BMJ Global Health最新文献

{"title":"Achieving universal health coverage; implementation of the 'supporting physician retention in deprived areas' programme in Iran.","authors":"Leila Pouraghasi, Saeed Manavi, Faeze Foruzanfar, Alireza Olyaeemanesh","doi":"10.1136/bmjgh-2023-014951","DOIUrl":"https://doi.org/10.1136/bmjgh-2023-014951","url":null,"abstract":"<p><p>From the WHO's perspective, trained and motivated healthcare workers can promote community access to essential health services in deprived areas; this could also help achieve the millennium development goals. The concentration of healthcare workers in the capital has caused a lack of them in deprived areas and made delivering services difficult in almost all rural and underdeveloped areas. So, one of the main concerns of all health systems is planning to attract and keep physicians in underprivileged areas.The number of retained physicians has tripled.24/7 coverage of specialised medical services in the hospital has been provided.People's access to health care has improved.Dispatching of patients to other cities' hospitals for essential medical services has been minimised by providing it locally.Illegal payments have been eliminated.This practice study aims to present Iran's Universal Health Coverage approach to addressing the lack of access to physicians in deprived areas through the 'supporting physician retention in deprived areas' programme and demonstrate its outcomes from 2014 to 2016. This national programme is designed to improve people's access to high-quality health services and reduce out-of-pocket payments at hospitals in underdeveloped areas.The number of retained physicians has tripled.24/7 coverage of specialised medical services in the hospital has been provided.People's access to health care has improved.Dispatching of patients to other cities' hospitals for essential medical services has been minimised by providing it locally.Illegal payments have been eliminated.The programme began by ranking all the cities in the country based on socioeconomic indicators. Then, 302 regions in 30 provinces of Iran were selected and classified into four groups. Finally, each group's incentive package was defined, consisting of a combination of fixed and performance-oriented payments. This programme has obtained the following achievements in the deprived areas:The number of retained physicians has tripled.24/7 coverage of specialised medical services in the hospital has been provided.People's access to health care has improved.Dispatching of patients to other cities' hospitals for essential medical services has been minimised by providing it locally.Illegal payments have been eliminated.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining and identifying the critical elements of operational readiness for public health emergency events: a rapid scoping review.","authors":"René English, Heather Carlson, Heike Geduld, Juliet Charity Yauka Nyasulu, Quinette Louw, Karina Berner, Maria Yvonne Charumbira, Michele Pappin, Michael McCaul, Conran Joseph, Nina Gobat, Linda Lucy Boulanger, Nedret Emiroglu","doi":"10.1136/bmjgh-2023-014379","DOIUrl":"10.1136/bmjgh-2023-014379","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 showed that countries must strengthen their operational readiness (OPR) capabilities to respond to an imminent pandemic threat rapidly and proactively. We conducted a rapid scoping evidence review to understand the definition and critical elements of OPR against five core sub-systems of a new framework to strengthen the global architecture for Health Emergency Preparedness Response and Resilience (HEPR).</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and Web of Science, targeted repositories, websites, and grey literature databases for publications between 1 January 2010 and 29 September 2021 in English, German, French or Afrikaans. Included sources were of any study design, reporting OPR, defined as immediate actions taken in the presence of an imminent threat, from groups who led or responded to a specified health emergency. We used prespecified and tested methods to screen and select sources, extract data, assess credibility and analyse results against the HEPR framework.</p><p><strong>Results: </strong>Of 7005 sources reviewed, 79 met the eligibility criteria, including 54 peer-reviewed publications. The majority were descriptive reports (28%) and qualitative analyses (30%) from early stages of the COVID-19 pandemic. Definitions of OPR varied while nine articles explicitly used the term 'readiness', others classified OPR as part of preparedness or response. Applying our working OPR definition across all sources, we identified OPR actions within all five HEPR subsystems. These included resource prepositioning for early detection, data sharing, tailored communication and interventions, augmented staffing, timely supply procurement, availability and strategic dissemination of medical countermeasures, leadership, comprehensive risk assessment and resource allocation supported by relevant legislation. We identified gaps related to OPR for research and technology-enabled manufacturing platforms.