Dissemination and selected publications

Quality improvement in emergency units in low resource settings: a qualitative assessment for understanding challenges and delivering solutions

Indrakantha Welgama, D. Lange, Gerard O’Reilly, Aurore Nishimwe, Agnieszka Ignatowicz, Justine Davies · BMJ Open Quality · Aug 1, 2026

OBJECTIVE: This study aimed to identify the barriers and facilitators for quality improvement (QI) in emergency units (EUs) in low- or middle-income countries (LMICs) and to understand the prioritisation of care quality domains to inform the development of EU-specific guidance for QI across all World Health Organisation (WHO quality domains for LMICs. METHODS: We conducted in-depth interviews (IDIs) with specialist emergency physicians from LMICs and convened a workshop with global technical experts in emergency care. A structured topic guide was used for the IDIs. Interviews were conducted vi...

Improving Trauma Data Quality in Rwanda: A Prospective Assessment of Registry Completeness and Accuracy

Jean Nepomuscene Ntezimana, Indrakantha Welgama, Assuman Nuhu, Irene Bagahirwa, Venantie Umuhoza, Fabrice Iradukunda, Leila Ghalichi, Ephrem Daniel Sheferaw, et al. · Journal of Clinical Medicine · Jul 18, 2026

Background: High-quality trauma data are essential for data-informed decision-making. However, completeness and accuracy of trauma registries remain challenging in low- and middle-income countries. This study aimed to assess trauma registry data quality in Rwanda and describe a coordinated implementation package used to support improvements in registry completeness and accuracy. Methods: We conducted a prospective, longitudinal quasi-experimental quality-improvement study with repeated monthly measurements across eight hospitals in Rwanda from October 2023 to September 2025. Trauma registry da...

A Conceptual Model for Ambient AI Adoption: Perspectives From Academia and Industry

Josh Biro, Jesse M. Pines, Sudha Jayaraman, Vamsi Chagari, Raj Ratwani · JMIR Medical Informatics · Jun 29, 2026

Unlabelled: Ambient AI technologies are increasingly marketed as solutions to reduce clinician burden and improve care efficiency; however, real-world performance varies widely across clinical settings. Health care provider organizations face challenges in determining which aspects of ambient AI performance matter most and how to obtain meaningful information about those aspects from vendors or through internal evaluation. This article presents a shared mental model to guide health system leaders in conceptualizing ambient AI performance across 3 interdependent dimensions: technical, interface...

Safety of Patient-Facing Agentic AI: a Consensus Framework for Risk Assessment and Mitigation (Preprint)

Sudha Jayaraman, Arooshi Kumar, Erin Palm, Melanie Fernando, Chethan Sarabu, Michael Choma, Kevin Wang, Vishnu Ravi, et al. · Jun 26, 2026

UNSTRUCTURED Deploying agentic AI systems without adequate plans for human supervision raises serious concerns about patient safety, privacy, and equity. To address this gap, a group of experts across industry, academic and clinical informatics interested in AI and safety convened a voice AI taskforce to discuss and develop consensus on the impact of agentic AI in healthcare. Through this collaboration, we developed a consensus framework to determine potential risks and plan mitigation efforts based on potential clinical use cases to aid health care delivery organizations assess, implement and...

A systems approach to understanding injury care in LMICs using causal loop diagrams

Justine Davies, Kathryn Chu, Lucia D’Ambruoso, Laura Bojke, Rene English, Heike Geduld, Sa’Ad Lahri, Hassan Mahomed, et al. · BMJ Global Health · Jun 1, 2026

BACKGROUND: Around 40% of mortality after injuries is avoidable with access to quality care. Investments in interventions which maximise the number of injured persons who access and receive quality care are paramount, especially in low-resourced settings. Selecting such interventions within complex adaptive health systems is challenging due to the multiple interactions within these systems. METHODS: We created a conceptual map, or causal loop diagram (CLD), representing the health system for injury care, focused on challenges to improving patient outcomes in low- or middle-income countries (LM...

