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Dimoko AA, Fyneface-Ogan S. Improvisation of surgical light: Another way round the obstacle. Trop Doct 2023; 53:489-491. [PMID: 37624705 DOI: 10.1177/00494755231191556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
The importance of surgical lighting is to illuminate the operative site on and within a patient for proper visualisation by operating theatre staff during a surgical procedure. With a good surgical illumination, a higher level of efficacy and safety can be achieved during surgery thus reducing the risk of complications. A rechargeable home LED bulb was converted into an improvised surgical lamp after removing the shade. This was mounted into the lamp holders of an old operating room lamp. This operating room lamp was plugged into an alternating current socket for power supply and recharging of the bulbs. This improvised surgical lamp provided a low temperature light source for more than 4 h. It is not however intended to replace standard operating lamps but is a viable alternative in resource challenged environments.
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Affiliation(s)
- Alexander A Dimoko
- Consultant General Surgeon and Lecturer, Department of Surgery, Bayelsa Medical University, Yenagoa, Nigeria
| | - Sotonye Fyneface-Ogan
- Consultant Anaesthetist and Professor, Department of Anaesthesia, University of Port Harcourt, Port Harcourt, Nigeria
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2
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Cash E, Albert C, Potts K, Chandran S, Horrell R. Near-Field LED Illumination Strategies for Tonsillectomy and Adenoid Surgery. EAR, NOSE & THROAT JOURNAL 2023:1455613231183568. [PMID: 37365826 DOI: 10.1177/01455613231183568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Objective: Perform a pilot feasibility study to demonstrate viability, quality, and safety advantages of light-emitting diode (LED) illumination when performing tonsillectomy. Study Design: Prospective cohort. Setting: Children's Hospital and Community Multispecialty Hospital. Methods: We tested a commercially available LED light, held in position with a minimally modified mouth gag, for off-label use in a "cavernous wound." We assessed surgeons', residents', and nurses' perceptions of function, safety, as well as preferences compared to headlights. Results: The light was used in 30 cases. Noted advantages over traditional lighting methods included superior brightness, stability and consistency of illumination, and the ability for others to assist more quickly. The inability to adjust brightness and/or the angle of light was an observed disadvantage. A small oral cavity or large tonsillar pillars creating a shadow required the temporary addition of a headlight. However, LED light use was not discontinued. Surgeons and residents reported a preference for not wearing a headlight, and nurses expressed concerns about headlight cleanliness. Conclusion: LED lighting technology demonstrated utility for teaching surgeons, residents, and nurses, and was perceived as safe. Additional specifications may make the light applicable to a wider variety of cases and could potentially mitigate headlight use during procedures of the oral cavity and oropharynx.Level of Evidence: 4.
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Affiliation(s)
- Elizabeth Cash
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Christina Albert
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kevin Potts
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Swapna Chandran
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Robin Horrell
- Department of Otolaryngology, Billings Clinic, Billings, MT, USA
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3
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Hussien M, Capo-Chichi N, Starr N, Johansen E, Negash S, Utam T, Negussie T, Fernandez K, Weiser TG. Exploring the Use of a Fit-for-Purpose Surgical Headlight in Sub-Saharan Africa: Mixed Methods Study. World J Surg 2023; 47:1633-1646. [PMID: 36864223 DOI: 10.1007/s00268-023-06952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND High-quality surgical lighting is often lacking in low-resource settings. Commercial surgical headlights are unavailable due to high cost and supply and maintenance challenges. We aimed to understand user needs of a surgical headlight for low-resource settings by evaluating a preselected robust but relatively inexpensive headlight and lighting conditions. METHODS We observed headlight use by ten surgeons in Ethiopia and six in Liberia. All surgeons completed surveys about their lighting environment and experience using headlight, and were subsequently interviewed. Twelve surgeons completed logbooks on headlight use. We distributed headlights to 48 additional surgeons, and all surgeons were surveyed for feedback. RESULTS In Ethiopia, five surgeons ranked operating room light quality as poor or very poor; seven delayed or cancelled operations within the last year and five described intraoperative complications due to poor lighting. In Liberia, lighting was rated as "good", however fieldnotes, and interviews noted generator fuel-rationing, and poor lighting conditions. In both countries, the headlight was considered extremely useful. Surgeons recommended nine improvements, including comfort, durability, affordability and availability of multiple rechargeable batteries. Thematic analysis identified factors influencing headlight use, specifications and feedback, and infrastructure challenges. CONCLUSION Lighting in surveyed operating rooms was poor. Although conditions and need for the headlights differed between Ethiopia and Liberia, headlights were considered highly useful. However, discomfort was a major limiting factor for ongoing use, and the hardest to objectively characterise for specification and engineering purposes. Specific needs for surgical headlights include comfort and durability. Refinement of a fit-for-purpose surgical headlight is ongoing.
