351
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Thompson KA, Krishnan A, Stehman C, Hanling S, Casey K. Collaborative Approach to the Creation of an Arteriovenous Fistula on a US Navy Hospital Ship. Vasc Endovascular Surg 2017; 51:146-148. [PMID: 28190377 DOI: 10.1177/1538574417692450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early creation of arteriovenous fistulas (AVFs) decreases morbidity and mortality in patients with end-stage renal disease and is the standard of care in the United States. However, this procedure is frequently not accessible in low- and middle-income countries (LMICs). We present the first reported case of successful AVF creation as part of a humanitarian assistance mission. The patient was a 51-year-old male with diabetes, hypertension, and end-stage renal disease on hemodialysis via a temporary dialysis catheter. Preoperative assessment and patient selection were coordinated with the host nation (HN) nephrologist and dialysis team. The visiting surgical team provided education on AVF anatomy, complications, and cannulation techniques to the HN dialysis team. A left brachiocephalic AVF was created under regional anesthesia performed by the visiting surgeon and anesthesiologists. There were no postoperative complications, and the AVF was matured and accessed successfully by the HN dialysis team 7 weeks after creation. Performing AVFs as part of humanitarian assistance missions has the potential to significantly reduce morbidity and mortality in LMICs.
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Affiliation(s)
| | | | | | | | - Kevin Casey
- 1 Naval Medical Center San Diego, San Diego, CA, USA
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352
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Douaiher J, Ravipati A, Grams B, Chowdhury S, Alatise O, Are C. Colorectal cancer-global burden, trends, and geographical variations. J Surg Oncol 2017; 115:619-630. [PMID: 28194798 DOI: 10.1002/jso.24578] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study is to describe the trends and variations in the global burden of colorectal cancer (CRC). METHODS Data (2012-2030) relating to CRC was extracted from GLOBOCAN 2012 database and analyzed. RESULTS The results of our study demonstrate a rising global burden of colorectal cancer which persists until the year 2035 and likely beyond. The rise in the global burden is not uniform with significant variations influenced by geographic location, socio-economic status, age, and gender. Although the EURO region has the highest burden, Asia as a continent continues to bear the heaviest brunt of the disease. Although the burden of disease is higher in more developed regions, mortality is considerably higher in less developed regions and this gap widens over the next two decades. The disease predominantly affects the male gender across all regions of the world. Age has a complex relation with the burden of CRC and is affected by the cross-influences relating to socio-economic status. CONCLUSIONS The results of our study demonstrate a rising global burden of CRC with some unique variations. Knowledge of this data can increase awareness and help strategic targeting of efforts and resources.
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Affiliation(s)
- Jeffrey Douaiher
- Department of Surgery, UniversityOf Nebraska Medical Center, Omaha, Nebraska
| | | | - Benjamin Grams
- Department of Surgery, UniversityOf Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Chandrakanth Are
- Department of Surgery, UniversityOf Nebraska Medical Center, Omaha, Nebraska
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353
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Beyond a Moral Obligation: A Legal Framework for Emergency and Essential Surgical Care and Anesthesia. World J Surg 2017; 41:1208-1217. [DOI: 10.1007/s00268-016-3866-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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354
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Kligerman MP, Alexandre A, Jean-Gilles P, Walmer D, Cheney ML, Messner AH. Otorhinolaryngology/Head and Neck Surgery in a low income country: The Haitian experience. Int J Pediatr Otorhinolaryngol 2017; 93:128-132. [PMID: 28109483 DOI: 10.1016/j.ijporl.2016.12.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/28/2016] [Accepted: 12/28/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Little is known regarding the diagnosis and management of pediatric surgical conditions of the head and neck in low-income countries. Haiti, the western hemisphere's poorest country, recently developed its first Otorhinolaryngology (ORL) department at the Hopital de L'Universite d'Etat d'Haiti (HUEH). This manuscript assesses the caseload at HUEH with a special emphasis on pediatric cases, with the aim of characterizing ORL related conditions and their treatments in low-income countries. METHODS We conducted a retrospective chart review of surgical case logs at HUEH for the calendar year of 2014 and recorded patient age, diagnosis, and surgical intervention for all ORL surgeries. RESULTS A total of 229 ORL surgeries were performed at HUEH during this time. The average age of the patient was 21.8 years and 54.2% of patients were 18 years or younger. The five most common diagnoses were tonsillar hypertrophy (23.6%), ingested foreign body (18%), mandibular fracture (9.2%), unspecified head or neck mass (6%), and thyroid goiter (4.8%). The five most common surgeries performed were tonsillectomy (23.6%), foreign body retrieval (17.9%), open reduction of mandibular fracture with direct skeletal fixation (6.9%), thyroidectomy (7.9%), and excision of unspecified mass. Trauma accounted for 33.6% of all ORL surgeries. CONCLUSIONS Diseases related to the head and neck constitute a common yet underserved surgical problem. Strengthening ORL surgical capacity in Haiti should focus on improving capacity for the most common conditions including tonsillar disease, ingested foreign bodies, and facial trauma, as well as improving capacity for rarely performed surgeries, such as ear surgery, nose and sinus surgery, and cancer resections.
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Affiliation(s)
- Maxwell P Kligerman
- Stanford University School of Medicine, Stanford, CA, USA; Family Health Ministries, 501-C3, Durham, NC, USA.
