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Memba R, Puyana JC, Grayling M, Climent C, Martínez P, Blanco E, Rigueiro J, Suárez D, Viscasillas G, Fortea E, Roman O, Gracia D, Feliu F, Nve S, Jorba R. The Use of a Theory of Change Model to Guide the Implementation of a Comprehensive Surgical Specialty Training Program in Equatorial Guinea. Ann Glob Health 2024; 90:43. [PMID: 39036647 PMCID: PMC11259116 DOI: 10.5334/aogh.4477] [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: 05/20/2024] [Accepted: 06/07/2024] [Indexed: 07/23/2024] Open
Abstract
Background: Equatorial Guinea (EG) is located on the African west coast, with only 0.4 trained physicians per 1,000 resident population. The country has one medical school and there is no specialist training program. From 2000 to 2022, 524 doctors have received their medical degree. However, the number of national surgical specialists in the entire country is currently 42. Objective: Formación Especializada Sanitaria en Guinea Ecuatorial (FES Guinea) is a program specifically aimed at designing and implementing a long-term national surgical specialist training program. Methods: Más Que Salud (+QS), which means "More than Health" in Spanish, is a nonprofit organization leading the FES Guinea program. We used the theory of change (ToC) framework to evaluate the work accomplished and implement subsequent phases. The initial phase (A) included a needs assessment and mapping of available resources. An intermediate phase (B) started with a memorandum of understanding to implement a Train the Trainer program. The consolidation phase (C) consists of educational interventions and future advanced training projects. Findings: The ToC model allowed us an analyses of initial and intermediate phases. The needs assessments and resources mapping were executed while several scientific meetings and workshops were given. Scholarships to support specialist training abroad benefited six physicians in a diverse set of surgical disciplines. A regulatory commission to implement the FES Guinea program and the National Medical Council of EG were created. Working directly with the EG Ministry of Health, +QS codesigned a National Health Development Plan that began implementation in 2021 to continue until 2025. Conclusions: The ToC model allowed us to predict the current and future potential effects of FES Guinea on surgical workforce development in EG. This is a unique surgical training program, which combined effective initiatives spearheaded initially by an NGO that successfully incorporated both local health and academic authorities, ensuring sustainability.
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Affiliation(s)
- Robert Memba
- Más Que Salud (More than Health), Non-Governmental Organization, Spain
- General Surgery Department, University Hospital of Tarragona Joan XXIII, Spain
- Rovira i Virgili University (URV), Pere Virgili Institute for Health Research (IISPV)
| | - Juan Carlos Puyana
- Global Health Surgery Department, University of Pittsburgh, US
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin
| | - Martha Grayling
- Más Que Salud (More than Health), Non-Governmental Organization, Spain
| | - Carme Climent
- Más Que Salud (More than Health), Non-Governmental Organization, Spain
- Pediatrics Department, University General Hospital of Catalonia, Spain
| | - Patrícia Martínez
- Más Que Salud (More than Health), Non-Governmental Organization, Spain
- Orthopedics and Trauma Surgery Department, Parc Taulí University Hospital, Spain
| | - Eunice Blanco
- Más Que Salud (More than Health), Non-Governmental Organization, Spain
- Social Work Department, Vall d'Hebron University Hospital, Spain
| | - Jordi Rigueiro
- Más Que Salud (More than Health), Non-Governmental Organization, Spain
- INnGEAUDIO (Innovation and Engineering for Hearing), Spain
| | - David Suárez
- Más Que Salud (More than Health), Non-Governmental Organization, Spain
| | - Guillem Viscasillas
- Más Que Salud (More than Health), Non-Governmental Organization, Spain
- Otorhinolaryngology Department, Althaia Manresa University Healthcare Network, Spain
| | - Emma Fortea
- Más Que Salud (More than Health), Non-Governmental Organization, Spain
- Dentistry Department, Dentalògic Dental Clinic, Spain
| | - Olga Roman
- Más Que Salud (More than Health), Non-Governmental Organization, Spain
- Gynecology and Obstetrics Department, Manacor Hospital, Spain
| | - Daniel Gracia
- Más Que Salud (More than Health), Non-Governmental Organization, Spain
| | - Francesc Feliu
- General Surgery Department, University Hospital of Tarragona Joan XXIII, Spain
- Rovira i Virgili University (URV), Pere Virgili Institute for Health Research (IISPV)
| | - Silvano Nve
- Anesthesiology Department, Bata General Hospital, Equatorial Guinea
| | - Rosa Jorba
- General Surgery Department, University Hospital of Tarragona Joan XXIII, Spain
- Rovira i Virgili University (URV), Pere Virgili Institute for Health Research (IISPV)
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Korzebor M, Nahavandi N. A bed allocation model for pandemic situation considering general demand: A case study of Iran. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024. [PMID: 38849212 DOI: 10.1111/risa.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/14/2023] [Accepted: 04/30/2024] [Indexed: 06/09/2024]
Abstract
Pandemics place a new type of demand from patients affected by the pandemic, imposing significant strain on hospital departments, particularly the intensive care unit. A crucial challenge during pandemics is the imbalance in addressing the needs of both pandemic patients and general patients. Often, the community's focus shifts toward the pandemic patients, causing an imbalance that can result in severe issues. Simultaneously considering both demands, pandemic-related and general healthcare needs, has been largely overlooked. In this article, we propose a bi-objective mathematical model for locating temporary hospitals and allocating patients to existing and temporary hospitals, considering both demand types during pandemics. Hospital departments, such as emergency beds, serve both demand types, but due to infection risks, accommodating a pandemic patient and a general patient in the same department is not feasible. The first objective function is to minimize the bed shortages considering both types of demands, whereas the second objective is cost minimization, which includes the fixed and variable costs of temporary facilities, the penalty cost of changing the allocation of existing facilities (between general and pandemic demand), the cost of adding expandable beds to existing facilities, and the service cost for different services and beds. To show the applicability of the model, a real case study has been conducted on the COVID-19 pandemic in the city of Qom, Iran. Comparing the model results with real data reveals that using the proposed model can increase demand coverage by 16%.
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Affiliation(s)
- Mohammadreza Korzebor
- Industrial and Systems Engineering Faculty, Tarbiat Modares University, Tehran, Iran
| | - Nasim Nahavandi
- Industrial and Systems Engineering Faculty, Tarbiat Modares University, Tehran, Iran
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Gadsden T, Sood T, Purwar P, Peiris D, Nambiar D, Downey LE. Impact of COVID-19 on essential service provision for reproductive, maternal, neonatal, and child health in the Southeast Asia region: a systematic review. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100357. [PMID: 39021483 PMCID: PMC467076 DOI: 10.1016/j.lansea.2024.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/16/2023] [Accepted: 01/12/2024] [Indexed: 07/20/2024]
Abstract
Background There is increasing evidence that the COVID-19 pandemic has impacted adversely on the provision of essential health services globally. The Southeast Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, with potential adverse impacts on provision of reproductive, maternal, neonatal, and child health (RMNCH) services. Methods We conducted a systematic literature review of quantitative evidence to characterise the impact of COVID-19 on the provision of essential RMNCH services across the SEAR. Studies published between December 2019 and May 2022 were included in the study. The quality of studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist. Findings We reviewed 1924 studies and analysed data from 20 peer-reviewed studies and three reports documenting quantitative pre-post estimates of RMNCH service disruption because of the COVID-19 pandemic. Eleven studies were of low methodological quality, in addition to seven and five studies of moderate and high methodological qualities respectively. Six countries in the region were represented in the included studies: India (11 studies), Bangladesh (4), Nepal (3), Sri Lanka (1), Bhutan (1) and Myanmar (1). These countries demonstrated a wide reduction in antenatal care services (-1.6% to -69.6%), facility-based deliveries (-2.3% to -52.4%), child immunisation provision (-13.5% to -87.7%), emergency obstetric care (+4.0% to -76.6%), and family planning services (-4.2% to -100%). Interpretation There have been large COVID-19 pandemic related disruptions for a wide range of RMNCH essential health service indicators in several SEAR countries. Notably, we found a higher level of service disruption than the WHO PULSE survey estimates. If left unaddressed, such disruptions may set back hard-fought gains in RMNCH outcomes across the region. The absence of studies in five SEAR countries is a priority evidence gap that needs addressing to better inform policies for service protection. Funding WHO Sri Lanka Country Office.
