101
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Burgess J, Meyers N, Rusin-Gomez D, Fox PM, Chang J. A New Model of Global Reconstructive Surgery Training With Reduced Carbon Footprint of Outreach. JAMA Surg 2024; 159:714-715. [PMID: 38506854 PMCID: PMC10955348 DOI: 10.1001/jamasurg.2023.8028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/09/2023] [Indexed: 03/21/2024]
Abstract
This economic evaluation compares carbon dioxide emissions from air transportation for surgical mission trips vs team training trips.
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Affiliation(s)
- Jordan Burgess
- Stanford University School of Medicine, Stanford, California
| | | | | | - Paige M. Fox
- Stanford University School of Medicine, Stanford, California
| | - James Chang
- Stanford University School of Medicine, Stanford, California
- ReSurge International, Sunnyvale, California
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102
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Braz LG, Braz JRC, Tiradentes TAA, Soares JVA, Corrente JE, Modolo NSP, do Nascimento Junior P, Braz MG. Global neonatal perioperative mortality: A systematic review and meta-analysis. J Clin Anesth 2024; 94:111407. [PMID: 38325248 DOI: 10.1016/j.jclinane.2024.111407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE There are large differences in health care among countries. A higher perioperative mortality rate (POMR) in neonates than in older children and adults has been recognized worldwide. The aim of this study was to provide a systematic review of published 24-h and 30-day POMRs in neonates from 2011 to 2022 in countries with different Human Development Index (HDI) levels. DESIGN AND SETTING A systematic review with a meta-analysis of studies that reported 24-h and 30-day POMRs in neonates was performed. We searched the databases from January 2011 to July 30, 2022. MEASUREMENTS The POMRs (per 10,000 procedures under anesthesia) were analyzed according to country HDI. The HDI levels ranged from 0 to 1, representing the lowest and highest levels, respectively (very-high-HDI: ≥ 0.800, high-HDI: 0.700-0.799, medium-HDI: 0.550-0.699, and low-HDI: < 0.550). The magnitude of the POMRs by country HDI was studied using meta-analysis. MAIN RESULTS Eighteen studies from 45 countries were included. The 24-h (n = 96 deaths) and 30-day (n = 459 deaths) POMRs were analyzed from 33,729 anesthetic procedures. The odds ratios (ORs) of the 24-h POMR in low-HDI countries were higher than those in very-high- (OR 8.4, 95% CI 1.7-40.4; p = 0.008), high- (OR 7.3, 95% CI 2.2-24.4; p = 0.001) and medium-HDI countries (OR 7.7, 95% CI 3.1-18.7; p < 0.0001) but with no odds differences between very-high- and high-HDI countries (p = 0.879), very-high- and medium-HDI countries (p = 0.915) and high- and medium-HDI countries (p = 0.689). The odds of a 30-day POMR in low-HDI countries were higher than those in very-high-HDI countries (OR 6.9, 95% CI 1.9-24.6; p = 0.002) but not in high-HDI countries (OR 1.4, 95% CI 0.6-3.0; p = 0.396). CONCLUSIONS The review demonstrated very high global POMRs in a surgical population of neonates independent of the country HDI level. We identified differences in 24-h and 30-day POMRs between low-HDI countries and other countries with higher HDI levels.
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Affiliation(s)
- Leandro G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
| | - Jose Reinaldo C Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Teofilo Augusto A Tiradentes
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Joao Vitor A Soares
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Jose E Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Norma Sueli P Modolo
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Paulo do Nascimento Junior
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Mariana G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
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103
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Stapleton E. Editorial: sustainability in global otolaryngology. Curr Opin Otolaryngol Head Neck Surg 2024; 32:186-187. [PMID: 38690639 DOI: 10.1097/moo.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Emma Stapleton
- Department of Otolaryngology, Manchester Royal Infirmary, Manchester, UK
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104
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Osebo C, Grushka J, Deckelbaum D, Razek T. Assessing Ethiopia's surgical capacity in light of global surgery 2030 initiatives: Is there progress in the past decade? Surg Open Sci 2024; 19:70-79. [PMID: 38595832 PMCID: PMC11002296 DOI: 10.1016/j.sopen.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024] Open
Abstract
Background Surgical, anesthetic, and obstetric (SAO) care plays a crucial role in global health, recognized by the World Health Organization (WHO) and The Lancet Commission on Global Surgery (LCoGS). LCoGS outlines six indicators for integrating SAO services into a country's healthcare system through National Surgical Obstetrics and Anesthesia Plans (NSOAPs). In Ethiopia, surgical services progress lacks evaluation. This study assesses current Ethiopian surgical capacity using the LCoGS NSOAPs framework. Methods We conducted a narrative review of published literature on critical LCoGS NSAOPs metrics to extract information on key domains; service delivery, workforce, infrastructure, finance, and information management. Results Ethiopia's surgical services face challenges, including a low surgical volume (43) and a scarcity of specialist SOA physicians (0.5) per 100,000 population. Over half of Ethiopians reside outside the 2-hour radius of surgery-ready hospitals, and 98 % face surgery-related impoverished expenditures. Lacking the LCoGS-recommended SOA reporting systems, approximately 44 % of facilities exist for handling bellwether procedures. Despite the prevalence of essential surgeries, primary district hospitals have limited operative infrastructures, resulting in disparities in the surgical landscape. Most surgery-ready facilities are concentrated in cities, leaving Ethiopia's 80 % rural population with inadequate access to surgical care. Conclusion Ethiopia's surgical capacity falls below LCoGS NSOAPs recommendations, with challenges in infrastructure, personnel, and data retrieval. Critical measures include scaling up access, workforce, public insurance, and information management to enhance SAO services. Ethiopia pioneered in Sub-Saharan Africa by establishing Saving Lives Through Safe Surgery (SaLTS) in response to NSOAPs, but progress lags behind LCoGS recommendations.
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Affiliation(s)
- Cherinet Osebo
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
- Hargelle Hospital, Emergency Surgery and Obstetrics Unit, Hargelle, Ethiopia
| | - Jeremy Grushka
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| | - Dan Deckelbaum
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| | - Tarek Razek
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
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105
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Asemu YM, Yigzaw T, Desta FA, Scheele F, van den Akker T. Does higher performance in a national licensing examination predict better quality of care? A longitudinal observational study of Ethiopian anesthetists. BMC Anesthesiol 2024; 24:188. [PMID: 38802780 PMCID: PMC11129401 DOI: 10.1186/s12871-024-02575-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Ethiopia made a national licensing examination (NLE) for associate clinician anesthetists a requirement for entry into the practice workforce. However, there is limited empirical evidence on whether the NLE scores of associate clinicians predict the quality of health care they provide in low-income countries. This study aimed to assess the association between anesthetists' NLE scores and three selected quality of patient care indicators. METHODS A multicenter longitudinal observational study was conducted between January 8 and February 7, 2023, to collect quality of care (QoC) data on surgical patients attended by anesthetists (n = 56) who had taken the Ethiopian anesthetist NLE since 2019. The three QoC indicators were standards for safe anesthesia practice, critical incidents, and patient satisfaction. The medical records of 991 patients were reviewed to determine the standards for safe anesthesia practice and critical incidents. A total of 400 patients responded to the patient satisfaction survey. Multivariable regressions were employed to determine whether the anesthetist NLE score predicted QoC indicators. RESULTS The mean percentage of safe anesthesia practice standards met was 69.14%, and the mean satisfaction score was 85.22%. There were 1,120 critical incidents among 911 patients, with three out of five experiencing at least one. After controlling for patient, anesthetist, facility, and clinical care-related confounding variables, the NLE score predicted the occurrence of critical incidents. For every 1% point increase in the total NLE score, the odds of developing one or more critical incidents decreased by 18% (aOR = 0.82; 95% CI = 0.70 = 0.96; p = 0.016). No statistically significant associations existed between the other two QoC indicators and NLE scores. CONCLUSION The NLE score had an inverse relationship with the occurrence of critical incidents, supporting the validity of the examination in assessing graduates' ability to provide safe and effective care. The lack of an association with the other two QoC indicators requires further investigation. Our findings may help improve education quality and the impact of NLEs in Ethiopia and beyond.
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Affiliation(s)
- Yohannes Molla Asemu
- Health Workforce Improvement Program, Jhpiego, an affiliate of Johns Hopkins University, Ethiopia country office, Addis Ababa, Ethiopia.
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Tegbar Yigzaw
- Health Workforce Improvement Program, Jhpiego, an affiliate of Johns Hopkins University, Ethiopia country office, Addis Ababa, Ethiopia
| | - Firew Ayalew Desta
- Health Workforce Improvement Program, Jhpiego, an affiliate of Johns Hopkins University, Ethiopia country office, Addis Ababa, Ethiopia
| | - Fedde Scheele
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Obstetrics and Gynecology, OLVG Teaching Hospital, Amsterdam, the Netherlands
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands
| | - Thomas van den Akker
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
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106
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Portela FSO, Rossetti CA, de Souza TF, Magnani AS, da Silva MFA, Portugal MFC, Teivelis MP, Wolosker N, Mendes CDA. Retrospective analysis of 1,203 cases of referral to a quaternary vascular surgery outpatient clinic within the Unified Health System, São Paulo, Brazil. EINSTEIN-SAO PAULO 2024; 22:eAO0676. [PMID: 38808797 PMCID: PMC11155721 DOI: 10.31744/einstein_journal/2024ao0676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/27/2023] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Through a retrospective analysis of 1,203 cases of referral from primary healthcare units to a specialized quaternary vascular surgical service, the findings of this study revealed a high proportion of inappropriate referrals, which may represent a substantial subutilization of this highly complex service. Consequently, in this study, we aimed to evaluate 1,203 cases of referral to a quaternary vascular surgical service, in São Paulo, Brazil, over a 6-year period, to assess the appropriate need for referral; in addition to the prevalence of surgical indications. METHODS In this retrospective analysis, we reviewed the institutional records of participants referred from Basic Healthcare Units to a vascular surgical service inside the Brazilian Unified Health System, between May 2015 and December 2020. Demographic and clinical data were collected. The participants were stratified, as per the reason for referral to the vascular surgical service, previous imaging studies, and surgical treatment indications. Referral appropriateness and complementary examinations were evaluated for each disease cohort. Finally, the prevalence of cases requiring surgical treatment was defined as the outcome measure. RESULTS Of the 1,203 referrals evaluated, venous disease was the main reason for referral (53%), followed by peripheral arterial disease (19.4%). A considerable proportion of participants had been referred without complementary imaging or after a long duration of undergoing an examination. Referrals were regarded as inappropriate in 517 (43%) cases. Of these, 32 cases (6.2%) had been referred to the vascular surgical service, as the incorrect specialty. The percentage of referred participants who ultimately underwent surgical treatment was 39.92%. Carotid (18%) and peripheral arterial diseases (18.4%) were correlated with a lower prevalence of surgical treatments. CONCLUSION The rate of referral appropriateness to specialized vascular care from primary care settings was low. This may represent a subutilization of quaternary surgical services, with low rates of surgical treatment.
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Affiliation(s)
| | - Carlos Augusto Rossetti
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Thulio Fernandes de Souza
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Arthur Souza Magnani
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | - Marcelo Passos Teivelis
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Nelson Wolosker
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Cynthia de Almeida Mendes
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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107
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Bandyopadhyay S, Philipo GS, Bokhary ZM, Lakhoo K. A review of twenty-first century developments in paediatric surgery in Africa. Pediatr Surg Int 2024; 40:137. [PMID: 38780635 DOI: 10.1007/s00383-024-05718-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
This review explores the significant advancements in paediatric surgery in Africa during the twenty-first century, with a particular focus on capacity-building, education, infrastructural development, and research. Historically, paediatric surgery has been an overlooked sector, especially in low-and-middle-income countries in Africa. However, recent years have seen considerable progress. Collaborative efforts such as the Global Initiative for Children's Surgery, and the formation of the Pan African Paediatric Surgery Association, the College of Surgeons of East, Central and Southern Africa and the West African College of Surgeons have facilitated knowledge sharing, collaboration, and advocacy for enhancing surgical standards. Local training programmes, including Master of Medicine programmes and fellowships, have been instrumental in building a skilled workforce. These initiatives have been complemented by infrastructural developments through non-governmental organisations like Kids Operating Room, which have expanded access to paediatric surgical care. Technological advancements, particularly in telemedicine, have further enhanced accessibility. Task-sharing strategies, where non-specialist physicians are trained in paediatric surgical skills, have also been utilised to address the shortage of specialised surgeons. Research in paediatric surgery has experienced an upswing, with local health professionals taking the lead. Research has been crucial for understanding the epidemiology of paediatric surgical conditions, and developing prevention strategies, and is increasingly leading to the inclusion of paediatric surgery in national health plans. Despite the progress, challenges remain, including the need for sustainable funding, continued investment in infrastructure, and training and retention of healthcare professionals. The review emphasises the importance of ongoing efforts in community engagement, innovative technologies, and health systems strengthening for the sustainable development of paediatric surgical services in Africa.
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Affiliation(s)
- Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK.
| | - Godfrey Sama Philipo
- The College of Surgeons of East Central and Southern Africa, Arusha, Tanzania
- The Branch for Global Surgical Care (BGSC), University of British Columbia (UBC), Columbia, Canada
| | - Zaitun Mohamed Bokhary
- Department of Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Kokila Lakhoo
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
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108
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Guo K, Xu F, Li Y, Ma M, Li J, Wang L. Mortality and cardiac arrest rates of emergency surgery in developed and developing countries: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:178. [PMID: 38769493 PMCID: PMC11104000 DOI: 10.1186/s12871-024-02559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND The magnitude of the risk of death and cardiac arrest associated with emergency surgery and anesthesia is not well understood. Our aim was to assess whether the risk of perioperative and anesthesia-related death and cardiac arrest has decreased over the years, and whether the rates of decrease are consistent between developed and developing countries. METHODS A systematic review was performed using electronic databases to identify studies in which patients underwent emergency surgery with rates of perioperative mortality, 30-day postoperative mortality, or perioperative cardiac arrest. Meta-regression and proportional meta-analysis with 95% confidence intervals (CIs) were performed to evaluate global data on the above three indicators over time and according to country Human Development Index (HDI), and to compare these results according to country HDI status (low vs. high HDI) and time period (pre-2000s vs. post-2000s). RESULTS 35 studies met the inclusion criteria, representing more than 3.09 million anesthetic administrations to patients undergoing anesthesia for emergency surgery. Meta-regression showed a significant association between the risk of perioperative mortality and time (slope: -0.0421, 95%CI: from - 0.0685 to -0.0157; P = 0.0018). Perioperative mortality decreased over time from 227 per 10,000 (95% CI 134-380) before the 2000s to 46 (16-132) in the 2000-2020 s (p < 0-0001), but not with increasing HDI. 30-day postoperative mortality did not change significantly (346 [95% CI: 303-395] before the 2000s to 292 [95% CI: 201-423] in the 2000s-2020 period, P = 0.36) and did not decrease with increasing HDI status. Perioperative cardiac arrest rates decreased over time, from 113 per 10,000 (95% CI: 31-409) before the 2000s to 31 (14-70) in the 2000-2020 s, and also with increasing HDI (68 [95% CI: 29-160] in the low-HDI group to 21 [95% CI: 6-76] in the high-HDI group, P = 0.012). CONCLUSIONS Despite increasing baseline patient risk, perioperative mortality has decreased significantly over the past decades, but 30-day postoperative mortality has not. A global priority should be to increase long-term survival in both developed and developing countries and to reduce overall perioperative cardiac arrest through evidence-based best practice in developing countries.