| | - Anahuma Alexandre
- Department of Otorhinolaryngology, Hopital de L'Universite d'Etat d'Haiti, Port-au-Prince, Haiti
| | - Patrick Jean-Gilles
- Department of Otorhinolaryngology, Hopital de L'Universite d'Etat d'Haiti, Port-au-Prince, Haiti
| | - David Walmer
- Duke Global Health Institute, Duke University, USA; Family Health Ministries, 501-C3, Durham, NC, USA
| | - Mack L Cheney
- Massachusetts Eye and Ear Infirmary, Harvard School of Medicine, USA
| | - Anna H Messner
- Department of Otolaryngology/Head & Neck Surgery, Stanford University, Stanford, CA, USA
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355
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Garg M, Peck GL, Arquilla B, Miller AC, Soghoian SE, Anderson Iii HL, Bloem C, Firstenberg MS, Galwankar SC, Guo WA, Izurieta R, Krebs E, Hansoti B, Nanda S, Nwachuku CO, Nwomeh B, Paladino L, Papadimos TJ, Sharpe RP, Swaroop M, Stawicki SP. A Comprehensive Framework for International Medical Programs: A 2017 consensus statement from the American College of Academic International Medicine. Int J Crit Illn Inj Sci 2017; 7:188-200. [PMID: 29291171 PMCID: PMC5737060 DOI: 10.4103/ijciis.ijciis_65_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The American College of Academic International Medicine (ACAIM) represents a group of clinicians who seek to promote clinical, educational, and scientific collaboration in the area of Academic International Medicine (AIM) to address health care disparities and improve patient care and outcomes globally. Significant health care delivery and quality gaps persist between high-income countries (HICs) and low-and-middle-income countries (LMICs). International Medical Programs (IMPs) are an important mechanism for addressing these inequalities. IMPs are international partnerships that primarily use education and training-based interventions to build sustainable clinical capacity. Within this overall context, a comprehensive framework for IMPs (CFIMPs) is needed to assist HICs and LMICs navigate the development of IMPs. The aim of this consensus statement is to highlight best practices and engage the global community in ACAIM's mission. Through this work, we highlight key aspects of IMPs including: (1) the structure; (2) core principles for successful and ethical development; (3) information technology; (4) medical education and training; (5) research and scientific investigation; and (6) program durability. The ultimate goal of current initiatives is to create a foundation upon which ACAIM and other organizations can begin to formalize a truly global network of clinical education/training and care delivery sites, with long-term sustainability as the primary pillar of international inter-institutional collaborations.
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Affiliation(s)
- Manish Garg
- Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Gregory L Peck
- Rutgers: Robert Wood Johnson Medical School, New Brunswick, United States of America
| | - Bonnie Arquilla
- Suny Downstate Medical Center, Brooklyn, United States of America
| | - Andrew C Miller
- East Carolina University, Greenville, NC, United States of America
| | | | | | - Christina Bloem
- Suny Downstate Medical Center, Brooklyn, United States of America
| | | | - Sagar C Galwankar
- University of Florida College of Medicine, Jacksonville, United States of America
| | - Weidun Alan Guo
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Ricardo Izurieta
- University of South Florida, Tampa, FL, United States of America
| | - Elizabeth Krebs
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - Bhakti Hansoti
- Johns Hopkins Medicine, Baltimore, MD, United States of America
| | - Sudip Nanda
- St. Luke's University Health Network, Bethlehem, PA, United States of America
| | - Chinenye O Nwachuku
- St. Luke's University Health Network, Bethlehem, PA, United States of America
| | - Benedict Nwomeh
- Nationwide Children's Hospital, Columbus, United States of America
| | - Lorenzo Paladino
- Suny Downstate Medical Center, Brooklyn, United States of America
| | - Thomas J Papadimos
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Richard P Sharpe
- Warren Hospital, St. Luke's University Health Network, Phillipsburg, NJ, United States of America
| | - Mamta Swaroop
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
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356
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Cherewick ML, Cherewick SD, Kushner AL. Operative needs in HIV+ populations: An estimation for sub-Saharan Africa. Surgery 2016; 161:1436-1443. [PMID: 28043694 DOI: 10.1016/j.surg.2016.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND In 2015, it was estimated that approximately 36.7 million people were living with HIV globally and approximately 25.5 million of those people were living in sub-Saharan Africa. Limitations in the availability and access to adequate operative care require policy and planning to enhance operative capacity. METHODS Data estimating the total number of persons living with HIV by country, sex, and age group were obtained from the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2015. Using minimum proposed surgical rates per 100,000 for 4, defined, sub-Saharan regions of Africa, country-specific and regional estimates were calculated. The total need and unmet need for operative procedures were estimated. RESULTS A minimum of 1,539,138 operative procedures were needed in 2015 for the 25.5 million persons living with HIV in sub-Saharan Africa. In 2015, there was an unmet need of 908,513 operative cases in sub-Saharan Africa with the greatest unmet need in eastern sub-Saharan Africa (427,820) and western sub-Saharan Africa (325,026). Approximately 55.6% of the total need for operative cases is adult women, 38.4% are adult men, and 6.0% are among children under the age of 15. CONCLUSION A minimum of 1.5 million operative procedures annually are required to meet the needs of persons living with HIV in sub-Saharan Africa. The unmet need for operative care is greatest in eastern and western sub-Saharan Africa and will require investments in personnel, infrastructure, facilities, supplies, and equipment. We highlight the need for global planning and investment in resources to meet targets of operative capacity.
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Affiliation(s)
- Megan L Cherewick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | | | - Adam L Kushner
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Surgery, Columbia University, New York, NY
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357
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Raykar NP, Yorlets RR, Liu C, Goldman R, Greenberg SLM, Kotagal M, Farmer PE, Meara JG, Roy N, Gillies RD. The How Project: understanding contextual challenges to global surgical care provision in low-resource settings. BMJ Glob Health 2016; 1:e000075. [PMID: 28588976 PMCID: PMC5321373 DOI: 10.1136/bmjgh-2016-000075] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/14/2016] [Accepted: 11/11/2016] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION 5 billion people around the world do not have access to safe, affordable, timely surgical care. This series of qualitative interviews was launched by The Lancet Commission on Global Surgery (LCoGS) with the aim of understanding the contextual challenges-the specific circumstances-faced by surgical care providers in low-resource settings who care for impoverished patients, and how those providers overcome these challenges. METHODS From January 2014 to February 2015, 20 LCoGS collaborators conducted semistructured interviews with 148 surgical providers in low-resource settings in 21 countries. Stratified purposive sampling was used to include both rural and urban providers, and reputational case selection identified individuals. Interviewers were trained with an implementation manual. Following immersion into de-identified texts from completed interviews, topical coding and further analysis of coded texts was completed by an independent analyst with periodic validation from a second analyst. RESULTS Providers described substantial financial, geographic and cultural barriers to patient access. Rural surgical teams reported a lack of a trained workforce and insufficient infrastructure, equipment, supplies and banked blood. Urban providers face overcrowding, exacerbated by minimal clinical and administrative support, and limited interhospital care coordination. Many providers across contexts identified national health policies that do not reflect the realities of resource-poor settings. Some findings were region-specific, such as weak patient-provider relationships and unreliable supply chains. In all settings, surgical teams have created workarounds to deliver care despite the challenges. DISCUSSION While some differences exist between countries, the barriers to safe surgery and anaesthesia are overall consistent and resource-dependent. Efforts to advance and expand global surgery must address these commonalities, while local policymakers can tailor responses to key contextual differences.
