1
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Wahlstedt ER, Wahlstedt JC, Rosenberg JS, deVries CR. Lifecycle of surgical devices: Global, environmental, and regulatory considerations. World J Surg 2024; 48:1045-1055. [PMID: 38530108 DOI: 10.1002/wjs.12140] [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: 11/21/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Technological advancements, improved surgical access, and heightened demand for surgery have fueled unprecedented device and supply turnover impelling wealthy hospitals to upgrade continually and sell, donate, recycle, or dispose of used, expired, antiquated, or surplus goods. This paper reviews the issues related to device and supply lifecycles and discusses the opportunities and challenges they present for sustainable surgical growth in low- and middle-income (LMICs) countries. OBSERVATIONS This review found, in LMICs countries, regulatory disparities persist that limit effective harmonization secondary to highly variable national policies and a lack of prioritized enforcement. Heterogeneity in the regulatory landscape, specifically in the classification, nomenclature, and identification of medical devices, encumbers effective regulation and distribution. Once devices are sold, donated, or reused in LMICs countries, complexities arise in regulatory compliance, maintenance, and appropriate use of these technologies. At the end of the lifecycle, waste management poses significant obstacles with limited resources hindering the implementation of best practices. CONCLUSION There are major disparities in access to quality surgical equipment and supplies around the world. Improved communication between relevant stakeholders and harmonization of manufacture and disposal regulations will be needed to ensure adequate and appropriate responses to these challenges. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Eric R Wahlstedt
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | | | - Jenna S Rosenberg
- Center for Global Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Catherine R deVries
- Center for Global Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
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2
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Sever MS, Luyckx V, Tonelli M, Kazancioglu R, Rodgers D, Gallego D, Tuglular S, Vanholder R. Disasters and kidney care: pitfalls and solutions. Nat Rev Nephrol 2023; 19:672-686. [PMID: 37479903 DOI: 10.1038/s41581-023-00743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.
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Affiliation(s)
- Mehmet Sukru Sever
- Istanbul University, Istanbul School of Medicine, Department of Nephrology, Istanbul, Turkey.
| | - Valerie Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard, Medical School, Boston, MA, USA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rumeyza Kazancioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Darlene Rodgers
- Independent Nurse Consultant, American Society of Nephrology, Washington, DC, USA
| | - Dani Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patient Federation, Wien, Austria
| | - Serhan Tuglular
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
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3
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Permaul Flores H, Kohler JC, Dimancesco D, Wong A, Lexchin J. Medicine donations: a review of policies and practices. Global Health 2023; 19:67. [PMID: 37658389 PMCID: PMC10474724 DOI: 10.1186/s12992-023-00964-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND To help promote the effective delivery of drug donations, the World Health Organization (WHO) developed the Guidelines for Medicine Donations. The need for revisions is timely given the large-scale influx of medicine donations since the start of the COVID-19 pandemic. This study analyses current policies of donors and recipients that are commensurate with the recommendations in the Guidelines and examines current practices, challenges, and revision suggestions. RESULTS A search for medicine donation policies of donors and recipients was conducted in May/June 2022 and repeated in January 2023. Potential donor countries were identified from the high-income countries on the United Nation's (UN) List of G20 Countries. Potential pharmaceutical company donors were selected from those with 2021 revenue of $30 billion or greater. Potential non-government organization donors came from the WHO list of non-governmental organizations (NGOs) and two other sources. Potential recipient countries were those on the UN List of Least Developed Countries. These four lists were supplemented with actual donors and recipients identified from the literature. All policies retrieved were screened to identify which of the 12 recommendations from the WHO Guidelines were incorporated. We identified 38 policies from 1 donor country, 6 brand-name multinational pharmaceutical companies, 6 NGOs and 25 recipient countries. Most policies incorporated all 12 recommendations. Twenty-five of the 38 policies were developed in 2010 or later. The majority of actual donors and recipients did not have policies that were publicly available. A rapid literature review for publications from 2010 onwards identified challenges in implementing the WHO Guidelines and suggested for revisions. Challenges included: (1) information management; (2) medication presentation; (3) influence from the pharmaceutical industry; (4) donation sustainability; and (5) the belief that donations are inherently good. CONCLUSIONS Our findings suggest that both donors and recipients could further align their policies with the existing Guidelines and both groups should be consulted on any revisions to ensure that their experiences are reflected and their needs are addressed. While the current WHO Guidelines for Medicine Donations are a solid base for medical humanitarian efforts, evidence points to the need for an update to meet current challenges.
