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Holt F, Kwok S, Garuba K, Kolawole I, White MC. The delivery and challenges of Pediatric Anesthesia within the humanitarian sector: Médecins Sans Frontières and Mercy Ships. Paediatr Anaesth 2024. [PMID: 38757915 DOI: 10.1111/pan.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Access to healthcare is inequitable. Poverty, natural disasters and war disproportionally effect those most vulnerable, including children. Non-governmental organizations (NGO) hold a vital role in providing pediatric care in these contexts. Here we describe the delivery and challenges of Pediatric Anesthesia with two such non-governmental organizations; Médecins Sans Frontières (MSF) and Mercy Ships. Descriptions of both are followed by case studies.
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Affiliation(s)
- Francesca Holt
- Department of Anaesthesia, Children's Health Ireland at Crumlin, Dublin, Ireland
- Médecins Sans Frontières
| | - Sarah Kwok
- Chief Medical Officer, Global Mercy, Freetown, Sierra Leone
| | - Kehinde Garuba
- Médecins Sans Frontières
- Department of Anaesthesia, Usman Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria
| | - Israel Kolawole
- Department of Anaesthesia, University of Ilorin, Ilorin, Nigeria
| | - Michelle C White
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
- Centre for Global Health and Health Partnerships, King's College London, London, UK
- Mercy Ships, London, UK
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Wiedermann J, Douse DM, Green KJ, Pang JC, Blount Q, Yu K, Shrime M. Outcomes of Short-Term Surgical Trips in Otolaryngology-Head and Neck Surgery: A Scoping Review. Laryngoscope 2024; 134:32-39. [PMID: 37249184 DOI: 10.1002/lary.30764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This scoping review aims to explore the current body of literature to characterize how short-term surgical trips (STSTs) in Otolaryngology-Head and Neck Surgery (OtoHNS) contribute to surgical, educational, and sustainability-based outcomes in low- and middle-income countries (LMICs). We aim to use these data to synthesize aspects of STSTs that are successful with the hopes of shaping future global efforts. DATA SOURCES Data sources included Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. REVIEW METHODS A comprehensive search was conducted on several databases from inception to October 14, 2021. We included primary studies exploring any surgical or educational outcomes of global short-term surgical endeavors within LMICs. Data were then extracted to evaluate the heterogenous body of literature that exists, characterizing the surgical, educational, and sustainability-based outcomes. RESULTS Forty-Seven studies were included in the final analysis. Most publications were focused on surgical interventions (39 of 47; 82.9%); 13 (27.7%) studies included education as the primary aim and 12 (25.5%) considered sustainability a significant aim. Of the 94 first and last authors, there were zero first authors and only one last author with an LMIC affiliation. Twenty-six studies (55%) mentioned that any patients were seen in follow-up, ranging from one day to five years. CONCLUSION Our scoping review demonstrates that most STSTs have focused primarily on surgical procedures with a lack of appropriate long-term follow-up. However, the available outcome-based information presented helps identify factors that characterize a strong short-term global surgical program. LEVEL OF EVIDENCE NA Laryngoscope, 134:32-39, 2024.
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Affiliation(s)
- Josh Wiedermann
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dontre' M Douse
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Katerina J Green
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | | | - Karina Yu
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA
| | - Mark Shrime
- Mercy Ships, Garden Valley, Texas, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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Huerta S, Huchim-Peña CJ, Ta T, Quiñones ME, Mendoza JA, Corzo VF, Ortiz C. Patients', Local Staff, and Medical Students' Perceptions on a Medical Mission Trip to Guatemala. Curr Probl Surg 2023; 60:101378. [PMID: 37993236 DOI: 10.1016/j.cpsurg.2023.101378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, Dallas, TX; Hospital Nacional de San Benito, El Peten, Guatemala.
