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Zadey S, Rao S, Gondi I, Sheneman N, Patil C, Nayan A, Iyer H, Kumar AR, Prasad A, Finley GA, Prasad CRK, Chintamani, Sharma D, Ghosh D, Jesudian G, Fatima I, Pattisapu J, Ko JS, Bains L, Shah M, Alam MS, Hadigal N, Malhotra N, Wijesuriya N, Shukla P, Khan S, Pandya S, Khan T, Tenzin T, Hadiga VR, Peterson D. Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia. Front Public Health 2024; 12:1325922. [PMID: 38450144 PMCID: PMC10915281 DOI: 10.3389/fpubh.2024.1325922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- GEMINI Research Center, Duke University School of Medicine, Durham, NC, United States
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
| | - Shirish Rao
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Isha Gondi
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Health and Human Sciences, Baylor University, Waco, TX, United States
| | - Natalie Sheneman
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
| | - Chaitrali Patil
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Biology and Statistics, George Washington University, Washington, DC, United States
| | - Anveshi Nayan
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Arti Raj Kumar
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Arun Prasad
- Indraprastha Apollo Hospital, New Delhi, India
| | - G. Allen Finley
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | | | - Chintamani
- Department of Surgery, Vardhman Mahavir Medical College Safdarjung Hospital, New Delhi, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Dhruva Ghosh
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Gnanaraj Jesudian
- Karunya Rural Community Hospital Karunya Nagar, Coimbatore, Tamil Nadu, India
- Association of Rural Surgeons of India, Wardha, India
- International Federation of Rural Surgeons, Ujjain, India
- Rural Surgery Innovations Private Limited, Dimapur, Nagaland, India
| | - Irum Fatima
- IRD Pakistan and the Global Surgery Foundation, Karachi, Sindh, Pakistan
| | - Jogi Pattisapu
- University of Central Florida College of Medicine, Orlando, FL, United States
| | - Justin Sangwook Ko
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, Maharashtra, India
| | - Mashal Shah
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammed Shadrul Alam
- Department of Pediatric Surgery, Mugda Medical College, Dhaka, Bangladesh
- American College of Surgeons: Bangladesh Chapter, Dhaka, Bangladesh
- Bangladesh Health Economist Forum, Dhaka, Bangladesh
- Association of Pediatric Surgeons of Bangladesh (APSB), DMCH, Dhaka, Bangladesh
| | - Narmada Hadigal
- Narmada Fertility Centre, Hyderabad, Telangana, India
- International Trauma Anesthesia and Critical Care Society, Stavander, Stavanger, Norway
| | - Naveen Malhotra
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nilmini Wijesuriya
- College of Anaesthesiologists and Intensivists of Sri Lanka, Rajagiriya, Sri Lanka
| | - Prateek Shukla
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sunil Pandya
- Department of Anaesthesia, Perioperative Medicine and Critical Care, AIG Hospitals, Hyderabad, Telangana, India
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tashi Tenzin
- Army Medical Services, Military Hospital, Thimphu, Bhutan
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Daniel Peterson
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
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MacKechnie MC, Shearer DW, Verhofstad MHJ, Martin C, Graham SM, Pesantez R, Schuetz M, Hüttl T, Kojima K, Bernstein BP, Miclau T. Establishing Consensus on Essential Resources for Musculoskeletal Trauma Care Worldwide: A Modified Delphi Study. J Bone Joint Surg Am 2024; 106:47-55. [PMID: 37708306 DOI: 10.2106/jbjs.23.00387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Despite evidence that formalized trauma systems enhance patient functional outcomes and decrease mortality rates, there remains a lack of such systems globally. Critical to trauma systems are the equipment, materials, and supplies needed to support care, which vary in availability regionally. The purpose of the present study was to identify essential resources for musculoskeletal trauma care across diverse resource settings worldwide. METHODS The modified Delphi method was utilized, with 3 rounds of electronic surveys. Respondents consisted of 1 surgeon with expertise in musculoskeletal trauma per country. Participants were identified with use of the AO Trauma, AO Alliance, Orthopaedic Trauma Association, and European Society for Trauma and Emergency Surgery networks. Respondents rated resources on a Likert scale from 1 (most important) to 9 (least important). The "most essential" resources were classified as those rated ≤2 by ≥75% of the sampled group. RESULTS One hundred and three of 111 invited surgeons completed the first survey and were included throughout the subsequent rounds (representing a 93% response rate). Most participants were fellowship-trained (78%) trauma and orthopaedic surgeons (90%) practicing in an academic setting (62%), and 46% had >20 years of experience. Respondents represented low-income and lower-middle-income countries (LMICs; 35%), upper-middle income countries (UMICs; 30%), and high-income countries (HICs; 35%). The initial survey identified 308 unique resources for pre-hospital, in-hospital, and post-hospital phases of care, of which 71 resources achieved consensus as the most essential. There was a significant difference (p < 0.0167) in ratings between income groups for 16 resources, all of which were related to general trauma care rather than musculoskeletal injury management. CONCLUSIONS There was agreement on a core list of essential musculoskeletal trauma care resources by respondents from LMICs, UMICs, and HICs. All significant differences in resource ratings were related to general trauma management. This study represents a first step toward establishing international consensus and underscores the need to prioritize resources that are locally available. The information can be used to develop effective guidelines and policies, create best-practice treatment standards, and advocate for necessary resources worldwide. CLINICAL RELEVANCE This study utilized the Delphi method representing expert opinion; however, this work did not examine patient management and therefore does not have a clinical Level of Evidence.
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Affiliation(s)
- Madeline C MacKechnie
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - David W Shearer
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Simon M Graham
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Liverpool Orthopaedic and Trauma Service, Liverpool University Teaching Hospital Trust, Liverpool, United Kingdom
| | - Rodrigo Pesantez
- Department of Orthopedic Surgery, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá, Colombia
| | - Michael Schuetz
- Queensland University of Technology, Herston, Queensland, Australia
| | | | - Kodi Kojima
- Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Brian P Bernstein
- Division of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
| | - Theodore Miclau
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California
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Alkhawashki HMI. Challenges of orthopaedics and trauma care in the Africa, Near and Middle East region. INTERNATIONAL ORTHOPAEDICS 2023; 47:2897-2899. [PMID: 37985481 DOI: 10.1007/s00264-023-06030-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
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Ullrich PJ, Ramsey MD. Global Plastic Surgery: A Review of the Field and a Call for Virtual Training in Low- and Middle-Income Countries. Plast Surg (Oakv) 2023; 31:118-125. [PMID: 37188140 PMCID: PMC10170637 DOI: 10.1177/22925503211034833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
Lack of surgical access severely harms countless populations in many low- and middle-income countries (LMICs). Many types of surgery could be fulfilled by the plastic surgeon, as populations in these areas often experience trauma, burns, cleft lip and palate, and other relevant medical issues. Plastic surgeons continue to contribute significant time and energy to global health, primarily by participating in short mission trips intended to provide many surgeries in a short time frame. These trips, while cost-effective for lack of long-term commitments, are not sustainable as they require high initial costs, often neglect to educate local physicians, and can interfere with regional systems. Education of local plastic surgeons is a key step toward creating sustainable plastic surgery interventions worldwide. Virtual platforms have grown popular and effective-particularly due to the coronavirus disease 2019 pandemic-and have shown to be beneficial in the field of plastic surgery for both diagnosis and teaching. However, there remains a large potential to create more extensive and effective virtual platforms in high-income nations geared to educate plastic surgeons in LMICs to lower costs and more sustainably provide capacity to physicians in low access areas of the world.
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Affiliation(s)
- Peter J. Ullrich
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew D. Ramsey
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Garcia RM, Shiraishi-Zapata CJ, Vallejos RCZ, Chiroque DPG, Maldonado MAO, Palacios JCP, Romero EE, Álamo AHV, Tovar JSC, Uribe SJA, Ruiz RD, Vilela YMM. Surgical care and trauma patients capacity in Piura, Perú - Cross-sectional study. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2023; 51:e1058. [PMID: 37904840 PMCID: PMC10615123 DOI: 10.5554/22562087.e1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction Low and medium income countries face challenges in access and delivery of surgical care, resulting in a high number of deaths and disabled individuals. Objective To estimate the capacity to provide surgical and trauma care in public hospitals in the Piura region, Perú, a middle income country. Methods A survey was administered in public hospitals in the Peruvian region of Piura, which combined the Spanish versions of the PIPES and INTACT surveys, and the WHO situational analysis tool. The extent of the event was assessed based in the absolute differences between the medians of the scores estimated, and the Mann-Whitney bilateral tests, according to the geographical location and the level of hospital complexity. Results Seven public hospitals that perform surgeries in the Piura region were assessed. Three provinces (3/8) did not have any complexity healthcare institutions. The average hospital in the peripheral provinces tended to be smaller than in the capital province in INTACT (8.25 vs. 9.5, p = 0.04). Additionally, water supply issues were identified (2/7), lack of incinerator (3/7), lack of uninterrupted availability of a CT-scanner (5/7) and problems with working hours; in other words, the blood banks in two hospitals were not open 24 hours. Conclusions There is a significant inequality among the provinces in the region in terms of their trauma care capacities and several shortfalls in the public sector healthcare infrastructure. This information is required to conduct future research on capacity measurements in every public and private institution in the Peruvian region of Piura.
