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Abstract
Laparoscopy has numerous clinical benefits compared to laparotomy. However, a functional laparoscopy program requires significant investment and, as a result, remains unavailable for the majority of the world’s population in low- and middle-income countries. The effort to bring laparoscopy to low-resource settings has produced variable outcomes resulting from the challenges inherent to a complex surgical program. This paper highlights these shortcomings and identifies opportunities to improve future laparoscopy programs.
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252
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Bijlmakers L, Cornelissen D, Cheelo M, Nthele M, Kachimba J, Broekhuizen H, Gajewski J, Brugha R. The cost of providing and scaling up surgery: a comparison of a district hospital and a referral hospital in Zambia. Health Policy Plan 2019; 33:1055-1064. [PMID: 30403781 DOI: 10.1093/heapol/czy086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2018] [Indexed: 12/21/2022] Open
Abstract
The lack of access to quality-assured surgery in rural parts of sub-Saharan Africa, where the numbers of trained health workers are often insufficient, presents challenges for national governments. The case for investing in scaling up surgical systems in low-resource settings is 3-fold: the potential beneficial impact on a large proportion of the global burden of disease; better access for rural populations who have the greatest unmet need; and the economic case. The economic losses from untreated surgical conditions far exceed any expenditure that would be required to scale up surgical care. We identified the resources used in delivering surgery at a rural district-level hospital and an urban based referral hospital in Zambia and calculated their cost through a combination of bottom-up costing and step-down accounting. Surgery performed at the referral hospital is ∼50% more expensive compared with the district hospital, mostly because of the higher cost of hospital stay. The low bed occupancy rates at the two hospitals suggest underutilization of the capacity, and/or missing elements of needed capacity, to conduct surgery. Nevertheless, our study confirms that scaling up district-level surgery makes sense, through bringing economies of scale, while acknowledging the need for more comprehensive assessments and costing of capacity constraints. We quantified the economies of scale under different scaling scenarios. If surgery at the district hospital was scaled up by 10, 20 or 50%, the total cost of surgery would increase proportionately less than that, i.e. by 6, 12 and 30%, respectively. If this were to lead to less demand for surgery at the referral hospital, say 10% less surgery, it would result in a reduction of 2.7% in the total cost. Although the health system as a whole would benefit, the referring hospitals would not derive the full economic benefit, unless Government increased resources for district-level surgery.
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Affiliation(s)
- Leon Bijlmakers
- Radboudumc, Department for Health Evidence, Radboud Institute of Health Sciences, 6500 HB, Nijmegen, The Netherlands
| | - Dennis Cornelissen
- Maastricht University, Department of Health Services Research, 6200 MD Maastricht, The Netherlands
| | - Mweene Cheelo
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
| | - Mzaza Nthele
- Ministry of Health, Ndeke House, Haile Selassie Avenue, Lusaka, Zambia
| | - John Kachimba
- Ministry of Health, Ndeke House, Haile Selassie Avenue, Lusaka, Zambia
| | - Henk Broekhuizen
- Radboudumc, Department for Health Evidence, Radboud Institute of Health Sciences, 6500 HB, Nijmegen, The Netherlands
| | - Jakub Gajewski
- Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland
| | - Ruairí Brugha
- Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland
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253
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Update on the management of craniomaxillofacial trauma in low-resource settings. Curr Opin Otolaryngol Head Neck Surg 2019; 27:274-279. [PMID: 31274568 DOI: 10.1097/moo.0000000000000545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Craniomaxillofacial (CMF) trauma is a common cause of global morbidity and mortality. Although in high resource settings the management of CMF trauma has improved substantially over the past several decades with internal rigid fixation technology; these advancements have remained economically unviable and have not yet reached low and middle-income countries (LMICs) en masse. The purpose of this review is to discuss the current management of CMF injuries in low-resource settings. RECENT FINDINGS Trauma injuries remain a global epidemic with head and neck injuries among the most common. CMF trauma injuries largely occur in LMICs, with motor vehicle trauma being a common cause. Patients present in a delayed fashion which increases complications. Diagnostic methods are often limited to plain radiographs as computed tomography is not always available. In low-resource settings, CMF trauma continues to be treated primarily by closed reduction, maxillomandibular fixation, and transosseous wiring, yielding acceptable results through affordable methods. With the advent of less expensive plating systems, internal fixation with plates and screws are gradually finding their place in the management of facial trauma in low-resource settings. A shortage of CMF surgeons in LMICs is a recognized problem and is being addressed by targeted curricula. SUMMARY CMF trauma is a major cause of morbidity and mortality globally that remains poorly addressed. Currently, conventional methods of treating CMF trauma in low-resource settings have evolved to meet resource constraints. The education of CMF surgeons remains a key leverage point in improving CMF trauma care globally.
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254
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Ward ZJ, Yeh JM, Bhakta N, Frazier AL, Girardi F, Atun R. Global childhood cancer survival estimates and priority-setting: a simulation-based analysis. Lancet Oncol 2019; 20:972-983. [DOI: 10.1016/s1470-2045(19)30273-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 01/04/2023]
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255
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Nwanna-Nzewunwa OC, Ajiko MM, Motwani G, Kabagenyi F, Carvalho M, Feldhaus I, Kirya F, Epodoi J, Dicker R, Juillard C. Identifying Information Gaps in a Surgical Capacity Assessment Tool for Developing Countries: A Methodological Triangulation Approach. World J Surg 2019; 43:1185-1192. [PMID: 30659343 DOI: 10.1007/s00268-019-04911-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical capacity assessment in low- and middle-income countries (LMICs) is challenging. The Surgeon OverSeas' Personnel Infrastructure Procedure Equipment and Supplies (PIPES) survey tool has been proposed to address this challenge. There is a need to examine the gaps in veracity and context appropriateness of the information obtained using the PIPES tool. METHODS We performed a methodological triangulation by comparing and contrasting information obtained using the PIPES tool with information obtained simultaneously via three other methods: time and motion study (T&M); provider focus group discussions (FGDs); and a retrospective review of hospital records. RESULTS In its native state, the PIPES survey does not capture the role of non-physician clinicians who contribute immensely to surgical care delivery in LMICs. The surgical workforce was more accurately captured by the FGDs and T&M. It may also not reflect the improvisations (e.g., patients sharing beds, partitioning the operating theater, and using preoperative rooms for surgery, etc.) that occur to expand surgical capacity to overcome the limited infrastructure and equipment. CONCLUSIONS The PIPES tool captures vital surgical capacity information but has gaps that can be filled by modifying the tool and/or using ancillary methodologies. The interests of the researcher and the local stakeholders' perspectives should inform such modifications.
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Affiliation(s)
- Obieze C Nwanna-Nzewunwa
- Department of Surgery, Zuckerberg San Francisco General Hospital & Trauma Center, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Rooms 400 and 401, San Francisco, CA, 94110, USA
| | | | - Girish Motwani
- Department of Surgery, Zuckerberg San Francisco General Hospital & Trauma Center, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Rooms 400 and 401, San Francisco, CA, 94110, USA
| | - Fiona Kabagenyi
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Melissa Carvalho
- Department of Surgery, Zuckerberg San Francisco General Hospital & Trauma Center, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Rooms 400 and 401, San Francisco, CA, 94110, USA
| | - Isabelle Feldhaus
- Department of Surgery, Zuckerberg San Francisco General Hospital & Trauma Center, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Rooms 400 and 401, San Francisco, CA, 94110, USA
| | - Fred Kirya
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Joseph Epodoi
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Rochelle Dicker
- Department of Surgical Critical Care, University of California, Los Angeles, Los Angeles, CA, 90095-1749, USA
| | - Catherine Juillard
- Department of Surgery, Zuckerberg San Francisco General Hospital & Trauma Center, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Rooms 400 and 401, San Francisco, CA, 94110, USA.
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256
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Surgical Procedures Performed by Emergency Medical Teams in Sudden-Onset Disasters: A Systematic Review. World J Surg 2019; 43:1226-1231. [PMID: 30680503 DOI: 10.1007/s00268-019-04915-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Emergency medical teams (EMTs) frequently provide surgical care after sudden-onset disasters (SODs) in low- and middle-income countries. The purpose of this review is to describe the types of surgical procedures performed by EMTs with general surgical capability in order to aid the recruitment and training of surgeons for these teams. METHODS A search of electronic databases (PubMed, MEDLINE, and EMBASE) was carried out to identify articles published between 1990 and 2018 that describe the type of surgical procedures performed by EMTs in the impact and post-impact phases of a SOD. Further relevant articles were obtained by hand searching reference lists. RESULTS A total of 16 articles met the inclusion criteria. Articles reporting on EMTs from a number of different countries and responding to a variety of SODs were included. There was a high prevalence of procedures for extremity soft tissue injuries (46.8%) and fractures (28.3%), although a number of abdominal and genitourinary/obstetric procedures were also reported. CONCLUSIONS Based upon this review, deployment of surgeons or teams with experience in the management of soft tissue wounds, orthopaedic trauma, abdominal surgery, and obstetrics is recommended.
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257
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Pyda J, Patterson RH, Caddell L, Wurdeman T, Koch R, Polatty D, Card B, Meara JG, Corlew DS. Towards resilient health systems: opportunities to align surgical and disaster planning. BMJ Glob Health 2019; 4:e001493. [PMID: 31275620 PMCID: PMC6577360 DOI: 10.1136/bmjgh-2019-001493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/08/2019] [Accepted: 05/11/2019] [Indexed: 11/10/2022] Open
Abstract
Natural disasters significantly contribute to human death and suffering. Moreover, they exacerbate pre-existing health inequalities by imposing an additional burden on the most vulnerable populations. Robust local health systems can greatly mitigate this burden by absorbing the extraordinary patient volume and case complexity immediately after a disaster. This resilience is largely determined by the predisaster local surgical capacity, with trauma, neurosurgical, obstetrical and anaesthesia care of particular importance. Nevertheless, the disaster management and global surgery communities have not coordinated the development of surgical systems in low/middle-income countries (LMIC) with disaster resilience in mind. Herein, we argue that an appropriate peridisaster response requires coordinated surgical and disaster policy, as only local surgical systems can provide adequate disaster care in LMICs. We highlight three opportunities to help guide this policy collaboration. First, the Lancet Commission on Global Surgery and the Sendai Framework for Disaster Risk Reduction set forth independent roadmaps for global surgical care and disaster risk reduction; however, ultimately both advocate for health system strengthening in LMICs. Second, the integration of surgical and disaster planning is necessary. Disaster risk reduction plans could recognise the role of surgical systems in disaster preparedness more explicitly and pre-emptively identify deficiencies in surgical systems. Based on these insights, National Surgical, Obstetric, and Anesthesia Plans, in turn, can better address deficiencies in systems and ensure increased disaster resilience. Lastly, the recent momentum for national surgical planning in LMICs represents a political window for the integration of surgical policy and disaster risk reduction strategies.
