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Zadey S, Rao S, Gondi I, Sheneman N, Patil C, Nayan A, Iyer H, Kumar AR, Prasad A, Finley GA, Prasad CRK, Chintamani, Sharma D, Ghosh D, Jesudian G, Fatima I, Pattisapu J, Ko JS, Bains L, Shah M, Alam MS, Hadigal N, Malhotra N, Wijesuriya N, Shukla P, Khan S, Pandya S, Khan T, Tenzin T, Hadiga VR, Peterson D. Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia. Front Public Health 2024; 12:1325922. [PMID: 38450144 PMCID: PMC10915281 DOI: 10.3389/fpubh.2024.1325922] [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: 10/22/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- GEMINI Research Center, Duke University School of Medicine, Durham, NC, United States
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
| | - Shirish Rao
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Isha Gondi
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Health and Human Sciences, Baylor University, Waco, TX, United States
| | - Natalie Sheneman
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
| | - Chaitrali Patil
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Biology and Statistics, George Washington University, Washington, DC, United States
| | - Anveshi Nayan
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Arti Raj Kumar
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Arun Prasad
- Indraprastha Apollo Hospital, New Delhi, India
| | - G. Allen Finley
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | | | - Chintamani
- Department of Surgery, Vardhman Mahavir Medical College Safdarjung Hospital, New Delhi, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Dhruva Ghosh
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Gnanaraj Jesudian
- Karunya Rural Community Hospital Karunya Nagar, Coimbatore, Tamil Nadu, India
- Association of Rural Surgeons of India, Wardha, India
- International Federation of Rural Surgeons, Ujjain, India
- Rural Surgery Innovations Private Limited, Dimapur, Nagaland, India
| | - Irum Fatima
- IRD Pakistan and the Global Surgery Foundation, Karachi, Sindh, Pakistan
| | - Jogi Pattisapu
- University of Central Florida College of Medicine, Orlando, FL, United States
| | - Justin Sangwook Ko
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, Maharashtra, India
| | - Mashal Shah
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammed Shadrul Alam
- Department of Pediatric Surgery, Mugda Medical College, Dhaka, Bangladesh
- American College of Surgeons: Bangladesh Chapter, Dhaka, Bangladesh
- Bangladesh Health Economist Forum, Dhaka, Bangladesh
- Association of Pediatric Surgeons of Bangladesh (APSB), DMCH, Dhaka, Bangladesh
| | - Narmada Hadigal
- Narmada Fertility Centre, Hyderabad, Telangana, India
- International Trauma Anesthesia and Critical Care Society, Stavander, Stavanger, Norway
| | - Naveen Malhotra
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nilmini Wijesuriya
- College of Anaesthesiologists and Intensivists of Sri Lanka, Rajagiriya, Sri Lanka
| | - Prateek Shukla
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sunil Pandya
- Department of Anaesthesia, Perioperative Medicine and Critical Care, AIG Hospitals, Hyderabad, Telangana, India
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tashi Tenzin
- Army Medical Services, Military Hospital, Thimphu, Bhutan
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Daniel Peterson
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
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Veerappan VR, Nagendra B, Thalluri P, Manda VS, Rao RN, Pattisapu JV. Reducing the neurotrauma burden in India- a national mobilization. World Neurosurg 2022; 165:106-113. [PMID: 35724880 DOI: 10.1016/j.wneu.2022.06.058] [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: 04/12/2022] [Revised: 06/11/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022]
Abstract
India has one of the highest TBI burdens due to RTA, with 60% of head injuries being attributable to RTA and more than 150000 lives being lost annually due to TBI. These numbers have prompted institutions and organizations at international, national and local levels to mobilize and address this burden through prevention, pre-hospital care and in hospital care. Academic institutions such as the AMC have run local campaigns promoting the wearing of helmets when riding two-wheelers. Prehospital care institutions such as GVK-EMRI have also made large strides nationally on delivering safe and timely care through novel and focused education to its EMTs, applying evidence-based practice to all facets of its work. These led to implementation of novel and innovative technological solutions faster and more efficient responses. National institutions such as the NSI and NTSI have been instrumental in promoting safety measures such as helmets and use of seat belts through social media videos, often using celebrities to disseminate the message. NSI have also focused on sharing best practices for the management of TBI through easy-to-use platforms such as YouTube. Institutions such as AAPI, NSI and NTSI have collaboratively developed TBI management guidelines that are specific to the Indian population (supported by AASAN). NGOs such as the IHIF and SLF have contributed to this movement by promoting awareness through campaigns and public education. While TBI remains a large burden in India, a mobilization, and coalesced efforts of such a scale holds promise tackling this burden.
