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Arboleda V, Lajevardi A, Barletti P, Medina M, Ramanujam A, Elsouri KN, Demory M. Augmented Reality (AR) in Surgery in Low- and Middle-Income Countries (LMICs): A Scoping Review. Cureus 2024; 16:e64278. [PMID: 39130987 PMCID: PMC11316668 DOI: 10.7759/cureus.64278] [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: 05/20/2024] [Accepted: 07/07/2024] [Indexed: 08/13/2024] Open
Abstract
Surgical disparities persist in low- and middle-income countries (LMICs). Insufficient access to surgical care places a large burden on these regions, with high mortality rates for otherwise standard procedures performed in high-income countries (HICs). Augmented Reality (AR) and Virtual Reality (VR) now provide us with a platform to improve the delivery of surgical access and training to LMICs. The use of AR technologies to provide additional training to surgeons and residents globally can help bridge the gap and reduce health disparities in LMICs. The goal of this scoping review is to evaluate whether surgical trainees and surgeons from LMICs have access to or use AR software in their training or practice. A systematic search was conducted on seven databases. Inclusion criteria included populations in LMICs with access to AR-based training. Articles using VR software, or those conducted in HICs were excluded from the review. From the 428 records screened, 58 reports were assessed for eligibility, and of these, a total of six studies were included in the review. Five of the six studies used mentors from an HIC, including the United States (US) and the United Kingdom (UK), whereas one study had mentorship from another LMIC. Three surgical specialties were explored: neurosurgery, plastic surgery, and urology. Although the integration of AR in surgical training is promising, the six studies evaluated in this review emphasize that costs and connection issues are major challenges that can set back these technologies in the operating room. Despite these revelations, with certain improvements, AR training programs are promising as they can help to reduce the global disparity in surgical proficiency.
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Affiliation(s)
- Vania Arboleda
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Aryan Lajevardi
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | | | - Mariapia Medina
- Biomedical Sciences, Nova Southeastern University, Orlando, USA
| | - Apurva Ramanujam
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Kawther N Elsouri
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Michelle Demory
- Immunology, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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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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Irving D, Page B, Carthey J, Higham H, Undre S, Vincent C. Adaptive strategies used by surgical teams under pressure: an interview study among senior healthcare professionals in four major hospitals in the United Kingdom. Patient Saf Surg 2024; 18:8. [PMID: 38383433 PMCID: PMC10880194 DOI: 10.1186/s13037-024-00390-3] [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: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Healthcare systems are operating under substantial pressures, and often simply cannot provide the standard of care they aspire to within the available resources. Organisations, managers, and individual clinicians make constant adaptations in response to these pressures, which are typically improvised, highly variable and not coordinated across clinical teams. The purpose of this study was to identify and describe the types of everyday pressures experienced by surgical teams and the adaptive strategies they use to respond to these pressures. METHODS We conducted interviews with 20 senior multidisciplinary healthcare professionals from surgical teams in four major hospitals in the United Kingdom. The interviews explored the types of everyday pressures staff were experiencing, the strategies they use to adapt, and how these strategies might be taught to others. RESULTS The primary pressures described by senior clinicians in surgery were increased numbers and complexity of patients alongside shortages in staff, theatre space and post-surgical beds. These pressures led to more difficult working conditions (e.g. high workloads) and problems with system functioning such as patient flow and cancellation of lists. Strategies for responding to these pressures were categorised into increasing or flexing resources, controlling and prioritising patient demand and strategies for managing the workload (scheduling for efficiency, communication and coordination, leadership, and teamwork strategies). CONCLUSIONS Teams are deploying a range of strategies and making adaptations to the way care is delivered. These findings could be used as the basis for training programmes for surgical teams to develop coordinated strategies for adapting under pressure and to assess the impact of different combinations of strategies on patient safety and surgical outcomes.
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Affiliation(s)
- Dulcie Irving
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Cicely Saunders Institute, King's College London, London, UK
| | | | - Helen Higham
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shabnam Undre
- Department of Urology, East and North Hertfordshire NHS Foundation Trust, Stevenage, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Alayande BT, Forbes C, Masimbi O, Kingpriest P, Shimelash N, Wina F, Hey MT, Philipo GS, Abahuje E, Robertson JM, Yule S, Riviello RR, Bekele A. The Implementation of Simulation-Based Learning for Training Undergraduate Medical Students in Essential Surgical Care Across Sub-Saharan Africa: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2024; 34:237-256. [PMID: 38510415 PMCID: PMC10948665 DOI: 10.1007/s40670-023-01898-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 03/22/2024]
Abstract
Much surgery in sub-Saharan Africa is provided by non-specialists who lack postgraduate surgical training. These can benefit from simulation-based learning (SBL) for essential surgery. Whilst SBL in high-income contexts, and for training surgical specialists, has been explored, SBL for surgical training during undergraduate medical education needs to be better defined. From 26 studies, we identify gaps in application of simulation to African undergraduate surgical education, including lack of published SBL for most (65%) World Bank-defined essential operations. Most SBL is recent (2017-2021), unsustained, occurs in Eastern Africa (78%), and can be enriched by improving content, participant spread, and collaborations.