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Affiliation(s)
- Roxanna M Garcia
- Department of Neurosurgery, Northwestern University. Chicago, USA
| | - Carlos Javier Shiraishi-Zapata
- Surgery and Anesthesiology Service, Hospital II Integrado Talara EsSalud. Talara, Perú. Second Specialization Unit, School of Health Sciences, Universidad Nacional de Piura, Perú
| | | | | | | | | | | | | | - Jaime Sergio Castillo Tovar
- Surgery and Anesthesiology Service, Hospital II Integrado Talara EsSalud. Talara, Perú. Second Specialization Unit, School of Health Sciences, Universidad Nacional de Piura, Perú
| | | | - Renato Díaz Ruiz
- Pediatrics Service, Hospital III José Cayetano Heredia" EsSalud. Piura, Perú
| | - Yovanky Miluska More Vilela
- Anesthesiology Service and Surgical Center "Telésforo León Velasco", Hospital III "José Cayetano Heredia" EsSalud. Piura, Perú
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Henry JA, Reyes AM, Ameh E, Yip CH, Nthumba P, Mehes M, Lelchuk A, Hollier L, Waqainabete I, Abdullah NH, Alliance T, Hill A, Ferguson MK. International consensus recommendations for the optimal prioritisation and distribution of surgical services in low-income and middle-income countries: a modified Delphi process. BMJ Open 2023; 13:e062687. [PMID: 36693687 PMCID: PMC9884888 DOI: 10.1136/bmjopen-2022-062687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To develop consensus statements regarding the regional-level or district-level distribution of surgical services in low and middle-income countries (LMICs) and prioritisation of service scale-up. DESIGN This work was conducted using a modified Delphi consensus process. Initial statements were developed by the International Standards and Guidelines for Quality Safe Surgery and Anesthesia Working Group of the Global Alliance for Surgical, Obstetric, Trauma and Anesthesia Care (G4 Alliance) and the International Society of Surgery based on previously published literature and clinical expertise. The Guidance on Conducting and REporting DElphi Studies framework was applied. SETTING The Working Group convened in Suva, Fiji for a meeting hosted by the Ministry of Health and Medical Services to develop the initial statements. Local experts were invited to participate. The modified Delphi process was conducted through an electronically administered anonymised survey. PARTICIPANTS Expert LMIC surgeons were nominated for participation in the modified Delphi process based on criteria developed by the Working Group. PRIMARY OUTCOME MEASURES The consensus panel voted on statements regarding the organisation of surgical services, principles for scale-up and prioritisation of scale-up. Statements reached consensus if there was ≥80% agreement among participants. RESULTS Fifty-three nominated experts from 27 LMICs voted on 27 statements in two rounds. Ultimately, 26 statements reached consensus and comprise the current recommendations. The statements covered three major themes: which surgical services should be decentralised or regionalised; how the implementation of these services should be prioritised; and principles to guide LMIC governments and international visiting teams in scaling up safe, accessible and affordable surgical care. CONCLUSIONS These recommendations represent the first step towards the development of international guidelines for the scaling up of surgical services in LMICs. They constitute the best available basis for policymaking, planning and allocation of resources for strengthening surgical systems.
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Affiliation(s)
- Jaymie A Henry
- Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA
- International Standards and Guidelines for Quality Safe Surgery and Anesthesia (ISG-QSSA), Global Alliance for Surgical, Obstetric, Trauma, and Anesthesia Care (G4 Alliance), Chicago, Illinois, USA
| | - Ana M Reyes
- Department of Surgery, University of Miami, Miami, Florida, USA
| | - Emmanuel Ameh
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Lembah Pantai, Malaysia
| | - Peter Nthumba
- Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mira Mehes
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, Chicago, Illinois, USA
| | - Ashley Lelchuk
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, Chicago, Illinois, USA
| | - Larry Hollier
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, USA
- Chairman of the Medical Board, Smile Train, New York, New York, USA
| | | | - Noor Hisham Abdullah
- Director General, Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan, Malaysia
| | - The Alliance
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, Chicago, Illinois, USA
| | - Andrew Hill
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Mark K Ferguson
- Department of Surgery, The University of Chicago, Chicago, Illinois, USA
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Jumbam DT, Amoako E, Blankson PK, Xepoleas M, Said S, Nyavor E, Gyedu A, Ampomah OW, Kanmounye US. The state of surgery, obstetrics, trauma, and anaesthesia care in Ghana: a narrative review. Glob Health Action 2022; 15:2104301. [PMID: 35960190 PMCID: PMC9586599 DOI: 10.1080/16549716.2022.2104301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Conditions amenable to surgical, obstetric, trauma, and anaesthesia (SOTA) care are a major contributor to death and disability in Ghana. SOTA care is an essential component of a well-functioning health system, and better understanding of the state of SOTA care in Ghana is necessary to design policies to address gaps in SOTA care delivery. Objective The aim of this study is to assess the current situation of SOTA care in Ghana. Methods A situation analysis was conducted as a narrative review of published scientific literature. Information was extracted from studies according to five health system domains related to SOTA care: service delivery, workforce, infrastructure, finance, and information management. Results Ghanaians face numerous barriers to accessing quality SOTA care, primarily due to health system inadequacies. Over 77% of surgical operations performed in Ghana are essential procedures, most of which are performed at district-level hospitals that do not have consistent access to imaging and operative room fundamentals. Tertiary facilities have consistent access to these modalities but lack consistent access to oxygen and/or oxygen concentrators on-site as well as surgical supplies and anaesthetic medicines. Ghanaian patients cover up to 91% of direct SOTA costs out-of-pocket, while health insurance only covers up to 14% of the costs. The Ghanaian surgical system also faces severe workforce inadequacies especially in district-level facilities. Most specialty surgeons are concentrated in urban areas. Ghana’s health system lacks a solid information management foundation as it does not have centralized SOTA databases, leading to incomplete, poorly coded, and illegible patient information. Conclusion This review establishes that surgical services provided in Ghana are focused primarily on district-level facilities that lack adequate infrastructure and face workforce shortages, among other challenges. A comprehensive scale-up of Ghana’s surgical infrastructure, workforce, national insurance plan, and information systems is warranted to improve Ghana’s surgical system.
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Affiliation(s)
- Desmond T Jumbam
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Ghana.,Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Emmanuella Amoako
- Department of Paediatrics and Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana.,Department of Paediatrics and Child Health, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Paa-Kwesi Blankson
- Oral and Maxillofacial Surgery Unit, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Meredith Xepoleas
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Shady Said
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Elikem Nyavor
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Ghana
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Surgery, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Opoku W Ampomah
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Ghana.,Plastics and Reconstructive Surgery Unit, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Ulrick Sidney Kanmounye
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Ghana.,Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
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Sykes AG, Seyi-Olajide J, Ameh EA, Ozgediz D, Abbas A, Abib S, Ademuyiwa A, Ali A, Aziz TT, Chowdhury TK, Abdelhafeez H, Ignacio RC, Keller B, Klazura G, Kling K, Martin B, Philipo GS, Thangarajah H, Yap A, Meara JG, Bundy DAP, Jamison DT, Mock CN, Bickler SW. Estimates of Treatable Deaths Within the First 20 Years of Life from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries. World J Surg 2022; 46:2114-2122. [PMID: 35771254 PMCID: PMC9334432 DOI: 10.1007/s00268-022-06622-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20 years of life. METHODS Epidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20 year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries. RESULTS An estimated 314,609 (95% UI, 239,619-402,005) deaths per year in the under 20 year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the treatable deaths are in the under-5 year age group (80.9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of treatable deaths after age 5 years. Sixty-one percent of the treatable deaths occur in lower middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20 years of age in LMICs per year. CONCLUSIONS Improving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 20 years of life.
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Affiliation(s)
| | | | - Emmanuel A Ameh
- Division of Pediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Doruk Ozgediz
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Simone Abib
- Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Adesoji Ademuyiwa
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | - Romeo C Ignacio
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Benjamin Keller
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Greg Klazura
- Loyola University Medical Center, Chicago, IL, USA
| | - Karen Kling
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Benjamin Martin
- Department of Paediatric Surgery and Urology, Bristol Children's Hospital, Bristol, UK
| | | | - Hariharan Thangarajah
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Ava Yap
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Donald A P Bundy
- Global Research Consortium for School Health and Nutrition, London School of Hygiene and Tropical Medicine, London, UK
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA.
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9
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Msokera C, Xepoleas M, Collier ZJ, Naidu P, Magee W. A plastic and reconstructive surgery landscape assessment of Malawi: a scoping review of Malawian literature. Eur J Med Res 2022; 27:119. [PMID: 35820981 PMCID: PMC9277806 DOI: 10.1186/s40001-022-00714-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background Plastic and reconstructive surgery (PRS) remains highly relevant to the unmet need for surgery in Malawi. Better understanding the current PRS landscape and its barriers may help address some of these challenges. This scoping review aimed to describe: (1) the scope and focus of the PRS literature being produced in Malawi and (2) the challenges, deficits, and barriers to providing accessible, high-quality PRS in Malawi. Methods This scoping review was conducted on four databases (SCOPUS, PubMed, Web of Science, EMBASE) from inception through September 1, 2020 following the PRISMA-ScR guidelines. Results The database search retrieved 3852 articles, of which 31 were included that examined the burden of PRS-related conditions in Malawi. Of these 31 articles, 25 primarily discussed burn-related care. Burns injuries have a high mortality rate; between 27 and 75% in the studies. The literature revealed that there are only two burn units nationally with one PRS specialist in each unit, compounded by a lack of interest in PRS specialization by Malawian medical students. Congenital anomalies were the only other PRS-related condition examined and reported in the literature, accounting for 23% of all pediatric surgeries in tertiary facilities. Conclusions There is a need to increase the country's capacity to handle burn reconstruction and other PRS-related conditions to reduce overall morbidity and mortality. Additional publicly funded research at the district and community level is warranted to determine the true burden of PRS disease in Malawi to derive health system strengthening and workforce capacity building strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-022-00714-y.