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Affiliation(s)
- Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Charles Liu
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Roberta Goldman
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sarah L M Greenberg
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Meera Kotagal
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- University of Washington, Seattle, Washington, USA
| | - Paul E Farmer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Partners in Health, Boston, Massachusetts,USA
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, Massachusetts, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Nobhojit Roy
- BARC Hospital (Government of India), HBNI University, Mumbai, Maharashtra, India
- Health Systems and Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Rowan D Gillies
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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358
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Medoff S, Freed J. The Need for Formal Surgical Global Health Programs and Improved Mission
Trip Coordination. Ann Glob Health 2016; 82:634-638. [DOI: 10.1016/j.aogh.2016.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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359
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Corlew DS, Alkire BC, Poenaru D, Meara JG, Shrime MG. Economic valuation of the impact of a large surgical charity using the value of lost welfare approach. BMJ Glob Health 2016; 1:e000059. [PMID: 28588975 PMCID: PMC5321371 DOI: 10.1136/bmjgh-2016-000059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 10/04/2016] [Accepted: 10/11/2016] [Indexed: 02/05/2023] Open
Abstract
Background The assessment of the economic burden of surgical disease is integral to determining allocation of resources for health globally. We estimate the economic gain realised over an 11-year period resulting from a vertical surgical programme addressing cleft lip (CL) and cleft palate (CP). Methods The database from a large non-governmental organisation (Smile Train) over an 11-year period was analysed. Incidence-based disability-adjusted life years (DALYs) averted through the programme were calculated, discounted 3%, using disability weights from the Global Burden of Disease (GBD) study and an effectiveness factor for each surgical intervention. The effectiveness factor allowed for the lack of 100% resolution of the disability from the operation. We used the value of lost welfare approach, based on the concept of the value of a statistical life (VSL), to assess the economic gain associated with each operation. Using income elasticities (IEs) tailored to the income level of each country, a country-specific VSL was calculated and the VSL-year (VSLY) was determined. The VSLY is the economic value of a DALY, and the DALYs averted were converted to economic gain per patient and aggregated to give a total value and an average per patient. Sensitivity analyses were performed based on the variations of IE applied for each country. Results Each CL operation averted 2.2 DALYs on average and each CP operation 3.3. Total averted DALYs were 1 325 678 (CP 686 577 and CL 639 102). The economic benefit from the programme was between US$7.9 and US$20.7 billion. Per patient, the average benefit was between US$16 133 and US$42 351. Expense per DALY averted was estimated to be $149. Conclusions Addressing basic surgical needs in developing countries provides a massive economic boost through improved health. Expansion of surgical capacity in the developing world is of significant economic and health value and should be a priority in global health efforts.
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Affiliation(s)
| | - Blake C Alkire
- Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Program in Global Surgery and Social Change, Department of Global Health Equity, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Dan Poenaru
- MyungSung Christian Medical Center, Addis Ababa, Oromia, Ethiopia.,Montreal Children's Hospital, Montreal, Quebec, Canada
| | - John G Meara
- Department of Plastic and Reconstructive Surgery, Boston's Children Hospital, Boston, Massachusetts, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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360
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Agarwal-Harding KJ, von Keudell A, Zirkle LG, Meara JG, Dyer GSM. Understanding and Addressing the Global Need for Orthopaedic Trauma Care. J Bone Joint Surg Am 2016; 98:1844-1853. [PMID: 27807118 DOI: 10.2106/jbjs.16.00323] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤The burden of musculoskeletal trauma is high worldwide, disproportionately affecting the poor, who have the least access to quality orthopaedic trauma care.➤Orthopaedic trauma care is essential, and must be a priority in the horizontal development of global health systems.➤The education of surgeons, nonphysician clinicians, and ancillary staff in low and middle income countries is central to improving access to and quality of care.➤Volunteer surgical missions from rich countries can sustainably expand and strengthen orthopaedic trauma care only when they serve a local need and build local capacity.➤Innovative business models may help to pay for care of the poor. Examples include reducing costs through process improvements and cross-subsidizing from profitable high-volume activities.➤Resource-poor settings may foster innovations in devices or systems with universal applicability in orthopaedics.
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Affiliation(s)
- Kiran J Agarwal-Harding
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Arvind von Keudell
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, Massachusetts
| | | | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - George S M Dyer
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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361
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The Role of Minimally Invasive Gynecologic Surgery in Sub Saharan Africa. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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362
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Gutnik L, Yamey G, Riviello R, Meara JG, Dare AJ, Shrime MG. Financial contributions to global surgery: an analysis of 160 international charitable organizations. SPRINGERPLUS 2016; 5:1558. [PMID: 27652131 PMCID: PMC5021658 DOI: 10.1186/s40064-016-3046-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 08/11/2016] [Indexed: 11/23/2022]
Abstract
Background The non-profit and volunteer sector has made notable contributions to delivering surgical services in low-and middle-income countries (LMICs). As an estimated 55 % of surgical care delivered in some LMICs is via charitable organizations; the financial contributions of this sector provides valuable insight into understanding financing priorities in global surgery. Methods Databases of registered charitable organizations in five high-income nations (United States, United Kingdom, Canada, Australia, and New Zealand) were searched to identify organizations committed exclusively to surgery in LMICs and their financial data. For each organization, we categorized the surgical specialty and calculated revenues and expenditures. All foreign currency was converted to U.S. dollars based on historical yearly average conversion rates. All dollars were adjusted for inflation by converting to 2014 U.S. dollars. Results
One hundred sixty organizations representing 15 specialties were identified. Adjusting for inflation, in 2014 U.S. dollars (US$), total aggregated revenue over the years 2008–2013 was $3·4 billion and total aggregated expenses were $3·1 billion. Twenty-eight ophthalmology organizations accounted for 45 % of revenue and 49 % of expenses. Fifteen cleft lip/palate organizations totaled 26 % of both revenue and expenses. The remaining 117 organizations, representing a variety of specialties, accounted for 29 % of revenue and 25 % of expenses. In comparison, from 2008 to 2013, charitable organizations provided nearly $27 billion for global health, meaning an estimated 11.5 % went towards surgery. Conclusion Charitable organizations that exclusively provide surgery in LMICs primarily focus on elective surgeries, which cover many subspecialties, and often fill deep gaps in care. The largest funding flows are directed at ophthalmology, followed by cleft lip and palate surgery. Despite the number of contributing organizations, there is a clear need for improvement and increased transparency in tracking of funds to global surgery via charitable organizations.
