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Watson G, Niang L, Chandresekhar S, Natchagande G, Payne SR. The feasibility of endourological surgery in low-resource settings. BJU Int 2022; 130:18-25. [PMID: 35524768 DOI: 10.1111/bju.15770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically, or restricted by the abilities of the surgeons in sub-Saharan Africa. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. They are, however, largely dependent upon the supply of equipment from non-governmental organisations in high income countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.
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Affiliation(s)
- Graham Watson
- East Sussex Hospitals NHS Trust, Eastbourne, UK.,Medi Tech Trust, Eastbourne, UK
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Regasa T, Zemedkun A, Neme D, Aweke Z, Tadese M, Getachew H, Alemu B, Hailu S. The impact of novel coronavirus disease (COVID-19) on emergency and essential surgical care in Gedeo and Sidama zone hospitals: An institutional-based multicenter cross-sectional study. Ann Med Surg (Lond) 2022; 77:103656. [PMID: 35475173 PMCID: PMC9023362 DOI: 10.1016/j.amsu.2022.103656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background COVID-19 was initially detected in China's Wuhan, the capital of Hubei Province, in December 2019, and has since spread throughout the world, including Ethiopia. Long-term epidemics will overwhelm the capacity of hospitals and the health system as a whole, with dire consequences for the developing world's damaged health systems. Focusing on COVID-19-related activities while continuing to provide essential services such as emergency and essential surgical care is critical not only to maintaining public trust in the health system but also to reducing morbidity and mortality from other illnesses. The goal of this study was to see how COVID-19 affected essential and emergency surgical care in Gedeo and Sidama zone hospitals. Method ology: A cross-sectional study was carried out in ten (10) hospitals in the Gedeo and Sidama zone. The information was gathered with the help of the world health organization (WHO) situational analysis tool for determining emergency and essential surgical care (EESC) capability. Infrastructure, human resources, interventions, and EESC equipment and supplies were used to assess the hospitals' capacity. Result 54.3% of the 35 fundamental therapies indicated in the instrument were available before COVID-19 at all sites, while 25.2 percent were available after the COVID-19 pandemic. During the COVID-19 pandemic, there was a sharing of resources for treatment centers, such as a scarcity of oxygen and anesthesia machines, and emergency surgery was postponed. Before admission, the average distance traveled was 58 km. Conclusion The COVID-19 pandemic, as well as existing disparities in infrastructure, human resources, service provision, and essential equipment and supplies, reveal significant gaps in hospitals' capacity to provide emergency and essential surgical services and effectively address the growing surgical burden of disease and injury in Gedeo and Sidama zone primary, general, and referral hospitals. 54.3% of basic interventions were available before COVID-19 at all facilities reduced to 25.2%. COVID-19 pandemic high effect on emergency and essential surgical cervices. Discrepancies in infrastructure, human resources, and other services also affect EESC.
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Affiliation(s)
- Teshome Regasa
- Anesthesia Department, Dilla University, Dilla, Ethiopia
- Corresponding author.
| | | | - Derartu Neme
- Anesthesia Department, Dilla University, Dilla, Ethiopia
| | - Zemedu Aweke
- Anesthesia Department, Dilla University, Dilla, Ethiopia
| | - Muddin Tadese
- Anesthesia Department, Dilla University, Dilla, Ethiopia
| | | | - Belete Alemu
- Anesthesia Department, Hawassa University, Hawassa, Ethiopia
| | - Seyoum Hailu
- Anesthesia Department, Dilla University, Dilla, Ethiopia
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103
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Buddeberg BS, Seeberger MD. Anesthesia and Oncology: Friend or Foe? Front Oncol 2022; 12:802210. [PMID: 35359377 PMCID: PMC8963958 DOI: 10.3389/fonc.2022.802210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/17/2022] [Indexed: 12/24/2022] Open
Abstract
Cancer is a leading cause of death, and surgery is an important treatment modality. Laboratory research and retrospective studies have raised the suspicion that the choice of anesthetics for cancer surgery might affect the course of cancerous disease. The aim of this review is to provide a critical overview of the current state of knowledge. Inhalational anesthesia with volatiles or total intravenous anesthesia (TIVA) with propofol are the two most commonly used anesthetic techniques. Most data comparing volatile anesthetics with TIVA is from either in vitro or retrospective studies. Although conflicting, data shows a trend towards favoring propofol. Opioids are commonly used in anesthesia. Data on potential effects of opioids on growth and recurrence of cancer are scarce and conflicting. Preclinical studies have shown that opioids stimulate cancer growth through the µ-opioid receptor. Opioids also act as immunosuppressants and, therefore, have the potential to facilitate metastatic spread. However, the finding of an adverse effect of opioids on tumor growth and cancer recurrence by some retrospective studies has not been confirmed by prospective studies. Regional anesthesia has not been found to have a beneficial effect on the outcome of surgically treated cancer patients, but prospective studies are scarce. Local anesthetics might have a beneficial effect, as observed in animal and in vitro studies. However, prospective clinical studies strongly question such an effect. Blood products, which may be needed during extensive cancer surgery suppress the immune system, and data strongly suggest a negative impact on cancer recurrence. The potential effects of other commonly used anesthetic agents on the outcome of cancer patients have not been sufficiently studied for drawing valid conclusions. In conclusion, laboratory data and most retrospective studies suggest a potential advantage of TIVA over inhalational anesthesia on the outcome of surgical cancer patients, but prospective, randomized studies are missing. Given the state of weak scientific evidence, TIVA may be used as the preferred type of anesthesia unless there is an individual contraindication against it. Studies on the effects of other drugs frequently used in anesthesia are limited in number and quality, and have found conflicting results.
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Affiliation(s)
- Bigna S. Buddeberg
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
- Medical School, University of Basel, Basel, Switzerland
| | - Manfred D. Seeberger
- Medical School, University of Basel, Basel, Switzerland
- *Correspondence: Manfred D. Seeberger,
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Impact of the COVID-19 Pandemic on Pediatric Surgical Volume in Four Low- and Middle-Income Country Hospitals: Insights from an Interrupted Time Series Analysis. World J Surg 2022; 46:984-993. [PMID: 35267077 PMCID: PMC8908743 DOI: 10.1007/s00268-022-06503-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 12/24/2022]
Abstract
Background The impact of the COVID-19 pandemic on surgical care delivery in low- and middle-income countries (LMIC) has been challenging to assess due to a lack of data. This study examines the impact of COVID-19 on pediatric surgical volumes at four LMIC hospitals. Methods Retrospective and prospective pediatric surgical data collected at hospitals in Burkina Faso, Ecuador, Nigeria, and Zambia were reviewed from January 2019 to April 2021. Changes in surgical volume were assessed using interrupted time series analysis. Results 6078 total operations were assessed. Before the pandemic, overall surgical volume increased by 21 cases/month (95% CI 14 to 28, p < 0.001). From March to April 2020, the total surgical volume dropped by 32%, or 110 cases (95% CI − 196 to − 24, p = 0.014). Patients during the pandemic were younger (2.7 vs. 3.3 years, p < 0.001) and healthier (ASA I 69% vs. 66%, p = 0.003). Additionally, they experienced lower rates of post-operative sepsis (0.3% vs 1.5%, p < 0.001), surgical site infections (1.3% vs 5.8%, p < 0.001), and mortality (1.6% vs 3.1%, p < 0.001). Conclusions During the COVID-19 pandemic, children’s surgery in LMIC saw a sharp decline in total surgical volume by a third in the month following March 2020, followed by a slow recovery afterward. Patients were healthier with better post-operative outcomes during the pandemic, implying a widening disparity gap in surgical access and exacerbating challenges in addressing the large unmet burden of pediatric surgical disease in LMICs with a need for immediate mitigation strategies. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06503-2.
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105
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Bergmark RW, Burks CA, Schnipper JL, Weissman JS. Understanding and Investigating Access to Surgical Care. Ann Surg 2022; 275:492-495. [PMID: 35120062 DOI: 10.1097/sla.0000000000005212] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - Ciersten A Burks
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Jeffrey L Schnipper
- Hospital Medicine Unit and Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Joel S Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
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Parker AS, Hill KA, Steffes BC, Mangaoang D, O’Flynn E, Bachheta N, Bates MF, Bitta C, Carter NH, Davis RE, Dressler JA, Eisenhut DA, Fadipe AE, Kanyi JK, Kauffmann RM, Kazal F, Kyamanywa P, Lando JO, Many HR, Mbithi VC, McCoy AJ, Meade PC, Ndegwa WY, Nkusi EA, Ooko PB, Osilli DJ, Parker ME, Rankeeti S, Shafer K, Smith JD, Snyder D, Sylvester KR, Wakeley ME, Wekesa MK, Torbeck L, White RE, Bekele A, Parker RK. Design of a Novel Online, Modular, Flipped-classroom Surgical Curriculum for East, Central, and Southern Africa. ANNALS OF SURGERY OPEN 2022; 3:e141. [PMID: 37600110 PMCID: PMC10431259 DOI: 10.1097/as9.0000000000000141] [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: 11/10/2021] [Accepted: 01/31/2022] [Indexed: 11/26/2022] Open
Abstract
Objective We describe a structured approach to developing a standardized curriculum for surgical trainees in East, Central, and Southern Africa (ECSA). Summary Background Data Surgical education is essential to closing the surgical access gap in ECSA. Given its importance for surgical education, the development of a standardized curriculum was deemed necessary. Methods We utilized Kern's 6-step approach to curriculum development to design an online, modular, flipped-classroom surgical curriculum. Steps included global and targeted needs assessments, determination of goals and objectives, the establishment of educational strategies, implementation, and evaluation. Results Global needs assessment identified the development of a standardized curriculum as an essential next step in the growth of surgical education programs in ECSA. Targeted needs assessment of stakeholders found medical knowledge challenges, regulatory requirements, language variance, content gaps, expense and availability of resources, faculty numbers, and content delivery method to be factors to inform curriculum design. Goals emerged to increase uniformity and consistency in training, create contextually relevant material, incorporate best educational practices, reduce faculty burden, and ease content delivery and updates. Educational strategies centered on developing an online, flipped-classroom, modular curriculum emphasizing textual simplicity, multimedia components, and incorporation of active learning strategies. The implementation process involved establishing thematic topics and subtopics, the content of which was authored by regional surgeon educators and edited by content experts. Evaluation was performed by recording participation, soliciting user feedback, and evaluating scores on a certification examination. Conclusions We present the systematic design of a large-scale, context-relevant, data-driven surgical curriculum for the ECSA region.
