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Kakodkar P, Ragulojan M, Hayawi L, Tsampalieros A, Chee SS, Wu M, Makoshi Z, Singhal A, Steinbok P, Fallah A, Robison RA, Tu A. Global trends and decision-making in the management of arachnoid cysts. Childs Nerv Syst 2024; 40:749-758. [PMID: 37955715 DOI: 10.1007/s00381-023-06212-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE In pediatric patients, middle cranial fossa (MCF) arachnoid cysts are often discovered incidentally on imaging in asymptomatic patients during workup for other indications. This study aims to describe current management gestalt and threshold for surgical intervention by surveying an international cohort of neurosurgeons. METHODS A web-based survey was circulated via email list of attendants of the 2019 Canadian Pediatric Neurosurgery Study Group (CPNSG) and International Society of Pediatric Neurosurgery (ISPN) mailing list. The survey consisted of 8 clinical scenarios involving patients with MCF arachnoid cysts. Demographic variables of respondents and their decisions regarding management for each scenario were analyzed using R computing software. RESULTS A total of 107 respondents were included. Cysts in asymptomatic patients (92%), younger age at diagnosis (81%), and presence of a mild learning delay were predominantly managed non-surgically (80.7 ± 9.4%). Patients with cyst enlargement, headaches, new seizures, or hemorrhage were divided between non-surgical (55.8 ± 3.3%) and surgical (44.2 ± 2.9%) management. Patients with contralateral hemiparesis were treated predominantly surgically (67%). For both Galassi I and II, papilledema was favored as the primary indication for surgical intervention in 54% of patients. Those inclined to surgery (n = 17) were more likely to practice and train outside North America compared to those not pro-surgical (adjusted P = 0.092). CONCLUSION Incidental MCF arachnoid cysts in asymptomatic patients and younger age of diagnosis are predominantly managed non-surgically. Mild learning delay was not considered an indication to intervene. In contrast, radiological progression, hemorrhagic evolution, or non-focal neurological deficits lead to uncertainty in management, while focal neurological deficits and papilledema with MCF cysts were favored to be intervened surgically. Among the provider level factors, only location of training and practice trended towards a pro-surgery approach.
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Affiliation(s)
- Pramath Kakodkar
- Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Malavan Ragulojan
- Department of Neurosurgery, University of Ottawa, Ottawa, ON, Canada.
| | - Lamia Hayawi
- Clinical Research Unit, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Mia Wu
- School of Medicine, Queens University, Kingston, ON, Canada
| | - Ziyad Makoshi
- Department of Neurosurgery, El Paso Children's Hospital, El Paso, TX, USA
| | - Ashutosh Singhal
- Department of Neurosurgery, Children's Hospital of British Columbia, Vancouver, BC, Canada
| | - Paul Steinbok
- Department of Neurosurgery, Children's Hospital of British Columbia, Vancouver, BC, Canada
| | - Aria Fallah
- Department of Neurosurgery, University of California LA, Los Angeles, CA, USA
| | - Richard A Robison
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA
| | - Albert Tu
- Department of Neurosurgery, University of Ottawa, Ottawa, ON, Canada
- Department of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Hackett AM, Adereti CO, Walker AP, Ozobu I, Petit J, Waldron KR, Rolle M. The impact of limited access to electronic medical records on neurosurgical care within the CARICOM countries: A survey and scoping review. BRAIN & SPINE 2023; 3:101747. [PMID: 37383430 PMCID: PMC10293305 DOI: 10.1016/j.bas.2023.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 06/30/2023]
Abstract
Introduction Global access to electronic medical records (EMRs) continues to grow, however many countries including those within the Caribbean Community (CARICOM) lack access to this system. Minimal research investigating EMR use in this region exists. Research question How does limited EMR access impact neurosurgical care within the CARICOM? Materials and methods The Cochrane Library, EMBASE, Scopus, PubMed/MEDLINE databases, and grey literature were queried for studies addressing this issue within the CARICOM and low- and/or middle-income countries (LMICs). A comprehensive search for hospitals within the CARICOM was performed and responses to a survey inquiring about neurosurgery availability and EMR access within each facility were recorded. Results 26 out of 87 surveys were returned leading to a response rate of 29.0%. Among the survey respondents, 57.7% stated neurosurgery was provided at their facility; however, only 38.4% admitted to using an EMR system. Paper charting was the primary means of record keeping for the majority of the facilities (61.5%). The most frequently reported barriers stalling EMR implementation were financial limitations (73.6%) and poor internet access (26.3%). A total of 14 articles were included in the scoping review. Results from these studies suggest that limited EMR access contributes to suboptimal neurosurgical outcomes within the CARICOM and LMICs. Discussion and conclusion This paper is the first to address the impact that limited EMR has on neurosurgical outcomes in the CARICOM. The lack of research addressing this issue also highlights the need for ongoing efforts to increase research output focused on EMR accessibility and neurosurgical outcomes in these countries.
