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Clinical Orthopaedics and Related Research®

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01.06.2015 | Basic Research

What Factors Influence the Production of Orthopaedic Research in East Africa? A Qualitative Analysis of Interviews

verfasst von: Iain S. Elliott, MD, Daniel B. Sonshine, MD, Sina Akhavan, BA, Angelique Slade Shantz, MBA, Amber Caldwell, MSc, Jesse Slade Shantz, MD, MBA, Richard A. Gosselin, MD, MPH, R. Richard Coughlin, MD, MSc

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 6/2015

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Abstract

Background

Research addressing the burden of musculoskeletal disease in low- and middle-income countries does not reflect the magnitude of the epidemic in these countries as only 9% of the world’s biomedical resources are devoted to addressing problems that affect the health of 90% of the world’s population. Little is known regarding the barriers to and drivers of orthopaedic surgery research in such resource-poor settings, the knowledge of which would help direct specific interventions for increasing research capacity and help surgeons from high-income countries support the efforts of our colleagues in low- and middle-income countries.

Purpose

We sought to identify through surveying academic orthopaedic surgeons in East Africa: (1) barriers impeding research, (2) factors that support or drive research, and (3) factors that were identified by some surgeons as barriers and others as drivers (what we term barrier-driver overlap) as they considered the production of clinical research in resource-poor environments.

Materials

Semistructured interviews were conducted with 21 orthopaedic surgeon faculty members at four academic medical centers in Ethiopia, Kenya, Tanzania, and Uganda. Qualitative content analysis of the interviews was conducted using methods based in grounded theory. Grounded theory begins with qualitative data, such as interview transcripts, and analyzes the data for repeated ideas or concepts which then are coded and grouped into categories which allow for identification of subjects or problems that may not have been apparent previously to the interviewer.

Results

We identified and quantified 19 barriers to and 21 drivers of orthopaedic surgery research (mentioned n = 1688 and n = 1729, respectively). Resource, research process, and institutional domains were identified to categorize the barriers (n = 7, n = 5, n = 7, respectively) and drivers (n = 7, n = 8, n = 6, respectively). Resource barriers (46%) were discussed more often by interview subjects compared with the research process (26%) and institutional barriers (28%). Drivers of research discussed at least once were proportionally similar across the three domains. Some themes such as research ethics boards, technology, and literature access occurred with similar frequency as barriers to and drivers of orthopaedic surgery research.

Conclusions

The barriers we identified most often among East African academic orthopaedic faculty members focused on resources to accomplish research, followed by institutional barriers, and method or process barriers. Drivers to be fostered included a desire to effect change, collaboration with colleagues, and mentorship opportunities. The identified barriers and drivers of research in East Africa provide a targeted framework for interventions and collaborations with surgeons and organizations from high-resource settings looking to be involved in global health.

Ahn J, Donegan DJ, Lawrence JT, Halpern SD, Mehta S. The future of the orthopaedic clinician-scientist: part II. Identification of factors that may influence orthopaedic residents’ intent to perform research. J Bone Joint Surg Am. 2010;92:1041–1046.CrossRefPubMed

Aluede EE, Phillips J, Bleyer J, Jergesen HE, Coughlin R. Representation of developing countries in orthopaedic journals: a survey of four influential orthopaedic journals. Clin Orthop Relat Res. 2012;470:2313–2318.CrossRefPubMedCentralPubMed

Atesok KI, Hurwitz SR, Egol KA, Ahn J, Owens BD, Crosby LA, Pellegrini VD Jr. Perspective: integrating research into surgical residency education: lessons learned from orthopaedic surgery. Acad Med. 2012;87:592–597.CrossRefPubMed

Beaton DE, Clark JP. Qualitative research: a review of methods with use of examples from the total knee replacement literature. J Bone Joint Surg Am. 2009;91(suppl 3):107–112.CrossRefPubMed

Beveridge M, Howard A. The burden of orthopaedic disease in developing countries. J Bone Joint Surg Am. 2004;86:1819–1822.PubMed

Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res. 2007;42:1758–7172.CrossRefPubMedCentralPubMed

Clark JP, Hudak PL, Hawker GA, Coyte PC, Mahomed NN, Kreder HJ, Wright JG. The moving target: a qualitative study of elderly patients’ decision-making regarding total joint replacement surgery. J Bone Joint Surg Am. 2004;86:1366–1374.PubMed

Clough JF, Zirkle LG, Schmitt RJ. The role of SIGN in the development of a global orthopaedic trauma database. Clin Orthop Relat Res. 2010;468:2592–2597.CrossRefPubMedCentralPubMed

Corbin JM, Strauss AL. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage Publications; 2008.

10.