</p><p><strong>Conclusions: </strong>OPR is in an early stage of adoption. Establishing a consistent and explicit framework for OPRs within the context of existing global legal and policy frameworks can foster coherence and guide evidence-based policy and practice improvements in health emergency management.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Famine mortality and contributions to later-life type 2 diabetes at the population level: a synthesis of findings from Ukrainian, Dutch and Chinese famines.","authors":"Chihua Li, Cormac Ó Gráda, L H Lumey","doi":"10.1136/bmjgh-2024-015355","DOIUrl":"10.1136/bmjgh-2024-015355","url":null,"abstract":"<p><p>Since the 1970s, influential literature has been using famines as natural experiments to examine the long-term health impact of prenatal famine exposure at the individual level. Although studies based on various famines have consistently shown that prenatal famine exposure is associated with an increased risk of type 2 diabetes (T2D), no studies have yet quantified the contribution of famines to later-life T2D at the population level. We, therefore, synthesised findings from the famines in Ukraine 1932-1933, the Western Netherlands 1944-1945 and China 1959-1961 to make preliminary estimates of T2D cases attributable to prenatal famine exposure. These famines were selected because they provide the most extensive and reliable data from an epidemiological perspective. We observed a consistent increase in T2D risk among prenatally exposed individuals in these famines, which translated into about 21 000, 400 and 0.9 million additional T2D cases due to prenatal famine exposure in Ukraine, Western Netherlands and China, respectively. The T2D increase related to famine exposure represented only around 1% of prevalent T2D cases in these countries. Our observations highlight the significant increase in later-life T2D risk among individuals with prenatal famine exposure but also the limited contribution of prenatal famine exposure to T2D epidemics at the population level.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living labs for migrant health research: the challenge of cocreating research with migrant population and policy makers.","authors":"Laura Giménez, Stella Evangelidou, Anne-Sophie Gresle, Leonardo de la Torre, Mònica Ubalde-López, Oriol Recasens, Eva Muñoz, Maria Jesus Pinazo, Ana Requena-Méndez","doi":"10.1136/bmjgh-2023-014795","DOIUrl":"10.1136/bmjgh-2023-014795","url":null,"abstract":"<p><p>The need for the public to take an active role in scientific research is becoming increasingly important, particularly in health-related research. However, the coexistence and alignment of scientific and citizen interests, needs, knowledge and timing is not straightforward, especially when involving migrant populations. To conduct impactful research, it becomes also essential to consider the perspectives of policymakers, thereby adding a layer of complexity to the processes.In this article we address the experience of a living lab created in a research institution and supported by the city council and a local foundation, in which we developed three experiences of patient and public involvement (PPI): (1) accessing to comprehensive care for people at risk of Chagas disease; (2) strategies towards improving access and quality of mental healthcare services in migrants; (3) promoting healthy and safe school environments in vulnerable urban settings.These three challenges provided an opportunity to delve into diverse strategies for involving key stakeholders, including migrant populations, expert researchers and political actors in health research. This article offers insights into the successes, challenges, and valuable lessons learnt from these endeavours, providing a vision that can be beneficial for future initiatives. Each living lab experience crafted its unique governance system and agenda tailored to specific challenge scenarios, giving rise to diverse methods and study designs.We have found that the management of the cocreation of the research question and the institutional support are key to building robust PPI processes with migrant groups.