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Affiliation(s)
- Barnabas T. Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Callum Forbes
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Ornella Masimbi
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | | | - Natnael Shimelash
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Felix Wina
- Department of Surgery, Bingham University Teaching Hospital, Jos, Nigeria
| | - Matthew T. Hey
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Godfrey Sama Philipo
- Research and Patient Outcomes, College of Surgeons of East Central and Southern Africa, Arusha, Tanzania
| | - Egide Abahuje
- Department of Surgery, University of Rwanda, Kigali, Rwanda
- Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Jamie M. Robertson
- Department of Surgery, Brigham and Women’s Hospital, Boston, USA
- Department of Surgery, Harvard Medical School, Boston, USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
| | - Steven Yule
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland UK
| | - Robert R. Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Kerray FM, Abahuje E, Tambyraja AL, Yule SJ. We asked the experts: The evolving role of non-technical skills for surgery in low- and middle-income countries. World J Surg 2024; 48:316-319. [PMID: 38686780 DOI: 10.1002/wjs.12046] [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)
- Fiona M Kerray
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh BioQuarter, Edinburgh, Scotland
- Edinburgh Vascular Service, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Egide Abahuje
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Andrew L Tambyraja
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh BioQuarter, Edinburgh, Scotland
- Edinburgh Vascular Service, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Steven J Yule
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh BioQuarter, Edinburgh, Scotland
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Page B, Irving D, Amalberti R, Vincent C. Health services under pressure: a scoping review and development of a taxonomy of adaptive strategies. BMJ Qual Saf 2023:bmjqs-2023-016686. [PMID: 38050158 DOI: 10.1136/bmjqs-2023-016686] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/07/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE The objective of this review was to develop a taxonomy of pressures experienced by health services and an accompanying taxonomy of strategies for adapting in response to these pressures. The taxonomies were developed from a review of observational studies directly assessing care delivered in a variety of clinical environments. DESIGN In the first phase, a scoping review of the relevant literature was conducted. In the second phase, pressures and strategies were systematically coded from the included papers, and categorised. DATA SOURCES Electronic databases (MEDLINE, Embase, CINAHL, PsycInfo and Scopus) and reference lists from recent reviews of the resilient healthcare literature. ELIGIBILITY CRITERIA Studies were included from the resilient healthcare literature, which used descriptive methodologies to directly assess a clinical environment. The studies were required to contain strategies for managing under pressure. RESULTS 5402 potential articles were identified with 17 papers meeting the inclusion criteria. The principal source of pressure described in the studies was the demand for care exceeding capacity (ie, the resources available), which in turn led to difficult working conditions and problems with system functioning. Strategies for responding to pressures were categorised into anticipatory and on-the-day adaptations. Anticipatory strategies included strategies for increasing resources, controlling demand and plans for managing the workload (efficiency strategies, forward planning, monitoring and co-ordination strategies and staff support initiatives). On-the-day adaptations were categorised into: flexing the use of existing resources, prioritising demand and adapting ways of working (leadership, teamwork and communication strategies). CONCLUSIONS The review has culminated in an empirically based taxonomy of pressures and an accompanying taxonomy of strategies for adapting in response to these pressures. The taxonomies could help clinicians and managers to optimise how they respond to pressures and may be used as the basis for training programmes and future research evaluating the impact of different strategies.
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Affiliation(s)
- Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Cicely Saunders Institute, King's College London, London, UK
| | - Dulcie Irving
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Rene Amalberti
- Foundation for Industrial Safety Culture, FONCSI, Toulouse, France
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Gunn EGM, Yule S, Tambyraja AL. World Journal of Surgery: We Asked the Experts-Performance Enhancement for Surgeons: Is Coaching the Answer? World J Surg 2023; 47:1839-1841. [PMID: 37039846 DOI: 10.1007/s00268-023-06998-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Eilidh G M Gunn
- Department of Vascular Surgery, NHS Lothian, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, Scotland, UK.
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland, UK.
| | - Steven Yule
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland, UK
| | - Andrew L Tambyraja
- Department of Vascular Surgery, NHS Lothian, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, Scotland, UK
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland, UK
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Poppens M, Oke R, Carvalho M, Ledesma Y, Okullu S, Ariokot MG, Agwang E, Ekuchu P, Wange H, Boeck M, Juillard C, Ajiko MM, Dicker R. In-Hospital Obstetric Delays in Rural Uganda: A Cross-Sectional Analysis of a Hospital Cohort. World J Surg 2023; 47:1426-1435. [PMID: 36897375 PMCID: PMC10156771 DOI: 10.1007/s00268-023-06964-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Deaths related to pregnancy and childbirth are extremely high in low-resource countries such as Uganda. Maternal mortality in low- and middle-income countries is related to delays in seeking, reaching, and receiving adequate health care. This study aimed to investigate the in-hospital delays to surgical care for women in labor arriving to Soroti Regional Referral Hospital (SRRH). METHODS From January 2017 to August 2020, we collected data on obstetric surgical patients in labor using a locally developed, context-specific obstetrics surgical registry. Data regarding patient demographics, clinical and operative characteristics, as well as delays in care and outcomes were documented. Descriptive and multivariate statistical analyses were conducted. RESULTS A total of 3189 patients were treated during our study period. Median age was 23 years, most gestations were at term (97%) at the time of operation, and nearly all patients underwent Cesarean Section (98.8%). Notably, 61.7% of patients experienced at least one delay in their surgical care at SRRH. Lack of surgical space was the greatest contributor to delay (59.9%), followed by lack of supplies or personnel. The significant independent predictors of delayed care were having a prenatal acquired infection (AOR 1.73, 95% CI 1.43-2.09) and length of symptoms less than 12 h (AOR 0.32, 95% CI 0.26-0.39) or greater than 24 h (AOR 2.61, 95% CI 2.18-3.12). CONCLUSION In rural Uganda, there is a significant need for financial investment and commitment of resources to expand surgical infrastructure and improve care for mothers and neonates.
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Affiliation(s)
- McKayla Poppens
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Rasheedat Oke
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Melissa Carvalho
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Yeranui Ledesma
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Silas Okullu
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | | | - Esther Agwang
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Peter Ekuchu
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Hyginus Wange
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Marissa Boeck
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Catherine Juillard
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Rochelle Dicker
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA.
