‘There are many millions of papers of clinical research — approximately 1 million papers from clinical trials have been published to date, along with tens of thousands of systematic reviews — but most of them are not useful.’ This is the central message of an essay by John Ioannidis in the open-access journal PLoS Medicine. Below are two extracts, citation, and abstract. The full text is here:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002049

“Useful clinical research” means that it can lead to a favorable change in decision making (when changes in benefits, harms, cost, and any other impact are considered) either by itself or when integrated with other studies and evidence in systematic reviews, meta-analyses, decision analyses, and guidelines.’

‘Overall, not only are most research findings false, but, furthermore, most of the true findings are not useful. Medical interventions should and can result in huge human benefit. It makes no sense to perform clinical research without ensuring clinical utility. Reform and improvement are overdue.’

CITATION: Ioannidis JPA (2016) Why Most Clinical Research Is Not Useful. PLoS Med 13(6): e1002049. doi:10.1371/journal.pmed.1002049

Published: June 21, 2016

SUMMARY POINTS

– Blue-sky research cannot be easily judged on the basis of practical impact, but clinical research is different and should be useful. It should make a difference for health and disease outcomes or should be undertaken with that as a realistic prospect.

– Many of the features that make clinical research useful can be identified, including those relating to problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency.

– Many studies, even in the major general medical journals, do not satisfy these features, and very few studies satisfy most or all of them. Most clinical research therefore fails to be useful not because of its findings but because of its design.

– The forces driving the production and dissemination of nonuseful clinical research are largely identifiable and modifiable.

– Reform is needed. Altering our approach could easily produce more clinical research that is useful, at the same or even at a massively reduced cost.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Sitting in a classroom at Georgetown Medical School usually reserved for committee meetings, we begin by reading an Emily Dickinson poem about the isolating power of sadness:

I measure every Grief I meet
With narrow, probing, eyes –
I wonder if It weighs like Mine –
Or has an Easier size.

It’s a strange sight: me, a surgical resident, reading poetry to 30 medical students late on a Tuesday night. Some of us are in scrubs, others in jeans; there are no white coats. Over the past four years, as the leader of the group, this has become my routine.

The students are here after long days in class and on the wards because they have discovered that medical education is changing them in ways that are unsettling. I remember that uneasiness well. My own medical education began with anatomy lab. The first day with the cadaver was unnerving, but after the first week the radio was blaring as we methodically dissected the anonymous body before us….more

See here

Go here to see more

ECONOMISTS and many policy makers think about how things are done, but they do not think much about where things are done. Where economic activity is concentrated in a country can be the difference between poverty and prosperity – for people as well as countries, says the World Bank. No rich country is predominantly rural. No country has grown to middle-income status without urbanising, and none has grown to high-income status without vibrant cities. Cities are the most potent force for social and economic progress and they make possible a standard of living that is inconceivable without them. Cities produce more than 80% of global economic output. The key platforms for national, regional and global growth are urban. The economies of SA’s major cities consistently outperform those of its towns and rural areas. The eight largest cities are home to about 37% of South Africans, yet they account for 59% of economic activity. Average per capita income in the metropolitan areas is about 60% higher than the national average, and is nearly four times higher than that in the rural areas……more

The Hippo Water Roller is used to gather water in developing countries. It was designed by two South Africans who grew up in rural areas. here

Below are extracts from an excellent blog (book chapter) by Kate Tulenko, IntraHealth International’s Vice President of Health Systems Innovation. The full text is available here: http://bit.ly/1Q7X7dC

—

This is the tenth chapter of the CHW Reference Guide produced under the Maternal and Child Health Integrated Program, the United States Agency for International Development Bureau for Global Health’s flagship maternal, neonatal and child health project.

Chapter 10 of the CHW Reference Guide explores the critical and complex issue of the supervision of community health workers (CHWs). Supervision of CHWs is a core health systems function that is often poorly understood and undervalued. Supervision is often incorrectly viewed as policing or as an unnecessary expense, but as this chapter shows, when supervision is properly designed and implemented, it can yield significant rewards in terms of quality of care, productivity, and retention of health workers…

There is still much to be done in the field of supervision, many innovations to be tested and challenges to be explored… The role of supervision of CHWs as a form of governance also needs greater recognition and exploration. CHWs are often the only formal representative of the central government in many communities.

