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Rohwer AC, Jessani NS, Mbeye NM, Balugaba BE, Akiteng AR, Tumusiime D, Ntawuyirushintege S, Kedir K, Howe R, Durao S, Toews I, Burns J. Evaluation of implementation of evidence-based public health training in sub-Saharan Africa. J Public Health Afr 2024; 15:576. [PMID: 39229343 PMCID: PMC11369575 DOI: 10.4102/jphia.v15i1.576] [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: 05/03/2024] [Accepted: 07/22/2024] [Indexed: 09/05/2024] Open
Abstract
Background The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) developed and offered a course on evidence-based public health (EBPH) in five sub-Saharan African (SSA) countries to enhance individual and institutional capacity. Aim This study aims to assess, compare and learn from implementing the CEBHA+ EBPH course using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and Practical, Robust, Implementation and Sustainability Model (PRISM). Setting This study involved CEHBA+ partner universities in five countries in SSA. Methods We developed a framework that draws on signalling questions for RE-AIM and PRISM dimensions. Country teams reflected on, discussed and mapped unique experiences. Using this framework, we then elicited common themes across countries and distilled country-specific experiences through virtual discussions. Results Across countries, 130 public health practitioners, researchers and students completed the course (Reach). The course increased EBPH knowledge and skills and the capacity to teach EBPH and resulted in immediate opportunities for applying skills (Effectiveness). Hybrid offering in two countries presented challenges regarding Internet connectivity and hybrid discussions. Facilitators had previous training in teaching EBPH. While learning material was the same across countries, the content was adapted to represent local public health priorities (Implementation, Adoption). Course materials have informed other related training leading to spin-offs (Maintenance). Institutionalisation is dependent on external funding. Conclusion Strengthening EBPH capacity across contexts is feasible. Curricula containing both core and contextualised elements create an authentic learning environment. Formal evaluations should be embedded within capacity-strengthening initiatives. Contribution This is the first study evaluating EBPH training in SSA using an implementation science lens, offering learning about context-relevant adaptations that assist with plans for sustainability and scale.
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Affiliation(s)
- Anke C Rohwer
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nasreen S Jessani
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Institute of Development Studies, Brighton, United Kingdom
| | - Nyanyiwe M Mbeye
- Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Bonny E Balugaba
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ann R Akiteng
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Tumusiime
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Kiya Kedir
- Armauer Hansen Research Institute, Non-Communicable Disease Ministry of Health, Addis Ababa, Ethiopia
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Non-Communicable Disease Ministry of Health, Addis Ababa, Ethiopia
| | - Solange Durao
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ingrid Toews
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Munich, Germany
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Rohwer A, Ngah V, Mavridis D, Young T, McCaul M. Building capacity for network meta-analysis in Sub-Saharan Africa: reflections and future direction. Syst Rev 2024; 13:7. [PMID: 38167514 PMCID: PMC10759577 DOI: 10.1186/s13643-023-02418-8] [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] [Received: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Robust, relevant, comprehensive, and up-to-date evidence syntheses are the cornerstone for evidence-informed healthcare decisions. When considering multiple treatment options, network meta-analysis (NMA) systematic reviews play a key role in informing impactful decisions and clinical practice guidelines. However, the capacity and literacy to conduct NMA systematic reviews and interpret its results remains out of reach for many clinicians and review authors, especially in low-to-middle-income countries. Despite ample resources and guides, NMA capacity and training opportunities remain limited to non-existent in Sub-Saharan Africa. Towards solutions and strengthening evidence synthesis and NMA capacity in the Sub-Saharan African region, we describe and reflect on two courses that build NMA capacity and aim to address NMA literacy in Sub-Saharan Africa.The Primer in NMA systematic reviews aimed for participants to be able to find, appraise, interpret, and consider the use of NMA SRs of intervention effects. It is a 6-week online course for clinicians, policy-makers, and researchers wanting to learn more about using NMA systematic reviews. The Global NMA Masterclass workshop aimed for participants to be able to understand and apply pairwise and NMA in STATA and R, evaluate NMA assumptions and confidence in NMA results, and appropriately report NMA results. This course was offered over 5 weeks to clinicians, biostatisticians, and researchers with basic knowledge of epidemiology and biostatics. Although the bulk of learning occurred through self-study, we had weekly, synchronous question-and-answer sessions for both courses. Using relevant examples throughout the courses helped to enable an authentic learning environment.This was the first NMA training developed in Africa for Africa. Development of the courses was a collaborative effort from a multi-disciplinary team. Both NMA courses were well received and attended by a diverse group of participants spread across Sub-Saharan African countries. Participants felt the courses were applicable to their setting. Although most participants appreciated the benefits of online learning, we also experienced some challenges. There is great potential to conduct NMA systematic reviews in Sub-Saharan Africa. The NMA Primer and NMA workshop can play an essential role in expanding and developing NMA SR capacity and literacy in SSA.
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Affiliation(s)
- Anke Rohwer
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Veranyuy Ngah
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Ioannina, Greece
| | - Taryn Young
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African GRADE Network, Stellenbosch University, Cape Town, South Africa
| | - Michael McCaul
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- South African GRADE Network, Stellenbosch University, Cape Town, South Africa.
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Bankole NDA, Dokponou YCH, De Koning R, Dalle DU, Kesici Ö, Egu C, Ikwuegbuenyi C, Adegboyega G, Yang Ooi SZ, Dada OE, Erhabor J, Mukambo E, Olobatoke TA, Takoutsing BD, Bandyopadhyay S. Epilepsy care and outcome in low- and middle-income countries: A scoping review. J Neurosci Rural Pract 2024; 15:8-15. [PMID: 38476408 PMCID: PMC10927051 DOI: 10.25259/jnrp_527_2023] [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: 10/05/2023] [Accepted: 12/25/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives Epilepsy is a common neurological condition in low- and middle-income countries (LMICs). This study aims to systematically review, analyze, evaluate, and synthesize information on the current state of medical and surgical management and outcomes of epilepsy in LMICs. Materials and Methods Systematic searches were conducted on MEDLINE, EMBASE, World Health Organization Global Index Medicus, African Journals Online, WOS, and Scopus, covering the period from the inception of the databases to August 18th, 2021, focusing on studies reporting management and outcomes of epilepsy in LMICs. Results A total of 2298 unique studies were identified, of which, 48 were included (38035 cases). The mean age was 20.1 ± 19.26 years with a male predominance in 60.92% of cases. The type of seizure commonly reported in most of the studies was absence seizures (n = 8302, 21.82%); partial focal seizure (n = 3891, 10.23%); and generalized tonic-clonic seizures (n = 3545, 9.32%) which were the next most common types of seizures. Mesiotemporal epilepsy was less frequently reported (n = 87, 0.22%). Electroencephalogram was commonly used (n = 2516, 6.61%), followed by computed tomography scan (n = 1028, 2.70%), magnetic resonance imaging (n = 638, 1.67%), and video telemetry (n = 484, 1.27%) in the care of patients with seizures. Primary epilepsy was recorded in 582 patients (1.53%) whereas secondary epilepsy was present in 333 patients (0.87%). Carbamazepine was the most used anti-epileptic drug (n = 2121, 5.57%). Surgical treatment was required for 465 (1.22%) patients. Conclusion In LMICs, epilepsy is underreported. There is still a lack of adequate tools for the diagnosis of primary or secondary epilepsy as well as adequate access to medical management of those reported.
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Affiliation(s)
| | | | - Rosaline De Koning
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - David Ulrich Dalle
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Özgür Kesici
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Chinedu Egu
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Gideon Adegboyega
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Olaoluwa E. Dada
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Joshua Erhabor
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Emmanuel Mukambo
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Berjo D. Takoutsing
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Soham Bandyopadhyay
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
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Gebrye T, Fatoye F, Mbada C, Hakimi Z. A scoping review on quality assessment tools used in systematic reviews and meta-analysis of real-world studies. Rheumatol Int 2023; 43:1573-1581. [PMID: 37326665 PMCID: PMC10348931 DOI: 10.1007/s00296-023-05354-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
Risk of bias tools is important in identifying inherent methodical flaws and for generating evidence in studies involving systematic reviews (SRs) and meta-analyses (MAs), hence the need for sensitive and study-specific tools. This study aimed to review quality assessment (QA) tools used in SRs and MAs involving real-world data. Electronic databases involving PubMed, Allied and Complementary Medicine Database, Cumulated Index to Nursing and Allied Health Literature, and MEDLINE were searched for SRs and MAs involving real-world data. Search was delimited to articles published in English, and between inception to 20 of November 2022 following the SRs and MAs extension for scoping checklist. Sixteen articles on real-world data published between 2016 and 2021 that reported their methodological quality met the inclusion criteria. Seven of these articles were observational studies, while the others were of interventional type. Overall, 16 QA tools were identified. Except one, all the QA tools employed in SRs and MAs involving real-world data are generic, and only three of these were validated. Generic QA tools are mostly used for real-world data SRs and MAs, while no validated and reliable specific tool currently exist. Thus, there is need for a standardized and specific QA tool of SRs and MAs for real-world data.
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Affiliation(s)
- Tadesse Gebrye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, Bonsall Street, 53 Bonsall Street, Manchester, M15 6GX UK
| | - Francis Fatoye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, Bonsall Street, 53 Bonsall Street, Manchester, M15 6GX UK
- Lifestyle Diseases, Faculty of Health Sciences, North-West University, Mahikeng, South Africa
| | - Chidozie Mbada
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, Bonsall Street, 53 Bonsall Street, Manchester, M15 6GX UK
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Rodriguez D, Martinez-Alvarado JD, Garcia-Toto R, Genel-Rey TI. Teaching evidence-based medicine in Mexico: a systematic review of medical doctor curriculums at a national level. BMJ Evid Based Med 2023; 28:30-39. [PMID: 35688607 DOI: 10.1136/bmjebm-2021-111910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To assess the teaching of evidence-based medicine (EBM) in medical curriculums. As a secondary objective, we assessed the representativeness of science courses related to EBM. DESIGN AND SETTING Systematic review. Accredited curriculums by the Mexican Council for the Accreditation of Medical Education. MAIN OUTCOME MEASURES We provided a descriptive analysis of the required or elective EBM courses and EBM-related courses, academic credits and teaching period. EBM-related courses included research methodology, epidemiology, biostatistics, clinical research, public health, clinical epidemiology, scientific dissemination and health informatics to explore scientific education and training offered by medical schools. Additionally, we examined the curriculum's structure, location, type of institution, total programme duration and academic credits. Data collection occurred from December 2020 to February 2021. RESULTS We identified 171 registered curriculums, of which we assessed 60 unique programmes (50% public) in our analysis. We identified 16 EBM single courses on the fifth and sixth semesters, of which 12 (20%) were mandatory and 4 were electives (6.7%). The allocated academic credits for EBM courses are minimal, without difference between public or private institutions, representing 0.08% of the total curriculum. Public health, epidemiology, research methodology and biostatistics courses are offered with greater frequency (55% or less) and curricular value (0.6% or less). In some cases, they are taught as combined courses. Clinical research, health informatics and clinical epidemiology are taught less than EBM, while scientific dissemination is nil. CONCLUSION In Mexico, EBM teaching is limited to only one of five curriculums with minimal curricular value. A comprehensive curricular review is necessary across programmes to incorporate EBM as a first step to improve medical education and, consequently, public health. We call to action through an online, collaborative platform with several applications to optimise teaching of EBM. REVIEW PROTOCOL REGISTRATION The systematic review protocol is excluded from the International Prospective Register of Systematic Reviews since this platform only accepts systematic reviews with health-related outcomes. Review protocol registration: https://osf.io/3xm2q/.