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Affiliation(s)
- Thomas Gadsden
- The George Institute for Global Health, Sydney, Australia
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Tushar Sood
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Parnika Purwar
- The George Institute for Global Health, New Delhi, India
| | - David Peiris
- The George Institute for Global Health, Sydney, Australia
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Devaki Nambiar
- The George Institute for Global Health, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Karnataka, India
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Laura E. Downey
- The George Institute for Global Health, Sydney, Australia
- School of Public Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
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Ukachukwu AEK, Njeru PN, Ayodele OA, Ahmad MH, Onyia CU, Morgan E, Ekweogwu OC, Usman B, Badejo OA, Dawang Y, Orhorhoro OI, Oyemolade TA, Okere OE, Abu-Bonsrah N, Petitt Z, Oboh EC, Otun A, Nischal SA, Deng DD, Mahmud MR, Mezue WC, Malomo AO, Shehu BB, Shokunbi MT, Ohaegbulam SC, Fuller AT, Haglund MM, Chikani MC, Adeolu AA, Adeleye AO. A Geospatial Analysis of the Availability, Distribution, and Accessibility of Neurosurgical Facilities, Workforce, and Infrastructure in Nigeria; and Projection Towards 2050. World Neurosurg 2024; 185:e16-e29. [PMID: 38741324 DOI: 10.1016/j.wneu.2023.10.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 05/16/2024]
Abstract
OBJECTIVE There has been a modest but progressive increase in the neurosurgical workforce, training, and service delivery in Nigeria in the last 2 decades. However, these resources are unevenly distributed. This study aimed to quantitatively assess the availability and distribution of neurosurgical resources in Nigeria while projecting the needed workforce capacity up to 2050. METHODS An online survey of Nigerian neurosurgeons and residents assessed the country's neurosurgical infrastructure, workforce, and resources. The results were analyzed descriptively, and geospatial analysis was used to map their distribution. A projection model was fitted to predict workforce targets for 2022-2050. RESULTS Out of 86 neurosurgery-capable health facilities, 65.1% were public hospitals, with only 17.4% accredited for residency training. Dedicated hospital beds and operating rooms for neurosurgery make up only 4.0% and 15.4% of the total, respectively. The population disease burden is estimated at 50.2 per 100,000, while the operative coverage was 153.2 cases per neurosurgeon. There are currently 132 neurosurgeons and 114 neurosurgery residents for a population of 218 million (ratio 1:1.65 million). There is an annual growth rate of 8.3%, resulting in a projected deficit of 1113 neurosurgeons by 2030 and 1104 by 2050. Timely access to neurosurgical care ranges from 21.6% to 86.7% of the population within different timeframes. CONCLUSIONS Collaborative interventions are needed to address gaps in Nigeria's neurosurgical capacity. Investments in training, infrastructure, and funding are necessary for sustainable development and optimized outcomes.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
| | - Paula N Njeru
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | | | - Misbahu H Ahmad
- Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Eghosa Morgan
- Department of Surgery, Babcock University Teaching Hospital, Ilishan Remo, Nigeria
| | - Ofodile C Ekweogwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Babagana Usman
- Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Yusuf Dawang
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Omuvie I Orhorhoro
- Department of Surgery, Delta State University Teaching Hospital, Oghara, Nigeria
| | | | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zoey Petitt
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA; School of Medicine, Duke University, Durham, NC, USA
| | - Ena C Oboh
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
| | - Ayodamola Otun
- School of Medicine, Washington University, St. Louis, MO, USA
| | - Shiva A Nischal
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
| | | | - Wilfred C Mezue
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Bello B Shehu
- Regional Center for Neurosurgery, Usman DanFodio University Teaching Hospital, Sokoto, Nigeria
| | - Matthew T Shokunbi
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | | | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | - Mark C Chikani
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Augustine A Adeolu
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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Ukachukwu AEK, Oyemolade TA, Nischal SA, Onyia CU, Morgan E, Ekweogwu OC, Orhorhoro OI, Ahmad MH, Ayodele OA, Usman B, Badejo OA, Dawang Y, Okere OE, Abu-Bonsrah N, Deng DD, Petitt Z, Njeru PN, Oboh EC, Otun A, Still MEH, Haglund MM, Fuller AT, Chikani MC, Adeleye AO, Adeolu AA. Assessing the Neurosurgical Capacity in Nigeria Using the Modified Neuro-PIPES Tool. World Neurosurg 2024; 185:e30-e43. [PMID: 38741328 DOI: 10.1016/j.wneu.2023.12.104] [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: 11/29/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 05/16/2024]
Abstract
BACKGROUND Like many low- and-middle-income countries in Africa, documented assessment of the neurosurgical workforce, equipment, infrastructure, and scope of service delivery in Nigeria is lacking. This study aimed to assess the capacity for the delivery of neurosurgical services in Nigeria. METHODS An 83-question survey was disseminated to neurosurgeons and residents in Nigeria. We report the findings from the capacity assessment section of the survey, which used the modified neurological-PIPES (personnel, infrastructure, procedures, equipment, and supplies) (MN-PIPES) tool to evaluate the availability of neurosurgical personnel, infrastructure, procedures, equipment, and supplies. A comparative analysis was done using the domain and total MN-PIPES scores and MN-PIPES index. RESULTS The national average MN-PIPES score and index were 176.4 and 9.8, respectively. Overall, the southwest and northwest regions had the highest scores and frequently had high subscores. The survey respondents reported that the main challenges impeding neurosurgery service delivery were a lack of adjunctive supplies (75.2%), a dearth of diagnostic and interventional equipment (72.4%), and an absence of a dedicated intensive care unit (72.4%). CONCLUSIONS The availability of workforce, infrastructure, equipment, and supplies needed to provide optimal neurosurgical care is uneven in many institutions in Nigeria. Although major strides have been made in recent years, targeted collaborative interventions at local, national, regional, and international levels will further improve neurosurgical service delivery in Nigeria and will have positive ripple effects on the rest of the healthcare system.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
| | | | - Shiva A Nischal
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Eghosa Morgan
- Department of Surgery, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - Ofodile C Ekweogwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Omuvie I Orhorhoro
- Department of Surgery, Delta State University Teaching Hospital, Oghara, Nigeria
| | - Misbahu H Ahmad
- Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Olabamidele A Ayodele
- Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Babagana Usman
- Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Oluwakemi A Badejo
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Yusuf Dawang
- Department of Surgery, University of Abuja Teaching Hospital, Abuja-FCT, Nigeria
| | - Oghenekevwe E Okere
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Zoey Petitt
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Paula N Njeru
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Ena C Oboh
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Ayodamola Otun
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida at Gainesville, Gainesville, Florida, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Mark C Chikani
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Amos O Adeleye
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Augustine A Adeolu
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
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McBenedict B, Ahmed YA, Reda Elmahdi R, Yusuf WH, Netto JGM, Valentim G, Abrahão A, Lima Pessôa B, Mesquita ET. Pericardial Diseases Mortality Trends in Brazil From 2000 to 2022. Cureus 2024; 16:e57949. [PMID: 38738132 PMCID: PMC11084855 DOI: 10.7759/cureus.57949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Background Pericardial diseases manifest in various clinical forms, including acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade, with acute pericarditis being the most prevalent. These conditions significantly contribute to mortality rates. Therefore, this article aimed to analyze mortality trends in the Brazilian population based on age and sex, shedding light on the impact of pericardial diseases on public health outcomes. Methods This is a retrospective time-series analysis of pericardial disease mortality rates in Brazil (2000-2022). Data was obtained from the Department of Informatics of the Unified Health System (DATASUS), and the 10th edition of the International Classification of Diseases (ICD-10) codes: I30, I31, and I32 were included for analysis. We gathered population and demographic data categorized by age range and sex from the Brazilian Institute of Geography and Statistics (IBGE). Subsequently, we computed the age-standardized mortality rate per 100,000 individuals and assessed the annual percentage changes (APCs) and average annual percentage changes (AAPCs) using joinpoint regression, along with their corresponding 95% confidence intervals (CIs). Results In terms of mortality trends based on sex, overall mortality rates remained stable for males and combined sexes over the study period. However, there was a notable increase in mortality rates among females (AAPC=1.18), particularly between 2020 and 2022, with a significant APC of 27.55. Analyzing pericardial diseases across different age groups (20 to 80 years and above), it wasobserved that mortality rates significantly increased in the 70-79 and 80 years and above age groups throughout the study period (AAPC=1.0339 and AAPC=3.4587, respectively). These two age groups experienced the highest significant rise in mortality between 2020 and 2022. Other age groups did not exhibit a significant change in AAPC. Conclusions This comprehensive analysis spanning two decades (2000-2022), examined the mortality trends of pericardial diseases in Brazil and revealed relative stability overall. Males exhibited an overall higher mortality number due to pericardial diseases; however, females showed the most significant increase in mortality trend throughout the whole period. In the first segment (2000-2015), mortality rose across all cohorts, which was attributed to substandard healthcare facilities and infectious diseases like tuberculosis. The second segment (2016-2020) saw a decline in mortality, likely due to improved healthcare, particularly the increased availability of echocardiograms. However, the third segment (2020-2022) witnessed a sharp rise in mortality, coinciding with the COVID-19 pandemic, with post-COVID-19 symptoms, particularly pericarditis. Pericarditis-related death rates declined compared to pericardial effusion, and mortality rates correlated directly with age, with older cohorts experiencing higher mortality due to increased comorbidities, and decline in health and immunocompetency.
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Affiliation(s)
| | | | | | | | | | | | - Ana Abrahão
- Public Health, Fluminense Federal University, Niterói, BRA
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Moncatar TJRT, Gomez AVD, Lorenzo FME, Saniel OP, Faraon EJA, Rosadia RAF, Garcia FB. Effects of the COVID-19 Pandemic on the Implementation of NCD Care at the Primary Care Level in the Philippines: A Qualitative Inquiry. ACTA MEDICA PHILIPPINA 2024; 58:10-21. [PMID: 39005619 PMCID: PMC11239989 DOI: 10.47895/amp.vi0.7678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background and Objective The focusing of resources to COVID-19 response hampered and disadvantaged primary care services including that for Non-Communicable Diseases (NCDs), compromising continuity of care and hence, patients' disease status. However, studies from low- and middle-income countries (LMICs) remain sparse; therefore, evidence generation on how the pandemic impacted the provision of these primary care services in LMICs will help further understand how policies can be reframed, and programs be made more efficient and effective despite similar crises. To bridge this gap, the study investigated how the pandemic affected the implementation of NCD care at the primary care level in the Philippines. Methods Thirty-one online focus group discussions via Zoom Meetings were conducted among 113 consenting physicians, nurses, midwives, and community health workers from various facilities - community health centers and stations, free-standing clinics, infirmaries, and level 1 hospitals - located within two provinces in the Philippines. All interviews were video-recorded upon participants' consent and transcribed verbatim. Inductive thematic analysis was employed through NViVo 12® to generate themes, identify categories, and describe codes. Results The impact of COVID-19 on NCD care at the primary care level revolved around heightened impediments to service delivery, alongside worsening of pre-existing challenges experienced by the healthcare workforce; subsequently compelling the public to resort to unhealthy practices. These detriments to the primary healthcare system involved resource constraints, discontinued programs, referral difficulties, infection, overburden among workers, and interrupted training activities. Citizens were also observed to adopt poor healthcare seeking behavior, thereby discontinuing treatment regimen. Conclusion Healthcare workers asserted that disadvantages caused by the pandemic in their NCD services at the primary care level possibly threaten patients' health status. Besides the necessity to address such detriments, this also emphasizes the need for quantitative studies that will aid in drawing inferences and evaluating the effect of health crises like the pandemic on such services to bridge gaps in improving quality of care.
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Affiliation(s)
- TJ Robinson T. Moncatar
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila
| | | | | | - Ofelia P. Saniel
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila
| | - Emerito Jose A. Faraon
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila
| | | | - Fernando B. Garcia
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila
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8
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Alzerwi NAN, Rayzah M, Alnemare AK, Elkhalifa AME. Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies. Healthcare (Basel) 2023; 12:96. [PMID: 38201002 PMCID: PMC10779415 DOI: 10.3390/healthcare12010096] [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: 11/16/2023] [Revised: 12/16/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic significantly disrupted surgical care worldwide, affecting different specialties in various ways. Lockdowns, surges in COVID-19 cases, and changes in hospital policies notably impacted patient attendance, management practices, and access to surgical services. This scoping review examines the adverse impacts of the COVID-19 pandemic on surgical services and the policies adopted to address these care barriers. METHODS We conducted a comprehensive literature review using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. Our search, spanning 31 December 2019, to 29 January 2023, focused on understanding the multifaceted impacts of COVID-19 on surgical services, particularly across different specialties. RESULTS An analysis of 75 articles indicated that the pandemic challenged surgeons worldwide to maintain a balance between delivering emergency and elective surgical care, and implementing safety measures against viral transmission. There was a marked decline in the surgical volume, leading to extended waitlists and decreased operating theater usage. Strategies such as prioritizing medically necessary and time-sensitive surgeries and integrating telemedicine have emerged as pivotal for ensuring the continuity of urgent care. Despite the reduced rates, essential surgeries such as appendectomies and cancer-related operations continued, yet faced hurdles, including reduced staffing, limited operating theater capacity, and complications in patient transfers. CONCLUSIONS This review emphasizes the steep reduction in surgical service utilization at the beginning of the pandemic and emergence of new compounded barriers. Policies that designated surgeries as essential, and focused on equitable and timely access, were effective. Incorporating these findings into post-pandemic assessments and future planning is crucial to sustain adequate surgical care during similar health emergencies.
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Affiliation(s)
- Nasser A. N. Alzerwi
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, Al-Majmaah City 11952, P.O. Box 66 Riyadh, Saudi Arabia
| | - Musaed Rayzah
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, Al-Majmaah City 11952, P.O. Box 66 Riyadh, Saudi Arabia
| | - Ahmad K. Alnemare
- Otolaryngology Department, College of Medicine, Majmaah University, Ministry of Education, Al-Majmaah City 11952, P.O. Box 66 Riyadh, Saudi Arabia;
| | - Ahmed M. E. Elkhalifa
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh 11673, Saudi Arabia;
- Department of Haematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti 1158, Sudan
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9
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Jain S, Mahajan A, Patil PM, Bhandarkar P, Khajanchi M. Trends of surgical-care delivery during the COVID-19 pandemic: A multi-centre study in India (IndSurg Collaboration). J Postgrad Med 2023; 69:198-204. [PMID: 37449588 PMCID: PMC10846812 DOI: 10.4103/jpgm.jpgm_485_22] [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: 06/14/2022] [Revised: 10/18/2022] [Accepted: 11/24/2022] [Indexed: 07/18/2023] Open
Abstract
Context The COVID-19 pandemic and subsequent lockdowns adversely affected global healthcare services to varying extents. To accommodate its added burden, emergency services were affected along-with elective surgeries. Aims To quantify and analyze the trends of essential surgeries and bellwether procedures during the waxing and waning of the pandemic, across various hospitals in India. Settings and Design Multi-centric retrospective study. Methods and Material A research consortium led by World Health Organization (WHO) Collaboration Center (WHOCC) for Research in Surgical Care Delivery in Low-and Middle-Income countries, India, conducted this study with 5 centers. All surgeries performed during April 2020 (Wave I), November 2020 (Recovery I), and April 2021 (Wave II) were compared with those performed in April 2019 (pre-pandemic period). Statistical Analysis Used Microsoft Excel 2019 and SPSS Version 20. Results The total number of surgeries reduced by 77% during Wave I, which improved to a 52% reduction in Recovery I compared to the pre-pandemic period. However, surgeries were reduced again during Wave II to 68%, but the reduction was less compared to Wave I. Emergency and essential surgeries were affected along with the elective ones but to a lesser extent. Conclusions The present study has quantified the effects of the pandemic on surgical-care delivery across a timeline and documented a reduction in overall surgical volumes during the peaks of the pandemic (Wave I and II) with minimal improvement as the surge of COVID-19 cases declined (Recovery II). The surgical volumes improved during the second wave compared to the first one which may be attributable to better preparedness. Cesarean sections were affected the least.