Supervision is strongly linked to citizen voice and to women’s empowerment. When community members have a role in supervising their CHWs, they can — sometimes for the first time — have a say in the delivery of government service…

Ultimately, CHWs have special supervision needs. Their general level of education, literacy, and numeracy is usually much lower than other health workers and their period of formal CHW training is often less than a year…

—

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

CITATION: Evidence-based medicine for all: what we can learn from a programme providing free access to an online clinical resource to health workers in resource-limited settings

Yannis K Valtis, Julie Rosenberg, Sudip Bhandari, Keri Wachter, Marie Teichman, Sophie Beauvais, Rebecca Weintraub

Valtis YK, et al. BMJ Glob Health 2016;1:e000041. doi:10.1136/bmjgh-2016-000041

http://gh.bmj.com/content/bmjgh/1/1/e000041.full.pdf

Correspondence to Dr Rebecca Weintraub: Rebecca@globalhealthdelivery.org

ABSTRACT

The rapidly changing landscape of medical knowledge and guidelines requires health professionals to have immediate access to current, reliable clinical resources. Access to evidence is instrumental in reducing diagnostic errors and generating better health outcomes. UpToDate, a leading evidence-based clinical resource is used extensively in the USA and other regions of the world and has been linked to lower mortality and length of stay in US hospitals. In 2009, the Global Health Delivery Project collaborated with UpToDate to provide free subscriptions to qualifying health workers in resource-limited settings. We evaluated the provision of UpToDate access to health workers by analysing their usage patterns. Since 2009, ~2000 individual physicians and healthcare institutions from 116 countries have received free access to UpToDate through our programme. During 2013–2014, users logged into UpToDate ~150 000 times; 61% of users logged in at least weekly; users in Africa were responsible for 54% of the total usage. Search patterns reflected local epidemiology with ‘clinical manifestations of malaria’ as the top search in Africa, and ‘management of hepatitis B’ as the top search in Asia. Our programme demonstrates that there are barriers to evidence-based clinical knowledge in resource-limited settings we can help remove. Some assumed barriers to its expansion (poor internet connectivity, lack of training and infrastructure) might pose less of a burden than subscription fees.

SELECTED EXTRACTS (selected by Neil PW)

‘according to WHO estimates, there are more than 100 000 physicians working in low-income countries; yet, only 1948 health workers applied for access to our programme.’

‘The relevance, or lack thereof, of EBCRs [Evidence based clinical reseources] in general, and UpToDate in particular, to LMIC clinical needs has not been evaluated: It is possible that UpToDate’s recommendations on clinical care are different from, and even in conflict with, local practice and guidelines. It is also possible that UpToDate recommends the use of diagnostic procedures and

therapeutic interventions that are unavailable in LMICs due to high cost or other constraints.’

‘It is clear that cost is one barrier to EBCRs that will need to be removed to realise the vision for evidence-based medicine for all. We are hopeful that the next steps towards this vision will be

bigger and broader and close the knowledge gap quickly.’

In an interview on Global Health Hub, the lead author puts forward an interesting hypothesis on the finding that topics such as heart failure, stroke, diabetes, and hypertension were extremely popular. One reason for this is of course the rising burden of NCDs. But another possible explanation is that existing guidance (and experience) on NCDs might not be widespread as compared with guidance on diseases that haave always been common, such as malaria. http://www.globalhealthhub.org/2016/06/13/access-to-information-literally-saves-lives-free-access-to-uptodate-in-lmics/

—

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

WONCA E-Update
Friday 17th June 2016

WONCA News – June 2016
The latest WONCA News is available via the WONCA website, packed with WONCA news, views and events.