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Affiliation(s)
- David Rodriguez
- Teaching Evidence-Based Medicine Mexico (TEBMx), Cuernavaca, Mexico
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Brownson RC, Shelton RC, Geng EH, Glasgow RE. Revisiting concepts of evidence in implementation science. Implement Sci 2022; 17:26. [PMID: 35413917 PMCID: PMC9004065 DOI: 10.1186/s13012-022-01201-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/04/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Evidence, in multiple forms, is a foundation of implementation science. For public health and clinical practice, evidence includes the following: type 1 evidence on etiology and burden; type 2 evidence on effectiveness of interventions; and type 3: evidence on dissemination and implementation (D&I) within context. To support a vision for development and use of evidence in D&I science that is more comprehensive and equitable (particularly for type 3 evidence), this article aims to clarify concepts of evidence, summarize ongoing debates about evidence, and provide a set of recommendations and tools/resources for addressing the "how-to" in filling evidence gaps most critical to advancing implementation science. MAIN TEXT Because current conceptualizations of evidence have been relatively narrow and insufficiently characterized in our opinion, we identify and discuss challenges and debates about the uses, usefulness, and gaps in evidence for implementation science. A set of questions is proposed to assist in determining when evidence is sufficient for dissemination and implementation. Intersecting gaps include the need to (1) reconsider how the evidence base is determined, (2) improve understanding of contextual effects on implementation, (3) sharpen the focus on health equity in how we approach and build the evidence-base, (4) conduct more policy implementation research and evaluation, and (5) learn from audience and stakeholder perspectives. We offer 15 recommendations to assist in filling these gaps and describe a set of tools for enhancing the evidence most needed in implementation science. CONCLUSIONS To address our recommendations, we see capacity as a necessary ingredient to shift the field's approach to evidence. Capacity includes the "push" for implementation science where researchers are trained to develop and evaluate evidence which should be useful and feasible for implementers and reflect community or stakeholder priorities. Equally important, there has been inadequate training and too little emphasis on the "pull" for implementation science (e.g., training implementers, practice-based research). We suggest that funders and reviewers of research should adopt and support a more robust definition of evidence. By critically examining the evolving nature of evidence, implementation science can better fulfill its vision of facilitating widespread and equitable adoption, delivery, and sustainment of scientific advances.
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Affiliation(s)
- Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO 63130 USA
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63130 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032 USA
| | - Elvin H. Geng
- Division of Infectious Diseases, Department of Medicine and Center for Dissemination and Implementation in the Institute for Public Health, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110 USA
| | - Russell E. Glasgow
- Department of Family Medicine and Adult & Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 USA
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McCaul M, Durao S, Kredo T, Garner P, Young T, Rohwer A. Evidence synthesis workshops: moving from face-to-face to online learning. BMJ Evid Based Med 2021; 26:255-260. [PMID: 32763960 PMCID: PMC8479735 DOI: 10.1136/bmjebm-2020-111394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 11/10/2022]
Abstract
Postgraduate training is moving from face-to-face workshops or courses to online learning to help increase access to knowledge, expertise and skills, and save the cost of face-to-face training. However, moving from face-to-face to online learning for many of us academics is intimidating, and appears even more difficult without the help of a team of technologists. In this paper, we describe our approach, our experiences and the lessons we learnt from converting a Primer in Systematic Reviews face-to-face workshop to a 6-week online course designed for healthcare professionals in Africa. We learnt that the team needs a balance of skills and experience, including technical know-how and content knowledge; that the learning strategies needed to achieve the learning objectives must match the content delivery. The online approach should result in both building knowledge and developing skills, and include interactive and participatory approaches. Finally, the design and delivery needs to keep in mind the limited and expensive internet access in some resource-poor settings in Africa.
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Affiliation(s)
- Michael McCaul
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Solange Durao
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
- Clinical Pharmacology, Stellenbosch University Department of Medicine, Cape Town, South Africa
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Taryn Young
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Anke Rohwer
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, Western Cape, South Africa
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Scott L, May C. Enhancing the role of nursing in primary care facilitates task sharing and addresses human resource shortages to achieve optimal population health outcomes. Evid Based Nurs 2020; 23:109. [PMID: 31519695 DOI: 10.1136/ebnurs-2019-103143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Lauren Scott
- Lawrence S Bloomberg Faculty of Nursing, The University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Courtney May
- Women's College Hospital, Toronto, Ontario, Canada
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Gyawali B, Bouche G, Crisp N, André N. Challenges and opportunities for cancer clinical trials in low- and middle-income countries. ACTA ACUST UNITED AC 2020; 1:142-145. [DOI: 10.1038/s43018-020-0030-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Karimi‐Shahanjarini A, Shakibazadeh E, Rashidian A, Hajimiri K, Glenton C, Noyes J, Lewin S, Laurant M, Colvin CJ. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 4:CD010412. [PMID: 30982950 PMCID: PMC6462850 DOI: 10.1002/14651858.cd010412.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced their own workload.Doctors and nurses pointed to the importance of having access to resources, such as enough staff, equipment and supplies; good referral systems; experienced leaders; clear roles; and adequate training and supervision. But they often had problems with these issues. They also pointed to the huge number of documents they needed to complete when tasks were moved from doctors to nurses. AUTHORS' CONCLUSIONS Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.
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Affiliation(s)
- Akram Karimi‐Shahanjarini
- Hamadan University of Medical SciencesDepartment of Public HealthMahdeieh Ave. Hamadan, IranHamadanHamadanIran
- Hamadan University of Medical SciencesSocial Determinants of Health Research CenterHamadanIran
| | - Elham Shakibazadeh
- Tehran University of Medical SciencesDepartment of Health Education and Health PromotionTehranTehranIran
| | - Arash Rashidian
- Tehran University of Medical SciencesDepartment of Health Management and Economics, School of Public HealthPoursina AveTehranIran1417613191
| | - Khadijeh Hajimiri
- School of Public Health, Zanjan University of Medical SciencesDepartment of Health Education and Health PromotionZanjanIran
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Jane Noyes
- Bangor UniversityCentre for Health‐Related Research, Fron HeulogBangorWalesUKLL57 2EF
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
- Institute of Nursing StudiesHAN University of Applied SciencesNijmegenNetherlands
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape TownDivision of Social and Behavioural SciencesCape TownSouth Africa
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Cabrera PA, Pardo R. Review of evidence based clinical practice guidelines developed in Latin America and Caribbean during the last decade: an analysis of the methods for grading quality of evidence and topic prioritization. Global Health 2019; 15:14. [PMID: 30782176 PMCID: PMC6380043 DOI: 10.1186/s12992-019-0455-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 02/01/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In the last decade, efforts have been made in Latin America and the Caribbean to advance in the methodological development of evidence based clinical practice guidelines, among other strategies to improve the health provision of services and indicators. OBJECTIVES To build an evidence map to show the regional GRADE impact in developing clinical practice guidelines and contrast the results with current needs. METHODS A systematic literature search was conducted in databases, developer's websites, health ministries, repositories and grey literature. Documents were included when they were evidence based clinical practice guidelines developed in Latin American and Caribbean countries in the last decade. Data from the Global Burden of Disease was used to highlight relevant health conditions. RESULTS Nine thousand seven hundred seventy-six documents were retrieved. 98 guidelines, with specific mention of the use of GRADE methodology were identified. 81% of the guidelines were developed within the last 4 years. 68% are from Colombia, 13% from Peru, 9% from Chile, 3% from Argentina and Costa Rica and Brazil, Honduras and Dominican Republic account 1%. 67% were developed for non-communicable diseases, 10% for communicable diseases, 9% for neonatal pathologies and 5% for maternal problems, 1% injuries and 7% other topics (nutrition, oral health). DISCUSSION Our findings show a slow and increasing incorporation of the GRADE methodology in the region. GRADE guidelines have been adopted mainly by Colombia and slowly by other countries. Topics for guidelines continue to be comparable to the high-income countries and they don't address communicable diseases or other relevant health issues in the region, such as violence or malnutrition; thus, the evidence based guidelines for clinical practice are only a tool within a complex multimodal strategy to tackle the challenges of the health determinants. CONCLUSIONS A prioritizing strategy for relevant regional health topics and the use of robust methodological approaches must be in the political agenda in the region. GRADE methods could help to improve the quality and validity of recommendations not only for chronic pathologies but also for ancient and challenging maladies prevalent in the region, as part of a multimodalintersectoral strategy.
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Affiliation(s)
| | - Rodrigo Pardo
- Clinical Research Institute and Health Technology Assessment Unit, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá D.C., Colombia
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Kredo T, Cooper S, Abrams A, Daniels K, Volmink J, Atkins S. National stakeholders' perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa. Health Res Policy Syst 2018; 16:68. [PMID: 30064440 PMCID: PMC6069850 DOI: 10.1186/s12961-018-0348-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/13/2018] [Indexed: 01/07/2023] Open
Abstract
Background There is increased international focus on improving the rigour of clinical practice guideline (CPG) development practices. However, few empirical studies on CPG development have been conducted in low- and middle-income countries. This paper explores national stakeholders’ perceptions of processes informing CPG development for primary healthcare in South Africa, focusing on both their aspirations and views of what is actually occurring. Methods A qualitative study design was employed including individual interviews with 37 South African primary care CPG development role-players. Participants represented various disciplines, sectors and provinces. The data were analysed through thematic analysis and an interpretivist conceptual framework. Results Strongly reflecting current international standards, participants identified six ‘aspirational’ processes that they thought should inform South African CPG development, as follows: (1) evidence; (2) stakeholder consultation; (3) transparency; (4) management of interests; (5) communication/co-ordination between CPG development groups; and (6) fit-for-context. While perceptions of a transition towards more robust processes was common, CPG development was seen to face ongoing challenges with regards to all six aspirational processes. Many challenges were attributed to inadequate financial and human resources, which were perceived to hinder capacity to undertake the necessary methodological work, respond to stakeholders’ feedback, and document and share decision-making processes. Challenges were also linked to a complex web of politics, power and interests. The CPG development arena was described as saturated with personal and financial interests, groups competing for authority over specific territories and unequal power dynamics which favour those with the time, resources and authority to make contributions. These were all perceived to affect efforts for transparency, collaboration and inclusivity in CPG development. Conclusion While there is strong commitment amongst national stakeholders to advance CPG development processes, a mix of values, politics, power and capacity constraints pose significant challenges. Contrasting perspectives regarding managing interests and how best to adapt to within-country contexts requires further exploration. Dedicated resources for CPG development, standardised systems for managing conflicting interests, and the development of a political environment that fosters collaboration and more equitable inclusion within and between CPG development groups are needed. These initiatives may enhance CPG quality and acceptability, with associated positive impact on patient care.