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Affiliation(s)
- Jordan Pyda
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Rolvix H Patterson
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,University of Miami School of Medicine, Miami, Florida, USA
| | - Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,University of Miami School of Medicine, Miami, Florida, USA
| | - Rachel Koch
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Polatty
- Humanitarian Response Program, US Naval War College, Newport, Rhode Island, USA
| | - Brittany Card
- Humanitarian Response Program, US Naval War College, Newport, Rhode Island, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Daniel Scott Corlew
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
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258
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Svendsen ØV, Helgerud C, van Duinen AJ, Salvesen Ø, George PM, Bolkan HA. Evaluation of a surgical task sharing training programme's logbook system in Sierra Leone. BMC MEDICAL EDUCATION 2019; 19:198. [PMID: 31186016 PMCID: PMC6560768 DOI: 10.1186/s12909-019-1647-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/04/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Personal logbooks are universally applied for monitoring and evaluation of surgical trainees; however, the quality and accuracy of such logbooks in low income countries (LICs) are poorly examined. Logbooks are kept by the individual trainee and detail every surgical procedure they perform and their role during the procedure. The aim of this study was to evaluate the quality of such a logbook system in Sierra Leone and to identify areas of improvement. METHODS The last 100 logbook entries for students and graduates participating in a surgical task sharing training programme were compared with hospital records (HRs). The logbook entries were categorized as matching, close matching or over-reported. Moreover, HRs were checked for under-reported procedures. Semi-structured interviews were conducted with the study participants on logbook recording routines. The results were analysed using mixed effects logistic regression models. RESULTS Three thousand one hundred sixty-nine database entries from 35 participants were analysed. Of that amount, 62.2% of the entries matched the HRs, 10.4% were close matches and 26.9% were over-reported. 20.7% of the investigated HRs were under-reported. CONCLUSIONS Information gathered from surgical logbook systems must be applied with care, and great efforts must be made to ensure that the logbook systems used provide reliable data. Based on analysis of the logbook data and interviews, focus areas are suggested to ensure reliable logbook data in LICs. Clear instructions and proper training should be provided when introducing the logbook system to the users. The importance of logging all procedures, including minor ones, should be emphasized. The logbook system should be user friendly and only as extensive as necessary. Lastly, keeping the logbooks exclusively digital is recommended, combined with sufficient IT equipment and training.
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Affiliation(s)
- Ø. V. Svendsen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
- CapaCare, c/o Dr Håkon Bolkan, Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
| | - C. Helgerud
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
| | - A. J. van Duinen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
- CapaCare, c/o Dr Håkon Bolkan, Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
| | - Ø. Salvesen
- Faculty Administration, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - P. M. George
- Surgical Department, University of Sierra Leone Teaching Hospital, Freetown, Sierra Leone
| | - H. A. Bolkan
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
- CapaCare, c/o Dr Håkon Bolkan, Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
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259
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Eichhorn T. [Global surgery from an otorhinolaryngological perspective]. HNO 2019; 67:519-527. [PMID: 31172203 DOI: 10.1007/s00106-019-0691-x] [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: 11/28/2022]
Abstract
Since the middle of this century, the United Nations (UN) has paid increasing attention to the surgical care of the worldwide population, with the aim of global access to basic surgical procedures ("global surgery") in the future. The current article describes models for training and continuing education of "global surgeons," with a focus on activities in the field of otolaryngology. The diagnostic inventory in which the global surgeon should be educated is presented. Lists of indications and operative procedures the global surgeon should master are suggested, as are the limits of his/her actions. The surgical instruments required by the global surgeon are summarized in a table, whereby their description is oriented toward the different individual anatomic regions relevant to the otorhinolaryngologist. The paper concludes with an outlook devoted particularly to the idealized vision of availability of global surgery in the future.
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Affiliation(s)
- T Eichhorn
- , Gaglower Str. 44, 03051, Cottbus, Deutschland.
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260
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Sabatino ME, Alkire BC, Corley J. Financial Investment in Global Surgery-Codevelopment as an Accretive Evolution of the Field. JAMA Surg 2019; 154:475-476. [PMID: 30892582 DOI: 10.1001/jamasurg.2019.0044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Blake C Alkire
- Massachusetts Eye and Ear, Boston.,Harvard Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Jacquelyn Corley
- Harvard Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.,Departrment of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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261
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Raykar N, Mukhopadhyay S, Saluja S, Amte S, David S, Gnanaraj J, Kataria R, Jadhav B, Johnson W, Meara J, Menon N, Prabhu RD, Shetty D, Singh R, Tongaonkar R, Vora R, Roy N. Implementation of The Lancet Commission on Global Surgery in India. Healthcare (Basel) 2019; 7:4-6. [DOI: 10.1016/j.hjdsi.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/04/2018] [Indexed: 11/28/2022] Open
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262
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Ganesan SK. Challenges of Running an Orthopaedic and Trauma Services in a Rural, Remote Setting in India—Our Experience. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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263
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Abstract
INTRODUCTION Empirical, observational data relating to the diagnosis, management and outcome of three common worldwide cancers requiring surgery is lacking. However, it has been demonstrated that patients in low/middle-income countries undergoing surgery for cancer are at increased risk of death and major complications postoperatively. This study aims to determine quality and outcomes in breast, gastric and colorectal cancer surgery across worldwide hospital settings. METHODS AND ANALYSIS This multicentre, international prospective cohort study will be undertaken by any hospital providing emergency or elective surgical services for breast, gastric or colorectal cancer. Centres will collect observational data on consecutive patients undergoing primary emergency or elective surgery for breast, gastric or colorectal cancer during a 6-month period. The primary outcome is the incidence of mortality and major complication rate at 30 days after cancer surgery. Infrastructure and care processes in the treatment of these cancers worldwide will also be characterised. ETHICS AND DISSEMINATION This project will not affect clinical practice and has been classified as clinical audit following research ethics review. The protocol will be disseminated through the international GlobalSurg network. TRIAL REGISTRATION NUMBER NCT03471494; Pre-results.
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264
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Fehlberg T, Rose J, Guest GD, Watters D. The surgical burden of disease and perioperative mortality in patients admitted to hospitals in Victoria, Australia: a population-level observational study. BMJ Open 2019; 9:e028671. [PMID: 31118179 PMCID: PMC6549668 DOI: 10.1136/bmjopen-2018-028671] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/14/2019] [Accepted: 04/24/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Comprehensive reporting of surgical disease burden and outcomes are vital components of resilient health systems but remain under-reported. The primary objective was to identify the Victorian surgical burden of disease necessitating treatment in a hospital or day centre, including a thorough epidemiology of surgical procedures and their respective perioperative mortality rates (POMR). DESIGN Retrospective population-level observational study. SETTING The study was conducted in Victoria, Australia. Access to data from the Victorian Admitted Episodes Dataset was obtained using the Dr Foster Quality Investigator tool. The study included public and private facilities, including day-case facilities. PARTICIPANTS From January 2014 to December 2016, all admissions with an International Statistical Classification of Diseases-10 code matched to the Global Health Estimates (GHE) disease categories were included. PRIMARY AND SECONDARY OUTCOME MEASURES Admissions were assigned a primary disease category according to the 23 GHE disease categories. Surgical procedures during hospitalisations were identified using the Australian Refined Diagnosis Related Groups (AR-DRG). POMR were calculated for GHE disease categories and AR-DRG procedures. RESULTS A total of 4 865 226 admitted episodes were identified over the 3-year period. 1 715 862 (35.3%) of these required a surgical procedure. The mortality rate for those undergoing a procedure was 0.42%, and 1.47% for those without. The top five procedures performed per GHE category were lens procedures (162 835 cases, POMR 0.001%), caesarean delivery (76 032 cases, POMR 0.01%), abortion with operating room procedure (65 451 cases, POMR 0%), hernia procedures (52 499 cases, POMR 0.05%) and other knee procedures (47 181 cases, POMR 0.004%). CONCLUSIONS Conditions requiring surgery were responsible for 35.3% of the hospital admitted disease burden in Victoria, a rate higher than previously published from Sweden, New Zealand and the USA. POMR is comparable to other studies reporting individual procedures and conditions, but has been reported comprehensively across all GHE disease categories for the first time.
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Affiliation(s)
- Trafford Fehlberg
- Department of Surgery, University Hospital Geelong, Geelong, Victoria, Australia
| | - John Rose
- Department of Plastics and Reconstructive Surgery, Johns Hopkins, Baltimore, Maryland, USA
| | - Glenn Douglas Guest
- Department of Surgery, University Hospital Geelong, Geelong, Victoria, Australia
| | - David Watters
- Royal Australasian College of Surgeons, Geelong, Victoria, Australia
- Surgery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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265
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Kontchou NAT, McCrary AW, Schulman KA. Workforce Cost Model for Expanding Congenital and Rheumatic Heart Disease Services in Kenya. World J Pediatr Congenit Heart Surg 2019; 10:321-327. [PMID: 31084310 DOI: 10.1177/2150135119837201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease is the number one global killer, with over three quarters of these deaths arising from the populations of low- and middle-income countries (LMICs). Addressing the burden of cardiovascular disease in LMICs must include medical and surgical services for these patients. In this article, we model the needs and costs to scale up the cardiac provider workforce in Kenya, which can be adapted to other LMICs based on country-specific workforce hours and workforce salaries. METHODS Using published epidemiological reports from sub-Saharan Africa, we structured the model based on the expected disease burden of congenital and rheumatic disease in a simulated 1,000-person population. Services modeled include clinic visits, echocardiograms, diagnostic cardiac catheterizations, interventional catheterizations, and heart surgery. Costs were modeled based on Kenyan public sector salaries. After scaling the model, we created a sensitivity analysis of change in service duration and salaries. RESULTS Based on a 1,000-person Kenyan population, we estimate that 2.5 heart surgeries will be needed every year, with a corresponding annual workforce cost of US$526. Including accompanying services of clinic visits, echocardiograms, and both diagnostic and interventional cardiac catheterizations, the total annual workforce cost is US$899. Based on estimated productive hours for public sector workforce, 196 full-time equivalent cardiac surgeons will be needed for the entire population of Kenya (2017 figure). CONCLUSIONS We present a model for appropriate cardiovascular service staffing based on disease burden and workforce costs. This model can be scaled up as needed to plan for local capacity building.
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Affiliation(s)
| | - Andrew W McCrary
- 2 Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Kevin A Schulman
- 3 Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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266
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Maswime S. Improving access to caesarean sections and perioperative care in LMICs. Lancet 2019; 393:1919-1920. [PMID: 30929892 DOI: 10.1016/s0140-6736(18)32589-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/13/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Salome Maswime
- Wits Obstetrics and Gynaecology Clinical Research Division, University of the Witwatersrand, Johannesburg 2193, South Africa; Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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267
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Guilloux AGA, Ramos JA, Citron I, Roa L, Amundson J, Massenburg BB, Saluja S, Miotto BA, Alonso N, Scheffer MC. Profiling recent medical graduates planning to pursue surgery, anesthesia and obstetrics in Brazil. BMC MEDICAL EDUCATION 2019; 19:136. [PMID: 31068165 PMCID: PMC6505198 DOI: 10.1186/s12909-019-1562-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 04/17/2019] [Indexed: 06/08/2023]
Abstract
BACKGROUND Lack of providers in surgery, anesthesia, and obstetrics (SAO) is a primary driver of limited surgical capacity worldwide. We aimed to identify predictors of entry into Surgery, Anesthesia, and Obstetrics and Gynecology (SAO) fields and preference of working in the public sector in Brazil which may help in profiling medical students for recruitment into these needed areas. METHODS A questionnaire was applied to all Brazilian medical graduates registered with a Board of Medicine from 2014 to 2015. Twenty-three characteristics were analyzed. Logistic regression was used to determine predictors' influence on outcome. RESULTS There were 4601 (28.2%) responders to the survey, of which 40.5% (CI 34.7-46.5%) plan to enter SAO careers. Of the 23 characteristics analyzed, eight differed significantly between those who planned to work in SAO and those who did not. Of those eight characteristics, just three were significant predictors in the regression model: preference for working in the hospital setting, having spent more than 70% of their clinical years in practical activities, and valuing the substantial earning potential. These three factors explained only 6.3% of the variance in SAO preference. Within the graduates who preferred SAO careers, there were only two predictors for working in the public sector ("preparatory time before medical school" and valuing "prestige/status"). CONCLUSIONS Factors affecting specialty and sector choice are multifaceted and difficult to predict. Future programs to fill provider gaps should identify methods other than medical student profiling to assure specialty and sector needs are met.
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Affiliation(s)
- Aline Gil Alves Guilloux
- Faculdade de Medicina, da Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP 01246-903 Brazil
| | - Jania A. Ramos
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115 USA
- Duke University School of Medicine DUMC, Durham, NC 27710 USA
| | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115 USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115 USA
- Department of Obstetrics and Gynecology, University of Alberta, 116 St. and 85 Ave, Edmonton, AB T6G 2R3 Canada
| | - Julia Amundson
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115 USA
| | - Benjamin B. Massenburg
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115 USA
| | - Saurabh Saluja
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115 USA
| | - Bruno Alonso Miotto
- Faculdade de Medicina, da Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP 01246-903 Brazil
| | - Nivaldo Alonso
- Faculdade de Medicina, da Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP 01246-903 Brazil
| | - Mario César Scheffer
- Faculdade de Medicina, da Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP 01246-903 Brazil
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268
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Coventry CA, Holland AJA, Read DJ, Ivers RQ. Australasian general surgical training and emergency medical teams: a review. ANZ J Surg 2019; 89:815-820. [PMID: 31066168 DOI: 10.1111/ans.15158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 01/09/2023]
Abstract
Emergency medical teams (EMTs) have provided surgical care in sudden-onset disasters in low- and middle-income countries. General surgeons have been heavily involved in many EMTs due to their traditional broad set of surgical skills and experience. With the increased subspecialization of general surgical training in many high-income countries, including Australia and New Zealand, finding general surgeons with adequately broad experience is becoming more challenging. Furthermore, it is now considered standard for EMTs deploying to a sudden-onset disaster to have undergone credentialing, demonstrating sufficient training of their deployed members. The purpose of this review was to highlight the challenges and potential solutions facing those involved in training and recruiting general surgeons for EMTs in Australasia.
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Affiliation(s)
- Charles A Coventry
- Children's Hospital at Westmead Clinic School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Children's Hospital at Westmead Clinic School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David J Read
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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269
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Prioritizing research for patients requiring surgery in low- and middle-income countries. Br J Surg 2019; 106:e113-e120. [PMID: 30620063 DOI: 10.1002/bjs.11037] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/13/2018] [Accepted: 10/02/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The National Institute for Health Research Global Health Research Unit on Global Surgery is establishing research Hubs in low- and middle-income countries (LMICs). The aim of this study was for the Hubs to prioritize future research into areas of unmet clinical need for patients in LMICs requiring surgery. METHODS A modified Delphi process was overseen by the research Hub leads and engaged LMIC clinicians, patients and expert methodologists. A four-stage iterative process was delivered to prioritize research topics. This included anonymous electronic voting, teleconference discussions and a 2-day priority-setting workshop. RESULTS In stage 1, Hub leads proposed 32 topics across six domains: access to surgery, cancer, perioperative care, research methods, acute care surgery and communicable disease. In stages 2 and 3, 40 LMICs and 20 high-income countries participated in online voting, leading to identification of three priority research topics: access to surgery; outcomes of cancer surgery; and perioperative care. During stage 4, specific research plans to address each topic were developed by Hub leads at a priority-setting workshop. CONCLUSION This process identified three priority areas for future research relevant to surgery in LMICs. It was driven by front-line LMIC clinicians, patients and other stakeholders representing a diverse range of settings. The results of the prioritization exercise provide a future framework for researchers and funders.
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270
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Lin BM, Varvares MA, Randolph GW, Shaye DA. United States-based global otolaryngology surgery: A call to more horizontal sustainable efforts. Am J Otolaryngol 2019; 40:404-408. [PMID: 30799209 DOI: 10.1016/j.amjoto.2019.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine global surgery involvement among general members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and characterize international otolaryngology surgical interventions. METHODS Data on global surgery involvement were derived from responses provided by voluntary online survey respondent members of the AAO-HNS, obtained in October 2017. These data were compared against World Bank metrics of national health expenditure and surgical specialists per capita as benchmarks for need. RESULTS There were 362 responses (response rate of 3.7%). A large proportion of respondents reported being involved in global surgery (61.3%). Locations where respondents worked included: South America (13.3%), Central America (17.7%), Caribbean (10.2%), Europe (4.1%), Africa (16.3%), Asia (16.6%), the Middle East (4.1%), and Oceania (3.6%). A greater proportion of respondents reported traveling to locations that have lower health care expenditure per capita and lower mean number of surgical specialists per 100,000 people, according to data from the World Bank. The primary purpose of trips was most commonly surgical mission (60.3%), followed by education (37.8%), and research (1.9%). CONCLUSION Members of the AAO-HNS are active in global surgery efforts around the world. Collaboration among members of the AAO-HNS may serve to improve long-term sustainability of these efforts.
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Affiliation(s)
- Brian M Lin
- Massachusetts Eye and Ear, Department of Otolaryngology, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Mark A Varvares
- Massachusetts Eye and Ear, Department of Otolaryngology, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Gregory W Randolph
- Massachusetts Eye and Ear, Department of Otolaryngology, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA; Massachusetts General Hospital, Department of Surgery, Division of Surgical Oncology, Boston, MA 02114, USA
| | - David A Shaye
- Massachusetts Eye and Ear, Department of Otolaryngology, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA; Rwanda Central Teaching Hospital, Department of Otolaryngology, Kigali, Rwanda.
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271
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Dewan MC, Rattani A, Baticulon RE, Faruque S, Johnson WD, Dempsey RJ, Haglund MM, Alkire BC, Park KB, Warf BC, Shrime MG. Operative and consultative proportions of neurosurgical disease worldwide: estimation from the surgeon perspective. J Neurosurg 2019; 130:1098-1106. [PMID: 29749918 DOI: 10.3171/2017.10.jns17347] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/18/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The global magnitude of neurosurgical disease is unknown. The authors sought to estimate the surgical and consultative proportion of diseases commonly encountered by neurosurgeons, as well as surgeon case volume and perceived workload. METHODS An electronic survey was sent to 193 neurosurgeons previously identified via a global surgeon mapping initiative. The survey consisted of three sections aimed at quantifying surgical incidence of neurological disease, consultation incidence, and surgeon demographic data. Surgeons were asked to estimate the proportion of 11 neurological disorders that, in an ideal world, would indicate either neurosurgical operation or neurosurgical consultation. Respondent surgeons indicated their confidence level in each estimate. Demographic and surgical practice characteristics-including case volume and perceived workload-were also captured. RESULTS Eighty-five neurosurgeons from 57 countries, representing all WHO regions and World Bank income levels, completed the survey. Neurological conditions estimated to warrant neurosurgical consultation with the highest frequency were brain tumors (96%), spinal tumors (95%), hydrocephalus (94%), and neural tube defects (92%), whereas stroke (54%), central nervous system infection (58%), and epilepsy (40%) carried the lowest frequency. Similarly, surgery was deemed necessary for an average of 88% cases of hydrocephalus, 82% of spinal tumors and neural tube defects, and 78% of brain tumors. Degenerative spine disease (42%), stroke (31%), and epilepsy (24%) were found to warrant surgical intervention less frequently. Confidence levels were consistently high among respondents (lower quartile > 70/100 for 90% of questions), and estimates did not vary significantly across WHO regions or among income levels. Surgeons reported performing a mean of 245 cases annually (median 190). On a 100-point scale indicating a surgeon's perceived workload (0-not busy, 100-overworked), respondents selected a mean workload of 75 (median 79). CONCLUSIONS With a high level of confidence and strong concordance, neurosurgeons estimated that the vast majority of patients with central nervous system tumors, hydrocephalus, or neural tube defects mandate neurosurgical involvement. A significant proportion of other common neurological diseases, such as traumatic brain and spinal injury, vascular anomalies, and degenerative spine disease, demand the attention of a neurosurgeon-whether via operative intervention or expert counsel. These estimates facilitate measurement of the expected annual volume of neurosurgical disease globally.
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Affiliation(s)
- Michael C Dewan
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 2Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | - Abbas Rattani
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 3Meharry Medical College, School of Medicine, Nashville, Tennessee
| | - Ronnie E Baticulon
- 4University of the Philippines College of Medicine-Philippine General Hospital, Manila, Republic of the Philippines
| | - Serena Faruque
- 5Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Walter D Johnson
- 6Emergency & Essential Surgical Care Programme Lead, World Health Organization, Geneva, Switzerland
| | - Robert J Dempsey
- 7Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
| | - Michael M Haglund
- 8Division of Global Neurosurgery and Neurology, Department of Neurosurgery and Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Blake C Alkire
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 9Office of Global Surgery and Health
| | - Kee B Park
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
| | - Benjamin C Warf
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 10Department of Neurological Surgery, Boston Children's Hospital, Harvard Medical School
| | - Mark G Shrime
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 11Department of Otolaryngology, Massachusetts Eye and Ear Infirmary
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272
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Abstract
BACKGROUND Global estimates show five billion people lack access to safe, quality, and timely surgical care. The wealthiest third of the world's population receives approximately 73.6% of the world's total surgical procedures while the poorest third receives only 3.5%. This pilot study aimed to assess the local burden of surgical disease in a rural region of India through the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey and the feasibility of using Accredited Social Health Activists (ASHAs) as enumerators. MATERIAL AND METHODS Data were collected in June and July 2015 in Nanakpur, Haryana from 50 households with the support of Indian community health workers, known as ASHAs. The head of household provided demographic data; two household members provided personal surgical histories. Current surgical need was defined as a self-reported surgical problem present at the time of the interview, and unmet surgical need as a surgical problem in which the respondent did not access care. RESULTS One hundred percent of selected households participated, totaling 93 individuals. Twenty-eight people (30.1%; 95% CI 21.0-40.5) indicated they had a current surgical need in the following body regions: 2 face, 1 chest/breast, 1 back, 3 abdomen, 4 groin/genitalia, and 17 extremities. Six individuals had an unmet surgical need (6.5%; 95% CI 2.45%-13.5%). CONCLUSIONS This pilot study in Nanakpur is the first implementation of the SOSAS survey in India and suggests a significant burden of surgical disease. The feasibility of employing ASHAs to administer the survey is demonstrated, providing a potential use of the ASHA program for a future countrywide survey. These data are useful preliminary evidence that emphasize the need to further evaluate interventions for strengthening surgical systems in rural India.
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273
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Varela C, Young S, Mkandawire N, Groen RS, Banza L, Viste A. TRANSPORTATION BARRIERS TO ACCESS HEALTH CARE FOR SURGICAL CONDITIONS IN MALAWI a cross sectional nationwide household survey. BMC Public Health 2019; 19:264. [PMID: 30836995 PMCID: PMC6402149 DOI: 10.1186/s12889-019-6577-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background It is estimated that nearly five billion people worldwide do not have access to safe surgery. This access gap disproportionately affects low-and middle-income countries (LMICs). One of the barriers to healthcare in LMICs is access to transport to a healthcare facility. Both availability and affordability of transport can be issues delaying access to health care. This study aimed to describe the main transportation factors affecting access and delay in reaching a facility for health care in Malawi. Methods This was a multi-stage, clustered, probability sampling with systematic sampling of households for transportation access to general health and surgical care. Malawi has an estimated population of nearly 18 million people, with a total of 48,233 registered settlements spread over 28 administrative districts. 55 settlements per district were randomly selected for data collection, and 2–4 households were selected, depending on the size. Two persons per household were interviewed. The Surgeons Overseas Assessment of Surgical need (SOSAS) tool was used by trained personnel to collect data during the months of July and August 2016. Analysis of data from 1479 households and 2958 interviewees was by univariate and multivariate methods. Results Analysis showed that 90.1% were rural inhabitants, and 40% were farmers. No formal employment was reported for 24.9% persons. Animal drawn carts prevailed as the most common mode of transport from home to the primary health facility - normally a health centre. Travel to secondary and tertiary level health facilities was mostly by public transport, 31.5 and 43.4% respectively. Median travel time from home to a health centre was 1 h, and 2.5 h to a central hospital. Thirty nine percent of male and 59% of female head of households reported lack financial resources to go to a hospital. Conclusion In Malawi, lack of suitable transport, finances and prolonged travel time to a health care centre, all pose barriers to timely access of health care. Improving the availability of transport between rural health centres and district hospitals, and between the district and central hospitals, could help overcome the transportation barriers to health care.
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Affiliation(s)
- Carlos Varela
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi. .,University of Malawi, College of Medicine, Lilongwe, Malawi. .,Department of Clinical Medicine and Centre for International Health, University of Bergen, Bergen, Norway.
| | - Sven Young
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,University of Malawi, College of Medicine, Lilongwe, Malawi.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Nyengo Mkandawire
- Department of Surgery, Queen Elizabeth Central Hospital, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Reinou S Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, USA.,Department of Obstetrics and Gynecology, Alaska Native Medical Centre, Anchorage, USA
| | - Leonard Banza
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,University of Malawi, College of Medicine, Lilongwe, Malawi.,Department of Clinical Medicine and Centre for International Health, University of Bergen, Bergen, Norway
| | - Asgaut Viste
- Department of Clinical Medicine and Centre for International Health, University of Bergen, Bergen, Norway.,Department of Research & Development, Haukeland University Hospital, Bergen, Norway
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274
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Maine RG, Kajombo C, Purcell L, Gallaher JR, Reid TD, Charles AG. Effect of in-hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi. BJS Open 2019; 3:367-375. [PMID: 31183453 PMCID: PMC6551403 DOI: 10.1002/bjs5.50152] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background In sub‐Saharan Africa, surgical access is limited by an inadequate surgical workforce, lack of infrastructure and decreased care‐seeking by patients. Delays in treatment can result from delayed presentation (pre‐hospital), delays in transfer (intrafacility) or after arrival at the treating centre (in‐hospital delay; IHD). This study evaluated the effect of IHD on mortality among patients undergoing emergency general surgery and identified factors associated with IHD. Methods Utilizing Malawi's Kamuzu Central Hospital Emergency General Surgery database, data were collected prospectively from September 2013 to November 2017. Included patients had a diagnosis considered to warrant urgent or emergency intervention for surgery. Bivariable analysis and Poisson regression modelling was done to determine the effect of IHD (more than 24 h) on mortality, and identify factors associated with IHD. Results Of 764 included patients, 281 (36·8 per cent) had IHDs. After adjustment, IHD (relative risk (RR) 1·68, 95 per cent c.i. 1·01 to 2·78; P = 0·045), generalized peritonitis (RR 4·49, 1·69 to 11·95; P = 0·005) and gastrointestinal perforation (RR 3·73, 1·25 to 11·08; P = 0·018) were associated with a higher risk of mortality. Female sex (RR 1·33, 1·08 to 1·64; P = 0·007), obtaining any laboratory results (RR 1·58, 1·29 to 1·94; P < 0·001) and night‐time admission (RR 1·59, 1·32 to 1·90; P < 0·001) were associated with an increased risk of IHD after adjustment. Conclusion IHDs were associated with increased mortality. Increased staffing levels and operating room availability at tertiary hospitals, especially at night, are needed.
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Affiliation(s)
- R. G. Maine
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - C. Kajombo
- Department of SurgeryKamuzu Central HospitalLilongweMalawi
| | - L. Purcell
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - J. R. Gallaher
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - T. D. Reid
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - A. G. Charles
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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275
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Corley J, Lepard J, Barthélemy E, Ashby JL, Park KB. Essential Neurosurgical Workforce Needed to Address Neurotrauma in Low- and Middle-Income Countries. World Neurosurg 2019; 123:295-299. [DOI: 10.1016/j.wneu.2018.12.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
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276
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Pittalis C, Brugha R, Crispino G, Bijlmakers L, Mwapasa G, Lavy C, Le G, Cheelo M, Kachimba J, Borgstein E, Mkandawire N, Juma A, Marealle P, Chilonga K, Gajewski J. Evaluation of a surgical supervision model in three African countries-protocol for a prospective mixed-methods controlled pilot trial. Pilot Feasibility Stud 2019; 5:25. [PMID: 30820336 PMCID: PMC6378729 DOI: 10.1186/s40814-019-0409-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background District-level hospitals (DLHs) can play an important role in the delivery of essential surgical services for rural populations in sub-Saharan Africa if adequately prepared and supported. This article describes the protocol for the evaluation of the Scaling up Safe Surgery for District and Rural Populations in Africa (SURG-Africa) project which aims to strengthen the capacity in district-level hospitals (DLHs) in Malawi, Tanzania and Zambia to deliver safe, quality surgery. The intervention comprises a programme of quarterly supervisory visits to surgically active district-level hospitals by specialists from referral hospitals and the establishment of a mobile phone-based consultation network. The overall objective is to test and refine the model with a view to scaling up to national level. Methods This mixed-methods controlled pilot trial will test the feasibility of the proposed supervision model in making quality-assured surgery available at DLHs. Firstly, the study will conduct a quantitative assessment of surgical service delivery at district facilities, looking at hospital preparedness, capacity and productivity, and how these are affected by the intervention. Secondly, the study will monitor changes in referral patterns from DLHs to a higher level of care as a result of the intervention. Data on utilisation of the mobile based-support network will also be collected. The analysis will compare changes over time and between intervention and control hospitals. The third element of the study will involve a qualitative assessment to obtain a better understanding of the functionality of DLH surgical systems and how these have been influenced by the intervention. It will also provide further information on feasibility, impact and sustainability of the supervision model. Discussion We seek to test a model of district-level capacity building through regular supervision by specialists and mobile phone technology-supported consultations to make safe surgical services more accessible, equitable and sustainable for rural populations in the target countries. The results of this study will provide robust evidence to inform and guide local actors in the national scale-up of the supervision model. Lessons learned will be transferred to the wider region.
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Affiliation(s)
- Chiara Pittalis
- 1Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Ireland
| | - Ruairi Brugha
- 1Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Ireland
| | - Gloria Crispino
- Statistica Medica, 26 Belarmine Court Enniskerry Road Stepaside, Dublin 18, Ireland
| | - Leon Bijlmakers
- 3Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 Nijmegen, GA Netherlands
| | - Gerald Mwapasa
- 4University of Malawi, College of Medicine, Mahatma Gandhi, Blantyre, Malawi
| | - Chris Lavy
- 5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7HE UK
| | - Grace Le
- 5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7HE UK
| | - Mweene Cheelo
- 6Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
| | - John Kachimba
- 6Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
| | - Eric Borgstein
- 4University of Malawi, College of Medicine, Mahatma Gandhi, Blantyre, Malawi
| | - Nyengo Mkandawire
- 4University of Malawi, College of Medicine, Mahatma Gandhi, Blantyre, Malawi
| | - Adinan Juma
- ECSA Health Community Secretariat, 157 Olorien, Njiro Road, PO Box 1009, Arusha, Tanzania
| | - Paul Marealle
- Tanzania Surgical Association, P.O. Box 65098, Dar Es Salaam, Tanzania
| | - Kondo Chilonga
- 9Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Jakub Gajewski
- 10Institute of Global Surgery, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
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277
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Smiley K, Ofori L, Spangler C, Acquaah-Arhin R, Deh D, Enos J, Manortey S, Baiden F, Finlayson S, Price R, McCrum M. Safety Culture and Perioperative Quality at the Volta River Authority Hospital in Akosombo, Ghana. World J Surg 2019; 43:16-23. [PMID: 30109388 DOI: 10.1007/s00268-018-4763-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Volta River Authority Hospital (VRAH) is a district hospital associated with a large public works project in Akosombo, Ghana, that has developed a reputation for high-quality care. We hypothesized that this stems from a culture of safety and standardized processes typical of high-risk engineering environments. To investigate this, we evaluated staff and patient perceptions of safety and quality, as well as perioperative process variability. MATERIALS AND METHODS The Safety Attitudes Questionnaire (SAQ) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys were used to evaluate staff and patient perceptions of safety. Perioperative general surgery and obstetrical procedure observations generated process maps, which were analyzed for variability and waste. RESULTS Thirty-one SAQs were administered. 83% of workers held a positive perception of teamwork, and 77.4% held a positive perception of safety culture. Fifteen HCAHPS surveys of surgical inpatients showed a median hospital rating of 10 [IQR 8.5-10] on a ten-point scale. 90% gave maximal scores for pain management and 84.4% for nurse communication. Ten general surgery and obstetrical procedures were observed for which process map analysis was notable for no consistent waste steps and 100% adherence to the World Health Organization Safe Surgery Checklist. CONCLUSIONS Surveys suggest an institutional commitment to safety with strong teamwork culture and patient communication. Perioperative process mapping supports this culture, with low levels of variability and waste, and is useful for evaluating standardization of care. VRAH demonstrates the feasibility of delivering high standards of perioperative care in a low-resource setting.
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Affiliation(s)
- Katherine Smiley
- Department of Surgery, University of Utah Center for Global Surgery, 30 N 1900 E, Rm 3B110 SOM, Salt Lake City, UT, 84132, USA
| | - Love Ofori
- Electro Volta House, Volta River Authority Hospital, 28th February Road, P.O. Box MB 77, Accra, Ghana
| | - Cindy Spangler
- Department of Surgery, University of Utah Center for Global Surgery, 30 N 1900 E, Rm 3B110 SOM, Salt Lake City, UT, 84132, USA
| | - Rebecca Acquaah-Arhin
- Electro Volta House, Volta River Authority Hospital, 28th February Road, P.O. Box MB 77, Accra, Ghana
| | - Deborah Deh
- Ensign College of Public Health, P.O. Box AK 136, Akosombo, Eastern Region, Ghana
| | - Juliana Enos
- Ensign College of Public Health, P.O. Box AK 136, Akosombo, Eastern Region, Ghana
| | - Stephen Manortey
- Ensign College of Public Health, P.O. Box AK 136, Akosombo, Eastern Region, Ghana
| | - Frank Baiden
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Samuel Finlayson
- Department of Surgery, University of Utah Center for Global Surgery, 30 N 1900 E, Rm 3B110 SOM, Salt Lake City, UT, 84132, USA
| | - Raymond Price
- Department of Surgery, University of Utah Center for Global Surgery, 30 N 1900 E, Rm 3B110 SOM, Salt Lake City, UT, 84132, USA
| | - Marta McCrum
- Department of Surgery, University of Utah Center for Global Surgery, 30 N 1900 E, Rm 3B110 SOM, Salt Lake City, UT, 84132, USA.
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278
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Albutt K, Punchak M, Kayima P, Namanya DB, Shrime MG. Operative volume and surgical case distribution in Uganda's public sector: a stratified randomized evaluation of nationwide surgical capacity. BMC Health Serv Res 2019; 19:104. [PMID: 30728037 PMCID: PMC6366061 DOI: 10.1186/s12913-019-3920-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/22/2019] [Indexed: 02/03/2023] Open
Abstract
Background Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda. Methods A standardized mixed-methods surgical assessment and retrospective operative logbook review were completed at 16 randomly selected public hospitals serving 64·0% of Uganda’s population. Results A total of 3014 operations were recorded, annualizing to a surgical volume of 36,670 cases/year or 144·5 operations/100,000people/year. Absolute surgical volume was greater at regional referral than general hospitals (p < 0·001); but, relative surgical volume/catchment population was greater at the general versus regional level (p = 0·03). Most patients undergoing operations were women (78·3%) with a mean age of 26·9 years. The overall case distribution was 69·0% obstetrics/gynecology, 23·7% general surgery, 4·0% orthopedics, and 3·3% other subspecialties. Cesarean sections were the most common operation (55·8%). Monthly operative volume was strongly predicted by number of surgical, anesthetic, and obstetric physician providers (훽=10·72, p = 0·005, R2 = 0·94) when controlling for confounders. Notably, operative volume was not correlated with availability of electricity, oxygen, light source, suction, blood, instruments, suture, gloves, intravenous fluid, or antibiotics. Conclusion An understanding of operative case volume and distribution is essential in facilitating targeted interventions to strengthen surgical capacity. These data suggest that surgical workforce is the critical driver of operative volume in the Ugandan public sector. Investment in the surgical workforce is imperative to ensure access to safe, timely, and affordable surgical and anaesthesia care.
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Affiliation(s)
- Katherine Albutt
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
| | - Maria Punchak
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Peter Kayima
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Didacus B Namanya
- Ministry of Health, Kampala, Uganda.,Uganda Martyrs University, Nkozi, Uganda
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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279
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Mullapudi B, Grabski D, Ameh E, Ozgediz D, Thangarajah H, Kling K, Alkire B, Meara JG, Bickler S. Estimates of number of children and adolescents without access to surgical care. Bull World Health Organ 2019; 97:254-258. [PMID: 30940982 PMCID: PMC6438256 DOI: 10.2471/blt.18.216028] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 12/17/2018] [Accepted: 12/25/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To estimate how many children and adolescent worldwide do not have access to surgical care. Methods We estimated the number of children and adolescents younger than 19 years worldwide without access to safe, affordable and timely surgical care, by using population data for 2017 from the United Nations and international data on surgical access in 2015. We categorized countries by World Bank country income group and obtained the proportion of the population with no access to surgical care from a study by the Lancet Commission on Global Surgery. Findings An estimated 1.7 billion (95% credible interval: 1.6–1.8) children and adolescents worldwide did not have access to surgical care in 2017. Lack of access occurred overwhelmingly in low- and middle-income countries where children and adolescents make up a disproportionately large fraction of the population. Moreover, 453 million children younger than 5 years did not have access to basic life-saving surgical care. According to Lancet Commission on Global Surgery criteria, less than 3% of the paediatric population in low-income countries and less than 8% in lower-middle-income countries had access to surgical care. Conclusion There were substantial gaps in the availability of surgical services for children worldwide, particularly in low- and middle-income countries. Future research should focus on developing specific measures for assessing paediatric surgical access, delivery and outcomes and on clarifying how limited surgical access in the poorest parts of the world affects child health, especially mortality in children younger than 5 years.
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Affiliation(s)
- Bhargava Mullapudi
- Division of Pediatric Surgery, Rady Children's Hospital-University of California San Diego, 3030 Children's Way, San Diego, California, CA 92123, United States of America (USA)
| | - David Grabski
- Department of Surgery, University of Virginia, Charlottesville, USA
| | - Emmanuel Ameh
- Department of Surgery, National Hospital, Abuja, Nigeria
| | - Doruk Ozgediz
- Division of Pediatric Surgery, Yale University, New Haven, USA
| | - Hariharan Thangarajah
- Division of Pediatric Surgery, Rady Children's Hospital-University of California San Diego, 3030 Children's Way, San Diego, California, CA 92123, United States of America (USA)
| | - Karen Kling
- Division of Pediatric Surgery, Rady Children's Hospital-University of California San Diego, 3030 Children's Way, San Diego, California, CA 92123, United States of America (USA)
| | - Blake Alkire
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Stephen Bickler
- Division of Pediatric Surgery, Rady Children's Hospital-University of California San Diego, 3030 Children's Way, San Diego, California, CA 92123, United States of America (USA)
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280
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Fagan JJ, Otiti J, Aswani J, Konney A, Diom ES, Baidoo K, Onakoya PA, Mugabo RM, Noah P, Mashamba V, Kundiona I, Garba M, Biadgelign MG, Macharia C, Bogale M, Koch WM. African head and neck fellowships: A model for a sustainable impact on head and neck cancer care in developing countries. Head Neck 2019; 41:1824-1829. [DOI: 10.1002/hed.25615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 10/30/2018] [Accepted: 12/11/2018] [Indexed: 01/28/2023] Open
Affiliation(s)
- Johannes J. Fagan
- Division of OtolaryngologyUniversity of Cape Town Cape Town South Africa
| | | | - Joyce Aswani
- Department of OtolaryngologyUniversity of Nairobi Nairobi Kenya
| | - Anna Konney
- Department of OtolaryngologyKomfo Anokye Teaching Hospital Kumasi Ghana
| | - Evelyne S. Diom
- Department of OtolaryngologyUniversité Assane Seck Ziguinchor Senegal
| | - Kenneth Baidoo
- Department of OtolaryngologyKorle Bu Teaching Hospital Accra Ghana
| | - Paul A. Onakoya
- University College HospitalUniversity of Ibadan Ibadan Nigeria
| | - Rajab M. Mugabo
- Department of OtolaryngologyKing Faisal Hospital Kigali Rwanda
| | - Patrick Noah
- College of MedicineUniversity of Malawi Blantyre Malawi
| | - Victor Mashamba
- Department of OtorhinolaryngologyMuhimbili National Hospital Dar Es Salaam Tanzania
| | - Innocent Kundiona
- Department of SurgeryParirenyatwa Group of Hospitals Harare Zimbabwe
| | - Mainasara Garba
- National Ear Care CentreKaduna State University Kaduna Nigeria
| | | | | | - Mesele Bogale
- ORL‐HNSAdama Hospital Medical College Addis Ababa Ethiopia
| | - Wayne M. Koch
- Department of OtolaryngologyJohns Hopkins University Baltimore
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281
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Assessing Spatial Accessibility to Medical Resources at the Community Level in Shenzhen, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020242. [PMID: 30654500 PMCID: PMC6352203 DOI: 10.3390/ijerph16020242] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 11/16/2022]
Abstract
Spatial accessibility to medical resources is an integral component of universal health coverage. However, research evaluating the spatial accessibility of healthcare services at the community level in China remains limited. We assessed the community-level spatial access to beds, doctors, and nurses at general hospitals and identified the shortage areas in Shenzhen, one of the fastest growing cities in China. Based on hospital and population data from 2016, spatial accessibility was analyzed using several methods: shortest path analysis, Gini coefficient, and enhanced 2-step floating catchment area (E2SFCA). The study found that 99.9% of the residents in Shenzhen could get to the nearest general hospital within 30 min. Healthcare supply was much more equitable between populations than across communities in the city. E2SFCA scores showed that the communities with the best and worst hospital accessibility were found in the southwest and southeast of the city, respectively. State-owned public hospitals still dominated the medical resources supply market and there was a clear spatial accessibility disparity between private and public healthcare resources. The E2SFCA scores supplement more details about resource disparity over space than do crude provider-to-population ratios (PPR) and can help improve the efficiency of the distribution of medical resources.
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282
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Banu T, Chowdhury TK, Aziz TT, Das A, Tamanna N, Pulock OS, Imam MS, Karim A, Akter M, Walid A. Cost Incurred by the Family for Surgery in Their Children: A Bangladesh Perspective. World J Surg 2019; 42:3841-3848. [PMID: 29947983 DOI: 10.1007/s00268-018-4700-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cost of getting health services is a major concern in Bangladesh as well as in many other countries. A family has to bear more than half of the health care cost despite many facilities provided by the public hospitals. This out-of-pocket (OOP) expenditure drives many families under the poverty line. The aim of this study was to find out the exact cost incurred by the family for a surgical operation of their child in the public and private sectors in Bangladesh. METHODS A cross-sectional study was conducted to find out the cost of child surgery in different settings of public and private hospitals in Chittagong division, Bangladesh. Cost of herniotomy was then compared across different settings. RESULTS In this study, cost of operation in urban private hospitals was highest mostly due to surgeon and anesthetist fee. The cost was lowest in outreach programs as surgeon fee, anesthetist fee and accommodation cost was nil; food and transport cost was minimum. However, cost of accommodation, food, transport and medicine contributed significantly to OOP expenditure especially in tertiary-level public hospitals, in both indoor and day care settings, and also in private urban hospitals. CONCLUSIONS Our study provides some insight into the OOP expenditure in different health care settings in Bangladesh. This study might be useful in developing a strategy to minimize the OOP expenditure in this country.
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Affiliation(s)
- Tahmina Banu
- Chittagong Research Institute for Children Surgery (CRICS), 29, Panchlaish R/A, Chittagong, Bangladesh.
- Department of Pediatric Surgery, Chittagong Medical College and Hospital (CMCH), Chittagong, Bangladesh.
| | - Tanvir K Chowdhury
- Chittagong Research Institute for Children Surgery (CRICS), 29, Panchlaish R/A, Chittagong, Bangladesh
- Department of Pediatric Surgery, Chittagong Medical College and Hospital (CMCH), Chittagong, Bangladesh
| | - Tasmiah T Aziz
- Chittagong Research Institute for Children Surgery (CRICS), 29, Panchlaish R/A, Chittagong, Bangladesh
| | - Arni Das
- Chittagong Research Institute for Children Surgery (CRICS), 29, Panchlaish R/A, Chittagong, Bangladesh
| | - Nowrin Tamanna
- Chittagong Research Institute for Children Surgery (CRICS), 29, Panchlaish R/A, Chittagong, Bangladesh
| | - Orindom S Pulock
- Chittagong Research Institute for Children Surgery (CRICS), 29, Panchlaish R/A, Chittagong, Bangladesh
| | - Md Sharif Imam
- Chittagong Research Institute for Children Surgery (CRICS), 29, Panchlaish R/A, Chittagong, Bangladesh
- Department of Pediatric Surgery, Chittagong Medical College and Hospital (CMCH), Chittagong, Bangladesh
| | - Anwarul Karim
- Chittagong Research Institute for Children Surgery (CRICS), 29, Panchlaish R/A, Chittagong, Bangladesh
| | - Mastura Akter
- Chittagong Research Institute for Children Surgery (CRICS), 29, Panchlaish R/A, Chittagong, Bangladesh
| | - Adnan Walid
- Chittagong Research Institute for Children Surgery (CRICS), 29, Panchlaish R/A, Chittagong, Bangladesh
- Department of Pediatric Surgery, Chittagong Medical College and Hospital (CMCH), Chittagong, Bangladesh
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283
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Wieser S, Eichler K. Measuring the gap to universal health coverage. THE LANCET PUBLIC HEALTH 2019; 4:e8-e9. [DOI: 10.1016/s2468-2667(18)30263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 11/27/2022] Open
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284
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McDow AD, Salman SO, Abughazaleh KM, Long KL. Improving Surgical Outreach in Palestine: Assessing Goals of Local and Visiting Surgeons. J Surg Res 2019; 233:139-143. [DOI: 10.1016/j.jss.2018.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
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285
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Sood R, Yorlets RR, Raykar NP, Menon R, Shah H, Roy N. The global surgery blood drought: frontline provider data on barriers and solutions in Bihar, India. Glob Health Action 2019; 12:1599541. [PMID: 31018826 PMCID: PMC6493310 DOI: 10.1080/16549716.2019.1599541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/14/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Limited access to safe, timely banked blood is a critical barrier to providing basic surgical care in resource-limited settings globally. Contextual, locally driven data are required to elucidate country needs, develop effective interventions, and guide policy decisions. OBJECTIVE We employ qualitative methodology to describe barriers faced and solutions proposed by front-line obstetric providers in Bihar - a poor, populous Indian state where maternal mortality exceeds the national average. We aim to make locally driven recommendations for ongoing policy work in India to strengthen the country's blood transfusion system. METHODS From February to May 2016, two researchers conducted semi-structured interviews with 19 obstetric providers across Bihar. Snowball sampling was employed until thematic saturation was reached. Following immersion into de-identified texts and dual codebook development, a primary analyst completed topical coding, and a secondary analyst confirmed reproducibility. RESULTS Providers report that pervasive banked blood shortages force hospitals to require replacement donation, but patients' families often cannot or will not donate. Providers wait one to six hours for blood, depending on availability of staff and supplies, blood bank proximity, and the ability of the patient being treated to navigate the system. Providers feel forced to refer their patients, often to distant, poorly equipped centers. Providers identify donor education, improved infrastructure, and improved local coordination as focus areas for intervention. CONCLUSIONS A multi-stakeholder approach that aims to increase blood donation through community education, mitigate limited infrastructure through short-term workarounds, and improve local-level coordination through state support and policy change is required in Bihar. This study generates data to guide policy and future research aimed at generating affordable, contextually appropriate interventions to the blood drought.
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Affiliation(s)
- Rachita Sood
- Division of Plastic and Reconstructive Surgery, Northwestern University, Chicago, IL, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Rachel R Yorlets
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Nobhojit Roy
- The Program in Global Surgery and Social Change, Department of Public Health Sciences, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
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286
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Søreide K, Winter DC. Global surgery in an ecosystem for worldwide health. Br J Surg 2018; 106:e12-e13. [PMID: 30548590 DOI: 10.1002/bjs.11070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 12/28/2022]
Abstract
A call for action now
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, PO Box 8100, Stavanger University Hospital, N-4068 Stavanger, Norway
| | - D C Winter
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
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287
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Ahmad T, Bouwman RA, Grigoras I, Aldecoa C, Hofer C, Hoeft A, Holt P, Fleisher LA, Buhre W, Pearse RM. Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery. Br J Anaesth 2018; 119:258-266. [PMID: 28854536 DOI: 10.1093/bja/aex185] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2017] [Indexed: 01/22/2023] Open
Abstract
Background The incidence and impact of postoperative complications are poorly described. Failure-to-rescue, the rate of death following complications, is an important quality measure for perioperative care but has not been investigated across multiple health care systems. Methods We analysed data collected during the International Surgical Outcomes Study, an international 7-day cohort study of adults undergoing elective inpatient surgery. Hospitals were ranked by quintiles according to surgical procedural volume (Q1 lowest to Q5 highest). For each quintile we assessed in-hospital complications rates, mortality, and failure-to-rescue. We repeated this analysis ranking hospitals by risk-adjusted complication rates (Q1 lowest to Q5 highest). Results A total of 44 814 patients from 474 hospitals in 27 low-, middle-, and high-income countries were available for analysis. Of these, 7508 (17%) developed one or more postoperative complication, with 207 deaths in hospital (0.5%), giving an overall failure-to-rescue rate of 2.8%. When hospitals were ranked in quintiles by procedural volume, we identified a three-fold variation in mortality (Q1: 0.6% vs Q5: 0.2%) and a two-fold variation in failure-to-rescue (Q1: 3.6% vs Q5: 1.7%). Ranking hospitals in quintiles by risk-adjusted complication rate further confirmed the presence of important variations in failure-to-rescue, indicating differences between hospitals in the risk of death among patients after they develop complications. Conclusions Comparison of failure-to-rescue rates across health care systems suggests the presence of preventable postoperative deaths. Using such metrics, developing nations could benefit from a data-driven approach to quality improvement, which has proved effective in high-income countries.
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Affiliation(s)
- T Ahmad
- Queen Mary University of London, London EC1M 6BQ, UK
| | - R A Bouwman
- Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - I Grigoras
- Regional Institute of Oncology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania
| | - C Aldecoa
- Hospital Universitario Rio Hortega, Valladolid, Spain
| | - C Hofer
- Triemli City Hospital, Zurich, Switzerland
| | - A Hoeft
- University Hospital of Bonn, 53105, Bonn, Germany
| | - P Holt
- St Georges University of London, London SW17 0RE, UK
| | - L A Fleisher
- University of Pennsylvania, Philadelphia, PA, USA
| | - W Buhre
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R M Pearse
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
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288
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The need to collect, aggregate, and analyze global anesthesia and surgery data. Can J Anaesth 2018; 66:218-229. [DOI: 10.1007/s12630-018-1261-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 10/27/2022] Open
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289
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Health-related Quality of Life and Body Image Disturbance of Adolescents With Severe Untreated Idiopathic Early-onset Scoliosis in a Developing Country. Spine (Phila Pa 1976) 2018; 43:1566-1571. [PMID: 29664812 DOI: 10.1097/brs.0000000000002686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE This study aimed to investigate the health-related quality of life (HRQOL) and body image disturbance of adolescents with untreated severe idiopathic early-onset scoliosis (IEOS) in a developing country. SUMMARY OF BACKGROUND DATA IEOS has the potential to progress rapidly and may lead to significant disability if left untreated. Moreover, it can lead to significant body image changes that may lead to social and psychological stresses on developing adolescents. In developing countries, untreated severe IEOS among adolescents is common. METHODS The Scoliosis Research Society 22 revision (SRS-22r) Arabic version questionnaire and Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S) were used to investigate the HRQOL and body image disturbance of these patients. RESULTS A total of 137 patients with untreated severe IEOS (mean age, 15.5 years; range, 12-21 years) were included: group 1 (76 patients) with major curve angles of 90° to 120°, group 2 (61 patients) with major curve angles above 120°, and group 3 comprising 50 healthy controls were used for comparison. No significant differences were found regarding age, sex, and body mass index among the groups. Group 1 had significantly lower scores than group 3 in all SRS-22r domains (P < 0.001). Group 2 had significantly lower scores than group 1 in all SRS-22r domains, except for satisfaction (P < 0.005); the satisfaction domain had 100% worst answers in groups 1 and 2. Group 2 had worse scores than group 1 in all BIDQ-S questions (P < 0.001). No significant differences were found between males and females in all SRS-22r domains and BIDQ-S questions (P > 0.05). Further, 13% to 100% and 25% to 71% of the patients provided the worst answers to the SRS-22r and BIDQ-S questions, respectively. CONCLUSION The HRQOL and body image of the adolescents with untreated severe IEOS in a developing country were severely impaired. LEVEL OF EVIDENCE 3.
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290
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Stevens JL, McKenna H, Gurusamy KS, Van Schoor J, Grocott MPW, Jell G, Martin D. Perioperative antioxidants for adults undergoing elective non-cardiac surgery. Hippokratia 2018. [DOI: 10.1002/14651858.cd013174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jia Liu Stevens
- Royal Free NHS Trust Hospital, University College London; Division of Surgery & Interventional Science; Pond Street London UK NW3 2QG
| | - Helen McKenna
- Royal Free NHS Trust Hospital, University College London; Division of Surgery & Interventional Science; Pond Street London UK NW3 2QG
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical School; Department of Surgery; Royal Free Hospital Rowland Hill Street London UK NW3 2PF
| | - Jason Van Schoor
- Royal Free NHS Trust Hospital, University College London; Division of Surgery & Interventional Science; Pond Street London UK NW3 2QG
| | - Michael PW Grocott
- Faculty of Medicine, University of Southampton; Critical Care Group, Clinical and Experimental Sciences; Tremona Road Southampton Hampshire UK SO16 6YD
| | - Gavin Jell
- University College London; Division of Surgery & Interventional Science, Royal Free NHS Trust Hospital; Pond Street London UK NW3 2QG
| | - Daniel Martin
- University College London and Royal Free Hospital; Perioperative & Critical Care Medicine; London UK NW3 2QG
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291
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Disability Weights for Pediatric Surgical Procedures: A Systematic Review and Analysis. World J Surg 2018; 42:3021-3034. [PMID: 29441407 DOI: 10.1007/s00268-018-4537-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Metrics to measure the burden of surgical conditions, such as disability weights (DWs), are poorly defined, particularly for pediatric conditions. To summarize the literature on DWs of children's surgical conditions, we performed a systematic review of disability weights of pediatric surgical conditions in low- and middle-income countries (LMICs). METHOD For this systematic review, we searched MEDLINE for pediatric surgery cost-effectiveness studies in LMICs, published between January 1, 1996, and April 1, 2017. We also included DWs found in the Global Burden of Disease studies, bibliographies of studies identified in PubMed, or through expert opinion of authors (ES and HR). RESULTS Out of 1427 publications, 199 were selected for full-text analysis, and 30 met all eligibility criteria. We identified 194 discrete DWs published for 66 different pediatric surgical conditions. The DWs were primarily derived from the Global Burden of Disease studies (72%). Of the 194 conditions with reported DWs, only 12 reflected pre-surgical severity, and 12 included postsurgical severity. The methodological quality of included studies and DWs for specific conditions varied greatly. INTERPRETATION It is essential to accurately measure the burden, cost-effectiveness, and impact of pediatric surgical disease in order to make informed policy decisions. Our results indicate that the existing DWs are inadequate to accurately quantify the burden of pediatric surgical conditions. A wider set of DWs for pediatric surgical conditions needs to be developed, taking into account factors specific to the range and severity of surgical conditions.
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292
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Latifi R, Rivera R, Gachabayov M, Borja Chiong MM, Noyes RD, Kleinmann M, Baluyot FS, Tilley E, Samson D, El-Menyar A. Outcomes of 1,327 patients operated on through twelve multispecialty surgical volunteerism missions: A retrospective cohort study. Int J Surg 2018; 60:15-21. [PMID: 30359780 DOI: 10.1016/j.ijsu.2018.10.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Surgical volunteer missions (SVMs) have become a popular approach for reducing the burden of surgical disease worldwide. The aim of this study was to evaluate the outcomes of 12 surgical missions between 2006 and 2018 from the mission entitled "Operation Giving Back Bohol" Tagbilaran, Philippines and discuss the lessons learned during these missions in particular seven challenges that every volunteer surgeon should be familiar with. METHODS This was a retrospective descriptive study of prospectively collected data on all patients treated during one SVM. The data collected included gender, age, diagnosis, types of surgeries performed, and perioperative adverse events. RESULTS During the study period 1327 operations were performed (842 females (63.4%) and 485 males (36.6%); (male-to-female ratio 0.59); mean age 37 ± 18 years. The majority of operations were for thyroid disease (31.6%), followed by hernia (17.3%), hysterectomies/salpingo-oophorectomies (12.2%), soft tissue tumors (9.9%), cleft lip/palate repairs (7.2%), breast (6.4%), gallbladder disease (4.7%), cataract (2.9%), parotid masses (1.4%) and others (6.4%). For each mission, there were an average 5.5 days of operating, performing a median of 105.5 (80-148) cases per mission. There were 27 complications (2%), of which, 22 were postoperative bleeding and two temporary tracheostomies. The mortality rate was 0.15% (2/1327). In one patient, the family withdrew care following compassionate last ditch effort thyroidectomy for advanced cancer and one patient died as a result of intracranial bleeding from a brain tumor, which was unrecognized before mastectomy. CONCLUSIONS Surgical volunteerism missions are safe and valuable in lessening the burden of surgical disease globally when performed in an organized fashion and with continuity of care. However, there is need for standardization of surgical care provided during SVMs and creation of a world-wide database of all SVMs, and each surgeon and others who participate in these mission should be familiar with critical elements and challenges for the successful mission.
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Affiliation(s)
- Rifat Latifi
- Department of Surgery, Westchester Medical Center, and New York Medical College, Valhalla, NY, USA; Operation Giving Back Bohol, Philippines; Department of Surgery, University of Arizona, Tucson, AZ, USA.
| | - Renato Rivera
- Operation Giving Back Bohol, Philippines; St. Joseph Hospital, Breese, IL, USA
| | - Mahir Gachabayov
- Department of Surgery, Westchester Medical Center, and New York Medical College, Valhalla, NY, USA
| | | | - R Dirk Noyes
- Huntsman Cancer Institute at University of Utah, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | | | - Elizabeth Tilley
- Department of Surgery, Westchester Medical Center, and New York Medical College, Valhalla, NY, USA
| | - David Samson
- Department of Surgery, Westchester Medical Center, and New York Medical College, Valhalla, NY, USA
| | - Ayman El-Menyar
- Department of Surgery, Westchester Medical Center, and New York Medical College, Valhalla, NY, USA
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293
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Albutt K, Punchak M, Kayima P, Namanya DB, Anderson GA, Shrime MG. Access to Safe, Timely, and Affordable Surgical Care in Uganda: A Stratified Randomized Evaluation of Nationwide Public Sector Surgical Capacity and Core Surgical Indicators. World J Surg 2018; 42:2303-2313. [PMID: 29368021 DOI: 10.1007/s00268-018-4485-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Access to safe surgery is critical to health, welfare, and economic development. In 2015, the Lancet Commission on Global Surgery recommended that all countries collect surgical indicators to lend insight into improving surgical care. No nationwide high-quality data exist for these metrics in Uganda. METHODS A standardized quantitative hospital assessment and a semi-structured interview were administered to key stakeholders at 17 randomly selected public hospitals. Hospital walk-throughs and retrospective reviews of operative logbooks were completed. RESULTS This study captured information for public hospitals serving 64.0% of Uganda's population. On average, <25% of the population had 2 h access to a surgically capable facility. Hospitals averaged 257 beds/facilities and there were 0.2 operating rooms per 100,000 people. Annual surgical volume was 144.5 cases per 100,000 people per year. Surgical, anesthetic, and obstetrician physician workforce density was 0.3 per 100,000 people. Most hospitals reported having electricity, oxygen, and blood available more than half the time and running water available at least three quarters of the time. In total, 93.8% of facilities never had access to a CT scan. Sterile gloves, nasogastric tubes, and Foley catheters were frequently unavailable. Uniform outcome reporting does not exist, and the WHO safe surgery checklist is not utilized. CONCLUSION The Ugandan public hospital system does not meet LCoGS targets for surgical access, workforce, or surgical volume. Critical policy and programmatic developments are essential to build surgical capacity and facilitate provision of safe, timely, and affordable surgical care. Surgery must become a public health priority in Uganda and other low resource settings.
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Affiliation(s)
- Katherine Albutt
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, USA.
| | - Maria Punchak
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peter Kayima
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Didacus B Namanya
- Ministry of Health (MOH), Kampala, Uganda.,Uganda Martyrs University (UMU), Nkozi, Uganda
| | - Geoffrey A Anderson
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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294
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Abstract
There is a devastating lack of access to surgical care, including orthopaedic surgery, in low- and middle-income countries. Similar to other low- and middle-income countries, Tanzania has a severe shortage of trained orthopaedic surgeons. The surgeons available are inundated with acute trauma care and musculoskeletal infections; elective procedures are infrequently performed and the burden of neglected care continues to rise annually. Over the past several years, our interdisciplinary team of both American and Tanzanian members has worked to understand the current local cultural and economic barriers to increasing surgical capacity, ensuring surgical safety, delivering affordable care, providing adequate patient follow-up, and improving surgical education. We propose a new paradigm for the delivery of musculoskeletal care and creation of sustained surgical capacity in this setting by building an Orthopaedic Center of Excellence in Moshi, Tanzania, augmented by international partner institutions year-round. This initiative is a public-private partnership led by the University of Pennsylvania in conjunction with Kilimanjaro Christian Medical Center. A growing number of contributors, including the Tanzanian Health Ministry, several universities, and industry partners, including general electric (GE) Health Care Africa, are currently helping to advance this concept into reality. Through our model, we aim to increase surgical capacity and quality, as well as enhance local surgical education, with the ultimate objective of training the next generation of African surgeons in the latest surgical techniques and equipment.
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295
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Role of North-South Partnership in Trauma Management: Uganda Sustainable Trauma Orthopaedic Program. J Orthop Trauma 2018; 32 Suppl 7:S21-S24. [PMID: 30247395 DOI: 10.1097/bot.0000000000001290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Uganda, as do many low-middle income countries, has an overwhelming volume of orthopaedic trauma injuries. The Uganda Sustainable Trauma Orthopaedic Program (USTOP) is a partnership between the University of British Columbia, McMaster University and Makerere University that was initiated in 2007. The goal of the project is to reduce the disabilities that occur secondary to musculoskeletal trauma in Uganda. USTOP works with local collaborators to build orthopaedic trauma capacity through teaching, innovation, and research. USTOP has maintained a multidisciplinary approach to training, involving colleagues in anesthesia, nursing, rehabilitation, and sterile reprocessing. The project was initiated at the invitation of the Department of Orthopaedics at Makerere University and Mulago Hospital in Kampala. The project is a collaboration between Canadian and Ugandan orthopaedic surgeons and is driven by the needs identified by the Ugandan surgeons. The program has also worked with collaborators to develop several technologies aimed at reducing the cost of providing orthopaedic care without compromising quality. As orthopaedic trauma capacity in Uganda advances, USTOP strives to continually evolve and provide relevant support to colleagues in Uganda to ensure that changes result in sustainable improvements in patient care.
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296
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Rudd KE, Kissoon N, Limmathurotsakul D, Bory S, Mutahunga B, Seymour CW, Angus DC, West TE. The global burden of sepsis: barriers and potential solutions. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:232. [PMID: 30243300 PMCID: PMC6151187 DOI: 10.1186/s13054-018-2157-z] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/10/2018] [Indexed: 12/29/2022]
Abstract
Sepsis is a major contributor to the global burden of disease. The majority of sepsis cases and deaths are estimated to occur in low and middle-income countries. Barriers to reducing the global burden of sepsis include difficulty quantifying attributable morbidity and mortality, low awareness, poverty and health inequity, and under-resourced and low-resilience public health and acute health care delivery systems. Important differences in the populations at risk, infecting pathogens, and clinical capacity to manage sepsis in high and low-resource settings necessitate context-specific approaches to this significant problem. We review these challenges and propose strategies to overcome them. These strategies include strengthening health systems, accurately identifying and quantifying sepsis cases, conducting inclusive research, establishing data-driven and context-specific management guidelines, promoting creative clinical interventions, and advocacy.
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Affiliation(s)
- Kristina E Rudd
- International Respiratory and Severe Illness Center, University of Washington, Seattle, WA, USA. .,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA. .,Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St., Scaife Hall, #639, Pittsburgh, PA, USA.
| | - Niranjan Kissoon
- Division of Critical Care, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Direk Limmathurotsakul
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sotharith Bory
- Division of Infectious Diseases, Department of Medicine, Calmette Hospital, Phnom Penh, Cambodia
| | | | - Christopher W Seymour
- Departments of Critical Care and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine and UPMC Health System, Pittsburgh, PA, USA
| | - T Eoin West
- International Respiratory and Severe Illness Center, University of Washington, Seattle, WA, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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297
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Barriers to Timely Presentation of Patients with Surgical Conditions at Tamale Teaching Hospital in Northern Ghana. World J Surg 2018; 43:346-352. [DOI: 10.1007/s00268-018-4800-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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298
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Chan Y, Banza L, Martin C, Harrison WJ. Essential fracture and orthopaedic equipment lists in low resource settings: consensus derived by survey of experts in Africa. BMJ Open 2018; 8:e023473. [PMID: 30224399 PMCID: PMC6144338 DOI: 10.1136/bmjopen-2018-023473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Low/middle-income countries (LMICs) have a growing need for trauma and orthopaedic (T&O) surgical interventions but lack surgical resources. Part of this is due to the high amount of road traffic accidents in LMICs. We aimed to develop recommendations for an essential list of equipment for three different levels of care providers. METHODS The Delphi method was used to achieve consensus on essential and desirable T&O equipment for LMICs. Twenty experts with T&O experience from LMICs underwent two rounds of questionnaires. Feedback was given after each round of questionnaires. The first round of questionnaire consisted of 45 items graded on a Likert scale with the second round consisting of 50 items. We used an electronic questionnaire to collect our data for three different levels of care: non-operative-based provider, specialist provider with operative fracture care and tertiary provider with operative fracture care and orthopaedics. RESULTS After two rounds of questionnaires, recommendations for each level of care in LMICs included 4 essential equipment items for non-operative-based providers; 27 essential equipment items for specialist providers with operative fracture care and 46 essential equipment items for tertiary providers with operative fracture care and orthopaedic care. CONCLUSION These recommendations can facilitate in planning of appropriate equipment required in an institution which in turn has the potential to improve the capacity and quality of T&O care in LMICs. The essential equipment lists provided here can help direct where funding for equipment should be targeted. Our recommendations can help with planning and organising national T&O care in LMICs to achieve appropriate capacity at all relevant levels of care.
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Affiliation(s)
- Yuen Chan
- Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Leonard Banza
- Department of Orthopaedics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Claude Martin
- AO Alliance, AO Alliance Foundation, Davos, Switzerland
| | - William J Harrison
- Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
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299
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Fezeu F, Ramesh A, Melmer PD, Moosa S, Larson PS, Henderson F. Challenges and Solutions for Functional Neurosurgery in Developing Countries. Cureus 2018; 10:e3314. [PMID: 30473947 PMCID: PMC6248809 DOI: 10.7759/cureus.3314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Functional neurosurgery techniques remain integral to the neurosurgical treatment armamentarium but data on global implementation remains scarce. In comparison to high-income countries (HIC), low- and middle-income countries (LMIC) suffer from an increased prevalence of diseases like epilepsy, which may be amenable to functional techniques, and therefore, LMIC may benefit from an increased utilization of these treatment modalities. However, functional techniques tend to be expensive and thus difficult to implement in the LMIC setting. A review was performed to assess the current status of functional neurosurgical techniques in LMIC as a starting point for future initiatives. For methodology, a review of the current body of literature on functional neurosurgery in LMIC was conducted through the United States National Library of Medicine Pubmed search engine. Search terms included “functional neurosurgery,” “developing countries,” “low and middle income,” and other related terms. It was found that though five billion people lack access to safe surgical care, the burden of disease amenable to treatment with functional neurosurgical procedures remains unknown. Increasingly, reports of successful, long-term, international neurosurgical collaborations are being reported, but reports in the sub-field of functional neurosurgery are lacking. In conclusion, awareness of global surgical disparities has increased dramatically while global guidelines for functional techniques are currently lacking. A concerted effort can harness these techniques for wider practice. Partnerships between centers in LMIC and HIC are making progress to better understand the burden of disease in LMIC and to create context-specific solutions for practice in the LMIC setting, but more collaborations are warranted.
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Affiliation(s)
| | - Arjun Ramesh
- Anesthesiology, Rush University Medical Center, Chicago, USA
| | | | - Shayan Moosa
- Neurosurgery, University of Virginia Health System, Charlottesville, USA
| | - Paul S Larson
- Neurological Surgery, University of California, San Francisco, USA
| | - Fraser Henderson
- Neurosurgery, Medical University of South Carolina, Charleston, USA
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300
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Ljungman D, Vaughan KA, Park KB, Makasa EM, Marten R, Meara JG. World Health Organization: Leading surgical care toward sustainable development in the era of globalization. Surgery 2018; 164:1137-1146. [PMID: 30205897 DOI: 10.1016/j.surg.2018.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/05/2018] [Indexed: 11/17/2022]
Affiliation(s)
- David Ljungman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Kerry A Vaughan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Emmanuel M Makasa
- Ministry of Foreign Affairs, Lusaka, Zambia; School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Robert Marten
- London School of Hygiene and Tropical Medicine, London, England
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA
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