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Alswang JM, Mbuguje EM, Chan SM, Ak M, Naif A, Rukundo I, Minja F, Newsome J, Ramalingam V, Laage Gaupp FM. Creating a Sustainable Foundation for IR Services and Training in Sub-Saharan Africa: 5-Year Update on the Road2IR Initiative. J Vasc Interv Radiol 2024; 35:1049-1056. [PMID: 38513756 DOI: 10.1016/j.jvir.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/14/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE To evaluate the growth and quality of an interventional radiology (IR) training model designed for resource-constrained settings and implemented in Tanzania as well as its overall potential to increase access to minimally invasive procedures across the region. MATERIALS AND METHODS IR training in Tanzania began in October 2018 through monthly deployment of visiting teaching teams for hands-on training combined with in-person and remote lectures. A competency-based 2-year Master of Science in IR curriculum was inaugurated at the nation's main teaching hospital in October 2019, with the first 2 classes graduating in 2021 and 2022. Procedural data, demographics, and clinical outcomes were collected and analyzed throughout the duration of this program. RESULTS From October 2018 to July 2022, 1,595 procedures were performed in Tanzania: 1,236 nonvascular and 359 vascular, all with local fellows as primary interventional radiologists. Of these, 97.2% were technically successful, 95.2% were without adverse events, and 28.9% were performed independently by Tanzanian fellows and faculty with no difference in adverse event and technical success rates (P = .63 and P = .90, respectively), irrespective of procedural class. Ten IR physicians graduated from this program during the study period, followed by another 3 per year going forward. Partner training programs in Uganda and Rwanda mirroring this model commenced in 2023 and 2024, respectively. CONCLUSIONS The reported training model offers a practical and effective solution to meet many of the challenges associated with the lack of access to IR in sub-Saharan Africa.
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Affiliation(s)
| | - Erick M Mbuguje
- Department of Radiology, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Shin Mei Chan
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Murat Ak
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Azza Naif
- Department of Radiology, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Ivan Rukundo
- Department of Radiology, Rwanda Military Hospital, Kigali, Rwanda
| | - Frank Minja
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Janice Newsome
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Vijay Ramalingam
- Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Fabian M Laage Gaupp
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
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Klazura G, Wong LY, Ribeiro LLPA, Kojo Anyomih TT, Ooi RYK, Berhane Fissha A, Alam SF, Daudu D, Nyalundja AD, Beltrano J, Patil PP, Wafford QE, Rapolti DI, Sullivan GA, Graf A, Veras P, Nico E, Sheth M, Shing SR, Mathur P, Langer M. Measurements of Impoverishing and Catastrophic Surgical Health Expenditures in Low- and Middle-Income Countries and Reduction Interventions in the Last 30 Years: A Systematic Review. J Surg Res 2024; 299:163-171. [PMID: 38759332 DOI: 10.1016/j.jss.2024.04.021] [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: 01/10/2024] [Revised: 03/14/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Approximately 33 million people suffer catastrophic health expenditure (CHE) from surgery and/or anesthesia costs. The aim of this systematic review is to evaluate catastrophic and impoverishing expenditure associated with surgery and anesthesia in low- and middle-income countries (LMICs). METHODS We performed a systematic review of all studies from 1990 to 2021 that reported CHE in LMICs for treatment of a condition requiring surgical intervention, including cesarean section, trauma care, and other surgery. RESULTS 77 studies met inclusion criteria. Tertiary facilities (23.4%) were the most frequently studied facility type. Only 11.7% of studies were conducted in exclusively rural health-care settings. Almost 60% of studies were retrospective in nature. The cost of procedures ranged widely, from $26 USD for a cesarean section in Mauritania in 2020 to $74,420 for a pancreaticoduodenectomy in India in 2018. GDP per capita had a narrower range from $315 USD in Malawi in 2019 to $9955 USD in Malaysia in 2015 (Median = $1605.50, interquartile range = $1208.74). 35 studies discussed interventions to reduce cost and catastrophic expenditure. Four of those studies stated that their intervention was not successful, 18 had an unknown or equivocal effect on cost and CHE, and 13 concluded that their intervention did help reduce cost and CHE. CONCLUSIONS CHE from surgery is a worldwide problem that most acutely affects vulnerable patients in LMICs. Existing efforts are insufficient to meet the true need for affordable surgical care unless assistance for ancillary costs is given to patients and families most at risk from CHE.
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Affiliation(s)
- Greg Klazura
- University of Illinois at Chicago, Chicago, Illinois
| | - Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford Hospital, Stanford, California.
| | | | | | | | - Aemon Berhane Fissha
- Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Syeda Fatema Alam
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Davina Daudu
- Faculty of Surgery, University of Western Australia, Nedlands, Western Australia, Australia
| | - Arsene Daniel Nyalundja
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, South Kivu, Democratic Republic of Congo
| | | | - Poorvaprabha P Patil
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Gwyneth A Sullivan
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Akua Graf
- University of Illinois at Chicago, Chicago, Illinois
| | - Perry Veras
- Loyola Stritch School of Medicine, Maywood, Illinois
| | - Elsa Nico
- University of Illinois at Chicago, Chicago, Illinois
| | - Monica Sheth
- Loyola Stritch School of Medicine, Oak Park, Illinois
| | - Samuel R Shing
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Priyanka Mathur
- Northwestern University Feinberg School of Medicine, Chicago Illinois
| | - Monica Langer
- Lurie Children's Hospital of Chicago, Chicago, Illinois
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Passos SC, de Jezus Castro SM, Stahlschmidt A, da Silva Neto PC, Irigon Pereira PJ, da Cunha Leal P, Lopes MB, Dos Reis Falcão LF, de Azevedo VLF, Lineburger EB, Mendes FF, Vilela RM, de Araújo Azi LMT, Antunes FD, Braz LG, Stefani LC. Development and validation of the Ex-Care BR model: a multicentre initiative for identifying Brazilian surgical patients at risk of 30-day in-hospital mortality. Br J Anaesth 2024; 133:125-134. [PMID: 38729814 DOI: 10.1016/j.bja.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Surgical risk stratification is crucial for enhancing perioperative assistance and allocating resources efficiently. However, existing models may not capture the complexity of surgical care in Brazil. Using data from various healthcare settings nationwide, we developed a new risk model for 30-day in-hospital mortality (the Ex-Care BR model). METHODS A retrospective cohort study was conducted in 10 hospitals from different geographic regions in Brazil. Data were analysed using multilevel logistic regression models. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), Brier score, and calibration plots. Derivation and validation cohorts were randomly assigned. RESULTS A total of 107,372 patients were included, and 30-day in-hospital mortality was 2.1% (n=2261). The final risk model comprised four predictors related to the patient and surgery (age, ASA physical status classification, surgical urgency, and surgical size), and the random effect related to hospitals. The model showed excellent discrimination (AUROC=0.93, 95% confidence interval [CI], 0.93-0.94), calibration, and overall performance (Brier score=0.017) in the derivation cohort (n=75,094). Similar results were observed in the validation cohort (n=32,278) (AUROC=0.93, 95% CI, 0.92-0.93). CONCLUSIONS The Ex-Care BR is the first model to consider regional and organisational peculiarities of the Brazilian surgical scene, in addition to patient and surgical factors. It is particularly useful for identifying high-risk surgical patients in situations demanding efficient allocation of limited resources. However, a thorough exploration of mortality variations among hospitals is essential for a comprehensive understanding of risk. CLINICAL TRIAL REGISTRATION NCT05796024.
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Affiliation(s)
- Sávio C Passos
- Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Anesthesiology and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Stela M de Jezus Castro
- Department of Statistics, Institute of Mathematics and Statistics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Adriene Stahlschmidt
- Anesthesiology and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Paulo C da Silva Neto
- Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | | | | | - Luiz F Dos Reis Falcão
- Department of Surgery, School of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | - Florentino F Mendes
- Department of Surgical Clinic, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Ramon M Vilela
- Department of Anesthesiology, Irmandade Santa Casa de Misericórdia Porto Alegre, Porto Alegre, Brazil
| | - Liana M T de Araújo Azi
- Department of Anesthesiology and Surgery, School of Medicine, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Fabrício D Antunes
- Department of Medicine, School of Medicine, Universidade Federal de Sergipe (UFS), Aracaju, Brazil
| | - Leandro G Braz
- Department of Surgical Specialties and Anesthesiology, School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Luciana C Stefani
- Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre, Brazil.
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Ma CY, Beck NA, Hockaday MZ, Niedziela CJ, Ritchie CA, Harris JA, Roudnitsky E, Guntaka PKR, Yeh SY, Middleton J, Norrlinger JY, Alvarez GA, Danquah SA, Yang S, Deoglas DK, Afshar S. The global distribution of oral and maxillofacial surgeons: a mixed-methods study. Int J Oral Maxillofac Surg 2024; 53:619-625. [PMID: 37840001 DOI: 10.1016/j.ijom.2023.09.002] [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: 03/22/2023] [Revised: 08/18/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023]
Abstract
Despite its role in treating the most dominant non-communicable diseases worldwide, the global workforce of oral and maxillofacial (OM) surgeons is not well-characterized. To address the current deficit in understanding of the global OM surgeon workforce and to elevate oral and maxillofacial surgery (OMS) in the global health discourse, we join other surgical specialties in evaluating global surgical capacity with a descriptive analysis of the distribution of OM surgeons worldwide. A mixed-methods study was implemented using a combination of literature review, in-country contacts, internet searches, and survey data. The survey was distributed globally from January to June 2022. Data regarding OM surgeon workforce estimates were obtained for 104 of 195 United Nations-recognized countries (53.3%). Among countries with available estimates, the median global workforce density was 0.518 OM surgeons per 100,000 population. Twenty-eight countries (26.9%) were reported to have two or fewer OM surgeons. The median OM surgeon workforce density for low-income countries was 0.015 surgeons per 100,000 population, compared to 1.087 surgeons per 100,000 population in high-income countries. low and middle-income countries countries have the least workforce density as well as the least data coverage. More work is needed to better understand the capacity of the global OM surgeon workforce and access to OMS care.
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Affiliation(s)
- C Y Ma
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - N A Beck
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - M Z Hockaday
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - C J Niedziela
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - C A Ritchie
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J A Harris
- Department of Oral and Maxillofacial Surgery, Jackson Memorial Hospital/University of Miami, Miami, Florida, USA
| | - E Roudnitsky
- Department of Oral and Maxillofacial Surgery, Rutgers University School of Dental Medicine, Newark, New Jersey, USA
| | - P K R Guntaka
- Division of Oral and Maxillofacial Surgery, Mount Sinai Health System, New York, USA
| | - S Y Yeh
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - J Middleton
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - J Y Norrlinger
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - G A Alvarez
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - S A Danquah
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - S Yang
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - D K Deoglas
- Oral and Maxillofacial Surgery Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - S Afshar
- Harvard School of Dental Medicine, Boston, Massachusetts, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, USA; Department of Plastic and Oral Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
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5
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Evans FM, Enright AC. Anesthesia Workforce Numbers: Only Part of the Story. Anesth Analg 2024; 139:1-3. [PMID: 38885394 DOI: 10.1213/ane.0000000000006950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Affiliation(s)
- Faye M Evans
- From the Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts
| | - Angela C Enright
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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6
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Law TJ, Lipnick MS, Morriss W, Gelb AW, Mellin-Olsen J, Filipescu D, Rowles J, Rod P, Khan F, Yazbeck P, Zoumenou E, Ibarra P, Ranatunga K, Bulamba F. The Global Anesthesia Workforce Survey: Updates and Trends in the Anesthesia Workforce. Anesth Analg 2024; 139:15-24. [PMID: 38470828 DOI: 10.1213/ane.0000000000006836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND There is a large global deficit of anesthesia providers. In 2016, the World Federation of Societies of Anaesthesiologists (WFSA) conducted a survey to count the number of anesthesia providers worldwide. Much work has taken place since then to strengthen the anesthesia health workforce. This study updates the global count of anesthesia providers. METHODS Between 2021 and 2023, an electronic survey was sent to national professional societies of physician anesthesia providers (PAPs), nurse anesthetists, and other nonphysician anesthesia providers (NPAPs). Data included number of providers and trainees, proportion of females, and limited intensive care unit (ICU) capacity data. Descriptive statistics were calculated by country, World Bank income group, and World Health Organization (WHO) region. Provider density is reported as the number of providers per 100,000 population. RESULTS Responses were obtained for 172 of 193 United Nations (UN) member countries. The global provider density was 8.8 (PAP 6.6 NPAP 2.3). Seventy-six countries had a PAP density <5, whereas 66 countries had a total provider density <5. PAP density increased everywhere except for high- and low-income countries and the African region. CONCLUSIONS The overall size of the global anesthesia workforce has increased over time, although some countries have experienced a decrease. Population growth and differences in which provider types that are counted can have an important impact on provider density. More work is needed to define appropriate metrics for measuring changes in density, to describe anesthesia cadres, and to improve workforce data collection processes. Effort to scale up anesthesia provider training must urgently continue.