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Affiliation(s)
- Kaikai Guo
- Department of pain medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beingjing, China
| | - Fengying Xu
- Department of anesthesiology, No. 971 Hospital of People's Liberation Army Navy, Qingdao, China
| | - Ye Li
- Department of pain medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beingjing, China
| | - Mingxing Ma
- Department of pain medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beingjing, China
| | - Jing Li
- Department of acupuncture, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Long Wang
- Department of pain medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beingjing, China.
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Holt F, Kwok S, Garuba K, Kolawole I, White MC. The delivery and challenges of Pediatric Anesthesia within the humanitarian sector: Médecins Sans Frontières and Mercy Ships. Paediatr Anaesth 2024. [PMID: 38757915 DOI: 10.1111/pan.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Access to healthcare is inequitable. Poverty, natural disasters and war disproportionally effect those most vulnerable, including children. Non-governmental organizations (NGO) hold a vital role in providing pediatric care in these contexts. Here we describe the delivery and challenges of Pediatric Anesthesia with two such non-governmental organizations; Médecins Sans Frontières (MSF) and Mercy Ships. Descriptions of both are followed by case studies.
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Affiliation(s)
- Francesca Holt
- Department of Anaesthesia, Children's Health Ireland at Crumlin, Dublin, Ireland
- Médecins Sans Frontières
| | - Sarah Kwok
- Chief Medical Officer, Global Mercy, Freetown, Sierra Leone
| | - Kehinde Garuba
- Médecins Sans Frontières
- Department of Anaesthesia, Usman Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria
| | - Israel Kolawole
- Department of Anaesthesia, University of Ilorin, Ilorin, Nigeria
| | - Michelle C White
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
- Centre for Global Health and Health Partnerships, King's College London, London, UK
- Mercy Ships, London, UK
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110
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Welch JM, Kamal RN, Kozin SH, Dyer GSM, Katarincic JA, Fox PM, Shapiro LM. Clinical Practice Guidelines to Support Capacity Building in Orthopaedic Surgical Outreach: An International Consensus Building Approach. J Bone Joint Surg Am 2024:00004623-990000000-01101. [PMID: 38753851 DOI: 10.2106/jbjs.23.01414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Surgical outreach to low- and middle-income countries (LMICs) by organizations from high- income countries is on the rise to help address the growing burden of conditions warranting surgery. However, concerns remain about the impact and sustainability of such outreach. Leading organizations (e.g., the World Health Organization) advocate for a capacity-building approach to ensure the safety, quality, and sustainability of the local health-care system. Despite this, to our knowledge, no guidelines exist to inform such efforts. We aimed to develop clinical practice guidelines (CPGs) to support capacity-building in orthopaedic surgical outreach utilizing a multistakeholder and international voting panel. METHODS We followed a modified American Academy of Orthopaedic Surgeons (AAOS) CPG development process. We systematically reviewed the existing literature across 7 predefined capacity-building domains (partnership, professional development, governance, community impact, finance, coordination, and culture). A writing panel composed of 6 orthopaedic surgeons with extensive experience in surgical outreach reviewed the existing literature and developed a consensus-based CPG for each domain. We created an international voting panel of orthopaedic surgeons and administrators who have leadership roles in outreach organizations or hospitals with which outreach organizations partner. Members individually reviewed the CPGs and voted to approve or disapprove each guideline. A CPG was considered approved if >80% of panel members voted to approve it. RESULTS An international voting panel of 14 surgeons and administrators from 6 countries approved all 7 of the CPGs. Each CPG provides recommendations for capacity-building in a specific domain. For example, in the domain of partnership, the CPG recommends the development of a documented plan for ongoing, bidirectional partnership between the outreach organization and the local team. In the domain of professional development, the CPG recommends the development of a needs-based curriculum focused on both surgical and nonsurgical patient care utilizing didactic and hands-on techniques. CONCLUSIONS As orthopaedic surgical outreach grows, best-practice CPGs to inform capacity-building initiatives can help to ensure that resources and efforts are optimized to support the sustainability of care delivery at local sites. These guidelines can be reviewed and updated in the future as evidence that supports capacity-building in LMICs evolves.The global burden of disease warranting surgery is substantial, and morbidity and mortality from otherwise treatable conditions remain disproportionately high in low- and middle-income countries (LMICs)1,2. It is estimated that up to 2 million (about 40%) of injury-related deaths in LMICs could be avoided annually if mortality rates were reduced to the level of those in high-income countries (HICs)3. Despite this, progress toward improved access to safe, timely surgery in resource-poor areas has been slow. Historically, nongovernmental organizations (NGOs) have tried to address unmet surgical needs through short-term outreach trips; however, growing criticism has highlighted the limitations of short-term trips, including limited follow-up, an increased burden on the local workforce, and further depletion of local resources4-6. In light of ongoing concerns, public health priorities have shifted toward models that emphasize long-term capacity-building rather than short-term care delivery. Capacity-building is an approach to health-care development that builds independence through infrastructure development, sustainability, and enhanced problem-solving while taking context into account7,8.
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Affiliation(s)
- Jessica M Welch
- Department or Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Scott H Kozin
- Shriners Hospitals for Children, Philadelphia, Pennsylvania
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia A Katarincic
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island
| | - Paige M Fox
- Department of Plastic Surgery, Stanford University, Stanford, California
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
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Ifeanyichi M, Dim C, Bognini M, Kebede M, Singh D, Onwujekwe O, Hargest R, Friebel R. Can sugar taxes be used for financing surgical systems in Nigeria? A mixed-methods political economy analysis. Health Policy Plan 2024; 39:509-518. [PMID: 38668636 PMCID: PMC11095260 DOI: 10.1093/heapol/czae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 01/11/2024] [Accepted: 03/26/2024] [Indexed: 05/16/2024] Open
Abstract
This study determined the feasibility of investing revenues raised through Nigeria's sugar-sweetened beverage (SSB) tax of 10 Naira/l to support the implementation of the National, Surgical, Obstetrics, Anaesthesia and Nursing Plan, which aims to strengthen access to surgical care in the country. We conducted a mixed-methods political economy analysis. This included a modelling exercise to predict the revenues from Nigeria's SSB tax based on its current tax rate over a period of 5 years, and for several scenarios such as a 20% ad valorem tax recommended by the World Health Organization. We performed a gap analysis to explore the differences between fiscal space provided by the tax and the implementation cost of the surgical plan. We conducted qualitative interviews with key stakeholders and performed thematic analyses to identify opportunities and barriers for financing surgery through tax revenues. At its current rate, the SSB tax policy has the potential to generate 35 914 111 USD in year 1, and 189 992 739 USD over 5 years. Compared with the 5-year adjusted surgical plan cost of 20 billion USD, the tax accounts for ∼1% of the investment required. There is a substantial scope for further increases in the tax rate in Nigeria, yielding potential revenues of up to 107 663 315 USD, annually. Despite an existing momentum to improve surgical care, there is no impetus to earmark sugar tax revenues for surgery. Primary healthcare and the prevention and treatment of non-communicable diseases present as the most favoured investment areas. Consensus within the medical community on importance of primary healthcare, along the recent government transition in Nigeria, offers a policy window for promoting a higher SSB tax rate and an adoption of other sin taxes to generate earmarked funds for the healthcare system. Evidence-based advocacy is necessary to promote the benefits from investing into surgery.
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Affiliation(s)
- Martilord Ifeanyichi
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
- Health Policy Research Group, Department of Pharmacology and Therapeutics, University of Nigeria Enugu Campus (UNEC), Enugu, Nigeria
| | - Cyril Dim
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Maeve Bognini
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
| | - Meskerem Kebede
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
| | - Darshita Singh
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
| | - Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, University of Nigeria Enugu Campus (UNEC), Enugu, Nigeria
| | - Rachel Hargest
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
- School of Medicine, University Hospital of Wales, Cardiff CF14 4XN, United Kingdom
- Royal College of Surgeons of England, London, United Kingdom
| | - Rocco Friebel
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
- Center for Global Development Europe, London SW1P 3SE, United Kingdom
- Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, United Kindom
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Faleiro MD, Fernandez MG, Feitosa KIB, Vervoort D. Global Cardiac Surgery in Brazil: A Call to Action. Braz J Cardiovasc Surg 2024; 39:e20230408. [PMID: 38748621 PMCID: PMC11093282 DOI: 10.21470/1678-9741-2023-0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 05/19/2024] Open
Abstract
Global Cardiac Surgery is an innovative initiative with a focus on improving health outcomes and achieving healthcare equity for individuals worldwide affected by cardiac surgical conditions or in need of cardiac surgical care. Considering the existing disparities in access to cardiac surgery and the substantial burden of cardiac conditions amenable to surgical procedures in Brazil, it is imperative to support and scale Global Cardiac Surgery initiatives and leave no Brazilian patient behind. Here, we advocate for national initiatives within this field and highlight opportunities and challenges to support their development.
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Affiliation(s)
- Matheus Daniel Faleiro
- International Student Surgical Network (InciSioN), Belo Horizonte,
Minas Gerais, Brazil
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo
Horizonte, Minas Gerais, Brazil
| | - Miguel Godeiro Fernandez
- International Student Surgical Network (InciSioN), Belo Horizonte,
Minas Gerais, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador,
Bahia, Brazil
| | - Kawanna Izabella Buzzo Feitosa
- International Student Surgical Network (InciSioN), Belo Horizonte,
Minas Gerais, Brazil
- Faculdade de Medicina, Universidade Positivo, Curitiba,
Paraná, Brazil
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto,
Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Ontario, Canada
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113
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Huang XY, Shao Z, Zhong NN, Wen YH, Wu TF, Liu B, Ma SR, Bu LL. Comparative analysis of GoPro and digital cameras in head and neck flap harvesting surgery video documentation: an innovative and efficient method for surgical education. BMC MEDICAL EDUCATION 2024; 24:531. [PMID: 38741079 DOI: 10.1186/s12909-024-05510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND An urgent need exists for innovative surgical video recording techniques in head and neck reconstructive surgeries, particularly in low- and middle-income countries where a surge in surgical procedures necessitates more skilled surgeons. This demand, significantly intensified by the COVID-19 pandemic, highlights the critical role of surgical videos in medical education. We aimed to identify a straightforward, high-quality approach to recording surgical videos at a low economic cost in the operating room, thereby contributing to enhanced patient care. METHODS The recording was comprised of six head and neck flap harvesting surgeries using GoPro or two types of digital cameras. Data were extracted from the recorded videos and their subsequent editing process. Some of the participants were subsequently interviewed. RESULTS Both cameras, set at 4 K resolution and 30 frames per second (fps), produced satisfactory results. The GoPro, worn on the surgeon's head, moves in sync with the surgeon, offering a unique first-person perspective of the operation without needing an additional assistant. Though cost-effective and efficient, it lacks a zoom feature essential for close-up views. In contrast, while requiring occasional repositioning, the digital camera captures finer anatomical details due to its superior image quality and zoom capabilities. CONCLUSION Merging these two systems could significantly advance the field of surgical video recording. This innovation holds promise for enhancing technical communication and bolstering video-based medical education, potentially addressing the global shortage of specialized surgeons.
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Affiliation(s)
- Xin-Yue Huang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhe Shao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yuan-Hao Wen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Tian-Fu Wu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Si-Rui Ma
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Okidi R, Sambo VDC, Okello I, Ekwem DA, Ekwang S, Obalim F, Kyegombe W. Associated factors of mortality and morbidity in emergency and elective abdominal surgery: a two-year prospective cohort study at lacor hospital, Uganda. BMC Surg 2024; 24:144. [PMID: 38730310 PMCID: PMC11088035 DOI: 10.1186/s12893-024-02433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The mortality rate associated with open abdominal surgery is a significant concern for patients and healthcare providers. This is particularly worrisome in Africa due to scarce workforce resources and poor early warning systems for detecting physiological deterioration in patients who develop complications. METHODS This prospective cohort study aimed to follow patients who underwent emergency or elective abdominal surgery at Lacor Hospital in Uganda. The participants were patients who underwent abdominal surgery at the hospital between April 27th, 2019 and July 07th, 2021. Trained research staff collected data using standardized forms, which included demographic information (age, gender, telephone contact, and location), surgical indications, surgical procedures, preoperative health status, postoperative morbidity and mortality, and length of hospital stay. RESULTS The present study involved 124 patients, mostly male, with an average age of 35 years, who presented with abdominal pain and varying underlying comorbidities. Elective cases constituted 60.2% of the total. The common reasons for emergency and elective surgery were gastroduodenal perforation and cholelithiasis respectively. The complication rate was 17.7%, with surgical site infections being the most frequent. The mortality rate was 7.3%, and several factors such as preoperative hypotension, deranged renal function, postoperative use of vasopressors, and postoperative assisted ventilation were associated with it. Elective and emergency-operated patients showed no significant difference in survival (P-value = 0.41) or length of hospital stay (P-value = 0.17). However, there was a significant difference in morbidity (p < 0.001). CONCLUSION Cholelithiasis and gastroduodenal perforation were key surgical indications, with factors like postoperative ventilation and adrenaline infusion linked to mortality. Emergency surgeries had higher complication rates, particularly surgical site infections, despite similar hospital stay and mortality rates compared to elective surgeries.
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Affiliation(s)
- Ronald Okidi
- Department of Surgery, Lacor Hospital, P.O. Box 180, Gulu, Uganda.