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Affiliation(s)
- Chifundo Msokera
- Operation Smile Inc, Virginia Beach, Virginia, USA. .,University of Malawi College of Medicine, Blantyre, Malawi. .,Operation Smile Malawi, Area 6, P.O BOX 484, Lilongwe, Malawi.
| | | | - Zachary J Collier
- Operation Smile Inc, Virginia Beach, Virginia, USA.,Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - William Magee
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.,Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Plastic Surgery, Shriners Hospital for Children, Los Angeles, CA, USA
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Identifying Research Priorities in Musculoskeletal Trauma Care in Sub-Saharan Africa. JB JS Open Access 2022; 7:e21.00043. [PMID: 35434446 PMCID: PMC9007213 DOI: 10.2106/jbjs.oa.21.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background In low and middle-income countries (LMICs), individuals suffer from a disproportionately higher number of musculoskeletal (MSK) injuries compared with those living in a high-income setting. However, despite the higher burden of death and disability from MSK injuries in LMICs, there has been little policy, research, and funding invested in addressing this distinctly overlooked problem. Using a consensus-based approach, the aim of this study was to identify research priorities for clinical trials and research in MSK trauma care across sub-Saharan Africa. Methods A modified Delphi technique was utilized; it involved an initial scoping survey, a 2-round Delphi process, and, finally, review by an expert panel with members of the Orthopaedic Research Collaboration in Africa. This study was conducted among MSK health-care practitioners treating trauma in sub-Saharan Africa. Results Participants from 34 countries across sub-Saharan Africa contributed to the 2 rounds of the Delphi process, and priorities were scored from 1 (low priority) to 5 (high priority). Public health topics related to trauma care ranked higher than those focused on clinical effectiveness, with the top 10 public health research questions scoring higher than the top 10 questions for clinical effectiveness. Ten public health and 10 clinical effectiveness questions related to MSK trauma care were identified; the highest-ranked questions in the respective categories were related to education and training and to the management of femoral fractures. Conclusions This consensus-driven research priority study will guide health-care professionals, academics, researchers, and funders to improve the evidence on MSK trauma care across sub-Saharan Africa and inform funders about priority areas of future research.
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Sykes AG, Brill JB, Wallace JD, Lee C, Lewis PR, Henry MC, Christman MS, Casey KM, Bickler SW, Ignacio RC. Trends in Surgical Case Volume During Pacific Partnership Missions Onboard USNS Mercy. Mil Med 2021; 188:usab500. [PMID: 34908148 DOI: 10.1093/milmed/usab500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/05/2021] [Accepted: 12/12/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Since 2006, the U.S. Navy has conducted six Pacific Partnership (PP) missions throughout Southeast Asia on board the U.S. Naval Ship Mercy (T-AH 19). This study describes trends in overall and surgical specialty operative volumes to better understand the burden of surgical disease treated during these humanitarian and civic assistance (HCA) operations. This information can assist medical planners and surgical leaders involved in future humanitarian missions. MATERIALS AND METHODS Following approval from the Naval Medical Center San Diego Institutional Review Board, a retrospective review of surgical case data was performed for the six PP missions from 2006 to 2018. Data collected included patient demographics, Current Procedural Terminology codes, and surgical specialty. The primary outcome was surgical case volume per specialty. Secondary outcomes included surgical staffing per mission and overall trends in operative volume. RESULTS A total of 3,826 operative procedures were performed during the study period. Mission years in which case volume for both general surgery and ophthalmology were below their respective medians were associated with the least total surgical services to host nations (HNs). The number of active duty Navy surgeons varied with each mission; however, the staffing for a PP mission generally included at least two general surgeons, one ophthalmologist, one plastic surgeon, one pediatric surgeon, one orthopedic surgeon, one otolaryngologist, one oral surgeon, one urologist, and one obstetrician-gynecologist. Case volume per surgeon was highest in 2006 (50 cases per surgeon) and decreased after 2006, reaching an all-time low during the 2018 PP mission (10 cases per surgeon). Pediatric surgery and plastic surgery had the highest average case volumes per surgeon at 58 and 46 cases per surgeon, respectively, while oromaxillofacial surgery and neurosurgery had the lowest average case volumes per surgeon at 9 and 14 cases per surgeon, respectively. CONCLUSIONS Operative volume on military HCA missions is greatly influenced by the priorities of the HN, the mission focus, the number of individuals from the HN that present for screening, and the availability of personnel and resources available on the hospital ship. Future mission planning should optimize general surgery and ophthalmology staffing and essential equipment, as total mission case volumes were highly dependent upon the productivity of these two specialties. Careful determination of the surgical needs of HNs should serve as a guide for the selection of subspecialists to maximize effectiveness in future military HCA missions.
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Affiliation(s)
- Alicia G Sykes
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Jason B Brill
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - James D Wallace
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Clara Lee
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Paul R Lewis
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Marion C Henry
- Division of Pediatric Surgery, The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL 60637, USA
| | - Matthew S Christman
- Department of Urology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Kevin M Casey
- Department of General Surgery, Cottage Hospital Santa Barbara, Santa Barbara, CA 93105, USA
| | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego, San Diego, CA 92093, USA
| | - Romeo C Ignacio
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego, San Diego, CA 92093, USA
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Turner J, Duffy S. Orthopaedic and trauma care in low-resource settings: the burden and its challenges. INTERNATIONAL ORTHOPAEDICS 2021; 46:143-152. [PMID: 34655318 DOI: 10.1007/s00264-021-05236-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND BURDEN Trauma with its early and late consequences disproportionately effects those from poor countries. The availability of effective orthopaedic and trauma care varies significantly across the globe. CHALLENGES The balancing out of quality care is required to reach the health-related UN development goal set out in 2015. A multifactorial approach addressing local, national and international aspects is key to improving the discrepancy seen between high- and low-income countries.
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Affiliation(s)
- James Turner
- Bristol Royal Hospital for Children, Bristol, UK.
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13
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Are Trauma Surgery Simulation Courses Beneficial in Low- and Middle-Income Countries—A Systematic Review and Meta-Analysis. TRAUMA CARE 2021. [DOI: 10.3390/traumacare1030012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite trauma-related injuries being a leading cause of death worldwide, low- and middle-income countries (LMICs) lack the infrastructure and resources required to offer immediate surgical care, further perpetuating the risk of morbidity and mortality. In high-income countries, trauma surgery simulation courses are routinely delivered to surgeons, teaching the fundamental skills of operative trauma. This study aimed to assess whether similar courses are beneficial in LMICs and how they can be improved. We performed a systematic review and meta-analysis using MEDLINE, Embase and Google Scholar, analysing studies evaluating trauma surgery simulation in LMICs. The outcomes measured included clinical knowledge improvement, participant confidence and general course-feedback. The review was carried out in-line with PRISMA guidelines. Five studies were included, summating a population of 172 participants. In three studies, meta-analysis showed an overall significant weighted mean improvement of knowledge post-course by 22.91% (95%CI 19.53, 26.29; p < 0.00001; I2 = 0%). One study reported a significant increase in participant confidence for 20/22 of operative skills taught (p < 0.04). We conclude that these courses are beneficial in LMICs; however, further research is necessary to establish the optimum course design, and whether patient outcomes are improved following their implementation. Collaboration between international trauma institutions is essential for closing the educational resource inequality gap between higher- and lower-income countries.
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A tale of three pandemics: Shining a light on a hidden problem. Surgeon 2021; 20:231-236. [PMID: 34167911 PMCID: PMC9300845 DOI: 10.1016/j.surge.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022]
Abstract
An “epidemic” is an event in which a disease, infectious or non-infectious, is actively spreading within a population and designated area. The term “pandemic” is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”. The global response to the COVID-19 pandemic has not been seen since the outbreak of Human Immunodeficiency Virus in the early eighties. But there is another unseen pandemic running alongside the current COVID-19 pandemic, which affects a vast number of people, crossing international boundaries and occurring in every single country worldwide. The pandemic of traumatic injuries. Traumatic injuries account for 11% of the current Global Burden of Disease, resulting in nearly 5 million deaths annually and is the third-leading cause of death worldwide. For every trauma-related death, it is estimated that up to 50 people sustain permanent or temporary disabilities. Furthermore, traumatic injuries occur at disproportionately higher rates in low- and middle-income countries, with approximately 90% of injuries and more than 90% of global deaths from injury occurring these countries. Injuries are increasing worldwide, crossing international boundaries and affecting a large number of people, in the same manner Human Immunodeficiency Virus did in the 1980's and COVID-19 is today. The tremendous global effort to tackle the COVID-19 and Human Immunodeficiency Virus pandemics has occurred whilst ignoring the comparable pandemic of injury. Without change and future engagement with policy makers and international donors this disparity is likely to continue.