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Affiliation(s)
- Tyler J Law
- From the Department of Anesthesia & Perioperative Care, University of California, San Francisco, California
- Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - Michael S Lipnick
- From the Department of Anesthesia & Perioperative Care, University of California, San Francisco, California
- Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - Wayne Morriss
- Department of Anaesthesia, University of Otago, Christchurch Hospital, Christchurch, New Zealand
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
| | - Adrian W Gelb
- From the Department of Anesthesia & Perioperative Care, University of California, San Francisco, California
- Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
- Department of Anesthesia, Intensive Care and Pain Management, Hôtel-Dieu University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Jannicke Mellin-Olsen
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anaesthesia, Baerum Hospital, Oslo, Norway
| | - Daniela Filipescu
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anaesthesiology & Intensive Care, Emergency Institute for Cardiovascular Disease, Bucharest, Romania
- Department of Anaesthesiology & Intensive Care, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Jackie Rowles
- School of Nurse Anesthesia, Texas Christian University, Fort Worth, Texas
- International Federation of Nurse Anesthetists, Mantes la Jolie, France
| | - Pascal Rod
- International Federation of Nurse Anesthetists, Mantes la Jolie, France
| | - Fauzia Khan
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Patrica Yazbeck
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia, Intensive Care and Pain Management, Hôtel-Dieu University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Eugene Zoumenou
- Department of Anesthesiology, Centre National Hospitalier Universitaire de Cotonou, Cotonou, Benin
| | - Pedro Ibarra
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesiology, Clinica Reina Sofia, Bogota, Colombia
| | - Kumudini Ranatunga
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Cardiothoracic Anesthesia & Intensive Care, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Fred Bulamba
- Department of Anaesthesia, Faculty of Health Sciences, Busitema University, Mbale, Uganda
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Lee RM, Rajaram R. Improving care in lung cancer surgery: a review of quality measures and evolving standards. Curr Opin Pulm Med 2024; 30:368-374. [PMID: 38587082 DOI: 10.1097/mcp.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW Lung cancer is the leading cause of cancer-related death in the United States. Pulmonary resection, in addition to perioperative systemic therapies, is a cornerstone of treatment for operable patients with early-stage and locoregional disease. In recent years, increased emphasis has been placed on surgical quality metrics: specific and evidence-based structural, process, and outcome measures that aim to decrease variation in lung cancer care and improve long term outcomes. These metrics can be divided into potential areas of intervention or improvement in the preoperative, intraoperative, and postoperative phases of care and form the basis of guidelines issued by organizations including the National Cancer Center Network (NCCN) and Society of Thoracic Surgeons (STS). This review focuses on established quality metrics associated with lung cancer surgery with an emphasis on the most recent research and guidelines. RECENT FINDINGS Over the past 18 months, quality metrics across the peri-operative care period were explored, including optimal invasive mediastinal staging preoperatively, the extent of intraoperative lymphadenectomy, surgical approaches related to minimally invasive resection, and enhanced recovery pathways that facilitate early discharge following pulmonary resection. SUMMARY Quality metrics in lung cancer surgery is an exciting and important area of research. Adherence to quality metrics has been shown to improve overall survival and guidelines supporting their use allows targeted quality improvement efforts at a local level to facilitate more consistent, less variable oncologic outcomes across centers.
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Affiliation(s)
- Rachel M Lee
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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8
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Ahmed A, Pandya R, Zajner C, Jin HJ, Daud A, Urbach DR. The Need for Health Policy Training for Surgeons. JOURNAL OF SURGICAL EDUCATION 2024; 81:889-892. [PMID: 38744644 DOI: 10.1016/j.jsurg.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/30/2024] [Accepted: 03/16/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Improvements in surgery at a systems level can be mediated by effective health policy. METHODS We reviewed three contemporary challenges in surgical care to understand the potential role of health policy. RESULTS The pandemic-related backlog, and international economic and logistical challenges to surgical care may be improved through policy change and advocacy by surgeons. CONCLUSIONS A surgeon-policy expert training pathway and professional role will ensure surgeons contribute meaningfully to health policy development.
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Affiliation(s)
- Abrar Ahmed
- Schulich School of Medicine, Western University, 1151 Richmond St, London, ON N6A 5C1; Reach Alliance, Munk school of Global Affairs & Public Policy, University of Toronto, 1 Devonshire Pl, Toronto, ON M5S 3K7
| | - Rudra Pandya
- Schulich School of Medicine, Western University, 1151 Richmond St, London, ON N6A 5C1
| | - Chris Zajner
- Schulich School of Medicine, Western University, 1151 Richmond St, London, ON N6A 5C1
| | - Helen Jingshu Jin
- Schulich School of Medicine, Western University, 1151 Richmond St, London, ON N6A 5C1
| | - Anser Daud
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor Toronto, ON M5S 3H2
| | - David R Urbach
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor Toronto, ON M5S 3H2; Head, Department of Surgery, Women's College Hospital, 76 Grenville St, Toronto ON M5S 1B2; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425 Toronto, ON M5T 3M6.
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9
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Politis GD, Drum ET, Habre W, Bosenberg AT. Global quality improvement programs: One size doesn't fit all. Paediatr Anaesth 2024. [PMID: 38935579 DOI: 10.1111/pan.14950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Affiliation(s)
- George D Politis
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Elizabeth T Drum
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Walid Habre
- Geneva Children's Hospital, Genève, Switzerland
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Virk A, King R, Heneise M, Aier L, Child C, Brown J, Jayne D, Ensor T. How ready is the health care system in Northeast India for surgical delivery? a mixed-methods study on surgical capacity and need. PLoS One 2024; 19:e0287941. [PMID: 38924079 PMCID: PMC11206862 DOI: 10.1371/journal.pone.0287941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Surgical services are scarce with persisting inequalities in access across populations and regions globally. As the world's most populous county, India's surgical need is high and delivery rates estimated to be sub-par to meet need. There is a dearth of evidence, particularly sub-regional data, on surgical provisioning which is needed to aid planning. AIM AND METHOD This mixed-methods study examines the state of surgical care in Northeast India, specifically health care system capacity and barriers to surgical delivery. It involved a facility-based census and semi-structured interviews with surgeons and patients across four states in the region. RESULTS Abdominal conditions constituted a large portion of the overall surgeries across public and private facilities in the region. Workloads varied among surgical providers across facilities. Task-shifting occurred, involving non-specialist nursing staff assisting doctors with surgical procedures or surgeons taking on anaesthetic tasks. Structural factors dis-incentivised facility-level investment in suitable infrastructure. Facility functionality was on average higher in private providers compared to public providers and private facilities offer a wider range of surgical procedures. Facilities in general had adequate laboratory testing capability, infrastructure and equipment. Public facilities often do not have surgeon available around the clock while both public and private facilities frequently lack adequate blood banking. Patients' care pathways were shaped by facility-level shortages as well as personal preferences influenced by cost and distance to facilities. DISCUSSION AND CONCLUSION Skewed workloads across facilities and regions indicate uneven surgical delivery, with potentially variable care quality and provider efficiency. The need for a more system-wide and inter-linked approach to referral coordination and human resource management is evident in the results. Existing task-shifting practices, along with incapacities induced by structural factors, signal the directions for possible policy action.
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Affiliation(s)
- Amrit Virk
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Michael Heneise
- Faculty of Humanities, Social Sciences and Teacher Education, Department of Archaeology, History and Religious Studies, UiT The Arctic University of Norway, Tromsø, Norway
| | | | | | - Julia Brown
- School of Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - David Jayne
- School of Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, United Kingdom
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Mishra S, Sannigrahi A, Ruidas S, Chatterjee S, Roy K, Misra D, Maity BK, Paul R, Ghosh CK, Saha KD, Bhaumik A, Chattopadhyay K. Conformational Switch of a Peptide Provides a Novel Strategy to Design Peptide Loaded Porous Organic Polymer for Pyroptosis Pathway Mediated Cancer Therapy. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024:e2402953. [PMID: 38923392 DOI: 10.1002/smll.202402953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/24/2024] [Indexed: 06/28/2024]
Abstract
While peptide-based drug development is extensively explored, this strategy has limitations due to rapid excretion from the body (or shorter half-life in the body) and vulnerability to protease-mediated degradation. To overcome these limitations, a novel strategy for the development of a peptide-based anticancer agent is introduced, utilizing the conformation switch property of a chameleon sequence stretch (PEP1) derived from a mycobacterium secretory protein, MPT63. The selected peptide is then loaded into a new porous organic polymer (PG-DFC-POP) synthesized using phloroglucinol and a cresol derivative via a condensation reaction to deliver the peptide selectively to cancer cells. Utilizing ensemble and single-molecule approaches, this peptide undergoes a transition from a disordered to an alpha-helical conformation, triggered by the acidic environment within cancer cells that is demonstrated. This adopted alpha-helical conformation resulted in the formation of proteolysis-resistant oligomers, which showed efficient membrane pore-forming activity selectively for negatively charged phospholipids accumulated in cancer cell membranes. The experimental results demonstrated that the peptide-loaded PG-DFC-POP-PEP1 exhibited significant cytotoxicity in cancer cells, leading to cell death through the Pyroptosis pathway, which is established by monitoring numerous associated events starting from lysosome membrane damage to GSDMD-induced cell membrane demolition. This novel conformational switch-based drug design strategy is believed to have great potential in endogenous environment-responsive cancer therapy and the development of future drug candidates to mitigate cancers.
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Affiliation(s)
- Snehasis Mishra
- Department of Cell, Developmental, & Integrative Biology, University of Alabama, Birmingham, AL, 35233, USA
| | - Achinta Sannigrahi
- Molecular genetics department, University of Texas Southwestern Medical center, Dallas, TX, 75390, USA
| | - Santu Ruidas
- School of Materials Sciences, Indian Association for the Cultivation of Science, Jadavpur, Kolkata, 700032, India
| | - Sujan Chatterjee
- NIPM and SoLs, University of Nevada Las Vegas, Nevada, NV, 89154, USA
| | - Kamalesh Roy
- School of Materials Science and Nanotechnology, Jadavpur University, Kolkata, 700032, India
| | - Deblina Misra
- Department of Biology, New Mexico State University, Las Cruces, NM, 88003, USA
| | - Barun Kumar Maity
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Rabindranath Paul
- Department of Chemical and Biomolecular Engineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
| | - Chandan Kumar Ghosh
- School of Materials Science and Nanotechnology, Jadavpur University, Kolkata, 700032, India
| | - Krishna Das Saha
- Cancer Biology and Inflammatory Disorder Division, CSIR-Indian Institute of Chemical Biology, Kolkata, 700032, India
| | - Asim Bhaumik
- School of Materials Sciences, Indian Association for the Cultivation of Science, Jadavpur, Kolkata, 700032, India
| | - Krishnananda Chattopadhyay
- Structural Biology and Bioinformatics Division, CSIR-Indian Institute of Chemical Biology, Kolkata, 700032, India
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Mulugeta H, Zemedkun A, Mergia G, Abate SM, Gebremariam M, Jemal B, Nenko G, Gebremichael G, Besha A, Aregu MB. Perioperative capacity and contextual challenges in teaching hospitals of southern Ethiopia: explanatory sequential mixed-methods research. Perioper Med (Lond) 2024; 13:61. [PMID: 38909267 PMCID: PMC11193207 DOI: 10.1186/s13741-024-00423-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 06/18/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Previous Ethiopian literature on surgical capacity and challenges has focused on quantitative investigations, lacking contextual understanding. This explanatory sequential mixed-methods research (MMR) aimed to assess perioperative capacity and contextual challenges at three teaching hospitals in southern Ethiopia. METHODS A quantitative survey assessed workforce, infrastructure, service delivery, financing, and information systems. The survey findings were explained by qualitative semi-structured interviews of twenty perioperative providers. Descriptive statistics were integrated with qualitative thematic analysis findings using the narrative waving approach. Key findings from both datasets were linked using a joint display table. RESULTS The survey revealed shortages in the specialist workforce (with a ratio of 0.58 per 100,000 population), surgical volume (at 115 surgeries per 100,000 population), equipment, supplies, financing, and perioperative data tracking. Hospitals' radiology services and blood products were only available 25-50% of the time, while anesthetic agents and essential laboratory services were often available 51-75% of the time. Perioperative management protocols were used rarely (1-25% of the time). Over 90% of patients lack health insurance coverage. Qualitative data also revealed scarcity of perioperative resources and equipment; unaffordable perioperative costs, lack of health insurance coverage, and unforeseen expenses; poor patient safety culture and communication barriers across the perioperative continuum of care; workforce shortages, job dissatisfaction, and concerns of competence; and weak national governance, and sociopolitical turmoil, and global market volatility exacerbating local challenges. These challenges are linked to risks in quality of care and patient safety, according to clinicians. CONCLUSION The study identifies deficiencies in the health system and sociopolitical landscape affecting safe surgery conduct. It highlights the need for comprehensive health system strengthening to expand workforce, upgrade facilities, improve safety culture, resilience, and leadership to ensure timely access to essential surgery. Exploring external factors, such as the impact of national governance and sociopolitical stability on reform efforts is also essential.