| | - Cristian J Huchim-Peña
- Federico Gomez Children's Hospital of Mexico, Mexico City, Mexico; Faculty of Medicine, Autonomous University of Yucatan, Merida, Yucatan, Mexico
| | - Timothy Ta
- Texas A&M University, College Station, TX
| | | | | | | | - Cesar Ortiz
- Hospital Nacional de San Benito, El Peten, Guatemala
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Duan Q, Zhou Y, Yang D. Endoplasmic reticulum stress in airway hyperresponsiveness. Biomed Pharmacother 2022; 149:112904. [PMID: 35367759 DOI: 10.1016/j.biopha.2022.112904] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 11/15/2022] Open
Abstract
Airway hyperresponsiveness(AHR) is a major clinical phenomenon in lung diseases (asthma, COPD and pulmonary fibrosis) and not only a high-risk factor for perioperative airway spasm leading to hypoxaemia, haemodynamic instability and even "silent lung", but also a potential risk for increased mortality from underlying diseases (e.g. asthma, COPD). Airway reactivity is closely linked to airway inflammation, remodelling and increased mucus secretion, and endoplasmic reticulum stress is an important mechanism for the development of these pathologies. This review, therefore, focuses on the effects of endoplasmic reticulum stress on the immune cells involved in airway hyperreactivity (epithelial cells, dendritic cells, eosinophils and neutrophils) in inflammation and mucus & sputum secretion; and on the differentiation and remodelling of airway smooth muscle cells and epithelial cells. The aim is to clarify the mechanisms associated with endoplasmic reticulum stress in airway hyperresponsiveness and to find new ideas and methods for the prevention of airway hyperresponsiveness in the perioperative period.
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Affiliation(s)
- Qirui Duan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing 100144, China
| | - Ying Zhou
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing 100144, China
| | - Dong Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing 100144, China.
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Politis GD, Gregory G, Yudkowitz FS, Fisher QA, Bhettay AZ, Wexler A. 2020 guidelines for conducting plastic reconstructive short-term surgical projects in low-middle income countries. Paediatr Anaesth 2020; 30:1308-1321. [PMID: 32621783 DOI: 10.1111/pan.13960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/11/2020] [Accepted: 06/27/2020] [Indexed: 11/30/2022]
Abstract
Many low- or middle-income countries (LMICs) continue to suffer from a lack of safe and timely essential and emergency surgery despite growing attention to this problem. Short-term surgical projects (STSPs) continue to play an important role in addressing LMIC unmet surgical need and strengthening local healthcare systems. Guidelines here present recommendations for performing plastic reconstructive STSPs for pediatric patients in a safe, ethical, and effective manner. These guidelines represent consensus physician expert opinions, assembled collaboratively by members of Volunteers in Plastic Surgery and the Society for Pediatric Anesthesia's global health committee, with broad input from physicians practicing daily in LMICs. Organizations must partner with hosts to thoughtfully plan and carefully execute STSPs. We outline crucial items to STSP success, including choice of host facility, team selection, patient selection, staffing, ensuring proper equipment and supplies, disinfecting reusable equipment, creation of a safety culture, and data collection for quality assessment/improvement and research. Patient factors are discussed and recommendations given for developing exclusion criteria, as well as for determining which patients and procedures may require the team to include expertise in pediatric anesthesia or critical care. We recommend that educational opportunities for hosts are sought and advanced to optimize education/training at both the resident and post-trainee levels. Host education during STSPs has become crucial as LMICs ramp up training at a time when their surgical volumes remain grossly behind well-resourced countries. Recommendations here aim to assist organizations, hosts, and volunteers as they navigate the enormously complex and ever changing STSP environment. Patient safety and transfer of knowledge and skills should be central concerns of all who participate in this highly rewarding endeavor.
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Affiliation(s)
- George D Politis
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - George Gregory
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, California, USA
| | - Francine S Yudkowitz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Quentin A Fisher
- Department of Anesthesiology, Pain, and Perioperative Medicine, Children's National Medical Center, Washington, District of Columbia, USA
| | - Anisa Z Bhettay
- Department of Anaesthesia and Perioperative Medicine, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Andrew Wexler
- Department of Plastic and Reconstructive Surgery, Kaiser Permanente, Los Angeles, California, USA.,Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
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Al-Hadidi A, Alslaim H, Ghawanmeh M, Alfarajat F, Habra H, Brahmamdam P, Novotny N. Short-term surgical trips: local collaboration and its effects on complications and patient satisfaction. Pediatr Surg Int 2020; 36:977-981. [PMID: 32415355 DOI: 10.1007/s00383-020-04667-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Short-term surgical missions can provide communities in need with desired expertise; however, it is uncertain who will manage the complications after visiting experts leave. Poor outcomes, decreased patient satisfaction, and tension on the healthcare system develop when local providers, often excluded from the initial patient care, are unable to cope with subsequent morbidity. METHODS Two-year retrospective review of pediatric general, plastic, and reconstructive surgery, and urology cases performed by a relief organization in the developing world. Case complexity and postoperative complications were analyzed. Phone interviews conducted with patients/families to quantify postoperative outcomes and satisfaction. RESULTS 474 surgeries were performed on pediatric patients with 60% response rate. Respondents stratified into three levels of complexity: 159 simple, 72 intermediate, and 54 advanced surgeries. Six (2.1%) high-level complications occurred. No association between the complexity of the surgery and the occurrence of a complications. 83.5% were satisfied with outcomes and > 92% were happy with the provided support. CONCLUSION Facilitating visiting and local surgeons performing cases together increases the expertise of local providers, strengthens infrastructure, and establishes clear follow-up. Despite complications, patients and families continued to recommend care to family and friends by the relief organization and were happy with support from local providers. Engaging local providers is the gold-standard for short-term trips.
