Global Health and Emergency Care: Overcoming Clinical Research Barriers
Global Health and Emergency Care: Overcoming Clinical Research Barriers
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DOI：
10.1111/acem.13142
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发表时间：
2017-04-01
影响因子：
4.4
通讯作者：
Hansoti, Bhakti
中科院分区：
文献类型：
--
作者：
Levine, Adam C.;Barry, Meagan A.;Hansoti, Bhakti
目标：有许多障碍阻碍高质量的急救护理研究的进行，特别是在低收入和中等收入国家。其中一些障碍最初是在2013年作为学术急诊医学全球健康和急诊护理共识会议的一部分提出的。本文旨在建立一个更广泛的共识，全球范围内的紧急护理研究的障碍，并提出了一个全面的阵列，新的建议，以克服这些barrier.Methods：一个电子调查进行了一个有目的的样本的全球急诊医学研究专家来自世界各地的描述的主要挑战和解决方案，在低资源环境下进行紧急护理研究，并按重要性进行排名。全球急诊医学智库临床研究工作组在学术急诊医学学会2016年年会上利用改良的德尔菲技术进行基于共识的决策，对这些障碍进行分类和扩展，并制定一系列全面的建议解决方案。结果：工作组确定了全球开展紧急护理研究的四大类障碍，包括1）研究人员有限，这些障碍包括：（1）研究人员缺乏研究经验;（2）后勤障碍和数据收集缺乏标准化;（3）在资源有限的环境中开展研究存在伦理障碍，特别是在没有当地机构审查委员会的情况下;（4）全球紧急护理研究的资金相对缺乏。建议的解决办法包括建立一个多样化和跨学科的研究团队，以促进对初级研究人员的指导，利用当地研究助理或远程医疗等技术工具进行语言翻译，利用移动的保健等新工具来标准化和简化数据收集，确定替代地方机构审查委员会批准的办法，并酌情征得社区同意，结论：进行高质量的全球急诊护理研究的重大障碍仍然存在，需要采取创新战略，以促进和发展全球急诊护理研究领域。本文就所确定的最重要的障碍达成了全球共识，并提出了克服这些障碍的具有成本效益的战略建议，其总体目标是促进高质量的研究和改善全球紧急护理。
Objectives: There are many barriers impeding the conduct of high-quality emergency care research, particularly in low-and middle-income countries. Several of these barriers were originally outlined in 2013 as part of the Academic Emergency Medicine Global Health and Emergency Care Consensus Conference. This paper seeks to establish a broader consensus on the barriers to emergency care research globally and proposes a comprehensive array of new recommendations to overcome these barriers.Methods: An electronic survey was conducted of a purposive sample of global emergency medicine research experts from around the world to describe the major challenges and solutions to conducting emergency care research in low-resource settings and rank them by importance. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting utilized a modified Delphi technique for consensus-based decision making to categorize and expand upon these barriers and develop a comprehensive array of proposed solutions.Results: The working group identified four broad categories of barriers to conducting emergency care research globally, including 1) the limited availability of research personnel, particularly those with prior research training; 2) logistic barriers and lack of standardization of data collection; 3) ethical barriers to conducting research in resource-limited settings, particularly when no local institutional review board is available; and 4) the relative dearth of funding for global emergency care research. Proposed solutions included building a diverse and interdisciplinary research team structured to promote mentorship of junior researchers, utilizing local research assistants or technologic tools such as telemedicine for language translation, making use of new tools such as mobile health (mHealth) to standardize and streamline data collection, identifying alternatives to local institutional review board approval and the use of community consent when appropriate, and increased advocacy for global emergency care research funding.Conclusions: Significant barriers to the conduct of high-quality global emergency care research persist, and innovative strategies need to be adopted to promote and grow the field of global emergency care research. This paper provides a global consensus on the most important barriers identified, as well as recommendations for cost-effective strategies for overcoming these barriers with the overall goal of promoting high-quality research and improving emergency care worldwide.