Developing an intervention to improve quality of myocardial infarction care in northern Tanzania

制定干预措施以提高坦桑尼亚北部心肌梗塞护理质量

基本信息

  • 批准号:
    10559610
  • 负责人:
  • 金额:
    $ 16.69万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2021
  • 资助国家:
    美国
  • 起止时间:
    2021-02-01 至 2026-01-31
  • 项目状态:
    未结题

项目摘要

PROJECT SUMMARY Myocardial infarction (MI) is a leading cause of death worldwide. There is a critical need to improve uptake of evidence-based care for MI in resource-limited settings. This proposal presents a research career development program to 1) identify barriers to evidence-based MI care in Tanzania, 2) develop a multicomponent intervention to improve care by adapting proven strategies from other settings, and 3) assess the feasibility, acceptability, and potential effectiveness of the intervention. The candidate, an Assistant Professor of Surgery at Duke University and emergency medicine physician, has experience conducting research regarding MI in Tanzania. The high MI-associated mortality he identified as an NIH Fogarty Global Health Fellow led him to seek additional training in implementation science, intervention development, and clinical trial design. Working with a diverse mentoring committee of experts in implementation research, clinical trials, and global cardiovascular disease, as well as Tanzanian colleagues with whom he has collaborated for the past ten years, he will build upon his prior study of MI in northern Tanzania. The proposed activities will equip the candidate with a combination of skills in global emergency implementation research and position him to become a successful independent investigator operating at the intersection of global health, emergency medicine, and implementation science. Growing evidence suggests that in sub-Saharan Africa (SSA), MI is common, frequently misdiagnosed, rarely treated with evidence-based therapies, and associated with high mortality. Preliminary research conducted by the candidate in Tanzania found that 22% of patients presenting to the emergency department (ED) with typical symptoms have an acute MI, but 90% of acute MI cases are missed by ED physicians. The candidate’s research found a 30-day mortality rate following acute MI of 43%--more than sixfold higher than the mortality rate in the United States. Such poor MI outcomes are likely related to low uptake of evidence-based MI care; for example, the candidate’s preliminary data found that only 23% of patients with acute MI were treated with aspirin—a WHO “best buy” for reducing noncommunicable disease mortality. Despite these alarming data, the barriers to evidence-based MI care in SSA remain largely unexplored and locally-tailored interventions to improve MI care in resource limited settings are sorely lacking. There is an urgent need to identify barriers to MI care and to develop locally-appropriate interventions that will improve MI outcomes in low-income settings like Tanzania. This proposal will bridge this knowledge gap by using an approach rooted in implementation science. Specifically, this study will 1) identify barriers to evidence-based diagnosis and treatment of MI in northern Tanzania, 2) develop a multicomponent tailored intervention to improve MI care, and 3) determine feasibility, acceptability, and potential effect of a tailored intervention on MI care. This study will be an important first step towards reducing excess MI-associated morbidity and mortality in resource-limited settings.
项目总结 心肌梗死(MI)是世界范围内主要的死亡原因。迫切需要提高对 在资源有限的情况下对心肌梗死的循证护理。这项建议代表了一种研究事业的发展 1)在坦桑尼亚确定循证心肌梗死护理的障碍,2)发展多成分干预 通过从其他环境中采用经过验证的策略来改善护理,以及3)评估可行性、可接受性、 以及干预的潜在有效性。候选人是杜克大学的外科助理教授 大学和急诊内科医生,有在坦桑尼亚进行心肌梗死研究的经验。 他确认为NIH Fogarty Global Health研究员的心肌梗死相关死亡率很高,这让他寻求更多 在实施科学、干预开发和临床试验设计方面的培训。与不同的 实施研究、临床试验和全球心血管疾病专家指导委员会,AS 作为过去十年来一直与他合作的坦桑尼亚同事,他将在之前的基础上再接再厉 坦桑尼亚北部的MI研究。拟议的活动将使应聘者具备以下技能 全球应急实施研究和定位,使他成为一名成功的独立调查员 在全球卫生、急救医学和实施科学的交叉点上运作。 越来越多的证据表明,在撒哈拉以南非洲(SSA),心肌梗塞很常见,经常被误诊,很少 使用循证疗法治疗,并与高死亡率相关。进行的初步研究 坦桑尼亚的候选人发现,在急诊科(ED)就诊的患者中,22%的人患有典型的 症状有急性心肌梗死,但急诊医生漏掉了90%的急性心肌梗死病例。候选人的研究 发现急性心肌梗死后30天的死亡率为43%--是美国患者死亡率的6倍多 美国。这种糟糕的心肌梗死结果可能与对循证心肌梗死护理的接受程度较低有关;例如, 候选人的初步数据发现,只有23%的急性心肌梗死患者使用阿司匹林治疗--世卫组织 降低非传染性疾病死亡率的“百思买”。尽管有这些令人震惊的数据,但 SSA的循证心肌梗死护理在很大程度上仍未被探索,并在当地量身定做干预措施以改善心肌梗死护理 在资源有限的情况下,严重缺乏。迫切需要确定MI护理的障碍,并 制定适合当地的干预措施,改善坦桑尼亚等低收入地区的心肌梗死结果。 这项提议将通过使用一种植根于执行科学的方法来弥合这一知识差距。 具体地说,这项研究将1)确定北部地区心肌梗死循证诊断和治疗的障碍 坦桑尼亚,2)开发多成分量身定制的干预措施,以改善MI护理,3)确定可行性, 可接受性,以及针对心肌梗死护理的个体化干预的潜在影响。这项研究将是重要的第一步 在资源有限的情况下,减少与心肌梗塞相关的过度发病率和死亡率。

