113843] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic has sped up digital health transformation across the health sectors to enable innovative health service delivery. Such transformation relies on competent managers with the capacity to lead and manage. However, the health system has not adopted a holistic approach in addressing the health management workforce development needs, with many hurdles to overcome. The objectives of this paper are to present the findings of a three-step approach in understanding the current hurdles in developing a health management workforce that can enable and maximize the benefits of digital health transformation, and to explore ways of overcoming such hurdles. METHODS A three-step, systematic approach was undertaken, including an Australian digital health policy documentary analysis, an Australian health service management postgraduate program analysis, and a scoping review of international literatures. RESULTS The main findings of the three-step approach confirmed the strategies required in developing a digitally enabled health management workforce and efforts in enabling managers in leading and managing in the digital health space. CONCLUSIONS With the ever-changing landscape of digital health, leading and managing in times of system transformation requires a holistic approach to develop the necessary health management workforce capabilities and system-wide capacity. The proposed framework, for overall health management workforce development in the digital health era, suggests that national collaboration is necessary to articulate a more coordinated, consistent, and coherent set of policy guidelines and the system, policy, educational, and professional organizational enablers that drive a digital health focused approach across all the healthcare sectors, in a coordinated and contextual manner.
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Affiliation(s)
- Mark Brommeyer
- College of Business, Government and Law, Flinders University, Adelaide 5042, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia
| | - Zhanming Liang
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia
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10
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van Heerden A, Kolozali Ş, Norris SA. Feasibility and acceptability of continuous at-home glucose monitoring during pregnancy: a mixed-methods pilot study. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2022.2114408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Şefki Kolozali
- School of Computer Science and Electronic Engineering, University of Essex, Essex, United Kingom
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Human Development, University of Southampton, Southampton, United Kingom
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11
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Pisani L, Rashan T, Shamal M, Ghose A, Kumar Tirupakuzhi Vijayaraghavan B, Tripathy S, Aryal D, Hashmi M, Nor B, Lam Minh Y, Dondorp AM, Haniffa R, Beane A. Performance evaluation of a multinational data platform for critical care in Asia. Wellcome Open Res 2022; 6:251. [PMID: 35141427 PMCID: PMC8812332 DOI: 10.12688/wellcomeopenres.17122.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 02/02/2023] Open
Abstract
Background: The value of medical registries strongly depends on the quality of the data collected. This must be objectively measured before large clinical databases can be promoted for observational research, quality improvement, and clinical trials. We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries of critically ill patients established in seven Asian low- and middle-income countries (LMICs). Methods: The Critical Care Asia federated registry platform enables ICUs to collect clinical, outcome and process data for aggregate and unit-level analysis. The evaluation used the standardised criteria of the Directory of Clinical Databases (DoCDat) and a framework for data quality assurance in medical registries. Six reviewers assessed structure, coverage, reliability and validity of the ICU registry data. Case mix and process measures on patient episodes from June to December 2020 were analysed. Results: Data on 20,507 consecutive patient episodes from 97 ICUs in Afghanistan, Bangladesh, India, Malaysia, Nepal, Pakistan and Vietnam were included. The quality level achieved according to the ten prespecified DoCDat criteria was high (average score 3.4 out of 4) as was the structural and organizational performance -- comparable to ICU registries in high-income countries. Identified strengths were types of variables included, reliability of coding, data completeness and validation. Potential improvements included extension of national coverage, optimization of recruitment completeness validation in all centers and the use of interobserver reliability checks. Conclusions: The Critical Care Asia platform evaluates well using standardised frameworks for data quality and equally to registries in resource-rich settings.
