Doctors recognized by the British honours systems: A retrospective analysis of the last decade

Objectives The British honours system is one of the oldest in the world rewarding individuals, including those of the medical profession. The authors were interested to see if any particular specialty was honoured to a greater extent. We aimed to establish the number of those honoured, the duration of clinical practice involved, as well as additional factors. Design A retrospective analysis of doctors receiving honours (Knight/Dame, CBE, OBE, MBE) in the last decade was performed. Setting UK-registered doctors. Participants Doctors were identified from publicly available listings. Main outcome measures Demographics of all honoured doctors, including number of years of service, specialty affiliation and the number of recipients holding professorial status were collected. Clinicians were stratified into four subgroups: General Practitioners, Physicians, Surgeons and Others. Data were analysed using parametric statistical tests. Results Four hundred and seventeen doctors were identified. Four hundred and two clinicians had a documented subspecialty affiliation. Of the 402: GPs ( n = 142), Physicians ( n = 100), Surgeons ( n = 34) and Others ( n = 126). The number of years in clinical practice from registration to conference of honours was significantly shorter for GPs when compared to hospital-based specialties ( P < 0.05). The top 10 specialties of individuals honoured are tabulated. Professors constituted 30% ( n = 131) of those honoured. These individuals were sub-divided according to specialty affiliation with a significant difference observed ( P < 0.05). Conclusions The most honoured specialty was General Practice. However, when corrected for total subspecialty population, the number one ranking specialty was Public Health Medicine. Academic clinicians are well represented. The findings may be of interest to the medical community.

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17. Boundaries or overlap: An examination of the community-oriented clinical practice of community medicine specialists and family/general practitioners

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2777 ◽

2007 ◽

Vol 30 (4) ◽

pp. 36

Author(s):

M. L. Russell ◽

L. McIntyre

Keyword(s):

Public Health ◽

Primary Care ◽

Clinical Practice ◽

Community Health ◽

Royal College ◽

Community Medicine ◽

Work Setting ◽

Public Health Medicine ◽

Work Settings ◽

Main Work

We compared the work settings and “community-oriented clinical practice” of Community Medicine (CM) specialists and family physicians/general practitioners (FP). We conducted secondary data analysis of the 2004 National Physician Survey (NPS) to examine main work setting and clinical activity reported by 154 CM (40% of eligible CM in Canada) and 11,041 FP (36% of eligible FP in Canada). Text data from the specialist questionnaire related to “most common conditions that you treat” were extracted from the Master database for CM specialists, and subjected to thematic analysis and coded. CM specialists were more likely than FP to engage in “community medicine/public health” (59.7% vs 15.3%); while the opposite was found for primary care (13% vs. 78.2%). CM specialists were less likely to indicate a main work setting of private office/clinic/community health centre/community hospital than were FP (13.6% vs. 75.6%). Forty-five percent of CM provided a response to “most common conditions treated” with the remainder either leaving the item blank or indicating that they did not treat individual patients. The most frequently named conditions in rank order were: psychiatric disorders; public health program/activity; respiratory problems; hypertension; and metabolic disorders (diabetes). There is some overlap in the professional activities and work settings of CM specialists and FP. The “most commonly treated conditions” suggest that some CM specialists may be practicing primary care as part of the Royal College career path of “community-oriented clinical practice.” However the “most commonly treated conditions” do not specifically indicate an orientation of that practice towards “an emphasis on health promotion and disease prevention” as also specified by the Royal College for that CM career path. This raises questions about the appropriateness of the current training requirements and career paths as delineated for CM specialists by the Royal College of Physicians & Surgeons of Canada. Bhopal R. Public health medicine and primary health care: convergent, divergent, or parallel paths? J Epidemiol Community Health 1995; 49:113-6. Pettersen BJ, Johnsen R. More physicians in public health: less public health work? Scan J Public Health 2005; 33:91-8. Stanwell-Smith R. Public health medicine in transition. J Royal Society of Medicine 2001; 94(7):319-21.