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Affiliation(s)
- S Jain
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - A Mahajan
- Government Medical College, Amritsar, Punjab, India
| | - PM Patil
- Department of Biostatistics, BARC Hospital, Mumbai, Maharashtra, India
| | - P Bhandarkar
- Department of Biostatistics, BARC Hospital, Mumbai, Maharashtra, India
| | - M Khajanchi
- Department of Surgery, Seth G.S. Medical College and K.E.M Hospital, Mumbai, Maharashtra, India
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10
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Qiao J, Ray B, Singh V, Geno A, Abadie J. Lessons learned from patient outcomes when lowering hemoglobin transfusion thresholds during COVID-19 blood shortages. Am J Clin Pathol 2023; 160:175-184. [PMID: 37086488 DOI: 10.1093/ajcp/aqad033] [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: 12/25/2022] [Accepted: 03/06/2023] [Indexed: 04/24/2023] Open
Abstract
OBJECTIVES This study examines whether patient outcomes were affected when the hemoglobin (Hb) transfusion threshold was lowered by 1 g/dL during COVID-19-related blood shortages. METHODS Outcomes of lowered Hb thresholds (from <7 to <6 g/dL) were defined by 14-month intervals in 2 patient groups (prepandemic [January 2019-February 2020] and pandemic [April 2020-May 2021]). We evaluated patient admissions, pretransfusion (if transfused) or nadir admission (if not transfused) Hb levels between 5.0 and 8.0 g/dL, and total red blood cell (RBC) transfusions during admission (if transfused). Baseline variables and outcomes were selected from electronic health records. Primary COVID-19-related admissions were excluded. Regression analysis was conducted to determine outcomes. RESULTS Those in the prepandemic group (1976) and pandemic group (1547) were transfused. Fewer RBCs (2186, vs 3337) were used in the prepandemic group than in the pandemic group, respectively. Those in the prepandemic group had significantly higher rates of hypertension and diabetes as well as more smokers. Significant differences were observed when comparing the number of procedures and incidence of sepsis between the patient groups. Similar patterns were observed for the not transfused and transfused subgroups. CONCLUSIONS Patient outcomes were not affected after implementing lower Hb pretransfusion thresholds. Although confounding factors were mitigated, some may have been associated with procedures or sepsis. Proactive patient blood management strategies during COVID-19-related blood shortages may include adopting lower Hb thresholds.
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Affiliation(s)
- Jesse Qiao
- Department of Pathology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, US
| | - Bradford Ray
- Patient Blood Management and Research, University Medical Center of El Paso, El Paso, TX, US
| | - Vishwajeet Singh
- Department of Research, Biostatistics, and Epidemiology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, US
| | - Aaron Geno
- Department of Pathology, Dartmouth Hitchcock Medical Center, Dartmouth Geisel School of Medicine, Lebanon, NH, US
| | - Jude Abadie
- Department of Pathology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, US
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11
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Chan A, Stathakis P, Goldsmith P, Smith S, Macutkiewicz C. The reorganisation of emergency general surgery services during the COVID-19 pandemic in the UK: outcomes of delayed presentation, socio-economic deprivation and Black, Asian and Minority Ethnic patients. Ann R Coll Surg Engl 2023; 105:S46-S53. [PMID: 35639022 PMCID: PMC10390243 DOI: 10.1308/rcsann.2022.0022] [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] [Accepted: 11/24/2021] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic is a global public health emergency. Lockdown restrictions and the reconfiguration of healthcare systems to accommodate an increase in critical care capacity have had an impact on 'non-COVID' specialties. This study characterises the utilisation of emergency general surgery (EGS) services during the UK lockdown period at a university teaching hospital with a catchment population that represents one of the most deprived and ethnically diverse areas in the UK. METHODS EGS admissions during the UK lockdown period (March to May 2020) were compared with the same period in 2019. Patient demographics were recorded together with clinical presentation, hospital stay and treatment outcomes, and readmission data. RESULTS The study included 645 patients, comprising 223 in the COVID-19 period and 422 in the non-COVID-19 period. There was no difference in age, sex, comorbidity or socio-economic status. A lower proportion of patients of Black, Asian and Minority Ethnicity (BAME) were admitted during the pandemic (20.6% vs 35.4%, p < 0.05). The duration of symptoms prior to presentation was longer, and admission clinical parameters and serum inflammatory markers. More patients presented with an acute kidney injury (9.9% vs 4.7%, p = 0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, p = 0.023). CONCLUSIONS The reorganisation of EGS to a senior-led model has been successful in terms of outcomes and access to treatment despite a more unwell population. There was a significantly lower proportion of BAME admissions suggesting additional barriers to healthcare access under pandemic lockdown conditions.
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Affiliation(s)
- A Chan
- Manchester University NHS Foundation Trust, UK
| | - P Stathakis
- Manchester University NHS Foundation Trust, UK
| | - P Goldsmith
- Manchester University NHS Foundation Trust, UK
| | - S Smith
- Manchester University NHS Foundation Trust, UK
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12
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Mehmood A, Barnett DJ, Kang BA, Chhipa UEA, Asad N, Afzal B, Razzak JA. Enhancing a Willingness to Respond to Disasters and Public Health Emergencies Among Health Care Workers, Using mHealth Intervention: A Multidisciplinary Approach. Disaster Med Public Health Prep 2023; 17:e469. [PMID: 37476984 PMCID: PMC11103243 DOI: 10.1017/dmp.2023.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Health care workers (HCWs) are increasingly faced with the continuous threat of confronting acute disasters, extreme weather-related events, and protracted public health emergencies. One of the major factors that determines emergency-department-based HCWs' willingness to respond during public health emergencies and disasters is self-efficacy. Despite increased public awareness of the threat of disasters and heightened possibility of future public health emergencies, the emphasis on preparing the health care workforce for such disasters is inadequate in low-and-middle-income countries (LMICs). Interventions for boosting self-efficacy and response willingness in public health emergencies and disasters have yet to be implemented or examined among emergency HCWs in LMICs. Mobile health (mHealth) technology seems to be a promising platform for such interventions, especially in a resource-constrained setting. This paper introduces an mHealth-focused project that demonstrates a model of multi-institutional and multidisciplinary collaboration for research and training to enhance disaster response willingness among emergency department workers in Pakistan.
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Affiliation(s)
- Amber Mehmood
- Department of Public Health, University of South Florida College of Public Health, Tampa, FL, USA
| | - Daniel J. Barnett
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bee-Ah Kang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ume-e-Aiman Chhipa
- Center of Excellence for Trauma and Emergency, Aga Khan University, Karachi, Pakistan
| | - Nargis Asad
- Department of Psychiatry, Medical College, Aga Khan University, Karachi, Pakistan
| | - Badar Afzal
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Junaid A. Razzak
- Center of Excellence for Trauma and Emergency, Aga Khan University, Karachi, Pakistan
- Department of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA
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13
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Zachari S, Papagiannis D, Kotsiou O, Malli F, Fradelos EC, Gourgoulianis KI. Factors of Compliance of Dental Patients in Primary Health Care Services during the Pandemic. Vaccines (Basel) 2023; 11:vaccines11040844. [PMID: 37112755 PMCID: PMC10142344 DOI: 10.3390/vaccines11040844] [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: 03/14/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The compliance of dentists with good hygiene practices during the COVID-19 pandemic was essential to minimize the transmission of SARS-CoV-2 strains, and the pandemic has significantly interrupted the provision of oral health care to many individuals. We aimed to examine, in a cross-sectional study, factors affecting dental patients' compliance in primary dental health settings during the pandemic period. The present study was conducted on 300 dental patients visiting four private dental offices in the city of Larissa in Central Greece during the period October-December 2021. The patients in the study sample were of an average age of 45.79 years with a standard deviation of 15.54 years, and 58% of the sample were females. A significant proportion of the participants, 22%, reported that they would be influenced if they knew that the dentist had been ill with COVID-19 despite being fully recovered. A total of 88% of the participants reported that they would feel safe if they knew their dentist was vaccinated against COVID-19. Regarding the information received by dentists, 88% of the participants agreed that the dentist's role is important in dealing with the COVID-19 pandemic, and 89% of them agreed that the information they received from the dentist about the COVID-19 pandemic was sufficient. One-third of the total sample reported that COVID-19 negatively impacted keeping dental appointments, and 43% of the sample kept scheduled appointments. A total of 98% reported that the dentist followed all health protocols against COVID-19 and that their office was equipped to follow health protocols. In the present study, we observe that dentists had adequate knowledge of, attitudes towards, and practices of infection control protocols against COVID-19 during the second wave, according to patients' perceptions.
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Affiliation(s)
- Sofia Zachari
- Primary Health Care Post Graduate Program, University of Thessaly, 41110 Larissa, Greece
| | - Dimitrios Papagiannis
- Public Health & Vaccines Laboratory, Department of Nursing, School of Health Science, University of Thessaly, 41500 Larissa, Greece
| | - Ourania Kotsiou
- Human Pathophysiology Laboratory, Department of Nursing, University of Thessaly, 41500 Larissa, Greece
| | - Foteini Malli
- Respiratory Disorders Laboratory, Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece
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14
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Chaves CER, Girón F, Núñez-Rocha RE, Benítez E, Ruiz S, Rodríguez L, Ayala D, Villamil CJ, Galvis V, Vanegas M, Gómez M, Nassar R, Hernández JD, Conde D, Zuleta MG. Variations in clinical course and surgical outcomes of acute appendicitis during COVID-19 Pandemic: a multicenter cohort study. BMC Surg 2023; 23:56. [PMID: 36918843 PMCID: PMC10011775 DOI: 10.1186/s12893-023-01933-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/03/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has led to changes in the presentation and treatment of surgical pathologies. Therefore, we aim to describe the influence of the COVID-19 pandemic on the clinical presentation and management of acute appendicitis (AAp) and its surgical outcomes. STUDY DESIGN A multicenter cohort study with prospectively collected databases. Three high-volume centers were included and all patients over 18 years of age who underwent appendectomy for AAp were included. Multiple logistic regression and multinomial logistic regression were performed, and odds ratio, relative risk, and B-coefficient were reported when appropriate, statistical significance was reached with p-values < 0.05. RESULTS 1.468 patients were included (709 in the pre-pandemic group and 759 in the COVID-19 group). Female patients constituted 51.84%. Mean age was 38.13 ± 16.96 years. Mean Alvarado's score was 7.01 ± 1.59 points. Open surgical approach was preferred in 90.12%. Conversion rate of 1.29%. Mortality rate was 0.75%. There was an increase of perforated and localized peritonitis (p 0.01) in the COVID-19 group. Presence of any postoperative complication (p 0.00), requirement of right colectomy and ileostomy (p 0.00), and mortality (p 0.04) were higher in the COVID-19 group. Patients in the pre-pandemic group have a lesser risk of mortality (OR 0.14, p 0.02, 95% CI 0.02-0.81) and a lesser relative risk of having complicated appendicitis (RR 0.68, p 0.00, 95% CI 0.54-0.86). CONCLUSION Complicated appendicitis was an unexpected consequence of the COVID-19 pandemic, due to surgical consultation delay, increased rates of morbidity, associated procedures, and mortality, influencing the clinical course and surgical outcomes of patients with AAp.