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Affiliation(s)
- Hannah Permaul Flores
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, University of Toronto, Toronto, Canada
- Faculty of Arts and Sciences, University of Toronto, Toronto, Canada
| | - Jillian C Kohler
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, University of Toronto, Toronto, Canada.
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada.
| | - Deirdre Dimancesco
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Anna Wong
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, University of Toronto, Toronto, Canada
- University of Toronto Faculty of Law, Toronto, Canada
| | - Joel Lexchin
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Health, York University, Toronto, Canada
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4
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Nasir N, Molyneux S, Were F, Aderoba A, Fuller SS. Medical device regulation and oversight in African countries: a scoping review of literature and development of a conceptual framework. BMJ Glob Health 2023; 8:e012308. [PMID: 37558270 PMCID: PMC10414093 DOI: 10.1136/bmjgh-2023-012308] [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: 03/15/2023] [Accepted: 07/13/2023] [Indexed: 08/11/2023] Open
Abstract
Regulatory and other governance arrangements influence the introduction of medical devices into health systems and are essential for ensuring their effective and safe use. Challenges with medical device safety, quality and use are documented globally, with evidence suggesting these are linked to poor governance. Yet, medical device regulation and oversight remain inadequately defined and described, particularly in low-income and middle-income settings. Through this review, we sought to examine the literature available on regulatory and oversight processes for medical devices in African countries.Following a systematic approach, we searched academic databases including PubMed, Embase (Ovid) and MEDLINE (Ovid), supplemented by search for grey literature and relevant organisational websites, for documents describing medical device regulation and oversight in African countries. We summarised the data to present key actors, areas for regulation and oversight and challenges.A total of 39 documents reporting regulation and oversight of medical devices were included for analysis. Regulatory and oversight guidelines and processes were reported as inadequate, including limited pre-market testing, reliance on international certifications and limited processes for post-market monitoring and reporting of adverse events. Challenges for regulation and oversight reported included inadequate funding, personnel and technical expertise to perform regulatory functions. The literature highlighted gaps in guidelines for donated medical devices and in information on governance processes at the national level.The current literature provides a general overview of medical device regulatory guidelines and limited evidence on the implementation of regulatory/oversight processes at national and especially subnational levels. We recommend further research to elucidate existing governance arrangements for medical devices within African countries and propose a conceptual framework to inform future studies. The framework provides entry points for careful examination of governance and oversight in policy and practice, the exploration of governance realities across the health system and the influence of wider system dynamics.
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Affiliation(s)
- Naima Nasir
- Health Systems Collaborative, Center for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sassy Molyneux
- Health Systems Collaborative, Center for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Fred Were
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Kenya Paediatric Research Consortium, Nairobi, Kenya
| | - Adeniyi Aderoba
- Reproductive, Maternal Health, and Healthy Ageing Unit, Universal Health Coverage-Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Democratic Republic of Congo
- Center for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sebastian S Fuller
- Health Systems Collaborative, Center for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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5
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Sumner C, Ikuta I, Garg T, Martin JG, Mansoori B, Chalian M, Englander BS, Chertoff J, Woolen S, Caplin D, Sneider MB, Desouches SL, Chan TL, Kadom N. Approaches to Greening Radiology. Acad Radiol 2023; 30:528-535. [PMID: 36114076 DOI: 10.1016/j.acra.2022.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/31/2022] [Accepted: 08/09/2022] [Indexed: 01/25/2023]
Abstract
The health care sector is a resource-intensive industry, consuming significant amounts of water and energy, and producing a multitude of waste. Health care providers are increasingly implementing strategies to reduce energy use and waste. Little is currently known about existing sustainability strategies and how they may be supported by radiology practices. Here, we review concepts and ideas that minimize energy use and waste, and that can be supported or implemented by radiologists.
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Affiliation(s)
- Christina Sumner
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ichiro Ikuta
- Department of Radiology & Biomedical Imaging, Yale Program for Innovation in Imaging Informatics, Department of Radiology, Yale University School of Medicine, New Haven, CT; Mayo Clinic Arizona, Phoenix, Arizona
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan G Martin
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina
| | - Bahar Mansoori
- Department of Radiology, University of Washington, Seattle, Washington
| | - Majid Chalian
- Department of Radiology, University of Washington, Seattle, Washington
| | - Brian S Englander
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jocelyn Chertoff
- Department of Radiology, Dartmouth Health and the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Sean Woolen
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California
| | - Drew Caplin
- Division of Interventional Radiology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York
| | - Michael B Sneider
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, Virginia
| | | | - Tiffany L Chan
- Department of Radiology, University of California, Los Angeles, California
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Radiology, Children's Healthcare of Atlanta- Egleston Campus, Atlanta, Georgia.