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Affiliation(s)
- Lily Gutnik
- Department of Surgery, University of Utah, Salt Lake City, UT USA ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA USA ; Tidziwe Center, UNC Project Malawi, Privae Bag A-104, Lilongwe, Malawi
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, NC USA
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA USA ; Department of Surgery, Brigham and Women's Hospital, Boston, MA USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA ; Department of Plastic Surgery, Boston Children's Hospital, Boston, MA USA
| | - Anna J Dare
- King's Centre for Global Health, King's Health Partners, King's College London, London, England, UK
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA ; Harvard University Interfaculty Initiative in Health Policy, Boston, MA USA ; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA USA ; Department of Otology and Laryngology, Harvard Medical School, Boston, MA USA
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363
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Timmers TK, Kortekaas E, Beyer B, Huizinga E, V Hezik van SM, Twagirayezu E, Bemelman M. Experience of collaboration between a Dutch surgical team in a Ghanaian Orthopaedic Teaching Hospital. Afr Health Sci 2016; 16:838-844. [PMID: 27917219 DOI: 10.4314/ahs.v16i3.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Surgery is an indivisible, indispensable part of healthcare. In Africa, surgery may be thought of as the neglected stepchild of global public health. We describe our experience over a 3-year period of intensive collaboration between specialized teams from a Dutch hospital and local teams of an orthopaedic hospital in Effiduase-Koforidua, Ghana. INTERVENTION During 2010-2012, medical teams from our hospital were deployed to St. Joseph's Hospital. These teams were completely self-supporting. They were encouraged to work together with the local-staff. Apart from clinical work, effort was also spent on education/ teaching operation techniques/ regional anaesthesia techniques/ scrubbing techniques/ and principles around sterility. RESULTS Knowledge and quality of care has improved. Nevertheless, the overall level of quality of care still lags behind compared to what we see in the Western world. This is mainly due to financial constraints; restricting the capacity to purchase good equipment, maintaining it, and providing regular education. CONCLUSION The relief provided by institutions like Care-to-Move is very valuable and essential to improve the level of healthcare. The hospital has evolved to such a high level that general European teams have become redundant. Focused and dedicated teams should be the next step of support within the nearby future.
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Affiliation(s)
- T K Timmers
- University Medical Center Utrecht, Department of Surgery/Trauma-surgery. P.O.-box 85500, 3508 GA Utrecht, The Netherlands
| | - E Kortekaas
- University Medical Center Utrecht, Department of Anaesthesiology
| | - Bpc Beyer
- University Medical Center Utrecht, Department of Vital Functions and Theatre Managment
| | - E Huizinga
- University Medical Center Utrecht, Department of Surgery/Trauma-surgery. P.O.-box 85500, 3508 GA Utrecht, The Netherlands
| | - S M V Hezik van
- University Medical Center Utrecht, Department of Vital Functions and Theatre Managment
| | - E Twagirayezu
- St. Joseph's Hospital, Department of Orthopaedic Surgery Effiduase-Koforidua, Ghana
| | - M Bemelman
- University Medical Center Utrecht, Department of Surgery/Trauma-surgery. P.O.-box 85500, 3508 GA Utrecht, The Netherlands
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Stewart BT, Tansley G, Gyedu A, Ofosu A, Donkor P, Appiah-Denkyira E, Quansah R, Clarke DL, Volmink J, Mock C. Mapping Population-Level Spatial Access to Essential Surgical Care in Ghana Using Availability of Bellwether Procedures. JAMA Surg 2016; 151:e161239. [PMID: 27331865 PMCID: PMC5577012 DOI: 10.1001/jamasurg.2016.1239] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Conditions that can be treated by surgery comprise more than 16% of the global disease burden. However, 5 billion people do not have access to essential surgical care. An estimated 90% of the 87 million disability-adjusted life-years incurred by surgical conditions could be averted by providing access to timely and safe surgery in low-income and middle-income countries. Population-level spatial access to essential surgery in Ghana is not known. OBJECTIVES To assess the performance of bellwether procedures (ie, open fracture repair, emergency laparotomy, and cesarean section) as a proxy for performing essential surgery more broadly, to map population-level spatial access to essential surgery, and to identify first-level referral hospitals that would most improve access to essential surgery if strengthened in Ghana. DESIGN, SETTING, AND PARTICIPANTS Population-based study among all households and public and private not-for-profit hospitals in Ghana. Households were represented by georeferenced census data. First-level and second-level referral hospitals managed by the Ministry of Health and all tertiary hospitals were included. Surgical data were collected from January 1 to December 31, 2014. MAIN OUTCOMES AND MEASURES All procedures performed at first-level referral hospitals in Ghana in 2014 were used to sort each facility into 1 of the following 3 hospital groups: those without capability to perform all 3 bellwether procedures, those that performed 1 to 11 of each procedure, and those that performed at least 12 of each procedure. Candidates for targeted capability improvement were identified by cost-distance and network analysis. RESULTS Of 155 first-level referral hospitals managed by the Ghana Health Service and the Christian Health Association of Ghana, 123 (79.4%) reported surgical data. Ninety-five (77.2%) did not have the capability in 2014 to perform all 3 bellwether procedures, 24 (19.5%) performed 1 to 11 of each bellwether procedure, and 4 (3.3%) performed at least 12. The essential surgical procedure rate was greater in bellwether procedure-capable first-level referral hospitals than in noncapable hospitals (median, 638; interquartile range, 440-1418 vs 360; interquartile range, 0-896 procedures per 100 000 population; P = .03). Population-level spatial access within 2 hours to a hospital that performed 1 to 11 and at least 12 of each bellwether procedure was 83.2% (uncertainty interval [UI], 82.2%-83.4%) and 71.4% (UI, 64.4%-75.0%), respectively. Five hospitals were identified for targeted capability improvement. CONCLUSIONS AND RELEVANCE Almost 30% of Ghanaians cannot access essential surgery within 2 hours. Bellwether capability is a useful metric for essential surgery more broadly. Similar strategic planning exercises might be useful for other low-income and middle-income countries aiming to improve access to essential surgery.