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Affiliation(s)
- Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Amber Abrams
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jimmy Volmink
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Deans Office, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Salla Atkins
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,New Social Research and Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Parisi A, Crump JA, Glass K, Howden BP, Furuya-Kanamori L, Vilkins S, Gray DJ, Kirk MD. Health Outcomes from Multidrug-Resistant Salmonella Infections in High-Income Countries: A Systematic Review and Meta-Analysis. Foodborne Pathog Dis 2018; 15:428-436. [PMID: 29624414 DOI: 10.1089/fpd.2017.2403] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Salmonella is a leading cause of foodborne enterocolitis worldwide. Antimicrobial use in food animals is the driving force for antimicrobial resistance among Salmonella particularly in high-income countries. Nontyphoidal Salmonella (NTS) infections that are multidrug resistant (MDR) (nonsusceptible to ≥1 agent in ≥3 antimicrobial categories) may result in more severe health outcomes, although these effects have not been systematically examined. We conducted a systematic review and meta-analysis to examine impacts of MDR NTS on disease outcomes in high-income settings. METHODS We systematically reviewed the literature from scientific databases, including PubMed, Scopus, and grey literature sources, using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We included peer-reviewed publications of case-control and cohort studies, outbreak investigations, and published theses, imposing no language restriction. We included publications from January 1, 1990 through September 15, 2016 from high-income countries as classified by the World Bank, and extracted data on duration of illness, hospitalization, morbidity and mortality of MDR, and pan-susceptible NTS infections. RESULTS After removing duplicates, the initial search revealed 4258 articles. After further screening, 16 eligible studies were identified for the systematic review, but, only 9 of these were included in the meta-analysis. NTS serotypes differed among the reported studies, but serotypes Typhimurium, Enteritidis, Newport, and Heidelberg were the most often reported MDR pathogens. Salmonella infections that were MDR were associated with excess bloodstream infections (odds ratio [OR] 1.73; 95% confidence interval [CI] 1.32-2.27), more frequent hospitalizations (OR 2.51; 95% CI 1.38-4.58), and higher mortality (OR 3.54; 95% CI 1.10-11.40) when compared with pan-susceptible isolates. CONCLUSIONS Our study suggests that MDR NTS infections have more serious health outcomes compared with pan-susceptible strains. With the emergence of MDR Salmonella strains in high-income countries, it is crucial to reduce the use of antimicrobials in animals and humans, and intervene to prevent foodborne infections.
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Affiliation(s)
- Andrea Parisi
- 1 National Center for Epidemiology and Population Health, Australian National University , Canberra, Australia
| | - John A Crump
- 2 Center for International Health, University of Otago , Dunedin, New Zealand
| | - Kathryn Glass
- 1 National Center for Epidemiology and Population Health, Australian National University , Canberra, Australia
| | - Benjamin P Howden
- 3 Department of Microbiology and Immunology, University of Melbourne , Melbourne, Australia
| | - Luis Furuya-Kanamori
- 4 Department of Population Medicine, College of Medicine, Qatar University , Doha, Qatar .,5 Department of Global Health, Australian National University , Canberra, Australia
| | - Samantha Vilkins
- 1 National Center for Epidemiology and Population Health, Australian National University , Canberra, Australia
| | - Darren J Gray
- 5 Department of Global Health, Australian National University , Canberra, Australia
| | - Martyn D Kirk
- 1 National Center for Epidemiology and Population Health, Australian National University , Canberra, Australia
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Cartledge PT, Bassat Q. Global Health Journal Club-Opening Editorial Applying Evidence-based Medicine in Resource-Limited Nations. J Trop Pediatr 2018; 64:85-89. [PMID: 29112756 DOI: 10.1093/tropej/fmx088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter T Cartledge
- Rwanda Human Resources for Health Program, Department of Pediatrics, Yale University, Kigali, Rwanda.,University Central Hospital of Kigali (CHUK), KN 4 Ave, Kigali, Rwanda
| | - Quique Bassat
- Barcelona Institute for Global Health (ISGlobal), Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona 08010, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1100, Mozambique.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluís Companys 23, Barcelona 08010, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona 08007, Spain.,Universidad Europea de Madrid, Madrid 28670, Spain
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Ayhan Baser D, Kahveci R, Baydar Artantas A, Yasar İ, Aksoy H, Koc EM, Kasim İ, Kunnamo I, Özkara A. Exploring guideline adaptation strategy for Turkey: Is "ADAPTE" feasible or does it need adaptation as well? J Eval Clin Pract 2018; 24:97-104. [PMID: 28449396 DOI: 10.1111/jep.12730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, OBJECTIVES Clinical Practice Guidelines are mostly developed by 3 methods; namely, de novo, adoption, and adaptation. Nonpublished studies and authors experience shows that most guidelines in Turkey are either by adoption or by adaptation. There is no available local tool for adaptation, so the process is not standardized and most of the time not explicitly defined. The objective of this study is to search for international guideline adaptation tools and test their feasibility in Turkish context, to serve a final goal of developing a unique local strategic tool for guideline adaptation. METHODS The methodological design of this study includes selection of an international tool for Clinical Practice Guideline adaptation, piloting this tool with selected Turkish guidelines, identifying the feasibility of this tool and exploring the needs for adaptation of the tool, drawing recommendations for adaptation of the strategies, and validation of the process by local experts. RESULTS The study from planning phase to finalizing the guidance, including pilot studies and panel but excluding translation of ADAPTE, lasted 18 months. Nine researchers were involved in the adaptation process and 15 more experts were involved in the validation panel. Following the suggestions of the research team on modifications and validation through the expert panel; 2 steps of the ADAPTE toolkit were rejected, 2 steps were accepted by modification, 7 steps were accepted by additional recommendations. In addition, 2 tools were suggested to be added to the toolkit. CONCLUSION This is the first study on adaptation of guidelines in Turkey. Pilot adaptation of 2 guidelines with ADAPTE revealed that ADAPTE is a useful and feasible tool in Turkish setting, but might require certain changes in recommendations and revision of tools.
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Affiliation(s)
| | - Rabia Kahveci
- Family Medicine, TC Saglik Bakanligi Ankara Numune, Egitim ve Arastirma, Hastanesi, Ankara, Turkey
| | - Aylin Baydar Artantas
- Family Medicine, TC Saglik Bakanligi Ankara Numune, Egitim ve Arastirma, Hastanesi, Ankara, Turkey
| | - İlknur Yasar
- Yenimahalle Public Health Center, Ankara, Turkey
| | - Hilal Aksoy
- Pamukkale Pelitlibağ Family Health Center, Denizli, Turkey
| | | | - İsmail Kasim
- Family Medicine, Department, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ilkka Kunnamo
- Duodecim Medical Publications Ltd., Helsinki, Finland
| | - Adem Özkara
- Department, Hitit University, Ankara, Turkey
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Egger JR, Stankevitz K, Korom R, Angwenyi P, Sullivan B, Wang J, Hatfield S, Smith E, Popli K, Gross J. Evaluating the effects of organizational and educational interventions on adherence to clinical practice guidelines in a low-resource primary-care setting in Kenya. Health Policy Plan 2017; 32:761-768. [PMID: 28334856 DOI: 10.1093/heapol/czx004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/12/2022] Open
Abstract
Background Mid-level care providers serve as the backbone of primary care in many parts of sub-Saharan Africa. Despite this, research suggests that the quality and consistency of this care is uneven. This study assessed the degree to which a set of four simple, low-cost interventions could improve adherence to a set of clinical quality measures (CQMs) associated with four common health conditions seen in a resource-constrained primary care setting. Methods A quasi-experimental, longitudinal study was carried out in three primary care clinics in Nairobi, Kenya from August 2014 to January, 2015. Mid-level clinical officers (COs) at each clinic participated in four interventions aimed at improving CQM adherence. A group of temporary COs acted as a control group. Clinical encounter data were abstracted from eligible medical charts and assessed for CQM adherence. Mixed-effects logistic regression models were then fitted to these data to determine whether adherence to CQMs improved over time, and if this adherence differed by provider type and other characteristics. Results Adherence to CQMs increased from 41.4% to 77.1% for COs that took part in the intervention, and dropped slightly from 26.5% to 21.8% for temporary COs over the 6-month study period. This difference was statistically different between treatment groups and suggests that environmental interventions alone cannot change behaviour. Adherence also varied significantly by health condition, but did not vary by provider gender, age or clinic site. Conclusions This study demonstrates the potential for low-tech, low-cost interventions to improve the quality of care delivered by mid-level care providers in resource-constrained settings. Given the widespread utilization of mid-level care providers across sub-Saharan Africa, multicomponent interventions such as this one, that consist of simple educational modules and clinic-based feedback sessions, could lead to substantial improvements in the quality of primary care in these settings.