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Zhong H, Zhou L, Liao S, Tang J, Yue L, Mo M, Zhong Y. Effects of a fixed nurse team in the orthopaedic surgery operating room on work efficiency and patient outcomes: a propensity score-matched historically controlled study. BMC Nurs 2022; 21:248. [PMID: 36068566 PMCID: PMC9450373 DOI: 10.1186/s12912-022-01027-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background The work value of operating room (OR) nurses is directly reflected in nursing quality. However, evaluating the work value of these nurses has not been sufficiently investigated. This study evaluated the effects of a fixed nurse team (FNT) in an orthopaedic surgery OR on work efficiency and patient outcomes. Methods A propensity score-matched historically controlled study conducted from 1 July 2015 to 30 June 2018 was used to investigate the difference in nursing quality between an FNT period and a non-FNT period in the orthopaedic surgery OR at a tertiary care hospital in China. The primary outcome was surgical site infections (SSIs) during in-hospital visits, and as a secondary outcome, other nursing-sensitive quality indicators were assessed with historically controlled data. A multifactor logistic regression model was constructed to examine the primary outcome differences between the FNT and non-FNT periods before and after propensity score matching. Results In total, 5365 patients and 33 nurses were included in the final analysis. The overall SSI rate was 2.1% (110/5365; the non-FNT period 2.6% [64/2474], the FNT period 1.6% [46/2891]). A lower incidence of SSIs in patients (odds ratio 0.57, 95% CI 0.36 to 0.88, P=0.013), a lower turnover time of the surgical procedure (odds ratio 0.653, 95% CI 0.505 to 0.844, P<0.001), and improvement in surgeon satisfaction (odds ratio 1.543, 95% CI 1.039 to 2.292, P=0.031), were associated with the FNT period compared with the non-FNT period. However, we did not find significant differences between the FNT period and the non-FNT period in terms of the other indicators. Conclusions The presence of an FNT in an OR reduces the incidence of SSIs in surgical patients and the turnover time of surgical procedures and improves surgeon satisfaction. Further implementation of an advanced-practice nurse model with nurse specialists is encouraged.
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Affiliation(s)
- Huaying Zhong
- Department of Operating Room, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, China
| | - Limin Zhou
- Department of Operating Room, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, China
| | - Shaoling Liao
- Department of Nursing Research, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, China
| | - Jing Tang
- Department of Anaesthesiology, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, China
| | - Liqun Yue
- Department of Nursing Research, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, China
| | - Meizhen Mo
- Department of Operating Room, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, China
| | - Yiyue Zhong
- Department of Operating Room, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, China.
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Meguerdichian DA, Huancahuari N, Pozner CN, Eyre A, Schuur J, Yule S. Evaluating Nontechnical Skills in US Emergency Departments Using Simulation: Validating and Contextualizing a UK Assessment Tool. Simul Healthc 2022; 17:104-111. [PMID: 34009906 DOI: 10.1097/sih.0000000000000567] [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: 11/25/2022]
Abstract
INTRODUCTION Nontechnical skills (NTS) in medicine are the "cognitive, social, and personal resource skills that complement technical skills contributing to safe and efficient care." We aimed to (1) evaluate the validity and reliability of a 12-element United Kingdom emergency medicine (EM) NTS assessment tool in the context of United States (US) EM practice and (2) identify behaviors unique to US clinical practice. METHODS This was a mixed methods study conducted in 2 phases, following Kane's validity framework. The intended use of the NTS tool is to provide formative assessment of US EM physicians (EPs) from a video of simulated clinical encounters. In phase I, a focus group assessed the appropriateness of each aspect of the tool in the context of US EM practice by reviewing and identifying the NTS of an EP in a simulated clinical scenario. In phase II, EPs (N = 208) attending a national EM conference evaluated an EP's behaviors in 1 of 2 video simulations. Reliability in the form of internal consistency was calculated using Cronbach α. All participants suggested exemplar behaviors for the 12 elements in the context of their own clinical practice and generated new assessment elements. RESULTS Internal consistency was acceptable (α > 0.7) for all categories, except teamwork and cooperation. Participants proposed 4 novel behavioral elements and suggested US exemplar behaviors for all 12 original elements. CONCLUSIONS This tool can be used to assess US EP's NTS for the purpose of formative assessment. Refinement of exemplar behaviors and inclusion of novel US-specific elements may optimize usability.
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Affiliation(s)
- David A Meguerdichian
- From the Neil and Elise Wallace STRATUS Center for Medical Simulation (D.A.M., C.N.P., A.E., S.Y.), and Department of Emergency Medicine (D.A.M., N.H., C.N.P., A.E., J.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School at Brown University, Providence, RI (J.S.); Department of Surgery (S.Y.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Clinical Surgery (S.Y.), The University of Edinburgh, Edinburgh, United Kingdom
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Georges MT, Roberts LR, Johnston Taylor E, Nick JM, Dehom S. Burnout, Self-Efficacy, and Resilience in Haitian Nurses: A Cross-Sectional Study. J Holist Nurs 2021; 40:310-325. [PMID: 34951321 DOI: 10.1177/08980101211065600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose of Study: Though nursing burnout is a global problem, research on nurse burnout in Haiti is scarce. In a context of multiple personal, social, and environmental challenges, this study assessed burnout and associated factors among Haitian nurses. Design of Study: A multi-site cross-sectional study. Methods: A survey in French and Haitian Creole was conducted in five Haitian hospitals using forward and back translated scales measuring burnout (emotional exhaustion [EE], depersonalization [DP], personal accomplishment [PA]), self-efficacy, nursing work environment, resilience, and demographics. Findings: Haitian nurses (N = 179) self-reported moderate EE (M = 21, SD = 11.18), low DP (Mdn = 2.0, range = 29), and high personal accomplishment (Mdn = 41.0, range = 33). General self-efficacy (M = 32.31, SD = 4.27) and resilience (M = 26.68, SD = 5.86) were high. Dissatisfaction with salary, autonomy, and staffing were evident. Conclusions: It is noteworthy that burnout was lower than expected given the scarce resource, difficult socio-politico-economic environment. High levels of self-efficacy and resilience likely mitigated a higher level of burnout. Adaptation enables these nurses to manage their critical conditions and practice holistic nursing, which may inspire hope among nurses in similar contexts.