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6
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Thornber K, Adshead F, Balayannis A, Brazier R, Brown R, Comber S, Court C, Davidson I, Depledge M, Farmer C, Gibb S, Hixson R, Kirchhelle C, Moore K, Motta M, Niemi L, Owen S, Pencheon D, Pfleger S, Pitchforth E, Powell N, Schmidt W, Smith R, Sowman G, Tyler-Batt W, Wilkinson H, Wilson EC, Fleming L, Gaze W, Tyler C. First, do no harm: time for a systems approach to address the problem of health-care-derived pharmaceutical pollution. Lancet Planet Health 2022; 6:e935-e937. [PMID: 36495886 DOI: 10.1016/s2542-5196(22)00309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Kelly Thornber
- College of Life and Environmental Sciences, Exeter TR10 9FE, UK.
| | | | | | - Richard Brazier
- Centre for Resilience in Environment, Water, and Waste, Exeter TR10 9FE, UK
| | - Ross Brown
- College of Life and Environmental Sciences, Exeter TR10 9FE, UK
| | - Sean Comber
- Faculty of Science and Engineering, University of Plymouth, Plymouth, UK
| | | | | | | | | | - Stuart Gibb
- Environmental Research Institute, University of the Highlands and Islands, Thurso, UK
| | - Richard Hixson
- County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | | | - Keith Moore
- Sustainable Healthcare Coalition, Newton Abbot, UK
| | - Marco Motta
- NHS Cornwall and Isles of Scilly, Bodmin, UK
| | - Lydia Niemi
- Environmental Research Institute, University of the Highlands and Islands, Thurso, UK
| | | | - David Pencheon
- University of Exeter Medical School, Exeter TR10 9FE, UK
| | | | | | - Neil Powell
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | | | | | | | | | | | | | - Lora Fleming
- University of Exeter Medical School, Exeter TR10 9FE, UK
| | - William Gaze
- University of Exeter Medical School, Exeter TR10 9FE, UK
| | - Charles Tyler
- College of Life and Environmental Sciences, Exeter TR10 9FE, UK
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7
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Alswang JM, Belshe WB, Killi D, Bandawe W, Silliman ES, Bastian AC, Upchurch BK, Bastian MF, Pinal SM, Klein MB, Ndhlozi B, Silva M, Chipolombwe J, Thompson RM. Mobility impairment and life satisfaction in the Northern Region of Malawi. Afr J Disabil 2022; 11:1013. [PMID: 36262824 PMCID: PMC9575362 DOI: 10.4102/ajod.v11i0.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background There exist many psychosocial sequelae associated with mobility impairment, especially in low-resource settings where access to mobility assistive devices is limited. Objectives This study aims to (1) define the burden and presenting aetiologies of mobility impairment in the rural Northern Region of Malawi and (2) assess the relationship between physical disability, life satisfaction and access to mobility aids. Methods At mobility device donation clinics throughout the Northern Region of Malawi, adults living with mobility impairment were surveyed with a demographic questionnaire and a series of validated surveys to assess their physical activity levels (Global Physical Activity Questionnaire [GPAQ]), degree of mobility impairment (Washington Group Extended Set Questions on Disability) and life satisfaction (patient-reported outcomes measurement information systems satisfaction with participation in social roles and general life satisfaction). Results There were 251 participants who qualified for inclusion, of which 193 completed all surveys. Higher physical activity scores were positively correlated with increased life satisfaction: (1) satisfaction with participation in social roles (0.481, p < 0.0001) and (2) general life satisfaction (0.230, p < 0.001). Respondents who had previously used a formal mobility device reported 235.5% higher physical activity levels ([139.0%, 333.0%], p = 0.006), significantly higher satisfaction with participation in social roles ([0.21, 6.67], p = 0.037) and equivocally higher general life satisfaction ([-1.77, 3.84], p = 0.470). Conclusion Disability and mental health do not exist in isolation from one another. Given the positive correlations between formal mobility device usage and both physical activity and life satisfaction, interventions that increase access to mobility-assistive devices in undertreated populations are imperative. Contribution This study contributes to the understanding of the complex relationship between physical disability, access to mobility aids, and life satisfaction. Results from this study suggest the potential benefit that increasing access to mobility aids may have in improving the quality of life of mobility impaired persons in resource-limited settings, such as the Northern Region of Malawi.
