The role of cardiac surgery in global surgery and global health: a case study from Tashkent

The teamwork structure, process, and context of a paediatric cardiac surgery team in Mongolia: A mixed-methods approach

Introduction

Effective teamwork in paediatric cardiac surgery is known to improve team performance and surgical outcomes. However, teamwork in low‐ and middle‐income countries (LMICs), including Mongolia, is understudied. We examined multiple dimensions of teamwork to inform a team‐based training programme to strengthen paediatric cardiac surgical care in Mongolia.

Methods

We used a mixed‐methods approach, combining social network analysis and in‐depth interviews with medical staff, to explore the structure, process, quality, and context of teamwork at a single medical centre. We conceptualised the team's structure based on communication frequency among the members (n = 24) and explored the process, quality, and context of teamwork via in‐depth interviews with select medical staff (n = 9).

Results

The team structure was highly dense and decentralised, but the intensive care unit nurses showed high betweenness‐centrality. In the quality and process domain of teamwork, we did not find a regular joint decision‐making process, leading to the absence of common goals among the team members. Although role assignment among the medical staff was explicit, those strictly defined roles hindered active communication about patient information and responsibility‐sharing. Most interviewees did not agree with the organisational policies that limited discussions among team members; therefore, medical staff continued to share training and work experiences with each other, leading to strong and trustworthy relationships.

Conclusion

The findings of this study underscore the importance of well‐structured and goal‐oriented communication between medical staff, as well as the management of the quality of collaboration within a team to increase teamwork effectiveness in paediatric cardiac surgery teams in LMICs.

Team‐based training interventions have been feasible and effective in low‐ and middle‐income countries.

Although ICU nurses are a central part of the paediatric cardiac surgery care team, there are no formal post‐operative or training activities that can facilitate the joint decision‐making and common goal‐sharing process.

Resource sharing, clear role assignment, and conflict resolution rules are lacking and organisational support is key to improving teamwork.

Building trust between hospital administrators and team leadership is needed.

Mitral valve surgery for rheumatic heart disease: replace, repair, retrain?

PURPOSE OF REVIEW

Rheumatic heart disease (RHD) affects over 30 million people worldwide. Substantial variation exists in the surgical treatment of patients with RHD. Here, we aim to review the surgical techniques to treat RHD with a focus on rheumatic mitral valve (MV) repair. We introduce novel educational paradigms to embrace repair-oriented techniques in cardiac centers.

RECENT FINDINGS

Due to the low prevalence of RHD in high-income countries, limited expertise in MV surgery for RHD, technical complexity of MV repair for RHD and concerns about durability, most surgeons elect for MV replacement. However, in some series, MV repair is associated with improved outcomes, fewer reinterventions, and avoidance of anticoagulation-related complications. In low- and middle-income countries, the RHD burden is large and MV repair is more commonly performed due to high rates of loss-to-follow-up and barriers associated with anticoagulation, international normalized ratio monitoring, and risk of reintervention.

SUMMARY

Increased consideration for MV repair in the setting of RHD may be warranted, particularly in low- and middle-income countries. We suggest some avenues for increased exposure and training in rheumatic valve surgery through international bilateral partnership models in endemic regions, visiting surgeons from endemic regions, simulation training, and courses by professional societies.

Establishing Surgical Care Sustainability in Sub-Saharan Africa for Global Child Health: Insights From Pediatric Cardiac Surgical Capacity-Building Programs in Ethiopia and Côte d'Ivoire

The global surgery research team of the JW LEE Center for Global Medicine, Seoul National University College of Medicine, introduced team-based health workforce training programs for pediatric cardiac surgery in Ethiopia and Côte d'Ivoire. A team-based collaborative capacity-building model was implemented in both countries, and details of the program design and delivery were documented. The research team shared their experiences and identified achievements, lessons, and challenges for cardiac surgical interventions in Sub-Saharan Africa. Future directions were put forward to advance and strengthen the low-and middle-income countries "Safe Surgery."