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Affiliation(s)
- Muaad Hussien
- Department of Surgery and Urology, Mälarsjukhuset Hospital, Eskilstuna, Sweden.
| | - Nina Capo-Chichi
- Smile Train, New York, USA
- Lifebox Foundation Inc., New York, USA
| | - Nichole Starr
- Lifebox Foundation Inc., New York, USA
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Samuel Negash
- Lifebox Foundation Inc., New York, USA
- Department of Surgery, Menelik II Hospital, Addis Ababa, Ethiopia
| | - Terseer Utam
- Lifebox Foundation Inc., New York, USA
- Department of Surgery, Redemption Hospital, New Kru Town, Monrovia, Liberia
| | - Tihitena Negussie
- Lifebox Foundation Inc., New York, USA
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Thomas G Weiser
- Lifebox Foundation Inc., New York, USA
- Department of Surgery, Stanford University, Stanford, CA, USA
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
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4
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Ghandour H, Vervoort D, Ravishankar R, Swain JBD. Cardiac surgery and the sustainable development goals: a review. THE CARDIOTHORACIC SURGEON 2022. [DOI: 10.1186/s43057-022-00072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In 2015, the United Nations adopted the Sustainable Development Goals (SDGs) as key priorities to improve the global health and international development agenda in an intersectoral manner, highlighting 17 SDGs. Six billion people lack access to safe, timely, and affordable cardiac surgical care due to capacity, geographic, and financial barriers. Nevertheless, cardiac surgery is largely disregarded on the global health agenda. In this review, we explore the intersection between cardiac surgery and the SDGs to delineate potential policy and advocacy avenues for the cardiothoracic surgical community.
Main body
A narrative review was performed using the PubMed/MEDLINE, Scopus, and WHO databases with variations of the search terms “cardiac surgery,” “cardiovascular diseases,” and keywords extracted from individual SDGs. All SDGs were manually reviewed to define intersectionality with global cardiac surgery. Out of 17 SDGs, 15 are relevant and require additional attention from the cardiovascular community. SDG3, “Good Health and Well-being,” is the most relevant, although the intersection between global cardiac surgery and other SDGs is apparent. A call for interdisciplinary collaboration through increased preventive mechanisms, rigorous, all-inclusive clinical trials, advocacy with relevant legislators, and mobilizing capacity building mechanisms are made.
Conclusion
Meeting the SDGs will require recognition of cardiovascular disease management, including cardiac surgical care. Cardiac surgeons are essential stakeholders of multidisciplinary collaborations working to improve access to safe, timely, and affordable cardiac surgery for all. Their role as advocates will be vital to establish local, national, regional, and international partnerships and to ensure progress towards SDG attainment.