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Affiliation(s)
- Barclay T Stewart
- Department of Surgery, University of Washington, Seattle2Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana3Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Gavin Tansley
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada5Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England
| | - Adam Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana3Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Anthony Ofosu
- Information and Monitoring Unit, Ghana Health Service, Accra
| | - Peter Donkor
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana3Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Robert Quansah
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana3Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Damian L Clarke
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa9Department of General Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Kwa-Zulu Natal, South Africa
| | - Jimmy Volmink
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa11Cochrane South Africa, South African Medical Research Council, Tygerberg
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle12Harborview Injury Prevention & Research Center, Seattle, Washington13Department of Global Health, University of Washington, Seattle
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365
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Reynolds JL, Sun WZ, Chen-Hsien Y. Measuring and reducing perioperative anesthetic-related mortality: View from East Asia. ACTA ANAESTHESIOLOGICA TAIWANICA : OFFICIAL JOURNAL OF THE TAIWAN SOCIETY OF ANESTHESIOLOGISTS 2016; 54:41-3. [PMID: 27524738 DOI: 10.1016/j.aat.2016.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 01/25/2023]
Affiliation(s)
| | - Wei-Zen Sun
- Acta Anaesthesiologica Taiwanica, Taipei, Taiwan; Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Yang Chen-Hsien
- Department of Anesthesiology, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
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366
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Shrime MG, Dare A, Alkire BC, Meara JG. A global country-level comparison of the financial burden of surgery. Br J Surg 2016; 103:1453-61. [PMID: 27428044 DOI: 10.1002/bjs.10249] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/11/2015] [Accepted: 05/23/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Approximately 30 per cent of the global burden of disease is surgical, and nearly one-quarter of individuals who undergo surgery each year face financial hardship because of its cost. The Lancet Commission on Global Surgery has proposed the elimination of impoverishment due to surgery by 2030, but no country-level estimates exist of the financial burden of surgical access. METHODS Using publicly available data, the incidence and risk of financial hardship owing to surgery was estimated for each country. Four measures of financial catastrophe were examined: catastrophic expenditure, and impoverishment at the national poverty line, at 2 international dollars (I$) per day and at I$1·25 per day. Stochastic models of income and surgical costs were built for each country. Results were validated against available primary data. RESULTS Direct medical costs of surgery put 43·9 (95 per cent posterior credible interval 2·2 to 87·1) per cent of the examined population at risk of catastrophic expenditure, and 57·0 (21·8 to 85·1) per cent at risk of being pushed below I$2 per day. The risk of financial hardship from surgery was highest in sub-Saharan Africa. Correlations were found between the risk of financial catastrophe and external financing of healthcare (positive correlation), national measures of well-being (negative correlation) and the percentage of a country's gross domestic product spent on healthcare (negative correlation). The model performed well against primary data on the costs of surgery. CONCLUSION Country-specific estimates of financial catastrophe owing to surgical care are presented. The economic benefits projected to occur with the scale-up of surgery are placed at risk if the financial burden of accessing surgery is not addressed in national policies.
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Affiliation(s)
- M G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Massachusetts, USA. .,Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston Children's Hospital, Boston, Massachusetts, USA.
| | - A Dare
- Department of Surgery, University of Toronto, Toronto, Canada
| | - B C Alkire
- Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston Children's Hospital, Boston, Massachusetts, USA
| | - J G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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367
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Barriers to essential surgical care experienced by women in the two northernmost regions of Ghana: a cross-sectional survey. BMC WOMENS HEALTH 2016; 16:27. [PMID: 27230890 PMCID: PMC4882854 DOI: 10.1186/s12905-016-0308-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 05/21/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Women in developing countries might experience certain barriers to care more frequently than men. We aimed to describe barriers to essential surgical care that women face in five communities in Ghana. METHODS Questions regarding potential barriers were asked during surgical outreaches to five communities in the northernmost regions of Ghana. Responses were scored in three dimensions from 0 to 18 (i.e., 'acceptability,' 'affordability,' and 'accessibility'; 18 implied no barriers). A barrier to care index out of 10 was derived (10 implied no barriers). An open-ended question to elicit gender-specific barriers was also asked. RESULTS Of the 320 participants approached, 315 responded (response rate 98 %); 149 were women (47 %). Women had a slightly lower barriers to surgical care index (median index 7.4; IQR 3.9-9.1) than men (7.9; IQR 3.9-9.4; p = 0.002). Compared with men, women had lower accessibility and acceptability dimension scores (14.4/18 vs 14.4/18; p = 0.001 and 13.5/18 vs 14/18; p = 0.05, respectively), but similar affordability scores (13.5/18 vs 13.5/18; p = 0.13). Factors contributing to low dimension scores among women included fear of anesthesia, lack of social support, and difficulty navigating healthcare, as well as lack of hospital privacy and confidentiality. CONCLUSION Women had a slightly lower barriers to surgical care index than men, which may indicate greater barriers to surgical care. However, the actual significance of this difference is not yet known. Community-level education regarding the safety and benefits of essential surgical care is needed. Additionally, healthcare facilities must ensure a private and confidential care environment. These interventions might ameliorate some barriers to essential surgical care for women in Ghana, as well as other LMICs more broadly.
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368
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Nwanna-Nzewunwa OC, Ajiko MM, Kirya F, Epodoi J, Kabagenyi F, Batibwe E, Feldhaus I, Juillard C, Dicker R. Barriers and facilitators of surgical care in rural Uganda: a mixed methods study. J Surg Res 2016; 204:242-50. [PMID: 27451893 DOI: 10.1016/j.jss.2016.04.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/31/2016] [Accepted: 04/20/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical care delivery is poorly understood in resource-limited settings. To effectively move toward universal health coverage, there is a critical need to understand surgical care delivery in developing countries. This study aims to identify the barriers and facilitators of surgical care delivery at Soroti Regional Referral Hospital in Uganda. METHODS In this mixed methods study, we (1) applied the Surgeons OverSeas' Personnel, Infrastructure, Procedures, Equipment, and Supplies tool to assess surgical capacity; (2) retrospectively reviewed inpatient records; (3) conducted four semistructured focus group discussions with 18 purposively sampled providers involved in perioperative care; and (4) observed the perioperative process of care using a time and motion approach. Descriptive statistics were generated from quantitative data. Qualitative data were thematically analyzed. RESULTS The Personnel, Infrastructure, Procedures, Equipment, and Supplies survey revealed severe deficiencies in workforce (P-score = 14) and infrastructure (I-score = 5). Equipment, supplies, and procedures were generally available. Male and female wards were overbooked 83% and 60% of the time, respectively. Providers identified lack of space, patient overload, and superfluous patients' attendants as barriers to surgical care. Workforce challenges were tackled using teamwork and task sharing. Inadequate equipment and processes were addressed using improvisations. All observed subjects (n = 31) received interventions. The median decision-to-intervention time was 2.5 h (Interquartile Range [IQR], 0.4, 21.4). However, 48% of subjects experienced delays. Median decision-to-intervention delay was 14.8 h (IQR, 0.9, 26.6). CONCLUSIONS Despite severe workforce and physical infrastructural deficiencies at Soroti Regional Referral Hospital, providers are adjusting and innovating to deliver surgical care.
