scholarly journals Variation in hypertension clinical practice guidelines: a global comparison

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Richu Philip ◽  
Thomas Beaney ◽  
Nick Appelbaum ◽  
Carmen Rodriguez Gonzalvez ◽  
Charlotte Koldeweij ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Practice ◽  
World Bank ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Low Income ◽  
Target Blood Pressure ◽  
Low Income Countries ◽  
Global Comparison ◽  
The World

Abstract Background Hypertension is the largest single contributor to the global burden of disease, affecting an estimated 1.39 billion people worldwide. Clinical practice guidelines (CPGs) can aid in the effective management of this common condition, however, inconsistencies exist between CPGs, and the extent of this is unknown. Understanding the differences in CPG recommendations across income settings may provide an important means of understanding some of the global variations in clinical outcomes related to hypertension. Aims This study aims to analyse the variation between hypertension CPGs globally. It aims to assess the variation in three areas: diagnostic threshold and staging, treatment and target blood pressure (BP) recommendations in hypertension. Methods A search was conducted on the MEDLINE repository to identify national and international hypertension CPGs from 2010 to May 2020. An additional country-specific grey-literature search was conducted for all countries and territories of the world as identified by the World Bank. Data describing the diagnosis, staging, treatment and target blood pressure were extracted from CPGs, and variations between CPGs for these domains were analysed. Results Forty-eight CPGs from across all World Bank income settings were selected for analysis. Ninety-six per cent of guidelines defined hypertension as a clinic-based BP of ≥140/90 mmHg, and 87% of guidelines recommended a target BP of < 140/90 mmHg. In the pharmacological treatment of hypertension, eight different first-step, 17 different second-step and six different third-step drug recommendations were observed. Low-income countries preferentially recommended diuretics (63%) in the first-step treatment, whilst high-income countries offered more choice between antihypertensive classes. Forty-four per cent of guidelines, of which 71% were from higher-income contexts recommended initiating treatment with dual-drug therapy at BP 160/100 mmHg or higher. Conclusion This study found that CPGs remained largely consistent in the definition, staging and target BP recommendations for hypertension. Extensive variation was observed in treatment recommendations, particularly for second-line therapy. Variation existed between income settings; low-income countries prescribed cheaper drugs, offered less clinician choice in medications and initiated dual therapy at later stages than higher-income countries. Future research exploring the underlying drivers of this variation may improve outcomes for hypertensive patients across clinical contexts.

scholarly journals Global trends in medical education accreditation

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Deborah Bedoll ◽  
Marta van Zanten ◽  
Danette McKinley
Keyword(s):  
Medical Education ◽  
World Bank ◽  
Low Income ◽  
Regional Cooperation ◽  
Medical Schools ◽  
Income Group ◽  
Low Income Countries ◽  
Fiscal Year ◽  
The World ◽  
Google Search

Abstract Background Accreditation systems in medical education aim to assure various stakeholders that graduates are ready to further their training or begin practice. The purpose of this paper is to explore the current state of medical education accreditation around the world and describe the incidence and variability of these accreditation agencies worldwide. This paper explores trends in agency age, organization, and scope according to both World Bank region and income group. Methods To find information on accreditation agencies, we searched multiple online accreditation and quality assurance databases as well as the University of Michigan Online Library and the Google search engine. All included agencies were recorded on a spreadsheet along with date of formation or first accreditation activity, name changes, scope, level of government independence, accessibility and type of accreditation standards, and status of WFME recognition. Comparisons by country region and income classification were made based on the World Bank’s lists for fiscal year 2021. Results As of August 2020, there were 3,323 operating medical schools located in 186 countries or territories listed in the World Directory of Medical Schools. Ninety-two (49%) of these countries currently have access to undergraduate accreditation that uses medical-specific standards. Sixty-four percent (n = 38) of high-income countries have medical-specific accreditation available to their medical schools, compared to only 20% (n = 6) of low-income countries. The majority of World Bank regions experienced the greatest increase in medical education accreditation agency establishment since the year 2000. Conclusions Most smaller countries in Europe, South America, and the Pacific only have access to general undergraduate accreditation, and many countries in Africa have no accreditation available. In countries where medical education accreditation exists, the scope and organization of the agencies varies considerably. Regional cooperation and international agencies seem to be a growing trend. The data described in our study can serve as an important resource for further investigations on the effectiveness of accreditation activities worldwide. Our research also highlights regions and countries that may need focused accreditation development support.

scholarly journals Systematic review of clinical practice guidelines for adults with fractures: identification of best evidence for rehabilitation to develop the WHO’s Package of Interventions for Rehabilitation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Francesca Gimigliano ◽  
◽  
Sara Liguori ◽  
Antimo Moretti ◽  
Giuseppe Toro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Hip Fracture ◽  
Distal Radius ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Adult Population ◽  
World Health ◽  
The World

Abstract Background The identification of existing rehabilitation interventions and related evidence represents a crucial step along the development of the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR). The methods for such identification have been developed by the WHO Rehabilitation Programme and Cochrane Rehabilitation under the guidance of the WHO’s Guideline Review Committee secretariat. The aim of this paper is to report on the results of the systematic search for clinical practice guidelines (CPGs) relevant to the rehabilitation of adults with fractures and to present the current state of evidence available from the identified CPGs. Methods This paper is part of the Best Evidence for Rehabilitation (be4rehab) series, developed according to the methodology presented in the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR) introductory paper. It is a systematic review of existing CPGs on fractures in adult population published from 2009 to 2019. Results We identified 23 relevant CPGs after title and abstract screening. According to inclusion/exclusion criteria, we selected 13 CPGs. After checking for quality, publication time, multiprofessionality, and comprehensiveness, we finally included five CPGs dealing with rehabilitative management of fractures in adult population, two CPGs addressing treatment of distal radius fracture and three the treatment of femoral/hip fracture. Conclusion The selected CPGs on management of distal radius and femoral/hip fracture include few recommendations regarding rehabilitation, with overall low to very low quality of evidence and weak/conditional strength of recommendation. Moreover, several gaps in specific rehabilitative topics occur. Further high-quality trials are required to upgrade the quality of the available evidence. Level of evidence Level 1.