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Affiliation(s)
- Joseph R Egger
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA
| | | | | | - Philip Angwenyi
- Greater Baltimore Medical Center, 6701 N Charles St, Baltimore, MD 21204
| | - Brittney Sullivan
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.,Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA
| | - Jun Wang
- McKinsey & CO, 133 Peachtree St NE # 4600, Atlanta, GA 30303, USA
| | - Sonia Hatfield
- International Trade Administration, 1401 Constitution Ave NW, Washington, DC 20230, USA
| | - Emma Smith
- College of Arts & Sciences, Duke University, Durham, NC 27710, USA
| | - Karishma Popli
- Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia PA 19104
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Series: Clinical Epidemiology in South Africa. Paper 3: Logic models help make sense of complexity in systematic reviews and health technology assessments. J Clin Epidemiol 2017; 83:37-47. [DOI: 10.1016/j.jclinepi.2016.06.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/26/2016] [Accepted: 06/10/2016] [Indexed: 02/02/2023]
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18
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Young T, Naude C, Brodovcky T, Esterhuizen T. Building capacity in Clinical Epidemiology in Africa: experiences from Masters programmes. BMC MEDICAL EDUCATION 2017; 17:46. [PMID: 28241762 PMCID: PMC5327556 DOI: 10.1186/s12909-017-0885-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 02/16/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND To describe and contrast programmatic offering of Clinical Epidemiology Masters programmes in Africa, to evaluate experiences of graduates and faculty, and assess if graduates are playing roles in research, practice and teaching of Clinical Epidemiology. METHODS We searched and identified relevant programmes, reviewed programmatic documentation, interviewed convenors and surveyed graduates. Participants provided informed consent, interviews with faculty were recorded and transcribed for analysis purposes, and graduates participated in an online survey. RESULTS Five structured Masters programmes requiring health science professionals to complete modules and research projects were assessed. Demand for programmes was high. Graduates enjoyed the variety of modules, preferred blended teaching, and regarded assessments as fair. Graduates felt that career paths were not obvious after graduating. Despite this, some have gone on to promote and teach evidence-based health care, and conduct and disseminate research. Areas of concern raised by faculty were quality assurance; research project initiation, implementation and supervisory capacity; staff availability; funding to support implementation and lack of experiential learning. CONCLUSION Although faced with challenges, these programmes build capacity of health professionals to practice in an evidence-informed way, and conduct rigorous research, which are central to advancing the practice of Clinical Epidemiology in Africa.
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Affiliation(s)
- Taryn Young
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Celeste Naude
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tania Brodovcky
- Research Development and Support, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tonya Esterhuizen
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Series: Clinical Epidemiology in South Africa. Paper 1: Evidence-based health care and policy in Africa: past, present, and future. J Clin Epidemiol 2016; 83:24-30. [PMID: 27349186 DOI: 10.1016/j.jclinepi.2016.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 05/15/2016] [Accepted: 06/17/2016] [Indexed: 12/21/2022]
Abstract
Africa has high disease burden and health system challenges but is making progress in recognizing, accepting, and adopting evidence-based health care (EBHC). In this article, we reflect on the developments of the past 2 decades and consider further steps that will help with the translation of reliable research results into the decision making process. There has been a rapid growth in various initiatives to promote EBHC in the African region. These include the conduct and reporting of primary and secondary research, research capacity development and supportive initiatives, access to information, and work with decision makers in getting research into clinical guidelines and health policies. Much, however, still needs to be done to improve the impact on health in the region. A multipronged approach consisting of regionally relevant well-conducted research addressing priority health problems, increased uptake of research in health care policy and practice, dedicated capacity development initiatives to support the conduct as well as use of research, facilitated by wider collaboration, and equitable partnerships will be important. Working together in mutually supporting partnerships is key to advancing both evidence-informed health care practices and better health.
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Fan H, Song F. An assessment of randomized controlled trials (RCTs) for non-communicable diseases (NCDs): more and higher quality research is required in less developed countries. Sci Rep 2015; 5:13221. [PMID: 26272174 PMCID: PMC4642521 DOI: 10.1038/srep13221] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/21/2015] [Indexed: 12/21/2022] Open
Abstract
Research is crucial to implement evidence-based health interventions for control of non-communicable diseases (NCDs). This study aims to assess main features of randomized controlled trials (RCTs) for control of NCDs, and to identify gaps in clinical research on NCDs between high-income and less developed countries. The study included 1177 RCTs in 82 Cochrane Systematic reviews (CSRs) and evaluated interventions for adults with hypertension, diabetes, stroke, or heart diseases. Multivariate logistic regression analyses were conducted to explore factors associated with risk of bias in included RCTs. We found that 78.2% of RCTs of interventions for major NCDs recruited patients in high-income countries. The number of RCTs included in the CSRs was increasing over time, and the increasing speed was more noticeable for RCTs conducted in middle-income countries. RCTs conducted in less developed countries tended to be more recently published, less likely to be published in English, with smaller sample sizes, and at a higher risk of bias. In conclusion, there is still a lack of research evidence for control of NCDs in less developed countries. To brace for rising NCDs and avoid waste of scarce research resources, not only more but also higher quality clinical trials are required in low-and-middle-income countries.
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Affiliation(s)
- Hong Fan
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R. China
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, U.K
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Young T, Rohwer A, van Schalkwyk S, Volmink J, Clarke M. Patience, persistence and pragmatism: experiences and lessons learnt from the implementation of clinically integrated teaching and learning of evidence-based health care - a qualitative study. PLoS One 2015; 10:e0131121. [PMID: 26110641 PMCID: PMC4482262 DOI: 10.1371/journal.pone.0131121] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/28/2015] [Indexed: 01/08/2023] Open
Abstract
Background Clinically integrated teaching and learning are regarded as the best options for improving evidence-based healthcare (EBHC) knowledge, skills and attitudes. To inform implementation of such strategies, we assessed experiences and opinions on lessons learnt of those involved in such programmes. Methods and Findings We conducted semi-structured interviews with 24 EBHC programme coordinators from around the world, selected through purposive sampling. Following data transcription, a multidisciplinary group of investigators carried out analysis and data interpretation, using thematic content analysis. Successful implementation of clinically integrated teaching and learning of EBHC takes much time. Student learning needs to start in pre-clinical years with consolidation, application and assessment following in clinical years. Learning is supported through partnerships between various types of staff including the core EBHC team, clinical lecturers and clinicians working in the clinical setting. While full integration of EBHC learning into all clinical rotations is considered necessary, this was not always achieved. Critical success factors were pragmatism and readiness to use opportunities for engagement and including EBHC learning in the curriculum; patience; and a critical mass of the right teachers who have EBHC knowledge and skills and are confident in facilitating learning. Role modelling of EBHC within the clinical setting emerged as an important facilitator. The institutional context exerts an important influence; with faculty buy-in, endorsement by institutional leaders, and an EBHC-friendly culture, together with a supportive community of practice, all acting as key enablers. The most common challenges identified were lack of teaching time within the clinical curriculum, misconceptions about EBHC, resistance of staff, lack of confidence of tutors, lack of time, and negative role modelling. Conclusions Implementing clinically integrated EBHC curricula requires institutional support, a critical mass of the right teachers and role models in the clinical setting combined with patience, persistence and pragmatism on the part of teachers.
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Affiliation(s)
- Taryn Young
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa; Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anke Rohwer
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jimmy Volmink
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa
| | - Mike Clarke
- All Ireland Hub for Trials Methodology Research, Queen's University Belfast, Belfast, Northern Ireland
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Nickerson JW, Hatcher-Roberts J, Adams O, Attaran A, Tugwell P. Assessments of health services availability in humanitarian emergencies: a review of assessments in Haiti and Sudan using a health systems approach. Confl Health 2015; 9:20. [PMID: 26106443 PMCID: PMC4477304 DOI: 10.1186/s13031-015-0045-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 05/07/2015] [Indexed: 11/09/2022] Open
Abstract
Background Assessing the availability of health services during humanitarian emergencies is essential for understanding the capacities and weaknesses of disrupted health systems. To improve the consistency of health facilities assessments, the World Health Organization has proposed the use of the Health Resources Availability Mapping System (HeRAMS) developed in Darfur, Sudan as a standardized assessment tool for use in future acute and protracted crises. This study provides an evaluation of HeRAMS’ comprehensiveness, and investigates the methods, quality and comprehensiveness of health facilities data and tools in Haiti, where HeRAMS was not used. Methods and findings Tools and databases containing health facilities data in Haiti were collected using a snowball sampling technique, while HeRAMS was purposefully evaluated in Sudan. All collected tools were assessed for quality and comprehensiveness using a coding scheme based on the World Health Organization’s health systems building blocks, the Global Health Cluster Suggested Set of Core Indicators and Benchmarks by Category, and the Sphere Humanitarian Charter and Minimum Standards in Humanitarian Response. Eight assessments and databases were located in Haiti, and covered a median of 3.5 of the 6 health system building blocks, 4.5 of the 14 Sphere standards, and 2 of the 9 Health Cluster indicators. None of the assessments covered all of the indicators in any of the assessment criteria and many lacked basic data, limiting the detail of analysis possible for calculating standardized benchmarks and indicators. In Sudan, HeRAMS collected data on 5 of the 6 health system building blocks, 13 of the 14 Sphere Standards, and collected data to allow the calculation of 7 of the 9 Health Cluster Core Indicators and Benchmarks. Conclusions There is a need to agree upon essential health facilities data in disrupted health systems during humanitarian emergencies. Although the quality of the assessments in Haiti was generally poor, the large number of platforms and assessment tools deployed suggests that health facilities data can be collected even during acute emergencies. Further consensus is needed to establish essential criteria for data collection and to establish a core group of health systems assessment experts to be deployed during future emergencies.
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Affiliation(s)
- Jason W Nickerson
- Bruyère Research Institute, 85 Primrose Ave, Room 308-B, Ottawa, ON K1R 6M1 Canada ; Institute of Population Health, University of Ottawa, Ottawa, ON Canada ; WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, ON K1R 6M1 Canada
| | - Janet Hatcher-Roberts
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, ON K1R 6M1 Canada
| | | | - Amir Attaran
- Faculties of Law and Medicine, University of Ottawa, Ottawa, ON Canada
| | - Peter Tugwell
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, ON K1R 6M1 Canada ; Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5 Canada
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Buchanan H. The uptake of evidence-based practice by occupational therapists in South Africa. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2014. [DOI: 10.1179/otb.2011.64.1.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Forland F, Rehfuess E, Klatser P, Kyamanywa P, Mayanja-Kizza H. Why Evidence Based Approaches are urgently needed in Africa. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108:606-8. [PMID: 25499116 DOI: 10.1016/j.zefq.2014.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Frode Forland
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway; KIT Biomedical Research, Amsterdam, the Netherlands.
| | - Eva Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Germany
| | - Paul Klatser
- KIT Biomedical Research, Amsterdam, the Netherlands
| | - Patrick Kyamanywa
- Dean School of Medicine and Pharmacy, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Harriet Mayanja-Kizza
- Dean School of Medicine, Makerere University, College of Health Sciences, School of Medicine, Kampala, Uganda
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Berkowitz AL, Westover MB, Bianchi MT, Chou SHY. Aspirin for secondary prevention after stroke of unknown etiology in resource-limited settings. Neurology 2014; 83:1004-11. [PMID: 25122202 DOI: 10.1212/wnl.0000000000000779] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To analyze the potential impact of aspirin therapy for long-term secondary prevention after stroke of undetermined etiology in resource-limited settings without access to neuroimaging to distinguish ischemic stroke from intracerebral hemorrhage (ICH). METHODS We conducted a decision analysis using a Markov state transition model. Sensitivity analyses were performed across the worldwide reported range of the proportion of strokes due to ICH and the 95% confidence intervals (CIs) of aspirin-associated relative risks in patients with ICH. RESULTS For patients with stroke of undetermined etiology, long-term aspirin was the preferred treatment strategy across the worldwide reported range of the proportion of strokes due to ICH. At 34% of strokes due to ICH (the highest proportion reported in a large epidemiologic study), the benefit of aspirin remained beyond the upper bounds of the 95% CIs of aspirin-associated post-ICH relative risks most concerning to clinicians (ICH recurrence risk and mortality risk if ICH recurs on aspirin). Based on the estimated 11,590,204 strokes in low- and middle-income countries in 2010, our model predicts that aspirin therapy for secondary stroke prevention in all patients with stroke in these countries could lead to an estimated yearly decrease of 84,492 recurrent strokes and 4,056 stroke-related mortalities. CONCLUSIONS The concern that the risks of aspirin in patients with stroke of unknown etiology could outweigh the benefits is not supported by our model, which predicts that aspirin for secondary prevention in patients with stroke of undetermined etiology in resource-limited settings could lead to decreased stroke-related mortality and stroke recurrence.
