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Mwachiro MM, Yankunze Y, Bachheta N, Scroope E, Mangaoang D, Bekele A, White RE, Parker RK. Operative Case Volumes and Variation for General Surgery Training in East, Central, and Southern Africa. World J Surg 2023; 47:3032-3039. [PMID: 37697170 PMCID: PMC10694114 DOI: 10.1007/s00268-023-07164-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Operative experience is a necessary part of surgical training. The College of Surgeons of East, Central, and Southern Africa (COSECSA), which oversees general surgery training programs in the region, has implemented guidelines for the minimum necessary case volumes upon completion of two (Membership) and five (Fellowship) years of surgical training. We aimed to review trainee experience to determine whether guidelines are being met and examine the variation of cases between countries. METHODS Operative procedures were categorized from a cohort of COSECSA general surgery trainees and compared to the guideline minimum case volumes for Membership and Fellowship levels. The primary and secondary outcomes were total observed case volumes and cases within defined categories. Variations by country and development indices were explored. RESULTS One hundred ninety-four trainees performed 69,283 unique procedures related to general surgery training. The review included 70 accredited hospitals and sixteen countries within Africa. Eighty percent of MCS trainees met the guideline minimum of 200 overall cases; however, numerous trainees did not meet the guideline minimum for each procedure. All FCS trainees met the volume target for total cases and orthopedics; however, many did not meet the guideline minimums for other categories, especially breast, head and neck, urology, and vascular surgery. The operative experience of trainees varied significantly by location and national income level. CONCLUSIONS Surgical trainees in East, Central, and Southern Africa have diverse operative training experience. Most trainees fulfill the overall case volume requirements; however, further exploration of how to meet the demands of specific categories and procedures is necessary.
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Affiliation(s)
- Michael M Mwachiro
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya
- College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
| | - Yves Yankunze
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya
| | - Niraj Bachheta
- College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
| | - Emma Scroope
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deirdre Mangaoang
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Abebe Bekele
- College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
- University of Global Health Equity, Kigali, Rwanda
| | - Russell E White
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Robert K Parker
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya.
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA.
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2
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Reid C, Hillman C. Children in a disaster: health protection and intervention. BMJ Mil Health 2022; 168:473-477. [PMID: 34987098 DOI: 10.1136/bmjmilitary-2021-002010] [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] [Received: 09/30/2021] [Accepted: 12/06/2021] [Indexed: 11/03/2022]
Abstract
Children are disproportionately affected by disasters. They have greater physiological, psychological and sociological vulnerabilities, often exacerbated by the fact that their unique needs can be overlooked during relief efforts. This article provides an overview of disasters, including how they are categorised, and the factors that need to be considered by military and civilian healthcare teams that respond to them. Information is drawn from a variety of previous disasters, with the effects considered across a range of different populations and communities. The lessons learnt from previous disasters need to inform the ongoing discussions around how to best train and supply both individual healthcare workers and the wider teams that will be expected to respond to future disasters. The importance of role-specific training incorporating caring for children, consideration of paediatric casualties during planning exercises and teaching scenarios, and the requirement for paediatric equipment and medications cannot be overemphasised. While provision of paediatric care may not be the primary role of an individual healthcare worker or their broader team, it still remains their ethical and often legal duty to plan for and deliver care for children when responding to a disaster. This is a paper commissioned as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
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Affiliation(s)
| | - C Hillman
- Emergency Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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3
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Su C, Chen J, Xie X, Gao Z, Guan Z, Mo X, Wang C, Hou G. Functionalized Electrospun Double-Layer Nanofibrous Scaffold for Wound Healing and Scar Inhibition. ACS OMEGA 2022; 7:30137-30148. [PMID: 36061738 PMCID: PMC9435051 DOI: 10.1021/acsomega.2c03222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/05/2022] [Indexed: 05/27/2023]
Abstract
Considerable advances have been made in developing materials that promote wound healing and inhibit scar formation in clinical settings. However, some challenges, such as cumbersome treatment processes and determination of optimal treatment time, remain unresolved. Thus, developing a multifunctional wound dressing with both wound healing and scar inhibition properties is crucial. Here, we present an integrated electrospun fibrous composite membrane (MPC12) for wound healing and scar inhibition, consisting of a quaternized chitosan-loaded inner membrane (PCQC5) and quaternized silicone-loaded outer membrane (MQP12). The inner membrane effectively coagulates blood and promotes wound healing, and the outer membrane moisturizes, resists bacteria, and inhibits scar formation. In vivo evaluation in a rabbit ear model revealed that MPC12 treatment results in faster wound healing and better alleviation of scar hypertrophy than treatment with commercial products (KELO-COTE and MSSG). Our strategy offers an excellent solution for the potential integration of wound healing and scar inhibition.