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Aukrust CG, Kamalo PD, Prince RJ, Sundby J, Mula C, Manda‐Taylor L. Improving competencies and skills across clinical contexts of care: a qualitative study on Malawian nurses' experiences in an institutional health and training programme. Nurs Open 2021; 8:3170-3180. [PMID: 34355870 PMCID: PMC8510767 DOI: 10.1002/nop2.1030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/15/2021] [Accepted: 07/25/2021] [Indexed: 11/21/2022] Open
Abstract
AIM To explore what competencies and skills Malawian nurses gained after participating in an institutional health and training programme in Norway and how they viewed these competencies applicable upon return to Malawi. Furthermore, to examine facilitators and challenges experienced on the exchange programme and opportunities and obstacles to make the competencies usable in own local hospital context. DESIGN Qualitative study with an explorative design. METHODS Fourteen interviews and one focus group discussion were conducted at Queen Elizabeth Central Hospital, Blantyre, Malawi, from August to September 2018. RESULTS Competencies gained in Norway included clinical skills, teamwork, coordination and strengthened professionalism. The main finding was that the exchange programme was a transformative experience. Upon return to Malawi, the competencies gained on the exchange were helpful. However, the return was characterized by mixed emotions due to the considerable difference between the two clinical settings.
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Affiliation(s)
- Camilla Grøver Aukrust
- Department of Community Medicine and Global HealthInstitute of Health and SocietyFaculty of MedicineUniversity of OsloOsloNorway
- Department of NeurosurgeryOslo University HospitalOsloNorway
| | | | - Ruth Jane Prince
- Department of Community Medicine and Global HealthInstitute of Health and SocietyFaculty of MedicineUniversity of OsloOsloNorway
| | - Johanne Sundby
- Department of Community Medicine and Global HealthInstitute of Health and SocietyFaculty of MedicineUniversity of OsloOsloNorway
| | - Chimwemwe Mula
- Kamuzu College of NursingClinical Nursing DepartmentUniversity of MalawiBlantyreMalawi
| | - Lucinda Manda‐Taylor
- Department of Health Systems and PolicySchool of Public Health and Family MedicineCollege of MedicineUniversity of MalawiBlantyreMalawi
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Lindegger DJ, Abahuje E, Ruzindana K, Mwachiro E, Karonkano GR, Williams W, Ntakiyiruta G, Riviello R, Yule S, Paterson-Brown S. Strategies for Improving Quality and Safety in Global Health: Lessons From Nontechnical Skills for Surgery Implementation in Rwanda. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:481-486. [PMID: 34593575 PMCID: PMC8514020 DOI: 10.9745/ghsp-d-21-00042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/23/2021] [Indexed: 11/15/2022]
Affiliation(s)
| | - Egide Abahuje
- Feinberg Medical School, Northwestern University, Chicago, IL, USA.,University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Kenneth Ruzindana
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | | | - Wendy Williams
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Robert Riviello
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Steven Yule
- NHS Lothian University Hospitals Division, Edinburgh, Scotland
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Traynor MD, Owino J, Rivera M, Parker RK, White RE, Steffes BC, Chikoya L, Matsumoto JM, Moir CR. Surgical Simulation in East, Central, and Southern Africa: A Multinational Survey. JOURNAL OF SURGICAL EDUCATION 2021; 78:1644-1654. [PMID: 33487586 DOI: 10.1016/j.jsurg.2021.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/17/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND High-income countries have increased the use of simulation-based training and assessment for surgical education. Learners in low- and middle-income countries may have different educational needs and levels of autonomy but they and their patients could equally benefit from the procedural training simulation provides. We sought to characterize the current state of surgical skills simulation in East, Central, and Southern Africa and determine residents' perception and future interest in such activities. METHODS A survey was created via collaboration and revision between trainees and educators with experiences spanning high-income countries and low- and middle-income countries. The survey was administered on paper to 76 trainees (PGY2-3) who were completing the College of Surgeons of East, Central, and Southern Africa (COSECSA) Membership of the College of Surgeons examination in Kampala, Uganda in December 2019. Data from paper responses were summarized using descriptive statistics and frequencies. RESULTS We received responses from 43 trainees (57%) from 11 countries in sub-Saharan Africa who participated in the examination. Fifty-eight percent of respondents reported having dedicated space for surgical skills simulation training, and most (91%) had participated in some form of simulation activity at some point in their training. However, just 16% used simulation as a regular part of training. The majority of trainees (90%) felt that surgical skills learned in simulation were transferrable to the operating room and agreed it should be a required part of training. Seventy-one percent of trainees felt that simulation could objectively measure technical skills, and 73% percent of respondents agreed that simulation should be integrated into formal assessment. However, residents split on whether proficiency in simulation should be achieved prior to operative experience (54%) and if nontechnical skills could be measured (51%). The most common cited barriers to the integration of surgical simulation into residents' education were lack of suitable tools and models (85%), funding (73%), and maintenance of facilities (49%). CONCLUSIONS Residents from East, Central, and Southern Africa strongly agree that simulation is a valuable educational tool and ought to be required during their surgical residency. Barriers to achieving this goal include availability of affordable tools, adequate funding and confidence in the value of the educational experience. Trainees affirm further efforts are necessary to make simulation more widely available in these contexts.
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Affiliation(s)
| | - June Owino
- Department of Surgery, Tenwek Hospital, Bomet, Kenya; Pan-African Academy of Christian Surgeons, Palatine, Illinois
| | - Mariela Rivera
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert K Parker
- Department of Surgery, Tenwek Hospital, Bomet, Kenya; Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island; Pan-African Academy of Christian Surgeons, Palatine, Illinois
| | - Russell E White
- Department of Surgery, Tenwek Hospital, Bomet, Kenya; Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island; Pan-African Academy of Christian Surgeons, Palatine, Illinois
| | - Bruce C Steffes
- Pan-African Academy of Christian Surgeons, Palatine, Illinois
| | - Laston Chikoya
- Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | | | - Christopher R Moir
- Department of Surgery, Mayo Clinic, Rochester, Minnesota; Pan-African Academy of Christian Surgeons, Palatine, Illinois.