- Faculty of Medicine, Gulu University, Gulu, Uganda.
| | | | - Isaac Okello
- Department of Surgery, Lacor Hospital, P.O. Box 180, Gulu, Uganda
| | | | - Solomon Ekwang
- Department of Surgery, Lacor Hospital, P.O. Box 180, Gulu, Uganda
| | - Fiddy Obalim
- Department of Surgery, Lacor Hospital, P.O. Box 180, Gulu, Uganda
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Cox ML, Allen DZ, Rodriguez MM, Green JC, Kain JJ. An Analysis of Global Surgery Opportunities in American Otolaryngology Residency Programs. Laryngoscope 2024. [PMID: 38733148 DOI: 10.1002/lary.31511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/05/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES To depict the current state of global surgery opportunities in United States ACGME-approved Otolaryngology residency programs and compare the characteristics of programs with and without these opportunities. METHODS In this cross-sectional analysis, websites of ACGME-accredited Otolaryngology residency programs were analyzed for information on program size, rank, age, and geographic region as obtained through the Doximity platform in 2023. Additional parameters were obtained for programs listing global surgery opportunities such as funding, faculty oversight, location/region, focus, and relationship to the community served. Data were tabulated and analyzed in Microsoft Excel and Stata. RESULTS Of the 131 ACGME-accredited Otolaryngology residency programs, 26 (20%) of programs advertised a global surgery opportunity. Nine (35%) of these promoted funding, 15 (58%) offered a clinical focus, one (4%) offered a research focus, and 10 (38%) offered a combined approach. The Midwest region had the most programs with global surgery opportunities (n = 8, 31%). Less than half (42%) of programs had an established partnership with local partners within low and middle-income countries (LMICs). When comparing programs, the average Doximity rank, average program age, and average program size of programs that offered global surgery opportunities was significantly higher than those that did not (37.2 vs. 71.5, 54 vs. 41, 19.5 vs. 13.7; all p < 0.05). CONCLUSIONS Approximately one-fifth of Otolaryngology training programs have a global surgery opportunity. Programs that offer these opportunities had a higher Doximity ranking, older program age, and a larger trainee cohort. These results highlight potential areas for expanding global surgery opportunities in academic institutions. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
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Affiliation(s)
- Madisyn L Cox
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - David Z Allen
- Department of Otolaryngology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Megan M Rodriguez
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jackson C Green
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Joshua J Kain
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
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Yadeta DA, Manyazewal T, Demessie DB, Kleive D. Incidence and predictors of postoperative complications in Sub-Saharan Africa: a systematic review and meta-analysis. FRONTIERS IN HEALTH SERVICES 2024; 4:1353788. [PMID: 38784705 PMCID: PMC11112115 DOI: 10.3389/frhs.2024.1353788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024]
Abstract
Background Postoperative complications remain a significant challenge, especially in settings where healthcare access and infrastructure disparities exacerbate. This systematic review and meta-analysis aimed to determine the pooled incidence and risk factors of postoperative complications among patients undergoing essential surgery in Sub-Saharan Africa (SSA). Method PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, and Google Scholar were searched from January 2010 to November 2022 for completed studies reporting the incidence and risk factors associated with postoperative complications among patients undergoing essential surgery in SSA. Severity of postoperative complications was ranked based on the Clavien-Dindo classification system, while risk factors were classified into three groups based on the Donabedian structure-process-outcome quality evaluation framework. Studies quality was appraised using the JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI), and data were analyzed using Comprehensive Meta-Analysis (CMA) software. The study protocol adhered to the PRISMA guidelines and was registered in PROSPERO (CRD42023414342). Results The meta-analysis included 19 studies (10 cohort and 9 cross-sectional) comprising a total of 24,136 patients. The pooled incidence of postoperative complications in SSA was 20.2% (95% CI: 18.7%-21.8%), with a substantial heterogeneity of incidence observed. The incidence varied from 14.6% to 27.5% based on the Clavien-Dindo classification. The random-effects model indicated significant heterogeneity among the studies (Q = 54.202, I = 66.791%, p < 0.001). Contributing factors to postoperative complications were: structure-related factors, which included the availability and accessibility of resources, as well as the quality of both the surgical facility and the hospital.; process-related factors, which encompassed surgical skills, adherence to protocols, evidence-based practices, and the quality of postoperative care; and patient outcome-related factors such as age, comorbidities, alcohol use, and overall patient health status. Conclusion The meta-analysis reveals a high frequency of postoperative complications in SSA, with noticeable discrepancies among the studies. The analysis highlights a range of factors, encompassing structural, procedural, and patient outcome-related aspects, that contribute to these complications. The findings underscore the necessity for targeted interventions aimed at reducing complications and improving the overall quality of surgical care in the region. Systematic Reviews Registration https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42023414342).
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Affiliation(s)
- Daniel Aboma Yadeta
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Dereje Bayissa Demessie
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Ooms GI, Usman MA, Reed T, van den Ham HA, Mantel-Teeuwisse AK. The impact of scheduling ketamine as an internationally controlled substance on anaesthesia care in Sub-Saharan Africa: a case study and key informant interviews. BMC Health Serv Res 2024; 24:598. [PMID: 38715038 PMCID: PMC11077710 DOI: 10.1186/s12913-024-11040-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Access to anaesthesia and surgical care is a major problem for people living in Sub-Saharan Africa. In this region, ketamine is critical for the provision of anaesthesia care. However, efforts to control ketamine internationally as a controlled substance may significantly impact its accessibility. This research therefore aims to estimate the importance of ketamine for anaesthesia and surgical care in Sub-Saharan Africa and assess the potential impact on access to ketamine if it were to be scheduled. METHODS This research is a mixed-methods study, comprising of a cross-sectional survey at the hospital level in Rwanda, and key informant interviews with experts on anaesthesia care in Sub-Saharan Africa. Data on availability of four anaesthetic agents were collected from hospitals (n = 54) in Rwanda. Semi-structured interviews with 10 key informants were conducted, collecting information on the importance of ketamine, the potential impact of scheduling ketamine internationally, and opinions on misuse of ketamine. Interviews were transcribed verbatim and analysed using a thematic analysis approach. RESULTS The survey conducted in Rwanda found that availability of ketamine and propofol was comparable at around 80%, while thiopental and inhalational agents were available at only about half of the hospitals. Significant barriers impeding access to anaesthesia care were identified, including a general lack of attention given to the specialty by governments, a shortage of anaesthesiologists and migration of trained anaesthesiologists, and a scarcity of medicines and equipment. Ketamine was described as critical for the provision of anaesthesia care as a consequence of these barriers. Misuse of ketamine was not believed to be an issue by the informants. CONCLUSION Ketamine is critical for the provision of anaesthesia care in Sub-Saharan Africa, and its scheduling would have a significantly negative impact on its availability for anaesthesia care.
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Affiliation(s)
- Gaby I Ooms
- Health Action International, Overtoom 60-2, 1054HK, Amsterdam, The Netherlands.
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
| | - Mohammed A Usman
- Federal University of Dutse, Dutse, Jigawa State, Nigeria
- Rasheed Shekoni Teaching Hospital, Dutse, Jigawa State, Nigeria
| | - Tim Reed
- Health Action International, Overtoom 60-2, 1054HK, Amsterdam, The Netherlands
| | - Hendrika A van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
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Karydi KI, Kabaghe S, Blamey H, Mohamed M, Shamambo N, Edgcombe H. Non-physician anaesthesia providers' perspectives on task sharing practices in Zambia and Somaliland: a qualitative study. BMJ Open 2024; 14:e078939. [PMID: 38719296 PMCID: PMC11086413 DOI: 10.1136/bmjopen-2023-078939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The 68th World Health Assembly, in 2015, called for surgical and anaesthesia services strengthening. Acknowledging the healthcare staff shortages, they referred to task sharing, among others, as a more effective use of the healthcare workforce. While task sharing has been increasingly proposed as an important strategy to increase the reach and safety of anaesthesia as well as a means of supporting the workforce in low-resource settings, most data on task sharing relate to non-anaesthetic healthcare contexts. The aim of this study was to understand anaesthetic task sharing as currently experienced and/or envisaged by non-physician anaesthesia providers in Zambia and Somaliland. METHODS An exploratory qualitative research methodology was used. Participants were recruited initially via contacts of the research team, then through snowballing using a purposive sampling strategy. There were 13 participants: 7 from Somaliland and 6 from Zambia. Semistructured interviews took place synchronously, then were recorded, anonymised, transcribed and analysed thematically. Triangulation and respondents' validation were used to maximise data validity. RESULTS Four major themes were identified in relation to task sharing practices: (1) participants recognised variable components of task sharing in their practice; (2) access to task sharing depends both on sources and resources; (3) implicit barriers may inhibit task sharing practices; (4) there is an appetite among participants for amelioration of current task sharing practices. CONCLUSIONS Empowering task sharing practices can be achieved only by understanding how these practices work, by identifying gaps and areas of improvement, and by addressing them. The findings from this exploratory study could help the global community understand how anaesthetic task sharing in low-resource settings works and inspire further research on the field. This could inform future modelling of workforce planning strategies in low-resource settings to maximise the effectiveness and professional well-being of the workforce.
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Affiliation(s)
- Konstantina Ilia Karydi
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Helen Blamey
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Naomi Shamambo
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Hilary Edgcombe
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Kewalramani D, Loftus TJ, Coleman JR, Kaafarani H, Narayan M. Using AI to bridge global surgical gaps: high tech, high impact. Lancet 2024; 403:1746-1747. [PMID: 38704161 DOI: 10.1016/s0140-6736(23)02753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 05/06/2024]
Affiliation(s)
| | | | - Julia R Coleman
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Mayur Narayan
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
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Alberti P, Bytyci J, Jindal J, Stephanou M, Thompson L, Tilahun Y, Ying Y, Killen A, Manirambona E, Niyukuri A, Lakhoo K, Ford K. Paediatric testicular torsion in low- and middle-income countries: an OxPLORE scoping study. Pediatr Surg Int 2024; 40:117. [PMID: 38695917 DOI: 10.1007/s00383-024-05704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Literature on paediatric surgical conditions in low- and middle-income countries (LMICs) remains limited. As a common emergency, timely treatment of testicular torsion acts as a benchmark of adequate emergency service delivery in paediatric surgery. This scoping study aims to synthesise all existing literature on paediatric testicular torsion in LMICs. METHODS A database search was conducted by the OxPLORE global paediatric surgery research group to identify studies containing the terms 'testicular torsion' or 'acute scrotum' originating from LMICs. A thematic analysis was applied to the results of the search and the quality of evidence was appraised for all included articles. RESULTS This review included 17 studies with 1798 patients. All studies originated from middle-income countries and the majority (76%) had sample sizes smaller than 100 patients. All studies were appraised as providing less than adequate evidence. Included studies identified long delays to treatment and highlighted ongoing debates on the value of scoring systems and Doppler ultrasonography in diagnosing torsion. Major heterogeneity in surgical approaches to treatment of testicular torsion in children was also observed. CONCLUSIONS Literature on paediatric testicular torsion in LMICs is scarce and heterogeneous. Prospective, multi-centre research on the management of this common paediatric surgical emergency is urgently required.
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Affiliation(s)
- Piero Alberti
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jola Bytyci
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jessy Jindal
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Michael Stephanou
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lucy Thompson
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Yedidiah Tilahun
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Yuxin Ying
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Annabel Killen
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Kokila Lakhoo
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Kathryn Ford
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
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Ukachukwu AEK, Njeru PN, Ayodele OA, Ahmad MH, Onyia CU, Morgan E, Ekweogwu OC, Usman B, Badejo OA, Dawang Y, Orhorhoro OI, Oyemolade TA, Okere OE, Abu-Bonsrah N, Petitt Z, Oboh EC, Otun A, Nischal SA, Deng DD, Mahmud MR, Mezue WC, Malomo AO, Shehu BB, Shokunbi MT, Ohaegbulam SC, Fuller AT, Haglund MM, Chikani MC, Adeolu AA, Adeleye AO. A Geospatial Analysis of the Availability, Distribution, and Accessibility of Neurosurgical Facilities, Workforce, and Infrastructure in Nigeria; and Projection Towards 2050. World Neurosurg 2024; 185:e16-e29. [PMID: 38741324 DOI: 10.1016/j.wneu.2023.10.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 05/16/2024]
Abstract
OBJECTIVE There has been a modest but progressive increase in the neurosurgical workforce, training, and service delivery in Nigeria in the last 2 decades. However, these resources are unevenly distributed. This study aimed to quantitatively assess the availability and distribution of neurosurgical resources in Nigeria while projecting the needed workforce capacity up to 2050. METHODS An online survey of Nigerian neurosurgeons and residents assessed the country's neurosurgical infrastructure, workforce, and resources. The results were analyzed descriptively, and geospatial analysis was used to map their distribution. A projection model was fitted to predict workforce targets for 2022-2050. RESULTS Out of 86 neurosurgery-capable health facilities, 65.1% were public hospitals, with only 17.4% accredited for residency training. Dedicated hospital beds and operating rooms for neurosurgery make up only 4.0% and 15.4% of the total, respectively. The population disease burden is estimated at 50.2 per 100,000, while the operative coverage was 153.2 cases per neurosurgeon. There are currently 132 neurosurgeons and 114 neurosurgery residents for a population of 218 million (ratio 1:1.65 million). There is an annual growth rate of 8.3%, resulting in a projected deficit of 1113 neurosurgeons by 2030 and 1104 by 2050. Timely access to neurosurgical care ranges from 21.6% to 86.7% of the population within different timeframes. CONCLUSIONS Collaborative interventions are needed to address gaps in Nigeria's neurosurgical capacity. Investments in training, infrastructure, and funding are necessary for sustainable development and optimized outcomes.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
| | - Paula N Njeru
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | | | - Misbahu H Ahmad
- Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Eghosa Morgan
- Department of Surgery, Babcock University Teaching Hospital, Ilishan Remo, Nigeria
| | - Ofodile C Ekweogwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Babagana Usman
- Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Yusuf Dawang
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Omuvie I Orhorhoro
- Department of Surgery, Delta State University Teaching Hospital, Oghara, Nigeria
| | | | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zoey Petitt
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA; School of Medicine, Duke University, Durham, NC, USA
| | - Ena C Oboh
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
| | - Ayodamola Otun
- School of Medicine, Washington University, St. Louis, MO, USA
| | - Shiva A Nischal
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
| | | | - Wilfred C Mezue
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Bello B Shehu
- Regional Center for Neurosurgery, Usman DanFodio University Teaching Hospital, Sokoto, Nigeria
| | - Matthew T Shokunbi
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | | | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | - Mark C Chikani
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Augustine A Adeolu
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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Ukachukwu AEK, Ogundeji OD, Abu-Bonsrah N, Still MEH, Trillo-Ordonez Y, Oboh EN, Nischal SA, Deng DD, Ugorji C, Seas A, Badejo OA, Malomo TA, Nwaribe EE, Oyemolade TA, Okere OE, Oboh E, Waguia-Kouam R, Rahman R, Asemota I, Reddy R, von Isenburg M, Haglund MM, Fuller AT, Adeleye AO. The Scope, Trends, and Challenges of Neurosurgical Research in Nigeria: A Bibliometric Review. World Neurosurg 2024; 185:e86-e98. [PMID: 37931875 DOI: 10.1016/j.wneu.2023.10.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE This study investigates the scope, trends, and challenges of neurosurgical research in Nigeria since inception of the specialty in 1962. METHODS A bibliometric review of the neurosurgical literature from Nigeria was performed. Variables extracted included year and journal of publication, article topic, article type, research type, study design, article focus area, and limitations. Descriptive and quantitative analyses were performed for all variables. Trends of research publications were described in three periods: pioneering (1962-1981), recession (1982-2001), and resurgent (2002-2021). RESULTS Of the 1023 included articles, 10.0% were published in the pioneering period, 9.2% in the recession period, and 80.8% in the resurgent period. Papers were predominantly published in World Neurosurgery (4.5%) and Nigerian Journal of Clinical Practice (4.0%). A total of 79.9% of the 4618 authors were from Nigerian institutions; 86.3% of the articles covered clinical research and were mainly focused on service delivery and epidemiology (89.9%). The most prominent topics were traumatic brain injury (25.8%) and central nervous system malignancy (21.4%). Only 4.4% of the publications received funding, mostly from agencies in the United States (31.7%). Barriers to neurosurgical research included lack of clinical databases (18.0%), increasing burden of disease (12.5%), and diagnostic challenges (12.4%). CONCLUSIONS Neurosurgical research in Nigeria continues to grow due to increased training, workforce, and infrastructural improvements. Addressing the major challenges through establishment of research databases, development of evidence-based management guidelines, and increasing research training, funding and opportunities can increase research capacity in Nigeria.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA.
| | - Olaniyi D Ogundeji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Yesel Trillo-Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ehita N Oboh
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Shiva A Nischal
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Di D Deng
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Chiazam Ugorji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Andreas Seas
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Pratt School of Engineering, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Toluyemi A Malomo
- Department of Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Ena Oboh
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | | | - Raphia Rahman
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Isaac Asemota
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ramya Reddy
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Megan von Isenburg
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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An SJ, Ngwira N, Davis D, Gallaher J, Charles A. Transfusion and Mortality in Acute Care Surgical Patients in Malawi: A Propensity-Matched Analysis. J Surg Res 2024; 297:121-127. [PMID: 38489932 PMCID: PMC11023752 DOI: 10.1016/j.jss.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/09/2024] [Accepted: 01/26/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Information on transfusion-associated outcomes is limited in sub-Saharan Africa. We sought to characterize predictors of mortality in transfused patients with acute care surgical conditions in Malawi. METHODS We performed a retrospective propensity-matched analysis of patients with acute care surgical conditions at Kamuzu Central Hospital in Malawi from 2013 to 2021. We compared outcomes between patients who did and did not receive transfusions. RESULTS A total of 7395 patients were included. Transfused patients (n = 1086) were older (median 43 y with interquartile range 30-59, versus 39 y [interquartile range 27-53] in the nontransfused group, P < 0.01), had a higher proportion of females (41% versus 27%, P < 0.01), presented earlier to the hospital (median 2.9 versus 3.7 d, P = 0.02), and with lower hemoglobin levels (27% versus 1% < 7 g/dL, P < 0.01). They had a lower rate of surgical intervention (48% versus 59%, P < 0.01) but a higher rate of complications (62% versus 33%, P < 0.01). Crude in-hospital mortality was 25.5% for the transfused group and 12.8% for the nontransfused group (P < 0.01). After propensity matching, transfused patients had three times the odds of mortality compared to nontransfused patients (odds ratio 3.3, 95% confidence interval 2.3, 4.8). CONCLUSIONS In this propensity-matched study, transfused surgical patients were more likely to experience in-hospital mortality. These results suggest that the transfusion requirement reflects critical illness and warrants further investigation in this low-resource setting.