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Affiliation(s)
- Obieze C Nwanna-Nzewunwa
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, San Francisco, California.
| | | | - Fred Kirya
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Joseph Epodoi
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Fiona Kabagenyi
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Emmanuel Batibwe
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Isabelle Feldhaus
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, San Francisco, California
| | - Catherine Juillard
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, San Francisco, California
| | - Rochelle Dicker
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, San Francisco, California
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369
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O'Hara NN, Mugarura R, Potter J, Stephens T, Rehavi MM, Francois P, Blachut PA, O'Brien PJ, Fashola BK, Mezei A, Beyeza T, Slobogean GP. Economic loss due to traumatic injury in Uganda: The patient's perspective. Injury 2016; 47:1098-103. [PMID: 26724174 DOI: 10.1016/j.injury.2015.11.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 10/28/2015] [Accepted: 11/28/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Traumatic injury is a growing public health concern globally, and is a major cause of death and disability worldwide. The purpose of this study was to quantify the socioeconomic impact of lower extremity fractures in Uganda. METHODS All adult patients presenting acutely to Uganda's national referral hospital with a single long bone lower extremity fracture in October 2013 were recruited. Consenting patients were surveyed at admission and again at six-months and 12-months post-injury. The primary outcome was the cumulative 12-month post-injury loss in income. Secondary outcome measures included the change in health-related quality of life (HRQoL) and the injury's effect on school attendance for the patients' dependents. RESULTS Seventy-four patients were recruited during the study period. Sixty-four (86%) of the patients were available for 12-months of follow-up. Compared to pre-injury earnings, patients lost 88.4% ($1822 USD) of their annual income in the 12-months following their injury. To offset this loss in income, patients borrowed an average of 28% of their pre-injury annual income. Using the EuroQol-5D instrument, the mean HRQoL decreased from 0.91 prior to the injury to 0.39 (p<0.0001) at 12-months post-injury. Ninety-three percent of school-aged dependents missed at least one month of school during their guardian's recovery and only 61% had returned to school by 12-months post-injury. CONCLUSION This study demonstrates that lower extremity fractures in Uganda had a profound impact on the socioeconomic status of the individuals in our sample population, as well as the socioeconomic health of the family unit.
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Affiliation(s)
- Nathan N O'Hara
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
| | - Rodney Mugarura
- Department of Orthopaedics, Makerere University, Kampala, Uganda
| | - Jeffrey Potter
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Trina Stephens
- Centre for Clinical Epidemiology & Evaluation, University of British Columbia, Vancouver, Canada
| | - M Marit Rehavi
- Vancouver School of Economics, University of British Columbia, Vancouver, Canada; Canadian Institute for Advanced Research, Toronto, Canada
| | - Patrick Francois
- Vancouver School of Economics, University of British Columbia, Vancouver, Canada; Canadian Institute for Advanced Research, Toronto, Canada
| | - Piotr A Blachut
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Peter J O'Brien
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Bababunmi K Fashola
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Alex Mezei
- Vancouver School of Economics, University of British Columbia, Vancouver, Canada
| | - Tito Beyeza
- Department of Orthopaedics, Makerere University, Kampala, Uganda
| | - Gerard P Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, USA
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370
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Ng-Kamstra JS, Greenberg SLM, Abdullah F, Amado V, Anderson GA, Cossa M, Costas-Chavarri A, Davies J, Debas HT, Dyer GSM, Erdene S, Farmer PE, Gaumnitz A, Hagander L, Haider A, Leather AJM, Lin Y, Marten R, Marvin JT, McClain CD, Meara JG, Meheš M, Mock C, Mukhopadhyay S, Orgoi S, Prestero T, Price RR, Raykar NP, Riesel JN, Riviello R, Rudy SM, Saluja S, Sullivan R, Tarpley JL, Taylor RH, Telemaque LF, Toma G, Varghese A, Walker M, Yamey G, Shrime MG. Global Surgery 2030: a roadmap for high income country actors. BMJ Glob Health 2016; 1:e000011. [PMID: 28588908 PMCID: PMC5321301 DOI: 10.1136/bmjgh-2015-000011] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/06/2016] [Accepted: 01/19/2016] [Indexed: 12/16/2022] Open
Abstract
The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future.
