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Khalid K, Schell CO, Oliwa J, English M, Onyango O, Mcknight J, Mkumbo E, Awadh K, Maiba J, Baker T. Hospital readiness for the provision of care to critically ill patients in Tanzania- an in-depth cross-sectional study. BMC Health Serv Res 2024; 24:182. [PMID: 38331742 PMCID: PMC10854052 DOI: 10.1186/s12913-024-10616-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Critical illness is a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and potential for reversibility. The burden of critical illness is high, especially in low- and middle-income countries. Critical care can be provided as Essential Emergency and Critical Care (EECC)- the effective, low-cost, basic care that all critically ill patients should receive in all parts of all hospitals in the world- and advanced critical care- complex, resource-intensive care usually provided in an intensive care unit. The required resources may be available in the hospital and yet not be ready in the wards for immediate use for critically ill patients. The ward readiness of these resources, although harder to evaluate, is likely more important than their availability in the hospital. This study aimed to assess the ward readiness for EECC and the hospital availability of resources for EECC and for advanced critical care in hospitals in Tanzania. METHODS An in-depth, cross-sectional study was conducted in five purposively selected hospitals by visiting all wards to collect data on all the required 66 EECC and 161 advanced critical care resources. We defined hospital-availability as a resource present in the hospital and ward-readiness as a resource available, functioning, and present in the right place, time and amounts for critically ill patient care in the wards. Data were analyzed to calculate availability and readiness scores as proportions of the resources that were available at hospital level, and ready at ward level respectively. RESULTS Availability of EECC resources in hospitals was 84% and readiness in the wards was 56%. District hospitals had lower readiness scores (less than 50%) than regional and tertiary hospitals. Equipment readiness was highest (65%) while that of guidelines lowest (3%). Availability of advanced critical care resources was 31%. CONCLUSION Hospitals in Tanzania lack readiness for the provision of EECC- the low-cost, life-saving care for critically ill patients. The resources for EECC were available in hospitals, but were not ready for the immediate needs of critically ill patients in the wards. To provide effective EECC to all patients, improvements are needed around the essential, low-cost resources in hospital wards that are essential for decreasing preventable deaths.
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Affiliation(s)
- Karima Khalid
- Department of Anaesthesia, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
- Ifakara Health Institute, Dar es Salaam, Tanzania.
- Department of Anaesthesia, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Medicine, Nyköping Hospital, Nyköping, Sweden
| | - Jacquie Oliwa
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Onesmus Onyango
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacob Mcknight
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Khamis Awadh
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - John Maiba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tim Baker
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Wright B, Baker T, Lennox A, Waxman B, Bragge P. Optimising acute non-critical inter-hospital transfers: A review of evidence, practice and patient perspectives. Aust J Rural Health 2024; 32:5-16. [PMID: 38108541 DOI: 10.1111/ajr.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/05/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Patients who present to hospital with an acute non-critical illness or injury, which is considered outside the capability framework of that hospital to treat, will require inter-hospital transfer (IHT) to a hospital with a higher level of capability for that condition. Delays in IHT can negatively impact patient care and patient outcomes. OBJECTIVE To review and synthesis academic evidence, practitioner insights and patient perspectives on ways to improve IHT from regional to metro hospitals. DESIGN A rapid review methodology identified one review and 14 primary studies. Twelve practitioner interviews identified insights into practice and implementation, and the patient perspectives were explored through a citizen panel with 15 participants. FINDINGS The rapid review found evidence relating to clinician and patient decision factors, protocols, communication practices and telemedicine. Practitioner interviews revealed challenges in making the initial decision, determining appropriate destinations and dealing with pushback. Adequate support and communication were raised as important to improve IHT. The citizen panel found that the main concern with IHT was delays. Citizen panel participants suggested dedicated transfer teams, education and information transfer systems to improve IHT. DISCUSSION AND CONCLUSION Common challenges in IHT include making the initial decision to transfer and communicating with other health services and patients and families. In identifying the appropriateness of transferring acute non-critical patients, clear and effective communication is central to appropriate and timely IHT; this evidence review indicates that education, protocols and information management could make IHT processes smoother.
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Affiliation(s)
- Breanna Wright
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Tim Baker
- Centre for Rural Emergency Medicine, Deakin University, Burwood, Victoria, Australia
| | - Alyse Lennox
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Bruce Waxman
- Bass Coast Health and Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
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Onyango OO, Willows TM, McKnight J, Schell CO, Baker T, Mkumbo E, Maiba J, Khalid K, English M, Oliwa JN. Third delay in care of critically ill patients: a qualitative investigation of public hospitals in Kenya. BMJ Open 2024; 14:e072341. [PMID: 38176878 PMCID: PMC10773318 DOI: 10.1136/bmjopen-2023-072341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES Third delay refers to delays in delivering requisite care to patients after they arrive at a health facility. In low-resource care settings, effective triage and flow of care are difficult to guarantee. In this study, we aimed to identify delays in the delivery of care to critically ill patients and possible ways to address these delays. DESIGN This was an exploratory qualitative study using in-depth interviews and patient journeys. The qualitative data were transcribed and aggregated into themes in NVivo V.12 Plus using inductive and deductive approaches. SETTING This study was conducted in four secondary-level public Kenyan hospitals across four counties between March and December 2021. The selected hospitals were part of the Clinical Information Network. PARTICIPANTS Purposive sampling method was used to identify administrative and front-line healthcare providers and patients. We conducted 12 in-depth interviews with 11 healthcare workers and patient journeys of 7 patients. Informed consent was sought from the participants and maintained throughout the study. RESULTS We identified a cycle of suboptimal systems for care with adaptive mechanisms that prevent quality care to critically ill patients. We identified suboptimal systems for identification of critical illness, inadequate resources for continuity care and disruption of the flow of care, as the major causes of delays in identification and the initiation of essential care to critically ill patients. Our study also illuminated the contribution of inflexible bureaucratic non-clinical business-related organisational processes to third delay. CONCLUSION Eliminating or reducing delays after patients arrive at the hospital is a time-sensitive measure that could improve the care outcomes of critically ill patients. This is achievable through an essential emergency and critical care package within the hospitals. Our findings can help emphasise the need for standardised effective and reliable care priorities to maintain of care of critically ill patients.
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Affiliation(s)
| | - Tamara M Willows
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jacob McKnight
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
- Department of Medicine, Nyköping Hospital, Nyköping, Sweden
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Muhimbili, Tanzania, United Republic Of
| | - Elibariki Mkumbo
- Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of
| | - John Maiba
- Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of
| | - Karima Khalid
- Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of
- Department of Anaesthesia and Critical Care, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Mike English
- KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jacquie N Oliwa
- KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
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McKnight J, Willows TM, Oliwa J, Onyango O, Mkumbo E, Maiba J, Khalid K, Schell CO, Baker T, English M. Receive, Sustain, and Flow: A simple heuristic for facilitating the identification and treatment of critically ill patients during their hospital journeys. J Glob Health 2023; 13:04139. [PMID: 38131357 PMCID: PMC10740342 DOI: 10.7189/jogh.13.04139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background Hospital patients can become critically ill anywhere in a hospital but their survival is affected by problems of identification and adequate, timely, treatment. This is issue of particular concern in lower middle-income countries' (LMICs) hospitals where specialised units are scarce and severely under-resourced. "Cross-sectional" approaches to improving narrow, specific aspects of care will not attend to issues that affect patients' care across the length of their experience. A simpler approach to understanding key issues across the "hospital journey" could help to deliver life-saving treatments to those patients who need it, wherever they are in the facility. Methods We carried out 31 narrative interviews with frontline health workers in five Kenyan and five Tanzanian hospitals from November 2020 to December 2021 during the COVID-19 pandemic and analysed using a thematic analysis approach. We also followed 12 patient hospital journeys, through the course of treatment of very sick patients admitted to the hospitals we studied. Results Our research explores gaps in hospital systems that result in lapses in effective, continuous care across the hospital journeys of patients in Tanzania and Kenya. We organise these factors according to the Systems Engineering Initiative for Patient Safety (SEIPS) approach to patient safety, which we extend to explore how these issues affect patients across the course of care. We discern three repeating, recursive phases we term Receive, Sustain, and Flow. We use this heuristic to show how gaps and weaknesses in service provision affect critically ill patients' hospital journeys. Conclusion Receive, Sustain, and Flow offers a heuristic for hospital management to identify and ameliorate limitations in human and technical resources for the care of the critically ill.
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Affiliation(s)
- Jacob McKnight
- Health Systems Collaborative, University of Oxford, Oxford, England, UK
| | | | - Jacquie Oliwa
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - Onesmus Onyango
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Elibariki Mkumbo
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - John Maiba
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Karima Khalid
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania
- Department of Anaesthesia, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Medicine Nyköping Hospital, Nyköping, Sweden
| | - Tim Baker
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, England, UK
| | - Mike English
- Health Systems Collaborative, University of Oxford, Oxford, England, UK
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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English M, Oliwa J, Khalid K, Onyango O, Willows TM, Mazhar R, Mkumbo E, Guinness L, Schell CO, Baker T, McKnight J. Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic. BMJ Glob Health 2023; 8:e013407. [PMID: 37918869 PMCID: PMC10626868 DOI: 10.1136/bmjgh-2023-013407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023] Open
Abstract
Care for the critically ill patients is often considered synonymous with a hospital having an intensive care unit. However, a focus on Essential Emergency and Critical Care (EECC) may obviate the need for much intensive care. Severe COVID-19 presented a specific critical care challenge while also being an exemplar of critical illness in general. Our multidisciplinary team conducted research in Kenya and Tanzania on hospitals' ability to provide EECC as the COVID-19 pandemic unfolded. Important basic inputs were often lacking, especially sufficient numbers of skilled health workers. However, we learnt that higher scores on resource readiness scales were often misleading, as resources were often insufficient or not functional in all the clinical areas they are needed. By following patient journeys, through interviews and group discussions, we revealed gaps in timeliness, continuity and delivery of care. Generic challenges in transitions between departments were identified in the receipt of critically ill patients, the ability to sustain monitoring and treatment and preparation for any subsequent transition. While the global response to COVID-19 focused initially on providing technologies and training, first ventilators and later oxygen, organisational and procedural challenges seemed largely ignored. Yet, they may even be exacerbated by new technologies. Efforts to improve care for the critically ill patients, which is a complex process, must include a whole system and whole facility view spanning all areas of patients' care and their transitions and not be focused on a single location providing 'critical care'. We propose a five-part strategy to support the system changes needed.