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Affiliation(s)
| | - Babu Nagendra
- Department of Neurosurgery, Andhra Medical College/KG Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Prashanth Thalluri
- Department of Neurosurgery, Andhra Medical College/KG Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Vijaya Sekhara Manda
- Department of Neurosurgery, Andhra Medical College/KG Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Raja Narsing Rao
- Department of Anesthesiology, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jogi V Pattisapu
- Department of Paediatric Neurosurgery, University of Central Florida College of Medicine, Orlando, Florida, USA
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Azzopardi PS, Hennegan J, Prabhu SM, Dagva B, Balibago MM, Htin PPW, Swe ZY, Kennedy EC. Key recommendations to strengthen public-private partnership for adolescent health in resource constrained settings: Formative qualitative inquiry in Mongolia, Myanmar and the Philippines. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100242. [PMID: 34528016 PMCID: PMC8357832 DOI: 10.1016/j.lanwpc.2021.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/04/2021] [Accepted: 07/20/2021] [Indexed: 11/15/2022]
Abstract
Background Public health services can be inaccessible for adolescents. The private sector provides many services, but often in parallel to the public sector. This study aimed to understand current private sector engagement in adolescent health service delivery and develop recommendations to strengthen partnerships. Methods The study focussed on Mongolia, Myanmar and the Philippines. An initial participatory workshop in each country was followed by semi-structured key-informant interviews (32 in total) with public and private sector actors and adolescents to explore: perceptions of the public and private sectors, strengths and challenges, existing models of partnership, and insights for successful public-private partnership (PPP). Interview transcripts were analysed thematically, with findings and recommendations verified through a second workshop in Mongolia and the Philippines. Findings The private sector already plays a significant role in adolescent health care, and stakeholders reported a genuine willingness for partnership. Strengthened PPP was identified as necessary to improve service accessibility and quality for adolescents, unburden the public sector and introduce new technologies, with advantages for the private sector including improved access to training and resources, and an enhanced public image. Recommendations for strengthened PPP included the need to establish the foundations for partnership, clearly define roles and co-ordinate stakeholders, ensure capacity and sustainability, and monitor and evaluate efforts. Interpretation This is the first comprehensive study of public-private partnership for adolescent health in the Asia Pacific region. It identifies stakeholders are willing for stronger partnerships and the benefits this partnership will bring. We define eight key recommendations to enable this partnership across sectors.
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Affiliation(s)
- Peter S Azzopardi
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Adolescent health and wellbeing program, Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Department of Paediatrics, School of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne Australia
| | - Julie Hennegan
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne
| | - Shirley Mark Prabhu
- Adolescent Health, Mental Health and HIV Specialist, UNICEF Middle East and North Africa Regional Office, Amman, Jordan (formerly UNICEF East Asia and Pacific Regional Office)
| | | | - Mx Mar Balibago
- Adolescent health and HIV/AIDS Specialist, UNICEF Philippines
| | | | - Zay Yar Swe
- Myanmar country program, International Development Discipline, Burnet Institute, Yangon, Myanmar
| | - Elissa C Kennedy
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Xuefang L, Guihua W, Fengru M. The effect of early cognitive training and rehabilitation for patients with cognitive dysfunction in stroke. Int J Methods Psychiatr Res 2021; 30:e1882. [PMID: 34132448 PMCID: PMC8412226 DOI: 10.1002/mpr.1882] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/26/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This article explores the effects of early cognitive training and rehabilitation for patients with cognitive dysfunction in stroke. METHODS Stroke patients have cognitive dysfunction, and the incidence of cognitive dysfunction in stroke patients is six to nine times that of patients without stroke. This article selects 118 patients with stroke in our hospital from August 2017 to August 2019, 42 patients with stroke disorders randomly divided into two groups. Both groups of patients received conventional rehabilitation training, and the observation group performed motion observation therapy in virtual reality equipment based on conventional cognitive training. Analysis of time parameters related to rehabilitation training before and after treatment, and evaluation of standard health effects. RESULTS After 4 weeks of treatment, the cognitive training time parameters of the two groups were compared. The cognitive reaction time was shorter than that before treatment. After treatment, the scores of cognitive training and rehabilitation effects were significantly lower than those before treatment, and the two scores of the observation group were significantly lower than those of the control group. CONCLUSION Stroke patients receive early cognitive training with the support of computer-assisted technology to obtain good rehabilitation results.
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Affiliation(s)
- Liu Xuefang
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Wang Guihua
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Miao Fengru
- Department of Neurology, Aerospace Center Hospital, Beijing, China
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Abstract
BACKGROUND AND PURPOSE Current uses of emergency care are ambiguous and lack clarity, leading to imprecise use of the term in nursing practice. An explicit definition of emergency care is necessary to build and advance the field. An empirically driven definition of emergency care is lacking in the refereed literature. The purpose of this article was to present an in-depth inquiry of emergency care that contributes to the advancement of knowledge and to articulate a defensible definition of emergency care. METHODS This concept analysis was performed using the eight-step approach of Walker and Avant. A database search within the disciplines of nursing, medicine, education, and social sciences was conducted using the keyword emergency care. Databases of refereed literature were reviewed. Additional searches of nonrefereed literature, such as dictionaries and thesauri, were also examined. CONCLUSIONS Based on this concept analysis, the attributes of emergency care include the immediate evaluation and treatment of an unexpected illness or injury. Emergency care is not specific to a setting or location. Antecedents to emergency care consist of a precipitating event, recognition that medical help is required, and access to emergency care. A model, borderline, related, and contrary cases of emergency care are presented. IMPLICATIONS FOR PRACTICE The identification of emergency care attributes in this concept analysis contributes to the body of knowledge in emergency care and clarifies the ambiguity of the concept to prompt developments in practice, theory, and research with implications for emergency nurse practitioner clinical education, and scope of practice regulation.