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An investigation on the frequency of thoughts, readiness and suicide attempt in individuals with thalassemia

10.53350/pjmhs211561847 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1847-1853

Author(s):

Sahar Attar ◽

Nour Mohammad Bakhshani ◽

Qasem Miri Aliabad

Keyword(s):

Suicidal Ideation ◽

Suicide Attempts ◽

Statistical Tests ◽

Genetic Diseases ◽

Thalassemia Major ◽

Cross Sectional Study ◽

World Health ◽

Cross Sectional ◽

Significant Difference ◽

The World

Background and Aim: Thalassemia major is one of the most common chronic genetic diseases in the world and in Iran that can impose many adverse effects on the self and society. Psychologically, patients with thalassemia are under stress. According to the World Health Organization (WHO), suicide is one of the leading causes of death worldwide. It is important to identify the people who have the highest risk factors for suicide. The present research investigates the frequency of thoughts, readiness and suicide attempts in people with thalassemia. Methods: This was a cross-sectional study. Its sample was 150 patients with thalassemia in the age range of 10 to 46 years whom we selected through census by sampling at convenience. We gave to patients a standardized Beck Suicide Thought Assessment Questionnaire. We analyzed the research data using descriptive and inferential statistical tests. Results: From among 150 patients with thalassemia in this study, 57.3% of the respondents were male and 42.7% were female. The results showed that there was a negative and significant relationship between suicide thoughts and attempts and age (-0.234) (P <0.05). The mean prevalence of suicide in men (1.89) was significantly higher compared to women (0.79) (P <0.05). We did not observe significant difference in prevalence of suicide thoughts and attempts between married and single groups with a mean difference (0.69) (P <0.05) and, in different educational groups, no significant difference was reported (P> 0.05). Conclusion: The findings of this research showed that among patients with thalassemia, the prevalence of suicidal ideation has a significant percentage. Since suicidal ideation provides a platform for preparation and attempt to commit suicide, so by providing mental health services and regular screening, we can take an effective step to prevent this problem among patients with thalassemia. Keywords: Thalassemia, Suicidal ideation, Suicide.

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Ethical Evaluation of Pharmaceutical Marketing in Sana’a City, Yemen

Yemeni Journal For Medical Sciences ◽

10.20428/yjms.14.1.a3 ◽

2021 ◽

Vol 14 (1) ◽

pp. 13-21

Author(s):

Gamil Q. Othman ◽

Abdulsalam M. Halboup ◽

Mohammed M. Battah

Keyword(s):

Work Experience ◽

Medical Profession ◽

Statistical Tests ◽

New Drugs ◽

Pharmaceutical Marketing ◽

Marketing Ethics ◽

Pharmaceutical Companies ◽

National Guidelines ◽

Ethical Guidelines ◽

Significant Difference

Objectives: To evaluate the ethics of pharmaceutical marketing practices in Sana’a city, Yemen. Methods: A cross-sectional study was conducted among 400 physicians and 50 pharmaceutical companies in the period from March to August 2018. Data about pharmaceutical marketing ethics were collected from physicians and pharmaceutical companies using two types of self-administrated, structured questionnaires. Data were analyzed with appropriate statistical tests using IBM SPSS Statistics, version 21.0. Results: The majority of physicians (60.0%) agreed that medical samples had been used most frequently as a promotional tool for pharmaceutical marketing, followed by gifts (14.0%). More than half of physicians were satisfied with the way of pharmaceutical marketing in Yemen. Personal relationships and medical samples and gifts were the factors affecting their prescriptions, being reported by about a third of physicians each. Meanwhile, most physicians (44.0%) preferred medical conferences and exhibitions as a promotional benefit to be gotten for prescribing the company’s products. The majority of physicians (62.0%) agreed that the availability of medical samples affect their prescriptions, and about 28.2% of physicians reported that all medical samples are used by their patients. Most physicians (37.0%) perceived that only 50% of medical representatives respond well to their queries related to marketed drugs, and 41.5% of physicians agreed that global companies are more compliant with ethical marketing. About 60% of the physicians reported not facing unethical promotions, and the majority (54.0%) agreed that unethical pharmaceutical marketing is the responsibility of companies, physicians, and representatives. There was a statistically significant difference in the proportion of drug prescriptions affected by medical representative visits and availability of medical samples on prescription in relation to the work experience of physicians. On the other hand, there was a statistically significant difference in facing an unethical promotion offered by companies for prescribing their products and the attribution of unethical pharmaceutical marketing in relation to the type of medical profession of physicians. Conclusions: Pharmaceutical marketing in Yemen still depends on traditional tools, with the lack of ethical guidelines or codes for pharmaceutical marketing in the country. Work experience and medical profession of physicians can significantly affect pharmaceutical marketing. The spread of unethical marketing is the responsibility of pharmaceutical companies, physicians and medical representatives. Therefore, it is recommended to develop well-defined and updated ethical standards and national guidelines for pharmaceutical marketing by the Ministry of Public Health and Population. Furthermore, official campaigns should be regularly carried out to control and restrict unethical promotion. Further studies on the ethics of pharmaceutical marketing are also recommended. Pharmaceutical companies should continuously train their medical representatives and provide physicians with the latest medical knowledge about new drugs. Keywords: Pharmaceutical marketing, Ethics, IFPMA guidelines, Sana’a

