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Fell M, Goldwasser M, Jayanth B, Pereira RMR, Nawej CT, Winer R, Daftari N, Brewster H, Goldschmied K, Almas CF, Eshete M, Galiwango GW, Hollier LH, Hussain A, Lo LJ, Salins P, Sell D, Tafase A, Zuker RM. Adapting Elements of Cleft Care Protocols in Low- and Middle-income Countries During and After COVID-19: A Process-driven Review With Recommendations. Cleft Palate Craniofac J 2023; 60:526-535. [PMID: 34982012 PMCID: PMC10102820 DOI: 10.1177/10556656211069827] [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] [Indexed: 11/16/2022] Open
Abstract
A consortium of global cleft professionals, predominantly from low- and middle-income countries, identified adaptations to cleft care protocols during and after COVID-19 as a priority learning area of need. A multidisciplinary international working group met on a videoconferencing platform in a multi-staged process to make consensus recommendations for adaptations to cleft protocols within resource-constrained settings. Feedback was sought from a roundtable discussion forum and global organizations involved in comprehensive cleft care. Foundational principles were agreed to enable recommendations to be globally relevant and two areas of focus within the specified topic were identified. First the safety aspects of cleft surgery protocols were scrutinized and COVID-19 adaptations, specifically in the pre- and perioperative periods, were highlighted. Second, surgical procedures and cleft care services were prioritized according to their relationship to functional outcomes and time-sensitivity. The surgical procedures assigned the highest priority were emergent interventions for breathing and nutritional requirements and primary palatoplasty. The cleft care services assigned the highest priority were new-born assessments, pediatric support for children with syndromes, management of acute dental or auditory infections and speech pathology intervention. A collaborative, interdisciplinary and international working group delivered consensus recommendations to assist with the provision of cleft care in low- and middle-income countries. At a time of global cleft care delays due to COVID-19, a united approach amongst global cleft care providers will be advantageous to advocate for children born with cleft lip and palate in resource-constrained settings.
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Affiliation(s)
- Matthew Fell
- CLEFT Charity, Chelmsford, UK
- Cleft Collective, University of
Bristol, Bristol, UK
| | - Michael Goldwasser
- Operation Smile, Virginia Beach,
USA
- Craniofacial and Surgical Care,
University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | | | - Rui Manuel Rodrigues Pereira
- Faculdade de Medicina da Universidade
de Sao Paulo, Sau Paulo, Brazil
- Instituto de Medicina Integral Prof
Fernando Figueira, Recife, Brazil
| | | | | | | | | | - Karen Goldschmied
- Craniofacial and Surgical Care,
University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | | | - Mekonen Eshete
- Cleft Lip and Palate Program, Yekatit
12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Larry H. Hollier
- Smile Train Global Medical Advisory
Board, New York, USA
- Division of Plastic Surgery, Michael
E. DeBakey Department of Surgery, Baylor College of Medicine, Department of Surgery,
Texas Children's Hospital, Houston, Texas, USA
| | - Akhter Hussain
- ABMSS, Bengaluru, India
- Yenepoya Dental College, Karnataka,
India
| | - Lun-Jou Lo
- Noordhoff Craniofacial Foundation,
Taipei, Taiwan
- Craniofacial Center, Plastic and
Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Paul Salins
- ABMSS, Bengaluru, India
- Mazumdar Shaw Medical Centre,
Karnataka, India
| | - Debbie Sell
- Great Ormond Street Hospital for
Children, London, UK
| | - Amanuel Tafase
- Project Harar, London United Kingdom
and Addis Ababa, Ethiopia
| | - Ronald M. Zuker
- Division of Plastic and
Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada
- The University of Toronto, Toronto,
Canada
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Daniel Pereira D, Market MR, Bell SA, Malic CC. Assessing the quality of reporting on quality improvement initiatives in plastic surgery: A systematic review. J Plast Reconstr Aesthet Surg 2023; 79:101-110. [PMID: 36907019 DOI: 10.1016/j.bjps.2023.01.036] [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: 09/24/2022] [Revised: 01/07/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND There has been a recent increase in the number and complexity of quality improvement studies in plastic surgery. To assist with the development of thorough quality improvement reporting practices, with the goal of improving the transferability of these initiatives, we conducted a systematic review of studies describing the implementation of quality improvement initiatives in plastic surgery. We used the SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guideline to appraise the quality of reporting of these initiatives. METHODS English-language articles published in Embase, MEDLINE, CINAHL, and the Cochrane databases were searched. Quantitative studies evaluating the implementation of quality improvement initiatives in plastic surgery were included. The primary endpoint of interest in this review was the distribution of studies per SQUIRE 2.0 criteria scores in proportions. Abstract screening, full-text screening, and data extraction were completed independently and in duplicate by the review team. RESULTS We screened 7046 studies, of which 103 full texts were assessed, and 50 met inclusion criteria. In our assessment, only 7 studies (14%) met all 18 SQUIRE 2.0 criteria. SQUIRE 2.0 criteria that were met most frequently were abstract, problem description, rationale, and specific aims. The lowest SQUIRE 2.0 scores appeared in funding, conclusion, and interpretation criteria. CONCLUSIONS Improvements in QI reporting in plastic surgery, especially in the realm of funding, costs, strategic trade-offs, project sustainability, and potential for spread to other contexts, will further advance the transferability of QI initiatives, which could lead to significant strides in improving patient care.