Creswell JW. Qualitative Inquiry and Research Design: Choosing Among Five Approaches. Thousand Oaks, CA: Sage Publications; 2007.

11.

Denzin NK, Lincoln YS. Handbook of Qualitative Research. Thousand Oaks, CA: Sage Publications; 1994.

12.

Dodani S, LaPorte RE. Ways to strengthen research capacity in developing countries: effectiveness of a research training workshop in Pakistan. Public Health. 2008;122:578–587.CrossRefPubMed

13.

Doyal L. Gender and the 10/90 gap in health research. Bull World Health Organ. 2004;82:162.PubMedCentralPubMed

14.

Emery SE, Gregory C. Physician incentives for academic productivity: an analysis of orthopaedic department compensation strategies. J Bone Joint Surg Am. 2006;88:2049–2056.CrossRefPubMed

15.

Farquhar C, Nathanson N. The Afya Bora Consortium: an Africa-US partnership to train leaders in global health. Infect Clin North Am. 2011;25:399–409.CrossRef

16.

Gill S, Levin A, Djurdjev O, Yoshida EM. Obstacles to residents’ conducting research and predictors of publication. Acad Med. 2001;76:477.CrossRefPubMed

17.

Gillum LA, Gouveia C, Dorsey ER, Pletcher M, Mathers CD, McCulloch CE, Johnston SC. NIH disease funding levels and burden of disease. PLoS One. 2011;6:e16837.CrossRefPubMedCentralPubMed

18.

Gooberman-Hill R, Sansom A, Sanders CM, Dieppe PA, Horwood J, Learmonth ID, Williams S, Donovan JL. Unstated factors in orthopaedic decision-making: a qualitative study. BMC Musculoskelet Disord. 2010;11:213.CrossRefPubMedCentralPubMed

19.

Gosselin RA. The increasing burden of injuries in developing countries: direct and indirect consequences. Tech Orthop. 2009;24:230–232.CrossRef

20.

Gosselin RA, Spiegel DA, Coughlin R, Zirkle LG. Injuries: the neglected burden in developing countries. Bull World Health Organ. 2009;87:246–246a.CrossRefPubMedCentralPubMed

21.

Guindon GE, Lavis JN, Becerra-Posada F, Malek-Afzali H, Shi G, Yesudian CA, Hoffman SJ; Research to Policy and Practice Study Team. Bridging the gaps between research, policy and practice in low- and middle-income countries: a survey of health care providers. CMAJ. 2010;182:E362–372.CrossRefPubMedCentralPubMed

22.

Lansang MA, Dennis R. Building capacity in health research in the developing world. Bull World Health Organ. 2004;82:764–770.PubMedCentralPubMed

23.

Lloyd T, Phillips BR, Aber RC. Factors that influence doctors’ participation in clinical research. Med Educ. 2004;38:848–851.CrossRefPubMed

24.

MacLeod JB, Okech M, Labib M, Aphivantrakul P, Lupasha E, Nthele M. Evaluation of trauma and critical care training courses on the knowledge and confidence of participants in Kenya and Zambia. World J Surg. 2011;35:9–16.CrossRefPubMed

25.

Manabe YC, Jacob ST, Thomas D, Quinn TC, Ronald A, Coutinho A, Mayanja-Kizza H, Merry C. Resurrecting the triple threat: academic social responsibility in the context of global health research. Clin Infect Dis. 2009;48:1420–1422.CrossRefPubMedCentralPubMed

26.

Matee MI, Manyando C, Ndumbe PM, Corrah T, Jaoko WG, Kitua AY, Ambene HP, Ndounga M, Zijenah L, Ofori-Adjei D, Agwale S, Shongwe S, Nyirenda T, Makanga M. European and Developing Countries Clinical Trials Partnership (EDCTP): the path towards a true partnership. BMC Public Health. 2009;9:249.CrossRefPubMedCentralPubMed

27.

Minja H, Nsanzabana C, Maure C, Hoffmann A, Rumisha S, Ogundahunsi O, Zicker F, Tanner M, Launois P. Impact of health research capacity strengthening in low- and middle-income countries: the case of WHO/TDR programmes. PLoS Negl Trop Dis. 2011;5:e1351.CrossRefPubMedCentralPubMed

28.

Mock C, Cherian M. The global burden of musculoskeletal injuries: challenges and solutions. Clin Orthop Relat Res. 2008;466:2306–2316.CrossRefPubMedCentralPubMed

29.

Zurück zum Zitat Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gonzalez-Medina D, Gosselin R, Grainger R, Grant B, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Laden F, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Levinson D, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mock C, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O’Donnell M, O’Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA 3rd, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiebe N, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, AlMazroa MA, Memish ZA. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197–2223. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gonzalez-Medina D, Gosselin R, Grainger R, Grant B, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Laden F, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Levinson D, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mock C, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O’Donnell M, O’Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA 3rd, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiebe N, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, AlMazroa MA, Memish ZA. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197–2223.