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Affiliation(s)
- Carlos Eduardo Rey Chaves
- Department of Surgery and Specialties, Pontificia Universidad Javeriana, Cra 6A #51A-48, 110100, Bogotá D.C, Colombia.
| | - Felipe Girón
- Department of Surgery, Fundación Santa Fé de Bogotá, Bogotá D.C, Colombia.,School of Medicine, Universidad de los Andes, Bogotá D.C, Colombia.,School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | | | - Elkin Benítez
- School of Medicine, Fundación Universitaria Juan N. Corpas, Bogotá D.C, Colombia
| | - Saralia Ruiz
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Lina Rodríguez
- School of Medicine, Universidad de los Andes, Bogotá D.C, Colombia
| | - Daniela Ayala
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | | | - Valentina Galvis
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Marco Vanegas
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Mónica Gómez
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Ricardo Nassar
- Department of Surgery, Fundación Santa Fé de Bogotá, Bogotá D.C, Colombia.,School of Medicine, Universidad de los Andes, Bogotá D.C, Colombia.,School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | | | - Danny Conde
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia.,Hospital Universitario Mayor, Méderi, Universidad El Rosario, Bogotá D.C, Colombia
| | - María Gómez Zuleta
- Department of Surgery and Specialties, Pontificia Universidad Javeriana, Cra 6A #51A-48, 110100, Bogotá D.C, Colombia
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15
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Das M, Saha N, Zahir S, Santra A. A retrospective study on clinical and epidemiological profile of nonsyndromic cleft lip and palate patients admitted in a large Comprehensive Cleft Care Centre in West Bengal, India. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2023. [DOI: 10.4103/jclpca.jclpca_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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16
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Taylor MK, Kinder K, George J, Bazemore A, Mannie C, Phillips R, Strydom S, Goodyear-Smith F. Multinational primary health care experiences from the initial wave of the COVID-19 pandemic: A qualitative analysis. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100041. [PMID: 35043104 PMCID: PMC8755427 DOI: 10.1016/j.ssmqr.2022.100041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/29/2021] [Accepted: 01/08/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To learn from primary health care experts' experiences from the COVID-19 pandemic across countries. METHODS We applied qualitative thematic analysis to open-text responses from a multinational rapid response survey of primary health care experts assessing response to the initial wave of the COVID-19 pandemic. RESULTS Respondents' comments focused on three main areas of primary health care response directly influenced by the pandemic: 1) impact on the primary care workforce, including task-shifting responsibilities outside clinician specialty and changes in scope of work, financial strains on practices, and the daily uncertainties and stress of a constantly evolving situation; 2) impact on patient care delivery, both essential care for COVID-19 cases and the non-essential care that was neglected or postponed; 3) and the shift to using new technologies. CONCLUSIONS Primary health care experiences with the COVID-19 pandemic across the globe were similar in their levels of workforce stress, rapid technologic adaptation, and need to pivot delivery strategies, often at the expense of routine care.
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Affiliation(s)
- Melina K. Taylor
- American Board of Family Medicine, 1648 McGrathiana Parkway Suite 550, Lexington, KY, 40511, USA,Corresponding author. American Board of Family Medicine, Lexington, KY, USA
| | - Karen Kinder
- Technische Universität Berlin, Fachgebiet Management im Gesundheitswesen, Straße des 17, Juni 135, H80, 10623, Berlin, Germany
| | - Joe George
- Center for Professionalism & Value in Health Care, 1016 16th St NW, Suite 700, Washington DC, 20036, USA
| | - Andrew Bazemore
- American Board of Family Medicine, 1648 McGrathiana Parkway Suite 550, Lexington, KY, 40511, USA,Center for Professionalism & Value in Health Care, 1016 16th St NW, Suite 700, Washington DC, 20036, USA
| | - Cristina Mannie
- Mast Analytics, 4th Floor, Sunclare Building, 21 Dreyer Street, Claremont, 7708, South Africa,Department of General Practice & Primary Health Care, University of Auckland, Room 3018, Building B507 Grafton Campus, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand
| | - Robert Phillips
- Center for Professionalism & Value in Health Care, 1016 16th St NW, Suite 700, Washington DC, 20036, USA
| | - Stefan Strydom
- Mast Analytics, 4th Floor, Sunclare Building, 21 Dreyer Street, Claremont, 7708, South Africa,Department of General Practice & Primary Health Care, University of Auckland, Room 3018, Building B507 Grafton Campus, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Room 3018, Building B507 Grafton Campus, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand
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17
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Dopke C, Connor J, Zheleva B, Gauvreau K, Bakalcheva B, Bina N, Calvimontes G, Cerovic I, Majani N, Oketcho M, Pechilkov D, Shidhika F, Shiryaev T, Jenkins K. Effects of COVID-19 on paediatric cardiac centres in low-income and middle-income countries: a mixed-methods study. BMJ Open 2022; 12:e065031. [PMID: 36418128 PMCID: PMC9684279 DOI: 10.1136/bmjopen-2022-065031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to understand the effects of the COVID-19 pandemic on paediatric cardiac services in critical access centres in low-income and middle-income countries. DESIGN A mixed-methods approach was used. SETTING Critical access sites that participate in the International Quality Improvement Collaborative (IQIC) for congenital heart disease (CHD) were identified. PARTICIPANTS Eight IQIC sites in low-income and middle-income countries agreed to participate. OUTCOME MEASURES Differences in volume and casemix before and during the pandemic were identified, and semistructured interviews were conducted with programme representatives and analysed by two individuals using NVivo software. The qualitative component of this study contributed to a better understanding of the centres' experiences and to identify themes that were common across centres. RESULTS In aggregate, among the seven critical access sites that reported data in both 2019 and 2020, there was a 20% reduction in case volume, though the reduction varied among programmes. Qualitative analysis identified a universal impact for all programmes related to Access to Care/Clinical Services, Financial Stability and Professional/Personal Issues for healthcare providers. CONCLUSIONS Our study identified and quantified a significant impact of the COVID-19 pandemic on critical access to CHD surgery in low-income and middle-income countries, as well as a significant adverse impact on both the skilled workforce needed to treat CHD and on the institutions in which care is delivered. These findings suggest that the COVID-19 pandemic has been a major threat to access to care for children with CHD in resource-constrained environments and that this effect may be long-lasting beyond the global emergency. Efforts are needed to preserve vulnerable CHD programmes even during unprecedented pandemic situations.
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Affiliation(s)
- Campbell Dopke
- Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA
- Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Jean Connor
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Najeebullah Bina
- Department of Cardiology, French Medical Institute for Children (FMIC), Kabul, Afghanistan
| | - Gonzalo Calvimontes
- Department of Cardiology, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala
| | - Ivana Cerovic
- Department of Cardiology, Mother and Child Health Institute of Serbia, Belgrade, Serbia
| | - Naizihijwa Majani
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, Dar Es Salaam, Tanzania, United Republic of
| | - Michael Oketcho
- Department of Paediatric Cardiac Surgery, Uganda Heart Institute, Kampala, Uganda
| | - Dimitar Pechilkov
- Department of Paediatric Cardiology, National Heart Hospital, Sofia, Bulgaria
| | - Fenny Shidhika
- Department of Paediatric Cardiology, Windhoek Central Hospital, Windhoek, Namibia
| | - Tengiz Shiryaev
- Congenital Cardiac Surgery Department, JoAnn McGowan Paediatric Cardiac Surgery Center, Tbilisi, Georgia
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Paediatrics, Harvard Medical School, Boston, Massachusetts, USA
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18
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Starr NE, Moore JN, Shreckengost CSH, Fernandez K, Ambulkar RP, Capo-Chichi N, Varallo JE, Ademuyiwa AO, Krouch S, Rana PS, Ingabire JA, Weiser TG, Mammo TN, Evans FM. Perioperative provider safety in the pandemic: Development, implementation and evaluation of an adjunct COVID-19 Surgical Patient Checklist. Anaesth Intensive Care 2022; 50:457-467. [PMID: 35765829 PMCID: PMC9597157 DOI: 10.1177/0310057x221092455] [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] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic has strained surgical systems worldwide and placed
healthcare providers at risk in their workplace. To protect surgical care
providers caring for patients with COVID-19, in May 2020 we developed a COVID-19
Surgical Patient Checklist (C19 SPC), including online training materials, to
accompany the World Health Organization Surgical Safety Checklist. In October
2020, an online survey was conducted via partner and social media networks to
understand perioperative clinicians’ intraoperative practice and perceptions of
safety while caring for COVID-19 positive patients and gain feedback on the
utility of C19 SPC. Descriptive statistics were used to characterise responses
by World Bank income classification. Qualitative analysis was performed to
describe respondents' perceptions of C19 SPC and recommended modifications.
Respondents included 539 perioperative clinicians from 63 countries. One-third
of respondents reported feeling unsafe in their workplace due to COVID-19 with
significantly higher proportions in low (39.8%) and lower-middle (33.9%) than
higher income countries (15.6%). The most cited concern was the risk of COVID-19
transmission to self, colleagues and family. A large proportion of respondents
(65.3%) reported that they had not used C19 SPC, yet 83.8% of these respondents
felt it would be useful. Of those who reported that they had used C19 SPC, 62.0%
stated feeling safer in the workplace because of its use. Based on survey
results, modifications were incorporated into a subsequent version. Our survey
findings suggest that perioperative clinicians report feeling unsafe at work
during the COVID-19 pandemic. In addition, adjunct tools such as the C19 SPC can
help to improve perceived safety.
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Affiliation(s)
- Nichole E Starr
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA.,Lifebox Foundation, London, UK
| | - Jolene N Moore
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,World Federation of Societies of Anaesthesiologists, London, UK
| | | | | | - Reshma P Ambulkar
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | | | - Adesoji O Ademuyiwa
- Department of Surgery, Faculty of Clinical Sciences, University of Lagos College of Medicine, Lagos, Nigeria
| | - Sophallyda Krouch
- Department of Anesthesia, Kampot Provincial Referral Hospital, Kampot, Cambodia
| | | | - Jc Allen Ingabire
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Thomas G Weiser
- Lifebox Foundation, London, UK.,Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.,University of Edinburgh, Department of Clinical Surgery, Edinburgh, UK
| | | | - Faye M Evans
- Lifebox Foundation, London, UK.,World Federation of Societies of Anaesthesiologists, London, UK.,Smile Train, New York, NY, USA.,Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital, Boston, MA, USA
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19
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Diniz FC, Hipkiss AR, Ferreira GC. The Potential Use of Carnosine in Diabetes and Other Afflictions Reported in Long COVID Patients. Front Neurosci 2022; 16:898735. [PMID: 35812220 PMCID: PMC9257001 DOI: 10.3389/fnins.2022.898735] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022] Open
Abstract
Carnosine is a dipeptide expressed in both the central nervous system and periphery. Several biological functions have been attributed to carnosine, including as an anti-inflammatory and antioxidant agent, and as a modulator of mitochondrial metabolism. Some of these mechanisms have been implicated in the pathophysiology of coronavirus disease-2019 (COVID-19). COVID-19 is caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The clinical manifestation and recovery time for COVID-19 are variable. Some patients are severely affected by SARS-CoV-2 infection and may experience respiratory failure, thromboembolic disease, neurological symptoms, kidney damage, acute pancreatitis, and even death. COVID-19 patients with comorbidities, including diabetes, are at higher risk of death. Mechanisms underlying the dysfunction of the afflicted organs in COVID-19 patients have been discussed, the most common being the so-called cytokine storm. Given the biological effects attributed to carnosine, adjuvant therapy with this dipeptide could be considered as supportive treatment in patients with either COVID-19 or long COVID.