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Affiliation(s)
- Aaron L Berkowitz
- From the Department of Neurology (A.L.B., S.H.C.), Brigham and Women's Hospital, Harvard Medical School; and Department of Neurology (M.B.W., M.T.B.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - M Brandon Westover
- From the Department of Neurology (A.L.B., S.H.C.), Brigham and Women's Hospital, Harvard Medical School; and Department of Neurology (M.B.W., M.T.B.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Matt T Bianchi
- From the Department of Neurology (A.L.B., S.H.C.), Brigham and Women's Hospital, Harvard Medical School; and Department of Neurology (M.B.W., M.T.B.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sherry H-Y Chou
- From the Department of Neurology (A.L.B., S.H.C.), Brigham and Women's Hospital, Harvard Medical School; and Department of Neurology (M.B.W., M.T.B.), Massachusetts General Hospital, Harvard Medical School, Boston
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Millard JD, Muhangi L, Sewankambo M, Ndibazza J, Elliott AM, Webb EL. Assessing the external validity of a randomized controlled trial of anthelminthics in mothers and their children in Entebbe, Uganda. Trials 2014; 15:310. [PMID: 25100338 PMCID: PMC4138365 DOI: 10.1186/1745-6215-15-310] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 07/18/2014] [Indexed: 12/29/2022] Open
Abstract
Background The ‘external validity’ of randomized controlled trials is an important measure of quality, but is often not formally assessed. Trials concerning mass drug administration for helminth control are likely to guide public health policy and careful interpretation of their context is needed. We aimed to determine how representative participants in one such trial were of their community. We explore implications for trial interpretation and resulting public health recommendations. Methods The trial assessed was the Entebbe Mother and Baby Study (EMaBS), a trial of anthelminthic treatment during pregnancy and early childhood. In a novel approach for assessing external validity, we conducted a two-stage cluster sample community survey within the trial catchment area and compared characteristics of potentially-eligible community children with characteristics of children participating in the trial. Results A total of 173 children aged three to five-years-old were surveyed from 480 households. Of children surveyed, we estimated that mothers of 60% would have been eligible for recruitment, and of these, 31% had actually been enrolled. Children surveyed were compared to 199 trial children in the same age group reviewed at annual trial visits during the same time period. There were significant differences in ethnicity between the trial participants and the community children, and in socioeconomic status, with those in the trial having, on average, more educated parents and higher maternal employment. Trial children were less likely to have barefoot exposure and more likely to use insecticide-treated bed nets. There were no significant differences in numbers of reported illness events over the last year. Conclusions The trial had not enrolled all eligible participants, and those enrolled were of higher socioeconomic status, and had lower risk of exposure to the parasitic infections targeted by the trial interventions. It is possible the trial may have underestimated the absolute effects of anthelminthic treatment during pregnancy and early childhood, although the fact that there were no differences in reported incidence of common infectious diseases (one of the primary outcomes of EMaBS) between the two groups provides reassurance. Concurrent community surveys may be an effective way to test the external validity of trials. EMaBS Trial registration ISRCTN32849447, registered 22 July 2005 Electronic supplementary material The online version of this article (doi:10.1186/1745-6215-15-310) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James D Millard
- Department of Global Health, Division of Clinical Medicine, Brighton and Sussex Medical School, Falmer, Brighton BN1 9PX, UK.
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Widyahening IS, Wangge G, Saldi SRF, Lestari BW, Apriani L, Sastroasmoro S, Glasziou P, van der Graaf Y, van der Heijden GJMG. Quality and reporting of publications by Indonesian researchers: a literature survey. J Evid Based Med 2014; 7:163-71. [PMID: 25156942 DOI: 10.1111/jebm.12112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 06/18/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate the quality of reporting of the risk of bias of the Indonesian medical research. METHODS Publications from PubMed and non-PubMed indexed Indonesian medical journals between January 2008 to December 2010 were assessed for risk of bias based on criterion combination from Hedges-criteria and the Oxford Center for Evidence-Based Medicine. We assessed whether the publications addressed the risk of bias adequately (quality of reporting) and whether the risk of bias criterion was fulfilled (quality of methods). The quality (both of reporting and of methods) of a study was classified as "high" if, for at least two-thirds of the criteria were adequately reported and fulfilled. It was classified as "low" when only one-third of the criteria were reported and or fulfilled. RESULTS Of the 1753 publications, 29% (n = 507) were original medical research. For 21% (109/507) the quality of reporting was high; for 15% (77/507) the quality of methods was high. The proportion of high quality was significantly higher among PubMed than non-PubMed, with difference between proportions: (95%CI of difference: 3 to 23). CONCLUSION A small proportion of Indonesian studies have high quality of reporting or methods. When international reporting guidelines are endorsed and followed, the quality of future studies may improve.
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Affiliation(s)
- Indah S Widyahening
- Community Medicine Department, Faculty of Medicine, University of Indonesia, Indonesia
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Dizon JMR, Grimmer-Somers K, Kumar S. Effectiveness of the tailored Evidence Based Practice training program for Filipino physical therapists: a randomized controlled trial. BMC MEDICAL EDUCATION 2014; 14:147. [PMID: 25034409 PMCID: PMC4131475 DOI: 10.1186/1472-6920-14-147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/30/2014] [Indexed: 05/02/2023]
Abstract
BACKGROUND This study evaluated the effectiveness of the contextualized EBP training program for Filipino physical therapists in terms of knowledge, skills, attitudes and behavior. METHODS A randomized controlled trial was designed to assess the effectiveness of the EBP training program. Fifty four physical therapists were randomly allocated to the EBP group (intervention) and waitlist (control) group. The EBP group had a one day face-to-face training with an online support, whilst the control was waitlisted. There were three measurement points which were pre, post, and three months post intervention for knowledge, skills and attitudes. Activity diaries were used to measure behavior. The diaries were collected after three months. Data analysis was by intention to treat in EBP domains of knowledge, skills and attitudes. RESULTS Fifty-four physical therapists were included in the study. Fifty two (52) completed the post training assessment and 26 completed the 3 months post training assessment for EBP knowledge, skills and attitudes. There were significant improvements in these domains in the EBP group from pre to post training and over a period of three months (p < 0.05) compared with the waitlist control group. Thirty seven (37) physical therapists completed their activity diaries over three months. Behavior significantly improved in the EBP group in terms of EBP behaviors (formulating PICO, searching, appraising and applying the evidence) when faced with both new/unique and usual case scenarios (p < 0.05). More physical therapists in the waitlist control group significantly performed non-EBP behaviors (asking doctors and reading textbooks) when faced with new/unique cases compared with the EBP group (p < 0.05). No differences were noted between groups regarding non-EBP behaviors (asking colleagues and doctors and reading textbooks) particularly when faced with usual cases. CONCLUSION The contextually designed EBP training program for Filipino physical therapists was effective in improving knowledge, skills and attitudes to EBP from pre to post training. Improvements were also observed at three months post training in knowledge, skills, attitudes and behavior to EBP. This model of training can be modified as needed based on the needs of the local context. Findings need to be interpreted with caution due to study limitations. CURRENT CONTROLLED TRIALS ISRCTN74485061 (Registration date: February 9, 2011).
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Affiliation(s)
- Janine Margarita R Dizon
- International Centre for Allied Health Evidence, University of South Australia, City East Campus, North Terrace, Adelaide 5000, Australia
- University of Santo Tomas, Manila 1015, Philippines
| | - Karen Grimmer-Somers
- International Centre for Allied Health Evidence, University of South Australia, City East Campus, North Terrace, Adelaide 5000, Australia
| | - Saravana Kumar
- International Centre for Allied Health Evidence, University of South Australia, City East Campus, North Terrace, Adelaide 5000, Australia
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Nickerson JW, Adams O, Attaran A, Hatcher-Roberts J, Tugwell P. Monitoring the ability to deliver care in low- and middle-income countries: a systematic review of health facility assessment tools. Health Policy Plan 2014; 30:675-86. [PMID: 24895350 PMCID: PMC4421835 DOI: 10.1093/heapol/czu043] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2014] [Indexed: 11/13/2022] Open
Abstract
Introduction Health facilities assessments are an essential instrument for health system strengthening in low- and middle-income countries. These assessments are used to conduct health facility censuses to assess the capacity of the health system to deliver health care and to identify gaps in the coverage of health services. Despite the valuable role of these assessments, there are currently no minimum standards or frameworks for these tools. Methods We used a structured keyword search of the MEDLINE, EMBASE and HealthStar databases and searched the websites of the World Health Organization, the World Bank and the International Health Facilities Assessment Network to locate all available health facilities assessment tools intended for use in low- and middle-income countries. We parsed the various assessment tools to identify similarities between them, which we catalogued into a framework comprising 41 assessment domains. Results We identified 10 health facility assessment tools meeting our inclusion criteria, all of which were included in our analysis. We found substantial variation in the comprehensiveness of the included tools, with the assessments containing indicators in 13 to 33 (median: 25.5) of the 41 assessment domains included in our framework. None of the tools collected data on all 41 of the assessment domains we identified. Conclusions Not only do a large number of health facility assessment tools exist, but the data they collect and methods they employ are very different. This certainly limits the comparability of the data between different countries’ health systems and probably creates blind spots that impede efforts to strengthen those systems. Agreement is needed on the essential elements of health facility assessments to guide the development of specific indicators and for refining existing instruments.