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Ram K, VaraPrasad K, Krishna MK, Kannan N, Sundar V, Joseph M, Sinha VD, Shukla D, Gururaj G, Narayan RK, Pattisapu JV, Vavilala MS. Prehospital Factors Associated with Discharge Outcomes: Baseline Data from the Andhra Pradesh Traumatic Brain Injury Project. World Neurosurg X 2019; 2:100020. [PMID: 31218294 PMCID: PMC6580889 DOI: 10.1016/j.wnsx.2019.100020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/25/2019] [Indexed: 11/18/2022] Open
Abstract
Objective Strategies to improve traumatic brain injury (TBI) outcomes in India are ill defined. The objective of this study was to examine baseline prehospital (PH) factors associated with outcomes from the Andhra Pradesh Traumatic Brain Injury Project. Methods We conducted a prospective observational cohort study of adult patients with TBI admitted to the primary referral hospital. Modes of injury, prehospital care and transport, and factors associated with increased in-hospital mortality were evaluated. Poisson regression with robust error variance and adjusted attributable risk percent estimates determined factors associated with outcomes. Results A total of 447 adults (38% with mild TBI, 30% with moderate TBI, and 32% with severe TBI; 81% men) with isolated TBI (89%) from road traffic accidents (48.1%) or falls (46.5%) were enrolled. Of the patients, 45.7% were transported by ambulance, 61% had scalp/facial bleeding, 11% had respiratory distress, and 7% had cervical spine stabilization. Of these, 25.3% died and 34% had unfavorable outcomes. Among 335 direct admits, 45% traveled more than 50 km and nearly 20% traveled more than 100 km. Bleeding was associated with higher mortality (adjusted relative risk [aRR], 1.56; 95% confidence interval [CI], 1.05–2.31) and unfavorable outcome (aRR, 1.60; 95% CI, 1.18–2.17). Of the patients, 45 (31%) with severe TBI received PH airway management prior to definitive treatment, and respiratory distress was associated with unfavorable discharge outcomes (aRR, 1.23; 95% CI, 1.00–1.51). Conclusions Patients with TBI often received treatment far away from injury, bypassing closer hospitals. Scalp/facial bleeding was common and associated with unfavorable outcomes. Ambulance use was infrequent, and few patients received PH airway management, hemorrhage control, or cervical spine stabilization when needed.
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Key Words
- AR%, Adjusted attributable risk percent
- CI, Confidence interval
- CT, Computed tomography
- ED, Emergency department
- GCS, Glasgow Coma Scale
- ICU, Intensive care unit
- IQR, Interquartile range
- KGH, King George Hospital
- LOS, Length of stay
- OR, Operating room
- Outcomes
- PH, Prehospital
- Risk factors
- TBI, Traumatic brain injury
- Trauma
- Trauma system
- Traumatic brain injury
- Triage
- aRR, Adjusted relative risk
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Affiliation(s)
- Kodanda Ram
- Department of Neurosurgery, King George Hospital, Andhra Medical College Visakhapatnam, KGH, Opp KGH OP Gate, Maharani Peta, Visakhapatnam, Andhra Pradesh, India
| | - Kadali VaraPrasad
- Department of Neurosurgery, King George Hospital, Andhra Medical College Visakhapatnam, KGH, Opp KGH OP Gate, Maharani Peta, Visakhapatnam, Andhra Pradesh, India
| | - Murali K. Krishna
- Department of Neurosurgery, King George Hospital, Andhra Medical College Visakhapatnam, KGH, Opp KGH OP Gate, Maharani Peta, Visakhapatnam, Andhra Pradesh, India
| | - Nithya Kannan
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Venkataraman Sundar
- Department of Neurosurgery, Madras Medical College and Dr. Rai Memorial Medical Centre, Madras Medical College, Park Town, Chennai, Tamil Nadu, India
| | - Mathew Joseph
- Division of Neurocritical Care & Trauma, Department of Neurological Science, Christian Medical College, Vellore, Tamil Nadu, India
| | - Virendar D. Sinha
- Department of Neurosurgery, S.M.S Medical College Jaipur, Jawahar Lal Nehru Marg, Gangawal Park, Adarsh Nagar, Jaipur, Rajasthan, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Gopalakrishnan Gururaj
- Department of Epidemiology and Centre for Public Health, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Raj K. Narayan
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, Hempstead, New York, USA
| | - Jogi V. Pattisapu
- Department of Pediatric Neurosurgery, University of Central Florida College of Medicine, Orlando, Florida, USA
- To whom correspondence should be addressed: Jogi V. Pattisapu, M.D.
| | - Monica S. Vavilala
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
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