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Affiliation(s)
- Fabiola Cardoso Diniz
- Laboratório de Erros Inatos do Metabolismo, Programa de Bioquímica e Biofísica Celular, Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Ciências Biológicas - Biofísica, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, United States
| | - Alan Roger Hipkiss
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, United Kingdom
| | - Gustavo Costa Ferreira
- Laboratório de Erros Inatos do Metabolismo, Programa de Bioquímica e Biofísica Celular, Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Ciências Biológicas - Biofísica, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Química Biológica, Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Downey LE, Gadsden T, Vilas VDR, Peiris D, Jan S. The impact of COVID-19 on essential health service provision for endemic infectious diseases in the South-East Asia region: A systematic review. THE LANCET REGIONAL HEALTH - SOUTHEAST ASIA 2022; 1:100011. [PMID: 35769109 PMCID: PMC9069250 DOI: 10.1016/j.lansea.2022.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background There is increasing evidence that the COVID-19 pandemic has impacted adversely on the provision of essential health services. The South East Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, and continues to bear a significant proportion of communicable disease burden worldwide. Methods We conducted a systematic literature review of quantitative evidence to estimate the impact of COVID-19 on the provision of essential prevention, detection, treatment, and management services for five high-burden infectious diseases across the SEAR. Findings A total of 2338 studies were reviewed, and 12 studies were included in our analysis, covering six countries across the SEAR (Bhutan, Sri Lanka, Nepal, Myanmar, Thailand, and India) for three conditions of interest (HIV, TB, dengue fever). We identified significant disruption to TB testing (range=25% to 77.9%) and diagnoses (range=50% to 58%) in India, Nepal, and Indonesia; and similar disruptions were observed for screening, new diagnoses and commencing HIV treatment in India and Thailand. There was also drastically reduced case detection for dengue fever (range=75% to 90% disrupted) in Bhutan and Sri Lanka. No studies were identified for malaria nor hepatitis in any country, and nor for any service in the remaining six SEAR countries. Interpretation We identified evidence of significant disruption to the prevention, diagnoses, treatment, and management of TB, HIV, and dengue fever due to the COVID-19 pandemic across multiple SEAR country settings. This has the potential to set back hard-fought gains in infectious disease control across the region. The lack of evidence for the impact of the pandemic on malaria and hepatitis services, and in the remaining six SEAR countries, is an important evidence gap that should be addressed in order to inform future policy for service protection and pandemic preparedness. Funding This work was supported by the WHO Sri Lanka Country office.
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21
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Pujolar G, Oliver-Anglès A, Vargas I, Vázquez ML. Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1749. [PMID: 35162772 PMCID: PMC8834942 DOI: 10.3390/ijerph19031749] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic and the measures adopted are having a profound impact on a major goal of public healthcare systems: universal access to health services. The objective is to synthesize the available knowledge on access to health care for non-COVID-19 conditions and to identify knowledge gaps. A scoping review was conducted searching different databases (Medline, Google Scholar, etc.) for original articles published between December 2019 and September 2021. A total of 53 articles were selected and analyzed using the Aday and Andersen framework as a guide. Of these, 37 analyzed changes in levels of use of health services, 15 focused on the influencing factors and barriers to access, and 1 studied both aspects. Most focused on specific diseases and the early stages of the pandemic, based on a review of records. Analyses of the impact on primary care services' use, unmet needs or inequalities in access were scarce. A generalized reduction in the use of health services was described. The most frequent access barrier described for non-COVID-19 conditions related to the services was a lack of resources, while barriers related to the population were predisposing (fear of contagion, stigma, or anticipating barriers) and enabling characteristics (worse socioeconomic status and an increase in technological barriers). In conclusion, our results show a general reduction in services' use in the early stages of the pandemic, as well as new barriers to access and the exacerbation of existing ones. In view of these results, more studies are required on the subsequent stages of the pandemic, to shed more light on the factors that have influenced access and the pandemic's impact on equity of access.
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Affiliation(s)
- Georgina Pujolar
- Health Policy Research Unit (SEPPS), Consorci de Salut i Social de Catalunya, 08022 Barcelona, Spain; (A.O.-A.); (I.V.); (M.-L.V.)
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22
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Fell M, Goldwasser M, Jayanth BS, Pereira RMR, Nawej CT, Winer R, Daftari N, Brewster H, Goldschmied K, Almas CF, Eshete M, Galiwango GW, Hollier LH, Hussain A, Lo LJ, Salins P, Sell D, Tafase A, Zuker RM. Adapting Elements of Cleft Care Protocols in Low- and Middle-income Countries During and After COVID-19: A Process-driven Review With Recommendations. Cleft Palate Craniofac J 2022; 60:526-535. [PMID: 34982012 PMCID: PMC10102820 DOI: 10.1177/10556656211069827] [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: 11/16/2022] Open
Abstract
A consortium of global cleft professionals, predominantly from low- and middle-income countries, identified adaptations to cleft care protocols during and after COVID-19 as a priority learning area of need. A multidisciplinary international working group met on a videoconferencing platform in a multi-staged process to make consensus recommendations for adaptations to cleft protocols within resource-constrained settings. Feedback was sought from a roundtable discussion forum and global organizations involved in comprehensive cleft care. Foundational principles were agreed to enable recommendations to be globally relevant and two areas of focus within the specified topic were identified. First the safety aspects of cleft surgery protocols were scrutinized and COVID-19 adaptations, specifically in the pre- and perioperative periods, were highlighted. Second, surgical procedures and cleft care services were prioritized according to their relationship to functional outcomes and time-sensitivity. The surgical procedures assigned the highest priority were emergent interventions for breathing and nutritional requirements and primary palatoplasty. The cleft care services assigned the highest priority were new-born assessments, pediatric support for children with syndromes, management of acute dental or auditory infections and speech pathology intervention. A collaborative, interdisciplinary and international working group delivered consensus recommendations to assist with the provision of cleft care in low- and middle-income countries. At a time of global cleft care delays due to COVID-19, a united approach amongst global cleft care providers will be advantageous to advocate for children born with cleft lip and palate in resource-constrained settings.
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Affiliation(s)
- Matthew Fell
- CLEFT Charity, Chelmsford, UK.,Cleft Collective, University of Bristol, Bristol, UK
| | - Michael Goldwasser
- Operation Smile, Virginia Beach, USA.,Craniofacial and Surgical Care, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | | | - Rui Manuel Rodrigues Pereira
- Faculdade de Medicina da Universidade de Sao Paulo, Sau Paulo, Brazil.,Instituto de Medicina Integral Prof Fernando Figueira, Recife, Brazil
| | | | | | | | | | - Karen Goldschmied
- Craniofacial and Surgical Care, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | | | - Mekonen Eshete
- Cleft Lip and Palate Program, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Larry H Hollier
- Smile Train Global Medical Advisory Board, New York, USA.,Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Akhter Hussain
- ABMSS, Bengaluru, India.,Yenepoya Dental College, Karnataka, India
| | - Lun-Jou Lo
- Noordhoff Craniofacial Foundation, Taipei, Taiwan.,Craniofacial Center, Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Paul Salins
- ABMSS, Bengaluru, India.,Mazumdar Shaw Medical Centre, Karnataka, India
| | - Debbie Sell
- Great Ormond Street Hospital for Children, London, UK
| | - Amanuel Tafase
- Project Harar, London United Kingdom and Addis Ababa, Ethiopia
| | - Ronald M Zuker
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada.,The University of Toronto, Toronto, Canada
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23
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Ademe Y, Genetu A, Laeke T, Taye M, Bekele A. Impact of COVID-19 on Surgical Volume: Single-Center Experience from Addis Ababa, Ethiopia. Ethiop J Health Sci 2022; 32:37-44. [PMID: 35250215 PMCID: PMC8864390 DOI: 10.4314/ejhs.v32i1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused substantial disruptions to surgical-care delivery mainly due to diversion of available resources from surgical to COVID-19 care, reduced flow of patients, supply-chain interruptions and social distancing and restriction measures. The purpose of this study was to understand the impact of the pandemic on surgical volume in our hospital. METHODS A descriptive cross-sectional study was done at Tikur Anbessa Specialized Hospital. A 2- year data was collected from March 2019 up to March 2021 from the operation theatre registration books. The data registry at the admission records office was also reviewed to extract the number pf patients on the elective surgery waiting list. Data were recorded, analyzed and reported using SPSS software package 26. RESULTS The findings showed that there was a significant drop in surgical volume during the COVID-19 era. Surgical volume has dropped by 19% for emergency and by 32% for elective surgeries. COVID-19 test positivity of patients was identified as the single most important reason for elective operation cancellation during the first wave of the pandemic, contributing to as high as 85% of the reasons. CONCLUSION The outcome of our study showed that COVID-19 has adversely affected elective and emergency surgical volume in our institution. This has also led to a dramatic increase in the surgical waiting list load. We recommend immediate surgical systems strengthening measures to re-build the surgical care ecosystem significantly affected by COVID-19. Surgical and anesthesia systems strengthening should be an integral part of pandemic preparedness and management.
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Affiliation(s)
- Yonas Ademe
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Surgery Addis Ababa, Ethiopia
| | - Abraham Genetu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Surgery Addis Ababa, Ethiopia
| | - Tsegazeab Laeke
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Surgery Addis Ababa, Ethiopia
| | - Mulat Taye
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Surgery Addis Ababa, Ethiopia
| | - Abebe Bekele
- Professor of Surgery, University of Global Health Equity, School of Medicine Kigali Heights, Plot 772, KG 7 AVE
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24
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Alhodaib H, Alanzi TM. Understanding the Impact of Digital Health Strategies During the COVID-19 Outbreak in Saudi Arabia. Risk Manag Healthc Policy 2021; 14:4581-4594. [PMID: 34803411 PMCID: PMC8595062 DOI: 10.2147/rmhp.s331084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The impact of COVID-19 has been analyzed from various aspects on the health care services management, accessibility and delivery of health care services. However, the COVID-19 pandemic has led to disruptions in health care services, which led to the increase in adoption of digital health technologies, mostly arising out of need and necessity. OBJECTIVE Focusing on the prevailing situations (increasing reliance on digital health services), this study investigates the impact of digital health technologies from the perspectives of policymakers and citizens. METHODS A mixed-methods approach was adopted. Twenty-seven semi-structured online interviews were conducted with experts and policymakers for assessing the impact from policymakers' perspectives. An online survey questionnaire instrument was used to collect the responses from 1698 Saudi Arabian citizens in relation to the various aspects of digital health applications. RESULTS Health care expenditures increased during the COVID-19 outbreak, resulting in launch of various digital health applications. While policymakers defended their stand in improving health care services and accessibility; citizens reflected inability to book medicines/personal medical equipment online (Mean=2.4) and suffered a lack of personalized care (Mean=2.9) through digital health applications. Moreover, disparities exist between the population groups with respect to the accessibility, utilization, and perceptions of digital health technologies. CONCLUSION Policymakers have to consider and address these differences in formulating digital health policies and implementing them.