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Incidence of clinically suspected venous thromboembolism in British Indian patients

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0058 ◽

2018 ◽

Vol 100 (5) ◽

pp. 413-416 ◽

Cited By ~ 1

Author(s):

BM Siddiqui ◽

MS Patel ◽

S Rudge ◽

A Best ◽

J Mangwani

Keyword(s):

Public Health ◽

Venous Thromboembolism ◽

Public Health Issue ◽

Major Public Health Issue ◽

Vein Thrombosis ◽

Indian Patients ◽

Significant Difference ◽

The World ◽

The Uk ◽

Deep Vein

Introduction Venous thromboembolism (VTE) remains a major public health issue around the world. Ethnicity is known to alter the incidence of VTE. To our knowledge, there are no reports in the literature investigating the incidence of VTE in British Indians. The aim of this study was to investigate the rates of symptomatic VTE in British Indian patients in the UK. Methods Patients referred to our institution between January 2011 and August 2013 with clinically suspected VTE were eligible for inclusion in the study. Those not of British Indian or Caucasian ethnicity were excluded. A retrospective review of these two cohorts was conducted. Results Overall, 15,529 cases were referred to our institution for suspected VTE. This included 1,498 individuals of British Indian ethnicity. Of these, 182 (12%) had confirmed VTE episodes. A further 13,159 of the patients with suspected VTE were coded as Caucasian, including 2,412 (16%) who had confirmed VTE events. VTE rates were a third lower in British Indians with clinically suspected VTE than in the equivalent Caucasian group. The British Indian cohort presented with VTE at a much earlier age than Caucasians (mean 57.0 vs 68.0 years). Conclusions This study suggests that British Indian patients have a lower incidence of VTE and are more likely to present at an earlier age than Caucasians. There was no significant difference in VTE type (deep vein thrombosis vs pulmonary embolism) among the ethnic groups. Clinicians should be aware of variations within ethnicities but should continue to adhere to existing VTE prevention guidance.

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Lyme Disease Frontiers: Reconciling Borrelia Biology and Clinical Conundrums

Pathogens ◽

10.3390/pathogens8040299 ◽

2019 ◽

Vol 8 (4) ◽

pp. 299 ◽

Cited By ~ 3

Author(s):

Vladimir V. Bamm ◽

Jordan T. Ko ◽

Iain L. Mainprize ◽

Victoria P. Sanderson ◽

Melanie K. B. Wills

Keyword(s):

Public Health ◽

Clinical Practice ◽

Phenotypic Plasticity ◽

Lyme Disease ◽

Biomedical Research ◽

Immune Modulation ◽

Incidence Rates ◽

The World ◽

Public Health Threat ◽

Host Genetic

Lyme disease is a complex tick-borne zoonosis that poses an escalating public health threat in several parts of the world, despite sophisticated healthcare infrastructure and decades of effort to address the problem. Concepts like the true burden of the illness, from incidence rates to longstanding consequences of infection, and optimal case management, also remain shrouded in controversy. At the heart of this multidisciplinary issue are the causative spirochetal pathogens belonging to the Borrelia Lyme complex. Their unusual physiology and versatile lifestyle have challenged microbiologists, and may also hold the key to unlocking mysteries of the disease. The goal of this review is therefore to integrate established and emerging concepts of Borrelia biology and pathogenesis, and position them in the broader context of biomedical research and clinical practice. We begin by considering the conventions around diagnosing and characterizing Lyme disease that have served as a conceptual framework for the discipline. We then explore virulence from the perspective of both host (genetic and environmental predispositions) and pathogen (serotypes, dissemination, and immune modulation), as well as considering antimicrobial strategies (lab methodology, resistance, persistence, and clinical application), and borrelial adaptations of hypothesized medical significance (phenotypic plasticity or pleomorphy).