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"At-home specimen self-collection as an additional testing strategy for chlamydia and gonorrhoea: a systematic literature review and meta-analysis.","authors":"Amanda C Smith, Phoebe G Thorpe, Emily R Learner, Eboni T Galloway, Ellen N Kersh","doi":"10.1136/bmjgh-2024-015349","DOIUrl":"10.1136/bmjgh-2024-015349","url":null,"abstract":"<p><strong>Introduction: </strong><i>Chlamydia trachomatis</i> (Ct) and <i>Neisseria gonorrhoeae</i> (Ng) infections are often asymptomatic; screening increases early detection and prevents disease, sequelae and further spread. To increase Ct and Ng testing, several countries have implemented specimen self-collection outside a clinical setting. While specimen self-collection at home is highly acceptable to patients and as accurate as specimens collected by healthcare providers, this strategy is new or not being used in some countries. To understand how offering at home specimen self-collection will affect testing uptake, test results, diagnosis and linkage to care, when compared with collection in clinical settings, we conducted a systematic literature review and meta-analysis of peer-reviewed studies.</p><p><strong>Methods: </strong>We searched Medline, Embase, Global Health, Cochrane Library, CINAHL (EBSCOHost), Scopus and Clinical Trials. Studies were included if they directly compared specimens self-collected at home or in other non-clinical settings to specimen collection at a healthcare facility (self or clinician) for Ct and/or Ng testing and evaluated the following outcomes: uptake in testing, linkage to care, and concordance (agreement) between the two settings for the same individuals. Risk of bias (RoB) was assessed using Cochrane Risk of Bias (RoB2) tool for randomised control trials (RCTs).</p><p><strong>Results: </strong>19 studies, from 1998 to 2024, comprising 15 RCTs with a total of 62 369 participants and four concordance studies with 906 participants were included. Uptake of Ct or Ng testing was 2.61 times higher at home compared with clinical settings. There was a high concordance between specimens collected at home and in clinical settings, and linkage to care was not significantly different between the two settings (prevalence ratio 0.96 (95% CI 0.91-1.01)).</p><p><strong>Conclusion: </strong>Our meta-analysis and systematic literature review show that offering self-collection of specimens at home or in other non-clinical settings could be used as an additional strategy to increase sexually transmitted infection testing in countries that have not yet widely adopted this collection method.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical preparedness of data monitoring committees (DMCs) to oversee international clinical trials: a qualitative descriptive study.","authors":"Alex Hinga, Akram Ibrahim, Diego Vintimilla, Mickayla Jones, Lisa Eckstein, Annette Rid, Seema K Shah, Dorcas Kamuya","doi":"10.1136/bmjgh-2024-015233","DOIUrl":"10.1136/bmjgh-2024-015233","url":null,"abstract":"<p><strong>Introduction: </strong>A data monitoring committee (DMC) is an independent group of experts who assess the ongoing scientific and ethical integrity of a study through periodic analyses of study data. The objective of this study was to explore the extent to which the structure, membership and deliberations of DMCs enable them to address ethical issues.</p><p><strong>Methods: </strong>We conducted qualitative individual interviews (n=22) with DMC members from countries across Africa, the Americas, South Asia and the UK. We selected interview respondents through purposive sampling, managed data using NVivo (Release V.1.7) and analysed data thematically.</p><p><strong>Results: </strong>All respondents were highly experienced professionals; many (18/22) had received training in medicine and/or statistics. One respondent had academic qualifications in ethics, and four indicated that they served on DMCs as ethicists. While respondents generally felt DMCs should be required for studies that were high-risk or enrolled vulnerable populations, some were concerned about the overuse of DMCs. There were divergent views on the necessity of geographical and disciplinary representation in DMC membership, including about whether ethicists were helpful. Many respondents described a DMC member recruitment process that they felt was somewhat exclusive. While one respondent received DMC-specific training, most described learning on the job. Respondents generally agreed that study protocols and DMC charters were key guiding documents for addressing ethical issues and described DMC deliberations that often, but not always, involved consensus-building.</p><p><strong>Conclusion: </strong>This study is one of the first to consider the ethical implications of DMC structure, membership and deliberations. The potential overuse of DMCs, DMC member recruitment processes that seem somewhat insular, limited training for DMC members, and divergent approaches to deliberation may limit the capacity of DMCs for addressing ethical issues. Further research on DMC structure and processes could help enhance the ethical preparedness of DMCs.