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Affiliation(s)
- Mike English
- KEMRI-Wellcome Trust Research Programme, Health Services Unit, Nairobi, Kenya
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jacquie Oliwa
- KEMRI-Wellcome Trust Research Programme, Health Services Unit, Nairobi, Kenya
| | - Karima Khalid
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Onesmus Onyango
- KEMRI-Wellcome Trust Research Programme, Health Services Unit, Nairobi, Kenya
| | - Tamara Mulenga Willows
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rosanna Mazhar
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, London, London, UK
- Centre for Global Development, London, UK
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Medicine, Nyköping Hospital, Nyköping, Sweden
| | - Tim Baker
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Karolinska Institute, Stockholm, Sweden
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacob McKnight
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Owoo C, Adhikari NKJ, Akinola O, Aryal D, Azevedo LC, Bacha T, Baelani JI, Baker T, Bartlett E, Bonney J, Convocar P, Dippenaar E, Dunser MW, Estenssoro E, Fowler R, Gore S, Guddu DK, Hashmi M, Hollong BG, Kabongo D, Kivlehan SM, King LL, Losonczy L, Lundeg G, McCurdy MT, Mer M, Misango D, Moll V, Murthy S, Pattnaik R, Petros S, Riviello E, Schell CO, Shrestha GS, Sultan M, Tefera M, Yim A, Tadesse AZ. The World Health Assembly resolution on integrated emergency, critical, and operative care for universal health coverage and protection from health emergencies: a golden opportunity to attenuate the global burden of acute and critical illness. Intensive Care Med 2023; 49:1223-1225. [PMID: 37578521 PMCID: PMC10556161 DOI: 10.1007/s00134-023-07176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023]
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Schell CO, Wellhagen A, Lipcsey M, Kurland L, Bjurling-Sjöberg P, Stålsby Lundborg C, Castegren M, Baker T. The burden of critical illness among adults in a Swedish region-a population-based point-prevalence study. Eur J Med Res 2023; 28:322. [PMID: 37679836 PMCID: PMC10483802 DOI: 10.1186/s40001-023-01279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Patients with critical illness have a high risk of mortality. Key decision-making in the health system affecting the outcomes of critically ill patients requires epidemiological evidence, but the burden of critical illness is largely unknown. This study aimed to estimate the prevalence of critical illness in a Swedish region. Secondary objectives were to estimate the proportion of hospital inpatients who are critically ill and to describe the in-hospital location of critically ill patients. METHODS A prospective, multi-center, population-based, point-prevalence study on specific days in 2017-2018. All adult (> 18 years) in-patients, regardless of admitting specially, in all acute hospitals in Sörmland, and the patients from Sörmland who had been referred to university hospitals, were included. Patients in the operating theatres, with a psychiatric cause of admission, women in active labor and moribund patients, were excluded. All participants were examined by trained data collectors. Critical illness was defined as "a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and a potential for reversibility". The presence of one or more severely deranged vital signs was used to classify critical illness. The prevalence of critical illness was calculated as the number of critically ill patients divided by the number of adults in the region. RESULTS A total of 1269 patients were included in the study. Median age was 74 years and 50% of patients were female. Critical illness was present in 133 patients, resulting in an adult population prevalence of critical illness per 100,000 people of 19.4 (95% CI 16.4-23.0). The proportion of patients in hospital who were critically ill was 10.5% (95% CI 8.8-12.3%). Among the critically ill, 125 [95% CI 94.0% (88.4-97.0%)] were cared for in general wards. CONCLUSIONS The prevalence of critical illness was higher than previous, indirect estimates. One in ten hospitalized patients were critically ill, the large majority of which were cared for in general wards. This suggests a hidden burden of critical illness of potential public health, health system and hospital management significance.
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Affiliation(s)
- Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
- Department of Medicine, Nyköping Hospital, Sörmland Region, Nyköping, Sweden.
| | - Andreas Wellhagen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Anaesthesia and Intensive Care, Nyköping Hospital, Sörmland Region, Nyköping, Sweden
| | - Miklós Lipcsey
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
| | - Lisa Kurland
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Emergency Medicine, Örebro University, Örebro University Hospital, Örebro, Sweden
| | - Petronella Bjurling-Sjöberg
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Patient Safety, Region Sörmland, Eskilstuna, Sweden
| | | | - Markus Castegren
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology (FyFa), Karolinska Institutet, Stockholm, Sweden
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mboya EA, Ndumwa HP, Amani DE, Nkondora PN, Mlele V, Biyengo H, Mashoka R, Haniffa R, Beane A, Mfinanga J, Sunguya BF, Sawe HR, Baker T. Critical illness at the emergency department of a Tanzanian national hospital in a three-year period 2019-2021. BMC Emerg Med 2023; 23:86. [PMID: 37553630 PMCID: PMC10408204 DOI: 10.1186/s12873-023-00858-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Critically ill patients have life-threatening conditions requiring immediate vital organ function intervention. But, critical illness in the emergency department (ED) has not been comprehensively described in resource-limited settings. Understanding the characteristics and dynamics of critical illness can help hospitals prepare for and ensure the continuum of care for critically ill patients. This study aimed to describe the pattern and outcomes of critically ill patients at the ED of the National Hospital in Tanzania from 2019 to 2021. METHODOLOGY This hospital-records-based retrospective cohort study analyzed records of all patients who attended the ED of Muhimbili National Hospital between January 2019 and December 2021. Data extracted from the ED electronic database included clinical and demographic information, diagnoses, and outcome status at the ED. Critical illness in this study was defined as either a severe derangement of one or more vital signs measured at triage or the provision of critical care intervention. Data were analyzed using Stata 17 to examine critical illnesses' burden, characteristics, first-listed diagnosis, and outcomes at the ED. RESULTS Among the 158,445 patients who visited the ED in the study period, 16,893 (10.7%) were critically ill. The burden of critical illness was 6,346 (10.3%) in 2019, 5,148 (10.9%) in 2020, and 5,400 (11.0%) in 2021. Respiratory (18.8%), cardiovascular (12.6%), infectious diseases (10.2%), and trauma (10.2%) were the leading causes of critical illness. Most (81.6%) of the critically ill patients presenting at the ED were admitted or transferred, of which 11% were admitted to the ICUs and 89% to general wards. Of the critically ill, 4.8% died at the ED. CONCLUSION More than one in ten patients attending the Tanzanian National Hospital emergency department was critically ill. The number of critically ill patients did not increase during the pandemic. The majority were admitted to general hospital wards, and about one in twenty died at the ED. This study highlights the burden of critical illness faced by hospitals and the need to ensure the availability and quality of emergency and critical care throughout hospitals.
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Affiliation(s)
- Erick A. Mboya
- School of Public Health and Social Sciences, Dar es Salaam, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Harrieth P. Ndumwa
- School of Public Health and Social Sciences, Dar es Salaam, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Davis E. Amani
- School of Public Health and Social Sciences, Dar es Salaam, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paulina N. Nkondora
- Emergency Medicine Department, Dar es Salaam, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Victoria Mlele
- Emergency Medicine Department, Dar es Salaam, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Happines Biyengo
- School of Public Health and Social Sciences, Dar es Salaam, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ramadhan Mashoka
- Emergency Medicine Department, Dar es Salaam, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- University College London Hospitals, London, UK
| | - Abi Beane
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Juma Mfinanga
- Emergency Medicine Department, Dar es Salaam, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Bruno F. Sunguya
- School of Public Health and Social Sciences, Dar es Salaam, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hendry R. Sawe
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tim Baker
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Oliwa JN, Mazhar RJ, Serem G, Khalid K, Amoth P, Kiarie H, Warfa O, Schell CO, Baker T, English M, Mcknight J. Policies and resources for strengthening of emergency and critical care services in the context of the global COVID-19 pandemic in Kenya. PLOS Glob Public Health 2023; 3:e0000483. [PMID: 37399177 DOI: 10.1371/journal.pgph.0000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/19/2023] [Indexed: 07/05/2023]
Abstract
Critical illnesses cause several million deaths annually, with many of these occurring in low-resource settings like Kenya. Great efforts have been made worldwide to scale up critical care to reduce deaths from COVID-19. Lower income countries with fragile health systems may not have had sufficient resources to upscale their critical care. We aimed to review how efforts to strengthen emergency and critical care were operationalised during the pandemic in Kenya to point towards how future emergencies should be approached. This was an exploratory study that involved document reviews, and discussions with key stakeholders (donors, international agencies, professional associations, government actors), during the first year of the pandemic in Kenya. Our findings suggest that pre-pandemic health services for the critically ill in Kenya were sparse and unable to meet rising demand, with major limitations noted in human resources and infrastructure. The pandemic response saw galvanised action by the Government of Kenya and other agencies to mobilise resources (approximately USD 218 million). Earlier efforts were largely directed towards advanced critical care but since the human resource gap could not be reduced immediately, a lot of equipment remained unused. We also note that despite strong policies on what resources should be available, the reality on the ground was that there were often critical shortages. While emergency response mechanisms are not conducive to addressing long-term health system issues, the pandemic increased global recognition of the need to fund care for the critically ill. Limited resources may be best prioritised towards a public health approach with focus on provision of relatively basic, lower cost essential emergency and critical care (EECC) that can potentially save the most lives amongst critically ill patients.
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Affiliation(s)
- Jacquie Narotso Oliwa
- Department of Health Systems & Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - Rosanna Jeffries Mazhar
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Oxford, United Kingdom
| | - George Serem
- Department of Health Systems & Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Karima Khalid
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Patrick Amoth
- Office of the Director General, Ministry of Health, Nairobi, Kenya
| | - Helen Kiarie
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Osman Warfa
- Office of the Director General, Ministry of Health, Nairobi, Kenya
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Internal Medicine, Nyköping Hospital, Nyköping, Sweden
| | - Tim Baker
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mike English
- Department of Health Systems & Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Oxford, United Kingdom
| | - Jacob Mcknight
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Oxford, United Kingdom
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Spencer SA, Adipa FE, Baker T, Crawford AM, Dark P, Dula D, Gordon SB, Hamilton DO, Huluka DK, Khalid K, Lakoh S, Limbani F, Rylance J, Sawe HR, Simiyu I, Waweru-Siika W, Worrall E, Morton B. A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive Care Med 2023; 49:772-784. [PMID: 37428213 PMCID: PMC10354139 DOI: 10.1007/s00134-023-07136-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to "ensure the timely and effective delivery of life-saving health care services to those in need". In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or "building blocks": (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings.
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Affiliation(s)
- Stephen A Spencer
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Tim Baker
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Queen Marys University of London, London, UK
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Paul Dark
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
| | - Dingase Dula
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Oliver Hamilton
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Karima Khalid
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Felix Limbani
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Jamie Rylance
- Health Care Readiness Unit, World Health Organisation, Geneva, Switzerland
| | - Hendry R Sawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ibrahim Simiyu
- Liverpool School of Tropical Medicine, Liverpool, UK
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Eve Worrall
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ben Morton
- Liverpool School of Tropical Medicine, Liverpool, UK.
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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Ndumwa HP, Mboya EA, Amani DE, Mashoka R, Nicholaus P, Haniffa R, Beane A, Mfinanga J, Sunguya B, Sawe HR, Baker T. Correction: The burden of respiratory conditions in the emergency department of Muhimbili National Hospital in Tanzania in the first two years of the COVID-19 pandemic: A cross sectional descriptive study. PLOS Glob Public Health 2023; 3:e0002125. [PMID: 37363890 PMCID: PMC10292689 DOI: 10.1371/journal.pgph.0002125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
[This corrects the article DOI: 10.1371/journal.pgph.0000781.].
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Baker T, Taylor N, Kloot K, Miller P, Egerton‐Warburton D, Shepherd J. Using the Cardiff model to reduce late-night alcohol-related presentations in regional Australia. Aust J Rural Health 2023; 31:532-539. [PMID: 37078513 PMCID: PMC10947014 DOI: 10.1111/ajr.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION The Cardiff model is a data sharing approach that aims to reduce the volume of intoxicated patients in emergency departments (EDs). This approach has not been tested in a rural setting. OBJECTIVE This study assessed whether this approach would reduce the number of alcohol-associated presentations during high-alcohol hours (HAH) in a regional ED. DESIGN From July 2017, people over the age of 18 attending the ED were asked by the triage nurse (1) whether they had consumed alcohol in the past 12 h, (2) their typical alcohol consumption level, (3) the location where most alcohol was purchased and (4) the location of the last drink. From April 2018, quarterly letters were sent to the top five venues reported within the ED. Deidentified, aggregated data were shared with local police, licensing authorities and local government, identifying the top five venues reported in the ED and providing a summary of alcohol-related attendances to the ED. Interrupted time series analyses were used to estimate the influence of the intervention on monthly injury and alcohol-related ED presentations. FINDINGS ITS models found that there was a significant gradual decrease in the monthly rate of injury attendances during HAH (Coefficient = -0.004, p = 0.044). No other significant results were found. DISCUSSION Our study found that sharing last drinks data collected in the ED with a local violence prevention committee was associated with a small, but significant reduction in the rate of injury presentations compared with all ED presentations. CONCLUSION This intervention continues to have promise for reducing alcohol-related harm.