World Family Doctor Day
Since its establishment by WONCA in 2010, World Family Doctor Day  – 19th May – has gained momentum each year and provides a wonderful opportunity to acknowledge the central role of family doctors in the delivery of personal, comprehensive and continuing health care for all people in every country. It is also a chance to celebrate the progress being made in recognizing the important role of family medicine in strengthening primary health care in each of our countries, and the special contributions that are made by wonderful individual family doctors all around the world.

This year there were more activities than ever, and WONCA News contains reports from many of our Member Organizations on how they celebrated this important day in our calendar.  There are many reports and messages, including a message from our President, Professor Michael Kidd.

Rural Roundup – Dr Rabia Afridi of Pakistan
Rural roundup always presents a fascinating picture of the lives of our colleagues working in rural and remote locations, but this month’s rural roundup from Pakistan is particularly fascinating.  The first of a two-part article, Dr Rabia Afridi describes her work in a Basic Health Unit (BHU) in CHAK 18, situated to the East of the Changa Manga forest in the Punjab province of Pakistan, where she has worked since 2014.  We urge you all to read this article from an incredible rural colleague.

From the CEO’s Desk
This month our CEO, Dr Garth Manning, reports on the latest Conference Planning Committee meeting held in Rio de Janeiro in April, and also reports on two fantastic events in Costa Rica – the Cumbre, or health summit, on 12th and 13th April and the first-ever Meso (central) American conference from 14th to 16th April. He highlights the changes to the WONCA website and also offers some advice on Zika virus in Latin America.

Global Jobs – WONCA jobs portal
WONCA has recently launched a jobs portal where you can find job listings for family doctors, locums, specialists, allied health professionals, medical support staff and academics from around the world.  You can also advertise a vacancy, and there are special rates for all WONCA members.  For more information go to www.globalfamilydoctor.com and click on the “Global Jobs” sidebar.

The new global mHealth compendium has come out, produced by USAID (see the note below), and the direct link is http://www.africanstrategies4health.org/uploads/1/3/5/3/13538666/2016_mhealth_31may16_final.pdf

It is the sixth edition, and expected to be the last. It is worth reading – the intro is a 10 page summary of eexperience (evidence, best tools, best resources, what you need to consider for sustainable scale). Then there case studies of the 10 most significant projects. They are:

– Airtel Insurance (health micro-insurance in 7 African countries)

– Aponjon (maternal health messaging in Bangladesh, part of MAMA)

– cStock (medical supply chain in Malawi)

– iCCM (mobile tool for health workers doing integrated community case management in Malawi)

– Kilkari (maternal health messaging via voice, train community health workers in India)

– mHERO (health worker SMS messaging for targeted care, in 6 countries mainly in West Africa)

– MomConnect (maternal health messaging fully in health system in South Africa)

– mSOS (disease surveillance reporting in Kenya)

– RapidSMS Rwanda (preventing maternal & child death in 1,000 days in Rwanda)

– U-Report (preventing adolescent AIDS through mobile counselling and polling in Uganda).

There is a lot to learn from here.

Best wishes,

Peter

HIFA profile: Peter Benjamin is SA director of HealthEnabled, South Africa. Professional interests: Digital health, mHealth, Empowerment through health information. Email address: peter AT healthenabled.org

Health Communication Capacity Collaborative (HC3) ‘Factors Impacting the Effectiveness of Community Health Worker Behavior Change: A Literature Review’ which examines the barriers and facilitators to CHW service provision in three areas: knowledge and competency, structural and contextual barriers, and motivational barriers

EXECUTIVE SUMMARY

Social and behavior change communication (SBCC), which uses communication to positively influence the social dimensions of health and well-being,

is an important strategy for improving health services at the provider level. As community health workers (CHWs) play an increasingly important role in providing health services, there is also an increasing focus on to how to use SBCC strategies to build CHWs’ capacity to offer quality services to the community members they serve. A key step in designing and implementing effective SBCC programs for CHWs is understanding the barriers and facilitators that effect CHWs in providing these services. The aim of this literature review is to examine the barriers and facilitators to CHW service provision in three areas: knowledge and competency barriers in which CHWs lack the skills and knowledge to provide services, structural and contextual barriers in which systemic and environmental factors influence CHWs’ ability to provide services, and motivational barriers in which social norms and attitudes that effect CHWs willingness to provide services. In all three areas, findings revealed that CHWs face significant barriers, ranging from lack of materials and high workloads to ingrained attitudes and insufficient training. The results and recommendations in this paper can be used to anticipate and respond to potential barriers and promote facilitators to service provision through SBCC programs for CHWs.