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Affiliation(s)
- Andrea S. Parker
- From the Department of Surgery, Tenwek Hospital, Bomet, Kenya
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI
- College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
| | - Katherine A. Hill
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Deirdre Mangaoang
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eric O’Flynn
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niraj Bachheta
- College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
| | - Maria F. Bates
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Caesar Bitta
- Department of Surgery, Maseno University, Kisumu, Kenya
| | | | | | | | | | | | - John K. Kanyi
- Department of Surgery, AIC Litein Hospital, Litein, Kenya
| | - Rondi M. Kauffmann
- Department of Surgery, Vanderbilt University Medical Center, Division of Oncologic and Endocrine Surgery, Nashville, TN
| | - Frances Kazal
- Warren Alpert Medical School at Brown University, Providence, RI
| | - Patrick Kyamanywa
- Department of Surgery, Kampala International University, Kampala, Uganda
| | - Justus O. Lando
- From the Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | - Heath R. Many
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN
| | | | - Amanda J. McCoy
- Department of Orthopedic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Wairimu Y.B. Ndegwa
- Department of Surgery, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Emmy A. Nkusi
- Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Philip B. Ooko
- Department of Surgery, AIC Litein Hospital, Litein, Kenya
| | - Dixon J.S. Osilli
- Department of Surgery, Barking, Havering, and Redbridge University Hospitals NHS Trust, Romford, England, UK
| | | | | | | | - James D. Smith
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - David Snyder
- Pan-African Academy of Christian Surgeons, Palatine, Illinois
| | | | - Michelle E. Wakeley
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI
| | | | - Laura Torbeck
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Russell E. White
- From the Department of Surgery, Tenwek Hospital, Bomet, Kenya
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI
- College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
| | - Abebe Bekele
- College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
- University of Global Health Equity, Kigali, Rwanda
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Robert K. Parker
- From the Department of Surgery, Tenwek Hospital, Bomet, Kenya
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI
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Nataraja RM, Yin Mar Oo, Ljuhar D, Pacilli M, Nyo Nyo Win, Stevens S, Aye Aye, Nestel D. Long-Term Impact of a Low-Cost Paediatric Intussusception Air Enema Reduction Simulation-Based Education Programme in a Low-Middle Income Country. World J Surg 2022; 46:310-321. [PMID: 34671841 DOI: 10.1007/s00268-021-06345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Intussusception is one of the commonest causes of bowel obstruction in infants. Most infants in Low- and Middle-Income Countries (LMICs) undergo an invasive operative intervention. Supported by simulation-based education (SBE), the Air Enema (AE) non-operative technique was introduced in 2016 in Myanmar. This study assesses the long-term outcomes. METHODS Mixed methods study design over 4 years including clinical outcomes and surgeon's attitudes towards the AE technique and SBE. Prospectively collected clinical outcomes and semi-structured interview with reflexive thematic analysis (RTA). Primary outcome measure was a long-term shift to non-operative intervention. SECONDARY OUTCOMES Length of Stay (LoS), recurrence rates, intestinal resection rates, compared to the operative group. The data was analysed according to intention to treat. Quantitative data analysis with Mann-Whitney U test, Fisher's exact test, Student's T-Test or Wilcoxon Signed-Rank Test utilised. A p-value of <.05 was considered significant. RESULTS A total of 311 infants with intussusception were included. A sustained shift to AE was revealed with high success rates (86.1-91.2%). AE had a reduced LoS (4 vs. 7 days p ≤ 0.0001), Duration of Symptoms (DoS) was lower with AE (1.9/7 vs. 2.5/7, p = 0.002). Low recurrence rates (0-5.8%) and intestinal resection rates stabilised at 30.5-31.8% vs.15.3% pre-intervention. Four RTA themes were identified: Expanding conceptions of healthcare professional education and training; realising far reaching advantages; promoting critical analysis and reflective practice of clinicians; and adapting clinical practice to local context. RTA revealed an overall positive paradigm shift in attitudes and application of SBE. CONCLUSIONS A sustained change in clinical outcomes and appreciation of the value of SBE was demonstrated following the intervention.
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Affiliation(s)
- R M Nataraja
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia.
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Yin Mar Oo
- Department of Paediatric Surgery, Yangon Children's Hospital, Yangon, Myanmar
| | - D Ljuhar
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - M Pacilli
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Nyo Nyo Win
- Department of Paediatric Surgery, Yangon Children's Hospital, Yangon, Myanmar
| | - S Stevens
- Austin Clinical School, University of Melbourne, Melbourne, VIC, Australia
- Austin Precinct, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Aye Aye
- Department of Paediatric Surgery, Yangon Children's Hospital, Yangon, Myanmar
| | - D Nestel
- Austin Precinct, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Expansion of Reconstructive Surgical Capacity in Vietnam: Experience from the ReSurge Global Training Program. Plast Reconstr Surg 2022; 149:563e-572e. [PMID: 35089267 DOI: 10.1097/prs.0000000000008874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Building local surgical capacity in low-income and middle-income countries is critical to addressing the unmet global surgical need. Visiting educator programs can be utilized to train local surgeons, but the quantitative impact on surgical capacity has not yet been fully described. The authors' objective was to evaluate the effectiveness of training utilizing a visiting educator program on local reconstructive surgical capacity in Vietnam. METHODS A reconstructive surgery visiting educator program was implemented in Vietnam. Topics of training were based on needs defined by local surgeons, including those specializing in hand surgery, microsurgery, and craniofacial surgery. A retrospective analysis of annual case numbers corresponding to covered topics between the years 2014 and 2019 at each hospital was conducted to determine reconstructive surgical volume and procedures per surgeon over time. Direct costs, indirect costs, and value of volunteer services for each trip were calculated. RESULTS Over the course of 5 years, 12 visiting educator trips were conducted across three hospitals in Vietnam. Local surgeons subsequently independently performed a total of 2018 operations corresponding to topics covered during visiting educator trips, or a mean of 136 operations annually per surgeon. Within several years, the hospitals experienced an 81.5 percent increase in surgical volume for these reconstructive clinical conditions, and annual case volume continues to increase over time. Total costs were $191,290, for a mean cost per trip of $15,941. CONCLUSIONS Surgical capacity can be successfully expanded by utilizing targeted visiting educator trips to train local reconstructive surgeons. Local providers ultimately independently perform an increased volume of complex procedures and provide further training to others.
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109
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Stanford-Moore GB, Cahill G, Raj A, Irakoze P, Alkire B, Bhutta MF. Density of Health Workforce Correlates to Disease Outcomes: Evidence From Global Data in Otolaryngology. OTO Open 2022; 6:2473974X221089840. [PMID: 35356270 PMCID: PMC8958679 DOI: 10.1177/2473974x221089840] [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: 10/23/2021] [Accepted: 02/18/2022] [Indexed: 12/05/2022] Open
Abstract
Objective To better understand the impact of the otolaryngology-specific workforce on the burden of related diseases. Study Design Retrospective analysis of existing workforce density data as compared with the incidence, mortality, and morbidity data for 4 otolaryngologic diseases. Setting An overall 138 countries with known otolaryngology-head and neck surgery workforce and epidemiologic data. Methods We obtained raw data on workforce estimates of ear, nose, and throat surgical specialists from the World Health Organization. Disease burdens for 4 conditions were estimated via 2 ratios, the mortality:incidence ratio (MIR) and YLD:incidence ratio (years lost to disability), as specified in the Global Burden of Disease database. These were correlated to country-specific otolaryngologist density data in univariate and multivariate analyses. Results Increased density of the ear, nose, and throat workforce correlated with better outcomes for otolaryngologic-treated surgical diseases. A 10% increase in otolaryngology workforce density was associated with a 0.27% reduction in YLD:incidence ratio for chronic otitis media, a 0.94% reduction in MIR for lip and oral cavity cancer, a 1.46% reduction in MIR for laryngeal cancer, and a 1.34% reduction in MIR for pharyngeal cancer (all P < .001)-an effect that remained after adjustment for health systems factors for all conditions but chronic otitis media. Conclusion The density of the surgical workforce is assumed to affect disease outcomes, but ours is the first analysis to show that increased workforce density for a specific surgical specialty correlates with improved disease outcomes. While there is a consensus to increase access to health care providers, quantifying the effect on disease outcomes is an important metric for those performing health economics modeling, particularly where resources are limited.
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Affiliation(s)
- Gaelen Britton Stanford-Moore
- Department of Otolaryngology–Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Gabrielle Cahill
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Ankit Raj
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | | | - Blake Alkire
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Mahmood F. Bhutta
- Brighton and Sussex Medical School, Brighton, UK
- Department of Ear, Nose, and Throat, University Hospitals Sussex, West Sussex, UK
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OUP accepted manuscript. BJS Open 2022; 6:6535409. [PMID: 35199142 PMCID: PMC8867031 DOI: 10.1093/bjsopen/zrac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/27/2021] [Accepted: 01/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background Existing emergency general surgery (EGS) guidelines rarely include evidence from low- and middle-income countries (LMICs) and may lack relevance to low-resource settings. The aim of this study was to develop global guidelines for EGS that are applicable across all hospitals and health systems. Methods A systematic review and thematic analysis were performed to identify recommendations relating to undifferentiated EGS. Those deemed relevant across all resource settings by an international guideline development panel were included in a four-round Delphi prioritization process and are reported according to International Standards for Clinical Practice Guidelines. The final recommendations were included as essential (baseline measures that should be implemented as a priority) or desirable (some hospitals may lack relevant resources at present but should plan for future implementation). Results After thematic analysis of 38 guidelines with 1396 unique recommendations, 68 recommendations were included in round 1 voting (410 respondents (219 from LMICs)). The final guidelines included eight essential, one desirable, and three critically unwell patient-specific recommendations. Preoperative recommendations included guidance on timely transfers, CT scan pathways, handovers, and discussion with senior surgeons. Perioperative recommendations included surgical safety checklists and recovery room monitoring. Postoperative recommendations included early-warning scores, discharge plans, and morbidity meetings. Recommendations for critically unwell patients included prioritization for theatre, senior team supervision, and high-level postoperative care. Conclusion This pragmatic and representative process created evidence-based global guidelines for EGS that are suitable for resource limited environments around the world.
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Turner J, Duffy S. Orthopaedic and trauma care in low-resource settings: the burden and its challenges. INTERNATIONAL ORTHOPAEDICS 2022; 46:143-152. [PMID: 34655318 DOI: 10.1007/s00264-021-05236-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND BURDEN Trauma with its early and late consequences disproportionately effects those from poor countries. The availability of effective orthopaedic and trauma care varies significantly across the globe. CHALLENGES The balancing out of quality care is required to reach the health-related UN development goal set out in 2015. A multifactorial approach addressing local, national and international aspects is key to improving the discrepancy seen between high- and low-income countries.
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Affiliation(s)
- James Turner
- Bristol Royal Hospital for Children, Bristol, UK.
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112
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Imani B, Bastami M, Koosha M. Operating room nurses' experience about patient cares for laparotomy surgeries: A phenomenological study. J Family Med Prim Care 2022; 11:1282-1287. [PMID: 35516685 PMCID: PMC9067200 DOI: 10.4103/jfmpc.jfmpc_1085_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/14/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: The primary purpose of the present study was to explain the lived experiences of operating room nurses in the field of patient care undergoing laparotomy surgeries. Methods: The analytical phenomenological method was used. Ten operating room nurses employed in the operating rooms were selected using purposeful sampling. In-depth and semi-structured interviews were used for data collection. Data analysis was also applied using van Manen’s six-step test. Results: In this study, 749 initial codes were extracted, classified into three main themes and six sub-themes following the elimination of similar codes. The main themes included a positive view of patient care, preservation of the physical safety of patients, and consideration of patient vulnerability in the operating room. Moreover, responsibility, holistic care, readiness standards of the surgical environment, physical care provision, medical team malpractice, and lack of care context were considered as sub-themes. Conclusion: The operating room nurses’ experiences of patient care in operating rooms included a positive view of patient care, preservation of the patient’s physical safety, and consideration of patient vulnerability in the operating room.
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Jayaram A, Pawlak N, Kahanu A, Fallah P, Chung H, Valencia-Rojas N, Rodas EB, Abbaslou A, Alseidi A, Ameh EA, Bekele A, Casey K, Chu K, Dempsey R, Dodgion C, Jawa R, Jimenez MF, Johnson W, Krishnaswami S, Kwakye G, Lane R, Lakhoo K, Long K, Madani K, Nwariaku F, Nwomeh B, Price R, Roser S, Rees AB, Roy N, Ruzgar NM, Sacoto H, Sifri Z, Starr N, Swaroop M, Tarpley M, Tarpley J, Terfera G, Weiser T, Lipnick M, Nabukenya M, Ozgediz D, Jayaraman S. Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach. J Surg Res 2021; 267:732-744. [PMID: 34905823 DOI: 10.1016/j.jss.2021.03.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We aimed to search the literature for global surgical curricula, assess if published resources align with existing competency frameworks in global health and surgical education, and determine if there is consensus around a fundamental set of competencies for the developing field of academic global surgery. METHODS We reviewed SciVerse SCOPUS, PubMed, African Medicus Index, African Journals Online (AJOL), SciELO, Latin American and Caribbean Health Sciences Literature (LILACS) and Bioline for manuscripts on global surgery curricula and evaluated the results using existing competency frameworks in global health and surgical education from Consortium of the Universities for Global Health (CUGH) and Accreditation Council for Graduate Medical Education (ACGME) professional competencies. RESULTS Our search generated 250 publications, of which 18 were eligible: (1) a total of 10 reported existing competency-based curricula that were concurrent with international experiences, (2) two reported existing pre-departure competency-based curricula, (3) six proposed theoretical competency-based curricula for future global surgery education. All, but one, were based in high-income countries (HICs) and focused on the needs of HIC trainees. None met all 17 competencies, none cited the CUGH competency on "Health Equity and Social Justice" and only one mentioned "Social and Environmental Determinants of Health." Only 22% (n = 4) were available as open-access. CONCLUSION Currently, there is no universally accepted set of competencies on the fundamentals of academic global surgery. Existing literature are predominantly by and for HIC institutions and trainees. Current frameworks are inadequate for this emerging academic field. The field needs competencies with explicit input from LMIC experts to ensure creation of educational resources that are accessible and relevant to trainees from around the world.