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Affiliation(s)
- Hailemariam Mulugeta
- Department of Anesthesiology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.
| | - Abebayehu Zemedkun
- Department of Anesthesiology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Getachew Mergia
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Semagn M Abate
- Department of Anesthesiology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Mintesnot Gebremariam
- Department of Surgery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Bedru Jemal
- Department of Anesthesiology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Getachew Nenko
- Department of Healthcare Leadership and Management, School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Genet Gebremichael
- Department of Nursing, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Aschalew Besha
- Department of Anesthesia and Critical Care, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Mekonnen B Aregu
- Department of Environmental Health, School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Daba AB, Beshah DT, Tekletsadik EA. Magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary public hospitals, West Oromia, Ethiopia, 2022. BMC Surg 2024; 24:193. [PMID: 38902650 PMCID: PMC11188532 DOI: 10.1186/s12893-024-02477-1] [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: 11/18/2023] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Laparotomy surgery, which involves making an incision in the abdominal cavity to treat serious abdominal disease and save the patient's life, causes significant deaths in both developed and developing countries, including Ethiopia. The number studies examining in-hospital mortality rates among individuals that undergone laparotomy surgery and associated risk factors is limited. OBJECTIVE To assess the magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary hospitals, West Oromia, Ethiopia, 2022. METHODS An institutional based retrospective cross-sectional study was conducted from January 1, 2017, to December 31, 2021. Data were collected using systematic random sampling and based on structured and pretested abstraction sheets from 548 medical records and patient register log. Data were checked for completeness and consistency, coded, imported using Epi-data version 4.6, cleaned and analyzed using SPSS version 25 software. Variables with p < 0.2 in the Bi-variable logistic regression analysis were included in the multivariate logistic regression analysis. The fit of the model was checked by the Hosmer‒Lemeshow test. Using the odds ratio adjusted to 95% CI and a p value of 0.05, statistical significance was declared. RESULTS A total of 512 patient charts were reviewed, and the response rate was 93.43%. The overall magnitude of in-hospital mortality was 7.42% [95% CI: 5.4-9.8]. American society of Anesthesiology physiological status greater than III [AOR = 7.64 (95% CI: 3.12-18.66)], systolic blood pressure less than 90 mmHg [AOR = 6.11 (95% CI: 1.98-18.80)], preoperative sepsis [AOR = 3.54 (95% CI: 1.53-8.19)], ICU admission [AOR = 4.75 (95% CI: 1.50-14.96)], and total hospital stay greater than 14 days [(AOR = 6.76 (95% CI: 2.50-18.26)] were significantly associated with mortality after laparotomy surgery. CONCUSSION In this study, overall in- hospital mortality was high. Early identification patient's American Society of Anesthesiologists physiological status and provision of early appropriate intervention, and pays special attention to patients admitted with low systolic blood pressure, preoperative sepsis, intensive care unit admission and prolonged hospital stay to improve patient outcomes after laparotomy surgery.
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Affiliation(s)
- Aliyi Benti Daba
- Institute of health science, Wallaga University, Nekemte, Ethiopia.
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Navi BB, Zhang C, Kaiser JH, Liao V, Cushman M, Kasner SE, Elkind MSV, Tagawa ST, Guntupalli SR, Gaudino MFL, Lee AYY, Khorana AA, Kamel H. Cancer and the risk of perioperative arterial ischaemic events. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:345-356. [PMID: 37757472 DOI: 10.1093/ehjqcco/qcad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND AND AIMS Most cancer patients require surgery for diagnosis and treatment. This study evaluated whether cancer is a risk factor for perioperative arterial ischaemic events. METHODS The primary cohort included patients registered in the National Surgical Quality Improvement Program (NSQIP) between 2006 and 2016. The secondary cohort included Healthcare Cost and Utilization Project (HCUP) claims data from 11 US states between 2016 and 2018. Study populations comprised patients who underwent inpatient (NSQIP, HCUP) or outpatient (NSQIP) surgery. Study exposures were disseminated cancer (NSQIP) and all cancers (HCUP). The primary outcome was a perioperative arterial ischaemic event, defined as myocardial infarction or stroke diagnosed within 30 days after surgery. RESULTS Among 5 609 675 NSQIP surgeries, 2.2% involved patients with disseminated cancer. The perioperative arterial ischaemic event rate was 0.96% among patients with disseminated cancer vs. 0.48% among patients without (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.90-2.13). In Cox analyses adjusting for demographics, functional status, comorbidities, surgical specialty, anesthesia type, and clinical factors, disseminated cancer remained associated with higher risk of perioperative arterial ischaemic events (HR, 1.37; 95% CI, 1.28-1.46). Among 1 341 658 surgical patients in the HCUP cohort, 11.8% had a diagnosis of cancer. A perioperative arterial ischaemic event was diagnosed in 0.74% of patients with cancer vs. 0.54% of patients without cancer (HR, 1.35; 95% CI, 1.27-1.43). In Cox analyses adjusted for demographics, insurance, comorbidities, and surgery type, cancer remained associated with higher risk of perioperative arterial ischaemic events (HR, 1.31; 95% CI, 1.21-1.42). CONCLUSION Cancer is an independent risk factor for perioperative arterial ischaemic events.
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Affiliation(s)
- Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Jed H Kaiser
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Vanessa Liao
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Mary Cushman
- Division of Hematology and Oncology, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT 05446, USA
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Scott T Tagawa
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora, CO 80045, USA
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York NY 10021, USA
| | - Agnes Y Y Lee
- Division of Hematology, Department of Medicine, University of British Columbia, BC Cancer, Vancouver, BC, Canada
| | - Alok A Khorana
- Department of Hematology and Oncology, Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY 10021, USA
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Schifino Wolmeister A, Hansen TG, Engelhardt T. Challenges of organizing pediatric anesthesia in low and middle-income countries. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024:844525. [PMID: 38906364 DOI: 10.1016/j.bjane.2024.844525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Affiliation(s)
- Anelise Schifino Wolmeister
- Montreal Children's Hospital, Department of Anesthesia, Montreal, Canada; Hospital de Clínicas de Porto Alegre, Departamento de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil.
| | - Tom G Hansen
- Akershus University Hospital, Department of Anesthesia & Intensive Care, Lørenskog, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Thomas Engelhardt
- Montreal Children's Hospital, Department of Anesthesia, Montreal, Canada
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Sukor N, Sunthornyothin S, Tran TV, Tarigan TJ, Mercado-Asis LB, Sum S, Aung MW, Yong AML, Tedjo T, Villa M, Khaing NEE, Azizan EA, Kang WH, Lim V, Teo AED, Zhang M, Tran H, Puar TH. Health Care Challenges in the Management of Primary Aldosteronism in Southeast Asia. J Clin Endocrinol Metab 2024; 109:1718-1725. [PMID: 38261997 PMCID: PMC11180499 DOI: 10.1210/clinem/dgae039] [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] [Received: 07/20/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 01/25/2024]
Abstract
CONTEXT While guidelines have been formulated for the management of primary aldosteronism (PA), following these recommendations may be challenging in developing countries with limited health care access. OBJECTIVE We aimed to assess the availability and affordability of health care resources for managing PA in the Association of Southeast Asian Nations (ASEAN) region, which includes low-middle-income countries. METHODS We instituted a questionnaire-based survey to specialists managing PA, assessing the availability and affordability of investigations and treatment. Population and income status data were taken from the national census and registries. RESULTS Nine ASEAN country members (48 respondents) participated. While screening with aldosterone-renin ratio is performed in all countries, confirmatory testing is routinely performed in only 6 countries due to lack of facilities and local assays, and cost constraint. Assays are locally available in only 4 countries, and some centers have a test turnaround time exceeding 3 weeks. In 7 countries (combined population of 442 million), adrenal vein sampling (AVS) is not routinely performed due to insufficient radiological facilities or trained personnel, and cost constraint. Most patients have access to adrenalectomy and medications. In 6 countries, the cost of AVS and adrenalectomy combined is more than 30% of its annual gross domestic product per capita. While most patients had access to spironolactone, it was not universally affordable. CONCLUSION Large populations currently do not have access to the health care resources required for the optimal management of PA. Greater efforts are required to improve health care access and affordability. Future guideline revisions for PA may need to consider these limitations.
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Affiliation(s)
- Norlela Sukor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur 56000, Malaysia
| | - Sarat Sunthornyothin
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Thang V Tran
- Department of Endocrinology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Tri Juli Tarigan
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | | | - Satha Sum
- Department of Internal Medicine, Calmette Hospital, Phnom Penh 12201, Cambodia
| | - Moe Wint Aung
- Department of Endocrinology, University of Medicine 1, Yangon General Hospital, Yangon 11131, Myanmar
| | - Alice M L Yong
- Department of Internal Medicine, R.I.P.A.S. Hospital, Bandar Seri Begawan BA1712, Brunei Darussalam
| | - Tania Tedjo
- Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro, Semarang, Jawa Tengah 50275, Indonesia
| | - Michael Villa
- Philippines Center for Diabetes, Thyroid and Endocrine Disorders, St. Luke's Medical Center, Taguig 1634, Philippines
| | - Nang Ei Ei Khaing
- Health Services Research, Changi General Hospital, Singapore 529889, Singapore
| | - Elena Aisha Azizan
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur 56000, Malaysia
| | - Waye Hann Kang
- Department of Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kuala Lumpur 53300, Malaysia
| | - Vivien Lim
- Gleneagles Medical Centre, Singapore 258500, Singapore
| | - Ada E D Teo
- Department of Medicine, Division of Endocrinology, National University Health System, Singapore 119228, Singapore
| | - Meifen Zhang
- Department of Endocrinology, Changi General Hospital, Singapore 529889, Singapore
| | - Hieu Tran
- Department of Endocrinology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Troy H Puar
- Department of Endocrinology, Changi General Hospital, Singapore 529889, Singapore
- Duke National University of Singapore (NUS) Medical School, Singapore 169857, Singapore
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McCulloch P, Martin J. IDEAL evaluation for global surgery innovation. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000297. [PMID: 38883695 PMCID: PMC11177697 DOI: 10.1136/bmjsit-2024-000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 06/18/2024] Open
Affiliation(s)
- Peter McCulloch
- Nuffield Department of Surgical Science, University of Oxford, Oxford, UK
| | - Janet Martin
- Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- MEDICI Centre, Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Bolton WS, Aruparayil NK, Cundill B, McCulloch P, Gnanaraj J, Bundu I, Culmer PR, Brown JM, Scott J, Jayne DG. No frugal innovation without frugal evaluation: the Global IDEAL Sub-Framework. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000248. [PMID: 38883696 PMCID: PMC11177672 DOI: 10.1136/bmjsit-2023-000248] [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: 11/09/2023] [Accepted: 03/28/2024] [Indexed: 06/18/2024] Open
Abstract
Objective The Global IDEAL Sub-Framework Study aimed to combine the intended effects of the 2009/2019 IDEAL (Idea, Development, Exploration, Assessment, Long-term study) Framework recommendations on evaluating surgical innovation with the vision outlined by the 2015 Lancet Commission on Global Surgery to provide recommendations for evaluating surgical innovation in low-resource environments. Design A mixture of methods including an online global survey and semistructured interviews (SSIs). Quantitative data were summarized with descriptive statistics and qualitative data were analyzed using the Framework Method. Participants Surgeons and surgical researchers from any country. Main outcome measures Findings were used to suggest the nature of adaptations to the IDEAL Framework to address the particular problems of evaluation in low-resource settings. Results The online survey yielded 66 responses representing experience from 40 countries, and nine individual SSIs were conducted. Most respondents (n=49; 74.2%) had experience evaluating surgical technologies across a range of life cycle stages. Innovation was most frequently adopted based on colleague recommendation or clinical evaluation in other countries. Four themes emerged, centered around: frugal innovation in technological development; evaluating the same technology/innovation in different contexts; additional methodologies important in evaluation of surgical innovation in low/middle-income countries; and support for low-income country researchers along the evaluation pathway. Conclusions The Global IDEAL Sub-Framework provides suggestions for modified IDEAL recommendations aimed at dealing with the special problems found in this setting. These will require validation in a stakeholder consensus forum, and qualitative assessment in pilot studies. From assisting researchers with identification of the correct evaluation stage, to providing context-specific recommendations relevant to the whole evaluation pathway, this process will aim to develop a comprehensive and applicable set of guidance that will benefit surgical innovation and patients globally.
