Abstract:
OBJECTIVE:To demonstrate a new application of structured expert judgement to assess the effectiveness of surgery to correct obstetric fistula in a low-income setting. Intervention effectiveness is a major input of evidence-informed priority setting in healthcare, but information on intervention effectiveness is generally lacking. This is particularly problematic in the context of poorly resourced healthcare settings where even efficacious interventions fail to translate into improvements in health. The few intervention effectiveness studies related to obstetric fistula treatment focus on the experience of single facilities and do not consider the impact of multiple factors that may affect health outcomes. DESIGN:We use the classical model of structured expert judgement, a method that has been used to quantify uncertainty in the areas of engineering and environmental risk assessment when data are unavailable. Under this method, experts quantify their uncertainty about rates of long-term disability in patients with fistula following treatment in different contexts, but the information content drawn from their responses is statistically conditioned on the accuracy and informativeness of their responses to a set of calibration questions. Through this method, we develop best estimates and uncertainty bounds for the rate of disability associated with each treatment scenario and setting. PARTICIPANTS:Eight experts in obstetric fistula repair in low and middle income countries. RESULTS:Estimates developed using performance weights were statistically superior to those involving a simple averaging of expert responses. The performance-weight decision maker's assessments are narrower for 9 of the 10 calibration questions and 21 of 23 variables of interest. CONCLUSIONS:We find that structured expert judgement is a viable approach to investigating the effectiveness of medical interventions where randomised controlled trials are not possible. Understanding the effectiveness of surgery performed at different types of facilities can guide programme planning to increase access to fistula treatment.
journal_name
BMJ Openjournal_title
BMJ openauthors
Colson AR,Adhikari S,Sleemi A,Laxminarayan Rdoi
10.1136/bmjopen-2014-007233subject
Has Abstractpub_date
2015-06-03 00:00:00pages
e007233issue
6issn
2044-6055pii
bmjopen-2014-007233journal_volume
5pub_type
杂志文章相关文献
BMJ Open文献大全abstract:INTRODUCTION:Gestational diabetes mellitus (GDM) is a state of glucose intolerance with onset during pregnancy. GDM carries prenatal and perinatal risks as well as long-term risks for the mother and her child. GDM may be involved in the foetal programming of long-term cardiovascular health. However, evidence is sparse ...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2017-016972
更新日期:2017-11-14 00:00:00
abstract:INTRODUCTION:Pseudomonas aeruginosa (PA) has historically been one of the major causes of severe sepsis and death among neutropenic cancer patients. There has been a recent increase of multidrug-resistant PA (MDRPA) isolates that may determine a worse prognosis, particularly in immunosuppressed patients. The aim of thi...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-025744
更新日期:2019-05-24 00:00:00
abstract:INTRODUCTION:Desert dust is estimated to constitute about 35% of aerosol in the troposphere. Desertification, climatic variability and global warming all can contribute to increased dust formation. This study aims to examine possible health effects of desert dust exposure on pregnant women and their children. The purpo...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2014-004863
更新日期:2014-06-23 00:00:00
abstract:BACKGROUND:There is a growing body of evidence associating financial strain (FS) with poor health but most of this research has been cross-sectional and adult-focused. During the 'Great Recession' many UK households experienced increased FS. The primary aim of this study was to determine the impact of increased FS on c...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-015559
更新日期:2017-03-09 00:00:00
abstract:OBJECTIVES:To summarise treatment success rate (TSR) among adult bacteriologically confirmed pulmonary tuberculosis (BC-PTB) patients in sub-Saharan Africa (SSA). DESIGN:We searched MEDLINE, EMBASE, Google Scholar and Web of Science electronic databases for eligible studies published in the decade between 1 July 2008 ...