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Abahuje E, Bartuska A, Koch R, Youngson G, Ntakiyiruta G, Williams W, Dias RD, Rosu C, Yule S, Riviello R. Understanding Barriers and Facilitators to Behavior Change After Implementation of an Interdisciplinary Surgical Non-Technical Skills Training Program in Rwanda. JOURNAL OF SURGICAL EDUCATION 2021; 78:1618-1628. [PMID: 33516750 DOI: 10.1016/j.jsurg.2021.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Nontechnical skills, such as situation awareness, decision making, leadership, communication, and teamwork play a crucial role on the quality of care and patient safety in the operating room (OR). In our previous work, we developed an interdisciplinary training program, based on the NOTSS (Non-Technical Skills for Surgeons) taxonomy. The aim of this study was to understand the challenges faced by Rwandan surgical providers, who had undergone NOTSS training, to apply these nontechnical skills during subsequent operative surgery. SETTING DESIGN A sequential exploratory mixed method study design was used to assess how participants who took the NOTSS in Rwanda applied nontechnical skills in surgical care delivery. The qualitative phase of this study deployed a constructivist grounded theory approach. Findings from the qualitative phase were used to build a quantitative survey tool that explored themes that emerged from the first phase. PARTICIPANTS Participants were nurses and resident from the departments of Surgery, Anesthesia, Obstetric, and Gynecology, from the University of Rwanda who attended the NOTSS course in March 2018. RESULTS A total of 25 participants and 49 participants were respectively enrolled in the qualitative phase and quantitative phase. Participants noted that nontechnical skills implementation in clinical practice was facilitated by working with other personnel also trained in NOTSS, anticipation, and preparation ahead of the time; while lack of interdisciplinary communication, hierarchy, work overload, and an inconsistently changing environment compromised nontechnical skills implementation. Nontechnical skills were useful both inside and outside the operating. Participants reported that nontechnical skills implementation resulted in improved team dynamics, safer patient care, and empowerment. CONCLUSION Surgical care providers who took the NOTSS course subsequently implemented nontechnical skills both inside and outside of the OR. Human and system-based factors affected the implementation of nontechnical skills in the clinical setting.
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Affiliation(s)
- Egide Abahuje
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; University of Rwanda, College of Medicine and Health Sciences, Kigali-Rwanda; MGH Institute of Health Professions, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Andrew Bartuska
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Rachel Koch
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - George Youngson
- Royal College of Surgeons of Edinburgh, Edinburgh, Scotland- United Kingdom
| | | | - Wendy Williams
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Roger D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Claudia Rosu
- MGH Institute of Health Professions, Boston, Massachusetts
| | - Steven Yule
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland-United Kingdom
| | - Robert Riviello
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; University of Rwanda, College of Medicine and Health Sciences, Kigali-Rwanda; Department of Surgery, Harvard Medical School, Boston, Massachusetts
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A retrospective review of gastroschisis epidemiology and referral patterns in northern Ghana. Pediatr Surg Int 2021; 37:1069-1078. [PMID: 34059928 DOI: 10.1007/s00383-021-04898-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the epidemiology and referral patterns of gastroschisis patients in northern Ghana. METHODS A hospital-based retrospective review was undertaken at Tamale Teaching Hospital (TTH) Neonatal Intensive Care Unit (NICU) between 2014 and 2019. Data from gastroschisis patients were compared to patients with other surgical diagnoses. Descriptive and inferential statistics were performed with SAS. Referral flow maps were made with ArcGIS. RESULTS From a total of 360 neonates admitted with surgical conditions, 12 (3%) were diagnosed with gastroschisis. Around 91% (n = 10) of gastroschisis patients were referred from other hospitals, traveling 4 h, on average. Referral patterns showed gastroschisis patients were admitted from three regions, whereas patients with other surgical diagnoses were admitted from eight regions. Only 6% (12/201) of expected gastroschisis cases were reported during the 6-year period in all regions. All gastroschisis deaths occurred within the first week of life. CONCLUSIONS Improving access to surgical care and reducing neonatal mortality related to gastroschisis in northern Ghana is critical. This study provides a baseline to inform future gastroschisis interventions at TTH. Priority areas may include special management of low birth weight newborns, better referral systems, empowerment of community health workers, and increasing access to timely, affordable, and safe neonatal transport.
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Yule S, Gupta A, Blair PG, Sachdeva AK, Smink DS. Gathering Validity Evidence to Adapt the Non-technical Skills for Surgeons (NOTSS) Assessment Tool to the United States Context. JOURNAL OF SURGICAL EDUCATION 2021; 78:955-966. [PMID: 33041250 DOI: 10.1016/j.jsurg.2020.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Nontechnical skills are of increasing focus for safe and effective performance in the operating room. Assessment tools have been developed in Europe, Africa, and Asia but not adapted to the unique aspects of surgical delivery in the United States. Our objective was to use the Non-Technical Skills for Surgeons (NOTSS) assessment tool as a basis to establish consensus on essential nontechnical skills for surgical trainees and practicing surgeons in the U.S surgical context. STUDY DESIGN A mixed-methods research design was used in the form of a modified Delphi process to build consensus on essential NOTSS. A panel of surgical experts from hospitals across the U.S used this iterative process in 4 rounds to generate, rate, and classify behaviors. The primary outcome was consensus on behaviors as being essential for surgeons to achieve the best patient outcomes in the operating room, with a median rating of ≥6 on a 7-point scale for inclusion. RESULTS A total of 10 surgical experts participated. One hundred and thirty eight behaviors were generated in Round 1, and reduced to 100 behaviors in Rounds 2 and 3 based on application of inclusion criteria. The final skill list consisted of behaviors in Situation Awareness (n = 26), Decision Making (n = 18), Teamwork (n = 25), and Leadership (n = 31). No additional NOTSS categories or elements emerged from the analysis. In Round 4, all 100 behaviors were successfully grouped into 12 nontechnical skills elements. Labels and definitions were reworded to reflect the U.S. context, and an appropriate assessment scale was selected. CONCLUSIONS A panel of surgical experts from across the U.S. reached consensus on the essential NOTSS to achieve the best patient outcomes in the operating room. These behaviors form an empirical basis for the first context-specific nontechnical skills assessment and training tool for practicing surgeons in the U.S.