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Affiliation(s)
- Joshua S Ng-Kamstra
- Department of Surgery, University of Toronto, Toronto, Canada
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sarah L M Greenberg
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Fizan Abdullah
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Vanda Amado
- Department of Surgery, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Geoffrey A Anderson
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matchecane Cossa
- National Program of Surgery, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Ainhoa Costas-Chavarri
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Haile T Debas
- University of California, San Francisco School of Medicine, San Francisco, California, USA
- University of California Global Health Institute, San Francisco, California, USA
| | - George S M Dyer
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Paul E Farmer
- Harvard University, Cambridge, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | | | - Lars Hagander
- Pediatric Surgery, Department of Clinical Sciences in Lund, Division of Pediatrics, Lund University, Lund, Sweden
| | - Adil Haider
- Center for Surgery and Public Health, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Yihan Lin
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, University of Colorado Faculty of Medicine, Denver, Colorado, USA
| | - Robert Marten
- The Rockefeller Foundation, New York, New York, USA
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Craig D McClain
- Department of Anaesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mira Meheš
- The G4 Alliance, New York, New York, USA
| | - Charles Mock
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Global Injury Section, Harborview Injury Prevention and Research Centre, Seattle, Washington, USA
| | - Swagoto Mukhopadhyay
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- University of Connecticut School of Medicine Integrated General Surgery Program, Farmington, Connecticut, USA
| | - Sergelen Orgoi
- Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- WHO Collaborating Centre for Essential Emergency and Surgical Care (MOG1), Ulaanbaatar, Mongolia
| | | | - Raymond R Price
- Department of Surgery, Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Intermountain Surgical Specialists, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA
| | - Johanna N Riesel
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Plastic Surgery Combined Residency Program, Boston, Massachusetts, USA
| | - Robert Riviello
- Center for Surgery and Public Health, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
- Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Saurabh Saluja
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Richard Sullivan
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
- Institute of Cancer Policy, King's College London, London, UK
| | - John L Tarpley
- Department of Surgery, Section of Surgical Sciences, Vanderbilt University, Nashville, Tennessee, USA
- Surgical Service, VA Tennessee Valley Health Care System, Nashville, USA
| | - Robert H Taylor
- Department of Surgery, Branch for International Surgical Care, University of British Columbia, Vancouver, Canada
| | - Louis-Franck Telemaque
- Department of Surgery, State Medical School, Port-au-Prince, Haiti
- State University Hospital, Port-au-Prince, Haiti
| | - Gabriel Toma
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Asha Varghese
- Developing Health Globally, GE Foundation, Fairfield, Connecticut, USA
| | - Melanie Walker
- President's Delivery Unit, World Bank Group, Washington DC, USA
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otology and Laryngology and Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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371
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Citron I, Chokotho L, Lavy C. Prioritisation of Surgery in the National Health Strategic Plans of Africa: A Systematic Review. World J Surg 2016; 40:779-83. [PMID: 26711637 PMCID: PMC4767853 DOI: 10.1007/s00268-015-3333-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Disease amenable to surgical intervention accounts for 11-15 % of world disability and there is increasing interest in surgery as a global public health issue. National Health Strategic Plans (NHSPs) reflect countries' long-term health priorities, plans and targets. These plans were analysed to assess the prioritisation of surgery as a public health issue in Africa. METHODS NHSPs of 43 independent Sub-Saharan African countries available in the public domain in March 2014 in French or English were searched electronically for key terms: surg*, ortho*, trauma, cancer, appendic*, laparotomy, HIV, tuberculosis, malaria. They were then searched manually for disease prevalence, targets, and human resources. RESULTS 19 % of NHSPs had no mention of surgery or surgical conditions. 63 % had five or less mentions of surgery. HIV and malaria had 3772 mentions across all the policies, compared to surgery with only 376 mentions. Trauma had 239 mentions, while the common surgical conditions of appendicitis, laparotomy and hernia had no mentions at all. Over 95 % of NHSPs specifically mentioned the prevalence of HIV, tuberculosis, malaria, infant mortality and maternal mortality. Whereas, the most commonly mentioned surgical condition for which a prevalence was given was trauma, in only 47 % of policies. All NHSPs had plans and measurable targets for the reduction of HIV and tuberculosis. Of the total 4064 health targets, only 2 % were related to surgical conditions or surgical care. 33 % of policies had no surgical targets. DISCUSSION NHSPs are the best available measure of health service and planning priorities. It is clear from our findings that surgery is poorly represented and that surgical conditions and surgical treatment are not widely recognised as a public health priority. Greater prioritisation of surgery in national health strategic policies is required to build resilient surgical systems.
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Affiliation(s)
- Isabelle Citron
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | | | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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372
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Alkire BC, Bergmark RW, Chambers K, Lin DT, Deschler DG, Cheney ML, Meara JG. Head and neck cancer in South Asia: Macroeconomic consequences and the role of the head and neck surgeon. Head Neck 2016; 38:1242-7. [PMID: 27028850 DOI: 10.1002/hed.24430] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 12/01/2015] [Accepted: 12/30/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Head and neck cancer constitutes a substantial portion of the burden of disease in South Asia, and there is an undersupply of surgical capacity in this region. The purpose of this study was to estimate the economic welfare losses due to head and neck cancer in India, Pakistan, and Bangladesh in 2010. METHODS We used publicly available estimates of head and neck cancer morbidity and mortality along with a concept termed the value of a statistical life to estimate economic welfare losses in the aforementioned countries in 2010. RESULTS Economic losses because of head and neck cancer in India, Pakistan, and Bangladesh totaled $16.9 billion (2010 US dollars [USD]), equivalent to 0.26% of the region's economic output. Bangladesh, the poorest country, experienced the greatest proportional losses. CONCLUSION The economic consequences of head and neck cancer in South Asia are significant, and building surgical capacity is essential to begin to address this burden. © 2016 Wiley Periodicals, Inc. Head Neck 38:1242-1247, 2016.
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Affiliation(s)
- Blake C Alkire
- Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Regan W Bergmark
- Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Kyle Chambers
- Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Derrick T Lin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Division of Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Daniel G Deschler
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Division of Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Mack L Cheney
- Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
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373
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Greenberg SLM, Ng-Kamstra JS, Ameh EA, Ozgediz DE, Poenaru D, Bickler SW. An investment in knowledge: Research in global pediatric surgery for the 21st century. Semin Pediatr Surg 2016; 25:51-60. [PMID: 26831138 DOI: 10.1053/j.sempedsurg.2015.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The body of literature addressing surgical and anesthesia care for children in low- and middle-income countries (LMICs) is small. This lack of research hinders full understanding of the nature of many surgical conditions in LMICs and compromises potential efforts to alleviate the significant health, welfare and economic burdens surgical conditions impose on children, families and countries. This article will evaluate the need for improved global pediatric surgery research by (1) presenting the current state of surgical research for children in LMICs and (2) discussing methods and opportunities for improvement within the political context of current global health priorities.
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Affiliation(s)
- Sarah L M Greenberg
- Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, Wisconsin 53266; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Joshua S Ng-Kamstra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Doruk E Ozgediz
- Department of Pediatric Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Dan Poenaru
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec; Bethany Kids at Myung Sung Christian Medical Center, Addis Ababa, Ethiopia
| | - Stephen W Bickler
- Division of Pediatric Surgery, Rady Children's Hospital, University of California, San Diego, California
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374
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Abstract
Surgery is increasingly recognized as an essential component of global health development. This article will review the state of global pediatric surgery, utilizing congenital anomalies as a framework in which to discuss the promise of pediatric surgery in reducing the global burden of disease. Congenital anomalies are responsible for a substantial burden of morbidity and mortality in low- and middle-income countries (LMICs), as well as significant emotional and economic harms to the families of children with congenital anomalies. Limited pediatric surgical capacity in many LMICs has culminated in a devastating burden of avertable disability and death. Pediatric surgery is an effective and cost-effective means to reduce this burden. Pediatric surgeons must continue to drive the growth of global pediatric surgery by engaging in clinical practice, educational partnerships, and research initiatives.