RECOMMENDATIONS

– CHW programs should have provisions for providing additional trainings that are responsive to CHW and community needs.

– If additional tasks are assigned to CHWs after the initial training, they should be coupled with corresponding trainings.

– CHW programs should be designed with resources designated for periodic refresher trainings.

– Training programs should match the expertise needed to master content and skills.

– Communication programs should work to clearly establish the role of CHWs within the community to manage community-level expectations.

– Programs should supply on-site mentorship or access to experts to supplement training.

– Trainings should move beyond teaching technical skills and include “soft” skills, such as time management, problem solving and communication.

– CHW programs should include training for supervisors and other health staff to ensure appropriate support for CHWs.

– Job descriptions for CHWs should be written through an inclusive process involving CHWs and impacted health workers.

– Scopes of work and targets should be based on realistic expectations and take into account the time required for communicating the information required and for travel.

– Community members should be engaged with CHW program development early in the process to secure support and buy-in.

– When designing CHW programs, care should be taken to ensure that appropriate systems and policies are in place to facilitate CHW service delivery objectives.

– Similarly, program planning should ensure that sustainable and ongoing resources are available to provide the supplies necessary for the assigned CHW responsibilities.

– Thoughtful consideration should be given to incentive structures as part of a strategy to retain trained CHWs.

– Programs should look beyond impacting CHWs to influencing the wider community, finding ways to engage the community around issues of stigma and discrimination.

– Recognition for CHWs’ contributions, both within the health system and in the community, and when possible, opportunities for advancement, should be included as part of a CHW program.

– CHW training should include components to help CHWs recognize and overcome their own preconceptions and stigma.

– If appropriate, selection of CHWs should include screening for stigmatizing beliefs held by CHWs that might impact their ability to provide equal and quality care for all community members.

The full review can be downloaded here: http://bit.ly/1sLLdf5

The following is a summery of the review from the CI website:

‘This 24-page literature review was produced to inform how social and behaviour change communication (SBCC) programmes can contribute to improving services provided by community health workers (CHWs) and strengthen their ability to effectively deliver quality health care to community members. Produced as part of the Health Communication Capacity Collaborative (HC3) project, the literature review examines barriers and facilitating factors for CHWs in three areas: knowledge and competency, structural and contextual barriers (systemic and environmental factors), and motivational barriers (such as social norms and attitudes that effect CHWs willingness to provide services).

‘Findings revealed that “CHWs face significant barriers, ranging from lack of materials and high workloads to ingrained attitudes and insufficient training.” The report shares results and recommendations that can be used to anticipate and respond to potential barriers and promote facilitators to service provision through SBCC programmes for CHWs.

‘Based on a literature review, which included both peer-reviewed journals and grey literature on the topic of CHWs (with a particular focus on CHWs abilities, performance and attitudes), limited to resources published in the last 10 years focussing on middle- and lower-income countries, the report outlines a number of key findings, summarised briefly below:

‘Knowledge and Competency Barriers

As discussed in the report, knowledge is an important factor in determining the success of a CHW programme, yet health workers often lack the knowledge necessary to safely and effectively perform their responsibilities. Research also shows that many programmes continue to provide training that is insufficient or of poor quality, resulting in knowledge gaps among health workers. These knowledge barriers comprise both technical topics, such as around contraceptive methods, as well as non-technical knowledge such as problem-solving or time management. It was also found that the role of CHWs is continually expanding, with community demands of and expectations for CHWs often extending beyond the scope of CHWs knowledge and competencies. This requires continual monitoring and responsive training, possibly integrating peer learning. Below are a few selected recommendations outlined in the report.

