دورية أكاديمية
Task-sharing spinal anaesthesia care in three rural Indian hospitals: a non-inferiority randomised controlled clinical trial
| العنوان: | Task-sharing spinal anaesthesia care in three rural Indian hospitals: a non-inferiority randomised controlled clinical trial |
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| المؤلفون: | Alexander W Peters, John G Meara, Saurabh Saluja, Isaac Wasserman, Salim Afshar, Simone Sandler, Anudari Zorigtbaatar, Craig D McClain, David Ljungman, Nakul Raykar, Raman Kataria, Emma Svensson, Veena Sheshadri, Regi George, Nandakumar Menon, Ravi Manoharan, Meredith B. Brooks, Alaska Pendleton, Sudarshana Chatterjee, Wesley Rajaleelan, Jithen Krishnan, Gnanaraj Jesudian |
| المصدر: | BMJ Global Health, Vol 9, Iss 8 (2024) |
| بيانات النشر: | BMJ Publishing Group, 2024. |
| سنة النشر: | 2024 |
| المجموعة: | LCC:Medicine (General) LCC:Infectious and parasitic diseases |
| مصطلحات موضوعية: | Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216 |
| الوصف: | Background Task-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether spinal anaesthesia failure rates of MOs were non-inferior to those of consultant anaesthesiologists (CA) following a standardised educational curriculum.Methods We performed a randomised, non-inferiority trial in three rural hospitals in Tamil Nadu and Chhattisgarh, India. Patients aged over 18 years with low perioperative risk (ASA I & II) were randomised to receive MO or CA care. Prior to the trial, MOs underwent task-based anaesthesia training, inclusive of remotely accessed lectures, simulation-based training and directly observed anaesthetic procedures and intraoperative care. The primary outcome measure was spinal anaesthesia failure with a non-inferiority margin of 5%. Secondary outcome measures consisted of incidence of perioperative and postoperative complications.Findings Between 12 July 2019 and 8 June 2020, a total of 422 patients undergoing surgical procedures amenable to spinal anaesthesia care were randomised to receive either MO (231, 54.7%) or CA care (191, 45.2%). Spinal anaesthesia failure rate for MOs (7, 3.0%) was non-inferior to those of CA (5, 2.6%); difference in success rate of 0.4% (95% CI=0.36–0.43%; p=0.80). Additionally, there were no statistically significant differences observed between the two groups for intraoperative or postoperative complications, or patients’ experience of pain during the procedure.Interpretation This study demonstrates that failure rates of spinal anaesthesia care provided by trained MOs are non-inferior to care provided by CAs in low-risk surgical patients. This may support policy measures that use task-sharing as a means of expanding anaesthesia care capacity in rural Indian hospitals.Trial registration number NCT04438811. |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 2023-0141 2059-7908 |
| Relation: | https://gh.bmj.com/content/9/8/e014170.full; https://doaj.org/toc/2059-7908 |
| DOI: | 10.1136/bmjgh-2023-014170 |
| URL الوصول: | https://doaj.org/article/394a06093d0b471e912f5d062c2002c6 |
| رقم الأكسشن: | edsdoj.394a06093d0b471e912f5d062c2002c6 |
| قاعدة البيانات: | Directory of Open Access Journals |
Full Text Finder | تدمد: | 20230141 20597908 |
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| DOI: | 10.1136/bmjgh-2023-014170 |