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Affiliation(s)
- Changming Su
- School
of Pharmacy, Key Laboratory of Prescription Effect and Clinical Evaluation
of State Administration of Traditional Chinese Medicine of China, Binzhou Medical University, Yantai 264003, People’s Republic of China
| | - Jing Chen
- School
of Pharmacy, Key Laboratory of Prescription Effect and Clinical Evaluation
of State Administration of Traditional Chinese Medicine of China, Binzhou Medical University, Yantai 264003, People’s Republic of China
| | - Xianrui Xie
- School
of Pharmacy, Key Laboratory of Prescription Effect and Clinical Evaluation
of State Administration of Traditional Chinese Medicine of China, Binzhou Medical University, Yantai 264003, People’s Republic of China
| | - Zhongfei Gao
- School
of Pharmacy, Key Laboratory of Prescription Effect and Clinical Evaluation
of State Administration of Traditional Chinese Medicine of China, Binzhou Medical University, Yantai 264003, People’s Republic of China
| | - Zhenxin Guan
- School
of Pharmacy, Key Laboratory of Prescription Effect and Clinical Evaluation
of State Administration of Traditional Chinese Medicine of China, Binzhou Medical University, Yantai 264003, People’s Republic of China
| | - Xiumei Mo
- State
Key Laboratory for Modification of Chemical Fibers and Polymer Materials,
College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, People’s Republic of China
| | - Chunhua Wang
- School
of Pharmacy, Key Laboratory of Prescription Effect and Clinical Evaluation
of State Administration of Traditional Chinese Medicine of China, Binzhou Medical University, Yantai 264003, People’s Republic of China
| | - Guige Hou
- School
of Pharmacy, Key Laboratory of Prescription Effect and Clinical Evaluation
of State Administration of Traditional Chinese Medicine of China, Binzhou Medical University, Yantai 264003, People’s Republic of China
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4
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Wei Q, Ma L, Zhang W, Ma G, Hu Z. EGCG-crosslinked carboxymethyl chitosan-based hydrogels with inherent desired functions for full-thickness skin wound healing. J Mater Chem B 2022; 10:3927-3935. [DOI: 10.1039/d2tb00074a] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hydrogel wound dressings have attracted intense and increasing interest for their extracellular matrix like property and bioactive material delivery ability. Various functional hydrogels loading metals (and their oxides), antibiotics and...
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Wang P, Pu Y, Ren Y, Liu S, Yang R, Tan X, Zhang W, Shi T, Li S, Chi B. Bio-inspired hydrogel-based bandage with robust adhesive and antibacterial abilities for skin closure. SCIENCE CHINA MATERIALS 2021; 65:246-254. [PMID: 34413988 PMCID: PMC8362644 DOI: 10.1007/s40843-021-1724-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/31/2021] [Indexed: 05/30/2023]
Abstract
UNLABELLED Although conventional suturing techniques are commonly used in assisting wound closure, they do pose limited conduciveness and may lead to secondary injury to wound tissues. Inspired by marine organism mussels, we designed and manufactured a bio-inspired hydrogel-based bandage with tough wet tissue adhesion to substitute traditional surgical suture, accelerate wound healing and avoid infection. Poly(γ-glutamic acid) was modified with 3,4-dihydroxyphenylalanine and glycidyl methacylate, then introduced into the acrylic acid-co-acrylamide hydrogel matrix with robust mechanical properties. The hydrogel bandage showed strong chemical linkage adhesion (70 ± 2.1 kPa), which is 2.8 times that of commercial tissue adhesive fibrin glue (25 ± 2.2 kPa). The hydrogel bandage can not only maintain the self-stability, but is also capable of self-tuning adhesive strength in the range of 14-70 kPa to achieve different adhesion effects by tuning constituent ratio. The bandage has desirable compression properties (0.7 ± 0.11 MPa) and tensile elongation (about 25 times), which ensures its resistance to damages, especially in joint spaces. Secondly, the bandage was endowed with antioxidant and endogenous broad-spectrum antibacterial properties with its catechol structure. Results also demonstrated excellent cell compatibility and blood compatibility, certifying its eligible biological safety profile. In a rat full-thickness cutaneous deficiency model, we can clearly observe that the bandage possesses the ability to promote wound healing (only need 6 days). Above all, this research provides a new strategy for the emergency treatment of liver hemostasis and myocardial repair during disaster rescue. SUPPLEMENTARY INFORMATION Experimental details and supporting data are available in the online version of the paper10.1007/s40843-021-1724-8.