Surgeons at the Policy Table

Denis A. Foretia, Sudha Jayaraman, Michael S. Nussbaum · Annals of Surgery · May 25, 2026

Validation of a mobile application for prehospital transport time data collection in Kigali, Rwanda

Teresa Bell, Jean Marie Uwitonze, Michael Oravic, Rebecca Maine, Jeanne d’Arc Nyinawankusi, Andrea Davis, Jean Nepomuscene Sindikubwabo, Robert Rickard, et al. · BMC Global and Public Health · Apr 22, 2026

BACKGROUND: Emergency medical services (EMS) are critical for patient outcomes during emergencies. Organised EMS systems that can promptly locate patients, deliver on-scene care, and transport patients to appropriate facilities are lacking in low- and middle-income countries. Through a long-standing partnership with Rwanda's Service d'Aide Médicale d'Urgence (SAMU), we developed and implemented an electronic application to capture prehospital times in Kigali, Rwanda. This study validates the accuracy of electronically captured data and establishes baseline response times for emergencies in Kig...

Data quality and associations over 4 years of use of WHO’s Clinical Registry - Trauma Module, in Rwanda

Indrakantha Welgama, Jean Nepomuscene Ntezimana, Irene Bagahirwa, Venantie Umuhoza, Fabrice Iradukunda, D. Lange, Leila Ghalichi, Sudha Jayaraman, et al. · medRxiv · Jan 25, 2026

Abstract Objective Poor quality of injury care causes avoidable death and disability. Quality data is integral to care-quality improvement. We assessed longitudinal data quality of the Trauma Module (TM) of WHO’s Clinical Registry in Rwanda, towards understanding data collection challenges in low resourced settings. Methods Retrospective analysis of TM data between its implementation in August 2019 and July 2023. We describe trends in overall TM case and variable missingness and their associations with availability of funding and formal training. Variable missingness is also described by each ...

A Conceptual Model for Ambient AI Adoption: Perspectives from Academia and Industry (Preprint)

Josh Biro, Jesse M. Pines, Sudha Jayaraman, Vamsi Reddy Chagari, Raj Ratwani · Jan 12, 2026

UNSTRUCTURED Ambient AI technologies are increasingly marketed as solutions to reduce clinician burden and improve care efficiency, yet real-world performance varies widely across clinical settings. Healthcare provider organizations face challenges in determining which aspects of ambient AI performance matter most and how to obtain meaningful information about those aspects from vendors or through internal evaluation. This article presents a shared mental model to guide health system leaders in conceptualizing ambient AI performance across three interdependent dimensions: technical, interface,...

Glucose-lowering medication use for diabetes: national evidence from 62 low- and middle-income countries

Felix Teufel, Pia Roddewig, Maja E. Marcus, Michaela Theilmann, H.HPACC Collaborators, Pascal Geldsetzer, Albertino Damasceno, Justine Davies, et al. · Diabetes Research and Clinical Practice · Dec 1, 2025

Access to quality trauma care after injury in Pakistan: a systematic review and narrative synthesis

Huba Atiq, Komal Abdul Rahim, Sijal Akhtar Shiekh, Badar Afzal, Zabin Wajidali, Zaheer Babar Chand, Asad Latif, Agnieszka Ignatowicz, et al. · BMJ Open · Dec 1, 2025

OBJECTIVES: To conduct a systematic review and narrative synthesis to identify barriers, facilitators and pre-existing interventions and describe the current status of initiatives/interventions aimed at improving access to quality trauma healthcare after injury in Pakistan. DESIGN: Systematic review and narrative synthesis DATA SOURCES: MEDLINE (Ovid), Embase (Ovid), Web of Science (Clarivate Analytics), Cochrane (Wiley), Scopus and ProQuest, as well as grey literature. ELIGIBILITY CRITERIA: Full-text peer-reviewed publications, including cross-sectional studies, cohort studies, case-control s...