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Affiliation(s)
| | | | - Alexis Kahanu
- Hackensack University Medical Center, Edison, NJ, USA
| | - Parisa Fallah
- Department of OB/GYN, Brigham & Women's Hospital and Massachusetts General Hospital, Boston, MA, USA
| | - Haniee Chung
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Edgar B Rodas
- Virginia Commonwealth University Department of Surgery, Richmond VA, USA
| | | | - Adnan Alseidi
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Emmanuel A Ameh
- National Hospital Division of Paediatric Surgery, Abuja, Nigeria
| | - Abebe Bekele
- Addis Ababa University Department of Surgery, Addis Ababa, Ethiopia; University of Global Health Equity, Rwanda
| | | | - Kathryn Chu
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Robert Dempsey
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Chris Dodgion
- Medical College of Wisconsin Division of Trauma and Critical Care, Wauwatosa, WI, USA
| | - Randeep Jawa
- Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Maria F Jimenez
- Hospital Universitario Mayor Mederi, Department of Surgery. Universidad del Rosario, Bogota, Colombia
| | | | | | - Gifty Kwakye
- University of Michigan Department of Surgery, Ann Arbor, MI, USA
| | - Robert Lane
- International Federation of Surgical Colleges
| | - Kokila Lakhoo
- University of Oxford, Oxford University Hospitals, UK
| | - Kristin Long
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Katayoun Madani
- Northwestern University Department of Surgery, Chicago, IL, USA
| | | | - Benedict Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Raymond Price
- University of Utah Dept of Surgery, Salt Lake City, UT, USA
| | - Steven Roser
- Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew B Rees
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nobhojit Roy
- BARC Hospital, HBNI University, Mumbai, India/ CARE-India, Bihar Technical Support Unit, Patna, Bihar, India
| | | | | | - Ziad Sifri
- Rutgers New Jersey Medical School Department of Surgery, Newark, NJ, USA
| | - Nichole Starr
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Mamta Swaroop
- Northwestern University Department of Surgery, Chicago, IL, USA
| | - Margaret Tarpley
- University of Botswana Department of Medical Education, Gaborone, Botswana
| | - John Tarpley
- University of Botswana Department of Surgery, Gaborone, Botswana
| | - Girma Terfera
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Thomas Weiser
- Stanford University Medical Center Department of Surgery, Stanford, CA, USA
| | - Michael Lipnick
- University of California San Francisco Department of Anesthesia, San Francisco, CA, USA
| | - Mary Nabukenya
- Makerere University Department of Anesthesia, Kampala, Uganda
| | - Doruk Ozgediz
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Sudha Jayaraman
- University of Utah Dept of Surgery, Salt Lake City, UT, USA.
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Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries. Glob Heart 2021; 16:75. [PMID: 34900566 PMCID: PMC8533658 DOI: 10.5334/gh.968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 08/31/2021] [Indexed: 11/20/2022] Open
Abstract
The care for patients with congenital heart disease (CHD) is multi-disciplinary and resource intensive. There is limited information about the infrastructure available among programs that care for CHD patients in low and middle-income countries (LMIC). A survey covering the entire care-pathway for CHD, from initial assessment to inpatient care and outpatient follow-up, was administered to institutions participating in the International Quality Improvement Collaborative for Congenital Heart Disease (IQIC). Surgical case complexity-mix was collected from the IQIC registry and estimated surgical capacity requirement was based on population data. The statistical association of selected infrastructure with case volume, case-complexity and percentage of estimated case-burden actually treated, was analyzed. Thirty-seven healthcare institutions in seventeen countries with median annual surgical volume of 361 (41-3503) operations completed the survey. There was a median of two (1-16) operating room/s (OR), nine (2-80) intensive care unit (ICU) beds, three (1-20) cardiac surgeons, five (3-30) OR nurses, four (2-35) anesthesiologists, four (1-25) perfusionists, 28 (5-194) ICU nurses, six (0-30) cardiologists and three (1-15) interventional cardiologists. Higher surgical volume was associated with higher OR availability (p = 0.007), number of surgeons (p = 0.002), OR nurses (0.008), anesthesiologists (p = 0.04), perfusionists (p = 0.001), ICU nurses (p < 0.001), years of experience of the most senior surgeon (p = 0.03) or cardiologist (p = 0.05), and ICU bed capacity (p = 0.001). Location in an upper-middle income country (P = 0.04), OR availability (p = 0.02), and number of cardiologists (p = 0.004) were associated with performing a higher percentage of complex cases. This study demonstrates an overall deficit in the infrastructure available for the care of CHD patients among the participating institutions. While there is considerable variation across institutions surveyed, deficits in infrastructure that requires long-term investment like operating rooms, intensive care capacity, and availability of trained staff, are associated with reduced surgical capacity and access to CHD care.
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Comment on "Managing COVID-19 in Surgical Systems": An Opportunity for Global Surgery to Advance Global Health. Ann Surg 2021; 274:e766-e767. [PMID: 32404667 DOI: 10.1097/sla.0000000000003966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Sung S, Hørthe H, Svendsen ØV, van Duinen AJ, Salvesen Ø, Vandi A, Bolkan HA. Early evaluation of the transition from an analog to an electronic surgical logbook system in Sierra Leone. BMC MEDICAL EDUCATION 2021; 21:578. [PMID: 34781930 PMCID: PMC8591157 DOI: 10.1186/s12909-021-03012-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/26/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND Surgical logbooks are a commonly used tool for quality assurance of surgical training. Electronic logbooks are increasingly applied in low-resource settings, but there is limited research on their quality. The aim of this study is to evaluate the quality of an app-based surgical e-logbook system shortly after its implementation in a low-income country and to identify potential areas of improvement for the system. METHODS Entries in the e-logbook system were cross-checked with hospital records and categorized as matched or overreported. Moreover, the hospital records were checked for underreported procedures. Additionally, semi-structured interviews were conducted with users of the e-logbook system. RESULTS A total of 278 e-logbook database entries and 379 procedures in the hospital records from 14 users were analyzed. Matches were found in the hospital records for 67.3% of the database entries. Moreover, 32.7% of the database entries were overreported and 50.7% of the procedures in the hospital records were underreported. A previous study of an analog surgical logbook system in the same setting estimated that 73.1% of the entries were matches or close matches. Interviews with 12 e-logbook users found overall satisfaction but also identified potential areas of improvement, including the need for more training in the use of the system, modifications to improve user-friendliness, and better access to the necessary technology. CONCLUSIONS A reliable documentation system is necessary to evaluate the quality of health workforce training. The early evaluation of a surgical e-logbook system in a low-income country showed that the collected data should be approached with caution. The quantitative analysis suggests that the e-logbook system needs to be improved in terms of accuracy. In interviews, users reported that digitalization of the logbook system was a much-needed innovation but also identified important areas of improvement. Recognition of these aspects at an early stage facilitates guidance and adjustment of further implementation and might improve the accuracy of the system.
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Affiliation(s)
- Sophia Sung
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
| | - Hilde Hørthe
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
| | - Øyvind Veel Svendsen
- CapaCare, c/o Dr Håkon Bolkan, Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
- Clinic of Internal Medicine and Rehabilitation, Levanger Hospital, P.O. Box 333, 7601 Levanger, Norway
| | - Alex J. van Duinen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
- CapaCare, c/o Dr Håkon Bolkan, Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
| | - Øyvind Salvesen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
| | - Alphonsus Vandi
- CapaCare, c/o Dr Håkon Bolkan, Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
| | - Håkon A. Bolkan
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
- CapaCare, c/o Dr Håkon Bolkan, Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
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Kowal M, Bolton W, Van Duren B, Burke J, Jayne D. Impact of surgical drain output monitoring on patient outcomes in hepatopancreaticobiliary surgery: A systematic review. Scand J Surg 2021; 111:14574969211030118. [PMID: 34749548 DOI: 10.1177/14574969211030118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Surgical drains are widely utilized in hepatopancreaticobiliary surgery to prevent intra-abdominal collections and identify postoperative complications. Surgical drain monitoring ranges from simple-output measurements to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect postoperative complications and impact on patient outcomes. METHODS A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library, and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing hepatopancreaticobiliary surgery were considered. Other invasive methods of intra-abdominal sampling were excluded. RESULTS The search returned 403 articles. Following abstract review, 390 were excluded and 13 articles were included for full review. The studies were classified according to speciality and featured 11 pancreatic surgery and 2 hepatobiliary surgery studies with a total sample of 3262 patients. Postoperative monitoring of drain amylase detected pancreatic fistula formation and drain bilirubin testing facilitated bile leak detection. Both methods enabled early drain removal. Improved patient outcomes were observed through decreased incidence of postoperative complications (pancreatic fistulas, intra-abdominal infections, and surgical-site infections), length of stay, and mortality rate. Isolated monitoring of drain output did not confer any clinical benefits. CONCLUSIONS Surgical drain monitoring has advantages in the postoperative care for selected patients undergoing hepatopancreaticobiliary surgery. Enhanced surgical drain monitoring involving the testing of drain amylase and bilirubin improves the detection of complications in the immediate postoperative period.
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Affiliation(s)
- Mikolaj Kowal
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK University of Leeds, Leeds, UK
| | - William Bolton
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK.,University of Leeds, Leeds, UK
| | - Bernard Van Duren
- University of Leeds, Leeds, UKLeeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Joshua Burke
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK.,University of Leeds, Leeds, UK
| | - David Jayne
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK.,University of Leeds, Leeds, UK
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Current methods of nurse-surgeon training and education: Systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Jayaraman S, Ntirenganya F, Nkeshimana M, Rosenberg A, Dushime T, Kabagema I, Uwitonze JM, Uwitonize E, Nyinawankusi JD, Riviello R, Bagahirwa I, Williams KL, Krebs E, Maine R, Banguti P, Rulisa S, Kyamanywa P, Byiringiro JC. Building Trauma and EMS Systems Capacity in Rwanda: Lessons and Recommendations. Ann Glob Health 2021; 87:104. [PMID: 34754760 PMCID: PMC8555476 DOI: 10.5334/aogh.3324] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Surgical capacity building has gained substantial momentum. However, care at the hospital level depends on improved access to emergency services. There is no established model for facilitating trauma and EMS system capacity in LMIC settings. This manuscript describes our model for multi-disciplinary collaboration to advance trauma and EMS capacity in Rwanda, along with our lessons and recommendations. Methods After high-level meetings at the Ministry of Health in Rwanda (MOH), in 2016, a capacity building plan focusing on improved clinical services, quality improvement/research and leadership capacity across prehospital and emergency settings. The main themes for the collaborative model included for empowerment of staff, improving clinical service delivery, and investing in systems and infrastructure. Funding was sought and incorporated into the Sector Wide Approaches to Planning process at the Ministry of Health of Rwanda. Findings A shared mental model was created through a fully funded immersion program for Rwandese leaders from emergency medicine, nursing, prehospital care, and injury policy. Prehospital care delivery was standardized within Kigali through a train-the-trainers program with four new context-appropriate short courses in trauma, medical, obstetric/neonatal, and pediatric emergencies and expanded across the country to reach >600 staff at district and provincial hospitals. Forty-two protocols and checklists were implemented to standardize prehospital care across specialties. The WHO Trauma Registry was instituted across four major referral centers in the country capturing over 5,000 injured patients. Long-term research capacity development included Masters' Degree support for 11 staff. Conclusions and Recommendations This collaboration was highly productive in empowering staff and leadership, standardizing clinical service delivery in EMS, and investing in systems and infrastructure. This can be a useful model for trauma and EMS system capacity development in other LMICs.