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Affiliation(s)
- Tim Baker
- Centre for Rural Emergency Medicine, Faculty of HealthDeakin UniversityWarrnamboolVictoriaAustralia
- South West HealthcareWarrnamboolVictoriaAustralia
| | - Nicholas Taylor
- School of Psychology, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
- National Drug Research InstituteCurtin UniversityPerthVictoriaAustralia
| | - Kate Kloot
- South West HealthcareWarrnamboolVictoriaAustralia
- School of MedicineDeakin UniversityWarrnamboolVictoriaAustralia
| | - Peter Miller
- School of Psychology, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
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Willows TM, Oliwa J, Onyango O, Mkumbo E, Maiba J, Schell CO, Baker T, McKnight J. COVID-19 and unintended steps towards further equity in global health research. BMJ Glob Health 2023; 8:e011888. [PMID: 37328283 PMCID: PMC10276961 DOI: 10.1136/bmjgh-2023-011888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/29/2023] [Indexed: 06/18/2023] Open
Abstract
There was, and possibly still is, potential for COVID-19 to disrupt power inequities and contribute to positive transformation in global health research that increases equity. While there is consensus about the need to decolonise by transforming global health, and a roadmap outlining how we could approach it, there are few examples of steps that could be taken to transform the mechanics of global health research. This paper contributes lessons learnt from experiences and reflections of our diverse multinational team of researchers involved in a multicountry research project. We demonstrate the positive impact on our research project of making further steps towards improving equity within our research practices. Some of the approaches adopted include redistributing power to researchers from the countries of interest at various stages in their career, by involving the whole team in decisions about the research; meaningfully involving the whole team in research data analysis; and providing opportunities for all researchers from the countries of interest to voice their perspectives as first authors in publications. Although this approach is consistent with how research guidance suggests research should be run, in reality it does not often happen in this way. The authors of this paper hope that by sharing our experience, we can contribute towards discussions about the processes required to continue developing a global health sector that is equitable and inclusive.
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Affiliation(s)
- Tamara Mulenga Willows
- Tropical Medicine and Global Health, University of Oxford Medical Sciences Division, Oxford, UK
| | - Jacquie Oliwa
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Onesmus Onyango
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Elibariki Mkumbo
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Tanzania
| | - John Maiba
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Tanzania
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Tim Baker
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Tanzania
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Jacob McKnight
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
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Shah HA, Baker T, Schell CO, Kuwawenaruwa A, Awadh K, Khalid K, Kairu A, Were V, Barasa E, Baker P, Guinness L. Cost Effectiveness of Strategies for Caring for Critically Ill Patients with COVID-19 in Tanzania. Pharmacoecon Open 2023:10.1007/s41669-023-00418-x. [PMID: 37178434 PMCID: PMC10181924 DOI: 10.1007/s41669-023-00418-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The resources for critical care are limited in many settings, exacerbating the significant morbidity and mortality associated with critical illness. Budget constraints can lead to choices between investing in advanced critical care (e.g. mechanical ventilators in intensive care units) or more basic critical care such as Essential Emergency and Critical Care (EECC; e.g. vital signs monitoring, oxygen therapy, and intravenous fluids). METHODS We investigated the cost effectiveness of providing EECC and advanced critical care in Tanzania in comparison with providing 'no critical care' or 'district hospital-level critical care' using coronavirus disease 2019 (COVID-19) as a tracer condition. We developed an open-source Markov model ( https://github.com/EECCnetwork/POETIC_CEA ) to estimate costs and disability-adjusted life-years (DALYs) averted, using a provider perspective, a 28-day time horizon, patient outcomes obtained from an elicitation method involving a seven-member expert group, a normative costing study, and published literature. We performed a univariate and probabilistic sensitivity analysis to assess the robustness of our results. , RESULTS EECC is cost effective 94% and 99% of the time when compared with no critical care (incremental cost-effectiveness ratio [ICER] $37 [-$9 to $790] per DALY averted) and district hospital-level critical care (ICER $14 [-$200 to $263] per DALY averted), respectively, relative to the lowest identified estimate of the willingness-to-pay threshold for Tanzania ($101 per DALY averted). Advanced critical care is cost effective 27% and 40% of the time, when compared with the no critical care or district hospital-level critical care scenarios, respectively. CONCLUSION For settings where there is limited or no critical care delivery, implementation of EECC could be a highly cost-effective investment. It could reduce mortality and morbidity for critically ill COVID-19 patients, and its cost effectiveness falls within the range considered 'highly cost effective'. Further research is needed to explore the potential of EECC to generate even greater benefits and value for money when patients with diagnoses other than COVID-19 are accounted for.
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Affiliation(s)
| | - Tim Baker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Medicine, Nyköping Hospital, Nyköping, Sweden
| | | | - Khamis Awadh
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Karima Khalid
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Angela Kairu
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Vincent Were
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Lorna Guinness
- Center for Global Development, London, UK.
- Global Health Economics Centre, London School of Hygiene and Tropical Medicine, London, UK.
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Mekontso Dessap A, Richard JCM, Baker T, Godard A, Carteaux G. Technical Innovation in Critical Care in a World of Constraints: Lessons from the COVID-19 Pandemic. Am J Respir Crit Care Med 2023; 207:1126-1133. [PMID: 36716353 PMCID: PMC10161748 DOI: 10.1164/rccm.202211-2174cp] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
The COVID-19 crisis was characterized by a massive need for respiratory support, which has unfortunately not been met globally. This situation mimicked those which gave rise to critical care in the past. Since the polio epidemic in the 50's, the technological evolution of respiratory support has enabled health professionals to save the lives of critically-ill patients worldwide every year. However, much of the current innovation work has turned around developing sophisticated, complex, and high-cost standards and approaches whose resilience is still questionable upon facing constrained environments or contexts, as seen in resuscitation work outside intensive care units, during pandemics, or in low-income countries. Ventilatory support is an essential life-saving tool for patients with respiratory distress. It requires an oxygen source combined to a ventilatory assistance device, an adequate monitoring system, and properly trained caregivers to operate it. Each of these elements can be subject to critical constraints, which we can no longer ignore. The innovation process should incorporate them as a prima materia, whilst focusing on the core need of the field using the concept of frugal innovation. Having a universal access to oxygen and respiratory support, irrespective of the context and constraints, necessitates: i) developing cost-effective, energy-efficient, and maintenance-free oxygen generation devices; ii) improving the design of non-invasive respiratory devices (for example, with oxygen saving properties); iii) conceiving fully frugal ventilators and universal monitoring systems; iv) broadening ventilation expertise by developing end-user training programs in ventilator assistance. The frugal innovation approach may give rise to a more resilient and inclusive critical care system. This paradigm shift is essential for the current and future challenges.
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Affiliation(s)
- Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Faculté de Santé de Créteil, IMRB, GRC CARMAS, Université Paris-Est Créteil, Créteil, France
- INSERM U955, Créteil, France
| | - Jean-Christophe Marie Richard
- Vent’Lab, Medical ICU, Angers University Hospital, University of Angers, Angers, France
- Med2Lab, Air Liquide Medical Systems, Antony, France
| | - Tim Baker
- Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom; and
| | - Aurélie Godard
- Médecins Sans Frontières – Centre Opérationel Paris, Paris, France
| | - Guillaume Carteaux
- Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Faculté de Santé de Créteil, IMRB, GRC CARMAS, Université Paris-Est Créteil, Créteil, France
- INSERM U955, Créteil, France
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Gundo R, Kayambankadzanja RK, Chipeta D, Gundo B, Chikumbanje SS, Baker T. Doctors' experiences of referring and admitting patients to the intensive care unit: a qualitative study of doctors' practices at two tertiary hospitals in Malawi. BMJ Open 2023; 13:e066620. [PMID: 37185185 PMCID: PMC10151975 DOI: 10.1136/bmjopen-2022-066620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To explore doctors' experiences of referring and admitting patients to the intensive care unit (ICU) at two tertiary hospitals in Malawi. DESIGN This was a qualitative study that used face-to-face interviews. The interviews were audiotaped and transcribed verbatim into English. The data were analysed manually through conventional content analysis. SETTING Two public tertiary hospitals in the central and southern regions of Malawi. Interviews were conducted from January to June 2021. PARTICIPANTS Sixteen doctors who were involved in the referral and admission of patients to the ICU. RESULTS Four themes were identified namely, lack of clear admission criteria, ICU admission requires a complex chain of consultations, shortage of ICU resources, and lack of an ethical and legal framework for discontinuing treatment of critically ill patients who were too sick to benefit from ICU. CONCLUSION Despite the acute disease burden and increased demand for ICU care, the two hospitals lack clear processes for referring and admitting patients to the ICU. Given the limited bed space in ICUs, hospitals in low-income countries, including Malawi, need to improve or develop admission criteria, severity scoring systems, ongoing professional development activities, and legislation for discontinuing intensive care treatments and end-of-life care.
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Affiliation(s)
- Rodwell Gundo
- School of Nursing, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Raphael Kazidule Kayambankadzanja
- Public Health & Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
- Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | | | - Tim Baker
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
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Abstract
BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disease, symmetrically affecting the small joints. Biomarkers are tools that can be used in the diagnosis and monitoring of RA. AIM To systematically explore the role of the biomarkers: C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated protein (Anti-CCP), 14-3-3η protein, and the multi-biomarker disease activity (MBDA) score for the diagnosis and treatment of RA. METHODS A systematic review of the English literature using four different databases was carried out. RESULTS CRP >7.1 mg/L predicted poor conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) outcome in RA. Anti-CCP, CRP ≥0.3 mg/dL, and RF predicted bone erosion and cartilage destruction. Combination of high 14-3-3η protein with RF and CRP improved the prediction of rapid erosion progression (REP). Anti-CCP was not associated with disease activity but was associated with increased radiographic damage (r = 0.46, p = 0.048). RF was not associated with joint damage but correlated with ultrasound-detected bone erosion. The 14-3-3η protein significantly correlated with inflammation, bone rremodeling, and osteoporosis in RA patients (p < 0.05). In addition, the 14-3-3η protein positively correlated with RA duration (p = 0.003), disease aactivity, and positive RF (p = 0.025) and it distinguished early from established RA. Early MBDA scores correlated with later response in disease activity after 6 and 12 weeks of treatment (p < 0.05). The MBDA score was able to differentiate between small differences in disease activity, predicted remission over 1-year pperiod, and was a strong predictor of radiographic progression of RA. CONCLUSION The investigated biomarkers are helpful tools in clinical practice for diagnosis, monitoring of treatment, and predicting prognosis in RA patients. However, further research is still required to investigate novel biomarkers for the pre-treatment selection of potentially responsive patients before starting therapy for a precision medicine in this area.
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Affiliation(s)
| | - T Baker
- Department of Integrated Medicine, Rotherham General Hospital, Rotherham, UK
| | - D A Glascow
- Lancaster Medical School, Lancaster, UK
- Department of Integrated Medicine, Rotherham General Hospital, Rotherham, UK
| | - Ah Abdelhafiz
- Department of Integrated Medicine, Rotherham General Hospital, Rotherham, UK
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Bryant M, Burton W, O'Kane N, Woodside JV, Ahern S, Garnett P, Spence S, Sharif A, Rutter H, Baker T, Evans CEL. Understanding school food systems to support the development and implementation of food based policies and interventions. Int J Behav Nutr Phys Act 2023; 20:29. [PMID: 36907879 PMCID: PMC10009978 DOI: 10.1186/s12966-023-01432-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Schools provide opportunities to improve the quality of children's diet, whilst reducing inequalities in childhood diet and health. Evidence supports whole school approaches, including consistency in food quality, eating culture and food education. However, such approaches are often poorly implemented due to the highly complex environments in which schools operate. We aimed to develop a school food systems map using a systems thinking approach to help identify the key factors influencing primary school children's dietary choice. METHODS Eight workshops were conducted with 80 children (from schools from varying locations (region of England/UK; urban/rural), deprivation levels and prioritisation of school food policies)) and 11 workshops were held with 82 adult stakeholders across the UK (principals, teachers, caterers, school governors, parents, and local and voluntary sector organisations) to identify factors that influence food choice in children across a school day and their inter-relationships. Initial exploratory workshops started with a 'blank canvas' using a group model building approach. Later workshops consolidated findings and supported a wider discussion of factors, relationships and influences within the systems map. Strengths of the relationship between factors/nodes were agreed by stakeholders and individually depicted on the map. We facilitated an additional eight interactive, in-person workshops with children to map their activities across a whole school day to enable the production of a journey map which was shared with stakeholders in workshops to facilitate discussion. RESULTS The final 'CONNECTS-Food' systems map included 202 factors that were grouped into 27 nodes. Thematic analysis identified four key themes: leadership and curriculum; child food preference; home environment; and school food environment. Network analysis highlighted key factors that influence child diet across a school day, which were largely in keeping with the thematic analysis; including: 'available funds/resources', 'awareness of initiatives and resources', 'child food preference and intake', 'eligibility of free school meals', 'family circumstances and eating behaviours', 'peer/social norms', 'priorities of head teachers and senior leaders'. CONCLUSIONS Our systems map demonstrates the need to consider factors external to schools and their food environments. The map supports the identification of potential actions, interventions and policies to facilitate a systems-wide positive impact on children's diets.