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Affiliation(s)
- Penghui Wang
- State Key Laboratory of Materials-Oriented Chemical Engineering, Nanjing Tech University, Nanjing, 211816 China
| | - Yajie Pu
- State Key Laboratory of Materials-Oriented Chemical Engineering, Nanjing Tech University, Nanjing, 211816 China
| | - Yanhan Ren
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois 60064 USA
| | - Shuai Liu
- School of Chemical Engineering, Nanjing University of Science and Technology, Nanjing, 210094 China
| | - Rong Yang
- State Key Laboratory of Materials-Oriented Chemical Engineering, Nanjing Tech University, Nanjing, 211816 China
| | - Xiaoyan Tan
- State Key Laboratory of Materials-Oriented Chemical Engineering, Nanjing Tech University, Nanjing, 211816 China
- Jiangsu National Synergetic Innovation Center for Advanced Materials, Nanjing Tech University, Nanjing, 211816 China
| | - Wenjie Zhang
- State Key Laboratory of Materials-Oriented Chemical Engineering, Nanjing Tech University, Nanjing, 211816 China
| | - Tianqi Shi
- State Key Laboratory of Materials-Oriented Chemical Engineering, Nanjing Tech University, Nanjing, 211816 China
| | - Shuang Li
- State Key Laboratory of Materials-Oriented Chemical Engineering, Nanjing Tech University, Nanjing, 211816 China
| | - Bo Chi
- State Key Laboratory of Materials-Oriented Chemical Engineering, Nanjing Tech University, Nanjing, 211816 China
- Jiangsu National Synergetic Innovation Center for Advanced Materials, Nanjing Tech University, Nanjing, 211816 China
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Surgical Training Throughout Africa: A Review of Operative Case Volumes at Multiple Training Centers. World J Surg 2020; 44:2100-2107. [DOI: 10.1007/s00268-020-05463-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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7
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Coventry CA, Dominguez L, Read DJ, Trelles M, Ivers RQ, Montazerolghaem M, Holland AJA. Comparison of Operative Logbook Experience of Australian General Surgical Trainees With Surgeons Deployed on Humanitarian Missions: What Can Be Learnt for the Future? JOURNAL OF SURGICAL EDUCATION 2020; 77:131-137. [PMID: 31451427 DOI: 10.1016/j.jsurg.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/28/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE General surgical training in Australia has undergone considerable change in recent years with less exposure to other areas of surgery. General surgeons from many high-income countries have played important roles in assisting with the provision of surgical care in low- and middle-income countries during sudden-onset disasters (SODs) as part of emergency medical teams (EMTs). It is not known if contemporary Australian general surgeons are receiving the broad surgical training required for work in EMTs. DESIGN Logbook data on the surgical procedures performed by Australian general surgical trainees were obtained from General Surgeons Australia (GSA) for the time period February 2008 to February 2017. Surgical procedures performed by Médecins sans Frontières (MSF) surgeons during 5 projects in 3 SODs (the 2010 Haiti earthquake, the 2013 Philippines typhoon and the 2015 Nepal earthquake) were obtained from previously published data for 6 months following each disaster. SETTING AND PARTICIPANTS This was carried out at the University of Sydney with input from MSF Operational Centre Brussels and GSA. RESULTS Australian general surgical trainees performed a mean of 2107 surgical procedures (excluding endoscopy) during their training (10 6-month rotations). Common procedures included abdominal wall hernia repairs (268, 12.7%), cholecystectomies (247, 11.8%), and specialist colorectal procedures (242, 11.5%). MSF surgeons performed a total of 3542 surgical procedures across the 5 projects analyzed. Common procedures included Caesarean sections (443, 12.5%), wound debridement (1115, 31.5%), and other trauma-related procedures (472, 13.3%). CONCLUSIONS Australian general surgical trainees receive exposure to both essential and advanced general surgery but lack exposure to specialty procedures including the obstetric and orthopedic procedures commonly performed by MSF surgeons after SODs. Further training in these areas would likely be beneficial for general surgeons prior to deployment with an EMT.