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Affiliation(s)
- Sudha Jayaraman
- Virginia Commonwealth University, Department of Surgery, US
- University of Utah, Department of Surgery, US
| | | | - Menelas Nkeshimana
- University Teaching Hospital – Kigali, Department of Accident and Emergency, RW
| | | | | | - Ignace Kabagema
- Ministry of Health of Rwanda, Service d’Aide Medicale Urgente, RW
| | | | - Eric Uwitonize
- Ministry of Health of Rwanda, Service d’Aide Medicale Urgente, RW
| | | | - Robert Riviello
- Brigham and Women’s Hospital/Harvard Medical School, Department of Surgery, US
| | | | | | - Elizabeth Krebs
- Thomas Jefferson University Hospital, Department of Emergency Medicine, US
| | - Rebecca Maine
- Harborview Medical Center, University of Washington, Department of Surgery, US
| | - Paulin Banguti
- University of Rwanda, Department of Anaesthesia, Emergency Medicine and Critical Care and King Faisal Hospital, RW
| | - Stephen Rulisa
- University Teaching Hospital – Kigali, Department of Obstetrics and Gynecology, RW
- University of Rwanda College of Medicine and Health Sciences, RW
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Ifeanyichi M, Aune E, Shrime M, Gajewski J, Pittalis C, Kachimba J, Borgstein E, Brugha R, Baltussen R, Bijlmakers L. Financing of surgery and anaesthesia in sub-Saharan Africa: a scoping review. BMJ Open 2021; 11:e051617. [PMID: 34667008 PMCID: PMC8527159 DOI: 10.1136/bmjopen-2021-051617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to provide an overview of current knowledge and situational analysis of financing of surgery and anaesthesia across sub-Saharan Africa (SSA). SETTING Surgical and anaesthesia services across all levels of care-primary, secondary and tertiary. DESIGN We performed a scoping review of scientific databases (PubMed, EMBASE, Global Health and African Index Medicus), grey literature and websites of development organisations. Screening and data extraction were conducted by two independent reviewers and abstracted data were summarised using thematic narrative synthesis per the financing domains: mobilisation, pooling and purchasing. RESULTS The search resulted in 5533 unique articles among which 149 met the inclusion criteria: 132 were related to mobilisation, 17 to pooling and 5 to purchasing. Neglect of surgery in national health priorities is widespread in SSA, and no report was found on national level surgical expenditures or budgetary allocations. Financial protection mechanisms are weak or non-existent; poor patients often forego care or face financial catastrophes in seeking care, even in the context of universal public financing (free care) initiatives. CONCLUSION Financing of surgical and anaesthesia care in SSA is as poor as it is underinvestigated, calling for increased national prioritisation and tracking of surgical funding. Improving availability, accessibility and affordability of surgical and anaesthesia care require comprehensive and inclusive policy formulations.
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Affiliation(s)
- Martilord Ifeanyichi
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
- EMAI Health Systems and Health Services Consulting, Nijmegen, The Netherlands
| | - Ellis Aune
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mark Shrime
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chiara Pittalis
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Kachimba
- Department of Surgery, University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Eric Borgstein
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ruairi Brugha
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rob Baltussen
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
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Should Ketamine Not Be Banned? A Scoping Review. Disaster Med Public Health Prep 2021; 17:e47. [PMID: 34664549 DOI: 10.1017/dmp.2021.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Although the importance of ketamine in clinical practice and in resource-poor settings and disaster zones, several attempts were made to reschedule it because of the issues around its misuse. Resisting future moves to reschedule ketamine is important for its continuous availability where needed. This scoping review addresses the question of whether ketamine should or should not be banned and the state of preparedness of low resource settings if ketamine petitions become successful in the future. METHODS A search was performed using PubMed and Google Scholar to identify articles published in the English language from March 2015 to August 2020. The articles were searched with a wide range of priori search terms related to the research questions. The selection of articles was based on relevance and eligibility. RESULTS Seventy-five articles were selected and grouped into 4 ethical themes. The search revealed that several articles addressed the importance of ketamine, pharmacology, misuse, supply, and consequences of a ketamine ban; however, none addressed how resource-poor countries should prepare for a future without the overreliance of ketamine. CONCLUSION Four ketamine petitions in about 10 years are an indication that another may resurface soon; therefore, it is important to continue to study the clinical importance of ketamine while discouraging its overreliance for clinical practice.
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Training programme in gasless laparoscopy for rural surgeons of India (TARGET study) - Observational feasibility study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021; 35:None. [PMID: 34632156 PMCID: PMC8480410 DOI: 10.1016/j.ijso.2021.100399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/11/2021] [Accepted: 08/21/2021] [Indexed: 12/11/2022]
Abstract
Background Benefits of laparoscopic surgery are well recognised but uptake in rural settings of low- and middle-income countries is limited due to implementation barriers. Gasless laparoscopy has been proposed as an alternative but requires a trained rural surgical workforce to upscale. This study evaluates a feasibility of implementing a structured laparoscopic training programme for rural surgeons of North-East India. Methods A 3-day training programme was held at Kolkata Medical College in March 2019. Laparoscopic knowledge and Fundamentals of Laparoscopic Skills (FLS) were assessed pre and post simulation training using multiple choice questions and the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), respectively. Competency with an abdominal lift device was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and live operating performance via the Global Operative Assessment of Laparoscopic Skills (GOALS) scores during live surgery. Costs of the training programme and qualitative feedback were evaluated. Results Seven rural surgeons participated. There was an improvement in knowledge acquisition (mean difference in MCQ score 5.57 (SD = 4.47)). The overall normalised mean MISTELS score for the FLS tasks improved from 386.02 (SD 110.52) pre-to 524.40 (SD 94.98) post-training (p = 0.09). Mean OSATS score was 22.4 out of 35 (SD 3.31) indicating competency with the abdominal lift device whilst a mean GOALS score of 16.42 out of 25 (SD 2.07) indicates proficiency in performing diagnostic laparoscopy using the gasless technique during live operating. Costs of the course were estimated at 354 USD for trainees and 461 USD for trainers. Conclusion Structured training programme in gasless laparoscopy improves overall knowledge and skills acquisition in laparoscopic surgery for rural surgeons of North-East India. It is feasible to deliver a training programme in gasless laparoscopy for rural surgeons. Larger studies are needed to assess the benefits for wider adoption in a similar context.
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Abdelbari S, Amer HA, Ayoub BM, Kamel R. Surgical Management of Parkinson’s Disease: The Role of Lesioning Procedures in Developing Countries in the Modern Era. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The known loss of dopaminergic cells in the pars-compacta of the substantia nigra that is the hallmark of PD. The cellular pathophysiology of the motor dysfunction is beginning to be better understood, thereby providing a stronger scientific rationale for surgical interventions. Yet, to date, there are no treatments that prevent, halt, or cure PD. Surgical strategies, offer symptomatic relief or control of motor complications associated with drug treatment.
Both pallidotomy and thalamotomy were extensively used in the treatment of PD in the1950’s and 1960’s. With the introduction of levodopa (L-dopa) in the1960’s and the realization of its striking benefits, surgery was almost abandoned and used only for patients with severe tremor. Surgical therapy is now being used earlier and more often. There are currently three brain regions being considered as targets for functional neurosurgery for PD (other than transplantation). Either CNS lesions (thalamotomy, pallidotomy or subthalamic nucleus lesions) or deep brain stimulation [DBS]. These targets are: The ventral intermediate nucleus of the thalamus (Vim), the internal segment of the Globus Pallidus (GPi) and the subthalamic nucleus (STN).
OBJECTIVE: To assess the outcome (3 months & 6 months) of lesioning procedures in parkinson’s disease (PD) patients meeting the inclusion criteria.
METHODS: A prospective clinical study conducted on 10 IPD patients during the period from October 2018 to March 2021 at Cairo University Hospitals. This study was concerned to improve the motor symptoms of IPD patients by stereotactic radiofrequency ablative procedures. Cases were restricted to 10 patients due to the Covid-19 pandemic and restriction of elective cases for chronic patients at Cairo University hospitals.
RESULTS: In our study we operated upon 10 IPD patients who were meeting our selection criteria by ablative procedures contralateral to parkinsonian symptoms.
Age of the patients ranged 17 – 70y with mean of 50.5 ± 16.35 y with predominance in males representing 6 patients. Mean duration of Parkinson`s disease according to history ranged from 2 to 12 y with mean of 8 ± 3.1 years. Patients were divided into three groups according to their presentation and the operation done for them. Thalamotomy group: Pre-operatively, the UPDRS III off & on respectively was 24.4/15.2 and post-operatively was 13/7.4 with improvement 47% / 51%. The tremor subscore was 5.4/2.8 pre-operatively and 1.4/0.8 post-operatively with average of 72% improvement. The UPDRS II pre was 17.2/11.6 and post it became 10.6/7 with 39% improvement. Modified H&Y 2.4/1.7 pre & post-operatively (29% improvement). Pallidotomy group: Pre-operatively, the UPDRS III off & on respectively was 38.5/23.5 and post-operatively was 28/16 with improvement 27% / 32%. The rigidity subscore was 5/2.5 pre-operatively and 2/1 post-operatively with average of 60% improvement. The bradykinesia subscore was 9/5.5 pre-operatively and 5.5/2.5 post-operatively with average of 47% improvement. The dyskinesia subscore was 4.5 pre-operatively and 1.2 post-operatively with average of 71% improvement. The UPDRS II pre was 22/12.5 and post it became 16/10 with 25% improvement. Modified H&Y 2.75/2.25 pre & post-operatively (18% improvement). Combined group: Pre-operatively, the UPDRS III off & on respectively was 41.33/28.67 and post-operatively was 15.67/11.33 with improvement 62% /60%. The rigidity subscore was 5/3.33 pre-operatively and 1.67/1 post-operatively with average of 68% improvement. The bradykinesia subscore was 10/6 pre-operatively and 4/1.33 post-operatively with average of 72% improvement. The UPDRS II pre was 28.33/19.33 and post it became 16.33/10.67 with 43% improvement. Modified H&Y 2.83/2 pre & post-operatively (29% improvement). Postoperatively, there was a high significant statistical finding in all clinical score and subscore of parkinsonian symptoms.
CONCLUSION: The study concludes that lesioning procedure should be revisited globally using the modern techniques of targeting and controlled thermal lesion protocols guided by capsular somatotopy and intraoperative macroelectrode stimulation, that will improve the outcome dramatically. Ablative procedures proved their efficacy in controlling motor symptoms of IPD and their cost-benefit in low & middle-income nations.
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Li HW, Scanlon ML, Kisilu N, Litzelman DK. The role of community health workers in the surgical cascade: a scoping review. HUMAN RESOURCES FOR HEALTH 2021; 19:122. [PMID: 34602064 PMCID: PMC8489043 DOI: 10.1186/s12960-021-00659-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Community health workers (CHWs) can increase access to various primary healthcare services; however, their potential for improving surgical care is under-explored. We sought to assess the role of CHWs in the surgical cascade, defined as disease screening, linkage to operative care, and post-operative care. Given the well-described literature on CHWs and screening, we focused on the latter two steps of the surgical cascade. METHODS We conducted a scoping review of the peer-reviewed literature. We searched for studies published in any language from January 1, 2000 to May 1, 2020 using electronic literature databases including Pubmed/MEDLINE, Web of Science, SCOPUS, and Google Scholar. We included articles on CHW involvement in linkage to operative care and/or post-operative surgical care. Narrative and descriptive methods were used to analyze the data. RESULTS The initial search identified 145 articles relevant to steps in the surgical cascade. Ten studies met our inclusion criteria and were included for review. In linkage to care, CHWs helped increase surgical enrollment, provide resources for vulnerable patients, and build trust in healthcare services. Post-operatively, CHWs acted as effective monitors for surgical-site infections and provided socially isolated patients with support and linkage to additional services. The complex and wide-ranging needs of surgical patients illustrated the need to view surgical care as a continuum rather than a singular operative event. CONCLUSION While the current literature is limited, CHWs were able to maneuver complex medical, cultural, and social barriers to surgical care by linking patients to counseling, education, and community resources, as well as post-operative infection prevention services. Future studies would benefit from more rigorous study designs and larger sample sizes to further elucidate the role CHWs can serve in the surgical cascade.
