Neurosurgical Randomized Trials in Low- and Middle-Income Countries.

Autor:	Griswold DP; Stanford University School of Medicine, Stanford, California.; Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom., Khan AA; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.; Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Bogotá, Colombia., Chao TE; Stanford University School of Medicine, Stanford, California.; Department of Surgery, Santa Clara Valley Medical Center, San Jose, California., Clark DJ; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.; Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom., Budohoski K; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.; Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom., Devi BI; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.; Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India., Azad TD; Stanford University School of Medicine, Stanford, California.; Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland., Grant GA; Stanford University School of Medicine, Stanford, California., Trivedi RA; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.; Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom., Rubiano AM; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.; Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Bogotá, Colombia., Johnson WD; Emergency and Essential Surgical Care Programme, World Health Organization, Geneva, Switzerland., Park KB; Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts., Broekman M; Department of Neurosurgery, Leiden University Medical Center, Leiden and Haaglanden Medical Center, the Hague, the Netherlands., Servadei F; Department of Neurosurgery, Humanitas Research Hospital, Humanitas University, Milan, Italy., Hutchinson PJ; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.; Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom., Kolias AG; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.; Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2020 Sep 01; Vol. 87 (3), pp. 476-483.
DOI:	10.1093/neuros/nyaa049
Abstrakt:	Background: The setting of a randomized trial can determine whether its findings are generalizable and can therefore apply to different settings. The contribution of low- and middle-income countries (LMICs) to neurosurgical randomized trials has not been systematically described before. Objective: To perform a systematic analysis of design characteristics and methodology, funding source, and interventions studied between trials led by and/or conducted in high-income countries (HICs) vs LMICs. Methods: From January 2003 to July 2016, English-language trials with >5 patients assessing any one neurosurgical procedure against another procedure, nonsurgical treatment, or no treatment were retrieved from MEDLINE, Scopus, and Cochrane Library. Income classification for each country was assessed using the World Bank Atlas method. Results: A total of 73.3% of the 397 studies that met inclusion criteria were led by HICs, whereas 26.7% were led by LMICs. Of the 106 LMIC-led studies, 71 were led by China. If China is excluded, only 8.8% were led by LMICs. HIC-led trials enrolled a median of 92 patients vs a median of 65 patients in LMIC-led trials. HIC-led trials enrolled from 7.6 sites vs 1.8 sites in LMIC-led studies. Over half of LMIC-led trials were institutionally funded (54.7%). The majority of both HIC- and LMIC-led trials evaluated spinal neurosurgery, 68% and 71.7%, respectively. Conclusion: We have established that there is a substantial disparity between HICs and LMICs in the number of published neurosurgical trials. A concerted effort to invest in research capacity building in LMICs is an essential step towards ensuring context- and resource-specific high-quality evidence is generated. (© Congress of Neurological Surgeons 2020.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu