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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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152
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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: 8] [Impact Index Per Article: 2.7] [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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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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155
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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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156
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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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157
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Lundy P, Miller C, Woodrow S. Current US neurosurgical resident involvement, interest, and barriers in global neurosurgery. Neurosurg Focus 2021; 48:E16. [PMID: 32114552 DOI: 10.3171/2019.12.focus19808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It is estimated that nearly 47 million preventable deaths occur annually due the current worldwide deficit in surgical care; subsequently, the World Health Organization resolved unanimously to endorse a decree to address this deficit. Neurosurgeons from industrialized nations can help address the needs of underserved regions. Exposure during training is critical for young neurosurgeons to gain experience in international work and to cultivate career-long interest. Here, the authors explore the opinions of current residents and interest in global neurosurgery as well as the current state of international involvement, opportunities, and barriers in North American residency training. METHODS An internet-based questionnaire was developed using the authors' university's REDCap database and distributed to neurosurgical residents from US ACGME (Accreditation Council for Graduate Medical Education)-approved programs. Questions focused on the resident's program's involvement and logistics regarding international rotations and the resident's interest level in pursuing these opportunities. RESULTS A 15% response rate was obtained from a broad range of training locations. Twenty-nine percent of respondents reported that their residency program offered elective training opportunities in developing countries, and 7.6% reported having participated in these programs. This cohort unanimously felt that the international rotation was a beneficial experience and agreed that they would do it again. Of those who had not participated, 81.3% reported interest or strong interest in international rotations. CONCLUSIONS The authors' results indicate that, despite a high level of desire for involvement in international rotations, there is limited opportunity for residents to become involved. Barriers such as funding and rotation approval were recognized. It is the authors' hope that governing organizations and residency programs will work to break down these barriers and help establish rotations for trainees to learn abroad and begin to join the cause of meeting global surgical needs. To meet overarching international neurosurgical needs, neurosurgeons of the future must be trained in global neurosurgery.
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158
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Igaga EN, Sendagire C, Ayebale ET. Task Sharing in Global Anesthesia and Surgery: Workforce Concerns. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-020-00433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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159
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Wang Y, Li H, Ye H, Xie G, Wu S, Song S, Cheng B, Fang X. Postoperative infectious complications in elderly patients after elective surgery in China: results of a 7-day cohort study from the International Surgical Outcomes Study. Psychogeriatrics 2021; 21:158-165. [PMID: 33415803 DOI: 10.1111/psyg.12648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
AIM Despite initiatives to increase elderly patients' access to surgical treatments, the prevalence and impact of postoperative infectious complications (PICs) in elderly patients in China are poorly described. The aim of our study was to describe PICs and associated mortality in elderly patients undertaking elective surgery in China. METHODS We analyzed data about elderly patients from China during the International Surgical Outcomes Study (ISOS), a 7-day prospective cohort study of outcomes after elective surgery in in-patient adults. All elderly patients (age ≥60 years) from 28 hospitals in China included in the ISOS study were included in this study as well. A review of 2014 elderly patients who underwent elective surgery in April 2014 was conducted. RESULTS Of 2014 elderly patients, 209 (10.4%) developed at least one postoperative complication. Infectious complications were most frequent, affecting 154 patients (7.6%); there was one death, or 0.6% 30-day mortality, which was a significantly higher rate than among patients without PICs (0%). The most frequent infectious complication was superficial surgical-site infection (3.3%). The length of hospital stay was longer in elderly patients with PICs than in those without PICs. Moreover, a total of 142 elderly patients (7.1%) were routinely sent to critical care after surgery, of whom 97 (68.3%) developed PICs. Compared to elderly patients admitted to a standard ward, those admitted to critical care immediately after surgery had a higher postoperative complication rate and critical care admission rate to treat complications. CONCLUSIONS The present prospective, multicentre study found that 7.6% of elderly patients in China had PICs after elective surgery that could prolong hospital stay and increase 30-day mortality. The clinical effectiveness of admission to critical care after surgery on elderly patients is not identified. Initiatives to increase elderly patients' access to surgical interventions should also enhance safe perioperative care to reduce PICs in China.
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Affiliation(s)
- Yan Wang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Li
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Ye
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guohao Xie
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuijing Wu
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shengwen Song
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Baoli Cheng
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiangming Fang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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O'Brien P, Bunzli S, Lin I, Bessarab D, Coffin J, Dowsey MM, Choong PFM. Addressing surgical inequity for Aboriginal and Torres Strait Islander people in Australia's universal health care system: a call to action. ANZ J Surg 2021; 91:238-244. [PMID: 33506978 DOI: 10.1111/ans.16557] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Abstract
Aboriginal and Torres Strait Islander people continue to experience health inequity within the Australian health care system. Little research has examined how disparities in surgical care access and outcomes contribute to Aboriginal health. In this narrative review and call to action, we discuss five care points along the journey to high-quality surgical care: health care seeking, primary health care services, specialist services, surgery and surgical outcomes. We highlight barriers and disparities that exist along this journey, drawing examples from the field of joint replacement surgery. Finally, we present opportunities for change at the health system, health service and clinician level, calling upon researchers, clinicians and policy makers to confront the surgical disparities experienced by Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Penny O'Brien
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ivan Lin
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Juli Coffin
- Social and Emotional Wellbeing of Aboriginal Young People, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Michelle M Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
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161
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Fagan JJ, Noronha V, Graboyes EM. Making the Best of Limited Resources: Improving Outcomes in Head and Neck Cancer. Am Soc Clin Oncol Educ Book 2021; 41:1-11. [PMID: 33793315 PMCID: PMC8059263 DOI: 10.1200/edbk_320923] [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] [Indexed: 12/26/2022]
Abstract
The overwhelming majority of head and neck cancers and related deaths occur in low- and middle-income countries, which have challenges related to burden of disease versus access to care. Yet the additional health care burden of the COVID-19 pandemic has also impacted access to care for patients with head and neck cancer in the United States. This article focuses on challenges and innovation in prioritizing head and neck cancer care in Sub-Saharan Africa, the Indian experience of value-added head and neck cancer care in busy and densely populated regions, and strategies to optimize the management of head and neck cancer in the United States during the COVID-19 pandemic.
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Affiliation(s)
- Johannes J. Fagan
- Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Evan Michael Graboyes
- Departments of Otolaryngology-Head and Neck Surgery and Public Health Sciences, Medical University of South Carolina, Charleston, SC
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162
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Agasaro O, Munezero G, Wong R, Hirwa A, Bekele A. Assessment of Delays in Emergency Surgical Care and Patient Postoperative Outcomes at a Referral Hospital in Northern Rwanda. World J Surg 2021; 45:1678-1685. [PMID: 33635340 DOI: 10.1007/s00268-021-06013-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgical interventions are cost-effective methods to save lives and prevent disabilities. Surgical delays and access to three Bellwether procedures are key monitoring indicators for universal access to safe and affordable surgical and anesthesia care and health system performance. This study assessed the delays in receiving surgical and anesthesia care for emergency surgical patients at a district hospital in Northern Rwanda. METHODS A questionnaire was used to survey all emergency surgical patients who presented at the hospital between May and July 2020, to assess the delays in seeking (first) and reaching (second) care. In-hospital (third) delay and patient outcomes within the first 7 days postsurgery were collected by patient file auditing. Factors associated with third delay were identified through healthcare provider in-depth interviews. RESULTS A total of 106 patients were surveyed, and nine healthcare providers were interviewed. The median was less than a day for first delay, 1 day for second delay, and 16.5 h for third delay for all emergency procedures. 20% of the Bellwether procedures were performed within two hours after arriving at the hospital. Factors affecting the delays included visiting a traditional healer, district of residence, referral system, income status, as well as shortage of surgeons and specialists, surgical supplies, and operating theaters. CONCLUSION Further research to study the cause of delays within the referral system is needed. Surgical outreach, equipment, and infrastructure would help to shorten in-hospital delays. Longer-term follow-up studies on patient complications and outcomes due to delay in surgical care are needed.
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Affiliation(s)
- Orietta Agasaro
- University of Global Health Equity, Kigali, PO Box 6955, Kigali, Rwanda.
| | | | - Rex Wong
- University of Global Health Equity, Kigali, PO Box 6955, Kigali, Rwanda.,School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
| | | | - Abebe Bekele
- University of Global Health Equity, Kigali, PO Box 6955, Kigali, Rwanda
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163
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Gachabayov M, Latifi LA, Rivera R, Baluyot FS, Latifi R. A Cost-Benefit Analysis of an Overseas Volunteer Mission to the Local Healthcare System. Am Surg 2021; 88:1680-1688. [PMID: 33635086 DOI: 10.1177/0003134821998683] [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: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to comparatively evaluate the sustainability and cost-benefit of the Operation Giving Back Bohol surgical volunteerism mission (SVM) carried out in Bohol Province, Philippines, over twelve consecutive missions. METHODS This was a cost-benefit analysis of prospectively collected financial data from twelve consecutive surgical volunteerism missions held between 2006 and 2018. The overall cost of an SVM and cost per patient were the endpoints of interest. Disability-adjusted life years (DALYs) and costs thereof were calculated for each patient undergoing surgery in the twelve SVMs. RESULTS A mean of 112 ± 22 patients were included per year of the SVM. A statistically significant increasing trend in the overall cost of SVMs over time was found (R2 = .469; P = .014). A nonsignificant decreasing trend in the cost per patient over time was found (R2 = .007; P = .795). A total of 8811.71 DALYs were averted in the twelve SVMs. DALYs averted per year ranged between 474.02 (2009) and 969.16 (2012). Cost per a DALY averted ranged between $466.9 (2006) and $865.6 (2009). Comparison of the latter with GDP per capita showed that this SVM was "very cost-effective." CONCLUSION The SVM contributes substantially to the health care system both clinically and financially. A total of 8812 DALYs were averted in these twelve SVMs. Costs per a DALY averted did not significantly change over the mission years. Increasing the number of patients served has increased the total cost of the mission with no impact on the cost per patient.
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Affiliation(s)
- Mahir Gachabayov
- Department of Surgery, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Lulejeta A Latifi
- Department of Surgery, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Renato Rivera
- Operation Giving Back Bohol, USA.,Department of Surgery, St. Joseph Hospital, Breese, IL, USA
| | | | - Rifat Latifi
- Department of Surgery, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA.,Operation Giving Back Bohol, USA
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Okoroh JS, Riviello R. Challenges in healthcare financing for surgery in sub-Saharan Africa. Pan Afr Med J 2021; 38:198. [PMID: 33995804 PMCID: PMC8106793 DOI: 10.11604/pamj.2021.38.198.27115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/05/2021] [Indexed: 01/14/2023] Open
Abstract
One-third of the global burden of disease is attributed to surgical conditions yet, 5 billion people globally, lack access to surgery. The Lancet Commission on Global Surgery, Obstetrics, and Anesthesia (LCOGS) published guidelines for improving access by reducing catastrophic health expenditures (CHEs) by 2030. This is especially important in sub-Saharan Africa (SSA) where 90% of the extreme poor reside. In this paper, we provide a narrative review of four studies on CHEs for surgical care in SSA published since 2015. We discuss healthcare financing in the countries and summarize the authors’ key findings of out-of-pocket payments (OOP) and CHEs. Briefly, the studies enrolled 130 to 300 patients and collected direct OOPs via chart review of health costs or patient interviews. Indirect costs were calculated from lost wages and transportation costs. CHEs were defined as health costs exceeding 10% of the GDP per capita or the household income. Despite healthcare being reported as free in all studies, 60%-90% of surgical patients had CHEs with all costs considered. OOPs persists for medicines and anesthesia that should be covered under any health insurance scheme. In some cases, indirect costs associated with transportation and wages were major drivers of CHEs for surgery. Without addressing these gaps in coverage, more people will risk impoverishment in seeking surgical care in SSA.
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Affiliation(s)
- Juliet Siena Okoroh
- University of Alabama, Department of Surgery, Birmingham, Alabama, United States of America
| | - Robert Riviello
- Brigham and Women´s Hospital, Division of Trauma, Burn, Surgical Critical Care, Boston, Massachusetts, United States of America
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165
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Neuroimmune Regulation of Surgery-Associated Metastases. Cells 2021; 10:cells10020454. [PMID: 33672617 PMCID: PMC7924204 DOI: 10.3390/cells10020454] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023] Open
Abstract
Surgery remains an essential therapeutic approach for most solid malignancies. Although for more than a century accumulating clinical and experimental data have indicated that surgical procedures themselves may promote the appearance and progression of recurrent and metastatic lesions, only in recent years has renewed interest been taken in the mechanism by which metastasizing of cancer occurs following operative procedures. It is well proven now that surgery constitutes a risk factor for the promotion of pre-existing, possibly dormant micrometastases and the acceleration of new metastases through several mechanisms, including the release of neuroendocrine and stress hormones and wound healing pathway-associated immunosuppression, neovascularization, and tissue remodeling. These postoperative consequences synergistically facilitate the establishment of new metastases and the development of pre-existing micrometastases. While only in recent years the role of the peripheral nervous system has been recognized as another contributor to cancer development and metastasis, little is known about the contribution of tumor-associated neuronal and neuroglial elements in the metastatic disease related to surgical trauma and wound healing. Specifically, although numerous clinical and experimental data suggest that biopsy- and surgery-induced wound healing can promote survival and metastatic spread of residual and dormant malignant cells, the involvement of the tumor-associated neuroglial cells in the formation of metastases following tissue injury has not been well understood. Understanding the clinical significance and underlying mechanisms of neuroimmune regulation of surgery-associated metastasis will not only advance the field of neuro–immuno–oncology and contribute to basic science and translational oncology research but will also produce a strong foundation for developing novel mechanism-based therapeutic approaches that may protect patients against the oncologically adverse effects of primary tumor biopsy and excision.
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Agarwal-Harding KJ, Kapadia A, Banza LN, Chawinga M, Mkandawire N, Kwon JY. Improving Management of Adult Ankle Fractures in Malawi: An Assessment of Providers' Knowledge and Treatment Strategies. J Bone Joint Surg Am 2021; 103:326-334. [PMID: 33369982 PMCID: PMC8444219 DOI: 10.2106/jbjs.20.00660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The burden of musculoskeletal trauma is increasing worldwide, especially in low-income countries such as Malawi. Ankle fractures are common in Malawi and may receive suboptimal treatment due to inadequate surgical capacity and limited provider knowledge of evidence-based treatment guidelines. METHODS This study was conducted in 3 phases. First, we assessed Malawian orthopaedic providers' understanding of anatomy, injury identification, and treatment methods. Second, we observed Malawian providers' treatment strategies for adults with ankle fractures presenting to a central hospital. These patients' radiographs underwent blinded, post hoc review by 3 U.S.-based orthopaedic surgeons and a Malawian orthopaedic surgeon, whose treatment recommendations were compared with actual treatments rendered by Malawian providers. Third, an educational course addressing knowledge deficits was implemented. We assessed post-course knowledge and introduced a standardized management protocol, specific to the Malawian context. RESULTS In Phase 1, deficits in injury identification, ideal treatment practices, and treatment standardization were identified. In Phase 2, 17 (35%) of 49 patients met operative criteria but did not undergo a surgical procedure, mainly because of resource limitations and provider failure to recognize unstable injuries. In Phase 3, 51 (84%) of 61 participants improved their overall performance between the pre-course and post-course assessments. Participants answered a mean of 32.4 (66%) of 49 questions correctly pre-course and 37.7 (77%) of 49 questions correctly post-course, a significant improvement of 5.2 more questions (95% confidence interval [CI], 3.8 to 6.6 questions; p < 0.001) answered correctly. Providers were able to identify 1 more injury correctly of 8 injuries (mean, 1.1 questions [95% CI, 0.6 to 1.6 questions]; p < 0.001) and to identify 1 more ideal treatment of the 7 that were tested (mean, 1.0 question [95% CI, 0.5 to 1.4 questions]; p < 0.001). CONCLUSIONS Adult ankle fractures in Malawi were predominantly treated nonoperatively despite often meeting evidence-based criteria for surgery. This was due to resource limitations, knowledge deficits, and lack of treatment standardization. We demonstrated a comprehensive approach to examining the challenges of providing adequate orthopaedic care in a resource-limited setting and the successful implementation of an educational intervention to improve care delivery. This approach can be adapted for other conditions to improve orthopaedic care in low-resource settings.
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Affiliation(s)
- Kiran J Agarwal-Harding
- Harvard Global Orthopaedics Collaborative, Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
- The Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ami Kapadia
- University of Texas Southwestern School of Medicine, Dallas, Texas
| | | | - Mabvuto Chawinga
- Department of Orthopedics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Nyengo Mkandawire
- Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - John Y Kwon
- Division of Foot and Ankle Surgery, Department of Orthopaedics, Beth Israel Deaconess Hospital, Boston, Massachusetts
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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Bhatia MB, Mohan SC, Blair KJ, Boeck MA, Bhalla A, Sharma S, Helenowski I, Tatebe LC, Nwomeh BC, Swaroop M. Surgical and Trauma Capacity Assessment in Rural Haryana, India. Ann Glob Health 2021; 87:15. [PMID: 33614421 PMCID: PMC7879992 DOI: 10.5334/aogh.3173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Trauma is a major global health problem and majority of the deaths occur in low- and middle-income countries (LMICs), at even higher rates in the rural areas. The three-delay model assesses three different delays in accessing healthcare and can be applied to improve surgical and trauma healthcare delivery. Prior to implementing change, the capacities of the rural India healthcare system need to be identified. Objective The object of this study was to estimate surgical and trauma care capacities of government health facilities in rural Nanakpur, Haryana, India using the Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT) tools. Methods The PIPES and INTACT tools were administered at eight government health facilities serving the population of Nanakpur in June 2015. Data analysis was performed per tool subsection, and an overall score was calculated. Higher PIPES or INTACT indices correspond to greater surgical or trauma care capacity, respectively. Findings Surgical and trauma care capacities increased with higher levels of care. The median PIPES score was significantly higher for tertiary facilities than primary and secondary facilities [13.8 (IQR 9.5, 18.2) vs. 4.7 (IQR 3.9, 6.2), p = 0.03]. The lower-level facilities were mainly lacking in personnel and procedures. Conclusions Surgical and trauma care capacities at healthcare facilities in Haryana, India demonstrate a shortage of surgical resources at lower-level centers. Specifically, the Primary Health Centers were not operating at full capacity. These results can inform resource allocation, including increasing education, across different facility levels in rural India.
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Affiliation(s)
- Manisha B. Bhatia
- Indiana University, School of Medicine, Department of Surgery, Indianapolis, IN, US
| | | | - Kevin J. Blair
- University of California Los Angeles, Department of Surgery, Los Angeles, USA
| | - Marissa A. Boeck
- University of California San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Ashish Bhalla
- Postgraduate Institute of Medical Education and Research, Chandigarh, IN
| | - Sristi Sharma
- University of Colorado, Department of Surgery, Denver, Colorado, USA
| | - Irene Helenowski
- Northwestern University Feinberg School of Medicine, Department of Preventative Medicine, Chicago, USA
| | - Leah C. Tatebe
- Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, USA
- Department of Trauma, Cook County Health, Chicago, IL, USA
| | - Benedict C. Nwomeh
- Surgeons Overseas, New York, NY, US
- Ohio State University, Nationwide Children’s Hospital, Department of Pediatric Surgery, Columbus, USA
| | - Mamta Swaroop
- Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, USA
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168
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Drevin G, Albutt K, Baluku M, Tuhumwiire C, Deng H, Musinguzi N, Modest V, Ngonzi J, Ttendo S, Firth P. Outcome Measurement at a Ugandan Referral Hospital: Validation of the Mbarara Surgical Services Quality Assurance Database. World J Surg 2021; 44:2550-2556. [PMID: 32333160 DOI: 10.1007/s00268-020-05537-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Five billion people lack access to surgery. Accurate and complete data have been identified as essential to the global scale-up of perioperative care. This study retrospectively validates the Mbarara Surgical Services Quality Assurance Database (SQUAD), an electronic outcomes database at a Ugandan secondary referral hospital. METHODS SQUAD data were compared to paper records from August 2013 to January 2017. To assess data entry accuracy, two researchers independently extracted 24 patient variables from 170 charts. To assess completeness of patient capture, SQUAD entries were compared to a sample of charts returned to the Medical Records Department, and to a sample of entries in ward and operating room logbooks. Two-tailed binomial proportions with 95% CI were calculated from the comparative results of patient observations, against a predefined accuracy of 0.85-0.95. RESULTS Agreement between completed validation observations from charts and SQUAD data was 91.5% (n = 3734/4080 data points). Binomial tests indicated that 15 variables had higher than 95% accuracy. A total 19 of 24 variables had ≥ 85% accuracy. The completeness of SQUAD patient capture was 98.2% (n = 167/170) of charts returned to the Medical Records Department, 97.5% (n = 198/203) of operating logbook entries, and 100% (n = 111/111) of ward logbook entries, respectively. CONCLUSION SQUAD closely reflects the primary surgical and anaesthetic data at a Ugandan secondary hospital. Data accuracy of key variables and completeness of population capture were comparable to those of databases in high-income countries and outperformed those of other low- and middle-income countries.
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Affiliation(s)
- Gustaf Drevin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department for Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katherine Albutt
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Moris Baluku
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Caleb Tuhumwiire
- Department of Surgery, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Nicholas Musinguzi
- Harvard-Mbarara University of Science and Technology Collaborative, Mbarara, Uganda
| | - Vicki Modest
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stephen Ttendo
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul Firth
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
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Vora K, Saiyed S, Shah AR, Mavalankar D, Jindal RM. Surgical Unmet Need in a Low-Income Area of a Metropolitan City in India: A Cross-Sectional Study. World J Surg 2021; 44:2511-2517. [PMID: 32253465 DOI: 10.1007/s00268-020-05502-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We investigated the burden of surgical conditions, level of unmet needs and reasons for non-utilization of surgical services in a slum of Ahmedabad, India. METHODS A community-based cross-sectional study was carried out from August to December 2019. Inclusion criteria was age > 14 years; any type of injury/condition that requires surgery; subject has had surgery in last 1 year, and death information of family members. Data were stored and coded in Microsoft excel and exported to IBM SPSS statistics version 25 software for data analysis. Frequencies and proportions (categorical variable) are used to summarize utilization of surgical services and understanding surgical need. The Surgeons Overseas Assessment of Surgical was used to identify surgical met and unmet needs translated into local language. Open Data Kit software was used to install questionnaire in the "Tablet" to collect information and stress-free workflow in field. RESULTS Out of 10,330 population in 2066 households, 7914 were more than 14 years of age. 3.46% (n = 274) people needed surgery; 116 did not avail surgery and were categorized in "unmet need." Fifty percent of individuals with surgical needs had abdominal- or extremities-related problems followed by eyes surgery need (14%); back, chest and breast surgical need was 13.5%. Seventeen percent of participants with surgical needs had wounds related to injury or accident while 63% had wounds that were not related to injury. Almost all participants had gone to a physician to seek healthcare, however 42% did not avail surgical care needed for a variety of reasons. Forty-six percent of participants needing surgical care underwent major surgical procedure, while 11% had minor procedures. Financial reasons (34.5%) and lack of trust (35.3%) were major reasons for not availing surgical care. CONCLUSIONS AND RELEVANCE Ahmedabad is a relatively high income metropolitan city, has universally free health care and multiple healthcare facilities. Despite this, we have shown that there is significant unmet need for surgical procedures in the low-income population. A unique finding was that most patients sought a consultation but approximately 50% did not avail of the free surgical procedures under the universally free health care system in this city. We propose creation of community healthcare workers focused on surgical conditions.
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Affiliation(s)
- Kranti Vora
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Shahin Saiyed
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Ankita R Shah
- Indian Institute of Technology, Gandhinagar, Gujarat, India
| | | | - Rahul M Jindal
- Surgery and Global Health, USU-Walter Reed Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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Editorial: Developing world perspectives in otolaryngology: infectious complications in otolaryngology. Curr Opin Otolaryngol Head Neck Surg 2021; 28:172-173. [PMID: 32332208 DOI: 10.1097/moo.0000000000000625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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171
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Hoefsmit PC, Cerfolio RJ, de Vries R, Dahele M, Zandbergen HR. Systematic Review of Interventions to Reduce Operating Time in Lung Cancer Surgery. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2021; 15:1179554920987105. [PMID: 33795942 PMCID: PMC7970684 DOI: 10.1177/1179554920987105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/17/2020] [Indexed: 12/25/2022]
Abstract
Introduction: Operating rooms are a scarce resource but often used inefficiently. Operating room efficiency emerges as an important part of maximizing surgical capacity and productivity, minimizing delays, and optimizing lung cancer outcomes. The operative time (time between patient entering and leaving the operating room) is discrete and the one that the surgical team can most directly influence. We performed a systematic review to evaluate the literature and identify methods to improve the efficiency of the intraoperative phase of operations for lung cancer. Methods: A literature search (in PubMed, Embase, Cochrane, and Scopus) was performed from inception up to March 9, 2020, according to the methodology described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Results: We identified 3 articles relevant to the intraoperative phase of lung cancer operating room efficiency. All 3 were consistent in showing clinically relevant time reductions in the intraoperative phase or procedures relevant to this phase. The authors demonstrated that the application of various improvement methodologies resulted in a substantial reduction in operative time, which was associated with a reduction in complications, and improved staff morale. Conclusions: Our systematic review found that various improvement methodologies have the potential to significantly reduce operative time for lung cancer surgery. This increases the value of lung cancer surgery. These findings are consistent with the wider literature on improving surgical efficiency.
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Affiliation(s)
- Paulien C Hoefsmit
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, USA
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - H Reinier Zandbergen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Bergkvist E, Zimunhu T, Mbanje C, Hagander L, Muguti GI. Nutritional status and outcome of surgery: A prospective observational cohort study of children at a tertiary surgical hospital in Harare, Zimbabwe. J Pediatr Surg 2021; 56:368-373. [PMID: 33131772 DOI: 10.1016/j.jpedsurg.2020.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Undernutrition contributes to nearly 50% of all child deaths in the world, yet there is conflicting evidence regarding the association between nutritional status and postoperative complications. The aim was to describe the preoperative nutritional status among pediatric surgery patients in Zimbabwe, and to assess if nutritional status was a risk factor for adverse postoperative outcome of mortality, surgical site infection, reoperation, readmission, and longer length of stay. METHODS This prospective observational cohort study included 136 children undergoing surgery at a tertiary pediatric hospital in Zimbabwe. Nutritional status was standardized using Z-scores for BMI, length, weight, and middle upper arm circumference. Primary outcomes after 30 days included mortality, surgical site infection, reoperation, and readmission. Secondary outcome was length of stay. Univariate and multivariable analyses with logistic regression were performed. RESULTS Of the 136 patients, 31% were undernourished. Postoperative adverse outcome occurred in 20%; the mortality rate was 6%, the surgical site infection rate was 17%, the reoperation rate was 3.5%, and readmission rate was 2.5%. Nutritional status, higher ASA classification, major surgical procedures, and lower preoperative hemoglobin levels were associated with adverse outcome. Univariate logistic regression identified a seven-fold increased risk of postoperative complications among undernourished children (OR 7.3 [2.3-22.8], p = 0.001), and there was a four- to six-fold increased adjusted risk after adjustment for ASA, major surgery, and preoperative hemoglobin. CONCLUSION A third of all pediatric surgery patients were undernourished, and undernourished children had a considerably higher risk of adverse outcome. With a positive correlation identified between undernourishment and increased postoperative complications, future aims would include assessing if preoperative nutritional treatment could be especially beneficial for undernourished children. LEVELS OF EVIDENCE Level II treatment study.
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Affiliation(s)
- Emil Bergkvist
- Pediatric surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Taurai Zimunhu
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe, Africa
| | - Chenesa Mbanje
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe, Africa
| | - Lars Hagander
- Pediatric surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - G I Muguti
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe, Africa.
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173
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Agarwal V, Muthuchellappan R, Shah BA, Rane PP, Kulkarni AP. Postoperative Outcomes Following Elective Surgery in India. Indian J Crit Care Med 2021; 25:528-534. [PMID: 34177172 PMCID: PMC8196380 DOI: 10.5005/jp-journals-10071-23807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The incidence of complications and mortality in patients undergoing elective surgery in India are unknown. We contributed Indian data to ISOS. Since there were fewer than ten centers, Indian data were not included in the primary analysis. We report postoperative outcomes in the Indian data set of patients following elective surgery. Materials and methods In this prospective 7-day observational study, after obtaining a waiver of informed consent, data were collected for 30 days from consecutive patients >18 years undergoing elective surgery. The primary outcome was in-hospital postoperative complications. The secondary outcomes were in-hospital all-cause mortality, the relationship between postoperative complications and admission to critical care, and the duration of hospital stay. Complications were graded as mild, moderate, and severe. Failure to rescue was defined as mortality in patients admitted to an intensive care unit (ICU) for the treatment of complications. Results Complications occurred in 57 (27.5%) patients, who were older (53 vs 47 years, p < 0.001) and had American Society of Anaesthesiologists grades III and IV physical status (p = 0.029). One hundred and thirty-eight (65.7%) patients underwent a major surgical procedure of which 132 (62.8%) procedures were done for malignancy. Postoperative complications were significantly higher (41.5% vs 22.7%) in patients electively admitted to ICU. The overall mortality rate was 2.4%, whereas the mortality rate was 8.8% in those who developed complications. Conclusion We found that 28% of patients developed postoperative complications. The overall mortality was 2.4% but was higher (8.8%) in those who developed complications. Age and complex surgical procedures independently predicted complications, while lower preoperative hemoglobin appeared to be protective. Study Registration ISRCTN51817007. How to cite this article Agarwal V, Muthuchellappan R, Shah BA,Rane PP, Kulkarni AP, et al. Postoperative Outcomes Following Elective Surgery in India. Indian J Crit Care Med 2021;25(5):528-534.
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Affiliation(s)
- Vandana Agarwal
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Radhakrishnan Muthuchellappan
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Bhagyesh A Shah
- Department of Intensive Care Medicine, CIMS Hospital, Care Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | - Pallavi P Rane
- Clinical Research Secretariat, Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Navi Mumbai, Maharashtra, India
| | - Atul P Kulkarni
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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The Globalization of Diverticulitis: A "Tic"-ing Time Bomb? Dis Colon Rectum 2021; 64:7-9. [PMID: 33306524 DOI: 10.1097/dcr.0000000000001832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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175
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Surgical Task-Sharing to Non-specialist Physicians in Low-Resource Settings Globally: A Systematic Review of the Literature. World J Surg 2020; 44:1368-1386. [PMID: 31915975 DOI: 10.1007/s00268-019-05363-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND As the global community increasingly recognizes the large and unmet burden of surgical disease, a new emphasis is being placed on strengthening the health system at the first-level hospital. The shortage of surgical care providers at this district and rural level can be met by surgical task-shifting/sharing to non-physician clinicians (NPCs) and non-specialist physicians (NSPs). While the role of NPCs in low-middle-income countries (LMICs), in particular in sub-Saharan Africa (SSA), has been well documented in the literature, there has been little focus on NSPs. In addition to providing essential surgical services, this physician cadre also practices generalist medicine, an advantage at the first-level hospital. The present study seeks to explore where, across all country income groups, NSPs are providing surgical services and what additional surgical training, if any, is available in each identified country. METHODS A systematic review of the literature was performed, following PRISMA guidelines. Medline, EMBASE, EBM Reviews, and CINAHL were searched. Including hand-searching for further references, 53 publications met inclusion/exclusion criteria and were identified for data extraction purposes. Gray literature was also explored within the time limits for this study. RESULTS Surgical task-shifting/sharing to NSPs occurs across all country income groups; some provide surgical obstetrics, while others also provide a broader scope of surgical services. Within LMIC countries, the majority are in SSA. In SSA, 16 of 54 countries were included in the reviewed articles, only 4 of which (Ethiopia, Niger, Nigeria, and Sierra Leone) have a formal surgical program beyond the regular medical officer/general practitioner training. Canada and Australia have established programs for both surgical obstetrics and the broader scope, while the USA has several programs for surgical obstetrics and is developing a new, broad-scope program. CONCLUSION This study has demonstrated that NSPs are providing surgical services across all income groups, with varying degrees of additional training specific to the surgical needs of their district/rural location. To "close the gap" in needed surgical services at the first-level hospital, more task-sharing needs to occur to both NSPs (the focus of this study) and NPCs. Collaboration between practitioners and training programs, given the shared challenges and practice environments, would help support task-sharing at the first-level hospital and improve access to the 5 billion underserved people.
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Maintaining Access to Orthopaedic Surgery During Periods of Operating Room Resource Constraint: Expanded Use of Wide-Awake Surgery During the COVID-19 Pandemic. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00100. [PMID: 33332853 PMCID: PMC7743835 DOI: 10.5435/jaaosglobal-d-20-00100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Wide-awake local anesthesia no tourniquet (WALANT) presents a nonstandard anesthetic approach initially described for use in hand surgery that has gained interest and utilization across a variety of orthopaedic procedures. In response to operating room resource constraints imposed by the COVID-19 pandemic, our orthopaedic service rapidly adopted and expanded its use of WALANT. METHODS A retrospective review of 16 consecutive cases performed by 7 surgeons was conducted. Patient demographics, surgical details, and perioperative outcomes were assessed. The primary end point was WALANT failure, defined as intraoperative conversion to general anesthesia. RESULTS No instances of WALANT failure requiring conversion to general anesthesia occurred. In recovery, one patient (6%) required narcotics for pain control, and the average postoperative pain numeric rating scale was 0.6. The maximum pain score experienced was 4 in the patient requiring postoperative narcotics. The average time in recovery was 42 minutes and ranged from 8 to 118 minutes. CONCLUSION The WALANT technique was safely and effectively used in 16 cases across multiple orthopaedic subspecialties, including three procedures not previously described in the literature. WALANT techniques hold promise for use in future disaster scenarios and should be evaluated for potential incorporation into routine orthopaedic surgical care.
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Utilizing Machine Learning Methods for Preoperative Prediction of Postsurgical Mortality and Intensive Care Unit Admission. Ann Surg 2020; 272:1133-1139. [PMID: 30973386 PMCID: PMC7668340 DOI: 10.1097/sla.0000000000003297] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: To compare the performance of machine learning models against the traditionally derived Combined Assessment of Risk Encountered in Surgery (CARES) model and the American Society of Anaesthesiologists-Physical Status (ASA-PS) in the prediction of 30-day postsurgical mortality and need for intensive care unit (ICU) stay >24 hours. Background: Prediction of surgical risk preoperatively is important for clinical shared decision-making and planning of health resources such as ICU beds. The current growth of electronic medical records coupled with machine learning presents an opportunity to improve the performance of established risk models. Methods: All patients aged 18 years and above who underwent noncardiac and nonneurological surgery at Singapore General Hospital (SGH) between 1 January 2012 and 31 October 2016 were included. Patient demographics, comorbidities, preoperative laboratory results, and surgery details were obtained from their electronic medical records. Seventy percent of the observations were randomly selected for training, leaving 30% for testing. Baseline models were CARES and ASA-PS. Candidate models were trained using random forest, adaptive boosting, gradient boosting, and support vector machine. Models were evaluated on area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC). Results: A total of 90,785 patients were included, of whom 539 (0.6%) died within 30 days and 1264 (1.4%) required ICU admission >24 hours postoperatively. Baseline models achieved high AUROCs despite poor sensitivities by predicting all negative in a predominantly negative dataset. Gradient boosting was the best performing model with AUPRCs of 0.23 and 0.38 for mortality and ICU admission outcomes respectively. Conclusions: Machine learning can be used to improve surgical risk prediction compared to traditional risk calculators. AUPRC should be used to evaluate model predictive performance instead of AUROC when the dataset is imbalanced.
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Truche P, NeMoyer RE, Patiño-Franco S, Herrera-Escobar JP, Torres M, Pino LF, Peck GL. Publicly funded interfacility ambulance transfers for surgical and obstetrical conditions: A cross sectional analysis in an urban middle-income country setting. PLoS One 2020; 15:e0241553. [PMID: 33156837 PMCID: PMC7647066 DOI: 10.1371/journal.pone.0241553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Interfacility transfers may reflect a time delay of definitive surgical care, but few studies have examined the prevalence of interfacility transfers in the urban low- and middle-income (LMIC) setting. The aim of this study was to determine the number of interfacility transfers required for surgical and obstetric conditions in an urban MIC setting to better understand access to definitive surgical care among LMIC patients. Methods A retrospective analysis of public interfacility transfer records was conducted from April 2015 to April 2016 in Cali, Colombia. Data were obtained from the single municipal ambulance agency providing publicly funded ambulance transfers in the city. Interfacility transfers were defined as any patient transfer between two healthcare facilities. We identified the number of transfers for patients with surgical conditions and categorized transfers based on patient ICD-9-CM codes. We compared surgical transfers from public vs. private healthcare facilities by condition type (surgical, obstetric, nonsurgical), transferring physician specialty, and transfer acuity (code blue, emergent, urgent and nonurgent) using logistic regression. Results 31,659 patient transports occurred over the 13-month study period. 22250 (70.2%) of all transfers were interfacility transfers and 7777 (35%) of transfers were for patients with surgical conditions with an additional 2,244 (10.3%) for obstetric conditions. 49% (8660/17675) of interfacility transfers from public hospitals were for surgical and obstetric conditions vs 32% (1466/4580) for private facilities (P<0.001). The most common surgical conditions requiring interfacility transfer were fractures (1,227, 5.4%), appendicitis (913, 4.1%), wounds (871, 3.9%), abdominal pain (818, 3.6%), trauma (652, 2.9%), and acute abdomen (271, 1.2%). Conclusion Surgical and obstetric conditions account for nearly half of all urban interfacility ambulance transfers. The most common reasons for transfer are basic surgical conditions with public healthcare facilities transferring a greater proportion of patient with surgical conditions than private facilities. Timely access to an initial healthcare facility may not be a reliable surrogate of definitive surgical care given the substantial need for interfacility transfers.
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Affiliation(s)
- Paul Truche
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
- * E-mail:
| | - Rachel E. NeMoyer
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | | | - Juan P. Herrera-Escobar
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Myerlandi Torres
- Red de Salud del Centro, Pool Ambulancias Públicas, Cali, Colombia
| | - Luis F. Pino
- Department of Surgery, Universidad Del Valle, Cali, Colombia
| | - Gregory L. Peck
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
- Department of Health Systems and Policy, Rutgers School of Public Health, Piscataway, New Jersey, United States of America
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Roa L, Velin L, Tudravu J, McClain CD, Bernstein A, Meara JG. Climate change: challenges and opportunities to scale up surgical, obstetric, and anaesthesia care globally. Lancet Planet Health 2020; 4:e538-e543. [PMID: 33159881 DOI: 10.1016/s2542-5196(20)30247-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/16/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
Climate change affects human health in a myriad of ways, requiring reassessment of the nature of scaling up care delivery and the effect that care delivery has on the environment. 5 billion people do not have access to safe and timely surgical care, and the quantity and severity of conditions that require surgical, obstetric, and anaesthesia care will increase substantially as a result of climate change. However, surgery is resource intensive and contributes substantially to greenhouse-gas emissions. In response to climate change, the surgical, obstetric, and anaesthesia community has a key role to play to ensure that a scale-up of service delivery incorporates mitigation and adaptation strategies. As countries scale up surgical care, understanding the implications of surgery on climate change and the implications of climate change on surgical care will be crucial in the development of health policies.
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Affiliation(s)
- Lina Roa
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.
| | - Lotta Velin
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Surgery and Public Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Craig D McClain
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Aaron Bernstein
- Center for Climate, Health and the Global Environment, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA; Climate and Health Initiative, Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
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Ensor T, Virk A, Aruparayil N. Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery. BMJ Open 2020; 10:e038470. [PMID: 33093032 PMCID: PMC7583072 DOI: 10.1136/bmjopen-2020-038470] [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 There continues to be a large gap between need and actual use of surgery in low-resource settings. While policy frequently focuses on expanding the supply of services, demand-side factors are at least as important in determining under utilisation and over utilisation. The aim of this study is to understand how these factors influence the use of selected essential obstetric and gynaecological surgical procedures in the underserved and remote setting of North-East India. METHODS The study combines and makes use of data from a variety of surveys and routine systems. Descriptive analysis of variations in caesarean section, hysterectomy and sterilisation and then multivariate logit analysis of demand-side and supply-side factors on access to these services is undertaken. RESULTS Surgical rates vary substantially both across and within North-East India, correlated with service capacity and socioeconomic status. Travel times to surgical facilities are associated with rates of caesarean section and hysterectomy but not sterilisation where services are much more deconcentrated. Travel is less important for surgery in private facilities where capacity is much more dispersed but dominated by the non-poor. The presence of non-doctor medical staff is associated with lower levels of surgical activity. CONCLUSION In low resource, remote settings policy interventions to improve access to services must recognise that surgical rates in low-resource settings are heavily influenced by demand-side factors. As well as boosting services, mechanisms need to mitigate demand-side barriers particularly distance and influence practice to encourage surgical intervention only where clinically indicated.
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Affiliation(s)
- Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Amrit Virk
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Noel Aruparayil
- Leeds Institute of Medical Research at St James', University of Leeds, Leeds, West Yorkshire, UK
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Dohlman LE, Kwikiriza A, Ehie O. Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings. Local Reg Anesth 2020; 13:147-158. [PMID: 33122941 PMCID: PMC7588832 DOI: 10.2147/lra.s236550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/29/2020] [Indexed: 01/19/2023] Open
Abstract
Safe and accessible surgical and anesthetic care is critically limited for over half of the world's population, particularly in Sub-Saharan African and Southeast Asian countries. Increasing the use of regional anesthesia in these areas has potential benefits regarding access, safety, and cost-effectiveness. Perioperative anesthesia-related mortality is significantly higher in resource-limited countries and every effort should be made to encourage the use of anesthetic techniques in these countries that are safest under the present conditions. Studies from Sub-Saharan Africa, although limited in number, have shown a lower risk of death with regional compared to general anesthesia. Regional anesthesia has the further benefit of decreasing the risk of COVID-19 spread to healthcare providers by avoiding the aerosol-generating procedures that occur during general anesthesia. Neuraxial regional anesthesia is relatively easy to teach and perform and is considered the anesthetic of choice for surgeries below the umbilicus in resource-limited settings due to its safety, efficacy, and low cost. Although regional anesthesia has multiple potential advantages, education and training of anesthetic providers in low-and-middle-income countries (LMIC) are a significant barrier to growth. Anesthesia professionals, especially in Sub-Saharan Africa, are often poorly supported and undervalued, and recruitment and retention of adequate numbers of trained practitioners are a continuing problem. Greater use of regional anesthesia could be one way to safely increase anesthesia access and simultaneously create value and enthusiasm for the field. Deficits in anesthesia infrastructure, equipment, and drugs also limit anesthesia capacity in low-and middle-income countries. Ultrasound-guided regional anesthesia may be helpful in improving access to safe and reliable anesthesia in low-resource countries as it continues to become more user-friendly, durable, and affordable.
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Affiliation(s)
- Lena Ebba Dohlman
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Kwikiriza
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Odinakachukwu Ehie
- Department of Anesthesiology and Perioperative Services, University of California San Francisco, San Francisco, CA, USA
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Behmer Hansen RT, Behmer Hansen RA, Behmer VA, Gold J, Silva N, Dubey A, Nanda A. Update on the global neurosurgery movement: A systematic review of international vernacular, research trends, and authorship. J Clin Neurosci 2020; 79:183-190. [PMID: 33070893 DOI: 10.1016/j.jocn.2020.07.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
In 2015, key global and neurosurgical organizations increased collaboration to improve neurosurgical care access, delivery, and outcomes, particularly in low- to middle-income countries (LMICs); sparking what has been termed the global neurosurgery movement. The authors sought to assess trends in usage of the term 'global neurosurgery' in academic literature with particular focus on author affiliations, world regions most frequently discussed, and topics of research performed. A PubMed search for articles indexed as 'global neurosurgery' was completed yielding 277 articles which met inclusion criteria. It was found that over time, use of the term 'global neurosurgery' has increased, with increasing growth notable starting in the year 2008 and continuing into October 2019. Statistical comparisons showed authors with affiliated global neurosurgery centers were more likely to publish studies related to the continent of Africa (47.4% vs 15.9%, p < 0.001), and less likely to focus on countries in Asia (2.6% vs 20.9%, p = 0.023). Use of the term 'global neurosurgery' in the article abstract/title/keywords was associated with focus on LMICs (18.6% vs. 5.1%, p = 0.006). Use of the term 'global neurosurgery' was associated with workforce and capacity as research topics (41.9% vs 22.6%, p = 0.036). While fairly new, the global neurosurgery movement has seen a rapid increase in publications utilizing the term 'global neurosurgery.' Articles frequently have focused on collaborative, targeted workforce capacity building in LMICs. We encourage the development of more global neurosurgery academic centers, especially in non-USA countries, to continue this momentum.
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Affiliation(s)
| | - Ryan A Behmer Hansen
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, United States.
| | | | - Justin Gold
- University of Rhode Island, Kingston, RI, United States.
| | - Nicole Silva
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, United States.
| | - Arjun Dubey
- Wollongong Hospital - NSW Health, Wollongong, Australia.
| | - Anil Nanda
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, United States.
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Gupta N, Coates MM, Bekele A, Dupuy R, Fénelon DL, Gage AD, Getachew T, Karmacharya BM, Kwan GF, Lulebo AM, Masiye JK, Mayige MT, Ndour Mbaye M, Mridha MK, Park PH, Dagnaw WW, Wroe EB, Bukhman G. Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries. BMJ Open 2020; 10:e038842. [PMID: 33040014 PMCID: PMC7549470 DOI: 10.1136/bmjopen-2020-038842] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
CONTEXT AND OBJECTIVES Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions. DESIGN Secondary analysis of existing cross-sectional survey data. SETTING We used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country. OUTCOME MEASURES We defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities. RESULTS Overall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1-2 hypertension (28%-83%). Availability was low for type 1 diabetes (1%-70%), type 2 diabetes (3%-57%), asthma (0%-7%) and acute presentations of diabetes (0%-26%) and asthma (0%-4%). Few hospitals had equipment or medications for heart failure (0%-32%), rheumatic heart disease (0%-23%), hypertensive emergencies (0%-64%) or acute minor surgical conditions (0%-5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability. CONCLUSIONS Our findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.
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Affiliation(s)
- Neil Gupta
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Matthew M Coates
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Abebe Bekele
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Roodney Dupuy
- Le Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | | | - Anna D Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- College of Medicine and Health Science, Institute of Public Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Biraj Man Karmacharya
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Gene F Kwan
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Aimée M Lulebo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | | | - Maïmouna Ndour Mbaye
- Department of Internal Medicine, University Hospital Center of Dakar, Cheikh Anta Diop University, Dakar, Senegal
| | - Malay Kanti Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Paul H Park
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Wubaye Walelgne Dagnaw
- Partners In Health, Boston, Massachusetts, USA
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Emily B Wroe
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Gene Bukhman
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Operative Self-Confidence, Hesitation, and Ability Assessment of Surgical Trainees in Rural Kenya. J Surg Res 2020; 258:137-144. [PMID: 33010559 DOI: 10.1016/j.jss.2020.08.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND The education of surgical trainees is ideally designed to produce surgeons with both confidence and competence. This involves the development of autonomy in the operating room. Factors associated with autonomy and entrustment have been studied in high-resource settings. In a resource-limited context, where autonomy is solely at the discretion of faculty, and there are fewer external constraints to restrict it, we hypothesized that assessment of a trainee's performance would be dependent upon reported confidence levels of both faculty and trainees in those trainees' abilities. MATERIALS AND METHODS At a teaching hospital in rural Kenya, operative experience surveys were administered to eleven general surgery trainees (PGY1-5) and six faculty paired dyads immediately following operative procedures in May 2016 to elicit self-reported assessments of confidence, hesitation, and ability as measured by the Zwisch Scale. We examined factors related to learning and used dyadic structural equation models to understand factors related to the assessment of ability. RESULTS There were 107 paired surveys among 136 trainees and 130 faculty evaluations. Faculty scrubbed into 76 (72%) cases. In comparison to trainees, faculty were more likely to give a higher average score for confidence (4.08 versus 3.90; P value: 0.005), a lower score for hesitation (2.67 versus 2.84; P value: 0.001), and a lower score for the ability to perform the operation independently (2.73 versus 3.02; P value: 0.01). Faculty and trainee perceptions of hesitation influenced their ability scores. Trainee hesitation (OR 12.1; 1.2-127.6, P = 0.04) predicted whether trainees reported experiencing learning. CONCLUSIONS Between trainees and faculty at a teaching program in rural Kenya, assessment scores of confidence, hesitation, and ability differ in value but remain fairly correlated. Hesitation is predictive of ability assessment, as well as self-reported learning opportunities. Focus upon identifying when trainees hesitate to proceed with a case may yield important educational opportunities.