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Affiliation(s)
- Helen W. Li
- Department of Surgery, Washington University School of Medicine in St Louis, St. Louis, MO United States of America
| | - Michael L. Scanlon
- Indiana University Center for Global Health, 702 Rotary Circle, Suite RO 101, Indianapolis, IN 46202 United States of America
| | - Nicholas Kisilu
- Department of General Surgery and Anesthesiology, Moi University School of Medicine, Eldoret, Kenya
| | - Debra K. Litzelman
- William M. Tierney Center for Health Services Research, Regenstrief Institute, Inc. and Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 United States of America
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Shaye DA, Nakarmi KK, Shakya P, Pradhan L, Bhattarai K, Rayamajhi B, Joshi HD, Yuen CM, Shrestha KK, Rai SM. Mobile Surgical Scouts Increase Surgical Access for Patients with Cleft Lip and Palate in Nepal. Facial Plast Surg Aesthet Med 2021; 24:447-452. [PMID: 34516932 DOI: 10.1089/fpsam.2021.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In Nepal's remote regions, challenging topography prevents patients with cleft lip and palate (CLP) from seeking care. Objective: To measure the effect of a mobile surgical scout program on CLP surgical care in remote regions of Nepal. Methods: Forty-four lay people were trained as mobile surgical scouts and over 5 months traversed remote districts of Nepal on foot to detect and refer CLP patients for surgical care. Surgical patients from remote districts were compared with matched time periods in the year before intervention. Diagnostic accuracy of the surgical scouts was assessed. Findings: Mobile surgical scouts accurately diagnosed (90%) and referred (82%) patients for cleft surgery. Before the intervention, CLP surgeries from remote districts represented 3.5% of cleft surgeries performed. With mobile surgical scouting, patients from remote districts comprised 8.2% of all cleft surgeries (p = 0.007). When transportation and accompaniment was provided in addition to mobile surgical scouts, patients from remote districts represented 13.5% (p ≤ 0.001) of all cleft surgeries. Conclusion: Task-shifting the surgical screening process to trained scouts resulted in accurate diagnoses, referrals, and increased access to cleft surgery in remote districts of Nepal.
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Affiliation(s)
- David A Shaye
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kiran Kishor Nakarmi
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Nepal
| | - Pramila Shakya
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Nepal
| | - Leeza Pradhan
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Nepal
| | - Kabita Bhattarai
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Nepal
| | - Badri Rayamajhi
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Nepal
| | - Hemanta Dhoj Joshi
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Nepal
| | - Courtney M Yuen
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kailash Khaki Shrestha
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Nepal
| | - Shankar Man Rai
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Nepal
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Gaba F, Bizzarri N, Kamfwa P, Saiz A, Blyuss O, Paranjothy S, Ramirez PT, Cibula D. Determining post-operative morbidity and mortality following gynecological oncology surgery: protocol for a multicenter, international, prospective cohort study (Global Gynaecological Oncology Surgical Outcomes Collaborative-GO SOAR). Int J Gynecol Cancer 2021; 31:1287-1291. [PMID: 34489356 DOI: 10.1136/ijgc-2021-002586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The Global Gynaecological Oncology Surgical Outcomes Collaborative (GO SOAR) aims to develop a network of gynecological oncology surgeons, surgical departments, and other interested parties that will have the long-term ability to collaborate on outcome studies. The protocol for the first collaborative study is presented here. PRIMARY OBJECTIVE To evaluate international variation in 30-day post-operative morbidity and mortality following gynecological oncology surgery between very high/high and medium/low human development index country settings. HYPOTHESIS There is no variation in post-operative morbidity and mortality following gynecological oncology surgery between very high/high and medium/low human development index country settings. STUDY DESIGN International, multicenter, prospective cohort study. Patient data will be collected over a consecutive 30-day period through gynecological oncology multidisciplinary teams/tumor boards and clinics across different human development index country groups. All data are collected on a customized, secure, password protected, central REDCap database. MAJOR INCLUSION/EXCLUSION CRITERIA Inclusion criteria include women aged ≥18 years undergoing elective/emergency, curative/palliative surgery for primary/recurrent tubo-ovarian/peritoneal, endometrial, cervical, vulval, vaginal, gestational trophoblastic malignancies. Surgical modality may be open, minimal access (laparoscopic/robotic), or vaginal. PRIMARY ENDPOINT 30-day post-operative morbidity and mortality defined as per Clavien-Dindo classification system. SAMPLE SIZE 1100 (550/arm). ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS It is estimated recruitment will be completed by 2022 and results published by 2023. TRIAL REGISTRATION ClinicalTrials.gov registry: NCT04579861 (https://clinicaltrials.gov/ct2/show/NCT04579861).
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Affiliation(s)
- Faiza Gaba
- Department of Gynaecological Oncology, North-East of Scotland Gynaecological Oncology Centre, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK .,Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Paul Kamfwa
- Department of Gynaecological Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Allison Saiz
- Department of Gynecologic Oncology, Northwestern University in Chicago, Evanston, Illinois, USA
| | - Oleg Blyuss
- School of Physics, Engineering & Computer Science, University of Hertfordshire, Hatfield, UK.,Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Shantini Paranjothy
- Aberdeen Health Data Science Research Centre, University of Aberdeen, Aberdeen, UK
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - David Cibula
- Department of Obstetrics and Gynaecology, General University Hospital, Prague, Czech Republic
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Sgarbura O, Mackenzie G, Holmberg M, Wigmore SJ, Søreide K. Social Media for the Hepato-Pancreato-Biliary community (#SoMe4HPB): connecting a specialized online group for scientific and clinical knowledge dissemination. HPB (Oxford) 2021; 23:1448-1455. [PMID: 33824082 DOI: 10.1016/j.hpb.2021.01.017] [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] [Received: 10/06/2020] [Revised: 12/10/2020] [Accepted: 01/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Social media has an increasingly important role in scientific communication, clinical discussions and knowledge distribution. While several surgical disciplines have taken to internet for increased connectivity, there is currently little knowledge about the social media activity in the field of hepatopancreatobiliary surgery. We aimed to evaluate the implementation and use of a specific HPB hashtag and Twitter handle. METHODS The hashtag and Twitter handle (#SoMe4HPB; @hpb_so) were initiated on February 2019. We evaluated the response during the initial 15 months by applying NodeXL to trace activity. RESULTS The Twitter handle had 1388 followers (by May 7, 2020) and had generated 855 tweets and retweets. A total of 1120 mentions of 182 accounts were recorded in original tweets by @hpb_so. The largest global reach was recorded in December 2019 (254.000 people). Pancreatic cancer was the subject of 15% of all posts, liver malignancies of 12% of all posts and minimally invasive surgery of 8%. CONCLUSION The Social Media for the Hepato-Pancreato-Biliary community (#SoMe4HPB) and its associated Twitter handle @hpb_so had a well-built inception followed by a progressive development connecting individuals interested in HPB Surgery internationally. The involvement of more actors is required in order to fully attain its scientific dissemination role.
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Affiliation(s)
- Olivia Sgarbura
- Surgical Oncology Department, Cancer Institute of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France; IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, F-34298, France.
| | - Graham Mackenzie
- NHS Education for Scotland, 102 West Port, Edinburgh, EH3 9DN, UK
| | - Marcus Holmberg
- Department for Upper Gastrointestinal Diseases, Unit for Hepatobiliary and Pancreatic Surgery, Karolinska University Hospital, Sweden
| | - Stephen J Wigmore
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, POB 8100, N-4068, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Ifeanyichi M, Gajewski J, Baltussen R, Borgstein E, Kachimba J, Brugha R, Bijlmakers L. COVID-19 pandemic: Revisiting the case for a dedicated financing mechanism for surgical care in resource-poor countries. J Glob Health 2021; 11:03090. [PMID: 34386211 PMCID: PMC8325879 DOI: 10.7189/jogh.11.03090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martilord Ifeanyichi
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.,EMAI Health Systems and Health Services Consulting, Nijmegen, the Netherlands
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rob Baltussen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Eric Borgstein
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - John Kachimba
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Ruairi Brugha
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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Roa L, Moeller E, Fowler Z, Carrillo F, Mohar S, Williams W, Meara J, Riviello R, Uribe-Leitz T, Macias V. Assessment of surgical capacity in Chiapas, Mexico: a cross-sectional study of the public and private sector. BMJ Open 2021; 11:e044160. [PMID: 34312192 PMCID: PMC8314748 DOI: 10.1136/bmjopen-2020-044160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Surgical, anaesthesia and obstetric (SAO) care are essential, life-saving components of universal healthcare. In Chiapas, Mexico's southernmost state, the capacity of SAO care is unknown. This study aims to assess the surgical capacity in Chiapas, Mexico, as it relates to access, infrastructure, service delivery, surgical volume, quality, workforce and financial risk protection. METHODS A cross-sectional study of Ministry of Health public hospitals and private hospitals in Chiapas was performed. The translated Surgical Assessment Tool (SAT) was implemented in sampled hospitals. Surgical volume was collected retrospectively from hospital logbooks. Fisher's exact test and Mann-Whitney U test were used to compare public and private hospitals. Catastrophic expenditure from surgical care was calculated. RESULTS Data were collected from 17 public hospitals and 20 private hospitals in Chiapas. Private hospitals were smaller than public hospitals and public hospitals performed more surgeries per operating room. Not all hospitals reported consistent electricity, running water or oxygen, but private hospitals were more likely to have these basic infrastructure components compared with public hospitals (84% vs 95%; 60% vs 100%; 94.1% vs 100%, respectively). Bellwether surgical procedures performed in private hospitals cost significantly more, and posed a higher risk of catastrophic expenditure, than those performed in public hospitals. CONCLUSION Capacity limitations are greater in public hospitals compared with private hospitals. However, the cost of care in the private sector is significantly higher than the public sector and may result in catastrophic expenditures. Targeted interventions to improve the infrastructure, workforce availability and data collection are needed.
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Affiliation(s)
- Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Ellie Moeller
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
| | - Zachary Fowler
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Sebastian Mohar
- Compañeros En Salud, Jaltenango, Mexico
- Hospital Basico Comunitario Angel Albino Corzo, Jaltenango, Mexico
| | - Wendy Williams
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John Meara
- Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tarsicio Uribe-Leitz
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Ifeanyichi M, Broekhuizen H, Cheelo M, Juma A, Mwapasa G, Borgstein E, Kachimba J, Gajewski J, Brugha R, Pittalis C, Bijlmakers L. Surgical ambulance referrals in sub-Saharan Africa - financial costs and coping strategies at district hospitals in Tanzania, Malawi and Zambia. BMC Health Serv Res 2021; 21:728. [PMID: 34301242 PMCID: PMC8299644 DOI: 10.1186/s12913-021-06709-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An estimated nine out of ten persons in sub-Saharan Africa (SSA) are unable to access timely, safe and affordable surgery. District hospitals (DHs) which are strategically located to provide basic (non-specialist) surgical care for rural populations have in many instances been compromised by resource inadequacies, resulting in unduly frequent patient referrals to specialist hospitals. This study aimed to quantify the financial burdens of surgical ambulance referrals on DHs and explore the coping strategies employed by these facilities in navigating the challenges. METHODS We employed a multi-methods descriptive case study approach, across a total of 14 purposively selected DHs; seven, three, and four in Tanzania, Malawi and Zambia, respectively. Three recurrent cost elements were identified: fuel, ambulance maintenance and staff allowances. Qualitative data related to coping mechanisms were obtained through in-depth interviews of hospital managers while quantitative data related to costs of surgical referrals were obtained from existing records (such as referral registers, ward registers, annual financial reports, and other administrative records) and expert estimates. Interview notes were analysed by manual thematic coding while referral statistics and finance data were processed and analysed using Microsoft Office Excel 2016. RESULTS At all but one of the hospitals, respondents reported inadequacies in numbers and functional states of the ambulances: four centres indicated employing non-ambulance vehicles to convey patients occassionally. No statistically significant correlation was found between referral trip distances and total annual numbers of referral trips, but hospital managers reported considering costs in referral practices. For instance, ten of the study hospitals reported combining patients to minimize trip frequencies. The total cost of ambulance use for patient transportation ranged from I$2 k to I$58 k per year. Between 34% and 79% of all patient referrals were surgical, with total costs ranging from I$1 k to I$32 k per year. CONCLUSION Cost considerations strongly influence referral decisions and practices, indicating a need for increases in budgetary allocations for referral services. High volumes of potentially avoidable surgical referrals provide an economic case - besides equitable access to healthcare - for scaling up surgery capacity at the district level as savings from decreased referrals could be reinvested in referral systems strengthening.