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Affiliation(s)
- Jason W Nickerson
- Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Orvill Adams
- Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Amir Attaran
- Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Janet Hatcher-Roberts
- Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Peter Tugwell
- Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, Bruyère Research Institute, Ottawa, ON, Canada, Orvill Adams and Associates, Ottawa, ON, Canada, Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, Canadian Society for International Health, Ottawa, ON, Canada and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
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Dizon JM, Dizon RJ, Regino J, Gabriel A. Evidence-based practice training for health professionals in the Philippines. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2014; 5:89-94. [PMID: 24790472 PMCID: PMC3998855 DOI: 10.2147/amep.s54459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Evidence-based practice (EBP) is integral in the health care system whether in developed or developing countries. Thus, all health professionals need to be trained in EBP. An EBP training program was conducted to health professionals in a developing country, the Philippines. The health professionals (medical doctors and allied health professionals [physical therapists and occupational therapists]) were working in hospitals in Manila, Philippines. The program aimed to build capacity in EBP in terms of knowledge and skills. The EBP training program was conducted as a 1-day face-to-face training. Pre- and post-test measures of EBP knowledge and skills were taken prior to and immediately after the 1-day training, using the Fresno test of evidence-based medicine for the medical doctors and the Adapted Fresno test for the allied health professionals. The EBP training program resulted in significant improvements in knowledge and skills for both the medical doctors (change in pre- and post-Fresno test measures, 95% confidence interval [CI]: 14.6-23.5; P≤0.05) and the allied health professionals (change in pre- and post-Adapted Fresno test measures, 95% CI: 32.7-38.5; P≤0.05). The EBP training conducted amongst the health professionals is an effective and tested undertaking in introducing EBP in developing countries such as the Philippines.
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Affiliation(s)
- Janine Margarita Dizon
- Center for Health Research and Movement Science, University of Santo Tomas, Manila, Philippines
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | | | - Jocel Regino
- Apolinario Mabini Rehabilitation Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Alberto Gabriel
- Department of Internal MedicineOspital ng Maynila, Manila, Philippines
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Chen Y, Hu S, Li Y, Yan B, Shen G, Wang L. Systematic review of hypertension clinical practice guidelines based on the burden of disease: a global perspective. J Evid Based Med 2014; 7:52-9. [PMID: 25155567 DOI: 10.1111/jebm.12082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 01/25/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To perform a systematic review for the development, geographical distribution, and subject classification of clinical practice guidelines (CPGs) for hypertension worldwide. METHODS CPGs for the management of hypertension were identified through the searching of Ovid, EMbase, and Chinese electronic databases. Major guidelines websites such as NGC (National Guideline Clearinghouse), GIN (Guidelines International Network), NICE (National Institute for Health and Clinical Excellence) and CPGN (Clinical Practice Guideline Network), as well as Google Scholar were also screened for additional information. EndNote X3 and Excel 2007 were used for extracting and analyzing the data of included CPGs. RESULTS A total of 375 hypertension CPGs were included, involving 6 continents, 33 countries, 4 regions, and 3 international organizations. The publication date ranged from the year of 1971 to 2012, with the number of CPGs increased year by year. The CPGs were mainly developed by North America, Europe, and Asia. Their subjects covered 3 categories and 11 sub-classes, which mainly focused on the management of adult hypertension (44.53%). CONCLUSION The number of CPGs varies in regions, countries, and academic organizations, with the development process differently. The regional disparity between the number CPGs and burden of hypertension were observed. The CPGs made a point of the management of adult hypertension.
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Affiliation(s)
- Yin Chen
- Anhui Evidence-based Medicine Center, Anhui Provincial Hospital, Hefei 230001, China; Chinese Evidence-based Medicine Center/Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Young T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One 2014; 9:e86706. [PMID: 24489771 PMCID: PMC3904944 DOI: 10.1371/journal.pone.0086706] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/09/2013] [Indexed: 01/08/2023] Open
Abstract
Background An evidence-based approach to health care is recognized internationally as a key competency for healthcare practitioners. This overview systematically evaluated and organized evidence from systematic reviews on teaching evidence-based health care (EBHC). Methods/Findings We searched for systematic reviews evaluating interventions for teaching EBHC to health professionals compared to no intervention or different strategies. Outcomes covered EBHC knowledge, skills, attitudes, practices and health outcomes. Comprehensive searches were conducted in April 2013. Two reviewers independently selected eligible reviews, extracted data and evaluated methodological quality. We included 16 systematic reviews, published between 1993 and 2013. There was considerable overlap across reviews. We found that 171 source studies included in the reviews related to 81 separate studies, of which 37 are in more than one review. Studies used various methodologies to evaluate educational interventions of varying content, format and duration in undergraduates, interns, residents and practicing health professionals. The evidence in the reviews showed that multifaceted, clinically integrated interventions, with assessment, led to improvements in knowledge, skills and attitudes. Interventions improved critical appraisal skills and integration of results into decisions, and improved knowledge, skills, attitudes and behaviour amongst practicing health professionals. Considering single interventions, EBHC knowledge and attitude were similar for lecture-based versus online teaching. Journal clubs appeared to increase clinical epidemiology and biostatistics knowledge and reading behavior, but not appraisal skills. EBHC courses improved appraisal skills and knowledge. Amongst practicing health professionals, interactive online courses with guided critical appraisal showed significant increase in knowledge and appraisal skills. A short workshop using problem-based approaches, compared to no intervention, increased knowledge but not appraisal skills. Conclusions EBHC teaching and learning strategies should focus on implementing multifaceted, clinically integrated approaches with assessment. Future rigorous research should evaluate minimum components for multifaceted interventions, assessment of medium to long-term outcomes, and implementation of these interventions.
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Affiliation(s)
- Taryn Young
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa
- Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- * E-mail:
| | - Anke Rohwer
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jimmy Volmink
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa
| | - Mike Clarke
- All Ireland Hub for Trials Methodology Research, Queen’s University Belfast, Belfast, Northern Ireland
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Young T, Garner P, Kredo T, Mbuagbaw L, Tharyan P, Volmink J. Cochrane and capacity building in low- and middle-income countries: where are we at? Cochrane Database Syst Rev 2013; 2013:ED000072. [PMID: 24524153 PMCID: PMC10846367 DOI: 10.1002/14651858.ed000072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Taryn Young
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesSouth Africa
- South African Cochrane Centre, South African Medical Research CouncilSouth Africa
| | - Paul Garner
- Liverpool School of Tropical MedicineEffective Health Care Research Consortium, Department of Clinical SciencesUK
| | - Tamara Kredo
- South African Cochrane Centre, South African Medical Research CouncilSouth Africa
| | | | - Prathap Tharyan
- South Asian Cochrane Network & Centre, Christian Medical CollegeVelloreIndia
| | - Jimmy Volmink
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesSouth Africa
- South African Cochrane Centre, South African Medical Research CouncilSouth Africa
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Isichei MW, Ismaila BO. The general surgeon in inter-disciplinary gynaecological cancer care. World J Obstet Gynecol 2013; 2:37-41. [DOI: 10.5317/wjog.v2.i3.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 03/01/2013] [Accepted: 04/10/2013] [Indexed: 02/05/2023] Open
Abstract
Gynaecological cancers pose a significant cancer burden globally. In 2008 cancers of the cervix, uterus and ovaries accounted for 529000 (4.2%), 287000 (2.3%) and 225000 (1.8%) cancers, respectively, and together were responsible for 486400 deaths. Inter-disciplinary gynaecological care is an emerging concept aimed at providing more effective care by integrating different disciplines into a team working together to perform the various aspects of management at one time. This model has both advantages and potential shortcomings. In advanced healthcare systems there appears to be little role for the general surgeon. However in developing world, the general surgeon has a valuable, but complementary role in inter-disciplinary gynaecological cancer care. This role depends on the available workforce and includes, but is not limited to, the establishment of a diagnosis and treatment, including the management of complications. There is however little evidence-based research to provide guidance on the general surgeon’s role in inter-disciplinary gynecologic cancer care and more research is needed.
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MANAVI S, OLYAEE MANESH A, YAZDANI S, SHAMS L, NASIRI T, SHIRVANI A, EMAMI RAZAVI H. Model for implementing evidence based health care system in iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2013; 42:758-66. [PMID: 24427754 PMCID: PMC3881621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/22/2013] [Indexed: 11/04/2022]
Abstract
BACKGROUND Regarding the role and importance of paradigm of evidence based practice and its remarkable impact on the effectiveness and efficiency of clinical services and healthcare, development of an integrated system seems necessary in order to manage dispersed data and ensure using evidence in clinical decision making, thus the aim of this study was designing a model for implementing national system of evidence based health care in Iran. METHODOS THIS PAPER IS A STUDY OF COMPARATIVE TYPE WHICH HAS BEEN WRITTEN IN THREE STAGES: investigation of structure and process of evidence based practice in selected countries, investigation and analysis of current status in Iran in this regard and recommendation of strategies which make model implementation feasible in the country. Such methods as review of literature, focus group discussion and Delphi technique were used for investigation. RESULTS According to studies, insuring an evidence based practice culture in the country requires a system called National Evidence Based Health Care System which consists of three subsystems including national system of clinical knowledge management, national evidence-based practice system and integrated national network of clinical effectiveness. CONCLUSION The ultimate goal of health care system in every country is maintaining and improving community health. Achievement of this goal depends on effectiveness of delivered services and consistency of the services with national and local priorities. In order to achieve clinical effectiveness, the best practice should be realized in the country, implementation of which requires a set of macro and micro strategies enabling facilitation, promotion or guaranteeing clinical knowledge application in the country.
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Affiliation(s)
- Saeed MANAVI
- Dept. of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Alireza OLYAEE MANESH
- Dept. of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
- Dept. of Payment and Financing of Health System, National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram YAZDANI
- School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Lida SHAMS
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Taha NASIRI
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Armin SHIRVANI
- Dept. of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Hasan EMAMI RAZAVI
- Dept. of Payment and Financing of Health System, National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
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Dizon JMR, Grimmer-Somers KA, Kumar S. Current evidence on evidence-based practice training in allied health: a systematic review of the literature. INT J EVID-BASED HEA 2013; 10:347-60. [PMID: 23173659 DOI: 10.1111/j.1744-1609.2012.00295.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It is essential that allied health practice decisions are underpinned by the best available evidence. Therefore, effective training needs to be provided for allied health professionals to do this. However, little is known about how evidence-based practice training programs for allied health professionals are delivered, the elements contained within them, how learning outcomes are measured or the effectiveness of training components in improving learning outcomes. METHODS We conducted a systematic literature review to identify effectiveness of evidence-based practice training programs and their components for allied health professionals. Key words of evidence-based practice programs OR journal clubs OR critical appraisal AND allied health OR physiotherapists OR occupational therapists OR speech pathologists AND knowledge OR skills OR attitudes OR behaviour were applied to all available databases. Papers were critically appraised using the Joanna Briggs Institute and McMaster tools and the checklist of recommendations for educational interventions. Data were extracted on participants, training program components and underpinning theories, methods of delivery and learning outcomes. Data were synthesised using a combination of narrative and realist synthesis approaches. RESULTS Six relevant studies (four randomised controlled trials and two before-and-after studies) reported on the effectiveness of evidence-based practice training programs for evidence-based practice for groups of health professionals. Specifically, only three of these studies (one randomised controlled trial and two before-and-after studies) reported on allied health professionals (physiotherapists, occupational therapists and social workers). Among these three studies on allied health, outcomes were variably measured, largely reporting on knowledge, skills, attitudes and/or behaviours. Significant changes in knowledge and skills were reported in all studies. Only the social work study, which reassessed outcomes after 3 months, reported significant changes in attitudes and behaviours. Training took from 3 hours to 2 days. While there was information on training program components, there was no evidence of effectiveness related to learning outcomes. CONCLUSION Overall, there is limited research regarding training of allied health professionals in evidence-based practice and learning outcomes. From the limited evidence base, there was consistent evidence that any training significantly influenced knowledge, skills and attitudes, irrespective of the allied health discipline. There was little information, however, regarding how to change or measure behaviours. This review cannot recommend components of training for allied health professionals in evidence-based practice, which significantly improve learning outcomes.