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Prognostic impact of immune-related adverse events with nivolumab in patients with advanced gastric cancer: A multicenter retrospective analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.347 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 347-347

Author(s):

Yuno Ohya ◽

Takayuki Ando ◽

Akira Ueda ◽

Kohei Ogawa ◽

Iori Motoo ◽

...

Keyword(s):

Gastric Cancer ◽

Clinical Practice ◽

Adverse Events ◽

Advanced Gastric Cancer ◽

Retrospective Analysis ◽

Prognostic Impact ◽

Significant Difference ◽

Metastatic Sites ◽

Practice Methods ◽

Ecog Ps

347 Background: Nivolumab was established as one of the standard treatments for previously treated advanced gastric cancer (AGC). The aim of this study is to evaluate the frequency of immune-related adverse events (irAEs) with Nivolumab and its impact on treatment efficacy in clinical practice. Methods: We performed multicenter retrospective analysis, which included 90 patients with advanced gastric cancer who received Nivolumab treatment between October 2017 and September 2019. The frequency of irAEs and its treatment outcome were evaluated, and survival was compared during Nivolumab treatment. Results: The characteristics of 90 patients in this analysis were as follows: median age (range), 68 (36-85); male/female, 56/34; ECOG PS 0-1/≥2, 62/28; number of metastatic sites 1/≥2, 36/56; treatment line 3/≥4, 63/27. Median treatment cycle of nivolumab treatment was 3 (range 1-26). The overall response in 68 patients with target lesions was 6.3% (4/68), and the median PFS and OS was 1.5 and 4.3 months, respectively. IrAEs were observed in 8 patients (8.8%), including grade 4 pneumonitis, grade 2 or 3 adrenal insufficiency, and grade 2 hypothyroidism, encephalitis, and immune thrombocytopenia. Median time to onset of irAEs was 1.3 (range 0.6-10.5) months. Six were treated with systemic corticosteroid therapy, and all irAEs were relieved. The median PFS and OS were 4.7 months (95%CI, 1.2-9.3) and 12.2 months (95% CI, 3.2-not reached) in patient with irAEs, and 1.4 months (95%CI, 1.1-1.9) and 4.1 months (95%CI, 2.6-6.6) in those without, respectively. There was significant difference in the PFS (p=0.005) and OS (p=0.03). Conclusions: Nivolumab was effective and well tolerated even in clinical practice. Development of irAEs may be associated with better outcome of Nivolumab in patients with AGC.

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A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF DARVYADI LEHYA AND DRAKSHADI LEHYA IN PANDU ROGA W.S.R TO I.D.A

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj0408092020 ◽

2020 ◽

Vol 8 (9) ◽

pp. 4324-4328

Author(s):

Karthika Raj ◽

Susheel Shetty

Keyword(s):

Clinical Practice ◽

Clinical Study ◽

Data Base ◽

Clinical Features ◽

The Other ◽

Significant Difference ◽

The World ◽

Before And After ◽

Comparative Clinical Study ◽

Global Data

Pandu is a Pitta Pradhana Tridoshaja Vikara affecting the Rasavaha srotas causing Sapta Dhatu Kshaya and Ojokshaya1. The disease is characterized by Panduvamata and Arohana Ayasa. Karnakshweda, Agnimandya, Daurbalya, Annadwesha, Srama, Bhrama, Gathrashoola, Arohanaayasa, Aruchi, Gaurava etc. are the other symptoms commonly found in the patients of Pandu. In the Present era, Anaemia is a burning issue around the world and W.H.O Global data base 2011 reveals that, in a 120 million population, 83% people are suffering from anaemia2.Present study was conducted on 60 diagnosed patients of Panduwho were randomly allocated with 30 each in two groups. Darvyadhi Lehya was given for one group and Drakshadhi Lehya a widely used formulation in clinical practice was given for another group. The study was conducted in 60 subjects for a period of 30 days. Clinical features and haematological parameters were documented before and after the treatment. The results of the study showed that, a statistically significant difference was not seen between the effect of Darvyadi and Drakshadilehya in Pandu roga.