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Gupta DK, Chen L, Heidari AE, Chau S, Dunn B, Wong BJF. Development of a Cost-Effective Surgical Headlight Using Consumer Light Emitting Diode Lighting and 3D Printing. Surg Innov 2021; 28:776-779. [PMID: 33629890 DOI: 10.1177/1553350621997764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Need. Battery-powered Light Emitting Diode (LED) surgical headlights are necessary for improved intraoperative illumination but may be costly. Technical Solution. The objective of this study was to develop a low-cost surgical headlight using a consumer-grade LED headlight and 3D-printed mount. Proof of Concept. Eighteen surgical residents performed simulation exercises that mimicked suturing in the oral cavity using both a custom prototype headlight and a commercial surgical headlight. The time required to complete the task with each headlight was recorded along with an exit survey. A second device was created based on the critiques of the first device and was tested by ten additional surgical trainees. Surgical residents completed the simulation task in 27 ± 8.6 seconds and 21 ± 5.6 seconds with the commercially available headlight and first prototype, respectively. In the second experiment, the simulation task was completed in 23 ± 11.1 and 23 ± 12.2 seconds with the commercially available headlight and second device, respectively. Survey results showed an overall positive consensus, with critiques about headband security, suggestions for smaller LED chassis, and a more robust mounting bracket. Some preferred the prototype headlight due to the wider field of illumination compared to the commercially available unit (ie, beam spread/beam angle). Next Steps. Future adjustments are required to optimize the location of the headlight and the battery to modify the weight distribution of the device. Conclusion. These findings demonstrate that our prototype models are viable alternatives to conventional surgical headlights and warrant continued optimization for broader adoption by surgeons and trainees for whom higher-cost alternatives are not an option.
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Affiliation(s)
- Deven K Gupta
- 218537Beckman Laser Institute and Medical Clinic, Irvine, CA, USA
| | - Lily Chen
- 218537Beckman Laser Institute and Medical Clinic, Irvine, CA, USA
| | - Andrew E Heidari
- 218537Beckman Laser Institute and Medical Clinic, Irvine, CA, USA
| | - Steven Chau
- Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Brandyn Dunn
- Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Brian J-F Wong
- 218537Beckman Laser Institute and Medical Clinic, Irvine, CA, USA.,Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, CA, USA.,Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
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Wichlas F, Hofmann V, Strada G, Deininger C. War surgery in Afghanistan: a model for mass causalities in terror attacks? INTERNATIONAL ORTHOPAEDICS 2020; 44:2521-2527. [PMID: 32915284 PMCID: PMC7483489 DOI: 10.1007/s00264-020-04797-2] [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] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/01/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of the study was to identify solution strategies from a non-governmental (NGO) hospital in a war region for violence-related injuries and to show how high-income countries (HIC) might benefit from this expertise. METHODS NGO trauma hospital in Lashkar Gah, Afghanistan. Four hundred eighty-four war victims admitted in a three month period (February 2016-May 2016) were included. Patients´ characteristics were analyzed. RESULTS The mean age was 23.5 years. Four hundred thirty-four (89.9%) were male, and 50 (10.1%) were female. The most common cause of injury was bullet injuries, shell injuries, and mine injuries. The most common injured body region was the lower extremity, upper extremity, and the chest or the face. Apart from surgical wound care and debridements, which were performed on every wound in the operation theatre, laparotomy was the most common surgical procedure, followed by installation of a chest drainage and amputation. CONCLUSION The surgical expertise and clear pathways outweigh modern infrastructure. In case of a mass casualty incident, fast decision-making with basic diagnostic means in order to take rapid measurements for life-saving therapies could make the difference.
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Affiliation(s)
- F Wichlas
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.