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Affiliation(s)
- Steven Yule
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland.
| | - Avni Gupta
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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Ullrich S, Kisa P, Ruzgar N, Okello I, Oyania F, Kayima P, Kakembo N, Sekabira J, Situma M, Ozgediz D. Implementation of a contextually appropriate pediatric emergency surgical care course in Uganda. J Pediatr Surg 2021; 56:811-815. [PMID: 33183745 DOI: 10.1016/j.jpedsurg.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Low- and middle-income countries like Uganda face a severe shortage of pediatric surgeons. Most children with a surgical emergency are treated by nonspecialist rural providers. We describe the design and implementation of a locally driven, pilot pediatric emergency surgical care course to strengthen skills of these providers. This is the first description of such a course in the current literature. METHODS The course was delivered three times from 2018 to 2019. Modules include perioperative management, neonatal emergencies, intestinal emergencies, and trauma. A baseline needs assessment survey was administered. Participants in the second and third courses also took pre and postcourse knowledge-based tests. RESULTS Forty-five providers representing multiple cadres participated. Participants most commonly perform hernia/hydrocele repair (17% adjusted rating) in their current practice and are least comfortable managing cleft lip and palate (mean Likert score 1.4 ± 0.9). Equipment shortage was identified as the most significant challenge to delivering pediatric surgical care (24%). Scores on the knowledge tests improved significantly from pre- (55.4% ± 22.4%) to postcourse (71.9% ± 14.0%, p < 0.0001). CONCLUSION Nonspecialist clinicians are essential to the pediatric surgical workforce in LMICs. Short, targeted training courses can increase provider knowledge about the management of surgical emergencies. The course has spurred local surgical outreach initiatives. Further implementation studies are needed to evaluate the impact of the training. LEVEL OF EVIDENCE V.
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Affiliation(s)
| | - Phyllis Kisa
- Mulago National Referral Hospital, Kampala, Uganda
| | - Nensi Ruzgar
- Yale University School of Medicine, New Haven, CT
| | | | - Felix Oyania
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | | | | | | | | | - Doruk Ozgediz
- University of California San Francisco, San Francisco, CA
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20
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Richter DL, Held M, Campos T, Wascher DC, Schenck RC. The Management of Knee Dislocations in the Limited-Resource Setting. J Bone Joint Surg Am 2020; 102:e136. [PMID: 33060423 DOI: 10.2106/jbjs.20.00743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Michael Held
- University of Cape Town, Cape Town, South Africa
| | - Túlio Campos
- Federal University of Minas Gerais, Belo Horizonte, Brazil
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21
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Ullrich S, Cheung M, Namugga M, Sion M, Ozgediz D, Yoo P. Navigating the COVID-19 Pandemic: Lessons From Global Surgery. Ann Surg 2020; 272:e216-e218. [PMID: 32520740 PMCID: PMC7299091 DOI: 10.1097/sla.0000000000004115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Sarah Ullrich
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Maija Cheung
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Martha Namugga
- Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Melanie Sion
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Doruk Ozgediz
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Peter Yoo
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Ullrich SJ, DeWane MP, Cheung M, Fleming M, Namugga MM, Fu W, Kurigamba G, Kabuye R, Mabweijano J, Galukande M, Ozgediz D, Pei KY. Development of an Operative Trauma Course in Uganda-A Report of a Three-Year Experience. J Surg Res 2020; 256:520-527. [PMID: 32799000 DOI: 10.1016/j.jss.2020.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/01/2020] [Accepted: 07/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Trauma is a leading cause of morbidity and mortality in low-income countries. Improved health care systems and training are potential avenues to combat this burden. We detail a collaborative and context-specific operative trauma course taught to postgraduate surgical trainees practicing in a low-resource setting and examine its effect on resident practice. METHOD Three classes of second year surgical residents participated in trainings from 2017 to 2019. The course was developed and taught in conjunction with local faculty. The most recent cohort logged cases before and after the course to assess resources used during initial patient evaluation and operative techniques used if the patient was taken to theater. RESULTS Over the study period, 52 residents participated in the course. Eighteen participated in the case log study and logged 117 cases. There was no statistically significant difference in patient demographics or injury severity precourse and postcourse. Postcourse, penetrating injuries were reported less frequently (40 to 21% P < 0.05) and road traffic crashes were reported more frequently (39 to 60%, P < 0.05). There was no change in the use of bedside interventions or diagnostic imaging, besides head CT. Of patients taken for a laparotomy, there was a nonstatistically significant increase in the use of four-quadrant packing 3.4 to 21.7%) and a decrease in liver repair (20.7 to 4.3%). CONCLUSIONS The course did not change resource utilization; however, it did influence clinical decision-making and operative techniques used during laparotomy. Additional research is indicated to evaluate sustained changes in practice patterns and clinical outcomes after operative skills training.
