Evidence map›Paper›PMID 29955924›Full record

ArticleIntensive care medicine2018

Increasing evidence-based interventions in patients with acute infections in a resource-limited setting: a before-and-after feasibility trial in Gitwe, Rwanda.

Olivier Urayeneza, Pierre Mujyarugamba, Zacharie Rukemba, Vincent Nyiringabo, Polyphile Ntihinyurwa, John I Baelani, Arthur Kwizera, Danstan Bagenda, Mervyn Mer, Ndidiamaka Musa and 10 more

Registry-linked trialAbstract readEquivalence Trial
PubMed Publisher
In one paragraph

Article in Intensive care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02697513 (The 'Bekele Afessa Scan-Teach-Treat Approach' to Improve Care of Patients With Acute Infection at the Gitwe Hospital in Gitwe/Rwanda), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02697513 naunknown statusnot on this map

The 'Bekele Afessa Scan-Teach-Treat Approach' to Improve Care of Patients With Acute Infection at the Gitwe Hospital in Gitwe/Rwanda

TypeinterventionalSponsorUniversity of SalzburgRan2016 to 2017Enrolled1,594ConditionsInfection, SepsisArmssimple infection management protocol
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Focus on paediatrics.Intensive care medicine · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Olivier UrayenezaGitwe Hospital and Gitwe School of Medicine, Gitwe, Rwanda.
Pierre MujyarugambaGitwe Hospital and Gitwe School of Medicine, Gitwe, Rwanda.
Zacharie RukembaGitwe Hospital and Gitwe School of Medicine, Gitwe, Rwanda.
Vincent NyiringaboGitwe Hospital and Gitwe School of Medicine, Gitwe, Rwanda.
Polyphile NtihinyurwaGitwe Hospital and Gitwe School of Medicine, Gitwe, Rwanda.
John I BaelaniGreat Lakes Free University, Goma, Democratic Republic of Congo.
Arthur KwizeraDepartment of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda.
Danstan BagendaDepartment of Anesthesiology, University of Nebraska Medical Center, Omaha, USA.
Mervyn MerDivision of Critical Care, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Ndidiamaka MusaSeattle Children's Hospital, University of Washington, Seattle, USA.
Julia T HoffmanDepartment of Anesthesiology, University of Nebraska Medical Center, Omaha, USA.
Ashok MudgapalliDepartment of Anesthesiology, University of Nebraska Medical Center, Omaha, USA.
Austin M PorterDepartment of Anesthesiology, University of Nebraska Medical Center, Omaha, USA.
Niranjan KissoonBC Children's Hospital, University of British Columbia, Vancouver, Canada.
Hanno UlmerInstitute of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria.
Lori A HarmonSociety of Critical Care Medicine on behalf of the Surviving Sepsis Campaign, Mount Prospect, IL, USA.
Joseph C FarmerDepartment of Critical Care Medicine, Mayo Clinic, Phoenix, AZ, USA.
Martin W DünserDepartment of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria. Martin.Duenser@i-med.ac.at.
Andrew J PattersonDepartment of Anesthesiology, University of Nebraska Medical Center, Omaha, USA.
Sepsis in Resource-Limited Nations Workgroup of the Surviving Sepsis Campaign

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo 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.

designSingle-center, prospective, before-and-after feasibility trial.

settingEmergency department of a sub-Saharan African district hospital. PATIENTS: Patients > 28 days of life admitted to the study hospital for an acute infection.

interventionsThe trial had three phases (each of 4 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

resultsDemographic, clinical, and laboratory data were collected at study enrollment; 24, 48, and 72 h after hospital admission; and at discharge. A total of 1594 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 h (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.

conclusionsOur 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 ( http://www.clinicaltrials.gov : NCT02697513).

Indexed as

Acute DiseaseAdolescentAdultChildChild, PreschoolControlled Before-After StudiesEvidence-Based MedicineFeasibility StudiesFluid TherapyHospitals, DistrictHumansInfantInfant, NewbornInfectionsLength of StayMedically Underserved AreaAfricaBundleEducationEvidence-based interventionInfectionSafetySepsis

Identifiers

PMID29955924

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.