Suchergebnisse

OBJECTIVES: The International Society of Nephrology (ISN) has called for zero deaths by 2025. This survey aimed to determine the preparedness of Southern African Development Community (SADC) countries and Nigeria to heed this call. SETTING: A questionnaire was emailed to facilities, where renal replacement therapy is available; to determine type of services available; quality of care and identify clinicians involved. PARTICIPANTS: Clinicians and administrators involved in the care of patients with acute kidney injury (AKI) completed the questionnaire. RESULTS: Completed questionnaires were received from 12 of the 15 SADC countries and Nigeria, covering 48 service providers. The government provided partial funding for dialysis in 41.7% of services. There was no funding for acute dialysis in two countries. Interdisciplinary teams in 72.9% of hospitals covered the intensive care units (ICUs), which included at least one nephrologist in 75%. Only 77% were able to provide dialysis in ICU. Intermittent haemodialysis was the most common modality available (91.7% of facilities), sustained low-efficiency dialysis in 50%, continuous therapies in 35% and peritoneal dialysis in 33.3%. Almost half (47.9%) of the sites were limited to one mode of dialysis and unable to care for severely ill patients. The clinical status was used to initiate and monitor dialysis, with very few sites having clear written standard operating procedures. CONCLUSION: In the 16 countries surveyed, the majority had limited ability to provide comprehensive dialysis programmes for patients with AKI due to lack of facilities and government funding. Additionally, nephrologists are scarce; modes of dialysis are limited; as is the care for severely ill patients and lack of standard operating procedures. Resources, training and funding need to be made available to create universal coverage of dialysis for AKI. The ISN goal of providing renal replacement therapy to all by 2025 is unlikely to be achieved in SADC and Nigeria.

AbstractBackgroundWell‐conducted systematic reviews contribute to informing clinical practice and public health guidelines. Between 2008 and 2018 Cochrane authors in sub‐Saharan Africa were publishing progressively fewer Cochrane Reviews, compared to non‐Cochrane reviews. The objective of this study was to determine what motivated trained Cochrane authors in sub‐Saharan Africa to conduct and publish non‐Cochrane reviews over Cochrane Reviews.MethodsWe conducted a mixed‐methods exploratory sequential study. We purposely selected 12 authors, who had published at least one Cochrane‐ and one non‐Cochrane review, for in‐depth, semi‐structured interviews. We manually coded and analysed the qualitative data using Grounded Theory approach and used the results to inform the survey questions. Subsequently we surveyed 60 authors with similar publishing experience. We analysed the quantitative data using descriptive and inferential statistics.ResultsFacilitators to publish with Cochrane were a high‐impact factor, rigorous research, and visibility. From barriers, the main categories were protracted time to complete Cochrane Reviews, complex title registration process, and inconsistencies between Cochrane Review groups regarding editorial practices. From the survey, authors confirmed rigorous research and reviewing process (84%), high impact factor (77%), and good mentorship (73%). The major barriers included Cochrane's long reviewing process (70%) and Cochrane's complicated title registration (50%). Authors with publishing experience in the previous 10 years at <95 percentile of systematic review publications, there was no significant difference between the medians for publishing with Cochrane (1) and non‐Cochrane (0) reviews, p = 0.06. Similarly, for those with publishing experience of ≥95 percentile of systematic review publication there was no significant difference between the medians for publishing with Cochrane (4) and non‐Cochrane (6), p = 0.344.ConclusionAuthors considered the visibility and relevance of Cochrane research as a trade‐off point. They continued publishing with Cochrane despite the barriers that they encountered. However, the concerns raised by many authors are worth addressing.