Evidence map›Paper›PMID 39424394›Full record

ArticleBMJ open2024

Evaluation of an electronic clinical decision support algorithm to improve primary care management of acute febrile illness in rural Cambodia: protocol for a cluster-randomised trial.

Rusheng Chew, Elke Wynberg, Marco Liverani, Huy Rekol, Chea Nguon, Lek Dysoley, Moul Vanna, James John Callery, Abhijit Mishra, Bipin Adhikari and 8 more

Abstract readClinical Trial Protocol
In one paragraph

Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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.

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

1 citing paper in PubMed.

  1. 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

18 authors.

Rusheng ChewMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand chris@tropmedres.ac.ORCID http://orcid.org/0000-0002-8992-4474
Elke WynbergMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Marco LiveraniMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Huy RekolNational Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
Chea NguonNational Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
Lek DysoleyNational Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
Moul VannaAction for Health Development, Battambang, Cambodia.
James John CalleryMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.ORCID http://orcid.org/0000-0002-3218-2166
Abhijit MishraMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Bipin AdhikariMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Rupam TripuraMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Arjun ChandnaCentre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
Greg FeganMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Naomi WaithiraMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Richard James MaudeMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.ORCID http://orcid.org/0000-0002-5355-0562
Nicholas P J DayMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Thomas Julian PetoMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.ORCID http://orcid.org/0000-0003-3197-9891
Yoel LubellMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.

Funding

Wellcome Trust
6 · The paper itself

Abstract

introductionAcute febrile illness (AFI), traditionally attributed to malaria, is a common reason for seeking primary healthcare in rural South and Southeast Asia. However, malaria transmission has declined while health workers are often poorly equipped to manage non-malarial AFIs. This results in indiscriminate antibiotic prescribing and care escalation, which promotes antibiotic resistance and may increase healthcare costs. To address this problem, an electronic clinical decision support algorithm (eCDSA) called 'Electronic clinical Decision support for Acute fever Management (EDAM)' has been developed for primary health workers which integrates clinical, epidemiological and vital sign data with simple point-of-care tests to produce a diagnosis and management plan. METHODS AND ANALYSIS: This is a pragmatic cluster-randomised trial aiming to assess the effect of EDAM and related training on antibiotic prescribing rates in rural Cambodian primary health centres (PHCs) as the primary outcome, along with a range of secondary outcomes including safety. Patients with AFI are eligible for recruitment if they are aged ≥1 year. A cluster is defined as a PHC and PHCs will be randomised to control (standard of care) and intervention (EDAM and associated training) arms, with 15 PHCs per arm. Patients will be followed up after 7 days to ascertain the safety profile of EDAM. Each PHC will recruit 152 patients (total 4560), based on a baseline antibiotic prescription rate of 25% and expected reduction to 17.5% with EDAM. ETHICS AND DISSEMINATION: Results will be published in international peer-reviewed journals to inform the design of future versions of EDAM and of future trials of similar eCDSAs and other digital health interventions targeted towards rural populations. This study was approved by the Oxford University Tropical Research Ethics Committee (550-23) and the Cambodian National Ethics Committee for Health Research (395-NECHR). TRIAL REGISTRATION NUMBER: International Standard Randomized Controlled Trial Number Registry (ISRCTN15157105).

Indexed as

AlgorithmsAnti-Bacterial AgentsDecision Support Systems, ClinicalFeverPrimary Health CareAcute DiseaseCambodiaHumansPragmatic Clinical Trials as TopicRural PopulationAnti-Bacterial AgentsClinical TrialeHealthPublic healthRandomized Controlled TrialTropical medicine

Identifiers

PMID39424394
PMCPMC11492946

What OpenQuestion holds

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Registered trials

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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.