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Affiliation(s)
- Hala Alhodaib
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyad, Saudi Arabia
| | - Turki M Alanzi
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
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25
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Vervoort D, Ma X, Sunderji A, Bookholane H. The international treaty for pandemic preparedness and response: same story, different times? Future Virol 2021; 0. [PMID: 34745317 PMCID: PMC8559593 DOI: 10.2217/fvl-2021-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/20/2021] [Indexed: 11/21/2022]
Abstract
In November, dozens of nations and the WHO will draft the international treaty for pandemic preparedness and response. Will the treaty be the needed change in global health equity or are we doomed to repeat history?
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
| | - Xiya Ma
- Division of Plastic Surgery, Faculty of Medicine, Universite de Montreal, Montreal, QC, H3T 1J4, Canada
| | - Alia Sunderji
- Department of Emergency Medicine, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Hloni Bookholane
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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26
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Stoehr JR, Hamidian Jahromi A, Chu QD, Zibari GB, Gosain AK. Considerations for resuming global surgery outreach programs during and after the coronavirus disease 2019 (COVID-19) pandemic. Surgery 2021; 170:1405-1410. [PMID: 34130811 PMCID: PMC8148426 DOI: 10.1016/j.surg.2021.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/16/2021] [Accepted: 05/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has disrupted the delivery of safe surgical care worldwide. One specific aspect of global surgical care that has been severely limited is the ability for physicians and trainees to participate in global surgical outreach programs in low- and middle-income countries. METHODS A narrative review of the literature regarding global surgical outreach programs during the coronavirus disease 2019 pandemic was performed. Factors that must be considered in the reinstatement of global surgical outreach programs were identified, and suggestions to address them were provided based on the available literature and the experiences of the senior authors. RESULTS As global surgical outreach programs were canceled at the start of the pandemic, many academic surgeons turned to digital solutions to continue to engage with low- and middle-income country partners. With the advent of coronavirus disease 2019 vaccines and improved access to testing and treatment worldwide, the recommencement of global surgical outreach programs may begin to be considered. Important considerations before initiation include vaccine and testing availability for visiting providers, local staff, and patients, local hospital capacity, staff and equipment shortages, and the characteristics of the patient population and visiting providers. Region- and country-specific factors, including local infection rates and concomitant health crises, must also be taken into account. Expansion of digital collaborative efforts may further deepen international connections and promote sustainable models of care. CONCLUSION With careful consideration, global surgical outreach programs may begin to be safely restarted in the near future. The current article evaluates individual factors that must be considered to safely restart global surgical outreach programs as the coronavirus disease 2019 pandemic is better controlled.
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Affiliation(s)
| | | | - Quyen D. Chu
- Division of Surgical Oncology, Department of Surgery, Louisiana State University Health–Shreveport, LA
| | - Gazi B. Zibari
- John C. McDonald Regional Transplant Center, Willis-Knighton Health System, Shreveport, LA
| | - Arun K. Gosain
- Feinberg School of Medicine, Northwestern University, Chicago, IL,Division of Plastic Surgery, Department of Surgery, Ann and Robert Lurie Children’s Hospital, Chicago, IL,Reprint requests: Arun K. Gosain, MD, FACS, Division Head, Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Professor of Pediatric Surgery, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611
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27
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Hill E, Gurbutt D, Makuloluwa T, Gordon M, Georgiou R, Roddam H, Seneviratne S, Byrom A, Pollard K, Abhayasinghe K, Chance-Larsen K. Collaborative healthcare education programmes for continuing professional education in low and middle-income countries: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 65. MEDICAL TEACHER 2021; 43:1228-1241. [PMID: 34499841 DOI: 10.1080/0142159x.2021.1962832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Large discrepancies exist between standards of healthcare provision in high-income (HICs) and low and middle-income countries (LMICs). The root cause is often financial, resulting in poor infrastructure and under-resourced education and healthcare systems. Continuing professional education (CPE) programmes improve staff knowledge, skills, retention, and practice, but remain costly and rare in low-resource settings. One potential solution involves healthcare education collaborations between institutions in HICs and LMICs to provide culturally appropriate CPE in LMICs. To be effective, educational partnerships must address the challenges arising from differences in cultural norms, language, available technology and organisational structures within collaborating countries. METHODS Seven databases and other sources were systematically searched on 7 July 2020 for relevant studies. Citations, abstracts, and studies were screened and consensus was reached on which to include within the review. 54 studies were assessed regarding the type of educational programme involved, the nature of HIC/LMIC collaboration and quality of the study design. RESULTS Studies varied greatly regarding the types and numbers of healthcare professionals involved, pedagogical and delivery methods, and the ways in which collaboration was undertaken. Barriers and enablers of collaboration were identified and discussed. The key findings were: 1. The methodological quality of reporting in the studies was generally poor. 2. The way in which HIC/LMIC healthcare education collaboration is undertaken varies according to many factors, including what is to be delivered, the learner group, the context, and the resources available. 3. Western bias was a major barrier. 4. The key to developing successful collaborations was the quality, nature, and duration of the relationships between those involved. CONCLUSION This review provides insights into factors that underpin successful HIC/LMIC healthcare CPE collaborations and outlines inequities and quality issues in reporting.
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Affiliation(s)
- Elaine Hill
- School of Sport and Health Sciences, UCLan, Preston, UK
| | - Dawne Gurbutt
- Centre for Collaborative Learning, UCLan, Preston, UK
| | - Thamasi Makuloluwa
- Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | | | | | - Hazel Roddam
- School of Sport and Health Sciences, UCLan, Preston, UK
| | - Sujatha Seneviratne
- Department of Nursing and Midwifery, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Anna Byrom
- School of Community Health and Midwifery, UCLan, Preston, UK
| | - Kerry Pollard
- School of Community Health and Midwifery, UCLan, Preston, UK
| | - Kalpani Abhayasinghe
- Department of Nursing and Midwifery, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
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28
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Qazi TF, Shaukat MZ, Niazi AAK, Basit A. Evaluating the Immediate Response of Country-Wide Health Systems to the Covid-19 Pandemic: Applying the Gray Incidence Analysis Model. Front Public Health 2021; 9:635121. [PMID: 34336753 PMCID: PMC8319644 DOI: 10.3389/fpubh.2021.635121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
The purpose of the study is to evaluate county-wide health systems using the data set of the first wave of the COVID-19 pandemic. The overall design of study comprises a literature review, secondary data, and a mathematical analysis. It is a cross-sectional quantitative study following a deductive approach. It uses the data of the first wave of the COVID-19 pandemic taken from the website of Worldometer as of April 8, 2020. The study uses a gray incidence analysis model (commonly known as Gray Relational Analysis, i.e., GRA) as its research methodology. On the basis of the results of GRA, a classification has been made under a predetermined scheme of ensigns: much better, better, somewhat better, fair, poor, somewhat worse, and worse health systems. There are a total 211 countries that have been divided into the seven aforementioned categories. Findings of the study show that Southern Africa Development Community (SADC) countries fall predominantly under the much better ensign, whereas Organization for Economic Co-operation and Development (OECD), Schengen Area (SA), and/or European Union (EU) countries fall under the worse ensign. Pakistan falls under the ensign of poor. It is an original attempt to evaluate the response of health systems based on real data using a scientific methodology. The study provides valuable information about the health systems of the countries for forming an informed opinion about the health systems herein. The study provides useful new information for stakeholders and a new framework for future research.
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Affiliation(s)
- Tehmina Fiaz Qazi
- Hailey College of Banking and Finance, University of the Punjab, Lahore, Pakistan
| | | | - Abdul Aziz Khan Niazi
- Institute of Business & Management, University of Engineering and Technology, Lahore, Pakistan
| | - Abdul Basit
- Lahore Institute of Science and Technology, Lahore, Pakistan
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29
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Mohamed M, Haq M, Ahmed I, Harky A. Cardiac surgery services during COVID-19-what did we learn? J Card Surg 2021; 36:3364-3367. [PMID: 34128270 PMCID: PMC8447174 DOI: 10.1111/jocs.15741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Malak Mohamed
- Faculty of Medicine and Health, Leeds School of Medicine, University of Leeds, Leeds, UK
| | - Mawiyah Haq
- Faculty of Medicine, St George's, University of London, London, UK
| | - Iqra Ahmed
- Faculty of Medicine, St George's, University of London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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30
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Neill R, Hasan MZ, Das P, Venugopal V, Jain N, Arora D, Gupta S. Evidence of integrated health service delivery during COVID-19 in low and lower-middle-income countries: protocol for a scoping review. BMJ Open 2021; 11:e042872. [PMID: 33941625 PMCID: PMC8098290 DOI: 10.1136/bmjopen-2020-042872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The importance of integrated, people-centred health systems has been recognised as a central component of Universal Health Coverage. Integration has also been highlighted as a critical element for building resilient health systems that can withstand the shock of health emergencies. However, there is a dearth of research and systematic synthesis of evidence on the synergistic relationship between integrated health services and pandemic preparedness, response, and recovery in low-income and lower-middle-income countries (LMICs). Thus, the authors are organising a scoping review aiming to explore the application of integrated health service delivery approaches during the emerging COVID-19 pandemic in LMICs. METHODS AND ANALYSIS This scoping review adheres to the six steps for scoping reviews from Arksey and O'Malley. Peer-reviewed scientific literature will be systematically assembled using a standardised and replicable search strategy from seven electronic databases, including PubMed, Embase, Scopus, Web of Science, CINAHL Plus, the WHO's Global Research Database on COVID-19 and LitCovid. Initially, the title and abstract of the collected literature, published in English from December 2019 to June 2020, will be screened for inclusion which will be followed by a full-text review by two independent reviewers. Data will be charted using a data extraction form and reported in narrative format with accompanying data matrix. ETHICS AND DISSEMINATION No ethical approval is required for the review. The study will be conducted from June 2020 to May 2021. Results from this scoping review will provide a snapshot of the evidence currently being generated related to integrated health service delivery in response to the COVID-19 pandemic in LMICs. The findings will be developed into reports and a peer-reviewed article and will assist policy-makers in making pragmatic and evidence-based decisions for current and future pandemic responses.
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Affiliation(s)
- Rachel Neill
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Md Zabir Hasan
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Priyanka Das
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vasuki Venugopal
- Department of Health and Family Welfare, Government of Gujarat, Gandhinagar, Gujarat, India
| | | | - Dinesh Arora
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shivam Gupta
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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31
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Mira JJ, Lorenzo S. Collateral damage for failing to do in the times of COVID-19. J Healthc Qual Res 2021; 36:125-127. [PMID: 33766472 PMCID: PMC7945869 DOI: 10.1016/j.jhqr.2021.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 06/12/2023]
Affiliation(s)
- J J Mira
- Universidad Miguel Hernández, Elche, Spain; Departamento de Salud Alicante-Sant Joan, Alicante, Spain; ATENEA Investigación (Prometeo 2017/173), FISABIO, Alicante, Spain.
| | - S Lorenzo
- Hospital Universitario Fundación Hospital Alcorcón, Madrid, Spain
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Farooq MAA, Kabir SMH, Chowdhury TK, Sadia A, Alam MA, Farhad T. Changes in children's surgical services during the COVID-19 pandemic at a tertiary-level government hospital in a lower middle-income country. BMJ Paediatr Open 2021; 5:e001066. [PMID: 34192202 PMCID: PMC8015790 DOI: 10.1136/bmjpo-2021-001066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/27/2021] [Accepted: 03/20/2021] [Indexed: 11/04/2022] Open
Abstract
Objective The aim of this study was to quantify the changes that occurred in the surgical services of children during the COVID-19 pandemic from the perspective of a low/middle-income country. Design A case-control study was conducted at a large referral centre in Bangladesh among patients aged ≤12 years. Comparisons were made between cases admitted during a period of 'April to September 2020' (Pandemic period) and controls during a similar period in 2019 (Reference period). The number of admissions and outpatient department (OPD) attendances, age and sex distribution, diagnosis, number and types of surgeries performed (elective vs emergency), variations in treatment of acute appendicitis, types of anaesthesia and mortality were compared. Results Admissions were only 41% of previous year (635 vs 1549), and OPD attendances were only 28% of previous year (603 vs 2152). Admission of children reduced by 65.8%, but neonatal admission reduced only by 7.6%. The median age of the admitted patients was significantly lower during the pandemic period (3 vs 4 years, p<0.01). Acute appendicitis (151, 9.8%) and trauma (61, 9.6%), respectively, were the the most common causes of admission during the reference and the pandemic period. Elective surgeries were only 17% and emergency surgeries were 64% of previous year (p<0.01). Appendectomy (88, 9.1%) and laparotomy (77, 17.6%), respectively, were the most common surgeries performed during the reference and the pandemic period. Conservative treatment of acute appendicitis was more during the pandemic period (47.5% vs 28.5%, p=0.01), but patients who underwent appendectomies had more complicated appendicitis (63.3% vs 42.1%, p=0.01). In all, 90.4% of surgeries were performed by resident doctors. There were no COVID-19- related deaths. Conclusion Trauma became the most common cause of admission during the pandemic, and neonatal surgical conditions remained almost unchanged with high mortality rates. Elective procedures and laparoscopy remained low and resident doctors played a major role in providing surgical services.