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking malaria vaccines: perspectives on currently approved malaria vaccines in India's path to elimination.","authors":"Ritesh Ranjha, Priyanka Bai, Kuldeep Singh, Mradul Mohan, Praveen K Bharti, Anup R Anvikar","doi":"10.1136/bmjgh-2024-016019","DOIUrl":"10.1136/bmjgh-2024-016019","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A framework for identifying opportunities for multisectoral action for drowning prevention in health and sustainable development agendas: a multimethod approach.","authors":"Justin-Paul Scarr, David R Meddings, Caroline Lukaszyk, Joanne Adrienne Vincenten, Aminur Rahman, Steve Wills, Jagnoor Jagnoor","doi":"10.1136/bmjgh-2024-016125","DOIUrl":"10.1136/bmjgh-2024-016125","url":null,"abstract":"<p><strong>Introduction: </strong>The 2023 World Health Assembly resolution 76.18 committed the World Health Organization to the coordination of drowning prevention efforts, including those of United Nations (UN) agencies. Here, we aim to map drowning prevention linkages across UN Agency agendas, make recommendations to guide global strategies and inform the development of the Global Alliance and a Global Strategy for drowning prevention.</p><p><strong>Methods: </strong>We applied a qualitative multimethod approach, including document review, key informant interviews, an interagency workshop and international conference panel discussion, to refine data and create our recommendations. We developed a framework to identify intersections between health and sustainable development agendas and applied it to map intersections and opportunities for the integration of drowning prevention across relevant UN Agency agendas.</p><p><strong>Results: </strong>Our framework categorised intersections for drowning prevention in UN Agendas according to potential for (a) shared understandings of problems and solutions, (b) shared capacities, guidelines and resources and (c) shared governance and strategic pathways, noting that some factors overlap. We present our Position, Add, Reach and Reframe approach to outlining opportunities for the integration of drowning prevention in health and sustainable development agendas. Our results emphasise the importance of establishing approaches to the Global Alliance and Global Strategy that ensure high-level political advocacy is converted into solutions for affected communities. We recommend using research to inform effective action, building capacity and best practices, and promoting evaluation frameworks to incentivise and verify progress.</p><p><strong>Conclusion: </strong>Our study identifies opportunities to expand drowning prevention efforts and to build Member State capacity to reduce drowning risk through evidence-informed measures that address vulnerabilities, exposures, hazards and build population-level resilience to drowning. Our framework for identifying opportunities for integration of drowning prevention across a multisectoral set of agendas offers a research and policy toolkit that may prove useful for other policy areas.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Core outcome sets for trials of interventions to prevent and to treat multimorbidity in adults in low and middle-income countries: the COSMOS study.","authors":"Aishwarya Lakshmi Vidyasagaran, Rubab Ayesha, Jan R Boehnke, Jamie Kirkham, Louise Rose, John R Hurst, Juan Jaime Miranda, Rusham Zahra Rana, Rajesh Vedanthan, Mehreen Riaz Faisal, Saima Afaq, Gina Agarwal, Carlos Alberto Aguilar-Salinas, Kingsley Akinroye, Rufus Olusola Akinyemi, Syed Rahmat Ali, Rabeea Aman, Cecilia Anza-Ramirez, Koralagamage Kavindu Appuhamy, Se-Sergio Baldew, Corrado Barbui, Sandro Rogerio Rodrigues Batista, María Del Carmen Caamaño, Asiful Haidar Chowdhury, Noemia Teixeira de Siqueira-Filha, Darwin Del Castillo Fernández, Laura Downey, Oscar Flores-Flores, Olga P García, Ana Cristina García-Ulloa, Richard Ig Holt, Rumana Huque, Johnblack K Kabukye, Sushama Kanan, Humaira Khalid, Kamrun Nahar Koly, Joseph Senyo Kwashie, Naomi S Levitt, Patricio Lopez-Jaramillo, Sailesh Mohan, Krishna Prasad Muliyala, Qirat Naz, Augustine Nonso Odili, Adewale L Oyeyemi, Niels Victor Pacheco-Barrios, Devarsetty Praveen, Marianna Purgato, Dolores Ronquillo, Kamran Siddiqi, Rakesh Singh, Phuong Bich Tran, Pervaiz Tufail, Eleonora P Uphoff, Josefien van Olmen, Ruth Verhey, Judy M Wright, Jessica Hanae Zafra-Tanaka, Gerardo A Zavala, Yang William Zhao, Najma Siddiqi","doi":"10.1136/bmjgh-2024-015120","DOIUrl":"10.1136/bmjgh-2024-015120","url":null,"abstract":"<p><strong>Introduction: </strong>The burden of multimorbidity is recognised increasingly in low- and middle-income countries (LMICs), creating a strong emphasis on the need for effective evidence-based interventions. Core outcome sets (COS) appropriate for the study of multimorbidity in LMICs do not presently exist. These are required to standardise reporting and contribute to a consistent and cohesive evidence-base to inform policy and practice. We describe the development of two COS for intervention trials aimed at preventing and treating multimorbidity in adults in LMICs.