项目成果

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Julian T Hertz其他文献

Acute coronary syndrome prevalence and outcomes in a Tanzanian emergency department: Results from a prospective surveillance study
  • DOI:
    10.1016/j.afjem.2024.11.003
  • 发表时间:
    2025-03-01
  • 期刊:
  • 影响因子:
  • 作者:
    Julian T Hertz;Francis M Sakita;Wai Yan Min Htike;Kilonzo G Kajiru;Blandina T Mmbaga;Tumsifu G Tarimo;Godfrey L Kweka;Jerome J Mlangi;Amedeus V Maro;Lauren Coaxum;Sophie W Galson;Alexander T Limkakeng;Gerald S Bloomfield
  • 通讯作者:
    Gerald S Bloomfield
The burden of multimorbidity-associated acute hospital admissions in Malawi and Tanzania: a prospective multicentre cohort study
马拉维和坦桑尼亚与多种疾病相关的急性住院入院负担:一项前瞻性多中心队列研究
  • DOI:
    10.1016/s2214-109x(25)00113-5
  • 发表时间:
    2025-07-01
  • 期刊:
  • 影响因子:
    18.000
  • 作者:
    Stephen A Spencer;Nateiya M Yongolo;Ibrahim G Simiyu;Hendry R Sawe;Paul Dark;Stephen B Gordon;Matthew P Rubach;Rachel Manongi;Julian T Hertz;Gimbo Hyuha;Grasiana Kimario;Juma Mfinanga;Blandina T Mmbaga;Adamson S Muula;Mulinda Nyirenda;Jacob Phulusa;Laura Rosu;Alice H Rutta;Francis Sakita;Charity Salima;Augustine Choko
  • 通讯作者:
    Augustine Choko

Julian T Hertz的其他文献

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{{ truncateString('Julian T Hertz', 18)}}的其他基金

Adapting and Piloting an Evidence-based Intervention to Improve Hypertension Care among Tanzanians Living with HIV
调整和试点循证干预措施以改善坦桑尼亚艾滋病毒感染者的高血压护理
  • 批准号:
    10750666
  • 财政年份:
    2023
  • 资助金额:
    $ 16.69万
  • 项目类别:

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