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15
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Khudadad U, Aftab W, Ali A, Khan NU, Razzak J, Siddiqi S. Perception of the healthcare professionals towards the current trauma and emergency care system in Kabul, Afghanistan: a mixed method study. BMC Health Serv Res 2020; 20:991. [PMID: 33121505 PMCID: PMC7596957 DOI: 10.1186/s12913-020-05845-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trauma and injury contribute to 11% of the all-cause mortality in Afghanistan. The study aimed to explore the perceptions of the healthcare providers (pre and in-hospital), hospital managers and policy makers of the public and private health sectors to identify the challenges in the provision of an effective trauma care in Kabul, Afghanistan. METHODS A concurrent mixed method design was used, including key-informant interviews (healthcare providers, hospital managers and policy makers) of the trauma care system (N = 18) and simultaneous structured emergency care system assessment questionnaire (N = 35) from July 15 to September 25, 2019. Interviews were analyzed using content analysis approach and structured questionnaire data were descriptively analyzed. RESULTS Four themes were identified that describe the challenges: 1) pre-hospital care, 2) cohesive trauma management system, 3) physical and human resources and 4) stewardship. Some key challenges were found related to scene and transportation care, in-hospital care and emergency preparedness within the wider trauma care system. Less than 25% of the population is covered by the pre-hospital ambulance system (n = 23, 65.7%) and there is no communication process between health care facilities to facilitate transfer (n = 28, 80%). Less than 25% of patients with an injury requiring emergent surgery have access to surgical care in a staffed operating theatre within 2 h of injury (n = 19, 54.2%) and there is no regular assessment of the ability of the emergency care system to mobilize resources (human and physical) to respond to disasters, and other large-scale emergencies (n = 28, 80%). CONCLUSION This study highlighted major challenges in the delivery of trauma care services across Kabul, Afghanistan. Systematic improvement in the workforce training, structural organization of the trauma care system and implementing externally validated clinical guidelines for trauma management could possibly enhance the functions of the existing trauma care services. However, an integrated state-run trauma care system will address the current burden of traumatic injury more effectively within the wider healthcare system of Afghanistan.
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Affiliation(s)
- Umerdad Khudadad
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Asrar Ali
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Junaid Razzak
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Ullrich SJ, DeWane MP, Cheung M, Fleming M, Namugga MM, Fu W, Kurigamba G, Kabuye R, Mabweijano J, Galukande M, Ozgediz D, Pei KY. Development of an Operative Trauma Course in Uganda-A Report of a Three-Year Experience. J Surg Res 2020; 256:520-527. [PMID: 32799000 DOI: 10.1016/j.jss.2020.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/01/2020] [Accepted: 07/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Trauma is a leading cause of morbidity and mortality in low-income countries. Improved health care systems and training are potential avenues to combat this burden. We detail a collaborative and context-specific operative trauma course taught to postgraduate surgical trainees practicing in a low-resource setting and examine its effect on resident practice. METHOD Three classes of second year surgical residents participated in trainings from 2017 to 2019. The course was developed and taught in conjunction with local faculty. The most recent cohort logged cases before and after the course to assess resources used during initial patient evaluation and operative techniques used if the patient was taken to theater. RESULTS Over the study period, 52 residents participated in the course. Eighteen participated in the case log study and logged 117 cases. There was no statistically significant difference in patient demographics or injury severity precourse and postcourse. Postcourse, penetrating injuries were reported less frequently (40 to 21% P < 0.05) and road traffic crashes were reported more frequently (39 to 60%, P < 0.05). There was no change in the use of bedside interventions or diagnostic imaging, besides head CT. Of patients taken for a laparotomy, there was a nonstatistically significant increase in the use of four-quadrant packing 3.4 to 21.7%) and a decrease in liver repair (20.7 to 4.3%). CONCLUSIONS The course did not change resource utilization; however, it did influence clinical decision-making and operative techniques used during laparotomy. Additional research is indicated to evaluate sustained changes in practice patterns and clinical outcomes after operative skills training.
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Affiliation(s)
- Sarah J Ullrich
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Michael P DeWane
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Maija Cheung
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew Fleming
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Martha M Namugga
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Whitney Fu
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Gideon Kurigamba
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Ronald Kabuye
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Jackie Mabweijano
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Moses Galukande
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Doruk Ozgediz
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Kevin Y Pei
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
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17
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Gualy S, Herrera C, Warden C, Valle T, Barnum J, Colman B, Siu A, Swanson JW. Enabling Community Health Worker Recognition and Referral of Surgical Diseases: Pilot Study Results of a Pictorial Guide. World J Surg 2020; 43:2949-2958. [PMID: 31511941 DOI: 10.1007/s00268-019-05173-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Access to surgical care is a pressing challenge, particularly for vulnerable populations. Informal and formal community health workers (CHWs), including lay people, increasingly function in pivotal roles in primary care, however, remain disconnected from surgical care in most environments. This study examined the degree to which CHW understanding of surgical conditions could be improved through the use of a pictorially based manual. METHODS A manual and associated situational problem-solving questionnaire instrument were developed and contextualized through focus groups in Central America. A baseline assessment was obtained. In the program implementation, cohorts of formal and informal CHWs were introduced and trained to use the manual through a short curriculum. Assessment was repeated in program implementation, first with access to relevant manual content only, and then after the teaching session. Participants were also surveyed about manual scheme, usability, and utility. RESULTS A total of 100 subjects (67% female) participated in baseline assessment, and 403 subjects (68% female) were assessed through the program implementation. Baseline problem-solving averaged 11.8 (SD 2.46) out of a possible 20 points. Mean score increased to 15.4 (SD 3.10) when participants had access to relevant surgical manual content and again to 15.9 (SD 3.09, p < 0.0001) following participation with an instructive curriculum. Participant score while utilizing the manual correlated with amount of education completed (r = 0.26), but baseline score did not. High readability 389 (96%) and high self-reported willingness for use 398 (96%) were noted. CONCLUSION Baseline familiarity with surgically treatable conditions appears modest among rural Central American populations, and improves with access to a contextualized, pictorial manual focused on recognizing and appropriately referring surgical conditions.
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Affiliation(s)
- Sebastian Gualy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Operation Smile, Tegucigalpa, Honduras
- Operation Smile, Managua, Nicaragua
| | - Christopher Herrera
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Operation Smile, Tegucigalpa, Honduras
- Operation Smile, Managua, Nicaragua
| | - Clara Warden
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tyron Valle
- General Surgery, Hospital Carlos Centeno, Siuna, Nicaragua
| | - Jeanie Barnum
- Operation Smile, Tegucigalpa, Honduras
- Operation Smile, Managua, Nicaragua
| | - Bessy Colman
- Operation Smile, Tegucigalpa, Honduras
- Operation Smile, Managua, Nicaragua
| | - Armando Siu
- Operation Smile, Tegucigalpa, Honduras
- Operation Smile, Managua, Nicaragua
| | - Jordan W Swanson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Operation Smile, Tegucigalpa, Honduras.
- Operation Smile, Managua, Nicaragua.
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Bath M, Bashford T, Fitzgerald JE. What is 'global surgery'? Defining the multidisciplinary interface between surgery, anaesthesia and public health. BMJ Glob Health 2019; 4:e001808. [PMID: 31749997 PMCID: PMC6830053 DOI: 10.1136/bmjgh-2019-001808] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/20/2019] [Accepted: 09/28/2019] [Indexed: 12/11/2022] Open
Abstract
'Global surgery' is the term adopted to describe a rapidly developing multidisciplinary field aiming to provide improved and equitable surgical care across international health systems. Sitting at the interface between numerous clinical and non-clinical specialisms, it encompasses multiple aspects that surround the treatment of surgical disease and its equitable provision across health systems globally. From defining the role of, and need for, optimal surgical care through to identifying barriers and implementing improvement, global surgery has an expansive remit. Advocacy, education, research and clinical components can all involve surgeons, anaesthetists, nurses and allied healthcare professionals working together with non-clinicians, including policy makers, epidemiologists and economists. Long neglected as a topic within the global and public health arenas, an increasing awareness of the extreme disparities internationally has driven greater engagement. Not necessarily restricted to specific diseases, populations or geographical regions, these disparities have led to a particular focus on surgical care in low-income and middle-income countries with the greatest burden and needs. This review considers the major factors defining the interface between surgery, anaesthesia and public health in these settings.
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Affiliation(s)
- Michael Bath
- Centre for Neuroscience, Surgery, and Trauma, Queen Mary University of London, London, UK
| | - Tom Bashford
- NIHR Global Health Research Group on Neurotrauma, Division of Anaesthesia, University of Cambridge, Cambridge, UK
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Ullrich SJ, Kakembo N, Grabski DF, Cheung M, Kisa P, Nabukenya M, Tumukunde J, Fitzgerald TN, Langer M, Situma M, Sekabira J, Ozgediz D. Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study. J Surg Res 2019; 246:93-99. [PMID: 31562991 DOI: 10.1016/j.jss.2019.08.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/25/2019] [Accepted: 08/29/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ninety-four percent of congenital anomalies occur in low- and middle-income countries. In Uganda, only three pediatric surgeons and three pediatric anesthesiologists serve more than 20 million children. This study estimates burden, outcomes, coverage, and economic benefit of neonatal surgical conditions in Uganda. METHODS A prospectively collected database was reviewed for neonatal surgical admissions from January 1, 2012, to December 31, 2017, at the only two sites with specialist pediatric surgical coverage. Outcomes were compared with high-income countries. Met and unmet need were estimated using disability-adjusted life years. Economic benefit was estimated using a value of statistical life-year approach. RESULTS For 1313 neonatal admissions, the median age of presentation was 3 d, overall mortality was 36%, and median distance traveled was 40 km. Anorectal malformations were most common (18%). Postoperative mortality was 24%. Mortality was significantly associated with surgical intervention (P < 0.0001). Met need was 4181 disability-adjusted life years per year, which corresponds to a $3.5 million net economic benefit to Uganda, with a potential additional benefit of $153 million if unmet need were fully addressed. Approximately 2% of the total need is met by the health care system. CONCLUSIONS Neonatal surgery is associated with improved survival for most conditions. Despite increases in workforce and infrastructure, a limited proportion of the need for neonatal surgery is currently being met. This is multifactorial, including lack of access to surgical care and severe shortages of workforce and infrastructure. Current and potential economic benefit to Uganda appears substantial.