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Affiliation(s)
- Martilord Ifeanyichi
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands. .,EMAI Health Systems and Health Services Consulting, Nijmegen, The Netherlands.
| | - Henk Broekhuizen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mweene Cheelo
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Adinan Juma
- East, Central and Southern Africa Health Community, Arusha, Tanzania
| | - Gerald Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Eric Borgstein
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - John Kachimba
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruairi Brugha
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chiara Pittalis
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Plastic Surgery Across Continents: A Comparison of Residency Training in Subsaharan Africa and the United States. Ann Plast Surg 2021; 87:3-11. [PMID: 33470626 DOI: 10.1097/sap.0000000000002672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT There is a demonstrated need for access to plastic surgical care in low- and middle-income countries worldwide. Recently, there is increasing interest in promoting transcontinental partnerships between academic institutions to improve training opportunities for local surgeons while increasing access to care for patients. Before such programs can be established, it is crucial for US-based surgeons and educators to understand the existing training models in different countries. The aim of this study is to identify the current plastic surgery training model in the College of Surgeons of East, Central, and Southern Africa (COSECSA) group of African nations and compare this to training in the United States. The curricula of 2 accrediting bodies of plastic surgery, COSECSA and the Accreditation Council for Graduate Medical Education of the United States, were compared. Similarities included the length of dedicated plastic surgery training, curriculum content, and final evaluation structure. Differences include training pathways, assessment methodology, and regulation regarding specific competencies, program requirements, and resident benefits. These findings establish a baseline understanding of how plastic surgical training is organized, delivered, and evaluated in Africa, highlight opportunities for educational initiatives, and serve as a foundation for future efforts to develop collaborative partnerships in these communities. Future research will include a survey sent to program directors and plastic surgery attendings in the COSECSA regions to gather additional information.
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Nwanna-Nzewunwa O, Oke R, Agwang E, Ajiko MM, Yoon C, Carvalho M, Kirya F, Marseille E, Dicker RA. The societal cost and economic impact of surgical care on patients' households in rural Uganda; a mixed method study. BMC Health Serv Res 2021; 21:568. [PMID: 34107950 PMCID: PMC8190862 DOI: 10.1186/s12913-021-06579-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background The epidemiology and cost of surgical care delivery in low-and middle-income countries (LMICs) is poorly understood. This study characterizes the cost of surgical care, rate of catastrophic medical expenditure and medical impoverishment, and impact of surgical hospitalization on patients’ households at Soroti Regional Referral Hospital (SRRH), Uganda. Methods We prospectively collected demographic, clinical, and cost data from all surgical inpatients and caregivers at SRRH between February 2018 and January 2019. We conducted and thematically analyzed qualitative interviews to discern the impact of hospitalization on patients’ households. We employed the chi-square, t-test, ANOVA, and Bonferroni tests and built regression models to identify predictors of societal cost of surgical care. Out of pocket spending (OOPS) and catastrophic expenses were determined. Results We encountered 546 patients, mostly male (62%) peasant farmers (42%), at a median age of 22 years; and 615 caregivers, typically married (87%), female (69%), at a median age of 35 years. Femur fractures (20.4%), soft tissue infections (12.3%), and non-femur fractures (11.9%) were commonest. The total societal cost of surgical care was USD 147,378 with femur fractures (USD 47,879), intestinal obstruction (USD 18,737) and non-femur fractures (USD 10,212) as the leading contributors. Procedures (40%) and supplies (12%) were the largest components of societal cost. About 29% of patients suffered catastrophic expenses and 31% were medically impoverished. Conclusion Despite free care, surgical conditions cause catastrophic expenses and impoverishment in Uganda. Femur fracture is the most expensive surgical condition due to prolonged hospitalization associated with traction immobilization and lack of treatment modalities with shorter hospitalization. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06579-x.
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Affiliation(s)
- Obieze Nwanna-Nzewunwa
- Department of Surgery, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA
| | - Rasheedat Oke
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Esther Agwang
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | | | - Christopher Yoon
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Melissa Carvalho
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Fred Kirya
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Elliot Marseille
- Principal, Health Strategies International, Oakland, California, USA
| | - Rochelle A Dicker
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, 90095, USA.
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Shrestha GS, Lamsal R, Tiwari P, Acharya SP. Anesthesiology and Critical Care Response to COVID-19 in Resource-Limited Settings: Experiences from Nepal. Anesthesiol Clin 2021; 39:285-292. [PMID: 34024431 PMCID: PMC7879105 DOI: 10.1016/j.anclin.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
It is difficult to predict the future course and length of the ongoing COVID-19 pandemic, which has devastated health care systems in low- and middle-income countries. Anesthesiology and critical care services are hard hit because many hospitals have stopped performing elective surgeries, staff and scarce hospital resources have been diverted to manage COVID-19 patients, and several makeshift COVID-19 units had to be set up. Intensive care units are overwhelmed with critically ill patients. In these difficult times, low- and middle-income countries need to improvise, perform indigenous research, adapt international guidelines to suit local needs, and target attainable clinical goals.
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Affiliation(s)
- Gentle S Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj Road, PO Box: 1524, Maharajgunj, Kathmandu 44600, Nepal.
| | - Ritesh Lamsal
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj Road, PO Box: 1524, Maharajgunj, Kathmandu 44600, Nepal
| | - Pradip Tiwari
- Department of Critical Care, Norvic International Hospital, PO Box: 14126, Thapathali, Kathmandu 44617, Nepal
| | - Subhash P Acharya
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj Road, PO Box: 1524, Maharajgunj, Kathmandu 44600, Nepal
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Fagan JJ. Africa: A window on challenges and opportunities for head and neck cancer. Laryngoscope Investig Otolaryngol 2021; 6:414-419. [PMID: 34195361 PMCID: PMC8223454 DOI: 10.1002/lio2.554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Head and neck cancer occurs predominantly in the Developing World, with significant challenges relating to a high burden of disease, late presentation, and poor access to curative and palliative care. AIMS This article describes challenges relating to head and neck cancer care in Sub-Saharan Africa. MATERIAL & METHODS Educational and training innovations that have been undertaken to improve access to cancer care are presented under the following headings: Open Access Educational Resources African Head and Neck Society (AfHNS); African head and neck surgery fellowship training; AfHNS Virtual Tumor Board; The AfHNS Clinical Practice Guidelines for Head & Neck Cancers in Developing Countries and Limited Resource Settings. Concerns are also raised about universally applicable cancer staging systems. RESULTS The challenges facing African patients apply to equally to many other parts of the developing world. DISCUSSION The challenges facing African patients apply to equally to many other parts of the developing world. CONCLUSIONS For outcomes of head and neck cancers to be improved globally, a far greater investment needs to be made in education and training to improve access to care in developing countries. To make a meaningful global impact on morbidity and mortality related to HNC, clinicians, academic institutions and professional societies in developed countries need to be sensitive to these developing world challenges and should directly engage in improving access to care through promoting open access educational resources, offering specialist and fellowship training, collaborating with appropriate research, and establishing and strengthening centers of excellence in developing countries. LEVEL OF EVIDENCE 2c "Outcomes research".
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Affiliation(s)
- Johannes J. Fagan
- Division of Otorhinolaryngology, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
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135
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Mahmoud Z, Angelé-Halgand N, Churruca K, Ellis LA, Braithwaite J. Access to surgical care as an efficiency issue: using lean management in French and Australian operating theatres. J Health Organ Manag 2021; ahead-of-print. [PMID: 34032110 DOI: 10.1108/jhom-08-2020-0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Millions around the world still cannot access safe, timely and affordable surgery. Considering access as a function of efficiency, this paper examines how the latter can be improved within the context of operating theatres. Carried out in France and Australia, this study reveals different types of waste in operating theatres and a series of successful tactics used to increase efficiency and eliminate wastefulness. DESIGN/METHODOLOGY/APPROACH Data for this qualitative study were collected through 48 semi-structured interviews with operating theatre staff in France (n = 20) and Australia (n = 28). Transcripts were coded using a theory-driven thematic analysis to characterise sources of waste in operating theatres and the tactics used to address them. FINDINGS The study confirmed the prominence of seven types of waste in operating theatres commonly found in industry and originally identified by Ohno, the initiator of lean: (1) underutilised operating rooms; (2) premature or delayed arrival of patients, staff or equipment; (3) need for large onsite storage areas and inventory costs; (4) unnecessary transportation of equipment; (5) needless staff movements; (6) over-processing and (7) quality defects. The tactics used to address each of these types of waste included multiskilling staff, levelling production and implementing just-in-time principles. ORIGINALITY/VALUE The tactics identified in this study have the potential of addressing the chronic and structurally embedded problem of waste plaguing health systems' operating theatres, and thus potentially improve access to surgical care. In a global context of resource scarcity, it is increasingly necessary for hospitals to optimise the ways in which surgery is delivered.
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Affiliation(s)
- Zeyad Mahmoud
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,LEMNA, Université de Nantes, Nantes, France
| | - Nathalie Angelé-Halgand
- LEMNA, Université de Nantes, Nantes, France.,University of New Caledonia, Noumea, New Caledonia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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136
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Manzano-Nunez R, Sarmiento C, Villegas-Vargas S, Angel-Barrios JA, Puyana JC, Peck G, Castro F, Gaviria A, García AF. Emergency surgery workforce and its inverse relationship with multidimensional poverty in Colombia. Eur J Trauma Emerg Surg 2021; 48:1159-1165. [PMID: 33961072 DOI: 10.1007/s00068-021-01690-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/28/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE General surgeons, anesthesiologists, obstetricians and gynecologists (ob-gyns), and orthopedic surgeons are the vital disciplines to provide emergency surgery within a healthcare system. This paper aims to examine the relationship (if any) between multidimensional poverty (MDP) and GDP per-capita with the emergency surgery workforce density in Colombia. METHODS We performed an ecological study, where the observation units were the 32 Colombian departments. The total numbers of general surgeons, anesthesiologists, ob-gyns, and orthopedic surgeons were obtained from the "Registro Unico Nacional de Talento Humano en Salud" (ReTHUS) registry. The 2020 population projections, the incidence of MDP and the GDP per capita were obtained from the Colombian National Administrative Department of Statistics. A spearman's correlation coefficient was calculated to measure the strength of the correlations between the surgical workforce density with MDP and GDP per-capita. RESULTS There were significant moderate inverse linear correlations between the incidence of multidimensional poverty and workforce density. The correlation coefficients for the incidence of multidimensional poverty and the workforce density were - 0.5273, - 0.5620, - 0.4704, and - 0.4612 for surgeons, anesthesiologists, ob-gyns, and orthopedic surgeons, respectively. Conversely, the correlation coefficients for the GDP per-capita and the workforce density were 0.4045, 0.3822, 0.4404, and 0.3742 for surgeons, anesthesiologists, ob-gyns, and orthopedic surgeons, respectively. CONCLUSION This study found that Colombian trauma and emergency surgery workforce density was inversely and directly correlated with multidimensional poverty and GDP per-capita levels, respectively. The relationship of these economic indicators with the surgical capacity deserves further investigation.