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Affiliation(s)
- Maria Bryant
- Department of Health Sciences, University of York, York, YO150DD, UK
- Hull York Medical School, University of York, York, YO150DD, UK
| | - Wendy Burton
- Department of Health Sciences, University of York, York, YO150DD, UK
| | - Niamh O'Kane
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK.
| | - Sara Ahern
- Bradford Institute of Health Research, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
| | - Phillip Garnett
- School for Business and Society, University of York, York, YO10 5DD, UK
| | - Suzanne Spence
- Human Nutrition Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Amir Sharif
- Faculty of Management, Law and Social Sciences, University of Bradford, Bradford, BD7, 1DP, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, BA2 7AY, UK
| | - Tim Baker
- Charlton Manor Primary School, Indus Road, Charlton, London, SE7 7EF, UK
| | - Charlotte E L Evans
- School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
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Yu Q, Pillai A, Liao A, Baker T, Fung J, DiSabato D, Van Ha T, Ungchusri E, Hwang G, Ahmed O. Abstract No. 125 Selective Internal Radiation Therapy using Yttrium-90 Microspheres for Treatment of Localized and Locally Advanced Intrahepatic Cholangiocarcinoma. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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20
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Guinness L, Kairu A, Kuwawenaruwa A, Khalid K, Awadh K, Were V, Barasa E, Shah H, Baker P, Schell CO, Baker T. Essential emergency and critical care as a health system response to critical illness and the COVID19 pandemic: what does it cost? Cost Eff Resour Alloc 2023; 21:15. [PMID: 36782287 PMCID: PMC9923646 DOI: 10.1186/s12962-023-00425-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023] Open
Abstract
Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill patients, focusing on first-tier, effective, low-cost, life-saving care and designed to be feasible even in low-resourced and low-staffed settings. This is distinct from advanced critical care, usually conducted in ICUs with specialised staff, facilities and technologies. This paper estimates the incremental cost of EECC and advanced critical care for the planning of care for critically ill patients in Tanzania and Kenya.The incremental costing took a health systems perspective. A normative approach based on the ingredients defined through the recently published global consensus on EECC was used. The setting was a district hospital in which the patient is provided with the definitive care typically provided at that level for their condition. Quantification of resource use was based on COVID-19 as a tracer condition using clinical expertise. Local prices were used where available, and all costs were converted to USD2020.The costs per patient day of EECC is estimated to be 1 USD, 11 USD and 33 USD in Tanzania and 2 USD, 14 USD and 37 USD in Kenya, for moderate, severe and critical COVID-19 patients respectively. The cost per patient day of advanced critical care is estimated to be 13 USD and 294 USD in Tanzania and USD 17 USD and 345 USD in Kenya for severe and critical COVID-19 patients, respectively.EECC is a novel approach for providing the essential care to all critically ill patients. The low costs and lower tech approach inherent in delivering EECC mean that EECC could be provided to many and suggests that prioritizing EECC over ACC may be a rational approach when resources are limited.
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Affiliation(s)
- Lorna Guinness
- Center for Global Development, Great Peter House, Abbey Gardens, Great College St, London, SW1P 3SE, UK. .,Global Health Economics Centre, London School of Hygiene and Tropical Medicine, London, UK.
| | - Angela Kairu
- grid.33058.3d0000 0001 0155 5938Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - August Kuwawenaruwa
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Dar es Salaam, Tanzania
| | - Karima Khalid
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Dar es Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Muhimbili University of Health and Allied Sciences, Dar Es Salaam, United Republic of Tanzania
| | - Khamis Awadh
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Dar es Salaam, Tanzania
| | - Vincent Were
- grid.33058.3d0000 0001 0155 5938Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Edwine Barasa
- grid.33058.3d0000 0001 0155 5938Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Hiral Shah
- Center for Global Development, Great Peter House, Abbey Gardens, Great College St, London, SW1P 3SE UK
| | - Peter Baker
- Center for Global Development, Great Peter House, Abbey Gardens, Great College St, London, SW1P 3SE UK
| | - Carl Otto Schell
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden ,grid.8993.b0000 0004 1936 9457Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden ,Department of Medicine, Nyköping Hospital, Nyköping, Sweden
| | - Tim Baker
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Dar es Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Muhimbili University of Health and Allied Sciences, Dar Es Salaam, United Republic of Tanzania ,grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden ,grid.8991.90000 0004 0425 469XDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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21
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Mkumbo E, Willows TM, Onyango O, Khalid K, Maiba J, Schell CO, Oliwa J, McKnight J, Baker T. Same label, different patients: Health-workers' understanding of the label 'critical illness'. Front Health Serv 2023; 3:1105078. [PMID: 36811083 PMCID: PMC7614203 DOI: 10.3389/frhs.2023.1105078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background During the course of patients' sickness, some become critically ill, and identifying them is the first important step to be able to manage the illness. During the course of care provision, health workers sometimes use the term 'critical illness' as a label when referring to their patient's condition, and the label is then used as a basis for communication and care provision. Their understanding of this label will therefore have a profound impact on the identification and management of patients. This study aimed to determine how Kenyan and Tanzanian health workers understand the label 'critical illness'. Methods A total of 10 hospitals-five in Kenya and five in Tanzania-were visited. In-depth interviews were conducted with 30 nurses and physicians from different departments in the hospitals who had experience in providing care for sick patients. We conducted a thematic analysis of the translated and transcribed interviews, synthesized findings and developed an overarching set of themes which captured healthcare workers' understandings of the label 'critical illness'. Results Overall, there does not appear to be a unified understanding of the label 'critical illness' among health workers. Health workers understand the label to refer to patients in four thematic ways: (1) those in a life-threatening state; (2) those with certain diagnoses; (3) those receiving care in certain locations; and (4) those in need of a certain level of care. Conclusion There is a lack of a unified understanding about the label 'critical illness' among health workers in Tanzania and Kenya. This potentially hampers communication and the selection of patients for urgent life-saving care. A recently proposed definition, "a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility", could be useful for improving communication and care.
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Affiliation(s)
- Elibariki Mkumbo
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania,Correspondence: Elibariki Mkumbo,
| | - Tamara Mulenga Willows
- Health Systems Collaborative, Department of Tropical Medicine and Global Health University of Oxford Health, Oxford, United Kingdom
| | - Onesmus Onyango
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Karima Khalid
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania,Department of Anaesthesia, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - John Maiba
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden,Department of Medicine, Nyköping Hospital, Nyköping, Sweden
| | - Jacquie Oliwa
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacob McKnight
- Health Systems Collaborative, Department of Tropical Medicine and Global Health University of Oxford Health, Oxford, United Kingdom
| | - Tim Baker
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania,Department of Anaesthesia, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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22
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Gill SD, Anagnostelos L, Stella J, Lowry N, Kloot K, Reade T, Baker T, Hayden G, Ryan M, Seward H, Page RS. Wrist, hand and finger injuries in Australian football: A prospective observational study of emergency department presentations. Emerg Med Australas 2023. [PMID: 36682734 DOI: 10.1111/1742-6723.14171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Investigate the characteristics of wrist, hand and finger (WHF) injuries in Australian footballers presenting to EDs and determine if injury profiles differed between females and males, and between children and adults. METHODS In this prospective observational study that took place during an entire football season, patients attended 1 of 10 EDs in Victoria, Australia with a WHF injury sustained while playing Australian football. Data were extracted from patient medical records by trained researchers. Data included injury type (e.g. fracture), body part (e.g. metacarpal) and mechanism of injury. Males versus females, and children versus adults were compared using chi-squared tests or Fisher's exact tests. RESULTS In total, 528 patients had a WHF injury, of which 105 (19.9%) were female and 308 (59.2%) were children. Fractures and sprains were the most common injury types (45.3% and 38.6%, respectively). Fingers were more often injured than wrists or hands (62.5%, 23.5% and 15.0%, respectively). Ball contact was the most common mechanism of injury (38.1% of injuries). Females were more likely than males to (i) have a sprain/strain injury, (ii) injure a finger (rather than wrist or hand) and (iii) injure themselves through ball contact. Children were more likely to injure their wrists, have a sprain/strain injury, or be injured falling to the ground. Adults were more likely to dislocate a joint or injure their hands. CONCLUSIONS Differences in injury type, location and mechanism between females and males, and children and adults, suggest an opportunity for customised injury prevention and management strategies by sex and age.
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Affiliation(s)
- Stephen D Gill
- Barwon Centre for Orthopaedic Research and Education, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Warrnambool, Victoria, Australia.,St John of God Geelong Hospital, Geelong, Victoria, Australia
| | - Lambros Anagnostelos
- Barwon Centre for Orthopaedic Research and Education, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Warrnambool, Victoria, Australia.,St John of God Geelong Hospital, Geelong, Victoria, Australia
| | - Julian Stella
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Nicole Lowry
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Kate Kloot
- School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Tom Reade
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Tim Baker
- Centre for Rural Emergency Medicine, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Georgina Hayden
- St John of God Geelong Hospital, Geelong, Victoria, Australia
| | - Matthew Ryan
- Emergency Department, Epworth Hospital Geelong, Geelong, Victoria, Australia
| | - Hugh Seward
- Newtown Medical Centre, Geelong, Victoria, Australia
| | - Richard S Page
- Barwon Centre for Orthopaedic Research and Education, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Warrnambool, Victoria, Australia.,St John of God Geelong Hospital, Geelong, Victoria, Australia
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23
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Crawford AM, Shiferaw AA, Ntambwe P, Milan AO, Khalid K, Rubio R, Nizeyimana F, Ariza F, Mohammed AD, Baker T, Banguti PR, Madzimbamuto F. Global critical care: a call to action. Crit Care 2023; 27:28. [PMID: 36670506 PMCID: PMC9854162 DOI: 10.1186/s13054-022-04296-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 01/22/2023] Open
Abstract
Critical care is underprioritized. A global call to action is needed to increase equitable access to care and the quality of care provided to critically ill patients. Current challenges to effective critical care in resource-constrained settings are many. Estimates of the burden of critical illness are extrapolated from common etiologies, but the true burden remains ill-defined. Measuring the burden of critical illness is epidemiologically challenging but is thought to be increasing. Resources, infrastructure, and training are inadequate. Millions die unnecessarily due to critical illness. Solutions start with the implementation of first-step, patient care fundamentals known as Essential Emergency and Critical Care. Such essential care stands to decrease critical-illness mortality, augment pandemic preparedness, decrease postoperative mortality, and decrease the need for advanced level care. The entire healthcare workforce must be trained in these fundamentals. Additionally, physician and nurse specialists trained in critical care are needed and must be retained as leaders of critical care initiatives, researchers, and teachers. Context-specific research is mandatory to ensure care is appropriate for the patient populations served, not just duplicated from high-resourced settings. Governments must increase healthcare spending and invest in capacity to treat critically ill patients. Advocacy at all levels is needed to achieve universal health coverage for critically ill patients.