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Affiliation(s)
- Selena J An
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Natasha Ngwira
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Dylane Davis
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
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Oyemolade TA, Mukumbya B, Oboh EN, Nischal SA, Ozobu I, Palla A, Ogundeji OD, Trillo-Ordonez Y, Nwaribe EE, Badejo OA, Okere OE, Malomo TA, Abu-Bonsrah N, Oboh EC, Seas A, Still MEH, Asemota I, Ugorji C, Reddy R, Rahman R, Waguia-Kouam R, Deng DD, von Isenburg M, Haglund MM, Fuller AT, Adeleye AO, Ukachukwu AEK. Profile of Pediatric Neurosurgery in Nigeria from 1962 to 2021: A Systematic Review. World Neurosurg 2024; 185:e143-e184. [PMID: 37939879 DOI: 10.1016/j.wneu.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This study aims to provide a comprehensive overview of pediatric neurosurgery in Nigeria, since 1962, by assessing epidemiological data, management strategies, and case outcomes. METHODS A systematic bibliometric review of Nigerian neurosurgical literature was reported with the PRISMA guidelines. The Risk of Bias Assessment Tool was applied to all nonrandomized studies, and a descriptive analysis was performed for all variables. RESULTS We identified 12,295 pediatric patients from 196 published studies. Most publications (72.4%) occurred in the recent 2 decades, of which 40.3% were observational case reports/series. The patients were predominantly male (57.2%) and aged 0-18 years, with the majority (66.1%) belonging to the 0-5 age range. Most patients (63.4%) presented between 1-12 months. The most common presenting feature was altered consciousness (7.7%), with computed tomography (38.8%) being the most frequently utilized diagnostic imaging modality. The diagnoses with the greatest prevalence (60.2%) were congenital abnormalities such as hydrocephalus and neural tube defects. 57.5% of cases received surgical therapy, with ventriculoperitoneal shunt placement being the most noticeable procedure performed (36.4%). Complications were identified in 9.5% of cases, with a 4.5% death rate. The Glasgow Outcome Score (95.7%) was the primary outcome measure utilized, with positive outcomes reported in 59.3% of cases. CONCLUSIONS This review provides significant epidemiological data which emphasizes the country's enormous burden of pediatric neurosurgical cases. The findings can help guide clinical decisions as well as future research and policy development.
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Affiliation(s)
| | - Benjamin Mukumbya
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Ehita N Oboh
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Shiva A Nischal
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ifeanyichukwu Ozobu
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Ross University School of Medicine, Miramar, Florida, USA
| | - Adhith Palla
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Olaniyi D Ogundeji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Yesel Trillo-Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | | | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | | | - Toluyemi A Malomo
- Department of Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ena C Oboh
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Andreas Seas
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Pratt School of Engineering, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Isaac Asemota
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Chiazam Ugorji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ramya Reddy
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Raphia Rahman
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | | | - Di D Deng
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Megan von Isenburg
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA
| | - Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Alvan-Emeka K Ukachukwu
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA.
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Dennis AT, Sheridan N. Extreme inequity in analgesia and peri-operative management of pregnant patients. Anaesthesia 2024; 79:455-460. [PMID: 38359534 DOI: 10.1111/anae.16237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Affiliation(s)
- A T Dennis
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Obstetric Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Pain and Perioperative Medicine, Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, St Albans, Victoria, Australia
| | - N Sheridan
- Department of Anaesthesia, Pain and Perioperative Medicine, Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, St Albans, Victoria, Australia
- Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Footscray, Victoria, Australia
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Ukachukwu AEK, Oyemolade TA, Nischal SA, Onyia CU, Morgan E, Ekweogwu OC, Orhorhoro OI, Ahmad MH, Ayodele OA, Usman B, Badejo OA, Dawang Y, Okere OE, Abu-Bonsrah N, Deng DD, Petitt Z, Njeru PN, Oboh EC, Otun A, Still MEH, Haglund MM, Fuller AT, Chikani MC, Adeleye AO, Adeolu AA. Assessing the Neurosurgical Capacity in Nigeria Using the Modified Neuro-PIPES Tool. World Neurosurg 2024; 185:e30-e43. [PMID: 38741328 DOI: 10.1016/j.wneu.2023.12.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 05/16/2024]
Abstract
BACKGROUND Like many low- and-middle-income countries in Africa, documented assessment of the neurosurgical workforce, equipment, infrastructure, and scope of service delivery in Nigeria is lacking. This study aimed to assess the capacity for the delivery of neurosurgical services in Nigeria. METHODS An 83-question survey was disseminated to neurosurgeons and residents in Nigeria. We report the findings from the capacity assessment section of the survey, which used the modified neurological-PIPES (personnel, infrastructure, procedures, equipment, and supplies) (MN-PIPES) tool to evaluate the availability of neurosurgical personnel, infrastructure, procedures, equipment, and supplies. A comparative analysis was done using the domain and total MN-PIPES scores and MN-PIPES index. RESULTS The national average MN-PIPES score and index were 176.4 and 9.8, respectively. Overall, the southwest and northwest regions had the highest scores and frequently had high subscores. The survey respondents reported that the main challenges impeding neurosurgery service delivery were a lack of adjunctive supplies (75.2%), a dearth of diagnostic and interventional equipment (72.4%), and an absence of a dedicated intensive care unit (72.4%). CONCLUSIONS The availability of workforce, infrastructure, equipment, and supplies needed to provide optimal neurosurgical care is uneven in many institutions in Nigeria. Although major strides have been made in recent years, targeted collaborative interventions at local, national, regional, and international levels will further improve neurosurgical service delivery in Nigeria and will have positive ripple effects on the rest of the healthcare system.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
| | | | - Shiva A Nischal
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Eghosa Morgan
- Department of Surgery, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - Ofodile C Ekweogwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Omuvie I Orhorhoro
- Department of Surgery, Delta State University Teaching Hospital, Oghara, Nigeria
| | - Misbahu H Ahmad
- Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Olabamidele A Ayodele
- Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Babagana Usman
- Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Oluwakemi A Badejo
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Yusuf Dawang
- Department of Surgery, University of Abuja Teaching Hospital, Abuja-FCT, Nigeria
| | - Oghenekevwe E Okere
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Zoey Petitt
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Paula N Njeru
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Ena C Oboh
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Ayodamola Otun
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida at Gainesville, Gainesville, Florida, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Mark C Chikani
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Amos O Adeleye
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Augustine A Adeolu
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
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Celie KB, Mocharnuk JW, Kanmounye US, Ayala R, Banu T, Lakhoo K. The importance of global bioethics to paediatric health care. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:379-384. [PMID: 38408455 DOI: 10.1016/s2352-4642(23)00317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 02/28/2024]
Abstract
The paradigm of values adopted by the global health community has a palpable, albeit often unseen, impact on patient health care. In this Viewpoint, we investigate an inherent tension in the core values of medical ethics and clinical practice that could explain why paediatric health care faces resource constraints despite compelling economic and societal imperatives to prioritise child health and wellbeing. The dominant narrative in the philosophy of medicine tends to disproportionately underscore values of independence and self-determination, which becomes problematic in the context of paediatric patients, who by their very nature epitomise vulnerability and dependence. A double-jeopardy situation arises when disadvantaged children see their inherent dependence leveraged against them. We illustrate this predicament through specific examples relating to rights and obligations and to autonomy. Alternative value perspectives-communitarianism and relational autonomy-might offer more robust protection for vulnerable children. A shift away from the dominant narrative towards a more explicit and inclusive discussion of values is necessary. Such a shift requires giving a legitimate platform to diverse perspectives, with the presumption that collective moral progress is possible; this endeavour is embodied by global bioethics. Successful implementation of global bioethics, in turn, hinges on close collaboration between practicing clinicians and bioethicists. Taking global bioethics seriously and actively pursuing collaboration could help the global health community achieve more equitable health care.
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Affiliation(s)
- Karel-Bart Celie
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK; Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Operation Smile, Department of Policy and Advocacy, Virginia Beach, VA, USA.
| | | | - Ulrick S Kanmounye
- Operation Smile, Department of Policy and Advocacy, Virginia Beach, VA, USA
| | - Ruben Ayala
- Operation Smile, Department of Policy and Advocacy, Virginia Beach, VA, USA
| | - Tahmina Banu
- Chittagong Research institute for Children Surgery, Chittagong, Bangladesh; Global Initiative for Children's Surgery, Sacramento, CA, USA
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Global Initiative for Children's Surgery, Sacramento, CA, USA
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James ND, Tannock I, N'Dow J, Feng F, Gillessen S, Ali SA, Trujillo B, Al-Lazikani B, Attard G, Bray F, Compérat E, Eeles R, Fatiregun O, Grist E, Halabi S, Haran Á, Herchenhorn D, Hofman MS, Jalloh M, Loeb S, MacNair A, Mahal B, Mendes L, Moghul M, Moore C, Morgans A, Morris M, Murphy D, Murthy V, Nguyen PL, Padhani A, Parker C, Rush H, Sculpher M, Soule H, Sydes MR, Tilki D, Tunariu N, Villanti P, Xie LP. The Lancet Commission on prostate cancer: planning for the surge in cases. Lancet 2024; 403:1683-1722. [PMID: 38583453 DOI: 10.1016/s0140-6736(24)00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/28/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Nicholas D James
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | - Ian Tannock
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Felix Feng
- University of California, San Francisco, USA
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Syed Adnan Ali
- University of Manchester, Manchester, UK; The Christie Hospital, Manchester, UK
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Eva Compérat
- Tenon Hospital, Sorbonne University, Paris; AKH Medical University, Vienna, Austria
| | - Ros Eeles
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | - Áine Haran
- The Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | | | - Stacy Loeb
- New York University, New York, NY, USA; Manhattan Veterans Affairs, New York, NY, USA
| | | | | | | | - Masood Moghul
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Michael Morris
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Declan Murphy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | | | | | | | | | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | | | - Derya Tilki
- Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Türkiye
| | - Nina Tunariu
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Li-Ping Xie
- First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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McCombie A, Bothara R, MacCormick A, Carne B, Hercus A, Eglinton T. A longitudinal study examining the relationship between prioritization scores and changes in impact on life scores in elective surgery patients. ANZ J Surg 2024. [PMID: 38661117 DOI: 10.1111/ans.19014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Healthcare systems globally face the issue of resource constraints and need for prioritization of elective surgery. Inclusive, explicit prioritization tools are important in improving consistency and equity of access to surgery across health systems. The General Surgical Prioritization Tool developed by New Zealand's Ministry of Health scores patients for elective non-cancer surgery based on surgeon's clinical judgement and patient derived Impact on Life (IoL) scores. This study aims to measure the changes in patient derived IoL scores after common general surgical procedures to enable direct comparison and inform future prioritization. METHOD This longitudinal observational study enrolled 322 participants who had undergone elective general surgical procedures. Participants were contacted 3 to 9 months after their procedures and requested to complete the IoL questionnaire. The primary endpoint was the change in IoL scores after surgery among the different procedures. RESULTS Overall, 229/304 (75%) participants responded to the questionnaire and there were no significant baseline differences between responders and non-responders. Patients in the gallbladder treatment group had the greatest improvement in IoL scores. Patients across all ethnic groups had similar changes in IoL scores. Multivariate analysis showed that gallbladder surgery (relative to hernia surgery) and pre-surgery IoL scores significantly predicted improvement. CONCLUSION The patient reported IoL score recorded at prioritization for surgery all reduced, albeit to varying amounts, after common general surgical procedures. This, combined with the fact that IoL scores predicted post-operative improvement support their inclusion in prioritization tools in addition to surgeon derived components.
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Affiliation(s)
- Andrew McCombie
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Roshit Bothara
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Andrew MacCormick
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Brennan Carne
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Alastair Hercus
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Tim Eglinton
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
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130
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Cacciamani GE, Sholklapper T, Eppler MB, Sayegh A, Storino Ramacciotti L, Abreu AL, Sotelo R, Desai MM, Gill IS. Study protocol for the Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) global cross-specialty surveys and consensus. PLoS One 2024; 19:e0297799. [PMID: 38626051 PMCID: PMC11020956 DOI: 10.1371/journal.pone.0297799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/12/2024] [Indexed: 04/18/2024] Open
Abstract
Annually, about 300 million surgeries lead to significant intraoperative adverse events (iAEs), impacting patients and surgeons. Their full extent is underestimated due to flawed assessment and reporting methods. Inconsistent adoption of new grading systems and a lack of standardization, along with litigation concerns, contribute to underreporting. Only half of relevant journals provide guidelines on reporting these events, with a lack of standards in surgical literature. To address these issues, the Intraoperative Complications Assessment and Reporting with Universal Standard (ICARUS) Global Surgical Collaboration was established in 2022. The initiative involves conducting global surveys and a Delphi consensus to understand the barriers for poor reporting of iAEs, validate shared criteria for reporting, define iAEs according to surgical procedures, evaluate the existing grading systems' reliability, and identify strategies for enhancing the collection, reporting, and management of iAEs. Invitation to participate are extended to all the surgical specialties, interventional cardiology, interventional radiology, OR Staffs and anesthesiology. This effort represents an essential step towards improved patient safety and the well-being of healthcare professionals in the surgical field.