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Affiliation(s)
| | - Luigi Pisani
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand,Doctors with Africa CUAMM, Padova, Italy,
| | - Thalha Rashan
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Maryam Shamal
- NICS-MORU collaboration, Crit Care Asia Afghanistan team, Kabul, Afghanistan
| | - Aniruddha Ghose
- Department of Medicine, Chattogram Medical Centre, Chattogram, Bangladesh
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Indian Registry of IntenSive care, IRIS, Chennai, India,Chennai Critical Care Consultants, Chennai, India,Critical Care Medicine,, Apollo Hospitals, Chennai, India
| | - Swagata Tripathy
- Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Diptesh Aryal
- Critical Care and Anesthesia, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Madiha Hashmi
- Department of Critical Care, Ziauddin University, Karachi, Pakistan
| | - Basri Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine,, International Islamic University Malaysia (IIUM), Kuala Lumpur, Malaysia
| | - Yen Lam Minh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Rashan Haniffa
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Abi Beane
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
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12
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Pisani L, Rashan T, Shamal M, Ghose A, Kumar Tirupakuzhi Vijayaraghavan B, Tripathy S, Aryal D, Hashmi M, Nor B, Lam Minh Y, Dondorp AM, Haniffa R, Beane A. Performance evaluation of a multinational data platform for critical care in Asia. Wellcome Open Res 2022; 6:251. [PMID: 35141427 PMCID: PMC8812332 DOI: 10.12688/wellcomeopenres.17122.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 02/02/2023] Open
Abstract
Background: The value of medical registries strongly depends on the quality of the data collected. This must be objectively measured before large clinical databases can be promoted for observational research, quality improvement, and clinical trials. We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries of critically ill patients established in seven Asian low- and middle-income countries (LMICs). Methods: The Critical Care Asia federated registry platform enables ICUs to collect clinical, outcome and process data for aggregate and unit-level analysis. The evaluation used the standardised criteria of the Directory of Clinical Databases (DoCDat) and a framework for data quality assurance in medical registries. Six reviewers assessed structure, coverage, reliability and validity of the ICU registry data. Case mix and process measures on patient episodes from June to December 2020 were analysed. Results: Data on 20,507 consecutive patient episodes from 97 ICUs in Afghanistan, Bangladesh, India, Malaysia, Nepal, Pakistan and Vietnam were included. The quality level achieved according to the ten prespecified DoCDat criteria was high (average score 3.4 out of 4) as was the structural and organizational performance -- comparable to ICU registries in high-income countries. Identified strengths were types of variables included, reliability of coding, data completeness and validation. Potential improvements included extension of national coverage, optimization of recruitment completeness validation in all centers and the use of interobserver reliability checks. Conclusions: The Critical Care Asia platform evaluates well using standardised frameworks for data quality and equally to registries in resource-rich settings.
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Affiliation(s)
| | - Luigi Pisani
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand,Doctors with Africa CUAMM, Padova, Italy,
| | - Thalha Rashan
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Maryam Shamal
- NICS-MORU collaboration, Crit Care Asia Afghanistan team, Kabul, Afghanistan
| | - Aniruddha Ghose
- Department of Medicine, Chattogram Medical Centre, Chattogram, Bangladesh
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Indian Registry of IntenSive care, IRIS, Chennai, India,Chennai Critical Care Consultants, Chennai, India,Critical Care Medicine,, Apollo Hospitals, Chennai, India
| | - Swagata Tripathy
- Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Diptesh Aryal
- Critical Care and Anesthesia, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Madiha Hashmi
- Department of Critical Care, Ziauddin University, Karachi, Pakistan
| | - Basri Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine,, International Islamic University Malaysia (IIUM), Kuala Lumpur, Malaysia
| | - Yen Lam Minh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Rashan Haniffa
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Abi Beane
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
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13