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Affiliation(s)
- William S Bolton
- Leeds Institute of Medical Research, University of Leeds, School of Medicine, Leeds, UK
| | - Noel K Aruparayil
- Leeds Institute of Medical Research, University of Leeds, School of Medicine, Leeds, UK
| | - Bonnie Cundill
- Leeds Institute of Clinical Trials Research, University of Leeds, School of Medicine, Leeds, UK
| | - Peter McCulloch
- Nuffield Department of Surgical Science, University of Oxford, Oxford, UK
| | - Jesudian Gnanaraj
- Rural Surgery Innovations, Dimapur, Nagaland, India
- Rural Surgery Innovations Private Limited, Karunya Institute of Technology and Sciences, Coimbatore, India
| | | | - Peter R Culmer
- School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Julia M Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, School of Medicine, Leeds, UK
| | - Julian Scott
- Leeds Institute of Medical Research, University of Leeds, School of Medicine, Leeds, UK
| | - David G Jayne
- Leeds Institute of Medical Research, University of Leeds, School of Medicine, Leeds, UK
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Madhuri V, Stewart RJ, Lakhoo K. Developing and transferring a children's surgical training program from India to Africa a south-to-south global initiative. Pediatr Surg Int 2024; 40:155. [PMID: 38856770 DOI: 10.1007/s00383-024-05720-1] [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] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE The availability of children's surgical care in lower middle-income countries is lacking. The authors describe a hub and spoke global training initiative in children's surgery for adult teams from district hospitals (spokes) comprising general and orthopaedic surgeons, anaesthetists, and nurses and specialist children's surgical trainers from tertiary centres (hubs) in delivering the course. METHODS The training course developed in Vellore, trained several sets of district hospital adult teams and trainer teams in India. Six specialist children's surgical trainer teams were invited from African countries to the course delivered in Vellore, India. The aim was to train them to deliver the course in their countries. RESULTS Participants underwent a precourse 'train the trainer' program, observed and assessed the suitability of the district hospital training course. The program received positive feedback, government supported planning of similar courses in some of the countries and discussions in others. CONCLUSION The availability of children's surgical care is similarly limited in the Asian and African continent, and the regions have shared challenges of disease burden, lack of access, poverty, deficient infrastructure, and trained human resources. They would benefit from this 'South to South' collaboration to impart training skills and modules to the children's surgical trainers.
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Affiliation(s)
- Vrisha Madhuri
- Christian Medical College, Vellore, India.
- Amara Hospital, Tirupati, India.
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Maia ACDSA, Lima SOAS, Jural LA, Moreira DC, Maia LC, Tanaka OM, Pithon MM, Prado FO. Association between sex of the individual with untreated cleft lip and social judgement made by lay persons: A cross-sectional study. Orthod Craniofac Res 2024. [PMID: 38859693 DOI: 10.1111/ocr.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE To assess whether there is an association between an individual's sex and social judgements made by lay persons regarding untreated cleft lip. MATERIALS AND METHODS Lay individuals over 18 years old were recruited through an application to respond online to two questionnaires: a sociodemographic survey and the Brazilian Version of Lay Persons' Social Judgements about Cleft-lip Scale (B-LSojCleft-S). B-LSojCleft-S comprises 14 items evaluating social judgements made by laypersons concerning different types of untreated cleft lips in teenagers. The 14 items are linked to 8 images featuring untreated cleft lips and 1 image without a cleft (control). Higher scores represented more favourable social judgements. Independent samples t-test, paired, and multiple linear regression were conducted (P < 0.05). The study assessed judgements of untreated cleft lips in male and female adolescents using the B-LSojCleft-S. RESULTS The mean age of the 217 participants was 37.78 ± 12.39 years, predominantly women (72.7%), married (47.7%), with a monthly income below three minimum wages (35.6%) in the majority of cases. Significantly higher social judgement scores were observed in the control group (no cleft) compared to any type of cleft (P < 0.001), with similar scores obtained for the same types of clefts with female or male images (P > 0.05). The participant's sex is associated with social judgement scores (F [1, 214] = 6.318, P = 0.013; adjusted R2 = 0.024), with females making more favourable judgements than males (P < 0.05). CONCLUSIONS Individuals with cleft lips receive more negative social judgement scores, regardless of their own sex. Women make better social judgements than men.
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Affiliation(s)
| | | | - Lucas Alves Jural
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - David Costa Moreira
- Department of Health I, School of Dentistry, Southwest Bahia State University, Jequié, Bahia, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Orlando Motohiro Tanaka
- Graduate Dentistry Program in Orthodontics, School of Life Sciences, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Matheus Melo Pithon
- Department of Health I, School of Dentistry, Southwest Bahia State University, Jequié, Bahia, Brazil
| | - Fabio Ornellas Prado
- Department of Health I, School of Dentistry, Southwest Bahia State University, Jequié, Bahia, Brazil
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Pascual JSG, de Lotbiniere-Bassett M, Khu KJO, Starreveld YP, Lama S, Legaspi GD, Berger MS, Duffau H, Sutherland GR. Challenges and Opportunities in Awake Craniotomy for Brain Tumor Surgery in Low- and Lower-Middle-Income Countries: A Narrative Review and Perspective. World Neurosurg 2024; 189:118-126. [PMID: 38857864 DOI: 10.1016/j.wneu.2024.06.017] [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: 03/19/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Low-income countries (LICs) and lower-middle-income countries (LMICs) are presented with unique challenges and opportunities when performing awake craniotomy (AC) for brain tumors. These circumstances arise from factors that are financial, infrastructural, educational, personnel, and sociocultural in nature. METHODS We performed a systematic narrative review of series on AC for intra-axial brain tumors in LICs/LMICs using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, focusing on the challenges and opportunities in these settings. The PubMed, Scopus, and Web of Science databases were searched. RESULTS After initially identifying 74 studies, inclusion-exclusion criteria were applied, leaving a total of 14 studies included in the review. These involved 409 patients who underwent AC in LICs/LMICs. These series were from India, Ghana, Nigeria, Iran, Pakistan, Morocco, the Philippines, and Egypt. The most common pathology encountered were gliomas (10-70%). Most studies (11/14, 78.5%) reported on their technique of cortical-subcortical mapping. All reported on motor mapping and 8 of these performed language mapping. The most common outcomes reported were seizure and neurologic deficits, and longest follow-up was at 1 year. Challenges noted were lack of equipment and trained personnel, need for validated tests for the local setting, and sociocultural factors. Opportunities identified were volume for training, technique innovation, and international collaboration. CONCLUSIONS There are numerous challenges and opportunities that arise when performing AC in LICs/LMICs. A collaborative approach toward harnessing the opportunities, and seeking creative solutions to address the challenges, would provide an ideal mechanism toward advancing neurosurgical care and specialty worldwide.
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Affiliation(s)
- Juan Silvestre G Pascual
- Department of Clinical Neurosciences; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Madeleine de Lotbiniere-Bassett
- Department of Clinical Neurosciences; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Yves P Starreveld
- Department of Clinical Neurosciences; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sanju Lama
- Department of Clinical Neurosciences; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gerardo D Legaspi
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors, Institute of Functional Genomics, INSERM U1191, University of Montpellier, Montpellier, France
| | - Garnette R Sutherland
- Department of Clinical Neurosciences; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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22
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Liosatos K, Tobiano G, Gillespie BM. Patient participation in surgical wound care in acute care settings: An integrative review. Int J Nurs Stud 2024; 157:104839. [PMID: 38901124 DOI: 10.1016/j.ijnurstu.2024.104839] [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: 02/05/2024] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Surgical site infections can significantly impact postoperative recovery. Patient participation, which involves patients actively engaging in wound care, has been linked to improved healing and reduced wound complications. However, there is limited synthesis of the literature that explores the patient's role and participation in the context of surgical wound care. OBJECTIVE To explore patients' perceptions of how they participate in surgical wound care, within 30 days post-operation. DESIGN An integrative review guided by Whittemore and Knafl's methodology. This review was registered with PROSPERO (CRD42022363669). DATA SOURCES Searches were conducted in Medline (Ovid), CINAHL (Complete), and EMBASE (Elsevier) databases in October 2023, supplemented by forward and backward citation searching. REVIEW METHODS Based on a priori eligibility criteria, two authors independently screened articles to select relevant studies. The quality of the included research articles was critically appraised using the Mixed Methods Appraisal Tool. A descriptive and thematic synthesis was used to synthesise the findings. RESULTS Of the 4701 records screened for titles and abstracts, 25 studies using qualitative, quantitative, and mixed-methods designs were included. Three key themes were identified. In theme 1, 'I am healing: how my wound shapes me and my journey,' physical symptoms, psychological factors and previous experiences significantly influenced patients' engagement in wound care. Theme 2, 'Taking charge of my healing: my active engagement in wound care' described how patient participation in surgical wound care goes beyond clinical procedures and can include the use of technology and holistic self-care. Finally, theme 3, 'Navigating the path to recovery: How others shape my experience' showed that effective communication is crucial for promoting participation, yet issues like inadequate information can leave patients unprepared for wound management. CONCLUSIONS This review highlights opportunities to personalise and prioritise a patient-oriented approach to surgical wound care. Clinicians and educators should adopt an individualised approach by tailoring patient participation based on patient factors (i.e. physical symptoms) and adopt patient-centred communication approaches. Researchers should focus on exploring approaches to self-care and technology, as these approaches may enhance patient participation in wound care.
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Affiliation(s)
- Kita Liosatos
- School of Nursing and Midwifery, Griffith Health, Gold Coast Campus, Queensland 4222, Australia.
| | - Georgia Tobiano
- NHMRC Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia; Gold Coast Hospital and Health Service, Queensland 4215, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith Health, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia; Gold Coast Hospital and Health Service, Queensland 4215, Australia
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Razak SS, West TR, Tunsiricharoengul S, Nair-Kanneganti A, Perez NA, Mazurek MH, Gal Z, Duvall JB, Rigney GH, Cerda IH, Morcos MM, Keay E, Hernández AS, Lawton MT, Nahed BV, Quiñones-Hinojosa A. International Hackathon as a Tool to Augment Education, Collaboration, and Innovation in Global Neurosurgery. Neurosurgery 2024:00006123-990000000-01182. [PMID: 38833559 DOI: 10.1227/neu.0000000000002991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/19/2023] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Health care providers' exposure to global surgical disparities is limited in current nursing and/or medical school curricula. For instance, global health is often associated with infectious diseases or maternal health without acknowledging the growing need for surgical care in low- and middle-income countries (LMICs). We propose an international virtual hackathon based on neurosurgical patient cases in under-resourced settings as an educational tool to bring awareness to global surgical disparities and develop relationships among trainees in different countries. METHODS Participants were recruited through email listservs, a social media campaign, and prize offerings. A 3-day virtual hackathon event was administered, which included workshops, mentorship, keynote panels, and pitch presentations to judges. Participants were presented with real patient cases and directed to solve a barrier to their care. Surveys assessed participants' backgrounds and event experience. The hackathon was executed through Zoom at Harvard Innovation Lab in Boston, MA, on March 25 to 27, 2022. Participants included medical students, with additional participants from business, engineering, or current health care workers. RESULTS Three hundred seven applications were submitted for 100 spots. Participants included medical students, physicians, nurses, engineers, entrepreneurs, and undergraduates representing 25 countries and 82 cities. Fifty-one participants previously met a neurosurgeon, while 39 previously met a global health expert, with no difference between LMIC and high-income countries' respondents. Teams spent an average of 2.75 hours working with mentors, and 88% of postevent respondents said the event was "very" or "extremely conducive" to networking. Projects fell into 4 categories: access, language barriers, education and training, and resources. The winning team, which was interdisciplinary and international, developed an application that analyzes patient anatomy while performing physical therapy to facilitate remote care and clinical decision-making. CONCLUSION An international virtual hackathon can be an educational tool to increase innovative ideas to address surgical disparities in LMICs and establish early collaborative relationships with medical trainees from different countries.
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Affiliation(s)
- Shahaan S Razak
- Harvard Medical School, Boston, Massachusetts,USA
- Mission Brain Foundation, Sausalito, California, USA
| | - Timothy R West
- Mission Brain Foundation, Sausalito, California, USA
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Aparna Nair-Kanneganti
- Harvard Medical School, Boston, Massachusetts,USA
- Mission Brain Foundation, Sausalito, California, USA
- Department of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Nicole A Perez
- Harvard Medical School, Boston, Massachusetts,USA
- Mission Brain Foundation, Sausalito, California, USA
| | | | - Zsombor Gal
- Harvard Medical School, Boston, Massachusetts,USA
- Mission Brain Foundation, Sausalito, California, USA
| | - Julia B Duvall
- Harvard Medical School, Boston, Massachusetts,USA
- Mission Brain Foundation, Sausalito, California, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Grant H Rigney
- Harvard Medical School, Boston, Massachusetts,USA
- Mission Brain Foundation, Sausalito, California, USA
| | - Ivo H Cerda
- Harvard Medical School, Boston, Massachusetts,USA
- Mission Brain Foundation, Sausalito, California, USA
| | - Mary M Morcos
- Harvard Medical School, Boston, Massachusetts,USA
- Mission Brain Foundation, Sausalito, California, USA
| | - Emma Keay
- Harvard Medical School, Boston, Massachusetts,USA
- Mission Brain Foundation, Sausalito, California, USA
| | | | - Michael T Lawton
- Mission Brain Foundation, Sausalito, California, USA
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Brian V Nahed
- Harvard Medical School, Boston, Massachusetts,USA
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alfredo Quiñones-Hinojosa
- Mission Brain Foundation, Sausalito, California, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
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24
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Bayuo J, Wong FKY, Yi W, Chung LYF. Adult Burn Survivors and Burn Care Staff Perceptions Regarding Transitioning From the Burn Unit: A Cross-Country Qualitative Study in Ghana and China. QUALITATIVE HEALTH RESEARCH 2024; 34:607-620. [PMID: 38205790 DOI: 10.1177/10497323231224378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Rehabilitative care for burn patients in developing countries is often wrought with several issues. Post-discharge support is equally challenging as there is often limited rehabilitative care as the burn survivors and their families transition. To inform practice, this study sought to explore the perspectives of adult burn survivors and burn care staff regarding transitioning from the burn unit and the development of a transitional rehabilitation programme. We employed interpretive description for this study. Semi-structured face-to-face interviews were conducted with adult burn survivors and burn care staff across two tertiary healthcare facilities in Lanzhou, Gansu Province of China, and Ghana. The thematic analytical approach was employed to analyse the data. Forty-six participants comprising 26 adult burn survivors and 20 burn care staff participated in this study. Two themes and five subthemes emerged from the data. Transitioning from the burn unit to the home was described as complex with varied biopsychosocial needs emerging. However, available support was not comprehensive to resolve these needs. Existing pre-discharge support is limited across both settings. Burn survivors expressed interest in taking on an active role in the rehabilitation process and being able to self-manage their post-burn symptoms following discharge. Transitional rehabilitative support should include an active follow-up system, ensure patient- and family-centred support, and offer a bundle of comprehensive rehabilitative services using locally available items which do not financially burden burn survivors and their families. In conclusion, transitioning from the burn unit is filled with varied health needs. Transitional rehabilitative care is required to bridge the pre-discharge and post-discharge periods.
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Affiliation(s)
- Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Wang Yi
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
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25
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Vervoort D, Afzal AM, Ruiz GZL, Mutema C, Wijeysundera HC, Ouzounian M, Fremes SE. Barriers to Access to Cardiac Surgery: Canadian Situation and Global Context. Can J Cardiol 2024; 40:1110-1122. [PMID: 37977275 DOI: 10.1016/j.cjca.2023.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Cardiovascular care spans primary, secondary, and tertiary prevention and care, whereby tertiary care is particularly prone to disparities in care. Challenges in access to care especially affect low- and middle-income countries (LMICs), however, multiple barriers also exist and persist across high-income countries. Canada is lauded for its universal health coverage but is faced with health care system challenges and substantial geographic barriers. Canada possesses 203 active cardiac surgeons, or 5.02 per million population, ranging from 3.70 per million in Newfoundland and Labrador to 7.48 in Nova Scotia. As such, Canada possesses fewer cardiac surgeons per million population than the average among high-income countries (7.15 per million), albeit more than the global average (1.64 per million) and far higher than the low-income country average (0.04 per million). In Canada, adult cardiac surgeons are active across 32 cardiac centres, representing 0.79 cardiac centres per million population, which is just above the global average (0.73 per million). In addition to centre and workforce variations, barriers to care exist in the form of waiting times, sociodemographic characteristics, insufficient virtual care infrastructure and electronic health record interoperability, and health care governance fragmentation. Meanwhile, Canada has highly favourable surgical outcomes, well established postacute cardiac care infrastructure, considerable spending on health, robust health administrative data, and effective health technology assessment agencies, which provides a foundation for continued improvements in care. In this narrative review, we describe successes and challenges surrounding access to cardiac surgery in Canada and globally.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Abdul Muqtader Afzal
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Gabriela Zamunaro Lopes Ruiz
- Division of Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Chileshe Mutema
- Division of Cardiothoracic Surgery, National Heart Hospital, Lusaka, Zambia
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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26
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Nthumba PM, Odhiambo M, Pusic A, Kamau S, Rohde C, Onyango O, Gosman A, Vyas R, Nthumba MN. The State of Surgical Research in Sub-Saharan Africa: An Urgent Call for Surgical Research Trainers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5903. [PMID: 38881962 PMCID: PMC11177832 DOI: 10.1097/gox.0000000000005903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/01/2024] [Indexed: 06/18/2024]
Abstract
Background Surgery in low- and middle-income countries (LMICs) is poorly developed because of years of neglect. Sustained research on global surgery led to its recognition as an indivisible and indispensable part of primary healthcare in 2015. However, this has had little visible effect on surgical ecosystems within LMICs, especially in sub-Saharan Africa (SSA). SSA surgical research systems strengthening, which includes skills transfer, with local priority setting driving the research agenda, is needed to propel global surgery into the future. Methods The authors performed a literature review of the state of surgical research within SSA and also report the initial efforts of two research training nonprofits to empower young African surgeons with research skills. Results Surgical research in SSA is disadvantaged even before it is birthed, facing monumental challenges at every stage of development, from research agenda determination to funding, study execution, and publication. Compared with a global output of 17.49 publications per 100,000 population, SSA produces 0.9 (P < 0.0001). The Surgeons in Humanitarian Alliance for Reconstructive, Research, and Education and Enabling Africa Clinical Health Research programs are involved in the longitudinal research mentorship of surgical residents within SSA; the improved quality of research and successful publications by participants suggest nascent steps in growing young surgical scientists. Conclusions In the absence of an existing surgical research infrastructure within LMICs, global surgery research trainers should link up and collaborate to help develop a surgical research community that will provide the local data required to help transform the SSA surgical ecosystem.
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Affiliation(s)
- Peter M Nthumba
- From the Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
- Department of Plastic Surgery, Baylor College of Medicine, Temple, Tex
- EACH Research, University of Nairobi, Nairobi, Kenya
| | - Moses Odhiambo
- From the Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- EACH Research, University of Nairobi, Nairobi, Kenya
| | - Andrea Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Stephen Kamau
- EACH Research, University of Nairobi, Nairobi, Kenya
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Christine Rohde
- Division of Plastic and Reconstructive Surgery, Columbia University Medical Center, New York, N.Y
| | - Onesmus Onyango
- EACH Research, University of Nairobi, Nairobi, Kenya
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Amanda Gosman
- Department of Plastic Surgery, UC San Diego School of Medicine, Calif
| | - Raj Vyas
- Department of Plastic Surgery, UC Irvine, School of Medicine, Irvine, Calif
| | - Michelle N Nthumba
- EACH Research, University of Nairobi, Nairobi, Kenya
- African Women's Studies Centre, University of Nairobi, Nairobi, Kenya
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27
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Elahi C. You Can and Should Specialize in Global Neurosurgery. World Neurosurg 2024; 186:155-157. [PMID: 38521217 DOI: 10.1016/j.wneu.2024.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Cyrus Elahi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
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Shlobin NA, Rosseau G. Opportunities and Considerations for the Incorporation of Artificial Intelligence into Global Neurosurgery: A Generative Pretrained Transformer Chatbot-Based Approach. World Neurosurg 2024; 186:e398-e412. [PMID: 38561032 DOI: 10.1016/j.wneu.2024.03.149] [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: 02/29/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Global neurosurgery is a public health focus in neurosurgery that seeks to ensure safe, timely, and affordable neurosurgical care to all individuals worldwide. Although investigators have begun to explore the promise of artificial intelligence (AI) for neurosurgery, its applicability to global neurosurgery has been largely hypothetical. We characterize opportunities and considerations for the incorporation of AI into global neurosurgery by synthesizing key themes yielded from a series of generative pretrained transformers (GPTs), discuss important limitations of GPTs and cautions when using AI in neurosurgery, and develop a framework for the equitable incorporation of AI into global neurosurgery. METHODS ChatGPT, Bing Chat/Copilot, You, Perplexity.ai, and Google Bard were queried with the prompt "How can AI be incorporated into global neurosurgery?" A layered ChatGPT-based thematic analysis was performed. The authors synthesized the results into opportunities and considerations for the incorporation of AI in global neurosurgery. A Pareto analysis was conducted to determine common themes. RESULTS Eight opportunities and 14 important considerations were synthesized. Six opportunities related to patient care, 1 to education, and another to public health planning. Four of the important considerations were deemed specific to global neurosurgery. The Pareto analysis included all 8 opportunities and 5 considerations. CONCLUSIONS AI may be incorporated into global neurosurgery in a variety of capacities requiring numerous considerations. The framework presented in this manuscript may facilitate the incorporation of AI into global neurosurgery initiatives while balancing contextual factors and the reality of limited resources.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA; Barrow Global, Barrow Neurological Institute, Phoenix, Arizona, USA
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Nepogodiev D, Ismail L, Meara JG, Roslani AC, Harrison EM, Bhangu A. Strengthening health systems through surgery. Lancet 2024; 403:2358-2360. [PMID: 38782001 DOI: 10.1016/s0140-6736(24)01031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Dmitri Nepogodiev
- NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, Institute of Translational Medicine, University of Birmingham, Birmingham B15 2TH, UK.
| | - Lawani Ismail
- Department of Visceral Surgery, University of Abomey-Calavi Faculty of Health Sciences, Cotonou, Benin
| | - John G Meara
- Program in Global Surgery and Social Change and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - April C Roslani
- Department of Surgery, University Malaya Medical Centre and Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ewen M Harrison
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Aneel Bhangu
- NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, Institute of Translational Medicine, University of Birmingham, Birmingham B15 2TH, UK
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de Cates C, Guéroult AM, Narantsolmon GE. Sustainable equipment donation in otolaryngology in low-resource settings. Curr Opin Otolaryngol Head Neck Surg 2024; 32:193-199. [PMID: 38547365 DOI: 10.1097/moo.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine current practices in surgical equipment donation to lower- and middle-income countries (LMICs) with a particular focus on otolaryngology-head and neck surgery (OHNS). This is designed as a pragmatic review to guide potential donor communities to implement sustainable OHNS equipment donation in LMICs. RECENT FINDINGS LMICs are increasingly reliant on international equipment donation. In terms of OHNS services, global OHNS have compiled a list of essential equipment for baseline care in LMICs. Especially in terms of audiology, OHNS equipment donation has the potential to have a significant impact on populational health. However, there is a scarcity of research on donated equipment in OHNS. A suggested blueprint for sustainable equipment donation follows these steps: establish partnerships, assess needs, source equipment, and follow-up and evaluate the intervention. Key further considerations for sustainability include remanufacturing and repurposing methods, maintenance, and contextual understanding. SUMMARY Sustainable equipment donation in otolaryngology is an important part of global health equity and healthcare delivery in low-resource settings. Despite the good intentions behind medical equipment donations, there are many challenges; donors and recipients should engage in collaborative, needs-based planning processes that result in long-term sustainability, local capacity building, and community participation.
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Affiliation(s)
- Catherine de Cates
- Department of Otolaryngology, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage
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31
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Awad AK, Ahmed A, Mohamed OA, Rais MA. A healthy heart for all: boosting cardiac surgery access in low-income countries. Int J Surg 2024; 110:3140-3142. [PMID: 38935826 PMCID: PMC10389569 DOI: 10.1097/js9.0000000000000000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/08/2022] [Indexed: 06/29/2024]
Affiliation(s)
- Ahmed K. Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Adham Ahmed
- CUNY School of Medicine, New York, New York, USA
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Shpata V, Lilaj K, Kodra N. Surgical Outcomes in Different Age Cohorts Undergoing Abdominal Surgery: A Retrospective Study. J Perianesth Nurs 2024; 39:403-408. [PMID: 37999690 DOI: 10.1016/j.jopan.2023.08.023] [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: 06/12/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE This study aimed to investigate and compare the surgical outcomes of younger and older patients after abdominal surgery and explore risk factors related to postoperative complications and in-hospital mortality in patients ≥65 years old. DESIGN A retrospective study on 540 adult patients who underwent abdominal surgery and stayed more than 48 hours in the hospital. METHODS The two groups of patients: younger than 65 years and ≥65 years old were compared related to postoperative complications, length of hospital stay, and mortality rates. The cohort of patients aged ≥65 years was selected to analyze risk factors for complications occurrence and in-hospital mortality. FINDINGS Patients ≥65 years old had poorer outcomes after abdominal surgery than younger patients. Pre-existence of comorbidities, American Society of Anesthesiologists physical status classification greater than two, emergency admission, and low preoperative serum albumin levels were risk factors for postoperative complications and mortality in elderly patients. Other risk factors for in-hospital mortality were the age ≥75 years, obesity, postoperative serum albumin level less than 30 g/L, presence of anemia before and after surgery, and occurrence of postoperative complications. Logistic regression revealed as independent risk factors for the postoperative complications the American Society of Anesthesiologists' physical status classification greater than two (odds ratio [OR]: 3.05, 95% confidence interval [CI]: 1.63-5.67, P = .0004) and preoperative serum albumin levels lower than 30 g/L (OR: 2.12, 95% CI: 1.08-4.17, P = .02), while for in-hospital postoperative mortality, independent risk factors were postoperative anemia (OR: 4.13; 95% CI: 1.22-13.97, P = .02) and obesity (OR: 7.65, 95% CI: 2.59-22.57, P = .0002). CONCLUSIONS Optimizing the preoperative conditions of older patients will improve their postoperative outcomes, especially for patients ≥75 years old, with obesity, comorbidities, anemia, severe nutritional risk, and emergency admission.
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Affiliation(s)
- Vjollca Shpata
- Faculty of Rehabilitation Sciences, University of Sports of Tirana, Tirana, Albania.
| | - Krenar Lilaj
- Faculty of Medicine, University of Medicine, Tirana, Albania; University Hospital Center of Tirana "Mother Theresa", Tirana, Albania
| | - Nertila Kodra
- University Hospital Center of Tirana "Mother Theresa", Tirana, Albania
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O'Neill RJ, Abdulrahman SA. Changing practices in septorhinoplasty: the Irish experience. Eur Arch Otorhinolaryngol 2024; 281:3031-3037. [PMID: 38356023 DOI: 10.1007/s00405-024-08479-2] [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: 12/23/2023] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Septorhinoplasty (SR) is one of the most complex surgical procedures of the head and neck. As an elective procedure aiming to enhance patient quality of life, it can be difficult to perform in single-payer healthcare systems due to capacity pressures from acute and oncological surgical demand. We aimed to review national trends in the practice of SR to inform future healthcare planning. METHODS This was a cross-sectional, population-based, longitudinal study of SR cases in Ireland's single-payer (public) healthcare system from 2005 to 2021. Time-series analysis using a linear regression model was performed to analyse trends by operation type, revision rates and length of stay. The impact of the COVID-19 pandemic and introduction of national surgical guidelines was analysed. RESULTS 1952 SR were performed. Annual mean cases declined in both real (r = - 0.76, p < 0.01) and relative (r = - 0.87, p < 0.01) terms by 31% and 43%, respectively. Ambulatory SR, while initially rarely performed, increased to account for 55% of cases performed. The mean hospital length of stay declined significantly (r = - 0.84, p < 0.01) by 44%. CONCLUSIONS SR increasingly struggles to find its place in Ireland's public healthcare system. New changes in SR practices including the rapid growth of ambulatory surgery and shorter lengths of hospital stay indicate positive responses to the mounting pressures faced by healthcare systems.
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Affiliation(s)
- Rory J O'Neill
- Department of Otorhinolaryngology, Tallaght University Hospital, Dublin, Ireland.
- Royal College of Surgeons, Dublin, Ireland.
| | - S A Abdulrahman
- Department of Otorhinolaryngology, Tallaght University Hospital, Dublin, Ireland
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Pogatzki-Zahn EM, Forget P. ICD-11: a major step forward towards the prediction and prevention of chronic postsurgical pain. Eur J Anaesthesiol 2024; 41:399-401. [PMID: 38690588 DOI: 10.1097/eja.0000000000001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Esther M Pogatzki-Zahn
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany (EMPZ), Pain AND Opioids after Surgery (PANDOS) European Society of Anaesthesiology and Intensive Care (ESAIC) Research Group, Brussels, Belgium (PF), The Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen (PF), Department of Anaesthesia, NHS Grampian, Aberdeen, UK (PF) and IMAGINE UR UM 103, Montpellier University, Anesthesia Critical Care, Emergency and Pain Medicine Division, Nîmes University Hospital, Nîmes, France (PF)
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Sharif K, de Santiago ER, David P, Afek A, Gralnek IM, Ben-Horin S, Lahat A. Ecogastroenterology: cultivating sustainable clinical excellence in an environmentally conscious landscape. Lancet Gastroenterol Hepatol 2024; 9:550-563. [PMID: 38554732 DOI: 10.1016/s2468-1253(23)00414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 04/02/2024]
Abstract
Gastrointestinal practices, especially endoscopy, have a substantial environmental impact, marked by notable greenhouse gas emissions and waste generation. As the world struggles with climate change, there emerges a pressing need to re-evaluate and reform the environmental footprint within gastrointestinal medicine. The challenge lies in finding a harmonious balance between ensuring clinical effectiveness and upholding environmental responsibility. This task involves recognising that the most significant reduction in the carbon footprint of endoscopy is achieved by avoiding unnecessary procedures; addressing the use of single-use endoscopes and accessories; and extending beyond the procedural suites to include clinics, virtual care, and conferences, among other aspects of gastrointestinal practice. The emerging digital realm in health care is crucial, given the potential environmental advantages of virtual gastroenterological care. Through an in-depth analysis, this review presents a path towards sustainable gastrointestinal practices, emphasising integrated strategies that prioritise both patient care and environmental stewardship.
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Affiliation(s)
- Kassem Sharif
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Enrique Rodriguez de Santiago
- Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERehd, ISCIII, Madrid, Spain
| | - Paula David
- Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel
| | - Arnon Afek
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Centre, Afula, Israel; Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Robinson SJ, Yin Mar Oo, Ljuhar D, McLeod E, Pacilli M, Nataraja RM. A guide to outcome evaluation of simulation-based education programmes in low and middle-income countries. ANZ J Surg 2024; 94:1011-1020. [PMID: 38553885 DOI: 10.1111/ans.18987] [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: 10/13/2023] [Revised: 02/16/2024] [Accepted: 03/13/2024] [Indexed: 06/19/2024]
Abstract
Evaluation is a vital part of any learning activity and is essential to optimize and improve educational programmes. It should be considered and prioritized prior to the implementation of any learning activity. However, comprehensive programme evaluation is rarely conducted, and there are numerous barriers to high-quality evaluation. This review provides a framework for conducting outcome evaluation of simulation-based education programmes in low and middle-income countries (LMICs). The basis of evaluation, including core ideas of theory, purpose and structure are outlined, followed by an examination of the levels and healthcare applications of the Kirkpatrick model of evaluation. Then, methods of conducting evaluation of simulation-based education in LMICs are discussed through the lens of a successful surgical simulation programme in Myanmar, a lower-middle-income country. The programme involved the evaluation of 11 courses over 4 years in Myanmar and demonstrated evaluation at the highest level of the Kirkpatrick model. Reviewing this programme provides a bridge between evaluation theory and practical implementation. A range of evaluation methods are outlined, including surveys, interviews, and clinical outcome measurement. The importance of a mixed-methods approach, enabling triangulation of quantitative and qualitative analysis, is highlighted, as are methods of analysing data, including statistical and thematic analysis. Finally, issues and challenges of conducting evaluation are considered, as well as strategies to overcome these barriers. Ultimately, this review informs readers about evaluation theory and methods, grounded in a practical application, to enable other educators in low-resource settings to evaluate their own activities.
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Affiliation(s)
- Samuel Ja Robinson
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Surgery and Monash Children's Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Yin Mar Oo
- Department of Paediatric Surgery, Yangon Children's Hospital, Yangon, Myanmar
| | - Damir Ljuhar
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Surgery and Monash Children's Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Elizabeth McLeod
- Department of Paediatric and Neonatal Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Maurizio Pacilli
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Surgery and Monash Children's Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Ramesh M Nataraja
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Surgery and Monash Children's Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
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Seguya A, Kabagenyi F, Tamir SO. 'Seeing is believing' - gender disparities in otolaryngology-head and neck surgery in Africa: a narrative review. Curr Opin Otolaryngol Head Neck Surg 2024; 32:188-192. [PMID: 38363234 DOI: 10.1097/moo.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE OF REVIEW Various factors affect otolaryngology - head and neck surgery (OHNS) services in low- and middle-income countries (LMICs); including inadequate infrastructure, limited academic positions, unfavorable hospital research policies, and traditional misconceptions about gender and surgery, among others. Although gender inequalities exist globally, they are particularly pronounced in LMICs, especially in Africa. RECENT FINDINGS A comparative narrative literature review for relevant manuscripts from January 1, 2017 to through January 10th, 2024, using PubMed, Embase and Google Scholar for articles from the United States/Canada and Africa was done. 195 relevant articles were from the United States/Canada, while only 5 were from Africa and only 1 manuscript was relevant to OHNS. The reviewed articles reported that gender disparities exist in medical training, authorship, and career advancement. We highlight possible solutions to some of these disparities to promote a more gender-diversified workforce in OHNS in Africa as well as all over the world. SUMMARY Additional studies on gender disparities in Africa, are needed. These studies will highlight need for inclusive policies, structured and accessible mentorship programs; through which these disparities can be highlighted and addressed. This will in the long run ensure sustainability of OHNS care in LMICs.
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Affiliation(s)
- Amina Seguya
- Department of Ear Nose and Throat, Mulago National Referral Hospital
- Global Otolaryngology-Head and Neck Surgery Initiative
| | - Fiona Kabagenyi
- Department of Ear Nose and Throat, Makerere University, Kampala, Uganda
- Global Otolaryngology-Head and Neck Surgery Initiative
| | - Sharon Ovnat Tamir
- Department of Otolaryngology/Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
- Global Otolaryngology-Head and Neck Surgery Initiative
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Burgess J, Meyers N, Rusin-Gomez D, Fox PM, Chang J. A New Model of Global Reconstructive Surgery Training With Reduced Carbon Footprint of Outreach. JAMA Surg 2024; 159:714-715. [PMID: 38506854 PMCID: PMC10955348 DOI: 10.1001/jamasurg.2023.8028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/09/2023] [Indexed: 03/21/2024]
Abstract
This economic evaluation compares carbon dioxide emissions from air transportation for surgical mission trips vs team training trips.
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Affiliation(s)
- Jordan Burgess
- Stanford University School of Medicine, Stanford, California
| | | | | | - Paige M. Fox
- Stanford University School of Medicine, Stanford, California
| | - James Chang
- Stanford University School of Medicine, Stanford, California
- ReSurge International, Sunnyvale, California
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Osebo C, Grushka J, Deckelbaum D, Razek T. Assessing Ethiopia's surgical capacity in light of global surgery 2030 initiatives: Is there progress in the past decade? Surg Open Sci 2024; 19:70-79. [PMID: 38595832 PMCID: PMC11002296 DOI: 10.1016/j.sopen.2024.03.015] [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: 01/31/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024] Open
Abstract
Background Surgical, anesthetic, and obstetric (SAO) care plays a crucial role in global health, recognized by the World Health Organization (WHO) and The Lancet Commission on Global Surgery (LCoGS). LCoGS outlines six indicators for integrating SAO services into a country's healthcare system through National Surgical Obstetrics and Anesthesia Plans (NSOAPs). In Ethiopia, surgical services progress lacks evaluation. This study assesses current Ethiopian surgical capacity using the LCoGS NSOAPs framework. Methods We conducted a narrative review of published literature on critical LCoGS NSAOPs metrics to extract information on key domains; service delivery, workforce, infrastructure, finance, and information management. Results Ethiopia's surgical services face challenges, including a low surgical volume (43) and a scarcity of specialist SOA physicians (0.5) per 100,000 population. Over half of Ethiopians reside outside the 2-hour radius of surgery-ready hospitals, and 98 % face surgery-related impoverished expenditures. Lacking the LCoGS-recommended SOA reporting systems, approximately 44 % of facilities exist for handling bellwether procedures. Despite the prevalence of essential surgeries, primary district hospitals have limited operative infrastructures, resulting in disparities in the surgical landscape. Most surgery-ready facilities are concentrated in cities, leaving Ethiopia's 80 % rural population with inadequate access to surgical care. Conclusion Ethiopia's surgical capacity falls below LCoGS NSOAPs recommendations, with challenges in infrastructure, personnel, and data retrieval. Critical measures include scaling up access, workforce, public insurance, and information management to enhance SAO services. Ethiopia pioneered in Sub-Saharan Africa by establishing Saving Lives Through Safe Surgery (SaLTS) in response to NSOAPs, but progress lags behind LCoGS recommendations.
