Advancing global health research equity

Parachute (or ‘helicopter’) research is the practice of conducting primary research within a host country and subsequently publishing findings with inadequate recognition of local researchers, staff and/or supporting infrastructure. In fact, almost 30% of publications of primary research conducted in LMICs did not contain any local authors. This new consensus statement from Morton et al. contains six recommendations which apply not just to research in our field, but broadly within academic publishing. It has achieved an Altmetric score of nearly 400, which demonstrates how well it was received by the academic community. A key element is the structured reflexivity statement, which the authors suggest should be completed with manuscript submissions from international research partnerships involving researchers from high- and low-to-middle-income countries. In the accompanying editorial, Jumbam et al. build upon this by encouraging journals and journal editors to adopt the recommendations (Fig. 1), and by encouraging us all to consider the reflexivity statement at every timepoint during project conception and implementation.

Figure 1 The position and power of journals within the global health research ecosystem. Journals influence the ecosystem by: (a) brokering research outputs which are predominantly led from HIC institutions; and (b) direct editorial statements (e.g. through ‘commissions’). These journal activities influence research prioritisation and funding allocation. The current predominance of HIC outputs and perspectives in journal activities further amplifies the impact of HIC perspectives on donor funding and research agendas. This can worsen existing inequities. 

In the UK, the Getting It Right First Time (GIRFT) programme was established by the Department of Health and Social Care as an initiative to investigate variation in healthcare delivery and patient outcomes between hospital Trusts in England. For their new paper, Gray et al. used the Hospital Episodes Statistics (HES) database to investigate variation in the rates Trusts discharged children the same day after tonsillectomy and associations with adverse postoperative outcomes. They provide evidence that outcomes for day-case and overnight stay tonsillectomy are similar, and argue the majority of specialist and non-specialist Trusts should increase day-case surgery rates. In the associated editorial, Stocker asks, why is there still a debate? Afterall, admitting a child to hospital is disruptive and, on occasions, distressing for not just the child but their extended family, as it necessitates the child and a parent to be away from the family home overnight. 

Video-assisted thoracoscopic surgery is associated with less pain and better recovery as compared with thoracotomy. Although enhanced recovery after surgery guidelines have been described, this PROSPECT guideline is the first specifically address evidence-based analgesia strategies. Recommendations support the use of: paravertebral and erector spinae plane blocks; systemic multimodal analgesia; intra-operative dexmedetomidine; and rescue opioids. The authors do not support thoracic epidural analgesia. In the associated editorial, Shelley et al. remind us that the supportive evidence for regional anaesthetic techniques in this cohort is weak. Although the guidelines are a useful benchmark, an individualised approach remains paramount, and more evidence is required urgently.

Obstructive sleep apnoea (OSA) is highly prevalent in the general population. This new secondary analysis from Moringo et al. aims to determine whether the STOP-Bang questionnaire can be distilled to develop an abbreviated screening tool to identify patients at high risk for severe OSA. They found that it can be reduced from eight to four variables to effectively identify patients at high risk for severe OSA. Neck circumference was most strongly associated with severe OSA, while observed apnoea, high blood pressure and BMI trended towards significance (Fig. 2). These four variables were termed the B-APNEIC score and together they demonstrated similar predictive accuracy to the STOP-Bang questionnaire for identifying individuals at high risk for severe OSA. In the associated editorial, Singh and Ramachandran welcome the B-APNEIC score and call for more research in areas such as POCUS screening, outcome prediction models and individualised evidence-based postoperative management strategies

Figure 2 Receiver operating characteristic curves of STOP-Bang questionnaire vs. B-APNEIC score for clinical diagnosis of severe obstructive sleep apnoea (OSA), severe apnoea-hypopnoea index (AHI), severe respiratory disturbance index (RDI) and severe oxygen desaturation index (ODI).

Many will routinely mix local anaesthetic agents or add adjuncts to alter block characteristics, but what are the true clinical consequences of this practice? Nestor et al. review the evidence, and find the supportive evidence to be lacking. They remind us that the long list of potential adjuncts will continue to grow if the vogue for mixing untested and unlicensed medications persists. Furthermore, doctors must be cognisant that, once the decision is made to use an ad-hoc admixture, they bear all responsibility and will be liable in the event of an adverse event. The same team also discuss mixtures of intravenous infusions in the context of target-controlled infusion systems. They argue that mixing two or more drugs in a syringe constitutes an unjustifiable patient risk, and has no place in modern practice. Do you agree? Send us a letter and we will publish it!

Elsewhere we have: a randomised controlled trial of erector spinae plane block vs. peri-articular injection for pain control after arthroscopic shoulder surgeryan assessment of introducers used for airway management; and a network meta-analysis of videolaryngoscopy vs. direct laryngoscopy for tracheal intubation in adults

Finally, make sure you catch up with two recent podcasts looking at perceptions of recruitment to higher specialty training during the COVID-19 pandemic and a randomised controlled trial of a text message intervention to reduce burnout in trainee anaesthetists. Both are essential listening and reading for all!

Mike Charlesworth and Andrew Klein

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