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Affiliation(s)
- Ashia M. Hackett
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | | | - Johnnie Petit
- Ross University School of Medicine, Miramar, FL, USA
| | | | - Myron Rolle
- Department of Neurosurgery, Massachusetts General Hospital, Harvard University, Boston, MA, USA
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Domenghino A, Walbert C, Birrer DL, Puhan MA, Clavien PA. Consensus recommendations on how to assess the quality of surgical interventions. Nat Med 2023; 29:811-822. [PMID: 37069361 DOI: 10.1038/s41591-023-02237-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/26/2023] [Indexed: 04/19/2023]
Abstract
Postoperative complications represent a major public health burden worldwide. Without standardized, clinically relevant and universally applied endpoints, the evaluation of surgical interventions remains ill-defined and inconsistent, opening the door for biased interpretations and hampering patient-centered health care delivery. We conducted a Jury-based consensus conference incorporating the perspectives of different stakeholders, who based their recommendations on the work of nine panels of experts. The recommendations cover the selection of postoperative outcomes from the perspective of patients and other stakeholders, comparison and interpretation of outcomes, consideration of cultural and demographic factors, and strategies to deal with unwarranted outcomes. With the recommendations developed exclusively by the Jury, we provide a framework for surgical outcome assessment and quality improvement after medical interventions, that integrates the main stakeholders' perspectives.
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Affiliation(s)
- Anja Domenghino
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | | | - Dominique Lisa Birrer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland.
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
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Khalid MU, Mac A, Biderman M, Errett L, Sriharan A. Partnering to build surgical capacity in low-resource settings: a qualitative study of Canadian global surgeons. BMJ Open 2023; 13:e070148. [PMID: 36948558 PMCID: PMC10040043 DOI: 10.1136/bmjopen-2022-070148] [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: 03/24/2023] Open
Abstract
OBJECTIVES This qualitative study aimed to explore the perspectives of Canadian global surgeons with experience developing surgical education partnerships with low- and middle-income countries (LMICs) for the purpose of identifying factors for success. DESIGN A purposive sample of leaders from global surgery programmes at Canadian Faculties of Medicine participated in virtual semi-structured interviews. A six-phase thematic analysis was performed using a constructivist lens on verbatim transcripts by three independent researchers. Key factors for success were thematically collated with constant comparison and inter-investigator triangulation in NVivo software until theoretical saturation was reached. PARTICIPANTS Fifteen surgeons, representing 11 subspecialties at 6 Canadian academic institutions and a combined experience across 6 continents, were interviewed between January and June 2022. RESULTS Four facilitators for success of global surgery training programmes were identified, with a strong undertone of relationship-building permeating all subthemes: (1) facilitative skill sets and infrastructure, (2) longitudinal engagement, (3) local ownership and (4) interpersonal humility. Participants defined facilitative skill sets to include demonstrated surgical competence and facilitative infrastructure to include pre-existing local networks, language congruency, sustainable funding and support from external organisations. They perceived longitudinal engagement as spanning multiple trips, enabled by strong personal motivation and arrangements at their home institutions. Ownership of projects by local champions, including in research output, was noted as key to preventing brain drain and catalysing a ripple effect of surgical trainees. Finally, interviewees emphasised interpersonal humility as being crucial to decolonising the institution of global surgery with cultural competence, reflexivity and sustainability. CONCLUSIONS The interviewed surgeons perceived strong cross-cultural relationships as fundamental to all other dimensions of success when working in low-resource capacity-building. While this study presents a comprehensive Canadian perspective informed by high-profile leadership in global surgery, a parallel study highlighting LMIC-partners' perspectives will be critical to a more complete understanding of programme success.