The Promise of Ambient AI Technology in Medical Education: Opportunities and Guardrails

S. Shafazand, Umar Bowers, Sudha Jayaraman · JMIR Medical Informatics · Nov 30, 2025

Abstract Ambient AI technologies, commonly known as AI scribes, are transforming clinical practice by autonomously capturing patient-provider conversations and structuring them into clinical notes. Short-term studies suggest that ambient AI can significantly reduce documentation time and improve job satisfaction. However, as health care systems accelerate the adoption of these tools, the medical education community must seek to answer unresolved questions regarding their full impact on learners. The inevitable integration of ambient AI in teaching hospitals presents both transformative opportu...

Bridging surgical education gaps in times of conflict: Experience with virtual and remote platforms for enhancing surgical workforce

Kala T Pham, Youmna A. Sherif, Melany C. Hughes, Sudha Jayaraman, Rachel W. Davis, Martin Höst · The American Journal of Surgery · Oct 10, 2025

National evidence on glucose-lowering medication use for diabetes from 62 low- and middle-income countries

Felix Teufel, Pia Roddewig, Maja E. Marcus, Michaela Theilmann, Glennis Andall‐Brereton, Krishna Kumar Aryal, Sina Azadnajafabad, Pascal Bovet, et al. · Nature Communications · Aug 4, 2025

Given rising diabetes prevalence globally, access to diabetes treatments is gaining urgency. Yet, it remains unknown which glucose-lowering medication types people with diabetes across low- and middle-income countries (LMICs) use. In this cross-sectional analysis, we pooled nationally representative data of 223,283 adults aged ≥25 years in 62 LMICs from 2009 to 2019. We found that 51.9% [95%-CI: 49.6%, 54.2%] of 21,715 individuals with diabetes were undiagnosed. Among individuals with diagnosed diabetes, 18.6% [95%-CI: 14.5%, 23.4%] reported using no glucose-lowering medication, 57.3% [95%-CI:...

Surgical health policy 2025–35: strengthening essential services for tomorrow's needs

Dmitri Nepogodiev, Maria Picciochi, Adesoji Ademuyiwa, Adewale Adisa, Anita Eseenam Agbeko, Maria-Lorena Aguilera, Fareeda Agyei, Philip Alexander, et al. · The Lancet · Jul 15, 2025

The time to care is now: a multidisciplinary call to action for addressing paediatric burn injuries globally

Kajsa Vlasic, Theresia Mwakyembe, Irma D Fleming, Giavonni Lewis, Sudha Jayaraman, Catherine A. Staton, Melissa H. Watt, Blandina T. Mmbaga, et al. · International Health · Apr 11, 2025

Childhood burn injuries are life-changing, leaving lasting physical and emotional scars that profoundly impact physical functioning, self-esteem, social interactions and future opportunities. Whether the injury is caused by an act of war or a cooking incident at home, the consequences are equally devastating for children and their families. Addressing the multiple challenges of paediatric burn injuries requires multidisciplinary coordination to ensure timely access to evidence-based care and comprehensive support for physical recovery, emotional healing and reintegration into daily life. In re...

Reaching the right facility for emergency patients - destinations of patients transported by emergency medical services in Kigali, Rwanda

Ephrem Daniel Sheferaw, Barnabas Alyande, Oda Munyura, Assuman Nuhu, Aurore Nishimwe, Jeanne D’Arc Nyinawankusi, Jean Marie Uwitonze, Jean Nepomuscene Sindikubwabo, et al. · International Journal of Emergency Medicine · Apr 10, 2025

BACKGROUND: Ensuring that emergency patients reach the right healthcare facility at the right time is a key component of providing quality emergency care. Rwanda's prehospital emergency care system, Service D'Aide Médicale Urgente (SAMU), was established in 2007 to provide prehospital emergency care services, but a formal assessment of the receiving facilities has not been done. We explored the characteristics of patients transported by SAMU to identify factors influencing the choice of destination health facilities. METHODS: We retrospectively analyzed SAMU data documenting patients transport...