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Affiliation(s)
- Ameer Al-Hadidi
- Department of General Surgery, Beaumont Health, 3535 W. 13 Mile Rd Ste 307, Royal Oak, MI, 48073, USA.
| | - Hossam Alslaim
- Department of General Surgery, Medical College of Georgia, Augusta, Georgia.,Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Hani Habra
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Pavan Brahmamdam
- Department of Pediatric Surgery, Beaumont Children's, Beaumont Health, Royal Oak, MI, USA
| | - Nathan Novotny
- Department of Pediatric Surgery, Beaumont Children's, Beaumont Health, Royal Oak, MI, USA
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Crockett CJ, Zeigler LN, Kynes JM, Lawson KC, Figueroa LI, Hayes CB, Samen CDK, McQueen KA. A prospective observational study of postoperative follow-ups and outcomes at a nonprofit, internationally supported pediatric surgery center in Guatemala. Paediatr Anaesth 2020; 30:469-479. [PMID: 31976589 DOI: 10.1111/pan.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Global surgical access is unequally distributed, with the greatest surgical burden in low- and middle-income countries, where surgical care is often supplemented by nongovernmental organizations. Quality data from organizations providing this care are rarely collected or reported. The Moore Pediatric Surgery Center in Guatemala City, Guatemala, is unique in that it offers a permanently staffed, freestanding pediatric surgical center. Visiting surgical teams supplement the local permanent staff by providing a broad range of pediatric subspecialty surgical and anesthesia care. AIM The aim of this study was to collect and report the incidence of completed postoperative follow-up visits and outcome measures at this nonprofit, internationally supported surgery center. METHODS De-identified demographic and postoperative outcome data were collected from each routinely scheduled, one-week pediatric surgical mission trip and incorporated into an electronic data collection system. Emphasis was placed on identification of completed postoperative visits and associated perioperative complications. After 27 months of data collection, results were analyzed to identify and quantify trends in patient follow-ups and postoperative outcomes. RESULTS Over 27 months, 1639 pediatric surgical procedures were performed and included in data analysis. The percentage of completed postoperative day-1 follow-up visits was 99.1%, and seven complications were identified out of these 1624 cases (postoperative complication rate of 0.4%). The percentage of completed first postoperative visits after discharge was 93.3%, and 67 complications were identified out of these 1530 cases (postoperative complication rate of 4.4%). CONCLUSION Our data show a high rate of postoperative follow-up visits completed and low perioperative complication rates similar to those of high-income countries. Our data suggest that The Moore Surgery Center model of care offers an alternative to the short-term visiting surgical model by incorporating the local system and allows for improved follow-up, outcomes analysis, and high quality of care.