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Affiliation(s)
- Jared M. Alswang
- Harvard Medical School, Harvard University, Boston, MA,United States of America
| | - William B. Belshe
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Dexter Killi
- Department of Physiotherapy, Mzuzu Central Hospital, Mzuzu, Malawi
| | - Weston Bandawe
- Department of Physiotherapy, St. John’s Hospital, Mzuzu, Malawi
| | - Erin S. Silliman
- School of Medicine, Boston University, Boston, MA, United States of America
| | - Aaron C. Bastian
- College of Osteopathic Medicine, New York Institute of Technology, Glen Head, NY, United States of America
| | - Brooke K. Upchurch
- Dell Medical School, University of Texas at Austin, Austin, TX, United States of America
| | - Megan F. Bastian
- School of Medicine, Saint Louis University, Saint Louis, MO, United States of America
| | - Sierra M. Pinal
- Department of Orthopedic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America,Center for Cerebral Palsy, Orthopaedic Institute for Children, Los Angeles, CA, United States of America
| | - Mark B. Klein
- Dornsife College of Letters, Arts and Science, University of Southern California, Los Angeles, CA, United States of America
| | | | - Mauricio Silva
- Department of Orthopedic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America,Orthopaedic Institute for Children, Los Angeles, CA, United States of America
| | - John Chipolombwe
- Department of Internal Medicine, Mzuzu Central Hospital, Mzuzu, Malawi
| | - Rachel M. Thompson
- Department of Orthopedic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America,Center for Cerebral Palsy, Orthopaedic Institute for Children, Los Angeles, CA, United States of America
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8
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Zivanov CN, Joseph J, Pereira DE, MacLeod JBA, Kauffmann RM. Qualitative Analysis of the Host-Perceived Impact of Unidirectional Global Surgery Training in Kijabe, Kenya: Benefits, Challenges, and a Desire for Bidirectional Exchange. World J Surg 2022; 46:2570-2584. [PMID: 35976431 PMCID: PMC9383670 DOI: 10.1007/s00268-022-06692-w] [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] [Accepted: 07/16/2022] [Indexed: 11/25/2022]
Abstract
Background As globalization of surgical training increases, growing evidence demonstrates a positive impact of global surgery experiences on trainees from high-income countries (HIC). However, few studies have assessed the impact of these largely unidirectional experiences from the perspectives of host surgical personnel from low- and middle-income countries (LMIC). This study aimed to assess the impact of unidirectional visitor involvement from the perspectives of host surgical personnel in Kijabe, Kenya. Methods Voluntary semi-structured interviews were conducted with 43 host surgical personnel at a tertiary referral hospital in Kijabe, Kenya. Qualitative analysis was used to identify salient and recurring themes related to host experiences with visiting surgical personnel. Perceived benefits and challenges of HIC involvement and host interest in bidirectional exchange were assessed. Results Benefits of visitor involvement included positive learning experiences (95.3%), capacity building (83.7%), exposure to diverse practices and perspectives (74.4%), improved work ethic (51.2%), shared workload (44.2%), access to resources (41.9%), visitor contributions to patient care (41.9%), and mentorship opportunities (37.2%). Challenges included short stays (86.0%), visitor adaptation and integration (83.7%), cultural differences (67.4%), visitors with problematic behaviors (53.5%), learner saturation (34.9%), language barriers (32.6%), and perceived power imbalances between HIC and LMIC personnel (27.9%). Nearly half of host participants expressed concerns about the lack of balanced exchange between HIC and LMIC programs (48.8%). Almost all (96.9%) host trainees expressed interest in a bidirectional exchange program. Conclusion As the field of global surgery continues to evolve, further assessment and representation of host perspectives is necessary to identify and address challenges and promote equitable, mutually beneficial partnerships between surgical programs in HIC and LMIC.
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Affiliation(s)
- Catherine N Zivanov
- Eskind Family Biomedical Library and Learning Center, Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, 37240, USA
| | - James Joseph
- Department of Surgery, Africa Inland Church Kijabe Hospital, Kijabe, Kenya
| | - Daniel E Pereira
- Eskind Family Biomedical Library and Learning Center, Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, 37240, USA
| | - Jana B A MacLeod
- Department of Surgery, Africa Inland Church Kijabe Hospital, Kijabe, Kenya.,Department of Surgery and Orthopedics, Kenyatta University School of Medicine, Nairobi, Kenya
| | - Rondi M Kauffmann
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, 597 Preston Research Building, 2220 Pierce Ave, Nashville, TN, 37232, USA.