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Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology (Preprint)

10.2196/preprints.16355 ◽

2019 ◽

Cited By ~ 1

Author(s):

Samira M Haddad ◽

Renato T Souza ◽

Jose Guilherme Cecatti ◽

Maria Barreix ◽

Tigist Tamrat ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Clinical Practice ◽

Decision Support ◽

Antenatal Care ◽

Digital Systems ◽

World Health ◽

Evidence Based ◽

Data Dictionary ◽

The World

BACKGROUND One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery. OBJECTIVE The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. METHODS The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module’s creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms. RESULTS The first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman’s health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows. CONCLUSIONS This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module’s implementation will inform the WHO’s ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability.

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Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology

Journal of Medical Internet Research ◽

10.2196/16355 ◽

2020 ◽

Vol 22 (10) ◽

pp. e16355

Author(s):

Samira M Haddad ◽

Renato T Souza ◽

Jose Guilherme Cecatti ◽

Maria Barreix ◽

Tigest Tamrat ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Clinical Practice ◽

Decision Support ◽

Antenatal Care ◽

Digital Systems ◽

World Health ◽

Evidence Based ◽

Data Dictionary ◽

The World

Background One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery. Objective The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. Methods The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module’s creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms. Results The first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman’s health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows. Conclusions This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module’s implementation will inform the WHO’s ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability.

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Variations in processes for guideline adaptation: a qualitative study of World Health Organization staff experiences in implementing guidelines

BMC Public Health ◽

10.1186/s12889-020-09812-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhicheng Wang ◽

Quinn Grundy ◽

Lisa Parker ◽

Lisa Bero

Keyword(s):

Public Health ◽

Clinical Practice ◽

Qualitative Study ◽

Local Development ◽

World Health ◽

Recent Experience ◽

Who Guidelines ◽

Guideline Adaptation ◽

The World ◽

Adaptation Processes

Abstract Background The World Health Organisation (WHO) publishes a large number of clinical practice and public health guidelines to promote evidence-based practice across the world. Due to the variety of health system capacities and contextual issues in different regions and countries, adapting the recommendations in the guidelines to the local situation is vital for the success of their implementation. We aim to understand the range of experiences with guideline adaptation from the perspectives of those working in WHO regional and country offices. Our findings will inform development of guidance on how to improve adaptability of WHO guidelines. Methods A grounded theory-informed, qualitative study was carried out between March 2018 and December 2018. Seventeen semi-structured interviews were conducted with participants who included WHO guideline developers and staff in the headquarters, regional and country offices recruited from a sample of published WHO guidelines. Participants were eligible for recruitment if they had recent experience in clinical practice or public health guideline implementation. Deidentified transcripts of these interview were analysed through three cycles of coding. Results We categorised the adaptation processes described by the participants into two dominant models along a spectrum of guideline adaptation processes. First, the Copy or Customise Model is a pragmatic approach of either copying or customising WHO guidelines to suit local needs. This is done by local health authorities and/or clinicians directly through consultations with WHO staff. Selections and adjustments of guideline recommendations are made according to what the implementers deemed important, feasible and applicable through the consensus discussions. Second, the Capacity Building Model focuses on WHO building local capacity in evidence synthesis methods and adaptation frameworks to support local development of a national guideline informed by international guidelines. Conclusions In comparing and contrasting these two models of guideline adaptation, we outline the different kinds of support from WHO that may be necessary to improve the effectiveness and efficiency of the respective models. We also suggest clarifications in the descriptions of the process of guideline adaptation in WHO and academic literature, to help guideline adaptors and implementers decide on the appropriate course of action according to their specific circumstances. Ethics This project was conducted with ethics approval from The University of Sydney (Project number: 2017/723) and WHO (Protocol ID: 00001).

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