Management of Guillain–Barré syndrome in Bangladesh: Clinical practice, limitations and recommendations for low- and middle-income countries

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY

Journal of the Peripheral Nervous System Pub Date : 2023-09-12 DOI:10.1111/jns.12597

Nowshin Papri, Zhahirul Islam, Gulshan Ara, Tamal Saha, Sonja E. Leonhard, Hubert P. Endtz, Bart C. Jacobs, Quazi D. Mohammad

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引用次数: 0

Abstract

Background and Aims

Considerable variation in clinical practice for management of Guillain-Barré syndrome (GBS) has been observed worldwide. Diagnosis and treatment are challenging in low- and middle-income countries (LMIC) due to lack of facilities and treatment availability. We aimed to evaluate current clinical practice and limitations and to provide recommendation for GBS management in low-resource settings.

Methods

We conducted an explanatory-sequential mixed-methods survey among neurologists and internists working in tertiary and secondary government hospitals in Bangladesh. There were two phases: (1) quantitative (cross-sectional survey to evaluate clinical practice and limitations); (2) qualitative (key informant interview to explain certain clinical practice and provide recommendations for GBS management in LMIC). Data were analyzed by frequencies, χ² test and thematic analysis.

Results

Among 159 physicians (65 neurologists and 94 internists), 11% and 8% physicians used Brighton and NINDS criteria respectively to diagnose GBS. Specific treatment protocols of GBS were used by 12% physicians. Overcrowding of patients, inadequate diagnostic facilities, high costs of standard therapy, and inadequate logistics and trained personnel for intensive care unit and rehabilitation services were considered major challenges for GBS management. In qualitative part, respondents recommended regular training for the physicians, development of cost-effective treatment strategies and appropriate patients' referral and management guideline considering existing limitations in health service delivery and socio-economic status of the country.

Interpretation

Current study design and recommendations might be applied for other LMIC. Such data can assist policymakers to identify areas requiring urgent attention and take required action to improve GBS management in LMIC.

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孟加拉国格林-巴利综合征的治疗：低收入和中等收入国家的临床实践、局限性和建议。

背景和目的：在全球范围内，格林-巴利综合征（GBS）的临床实践存在相当大的差异。由于缺乏设施和治疗，中低收入国家的诊断和治疗具有挑战性。我们旨在评估当前的临床实践和局限性，并为低资源环境下的GBS管理提供建议。方法：我们对孟加拉国三级和二级政府医院的神经科医生和内科医生进行了解释性顺序混合方法调查。分为两个阶段：（1）定量（横断面调查，以评估临床实践和局限性）；（2）定性（关键信息者访谈，解释某些临床实践，并为LMIC的GBS管理提供建议）。采用频率、χ2检验和专题分析等方法对数据进行分析。结果：在159名医生（65名神经科医生和94名内科医生）中，11%和8%的医生分别使用Brighton和NINDS标准诊断GBS。12%的医生使用了GBS的特定治疗方案。患者过度拥挤、诊断设施不足、标准治疗成本高昂、重症监护室和康复服务的后勤和训练有素的人员不足被认为是GBS管理面临的主要挑战。在质量部分，受访者建议对医生进行定期培训，制定具有成本效益的治疗策略，并考虑到该国医疗服务提供和社会经济地位方面的现有限制，制定适当的患者转诊和管理指南。解释：目前的研究设计和建议可能适用于其他LMIC。这些数据可以帮助决策者确定需要紧急关注的领域，并采取必要行动改善LMIC的GBS管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the Peripheral Nervous System 医学-临床神经学

CiteScore

6.10

自引率

7.90%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of the Peripheral Nervous System is the official journal of the Peripheral Nerve Society. Founded in 1996, it is the scientific journal of choice for clinicians, clinical scientists and basic neuroscientists interested in all aspects of biology and clinical research of peripheral nervous system disorders. The Journal of the Peripheral Nervous System is a peer-reviewed journal that publishes high quality articles on cell and molecular biology, genomics, neuropathic pain, clinical research, trials, and unique case reports on inherited and acquired peripheral neuropathies. Original articles are organized according to the topic in one of four specific areas: Mechanisms of Disease, Genetics, Clinical Research, and Clinical Trials. The journal also publishes regular review papers on hot topics and Special Issues on basic, clinical, or assembled research in the field of peripheral nervous system disorders. Authors interested in contributing a review-type article or a Special Issue should contact the Editorial Office to discuss the scope of the proposed article with the Editor-in-Chief.