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Chanyalew MA, Yitayal M, Atnafu A, Mengiste SA, Tilahun B. The Effectiveness of the Capacity Building and Mentorship Program in Improving Evidence-Based Decision-making in the Amhara Region, Northwest Ethiopia: Difference-in-Differences Study. JMIR Med Inform 2022; 10:e30518. [PMID: 35451990 PMCID: PMC9077516 DOI: 10.2196/30518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 02/13/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Weak health information systems (HISs) hobble countries’ abilities to effectively manage and distribute their resources to match the burden of disease. The Capacity Building and Mentorship Program (CBMP) was implemented in select districts of the Amhara region of Ethiopia to improve HIS performance; however, evidence about the effectiveness of the intervention was meager. Objective This study aimed to determine the effectiveness of routine health information use for evidence-based decision-making among health facility and department heads in the Amhara region, Northwest Ethiopia. Methods The study was conducted in 10 districts of the Amhara region: five were in the intervention group and five were in the comparison group. We employed a quasi-experimental study design in the form of a pretest-posttest comparison group. Data were collected from June to July 2020 from the heads of departments and facilities in 36 intervention and 43 comparison facilities. The sample size was calculated using the double population formula, and we recruited 172 participants from each group. We applied a difference-in-differences analysis approach to determine the effectiveness of the intervention. Heterogeneity of program effect among subgroups was assessed using a triple differences method (ie, difference-in-difference-in-differences [DIDID] method). Thus, the β coefficients, 95% CIs, and P values were calculated for each parameter, and we determined that the program was effective if the interaction term was significant at P<.05. Results Data were collected using the endpoint survey from 155 out of 172 (90.1%) participants in the intervention group and 166 out of 172 (96.5%) participants in the comparison group. The average level of information use for the comparison group was 37.3% (95% CI 31.1%-43.6%) at baseline and 43.7% (95% CI 37.9%-49.5%) at study endpoint. The average level of information use for the intervention group was 52.2% (95% CI 46.2%-58.3%) at baseline and 75.8% (95% CI 71.6%-80.0%) at study endpoint. The study indicated that the net program change over time was 17% (95% CI 5%-28%; P=.003). The subgroup analysis also indicated that location showed significant program effect heterogeneity, with a DIDID estimate equal to 0.16 (95% CI 0.026-0.29; P=.02). However, sex, age, educational level, salary, and experience did not show significant heterogeneity in program effect, with DIDID estimates of 0.046 (95% CI –0.089 to 0.182), –0.002 (95% CI –0.015 to 0.009), –0.055 (95% CI –0.190 to 0.079), –1.63 (95% CI –5.22 to 1.95), and –0.006 (95% CI –0.017 to 0.005), respectively. Conclusions The CBMP was effective at enhancing the capacity of study participants in using the routine HIS for decision-making. We noted that urban facilities had benefited more than their counterparts. The intervention has been shown to produce positive outcomes and should be scaled up to be used in other districts. Moreover, the mentorship modalities for rural facilities should be redesigned to maximize the benefits. Trial Registration Pan African Clinical Trials Registry PACTR202001559723931; https://tinyurl.com/3j7e5ka5
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Affiliation(s)
- Moges Asressie Chanyalew
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shegaw Anagaw Mengiste
- Management Information Systems, School of Business, University of South-Eastern Norway, Notodden, Norway
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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14
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Aryal D, Beane A, Dondorp AM, Green C, Haniffa R, Hashmi M, Jayakumar D, Marshall JC, McArthur CJ, Murthy S, Webb SA, Acharya SP, Ishani PGP, Jawad I, Khanal S, Koirala K, Luitel S, Pabasara U, Paneru HR, Kumar A, Patel SS, Ramakrishnan N, Salahuddin N, Shaikh M, Tolppa T, Udayanga I, Umrani Z. Operationalisation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 trials in a low and lower-middle income critical care learning health system. Wellcome Open Res 2021; 6:14. [PMID: 33604455 PMCID: PMC7883321 DOI: 10.12688/wellcomeopenres.16486.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
The Randomized Embedded Multifactorial Adaptive Platform (REMAP-CAP) adapted for COVID-19) trial is a global adaptive platform trial of hospitalised patients with COVID-19. We describe implementation in three countries under the umbrella of the Wellcome supported Low and Middle Income Country (LMIC) critical care network: Collaboration for Research, Implementation and Training in Asia (CCA). The collaboration sought to overcome known barriers to multi centre-clinical trials in resource-limited settings. Methods described focused on six aspects of implementation: i, Strengthening an existing community of practice; ii, Remote study site recruitment, training and support; iii, Harmonising the REMAP CAP- COVID trial with existing care processes; iv, Embedding REMAP CAP- COVID case report form into the existing CCA registry platform, v, Context specific adaptation and data management; vi, Alignment with existing pandemic and critical care research in the CCA. Methods described here may enable other LMIC sites to participate as equal partners in international critical care trials of urgent public health importance, both during this pandemic and beyond.