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Morris SC, Nelson SC, Zuckerman LM. Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e19.00172. [PMID: 33986213 PMCID: PMC7537826 DOI: 10.5435/jaaosglobal-d-19-00172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 08/15/2020] [Indexed: 11/18/2022]
Abstract
Although there is literature discussing the treatment of acute and chronic trauma in austere environments, no literature or guidelines for the treatment of musculoskeletal tumors exist. This series discusses case examples with considerations and pitfalls of performing limb-salvage surgery in an underserved location. Cases of limb-salvage surgery performed by the same orthopaedic oncologist in Haiti and the Dominican Republic are discussed with a review of the literature on limb salvage for musculoskeletal tumors in developing nations. All patients successfully underwent limb-salvage surgery after considering multiple factors including tumor type and location. Patients with metastatic disease, likelihood of substantial blood loss, and poor health were not candidates for limb-salvage surgery. Medical missions and the development of partnerships with established training programs make limb salvage a greater possibility. Knowledge of the facility, anesthesia support, and instrumentation available is vital. Advanced imaging, blood products, and allograft are likely unavailable or difficult to obtain. Established continuity of care is necessary, and training of the local surgeon should be provided. Surgery should only be considered if it is safe and provides more of a benefit to the patient than an amputation.
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Affiliation(s)
- S Craig Morris
- From the Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA (Dr. Morris, Dr. Nelson); the Department of Surgery, Hopital Adventiste d'Haiti, Port-au-Prince, Haiti (Dr. Nelson); and the Division of Orthopaedic Surgery, Department of Surgery, City of Hope National Medical Center, Duarte CA (Dr. Zuckerman)
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Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg 2020; 107:1440-1449. [PMID: 32395848 PMCID: PMC7272903 DOI: 10.1002/bjs.11746] [Citation(s) in RCA: 622] [Impact Index Per Article: 155.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. METHODS A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. RESULTS The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. CONCLUSION A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.
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Economic Case for Scale-up of the WHO Surgical Safety Checklist at the National Level in Sub-Saharan Africa. Ann Surg 2020; 275:1018-1024. [PMID: 32941283 DOI: 10.1097/sla.0000000000004498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the economic case for nationwide scale-up of the World Health Organisation (WHO) Surgical Safety Checklist using cost-effectiveness and benefit-cost analyses. BACKGROUND The Checklist improves surgical outcomes but the economic case for widespread use remains uncertain. For perioperative quality improvement interventions to compete successfully against other worthwhile health and non-health interventions for limited government resources they must demonstrate cost-effectiveness and positive societal benefit. METHODS Using data from three countries, we estimated the benefits as the total years of life lost (YLL) due to post-operative mortality averted over a 3 year period; converted the benefits to dollar equivalent values using estimates of the economic value of an additional year of life expectancy; estimated total implementation costs; and determined incremental cost-effectiveness ratios (ICER) and benefit-cost-ratios (BCR). Costs are reported in international dollars using Word Bank purchasing power parity conversion factors at 2016 price-levels. RESULTS In Benin, Cameroon and Madagascar ICERs were: $31, $138 and $118 per additional YLL averted; and BCRs were 62, 29, and 9, respectively. Sensitivity analysis demonstrated that the associated mortality reduction and increased usage due to Checklist scale-up would need to deviate approximately 10-fold from published data to change our main interpretations. CONCLUSIONS According to WHO criteria, Checklist scale-up is considered "very cost-effective" and for every $1 spent the potential return on investment is $9-62. These results compare favourably with other health and non-health interventions and support the economic argument for investing in Checklist scale-up as part of a national strategy for improving surgical outcomes.
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Nataraja RM, Yin Mar Oo, Andolfatto L, Moore EM, Watters D, Aye Aye, Htun Oo, Moe Moe Tin, Shrime M, McLeod E. Analysis of Financial Risk Protection Indicators in Myanmar for Paediatric Surgery. World J Surg 2020; 44:3986-3992. [PMID: 32920705 DOI: 10.1007/s00268-020-05775-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To estimate proportion of Myanmar paediatric population at risk of impoverishment and catastrophic expenditure due to emergency surgical intervention. METHODS Prospective data were collected at two tertiary surgical centres including income, household expenses, expenses related to surgery. Data analysis was performed to estimate out-of-pocket (OOP) direct medical costs and OOP total costs. Catastrophic expenditure: expense exceeded 10% of household income. Risk of impoverishment: net income drops were below an impoverishment threshold (PPP-purchasing power parity): I$ 2.00 PPP/day, I$ 1.25/day PPP, national poverty line. Distribution of income was estimated using a gamma distribution. Comparison to an adult cohort was performed using Chi-square test with a p value of <0.05 being significant. RESULTS A total of 145 surveys were collected, and 119 (82.1%) contained sufficient data: Paediatric Centre (n = 99) and Adult Centre (n = 20). Overall average per patient direct medical and non-medical OOP costs was I$493: Centre 1: I$540 PPP (range I$41-6,588 PPP) and Centre 2: I$437 PPP (range I$ 36-1,405 PPP). 64% experienced catastrophic expense. There is no significant difference between the centres in the risks of impoverishment or catastrophic expenditure (p = 0.05). Up to 44% are at risk of catastrophic expenditure should surgery be required. Most of the risk (90%) is derived from direct non-medical costs. A high proportion were at the national poverty line threshold (36.1%). Seeking surgical treatment would imperil up to 37% at the national poverty line threshold, and up to 5.7% at the I$2 PPP per day limit. CONCLUSIONS A large proportion of the Myanmar population are at risk of impoverishment or catastrophic expenditure should they require surgery. Financial risk protection mechanisms are needed.
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Affiliation(s)
- Ramesh Mark Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, 3168, Australia. .,Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Yin Mar Oo
- Department of Paediatric Surgery, Yangon Children's Hospital, Yangon, Myanmar
| | - Lilly Andolfatto
- The Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, Australia
| | - Eileen M Moore
- Department of General Surgery, Barwon Health, Geelong, Australia.,Department of General Surgery, Deakin University, Geelong, Australia
| | - David Watters
- Department of General Surgery, Barwon Health, Geelong, Australia.,Department of General Surgery, Deakin University, Geelong, Australia
| | - Aye Aye
- Department of Paediatric Surgery, Yangon Children's Hospital, Yangon, Myanmar
| | - Htun Oo
- Department of ENT Surgery, NOGH, Yangon, Myanmar
| | - Moe Moe Tin
- Department of General Surgery, North Okkalapa General Hospital, Yangon, Myanmar
| | - Mark Shrime
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, USA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA.,Center for Health and Well-Being, Princeton University, Princeton, USA
| | - Elizabeth McLeod
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, 3168, Australia
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The Global Craniofacial Surgery Deficit. J Craniofac Surg 2020; 32:10-11. [PMID: 32890141 DOI: 10.1097/scs.0000000000006906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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O'Reilly-Shah VN, Van Cleve W, Long DR, Moll V, Evans FM, Sunshine JE, Kassebaum NJ, Harrison EM, Jabaley CS. Impact of COVID-19 response on global surgical volumes: an ongoing observational study. Bull World Health Organ 2020; 98:671-682. [PMID: 33177757 PMCID: PMC7652560 DOI: 10.2471/blt.20.264044] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To determine whether location-linked anaesthesiology calculator mobile application (app) data can serve as a qualitative proxy for global surgical case volumes and therefore monitor the impact of the coronavirus disease 2019 (COVID-19) pandemic. Methods We collected data provided by users of the mobile app “Anesthesiologist” during 1 October 2018–30 June 2020. We analysed these using RStudio and generated 7-day moving-average app use plots. We calculated country-level reductions in app use as a percentage of baseline. We obtained data on COVID-19 case counts from the European Centre for Disease Prevention and Control. We plotted changing app use and COVID-19 case counts for several countries and regions. Findings A total of 100 099 app users within 214 countries and territories provided data. We observed that app use was reduced during holidays, weekends and at night, correlating with expected fluctuations in surgical volume. We observed that the onset of the pandemic prompted substantial reductions in app use. We noted strong cross-correlation between COVID-19 case count and reductions in app use in low- and middle-income countries, but not in high-income countries. Of the 112 countries and territories with non-zero app use during baseline and during the pandemic, we calculated a median reduction in app use to 73.6% of baseline. Conclusion App data provide a proxy for surgical case volumes, and can therefore be used as a real-time monitor of the impact of COVID-19 on surgical capacity. We have created a dashboard for ongoing visualization of these data, allowing policy-makers to direct resources to areas of greatest need.
