Increasing Evidence-Based Interventions in Patients with Acute Infections in a Resource-Limited Setting: A Before-and-After Feasibility Trial in Gitwe, Rwanda

Domaine:

healthcare

Type de record:

paper

Créateur:

OliPieZacVin

Éditeur:

Ovi

Hôte:

Objective: To evaluate whether a focused education program and implementation of a treatment bundle increases the rate of early evidence-based interventions in patients with acute infections. Design: Single-center, prospective, before-and-after feasibility trial. Setting: Emergency department of a sub-Saharan African district hospital. Patients: Patients > 28 days of life admitted to the study hospital for an acute infection. Interventions: The trial had three phases (each of four months). Interventions took place during the second (educational program followed by implementation of the treatment bundle) and third (provision of resources to implement treatment bundle) phases. Measurements and Main Results: Demographic, clinical, and laboratory data were collected at study enrollment; 24, 48, and 72 hours after hospital admission; and at discharge. A total of 1,594 patients were enrolled (pre-intervention, n = 661; intervention I, n = 531; intervention II, n = 402). The rate of early evidence-based interventions per patient during Intervention Phase I was greater than during the pre-intervention phase (74 ± 17 vs. 79 ± 15%, p < 0.001). No difference was detected when data were compared between Intervention Phases I and II (79 ± 15 vs. 80 ± 15%, p = 0.58). No differences in the incidence of blood transfusion (pre-intervention, 6%; intervention I, 7%; intervention II, 7%) or severe adverse events in the first 24 hours (allergic reactions: pre-intervention, 0.2%; intervention I, 0%; intervention II, 0%; respiratory failure: pre-intervention, 2%; intervention I, 2%; intervention II, 2%; acute renal failure: pre-intervention, 2%; intervention I, 2%; intervention II, 1%) were observed. Conclusions: Our results indicate that a focused education program and implementation of an infection treatment bundle in clinical practice increased the rate of early evidence-based interventions in patients with acute infections (mostly malaria) admitted to a sub-Saharan African district hospital. Provision of material resources did not further increase this rate. While no safety issues were detected, this could be related to the very low disease severity of the enrolled patient population (www.clinicaltrials.gov: NCT02697513).

Visit

doi.org

Similaires

Diagnostic accuracy of the Tzanakis score for acute appendicitis in a resource-limited setting: A tertiary hospital-based surveyFeasibility of automated artificial intelligence screening for diabetic retinopathy in a resource-limited settingDiagnosis of soil-transmitted helminth infections with digital mobile microscopy and artificial intelligence in a resource-limited settingA Machine Learning-Based Triage Tool for Children With Acute Infection in a Low Resource Setting*A profile of patients presenting at a low vision clinic in a resource-limited settingDirect Transfer to a Tertiary Care Hospital After Traumatic Injury is Associated with a Survival Benefit in a Resource‐Limited Setting

Diagnostic accuracy of the Tzanakis score for acute appendicitis in a resource-limited setting: A tertiary hospital-based survey

Background: The management of acute appendicitis remains challenging with high peri-operative morbid

Feasibility of automated artificial intelligence screening for diabetic retinopathy in a resource-limited setting

Background: Diabetic retinopathy (DR), a leading cause of blindness, requires effective screening, w

Diagnosis of soil-transmitted helminth infections with digital mobile microscopy and artificial intelligence in a resource-limited setting

Background Infections caused by soil-transmitted helminths (STHs) are the most prevalent neglected

A Machine Learning-Based Triage Tool for Children With Acute Infection in a Low Resource Setting*

Objectives: To deploy machine learning tools (random forests) to develop a model that

A profile of patients presenting at a low vision clinic in a resource-limited setting

Background: The university-based low vision clinic is one of the few low vision clinics in South Afr

Direct Transfer to a Tertiary Care Hospital After Traumatic Injury is Associated with a Survival Benefit in a Resource‐Limited Setting

Abstract Introduction Trauma is a leading cause of morbidity and mortality worldwide, and patient