“CHW programs should have provisions for providing additional trainings that are responsive to CHW and community needs.”

“Communication programs should work to clearly establish the role of CHWs within the community to manage community-level expectations.”

“Programs should supply on-site mentorship or access to experts to supplement training.”

‘Structural and Contextual Barriers

This section discusses how institutionalised and structural deficiencies can pose significant barriers to CHWs. CHWs’ informal position within the health sector itself can lead to difficult relationships between CHWs and professional health workers, which can be avoided by effectively engaging both throughout the planning process. Other structural challenges include limited resources and capacity at the facilities that CHWs may refer their clients, heavy workloads, and lack of necessary supplies and resources. Other contextual barriers result from the community’s attitude toward and support for CHW activities. This can include lack of clarity on the CHWs role, as well as stigma and tradition around controversial health topics, such as family planning. CHW programmes benefit significantly from interventions that encourage community ownership and community support for the CHWs and their activities. Below are a just a few selected recommendations outlined in the report:

“Community members should be engaged with CHW program development early in the process to secure support and buy-in.”

“When designing CHW programs, care should be taken to ensure that appropriate systems and policies are in place to facilitate CHW service delivery objectives.”

“Programs should look beyond impacting CHWs to influencing the wider community, finding ways to engage the community around issues of stigma and discrimination.”

‘Attitudinal Barriers

The third section outlines how CHWs’ attitudes toward their work, controversial health topics, or certain individuals or groups within their community can prevent them from providing health services. “However, these attitudinal barriers also present opportunities in which SBCC programs can be particularly effective in influencing CHWs and thereby improving service delivery.” This largely focuses on improving motivation and countering stigma and negative attitudes among CHWs themselves. These could be negative attitudes toward certain health topics – such as HIV/AIDS or family planning – but can also be a result of stigmatising attitudes toward individuals based on socio-economic status, ethnic profile, or perceived affiliations. The following are a few selected recommendations:

“Recognition for CHWs’ contributions, both within the health system and in the community, and when possible, opportunities for advancement, should be included as part of a CHW program.”

“CHW training should include components to help CHWs recognize and overcome their own preconceptions and stigma.”

“If appropriate, selection of CHWs should include screening for stigmatizing beliefs held by CHWs that might impact their ability to provide equal and quality care for all community members.”

‘The report concludes that “while identifying and understanding barriers can assist in the design and implementation of SBCC programs, additional research is needed to evaluate the actual impact of SBCC programs in overcoming these barriers. Some knowledge and attitudinal barriers may be easily addressed through communication strategies, however, more serious systemic barriers may prove more challenging to resolve.”‘

—

Best wishes,

Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

As South Africa grapples with how to implement “universal health service” via the National Health Insurance, a specialist advises more pragmatism and less ideology.

Just as the apartheid regime fed it’s supporters with horror stories about marauding ‘Reds’ out to confiscate everything privately owned, so some post-apartheid ANC leaders have made the private sector synonymous with everything that is greedy and selfish.

Like most things, the truth is often found somewhere in between, which is why the “triple Ps” – public-private partnerships – can be effective in delivering services by harnessing the public sector’s mandate to deliver services to all with private sector’s often more efficient delivery mechanisms….more

Despite the SA government having pumped more than R1bn into 11 National Health Insurance pilot districts over five years, medical care in these areas has not improved much – and in some cases has worsened, reports the Sunday Times. Doctors, dentists, nurses, physiotherapists, activists and business people recently filed their responses to the NHI white paper, which details an initiative to improve clinics and create a single state-run medical aid — “which would spell the end of medical aids in their current form”. The report says according to various submissions, there was little to show for the money spent on the NHI pilot project, and the state sector remained in appalling shape. Some submissions criticised the lack of information about the NHI scheme, saying little could be learnt from the 11 pilot projects or about how the money had been spent….more