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Affiliation(s)
- Giovanni E. Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- Artificial Intelligence Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, United States of America
- Norris Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Tamir Sholklapper
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, United States of America
| | - Michael B. Eppler
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Aref Sayegh
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- Department of Surgery, MedStar Good Samaritan Hospital, Baltimore, MD, United States of America
| | - Lorenzo Storino Ramacciotti
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Andre L. Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- Artificial Intelligence Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, United States of America
- Norris Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Rene Sotelo
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Mihir M. Desai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Inderbir S. Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
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Quintão VC, Concha M, Argüello LAS, Cavallieri S, Cortinez LI, de Sousa GS, Clemente MMM, Carlos RV, Rodríguez JM, Gutiérrez K, Jablonka DH, García-Marcinkiewicz AG. Pediatric anesthesiology in Brazil, Chile, and Mexico. Paediatr Anaesth 2024. [PMID: 38619275 DOI: 10.1111/pan.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Latin America comprises an extensive and diverse territory composed of 33 countries in the Caribbean, Central, and South America where Romance languages-languages derived from Latin are predominantly spoken. Economic disparities exist, with inequitable access to pediatric surgical care. The Latin American Surgical Outcomes Study in Pediatrics (LASOS-Peds), a multi-national collaboration, will determine safety of pediatric anesthesia and perioperative care. OBJECTIVE Below, we provide a descriptive initiative to share how pediatric anesthesia in Brazil, Chile, and Mexico operate. Theses descriptions do not represent all of Latin America. DESCRIPTIONS AND CONCLUSIONS Brazil an upper middle-income country, population 203 million, has a public system insufficiently resourced and a private system, resulting in inequitable safety and accessibility. Surgical complications constitute the third leading cause of mortality. Anesthesiology residency is 3 years, with required rotations in pediatric anesthesia; five hospitals offer pediatric anesthesia fellowships. Anesthesiology is a physician-only practice. A Pediatric Anesthesia Committee within the Brazilian Society of Anesthesiology offers education through seasonal courses and workshops including pediatric advanced life support. Chile is a high-income country, population 19.5 million, the majority cared for in the public system, the remainder in university, private, or military systems. Government efforts have gradually corrected the long-standing anesthesiology shortage: twenty 3-year residency programs prepare graduates for routine pediatric cases. The Chilean Society of Anesthesiology runs a 1-month program for general anesthesiologists to enhance pediatric anesthesia skills. Pediatric anesthesia fellowship training occurs in Europe, USA, and Australia, or in two 2-year Chilean university programs. Public health policies have increased the medical and surgical pediatric specialists and general anesthesiologists, but not pediatric anesthesiologists, which creates safety concerns for neonates, infants, and medically complex. Chile needs more pediatric anesthesia fellowship programs. Mexico, an upper middle-income country, with a population of about 126 million, has a five-sector healthcare system: public, social security for union workers, state for public employees, armed forces for the military, and a private "self-pay." There are inequities in safety and accessibility for children. Pediatric Anesthesiology fellowship is 2 years, after 3 years residency. A shortage of pediatric anesthesiologists limits accessibility and safety for surgical care, driven by added training at low salary and hospital under appreciation. The Mexican Society of Pediatric Anesthesiology conducts refresher courses, workshops, and case conferences. Insufficient resources and culture limits research.
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Affiliation(s)
- Vinícius Caldeira Quintão
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mario Concha
- Department of Anesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Silvana Cavallieri
- Department of Anesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Anesthesiology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Luis I Cortinez
- Department of Anesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gabriel Soares de Sousa
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Serviços Médicos de Anestesia, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Ricardo Vieira Carlos
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Karla Gutiérrez
- Department of Pediatric Anesthesia, Instituto Mexicano del Seguro Social La Raza, Hospital Medica Sur, Mexico City, Mexico
| | - Denis H Jablonka
- Children's Hospital of Philadelphia, USA Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Annery G García-Marcinkiewicz
- Children's Hospital of Philadelphia, USA Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Raguveer V, Sawhney R, Roy N, Raykar N. The rural surgeon: a practice to strive for. BMJ Glob Health 2024; 9:e013449. [PMID: 38724077 PMCID: PMC11029196 DOI: 10.1136/bmjgh-2023-013449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/30/2023] [Indexed: 05/12/2024] Open
Affiliation(s)
- Vanitha Raguveer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Riya Sawhney
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low- and Middle-Income Countries, Mumbai, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low- and Middle-Income Countries, Mumbai, India
- Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Nakul Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Torborg A, Meyer H, El Fiky M, Fawzy M, Elhadi M, Ademuyiwa AO, Osinaike BB, Hewitt-Smith A, Nabukenya MT, Bisegerwa R, Bouaoud S, Abdoun M, El Adib AR, Kifle Belachew F, Gebre M, Taye DB, Kechiche N, Fadalla T, Abdallah B, Chaibou MS, Nyarko MYA, Ki KB, Shalongo S, Mulwafu W, Thomson E, Traore MM, Ndonga A, Bittaye M, Samateh AL, Munlemvo DM, Kalongo JJ, Coulibaly Y, Coulibaly Y, Ravelojaona V, ANDRIAMANARIVO L, RAHERISON AR, RANDRIAMIZAO HMR, RAMKALAWAN K, Omar MA, Ndikontar R, Joseph D, Dahir S, Mohamed M, Ali Daoud H, Ndarukwa P, OTIOBANDA GF, Banguti P, Neil K, Derbew M, Fanny M, Smalle I, Taylor EH, Duvenage H, Hardy A, Kluyts H, Pearse R, Biccard B, AARON OI, Abd Elazeem Mohammed HAS, Abdalkarim B, Abdalla A, Abdallah MAA, Abdeewi S, Abdel Ghafar T, Abdelaleem A, Abdelaleem IA, Abdelgader K, Abdelgadir W, Abdelhafez M, Abdelhalim A, Abdelkabir M, Abdelkader Osman M, Abdelkarim M, Abdelkarim M, Abdelmohsen SM, Abdelnassir M, Abdelrahman ASM, Abdelwahed AE, Abdelzaher M, Abderrahim BA, Abdoulaye T, Abdulai S, Abdulghaffar YA, Abdullah F, Abdullahi LB, Abdullahi M, Abdulrazik S, Abdulsalam KI, Abdulwahed E, Abdus-Salam R, ABE TOLUSHE, Abera Mulugeta G, Aboelghait AA, Abol Oyoun N, Aboubekr B, Abraham M, Abu M, Abuagila AA, Abubakar M, Abugilah M, Abuzeid IA, Achouri D, Acquah SA, Adam NBA, ADAMU AUWAL, Adamu KM, ADAMU MUHAMMAD, ADAMU S, Adane SG, Adeaga M, Adebayo S, Adedire A, Adegoke PA, Ademuyiwa AO, Adeniyi AA, Adeoye I, Aderibigbe G, ADEROUNMU A, ADEYEMI WILLIAMS, ADEYEMO A, Adigun T, Adika ED, ADISA AO, Adjei E, Adjepong-Tandoh EK, Ads AM, ADUMAH DCC, ADUMAH LO, Adzamli I, Afari J, Afedo W, Affan A, AFOLAYAN AO, Agaba S, Agbeno E, Agbonrofo P, Aghadi I, AGU EDITH, Agyen T, Agyen-Mensah K, Ahensan D, Ahmad MH, AHMED A, Ahmed L, Ahmed NYAA, Ahmed R, Ahmed Jroush M, ahmed maghur H, AHOGNI GG, Ait Yahia S, Aji N, Aji SA, Akerele W, Akhideno I, Akinmokun I, AKINNIYI AT, Akinniyi A, AKINYEMI S, Akitoye OA, AKPAETTE IC, Akuma TJ, Akuokor D, Akwei CNA, Al Bashir RBH, Al Gharyani MF, al Islam ben Jouira R, Aladelusi T, Alakaloko F, Alameen H, Alameen Moheyaldeen M, Alaogaly M, Alarabi R, Alawami M, Alazabi BM, Alazabi M, Albakosh BA, ALBDULRRAZIQ HUSAYNMOHAMMEDE, Aldieb A, Aldressi W, Alegbeleye GE, Alfa Y, Alhadad Q, Alhaddad AR, Alhaddad HF, Alhadi A, Alhamali A, Alharam A, Alhlafi M, Alhouwasi B, Alhudhairy S, Ali AMA, Ali AJ, Ali A, Ali A, Ali E, Ali M, Ali S, Ali YY, Ali Ahmed A, Aliozor S, Aljamal S, Alkaseek A, Alkhalifa E, Alkoni S, Allie A, Almelyan K, Almugaddami A, Almujreesi A, Alqady E, Alragheai AA, Alshareea E, Alshareef A, Alsori M, Altomy SA, Al-Touny A, Al-Touny SA, Alum Aguma R, Alwaer NM, Al-zletni H, Alzwai M, Amaambo N, Amah CC, Amary M, Amengle LA, Amesho SLO, Ametepe M, Amkhatirah E, Amnaina MG, Amoah B, Amoah JK, Amo-Aidoo NAS, Amoako-Boateng M, Ampong J, Anane-Fenin B, Anarfi S, Andriamanarivo ML, Aniakwo L, Aniteye E, Ankrah LNA, Anno A, Anyanwu LJC, Anyigba E, Appeadu-Mensah W, Appiah-Thompson P, Apraku-Peprah EL, Aremu SK, Arinaitwe M, Armah R, Arthur A, Arthur D, Asah-Opoku K, Asante M, Asante-Asamani A, Asare A, Asasira L, Ashfersh M, ASHINDOITIANG JA, Ashong J, Ashraf Salah M, Asiedu C, Asiedu I, Asiyanbi K, Asla A, Asman W, Asoegwu EJ, Assalhi M, Assim C, Asudo FD, Atai AG, Ateeqa SB, Atim T, Atindama S, ATIQUI IJLAL, Atrih Z, Attah RA, Awad AK, Awedew AF, Awedew AF, Aween H, Awere-Kyere L, Awindaogo J, Awori Achani M, Ayad K, Azab A, Azas A, Aziza B, Azize DA, AZOUI A, Azouz J, Baba S, Babalola OF, Babiker M, Baddoo D, Badi A, BADMUS SA, Badr H, Bah A, Bah FY, Bah K, Bah MT, Bahroun S, Baidoo E, Baidoo K, Baidoo R, Bakare A, Bakeer HB, Baky Fahmy MA, Balogun J, Bamigboye B, Bankah P, Banson M, Barhouma YE, Barongo M, BASHIR RABIU MOHAMMED, Bassem A, Bedair MAA, Beeharry HR, Beeharry S, Bekele S, Belie O, Belkhair A, Ben Ahmed Y, Ben Ashur A, Ben Hamida B, Benade C, BENMANSEUR S, Bensebti AA, BERDAI MA, Beyuo V, Biala M, Bilson-Amoah E, Bin wali SS, Binnawara M, Birlie Chekol W, Birqeeq G, Biyase T, Blankson PK, Boakye B, Boakye B, Boakye-Acheampong K, Boakye-Yiadom K, Boateng J, Bobaker S, Bode C, Bogoslovskiy A, Bolarinwa ES, Boretti L, Botchway MT, Botha C, BOUDA BD, BOURENANE H, BOUZBID S, Boye J, Branny M, Brown GD, Brown W, Bua E, BWALA KEFASJOHN, Camara B, Camara ML, Carol T, Ceesay W, Chafee K, Chaklie Agegnehu B, Chamir C, Chaziya PYC, Chellan C, Cheniki N, Chennouf S, Chepkoech E, Chilango C, Chinda JY, Chokwe TM, Choutri H, Christian NA, Chukwu I, Chummun G, Cilliers C, Cloete E, Collison C, Cronje L, Daary D, DAD B, Daddy H, Dahilo EA, Dairam J, Dalaf MS, Damson P, Daneji SM, Daniel A, Daoud A, Daoud H, Darat TD, Darko KO, Darko K, Davidson K, Davies A, Dawang YD, Dayal K, Dayie M, de Goede A, de Goede A, Deelawar BW, Derwish K, Desalu I, Dessalegn Beza A, Dhege C, Dhilraj D, Diallo TS, Diaw M, Diaw Diop A, DIENE M, Dieng M, Dippenaar T, Djagbletey R, Djedid NK, Djouonang KT, Dominique S, Drammeh B, Drissi H, du Bruyn A, Dube T, Dufe R, Dung D, Earl E, Ebrahem OKA, Ebrahim Z, Edena ME, Effa Ngono R, Egbuchulem K, Egdeer A, Eguma SA, Ehimhantie M, EJIOFOR OC, Ejuma LO, Ekenze S, Ekhmaj RA, Ekor O, EKPA S, Ekpemo CS, Ekudo J, Ekwunife OH, El Koraichi A, El Magrahi H, El Mejrab M, El Sadek R, El YOUBI H, Eladani O, Elamesh SAH, Elamien M, Elamin Elnour MA, Elbadawy MA, Elbaseet H, Elderwy AA, Elebute O, Elgamal M, Elgenidy A, Elghareeb A, Elgherwi L, Elhadad R, Elhadi A, Elhassan M, Elkhouly AM, Ellebedy M, ELMAJRI MOHAMEDFUAD, Elmandouh