- Emergency NGO, Milan, Italy.
| | - V Hofmann
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | | | - C Deininger
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
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7
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Mechtenberg A, McLaughlin B, DiGaetano M, Awodele A, Omeeboh L, Etwalu E, Nanjula L, Musaazi M, Shrime M. Health care during electricity failure: The hidden costs. PLoS One 2020; 15:e0235760. [PMID: 33147212 PMCID: PMC7641375 DOI: 10.1371/journal.pone.0235760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background Surgery risks increase when electricity is accessible but unreliable. During unreliable electricity events and without data on increased risk to patients, medical professionals base their decisions on anecdotal experience. Decisions should be made based on a cost-benefit analysis, but no methodology exists to quantify these risks, the associated hidden costs, nor risk charts to compare alternatives. Methods Two methodologies were created to quantify these hidden costs. In the first methodology through research literature and/or measurements, the authors obtained and analyzed a year’s worth of hour-by-hour energy failures for four energy healthcare system (EHS) types in four regions (SolarPV in Iraq, Hydroelectric in Ghana, SolarPV+Wind in Bangladesh, and Grid+Diesel in Uganda). In the second methodology, additional patient risks were calculated according to time and duration of electricity failure and medical procedure impact type. Combining these methodologies, the cost from the Value of Statistical Lives lost divided by Energy shortage ($/kWh) is calculated for EHS type and region specifically. The authors define hidden costs due to electricity failure as VSL/E ($/kWh) and compare this to traditional electricity costs (always defined in $/kWh units), including Levelized Cost of Electricity (LCOE also in $/kWh). This is quantified into a fundamentally new energy healthcare system risk chart (EHS-Risk Chart) based on severity of event (probability of deaths) and likelihood of event (probability of electricity failure). Results VSL/E costs were found to be 10 to 10,000 times traditional electricity costs (electric utility or LCOE based). The single power source EHS types have higher risks than hybridized EHS types (especially as power loads increase over time), but all EHS types have additional risks to patients due to electricity failure (between 3 to 105 deaths per 1,000 patients). Conclusions These electricity failure risks and hidden healthcare costs can now be calculated and charted to make medical decisions based on a risk chart instead of anecdotal experience. This risk chart connects public health and electricity failure using this adaptable, scalable, and verifiable model.
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Affiliation(s)
- Abigail Mechtenberg
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
- * E-mail:
| | - Brady McLaughlin
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Michael DiGaetano
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Abigail Awodele
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Leslie Omeeboh
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Emmanuel Etwalu
- College of Engineering, Design, Art, and Technology (CEDAT), Makerere University, Kampala, Uganda
| | | | - Moses Musaazi
- College of Engineering, Design, Art, and Technology (CEDAT), Makerere University, Kampala, Uganda
| | - Mark Shrime
- Harvard Medical School, Harvard University, Boston, MA, United States of America
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8
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Affiliation(s)
- Renee N Salas
- Harvard Global Health Institute, Cambridge, MA, USA
- Center for Climate, Health, and the Global Environment, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Edward Maibach
- Center for Climate Change Communication, George Mason University, Fairfax, VA, USA
| | - David Pencheon
- Medical and Health School, University of Exeter, Exeter, UK
| | - Nick Watts
- Lancet Countdown: Tracking Progress on Health and Climate Change, London, UK
| | - Howard Frumkin
- University of Washington School of Public Health, Seattle, WA, USA
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9