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Affiliation(s)
- Sarah J Ullrich
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Nasser Kakembo
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - David F Grabski
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Maija Cheung
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Phyllis Kisa
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Mary Nabukenya
- Department of Anesthesiology, Mulago Hospital, Makerere University, Kampala, Uganda
| | - Janat Tumukunde
- Department of Anesthesiology, Mulago Hospital, Makerere University, Kampala, Uganda
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Monica Langer
- Department of Surgery, Lurie Children's Hospital, Chicago, Illinois
| | - Martin Situma
- Department of Surgery, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - John Sekabira
- Department of Surgery, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Doruk Ozgediz
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Abstract
AIMS Although injuries have been linked to worse mental health, little is known about this association among the general population in low- and middle-income countries (LAMICs). This study examined the association between injuries and depression in 40 LAMICs that participated in the World Health Survey. METHODS Cross-sectional information was obtained from 212 039 community-based adults on the past 12-month experience of road traffic and other (non-traffic) injuries and depression, which was assessed using questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview. Multivariable logistic regression analysis and meta-analysis were used to examine associations. RESULTS The overall prevalence (95% CI) of past 12-month traffic injury, other injury, and depression was 2.8% (2.6-3.0%), 4.8% (4.6-5.0%) and 7.4% (7.1-7.8%), respectively. The prevalence of traffic injuries [range 0.1% (Ethiopia) to 5.1% (Bangladesh)], and other (non-traffic) injuries [range 0.9% (Myanmar) to 12.1% (Kenya)] varied widely across countries. After adjusting for demographic variables, alcohol consumption and smoking, the pooled OR (95%CI) for depression among individuals experiencing traffic injury based on a meta-analysis was 1.72 (1.48-1.99), and 2.04 (1.85-2.24) for those with other injuries. There was little between-country heterogeneity in the association between either form of injury and depression, although for traffic injuries, significant heterogeneity was observed between groups by country-income level (p = 0.043) where the pooled association was strongest in upper middle-income countries (OR = 2.37) and weakest in low-income countries (OR = 1.46). CONCLUSIONS Alerting health care providers in LAMICs to the increased risk of worse mental health among injury survivors and establishing effective trauma treatment systems to reduce the detrimental effects of injury should now be prioritised.
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Jesus TS, Landry MD, Hoenig H. Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060980. [PMID: 30893793 PMCID: PMC6466363 DOI: 10.3390/ijerph16060980] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/19/2019] [Accepted: 03/15/2019] [Indexed: 12/29/2022]
Abstract
Background: To inform global health policies and resources planning, this paper analyzes evolving trends in physical rehabilitation needs, using data on Years Lived with Disability (YLDs) from the Global Burden of Disease Study (GBD) 2017. Methods: Secondary analysis of how YLDs from conditions likely benefiting from physical rehabilitation have evolved from 1990 to 2017, for the world and across countries of varying income levels. Linear regression analyses were used. Results: A 66.2% growth was found in estimated YLD Counts germane to physical rehabilitation: a significant and linear growth of more than 5.1 billion YLDs per year (99% CI: 4.8–5.4; r2 = 0.99). Low-income countries more than doubled (111.5% growth) their YLD Counts likely benefiting from physical rehabilitation since 1990. YLD Rates per 100,000 people and the percentage of YLDs likley benefiting from physical rehabilitation also grew significantly over time, across locations (all p > 0.05). Finally, only in high-income countries did Age-standardized YLD Rates significantly decrease (p < 0.01; r2 = 0.86). Conclusions: Physical rehabilitation needs have been growing significantly in absolute, per-capita and in percentage of total YLDs. This growth was found globally and across countries of varying income level. In absolute terms, growths were higher in lower income countries, wherein rehabilitation is under-resourced, thereby highlighting important unmet needs.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine & WHO Collaborating Center on Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon, Rua da Junqueira 100, 1349-008 Lisbon, Portugal.
| | - Michel D Landry
- Physical Therapy Division, Department of Orthopeadic Surgery, School of Medicine, Duke University, Durham, NC 27705, USA.
- Duke Global Health Institute (DGHI), Duke University, Durham, NC 27710, USA.
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC 27705, USA.
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Tessler RA, Stadeli KM, Chadbunchachai W, Gyedu A, Lagrone L, Reynolds T, Rubiano A, Mock CN. Utilization of injury care case studies: a systematic review of the World Health Organization's "Strengthening care for the injured: Success stories and lessons learned from around the world". Injury 2018; 49:1969-1978. [PMID: 30195833 PMCID: PMC6432919 DOI: 10.1016/j.injury.2018.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Translation of evidence to practice is a public health priority. Worldwide, injury is a leading cause of morbidity and mortality. Case study publications are common and provide potentially reproducible examples of successful interventions in healthcare from the patient to systems level. However, data on how well case study publications are utilized are limited. To our knowledge, the World Health Organization (WHO) published the only collection of international case studies on injury care at the policy level. We aimed to determine the degree to which these injury care case studies have been translated to practice and to identify opportunities for enhancement of the evidence-to-practice pathway for injury care case studies overall. METHODS We conducted a systematic review across 19 databases by searching for the title, "Strengthening care for the injured: Success stories and lessons learned from around the world." Data synthesis included realist narrative methods and two authors independently reviewed articles for injury topics, reference details, and extent of utilization. FINDINGS Forty-seven publications referenced the compilation of case studies, 20 of which included further descriptions of one or more of the specific cases and underwent narrative review. The most common category utilized was hospital-based care (15 publications), with the example of Thailand's quality improvement (QI) programme (10 publications) being the most commonly cited case. Also frequently cited were case studies on prehospital care (10 publications). There was infrequent utilization of case studies on rehabilitation (3 publications) and trauma systems (2 publications). No reference described a case translated to a new scenario. CONCLUSIONS The only available collection of policy-level injury care case studies has been utilized to a moderate extent however we found no evidence of case study translation to a new circumstance. QI programs seem especially amenable for knowledge-sharing through case studies. Prehospital care also showed promise. Greater emphasis on rehabilitation and health policy related to trauma systems is warranted. There is also a need for greater methodologic rigor in evaluation of the use of case study collections in general.
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Affiliation(s)
- Robert A. Tessler
- Harborview Injury Prevention and Research Center, Seattle, USA,University of Pittsburgh, Pittsburgh, USA,Corresponding author at: Harborview Injury Prevention and Research Center, 401 Broadway, 4th Floor, Seattle, WA 98122, USA., (R.A. Tessler)
| | | | | | - Adam Gyedu
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | - Charles N. Mock
- Harborview Injury Prevention and Research Center, Seattle, USA,University of Washington, Seattle, USA
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Prin M, Eaton J, Mtalimanja O, Charles A. High Elective Surgery Cancellation Rate in Malawi Primarily Due to Infrastructural Limitations. World J Surg 2018; 42:1597-1602. [PMID: 29147893 DOI: 10.1007/s00268-017-4356-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The provision of safe and timely surgical care is essential to global health care. Low- and middle-income countries have a disproportionate share of the global surgical disease burden and struggle to provide care with the given resources. Surgery cancellation worldwide occurs for many reasons, which are likely to differ between high-income and low-income settings. We sought to evaluate the proportion of elective surgery that is cancelled and the associated reasons for cancellation at a tertiary hospital in Malawi. METHODS This was a retrospective review of a database maintained by the Department of Anesthesiology at Kamuzu Central Hospital in Lilongwe, Malawi. Data were available from August 2011 to January 2015 and included weekday records for the number of scheduled surgeries, the number of cancelled surgeries, and the reasons for cancellation. Descriptive statistics were performed. RESULTS Of 10,730 scheduled surgeries, 4740 (44.2%) were cancelled. The most common reason for cancellation was infrastructural limitations (84.8%), including equipment shortages (50.9%) and time constraints (33.3%). Provider limitations accounted for 16.5% of cancellations, most often due to shortages of anaesthesia providers. Preoperative medical conditions contributed to 26.3% of cancellations. CONCLUSION This study demonstrates a high case cancellation rate at a tertiary hospital in Malawi, attributable primarily to infrastructural limitations. These data provide evidence that investments in medical infrastructure and prevention of workforce brain drain are critical to surgical services in this region.