journal_title:BMJ open
pub_type: 杂志文章,meta分析
doi:10.1136/bmjopen-2019-029400
更新日期:2019-09-06 00:00:00
abstract:INTRODUCTION:Fracture healing can fail in up to 10% of cases despite appropriate treatment. While lithium has been the standard treatment for bipolar disorder, it may also have a significant impact to increase bone healing in patients with long bone fractures. To translate this knowledge into clinical practice, a rando...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-031545
更新日期:2020-01-07 00:00:00
abstract:OBJECTIVE:To assess the seroprevalence of recent/acute and past exposure to rubella virus infection and associated risk factors among pregnant women. DESIGN:A hospital-based cross-sectional study. SETTING:The study was conducted in two public hospitals in Hawassa City, Southern Ethiopia. PARTICIPANTS:A total of 422 ...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2017-016824
更新日期:2017-10-05 00:00:00
abstract:OBJECTIVE:To describe help seeking behaviour from a medical doctor and antimicrobial use for common infections among rural residents of Anhui province, China. DESIGN:A cross-sectional retrospective household survey. SETTING:12 administrative villages from rural Anhui, China. PARTICIPANTS:2760 rural residents selecte...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-024856
更新日期:2019-04-11 00:00:00
abstract:OBJECTIVE:In this study, we aimed to determine the performance characteristics of toluidine red unheated serum test on cerebrospinal fluids (CSF-TRUST) as compared to venereal disease research laboratory test on cerebrospinal fluids (CSF-VDRL) for laboratory the diagnosis of neurosyphilis. DESIGN:A cross-sectional stu...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-002204
更新日期:2013-02-21 00:00:00
abstract:INTRODUCTION:Dexamethasone is a drug used to prolong the postoperative analgesia in children after peripheral nerve blockade, although the dose usually used (0.2 mg/kg) has not been studied yet. This study is a monocentric, prospective, randomised, placebo-controlled, double-blinded study in a university hospital in Fr...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-036863
更新日期:2020-09-30 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the implementation of the Ohio Emergency and Acute Care Facility Opioids and Other Controlled Substances Prescribing Guidelines and their perceived impact on local policies and practice. METHODS:The study design was a cross-sectional survey of emergency department (ED) medical directors, or...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-020477
更新日期:2018-06-30 00:00:00
abstract:OBJECTIVE:In the field of palliative care (PC) as it is integrated into heart failure (HF) treatment, it is essential to explore the patient experience and build on this knowledge for the further development of PC practice and policy. Based on an intervention study, this paper explores what patients with HF find signif...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-043955
更新日期:2020-12-31 00:00:00
abstract:INTRODUCTION:Complex coronary artery disease (left main and three-vessel disease) carries high risks of adverse events and cost burden. However, in China, little is known about which patients are directed toward which treatment strategies and what outcomes are being achieved. METHODS AND ANALYSIS:Using the China PEACE...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2015-009743
更新日期:2016-02-15 00:00:00
abstract:OBJECTIVE:To complete a systematic review of the literature describing associations between all environmental exposures and asthma symptoms and exacerbations in children up to mean age of 9 years. DESIGN:Systematic review. SETTING:Reference lists of identified studies and reviews were searched for all articles publis...
journal_title:BMJ open
pub_type: 杂志文章,评审
doi:10.1136/bmjopen-2013-003827
更新日期:2014-02-12 00:00:00
abstract:OBJECTIVE:To report on the relative cost-effectiveness of total hip arthroplasty and resurfacing arthroplasty (replacement of articular surface of femoral head only) in patients with severe arthritis suitable for hip joint resurfacing arthroplasty. DESIGN:Cost-effectiveness analysis on an intention-to-treat basis of a...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-001162
更新日期:2012-10-12 00:00:00
abstract:OBJECTIVES:The aim of this study was to (1) demonstrate the development and testing of tools and procedures designed to monitor and assess the integrity of a complex intervention for chronic pain (COping with persistent Pain, Effectiveness Research into Self-management (COPERS) course); and (2) make recommendations bas...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2013-003555
更新日期:2013-11-15 00:00:00
abstract:INTRODUCTION:Exercise-based rehabilitation is a standard feature of chronic heart failure management. The effectiveness of eccentric exercise could offer new opportunities for better tailoring rehabilitation programme to patients' limitations. The goal of the study is to contrast the impact of a mixed eccentric and con...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-028749
更新日期:2019-09-26 00:00:00
abstract:INTRODUCTION:Falls are increasingly recognised for their ability to herald impending health decline. Despite the likely susceptibility of postsurgical patients to falls, a detailed description of postoperative falls in an unselected surgical population has never been performed. One study suggests that preoperative fall...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-011570
更新日期:2016-09-21 00:00:00
abstract:OBJECTIVES:This systematic review aims to evaluate evidence on the effectiveness of sexual and reproductive health (SRH) interventions delivered in humanitarian crises. SETTING:Crisis affected low-income or middle-income countries. PARTICIPANTS:Crisis-affected populations in low-income or middle-income countries. ME...