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Affiliation(s)
- Vikas N O'Reilly-Shah
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, RR450, 1959 NE Pacific St, Seattle, Washington 98195, United States of America (USA)
| | - Wil Van Cleve
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Dustin R Long
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, RR450, 1959 NE Pacific St, Seattle, Washington 98195, United States of America (USA)
| | - Vanessa Moll
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Faye M Evans
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, USA
| | - Jacob E Sunshine
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, RR450, 1959 NE Pacific St, Seattle, Washington 98195, United States of America (USA)
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Ewen M Harrison
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Craig S Jabaley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA
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Hanna JS, Herrera-Almario GE, Pinilla-Roncancio M, Tulloch D, Valencia SA, Sabatino ME, Hamilton C, Rehman SU, Mendoza AK, Gómez Bernal LC, Salas MFM, Navarro MAP, Nemoyer R, Scott M, Pardo-Bayona M, Rubiano AM, Ramirez MV, Londoño D, Dario-Gonzalez I, Gracias V, Peck GL. Use of the six core surgical indicators from the Lancet Commission on Global Surgery in Colombia: a situational analysis. LANCET GLOBAL HEALTH 2020; 8:e699-e710. [PMID: 32353317 DOI: 10.1016/s2214-109x(20)30090-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Surgical, anaesthetic, and obstetric (SAO) health-care system strengthening is needed to address the emergency and essential surgical care that approximately 5 billion individuals lack globally. To our knowledge, a complete, non-modelled national situational analysis based on the Lancet Commission on Global Surgery surgical indicators has not been done. We aimed to undertake a complete situation analysis of SAO system preparedness, service delivery, and financial risk protection using the core surgical indicators proposed by the Commission in Colombia, an upper-middle-income country. METHODS Data to inform the six core surgical system indicators were abstracted from the Colombian national health information system and the most recent national health survey done in 2007. Geographical access to a Bellwether hospital (defined as a hospital capable of providing essential and emergency surgery) within 2 h was assessed by determining 2 h drive time boundaries around Bellwether facilities and the population within and outside these boundaries. Physical 2 h access to a Bellwether was determined by the presence of a motor vehicle suitable for individual transportation. The Department Administrativo Nacional de Estadística population projection for 2016 and 2018 was used to calculate the SAO provider density. Total operative volume was calculated for 2016 and expressed nationally per 100 000 population. The total number of postoperative deaths that occurred within 30 days of a procedure was divided by the total operative volume to calculate the all-cause, non-risk-adjusted postoperative mortality. The proportion of the population subject to impoverishing costs was calculated by subtracting the baseline number of impoverished individuals from those who fell below the poverty line once out-of-pocket payments were accounted for. Individuals who incurred out-of-pocket payments that were more than 10% of their annual household income were considered to have experienced catastrophic expenditure. Using GIS mapping, SAO system preparedness, service delivery, and cost protection were also contextualised by socioeconomic status. FINDINGS In 2016, at least 7·1 million people (15·1% of the population) in Colombia did not have geographical access to SAO services within a 2 h driving distance. SAO provider density falls short of the Commission's minimum target of 20 providers per 100 000 population, at an estimated density of 13·7 essential SAO health-care providers per 100 000 population in 2018. Lower socioeconomic status of a municipality, as indicated by proportion of people enrolled in the subsidised insurance regime, was associated with a smaller proportion of the population in the municipality being within 2 h of a Bellwether facility, and the most socioeconomically disadvantaged municipalities often had no SAO providers. Furthermore, Colombian providers appear to be working at or beyond capacity, doing 2690-3090 procedures per 100 000 population annually, but they have maintained a relatively low median postoperative mortality of 0·74% (IQR 0·48-0·84). Finally, out-of-pocket expenses for indirect health-care costs were a key barrier to accessing surgical care, prompting 3·1 million (6·4% of the population) individuals to become impoverished and 9·5 million (19·4% of the population) individuals to incur catastrophic expenditures in 2007. INTERPRETATION We did a non-modelled, indicator-based situation analysis of the Colombian SAO system, finding that it has not yet met, but is working towards achieving, the targets set by the Lancet Commission on Global Surgery. The observed interdependence of these indicators and correlation with socioeconomic status are consistent with well recognised factors and outcomes of social, health, and health-care inequity. The internal consistency observed in Colombia's situation analysis validates the use of the indicators and has now informed development of an early national SAO plan in Colombia, to set a data-informed stage for implementation and evaluation of timely, safe, and affordable SAO health care, within the National Public Health Decennial Plan, which is due in 2022. FUNDING Zoll Medical.
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Affiliation(s)
- Joseph S Hanna
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
| | - Gabriel E Herrera-Almario
- Fundación Santa Fe de Bogotá, Bogotá, Colombia; School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - David Tulloch
- Center for Remote Sensing and Spatial Analysis, Rutgers School of Environmental and Biological Sciences, The State University of New Jersey, New Brunswick, NJ, USA
| | | | - Marlena E Sabatino
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Charles Hamilton
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Shahyan U Rehman
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Ardi Knobel Mendoza
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | | | | | | | - Rachel Nemoyer
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Michael Scott
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | | | - Andres M Rubiano
- School of Medicine and Neuroscience Institute, Universidad el Bosque, Bogotá, Colombia
| | | | | | | | - Vicente Gracias
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA; Rutgers New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Gregory L Peck
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA; Rutgers School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
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Estimating the impact of treatment and imaging modalities on 5-year net survival of 11 cancers in 200 countries: a simulation-based analysis. Lancet Oncol 2020; 21:1077-1088. [PMID: 32758462 DOI: 10.1016/s1470-2045(20)30317-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Accurate survival estimates are important for cancer control planning. Although observed survival estimates are unavailable for many countries, where they are available, wide variations are reported. Understanding the impact of specific treatment and imaging modalities can help decision makers to effectively allocate resources to improve cancer survival in their local context. METHODS We developed a microsimulation model of stage-specific cancer survival in 200 countries and territories for 11 cancers (oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, breast, cervix uteri, and prostate) comprising 60% of global diagnosed cancer cases. The model accounts for country-specific availability of treatment (chemotherapy, surgery, radiotherapy, and targeted therapy) and imaging modalities (ultrasound, x-ray, CT, MRI, PET, single-photon emission CT), as well as quality of care. We calibrated the model to reported survival estimates from CONCORD-3 (which reports global trends in cancer survival in 2000-14). We estimated 5-year net survival for diagnosed cancers in each country or territory and estimated potential survival gains from increasing the availability of individual treatment and imaging modalities, and more comprehensive packages of scale-up of these interventions. We report the mean and 95% uncertainty intervals (UIs) for all outcomes, calculated as the 2·5 and 97·5 percentiles of the simulation results. FINDINGS The estimated global 5-year net survival for all 11 cancers combined is 42·6% (95% uncertainty interval 40·3-44·3), with survival in high-income countries being an average of 12 times (range 4-17) higher than that in low-income countries. Expanding availability of surgery or radiotherapy or improving quality of care would yield the largest survival gains in low-income (2·5-3·4 percentage point increase in survival) and lower-middle-income countries (2·4-6·1 percentage point increase), whereas upper-middle-income and high-income countries are more likely to benefit from improved availability of targeted therapy (0·7 percentage point increase for upper-middle income and 0·4 percentage point increase for high income). Investing in medical imaging will also be necessary to achieve substantial survival gains, with traditional modalities estimated to provide the largest gains in low-income settings, while MRI and PET would yield the largest gains in higher-income countries. Simultaneous expansion of treatment, imaging, and quality of care could improve 5-year net survival by more than ten times in low-income countries (3·8% [95% UI 0·5-9·2] to 45·2% [40·2-52·1]) and could more than double 5-year net survival in lower-middle-income countries (20·1% [7·2-31·7] to 47·1% [42·8-50·8]). INTERPRETATION Scaling up both treatment and imaging availability could yield synergistic survival gains for patients with cancer. Expanding traditional modalities in lower-income settings might be a feasible pathway to improve survival before scaling up more modern technologies. FUNDING Harvard T H Chan School of Public Health.
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Nataraja RM, Oo YM, Ljuhar D, Webb NR, Pacilli M, Win NN, Aye A. Overview of a novel paediatric surgical simulation‐based medical education programme in Myanmar. ANZ J Surg 2020; 90:1925-1932. [DOI: 10.1111/ans.16200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/29/2020] [Accepted: 07/10/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Ramesh M. Nataraja
- Department of Paediatric Surgery and Surgical Simulation Monash Children's Hospital Melbourne Victoria Australia
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
| | - Yin Mar Oo
- Department of Paediatric Surgery Yangon Children's Hospital Yangon Myanmar
| | - Damir Ljuhar
- Department of Paediatric Surgery and Surgical Simulation Monash Children's Hospital Melbourne Victoria Australia
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
| | - Nathalie R. Webb
- Department of Paediatric Surgery and Surgical Simulation Monash Children's Hospital Melbourne Victoria Australia
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery and Surgical Simulation Monash Children's Hospital Melbourne Victoria Australia
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
| | - Nyo Nyo Win
- Department of Paediatric Surgery Yankin Children's Hospital Yangon Myanmar
| | - Aye Aye
- Department of Paediatric Surgery Yangon Children's Hospital Yangon Myanmar
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Sheshadri V, Wasserman I, Peters AW, Santhirapala V, Mitra S, Sandler S, Svensson E, Ljungman D, George R, Ambepu A, Krishnan J, Kataria R, Afshar S, Meara JG, Galea JT, Weinstock P, Roussin C, Taylor M, Menon N, McClain CD. Simulation capacity building in rural Indian hospitals: a 1-year follow-up
qualitative analysis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:140-145. [DOI: 10.1136/bmjstel-2019-000577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/08/2020] [Indexed: 11/03/2022]
Abstract
Introduction
The benefits of simulation-based medical training are well described. The
most effective way to plant and scale simulation training in rural locations
remains undescribed. We sought to plant simulation training programmes for
anaesthesia emergencies in two rural Indian hospitals.