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Affiliation(s)
| | - Diana L Farmer
- Department of Surgery, University of California, Davis, 2221 Stockton Blvd, Suite 3112, Sacramento, CA; UC Davis Children's Hospital, UC Davis Health System, Sacramento, CA; UC Davis School of Medicine, Sacramento, CA.
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375
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Zafar SN, Changoor NR, Williams K, Acosta RD, Greene WR, Fullum TM, Haider AH, Cornwell EE, Tran DD. Race and socioeconomic disparities in national stoma reversal rates. Am J Surg 2016; 211:710-5. [PMID: 26852146 DOI: 10.1016/j.amjsurg.2015.11.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/01/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Many temporary stomas are never reversed leading to significantly worse quality of life. Recent evidence suggests a lower rate of reversal among minority patients. Our study aimed to elucidate disparities in national stoma closure rates by race, medical insurance status, and household income. METHODS Five years of data from the Nationwide Inpatient Sample (2008 to 2012) was used to identify the annual rates of stoma formation and annual rates of stoma closure. Stomas labeled as "permanent" or those created secondary to colorectal cancers were excluded. Temporary stoma closure rates were calculated, and differences were tested with the chi-square test. Separate analyses were performed by race/ethnicity, insurance status, and household income. Nationally representative estimates were calculated using discharge-level weights. RESULTS The 5-year average annual rate of temporary stoma creation was 76,551 per year (46% colostomies and 54% ileostomies). The annual rate of stoma reversal was 50,155 per year that equated to an annual reversal rate of 65.5%. Reversal rates were higher among white patients compared with black patients (67% vs 56%, P < .001) and among privately insured patients compared with uninsured patients (88% vs 63%, P < .001). Reversal rates increased as the household income increased from 61% in the lowest income quartile to 72% in the highest quartile (P < .001). CONCLUSIONS Stark disparities exist in national rates of stoma closure. Stoma closure is associated with race, insurance, and income status. This study highlights the lack of access to surgical health care among patients of minority race and low-income status.
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Affiliation(s)
- Syed Nabeel Zafar
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA.
| | - Navin R Changoor
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Kibileri Williams
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Rafael D Acosta
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Wendy R Greene
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Terrence M Fullum
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Edward E Cornwell
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Daniel D Tran
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
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376
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Affiliation(s)
- Isobel H Marks
- Global Surgery National Working Group, Medsin, London, UK; Global Surgery Working Group, International Federation of Medical Students' Associations, Amsterdam, Netherlands; Barts and The London School of Medicine and Dentistry, London, UK.
| | - Salil B Patel
- Global Surgery National Working Group, Medsin, London, UK; Exeter Spine Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, UK
| | - Hampus Holmer
- Global Surgery Working Group, International Federation of Medical Students' Associations, Amsterdam, Netherlands; Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Lund University, Sweden
| | - Michael L Billingsley
- Global Surgery National Working Group, Medsin, London, UK; St George's, University of London, UK
| | - Godfrey S Philipo
- Global Surgery Working Group, International Federation of Medical Students' Associations, Amsterdam, Netherlands; Mwananyamala Regional Referral Hospital, Dar Es Salaam, Tanzania
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377
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Prabhu VC. Neurosurgery Initiatives in Global Health. World Neurosurg 2015; 84:1544-6. [PMID: 26265303 DOI: 10.1016/j.wneu.2015.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Vikram C Prabhu
- Professor & Residency Program Director, Loyola University Medical Center/Stritch School of Medicine, Maywood, IL.
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378
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Roy N, Khajanchi MU. A hospital too far--access to surgical facilities in India. LANCET GLOBAL HEALTH 2015; 3:e587-8. [PMID: 26278187 DOI: 10.1016/s2214-109x(15)00148-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/13/2015] [Indexed: 11/18/2022]
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379
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Hider P, Wilson L, Rose J, Weiser TG, Gruen R, Bickler SW. The role of facility-based surgical services in addressing the national burden of disease in New Zealand: An index of surgical incidence based on country-specific disease prevalence. Surgery 2015; 158:44-54. [PMID: 25979439 DOI: 10.1016/j.surg.2015.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgery is a crucial component of health systems, yet its contribution has been difficult to define. We linked national hospital service utilization with national epidemiologic data to describe the use of surgical procedures in the management of a broad spectrum of conditions. METHODS We compiled International Classification of Diseases-10-Australian Modification codes from the New Zealand National Minimum Dataset, 2008-2011. Using primary cause of admission, we aggregated hospitalizations into 119 disease states and 22 disease subcategories of the World Health Organization Global Health Estimate (GHE). We queried each hospitalization for any surgical procedure in a binary manner to determine the volume of surgery for each disease state. Surgical procedures were defined as requiring general or neuroaxial anesthesia. We then divided the volume of surgical cases by counts of disease prevalence from the Global Burden of Disease Study 2010 to determine annual surgical incidence. RESULTS Between 2008 and 2011, there were 1,108,653 hospital admissions with 275,570 associated surgical procedures per year. Surgical procedures were associated with admissions for all 22 GHE disease subcategories and 116 of 119 GHE disease states. The sub-categories with the largest surgical case volumes were Unintentional Injuries (48,073), Musculoskeletal Diseases (38,030), and Digestive Diseases (27,640). Surgical incidence ranged widely by individual disease states with the highest in: Other Neurological Conditions, Abortion, Appendicitis, Obstructed Labor, and Maternal Sepsis. CONCLUSION This study confirms that surgical care is required across the entire spectrum of GHE disease subcategories, illustrating a critical role in health systems. Surgical incidence might be useful as an index to estimate the need for surgical procedures in other populations.
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Affiliation(s)
- Phil Hider
- Department of Population Health, University of Otago, Christchurch, New Zealand; Perioperative Mortality Review Committee, Health Quality and Safety Commission, New Zealand
| | - Leona Wilson
- Perioperative Mortality Review Committee, Health Quality and Safety Commission, New Zealand; Department of Anesthesia, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - John Rose
- Division of Pediatric Surgery, Rady Children's Hospital, University of California, San Diego, CA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
| | - Thomas G Weiser
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Russell Gruen
- National Trauma Research Institute, Monash University, Melbourne, Australia
| | - Stephen W Bickler
- Division of Pediatric Surgery, Rady Children's Hospital, University of California, San Diego, CA
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380
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