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Affiliation(s)
- Diptesh Aryal
- Critical Care and Anaesthesia, Nepal Mediciti Hospital, Lalitpur, Bagmati Pradesh, 44600, Nepal
| | - Abi Beane
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand, 10400, Thailand.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Arjen M Dondorp
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand, 10400, Thailand.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine Monash University, Melbourne, Victoria, Australia
| | - Rashan Haniffa
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand, 10400, Thailand.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Madiha Hashmi
- Department of Critical Care, Ziauddin University, Karachi, Sindh, Pakistan
| | - Devachandran Jayakumar
- Chennai Critical Care Consultants, Chennai, Tamil Nadu, 600 040, India.,Critical Care Medicine, Apollo Specialty Hospital OMR, Chennai, Tamil Nadu, India
| | - John C Marshall
- The Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Ontario, Canada
| | - Colin J McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.,Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Srinivas Murthy
- Faculty of Medicine, University of British Columbia School of Medicine, Vancouver, British Columbia, Canada
| | - Steven A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine Monash University, Melbourne, Victoria, Australia.,School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.,St John of God Hospital, Subiaco, Western Australia, Australia
| | - Subhash P Acharya
- Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati Pradesh, 44600, Nepal
| | - Pramodya G P Ishani
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Issrah Jawad
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Sushil Khanal
- Critical Care Medicine, Grande International Hospital, Kathmandu, Bagmati Pradesh, 44600, Nepal
| | - Kanchan Koirala
- Critical Care and Anaesthesia, Nepal Mediciti Hospital, Lalitpur, Bagmati Pradesh, 44600, Nepal
| | - Subekshya Luitel
- Nepal Intensive Care Foundation, Kathmandu, Bagmati Pradesh, Nepal
| | - Upulee Pabasara
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Hem Raj Paneru
- Pulmonary and Critical Care, Hospital for Advanced Medicine and Surgery, Kathmandu, Bagmati Pradesh, Nepal
| | - Ashok Kumar
- Department of Chest Medicine and Critical Care, Ziauddin University, Karachi, Sindh, Pakistan
| | - Shoaib Siddiq Patel
- South East Asian Research in Critical care and Health, Remedial Centre Hospital, Karachi, Sindh, Pakistan
| | | | - Nawal Salahuddin
- Pulmonary & Critical Care Medicine, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Mohiuddin Shaikh
- South East Asian Research in Critical care and Health, Remedial Centre Hospital, Karachi, Sindh, Pakistan
| | - Timo Tolppa
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Ishara Udayanga
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Zulfiqar Umrani
- Office of Research, Innovation & Commercialization (ORIC), Zuiddin University, Karachi, Pakistan
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15
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Addressing priorities for surgical research in Africa: implementation of a multicentre cloud-based peri-operative registry in Ethiopia. Anaesthesia 2021; 76:933-939. [PMID: 33492690 PMCID: PMC8248420 DOI: 10.1111/anae.15394] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/14/2022]
Abstract
In resource‐constrained settings, where inequalities in access to and quality of surgical care results in excess mortality, peri‐operative care registries are uncommon. A south‐south collaboration supported the implementation of a context specific, clinician‐led, multicentre real‐time peri‐operative registry in Ethiopia. Peri‐operative information, including the Ethiopian Ministry of Health’s national ‘Saving Lives through Safe Surgery initiative’, was linked to real‐time dashboards, providing clinicians and administrators with information on service utilisation, surgical access, national surgical key performance indicators and measures of quality of care. We recruited four hospitals representing 285 in‐patient beds from the Amhara and Southern Nations Nationalities and Peoples regions and Addis Ababa city, and reported on 1748 consecutive surgical cases from April 2019 to April 2020. Key performance indicators included: compliance with the World Health Organization’s Surgical Safety Checklist in 1595 (92.1%) surgical cases; adverse events during anaesthesia in 33 (3.1%) cases; and surgical site infections in 21 (2.0%) patients. This collaboration has successfully implemented a multicentre digital surgical registry that can enable measurement of key performance indicators for surgery and evaluation of peri‐operative outcomes. The peri‐operative registry is currently being rolled out across the Amhara region and Addis Ababa city administration. It will provide continuous granular healthcare information necessary to empower clinicians to drive context‐specific priorities for service improvement and research, in collaboration with national stakeholders and international research consortiums.
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Affiliation(s)
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- Debre Birhan University and Debre Birhan Comprehensive Specialized Hospital, Ethiopia
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16
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Hashmi M, Beane A, Murthy S, Dondorp AM, Haniffa R. Leveraging a Cloud-Based Critical Care Registry for COVID-19 Pandemic Surveillance and Research in Low- and Middle-Income Countries. JMIR Public Health Surveill 2020; 6:e21939. [PMID: 33147162 PMCID: PMC7717923 DOI: 10.2196/21939] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/04/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 pandemic has revealed limitations in real-time surveillance needed for responsive health care action in low- and middle-income countries (LMICs). The Pakistan Registry for Intensive CarE (PRICE) was adapted to enable International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)–compliant real-time reporting of severe acute respiratory infection (SARI). The cloud-based common data model and standardized nomenclature of the registry platform ensure interoperability of data and reporting between regional and global stakeholders. Inbuilt analytics enable stakeholders to visualize individual and aggregate epidemiological, clinical, and operational data in real time. The PRICE system operates in 5 of 7 administrative regions of Pakistan. The same platform supports acute and critical care registries in eleven countries in South Asia and sub-Saharan Africa. ISARIC-compliant SARI reporting was successfully implemented by leveraging the existing PRICE infrastructure in all 49 member intensive care units (ICUs), enabling clinicians, operational leads, and established stakeholders with responsibilities for coordinating the pandemic response to access real-time information on suspected and confirmed COVID-19 cases (N=592 as of May 2020) via secure registry portals. ICU occupancy rates, use of ICU resources, mechanical ventilation, renal replacement therapy, and ICU outcomes were reported through registry dashboards. This information has facilitated coordination of critical care resources, health care worker training, and discussions on treatment strategies. The PRICE network is now being recruited to international multicenter clinical trials regarding COVID-19 management, leveraging the registry platform. Systematic and standardized reporting of SARI is feasible in LMICs. Existing registry platforms can be adapted for pandemic research, surveillance, and resource planning.