The World Bank and Educational Assistance

2017 ◽  
Author(s):  
D. Brent Edwards ◽  
Inga Storen
Keyword(s):  
Education Reform ◽  
World Bank ◽  
Low Income ◽  
Technical Assistance ◽  
International Political Economy ◽  
Low Income Countries ◽  
Educational Assistance ◽  
Country Level ◽  
The World Bank ◽  
The World

Since the 1950s, the World Bank’s involvement and influence in educational assistance has increased greatly. The World Bank has not only been a key player, but, at times, has been the dominant international organization working with low-income countries to reform their education systems. Given the contributions that education makes to country development, the World Bank works in the realm of education as part of its broad mission to reduce poverty and to increase prosperity. This work takes the form of financing, technical assistance and knowledge production (among others) and occurs at multiple levels, as the World Bank seeks to contribute to country development and to shape the global conversation around the purposes and preferred models of education reform, in addition to engaging in international processes and politics with other multi- and bilateral organizations. The present article examines the work of the World Bank in historical perspective in addition to discussing how the role of this institution has been theorized and research by scholars. Specifically, the first section provides an overview of this institution’s history with a focus on how the leadership, preferred policies, organizational structure, lending, and larger politics to which it responds have changed over time, since the 1940s. Second, the article addresses the ways that the World Bank is conceptualized and approached by scholars of World Culture Theory, international political economy, and international relations. The third section contains a review of research on (a) how the World Bank is involved in educational policy making at the country level, (b) the ways the World Bank engages with civil society and encourages its general participation in educational assistance, (c) what is known about the World Bank in relation to policy implementation, and (d) the production of research in and on the Bank.

scholarly journals The Effect of Globalization on Economic Development Indicators: An Inter-Regional Approach

2020 ◽  
Vol 12 (5) ◽  
pp. 1942 ◽  
Author(s):  
Pedro Antonio Martín Cervantes ◽  
Nuria Rueda López ◽  
Salvador Cruz Rambaud
Keyword(s):  
Economic Development ◽  
World Bank ◽  
Low Income ◽  
Public Expenditure ◽  
Low Income Countries ◽  
Development Indicators ◽  
The World Bank ◽  
The World ◽  
Economic Institute ◽  
Double Character

Background: The analysis of the problems derived from globalization has become one of the most densely studied topics at the beginning of this millennium, as they can have a crucial impact on present and future sustainable development. This paper analyzes the differential patterns of globalization in four worldwide areas predefined by The World Bank (namely, High-, Upper-Middle-, Lower-Middle-, and Low-Income countries). The main objective of this work is to estimate the effect of globalization on some economic development indicators (specifically per capita income and public expenditure on health) in 217 countries over the period 2000–2016. Methods: Our empirical approach is based on the implementation of a novel econometric methodology: The so-called Toda–Yamamoto procedure, which has been used to analyze the possible causal relationships between the involved variables. We employ World Development Indicators, provided by The World Bank, and the KOF Globalization Index, elaborated by the KOF Swiss Economic Institute. Results: The results show that there is a causal relationship in the sense of Granger between globalization and public expenditure on health, except in High-Income countries. This can be interpreted both negatively and positively, confirming the double character of globalization, as indicated by Stiglitz.

scholarly journals Guidelines for Cancer Care during the COVID-19 Pandemic in South Korea

2021 ◽  
Vol 53 (2) ◽  
pp. 323-329
Author(s):  
Jii Bum Lee ◽  
Minkyu Jung ◽  
June Hyuk Kim ◽  
Bo Hyun Kim ◽  
Yeol Kim ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Severe Acute Respiratory Syndrome ◽  
Cancer Patients ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cancer Care ◽  
Task Force ◽  
World Health ◽  
The World ◽  
Health Organization

At the end of 2019, the cause of pneumonia outbreaks in Wuhan, China, was identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In February 2020, the World Health Organization named the disease cause by SARS-CoV-2 as coronavirus disease 2019 (COVID-19). In response to the pandemic, the Korean Cancer Association formed the COVID-19 task force to develop practice guidelines. This special article introduces the clinical practice guidelines for cancer patients which will help oncologists best manage cancer patients during the COVID-19 pandemic.

Assessing Bias and Accuracy in the World Bank-IMF's Debt Sustainability Framework for Low-Income Countries

2014 ◽  
Vol 14 (48) ◽  
pp. 1 ◽  
Author(s):  
Andrew Berg ◽  
Enrico Berkes ◽  
Catherine Pattillo ◽  
Andrea Presbitero ◽  
Yorbol Yakhshilikov ◽  
...  
Keyword(s):  
World Bank ◽  
Low Income ◽  
Low Income Countries ◽  
Debt Sustainability ◽  
The World Bank ◽  
The World ◽  
Sustainability Framework
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