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Starr N, Panda N, Johansen EW, Forrester JA, Wayessa E, Rebollo D, August A, Fernandez K, Bitew S, Mammo TN, Weiser TG. The Lifebox Surgical Headlight Project: engineering, testing, and field assessment in a resource-constrained setting. Br J Surg 2020; 107:1751-1761. [PMID: 32592513 DOI: 10.1002/bjs.11756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/25/2020] [Accepted: 05/12/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Poor surgical lighting represents a major patient safety issue in low-income countries. This study evaluated device performance and undertook field assessment of high-quality headlights in Ethiopia to identify critical attributes that might improve safety and encourage local use. METHODS Following an open call for submissions (December 2018 to January 2019), medical and technical (non-medical) headlights were identified for controlled specification testing on 14 prespecified parameters related to light quality/intensity, mounting and battery performance, including standardized illuminance measurements over time. The five highest-performing devices (differential illumination, colour rendering, spot size, mounting and battery duration) were distributed to eight Ethiopian surgeons working in resource-constrained facilities. Surgeons evaluated the devices in operating rooms, and in a comparative session rated each headlight in terms of performance and willingness to purchase. RESULTS Of 25 submissions, eight headlights (6 surgical and 2 technical) met the criteria for full specification testing. Scores ranged from 8 to 12 (of 14), with differential performance in lighting, mounting and battery domains. Only two headlights met the illuminance parameters of more than 35 000 lux during initial testing, and no headlight satisfied all minimum specifications. Of the five headlights evaluated in Ethiopia, daily operation logbooks noted variability in surgeons' opinions of lighting quality (6-92 per cent) and spot size (0-92 per cent). Qualitative interviews also yielded important feedback, including preference for easy transport. Surgeons sought high quality with price sensitivity (using out-of-pocket funds) and identified the least expensive but high-functioning device as their first choice. CONCLUSION No device satisfied all the predetermined specifications, and large price discrepancies were critical factors leading surgeons' choices. The favoured device is undergoing modification by the manufacturer based on design feedback so an affordable, high-quality surgical headlight crafted specifically for the needs of resource-constrained settings can be used to improve surgical safety.
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Affiliation(s)
- N Starr
- Departments of Surgery, University of California, San Francisco, San Francisco, USA.,Lifebox Foundation, London, UK
| | - N Panda
- Ariadne Labs, Brigham and Women's Hospital, Harvard T. H. School of Public Health, Boston, USA.,Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - E W Johansen
- Spark Health Design, Hanover, Massachusetts, USA
| | - J A Forrester
- Stanford University, Stanford, California, USA.,Lifebox Foundation, London, UK
| | - E Wayessa
- Departments of Surgery, Wollega University, Nekempte, Ethiopia
| | - D Rebollo
- School of Medicine, New York University, New York, USA
| | - A August
- Stanford University, Stanford, California, USA
| | | | - S Bitew
- Lifebox Foundation, London, UK
| | - T Negussie Mammo
- Lifebox Foundation, London, UK.,Addis Ababa University, Addis Ababa, Ethiopia
| | - T G Weiser
- Stanford University, Stanford, California, USA.,Lifebox Foundation, London, UK.,Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
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Irwin BR, Hoxha K, Grépin KA. Conceptualising the effect of access to electricity on health in low- and middle-income countries: A systematic review. Glob Public Health 2019; 15:452-473. [PMID: 31770072 DOI: 10.1080/17441692.2019.1695873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Access to electricity is an important issue in low- and middle-income countries (LMICs) however its health implications are poorly understood. This paper systematically reviews the health effects of access to electricity and develops a conceptual model to summarise the pathways through which these effects may occur. The databases CINAHL, Embase, and MEDLINE were searched for studies examining the effects of access to electricity on health in LMICs. Thirty-three studies met the inclusion criteria: 23 focusing on electrification and 10 focusing on electricity reliability. Using a modified socio-ecological model, 4 main levels of influence were identified: (1) individual, (2) household, (3) community, and (4) institutional. Electrification was generally associated with positive health outcomes, such as reduced mortality, lower rates of disease, and improved quality of and access to care, while poor electricity reliability was associated with negative health outcomes, including increased morbidity and mortality, lower quality of care, and reduced utilisation of health services. Although the overall quality of the evidence was weak, given the many potential pathways through which electricity may affect health, efforts should be made not only to increase the number of connected households globally, but to improve the reliability of the electricity supply as well.