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Affiliation(s)
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- Collaboration for Research, Improvement and Training in Critical Care in Asia, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Please see acknowledgements section for list of collaborators, Bangkok, Thailand
| | - Madiha Hashmi
- Department of Critical Care, Ziauddin University, Karachi, Pakistan
| | - Abi Beane
- Collaboration for Research, Improvement and Training in Critical Care in Asia, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Srinivas Murthy
- Department of Pediatrics, University of British Colombia, Vancouver, BC, Canada
| | - Arjen M Dondorp
- Collaboration for Research, Improvement and Training in Critical Care in Asia, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rashan Haniffa
- Collaboration for Research, Improvement and Training in Critical Care in Asia, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
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17
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Establishing a critical care network in Asia to improve care for critically ill patients in low- and middle-income countries. Crit Care 2020; 24:608. [PMID: 33059761 PMCID: PMC7558669 DOI: 10.1186/s13054-020-03321-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/19/2022] Open
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18
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Lemma S, Janson A, Persson LÅ, Wickremasinghe D, Källestål C. Improving quality and use of routine health information system data in low- and middle-income countries: A scoping review. PLoS One 2020; 15:e0239683. [PMID: 33031406 PMCID: PMC7544093 DOI: 10.1371/journal.pone.0239683] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/11/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A routine health information system is one of the essential components of a health system. Interventions to improve routine health information system data quality and use for decision-making in low- and middle-income countries differ in design, methods, and scope. There have been limited efforts to synthesise the knowledge across the currently available intervention studies. Thus, this scoping review synthesised published results from interventions that aimed at improving data quality and use in routine health information systems in low- and middle-income countries. METHOD We included articles on intervention studies that aimed to improve data quality and use within routine health information systems in low- and middle-income countries, published in English from January 2008 to February 2020. We searched the literature in the databases Medline/PubMed, Web of Science, Embase, and Global Health. After a meticulous screening, we identified 20 articles on data quality and 16 on data use. We prepared and presented the results as a narrative. RESULTS Most of the studies were from Sub-Saharan Africa and designed as case studies. Interventions enhancing the quality of data targeted health facilities and staff within districts, and district health managers for improved data use. Combinations of technology enhancement along with capacity building activities, and data quality assessment and feedback system were found useful in improving data quality. Interventions facilitating data availability combined with technology enhancement increased the use of data for planning. CONCLUSION The studies in this scoping review showed that a combination of interventions, addressing both behavioural and technical factors, improved data quality and use. Interventions addressing organisational factors were non-existent, but these factors were reported to pose challenges to the implementation and performance of reported interventions.
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Affiliation(s)
- Seblewengel Lemma
- Department of Disease control, London School of Hygiene and Tropical Medicine, based at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Annika Janson
- Department of Disease control, London School of Hygiene and Tropical Medicine, based at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Lars-Åke Persson
- Department of Disease control, London School of Hygiene and Tropical Medicine, based at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Deepthi Wickremasinghe
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carina Källestål
- Department of Disease control, London School of Hygiene and Tropical Medicine, based at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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19
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O'Reilly-Shah VN, Van Cleve W, Long DR, Moll V, Evans FM, Sunshine JE, Kassebaum NJ, Harrison EM, Jabaley CS. Impact of COVID-19 response on global surgical volumes: an ongoing observational study. Bull World Health Organ 2020; 98:671-682. [PMID: 33177757 PMCID: PMC7652560 DOI: 10.2471/blt.20.264044] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To determine whether location-linked anaesthesiology calculator mobile application (app) data can serve as a qualitative proxy for global surgical case volumes and therefore monitor the impact of the coronavirus disease 2019 (COVID-19) pandemic. Methods We collected data provided by users of the mobile app “Anesthesiologist” during 1 October 2018–30 June 2020. We analysed these using RStudio and generated 7-day moving-average app use plots. We calculated country-level reductions in app use as a percentage of baseline. We obtained data on COVID-19 case counts from the European Centre for Disease Prevention and Control. We plotted changing app use and COVID-19 case counts for several countries and regions. Findings A total of 100 099 app users within 214 countries and territories provided data. We observed that app use was reduced during holidays, weekends and at night, correlating with expected fluctuations in surgical volume. We observed that the onset of the pandemic prompted substantial reductions in app use. We noted strong cross-correlation between COVID-19 case count and reductions in app use in low- and middle-income countries, but not in high-income countries. Of the 112 countries and territories with non-zero app use during baseline and during the pandemic, we calculated a median reduction in app use to 73.6% of baseline. Conclusion App data provide a proxy for surgical case volumes, and can therefore be used as a real-time monitor of the impact of COVID-19 on surgical capacity. We have created a dashboard for ongoing visualization of these data, allowing policy-makers to direct resources to areas of greatest need.