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Affiliation(s)
- Cherinet Osebo
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
- Hargelle Hospital, Emergency Surgery and Obstetrics Unit, Hargelle, Ethiopia
| | - Jeremy Grushka
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| | - Dan Deckelbaum
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| | - Tarek Razek
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
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Stapleton E. Editorial: sustainability in global otolaryngology. Curr Opin Otolaryngol Head Neck Surg 2024; 32:186-187. [PMID: 38690639 DOI: 10.1097/moo.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Emma Stapleton
- Department of Otolaryngology, Manchester Royal Infirmary, Manchester, UK
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Braz LG, Braz JRC, Tiradentes TAA, Soares JVA, Corrente JE, Modolo NSP, do Nascimento Junior P, Braz MG. Global neonatal perioperative mortality: A systematic review and meta-analysis. J Clin Anesth 2024; 94:111407. [PMID: 38325248 DOI: 10.1016/j.jclinane.2024.111407] [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: 08/10/2023] [Revised: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE There are large differences in health care among countries. A higher perioperative mortality rate (POMR) in neonates than in older children and adults has been recognized worldwide. The aim of this study was to provide a systematic review of published 24-h and 30-day POMRs in neonates from 2011 to 2022 in countries with different Human Development Index (HDI) levels. DESIGN AND SETTING A systematic review with a meta-analysis of studies that reported 24-h and 30-day POMRs in neonates was performed. We searched the databases from January 2011 to July 30, 2022. MEASUREMENTS The POMRs (per 10,000 procedures under anesthesia) were analyzed according to country HDI. The HDI levels ranged from 0 to 1, representing the lowest and highest levels, respectively (very-high-HDI: ≥ 0.800, high-HDI: 0.700-0.799, medium-HDI: 0.550-0.699, and low-HDI: < 0.550). The magnitude of the POMRs by country HDI was studied using meta-analysis. MAIN RESULTS Eighteen studies from 45 countries were included. The 24-h (n = 96 deaths) and 30-day (n = 459 deaths) POMRs were analyzed from 33,729 anesthetic procedures. The odds ratios (ORs) of the 24-h POMR in low-HDI countries were higher than those in very-high- (OR 8.4, 95% CI 1.7-40.4; p = 0.008), high- (OR 7.3, 95% CI 2.2-24.4; p = 0.001) and medium-HDI countries (OR 7.7, 95% CI 3.1-18.7; p < 0.0001) but with no odds differences between very-high- and high-HDI countries (p = 0.879), very-high- and medium-HDI countries (p = 0.915) and high- and medium-HDI countries (p = 0.689). The odds of a 30-day POMR in low-HDI countries were higher than those in very-high-HDI countries (OR 6.9, 95% CI 1.9-24.6; p = 0.002) but not in high-HDI countries (OR 1.4, 95% CI 0.6-3.0; p = 0.396). CONCLUSIONS The review demonstrated very high global POMRs in a surgical population of neonates independent of the country HDI level. We identified differences in 24-h and 30-day POMRs between low-HDI countries and other countries with higher HDI levels.
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Affiliation(s)
- Leandro G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
| | - Jose Reinaldo C Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Teofilo Augusto A Tiradentes
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Joao Vitor A Soares
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Jose E Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Norma Sueli P Modolo
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Paulo do Nascimento Junior
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Mariana G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
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Asemu YM, Yigzaw T, Desta FA, Scheele F, van den Akker T. Does higher performance in a national licensing examination predict better quality of care? A longitudinal observational study of Ethiopian anesthetists. BMC Anesthesiol 2024; 24:188. [PMID: 38802780 PMCID: PMC11129401 DOI: 10.1186/s12871-024-02575-w] [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] [Received: 09/12/2023] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Ethiopia made a national licensing examination (NLE) for associate clinician anesthetists a requirement for entry into the practice workforce. However, there is limited empirical evidence on whether the NLE scores of associate clinicians predict the quality of health care they provide in low-income countries. This study aimed to assess the association between anesthetists' NLE scores and three selected quality of patient care indicators. METHODS A multicenter longitudinal observational study was conducted between January 8 and February 7, 2023, to collect quality of care (QoC) data on surgical patients attended by anesthetists (n = 56) who had taken the Ethiopian anesthetist NLE since 2019. The three QoC indicators were standards for safe anesthesia practice, critical incidents, and patient satisfaction. The medical records of 991 patients were reviewed to determine the standards for safe anesthesia practice and critical incidents. A total of 400 patients responded to the patient satisfaction survey. Multivariable regressions were employed to determine whether the anesthetist NLE score predicted QoC indicators. RESULTS The mean percentage of safe anesthesia practice standards met was 69.14%, and the mean satisfaction score was 85.22%. There were 1,120 critical incidents among 911 patients, with three out of five experiencing at least one. After controlling for patient, anesthetist, facility, and clinical care-related confounding variables, the NLE score predicted the occurrence of critical incidents. For every 1% point increase in the total NLE score, the odds of developing one or more critical incidents decreased by 18% (aOR = 0.82; 95% CI = 0.70 = 0.96; p = 0.016). No statistically significant associations existed between the other two QoC indicators and NLE scores. CONCLUSION The NLE score had an inverse relationship with the occurrence of critical incidents, supporting the validity of the examination in assessing graduates' ability to provide safe and effective care. The lack of an association with the other two QoC indicators requires further investigation. Our findings may help improve education quality and the impact of NLEs in Ethiopia and beyond.
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Affiliation(s)
- Yohannes Molla Asemu
- Health Workforce Improvement Program, Jhpiego, an affiliate of Johns Hopkins University, Ethiopia country office, Addis Ababa, Ethiopia.
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Tegbar Yigzaw
- Health Workforce Improvement Program, Jhpiego, an affiliate of Johns Hopkins University, Ethiopia country office, Addis Ababa, Ethiopia
| | - Firew Ayalew Desta
- Health Workforce Improvement Program, Jhpiego, an affiliate of Johns Hopkins University, Ethiopia country office, Addis Ababa, Ethiopia
| | - Fedde Scheele
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Obstetrics and Gynecology, OLVG Teaching Hospital, Amsterdam, the Netherlands
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands
| | - Thomas van den Akker
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
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Portela FSO, Rossetti CA, de Souza TF, Magnani AS, da Silva MFA, Portugal MFC, Teivelis MP, Wolosker N, Mendes CDA. Retrospective analysis of 1,203 cases of referral to a quaternary vascular surgery outpatient clinic within the Unified Health System, São Paulo, Brazil. EINSTEIN-SAO PAULO 2024; 22:eAO0676. [PMID: 38808797 PMCID: PMC11155721 DOI: 10.31744/einstein_journal/2024ao0676] [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: 08/16/2023] [Accepted: 11/27/2023] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Through a retrospective analysis of 1,203 cases of referral from primary healthcare units to a specialized quaternary vascular surgical service, the findings of this study revealed a high proportion of inappropriate referrals, which may represent a substantial subutilization of this highly complex service. Consequently, in this study, we aimed to evaluate 1,203 cases of referral to a quaternary vascular surgical service, in São Paulo, Brazil, over a 6-year period, to assess the appropriate need for referral; in addition to the prevalence of surgical indications. METHODS In this retrospective analysis, we reviewed the institutional records of participants referred from Basic Healthcare Units to a vascular surgical service inside the Brazilian Unified Health System, between May 2015 and December 2020. Demographic and clinical data were collected. The participants were stratified, as per the reason for referral to the vascular surgical service, previous imaging studies, and surgical treatment indications. Referral appropriateness and complementary examinations were evaluated for each disease cohort. Finally, the prevalence of cases requiring surgical treatment was defined as the outcome measure. RESULTS Of the 1,203 referrals evaluated, venous disease was the main reason for referral (53%), followed by peripheral arterial disease (19.4%). A considerable proportion of participants had been referred without complementary imaging or after a long duration of undergoing an examination. Referrals were regarded as inappropriate in 517 (43%) cases. Of these, 32 cases (6.2%) had been referred to the vascular surgical service, as the incorrect specialty. The percentage of referred participants who ultimately underwent surgical treatment was 39.92%. Carotid (18%) and peripheral arterial diseases (18.4%) were correlated with a lower prevalence of surgical treatments. CONCLUSION The rate of referral appropriateness to specialized vascular care from primary care settings was low. This may represent a subutilization of quaternary surgical services, with low rates of surgical treatment.
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Affiliation(s)
| | - Carlos Augusto Rossetti
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Thulio Fernandes de Souza
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Arthur Souza Magnani
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | - Marcelo Passos Teivelis
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Nelson Wolosker
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Cynthia de Almeida Mendes
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Bandyopadhyay S, Philipo GS, Bokhary ZM, Lakhoo K. A review of twenty-first century developments in paediatric surgery in Africa. Pediatr Surg Int 2024; 40:137. [PMID: 38780635 DOI: 10.1007/s00383-024-05718-9] [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] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
This review explores the significant advancements in paediatric surgery in Africa during the twenty-first century, with a particular focus on capacity-building, education, infrastructural development, and research. Historically, paediatric surgery has been an overlooked sector, especially in low-and-middle-income countries in Africa. However, recent years have seen considerable progress. Collaborative efforts such as the Global Initiative for Children's Surgery, and the formation of the Pan African Paediatric Surgery Association, the College of Surgeons of East, Central and Southern Africa and the West African College of Surgeons have facilitated knowledge sharing, collaboration, and advocacy for enhancing surgical standards. Local training programmes, including Master of Medicine programmes and fellowships, have been instrumental in building a skilled workforce. These initiatives have been complemented by infrastructural developments through non-governmental organisations like Kids Operating Room, which have expanded access to paediatric surgical care. Technological advancements, particularly in telemedicine, have further enhanced accessibility. Task-sharing strategies, where non-specialist physicians are trained in paediatric surgical skills, have also been utilised to address the shortage of specialised surgeons. Research in paediatric surgery has experienced an upswing, with local health professionals taking the lead. Research has been crucial for understanding the epidemiology of paediatric surgical conditions, and developing prevention strategies, and is increasingly leading to the inclusion of paediatric surgery in national health plans. Despite the progress, challenges remain, including the need for sustainable funding, continued investment in infrastructure, and training and retention of healthcare professionals. The review emphasises the importance of ongoing efforts in community engagement, innovative technologies, and health systems strengthening for the sustainable development of paediatric surgical services in Africa.
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Affiliation(s)
- Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK.
| | - Godfrey Sama Philipo
- The College of Surgeons of East Central and Southern Africa, Arusha, Tanzania
- The Branch for Global Surgical Care (BGSC), University of British Columbia (UBC), Columbia, Canada
| | - Zaitun Mohamed Bokhary
- Department of Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Kokila Lakhoo
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
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Alatise OI, Yibrehu B, Jackman J, Arije O, Olasehinde O, Keli E, Offei A, Jaiteh L, Aderounmu A, Kingham PT. Hepato-pancreato-biliary surgery in West Africa: a timely capacity assessment. HPB (Oxford) 2024:S1365-182X(24)01735-0. [PMID: 38862377 DOI: 10.1016/j.hpb.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/25/2024] [Accepted: 05/20/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND West Africa has among the highest rates of hepato-pancreato-biliary (HPB) malignancies in the world. Although surgery is critical for treatment, the availability of HPB surgery in Africa is unknown. This cross-sectional study investigated the current HPB surgical capacity of West African hospitals. METHOD The Surgeons OverSeas Personnel, Infrastructure, Procedure, Equipment, and Supplies (PIPES) survey was modified to include HPB-specific parameters and quantify capacity. The survey was completed by consultant surgeons from West Africa. A PIPES index was calculated, and a higher score corresponded to greater HPB surgical capacity. RESULTS The HPB PIPES survey was completed by 35 institutions from The Gambia, Ghana, Ivory Coast, and Nigeria. Most institutions (94.2%) were tertiary referral centres; five had an HPB-trained surgeon. The most commonly available procedure was an open cholecystectomy (91.4%), followed by gastric bypass (88.6%). Major hepatic resections (14.3%) and the Whipple procedure (17.1%) were rare. ICU capabilities were present at 88.6% of facilities while interventional radiology was present in 25.7%. CONCLUSIONS This is the first HPB capacity assessment in Africa. This study showed the limited availability of HPB surgery in West Africa. These results can be used for regional quality improvement initiatives and as a baseline for future capacity assessments.
