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Farrow NE, Commander SJ, Reed CR, Mueller JL, Gupta A, Loh AHP, Sekabira J, Fitzgerald TN. Laparoscopic experience and attitudes toward a low-cost laparoscopic system among surgeons in East, Central, and Southern Africa: a survey study. Surg Endosc 2020; 35:6539-6548. [PMID: 33201314 DOI: 10.1007/s00464-020-08151-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Laparoscopic surgery has become standard of care in high-income countries but is rarely accessible in low- and middle-income countries (LMICs). This study assessed experience with laparoscopy and attitudes toward a low-cost laparoscopic system among surgeons in sub-Saharan Africa. METHODS A survey assessing current laparoscopic practice and feedback on a low-cost laparoscopic system was administered to attendees of the College of Surgeons of East, Central, and Southern Africa (COSECSA) Scientific Conference between December 4 and December 6, 2019 in Kampala, Uganda. RESULTS Fifty-six surgeons from 14 countries participated. A majority were male (n = 46, 82%) general surgeons (n = 37, 66%) from tertiary/teaching hospitals (n = 36, 64%). For those with training in laparoscopy (n = 33, 59%), 22 (67%) reported less than 1 year of training and over half (n = 17, 52%) reported 1 month or less. Overall, a minority (n = 21, 38%) used laparoscopy in current practice, with 57% (n = 12) of those performing laparoscopy less than once per week. The most common laparoscopic surgeries performed were cholecystectomy (n = 15), diagnostic laparoscopy (n = 14), and appendectomy (n = 12). Few surgeons were performing more complex cases (n = 5). Barriers to laparoscopy included poor access to training equipment (n = 34, 61%), mentors (n = 33, 59%), laparoscopic equipment (n = 31, 55%), equipment maintenance (n = 25, 45%), access to consumable supplies (n = 21, 38%), and cost (n = 31, 55%). Fifty-two participants (93%) were interested in increasing their use of laparoscopy; the majority felt that a low-cost laparoscope (n = 52, 93%) and lift retractor for gasless laparoscopy (n = 46, 82%) would serve an unmet need in their practice. CONCLUSIONS While the use of laparoscopy is currently limited in COSECSA countries, there is a significant interest among surgeons to increase implementation. A low-cost, durable laparoscopic system was viewed as a potential solution to the current barriers and could improve implementation in LMICs.
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Affiliation(s)
- Norma E Farrow
- Department of Surgery, DUMC, Duke University, Box 3815, Durham, NC, 27710, USA
| | - Sarah J Commander
- Department of Surgery, DUMC, Duke University, Box 3815, Durham, NC, 27710, USA
| | - Christopher R Reed
- Department of Surgery, DUMC, Duke University, Box 3815, Durham, NC, 27710, USA
| | - Jenna L Mueller
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Aryaman Gupta
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Amos H P Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore.,Duke NUS Medical School, SingHealth Duke NUS Global Health Institute, Singapore, Singapore
| | - John Sekabira
- Pediatric Surgery Unit, Mulago Hospital, Kampala, Uganda
| | - Tamara N Fitzgerald
- Department of Surgery, DUMC, Duke University, Box 3815, Durham, NC, 27710, USA. .,Duke Global Health Institute, Duke University, Durham, NC, USA.