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Affiliation(s)
- Vikas N O'Reilly-Shah
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, RR450, 1959 NE Pacific St, Seattle, Washington 98195, United States of America (USA)
| | - Wil Van Cleve
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Dustin R Long
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, RR450, 1959 NE Pacific St, Seattle, Washington 98195, United States of America (USA)
| | - Vanessa Moll
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Faye M Evans
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, USA
| | - Jacob E Sunshine
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, RR450, 1959 NE Pacific St, Seattle, Washington 98195, United States of America (USA)
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Ewen M Harrison
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Craig S Jabaley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA
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Ngoc Dinh M, Nygate J, Hoang Minh Tu V, Thwaites CL. New technologies to improve healthcare in low- and middle-income countries: Global Grand Challenges satellite event, Oxford University Clinical Research Unit, Ho Chi Minh City, 17th-18th September 2019. Wellcome Open Res 2020; 5:142. [PMID: 32864470 PMCID: PMC7443781 DOI: 10.12688/wellcomeopenres.16008.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 11/20/2022] Open
Abstract
We report the outputs of a satellite event in Ho Chi Minh City, Vietnam, organized as part of the "2 nd Global Grand Challenges of Engineering Summit". The event considered challenges and potential solutions for improving low- and middle-income country (LMIC) healthcare systems, with particular reference to critical care. Participants from key regional and local stakeholders in healthcare and engineering discussed how new advances in technology, especially in the field of Artificial Intelligence, could be of potential benefit. This article summarizes the perspectives and conclusions of a group of key stakeholders from LMICs across South and South East Asia.
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Affiliation(s)
- Minh Ngoc Dinh
- School of Science & Technology, Royal Melbourne Institute of Technology University, Ho Chi Minh City, Vietnam
| | - Joseph Nygate
- School of Science & Technology, Royal Melbourne Institute of Technology University, Ho Chi Minh City, Vietnam
| | | | - C. Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Global Grand Challenges Event Vietnam Group
- School of Science & Technology, Royal Melbourne Institute of Technology University, Ho Chi Minh City, Vietnam
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Ng-Kamstra JS, Nepogodiev D, Lawani I, Bhangu A. Perioperative mortality as a meaningful indicator: Challenges and solutions for measurement, interpretation, and health system improvement. Anaesth Crit Care Pain Med 2020; 39:673-681. [PMID: 32745634 DOI: 10.1016/j.accpm.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/20/2022]
Abstract
Expanding global access to safe surgical and anaesthesia care is crucial to meet the health targets of the Sustainable Development Goals (SDGs). As global surgical volume increases, improving safety throughout the patient care pathway is a public health priority. At present, an estimated 4.2 million individuals die within 30 days of surgery each year, and many of these deaths are preventable. Important considerations for the collection and reporting of perioperative mortality data have been identified in the literature, but consensus has not been established on the best methodology for the quantification of excess surgical mortality at a hospital or health system level. In this narrative review, we address challenges in the use of perioperative mortality rates (POMR) for improving patient safety. First, we discuss controversies in the use of POMR as a health system indicator and suggest advantages for using a "basket" of procedure-specific mortality rates as an adjunct to gross POMR. We offer then solutions to challenges in the collection and reporting of POMR data, and propose interventions for improving care in the preoperative, operative, and postoperative periods. Finally, we discuss how health systems leaders and frontline clinicians can integrate surgical safety into both national health plans and patient care pathways to drive a sustainable safety revolution in perioperative care.