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Affiliation(s)
- Charles A Coventry
- The Children's Hospital at Westmead Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.
| | - Lynette Dominguez
- Médecins sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - David J Read
- National Critical Care and Trauma Response Centre, Darwin, NT, Australia
| | - Miguel Trelles
- Médecins sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Andrew J A Holland
- The Children's Hospital at Westmead Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia; Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Pyda J, Patterson RH, Caddell L, Wurdeman T, Koch R, Polatty D, Card B, Meara JG, Corlew DS. Towards resilient health systems: opportunities to align surgical and disaster planning. BMJ Glob Health 2019; 4:e001493. [PMID: 31275620 PMCID: PMC6577360 DOI: 10.1136/bmjgh-2019-001493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/08/2019] [Accepted: 05/11/2019] [Indexed: 11/10/2022] Open
Abstract
Natural disasters significantly contribute to human death and suffering. Moreover, they exacerbate pre-existing health inequalities by imposing an additional burden on the most vulnerable populations. Robust local health systems can greatly mitigate this burden by absorbing the extraordinary patient volume and case complexity immediately after a disaster. This resilience is largely determined by the predisaster local surgical capacity, with trauma, neurosurgical, obstetrical and anaesthesia care of particular importance. Nevertheless, the disaster management and global surgery communities have not coordinated the development of surgical systems in low/middle-income countries (LMIC) with disaster resilience in mind. Herein, we argue that an appropriate peridisaster response requires coordinated surgical and disaster policy, as only local surgical systems can provide adequate disaster care in LMICs. We highlight three opportunities to help guide this policy collaboration. First, the Lancet Commission on Global Surgery and the Sendai Framework for Disaster Risk Reduction set forth independent roadmaps for global surgical care and disaster risk reduction; however, ultimately both advocate for health system strengthening in LMICs. Second, the integration of surgical and disaster planning is necessary. Disaster risk reduction plans could recognise the role of surgical systems in disaster preparedness more explicitly and pre-emptively identify deficiencies in surgical systems. Based on these insights, National Surgical, Obstetric, and Anesthesia Plans, in turn, can better address deficiencies in systems and ensure increased disaster resilience. Lastly, the recent momentum for national surgical planning in LMICs represents a political window for the integration of surgical policy and disaster risk reduction strategies.
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Affiliation(s)
- Jordan Pyda
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Rolvix H Patterson
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,University of Miami School of Medicine, Miami, Florida, USA
| | - Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,University of Miami School of Medicine, Miami, Florida, USA
| | - Rachel Koch
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Polatty
- Humanitarian Response Program, US Naval War College, Newport, Rhode Island, USA
| | - Brittany Card
- Humanitarian Response Program, US Naval War College, Newport, Rhode Island, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Daniel Scott Corlew
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
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Coventry CA, Holland AJA, Read DJ, Ivers RQ. Australasian general surgical training and emergency medical teams: a review. ANZ J Surg 2019; 89:815-820. [PMID: 31066168 DOI: 10.1111/ans.15158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 01/09/2023]
Abstract
Emergency medical teams (EMTs) have provided surgical care in sudden-onset disasters in low- and middle-income countries. General surgeons have been heavily involved in many EMTs due to their traditional broad set of surgical skills and experience. With the increased subspecialization of general surgical training in many high-income countries, including Australia and New Zealand, finding general surgeons with adequately broad experience is becoming more challenging. Furthermore, it is now considered standard for EMTs deploying to a sudden-onset disaster to have undergone credentialing, demonstrating sufficient training of their deployed members. The purpose of this review was to highlight the challenges and potential solutions facing those involved in training and recruiting general surgeons for EMTs in Australasia.
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Affiliation(s)
- Charles A Coventry
- Children's Hospital at Westmead Clinic School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Children's Hospital at Westmead Clinic School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David J Read
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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