Evidence map›Paper›PMID 35534061›Full record

ArticleBMJ open2022

Systems approach to improving traumatic brain injury care in Myanmar: a mixed-methods study from lived experience to discrete event simulation.

Katharina Kohler, Phyu Phyu Nwe Myint, Sein Wynn, Alexander Komashie, Robyn Winters, Myat Thu, Mu Mu Naing, Thinn Hlaing, Rowan Burnstein, Zaw Wai Soe and 4 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
1.3field-weighted citation impact, top 22% of its field
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 7 citations in OpenAlex.

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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

14 authors at 3 institutions in 2 countries.

Katharina KohlerDivision of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK kk371@cam.ac.uk.ORCID 0000-0003-1919-0193
Phyu Phyu Nwe MyintDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Sein WynnDepartment of Neurosurgery, University of Medicine I, Yangon, Yangon Region, Myanmar.
Alexander KomashieEngineering Design Centre, Department of Engineering, University of Cambridge School of Technology, Cambridge, UK.
Robyn WintersNeurocritical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Myat ThuDepartment of Neurosurgery, University of Medicine I, Yangon, Yangon Region, Myanmar.
Mu Mu NaingDepartment of Intensive Care, University of Medicine I, Yangon, Yangon Region, Myanmar.
Thinn HlaingMyanmar Country Director, THET, London, UK.
Rowan BurnsteinNeurocritical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Zaw Wai SoeRector, University of Medicine I, Yangon, Yangon Region, Myanmar.
John ClarksonDepartment of Enginering, University of Cambridge School of Technology, Cambridge, UK.
David MenonDivision of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK.ORCID 0000-0002-3228-9692
Peter John HutchinsonNIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK.ORCID 0000-0002-2796-1835
Tom BashfordNIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK.ORCID 0000-0003-0228-9779
University of Cambridge · GBUniversity Of Medicine 1 Yangon · MMCambridge University Hospitals NHS Foundation Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTraumatic brain injury (TBI) is a global health problem, whose management in low-resource settings is hampered by fragile health systems and lack of access to specialist services. Improvement is complex, given the interaction of multiple people, processes and institutions. We aimed to develop a mixed-method approach to understand the TBI pathway based on the lived experience of local people, supported by quantitative methodologies and to determine potential improvement targets.

designWe describe a systems approach based on narrative exploration, participatory diagramming, data collection and discrete event simulation (DES), conducted by an international research collaborative.

settingThe study is set in the tertiary neurotrauma centre in Yangon General Hospital, Myanmar, in 2019-2020 (prior to the SARS-CoV2 pandemic).

participantsThe qualitative work involved 40 workshop participants and 64 interviewees to explore the views of a wide range of stakeholders including staff, patients and relatives. The 1-month retrospective admission snapshot covered 85 surgical neurotrauma admissions.

resultsThe TBI pathway was outlined, with system boundaries defined around the management of TBI once admitted to the neurosurgical unit. Retrospective data showed 18% mortality, 71% discharge to home and an 11% referral rate. DES was used to investigate the system, showing its vulnerability to small surges in patient numbers, with critical points being CT scanning and observation ward beds. This explorative model indicated that a modest expansion of observation ward beds to 30 would remove the flow-limitations and indicated possible consequences of changes.

conclusionsA systems approach to improving TBI care in resource-poor settings may be supported by simulation and informed by qualitative work to ground it in the direct experience of those involved. Narrative interviews, participatory diagramming and DES represent one possible suite of methods deliverable within an international partnership. Findings can support targeted improvement investments despite coexisting resource limitations while indicating concomitant risks.

Indexed as

Brain Injuries, TraumaticCOVID-19HumansMyanmarRetrospective StudiesRNA, ViralSARS-CoV-2Systems AnalysisRNA, Viralhealth services administration & managementneurosurgeryorganisation of health servicesstatistics & research methodstrauma management

Identifiers

PMID35534061
PMCPMC9086681
OpenAlexW4280497181

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

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.