Overworked SA junior doctors are calling for new regulations on working hours following the death of a young intern who allegedly fell asleep behind the wheel after working a very long shift. The Cape Times reports that young doctors are blaming the Western Cape Department of Health and the Health Professions Council of SA (HPCSA) for allowing interns to work shifts of up to 30 hours or even longer. The matter was raised by a concerned citizen and member of the medical profession, Dr John Roos, who wrote a letter to the newspaper to highlight doctors’ concerns…….more

http://m.jamia.oxfordjournals.org/content/23/3/544.full

CITATION: William M Tierney et al. Assessing the impact of a primary care electronic medical record system in three Kenyan rural health centers. J Am Med Inform Assoc (2016) 23 (3): 544-552. doi: 10.1093/jamia/ocv074

ABSTRACT

Objective: Efficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers.

Method: Local clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers’ satisfaction with the EMR.

Results: Between September 2008 and December 2011, 72 635 primary care patients were registered and 114 480 encounter forms were completed. During 2011, 32 193 unique patients visited primary care clinics, and encounter forms were completed for all visits. Of 1031 (3.2%) who were HIV-infected, 85% received HIV care.

Patient clinic time increased from 37 to 81 min/visit after EMR implementation in one health center and 56 to 106 min/visit in the other. However, outpatient visits to both health centers increased by 85%. Three-quarters of increased time was spent waiting. Despite nearly doubling visits, there was no change in clinical officers’ work patterns, but the nurses’ and the clerks’ patient care time decreased after EMR implementation. Providers were generally satisfied with the EMR but desired additional training.

Conclusions: We successfully implemented a primary care EMR in three rural Kenyan health centers. Patient waiting time was dramatically lengthened while the nurses’ and the clerks’ patient care time decreased. Long-term use of EMRs in such settings will require changes in culture and workflow.

‘Effective and efficient patient care management requires information. Improving information capture and flow should allow low-resource countries to deliver the most care and realize the best outcomes possible for the restricted funds available for health care. EMRs can enhance the timely capture and use of key medical data by providers and health system managers. Much additional research and development is needed before EMRs can be most useful, fully implemented into developing countries’ health care settings, and used to manage and improve patient care.’

—

As a personal comment, electronic medical records are desirable for many reasons and most high-income countries are investing large sums of money to implement them. They have the potential to improve individual patient care, partly because information about the patient can be collected (and be built upon) in one place, potentially accessible to all healthcare providers in primary, secondary and tertiary care. Individual patient care can also potentially be enhanced by the avoidance of the need constantly to re-collect the basic information on a patient each time he/she presents, and the consequent risk of missing an important piece of data in the medical history. There is also the potential for the electronic medical record to sit side-by-side with clinical decision-making tools, ranging from alerts to potential drug interactions to algorithms such as those produced by the Map of Medicine (we haven’t heard from them on HIFA for some time – can anyone provide an update?). There is also the issue of personal access to, and ownership of, electronic medical records. And then there is the huge potential benefit to public health, whereby the data from thousands of EMRs can be pooled to provide important evidence for population health and health systems research…

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

IT’S POLL TIME: We like to reach out to our users to help us better plan Trip’s developments. As such we have developed this very brief poll (three questions only). We really do listen – so now’s your time to help make Trip better for you and other Trip users.

COMMUNITY Q&A: An idea we’re working on and looking for volunteers! Trip answers around 70% of the questions users have, so can we provide a function to help with the other 30%? So, we’re at the very early stages of planning a system to allow users to ask their unanswered question to the wider Trip community. We’re really just needing a little bit of your time to help us understand a few issues relating to creating such a community. So, if you’re interested please contact us via community@tripdatabase.com

FASTFACTS: This is a great site we’re starting to work with. It’s a great resource to turn to when you’re looking for a great refresher/overview of a topic. It’s excellently written and they are highly readable and relevant. Visit their site today.

YOUTUBE: We have created a great YouTube Channel with a number of great ‘how to use Trip’ guides. Please follow the link and subscribe, we’re really keen to get 100 subscribers as then we’re given more flexibility by YouTube to make the channel even better!