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Affiliation(s)
- Meghan Prin
- Department of Anesthesiology and Critical Care, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH-505, New York, NY, 10032, USA.
| | - Jessica Eaton
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Onias Mtalimanja
- Department of Anesthesiology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
BACKGROUND Surgical care is essential to health systems but remains a challenge for low- and middle-income countries (LMICs). Current metrics to assess access and delivery of surgical care focus on the structural components of surgery and are not readily applicable to all settings. This study assesses a new metric for surgical care access and delivery, the ratio of emergent surgery to elective surgery (Ee ratio), which represents the number of emergency surgeries performed for every 100 elective surgeries. METHODS A systematic search of PubMed and Medline was conducted for studies describing surgical volume and acuity published between 2006 and 2016. The relationship between Ee ratio and three national indicators (gross domestic product, per capital healthcare spending, and physician density) was analyzed using weighted Pearson correlation coefficients (r w) and linear regression models. RESULTS A total of 29 studies with 33 datasets were included for analyses. The median Ee ratio was 14.6 (IQR 5.5-62.6), with a range from 1.6 to 557.4. For countries in sub-Saharan Africa the median value was 62.6 (IQR 17.8-111.0), compared to 9.4 (IQR 3.4-13.4) for the United States and 5.5 (IQR 4.4-10.1) for European countries. In multivariable linear regression, the per capita healthcare spending was inversely associated with the Ee ratio, with a 63-point decrease in the Ee ratio for each 1 point increase in the log of the per capita healthcare spending (regression coefficient β = -63.2; 95% CI -119.6 to -6.9; P = 0.036). CONCLUSIONS The Ee ratio appears to be a simple and valid indicator of access to available surgical care. Global health efforts may focus on investment in low-resource settings to improve access to available surgical care.
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25
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Kiragu AW, Dunlop SJ, Mwarumba N, Gidado S, Adesina A, Mwachiro M, Gbadero DA, Slusher TM. Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions. Front Pediatr 2018; 6:155. [PMID: 29915778 PMCID: PMC5994692 DOI: 10.3389/fped.2018.00155] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/09/2018] [Indexed: 12/15/2022] Open
Abstract
Trauma constitutes a significant cause of death and disability globally. The vast majority -about 95%, of the 5.8 million deaths each year, occur in low-and-middle-income countries (LMICs) 3-6. This includes almost 1 million children. The resource-adapted introduction of trauma care protocols, regionalized care and the growth specialized centers for trauma care within each LMIC are key to improved outcomes and the lowering of trauma-related morbidity and mortality globally. Resource limitations in LMICs make it necessary to develop injury prevention strategies and optimize the use of locally available resources when injury prevention measures fail. This will lead to the achievement of the best possible outcomes for critically ill and injured children. A commitment by the governments in LMICs working alone or in collaboration with international non-governmental organizations (NGOs) to provide adequate healthcare to their citizens is also crucial to improved survival after major trauma. The increase in global conflicts also has significantly deleterious effects on children, and governments and international organizations like the United Nations have a significant role to play in reducing these. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.
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Affiliation(s)
- Andrew W. Kiragu
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
| | - Stephen J. Dunlop
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- Division of Global Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Njoki Mwarumba
- Department of Political Science, Oklahoma State University, Stillwater, OK, United States
| | - Sanusi Gidado
- Department of Surgery, Bingham University Teaching Hospital, Jos, Nigeria
| | - Adesope Adesina
- Department of Surgery, Bowen University Teaching Hospital, Ogbomosho, Nigeria
| | | | - Daniel A. Gbadero
- Department of Pediatrics, Bowen University Teaching Hospital, Ogbomosho, Nigeria
| | - Tina M. Slusher
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
- Division of Global Pediatrics, University of Minnesota, Minneapolis, MN, United States
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Muhirwa E, Habiyakare C, Hedt-Gauthier BL, Odhiambo J, Maine R, Gupta N, Toma G, Nkurunziza T, Mpunga T, Mukankusi J, Riviello R. Non-Obstetric Surgical Care at Three Rural District Hospitals in Rwanda: More Human Capacity and Surgical Equipment May Increase Operative Care. World J Surg 2017; 40:2109-16. [PMID: 27098541 PMCID: PMC4982876 DOI: 10.1007/s00268-016-3515-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background Most mortality attributable to surgical emergencies occurs in low- and middle-income countries. District hospitals, which serve as the first-level surgical facility in rural sub-Saharan Africa, are often challenged with limited surgical capacity. This study describes the presentation, management, and outcomes of non-obstetric surgical patients at district hospitals in Rwanda. Methods This study included patients seeking non-obstetric surgical care at three district hospitals in rural Rwanda in 2013. Demographics, surgical conditions, patient care, and outcomes are described; operative and non-operative management were stratified by hospitals and differences assessed using Fisher’s exact test. Results Of the 2660 patients who sought surgical care at the three hospitals, most were males (60.7 %). Many (42.6 %) were injured and 34.7 % of injuries were through road traffic crashes. Of presenting patients, 25.3 % had an operation, with patients presenting to Butaro District Hospital significantly more likely to receive surgery (57.0 %, p < 0.001). General practitioners performed nearly all operations at Kirehe and Rwinkwavu District Hospitals (98.0 and 100.0 %, respectively), but surgeons performed 90.6 % of the operations at Butaro District Hospital. For outcomes, 39.5 % of all patients were discharged without an operation, 21.1 % received surgery and were discharged, and 21.1 % were referred to tertiary facilities for surgical care. Conclusion Significantly more patients in Butaro, the only site with a surgeon on staff and stronger surgical infrastructure, received surgery. Availing more surgeons who can address the most common surgical needs and improving supplies and equipment may improve outcomes at other districts. Surgical task sharing is recommended as a temporary solution.
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Affiliation(s)
| | | | - Bethany L Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Rebecca Maine
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Surgery, University of California, San Francisco, CA, USA
| | - Neil Gupta
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Gabriel Toma
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Robert Riviello
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,University Teaching Hospital, Kigali, Rwanda
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Merchant AI, Walters CB, Valenzuela J, McQueen KA, May AK. Creating a Global Acute Care Surgery Fellowship to Meet International Need. JOURNAL OF SURGICAL EDUCATION 2017; 74:780-786. [PMID: 28427944 DOI: 10.1016/j.jsurg.2017.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/04/2017] [Accepted: 01/30/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Existing Acute Care Surgery (ACS) fellowships are positioned to develop well-trained surgeons with specific skills to facilitate improvements in care delivery in Global ACS. Many resident and fellowship programs offer clinical electives that expose trainees to operative experiences, exposing trainees to the needs in resource-challenged settings. However, most lack a focus on long-term development and research designed to enhance the country's local skills, capability, and capacity. The Global Acute Care Surgery (Global ACS) fellowship produces a surgeon who focuses on capacity building and systems development across the world. METHODS At Vanderbilt University, the current American Association for the Surgery of Trauma-Acute Care Surgery (AAST-ACS) fellowship was adapted to create an academic Global Acute Care Surgery (Global ACS) fellowship. This fellowship specifically enhances fellowship trainee's skills in needs assessment and performing research to facilitate the development and implementation of trauma and acute care surgery systems in low- and middle income countries. This research will foster context-appropriate data, collected and based in low- and middle-income countries, to guide practice and policy. RESULTS AND CONCLUSION Two fellows have completed the Global ACS fellowship at Vanderbilt University. The fellowship requirements, clinical skills, project development and overall goals are outlined within the article. Challenges, funding, and mentorship must also be addressed to develop a comprehensive fellowship. A sample two-year timeline is provided to complete the fellowship track and meet the defined goals. A structured global acute care surgery fellowship enables fellows to reduce the surgical burden of disease and contribute to surgical systems development at both local and international levels by creating meaningful research and developing sustainable change in LMIC countries.
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Affiliation(s)
- Amina I Merchant
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Camila B Walters
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie Valenzuela
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelly A McQueen
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Addison K May
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
OBJECTIVE To quantify the burden of surgical conditions in Uganda. BACKGROUND Data on the burden of disease have long served as a cornerstone to health policymaking, planning, and resource allocation. Population-based data are the gold standard, but no data on surgical burden at a national scale exist; therefore, we adapted the Surgeons OverSeas Assessment of Surgical Need survey and conducted a nation-wide, cross-sectional survey of Uganda to quantify the burden of surgically treatable conditions. METHODS The 2-stage cluster sample included 105 enumeration areas, representing 74 districts and Kampala Capital City Authority. Enumeration occurred from August 20 to September 12, 2014. In each enumeration area, 24 households were randomly selected; the head of the household provided details regarding any household deaths within the previous 12 months. Two household members were randomly selected for a head-to-toe verbal interview to determine existing untreated and treated surgical conditions. RESULTS In 2315 households, we surveyed 4248 individuals: 461 (10.6%) reported 1 or more conditions requiring at least surgical consultation [95% confidence interval (CI) 8.9%-12.4%]. The most frequent barrier to surgical care was the lack of financial resources for the direct cost of care. Of the 153 household deaths recalled, 53 deaths (34.2%; 95% CI 22.1%-46.3%) were associated with surgically treatable signs/symptoms. Shortage of time was the most frequently cited reason (25.8%) among the 11.6% household deaths that should have, but did not, receive surgical care (95% CI 6.4%-16.8%). CONCLUSIONS Unmet surgical need is prevalent in Uganda. There is an urgent need to expand the surgical care delivery system starting with the district-level hospitals. Routine surgical data collection at both the health facility and household level should be implemented.