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Affiliation(s)
- Muhammad Uzair Khalid
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Mac
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maya Biderman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lee Errett
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Abi Sriharan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Ukachukwu AEK, Seas A, Petitt Z, Dai KZ, Shlobin NA, Khalafallah AM, Patel DN, Rippeon E, von Isenburg M, Haglund MM, Fuller AT. Assessing the Success and Sustainability of Global Neurosurgery Collaborations: Systematic Review and Adaptation of the Framework for Assessment of InteRNational Surgical Success Criteria. World Neurosurg 2022; 167:111-121. [PMID: 36058483 DOI: 10.1016/j.wneu.2022.08.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The high unmet neurosurgical burden in low- and middle-income countries has necessitated multiple global neurosurgical collaborations. We identified these collaborations and their peer-reviewed journal publications and evaluated them using a modified version of the Framework for Assessment of InteRNational Surgical Success (FAIRNeSS). METHODS A systematic literature review yielded 265 articles describing neurosurgery-focused collaborations. A subset of 101 papers from 17 collaborations were evaluated with the modified FAIRNeSS criteria. Analysis of trends was performed for both individual articles and collaborations. RESULTS Most of the articles were general reviews (64), and most focused on clinical research (115). The leading collaboration focus was workforce and infrastructure development (45%). Composite FAIRNeSS scores ranged from 7/34 to 30/34. Average FAIRNeSS scores for individual articles ranged from 0.25 to 26.75, while collaboration-wide FAIRNeSS score averages ranged from 5.25 to 20.04. There was significant variability within each subset of FAIRNeSS indicators (P value <0.001). Short-term goals had higher scores than medium- and long-term goals (P value <0.001). Collaboration composite scores correlated with the number of papers published (R2 = 0.400, P = 0.007) but not with the number of years active (R2 = 0.072, P = 0.3). Finally, the overall agreement between reviewers was 53.5%, and the overall correlation was 38.5%. CONCLUSIONS Global neurosurgery has no established metrics for evaluating collaborations; therefore, we adapted the FAIRNeSS criteria to do so. The criteria may not be well suited for measuring the success and sustainability of global neurosurgery collaborations, creating a need to develop a more applicable alternate set of metrics.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA
| | - Andreas Seas
- Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Zoey Petitt
- Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Duke Global Health Institute, Durham, North Carolina, USA
| | - Kathy Z Dai
- Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Duke Global Health Institute, Durham, North Carolina, USA
| | - Nathan A Shlobin
- Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adham M Khalafallah
- Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Dev N Patel
- Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA; Aureus University School of Medicine, Oranjestad, Aruba; NYU Langone Health, New York, New York, USA
| | - Elena Rippeon
- Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Megan von Isenburg
- Duke University Medical Center Library & Archives, Durham, North Carolina, USA
| | - Michael M Haglund
- Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Duke Global Health Institute, Durham, North Carolina, USA
| | - Anthony T Fuller
- Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Duke Global Health Institute, Durham, North Carolina, USA.
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6
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Awad AK, Rais MA, Ahmed A. The beat heard around the world: Making the case for global cardiac surgery. J Card Surg 2022; 37:3958-3960. [PMID: 36069154 DOI: 10.1111/jocs.16919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohammed A Rais
- Faculty of Medicine, University of Algiers, Alger Ctre, Algeria
| | - Adham Ahmed
- City University of New York School of Medicine, New York, New York, USA
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7
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Global outcomes, surgical teams and COVID-19 pandemic: Will the same objectives of global surgery persist? Ann Med Surg (Lond) 2021; 71:103002. [PMID: 34745606 PMCID: PMC8556179 DOI: 10.1016/j.amsu.2021.103002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023] Open
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8
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Shlobin NA, Kanmounye US, Ozair A, de Koning R, Zolo Y, Zivkovic I, Niquen-Jimenez M, Affana CK, Jogo L, Abongha GB, Garba DL, Rosseau G. Educating the Next Generation of Global Neurosurgeons: Competencies, Skills, and Resources for Medical Students Interested in Global Neurosurgery. World Neurosurg 2021; 155:150-159. [PMID: 34464771 DOI: 10.1016/j.wneu.2021.08.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Global neurosurgery operates at the intersection of neurosurgery and public health. Although most global neurosurgery initiatives have targeted neurosurgeons and trainees, medical students represent the future of global neurosurgery. METHODS A narrative review of the literature regarding research methodology, education, economics, health policy, health advocacy, relevant to global neurosurgery was conducted. RESULTS We summarize pearls that all medical students interested in global neurosurgery should know. DISCUSSION To become effective agents of change within global neurosurgery, medical students must master competencies of motivation, organization, collaborativeness, dependability, flexibility, resilience, creative problem-solving, ethical thinking, cultural humility, and global awareness and gain knowledge and skills regarding research, education, policy making, and advocacy. Discussions with neurosurgeons and trainees, neurosurgery interest groups, conferences, university global neurosurgery initiatives, and student organizations represent opportunities for learning and becoming involved in global neurosurgery.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Foundation for International Education in Neurological Surgery; G4 Alliance, Chicago, Illinois, USA.