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Affiliation(s)
- Janine Margarita Roy Dizon
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia.
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Hoehner CM, Ribeiro IC, Parra DC, Reis RS, Azevedo MR, Hino AA, Soares J, Hallal PC, Simões EJ, Brownson RC. Physical activity interventions in Latin America: expanding and classifying the evidence. Am J Prev Med 2013; 44:e31-40. [PMID: 23415133 PMCID: PMC4217143 DOI: 10.1016/j.amepre.2012.10.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/22/2012] [Accepted: 10/22/2012] [Indexed: 12/04/2022]
Abstract
CONTEXT Systematic reviews of public health interventions are useful for identifying effective strategies for informing policy and practice. The goals of this review were to (1) update a previous systematic review of physical activity interventions in Latin America which found that only school-based physical education had sufficient evidence to recommend widespread adoption; (2) assess the reporting of external validity elements; and (3) develop and apply an evidence typology for classifying interventions. EVIDENCE ACQUISITION In 2010-2011, community-level, physical activity intervention studies from Latin America were identified, categorized, and screened based on the peer-reviewed literature or Brazilian theses published between 2006 and 2010. Articles meeting inclusion criteria were evaluated using U.S. Community Guide methods. External validity reporting was assessed among a subset of articles reviewed to date. An evidence rating typology was developed and applied to classify interventions along a continuum based on evidence about their effectiveness in the U.S. context, reach, adoption, implementation, institutionalization, and benefits and costs. EVIDENCE SYNTHESIS Thirteen articles published between 2006 and 2010 met inclusion criteria and were abstracted systematically, yet when combined with evidence from articles from the previous systematic review, no additional interventions could be recommended for practice. Moreover, the reporting of external validity elements was low among a subset of 19 studies published to date (median=21% of elements reported). By applying the expanded evidence rating typology, one intervention was classified as evidence-based, seven as promising, and one as emerging. CONCLUSIONS Several physical activity interventions have been identified as promising for future research and implementation in Latin America. Enhanced reporting of external validity elements will inform the translation of research into practice.
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Affiliation(s)
- Christine M Hoehner
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA.
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Rashidian A, Shakibazadeh E, Karimi- Shahanjarini A, Glenton C, Noyes J, Lewin S, Colvin CJ, Laurant M. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: qualitative evidence synthesis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010412] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Arash Rashidian
- Tehran University of Medical Sciences; Department of Health Management and Economics, School of Public Health; Poursina Ave Tehran Iran 1417613191
| | - Elham Shakibazadeh
- Zanjan University of Medical Sciences; Department of Midwifery; Parvin Etesami street, School of Nursing and Midwifery Zanjan Zanjan Iran 4515786339
| | - Akram Karimi- Shahanjarini
- Hamedan University of Medical Sciences; Department of Public Health; Mahdeieh Ave. Hamedan, Iran Hamedan Hamedan Iran
| | - Claire Glenton
- Norwegian Knowledge Centre for the Health Services; Global Health Unit; PO Box 7004 St Olavs plass Oslo Norway N-0130
| | - Jane Noyes
- Bangor University; Centre for Health-Related Research, Fron Heulog; Bangor Wales UK LL57 2EF
| | - Simon Lewin
- Norwegian Knowledge Centre for the Health Services; Global Health Unit; PO Box 7004 St Olavs plass Oslo Norway N-0130
- Medical Research Council of South Africa; Health Systems Research Unit; PO Box 19070 Tygerberg South Africa 7505
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape Town; Centre for Infectious Disease Epidemiology and Research (CIDER); 7 Alfred St., Observatory 7925 Cape Town South Africa
| | - Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcare; Radboud University Medical Center; PO Box 9101 Nijmegen Netherlands 6500 HB
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Forland F, Rohwer AC, Klatser P, Boer K, Mayanja-Kizza H. Strengthening evidence-based healthcare in Africa. ACTA ACUST UNITED AC 2013; 18:204-6. [PMID: 23416418 DOI: 10.1136/eb-2012-101143] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Frode Forland
- KIT Biomedical Research, Royal Tropical Institute (KIT), , Amsterdam, The Netherlands
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Katchanov J, Birbeck GL. Epilepsy care guidelines for low- and middle- income countries: From WHO mental health GAP to national programs. BMC Med 2012; 10:107. [PMID: 23006668 PMCID: PMC3523062 DOI: 10.1186/1741-7015-10-107] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/24/2012] [Indexed: 11/10/2022] Open
Abstract
In 2011, the World Health Organization's (WHO) mental health Gap Action Programme (mhGAP) released evidence-based epilepsy-care guidelines for use in low and middle income countries (LAMICs). From a geographical, sociocultural, and political perspective, LAMICs represent a heterogenous group with significant differences in the epidemiology, etiology, and perceptions of epilepsy. Successful implementation of the guidelines requires local adaptation for use within individual countries. For effective implementation and sustainability, the sense of ownership and empowerment must be transferred from the global health authorities to the local people. Sociocultural and financial barriers that impede the implementation of the guidelines should be identified and ameliorated. Impact assessment and program revisions should be planned and a budget allocated to them. If effectively implemented, as intended, at the primary-care level, the mhGAP guidelines have the potential to facilitate a substantial reduction in the epilepsy treatment gap and improve the quality of epilepsy care in resource-limited settings.
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Affiliation(s)
- Juri Katchanov
- Michigan State University, International Neurologic and Psychiatric Epidemiology Program, East Lansing, Michigan, USA
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Rashidian A, Yousefi-Nooraie R. Development of a Farsi translation of the AGREE instrument, and the effects of group discussion on improving the reliability of the scores. J Eval Clin Pract 2012; 18:676-81. [PMID: 21410842 DOI: 10.1111/j.1365-2753.2011.01649.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We aimed to develop a formal Farsi (Persian) translation of the Appraisal of Guidelines for Research and Evaluation (AGREE) clinical guideline appraisal instrument. We considered the effect of group discussion in improving the reliability of scores. METHODS We followed a multi-step process of translation including independent translations of the instrument and extensive assessment of face validity and fluency. We used the instruments to appraise 11 guidelines from three specialities. After the first appraisal, the raters discussed about each guideline in groups, and had the opportunity to revise their scores individually. In total 96 appraisals were conducted. The intra-class correlations (1,1) were calculated for domain scores obtained by two versions at each time point. RESULTS We observed no statistically significant differences between the mean values obtained from the English and the translated versions of AGREE, and the scores at two time points. The average domain scores, as well as the reliability rose significantly after discussion. CONCLUSION The Farsi version of the AGREE instrument yields in the scores comparable to the original version, despite a lower reliability. Revision of scores after group discussion leads to higher reliability, probably by helping the raters recognize what they might have overlooked during the short time of assessment.
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Affiliation(s)
- Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Abrams AL. One of a kind--the Pan African Clinical Trials Registry, a regional registry for Africa. Pan Afr Med J 2012; 9:42. [PMID: 22355440 PMCID: PMC3215564 DOI: 10.4314/pamj.v9i1.71221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 08/14/2011] [Indexed: 11/30/2022] Open
Abstract
The 2004 Ministerial Summit on Health Research called on the World Health Organization to to establish a registry network with the intention of providing a single access point to identify trials. In 2007 the International Committee of Medical Journal Editors amended their support of this initiative stating that only trials registered prospectively on a member registry of the WHO's Network of Primary Registers would be published. The Pan African Clinical Trials Registry (www.pactr.org), was established in early 2007 as the AIDS, TB and Malaria (ATM) Clinical Trials Registry with the aim of piloting the concept of a registry that would cater to the specific needs of African trialists. In 2009 the ATM Registry expanded its remit to include all diseases for all regions of Africa; The Pan African Clinical Trials Registry became the first and is presently the only African member of the World Health Organization's Network of Primary Registers.
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Affiliation(s)
- Amber L Abrams
- South African Cochrane Centre, South African Medical Research Council
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Kredo T, Gerritsen A, van Heerden J, Conway S, Siegfried N. Clinical practice guidelines within the Southern African Development Community: a descriptive study of the quality of guideline development and concordance with best evidence for five priority diseases. Health Res Policy Syst 2012; 10:1. [PMID: 22221856 PMCID: PMC3286374 DOI: 10.1186/1478-4505-10-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 01/05/2012] [Indexed: 11/28/2022] Open
Abstract
Background Reducing the burden of disease relies on availability of evidence-based clinical practice guidelines (CPGs). There is limited data on availability, quality and content of guidelines within the Southern African Development Community (SADC). This evaluation aims to address this gap in knowledge and provide recommendations for regional guideline development. Methods We prioritised five diseases: HIV in adults, malaria in children and adults, pre-eclampsia, diarrhoea in children and hypertension in primary care. A comprehensive electronic search to locate guidelines was conducted between June and October 2010 and augmented with email contact with SADC Ministries of Health. Independent reviewers used the AGREE II tool to score six quality domains reporting the guideline development process. Alignment of the evidence-base of the guidelines was evaluated by comparing their content with key recommendations from accepted reference guidelines, identified with a content expert, and percentage scores were calculated. Findings We identified 30 guidelines from 13 countries, publication dates ranging from 2003-2010. Overall the 'scope and purpose' and 'clarity and presentation' domains of the AGREE II instrument scored highest, median 58%(range 19-92) and 83%(range 17-100) respectively. 'Stakeholder involvement' followed with median 39%(range 6-75). 'Applicability', 'rigour of development' and 'editorial independence' scored poorly, all below 25%. Alignment with evidence was variable across member states, the lowest scores occurring in older guidelines or where the guideline being evaluated was part of broader primary healthcare CPG rather than a disease-specific guideline. Conclusion This review identified quality gaps and variable alignment with best evidence in available guidelines within SADC for five priority diseases. Future guideline development processes within SADC should better adhere to global reporting norms requiring broader consultation of stakeholders and transparency of process. A regional guideline support committee could harness local capacity to support context appropriate guideline development.