MEDICAL IMAGES: I’m incredibly pleased with this development. Our medical image search is brilliant, but it’s just got even better. You can now restrict images that are either completely or majorly free to use (permissive/open copyright licences). Read this post for more information

LATEST EVIDENCE: Below is a link below to find the latest evidence, from the Trip Database, that we’ve found for you this month:

Click here for your latest evidence

The evidence is generated from the details you gave us when you registered. If these interests have changed or you want to ‘fine tune’ things you can easily alter your preferences via your profile. If you have any trouble send me an email and I’m sure I’ll be able to help.

SUBSCRIBE TO TRIP PRO: Have a great month and remember Trip is still a great FREE resource. However, Trip Pro is even better with amazing extra content, features and NO adverts. Upgrade today (follow the link to see all the great benefits). Institutional subscriptions are available, via this link.

Trip, making evidence easy to find!

Best wishes

Jon Brassey , Trip Database

Below are the first and concluding paragraphs of an article in the New England Journal of Medicine, highlighting the ‘hell of Syria’s field hospitals’ and paying tribute to the health workers who are struggling to save lives ‘amid all this brutality and madness’.

http://www.nejm.org/doi/full/10.1056/NEJMp1603673?af=R&rss=currentIssue&#t=article

The Hell of Syria’s Field Hospitals by Samer Attar, M.D

“Where’s my mom?” a boy asked as he woke from surgery. Both his legs had been amputated when a missile hit his home in Aleppo, Syria. His mother had died in the blast. It didn’t take him long to realize the answer. […]

As medics, we would go to sleep hoping that when we woke up, the previous day would turn out to have been only a nightmare. No one should ever suffer like this. Yet we’d wake to the truth, and the nightmare day would repeat itself: mangled limbs, dismembered bodies, dead children.

My experience is merely a glimpse of the systematic campaigns of torture, starvation, aerial bombardment, and chemical weapons deployment that are still threatening the Syrian people in their homeland. They have been ongoing since the civil war started 5 years ago. Civilians, homes, schools, hospitals, and markets are deliberately targeted. To date, hundreds of thousands of people have been killed, and millions more have been displaced.

I cannot claim to have the solution to the war, but I know that there are good people in Syria trying to make a difference. There is still some humanity amid all this brutality and madness. Paramedics brave sniper fire to rescue the wounded. White-helmeted rescue workers dig through rubble with their bare hands to find survivors. Doctors and nurses in bombed-out basement hospitals use cell phones to illuminate operations when the power goes out. These good people will be the ones to pick up the pieces if and when this horrific war ends. They don’t plan on abandoning the helpless, and they need all the help they can get.

All I can do from here is bring attention to the suffering of the Syrian people, raise awareness for the exhausted medical workers who care for them, and continue to advocate for their support and protection.”

—

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

The USAID Applying Science to Strengthen and Improve Systems (ASSIST) project is pleased to share our new publication: “Improving Quality of Postpartum Family Planning in Low-Resource Settings: A Framework for Policy Makers, Managers, and Medical Care Providers”

https://www.usaidassist.org/resources/improving-quality-post-partum-family-planning-low-resource-settings

Postpartum Family Planning (PPFP), aiming to prevent the high risk of unintended and closely spaced pregnancies during the first year following childbirth, is one of the highest impact interventions to avoid increased risk of premature birth, low birth weight, fetal and neonatal death, and adverse maternal health outcomes. Despite monumental gains in training and family planning commodities distribution, persistent system, and quality of care gaps continue to prevent many postpartum women from receiving effective PPFP services in low-resource countries. Major barriers include problems at the health facility level, barriers to demand for PPFP, and weaknesses in underlying health system functions needed to support PPFP services. Unmet demand for PPFP services remains high in many countries, resulting in a failure to achieve Healthy Timing and Spacing of Pregnancies (HTSP) and indirectly contributing to high rates of maternal and child mortality.

