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Frechette R, Colas N, Augustin M, Edema N, Pyram G, Louis S, Crevecoeur CE, Mathurin C, Louigne R, Patel B, Humphreys M, Chapital A, Martin M, Ayoub Q, Hottinger D, McCurdy MT, Tran Q, Skupski R, Zimmer D, Walsh M. Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project. Glob Health Action 2023; 16:2180867. [PMID: 36856725 PMCID: PMC9980030 DOI: 10.1080/16549716.2023.2180867] [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] [Indexed: 03/02/2023] Open
Abstract
In response to the 2010 earthquake and subsequent cholera epidemic, St Luke's Medical Center was established in Port-au-Prince, Haiti. Here, we describe its inception and evolution to include an intensive care unit and two operating rooms, as well as the staffing, training and experiential learning activities, which helped St Luke's become a sustainable surgical resource. We describe a three-phase model for establishing a sustainable surgical centre in Haiti (build facility and acquire equipment; train staff and perform surgeries; provide continued education and expansion including regular specialist trips) and we report a progressive increase in the number and complexity of cases performed by all-Haitian staff from 2012 to 2022. The results are generalised in the context of the 'delay framework' to global health along with a discussion of the application of this three-phase model to resource-limited environments. We conclude with a brief description of the formation of a remote surgical centre in Port-Salut, an unforeseen benefit of local competence and independence. Establishing sustainable and collaborative surgery centres operated by local staff accelerates the ability of resource-limited countries to meet high surgical burdens.
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Affiliation(s)
- Richard Frechette
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Nathalie Colas
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Marc Augustin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Nathalie Edema
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Gerson Pyram
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Stanley Louis
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Carl Eric Crevecoeur
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Carmeline Mathurin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Raphael Louigne
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Bhavesh Patel
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Mitchell Humphreys
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Alyssa Chapital
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Mallory Martin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Qamarissa Ayoub
- Bamiyan Maternal and Child Health Project and the Andeshgah Library, Kabul, Afghanistan
| | - Daniel Hottinger
- Department of Anesthesia, Metropolitan Anesthesia Network, LLP, Plymouth, MN, USA
| | - Michael T McCurdy
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Quincy Tran
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Richard Skupski
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Department of Anesthesia, Memorial Hospital Beacon Medical Group of South Bend, South Bend, IN, USA
| | - Donald Zimmer
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Department of Emergency Medicine, Memorial Hospital Beacon Medical Group of South Bend, South Bend, IN, USA
| | - Mark Walsh
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, USA
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Chen HL, Yu XH, Yin YH, Shan EF, Xing Y, Min M, Ding YP, Fei Y, Li XW. Multimorbidity patterns and the association with health status of the oldest-old in long-term care facilities in China: a two-step analysis. BMC Geriatr 2023; 23:851. [PMID: 38093203 PMCID: PMC10720091 DOI: 10.1186/s12877-023-04507-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The increasing prevalence of multimorbidity has created a serious global public health problem in aging populations. Certain multimorbidity patterns across different age ranges and their association with health status remain unclear. The main aim of this study is to identify multimorbidity patterns discrepancies and associated health status between younger-old and oldest-old. METHODS The Ethics Committee of Nanjing Medical University approved the study protocol (No.2019-473). Convenience sampling method was used to recruit older adults aged ≥ 60 years with multimorbidity from July to December 2021 from 38 Landsea long-term care facilities in China. The multimorbidity patterns were analyzed using network analysis and two-step cluster analysis. One-Way ANOVA was utilized to explore their association with health status including body function, activity of daily living, and social participation. A Sankey diagram visualized the flow of health status within different multimorbidity patterns. This study is reported following the STROBE guidelines. RESULTS A total of 214 younger-old (60-84 years) and 173 oldest-old (≥ 85 years) were included. Leading coexisting diseases were cardiovascular disease (CD), metabolic and endocrine disease (MED), neurological disease (ND), and orthopedic disease (OD). Cluster 1 (53, 24.8%) of CD-ND (50, 94.3%; 31, 58.8%), cluster 2 (39, 18.2%) of MED-ND-CD (39, 100%; 39, 100%; 37, 94.9%), cluster 3 (37, 17.3%) of OD-CD-MED-ND (37, 100%; 33, 89.2%; 27, 73.0%; 16, 43.2%), and cluster 4 (34, 15.9%) of CD-MED (34, 100%; 34, 100%) were identified in the younger-old. In the oldest-old, the primary multimorbidity patterns were: cluster 1 (33, 19.1%) of CD-respiratory disease-digestive disease-urogenital disease (CD-RD-DSD-UD) (32, 97.0%; 9, 27.3%; 8, 24.2%; 7, 21.2%), cluster 2 (42, 24.3%) of ND-CD-MED (42, 100%; 35, 83.3%; 14, 33.3%), cluster 3 (28, 16.2%) of OD-CD-MED (28, 100%; 25, 89.3%; 18, 64.3%), and cluster 4 (35, 20.2%) of CD-MED (35, 100%; 35, 100%). Younger-old with CD-ND or MED-ND-CD, and oldest-old with ND-CD-MED have worse health status compared with other multimorbidity patterns (e.g., CD-MED and OD-CD-MED). CONCLUSION Discrepancies in common patterns of multimorbidity across age groups suggest that caregivers in long-term care facilities should consider changes in multimorbidity patterns with ageing when developing prevention plans for individualized management. Neurological disease concurrent with other diseases was the major determinant of health status, especially for the oldest-old. Interventions targeting multimorbidity need to be focused, yet generic. It is essential to assess complex needs and health outcomes that arise from different multimorbidity patterns and manage them through an interdisciplinary approach and consider their priorities to gain high-quality primary care for older adults living in long-term care facilities.
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Affiliation(s)
- Hong-Li Chen
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiao-Hong Yu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yue-Heng Yin
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - En-Fang Shan
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ying Xing
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Min Min
- Landsea Long-Term Care Facility, Nanjing, Jiangsu province, China
- Xia Man Yun Jian Social Welfare Development Centre, Shanghai, China
| | - Ya-Ping Ding
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yang Fei
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xian-Wen Li
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Eyowas FA, Schneider M, Alemu S, Getahun FA. Multimorbidity and adverse longitudinal outcomes among patients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia. Front Med (Lausanne) 2023; 10:1085888. [PMID: 37250625 PMCID: PMC10213652 DOI: 10.3389/fmed.2023.1085888] [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: 10/31/2022] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background Multimorbidity is becoming more prevalent in low-and middle-income countries (LMICs). However, the evidence base on the burden and its longitudinal outcomes are limited. This study aimed to determine the longitudinal outcomes of patients with multimorbidity among a sample of individuals attending chronic outpatient non communicable diseases (NCDs) care in Bahir Dar, northwest Ethiopia. Methods A facility-based longitudinal study was conducted among 1,123 participants aged 40+ attending care for single NCD (n = 491) or multimorbidity (n = 633). Data were collected both at baseline and after 1 year through standardized interviews and record reviews. Data were analyzed using Stata V.16. Descriptive statistics and longitudinal panel data analyzes were run to describe independent variables and identify factors predicting outcomes. Statistical significance was considered at p-value <0.05. Results The magnitude of multimorbidity has increased from 54.8% at baseline to 56.8% at 1 year. Four percent (n = 44) of patients were diagnosed with one or more NCDs and those having multimorbidity at baseline were more likely than those without multimorbidity to develop new NCDs. In addition, 106 (9.4%) and 22 (2%) individuals, respectively were hospitalized and died during the follow up period. In this study, about one-third of the participants had higher quality of life (QoL), and those having higher high activation status were more likely to be in the higher versus the combined moderate and lower QoL [AOR1 = 2.35, 95%CI: (1.93, 2.87)] and in the combined higher and moderate versus lower level of QoL [AOR2 = 1.53, 95%CI: (1.25, 1.88)]. Conclusion Developing new NCDs is a frequent occurrence and the prevalence of multimorbidity is high. Living with multimorbidity was associated with poor progress, hospitalization and mortality. Patients having a higher activation level were more likely than those with low activation to have better QoL. If health systems are to meet the needs of the people with chronic conditions and multimorbidity, it is essential to understand diseases trajectories and of impact of multimorbidity on QoL, and determinants and individual capacities, and to increase their activation levels for better health improve outcomes through education and activation.
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Affiliation(s)
- Fantu Abebe Eyowas
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Shitaye Alemu
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fentie Ambaw Getahun
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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