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Affiliation(s)
- Ana Maria Crawford
- grid.168010.e0000000419368956Anesthesiology and Critical Care, Stanford University, 300 Pasteur Drive, Stanford, CA USA
| | - Ananya Abate Shiferaw
- grid.7123.70000 0001 1250 5688College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Papytcho Ntambwe
- grid.79746.3b0000 0004 0588 4220Anaesthesia and Critical Care, Livingstone University Teaching Hospital, Livingstone, Zambia
| | - Alexei Ortiz Milan
- Critical Care Medicine Physician, Sir Ketumile Masire Teaching Hospital, Notwane and Mabutho Road, Plot 4775, Private Bag UB 001, Gaborone, Botswana
| | - Karima Khalid
- grid.25867.3e0000 0001 1481 7466Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rodrigo Rubio
- Departamento de Anestesia, Hospital ABC, Vasco de Quiroga 154, Cuajimalpa, 05348 Ciudad de Mexico, Mexico
| | - Francoise Nizeyimana
- grid.418074.e0000 0004 0647 8603Consultant Anesthesiology and Critical Care, Head of Department CHUK, Kigali, Rwanda
| | - Fredy Ariza
- grid.477264.4Anesthesia and Perioperative Medicine, Fundación Valle del Lili, ICESI/UNIVALLE Universities, Cali, Colombia
| | - Alhassan Datti Mohammed
- grid.413710.00000 0004 1795 3115Department of Anaesthesiology and Intensive Care, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Tim Baker
- grid.25867.3e0000 0001 1481 7466Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania ,grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden ,grid.4868.20000 0001 2171 1133Queen Mary University of London, London, UK
| | - Paulin Ruhato Banguti
- grid.10818.300000 0004 0620 2260Anesthesiology and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Farai Madzimbamuto
- grid.7621.20000 0004 0635 5486Anaesthesiology and Critical Care, University of Botswana School of Medicine, Notwane and Mabutho Road, Plot 4775, Private Bag UB 001, Gaborone, Botswana
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24
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Gill SD, Stella J, Chatterton ML, Lowry N, Kloot K, Reade T, Baker T, Hayden G, Ryan M, Seward H, Page RS. Economic consequences of injury in female Australian footballers: A prospective observational study of emergency department presentations. Emerg Med Australas 2023; 35:496-503. [PMID: 36623933 DOI: 10.1111/1742-6723.14156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Investigate the economic consequences of injuries to female Australian footballers from a health sector and societal perspective. METHODS This prospective observational study invited 242 females to complete an online questionnaire 3-6 months following an Australian football injury which involved presentation to an ED in Victoria, Australia. The questionnaire inquired regarding healthcare use, time off work, return to playing football and extent of recovery following injury. Relevant information was also extracted from respondents' medical records regarding injury-type, body part injured, investigations and treatments. Healthcare costs were determined for each respondent's ED presentation, hospital admission/s (when relevant), and subsequent healthcare use. Societal costs were determined as lost income to the respondent and/or carer. RESULTS A total of 108 people responded to the questionnaire. Sprains/strains and fractures accounted for 84.2% of respondents' injuries. Sixteen respondents (14.8%) required admission to hospital at the time of injury and 81 (75.0%) required subsequent healthcare appointments following discharge from the ED or hospital. Time off work or school following the injury was common (64.8% of respondents) and 27.8% of respondents had a carer take time off work. More than 80% of respondents missed training and matches following the injury. The median healthcare cost per respondent was AUD$753 and the median cost due to work absence was AUD$1393. One-quarter of respondents reported a full recovery. CONCLUSIONS Injuries to female Australian footballers can produce substantial healthcare and societal costs, which has important implications for healthcare provision and prioritising and implementing injury prevention programmes and post-injury rehabilitation.
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Affiliation(s)
- Stephen D Gill
- Barwon Centre for Orthopaedic Research and Education, School of Medicine, Deakin University and St John of God Geelong Hospital, Geelong, Victoria, Australia.,Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Julian Stella
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nicole Lowry
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Kate Kloot
- School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Tom Reade
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Tim Baker
- Centre for Rural Emergency Medicine, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Georgina Hayden
- Emergency Department, St John of God Geelong Hospital, Geelong, Victoria, Australia
| | - Matthew Ryan
- Emergency Department, Epworth Hospital Geelong, Geelong, Victoria, Australia
| | - Hugh Seward
- Newtown Medical Centre, Geelong, Victoria, Australia
| | - Richard S Page
- Barwon Centre for Orthopaedic Research and Education, School of Medicine, Deakin University and St John of God Geelong Hospital, Geelong, Victoria, Australia
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25
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Bedwell GJ, Dias P, Hahnle L, Anaeli A, Baker T, Beane A, Biccard BM, Bulamba F, Delgado-Ramirez MB, Dullewe NP, Echeverri-Mallarino V, Haniffa R, Hewitt-Smith A, Hoyos AS, Mboya EA, Nanimambi J, Pearse R, Pratheepan AP, Sunguya B, Tolppa T, Uruthirakumar P, Vengadasalam S, Vindrola-Padros C, Stephens TJ. Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study. Anesth Analg 2022; 135:1217-1232. [PMID: 36005395 DOI: 10.1213/ane.0000000000006113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Provision of timely, safe, and affordable surgical care is an essential component of any high-quality health system. Increasingly, it is recognized that poor quality of care in the perioperative period (before, during, and after surgery) may contribute to significant excess mortality and morbidity. Therefore, improving access to surgical procedures alone will not address the disparities in surgical outcomes globally until the quality of perioperative care is addressed. We aimed to identify key barriers to quality perioperative care delivery for 3 "Bellwether" procedures (cesarean delivery, emergency laparotomy, and long-bone fracture fixation) in 5 low- and middle-income countries (LMICs). METHODS Ten hospitals representing secondary and tertiary facilities from 5 LMICs were purposefully selected: 2 upper-middle income (Colombia and South Africa); 2 lower-middle income (Sri Lanka and Tanzania); and 1 lower income (Uganda). We used a rapid appraisal design (pathway mapping, ethnography, and interviews) to map out and explore the complexities of the perioperative pathway and care delivery for the Bellwether procedures. The framework approach was used for data analysis, with triangulation across different data sources to identify barriers in the country and pattern matching to identify common barriers across the 5 LMICs. RESULTS We developed 25 pathway maps, undertook >30 periods of observation, and held >40 interviews with patients and clinical staff. Although the extent and impact of the barriers varied across the LMIC settings, 4 key common barriers to safe and effective perioperative care were identified: (1) the fragmented nature of the care pathways, (2) the limited human and structural resources available for the provision of care, (3) the direct and indirect costs of care for patients (even in health systems for which care is ostensibly free of charge), and (4) patients' low expectations of care. CONCLUSIONS We identified key barriers to effective perioperative care in LMICs. Addressing these barriers is important if LMIC health systems are to provide safe, timely, and affordable provision of the Bellwether procedures.
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Affiliation(s)
- Gillian J Bedwell
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Priyanthi Dias
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Lina Hahnle
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Tim Baker
- Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Abi Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Bruce M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Fred Bulamba
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martha B Delgado-Ramirez
- Departments of Clinical Epidemiology and Biostatistics.,Anesthesia, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Bogota, Bogota, Colombia
| | - Nilmini P Dullewe
- Post Basic School of Nursing, Colombo, Sri Lanka.,Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
| | | | - Rashan Haniffa
- Anesthesia, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Bogota, Bogota, Colombia
| | - Adam Hewitt-Smith
- Elgon Centre for Health, Research and Innovation, Mbale' Uganda.,Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alejandra Sanin Hoyos
- Anesthesia, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Bogota, Bogota, Colombia
| | - Erick A Mboya
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Juliana Nanimambi
- Department of Anaesthesia and Critical Care, Faculty of Health Sciences, Busitema University, Mbale, Uganda.,Elgon Centre for Health, Research and Innovation, Mbale' Uganda
| | - Rupert Pearse
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Anton Premadas Pratheepan
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Jaffna Teaching Hospital, Jaffna, Sri Lanka
| | - Bruno Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Timo Tolppa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Powsiga Uruthirakumar
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | | | | | - Timothy J Stephens
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
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26
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Kazibwe J, Shah HA, Kuwawenaruwa A, Schell CO, Khalid K, Tran PB, Ghosh S, Baker T, Guinness L. Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review. BMJ Open 2022; 12:e060422. [PMID: 36414306 PMCID: PMC9684998 DOI: 10.1136/bmjopen-2021-060422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Critical care is essential in saving lives of critically ill patients, however, provision of critical care across lower resource settings can be costly, fragmented and heterogenous. Despite the urgent need to scale up the provision of critical care, little is known about its availability and cost. Here, we aim to systematically review and identify reported resource use, availability and costs for the provision of critical care and the nature of critical care provision in Tanzania. DESIGN This is a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Medline, Embase and Global Health databases were searched covering the period 2010 to 17 November 2020. ELIGIBILITY CRITERIA We included studies that reported on forms of critical care offered, critical care services offered and/or costs and resources used in the provision of care in Tanzania published from 2010. DATA EXTRACTION AND SYNTHESIS Quality assessment of the articles and data extraction was done by two independent researchers. The Reference Case for Estimating the Costs of Global Health Services and Interventions was used to assess quality of included studies. A narrative synthesis of extracted data was conducted. Costs were adjusted and reported in 2019 US$ and TZS using the World Bank GDP deflators. RESULTS A total 31 studies were found to fulfil the inclusion and exclusion criteria. Critical care identified in Tanzania was categorised into: intensive care unit (ICU) delivered critical care and non-ICU critical care. The availability of ICU delivered critical care was limited to urban settings whereas non-ICU critical care was found in rural and urban settings. Paediatric critical care equipment was more scarce than equipment for adults. 15 studies reported on the costs of services related to critical care yet no study reported an average or unit cost of critical care. Costs of medication, equipment (eg, oxygen, personal protective equipment), services and human resources were identified as inputs to specific critical care services in Tanzania. CONCLUSION There is limited evidence on the resource use, availability and costs of critical care in Tanzania. There is a strong need for further empirical research on critical care resources availability, utilisation and costs across specialties and hospitals of different level in low/middle-income countries like Tanzania to inform planning, priority setting and budgeting for critical care services. PROSPERO REGISTRATION NUMBER CRD42020221923.
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Affiliation(s)
- Joseph Kazibwe
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Hiral A Shah
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Center for Global Development, Washington, DC, USA
| | - August Kuwawenaruwa
- Health System Impact Evaluation and Policy Unit, Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Karima Khalid
- Department of Anaesthesia and Critical Care, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Phuong Bich Tran
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Srobana Ghosh
- Global Health Department, Center for Global Development, Washington, DC, USA
| | - Tim Baker
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Department of Emergency Medicine, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Lorna Guinness
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Center for Global Development, Washington, DC, USA
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Hay JA, Kissler SM, Fauver JR, Mack C, Tai CG, Samant RM, Connolly S, Anderson DJ, Khullar G, MacKay M, Patel M, Kelly S, Manhertz A, Eiter I, Salgado D, Baker T, Howard B, Dudley JT, Mason CE, Nair M, Huang Y, DiFiori J, Ho DD, Grubaugh ND, Grad YH. Quantifying the impact of immune history and variant on SARS-CoV-2 viral kinetics and infection rebound: A retrospective cohort study. eLife 2022; 11:81849. [PMID: 36383192 PMCID: PMC9711520 DOI: 10.7554/elife.81849] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background The combined impact of immunity and SARS-CoV-2 variants on viral kinetics during infections has been unclear. Methods We characterized 1,280 infections from the National Basketball Association occupational health cohort identified between June 2020 and January 2022 using serial RT-qPCR testing. Logistic regression and semi-mechanistic viral RNA kinetics models were used to quantify the effect of age, variant, symptom status, infection history, vaccination status and antibody titer to the founder SARS-CoV-2 strain on the duration of potential infectiousness and overall viral kinetics. The frequency of viral rebounds was quantified under multiple cycle threshold (Ct) value-based definitions. Results Among individuals detected partway through their infection, 51.0% (95% credible interval [CrI]: 48.3-53.6%) remained potentially infectious (Ct <30) 5 days post detection, with small differences across variants and vaccination status. Only seven viral rebounds (0.7%; N=999) were observed, with rebound defined as 3+days with Ct <30 following an initial clearance of 3+days with Ct ≥30. High antibody titers against the founder SARS-CoV-2 strain predicted lower peak viral loads and shorter durations of infection. Among Omicron BA.1 infections, boosted individuals had lower pre-booster antibody titers and longer clearance times than non-boosted individuals. Conclusions SARS-CoV-2 viral kinetics are partly determined by immunity and variant but dominated by individual-level variation. Since booster vaccination protects against infection, longer clearance times for BA.1-infected, boosted individuals may reflect a less effective immune response, more common in older individuals, that increases infection risk and reduces viral RNA clearance rate. The shifting landscape of viral kinetics underscores the need for continued monitoring to optimize isolation policies and to contextualize the health impacts of therapeutics and vaccines. Funding Supported in part by CDC contract #200-2016-91779, a sponsored research agreement to Yale University from the National Basketball Association contract #21-003529, and the National Basketball Players Association.