30.

Noordin S, Wright JG, Howard AW. Global relevance of literature on trauma. Clin Orthop Relat Res. 2008;466:2422–1427.

31.

Nuyens Y. No development without research: a challenge for research capacity strengthening. Available at: http://www.sdh-net.eu/data/uploads/publications-library/no-development-without-research.pdf. Accessed February 11, 2015.

32.

Ozgediz D, Kijjambu S, Galukande M, Dubowitz G, Mabweijano J, Mijumbi C, Cherian M, Kaggwa S, Luboga S. Africa’s neglected surgical workforce crisis. Lancet. 2008;371:627–628.CrossRefPubMed

33.

Page J, Heller RF, Kinlay S, Lim LL, Qian W, Suping Z, Kongpatanakul S, Akhtar M, Khedr S, Macharia W. Attitudes of developing world physicians to where medical research is performed and reported. BMC Public Health. 2003;3:6.CrossRefPubMedCentralPubMed

34.

Rosier RN. Institutional barriers to the orthopaedic clinician-scientist. Clin Orthop Relat Res. 2006;449:159–164.CrossRefPubMed

35.

Sabzwari S, Kauser S, Khuwaja AK. Experiences, attitudes and barriers towards research amongst junior faculty of Pakistani medical universities. BMC Med Educ. 2009;9:68.CrossRefPubMedCentralPubMed

36.

Sonshine DB, Caldwell A, Gosselin RA, Born CT, Coughlin RR. Critically assessing the Haiti earthquake response and the barriers to quality orthopaedic care. Clin Orthop Relat Res. 2012;470:2895–2904.CrossRefPubMedCentralPubMed

37.

Spiegel DA, Gosselin RA, Coughlin RR, Joshipura M, Browner BD, Dormans JP. The burden of musculoskeletal injury in low and middle-income countries: challenges and opportunities. J Bone Joint Surg Am. 2008;90:915–923.CrossRefPubMed

38.

Spiegel DA, Gosselin RA, Coughlin RR, Kushner AL, Bickler SB. Topics in global public health. Clin Orthop Relat Res. 2008;466:2377–2384.CrossRefPubMedCentralPubMed

39.

Stewart KA, Groen RS, Kamara TB, Farahzad MM, Samai M, Cassidy LD, Kushner AL, Wren SM. Traumatic injuries in developing countries: report from a nationwide cross-sectional survey of Sierra Leone. JAMA Surg. 2013;148:463–469.CrossRefPubMedCentralPubMed

40.

Utrobicic A, Chaudhry N, Ghaffar A, Marusic A. Bridging knowledge translation gap in health in developing countries: visibility, impact and publishing standards in journals from the Eastern Mediterranean. BMC Med Res Methodol. 2012;12:66.CrossRefPubMedCentralPubMed

41.

Wengraf T. Qualitative Research Interviewing: Biographic Narrative and Semi-Structured Methods. Thousand Oaks, CA: Sage Publications; 2001.CrossRef

42.

Wildeman MA, Zandbergen J, Vincent A, Herdini C, Middeldorp JM, Fles R, Dalesio O, van der Donk E, Tan IB. Can an online clinical data management service help in improving data collection and data quality in a developing country setting? Trials. 2011;12:190.CrossRefPubMedCentralPubMed

43.

Wilkins KE. Providing outreach continuing education in countries with limited resources. Clin Orthop Relat Res. 2008;466:2413–2417.CrossRefPubMedCentralPubMed

44.

Williams F, Boren SA. The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. Inform Prim Care. 2008;16:139–145.PubMed

45.

Xie F, Li SC, Fong KY, Lo NN, Yeo SJ, Yang KY, Thumboo J. What health domains and items are important to patients with knee osteoarthritis? A focus group study in a multiethnic urban Asian population. Osteoarthritis Cartilage. 2006;14:224–230.CrossRefPubMed

Titel: What Factors Influence the Production of Orthopaedic Research in East Africa? A Qualitative Analysis of Interviews
verfasst von: Iain S. Elliott, MD
Daniel B. Sonshine, MD
Sina Akhavan, BA
Angelique Slade Shantz, MBA
Amber Caldwell, MSc
Jesse Slade Shantz, MD, MBA
Richard A. Gosselin, MD, MPH
R. Richard Coughlin, MD, MSc
Publikationsdatum: 01.06.2015
Verlag: Springer US
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 6/2015
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-015-4254-5

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What Factors Influence the Production of Orthopaedic Research in East Africa? A Qualitative Analysis of Interviews

Abstract

Background

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Materials

Results

Conclusions

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