O, Elmandouh R, Elmorsi R, ELOMBILA M, Elsadek M, Elsalhawy S, Elsayem K, Elshafiey M, El-Sharkawi M, Elshazly M, Eltaub D, Eltayeb AA, Eltayeb MEZ, Eltegani Abdalla A, ElWakeel M, Embu H, Emoru A, Enicker B, Enti D, Entsua-Mensah K, Eseile SI, Essuman VA, Et-taghy H, Etwire V, Eyaman KD, Ezbeida M, EZEKIEL ANTHONYSABO, Ezidiegwu SU, Ezomike UO, FABOYA O, Fadlalmola H, FAGBAYIMU OM, Faida H, FALL K, Farahat S, Faraj A, Faraj N, Farghaly A, Farhat KOA, Farinyaro AU, Fathi Bani G, Fattah A, Fawzy M, Fening N, Fentahun Emrie A, Fidieley M, Fikadu Keneni D, Fischer M, Flint M, Fodo N, Fofana N, Fokeerah N, Folami E, Folokwe S, Fonternel D, Fosi Kamga G, Fotso LK, Fourtounas M, Frankish L, Gabier I, Gacii VM, Gaffoor MS, Gagara M, GALADIMA HA, Gamubaka R, Ganey M, Ganiyu OO, Gasa N, Gatheru AP, Gawu VS, Gaya SSD, GAYE I, Gebremichael Ganta A, Gelaw KG, Geldenhuys L, Getachew Tegegn A, Ghemmied M, Ghmagh R, GILES AHEREZA, Ginsburg RG, Girma K, Gjam F, Glover-Addy H, Gobin V, Gomeh P, Gomez D, Gorelyk A, Gossaye A, Govender V, Grant J, Grayson BL, Grobbelaar M, Gueye KR, GUIRO H, Gumede S, Gurure D, Gusibat A, Gyeke-Boafo NK, HACHEMI S, Haddis K, Haidar A, Haif A, Hameed-Ikram S, Hamid H, Hamukwaya D, Hanson NA, Hanzi J, Hardcastle T, Harissou A, Hasan A, Hasan HB, Hasan NB, Hashi AS, Hashish AA, Hassaan I, Hassan S, Hassan SA, Hassan T, Hassan Z, Hassane ML, Hassanein M, Hawu Y, Haywood D, Heelan H, Hendricks N, Hillah A, Hlela Q, HMAMOUCHI B, Hoko Z, Honny D, Honore S, Houidi S, Human T, Hussain E, Hussain Kona MH, Hussein Y, Ibekwe TS, Ibiyemi A, IBIYEYE TAIBAT, Ibrahim IA, Ibrahim LI, Ibrahim S, Ibrahim Abubakar A, Ibrahim Alain T, Idipo F, Idoko G, Idowu O, Idris MEA, Igaga EN, Iindongo E, IITULA P, IKOTUN O, ILLE G, Imposo DH, Invernizzi J, Irungu E, Isbayqah AM, Isbayqah EM, Ismael G, Ismail AM, Itambi AM, Jabang JN, Jaga R, Jaganath U, Jaiteh L, Jallow CS, James O, Javed S, Jithoo S, Jlidi S, Joel L, Johnson M, JONES TAIWO, Jooma Z, Joomye S, Joosab M, JOUINI R, Jubail MJ, Juggoo C, Jumbi TM, Kaabar N, Kabirou M, Kabiru AM, Kabre BY, Kache S, Kacimi SEO, KADAS ABUBAKARSAIDU, KAHANSIM B, Kalipa M, Kalongo JJK, Kalu NE, Kamate B, Kamwangen GM, Kandjimi M, Kanjana-Zondo N, Kankpeyeng L, Kapalamula T, Karadji S, Kargbo MA, Karghul M, Kaskar R, Kasker R, Kasobya F, Kassem O, Kateregga G, Kayima P, Kedwany AM, Ken-Amoah S, Kenneth TK, KERISSE ANEH, KERKENI Y, Khairi R, Khaled M, Khalifa E, Khalifa MS, Khalil MK, Khattab MSI, Khodary AR, Khumalo BF, Khumalo P, Kigayi JP, Kimutai TK, KINDO B, KIRFI ABDULLAHIMUSA, Koggoh P, Koko AA, Kopieniak M, Kotagiri C, Kotey E, Kouicem AT, Kpangkpari R, Kudoh V, Kufonya N, Kuhn W, Kutor J, Kwakye A, Kynes JM, Lambrechts L, Lamiri R, LANRE OLOKONASIRUDEEN, Larvie P, Lateef AK, LATRECHE S, Lawal T, Leballo G, Lebereki S, Lee D, Leeb G, Leonard T, LEYONO-MAWANDZA PDG, Likongo TB, Limalia Z, LIMAN HARUNAUSMAN, Loae N, Lompoli BNE, Lusungu D, M.Mokhtar FALZ, Madany MEDM, Maddy RJ, Madombwe G, Mafabi S, Magashi MK, Maharaj S, Mahfouz SM, Mahlare KRV, Mahmoud F, Maikassoua M, Maison P, Maiwald D, Makhoba P, Makinita SG, Makou epse Tolefac M, Malau TK, Mamathuntsha TG, Mamo TN, Mamuda A, Mandundzo P, Mangray H, Mani S, Manneh EK, Mansour NM, Manyere DV, Mapurisa A, Mare P, Martin ME, Mashaal A, Mashaya S, Masilela PB, Mathebula R, Mathinya T, Matlala TK, Matlou M, Matos-Puig R, Matoug S, Maudarbocus MJ, Mavesere HP, Mavila J, Mayet S, Maygag M, Mbatha N, Mbatudde R, Mbiya Kapinga A, Mbuyamba J, Mbuyi AT, Mdlalose N, Prowling M, Mejeni N, Mekonnen Ejigu Y, Merghani S, Metogo JEN, Mhiri R, Mhone L, Michael A, Miko AM, Milad A, Mishra R, Mjadu L, Mkhontwana N, Mlambo N, Mncwango Z, Mngoma G, Mnguni M, Modekwe VI, Mogane P, Moghazy R, Mogotsi K, Mohalal MS, Mohamed AAA, Mohamed M, Mohamed MEE, Mohamed SA, Mohamedkheir MA, Mohammad AL, Mohammad AD, Mohammad AM, Mohammed A, Mohammed M, Mohammed RI, Mohammed R, Mohammed TSA, Mohammedosman D, Mohsen SM, Molla Getahun A, Moloisi M, Monib FA, Moodley K, Moopanar M, Morgan F, Moris B, Morna M, Moses V, Mostafa MM, Motiang M, Motseoile T, Motshabi P, MOUSSAOUI N, Mpoto DB, MPOY EMY MONKESSA CM, MRARA BUSISIWE, Mshelbwala PM, Msherghi A, Msibi T, Mubunda RK, Muhammad AB, Muhammad S, Muhanguzi J, Muhindo R, Mukenga MM, Mukuna PM, Mulewa D, Munanzvi KS, Mungur L, Munubi A, Munyalo FS, Muriithi JM, Musa AA, Musa K, Musa MAE, Musana F, Musewu TD, Musiitwa AK, Mwangi CM, Mwepu IM, Mwepu MI, Mwika PM, Mwiti TM, Myeni P, Mzoneli N, Naana R, Nabukenya G, Nabunya S, Naidoo A, Naidoo V, Naidu P, Nakyanzi C, Nambi E, Nampawu MJ, Nampiina G, Namutebi H, Nana B, Nanda JSY, Nanimambi J, Nantongo B, Napolitano L, Naser A, Nassar AS, Nassar MS, Nasser N, Nawezo JG, NDIAYE A, NDIAYE CAT, Ndiaye F, Ndibarekera SH, Ndjoko SM, Ndlovu M, Nduwayezu R, Negash S, Nehema S, Neil K, Neizer M, NEJMI S, Nezam-Parast M, Ng How Tseung K, Ngcelwane T, Ngene I, Nghidinwa H, Ngissah R, Ngock GFFN, Ngouane D, Ngumi Z, Nibret Y, NIENGO OUTSOUTA G, Njie M, NJOKANMA RA, Nkhata L, Nkhuna NT, Nkosi N, Nkosi S, Nkwembe CM, Nnaji C, Nneji-Akazie T, Nongqo N, Nortey M, Noutakdie Tochie J, Nsaful J, Nsimire BB, Nte SK, Ntshingila C, Ntsie NP, Ntsoane D, Ntumy MY, Nuer-Allornuvor G, Nuhu S, Nutsuklo P, Nwachukwu CU, NWAFULUME NNAEMEKA, Nwangwu E, Nwankwo EP, Nyame CA, Nyamekye E, Nyankah E, Nyoka-Mokgalong C, Oase D, Obande JO, Obbeng A, Obeng-Adjei GI, Obianyo I, Obianyo NE, Obiechina S, OBRI AI, ODI TEMITOPE, Odingo J, Oelofsen S, Ofori E, Ofori-Adjei D, Ogaji IM, Ogundoyin OO, OGUNLEYE OLABISI, OGUNS A, Ogunsua O, Ohemeng-Mensah E, Ojediran O, Ojediran O, Ojewuyi A, Ojewuyi O, Ojo A, OJO OO, Ojo O, Okedare A, Okenwa SC, Oko AG, Okojie N, Okonkwo LN, Okoth P, Okunlola AI, Okunlola CK, Okurut M, Oladimeji M, Oladiran A, Olagunju GR, Olajide ARL, Olajide AT, Olang PR, Olayinka O, Olori S, Olulana D, Olulana DI, Olusanya B, Omar DE, Omar MA, Onakpoya U, ONeil M, Onen H, ONYEKA C, Oosthuizen A, Opandoh I, Opiyo S, Oppong J, Orewole TO, Orji M, Osagie O, Osagie OT, Osaheni O, Osama Sleem A, Osawa FO, Osei F, Osei-Nketiah S, Osei-Poku D, Osman A, Osman Ahmed M, Osman Suliman SO, Otchere K, Othman AAA, Othman E, Othman M, Otim P, Otim T, Otman RH, Otoki V, OUDJHIH M, OUEDRAOGO I, OUEDRAOGO PJ, Ousmane Hamady I, Ouyahia A, OWOJUYIGBE A, Owoo C, Owoo P, Owusu Boamah M, Oyedele A, Oyedepo O, Oyegbola C, Panday J, Parker EUE, Parker I, Parker RK, Pembe JN, Percivale B, Pereko J, Pérez M, Perumal N, Pillay L, Pretorius R, Prinsloo R, Pryce C, Puryag A, QUADRI OR, Quansah K, Quarcoopome C, Quarshie A, Quartson E, Quashie-Sam J, Rabiu A, Rabiu T, Rahma M, Rahman GA, Rais M, Rajah C, Rakotondrainibe A, Ramakrishnan R, Ramatou S, Ramdawon B, Ramdhani K, Ramkaun Y, RAPHAEL OSELE, Raslan HMA, Redelinghuys C, Riffi O, Rikhotso H, Roberts CAP, Robertson C, Roland N, Roos J, S. Abdalgadir E, Saad A, Saad MM, Saad El-Tanekhy A, Saadi C, Saadu T, Saber M, Sabir Yassin FM, Sabo VY, Sabra TA, Saeid DA, Safar A, Sagboze S, Sahnoun L, Salahu BM, Salami K, Salawu AI, Saleh H, Saleh IA, Saleh KM, Salele AM, Salem F, Salem O, Salih MAIA, Salisu I, Sall M, SAMB CF, Sangak IA, Sanoussi NM, Sanya D, Sanyang AB, Sarpong P, SARR JN, Schnaubelt R, Searyoh K, SECK NF, Secka AS, Seif M, Seilbea Y, Semret Hailu B, Sepenu P, Sewlall J, Seyi-Olajide J, Shai S, Shalaby AMO, SHAPHAT IBRAHIM, Shava G, Sheidu Owuda A, Sheshe AA, Shetiwy M, Shezi N, Shihab MH, Shitakumuna H, Shitaye N, Shitta AH, Sholadoye TT, Shouasha P, Shu'aibu NG, Shuiap NM, Sibeko B, Sikhakhane S, Sikwete G, Sime Gizaw H, Simelane N, Simon E, Singh U, SIRAJALDIN A, Siriboe E, Siyothula T, Siyotula T, Smart-Yeboah A, SMITH S, Solala S, Soliman EA, Solo CE, Sombéwendin Charles I, Sonaike M, Songden DZ, Sottie D, Soualili Z, Soula E, Souleymane S, SOWANDE OA, Spytko A, Srir DOM, Ssebuguzi L, Stegmann GF, Strauss L, Struwig E, Succi M, Suleiman AR, Suliman M, Swartz M, Taha TM, Takai IU, Takou BH, Takrouney MH, Takure A, TALABI AO, Tall M, Taute C, Tawfik M, Taylor J, Tembe DS, Temesgen F, Tesfaye E, Theko D, Thiart M, Thompson R, Thuer L, Tientcheu Fabrice T, Tilahun ZB, Tilahun Woldetsadik T, Timo M, Timotews N, Tjiyokola D, Tolani MA, TOUABTI S, Traoré D, Tsegha LJ, Tseli M, Tumuhimbise C, Tumukunde J, Tunkara SFS, Turshan L, Turton E, Uchendu CC, UDIE GU, UDOSEN JE, Ugalahi M, Ugwu EM, UGWU IE, Ugwu JO, Ugwunne CA, Ukpabio UE, Umar AM, UMEH CL, Ungen R, Usang U, Usenbo T, Usman MI, UWAYESU R, Van Aswegen B, van der Byl A, van der Linde P, van der Walt S, van Schalkwyk HP, van Tonder C, van Vuuren S, van Wyk J, van Zyl S, Wabule A, Wacays A, Waheed Mowafy G, Waisiko B, Walawah D, Walithandia E, Wamwaki J, Wataaka N, Wessels N, Wessels N, Williams E, WILLIAMS O, Woldegiorgis A, Wolfaardt G, Wondossen M, Woodun R, Workineh ST, Wubetu S, Yahia M, Yakubu H, Yakubu SY, Yalewu DZ, YAMEOGO TAC, Yeboah F, YENYI AHUKA LONGOMBE T, Younes E, Young C, Younis N, Younus TYI, YUSUF STEPHEN, Zaki F, Zbida I, Zenda T, ZERIZER Y, Zingoni K, Zitouni H, ZONGO PV, Zubi A, Zulu N, Zulu N, Yakubu H, Yakubu SY, Yalewu DZ, YAMEOGO TAC, Yeboah F, YENYI AHUKA LONGOMBE T, Younes E, Young C, Younis N, Younus TYI, YUSUF STEPHEN, Zaki F, Zbida I, Zenda T, ZERIZER Y, Zingoni K, Zitouni H, ZONGO PV, Zubi A, Zulu N, Zulu N. Outcomes after surgery for children in Africa (ASOS-Paeds): a 14-day prospective observational cohort study. Lancet 2024; 403:1482-1492. [PMID: 38527482 DOI: 10.1016/s0140-6736(24)00103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Safe anaesthesia and surgery are a public health imperative. There are few data describing outcomes for children undergoing anaesthesia and surgery in Africa. We aimed to get robust epidemiological data to describe patient care and outcomes for children undergoing anaesthesia and surgery in hospitals in Africa. METHODS This study was a 14-day, international, prospective, observational cohort study of children (aged <18 years) undergoing surgery in Africa. We recruited as many hospitals as possible across all levels of care (first, second, and third) providing surgical treatment. Each hospital recruited all eligible children for a 14-day period commencing on the date chosen by each participating hospital within the study recruitment period from Jan 15 to Dec 23, 2022. Data were collected prospectively for consecutive patients on paper case record forms. The primary outcome was in-hospital postoperative complications within 30 days of surgery and the secondary outcome was in-hospital mortality within 30 days after surgery. We also collected hospital-level data describing equipment, facilities, and protocols available. This study is registered with ClinicalTrials.gov, NCT05061407. FINDINGS We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals). INTERPRETATION Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4-14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 deaths per 1000 children). To improve surgical outcomes for children in Africa, we need health system strengthening, provision of safe environments for anaesthesia and surgery, and strategies to address the high rate of failure to rescue. FUNDING Jan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda.
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Karekezi C. Global neurosurgery partnership: need for more adequate collaborations between high-income countries and low-income countries. Acta Neurochir (Wien) 2024; 166:176. [PMID: 38607404 DOI: 10.1007/s00701-024-06061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Claire Karekezi
- Department of Surgery, Neurosurgery UnitRwanda Military HospitalUniversity of Rwanda, Street KK 739ST Kanombe, Kicukiro District, P.O.Box: 3377, Kigali, Rwanda.