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Affiliation(s)
- James A Hay
- Harvard TH Chan School of Public HealthBostonUnited States
| | | | - Joseph R Fauver
- Yale School of Public HealthNew HavenUnited States
- University of Nebraska Medical CenterOmahaUnited States
| | | | | | | | | | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection PreventionDurhamUnited States
| | | | | | | | | | | | | | | | | | | | | | | | - Manoj Nair
- Vagelos College of Physicians and Surgeons, Columbia UniversityNew YorkUnited States
| | - Yaoxing Huang
- Vagelos College of Physicians and Surgeons, Columbia UniversityNew YorkUnited States
| | - John DiFiori
- Hospital for Special SurgeryNew YorkUnited States
- National Basketball AssociationNew YorkUnited States
| | - David D Ho
- Vagelos College of Physicians and Surgeons, Columbia UniversityNew YorkUnited States
| | | | - Yonatan H Grad
- Harvard TH Chan School of Public HealthBostonUnited States
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Mak F, Candelaria A, Baker T, Ramirez C. Cervical Fibroids - Key Surgical Steps. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Carstens Yalom A, Baker T, Nimz A, Ramirez C. Posterior Colpotomy: A Less Invasive Option for Tissue Extraction. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Kopelman Z, Baker T, Ramirez C. The Roeder Knot: An Innovative Tool for Laparoscopic Myomectomy. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Critical illness is a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided, and the potential for reversibility. An estimated 45 million adults become critically ill each year. While some are treated in emergency departments or intensive care units, most are cared for in general hospital wards. We outline a priority for health systems globally: the first-tier care that all critically ill patients should receive in all parts of all hospitals: Essential Emergency and Critical Care. We describe its relation to other specialties and care and opportunities for implementation.
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Affiliation(s)
- Dabota Yvonne Buowari
- Department of Accident and Emergency, University of Port Harcourt Teaching Hospital, Along East West Road, Alakahia, Port Harcourt, Rivers State 23401, Nigeria
| | - Christian Owoo
- Department of Anaesthesia, University of Ghana Medical School, College of Health Sciences, Guggisberg Avenue, Korle Bu, GA-029-4296 Accra, Ghana; Department of Anaesthesia, Korle Bu Teaching Hospital, Guggisberg Avenue, Korle Bu, GA-029-4296 Accra, Ghana; Ghana Infectious Disease Centre, Kwabenya, Ga East, Municipal Hospital, GE-255-9501 (PQ47+FGV), Accra, Ghana; University of Ghana Medical Centre, Indian Ocean Link, University of Ghana, GA-337-6980 (JRJ7+WJP) Accra, Ghana
| | - Lalit Gupta
- Department of Anaesthesia and Critical Care, Maulana Azad Medical College, 2 Bahadur Shah Zafar Marg, New Delhi 110002, India
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Solna Väg, Stockholm, 171 77, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Sveavägen entré 9 Mälarsjukhuset, Eskilstuna, 631 88 Sweden; Department of Medicine, Nyköping Hospital, Nyköping 61185, Sweden
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Solna Väg, Stockholm, 171 77, Sweden; Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam, P.O. Box 65001, Tanzania; Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK; Ifakara Health Institute, 5 Ifakara Street, Plot 463 Mikocheni, Dar es Salaam, P.O. Box 78 373, Tanzania.
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Miller P, Vakidis T, Taylor N, Baker T, Stella J, Egerton-Warburton D, Hyder S, Staiger P, Bowe SJ, Shepherd J, Zordan R, Walby A, Jones ML, Caldicott D, Barker D, Hall M, Doran CM, Ezard N, Preisz P, Havard A, Shakeshaft A, Akhlaghi H, Kloot K, Lowry N, Bumpstead S. Most common principal diagnoses assigned to Australian emergency department presentations involving alcohol use: a multi-centre study. Aust N Z J Public Health 2022; 46:903-909. [PMID: 36121276 DOI: 10.1111/1753-6405.13303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/01/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Alcohol is the most widely consumed psychoactive substance in Australia and the consequences of alcohol consumption have enormous personal and social impacts. This study aimed to describe the principal diagnoses of emergency department (ED) presentations involving alcohol use in the previous 12 hours at eight hospitals in Victoria and the Australian Capital Territory, Australia. METHODS Twelve months' data (1 July 2018 - 30 June 2019) were collected from eight EDs, including demographics, ICD-10 codes, hospital location and self-reported drinking in the preceding 12 hours. The ten most common ICD-10 discharge codes were analysed based on age, sex and hospital geographic area. RESULTS ICD codes pertaining to mental and behavioural disorders due to alcohol use accounted for the highest proportion in most EDs. Suicide ideation/attempt was in the five highest ICD codes for all but one hospital. It was the second most common alcohol-related presentation for both males and females. CONCLUSIONS Alcohol plays a major role in a range of presentations, especially in relation to mental health and suicide. IMPLICATIONS FOR PUBLIC HEALTH The collection of alcohol involvement in ED presentations represents a major step forward in informing the community about the burden of alcohol on their health resources.
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Affiliation(s)
- Peter Miller
- School of Psychology, Deakin University, Victoria
| | - Thea Vakidis
- School of Psychology, Deakin University, Victoria
| | - Nicholas Taylor
- School of Psychology, Deakin University, Victoria.,National Drug Research Institute, Curtin University, Victoria
| | - Tim Baker
- Centre for Rural Emergency Medicine, Faculty of Health, Deakin University, Victoria.,South West Healthcare, Victoria
| | | | | | | | | | | | - Jonathan Shepherd
- Crime and Security Research Institute, Cardiff University, Wales, UK
| | - Rachel Zordan
- St Vincent's Hospital Melbourne, Victoria.,Melbourne Medical School, University of Melbourne, Victoria
| | | | - Martyn Lloyd Jones
- VMO Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria.,Alfred Addiction and Mental Health, the Alfred Hospital, Victoria
| | | | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, New South Wales
| | | | - Christopher M Doran
- Cluster for Resilience and Well-being, Appleton Institute, Central Queensland University, Queensland
| | - Nadine Ezard
- St Vincent's Hospital Sydney, National Centre for Clinical Research on Emerging Drugs, New South Wales.,National Drug and Alcohol Research Centre, UNSW Sydney, New South Wales
| | - Paul Preisz
- St Vincent's Hospital Darlinghurst, New South Wales.,Faculty of Medicine & Health, UNSW Sydney, New South Wales.,School of Medicine, University Notre Dame, New South Wales
| | - Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, New South Wales.,Centre for Big Data Research in Health, UNSW Sydney, New South Wales
| | | | - Hamed Akhlaghi
- St Vincent's Hospital Melbourne, Victoria.,Melbourne Medical School, University of Melbourne, Victoria
| | - Kate Kloot
- School of Medicine, Deakin University, Victoria
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Kayambankadzanja RK, Schell CO, Gerdin Wärnberg M, Tamras T, Mollazadegan H, Holmberg M, Alvesson HM, Baker T. Towards definitions of critical illness and critical care using concept analysis. BMJ Open 2022; 12:e060972. [PMID: 36606666 PMCID: PMC9445819 DOI: 10.1136/bmjopen-2022-060972] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE As 'critical illness' and 'critical care' lack consensus definitions, this study aimed to explore how the concepts' are used, describe their defining attributes, and propose potential definitions. DESIGN AND METHODS We used the Walker and Avant approach to concept analysis. The uses and definitions of the concepts were identified through a scoping review of the literature and an online survey of 114 global clinical experts. We used the Arksey and O'Malley framework for scoping reviews and searched in PubMed and Web of Science with a strategy including terms around critical illness/care and definitions/etymologies limited to publications in English between 1 January 2008 and 1 January 2020. The experts were selected through purposive sampling and snowballing, with 36.8% in Africa, 25.4% in Europe, 22.8% in North America, 10.5% in Asia, 2.6% in South America and 1.8% in Australia. They worked with anaesthesia or intensive care 59.1%, emergency care 15.8%, medicine 9.5%, paediatrics 5.5%, surgery 4.7%, obstetrics and gynaecology 1.6% and other specialties 3.9%. Through content analysis of the data, we extracted codes, categories and themes to determine the concepts' defining attributes and we proposed potential definitions. To assist understanding, we developed model, related and contrary cases concerning the concepts, we identified antecedents and consequences to the concepts, and defined empirical referents. RESULTS Nine and 13 articles were included in the scoping reviews of critical illness and critical care, respectively. A total of 48 codes, 14 categories and 4 themes were identified in the uses and definitions of critical illness and 60 codes, 13 categories and 5 themes for critical care. The defining attributes of critical illness were a high risk of imminent death; vital organ dysfunction; requirement for care to avoid death; and potential reversibility. The defining attributes of critical care were the identification, monitoring and treatment of critical illness; vital organ support; initial and sustained care; any care of critical illness; and specialised human and physical resources. The defining attributes led to our proposed definitions of critical illness as, 'a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility', and of critical care as, 'the identification, monitoring and treatment of patients with critical illness through the initial and sustained support of vital organ functions.' CONCLUSION The concepts critical illness and critical care lack consensus definitions and have varied uses. Through concept analysis of uses and definitions in the literature and among experts, we have identified the defining attributes of the concepts and proposed definitions that could aid clinical practice, research and policy-making.
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Affiliation(s)
- Raphael Kazidule Kayambankadzanja
- Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Carl Otto Schell
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Internal Medicine, Nyköping Hospital, Nyköping, Sweden
| | - Martin Gerdin Wärnberg
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Tamras
- Internal Medicine, Södertälje Hospital, Stockholm, Sweden
| | | | - Mats Holmberg
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Centre of Interprofessional Collaboration within Emergency care, Linnaeus University, Växjö, Sweden
- Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | | | - Tim Baker
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Ahmed O, Yu Q, Pillai A, Liao A, Baker T. Abstract No. 303 ▪ FEATURED ABSTRACT Combination yttrium-90 radioembolization with concomitant systemic gemcitabine, cisplatin, and capecitabine as first-line therapy for intrahepatic cholangiocarcinoma (iCCA). J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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35
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Talwar A, Varghese J, Knight G, Katariya N, Caicedo-Ramirez J, Dietch Z, Borja-Cacho D, Ladner D, Christopher D, Baker T, Abecassis M, Mouli S, Desai K, Riaz A, Thornburg B, Salem R. Abstract No. 184 Pre-operative portal vein recanalization-transjugular intrahepatic portosystemic shunt for chronic, obliterative portal vein thrombosis: outcomes following liver transplantation. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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36
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Ahmed O, Yu Q, Pillai A, Liao A, Baker T. Abstract No. 307 Y-90 radioembolization as a first line therapy for intrahepatic cholangiocarcinoma. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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37
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Halmin M, Abou Mourad G, Ghneim A, Rady A, Baker T, Von Schreeb J. Development of a quality assurance tool for intensive care units in Lebanon during the COVID-19 pandemic. Int J Qual Health Care 2022; 34:6580928. [PMID: 35512363 PMCID: PMC9129220 DOI: 10.1093/intqhc/mzac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/05/2022] [Accepted: 05/04/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND During the coronavirus disease (COVID-19) pandemic, low- and middle-income countries have rapidly scaled up intensive care unit (ICU) capacities. Doing this without monitoring the quality of care poses risks to patient safety and may negatively affect patient outcomes. While monitoring the quality of care is routine in high-income countries, it is not systematically implemented in most low- and middle-income countries. In this resource-scarce context, there is a paucity of feasibly implementable tools to monitor the quality of ICU care. Lebanon is an upper middle-income country that, during the autumn and winter of 2020-1, has had increasing demands for ICU beds for COVID-19. The World Health Organization has supported the Ministry of Public Health to increase ICU beds at public hospitals by 300%, but no readily available tool to monitor the quality of ICU care was available. OBJECTIVE The objective with this study was to describe the process of rapidly developing and implementing a tool to monitor the quality of ICU care at public hospitals in Lebanon. METHODS In the midst of the escalating pandemic, we applied a systematic approach to develop a realistically implementable quality assurance tool. We conducted a literature review, held expert meetings and did a pilot study to select among identified quality indicators for ICU care that were feasible to collect during a 1-hour ICU visit. In addition, a limited set of the identified indicators that were quantifiable were specifically selected for a scoring protocol to allow comparison over time as well as between ICUs. RESULTS A total of 44 quality indicators, which, using different methods, could be collected by an external person, were selected for the quality of care tool. Out of these, 33 were included for scoring. When tested, the scores showed a large difference between hospitals with low versus high resources, indicating considerable variation in the quality of care. CONCLUSIONS The proposed tool is a promising way to systematically assess and monitor the quality of care in ICUs in the absence of more advanced and resource-demanding systems. It is currently in use in Lebanon. The proposed tool may help identifying quality gaps to be targeted and can monitor progress. More studies to validate the tool are needed.