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Affiliation(s)
- Christy J Crockett
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura N Zeigler
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James M Kynes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katheryne C Lawson
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Caleb B Hayes
- Pathology Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Christelle D K Samen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A McQueen
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Tao KM, Sokha S, Yuan HB. The challenge of safe anesthesia in developing countries: defining the problems in a medical center in Cambodia. BMC Health Serv Res 2020; 20:204. [PMID: 32164745 PMCID: PMC7068932 DOI: 10.1186/s12913-020-5068-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 03/03/2020] [Indexed: 12/31/2022] Open
Abstract
Background The International Standards for a Safe Practice of Anesthesia (ISSPA) were developed on behalf of the World Federation of Societies of Anaesthesiologists and the World Health Organization. It has been recommend as an assessment tool that allows anesthetic providers in developing countries to assess their compliance and needs. This study was performed to describe the anesthesia service in one main public hospital during an 8-month medical mission in Cambodia and evaluate its anesthetic safety issues according to the ISSPA. Methods We conduct a retrospective study involving 1953 patients at the Preah Ket Mealea hospital. Patient demographics, anesthetic techniques, and complications were reviewed according to the registers of the anesthetic services and questionnaires. The inadequacies in personnel, facilities, equipment, medications, and conduct of anesthesia drugs were recorded using a checklist based on the ISSPA. Results A total of 1792 patients received general and regional anesthesia in the operating room, while 161 patients receiving sedation for gastroscopy. The patients’ mean age was 45.0 ± 16.6 years (range, 17–87 years). The three most common surgical procedures were abdominal (52.0%; confidence interval [CI], 49.3–54.7), orthopedic (27.6%; CI, 25.2–29.9), and urological surgery (14.7%; CI, 12.8–16.6). General anesthesia, spinal anesthesia, and brachial plexus block were performed in 54.3% (CI, 51.7–56.8), 28.2% (CI, 25.9–30.5), and 9.4% (CI, 7.9–10.9) of patients, respectively. One death occurred. Twenty-six items related to professional aspects, monitoring, and conduct of anesthesia did not meet the ISSPA-recommended standards. A lack of commonly used drugs and monitoring equipment was noted, posing major threats to the safety of anesthesia practice, especially in emergency situations. Conclusions This study adds to the scarce literature on anesthesia practice in low- and middle-income countries such as Cambodia. Future medical assistance should help to strengthen these countries’ inadequacies, allowing for the adoption of international standards for the safe practice of anesthesia.
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Affiliation(s)
- Kun-Ming Tao
- Department of Anesthesiology, Eastern Hepatobillary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Sann Sokha
- Department of Anesthesiology, Preah Ket Mealea Hospital, Phnom Penh, Cambodia
| | - Hong-Bin Yuan
- Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, P.R. China.
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Kudsk-Iversen S, Trelles M, Ngowa Bakebaanitsa E, Hagabimana L, Momen A, Helmand R, Saint Victor C, Shah K, Masu A, Kendell J, Edgcombe H, English M. Anaesthesia care providers employed in humanitarian settings by Médecins Sans Frontières: a retrospective observational study of 173 084 surgical cases over 10 years. BMJ Open 2020; 10:e034891. [PMID: 32139492 PMCID: PMC7059447 DOI: 10.1136/bmjopen-2019-034891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe the extent to which different categories of anaesthesia provider are used in humanitarian surgical projects and to explore the volume and nature of their surgical workload. DESIGN Descriptive analysis using 10 years (2008-2017) of routine case-level data linked with routine programme-level data from surgical projects run exclusively by Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB). SETTING Projects were in contexts of natural disaster (ND, entire expatriate team deployed by MSF-OCB), active conflict (AC) and stable healthcare gaps (HG). In AC and HG settings, MSF-OCB support pre-existing local facilities. Hospital facilities ranged from basic health centres with surgical capabilities to tertiary referral centres. PARTICIPANTS The full dataset included 178 814 surgical cases. These were categorised by most senior anaesthetic provider for the project, according to qualification: specialist physician anaesthesiologists, qualified nurse anaesthetists and uncertified anaesthesia providers. PRIMARY OUTCOME MEASURE Volume and nature of surgical workload of different anaesthesia providers. RESULTS Full routine data were available for 173 084 cases (96.8%): 2518 in ND, 42 225 in AC, 126 936 in HG. Anaesthesia was predominantly led by physician anaesthesiologists (100% in ND, 66% in AC and HG), then nurse anaesthetists (19% in AC and HG) or uncertified anaesthesia providers (15% in AC and HG). Across all settings and provider groups, patients were mostly healthy young adults (median age range 24-27 years), with predominantly females in HG contexts, and males in AC contexts. Overall intra-operative mortality was 0.2%. CONCLUSION Our findings contribute to existing knowledge of the nature of anaesthetic provision in humanitarian settings, while demonstrating the value of high-quality, routine data collection at scale in this sector. Further evaluation of perioperative outcomes associated with different models of humanitarian anaesthetic provision is required.