Universal access to surgical care—A global public health priority

Salome Maswime, Sudha Jayaraman, Olufunke Alaba, Magda Robalo · PLOS Global Public Health · Apr 9, 2025

Author reply: Letter to the Editor regarding “Blunt cerebrovascular injury: The case for universal screening”

Stefan W. Leichtle, Sudha Jayaraman, Edgar B. Rodas, Michel B. Aboutanos · The Journal of Trauma: Injury, Infection, and Critical Care · Jan 6, 2025

Attainment of Global Diabetes Targets in 2021: A Pooled Analysis of Individual-Level Data from National Surveys in 100 Low-, Middle-, and High-Income Countries

Grace S. Chung, Yajuan Si, Krishna Aryal, Silver Bahendeka, José R. Banegas, Till Bärnighausen, Marta Barreto, Abdul Basit, et al. · SSRN Electronic Journal · Jan 1, 2025

Developing and integrating a destination decision support algorithm into an innovative electronic communication platform to improve injury care service coordination in Rwanda: The Rwanda912 study protocol

Rwanda RIGHT Group, Aurore Nishimwe, Justine Davies, Jean Claude Byiringiro, Abebe Bekele, Lucia D’Ambruoso, Agnieszka Ignatowicz, Barnabas Tobi Alayande, et al. · Research Square · Dec 24, 2024

Developing and integrating a destination decision support algorithm into an innovative electronic communication platform to improve injury care service coordination in Rwanda: The Rwanda912 study protocol

Rwanda RIGHT Group, Aurore Nishimwe, Justine Davies, Jean Claude Byiringiro, Abebe Bekele, Lucia D’Ambruoso, Agnieszka Ignatowicz, Barnabas Tobi Alayande, et al. · Research Square · Dec 24, 2024

Community perspectives on barriers to injury care in Northern Malawi: a three delays framed assessment using focus groups and photovoice

John Whitaker, Ella Togun, Levie Gondwe, Donaria Zgambo, Abena S. Amoah, Albert Dube, Rory Rickard, Andrew Leather, et al. · BMC Health Services Research · Nov 12, 2024

INTRODUCTION: The global burden of injury is huge, falling disproportionately on poorer populations. The benefits of qualitative research in injury care are recognised and its application is growing. We used a novel application of focus group discussions with photovoice to rapidly assess barriers at each of three delay stages; seeking (delay-1), reaching (delay-2) or receiving (delay-3) injury care in Northern Malawi. METHODS: Three community Focus Group Discussions (FGDs) of individuals with (FGD1) and without (FGD2) recent injury experience and community leaders (FGD3) discussed barriers to ...

Innovative External Cranial Devices for Protecting a Craniectomy Site: A Scoping Review on Noninvasive Approaches for Patients Awaiting Cranioplasty

Laura Fernández, Diana Victoria Rodriguez De Francisco, Dylan Griswold, Isla Khun, Sarita Aristizabal, Jorge Aristizabal, Grace Richards, Adriene Pavek, et al. · Neurosurgery · Sep 9, 2024

BACKGROUND AND OBJECTIVES: Decompressive craniectomy (DC) is a commonly performed procedure to alleviate high intracranial pressure. To enhance patient quality of life and minimize complications after DC in patients awaiting cranioplasty (CP), multidisciplinary teams have designed and implemented external protective prototypes, including 3-dimensional printing and plaster models, whenever feasible. The aim of this scoping review was to assess the evidence available on innovative external cranial devices that protect the craniectomy site for patients who have undergone DC while awaiting CP in h...

Understanding the health system utilisation and reasons for avoidable mortality after fatal injury within a Three-Delays framework in Karonga, Northern Malawi: a retrospective analysis of verbal autopsy data

John Whitaker, Idara Edem, Abena S. Amoah, Albert Dube, Lucia D’Ambruoso, Rory Rickard, Andrew Leather, Justine Davies · BMJ Open · Apr 1, 2024

OBJECTIVES: To use verbal autopsy (VA) data to understand health system utilisation and the potential avoidability associated with fatal injury. Then to categorise any evident barriers driving avoidable delays to care within a Three-Delays framework that considers delays to seeking (Delay 1), reaching (Delay 2) or receiving (Delay 3) quality injury care. DESIGN: Retrospective analysis of existing VA data routinely collected by a demographic surveillance site. SETTING: Karonga Health and Demographic Surveillance Site (HDSS) population, Northern Malawi. PARTICIPANTS: Fatally injured members of t...