Methods
Two Indian consultant anaesthetists without experience in medical
simulation underwent a 3-day course at the Boston Children’s Hospital’s (BCH)
Simulator Program. They returned to their institutions and launched simulation
programmes with an airway manikin and mock patient monitor. The 1-year
experience was evaluated using individual, in-depth interviews of simulation
facilitators. Three staff members (responsible for facilitating medical
simulations over the prior year) at two rural hospitals in India were
interviewed. None attended the BCH training; instead, they received on-the-job
training from the BCH-trained, consultant anaesthetist colleagues.
Results
Successes included organisational adoption of simulation training with
exercises 1 year after the initial BCH-training, increased interdisciplinary
teamwork and improved clinical competency in managing emergencies. Barriers to
effective, local implementation of simulation programmes fell into three
categories: time required to run simulations, fixed and rigid roles, and
variable resources. Thematic improvement requests were for standardised
resources to help train simulation facilitators and demonstrate to participants
a well-run simulation, in addition to context-sensitive scenarios.
Conclusion
An in-person training of simulation facilitators to promote medical
simulation programmes in rural hospitals produced ongoing simulation programmes
1 year later. In order to make these programmes sustainable, however, increased
investment in developing simulation facilitators is required. In particular,
simulation facilitators must be prepared to formally train other simulation
facilitators, too.
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Ng-Kamstra JS, Nepogodiev D, Lawani I, Bhangu A. Perioperative mortality as a meaningful indicator: Challenges and solutions for measurement, interpretation, and health system improvement. Anaesth Crit Care Pain Med 2020; 39:673-681. [PMID: 32745634 DOI: 10.1016/j.accpm.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/20/2022]
Abstract
Expanding global access to safe surgical and anaesthesia care is crucial to meet the health targets of the Sustainable Development Goals (SDGs). As global surgical volume increases, improving safety throughout the patient care pathway is a public health priority. At present, an estimated 4.2 million individuals die within 30 days of surgery each year, and many of these deaths are preventable. Important considerations for the collection and reporting of perioperative mortality data have been identified in the literature, but consensus has not been established on the best methodology for the quantification of excess surgical mortality at a hospital or health system level. In this narrative review, we address challenges in the use of perioperative mortality rates (POMR) for improving patient safety. First, we discuss controversies in the use of POMR as a health system indicator and suggest advantages for using a "basket" of procedure-specific mortality rates as an adjunct to gross POMR. We offer then solutions to challenges in the collection and reporting of POMR data, and propose interventions for improving care in the preoperative, operative, and postoperative periods. Finally, we discuss how health systems leaders and frontline clinicians can integrate surgical safety into both national health plans and patient care pathways to drive a sustainable safety revolution in perioperative care.
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Affiliation(s)
- Joshua S Ng-Kamstra
- Department of Critical Care Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
| | - Dmitri Nepogodiev
- National Institute for Health Research Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Ismaïl Lawani
- Department of Surgery and Surgical Specialties, Faculty of Health Sciences, University of Abomey Calavi, Cotonou, Benin; Rediet Shimeles Workneh, MD, Department of Anaesthesiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aneel Bhangu
- National Institute for Health Research Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
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Cristina da Silva N, Rocha TAH, Amaral PV, Elahi C, Thumé E, Thomaz EBAF, Queiroz RCDS, Vissoci JRN, Staton C, Facchini LA. Comprehending the lack of access to maternal and neonatal emergency care: Designing solutions based on a space-time approach. PLoS One 2020; 15:e0235954. [PMID: 32702067 PMCID: PMC7377445 DOI: 10.1371/journal.pone.0235954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/26/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to better understand how the lack of emergency child and obstetric care can be related to maternal and neonatal mortality levels. METHODS We performed spatiotemporal geospatial analyses using data from Brazilian municipalities. An emergency service accessibility index was derived using the two-step floating catchment area (2SFCA) for 951 hospitals. Mortality data from 2000 to 2015 was used to characterize space-time trends. The data was overlapped using a spatial clusters analysis to identify regions with lack of emergency access and high mortality trends. RESULTS From 2000 to 2015 Brazil the overall neonatal mortality rate varied from 11,42 to 11,71 by 1000 live births. The maternal mortality presented a slightly decrease from 2,98 to 2,88 by 100 thousand inhabitants. For neonatal mortality the Northeast and North regions presented the highest percentage of up trending. For maternal mortality the North region exhibited the higher volume of up trending. The accessibility index obtained highlighted large portions of the rural areas of the country without any coverage of obstetric or neonatal beds. CONCLUSIONS The analyses highlighted regions with problems of mortality and access to maternal and newborn emergency services. This sequence of steps can be applied to other low and medium income countries as health situation analysis tool. SIGNIFICANCE STATEMENT Low and middle income countries have greater disparities in access to emergency child and obstetric care. There is a lack of approaches capable to support analysis considering a spatiotemporal perspective for emergency care. Studies using Geographic Information System analysis for maternal and child care, are increasing in frequency. This approach can identify emergency child and obstetric care saturated or deprived regions. The sequence of steps designed here can help researchers, and policy makers to better design strategies aiming to improve emergency child and obstetric care.
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Affiliation(s)
- Núbia Cristina da Silva
- Methods, Analytics and Technology for Health (M.A.T.H) Consortium, Belo Horizonte, Minas Gerais, Brazil
| | | | - Pedro Vasconcelos Amaral
- Centre for Development and Regional Planning, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cyrus Elahi
- Duke Global Neurosurgery and Neurology Division, Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Elaine Thumé
- Post-Graduate Program in Nursing, Faculty of Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | | | - João Ricardo Nickenig Vissoci
- Methods, Analytics and Technology for Health (M.A.T.H) Consortium, Belo Horizonte, Minas Gerais, Brazil
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Catherine Staton
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Luiz Augusto Facchini
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Abstract
INTRODUCTION There has been a growing interest in addressing the surgical disease burden in low- and middle-income countries (LMICs). Assessing the current state of global surgery research activity is an important step in identifying gaps in knowledge and directing research efforts towards important unaddressed issues. The aim of this bibliometric analysis was to identify trends in the publication of global surgical research over the last 30 years. METHODS Scopus® was searched for global surgical publications (1987-2017). Results were hand-screened, and data were collected for included articles. Bibliometric data were extracted from Scopus® and Journal Citation Reports. Country-level economic and population data were obtained from the World Bank. Descriptive statistics were used to summarise data and identify significant trends. RESULTS A total of 1623 articles were identified. The volume of scientific production on global surgery increased from 14 publications in 1987 to 149 in 2017. Similarly, the number of articles published open access increased from four in 1987 to 68 in 2017. Observational studies accounted for 88.7% of the included studies. The three most common specialties were obstetrics and gynaecology 260 (16.0%), general surgery 256 (15.8%), and paediatric surgery 196 (12.1%). Over two times as many authors were affiliated to an LMIC institution than to a high-income country (HIC) institution (6628, 71.5% vs 2481, 28.5%, P < 0.001). A total of 965 studies (59.5%) were conducted entirely by LMIC authors, and 534 (32.9%) by collaborations between HICs and LMICs. CONCLUSION The quantity of research in global surgery has substantially increased over the past 30 years. Authors from LMICs seemed the most proactive in addressing the global surgical disease burden. Increasing the funding for interventional studies, and therefore the quality of evidence in surgery, has the potential for greater impact for patients in LMICs.
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199
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Montesi SB. Practice guidelines for interstitial lung diseases: Widening the reach. Lung India 2020; 37:289-291. [PMID: 32643634 PMCID: PMC7507928 DOI: 10.4103/lungindia.lungindia_487_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sydney B. Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA E-mail:
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200
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Ma X, Vervoort D, Reddy CL, Park KB, Makasa E. Emergency and essential surgical healthcare services during COVID-19 in low- and middle-income countries: A perspective. Int J Surg 2020; 79:43-46. [PMID: 32426019 PMCID: PMC7229460 DOI: 10.1016/j.ijsu.2020.05.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 10/29/2022]
Abstract
The COVID-19 pandemic resulted in significant changes in health care systems worldwide, with low- and middle-income countries (LMIC) sustaining important repercussions. Specifically, alongside cancellation and postponements of non-essential surgical services, emergency and essential surgical care delivery may become affected due to the shift of human and material resources towards fighting the pandemic. For surgeries that do get carried through, new difficulties arise in protecting surgical personnel from contracting SARS-CoV-2. This scarcity in LMIC surgical ecosystems may result in higher morbidity and mortality, in addition to the COVID-19 toll. This paper aims to explore the potential consequences of COVID-19 on the emergency and essential surgical care in LMICs, to offer recommendations to mitigate damages and to reflect on preparedness for future crises. Reducing the devastating consequences of the COVID-19 pandemic on LMIC emergency and essential surgical services can be achieved through empowering communities with accurate information and knowledge on prevention, optimizing surgical material resources, providing quality training of health care personnel to treat SARS-CoV-2, and ensuring adequate personal protection equipment for workers on the frontline. While LMIC health systems are under larger strain, the experience from previous outbreaks may aid in order to innovate and adapt to the current pandemic. Protecting LMIC surgical ecosystems will be a pivotal process in ensuring that previous health system strengthening efforts are preserved, comprehensive care for populations worldwide are ensured, and to allow for future developments beyond the pandemic.
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Affiliation(s)
- Xiya Ma
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
| | | | - Ché L Reddy
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Emmanuel Makasa
- Wit Centre of Surgical Care for Primary Health & Sustainable Development, Faculty of Health Sciences, University of Witwatersrand, South Africa
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