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Affiliation(s)
- Sarah J Ullrich
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Michael P DeWane
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Maija Cheung
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew Fleming
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Martha M Namugga
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Whitney Fu
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Gideon Kurigamba
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Ronald Kabuye
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Jackie Mabweijano
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Moses Galukande
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Doruk Ozgediz
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Kevin Y Pei
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
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Starr N, Panda N, Johansen EW, Forrester JA, Wayessa E, Rebollo D, August A, Fernandez K, Bitew S, Mammo TN, Weiser TG. The Lifebox Surgical Headlight Project: engineering, testing, and field assessment in a resource-constrained setting. Br J Surg 2020; 107:1751-1761. [PMID: 32592513 DOI: 10.1002/bjs.11756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/25/2020] [Accepted: 05/12/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Poor surgical lighting represents a major patient safety issue in low-income countries. This study evaluated device performance and undertook field assessment of high-quality headlights in Ethiopia to identify critical attributes that might improve safety and encourage local use. METHODS Following an open call for submissions (December 2018 to January 2019), medical and technical (non-medical) headlights were identified for controlled specification testing on 14 prespecified parameters related to light quality/intensity, mounting and battery performance, including standardized illuminance measurements over time. The five highest-performing devices (differential illumination, colour rendering, spot size, mounting and battery duration) were distributed to eight Ethiopian surgeons working in resource-constrained facilities. Surgeons evaluated the devices in operating rooms, and in a comparative session rated each headlight in terms of performance and willingness to purchase. RESULTS Of 25 submissions, eight headlights (6 surgical and 2 technical) met the criteria for full specification testing. Scores ranged from 8 to 12 (of 14), with differential performance in lighting, mounting and battery domains. Only two headlights met the illuminance parameters of more than 35 000 lux during initial testing, and no headlight satisfied all minimum specifications. Of the five headlights evaluated in Ethiopia, daily operation logbooks noted variability in surgeons' opinions of lighting quality (6-92 per cent) and spot size (0-92 per cent). Qualitative interviews also yielded important feedback, including preference for easy transport. Surgeons sought high quality with price sensitivity (using out-of-pocket funds) and identified the least expensive but high-functioning device as their first choice. CONCLUSION No device satisfied all the predetermined specifications, and large price discrepancies were critical factors leading surgeons' choices. The favoured device is undergoing modification by the manufacturer based on design feedback so an affordable, high-quality surgical headlight crafted specifically for the needs of resource-constrained settings can be used to improve surgical safety.
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Affiliation(s)
- N Starr
- Departments of Surgery, University of California, San Francisco, San Francisco, USA.,Lifebox Foundation, London, UK
| | - N Panda
- Ariadne Labs, Brigham and Women's Hospital, Harvard T. H. School of Public Health, Boston, USA.,Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - E W Johansen
- Spark Health Design, Hanover, Massachusetts, USA
| | - J A Forrester
- Stanford University, Stanford, California, USA.,Lifebox Foundation, London, UK
| | - E Wayessa
- Departments of Surgery, Wollega University, Nekempte, Ethiopia
| | - D Rebollo
- School of Medicine, New York University, New York, USA
| | - A August
- Stanford University, Stanford, California, USA
| | | | - S Bitew
- Lifebox Foundation, London, UK
| | - T Negussie Mammo
- Lifebox Foundation, London, UK.,Addis Ababa University, Addis Ababa, Ethiopia
| | - T G Weiser
- Stanford University, Stanford, California, USA.,Lifebox Foundation, London, UK.,Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
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Identification of the Critical Nontechnical Skills for Surgeons Needed for High Performance in a Variable-resource Context (NOTSS-VRC). Ann Surg 2020; 270:1070-1078. [PMID: 29781847 DOI: 10.1097/sla.0000000000002828] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify the critical nontechnical skills (NTS) required for high performance in variable-resource contexts (VRC). BACKGROUND As surgical training and capacity increase in low- and middle-income countries (LMICs), new strategies for improving surgical education and care in these settings are required. NTS are critical for high performance in surgery around the world. However, the essential NTS used by surgeons operating in LMICs to overcome the challenges specific to their contexts have never been described. METHOD Using a constructivist grounded theory approach, 52 intraoperative team observations as well as 34 critical incident interviews with surgical providers (surgeons, anesthetists, and nurses) were performed at the 4 tertiary referral hospitals in Rwanda. Interview transcripts and field notes from observations were analyzed using line-by-line coding to identify emerging themes until thematic saturation was achieved. RESULTS Four skill categories of situation awareness, decision-making, communication/teamwork, and leadership emerged. This provided the framework for a contextually informed skills taxonomy consisting of 12 skill elements with examples of specific behaviors indicative of high performance. While the main skill categories were consistent with those encountered in high-income countries, the specific behaviors associated with these skills often focused on overcoming the frequently encountered variability in resources, staff, systems support, and language in this context. CONCLUSION This is the first description of the critical nontechnical skills, and associated example behaviors, used by surgeons in a VRC to overcome common challenges to safe and effective surgical patient care. Improvements in the NTS used by surgeons operating in VRCs have the potential to improve surgical care delivery worldwide.
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Abstract
PURPOSE OF REVIEW Two-thirds of the world's population lacks access to surgical care, many of them being children. This review provides an update on recent advances in global children's surgery. RECENT FINDINGS Surgery is being increasingly recognized as an essential component of global and child health. There is a greater focus on sustainable collaborations between high-income countries (HICs) and low-and-middle-income countries (HICs and LMICs). Recent work provides greater insight into the global disease burden, perioperative outcomes and effective context-specific solutions. Surgery has continued to be identified as a cost-effective intervention in LMICs. There have also been substantial advances in research and advocacy for a number of childhood surgical conditions. SUMMARY Substantial global disparities persist in the care of childhood surgical conditions. Recent work has provided greater visibility to the challenges and solutions for children's surgery in LMICs. Capacity-building and scale up of children's surgical care, more robust implementation research and ongoing advocacy are needed to increase access to children's surgical care worldwide.