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Affiliation(s)
- Märit Halmin
- Address reprint requests to: Märit Halmin, Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden. Tel: +46737108550; E-mail:
| | - Ghada Abou Mourad
- The World Health Organization, Bloc left 4th floor, Glass building, Museum Square, Beirut 5391, Lebanon
| | - Adam Ghneim
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
| | - Alissar Rady
- The World Health Organization, Bloc left 4th floor, Glass building, Museum Square, Beirut 5391, Lebanon
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
| | - Johan Von Schreeb
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
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Affiliation(s)
- Bruce M Biccard
- From the Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, Observatory, South Africa
| | - Tim Baker
- Department of Emergency Medicine. Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Delia Mabedi
- Department of Anaesthesia and Intensive Care, Zomba Central Hospital, Zomba, Malawi
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Ramirez C, Baker T. Office hysteroscopy: the basics and beyond. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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40
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Baker T, Moore K, Lim J, Papanastasiou C, McCarthy S, Schreve F, Lawson M, Versace V. Rural emergency care facilities may be adapting to their context: A population-level study of resources and workforce. Aust J Rural Health 2022; 30:393-401. [PMID: 35171520 PMCID: PMC9305935 DOI: 10.1111/ajr.12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/21/2021] [Accepted: 01/11/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To provide a structured understanding of rural hospital‐based emergency care facility workforce and resources. Design The resources of regional training hubs were used to survey eligible emergency care facilities in their surrounding region. Setting Rural emergency care facilities manage more than one third of Australia's emergency presentations. These emergency care facilities include emergency departments and less‐resourced facilities in smaller towns. Participants Hospital facilities located outside metropolitan areas that report emergency presentations to the Australian Institute of Health and Welfare. Interventions A survey tool was sent by email. Main outcome measures Presence of human, diagnostic and other resources as reported on a questionnaire. Results A completed questionnaire was received from 195 emergency care facilities. Over 60% of Small hospitals had on‐call doctors only. General practitioners/generalists and nurses with extended emergency skills were found in all hospital types. Emergency physicians were present across all remoteness areas, but more commonly seen in larger facilities. All Major/Large facilities and most Medium facilities reported having onsite pathology and radiology. Point of care testing and clinician radiography were more commonly reported in smaller facilities. Among Small hospitals, Very Remote hospitals were more likely than Inner Regional hospitals to have an onsite doctor in the emergency care facility and/or a high dependency unit. Conclusion Smaller and more remote facilities appear to adapt by using different workforce structures and bedside investigations.
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Affiliation(s)
- Tim Baker
- Deakin University Centre for Rural Emergency Medicine, Warrnambool, Victoria, Australia
| | - Katie Moore
- Australasian College for Emergency Medicine, West Melbourne, Victoria, Australia
| | - Jolene Lim
- Australasian College for Emergency Medicine, West Melbourne, Victoria, Australia
| | | | - Sally McCarthy
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Mary Lawson
- Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Vincent Versace
- Deakin University Rural Health, Warrnambool, Victoria, Australia
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Adams J, Brumby S, Kloot K, Baker T, Mohebbi M. High-Heat Days and Presentations to Emergency Departments in Regional Victoria, Australia. Int J Environ Res Public Health 2022; 19:ijerph19042131. [PMID: 35206318 PMCID: PMC8872328 DOI: 10.3390/ijerph19042131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023]
Abstract
Heat kills more Australians than any other natural disaster. Previous Australian research has identified increases in Emergency Department presentations in capital cities; however, little research has examined the effects of heat in rural/regional locations. This retrospective cohort study aimed to determine if Emergency Department (ED) presentations across the south-west region of Victoria, Australia, increased on high-heat days (1 February 2017 to 31 January 2020) using the Rural Acute Hospital Data Register (RAHDaR). The study also explored differences in presentations between farming towns and non-farming towns. High-heat days were defined as days over the 95th temperature percentile. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes associated with heat-related illness were identified from previous studies. As the region has a large agricultural sector, a framework was developed to identify towns estimated to have 70% or more of the population involved in farming. Overall, there were 61,631 presentations from individuals residing in the nine Local Government Areas. Of these presentations, 3064 (5.0%) were on days of high-heat, and 58,567 (95.0%) were of days of non-high-heat. Unlike previous metropolitan studies, ED presentations in rural south-west Victoria decrease on high-heat days. This decrease was more prominent in the farming cohort; a potential explanation for this may be behavioural adaption.
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Affiliation(s)
- Jessie Adams
- National Centre for Farmer Health, Western District Health Service, Hamilton, VIC 3300, Australia;
- Correspondence: ; Tel.: +61-3-5551-8533
| | - Susan Brumby
- National Centre for Farmer Health, Western District Health Service, Hamilton, VIC 3300, Australia;
| | - Kate Kloot
- School of Medicine, Deakin University, Warrnambool, VIC 3280, Australia;
| | - Tim Baker
- Centre for Rural Emergency Medicine, Deakin University, Warrnambool, VIC 3280, Australia;
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia;
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Kayambankadzanja RK, Samwel R, Baker T. Pragmatic sedation strategies to prevent secondary brain injury in low‐resource settings. Anaesthesia 2022; 77 Suppl 1:43-48. [DOI: 10.1111/anae.15621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 01/22/2023]
Affiliation(s)
- R. K. Kayambankadzanja
- School of Public Health Kamuzu University of Health Science Blantyre Malawi
- Department of Anaesthesia and Intensive Care Queen Elizabeth Central Hospital Blantyre Malawi
| | - R. Samwel
- Department of Anaesthesia and Intensive Care Bugando Medical Centre Mwanza Tanzania
| | - T. Baker
- Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
- Department of Clinical Research London School of Hygiene and Tropical Medicine London UK
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Ndumwa HP, Mboya EA, Amani DE, Mashoka R, Nicholaus P, Haniffa R, Beane A, Mfinanga J, Sunguya B, Sawe HR, Baker T. The burden of respiratory conditions in the emergency department of Muhimbili National Hospital in Tanzania in the first two years of the COVID-19 pandemic: A cross sectional descriptive study. PLOS Glob Public Health 2022; 2:e0000781. [PMID: 36962777 PMCID: PMC10021642 DOI: 10.1371/journal.pgph.0000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022]
Abstract
Globally, respiratory diseases cause 10 million deaths every year. With the COVID-19 pandemic, the burden of respiratory illness increased and led to significant morbidity and mortality in both high- and low-income countries. This study assessed the burden and trend of respiratory conditions among patients presenting to the emergency department of Muhimbili National Hospital in Tanzania and compared with national COVID-19 data to determine if this knowledge may be useful for the surveillance of disease outbreaks in settings of limited specific diagnostic testing. The study used routinely collected data from the electronic information system in the Emergency Medical Department (EMD) of Muhimbili National Hospital in Tanzania. All patients presenting to the EMD in a 2-year period, 2020 and 2021 with respiratory conditions were included. Descriptive statistics and graphical visualizations were used to describe the burden of respiratory conditions and the trends over time and to compare to national Tanzanian COVID-19 data during the same period. One in every four patients who presented to the EMD of the Muhimbili National Hospital had a respiratory condition- 1039 patients per month. Of the 24,942 patients, 52% were males, and the median age (IQR) was 34.7 (21.7, 53.7) years. The most common respiratory diagnoses were pneumonia (52%), upper respiratory tract infections (31%), asthma (4.8%) and suspected COVID-19 (2.5%). There were four peaks of respiratory conditions coinciding with the four waves in the national COVID-19 data. We conclude that the burden of respiratory conditions among patients presenting to the EMD of Muhimbili National Hospital is high. The trend shows four peaks of respiratory conditions in 2020-2021 seen to coincide with the four waves in the national COVID-19 data. Real-time hospital-based surveillance tools may be useful for early detection of respiratory disease outbreaks and other public health emergencies in settings with limited diagnostic testing.
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Affiliation(s)
- Harrieth P Ndumwa
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Erick A Mboya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Davis Elias Amani
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ramadhani Mashoka
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Paulina Nicholaus
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- University College London Hospitals, London, United Kingdom
| | - Abi Beane
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Juma Mfinanga
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hendry R Sawe
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tim Baker
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
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Kissler SM, Fauver JR, Mack C, Tai CG, Breban MI, Watkins AE, Samant RM, Anderson DJ, Metti J, Khullar G, Baits R, MacKay M, Salgado D, Baker T, Dudley JT, Mason CE, Ho DD, Grubaugh ND, Grad YH. Viral Dynamics of SARS-CoV-2 Variants in Vaccinated and Unvaccinated Persons. N Engl J Med 2021; 385:2489-2491. [PMID: 34941024 PMCID: PMC8693673 DOI: 10.1056/nejmc2102507] [Citation(s) in RCA: 150] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC
| | | | | | | | | | | | | | | | | | - David D Ho
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Milner G, Jessel I, Ho N, Robert O'Neill J, Martin J, Alagarsamy F, Baker T. P-OGC64 High Fidelity Patient-Reported Outcome Monitoring following Upper Gastrointestinal and Hepato-Pancreato-Biliary Cancer Surgery. Early Experience with a Novel Application. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Patients undergoing complex upper-gastrointestinal and hepatopancreatobiliary resections experience a high incidence of post-operative symptoms. There is significant scope to expand clinicians’ understanding of longitudinal symptom progression and recognise a greater range of post-operative symptoms than those traditionally recorded. By identifying symptoms most troublesome to patients we anticipate improvement in patients’ symptom management, the surgical consent process and, ultimately, patient experience. The myICUvoice application provides patients with the opportunity to report symptoms across a wide range of domains in real-time. We report our early experience using this application with patients in the post-operative setting.
Methods
Following institutional governance approval, consecutive patients undergoing pancreatic, or hepatic (H) or oesophagogastric (U) resectional surgery during a four week period at a single tertiary centre were offered the opportunity to use the application. From day-1 post-op to discharge, each patient completed surveys at least twice daily, reporting their experience across a list of 34 symptoms together with pain, breathing, mood and physical state. Both individual and cohort time-series data were obtained for each symptom and stratified by resection type. A dashboard has been developed as part of the application to allow summary data to be easily displayed.
Results
342 symptom surveys were completed by a total of 15 patients (5U, 10H). The median length-of-stay was 11-days and 91% of patients completed 2 surveys/day (Table-1). High frequency symptoms were tiredness (reported in H:80%;U:86% of surveys), dry mouth (14/15 patients, H:91%,U:59%) and uncomfortable position (13/15 patients, H:27%,U:43%). Whilst most patients remained happy, there were frequent reports of psychological distress; 53% reported nightmares (H:6%,U:12% of surveys), 67% felt depressed, (H:12%,U:6% of surveys) and 53% anxious (H:14%,U:6% of surveys). Pain statement analysis (Figure-1) revealed distinct profiles providing high resolution data on the efficacy of analgesic regimes/techniques.
Conclusions
As expected, our patient cohort experienced a wide range, and high frequency, of post-operative symptoms. Experience conducting symptom surveys demonstrated a high incidence of disconnect between clinical expectations and reported symptoms. Our data illustrate the value of detailed symptom monitoring and this application could be used routinely to measure and improve the patient experience. Further research is planned to compare the performance of these standardised symptom surveys to current methods of identifying symptoms. Furthermore, data from specific patient populations could better inform patient expectations of the post-operative symptoms they may experience, thus improving the surgical consent process.
