Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study

Physical rehabilitation interventions address functional deficits caused by impairments that affect someone's performance. Whilst rehabilitation is important, it is assumed that these services are either minimal or nonexistent in low-resource settings. Our data expand on the data from the Situation Assessment of Rehabilitation in the Republic of Rwanda report to describe rehabilitation services and who access them at public and semiprivate facilities (primarily funded by the private sector).Objectives: This article describes the use of the outpatient physical rehabilitation services across nine health facilities, the characteristics of adults attending these health facilities and some of the facilitators and barriers they encounter when attending rehabilitation. Method: Data were collected between September and December 2018 from the heads of departments and adult patients attending outpatient rehabilitation services funded by the government, international nongovernmental organizations or faith-based organizations. Results: Two hundred and thirteen adults were recruited from nine facilities. There is a sixfold difference in the number of rehabilitation personnel between public and semiprivate hospitals in these facilities' catchment areas. However, most participants were recruited at public facilities (186 [87%]), primarily with physical disorders. Patients reported that family support (94%) was the most crucial facilitator for attending rehabilitation, whilst transportation cost (96%) was a significant barrier. Conclusion: Rehabilitation service availability for Rwandan adults with disabilities is limited. Whilst family support helps patients attend rehabilitation, transportation costs remain a significant barrier to people attending rehabilitation. Strategies to address these issues include developing triage protocols, training community health workers and families. Contribution: Data on rehabilitation service provision in Rwanda and most African countries are either non-existent or very limited. These data contain important information regarding the services provided and the people who used them across different health facilities (public versus private) and urban versus rural settings). To improve rehabilitation service provision, we first need to understand the current situation. These data are an important step to better understanding rehabilitation in Rwanda

The future of precision medicine in opioid use disorder: inclusion of patient-important outcomes in clinical trials

Opioid use has reached an epidemic proportion in Canada and the United States that is mostly attributed to excess availability of prescribed opioids for pain. This excess in opioid use led to an increase in the prevalence of opioid use disorder (OUD) requiring treatment. The most common treatment recommendations include medication-assisted treatment (MAT) combined with psychosocial interventions. Clinical trials investigating the effectiveness of MAT, however, have a limited focus on effectiveness measures that overlook patient-important outcomes. Despite MAT, patients with OUD continue to suffer negative consequences of opioid use. Patient goals and personalized medicine are overlooked in clinical trials and guidelines, thus missing an opportunity to improve prognosis of OUD by considering precision medicine in addiction trials. In this mixed-methods study, patients with OUD receiving MAT (n=2,031, mean age 39.1 years [SD 10.7], 44% female) were interviewed to identify patient goals for MAT. The most frequently reported patient-important outcomes were to stop treatment (39%) and to avoid all drugs (25%). These results are inconsistent with treatment recommendations and trial outcome measures. We discuss theses inconsistencies and make recommendations to incorporate these outcomes to achieve patient-centered and personalized treatment strategies.

Evaluating Journal Impact Factor: a systematic survey of the pros and cons, and overview of alternative measures

Journal Impact Factor (JIF) has several intrinsic flaws, which highlight its inability to adequately measure citation distributions or indicate journal quality. Despite these flaws, JIF is still widely used within the academic community, resulting in the propagation of potentially misleading information. A critical review of the usefulness of JIF is needed including an overview of the literature to identify viable alternative metrics. The objectives of this study are: (1) to assess the usefulness of JIF by compiling and comparing its advantages and disadvantages; (2) to record the differential uses of JIF within research environments; and (3) to summarize and compare viable alternative measures to JIF. Methods: Three separate literature search strategies using MEDLINE and Web of Science were completed to address the three study objectives. Each search was completed in accordance with PRISMA guidelines. Results were compiled in tabular format and analyzed based on reporting frequency. Results: For objective (1), 84 studies were included in qualitative analysis. It was found that the recorded advantages of JIF were outweighed by disadvantages (18 disadvantages vs. 9 advantages). For objective (2), 653 records were included in a qualitative analysis. JIF was found to be most commonly used in journal ranking (n = 653, 100%) and calculation of scientific research productivity (n = 367, 56.2%). For objective (3), 65 works were included in qualitative analysis. These articles revealed 45 alternatives, which includes 18 alternatives that improve on highly reported disadvantages of JIF. Conclusion: JIF has many disadvantages and is applied beyond its original intent, leading to inaccurate information. Several metrics have been identified to improve on certain disadvantages of JIF. Integrated Impact Indicator (I3) shows great promise as an alternative to JIF. However, further scientometric analysis is needed to assess its properties.(AU)

Key factors of clinical research network capacity building

In general, clinical research network capacity building refers to programs aimed at enhancing networks of researchers to conduct clinical research. Although in the literature there is a large body of research on how to develop and build capacity in clinical research networks, the conceptualizations and implementations remain controversial and challenging. Moreover, the experiences learnt from the past accomplishments and failures can assist in the future capacity building efforts to be more practical, effective and efficient. In this paper, we aim to provide an overview of capacity building in clinical research network by (1) identifying the key barriers to clinical research network capacity building, (2) providing insights into how to overcome those obstacles, and (3) sharing our experiences in collaborating with national and international partners to build capacity in clinical research networks. In conclusion, we have provided some insight into how to address the key factors of clinical research network capacity building and shared some empirical experiences. A successful capacity building practice requires a joint endeavor to procure sufficient resources and support from the relevant stakeholders, to ensure its efficiency, cost-effectiveness, and sustainability.(AU)

Introducing the CONSORT extension to pilot trials: enhancing the design, conduct and reporting of pilot or feasibility trials

This editorial provides a brief overview of the importance of pilot or feasibility trials or studies, the challenges with current practices in their conduct and reporting, an introduction to the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot trials aimed at improving their reporting, along with some key resources on aspects related to pilot and feasibility studies.

Key factors of clinical research network capacity building

In general, clinical research network capacity building refers to programs aimed at enhancing networks of researchers to conduct clinical research. Although in the literature there is a large body of research on how to develop and build capacity in clinical research networks, the conceptualizations and implementations remain controversial and challenging. Moreover, the experiences learnt from the past accomplishments and failures can assist in the future capacity building efforts to be more practical, effective and efficient. In this paper, we aim to provide an overview of capacity building in clinical research network by (1) identifying the key barriers to clinical research network capacity building, (2) providing insights into how to overcome those obstacles, and (3) sharing our experiences in collaborating with national and international partners to build capacity in clinical research networks. In conclusion, we have provided some insight into how to address the key factors of clinical research network capacity building and shared some empirical experiences. A successful capacity building practice requires a joint endeavor to procure sufficient resources and support from the relevant stakeholders, to ensure its efficiency, cost-effectiveness, and sustainability.

Introducing the CONSORT extension to pilot trials: enhancing the design, conduct and reporting of pilot or feasibility trials

This editorial provides a brief overview of the importance of pilot or feasibility trials or studies, the challenges with current practices in their conduct and reporting, an introduction to the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot trials aimed at improving their reporting, along with some key resources on aspects related to pilot and feasibility studies.(AU)