journal_title:BMJ open
pub_type: 杂志文章,评审
doi:10.1136/bmjopen-2015-008226
更新日期:2015-12-18 00:00:00
abstract:INTRODUCTION:The significant increase in the rate of morbidity and mortality due to cardiovascular diseases has become a health challenge globally. Lack of enough knowledge on the underlying causes in Iran and taking the unique characteristics of the Shiraz metropolitan city (the capital city of Fars Province) into con...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2018-026317
更新日期:2019-04-03 00:00:00
abstract:OBJECTIVE:We aimed to adapt, translate and validate the Chronic Liver Disease Questionnaire (CLDQ) in Malaysian patients with chronic liver diseases of various aetiologies. SETTING:Tertiary level teaching institution in Malaysia. PARTICIPANTS:The validation process involved 211 adult patients (English language n=101,...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-013873
更新日期:2017-05-25 00:00:00
abstract:OBJECTIVE:This research aims to determine the long-term impact of the Bloor Street Viaduct suicide barrier on rates of suicide in Toronto and whether media reporting had any impact on suicide rates. DESIGN:Natural experiment. SETTING:City of Toronto, Canada; records at the chief coroner's office of Ontario 1993-2003 ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-015299
更新日期:2017-06-19 00:00:00
abstract:INTRODUCTION:Alzheimer's disease and related dementias can be considered the epidemic of the 21st century. Particularly, the predicted growth in the size of elderly populations in low-income and middle-income countries is expected to produce a dramatic surge in dementia prevalence and incidence. Although a rising burde...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-030300
更新日期:2019-07-31 00:00:00
abstract:OBJECTIVES:To identify the determinants of antenatal care (ANC) utilisation in sub-Saharan Africa. DESIGN:Systematic review. DATA SOURCES:Databases searched were PubMed, OVID, EMBASE, CINAHL and Web of Science. ELIGIBILITY CRITERIA:Primary studies reporting on determinants of ANC utilisation following multivariate a...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-031890
更新日期:2019-10-07 00:00:00
abstract:OBJECTIVE:To investigate social inequalities underlying low birthweight (LBW) outcomes in Sri Lanka. DESIGN:Cross-sectional study. SETTING:This study used the Sri Lanka Demographic and Health Survey 2016, the first such survey to cover the entire country since the Civil War ended in 2001. PARTICIPANTS:Birthweight da...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-037223
更新日期:2020-05-25 00:00:00
abstract:OBJECTIVES:To assess people's procedural preferences for making medical surrogate decisions, from the perspectives of both a potential surrogate and an incapacitated patient. DESIGN:Computer-assisted telephone interviews. Respondents were randomly assigned either the role of an incapacitated patient or that of a poten...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-022289
更新日期:2018-07-25 00:00:00
abstract:OBJECTIVE:To investigate the incidence of primary care presentations for herpes zoster (zoster) in a representative New Zealand population and to evaluate the utilisation of primary healthcare services following zoster diagnosis. DESIGN:A cross-sectional retrospective cohort study used a natural language processing so...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-021241
更新日期:2018-05-31 00:00:00
abstract:INTRODUCTION:Although studies showed that physical activity (PA) and sedentary behaviour (SB) were associated with cardiometabolic risk factors and cognitive function, both independent and combined associations among them are inconsistent. Cardiometabolic risk factors are also associated with cognitive function, but re...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-030322
更新日期:2019-10-31 00:00:00
abstract:OBJECTIVES:Record review is the most used method to quantify patient safety. We systematically reviewed the reliability and validity of adverse event detection with record review. DESIGN:A systematic review of the literature. METHODS:We searched PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library and from their...
journal_title:BMJ open
pub_type: 杂志文章,评审
doi:10.1136/bmjopen-2016-011078
更新日期:2016-08-22 00:00:00
abstract:OBJECTIVE:To evaluate the incidence and management of local and systemic complications afflicting patients with de novo metastatic prostate cancer (mPCa) in Singapore. DESIGN:Retrospective analysis of a large prospective Uro-oncology registry of mPCa. SETTING:This study is carried out in a tertiary hospital in Singap...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-034331
更新日期:2020-02-18 00:00:00