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Affiliation(s)
| | - Betel Yibrehu
- Department of Surgery, University of Toronto, Toronto, Canada; Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York City, United States
| | - Julia Jackman
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York City, United States
| | - Olujide Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Elie Keli
- Department of General and Digestive Surgery, Hôpital Militaire d'Abidjan, Abidjan, Cote d'Ivoire
| | - Asare Offei
- Department of Surgery, Korle Bu Teaching Hospital and the University of Ghana Medical School, Accra, Ghana
| | - Lamin Jaiteh
- Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | | | - Peter T Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States
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Mortensen SØ, Bolther Pælestik M, Lind PC, Holmberg MJ, Granfeldt A, Stankovic N, Andersen LW. Characteristics and outcomes for general anesthesia in Denmark. Acta Anaesthesiol Scand 2024. [PMID: 38767280 DOI: 10.1111/aas.14442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND General anesthesia is common, but concerns regarding post-operative complications and mortality remain. No study has described the Danish patient population undergoing general anesthesia on a national level. The aim of this study was to describe the characteristics and outcomes of patients undergoing general anesthesia in Denmark. METHODS This study was a registry-based observational cohort study of adult patients (≥18 years) undergoing general anesthesia in Denmark during 2020 and 2021. Data from nationwide registries covering patient characteristics, anesthesia and procedure information, and patient outcomes were combined. Descriptive statistics were used to present findings, both overall and in subgroups based on the American Society of Anesthesiologists (ASA) classification. RESULTS We identified 453,133 cases of general anesthesia in 328,951 unique patients. The median age was 57 years (quartiles: 41, 71), and 242,679 (54%) were females. Data on ASA classification were missing for less than 1% of the population, and ASA II was the most prevalent ASA classification (49%). Among cases of general anesthesia, 0.1% experienced a stroke, 0.2% had in-hospital cardiac arrest, and 3.9% had a stay in the intensive care unit within 30 days. Mortality at 30 days and 1 year were 1.8% and 6.3%, respectively, increasing with a higher ASA classification. CONCLUSION This study offers the first comprehensive overview of adult patients undergoing general anesthesia in Denmark. Post-anesthesia complications were few and increased with ASA classification.
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Affiliation(s)
- Signe Østergaard Mortensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Bolther Pælestik
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Carøe Lind
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Johan Holmberg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Asger Granfeldt
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Nikola Stankovic
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Wiuff Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Prehospital Emergency Medical Services, Central Denmark Region, Denmark
- Department of Anesthesiology and Intensive Care, Viborg Hospital, Viborg, Denmark
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Guo K, Xu F, Li Y, Ma M, Li J, Wang L. Mortality and cardiac arrest rates of emergency surgery in developed and developing countries: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:178. [PMID: 38769493 PMCID: PMC11104000 DOI: 10.1186/s12871-024-02559-w] [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] [Received: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND The magnitude of the risk of death and cardiac arrest associated with emergency surgery and anesthesia is not well understood. Our aim was to assess whether the risk of perioperative and anesthesia-related death and cardiac arrest has decreased over the years, and whether the rates of decrease are consistent between developed and developing countries. METHODS A systematic review was performed using electronic databases to identify studies in which patients underwent emergency surgery with rates of perioperative mortality, 30-day postoperative mortality, or perioperative cardiac arrest. Meta-regression and proportional meta-analysis with 95% confidence intervals (CIs) were performed to evaluate global data on the above three indicators over time and according to country Human Development Index (HDI), and to compare these results according to country HDI status (low vs. high HDI) and time period (pre-2000s vs. post-2000s). RESULTS 35 studies met the inclusion criteria, representing more than 3.09 million anesthetic administrations to patients undergoing anesthesia for emergency surgery. Meta-regression showed a significant association between the risk of perioperative mortality and time (slope: -0.0421, 95%CI: from - 0.0685 to -0.0157; P = 0.0018). Perioperative mortality decreased over time from 227 per 10,000 (95% CI 134-380) before the 2000s to 46 (16-132) in the 2000-2020 s (p < 0-0001), but not with increasing HDI. 30-day postoperative mortality did not change significantly (346 [95% CI: 303-395] before the 2000s to 292 [95% CI: 201-423] in the 2000s-2020 period, P = 0.36) and did not decrease with increasing HDI status. Perioperative cardiac arrest rates decreased over time, from 113 per 10,000 (95% CI: 31-409) before the 2000s to 31 (14-70) in the 2000-2020 s, and also with increasing HDI (68 [95% CI: 29-160] in the low-HDI group to 21 [95% CI: 6-76] in the high-HDI group, P = 0.012). CONCLUSIONS Despite increasing baseline patient risk, perioperative mortality has decreased significantly over the past decades, but 30-day postoperative mortality has not. A global priority should be to increase long-term survival in both developed and developing countries and to reduce overall perioperative cardiac arrest through evidence-based best practice in developing countries.
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Affiliation(s)
- Kaikai Guo
- Department of pain medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beingjing, China
| | - Fengying Xu
- Department of anesthesiology, No. 971 Hospital of People's Liberation Army Navy, Qingdao, China
| | - Ye Li
- Department of pain medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beingjing, China
| | - Mingxing Ma
- Department of pain medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beingjing, China
| | - Jing Li
- Department of acupuncture, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Long Wang
- Department of pain medicine, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beingjing, China.
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Holt F, Kwok S, Garuba K, Kolawole I, White MC. The delivery and challenges of Pediatric Anesthesia within the humanitarian sector: Médecins Sans Frontières and Mercy Ships. Paediatr Anaesth 2024. [PMID: 38757915 DOI: 10.1111/pan.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Access to healthcare is inequitable. Poverty, natural disasters and war disproportionally effect those most vulnerable, including children. Non-governmental organizations (NGO) hold a vital role in providing pediatric care in these contexts. Here we describe the delivery and challenges of Pediatric Anesthesia with two such non-governmental organizations; Médecins Sans Frontières (MSF) and Mercy Ships. Descriptions of both are followed by case studies.
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Affiliation(s)
- Francesca Holt
- Department of Anaesthesia, Children's Health Ireland at Crumlin, Dublin, Ireland
- Médecins Sans Frontières
| | - Sarah Kwok
- Chief Medical Officer, Global Mercy, Freetown, Sierra Leone
| | - Kehinde Garuba
- Médecins Sans Frontières
- Department of Anaesthesia, Usman Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria
| | - Israel Kolawole
- Department of Anaesthesia, University of Ilorin, Ilorin, Nigeria
| | - Michelle C White
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
- Centre for Global Health and Health Partnerships, King's College London, London, UK
- Mercy Ships, London, UK
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Welch JM, Kamal RN, Kozin SH, Dyer GSM, Katarincic JA, Fox PM, Shapiro LM. Clinical Practice Guidelines to Support Capacity Building in Orthopaedic Surgical Outreach: An International Consensus Building Approach. J Bone Joint Surg Am 2024:00004623-990000000-01101. [PMID: 38753851 DOI: 10.2106/jbjs.23.01414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Surgical outreach to low- and middle-income countries (LMICs) by organizations from high- income countries is on the rise to help address the growing burden of conditions warranting surgery. However, concerns remain about the impact and sustainability of such outreach. Leading organizations (e.g., the World Health Organization) advocate for a capacity-building approach to ensure the safety, quality, and sustainability of the local health-care system. Despite this, to our knowledge, no guidelines exist to inform such efforts. We aimed to develop clinical practice guidelines (CPGs) to support capacity-building in orthopaedic surgical outreach utilizing a multistakeholder and international voting panel. METHODS We followed a modified American Academy of Orthopaedic Surgeons (AAOS) CPG development process. We systematically reviewed the existing literature across 7 predefined capacity-building domains (partnership, professional development, governance, community impact, finance, coordination, and culture). A writing panel composed of 6 orthopaedic surgeons with extensive experience in surgical outreach reviewed the existing literature and developed a consensus-based CPG for each domain. We created an international voting panel of orthopaedic surgeons and administrators who have leadership roles in outreach organizations or hospitals with which outreach organizations partner. Members individually reviewed the CPGs and voted to approve or disapprove each guideline. A CPG was considered approved if >80% of panel members voted to approve it. RESULTS An international voting panel of 14 surgeons and administrators from 6 countries approved all 7 of the CPGs. Each CPG provides recommendations for capacity-building in a specific domain. For example, in the domain of partnership, the CPG recommends the development of a documented plan for ongoing, bidirectional partnership between the outreach organization and the local team. In the domain of professional development, the CPG recommends the development of a needs-based curriculum focused on both surgical and nonsurgical patient care utilizing didactic and hands-on techniques. CONCLUSIONS As orthopaedic surgical outreach grows, best-practice CPGs to inform capacity-building initiatives can help to ensure that resources and efforts are optimized to support the sustainability of care delivery at local sites. These guidelines can be reviewed and updated in the future as evidence that supports capacity-building in LMICs evolves.The global burden of disease warranting surgery is substantial, and morbidity and mortality from otherwise treatable conditions remain disproportionately high in low- and middle-income countries (LMICs)1,2. It is estimated that up to 2 million (about 40%) of injury-related deaths in LMICs could be avoided annually if mortality rates were reduced to the level of those in high-income countries (HICs)3. Despite this, progress toward improved access to safe, timely surgery in resource-poor areas has been slow. Historically, nongovernmental organizations (NGOs) have tried to address unmet surgical needs through short-term outreach trips; however, growing criticism has highlighted the limitations of short-term trips, including limited follow-up, an increased burden on the local workforce, and further depletion of local resources4-6. In light of ongoing concerns, public health priorities have shifted toward models that emphasize long-term capacity-building rather than short-term care delivery. Capacity-building is an approach to health-care development that builds independence through infrastructure development, sustainability, and enhanced problem-solving while taking context into account7,8.
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Affiliation(s)
- Jessica M Welch
- Department or Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Scott H Kozin
- Shriners Hospitals for Children, Philadelphia, Pennsylvania
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia A Katarincic
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island
| | - Paige M Fox
- Department of Plastic Surgery, Stanford University, Stanford, California
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
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Duc Lien N, Van Linh N, Cam Van NT, Giang LT, King DT, Tarren A, Dat ND, Rocque BG. Selective Dorsal Rhizotomy for Spastic Cerebral Palsy: Report of 18 Cases Performed in the North of Vietnam. World Neurosurg 2024:S1878-8750(24)00819-2. [PMID: 38762026 DOI: 10.1016/j.wneu.2024.05.055] [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: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE The purpose of this report is to describe a case series of children undergoing selective dorsal rhizotomy (SDR) for the treatment of spastic cerebral palsy in Vietnam. Also described is an international cooperation model to facilitate the development of a new, multidisciplinary team for the evaluation and treatment of these children. METHODS Details of international collaboration are described, including in-person travel and virtual interactions. All cases of children younger than 18 years undergoing SDR for treatment of spastic cerebral palsy at a single center in Hanoi, Vietnam are described, including preoperative evaluation of spasticity and gait as well as results at 6 and 12 months. Results are summarized using descriptive statistics. RESULTS Since the beginning of cooperation in training and transferring SDR techniques by experts from the United States, in the period from June 2016 to December 2022, 18 SDR surgeries were performed in Hanoi. Patients' ages ranged from 2 to 14 years; 13 were male and 5 were female. Overall, approximately 60% of nerve rootlets were cut. Modified Ashworth Scale scores at 6 and 12 months after surgery in the hip, knee, and ankle joints showed improvement from preoperative values. There were 2 recorded complications: intracranial hypotension causing subdural hemorrhage and a case of skin infection at the incision site. CONCLUSIONS The ongoing international cooperation between Vietnamese and American physicians has helped improve the surgical treatment of spasticity in children with cerebral palsy in Hanoi, providing children with a surgical treatment option with successful outcomes.
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Affiliation(s)
- Nguyen Duc Lien
- Department of Neurosurgery, Vietnam National Cancer Hospital, Hanoi, Vietnam; National Children Hospital, Hanoi, Vietnam.
| | - Nguyen Van Linh
- Department of Neurosurgery, Vietnam National Cancer Hospital, Hanoi, Vietnam; National Children Hospital, Hanoi, Vietnam
| | - Nguyen Thi Cam Van
- Department of Neurosurgery, Vietnam National Cancer Hospital, Hanoi, Vietnam; National Children Hospital, Hanoi, Vietnam
| | - Le Thi Giang
- Department of Neurosurgery, Vietnam National Cancer Hospital, Hanoi, Vietnam; National Children Hospital, Hanoi, Vietnam
| | | | - Anna Tarren
- Children's of Alabama, Birmingham, Alabama, USA
| | | | - Brandon G Rocque
- Children's of Alabama, Birmingham, Alabama, USA; Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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