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Affiliation(s)
- Tamara Kredo
- South African Cochrane Centre, South African Medical Research Council, Cape Town, Western Cape, South Africa.
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Randomized controlled trials of HIV/AIDS prevention and treatment in Africa: results from the Cochrane HIV/AIDS Specialized Register. PLoS One 2011; 6:e28759. [PMID: 22194905 PMCID: PMC3240627 DOI: 10.1371/journal.pone.0028759] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 11/14/2011] [Indexed: 11/26/2022] Open
Abstract
Introduction To effectively address HIV/AIDS in Africa, evidence on preventing new infections and providing effective treatment is needed. Ideally, decisions on which interventions are effective should be based on evidence from randomized controlled trials (RCTs). Our previous research described African RCTs of HIV/AIDS reported between 1987 and 2003. This study updates that analysis with RCTs published between 2004 and 2008. Objectives To describe RCTs of HIV/AIDS conducted in Africa and reported between 2004 and 2008. Methods We searched the Cochrane HIV/AIDS Specialized Register in September 2009. Two researchers independently evaluated studies for inclusion and extracted data using standardized forms. Details included location of trials, interventions, methodological quality, location of principal investigators and funders. Results Our search identified 834 RCTs, with 68 conducted in Africa. Forty-three assessed prevention-interventions and 25 treatment-interventions. Fifteen of the 43 prevention RCTs focused on preventing mother-to-child HIV transmission. Thirteen of the 25 treatment trials focused on opportunistic infections. Trials were conducted in 16 countries with most in South Africa (20), Zambia (12) and Zimbabwe (9). The median sample size was 628 (range 33-9645). Methods used for the generation of the allocation sequence and allocation concealment were adequate in 38 and 32 trials, respectively, and 58 reports included a CONSORT recommended flow diagram. Twenty-nine principal investigators resided in the United States of America (USA) and 18 were from African countries. Trials were co-funded by different agencies with most of the funding obtained from USA governmental and non-governmental agencies. Nineteen pharmaceutical companies provided partial funding to 15 RCTs and African agencies co-funded 17 RCTs. Ethical approval was reported in 65 trials and informed consent in 61 trials. Conclusion Prevention trials dominate the trial landscape in Africa. Of note, few principal investigators and funders are from Africa. These findings mirror our previous work and continue to indicate a need for strengthening trial research capacity in Africa.
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Ehrhardt S, Meyer CG. Transfer of evidence-based medical guidelines to low- and middle-income countries. Trop Med Int Health 2011; 17:144-6. [PMID: 22017603 DOI: 10.1111/j.1365-3156.2011.02910.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tomatis C, Taramona C, Rizo-Patrón E, Hernández F, Rodríguez P, Piscoya A, Gonzales E, Gotuzzo E, Heudebert G, Centor RM, Estrada CA. Evidence-based medicine training in a resource-poor country, the importance of leveraging personal and institutional relationships. J Eval Clin Pract 2011; 17:644-50. [PMID: 21276140 PMCID: PMC3145831 DOI: 10.1111/j.1365-2753.2011.01635.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Efforts to implement evidence-based medicine (EBM) training in developing countries are limited. We describe the results of an international effort to improve research capacity in a developing country; we conducted a course aimed at improving basic EBM attitudes and identified challenges. METHOD Between 2005 and 2009, we conducted an annual 3-day course in Perú consisting of interactive lectures and case-based workshops. We assessed self-reported competence and importance in EBM using a Likert scale (1 = low, 5 = high). RESULTS Totally 220 clinicians participated. For phase I (2005-2007), self-reported EBM competence increased from a median of 2 to 3 (P < 0.001) and the perceived importance of EBM did not change (median = 5). For phase II (2008-2009), before the course, 8-72% graded their competence very low (score of 1-2). After the course, 67-92% of subjects graded their increase in knowledge very high (score of 4-5). The challenges included limited availability of studies relevant to the local reality written in Spanish, participants' limited time and lack of long-term follow-up on practice change. Informal discussion and written evaluation from participants were universally in agreement that more training in EBM is needed. CONCLUSIONS In an EBM course in a resource-poor country, the baseline self-reported competence and experience on EBM were low, and the course had measurable improvements of self-reported competence, perceived utility and readiness to incorporate EBM into their practices. Similar to developed countries, translational research and building the research capacity in developing countries is critical for translating best available evidence into practice.
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Lodge M, Corbex M. Establishing an evidence-base for breast cancer control in developing countries. Breast 2011; 20 Suppl 2:S65-9. [PMID: 21440846 DOI: 10.1016/j.breast.2011.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Reports about breast cancer (BC) research in low and middle income countries (LMCs) are difficult to access. A bibliographic database was constituted and is described in the present review. Six databases and cancer conference proceedings were searched. The search included publications focusing on the prevention, early detection, diagnosis, treatment and supportive/palliative care of BC in LMCs (2000-2008). Biological/genetic studies or animal studies were excluded. In all, 44,096 publications were identified of which 4362 met the inclusion criteria, including 210 reports of randomized controlled trials. Only 53% of publications were indexed in Medline. Publications about treatment represented the largest contribution (29%). Mainland China produced the most published research (18%). Only 2.4% of all publications related to palliative care of BC patients. More research is needed in the fields of BC prevention, awareness-raising, early detection, and palliative care in LMCs. Systematic reviews are needed to select those studies that can be safely regarded as "best evidence".
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Dizon JM, Grimmer-Somers K, Kumar S. Effectiveness of the tailored EBP training program for Filipino physiotherapists: a randomised controlled trial. BMC MEDICAL EDUCATION 2011; 11:14. [PMID: 21489229 PMCID: PMC3100239 DOI: 10.1186/1472-6920-11-14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 04/13/2011] [Indexed: 05/02/2023]
Abstract
BACKGROUND Evidence implementation continues to challenge health professionals most especially those from developing countries. Filipino physiotherapists represent a group of health professionals in a developing country who by tradition and historical practice, take direction from a doctor, on treatment options. Lack of autonomy in decision-making challenges their capacity to deliver evidence-based care. However, this scenario should not limit them from updating and up-skilling themselves on evidence- based practice (EBP). EBP training tailored to their needs and practice was developed to address this gap. This study will be conducted to assess the effectiveness of a tailored EBP-training program for Filipino physiotherapists, in improving knowledge, skills, attitudes and behaviour to EBP. Participation in this program aims to improve capacity to EBP and engage with referring doctors to determine the most effective treatments for their patients. METHODS/DESIGN A double blind randomised controlled trial, assessing the effectiveness of the EBP training intervention, compared with a waitlist control, will be conducted. An adequately powered sample of 54 physiotherapists from the Philippines will be recruited and randomly allocated to EBP intervention or waitlist control. INTERVENTION The EBP program for Filipino physiotherapists is a one-day program on EBP principles and techniques, delivered using effective adult education strategies. It consists of lectures and practical workshops. A novel component in this program is the specially-developed recommendation form, which participants can use after completing their training, to assist them to negotiate with referring doctors regarding evidence-based treatment choices for their patients.Pre and post measures of EBP knowledge, skills and attitudes will be assessed in both groups using the Adapted Fresno Test and the Questions to EBP attitudes. Behaviour to EBP will be measured using activity diaries for a period of three months. DISCUSSION Should the EBP-training program be found to be effective in improving EBP-uptake in Filipino physiotherapists, it will form the basis of a much needed national intervention which is contextually appropriate to Filipino physiotherapists. It will therefore form the genesis for a model for building EBP capacity of other health professionals in the Philippines as well as physiotherapists in developing countries. TRIAL REGISTRATION Current Controlled Trials: ISRCTN74485061.
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Affiliation(s)
- Janine Margarita Dizon
- International Centre for Allied Health Evidence University of South Australia City East Campus, North Terrace Adelaide 5000, Australia
- University of Santo Tomas Manila 1015 Philippines
| | - Karen Grimmer-Somers
- International Centre for Allied Health Evidence University of South Australia City East Campus, North Terrace Adelaide 5000, Australia
| | - Saravana Kumar
- International Centre for Allied Health Evidence University of South Australia City East Campus, North Terrace Adelaide 5000, Australia
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Geographical representativeness of published and ongoing randomized controlled trials. The example of: Tobacco consumption and HIV infection. PLoS One 2011; 6:e16878. [PMID: 21347383 PMCID: PMC3036724 DOI: 10.1371/journal.pone.0016878] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 01/06/2011] [Indexed: 12/12/2022] Open
Abstract
Background The challenge for evidence-based healthcare is to reduce mortality and the burden of diseases. This study aimed to compare where research is conducted to where research is needed for 2 public health priorities: tobacco consumption and HIV infection. Methods We identified randomized controlled trials (RCTs) included in Cochrane systematic reviews published between 1997 and 2007 and registered ongoing RCTs identified in January 2009 through the World Health Organization's International Clinical Trials Registry Platform (WHO-ICTRP) evaluating interventions aimed at reducing or stopping tobacco use and treating or preventing HIV infection. We used the WHO and World Bank reports to classify the countries by income level, as well as map the global burden of disease and mortality attributable to tobacco use and HIV infection to the countries where the trials performed. Results We evaluated 740 RCTs included in systematic reviews and 346 ongoing RCTs. For tobacco use, 4% of RCTs included in systematic reviews and 2% of ongoing trials were performed in low- and middle-income countries, even though these countries represented 70% of the mortality related to tobacco use. For HIV infection, 31% of RCTs included in systematic reviews and 33% of ongoing trials were performed in low- and middle-income countries, even though these countries represented 99% of the mortality related to HIV infection. Conclusions Our results highlight an important underrepresentation of low- and middle-income countries in currently available evidence (RCTs included in systematic reviews) and awaiting evidence (registered ongoing RCTs) for reducing or stopping tobacco use and treating or preventing HIV infection.
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Miranda JJ, Zaman MJ. Exporting 'failure': why research from rich countries may not benefit the developing world. Rev Saude Publica 2010; 44:185-9. [PMID: 20140343 DOI: 10.1590/s0034-89102010000100020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 06/30/2009] [Indexed: 11/21/2022] Open
Abstract
The '10/90 gap' was first highlighted by the Global Forum for Health Research. It refers to the finding that 90% of worldwide medical research expenditure is targeted at problems affecting only 10% of the world's population. Applying research results from the rich world to the problems of the poor may be a tempting, potentially easy and convenient solution for this gap. This paper had the objective of presenting arguments that such an approach runs the risk of exporting failure. Health interventions that are shown to be effective in the specific context of a Western industrialized setting will not necessarily work in the developing world.
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Affiliation(s)
- J Jaime Miranda
- Department of Medicine, Faculdad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.
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