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Abdul Rahim K, Shaikh NQ, Lakhdir MPA, Afzal N, Merchant AAH, Mahmood SBZ, Bakhshi SK, Ali M, Samad Z, Haider AH. No healthcare coverage, big problem: lack of insurance for older population associated with worse emergency general surgery outcomes. Trauma Surg Acute Care Open 2024; 9:e001165. [PMID: 38616789 PMCID: PMC11015297 DOI: 10.1136/tsaco-2023-001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 03/20/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Older populations, being a unique subset of patients, have poor outcomes for emergency general surgery (EGS). In regions lacking specialized medical coverage for older patients, disparities in healthcare provision lead to poor clinical outcomes. We aimed to identify factors predicting index admission inpatient mortality from EGS among sexagenarians, septuagenarians, and octogenarians. Methods Data of patients aged >60 years with EGS conditions defined by the American Association for the Surgery of Trauma at primary index admission from 2010 to 2019 operated and non-operated at a large South Asian tertiary care hospital were analyzed. The primary outcome was primary index admission inpatient 30-day mortality. Parametric survival regression using Weibull distribution was performed. Factors such as patients' insurance status and surgical intervention were assessed using adjusted HR and 95% CI with a p-value of <0.05 considered statistically significant. Results We included 9551 primary index admissions of patients diagnosed with the nine most common primary EGS conditions. The mean patient age was 69.55±7.59 years. Overall mortality and complication rates were 3.94% and 42.29%, respectively. Primary index admission inpatient mortality was associated with complications including cardiac arrest and septic shock. Multivariable survival analysis showed that insurance status was not associated with mortality (HR 1.13; 95% CI 0.79, 1.61) after adjusting for other variables. The odds of developing complications among self-paid individuals were higher (adjusted OR 1.17; 95% CI 1.02, 1.35). Conclusion Lack of healthcare coverage for older adults can result in delayed presentation, leading to increased morbidity. Close attention should be paid to such patients for timely provision of treatment. There is a need to expand primary care access and proper management of comorbidities for overall patient well-being. Government initiatives for expanding insurance coverage for older population can further enhance their healthcare access, mitigating the risk of essential treatments being withheld due to financial limitations. Level of evidence III.
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Affiliation(s)
| | | | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
| | - Noreen Afzal
- Medical College, The Aga Khan University, Karachi, Pakistan
| | | | | | - Saqib Kamran Bakhshi
- Section of Neurosurgery, Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
| | - Mushyada Ali
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Adil H Haider
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
- Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
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Oduoye MO, Riaz R, Khan A, Okon II, Akpan U, Bello IM, Munsab R, Furqan M, Akilimali A. The current state of neurosurgical care in Africa - a correspondence. Neurosurg Rev 2024; 47:149. [PMID: 38600422 DOI: 10.1007/s10143-024-02398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Malik Olatunde Oduoye
- Department of Research, Medical Research Circle (MedReC), Postal code 50 Goma, Bukavu, DR, Congo
| | - Rumaisa Riaz
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Afsheen Khan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Inibehe Ime Okon
- Department of Research, Medical Research Circle (MedReC), Postal code 50 Goma, Bukavu, DR, Congo.
- Department of Neurosurgery, Hospital of the Babcock University, Ogun state, Ilishan-Remo, Nigeria.
| | | | | | - Rabbia Munsab
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Furqan
- Faculty of medicine, King Edward Medical University, Lahore, Pakistan
| | - Aymar Akilimali
- Department of Research, Medical Research Circle (MedReC), Postal code 50 Goma, Bukavu, DR, Congo
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Chelales E, von Windheim K, Banipal AS, Siebeneck E, Benham C, Nief CA, Crouch B, Everitt JI, Sag AA, Katz DF, Ramanujam N. Determining the Relationship between Delivery Parameters and Ablation Distribution for Novel Gel Ethanol Percutaneous Therapy in Ex Vivo Swine Liver. Polymers (Basel) 2024; 16:997. [PMID: 38611255 PMCID: PMC11013462 DOI: 10.3390/polym16070997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Ethyl cellulose-ethanol (ECE) is emerging as a promising formulation for ablative injections, with more controllable injection distributions than those from traditional liquid ethanol. This study evaluates the influence of salient injection parameters on forces needed for infusion, depot volume, retention, and shape in a large animal model relevant to human applications. Experiments were conducted to investigate how infusion volume (0.5 mL to 2.5 mL), ECE concentration (6% or 12%), needle gauge (22 G or 27 G), and infusion rate (10 mL/h) impacted the force of infusion into air using a load cell. These parameters, with the addition of manual infusion, were investigated to elucidate their influence on depot volume, retention, and shape (aspect ratio), measured using CT imaging, in an ex vivo swine liver model. Force during injection increased significantly for 12% compared to 6% ECE and for 27 G needles compared to 22 G. Force variability increased with higher ECE concentration and smaller needle diameter. As infusion volume increased, 12% ECE achieved superior depot volume compared to 6% ECE. For all infusion volumes, 12% ECE achieved superior retention compared to 6% ECE. Needle gauge and infusion rate had little influence on the observed depot volume or retention; however, the smaller needles resulted in higher variability in depot shape for 12% ECE. These results help us understand the multivariate nature of injection performance, informing injection protocol designs for ablations using gel ethanol and infusion, with volumes relevant to human applications.
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Affiliation(s)
- Erika Chelales
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Katriana von Windheim
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Arshbir Singh Banipal
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Elizabeth Siebeneck
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Claire Benham
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Corrine A. Nief
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Brian Crouch
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Jeffrey I. Everitt
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Alan Alper Sag
- Department of Radiology, Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, NC 27710, USA
| | - David F. Katz
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
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Cooper GM, Bayram JM, Clement ND. The functional and psychological impact of delayed hip and knee arthroplasty: a systematic review and meta-analysis of 89,996 patients. Sci Rep 2024; 14:8032. [PMID: 38580681 PMCID: PMC10997604 DOI: 10.1038/s41598-024-58050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
This systematic review and meta-analysis aimed to determine the impact of presurgical waiting times on pre-/post-operative joint specific pain and function, health-related quality of life (HRQOL) and perspectives of patients awaiting primary elective total hip (THR) and knee (TKR) replacements. MEDLINE, EMBASE, PUBMED, and CENTRAL databases were searched from inception until 30th January 2023 (CRD42022288128). Secondary literature and unpublished datasets containing paediatric, non-elective, partial, or revision replacement populations were excluded. PRISMA 2020 reporting and GRADE certainty of evidence guidelines were followed. Residual maximum likelihood meta-analysis and linear meta-regression was performed to elucidate the influence of presurgical waiting time. Twenty-six studies were eligible for systematic review and sixteen for meta-analysis, capturing 89,996 patients (60.6% female, mean age 67.4 years) between 2001 and 2022. A significant deterioration in joint function (mean difference (MD):0.0575%; 95% CI 0.0064, 0.1086; p = 0.028(4d.p.); I2 = 73.1%) and HRQOL (MD: 0.05%; 95% CI - 0.0001.0009; p = 0.011(4 d.p.); I2 = 80.6%) was identified per additional day of waiting. Despite qualitative evidence, meta-analysis could not observe a relationship with postoperative outcome data. Patient responses to delayed THR and TKR surgery were unanimously negative. Immediate action should seek to reduce the increased patient anxiety and significant reductions in pre-operative joint functionality and HRQOL associated with prolonged pre-surgical waiting time, whilst mitigating any potential deleterious post-operative effects.
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Affiliation(s)
- G M Cooper
- University of Edinburgh Medical School, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - J M Bayram
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - N D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
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Davies J, Chu K, Tabiri S, Byiringiro JC, Bekele A, Razzak J, D’Ambruoso L, Ignatowicz A, Bojke L, Nkonki L, Laurenzi C, Sitch A, Bagahirwa I, Belli A, Sam NB, Amberbir A, Whitaker J, Ndangurura D, Ghalichi L, MacQuene T, Tshabalala N, Fikadu Berhe D, Nepomuscene NJ, Agbeko AE, Sarfo-Antwi F, Babar Chand Z, Wajidali Z, Sahibjan F, Atiq H, Mali Y, Tshabalala Z, Khalfe F, Nodo O, Umwali G, Twizeyimana E, Mugisha N, Munyura NO, Nakure S, Ishimwe SMC, Nzasabimana P, Dramani A, Acquaye J, Tanweer A. Equitable access to quality injury care; Equi-Injury project protocol for prioritizing interventions in four low- or middle-income countries: a mixed method study. BMC Health Serv Res 2024; 24:429. [PMID: 38576004 PMCID: PMC10996087 DOI: 10.1186/s12913-024-10668-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/31/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Equitable access to quality care after injury is an essential step for improved health outcomes in low- and middle-income countries (LMICs). We introduce the Equi-Injury project, in which we will use integrated frameworks to understand how to improve equitable access to quality care after injury in four LMICs: Ghana, Pakistan, Rwanda and South Africa. METHODS This project has 5 work packages (WPs) as well as essential cross-cutting pillars of community engagement, capacity building and cross-country learning. In WP1, we will identify needs, barriers, and facilitators to impactful stakeholder engagement in developing and prioritising policy solutions. In WP2, we will collect data on patient care and outcomes after injuries. In WP3, we will develop an injury pathway model to understand which elements in the pathway of injury response, care and treatment have the biggest impact on health and economic outcomes. In WP4, we will work with stakeholders to gain consensus on solutions to address identified issues; these solutions will be implemented and tested in future research. In WP5, in order to ascertain where learning is transferable across contexts, we will identify which outcomes are shared across countries. The study has received approval from ethical review boards (ERBs) of all partner countries in South Africa, Rwanda, Ghana, Pakistan and the University of Birmingham. DISCUSSION This health system evaluation project aims to provide a deeper understanding of injury care and develop evidence-based interventions within and across partner countries in four diverse LMICs. Strong partnership with multiple stakeholders will facilitate utilisation of the results for the co-development of sustainable interventions.
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140
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Luo W, Kim Y, Tan V, Ek P, Hunt S, Howells H. Functional and clinical outcomes in the Krukenberg amputation. J Hand Surg Eur Vol 2024; 49:458-462. [PMID: 37728868 DOI: 10.1177/17531934231202010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
We evaluated the outcomes of the Krukenberg procedure conducted for the loss of a hand secondary to an electrical burn injury in six patients (10 hands). Patient demographics, indications for surgery, surgical strategy, complications, clinical measurements and Disabilities of the Arm, Shoulder and Hand (DASH) score were recorded, in addition to subjective outcome measures, including self-perception of social acceptance and employment status. The median DASH score at follow-up was 22 (range 4-50, interquartile range 25). Patients reported recovery of useful function in operated limbs. We recommend this procedure in low-resource settings when other reconstruction is impossible.Level evidence: IV.
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Affiliation(s)
- Weisang Luo
- Children's Surgical Centre, National Rehabilitation Center, Kien Khleang, Phnom Penh, Cambodia
| | - Yongjune Kim
- Children's Surgical Centre, National Rehabilitation Center, Kien Khleang, Phnom Penh, Cambodia
| | - Vichet Tan
- Children's Surgical Centre, National Rehabilitation Center, Kien Khleang, Phnom Penh, Cambodia
| | - Picheata Ek
- Children's Surgical Centre, National Rehabilitation Center, Kien Khleang, Phnom Penh, Cambodia
| | - Sophie Hunt
- Children's Surgical Centre, National Rehabilitation Center, Kien Khleang, Phnom Penh, Cambodia
| | - Harriet Howells
- Children's Surgical Centre, National Rehabilitation Center, Kien Khleang, Phnom Penh, Cambodia
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Elahi C, Shaftel KA, Cole TS, Nickenig Vissoci JR, Little AS. h global-Index: A Novel Author-Level Measure of the Diffusion of Scientific Ideas Among High-, Low-, and Middle-Income Countries. World Neurosurg 2024; 184:e360-e366. [PMID: 38302003 DOI: 10.1016/j.wneu.2024.01.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To describe an intuitive and useful method for measuring the global impact of a medical scholar's research ideas by examining cross-border citations (CBCs) of peer-reviewed neurosurgical publications. METHODS Publication and citation data for a random sample of the top 50 most academically productive neurosurgeons were obtained from Scopus Application Programming Interface. We characterized an author-level global impact index analogous to the widely used h-index, the hglobal-index, defined as the number of published peer-reviewed manuscripts with at least the same number of CBCs. To uncover socioeconomic insights, we explored the hglobal-index for high-, middle-, and low-income countries. RESULTS The median (interquartile range) number of publications and CBCs were 144 (62-255) and 2704 (959-5325), respectively. The median (interquartile range) h-index and hglobal-index were 42 (23-61) and 32 (17-38), respectively. Compared with neurosurgeons in the random sample, the 3 global neurosurgeons had the highest hglobal-indices in low-income countries at 17, 13, and 9, despite below-average h-index scores of 33, 38, and 19, respectively. CONCLUSION This intuitive update to the h-index uses CBCs to measure the global impact of scientific research. The hglobal-index may provide insight into global diffusion of medical ideas, which can be used for social science research, author self-assessment, and academic promotion.
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Affiliation(s)
- Cyrus Elahi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kelly A Shaftel
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - João Ricardo Nickenig Vissoci
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew S Little
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Kovacheva VP, Nagle B. Opportunities of AI-powered applications in anesthesiology to enhance patient safety. Int Anesthesiol Clin 2024; 62:26-33. [PMID: 38348838 PMCID: PMC11185868 DOI: 10.1097/aia.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Vesela P. Kovacheva
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Baily Nagle
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Stroda A, Mauermann E, Ionescu D, Szczeklik W, De Hert S, Filipovic M, Beck Schimmer B, Spadaro S, Matute P, Ganter MT, Ovezov A, Turhan SC, van Waes J, Lagarto F, Theodoraki K, Gupta A, Gillmann HJ, Guzzetti L, Kotfis K, Larmann J, Corneci D, Buggy DJ, Howell SJ, Lurati Buse G. Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study. Br J Anaesth 2024; 132:675-684. [PMID: 38336516 DOI: 10.1016/j.bja.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND In 2022, the European Society of Cardiology updated guidelines for preoperative evaluation. The aims of this study were to quantify: (1) the impact of the updated recommendations on the yield of pathological findings compared with the previous guidelines published in 2014; (2) the impact of preoperative B-type natriuretic peptide (NT-proBNP) use for risk estimation on the yield of pathological findings; and (3) the association between 2022 guideline adherence and outcomes. METHODS This was a secondary analysis of MET-REPAIR, an international, prospective observational cohort study (NCT03016936). Primary endpoints were reduced ejection fraction (EF<40%), stress-induced ischaemia, and major adverse cardiovascular events (MACE). The explanatory variables were class of recommendations for transthoracic echocardiography (TTE), stress imaging, and guideline adherence. We conducted second-order Monte Carlo simulations and multivariable regression. RESULTS In total, 15,529 patients (39% female, median age 72 [inter-quartile range: 67-78] yr) were included. The 2022 update changed the recommendation for preoperative TTE in 39.7% patients, and for preoperative stress imaging in 12.9% patients. The update resulted in missing 1 EF <40% every 3 fewer conducted TTE, and in 4 additional stress imaging per 1 additionally detected ischaemia events. For cardiac stress testing, four more investigations were performed for every 1 additionally detected ischaemia episodes. Use of NT-proBNP did not improve the yield of pathological findings. Multivariable regression analysis failed to find an association between adherence to the updated guidelines and MACE. CONCLUSIONS The 2022 update for preoperative cardiac testing resulted in a relevant increase in tests receiving a stronger recommendation. The updated recommendations for TTE did not improve the yield of pathological cardiac testing.