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Affiliation(s)
- Søren Kudsk-Iversen
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Miguel Trelles
- Operational Centre Brussels, Médecins Sans Frontières, Bruxelles, Belgium
| | - Elie Ngowa Bakebaanitsa
- Operational Centre Brussels, Médecins Sans Frontières, Bruxelles, Belgium
- Masisi Referral Hospital, Masisi-MSF Democratic Republic of the Congo mission, Masisi, The Democratic Republic of the Congo
| | - Longin Hagabimana
- Operational Centre Brussels, Médecins Sans Frontières, Bruxelles, Belgium
- Arche Trauma Hospital, Bujumbura-MSF Burundi mission, Bujumbura, Burundi
| | - Abdul Momen
- Operational Centre Brussels, Médecins Sans Frontières, Bruxelles, Belgium
- Khost Maternity, Khost-MSF Afghanistan mission, Khost, Afghanistan
| | - Rahmatullah Helmand
- Operational Centre Brussels, Médecins Sans Frontières, Bruxelles, Belgium
- Ahmad Shah Baba Hospital, Kabul-MSF Afghanistan mission, Kabul, Afghanistan
| | - Carline Saint Victor
- Operational Centre Brussels, Médecins Sans Frontières, Bruxelles, Belgium
- Tabarre Trauma Hospital, Port-au-Prince-MSF Haiti mission, Port-au-Prince, Haiti
| | - Khalid Shah
- Operational Centre Brussels, Médecins Sans Frontières, Bruxelles, Belgium
- Timurgara District Headquarter Hospital, Timurgara-MSF Pakistan mission, Timurgara, Pakistan
| | - Adolphe Masu
- Operational Centre Brussels, Médecins Sans Frontières, Bruxelles, Belgium
- Arche Trauma Hospital, Bujumbura-MSF Burundi mission, Bujumbura, Burundi
- Khost Maternity, Khost-MSF Afghanistan mission, Khost, Afghanistan
- Castors Maternity, Bangui-MSF Central African Republic mission, Bangui, Central African Republic
| | - Judith Kendell
- Operational Centre Brussels, Médecins Sans Frontières, Bruxelles, Belgium
| | - Hilary Edgcombe
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
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Isaacson G, Doyle W, Summer D. Reducing Surgical Site Infections During Otolaryngology Surgical Missions. Laryngoscope 2019; 130:1388-1395. [PMID: 31755991 DOI: 10.1002/lary.28418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine what measures an otolaryngology-head and neck surgery team might adopt to decrease the incidence of surgical site infection (SSI) on a short-term surgical mission. Despite concerns about safety and efficacy, short-term surgical missions remain the predominant structure for humanitarian surgical care in low- and middle-income countries (LMIC). Hospitals in high-income countries strive to improve surgical outcomes through implementation of World Health Organization (WHO) safe surgery guidelines. Reduction of SSI risk is a key part of this effort. METHODS Literature review and practical experience. RESULTS WHO recommendations for reducing SSI are based largely on research done in the North America and Europe. LMIC populations are younger; comorbidities are fewer; infectious disease and trauma are prevalent; and delays in access to care are common. SSI are much more frequent in resource-limited settings. Recommendations regarding preoperative assessment, operating room environment, instrument sterilization, surgical antibiotic prophylaxis, surgical site preparation, gloving, draping, and postsurgical care are reviewed in the context of a surgical mission at a typical LMIC government hospital. CONCLUSION Many of the WHO guidelines on reduction of SSI are logical and applicable to the short-term surgical missions; others may need to be modified. Careful prospective data collection and clinical trials are needed to learn which interventions are valid and which should be changed. LEVEL OF EVIDENCE 5 Laryngoscope, 130:1388-1395, 2020.
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Affiliation(s)
- Glenn Isaacson
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Winifred Doyle
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Deborah Summer
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
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Zitzman E, Berkley H, Jindal RM. Accountability in global surgery missions. BMJ Glob Health 2018; 3:e001025. [PMID: 30687523 PMCID: PMC6326286 DOI: 10.1136/bmjgh-2018-001025] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/07/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Elena Zitzman
- USU-Walter Reed Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Holly Berkley
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, California, USA
| | - Rahul M Jindal
- USU-Walter Reed Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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