</p><p><strong>Methods: </strong>To generate a comprehensive list of relevant prevention and treatment outcomes, we conducted a systematic review and qualitative interviews with people with multimorbidity and their caregivers living in LMICs. We then used a modified two-round Delphi process to identify outcomes most important to four stakeholder groups (people with multimorbidity/caregivers, multimorbidity researchers, healthcare professionals and policymakers) with representation from 33 countries. Consensus meetings were used to reach agreement on the two final COS.</p><p><strong>Registration: </strong>https://www.comet-initiative.org/Studies/Details/1580.</p><p><strong>Results: </strong>The systematic review and qualitative interviews identified 24 outcomes for prevention and 49 for treatment of multimorbidity. An additional 12 prevention and 6 treatment outcomes were added from Delphi round 1. Delphi round 2 surveys were completed by 95 of 132 round 1 participants (72.0%) for prevention and 95 of 133 (71.4%) participants for treatment outcomes. Consensus meetings agreed four outcomes for the prevention COS: (1) adverse events, (2) development of new comorbidity, (3) health risk behaviour and (4) quality of life; and four for the treatment COS: (1) adherence to treatment, (2) adverse events, (3) out-of-pocket expenditure and (4) quality of life.</p><p><strong>Conclusion: </strong>Following established guidelines, we developed two COS for trials of interventions for multimorbidity prevention and treatment, specific to adults in LMIC contexts. We recommend their inclusion in future trials to meaningfully advance the field of multimorbidity research in LMICs.</p><p><strong>Prospero registration number: </strong>CRD42020197293.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 8","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Task-sharing spinal anaesthesia care in three rural Indian hospitals: a non-inferiority randomised controlled clinical trial.","authors":"Nandakumar Menon, Regi George, Raman Kataria, Ravi Manoharan, Meredith B Brooks, Alaska Pendleton, Veena Sheshadri, Sudarshana Chatterjee, Wesley Rajaleelan, Jithen Krishnan, Simone Sandler, Saurabh Saluja, David Ljungman, Nakul Raykar, Emma Svensson, Isaac Wasserman, Anudari Zorigtbaatar, Gnanaraj Jesudian, Salim Afshar, John G Meara, Alexander W Peters, Craig D McClain","doi":"10.1136/bmjgh-2023-014170","DOIUrl":"10.1136/bmjgh-2023-014170","url":null,"abstract":"<p><strong>Background: </strong>Task-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether spinal anaesthesia failure rates of MOs were non-inferior to those of consultant anaesthesiologists (CA) following a standardised educational curriculum.</p><p><strong>Methods: </strong>We performed a randomised, non-inferiority trial in three rural hospitals in Tamil Nadu and Chhattisgarh, India. Patients aged over 18 years with low perioperative risk (ASA I & II) were randomised to receive MO or CA care. Prior to the trial, MOs underwent task-based anaesthesia training, inclusive of remotely accessed lectures, simulation-based training and directly observed anaesthetic procedures and intraoperative care. The primary outcome measure was spinal anaesthesia failure with a non-inferiority margin of 5%. Secondary outcome measures consisted of incidence of perioperative and postoperative complications.</p><p><strong>Findings: </strong>Between 12 July 2019 and 8 June 2020, a total of 422 patients undergoing surgical procedures amenable to spinal anaesthesia care were randomised to receive either MO (231, 54.7%) or CA care (191, 45.2%). Spinal anaesthesia failure rate for MOs (7, 3.0%) was non-inferior to those of CA (5, 2.6%); difference in success rate of 0.4% (95% CI=0.36-0.43%; p=0.80). Additionally, there were no statistically significant differences observed between the two groups for intraoperative or postoperative complications, or patients' experience of pain during the procedure.</p><p><strong>Interpretation: </strong>This study demonstrates that failure rates of spinal anaesthesia care provided by trained MOs are non-inferior to care provided by CAs in low-risk surgical patients. This may support policy measures that use task-sharing as a means of expanding anaesthesia care capacity in rural Indian hospitals.</p><p><strong>Trial registration number: </strong>NCT04438811.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}