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Affiliation(s)
| | - S M Humayun Kabir
- Director, Chattogram Medical College Hospital, Chattogram, Bangladesh
| | | | - Ayesha Sadia
- Department of Paediatric Surgery, Chittagong Medical College, Chattogram, Bangladesh
| | - Md. Afruzul Alam
- Department of Paediatric Surgery, Chittagong Medical College, Chattogram, Bangladesh
| | - Tanzil Farhad
- Department of Paediatric Surgery, Chittagong Medical College, Chattogram, Bangladesh
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Abdul-Mumin A, Cotache-Condor C, Bimpong KA, Grimm A, Kpiniong MJ, Yakubu RC, Kwarteng PG, Fuseini YH, Smith ER. Decrease in Admissions and Change in the Diagnostic Landscape in a Newborn Care Unit in Northern Ghana During the COVID-19 Pandemic. Front Pediatr 2021; 9:642508. [PMID: 33842411 PMCID: PMC8027062 DOI: 10.3389/fped.2021.642508] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background: The coronavirus disease (COVID-19) has spread worldwide with an increasing number of patients, including pregnant women and neonates. This study aims to evaluate morbidity and mortality in the COVID-19 era compared to the preceding year in the Neonatal Intensive Care Unit (NICU) at Tamale Teaching Hospital, Ghana. Methods: This is a cross-sectional study carried out on neonates admitted to NICU between March 1st to August 31st, 2019 (pre-COVID-19 era) and March 1st to August 31st, 2020 (COVID-19 era). Multivariate logistic regression was performed to identify predictors of mortality for both periods. Results: From 2,901 neonates, 1,616 (56%) were admitted before, and 1,285 (44%) were admitted during the pandemic. Admissions decreased during the COVID-19 era, reaching their lowest point between June and August 2020. Compared to the previous year, during the COVID-19 era, admissions of patients born at TTH, delivered at home, and with infections decreased from 50 to 39%, 7 to 4%, and 22 to 13%, respectively. Referred status (OR = 3.3) and vaginal delivery (OR = 1.6) were associated with an increased likelihood of mortality. For low- birth weight neonates, admissions of patients born at TTH, with vaginal and home delivery decreased from 62 to 48%, 8 to 2%, and 59 to 52%, respectively. Neonatal infections and congenital anomalies decreased from 8 to 4%, 5 to 3%, respectively. The likelihood of mortality among referred patients increased by 50%. Conclusion: We observed a marked decrease in admissions and change in the diagnosis landscape and related mortality during the pandemic. Underlying challenges, including fear, financing, and health system capacity, might intensify delays and lack of access to newborn care in northern Ghana, leading to higher rates of lifelong disabilities and mortality. Immediate damage control measures, including an improved home-based continuum of care and equipping families to participate in the newborn care with complemented m-health approaches, are needed with urgency.
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Affiliation(s)
- Alhassan Abdul-Mumin
- Department of Pediatrics and Child Health, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
- Department of Pediatrics and Child Health, Tamale Teaching Hospital, Tamale, Ghana
| | - Cesia Cotache-Condor
- Department of Public Health, Robbins College of Health and Human Services, Baylor University, Waco, TX, United States
| | | | - Andie Grimm
- Department of Public Health, Robbins College of Health and Human Services, Baylor University, Waco, TX, United States
| | - Mary Joan Kpiniong
- Department of Pediatrics and Child Health, Tamale Teaching Hospital, Tamale, Ghana
| | - Rafiuk Cosmos Yakubu
- Department of Pediatrics and Child Health, Tamale Teaching Hospital, Tamale, Ghana
| | | | | | - Emily R. Smith
- Department of Public Health, Robbins College of Health and Human Services, Baylor University, Waco, TX, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
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Nazir A, Vervoort D, Reddy CL. From the first mile to the last: Challenges of the global surgical supply chain. Am J Surg 2021; 222:709-711. [PMID: 33775412 PMCID: PMC7983454 DOI: 10.1016/j.amjsurg.2021.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/06/2021] [Accepted: 03/15/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Anisa Nazir
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Foundation University Medical College, Islamabad, Pakistan
| | | | - Che L Reddy
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Division of Global Surgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
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35
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Penttilä PA, Van Gassen S, Panovska D, Vanderbeke L, Van Herck Y, Quintelier K, Emmaneel A, Filtjens J, Malengier-Devlies B, Ahmadzadeh K, Van Mol P, Borràs DM, Antoranz A, Bosisio FM, Wauters E, Martinod K, Matthys P, Saeys Y, Garg AD, Wauters J, De Smet F. High dimensional profiling identifies specific immune types along the recovery trajectories of critically ill COVID19 patients. Cell Mol Life Sci 2021; 78:3987-4002. [PMID: 33715015 PMCID: PMC7955698 DOI: 10.1007/s00018-021-03808-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/27/2021] [Accepted: 03/03/2021] [Indexed: 12/26/2022]
Abstract
The COVID-19 pandemic poses a major burden on healthcare and economic systems across the globe. Even though a majority of the population develops only minor symptoms upon SARS-CoV-2 infection, a significant number are hospitalized at intensive care units (ICU) requiring critical care. While insights into the early stages of the disease are rapidly expanding, the dynamic immunological processes occurring in critically ill patients throughout their recovery at ICU are far less understood. Here, we have analysed whole blood samples serially collected from 40 surviving COVID-19 patients throughout their recovery in ICU using high-dimensional cytometry by time-of-flight (CyTOF) and cytokine multiplexing. Based on the neutrophil-to-lymphocyte ratio (NLR), we defined four sequential immunotypes during recovery that correlated to various clinical parameters, including the level of respiratory support at concomitant sampling times. We identified classical monocytes as the first immune cell type to recover by restoration of HLA-DR-positivity and the reduction of immunosuppressive CD163 + monocytes, followed by the recovery of CD8 + and CD4 + T cell and non-classical monocyte populations. The identified immunotypes also correlated to aberrant cytokine and acute-phase reactant levels. Finally, integrative analysis of cytokines and immune cell profiles showed a shift from an initially dysregulated immune response to a more coordinated immunogenic interplay, highlighting the importance of longitudinal sampling to understand the pathophysiology underlying recovery from severe COVID-19.
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Affiliation(s)
- P A Penttilä
- KU Leuven Flow and Mass Cytometry Facility, KU Leuven, Leuven, Belgium
| | - S Van Gassen
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium.,Data Mining and Modeling for Biomedicine, VIB Center for Inflammation Research, Ghent, Belgium
| | - D Panovska
- Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - L Vanderbeke
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Y Van Herck
- Laboratory of Experimental Oncology, Department of Oncology,, KU Leuven, Leuven, Belgium
| | - K Quintelier
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium.,Data Mining and Modeling for Biomedicine, VIB Center for Inflammation Research, Ghent, Belgium
| | - A Emmaneel
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium.,Data Mining and Modeling for Biomedicine, VIB Center for Inflammation Research, Ghent, Belgium
| | - J Filtjens
- Laboratory of Immunobiology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - B Malengier-Devlies
- Laboratory of Immunobiology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - K Ahmadzadeh
- Laboratory of Immunobiology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - P Van Mol
- Laboratory of Translational Genetics, Department of Human Genetics, VIB-KU Leuven, Leuven, Belgium
| | - D M Borràs
- Laboratory for Cell Stress and Immunity (CSI), Department of Cellular and Molecular Medicine (CMM), KU Leuven, Leuven, Belgium
| | - A Antoranz
- Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - F M Bosisio
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - E Wauters
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - K Martinod
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - P Matthys
- Laboratory of Immunobiology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - Y Saeys
- Data Mining and Modeling for Biomedicine, VIB Center for Inflammation Research, Ghent, Belgium
| | - A D Garg
- Laboratory for Cell Stress and Immunity (CSI), Department of Cellular and Molecular Medicine (CMM), KU Leuven, Leuven, Belgium
| | - J Wauters
- Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - F De Smet
- Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
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Lopez-Lopez V, Morales A, García-Vazquez E, González M, Hernandez Q, Baroja-Mazo A, Palazon D, Tortosa JA, Rodriguez MA, Torregrosa NM, Kanyi W, Ndungu JK, Martinez JG, Rodriguez JM. Humanitarian Surgical Missions in Times of COVID-19: Recommendations to Safely Return to a Sub-Saharan Africa Low-Resource Setting. World J Surg 2021; 45:1297-1305. [PMID: 33611661 PMCID: PMC7896831 DOI: 10.1007/s00268-021-06001-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 12/03/2022]
Abstract
Background Since the declaration of the pandemic, humanitarian medicine has been discontinued. Until now, there have been no general recommendations on how humanitarian surgical missions should be organized. Methods Based on our experience in the field of humanitarian surgical missions to Sub-Saharan Africa, a panel of recommendations in times of COVID-19 was developed. The fields under study were as follows: (1) Planning of a multidisciplinary project; (2) Organization of the infrastructure; (3) Screening, management and treatment of SARS-COV-2; (4) Diagnostic tests for SARS-COV-2; (5) Surgical priorization and (6) Context of patients during health-care assistance. We applied a risk bias measurement to obtain a consensus among humanitarian health-care providers with experience in this field. Results A total of 94.36% of agreement were reached for the approval of the recommendations. Emergency surgery must be a priority, and elective surgery adapted. For emergency surgery, we established a priority level 1a (< 24 h) and 1b (< 72 h). For an elective procedure, according our American College of Surgeon adaptation score, process with more than 60 points should be reconsidered. Due to the low life expectancy in many African countries, we consider 45–50 years as age of risk. In case of SARS-COV-2 active infection or high clinical suspicion, the screening, management and treatment should be following the international guidelines adapted to duration of the stay, available infrastructure, size of the cooperation team and medical resources. Conclusions Humanitarian surgical mission in times of COVID-19 is a challenge that must extrapolate the established recommendations to the local cooperation environment. Supplementary Information The online version contains supplementary material available at (10.1007/s00268-021-06001-x).