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Affiliation(s)
- George Milner
- Department of Anaesthesia, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Irene Jessel
- Department of Anaesthesia, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Natalie Ho
- Department of Anaesthesia, Cambridge University Hospitals, Cambridge, United Kingdom
| | | | - Jack Martin
- Department of Surgery, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Famila Alagarsamy
- Department of Anaesthesia, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Tim Baker
- Department of Anaesthesia, Cambridge University Hospitals, Cambridge, United Kingdom
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Torres-Rueda S, Sweeney S, Bozzani F, Naylor NR, Baker T, Pearson C, Eggo R, Procter SR, Davies N, Quaife M, Kitson N, Keogh-Brown MR, Jensen HT, Saadi N, Khan M, Huda M, Kairu A, Zaidi R, Barasa E, Jit M, Vassall A. Stark choices: exploring health sector costs of policy responses to COVID-19 in low-income and middle-income countries. BMJ Glob Health 2021; 6:e005759. [PMID: 34857521 PMCID: PMC8640196 DOI: 10.1136/bmjgh-2021-005759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/05/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES COVID-19 has altered health sector capacity in low-income and middle-income countries (LMICs). Cost data to inform evidence-based priority setting are urgently needed. Consequently, in this paper, we calculate the full economic health sector costs of COVID-19 clinical management in 79 LMICs under different epidemiological scenarios. METHODS We used country-specific epidemiological projections from a dynamic transmission model to determine number of cases, hospitalisations and deaths over 1 year under four mitigation scenarios. We defined the health sector response for three base LMICs through guidelines and expert opinion. We calculated costs through local resource use and price data and extrapolated costs across 79 LMICs. Lastly, we compared cost estimates against gross domestic product (GDP) and total annual health expenditure in 76 LMICs. RESULTS COVID-19 clinical management costs vary greatly by country, ranging between <0.1%-12% of GDP and 0.4%-223% of total annual health expenditure (excluding out-of-pocket payments). Without mitigation policies, COVID-19 clinical management costs per capita range from US$43.39 to US$75.57; in 22 of 76 LMICs, these costs would surpass total annual health expenditure. In a scenario of stringent social distancing, costs per capita fall to US$1.10-US$1.32. CONCLUSIONS We present the first dataset of COVID-19 clinical management costs across LMICs. These costs can be used to inform decision-making on priority setting. Our results show that COVID-19 clinical management costs in LMICs are substantial, even in scenarios of moderate social distancing. Low-income countries are particularly vulnerable and some will struggle to cope with almost any epidemiological scenario. The choices facing LMICs are likely to remain stark and emergency financial support will be needed.
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Affiliation(s)
- Sergio Torres-Rueda
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiammetta Bozzani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Nichola R Naylor
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Tim Baker
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Carl Pearson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rosalind Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon R Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nicholas Davies
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew Quaife
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nichola Kitson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Marcus R Keogh-Brown
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Henning Tarp Jensen
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Nuru Saadi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Mishal Khan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Honorary Faculty, The Aga Khan University, Karachi, Pakistan
| | - Maryam Huda
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Angela Kairu
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Raza Zaidi
- Health Planning, System Strengthening and Information Analysis Unit, Pakistan Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan
| | - Edwine Barasa
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Wooldridge G, O'Brien N, Muttalib F, Abbas Q, Adabie Appiah J, Baker T, Bansal A, Basnet S, Campos-Miño S, de Souza DC, Díaz F, Dramowski A, Fernández-Sarmiento J, Fustiñana A, González G, Jabornisky R, Jaramillo-Bustamante JC, Yek Kee C, Lang HJ, Soares Lanziotti V, Kohn Loncarica G, Mohsenibod H, Ode B, Murthy S, Andre-von Arnim AVS, Hansmann A, González-Dambrauskas S. Challenges of implementing the Paediatric Surviving Sepsis Campaign International Guidelines 2020 in resource-limited settings: A real-world view beyond the academia. Andes Pediatr 2021; 92:954-962. [PMID: 35506809 DOI: 10.32641/andespediatr.v92i6.4030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/28/2021] [Indexed: 06/14/2023]
Abstract
The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children was released in 2020 and is intended for use in all global settings that care for children with sepsis. However, practitioners managing children with sep sis in resource-limited settings (RLS) face several challenges and disease patterns not experienced by those in resource-rich settings. Based upon our collective experience from RLS, we aimed to reflect on the difficulties of implementing the international guidelines. We believe there is an urgent need for more evidence from RLS on feasible, efficacious approaches to the management of sepsis and septic shock that could be included in future context-specific guidelines.
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Affiliation(s)
| | | | - Fiona Muttalib
- Department of Paediatric Critical Care, BC Children's Hospital, Vancouver, Canada
| | - Qalab Abbas
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - John Adabie Appiah
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Arun Bansal
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sangita Basnet
- School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | | | | | - Franco Díaz
- Escuela de Postgrado, Universidad Finis Terrae, Santiago, Chile
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - Ana Fustiñana
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo González
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | - Hans-Joerg Lang
- Global Child Health Department, University Witten/Herdecke. Witten, Germany
| | - Vanessa Soares Lanziotti
- Paediatric Intensive Care Unit & Research and Education Division/Maternal and Child Health Postgraduate Program, Federal University of Rio De Janeiro. Rio De Janeiro, Brazil
| | - Guillermo Kohn Loncarica
- Paediatric Emergency Department, Hospital Juan P. Garrahan. Buenos Aires, Argentina; Universidad de Buenos Aires (UBA). Argentina; and Sociedad Latinoamericana de Emergencia Pediatrica (SLEPE)
| | - Hadi Mohsenibod
- PICU, The Hospital for Sick Children. Toronto, Canada; and ERU delegate, Canadian Red Cross, Canada
| | - Bunmi Ode
- Pédiatre Reanimatrice volante. NGO ALIMA-The Alliance for International Medical Action, Senegal
| | - Srinivas Murthy
- Department of Paediatric Critical Care, BC Children's Hospital. Vancouver, Canada
| | - Amelie von Saint Andre-von Arnim
- Department of Pediatrics, Division of Paediatric Critical Care, University of Washington, Seattle Children's. Seattle, USA; and Paediatric Emergency and Critical Care, University of Nairobi. Nairobi, Kenya
| | | | - Sebastián González-Dambrauskas
- Cuidados Intensivos Pediátricos Especializados (CIPe), Casa de Galicia. Montevideo, Uruguay; and Red Colaborativa Pediátrica de Latinoamérica (LARed Network)
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Kayambankadzanja RK, Schell CO, Mbingwani I, Mndolo SK, Castegren M, Baker T. Unmet need of essential treatments for critical illness in Malawi. PLoS One 2021; 16:e0256361. [PMID: 34506504 PMCID: PMC8432792 DOI: 10.1371/journal.pone.0256361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/04/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Critical illness is common throughout the world and has been the focus of a dramatic increase in attention during the COVID-19 pandemic. Severely deranged vital signs such as hypoxia, hypotension and low conscious level can identify critical illness. These vital signs are simple to check and treatments that aim to correct derangements are established, basic and low-cost. The aim of the study was to estimate the unmet need of such essential treatments for severely deranged vital signs in all adults admitted to hospitals in Malawi. METHODS We conducted a point prevalence cross-sectional study of adult hospitalized patients in Malawi. All in-patients aged ≥18 on single days Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH) were screened. Patients with hypoxia (oxygen saturation <90%), hypotension (systolic blood pressure <90mmHg) and reduced conscious level (Glasgow Coma Scale <9) were included in the study. The a-priori defined essential treatments were oxygen therapy for hypoxia, intravenous fluid for hypotension and an action to protect the airway for reduced consciousness (placing the patient in the lateral position, insertion of an oro-pharyngeal airway or endo-tracheal tube or manual airway protection). RESULTS Of the 1135 hospital in-patients screened, 45 (4.0%) had hypoxia, 103 (9.1%) had hypotension, and 17 (1.5%) had a reduced conscious level. Of those with hypoxia, 40 were not receiving oxygen (88.9%). Of those with hypotension, 94 were not receiving intravenous fluids (91.3%). Of those with a reduced conscious level, nine were not receiving an action to protect the airway (53.0%). CONCLUSION There was a large unmet need of essential treatments for critical illness in two hospitals in Malawi.
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Affiliation(s)
- Raphael Kazidule Kayambankadzanja
- University of Malawi, College of Medicine, Blantyre, Malawi
- Department of Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
- * E-mail:
| | - Carl Otto Schell
- Health Systems & Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Internal Medicine, Nyköping Hospital, Sörmland Region, Nyköping, Sweden
| | - Isaac Mbingwani
- University of Malawi, College of Medicine, Blantyre, Malawi
- Chiradzulu District Hospital, Chiradzulu, Malawi
| | - Samson Kwazizira Mndolo
- Department of Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Markus Castegren
- CLINTEC and FyFa, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine & Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Tim Baker
- University of Malawi, College of Medicine, Blantyre, Malawi
- Department of Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Health Systems & Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine & Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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49
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Schell CO, Khalid K, Wharton-Smith A, Oliwa J, Sawe HR, Roy N, Sanga A, Marshall JC, Rylance J, Hanson C, Kayambankadzanja RK, Wallis LA, Jirwe M, Baker T. Essential Emergency and Critical Care: a consensus among global clinical experts. BMJ Glob Health 2021; 6:e006585. [PMID: 34548380 PMCID: PMC8458367 DOI: 10.1136/bmjgh-2021-006585] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/19/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19. METHODS In a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC's Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements. RESULTS The 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19. CONCLUSION The study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.
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Affiliation(s)
- Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Internal Medicine, Nyköping Hospital, Nyköping, Sweden
| | - Karima Khalid
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Alexandra Wharton-Smith
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacquie Oliwa
- KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The George Institute for Global Health India, New Delhi, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, BARC Hospital, Mumbai, India
| | - Alex Sanga
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - John C Marshall
- Departments of Surgery and Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jamie Rylance
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Raphael K Kayambankadzanja
- Department of Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
- School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Maria Jirwe
- Department of Health Sciences, The Red Cross University College, Huddinge, Sweden
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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50
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Kazibwe J, Shah HA, Kuwawenaruwa A, Schell CO, Khalid K, Tran PB, Ghosh S, Baker T, Guinness L. Resource availability, utilisation and cost in the provision of critical care in Tanzania: a protocol for a systematic review. BMJ Open 2021; 11:e050881. [PMID: 34433607 PMCID: PMC8388301 DOI: 10.1136/bmjopen-2021-050881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/16/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Critical care is essential in saving lives of those that are critically ill, however, provision of critical care can be costly and heterogeneous across lower-resource settings. This paper describes the protocol for a systematic review of the literature that aims to identify the reported costs and resources available for the provision of critical care and the forms of critical care provision in Tanzania. METHODS AND ANALYSIS The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (MEDLINE, Embase and Global Health) will be searched to identify articles that report the forms of critical care, resources used in the provision of critical care in Tanzania, their availability and the associated costs. The search strategy will be developed from four key concepts; critical care provision, critical illness, resource use, Tanzania. The articles that fulfil the inclusion and exclusion criteria will be assessed for quality using the Reference Case for Estimating the Costs of Global Health Services and Interventions checklist. The extracted data will be summarised using descriptive statistics including frequencies, mean and median of the quantity and costs of resources used in the components of critical care services, depending on the data availability. This study will be carried out between February and November 2021. ETHICS AND DISSEMINATION This study is a review of secondary data and ethical clearance was sought from and granted by the Tanzanian National Institute of Medical Research (reference: NIMR/HQ/R.8a/Vol. IX/3537) and London School of Hygiene and Tropical Medicine (ethics ref: 22866). We will publish the review in a peer-reviewed journal as an open access article in addition to presenting the findings at conferences and public scientific gatherings. PROSPERO REGISTRATION NUMBER The protocol was registered with PROSPERO; registration number: CRD42020221923.
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Affiliation(s)
- Joseph Kazibwe
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Hiral A Shah
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Department of Infectious Disease Epidemiology, Center for Global Development, London, UK
| | - A Kuwawenaruwa
- Health System Impact Evaluation and Policy Unit, Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health, Uppsala University, Uppsala, Sweden
| | - Karima Khalid
- Health System Impact Evaluation and Policy Unit, Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Department of Anaesthesia and Critical Care, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Phuong Bich Tran
- Department of Family and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Srobana Ghosh
- Global Health Department, Center for Global Development, London, UK
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lorna Guinness
- Global Health Department, Center for Global Development, London, UK
- Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
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