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29
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Blair KJ, Boeck MA, Gallardo Barrientos JL, Hidalgo López JL, Helenowski IB, Nwomeh BC, Shapiro MB, Swaroop M. Assessment of Surgical and Trauma Capacity in Potosí, Bolivia. Ann Glob Health 2017; 83:262-273. [PMID: 28619401 DOI: 10.1016/j.aogh.2017.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Scaling up surgical and trauma care in low- and middle-income countries could prevent nearly 2 million annual deaths. Various survey instruments exist to measure surgical and trauma capacity, including Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT). OBJECTIVE We sought to evaluate surgical and trauma capacity in the Bolivian department of Potosí using a combined PIPES and INTACT tool, with additional questions to further inform intervention targets. METHODS In June and July 2014 a combined PIPES and INTACT survey was administered to 20 government facilities in Potosí with a minimum of 1 operating room: 2 third-level, 10 second-level, and 8 first-level facilities. A surgeon, head physician, director, or obstetrician-gynecologist completed the survey. Additional personnel responded to 4 short-answer questions. Survey items were divided into subsections, and PIPES and INTACT indices calculated. Medians were compared via Wilcoxon rank sum and Kruskal-Wallis tests. FINDINGS Six of 20 facilities were located in the capital city and designated urban. Urban establishments had higher median PIPES (8.5 vs 6.7, P = .11) and INTACT (8.5 vs 6.9, P = .16) indices compared with rural. More than half of surgeons and anesthesiologists worked in urban hospitals. Urban facilities had higher median infrastructure and procedure scores compared with rural. Fifty-three individuals completed short-answer questions. Training was most desired in laparoscopic surgery and trauma management; less than half of establishments reported staff with trauma training. CONCLUSIONS Surgical and trauma capacity in Potosí was most limited in personnel, infrastructure, and procedures at rural facilities, with greater personnel deficiencies than previously reported. Interventions should focus on increasing the number of surgical and anesthesia personnel in rural areas, with a particular focus on the reported desire for trauma management training. Results have been made available to key stakeholders in Potosí to inform targeted quality improvement interventions.
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Affiliation(s)
- Kevin J Blair
- Northwestern University, Feinberg School of Medicine, Department of Surgery, Division of Trauma & Critical Care, Chicago, IL.
| | - Marissa A Boeck
- Northwestern University, Feinberg School of Medicine, Department of Surgery, Division of Trauma & Critical Care, Chicago, IL; New York Presbyterian Hospital, Columbia University Medical Center, Department of Surgery, New York, NY; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | | | | | - Irene B Helenowski
- Northwestern University, Feinberg School of Medicine, Department of Preventative Medicine, Chicago, IL
| | - Benedict C Nwomeh
- Nationwide Children's Hospital, Department of Pediatric Surgery, Columbus, OH
| | - Michael B Shapiro
- Northwestern University, Feinberg School of Medicine, Department of Surgery, Division of Trauma & Critical Care, Chicago, IL
| | - Mamta Swaroop
- Northwestern University, Feinberg School of Medicine, Department of Surgery, Division of Trauma & Critical Care, Chicago, IL
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30
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Reynolds TA, Stewart B, Drewett I, Salerno S, Sawe HR, Toroyan T, Mock C. The Impact of Trauma Care Systems in Low- and Middle-Income Countries. Annu Rev Public Health 2017; 38:507-532. [DOI: 10.1146/annurev-publhealth-032315-021412] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Injury is a leading cause of death globally, and organized trauma care systems have been shown to save lives. However, even though most injuries occur in low- and middle-income countries (LMICs), most trauma care research comes from high-income countries where systems have been implemented with few resource constraints. Little context-relevant guidance exists to help policy makers set priorities in LMICs, where resources are limited and where trauma care may be implemented in distinct ways. We have aimed to review the evidence on the impact of trauma care systems in LMICs through a systematic search of 11 databases. Reports were categorized by intervention and outcome type and summarized. Of 4,284 records retrieved, 71 reports from 32 countries met inclusion criteria. Training, prehospital systems, and overall system organization were the most commonly reported interventions. Quality-improvement, costing, rehabilitation, and legislation and governance were relatively neglected areas. Included reports may inform trauma care system planning in LMICs, and noted gaps may guide research and funding agendas.
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Affiliation(s)
- Teri A. Reynolds
- Department for the Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, Geneva CH-1211, Switzerland;, ,
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington 98105
| | - Isobel Drewett
- School of Medicine, Monash University, Melbourne 3800, Australia
| | - Stacy Salerno
- Department for the Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, Geneva CH-1211, Switzerland;, ,
| | - Hendry R. Sawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania
| | - Tamitza Toroyan
- Department for the Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, Geneva CH-1211, Switzerland;, ,
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, Washington 98105
- Department Global Health, University of Washington, Seattle, Washington 98105
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31
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Bendix P, Havens JM. The Global Burden of Surgical Disease. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0070-6] [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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Blair KJ, Paladino L, Shaw PL, Shapiro MB, Nwomeh BC, Swaroop M. Surgical and trauma care in low- and middle-income countries: a review of capacity assessments. J Surg Res 2016; 210:139-151. [PMID: 28457320 DOI: 10.1016/j.jss.2016.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/04/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgical and trauma capacity assessments help guide resource allocation and plan interventions to improve care for the injured in low- and middle-income countries (LMICs). To forge expert consensus on conducting these assessments, we undertook a systematic review of studies using five tools: (1) World Health Organization's (WHO) Guidelines for Essential Trauma Care, (2) WHO's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, (3) Personnel, Infrastructure, Procedures, Equipment, and Supplies tool, (4) Harvard Humanitarian Initiative tool, and (5) Emergency and Critical Care tool. MATERIALS AND METHODS Publications describing utilization of survey instruments to assess surgical or trauma capacity in LMICs were reviewed. Included articles underwent thematic analysis to develop recommendations. A modified Delphi method was used to establish expert consensus. Experts rated recommendations on a Likert-type scale via online survey. Consensus was defined by Cronbach's α ≥ 0.80. Recommendations achieving agreement by ≥80% of experts were included. RESULTS Two hundred and ninety-eight publications were identified and 41 included, describing evaluation of 1170 facilities across 36 LMICs. Nine recommendations were agreed upon by expert consensus: (1) inclusion of district hospitals, (2) inclusion of highest level public hospital, (3) inclusion of private facilities, (4) facility visits for on-site completion, (5) direct inspections, (6) checking surgical logs, (7) adaptation of survey instrument, (8) repeat assessments, and (9) need for increased collaboration. CONCLUSIONS Expert recommendations developed in this review describe methodology to be employed when conducting assessments of surgical and trauma capacity in LMICs. Consensus has yet to be achieved for tool selection.
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Affiliation(s)
- Kevin J Blair
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Lorenzo Paladino
- Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Pamela L Shaw
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael B Shapiro
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Benedict C Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Mamta Swaroop
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Valles P, Van den Bergh R, van den Boogaard W, Tayler-Smith K, Gayraud O, Mammozai BA, Nasim M, Cheréstal S, Majuste A, Charles JP, Trelles M. Emergency department care for trauma patients in settings of active conflict versus urban violence: all of the same calibre? Int Health 2016; 8:390-397. [PMID: 27810881 PMCID: PMC5181548 DOI: 10.1093/inthealth/ihw035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/16/2016] [Accepted: 04/05/2016] [Indexed: 11/16/2022] Open
Abstract
Background Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts. Methods A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in two EDs over the course of 2014. Results 31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians’ maximum working capacity was exceeded in both centres, and mainly during rush hours. Conclusions This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs.
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Affiliation(s)
- Pola Valles
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Brussels, Belgium
| | - Rafael Van den Bergh
- Médecins Sans Frontières - Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - Wilma van den Boogaard
- Médecins Sans Frontières - Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - Katherine Tayler-Smith
- Médecins Sans Frontières - Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - Olivia Gayraud
- Médecins Sans Frontières - Operational Centre Brussels, Port-au-Prince, Haiti
| | | | - Masood Nasim
- Médecins Sans Frontières - Operational Centre Brussels, Kunduz, Afghanistan
| | - Sophia Cheréstal
- Médecins Sans Frontières - Operational Centre Brussels, Port-au-Prince, Haiti
| | - Alberta Majuste
- Médecins Sans Frontières - Operational Centre Brussels, Port-au-Prince, Haiti
| | | | - Miguel Trelles
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Brussels, Belgium
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Vreugdenburg TD, Ma N, Duncan JK, Riitano D, Cameron AL, Maddern GJ. Comparative diagnostic accuracy of hepatocyte-specific gadoxetic acid (Gd-EOB-DTPA) enhanced MR imaging and contrast enhanced CT for the detection of liver metastases: a systematic review and meta-analysis. Int J Colorectal Dis 2016; 31:1739-1749. [PMID: 27682648 DOI: 10.1007/s00384-016-2664-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE This systematic review evaluated the diagnostic accuracy and impact on patient management of hepatocyte-specific gadoxetic acid enhanced magnetic resonance imaging (GA-MRI) compared to contrast enhanced computed tomography (CE-CT) in patients with liver metastases. METHOD Four biomedical databases (PubMed, EMBASE, Cochrane Library, York CRD) were searched from January 1991 to February 2016. Studies investigating the accuracy or management impact of GA-MRI compared to CE-CT in patients with known or suspected liver metastases were included. Bias was evaluated using QUADAS-II. Univariate meta-analysis of sensitivity ratios (RR) were conducted in the absence of heterogeneity, calculated using I 2 , Tau values (τ) and prediction intervals. RESULTS Nine diagnostic accuracy studies (537 patients with 1216 lesions) and four change in management studies (488 patients with 281 lesions) were included. Per-lesion sensitivity and specificity estimates for GA-MRI ranged from 86.9-100.0 % and 80.2-98.0 %, respectively, compared to 51.8-84.6 % and 77.2-98.0 % for CE-CT. Meta-analysis found GA-MRI to be significantly more sensitive than CE-CT (RR = 1.29, 95 % CI = 1.18-1.40, P < 0.001), with equivalent specificity (RR = 0.97, 95 % CI 0.910-1.042, P = 0.44). The largest difference was observed for lesions smaller than 10 mm for which GA-MRI was significantly more sensitive (RR = 2.21, 95 % CI = 1.47-3.32, P < 0.001) but less specific (RR = 0.92, 95 % CI 0.87-0.98, P = 0.008). GA-MRI affected clinical management in 26 of 155 patients (16.8 %) who had a prior CE-CT; however, no studies investigated the consequences of using GA-MRI instead of CE-CT. CONCLUSION GA-MRI is significantly more sensitive than CE-CT for detecting liver metastases, which leads to a modest impact on patient management in the context of an equivocal CE-CT result.