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Affiliation(s)
- Joshua S Ng-Kamstra
- Department of Critical Care Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
| | - Dmitri Nepogodiev
- National Institute for Health Research Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Ismaïl Lawani
- Department of Surgery and Surgical Specialties, Faculty of Health Sciences, University of Abomey Calavi, Cotonou, Benin; Rediet Shimeles Workneh, MD, Department of Anaesthesiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aneel Bhangu
- National Institute for Health Research Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
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Ngoc Dinh M, Nygate J, Hoang Minh Tu V, Thwaites CL. New technologies to improve healthcare in low- and middle-income countries: Global Grand Challenges satellite event, Oxford University Clinical Research Unit, Ho Chi Minh City, 17th-18th September 2019. Wellcome Open Res 2020; 5:142. [PMID: 32864470 PMCID: PMC7443781 DOI: 10.12688/wellcomeopenres.16008.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 03/30/2024] Open
Abstract
We report the outputs of a satellite event in Ho Chi Minh City, Vietnam, organized as part of the "2 nd Global Grand Challenges of Engineering Summit". The event considered challenges and potential solutions for improving low- and middle-income country (LMIC) healthcare systems, with particular reference to critical care. Participants from key regional and local stakeholders in healthcare and engineering discussed how new advances in technology, especially in the field of Artificial Intelligence, could be of potential benefit. This article summarizes the perspectives and conclusions of a group of key stakeholders from LMICs across South and South East Asia.
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Affiliation(s)
- Minh Ngoc Dinh
- School of Science & Technology, Royal Melbourne Institute of Technology University, Ho Chi Minh City, Vietnam
| | - Joseph Nygate
- School of Science & Technology, Royal Melbourne Institute of Technology University, Ho Chi Minh City, Vietnam
| | | | - C. Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Global Grand Challenges Event Vietnam Group
- School of Science & Technology, Royal Melbourne Institute of Technology University, Ho Chi Minh City, Vietnam
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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O’Reilly-Shah VN, Van Cleve W, Long DR, Moll V, Evans FM, Sunshine JE, Kassebaum NJ, Harrison EM, Jabaley CS. Real-time assessment of COVID-19 impact on global surgical case volumes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.05.03.20086819. [PMID: 32511532 PMCID: PMC7273300 DOI: 10.1101/2020.05.03.20086819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Importance The COVID-19 pandemic has disrupted global surgical capacity. The impact of the pandemic in low and middle income countries has the potential to worsen already strained access to surgical care. Timely assessment of surgical volumes in these countries remains challenging. Objective To determine whether usage data from a globally used anesthesiology calculator mobile application can serve as a proxy for global surgical case volume and contribute to monitoring of the impact of the COVID-19 pandemic, particularly in World Bank low income countries where official data collection is not currently practical. Design Subset of data from an ongoing observational cohort study of users of the application collected from October 1, 2018 to April 18, 2020. Setting The mobile application is available from public sources; users download and use the application per their own clinical needs on personal mobile devices. Participants No user data was excluded from the study. Exposures Events with impacts on surgical case volumes, including weekends, holidays, and the COVID-19 pandemic. Main Outcomes and Measures It was previously noted that application usage was decreased on weekends and during winter holidays. We subsequently hypothesized that more detailed analysis would reveal impacts of country-specific or region-specific holidays on the volume of app use. Results 4,300,975 data points from 92,878 unique users were analyzed. Physicians and other anesthesia providers comprised 85.8% of the study population. Application use was reduced on holidays and weekends and correlated with fluctuations in surgical volume. The COVID-19 pandemic was associated with substantial reductions in app use globally and regionally. There was strong cross correlation between COVID-19 case count and reductions in app use. By country, there was a median global reduction in app use to 58% of baseline (interquartile range, 46%-75%). Application use in low-income continues to decline but in high-income countries has stabilized. Conclusions and Relevance Application usage metadata provides a real-time indicator of surgical volume. This data may be used to identify impacted regions where disruptions to surgical care are disproportionate or prolonged. A dashboard for continuous visualization of these data has been deployed.