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Affiliation(s)
- Alexandra Stroda
- Department of Anaesthesiology, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
| | - Eckhard Mauermann
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Daniela Ionescu
- Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Stefan De Hert
- Department of Anaesthesiology and Peri-operative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Miodrag Filipovic
- Division of Anaesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Beatrice Beck Schimmer
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Savino Spadaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Purificación Matute
- Department of Anaesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Michael T Ganter
- Department of Anaesthesiology and Intensive Care Medicine, Klinik Hirslanden, Zurich, Switzerland
| | - Alexey Ovezov
- Department of Anaesthesiology, Moscow Regional Research Clinical Institute, Moscow, Russia
| | - Sanem C Turhan
- Department of Anaesthesiology and ICU, Ankara University Medical School, Ankara, Turkey
| | - Judith van Waes
- Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Filipa Lagarto
- Department of Anaesthesiology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Kassiani Theodoraki
- Aretaieion University Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - Anil Gupta
- Department of Perioperative Medicine and Intensive Care, Karolinska Hospital and Institution for Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Jörg Gillmann
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Luca Guzzetti
- Anesthesia and Intensive Care Department, University Hospital, Varese, Italy
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Pain Management, Pomeranian Medical University, Szczecin, Poland
| | - Jan Larmann
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dan Corneci
- Anesthesia and Intensive Care Department III, Carol Davila University of Medicine and Pharmacy Bucharest, Central Military Emergency University Hospital "Dr. Carol Davila Bucharest", Bucharest, Romania
| | - Donal J Buggy
- Department of Anaesthesiology, Mater University Hospital, Dublin, Ireland
| | - Simon J Howell
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Giovanna Lurati Buse
- Department of Anaesthesiology, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany; CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Srinivasan Y, Shamritsky D, Bhatta A, Chou E, Pham T, Sanghvi Y, Woolf L, Zhang M, Odigie E, Chidziva C, Muganda E, Zimani P, de Faria N, Rameau A. Design and Usability of an Open-Source, Low-Cost Flexible Laryngoscope for Resource-Limited Settings. JAMA Otolaryngol Head Neck Surg 2024; 150:342-348. [PMID: 38451500 PMCID: PMC10921344 DOI: 10.1001/jamaoto.2024.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/16/2024] [Indexed: 03/08/2024]
Abstract
Importance Endoscopes are paramount to the practice of otolaryngology. To provide physicians in low-middle-income countries with adequate tools to treat otolaryngologic problems, it is necessary to create a low-cost sustainable option. Objective To describe the design and usability of an open-source, low-cost flexible laryngoscope that addresses the lack of affordable and accessible methods for otolaryngologic visualization in resource-limited settings. Design, Setting, and Participants This quality improvement study used a mixed-methods approach, including a technical description of device design as well as quantitative and qualitative survey evaluation of device usability. Engineering involved device design, sourcing or manufacturing individual components, fabricating a prototype, and iterative testing. Key assumptions and needs for the device were identified in collaboration with otolaryngologists in Zimbabwe, and designed and simulated by biomedical engineers in a US university laboratory. Board-certified otolaryngologists at a single US university hospital trialed a completed prototype on simulated airways between May 2023 and June 2023. Main Outcomes and Measures Technical details on the design of the device are provided. Otolaryngologist gave feedback on device characteristics, maneuverability, and visualization using the System Usability Scale, a customized Likert-scale questionnaire (5-point scale), and semistructured interviews. Results A functional prototype meeting requirements was completed consisting of a distal-chip camera, spring bending tip, handle housing the control mechanism and electronics, and flexible polyether block amide-coated silicone sheath housing the camera and control wires; an external monitor provided real-time visualization and ability to store data. A total of 14 otolaryngologists participated in the device review. The mean (SD) System Usability Scale score was 88.93 (10.08), suggesting excellent usability. The device was rated highly for ease of set up, physical attributes, image quality, and functionality. Conclusions and Relevance This quality improvement study described the design of a novel open-source low-cost flexible laryngoscope that external review with otolaryngologists suggests was usable and feasible in various resource-limited environments. Future work is needed to translate the model into a clinical setting.
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Affiliation(s)
- Yashes Srinivasan
- Sean Parker Institute for the Voice, Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medicine, New York, New York
| | - David Shamritsky
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Asmita Bhatta
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Ellaine Chou
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Trang Pham
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Yashi Sanghvi
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Lily Woolf
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Michael Zhang
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Eseosa Odigie
- Sean Parker Institute for the Voice, Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medicine, New York, New York
| | | | - Erasmus Muganda
- Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
| | | | - Newton de Faria
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medicine, New York, New York
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145
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Smith CB, Marapese KD, Charles AG. Management of acute appendicitis in low- and middle-income countries. Curr Probl Surg 2024; 61:101444. [PMID: 38548428 DOI: 10.1016/j.cpsurg.2024.101444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 04/02/2024]
Affiliation(s)
| | | | - Anthony G Charles
- School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Encarnación-Santos D, Chmutin G, Bozkurt I, Chaurasia B, Umana GE, Scalia G. Letter to the Editor Regarding "What's in a Name? "Global Neurosurgery" in the 21st Century". World Neurosurg 2024; 184:341-342. [PMID: 38590056 DOI: 10.1016/j.wneu.2023.11.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 04/10/2024]
Affiliation(s)
| | - Gennady Chmutin
- Department of Neurosurgery, People's Friendship University, Moscow, Russia
| | - Ismail Bozkurt
- Department of Neurosurgery, Medical Park Ankara Hospital, Ankara, Turkey; Department of Neurosurgery, School of Medicine, Yuksek Ihtisas University, Ankara, Turkey
| | - Bipin Chaurasia
- Department of Neurosurgery, Bhawani Hospital and Research Center, Birgunj, Nepal
| | | | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital, Catania, Italy
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147
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Dje Bi Dje-Assi V, Amouzou KS, Kouevi-Koko TE, Jalloh A. African primary research publications in plastic surgery: A PRISMA-S-compliant systematic review. J Plast Reconstr Aesthet Surg 2024; 91:421-429. [PMID: 38479124 DOI: 10.1016/j.bjps.2024.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Plastic surgery (PS) in Africa is a relatively young surgery specialty, and the number of available plastic surgeons on average is one or two surgeons per country in many African low-income countries. This systematic review aims to geographically map the research activities through scientific publications of African PS centres, between February 2012-February 2023. METHODS We searched four literature databases (Medline, Embase, Google Scholar and African Journal Online) and did a manual search. We included case reports, randomised controlled trials, and clinical, comparative, observational and multicentre studies conducted in Africa and published in English and French. In the Google Scholar database, we analysed the first 200 references (scientific articles) selected per relevance according to the Boolean terms. In the African Journals Online database, we analysed the references from the first five pages. The selected keywords were: burns, trauma reconstruction, pressure injuries, wound, cleft lip and palate, breast reconstruction, microsurgery, aesthetic surgery, face surgery, head and neck surgery, hand surgery, open fracture surgery, oculoplastic surgery, skin surgery, and soft tissue surgery. RESULTS We retrieved a total of 228 articles. Out of the 73 African centres we identified, 27 were in the North, 22 in the West, 8 in the East, 3 in the Centre, and 14 in the South. Most of the retrieved 228 articles involved burns (60, 26.31%), congenital abnormalities (52, 22.80%) and reconstruction (28,12.80%); however, other conditions, such as breast or skin cancer, hand surgery, microsurgery or aesthetics are emerging. The studies were case reports/case series (93, 40.78%), retrospective (78, 34.21%), prospective (36, 15.78%), randomised controlled studies (10, 4.38%), cross-sectional (5, 2,19%) and cohort (2, 0.87%). CONCLUSIONS Beyond burns, congenital abnormalities, or reconstructions, other PS indications are emerging, such as skin cancer, breast reconstruction, hand surgery, microsurgery, and aesthetics.
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Affiliation(s)
- Valerie Dje Bi Dje-Assi
- Service de Chirurgie Plastique, Reconstructice et Esthétique, Chirurgie de la main et de Brulologie du CHU de Treichville, Abidjan, Ivory Coast
| | - Komla Séna Amouzou
- Department of Surgery, University of Lomé, Sylvanus Olympio Teaching Hospital, Lomé, Togo.
| | - Tete Edem Kouevi-Koko
- Department of Surgery, University of Lomé, Sylvanus Olympio Teaching Hospital, Lomé, Togo
| | - Abdulai Jalloh
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Takoutsing BD, Endalle G, Senyuy WP, Celestin BM, Kwasseu GK, Tanyi PB, Jumbam DT, Kanmounye US. Identifying opportunities for global surgery in Cameroon: an analysis of existing health policies and events. Pan Afr Med J 2024; 47:143. [PMID: 38933430 PMCID: PMC11204985 DOI: 10.11604/pamj.2024.47.143.38399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/18/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction the burden of diseases amenable to surgery, obstetrics, trauma, and anesthesia (SOTA) care is increasing globally but low- and middle-income countries are disproportionately affected. The Lancet Commission on Global Surgery proposed National Surgical, Obstetrics, and Anesthesia Plans as national policies to reduce the global SOTA burden. These plans are dependent on comprehensive stakeholder engagement and health policy analysis. Objective: in this study, we analyzed existing national health policies and events in Cameroon to identify opportunities for SOTA policies. Methods we searched the Cameroonian Ministry of Health´s health policy database to identify past and current policies. Next, the policies were retrieved and screened for mentions of SOTA-related interventions using relevant keywords in French and English, and analyzed using the 'eight-fold path´ framework for public policy analysis. Results we identified 136 policies and events and excluded 16 duplicates. The health policies and events included were implemented between 1967 and 2021. Fifty-nine policies and events (49.2%) mentioned SOTA care: governance (n=25), infrastructure (n=21), service delivery (n=11), workforce (n=11), information management (n=10), and funding (n=8). Most policies and events focused on maternal and neonatal health, followed by anesthesia, ophthalmologic surgery, and trauma. National, multinational civil society organizations and private stakeholders supported these policies and events, and the Cameroonian Ministry of Public Health was the largest funder. Conclusion most Cameroonian SOTA-related policies and events focus on maternal and neonatal care, and health financing is the health system component with the least policies and events. Future SOTA policies should build on existing strengths while improving neglected areas, thus attaining shared global and national goals by 2030.
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Affiliation(s)
- Berjo Dongmo Takoutsing
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Geneviève Endalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Wah Praise Senyuy
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Bilong Mbangtang Celestin
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | | | - Desmond Tanko Jumbam
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Greater Accra, Ghana
| | - Ulrick Sidney Kanmounye
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Greater Accra, Ghana
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Malemo LK, Yap A, Mitume B, Salmon C, Karafuli K, Poenaru D, Onyango R. Essential surgery delivery in the Northern Kivu Province of the Democratic Republic of the Congo. BMC Surg 2024; 24:95. [PMID: 38519894 PMCID: PMC10958871 DOI: 10.1186/s12893-024-02386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Surgical services are an essential part of a functional healthcare system, but the Lancet Commission of Global Surgery (LCoGS) indicators of surgical capacity such as perioperative workforce and surgical volume are unknown in many low- and middle-income countries (LMICs) including the Democratic Republic of Congo (DRC). We aimed to determine the surgical capacity and its associated factors within the DRC. METHODS Hospitals were assessed in the North Kivu province of the DRC. Hospital characteristics and surgical rates were determined using the WHO-PGSSC hospital assessment tool and operating room (OR) registries. The primary outcome of interest was the number of Bellwether operations (i.e. Caesarean sections, laparotomies, and external fixation for bone fractures) per 100,000 people. Univariate and multiple linear regressions were performed. Primary predictors were the number of trained surgeons, anaesthesiologists, and obstetricians (SAOs) and the number of perioperative providers (including clinical officers and nurse anaesthetists) per 100,000 people. RESULTS Twenty-eight hospitals in North Kivu were assessed over one year in 2021; 24 (86%) were first-level referral health centres while 4 (14%) were second-level referral hospitals. In total, 11,176 Bellwether procedures were performed in the region in one year. Rates per 100,000 people were 1,461 Bellwether surgical interventions, 1.05 SAOs, and 13.1 perioperative providers. In univariate linear regression analysis, each additional SAO added 239 additional cases annually (p = 0.023), while each additional perioperative provider added 110 cases annually (p < 0.001). In our multiple regression analysis adjusting for other hospital services, the association between workforce and Bellwether surgeries was no longer significant. CONCLUSIONS The surgical workforce in DRC did not meet the LCoGS benchmark of 20 SAOs per 100,000 people but was not an independent predictor of surgical capacity. Major investment is needed to simultaneously bolster healthcare facilities and increase surgical workforce training.
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Affiliation(s)
- Luc Kalisya Malemo
- School of Medicine, The University of Goma, Goma, Democratic Republic of Congo.
| | - Ava Yap
- Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, USA
| | - Boniface Mitume
- Department of Computer Engineering, Université Officielle de Ruwenzori, Butembo, Democratic Republic of Congo
| | - Christian Salmon
- Centre for Global Health Engineering, Department of Engineering Management and Industrial Engineering, Western New England University, Springfield, MA, USA
| | - Kambale Karafuli
- Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo
| | - Dan Poenaru
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
| | - Rosebella Onyango
- Department of Community Health and Development, Great Lakes University of Kisumu, Kisumu, Kenya
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Gallagher RS, Karsalia R, Borja AJ, Malhotra EG, Punchak MA, Na J, McClintock SD, Malhotra NR. Low Household Income Increases Hospital Length of Stay and Decreases Home Discharge Rates in Lumbar Fusion. Global Spine J 2024:21925682241239609. [PMID: 38514934 DOI: 10.1177/21925682241239609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
STUDY DESIGN Retrospective Matched Cohort Study. OBJECTIVES Low median household income (MHI) has been correlated with worsened surgical outcomes, but few studies have rigorously controlled for demographic and medical factors at the patient level. This study isolates the relationship between MHI and surgical outcomes in a lumbar fusion cohort using coarsened exact matching. METHODS Patients undergoing single-level, posterior lumbar fusion at a single institution were consecutively enrolled and retrospectively analyzed (n = 4263). Zip code was cross-referenced to census data to derive MHI. Univariate regression correlated MHI to outcomes. Patients with low MHI were matched to those with high MHI based on demographic and medical factors. Outcomes evaluated included complications, length of stay, discharge disposition, 30- and 90 day readmissions, emergency department (ED) visits, reoperations, and mortality. RESULTS By univariate analysis, MHI was significantly associated with 30- and 90 day readmission, ED visits, reoperation, and non-home discharge, but not mortality. After exact matching (n = 270), low-income patients had higher odds of non-home discharge (OR = 2.5, P = .016) and higher length of stay (mean 100.2 vs 92.6, P = .02). There were no differences in surgical complications, ED visits, readmissions, or reoperations between matched groups. CONCLUSIONS Low MHI was significantly associated with adverse short-term outcomes from lumbar fusion. A matched analysis controlling for confounding variables uncovered longer lengths of stay and higher rates of discharge to post-acute care (vs home) in lower MHI patients. Socioeconomic disparities affect health beyond access to care, worsen surgical outcomes, and impose costs on healthcare systems. Targeted interventions must be implemented to mitigate these disparities.
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Affiliation(s)
- Ryan S Gallagher
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ritesh Karsalia
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Emelia G Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Maria A Punchak
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jianbo Na
- University of Pennsylvania, Philadelphia, PA, USA
| | - Scott D McClintock
- The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, PA, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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