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Affiliation(s)
- Thomas D Vreugdenburg
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia.
| | - Ning Ma
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Joanna K Duncan
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Dagmara Riitano
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Alun L Cameron
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Guy J Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
- Discipline of Surgery, University of Adelaide and The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Lyon CB, Merchant AI, Schwalbach T, Pinto EFV, Jeque EC, McQueen KAK. Anesthetic Care in Mozambique. Anesth Analg 2016; 122:1634-9. [PMID: 26983052 DOI: 10.1213/ane.0000000000001223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The World Bank and Lancet Commission in 2015 have prioritized surgery in Low-Income Countries (LIC) and Lower-Middle Income Countries (LMICs). This is consistent with the shift in the global burden of disease from communicable to noncommunicable diseases over the past 20 years. Essential surgery must be performed safely, with adequate anesthesia monitoring and intervention. Unfortunately, a huge barrier to providing safe surgery includes the paucity of an anesthesia workforce. In this study, we qualitatively evaluated the anesthesia capacity of Mozambique, a LIC in Africa with limited access to anesthesia and safe surgical care. Country-based solutions are suggested that can expand to other LIC and LMICs. METHODS A comprehensive review of the Mozambique anesthesia system was conducted through interviews with personnel in the Ministry of Health (MOH), a school of medicine, a public central referral hospital, a general first referral hospital, a private care hospital, and leaders in the physician anesthesia community. Personnel databases were acquired from the MOH and Maputo Central Hospital. RESULTS Quantitative results reveal minimal anesthesia capacity (290 anesthesia providers for a population of >25 million or 0.01:10,000). The majority of physician anesthesiologists practice in urban settings, and many work in the private sector. There is minimal capacity for growth given only 1 Mozambique anesthesia residency with inadequate resources. The most commonly perceived barriers to safe anesthesia in this critical shortage are lack of teachers, lack of medical student interest in and exposure to anesthesia, need for more schools, low allocation to anesthesia from the list of available specialist prospects by MOH, and low public payments to anesthesiologists. Qualitative results show assets of a good health system design, a supportive environment for learning in the residency, improvement in anesthetic care in past decades, and a desire for more educational opportunities and teachers. CONCLUSIONS Mozambique has a strong health system design but few resources for surgery and safe anesthesia. At present, similar to other LICs, human resources, access to essential medicines, and safety monitoring limit safe anesthesia in Mozambique.
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Affiliation(s)
- Camila B Lyon
- From the *Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee; †Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University, Nashville, Tennessee; ‡Universidade Eduardo Mondlane, Maputo, Mozambique; §Department of Anesthesiology, Maputo Central Hospital, Maputo, Mozambique; and ‖Department of Anesthesiology, Maputo Central Hospital and Ministry of Health, Maputo, Mozambique
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Assessment of trauma patients. Int J Orthop Trauma Nurs 2016; 21:21-30. [DOI: 10.1016/j.ijotn.2015.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 11/17/2022]
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Applications of the epidemiological modelling outputs for targeted mental health planning in conflict-affected populations: the Syria case-study. Glob Ment Health (Camb) 2016; 3:e8. [PMID: 28596877 PMCID: PMC5314753 DOI: 10.1017/gmh.2016.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/03/2015] [Accepted: 01/20/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Epidemiological models are frequently utilised to ascertain disease prevalence in a population; however, these estimates can have wider practical applications for informing targeted scale-up and optimisation of mental health services. We explore potential applications for a conflict-affected population, Syria. METHODS We use prevalence estimates of major depression and post-traumatic stress disorder (PTSD) in conflict-affected populations as inputs for subsequent estimations. We use Global Burden of Disease (GBD) methodology to estimate years lived with a disability (YLDs) for depression and PTSD in Syrian populations. Human resource (HR) requirements to scale-up recommended packages of care for PTSD and depression in Syria over a 15-year period were modelled using the World Health Organisation mhGAP costing tool. Associated avertable burden was estimated using health benefit analyses. RESULTS The total number of cases of PTSD in Syria was estimated at approximately 2.2 million, and approximately 1.1 million for depression. An age-standardised major depression rate of 13.4 (95% UI 9.8-17.5) YLDs per 1000 Syrian population is estimated compared with the GBD 2010 global age-standardised YLD rate of 9.2 (95% UI 7.0-11.8). HR requirements to support a linear scale-up of services in Syria using the mhGAP costing tool demonstrates a steady increase from 0.3 FTE in at baseline to 7.6 FTE per 100 000 population after scale-up. Linear scale-up over 15 years could see 7-9% of disease burden being averted. CONCLUSION Epidemiological estimates of mental disorders are key inputs into determining disease burden and guiding optimal mental health service delivery and can be used in target populations such as conflict-affected populations.
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Evaluating Progress in the Global Surgical Crisis: Contrasting Access to Emergency and Essential Surgery and Safe Anesthesia Around the World. World J Surg 2015; 39:2630-5. [DOI: 10.1007/s00268-015-3179-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shawar YR, Shiffman J, Spiegel DA. Generation of political priority for global surgery: a qualitative policy analysis. LANCET GLOBAL HEALTH 2015; 3:e487-e495. [DOI: 10.1016/s2214-109x(15)00098-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/05/2015] [Accepted: 03/10/2015] [Indexed: 11/25/2022]
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A Banner Year for Global Surgery: Now How to Make it Make a Difference on the Ground. World J Surg 2015; 39:2111-4. [DOI: 10.1007/s00268-015-3154-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Löfgren J, Kadobera D, Forsberg BC, Mulowooza J, Wladis A, Nordin P. District-level surgery in Uganda: Indications, interventions and perioperative mortality. Surgery 2015; 158:7-16. [PMID: 25958070 DOI: 10.1016/j.surg.2015.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 03/11/2015] [Accepted: 03/20/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The world's poorest 2 billion people, benefit from no more than about 3.5% of the world's operative procedures. The burden of surgical disease is greatest in Africa, where operations could save many lives. Previous facility-based studies have described operative procedure caseloads, but prospective studies investigating interventions, indications and perioperative mortality rates (POMR), are rare. METHODS A prospective, questionnaire-based collection of data on all major and minor operative procedures was undertaken at 2 hospitals in rural Uganda covering 4 and 3 months in 2011, respectively. Data included patient characteristics, indications for the interventions performed, and outcome after surgery. RESULTS We recorded 2,790 operative procedures on 2,701 patients. The rate of major operative procedures per 100,000 population per year was 225. Patients undergoing major operative procedures (n = 1,051) were mostly women (n = 923; 88%) because most interventions were performed owing to pregnancy-related complications (n = 747; 67%) or gynecologic conditions (n = 114; 10%). General operative interventions registered included herniorrhaphy (n = 103; 9%), exploratory laparotomy (n = 60; 5%), and appendectomy (n = 31; 3%). The POMR for major operative procedures was 1% (n = 14) and was greatest after exploratory laparotomy (13%; n = 8) and caesarean delivery (1%; n = 4). Most deaths (n = 16) were a result of sepsis (n = 10-11) or hemorrhage (n = 3-5). CONCLUSION The volume of surgery was low relative to the size of the catchment population. The POMR was high. Exploratory laparotomy and caesarean section were identified as high-risk procedures. Increased availability of blood, improved perioperative monitoring, and early intervention could be part of a solution to reduce the POMR.
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Affiliation(s)
- Jenny Löfgren
- Department of Surgery and Perioperative Sciences, Umeå University Hospital, Umeå, Sweden.
| | - Daniel Kadobera
- School of Public Health, Iganga/Mayuge Health and Demographic Surveillance Site, Iganga, Uganda
| | - Birger C Forsberg
- Department of Public Health Sciences, Karolinska Institute, Solna, Sweden
| | | | - Andreas Wladis
- Department of Clinical Science and Education (KI SÖS), Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Pär Nordin
- Department of Surgery and Perioperative Sciences, Umeå University Hospital, Umeå, Sweden
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Verguet S, Alkire BC, Bickler SW, Lauer JA, Uribe-Leitz T, Molina G, Weiser TG, Yamey G, Shrime MG. Timing and cost of scaling up surgical services in low-income and middle-income countries from 2012 to 2030: a modelling study. LANCET GLOBAL HEALTH 2015; 3 Suppl 2:S28-37. [DOI: 10.1016/s2214-109x(15)70086-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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