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Lin Y, Scott JW, Yi S, Taylor KK, Ntakiyiruta G, Ntirenganya F, Banguti P, Yule S, Riviello R. Improving Surgical Safety and Nontechnical Skills in Variable-Resource Contexts: A Novel Educational Curriculum. JOURNAL OF SURGICAL EDUCATION 2018; 75:1014-1021. [PMID: 29074364 DOI: 10.1016/j.jsurg.2017.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/03/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE A substantial proportion of adverse intraoperative events are attributed to failures in nontechnical skills. To strengthen these skills and improve surgical safety, the Non-Technical Skills for Surgeons (NOTSS) taxonomy was developed as a common framework. The NOTSS taxonomy was adapted for low- and middle-income countries, where variable resources pose a significant challenge to safe surgery. The NOTSS for variable-resource contexts (VRC) curriculum was developed and implemented in Rwanda, with the aim of enhancing knowledge and attitudes about nontechnical skills and promoting surgical safety. DESIGN The NOTSS-VRC curriculum was developed through a rigorous process of integrating contextually appropriate values. It was implemented as a 1-day training course for surgical and anesthesia postgraduate trainees. The curriculum comprises lectures, videos, and group discussions. A pretraining and posttraining questionnaire was administered to compare knowledge and attitudes regarding nontechnical skills, and their potential to improve surgical safety. SETTING The setting of this study was in the tertiary teaching hospital of Kigali, Rwanda. PARTICIPANTS Participants were residents of the University of Kigali. A total of 55 residents participated from general surgery (31.4%), obstetrics (25.5%), anesthesia (17.6%), and other surgical specialties (25.5%). RESULTS In a paired analysis, understanding of NOTSS improved significantly (55.6% precourse, 80.9% postcourse, p<0.01). All residents reported that the course would improve their ability to provide safer patient care, and 97.4% believed developing nontechnical skills would improve patient outcomes. CONCLUSIONS Nontechnical skills must be highlighted in surgical training in low- and middle-income countries. The NOTSS-VRC curriculum can be implemented without additional technology or significant financial cost. Its deliberate design for resource-constrained settings allows it to be used both as an educational course and a quality improvement strategy. Our research demonstrates it is feasible to improve knowledge and attitudes about NOTSS through a 1-day course, and represents a novel approach to improving global surgical safety.
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Affiliation(s)
- Yihan Lin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Department of Surgery, University of Colorado School of Medicine, Denver, Colorodo.
| | - John W Scott
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sojung Yi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Kathryn K Taylor
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Georges Ntakiyiruta
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Faustin Ntirenganya
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Paulin Banguti
- Department of Anesthesia, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Steven Yule
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda; STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts
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Albutt K, Yorlets RR, Punchak M, Kayima P, Namanya DB, Anderson GA, Shrime MG. You pray to your God: A qualitative analysis of challenges in the provision of safe, timely, and affordable surgical care in Uganda. PLoS One 2018; 13:e0195986. [PMID: 29664956 PMCID: PMC5903624 DOI: 10.1371/journal.pone.0195986] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 04/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Five billion people lack access to safe, affordable, and timely surgical and anesthesia care. Significant challenges remain in the provision of surgical care in low-resource settings. Uganda is no exception. METHODS From September to November 2016, we conducted a mixed-methods countrywide surgical capacity assessment at 17 randomly selected public hospitals in Uganda. Researchers conducted 35 semi-structured interviews with key stakeholders to understand factors related to the provision of surgical care. The framework approach was used for thematic and explanatory data analysis. RESULTS The Ugandan public health care sector continues to face significant challenges in the provision of safe, timely, and affordable surgical care. These challenges can be broadly grouped into preparedness and policy, service delivery, and the financial burden of surgical care. Hospital staff reported challenges including: (1) significant delays in accessing surgical care, compounded by a malfunctioning referral system; (2) critical workforce shortages; (3) operative capacity that is limited by inadequate infrastructure and overwhelmed by emergency and obstetric volume; (4) supply chain difficulties pertaining to provision of essential medications, equipment, supplies, and blood; (5) significant, variable, and sometimes catastrophic expenditures for surgical patients and their families; and (6) a lack of surgery-specific policies and priorities. Despite these challenges, innovative strategies are being used in the public to provide surgical care to those most in need. CONCLUSION Barriers to the provision of surgical care are cross-cutting and involve constraints in infrastructure, service delivery, workforce, and financing. Understanding current strengths and shortfalls of Uganda's surgical system is a critical first step in developing effective, targeted policy and programming that will build and strengthen its surgical capacity.
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Affiliation(s)
- Katherine Albutt
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States of America
| | - Rachel R. Yorlets
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maria Punchak
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Peter Kayima
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Didacus B. Namanya
- Ministry of Health (MOH), Kampala, Uganda
- Uganda Martyrs University (UMU), Nkozi, Uganda
| | - Geoffrey A. Anderson
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States of America
| | - Mark G. Shrime
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Boston, Massachusetts, United States of America
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Trelles Centurion M, Crestani R, Dominguez L, Caluwaerts A, Benedetti G. Surgery with Limited Resources in Natural Disasters: What Is the Minimum Standard of Care? CURRENT TRAUMA REPORTS 2018; 4:89-95. [PMID: 29888165 PMCID: PMC5972172 DOI: 10.1007/s40719-018-0124-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose of Review In a challenging scenario, such as in the aftermath of a natural disaster, minimum standards of care must be in place from the moment surgical care activities are launched. Recent Findings Natural disasters cause destruction and human suffering, especially in low- and middle-income countries, which suffer the most when exposed to their consequences. Health systems can quickly get overwhelmed and can collapse under the burden of injured patients during this event, while qualified surgical care remains crucial. Medécins Sans Frontières (MSF) has a vast experience providing surgical care after natural disasters, and quality is assured through the Donabedian model. Minimum structure standards are put in place from the beginning of an emergency response, together with standard operating procedures providing guidance to professionals working in challenging conditions. Summary MSF believes that it is always possible to deliver surgical care, ensuring the best possible quality guaranteeing adequate levels of structure and process. The "do no harm" principle must always be respected as adherence to medical ethics is a must in any context, even a challenging one.
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Affiliation(s)
| | - Rosa Crestani
- 2Emergency Medical Unit, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - Lynette Dominguez
- 1Surgical Care Unit, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - An Caluwaerts
- 3Health Structure Unit, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - Guido Benedetti
- 4Operational Research Unit, Médecins Sans Frontières, 68, Rue de Gasperich, L-1617 Luxembourg, Luxembourg
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