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Affiliation(s)
- D Daniel Pereira
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada.
| | - Marisa R Market
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephanie A Bell
- Department of Plastic Surgery, Children's Hospital of Eastern Ontario, Canada
| | - Claudia C Malic
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Plastic Surgery, Children's Hospital of Eastern Ontario, Canada
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Effect of Nonradical Intravelar Veloplasty in Patients With Unilateral Cleft Lip and Palate: A Comparative Study and Systematic Review. J Craniofac Surg 2021; 32:1999-2004. [PMID: 33534327 DOI: 10.1097/scs.0000000000007481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare 2 techniques used for primary muscular repair and perform a systematic review of the literature to evaluate the effects of radical intravelar veloplasty (IVV) on nonsyndromic unilateral cleft lip and palate. METHODS This is an ambispective study between 2 groups of patients with unilateral cleft lip and palate who were operated using a radical and conservative form of IVV in Lima Peru. Data collection was accomplished by evaluation of speech development and middle ear function of the patients. A systematic review of the literature for studies published until June 2020 to evaluate the effect using the radical IVV in patients with cleft lip and palate. RESULTS Our comparative study did not find statistically significant differences in speech development between the studied techniques for unilateral cleft palate repair. Increased number of ear tube placements have been observed in the group treated with radical form of IVV. After systematic literature searching, 10 identified studies were qualified for the final analysis, which included 1367 patients. The overall study quality according to Oxford CEBM and GRADE scale was low. CONCLUSIONS The results arising from this study provides statistical evidence that one technique let us obtain better speech outcomes. A technique with conservative IVV has statistical significant fewer rate of middle ear disorders after primary cleft palate repair. Based on available scientific evidence, definitive conclusions about the effectiveness of radical IVV on velopharyngeal and middle ear function cannot be drawn.
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Rossell-Perry P, Gavino-Gutierrez A. Cleft Lip and Palate Surgery during COVID-19 Pandemic. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3692. [PMID: 34235042 PMCID: PMC8245116 DOI: 10.1097/gox.0000000000003692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic has caused a negative impact in every sector of life, especially in the health sector. Patients with different medical conditions are suffering delays in their surgical treatments. Cleft lip and palate is a common congenital disease that requires early interdisciplinary attention, and there is uncertainty about the safety of performing its surgical treatment during the COVID-19 pandemic. The objective of this study was to evaluate the safety of a surgical cleft protocol for cleft lip and palate used during the COVID-19 pandemic at a high volume cleft center in Lima, Peru. METHODS This is a comparative study between two groups of patients with nonsyndromic cleft lip and palate who were operated on before and during the COVID-19 pandemic. Data collection was done by evaluation of presurgical condition, and surgical and nonsurgical postoperative outcomes and complications. RESULTS Significant differences were observed regarding both the age of the patients at the time of the primary surgeries, and surgical times between the two groups. Nonstatistical significant differences were observed between the two groups regarding the presurgical conditions, postoperative outcomes, and complications. Rate of COVID-19 infection was 1.25%. CONCLUSIONS The surgical protocol used for cleft lip and palate repair during the COVID-19 pandemic is a safe method based on the observed postoperative outcomes. However, the COVID-19 pandemic caused delays of the time of the primary cleft lip and palate repair, and its long-term impact should be well evaluated.
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Affiliation(s)
- Percy Rossell-Perry
- From the Post Graduate Studies, Faculty of Medicine, San Martin de Porres University, Lima, Peru
- South American Medical Advisory Council, Smile Train Foundation, New York, N.Y
| | - Arquimedes Gavino-Gutierrez
- From the Post Graduate Studies, Faculty of Medicine, San Martin de Porres University, Lima, Peru
- Pre Graduate Studies, Faculty of Medicine, Cayetano Heredia University, Lima, Peru
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