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Affiliation(s)
- Ramiro Manzano-Nunez
- Center for Sustainable Development Objectives, Universidad de Los Andes, Bogotá, Colombia.
| | | | - Sofía Villegas-Vargas
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | - Juan C Puyana
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gregory Peck
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Felipe Castro
- Center for Sustainable Development Objectives, Universidad de Los Andes, Bogotá, Colombia
| | - Alejandro Gaviria
- Center for Sustainable Development Objectives, Universidad de Los Andes, Bogotá, Colombia.,Universidad de Los Andes, Bogotá, Colombia
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137
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Cossa M, Rose J, Berndtson AE, Noormahomed E, Bickler SW. Assessment of Surgical Care Provided in National Health Services Hospitals in Mozambique: The Importance of Subnational Metrics in Global Surgery. World J Surg 2021; 45:1306-1315. [PMID: 33521876 PMCID: PMC8530447 DOI: 10.1007/s00268-020-05925-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Surgery plays a critical role in sustainable healthcare systems. Validated metrics exist to guide implementation of surgical services, but low-income countries (LIC) struggle to report recommended metrics and this poses a critical barrier to addressing unmet need. We present a comprehensive national sample of surgical encounters from a LIC by assessing the National Health Services of Mozambique. MATERIAL AND METHODS A prospective cohort of all surgical encounters from Mozambique's National Health Service was gathered for all provinces between July and December 2015. Primary outcomes were timely access, provider densities for surgery, anesthesiology, and obstetrics (SAO) per 100,000 population, annualized surgical procedure volume per 100,000, and postoperative mortality (POMR). Secondary outcomes include operating room density and efficiency. RESULTS Fifty-four hospitals had surgical capacity in 11 provinces with 47,189 surgeries. 44.9% of Mozambique's population lives in Districts without access to surgical services. National SAO density was 1.2/100,000, ranging from 0.4/100,000 in Manica Province to 9.8/100,000 in Maputo City. Annualized national surgical case volume was 367 procedures/100,000 population, ranging from 180/100,000 in Zambezia Province to 1,897/100,000 in Maputo City. National POMR was 0.74% and ranged from 0.23% in Maputo Province to 1.78% in Niassa Province. DISCUSSION Surgical delivery in Mozambique falls short of international targets. Subnational deficiencies and variations between provinces pose targets for quality improvement in advancing national surgical plans. This serves as a template for LICs to follow in gathering surgical metrics for the WHO and the World Bank and offers short- and long-term targets for surgery as a component of health systems strengthening.
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Affiliation(s)
- Matchecane Cossa
- Department of Surgery, Maputo Central Hospital, Eduardo Mondlane University, Maputo, Mozambique
| | - John Rose
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
| | - Allison E Berndtson
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Emilia Noormahomed
- Microbiology Department, Parasitology Laboratory, Department of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute of Health Education and Research, Maputo, Mozambique
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, CA, USA
| | - Stephen W Bickler
- Division of Pediatric Surgery, Rady Children's Hospital, University of California, San Diego, CA, USA
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Rao SM. National Registries: The Need of the Hour. Indian J Crit Care Med 2021; 25:491-492. [PMID: 34177165 PMCID: PMC8196393 DOI: 10.5005/jp-journals-10071-23839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Rao SM. National Registries: The Need of the Hour. Indian J Crit Care Med 2021;25(5):491-492.
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Affiliation(s)
- Surath Manimala Rao
- Department of Critical Care Medicine KIMS Hospital, Hyderabad, Telangana, India
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139
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Pabinger C, Lothaller H, Lorenz A, Dammerer D. Telemedicine versus on-site treatment at a surgical university clinic: Study of 225 consecutive patients. Int J Med Inform 2021; 151:104460. [PMID: 33965683 DOI: 10.1016/j.ijmedinf.2021.104460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Recently, telemedical services are increasingly used. It remains unclear, if outpatients in general surgery can be treated via telemedicine (e.g. telework). We aimed to evaluate, if diagnosis and therapies of outpatients in general surgery can be found using a mobile healthcare communication app instead of personal contact. MATERIAL AND METHODS In a prospective, double blind, anonymized clinical study we included consecutive outpatients at a general surgery department at a university hospital. For the telemedical "treatment" the on-site doctors uploaded variables (e.g. anamnesis, radiograph, etc.) for each patient. The telemedical doctor received the information only via app and did not see the patient physically. Both, the doctor on-site and the virtual telemedical-doctor then uploaded the diagnosis and their suggested therapy - blinded to each other. The outpatient received the on-site treatment only. The virtual treatment was solely for scientific purposes and had no therapeutic impact. RESULTS 225 consecutive surgical outpatients (53 % female and 47 % male) were included. Mean age was 61 years. In 84 % of cases the telemedical diagnosis matched the on-site diagnosis. The telemedical treatment was not inferior as compared to the on-site treatment in 94 % of all cases and the same therapy was proposed in 76 %. In 6% of all cases the telemedical therapeutic regimen could possibly harm or lead to an over- or under treatment of the patient. CONCLUSION Telemedical consultation seems to work in the field of general surgery. Telemedicine in general surgery potentially could decrease waiting time for an appointment and patient frequency. However, the potential harm of a wrong therapy remains due to the lack of a clinical observation.
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Affiliation(s)
- C Pabinger
- Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52 A, Innsbruck, 6020, Austria.
| | - H Lothaller
- University of Music and Performing Arts Graz, 8010 Graz, Leonhardstraße 15, Graz, 8010, Austria
| | - A Lorenz
- Medical University of Innsbruck, Department of Visceral, Transplantation and Thoracic Surgery, Center of Operative Medicine, Anichstraße 35, Innsbruck, 6020, Austria
| | - D Dammerer
- Medical University of Innsbruck, Anichstraße 35, Innsbruck, 6020, Austria
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Andrés de León Caez K, García Paredes JJ, Escobar Pacheco CA, Ortega Sierra MG, Lozada-Martínez ID. A commentary on "The application of virtual reality in the training of laparoscopic surgery: A systematic review and meta-analysis" (Int J Surg; 87:105859). Int J Surg 2021; 89:105959. [PMID: 33930568 DOI: 10.1016/j.ijsu.2021.105959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | | | - Ivan David Lozada-Martínez
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cra. 50 #24-120, Cartagena, Colombia.
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141
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Rolle ML, Garba DL, Buda A, Vital A, Ekedede M. Timely Access to Neurosurgical Care in the Caribbean Using Geospatial Analysis. World Neurosurg 2021; 151:e545-e551. [PMID: 33905905 DOI: 10.1016/j.wneu.2021.04.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Access to timely neurosurgical care in particular remains limited worldwide, and is associated with increased morbidity and mortality, a decrease in overall life expectancy, and catastrophic economic costs. To date, access to neurosurgical care has not been completely studied and reported in the Caribbean neurosurgical literature. In this study, we aim to understand the geographic distribution of hospital facilities with neurosurgical capacity among the CARICOM member states to determine timely access to neurosurgical care. METHODS We assessed geographical access to facilities capable of providing neurosurgical care in the Caribbean. The GPS coordinates of the hospitals that provide neurosurgical care were identified using street addresses and satellite imaging from Google Maps. Facilities with neurosurgical care were mapped in ArcGIS Pro (Version 2.6.0). using Manhattan distance. We identified the area around each facility and stratified by 30- minute, 1-hour, 2-hour, and 4-hour geographic driving intervals. RESULTS A total of 16 hospitals were identified as providing neurosurgical care in the Caribbean. Our results suggest that 14 million people (76% of the population) had 4-hour geographic access to a facility capable of providing neurosurgical care. In addition, 7 million people (40% of the population) had 2-hour geographical access to neurosurgical care. CONCLUSIONS Timely access to care is an important tenet of global neurosurgery. We found that 3.5 million Caribbean residents are outside of the access zone to neurosurgical capacity. Public health advocates, governments, providers, and patients should be aware of the inequity in access to neurosurgical care and should collectively work to close the gap.
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Affiliation(s)
- Myron L Rolle
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Deen L Garba
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
| | - Alexandra Buda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; University of Rochester School of Medicine, Rochester, New York, USA
| | - Anchelo Vital
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; State University of Haiti Faculty of Medicine and Pharmacy, Port-au-Prince, Ouest, Haiti
| | - Magnus Ekedede
- Department of Neurosurgery, Princess Margaret Hospital, Nassau, Bahamas
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Equity in global surgical care: A commentary. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Windon MJ, Faniriko MBA, Bogale M, Acha E, Koch W. Otolaryngology burden of disease and surgical case triage in resource-limited settings: An example from Cameroon. Laryngoscope Investig Otolaryngol 2021; 6:177-182. [PMID: 33869748 PMCID: PMC8035949 DOI: 10.1002/lio2.522] [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: 12/13/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Otolaryngology services worldwide faced an unprecedented demand for case triage during the SARS-CoV-2 pandemic. We propose and apply a novel case-leveling schema in a resource-limited setting. Describing the surgical burden of otolaryngologic disease in this setting may critically inform resource planning to address global surgical disparities. METHODS This is a retrospective study of otolaryngology cases performed over a 28-month period (1/2016-4/2018) at a hospital in rural Cameroon. Case details were collated and categorized as a surrogate measure of otolaryngologic disease in resource-limited settings. A case-levelling schema based on temporal urgency and anticipated impact on health was proposed and applied. RESULTS 1277 cases took place during the study. The largest proportion of cases were head and neck (517, 40%), followed by pediatrics (316, 25%). A four-tiered leveling system was generated: level 1 cases were immediately life-saving; level 2 cases were expected to result in a significant return to functions of daily living, or would prevent future death from cancer; level 3 cases aimed to significantly improve quality of life; level 4 cases were purely elective. Upon application of the schema, most cases were deemed to be level 2 (661, 52%). CONCLUSION We use our experience in a resource-limited setting to generate and apply a novel schema to be used for otolaryngology case triage in services facing unprecedented states of emergency such as the SARS-CoV-2 pandemic. This is the first study describing the surgical otolaryngologic disease burden in a resource-limited setting, data which may be used for future resource allocation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Melina J. Windon
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Mesele Bogale
- Department of SurgeryAdama Hospital Medical CollegeAdamaEthiopia
| | - Everistus Acha
- Department of Ear, Nose, and Throat SurgeryMbingo Baptist HospitalMbingoCameroon
| | - Wayne Koch
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Ear, Nose, and Throat SurgeryMbingo Baptist HospitalMbingoCameroon
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Vervoort D, Swain JD, Pezzella AT, Kpodonu J. Cardiac Surgery in Low- and Middle-Income Countries: A State-of-the-Art Review. Ann Thorac Surg 2021; 111:1394-1400. [DOI: 10.1016/j.athoracsur.2020.05.181] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/10/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
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Gyedu A, Stewart B, Gaskill C, Salia E, Wadie R, Abantanga F, Donkor P, Mock C. A Nationwide Enumeration of Operations Performed for Pediatric Patients in Ghana. Eur J Pediatr Surg 2021; 31:199-205. [PMID: 32242327 DOI: 10.1055/s-0040-1705130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Currently, there are no existing benchmarks for evaluating a nation's pediatric surgical capacity in terms of met and unmet needs. MATERIALS AND METHODS Data on pediatric operations performed from 2014 to 2015 were obtained from a representative sample of hospitals in Ghana, then scaled up for national estimates. Operations were categorized as "essential" (most cost-effective, highest population impact) as designated by the World Bank's Disease Control Priorities versus "other." Estimates were then compared with pediatric operation rates in New Zealand to determine unmet pediatric surgery need in Ghana. RESULTS A total of 29,884 operations were performed for children <15 years, representing an annual operation rate of 284/100,000 (95% uncertainty interval: 205-364). Essential procedures constituted 66% of all pediatric operations; 12,397 (63%) were performed at district hospitals. General surgery (8,808; 29%) and trauma (6,302; 21%) operations were most common. Operations for congenital conditions were few (826; 2.8%). Tertiary hospitals performed majority (55%) of operations outside of the essential category. Compared with the New Zealand benchmark (3,806 operations/100,000 children <15 years), Ghana is meeting only 7% of its pediatric surgical needs. CONCLUSION Ghana has a large unmet need for pediatric surgical care. Pediatric-specific benchmarking is needed to guide surgical capacity efforts in low- and middle-income country healthcare systems.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, Kwame Nkrumah University of Science and Technology College of Health Sciences, Kumasi, Ghana
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, United States
| | - Cameron Gaskill
- Department of Surgery, University of Washington, Seattle, Washington, United States
| | - Emmanuella Salia
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Raymond Wadie
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Francis Abantanga
- Department of Surgery, University for Development Studies, Tamale, Northern, Ghana
| | - Peter Donkor
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, Washington, United States
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146
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Turcotte JJ, Gelfand JM, Jones CM, Jackson RS. Development of a Low-Resource Operating Room and a Wide-Awake Orthopedic Surgery Program During the COVID-19 Pandemic. Surg Innov 2021; 28:183-188. [PMID: 33780646 DOI: 10.1177/15533506211003530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. The COVID-19 pandemic resulted in significant medication, supply and equipment, and provider shortages, limiting the resources available for provision of surgical care. In response to mandates restricting surgery to high-acuity procedures during this period, our institution developed a multidisciplinary Low-Resource Operating Room (LROR) Taskforce in April 2020. This study describes our institutional experience developing an LROR to maintain access to urgent surgical procedures during the peak of the COVID-19 pandemic. Methods. A delineation of available resources and resource replacement strategies was conducted, and a final institution-wide plan for operationalizing the LROR was formed. Specialty-specific subgroups then convened to determine best practices and opportunities for LROR utilization. Orthopedic surgery performed in the LROR using wide-awake local anesthesia no tourniquet (WALANT) is presented as a use case. Results. Overall, 19 limited resources were identified, spanning across the domains of physical space, drugs, devices and equipment, and personnel. Based on the assessment, the decision to proceed with creation of an LROR was made. Sixteen urgent orthopedic surgeries were successfully performed using WALANT without conversion to general anesthesia. Conclusion. In response to the COVID-19 pandemic, a LROR was successfully designed and operationalized. The process for development of a LROR and recommended strategies for operating in a resource-constrained environment may serve as a model for other institutions and facilitate rapid implementation of this care model should the need arise in future pandemic or disaster situations.