This framework, developed by ASSIST, is designed to help managers and care providers at all system levels to understand common challenges in PPFP service delivery and specific solutions that may help to close these gaps. It outlines a new approach to improving PPFP services and outcomes, based on well-developed improvement methods that have proven effective and cost effective in other areas of health care. The framework provides a step-by-step approach for how PPFP programs can benefit from the application of improvement methods. A real life example, a case study from work conducted by ASSIST in Niger, is provided to orient participants on how to plan, implement, continuously assess, and refine interventions to improve PPFP services.

The report is based on extensive experience of ASSIST, managed by University Research Co., LLC (URC), and URC’s predecessor health improvement projects in various low- and middle-income settings. It complements the World Health Organization and USAID PPFP 2013 document Programming Strategies for Postpartum Family Planning and the 2012 WHO Statement for Collective Action.   

Kind regards,

Tamar Chitashvili, MD, MHP&M

Senior Quality Improvement Advisor – Maternal and Child Health and Non-communicable Diseases

Quality & Performance Institute

USAID Apply Science to Strengthen and Improve Systems (ASSIST) Project

T: +1-301-941-8581

tchitashvili@urc-chs.com    |   www.usaidassist.org |   www.URC-CHS.com

7200 Wisconsin Avenue, Suite 600, Bethesda, MD 20814 USA

URC University Research Co., LLC – CHS Center for Human Services

Improving systems. Empowering communities.

Celebrating 50 years of excellence: 1965-2015

Dear HIFA and CHIFA colleagues,

I would like to share with you our recent publication on how malaria research conducted in Malawi has influenced the anti-malarial drug policy changes.

http://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-016-0108-1

 Abstract:

Background: In 1993, Malawi changed its first-line anti-malarial treatment for uncomplicated malaria from chloroquine to sulfadoxine-pyrimethamine (SP), and in 2007, it changed from SP to lumefantrine-artemether. The change in 1993 raised concerns about whether it had occurred timely and whether it had potentially led to early development of Plasmodium falciparum resistance to SP. This case study examined evidence from Malawi in order to assess if the policy changes were justifiable and supported by evidence.

Methods: A systematic review of documents and published evidence between 1984 and 1993, when chloroquine was the first-line drug, and 1994 and 2007, when SP was the first-line drug, was conducted herein. The review was accompanied with key informant interviews.

Results: A total of 1287 publications related to malaria drug policy changes in sub-Saharan Africa were identified. Using the inclusion criteria, four articles from 1984 to 1993 and eight articles from 1994 to 2007 were reviewed. Between 1984 and 1993, three studies reported on chloroquine poor efficacy prompting policy change according to WHO’s recommendation. From 1994 to 2007, four studies conducted in the early years of policy change reported a high SP efficacy of above 80%, retaining it as a first-line drug. Unpublished sentinel site studies between 2005 and 2007 showed a reduced efficacy of SP, influencing policy change to lumefantrine-artemether. The views of key informants indicate that the switch from chloroquine to SP was justified based on local evidence despite unavailability of WHO’s policy recommendations, while the switch to lumefantrine-artemether was uncomplicated as the country was following the recommendations from WHO.

Conclusion: Ample evidence from Malawi influenced and justified the policy changes. Therefore, locally generated evidence is vital for decision making during policy change.

HIFA profile: Chikondi Mwendera is a Senior Lecturer (PhD Student) at the University of Malawi in Malawi. Professional interests: My interests are to champion the promotion of malaria research for policy development leading to practical interventions that will address the malaria burden in Malawi. My research focuses on developing a framework that will facilitate the utilization of malaria research for policy development. I am currently analyzing my data on barriers and facilitators of malaria research in policy formulation. This topic is therefore, very relevant for my research. mwenderac AT gmail.com

Hey All

We are having a Wikipedia and Medicine meeting Jun 23rd 2016 in Varenna Italy. This is a pre-conference to Wikimania, the big yearly Wikipedia conference.

If you are in interested in joining us further details are here https://wikimania2016.wikimedia.org/wiki/Programme/Wiki_Project_Med

The full program is here https://wikimania2016.wikimedia.org/wiki/Programme

—

James Heilman

MD, CCFP-EM, Wikipedian

The Wikipedia Open Textbook of Medicine

www.opentextbookofmedicine.com