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Affiliation(s)
- Vikas N. O’Reilly-Shah
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195
| | - Wil Van Cleve
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195
| | - Dustin R. Long
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195
| | - Vanessa Moll
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8032 Zurich, Switzerland, +41 78 9322617
| | - Faye M. Evans
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston MA, USA
| | - Jacob E. Sunshine
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195
| | - Nicholas J. Kassebaum
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195
- Dept of Health Metrics Sciences, University of Washington, Seattle, WA, USA
- Dept of Global Health, University of Washington, Seattle, WA, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh Secretary: 0131 242 3614 (Susan Keggie, Administrative Assistant) and 0131 242 3616 (Murray Britton, Administrative Secretary)
| | - Craig S. Jabaley
- Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, NE, Atlanta, GA, 30322, 404-778-7777
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Ranasinghe WG, Beane A, Vithanage TDP, Priyadarshani GDD, Colombage DDE, Ponnamperuma CJ, Karunarathne S, Schultsz C, Dondorp AM, Haniffa R. Quality evaluation and future priorities for delivering acute myocardial infarction care in Sri Lanka. Heart 2019; 106:603-608. [PMID: 31843877 PMCID: PMC7146937 DOI: 10.1136/heartjnl-2019-315396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/25/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023] Open
Abstract
Aim This study evaluates the quality of care for patients admitted with acute myocardial infarction (AMI) in a tertiary hospital in Colombo using the European Society of Cardiology Quality of Care Working Group’s guidelines (2017). Methods A recently implemented electronic AMI registry m-Health tool was used for prospective data collection. Each patient was assessed for eligibility for each of the six domains of quality. Global Registry of Acute Coronary Events Risk Model for predicted probability of mortality, and scores for risk of bleeding complications (CRUSADE) and severity of heart failure (Killip classification) were calculated as per published guidelines. A composite measure of quality was derived from compliance with the six domains. Patients were followed up via telephone at 30 days following discharge to evaluate outcome and satisfaction. Organisational information was assessed by administrative review and interview. Results Between March 2017 and April 2018, 934 patients with AMI presented to the cardiology department. The majority of patients (90.4%) presented with features of ST-elevation myocardial infarction (STEMI). Mean (SD) overall compliance with the composite quality indicator (CQI) was 44% (0.07). Compliance of ≥50% to the CQI was achieved in 9.8% of STEMI patients. The highest compliance was observed for antithrombotics during hospitalisation (79.1%) and continuous measure of patient satisfaction (76.1%). The lowest compliance was for organisational structure and care processes (22.4%). Conclusion This study reports a registry-based continuous evaluation of the quality of AMI care from a low and middle-income country. Priorities for improvement include improved referral, and networking of primary and secondary health facilities with the percutaneous coronary intervention centre.
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Affiliation(s)
| | - Abi Beane
- Department of Critical care and Malaria, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand .,Network for Improving Critical Care System and Training, Colombo, Sri Lanka.,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Global Health - AIGHD Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gamage Dona Dilanthi Priyadarshani
- Department of Critical care and Malaria, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.,Network for Improving Critical Care System and Training, Colombo, Sri Lanka
| | | | | | | | - Constance Schultsz
- Department of Global Health - AIGHD Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arjen M Dondorp
- Department of Critical care and Malaria, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rashan Haniffa
- Department of Critical care and Malaria, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.,Network for Improving Critical Care System and Training, Colombo, Sri Lanka.,Internal Medicine, University College London, London, United Kingdom
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Bath M, Bashford T, Fitzgerald JE. What is 'global surgery'? Defining the multidisciplinary interface between surgery, anaesthesia and public health. BMJ Glob Health 2019; 4:e001808. [PMID: 31749997 PMCID: PMC6830053 DOI: 10.1136/bmjgh-2019-001808] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/20/2019] [Accepted: 09/28/2019] [Indexed: 12/11/2022] Open
Abstract
'Global surgery' is the term adopted to describe a rapidly developing multidisciplinary field aiming to provide improved and equitable surgical care across international health systems. Sitting at the interface between numerous clinical and non-clinical specialisms, it encompasses multiple aspects that surround the treatment of surgical disease and its equitable provision across health systems globally. From defining the role of, and need for, optimal surgical care through to identifying barriers and implementing improvement, global surgery has an expansive remit. Advocacy, education, research and clinical components can all involve surgeons, anaesthetists, nurses and allied healthcare professionals working together with non-clinicians, including policy makers, epidemiologists and economists. Long neglected as a topic within the global and public health arenas, an increasing awareness of the extreme disparities internationally has driven greater engagement. Not necessarily restricted to specific diseases, populations or geographical regions, these disparities have led to a particular focus on surgical care in low-income and middle-income countries with the greatest burden and needs. This review considers the major factors defining the interface between surgery, anaesthesia and public health in these settings.
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Affiliation(s)
- Michael Bath
- Centre for Neuroscience, Surgery, and Trauma, Queen Mary University of London, London, UK
| | - Tom Bashford
- NIHR Global Health Research Group on Neurotrauma, Division of Anaesthesia, University of Cambridge, Cambridge, UK
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