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Affiliation(s)
- Justin J Turcotte
- Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Jeffrey M Gelfand
- Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, USA
| | | | - Rubie S Jackson
- Department of Surgery, Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA
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Kanmounye US, Sebopelo LA, Keke C, Zolo Y, Senyuy WP, Endalle G, Takoukam R, Sichimba D, Nguembu S, Ghomsi N. Mapping Global Neurosurgery Research Collaboratives: A Social Network Analysis of the 50 Most Cited Global Neurosurgery Articles. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okab006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
ABSTRACTSocial network analysis of bibliometric data evaluates the relationships between the articles, authors, and themes of a research niche. The network can be visualized as maps composed of nodes and links. This study aimed to identify and evaluate the relationships between articles, authors, and keywords in global neurosurgery. The authors searched global neurosurgery articles on the Web of Science database from inception to June 18, 2020. The 50 most cited articles were selected and their metadata (document coupling, co-authorship, and co-occurrence) was exported. The metadata were analyzed and visualized with VOSViewer (Centre for Science and Technology Studies, Leiden University, The Netherlands). The articles were published between 1995 and 2020 and they had a median of 4.0 (interquartile range [IQR] = 5.0) citations. There were 5 clusters in the document coupling and 10 clusters in the co-authorship analysis. A total of 229 authors contributed to the articles and Kee B. Park contributed the most to articles (14 publications). Backward citation analysis was organized into 4 clusters and co-occurrence analysis into 7 clusters. The most common themes were pediatric neurosurgery, neurotrauma, and health system strengthening. The authors identified trends, contributors, and themes of highly cited global neurosurgery research. These findings can help establish collaborations and set the agenda in global neurosurgery research.
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Affiliation(s)
| | - Lorraine Arabang Sebopelo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Chiuyu Keke
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Medicine, University of Zambia, Lusaka, Zambia
| | - Yvan Zolo
- 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
| | - Genevieve Endalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Régis Takoukam
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Neurosurgery Department, Felix Houphouet Boigny University, Abidjan, Côte d'Ivoire
| | - Dawin Sichimba
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- School of Medicine, Copperbelt University, Kitwe, Zambia
| | - Stéphane Nguembu
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Nathalie Ghomsi
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Neurosurgery Department, Felix Houphouet Boigny University, Abidjan, Côte d'Ivoire
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148
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Ishikawa M, Iwasaki M, Sakamoto A, Ma D. Anesthetics may modulate cancer surgical outcome: a possible role of miRNAs regulation. BMC Anesthesiol 2021; 21:71. [PMID: 33750303 PMCID: PMC7941705 DOI: 10.1186/s12871-021-01294-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
Background microRNAs (miRNAs) are single-stranded and noncoding RNA molecules that control post-transcriptional gene regulation. miRNAs can be tumor suppressors or oncogenes through various mechanism including cancer cell biology, cell-to-cell communication, and anti-cancer immunity. Main Body Anesthetics can affect cell biology through miRNA-mediated regulation of messenger RNA (mRNA). Indeed, sevoflurane was reported to upregulate miR-203 and suppresses breast cancer cell proliferation. Propofol reduces matrix metalloproteinase expression through its impact on miRNAs, leading to anti-cancer microenvironmental changes. Propofol also modifies miRNA expression profile in circulating extracellular vesicles with their subsequent anti-cancer effects via modulating cell-to-cell communication. Conclusion Inhalational and intravenous anesthetics can alter cancer cell biology through various cellular signaling pathways induced by miRNAs’ modification. However, this area of research is insufficient and further study is needed to figure out optimal anesthesia regimens for cancer patients.
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Affiliation(s)
- Masashi Ishikawa
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo, Tokyo, 113-8603, Japan. .,Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, 369 Fulham Rd, London, SW10 9NH, UK.
| | - Masae Iwasaki
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo, Tokyo, 113-8603, Japan.,Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, 369 Fulham Rd, London, SW10 9NH, UK
| | - Atsuhiro Sakamoto
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo, Tokyo, 113-8603, Japan
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, 369 Fulham Rd, London, SW10 9NH, UK
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149
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Laeke T, Tirsit A, Kassahun A, Sahlu A, Yesehak B, Getahun S, Zenebe E, Deyassa N, Moen BE, Lund-Johansen M, Sundstrøm T. Prospective Study of Surgery for Traumatic Brain Injury in Addis Ababa, Ethiopia: Surgical Procedures, Complications, and Postoperative Outcomes. World Neurosurg 2021; 150:e316-e323. [PMID: 33706016 DOI: 10.1016/j.wneu.2021.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is an important cause of trauma-related mortality and morbidity in Ethiopia. There are significant resource limitations along the entire continuum of care, and little is known about the neurosurgical activity and patient outcomes. METHODS All surgically treated TBI patients at the 4 teaching hospitals in Addis Ababa, Ethiopia were prospectively registered from October 2012 to December 2016. Data registration included surgical procedures, complications, reoperations, discharge outcomes, and mortality. RESULTS A total of 1087 patients were included. The most common procedures were elevation of depressed skull fractures (49.5%) and craniotomies (47.9%). Epidural hematoma was the most frequent indication for a craniotomy (74.7%). Most (77.7%) patients were operated within 24 hours of admission. The median hospital stay for depressed skull fracture operations or craniotomies was 4 days. Decompressive craniectomy was only done in 10 patients. Postoperative complications were seen in 17% of patients, and only 3% were reoperated. Cerebrospinal fluid leak was the most common complication (7.9%). The overall mortality was 8.2%. Diagnosis, admission Glasgow Coma Scale (GCS) score, surgical procedure, and complications were significant predictors of discharge GCS score (P < 0.01). Age, admission GCS score, and length of hospital stay were significantly associated with mortality (P ≤ 0.005). CONCLUSIONS The injury panorama, surgical activity, and outcome are significantly influenced by patient selection due to deficits within both prehospital and hospital care. Still, the neurosurgical services benefit a large number of patients in the greater Addis region and are qualitatively comparable with reports from high-income countries.
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Affiliation(s)
- Tsegazeab Laeke
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Abenezer Tirsit
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Azarias Kassahun
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Abat Sahlu
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Betelehem Yesehak
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Samuel Getahun
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Eyob Zenebe
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Negussie Deyassa
- School of Public Health, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Bente E Moen
- Department of Global Public Health and Primary Care, Center for International Health, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Terje Sundstrøm
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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150
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Wicaksono AS, Tamba DA, Sudiharto P, Basuki E, Pramusinto H, Hartanto RA, Ekong C, Manusubroto W. Neurosurgery residency program in Yogyakarta, Indonesia: improving neurosurgical care distribution to reduce inequality. Neurosurg Focus 2021; 48:E5. [PMID: 32114561 DOI: 10.3171/2019.12.focus19831] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Educating future neurosurgeons is of paramount importance, and there are many aspects that must be addressed within the process. One of the essential issues is the disproportion in neurosurgical care, especially in low- and middle-income countries (LMICs). As stated in their report "Global Surgery 2030," The Lancet Commission on Global Surgery has emphasized that the availability of adequate neurosurgical care does not match the burden of neurosurgical disease. A strong partnership with the local and national government is very desirable to improve the way everyone addresses this issue. In addition, international collaborative effort is absolutely essential for the transfer of knowledge and technology from a developed country to an LMIC. This paper shows what the authors have done in Yogyakarta to build an educational model that helps to improve neurosurgical care distribution in Indonesia and reduce the inequity between provinces. METHODS The authors gathered data about the number of neurosurgical procedures that were performed in the sister hospital by using data collected by their residents. Information about the distribution of neurosurgeons in Indonesia was adapted from the Indonesian Society of Neurological Surgeons. RESULTS The data show that there remains a huge disparity in terms of distribution of neurosurgeons in Indonesia. To tackle the issue, the authors have been able to develop a model of collaboration that can be applied not only to the educational purpose but also for establishing neurosurgical services throughout Indonesia. Currently they have signed a memorandum of understanding with four sister hospitals, while an agreement with one sister hospital has come to an end. There were more than 400 neurosurgical procedures, ranging from infection to trauma, treated by the authors' team posted outside of Yogyakarta. CONCLUSIONS Indonesia has a high level of inequality in neurological surgery care. This model of collaboration, which focuses on the development of healthcare providers, universities, and related stakeholders, might be essential in reducing such a disparity. By using this model, the authors hope they can be involved in achieving the vision of The Lancet Commission on Global Surgery, which is "universal access to safe, affordable surgical and anesthesia care when needed."
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Affiliation(s)
- Adiguno S Wicaksono
- 1Division of Neurosurgery, Department of Surgery, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia; and
| | - Daniel Agriva Tamba
- 1Division of Neurosurgery, Department of Surgery, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia; and
| | - Paulus Sudiharto
- 1Division of Neurosurgery, Department of Surgery, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia; and
| | - Endro Basuki
- 1Division of Neurosurgery, Department of Surgery, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia; and
| | - Handoyo Pramusinto
- 1Division of Neurosurgery, Department of Surgery, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia; and
| | - Rachmat Andi Hartanto
- 1Division of Neurosurgery, Department of Surgery, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia; and
| | - Chris Ekong
- 2Division of Neurosurgery, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Wiryawan Manusubroto
- 1Division of Neurosurgery, Department of Surgery, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia; and
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