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9
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Critical elements in the design, development and use of medical devices. A systemic perspective of orthopedic devices landscape in low- and middle-income countries. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Material convergence issue in the pharmaceutical supply chain during a disease outbreak. INTERNATIONAL JOURNAL OF LOGISTICS MANAGEMENT 2021. [DOI: 10.1108/ijlm-11-2020-0425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Pharmaceutical donations are a practical approach to increase medicine availability during disasters such as disease outbreaks. However, often donated pharmaceuticals are inappropriate and unsuitable. This convergence of inappropriate pharmaceuticals is a severe operational challenge and results in environmental hazards. This study explores the pharmaceutical supply chains (PSCs) during a disease outbreak to relieve the negative impact of the material convergence problem (MCP).
Design/methodology/approach
This study adopts a situation-actors-process learning-action-performance (SAP-LAP) linkage framework to understand the PSC dynamics. The problem-solving component of the SAP-LAP analysis provides the strategies catering to MCP. The findings from the SAP-LAP helped to develop the causal loop diagram (CLD). This study conducts several experiments on the proposed strategies by integrating CLD into a stock and flow diagram. Later, a disease outbreak case study accessed the pharmaceutical donations effect on PSC performance.
Findings
The study synthesises and evaluates propositions and strategies to incorporate circular economy (CE) principles in PSC. This study proposed two strategies; one to sort and supply and the other to sort, supply and resell. The reuse policy improves humanitarian organisations' finances in the simulation study. This study verified the operational improvement of PSC by reducing the transport and storage burden due to MCP.
Originality/value
This study comprehensively approaches the issue of drug donation and uniquely produced several propositions for incorporating a CE perspective in PSC. The study also proposed a unique simulation approach to model the donation arrivals in response to a disease outbreak using susceptible, exposed, infectious and recovered modelling.
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11
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White AM, Mutai D, Cheruiyot D, Rule ARL. Get Me a Mask! The Challenge of Equipment Supply Chains. Pediatrics 2021; 148:peds.2020-044305. [PMID: 34376529 DOI: 10.1542/peds.2020-044305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Anne M White
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Amy R L Rule
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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12
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Monestime S, Magallon T, Jenkins L, Page R. Guidance on Implementing an Oral Chemotherapy Drug Repository Program in a Medically Integrated Pharmacy Setting. JCO Oncol Pract 2021; 17:e448-e453. [PMID: 33900790 DOI: 10.1200/op.20.00959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Oncology drug repository programs allow patients to donate oral chemotherapy that can be redispensed to patients in need and could ultimately reduce drug waste. Medically integrated pharmacies can serve as a platform for drug repository programs because of the integration of healthcare providers and pharmacists at one location, facilitating an effective transition from donation to redispensing. Before implementing a program, pharmacies should consider state laws regarding who can donate medications, the type of setting (including open or closed systems), as well as how to assess the quality of the medication donated, expiration dates, storing and maintenance of a separate inventory, written policies and procedures, and a priority list for dispensing medications to patients. In this article, we provide the initial steps to assist states and oncology pharmacists interested in developing a drug repository program.
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Affiliation(s)
- Shanada Monestime
- Department of Pharmacotherapy, University of North Texas System College of Pharmacy, Fort Worth, TX
| | - Tara Magallon
- Department of Pharmacotherapy, University of North Texas System College of Pharmacy, Fort Worth, TX
| | - Lauren Jenkins
- Department of Pharmacotherapy, University of North Texas System College of Pharmacy, Fort Worth, TX
| | - Ray Page
- The Center for Cancer and Blood Disorders, Fort Worth, TX
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13
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Zeitoun M, Sittah GA, Shomar R, el Ach N. AMR and Covid-19 on the Frontline: A Call to Rethink War, WASH, and Public Health. Ann Glob Health 2021; 87:21. [PMID: 33665143 PMCID: PMC7908922 DOI: 10.5334/aogh.3140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This Viewpoint calls for a greater understanding of the role that water plays in the transmission of anti-microbial resistance and covid-19 in protracted urban armed conflict, in order to develop a 'pathogen-safe' practice. It argues that dealing with the twin threats is difficult enough in the best of circumstances, and is so little understood in war zones that surgeons and water engineers now question if their practice does more harm than good. Experience suggests that the known transmission routes are complicated by a great number of factors, including the entry of heavy metals through bullets in patients' wounds, hospital over-crowding, mutation in treated water or wastewater, and other threats which endure long after the bombing has stopped. The skeleton research agenda proposes greater sewage surveillance, testing of phages and monitoring of treatment designed to dispel or substantiate these assertions.
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Affiliation(s)
- Mark Zeitoun
- Water Security Research Centre, University of East Anglia, Norwich NR4 7TJ, UK
| | | | | | - Nassim el Ach
- Conflict Medicine Programme, American University of Beirut, LB
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