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Trauma patients with human immunodeficiency virus (HIV): a propensity matched analysis. Eur J Trauma Emerg Surg 2020; 48:449-454. [PMID: 32448942 PMCID: PMC7246034 DOI: 10.1007/s00068-020-01402-4] [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: 04/01/2020] [Accepted: 05/16/2020] [Indexed: 11/24/2022]
Abstract
Background Given the growing number of people worldwide living with human immunodeficiency virus (HIV), a larger subset of these patients are now susceptible to sustaining a traumatic injury. However, the impact of HIV on outcomes in trauma with modern antiretroviral treatment remains unclear. We hypothesized mortality and rates of infectious and inflammatory complications would be higher in HIV positive (HIV+) trauma patients. Methods The Trauma Quality Improvement Program was queried to identify trauma patients ≥ 18 years of age with HIV. Due to the imbalance between HIV+ and HIV negative (HIV−) trauma patients, a 1:2 propensity-matched model was utilized. Matched variables included age, injury severity score, mechanism of injury, systolic blood pressure, pulse rate, Glasgow Coma Scale score, and patient comorbidities. Results 84 HIV+ patients were matched to 168 HIV− patients. Compared to HIV− patients, HIV+ patients had no significant differences in mortality rate (9.5% vs. 4.8%, p = 0.144) or infectious complications, including pneumonia (6.0% vs. 4.2%, p = 0.530), urinary tract infection (1.2% vs. 1.2%, p = 1.000), or severe sepsis (1.2% vs. 0.0%, p = 0.156). However, higher rates of acute respiratory distress syndrome (ARDS) (9.5% vs. 0.6%, p < 0.001) and acute kidney injury (AKI) (4.8% vs. 0.0%, p = 0.004) were observed. Conclusion HIV+ trauma patients are not at higher risk of mortality or infectious complications, likely due to the advent and prevalence of combination antiretroviral therapy. However, HIV positivity appears to increase the risk of AKI and ARDS in trauma patients. Further research is needed to confirm this finding to elucidate the etiology underlying this association.
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Rostamzadeh M, Afkhamzadeh A, Afrooz S, Mohamadi K, Rasouli MA. Dentists' knowledge, attitudes and practices regarding Hepatitis B and C and HIV/AIDS in Sanandaj, Iran. BMC Oral Health 2018; 18:220. [PMID: 30563497 PMCID: PMC6299669 DOI: 10.1186/s12903-018-0685-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/04/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Healthcare workers including physicians, dentists, nurses and laboratory workers are considered to be among the groups at the risk of blood-borne pathogen transmission. Thus, it is necessary to evaluate the Knowledge, Attitude, and Practices (KAP) of dentists regarding infection control and basic principles. METHODS This cross-sectional study recruited 106 dentists in Sanandaj, Iran. The dentists' KAP regarding hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV/AIDS were evaluated. Chi-square test, student's t-test, and one-way ANOVA were used to assess differences between the groups. Data were analyzed in Stata 12. RESULTS The results showed that the majority of the subjects in the study population (53.8%) were female. The mean ± standard deviation (SD) for age and work experience was 39.6 ± 9.80 and 10.6 ± 8.7 years, respectively. The mean ± SD for knowledge, attitude and practices of participants was 37.3 ± 3.01, 22.9 ± 4.80 and 24.07 ± 5.06, respectively. The results also indicated that dentists' higher level of knowledge about HBV, HCV and HIV/AIDS was significantly influenced by work experience (≥10 years; P < 0.001) and graduation year (after 2006: P < 0.001). Positive attitude towards HBV, HCV and HIV/AIDS was considerably influenced by age group (< 30 years: P = 0.021), work experience (≥10 years: P < 0.001), and workplace (dental office: P = 0.016). CONCLUSIONS The results of this study demonstrated a satisfactory level of knowledge and attitude of dentists about HBV, HCV and HIV/AIDS infections, but some gaps were observed, suggesting that higher knowledge level of dentists plays a very important role in forming the attitudes and practices regarding patients with HBV, HCV and HIV/AIDS.
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Affiliation(s)
- Masomeh Rostamzadeh
- Department of Prosthodontics, Faculty of Dentistry, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Abdorrahim Afkhamzadeh
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sirus Afrooz
- Dentistry Student, Faculty of Dentistry, Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Kaveh Mohamadi
- DDS & Fellowship Oral Implantology (ICOI Fellowship), Faculty of Dentistry, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Aziz Rasouli
- Vice Chancellor for Educational and Research, Kowsar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
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