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Affiliation(s)
- Víctor Lopez-Lopez
- Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Arrixaca, El Palmar, Murcia, Spain.
| | - Ana Morales
- Department of Neurology, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Elisa García-Vazquez
- Department of Internal Medicine, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Miguel González
- Department of Surgery, Reina Sofía University Hospital, Murcia, Spain
| | - Quiteria Hernandez
- Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Alberto Baroja-Mazo
- Digestive and Endocrine Surgery and Transplantation of Abdominal Organs, Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Dolores Palazon
- Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Jose A Tortosa
- Department of Anesthesiology, Molina Hospital, Murcia, Spain
| | - Maria A Rodriguez
- Department of Maxilofacial Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Nuria M Torregrosa
- Department of Surgery, Santa Lucía University Hospital, Cartagena, Murcia, España
| | | | - J K Ndungu
- Department of Surgery Maragua Hospital, Maragua, Kenia
| | - José Gil Martinez
- Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - José M Rodriguez
- Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Arrixaca, El Palmar, Murcia, Spain
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COVID-19 and Orthopaedic International Humanitarianism. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202102000-00005. [PMID: 33570868 PMCID: PMC7884298 DOI: 10.5435/jaaosglobal-d-20-00222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022]
Abstract
As the world continues to adjust to life with COVID-19, one topic that requires further thought and discussion is whether elective international medical volunteerism can continue, and, if so, what challenges will need to be addressed. During a pandemic, the medical community is attentive to controlling the disease outbreak, and most of the literature regarding physician involvement during a pandemic focuses primarily on physicians traveling to areas of need to help treat the disease. As a result, little has been written about medical volunteerism that focuses on medical treatment unrelated to the disease outbreak. In a world-wide pandemic, many factors are to be considered in determining whether, and when, a physician should travel to another region to provide care and training for medical issues not directly related to the pandemic. Leaders of humanitarian committees of orthopaedic surgery subspecialties engaged with one another and host orthopaedic surgeons and a sponsoring organization to provide thoughtful insight and expert opinion on the challenges faced and possible pathways to provide continued orthopaedic support around the globe. Although this discussion focuses on international orthopaedic care, these suggestions may have a much broader application to the international medical community as a whole.
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Dillman A, Zoratti MJ, Park JJH, Hsu G, Dron L, Smith G, Harari O, Rayner CR, Zannat NE, Gupta A, Mackay E, Arora P, Lee Z, Mills EJ. The Landscape of Emerging Randomized Clinical Trial Evidence for COVID-19 Disease Stages: A Systematic Review of Global Trial Registries. Infect Drug Resist 2020; 13:4577-4587. [PMID: 33376364 PMCID: PMC7764888 DOI: 10.2147/idr.s288399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/10/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose A multitude of randomized controlled trials (RCTs) have emerged in response to the novel coronavirus disease (COVID-19) pandemic. Understanding the distribution of trials among various settings is important to guide future research priorities and efforts. The purpose of this review was to describe the emerging evidence base of COVID-19 RCTs by stages of disease progression, from pre-exposure to hospitalization. Methods We collated trial data across international registries: ClinicalTrials.gov; International Standard Randomised Controlled Trial Number Registry; Chinese Clinical Trial Registry; Clinical Research Information Service; EU Clinical Trials Register; Iranian Registry of Clinical Trials; Japan Primary Registries Network; German Clinical Trials Register (up to 7 October 2020). Active COVID-19 RCTs in international registries were eligible for inclusion. We extracted trial status, intervention(s), control, sample size, and clinical context to generate descriptive frequencies, network diagram illustrations, and statistical analyses including odds ratios and the Mann–Whitney U-test. Results Our search identified 11503 clinical trials registered for COVID-19 and identified 2388 RCTs. After excluding 45 suspended RCTs and 480 trials with unclear or unreported disease stages, 1863 active RCTs were included and categorized into four broad disease stages: pre-exposure (n=107); post-exposure (n=208); outpatient treatment (n=266); hospitalization, including the intensive care unit (n=1376). Across all disease stages, most trials had two arms (n=1500/1863, 80.52%), most often included (hydroxy)chloroquine (n=271/1863, 14.55%) and were US-based (n=408/1863, 21.90%). US-based trials had lower odds of including (hydroxy)chloroquine than trials in other countries (OR: 0.63, 95% CI: 0.45–0.90) and similar odds of having two arms compared to other geographic regions (OR: 1.05, 95% CI: 0.80–1.38). Conclusion There is a marked difference in the number of trials across settings, with limited studies on non-hospitalized persons. Focus on pre- and post-exposure, and outpatients, is worthwhile as a means of reducing infections and lessening the health, social, and economic burden of COVID-19.
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Affiliation(s)
- Alison Dillman
- School of Public Health, Faculty of Medicine, Imperial College London, London, England
| | - Michael J Zoratti
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Jay J H Park
- Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Grace Hsu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Louis Dron
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Gerald Smith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Ofir Harari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Craig R Rayner
- Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Noor-E Zannat
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Alind Gupta
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Eric Mackay
- Department of Statistical Sciences, University of Toronto, Toronto, Canada
| | - Paul Arora
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Zelyn Lee
- Department of Physiology & Department of Neuroscience, University of Toronto, Toronto, Canada
| | - Edward J Mills
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Farhadieh RD, Yousef J. How can we optimise patient care in the era of COVID-19? J Wound Care 2020; 29:620-621. [PMID: 33175621 DOI: 10.12968/jowc.2020.29.11.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rostam D Farhadieh
- Plastic & Reconstructive Surgeon, Clinical Senior Lecturer, University of Sydney Medical School, Australian National University Medical School, Australia
| | - Justin Yousef
- Dip Surgical Anatomy, Master of Surgery (Surgical Sciences) Department of Plastic & Reconstructive Surgery, The Canberra Hospital, Australian Capital Territory, Australia
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40
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Abate SM, Mantefardo B, Basu B. Postoperative mortality among surgical patients with COVID-19: a systematic review and meta-analysis. Patient Saf Surg 2020; 14:37. [PMID: 33062056 PMCID: PMC7549731 DOI: 10.1186/s13037-020-00262-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic puts perioperative providers and staff at risk of viral exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during aerosol-generating procedures, particularly in asymptomatic carriers.However, the perioperative risk for adverse outcomes in SARS-CoV-2 infected patients remain uncertain and the topic of debate. The current study was designed to determine the postoperative mortality in COVID-19 patients based on a systematic review and meta-analysis of the global published peer-reviewed literature. METHODS A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019, to August15, 2020, without language restriction. All observational studies reporting the prevalence of mortality were included while case reports and reviews were excluded. The data from each study were extracted with two independent authors with a customized format excel sheet and the disagreements were resolved by the third author. The methodological quality of included studies was evaluated using a standardized critical appraisal Tool adapted from the Joanna Briggs Institute. RESULTS A total of 715 articles were identified from different databases and 45 articles were selected for evaluation after the successive screening. Twenty-three articles with 2947 participants were included. The meta-analysis revealed a very high global rate of postoperative mortality among COVID-19 patients of 20% (95% CI: 15 to 26) and a postoperative ICU admission rate of 15% (95% confidence interval (CI):10 to 21). CONCLUSION The unexpected high postoperative mortality rate in SARS-CoV-2 infected patients of 20% in the global literature mandates further scrutiny in assuring appropriate surgical indications and perioperative surgical safety measures in this vulnerable cohort of patients. REGISTRATION This systematic review and meta-analysis was registered in Prospero's international prospective register of systematic reviews (CRD42020203362) on August 10, 2020.
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, PO.BOX:419, Dilla, Ethiopia
| | - Bahiru Mantefardo
- Department of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences, University of Calcutta, Kolkata, India
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Qureshi MN, AlRajhi A. Challenge of COVID-19 crisis managed by emergency department of a big tertiary centre in Saudi Arabia. Int J Pediatr Adolesc Med 2020; 7:147-152. [PMID: 32868998 PMCID: PMC7448782 DOI: 10.1016/j.ijpam.2020.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/12/2020] [Indexed: 12/29/2022]
Abstract
Background The Kingdom of Saudi Arabia was hit hard by the COVID-19 pandemic wave. King Faisal Specialist Hospital and Research Centre, Riyadh dealt with the crisis in a proactive way with the emergency department (ED) playing a pivotal role. Patients and methods We searched the international literature to review the processes adopted by healthcare institutions and also used our experience of managing a previous epidemic to devise safe processes for our ED patients. Results The interventions done by ED, led to safer patient care, avoidance of unnecessary admissions, reduced risk of cross infection and enhanced staff safety. Conclusions Integrated ED processes helped streamline Covid-19 patients.
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Affiliation(s)
- Muhammad Nauman Qureshi
- Department of Emergency Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Abdulaziz AlRajhi
- Department of Emergency Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Affiliation(s)
- Amer Harky
- Department of Integrative Biology, Faculty of Life Sciences, University of Liverpool, Liverpool, UK.,Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Grace Poole
- St George's School of Medicine, University of London, London, UK
| | - Ariana Axiaq
- School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bilal H Kirmani
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Hamid H, Abid Z, Amir A, Rehman TU, Akram W, Mehboob T. Current burden on healthcare systems in low- and middle-income countries: recommendations for emergency care of COVID-19. DRUGS & THERAPY PERSPECTIVES 2020; 36:466-468. [PMID: 32837195 PMCID: PMC7415010 DOI: 10.1007/s40267-020-00766-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Husnain Hamid
- Faculty of Pharmacy, University of Central Punjab, Lahore, 54000 Pakistan
| | - Zubia Abid
- Faculty of Pharmacy, University of Central Punjab, Lahore, 54000 Pakistan
| | - Attiya Amir
- Faculty of Pharmacy, University of Central Punjab, Lahore, 54000 Pakistan
| | - Touseef Ur Rehman
- Faculty of Pharmacy, University of Central Punjab, Lahore, 54000 Pakistan
| | - Waqas Akram
- Faculty of Pharmacy, University of Central Punjab, Lahore, 54000 Pakistan
| | - Tooba Mehboob
- Faculty of Pharmacy, University of Central Punjab, Lahore, 54000 Pakistan
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Trivedy C. Is 2020 the year when primatologists should cancel fieldwork? A reply. Am J Primatol 2020; 82:e23173. [PMID: 32662075 PMCID: PMC7404521 DOI: 10.1002/ajp.23173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/26/2020] [Accepted: 07/04/2020] [Indexed: 11/23/2022]
Abstract
The aim of this article is to explore the impact of coronavirus disease (COVID-19) pandemic on primate-related conservation work. The withdrawal of primatologists and conservation staff from field research can lead to a number of detrimental effects not just on conservation but also on local communities in low- and middle-income countries. Inequalities in access to health and financial insecurities may be drivers for the illegal wildlife trade and the lack of tourism and research activity may allow poachers to work with greater ease. The paper also looks at how conservation organizations and research bodies should modify their field protocols by developing robust occupational health policies that will not only make field work safer but also support local staff as they are likely to face the greatest threats to their physical health, psychological health, and economic loss from COVID-19. By adopting a One Health approach that considers the complex interactions between human and primate health, researchers will be able to find new ways of working not only to protect primates but understand how they adapt to the COVID-19 pandemic.
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Affiliation(s)
- Chet Trivedy
- Department of Neuroscience and Trauma, Blizard Institute, Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
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Vervoort D, Ma X, Bookholane H, Nguyen TC. Conference cancelled: The equitable flip side of the academic surgery coin. Am J Surg 2020; 220:1539-1540. [PMID: 32711858 PMCID: PMC7367806 DOI: 10.1016/j.amjsurg.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Dominique Vervoort
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Xiya Ma
- Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada
| | - Hloni Bookholane
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; University of Cape Town, Cape Town, South Africa
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, United States
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Griffin MF. An Invited Commentary on: Emergency and essential surgical healthcare services during COVID-19 in low- and middle-income countries: A perspective. Int J Surg 2020; 79:265-266. [PMID: 32531307 PMCID: PMC7280817 DOI: 10.1016/j.ijsu.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 12/02/2022]
Affiliation(s)
- M F Griffin
- Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom; Division of Surgery & Interventional Science, University College London, London, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom.
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