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Affiliation(s)
- Bridget R Irwin
- Health Sciences Department, Wilfrid Laurier University, Waterloo, Canada
| | - Klesta Hoxha
- Health Sciences Department, Wilfrid Laurier University, Waterloo, Canada.,The School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Karen A Grépin
- Health Sciences Department, Wilfrid Laurier University, Waterloo, Canada.,School of Public Health, University of Hong Kong, Pokfulam, Hong Kong SAR
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Forrester JA, Torgeson K, Weiser TG. Minimum Specifications for a Lifebox Surgical Headlight for Resource-Constrained Settings. JAMA Surg 2019; 154:80-82. [PMID: 30427987 DOI: 10.1001/jamasurg.2018.4205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jared A Forrester
- Department of Surgery, Stanford University, Stanford, California.,Lifebox Foundation, Boston, Massachusetts
| | | | - Thomas G Weiser
- Department of Surgery, Stanford University, Stanford, California.,Lifebox Foundation, Boston, Massachusetts.,Department of Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom
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12
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Isaacson G, Doyle W, Summer D. Reducing Surgical Site Infections During Otolaryngology Surgical Missions. Laryngoscope 2019; 130:1388-1395. [PMID: 31755991 DOI: 10.1002/lary.28418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine what measures an otolaryngology-head and neck surgery team might adopt to decrease the incidence of surgical site infection (SSI) on a short-term surgical mission. Despite concerns about safety and efficacy, short-term surgical missions remain the predominant structure for humanitarian surgical care in low- and middle-income countries (LMIC). Hospitals in high-income countries strive to improve surgical outcomes through implementation of World Health Organization (WHO) safe surgery guidelines. Reduction of SSI risk is a key part of this effort. METHODS Literature review and practical experience. RESULTS WHO recommendations for reducing SSI are based largely on research done in the North America and Europe. LMIC populations are younger; comorbidities are fewer; infectious disease and trauma are prevalent; and delays in access to care are common. SSI are much more frequent in resource-limited settings. Recommendations regarding preoperative assessment, operating room environment, instrument sterilization, surgical antibiotic prophylaxis, surgical site preparation, gloving, draping, and postsurgical care are reviewed in the context of a surgical mission at a typical LMIC government hospital. CONCLUSION Many of the WHO guidelines on reduction of SSI are logical and applicable to the short-term surgical missions; others may need to be modified. Careful prospective data collection and clinical trials are needed to learn which interventions are valid and which should be changed. LEVEL OF EVIDENCE 5 Laryngoscope, 130:1388-1395, 2020.
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Affiliation(s)
- Glenn Isaacson
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Winifred Doyle
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Deborah Summer
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
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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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14
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Trelles Centurion M, Crestani R, Dominguez L, Caluwaerts A, Benedetti G. Surgery with Limited Resources in Natural Disasters: What Is the Minimum Standard of Care? CURRENT TRAUMA REPORTS 2018; 4:89-95. [PMID: 29888165 PMCID: PMC5972172 DOI: 10.1007/s40719-018-0124-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose of Review In a challenging scenario, such as in the aftermath of a natural disaster, minimum standards of care must be in place from the moment surgical care activities are launched. Recent Findings Natural disasters cause destruction and human suffering, especially in low- and middle-income countries, which suffer the most when exposed to their consequences. Health systems can quickly get overwhelmed and can collapse under the burden of injured patients during this event, while qualified surgical care remains crucial. Medécins Sans Frontières (MSF) has a vast experience providing surgical care after natural disasters, and quality is assured through the Donabedian model. Minimum structure standards are put in place from the beginning of an emergency response, together with standard operating procedures providing guidance to professionals working in challenging conditions. Summary MSF believes that it is always possible to deliver surgical care, ensuring the best possible quality guaranteeing adequate levels of structure and process. The "do no harm" principle must always be respected as adherence to medical ethics is a must in any context, even a challenging one.
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Affiliation(s)
| | - Rosa Crestani
- 2Emergency Medical Unit, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - Lynette Dominguez
- 1Surgical Care Unit, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - An Caluwaerts
- 3Health Structure Unit, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - Guido Benedetti
- 4Operational Research Unit, Médecins Sans Frontières, 68, Rue de Gasperich, L-1617 Luxembourg, Luxembourg
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