| | - Ulrick Sidney Kanmounye
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Foundation for International Education in Neurological Surgery; Research Department, Association of Future African Neurosurgeons, Cameroon; Department of Neurosurgery, University of Kinsasha Faculty of Medicine, Kinsasha, Democratic Republic of the Congo
| | - Ahmad Ozair
- Faculty of Medicine, King George's Medical University, Lucknow, India
| | | | - Yvan Zolo
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Department of Neurosurgery, University of Kinsasha Faculty of Medicine, Kinsasha, Democratic Republic of the Congo; Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Irena Zivkovic
- School of Medicine, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Milagros Niquen-Jimenez
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Facultad de Medicina Humana Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Leslie Jogo
- Faculty of Medicine and Biomedical Sciences, University of Ngaoundéré, Garoua, Cameroon
| | | | - Deen L Garba
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gail Rosseau
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Foundation for International Education in Neurological Surgery; G4 Alliance, Chicago, Illinois, USA; Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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9
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Grisman-Laverde JL, Becerra-Poveda DDC, Parra-Pinzón SL, Fernández-de la Rosa SE, Bolaño-Romero MP. A commentary on "nomogram of conditional survival probability of long-term Survival for Metastatic Colorectal Cancer: A Real-World Data Retrospective Cohort Study from SEER database" (Int J Surg 2021; 106013). Int J Surg 2021; 92:106039. [PMID: 34339881 DOI: 10.1016/j.ijsu.2021.106039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - María Paz Bolaño-Romero
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cra. 50 #24-120, Cartagena, Colombia.
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10
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A commentary on "Economic impact of surgery on households and individuals in low income countries: A systematic review" [Int. J. Surg. 90 (2021) 105956]. Int J Surg 2021; 91:105991. [PMID: 34118438 DOI: 10.1016/j.ijsu.2021.105991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 01/28/2023]
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11
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Rodríguez-Gutiérrez MM, Lozada-Martínez ID, Cabarcas-Sabbag PJ, Díaz-Rivera MC. A commentary on "Are we curing by cutting? A call for long-term follow up and outcomes research in global surgery interventions - Perspective" (Int J Surg 2021; 87:105885). Int J Surg 2021; 89:105945. [PMID: 33878490 DOI: 10.1016/j.ijsu.2021.105945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 01/23/2023]
Affiliation(s)
| | - Ivan David Lozada-Martínez
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cra. 50 #24-120, Cartagena, Colombia.
| | - Pedro Jose Cabarcas-Sabbag
- Group Prometeus and Biomedicine Applied to Clinical Sciences, School of Medicine, University of Cartagena, Cra. 50 #24-120, Cartagena, Colombia
| | - María Carolina Díaz-Rivera
- Semillero de Investigación en Ciencias Médicas y Quirúrgicas. Facultad de Medicina, Fundación Universitaria Autónoma de Las Américas, 660001, Pereira, Colombia
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12
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Veerappan VR, Jindal RM. Community participation in global surgery. BMJ Glob Health 2021; 6:e005044. [PMID: 33827792 PMCID: PMC8031061 DOI: 10.1136/bmjgh-2021-005044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Rahul M Jindal
- Department of Surgery, Uniformed Services University, Bethesda, Maryland, USA
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